Asthma Inhalers

There are three types of asthma inhalers that use different mechanisms to release the medication. These include metered-dose inhalers (MDIs), MDIs with a spacer, which gives more time to inhale the drug, and dry-powder inhalers – also known as breath-activated inhalers.

The most common asthma inhalers are the brown inhaler (for prevention) and the blue inhaler (for attacks of asthma and/or prevention).

The standard metered-dose inhaler includes the blue inhaler (e.g. Ventolin) and has been used for several decades. It consists of a small can fitted into a plastic body with a mouthpiece. Each time you press the canister into the boot, one dose of drug is released. You need to press and inhale the medication. This type of inhaler is also known as an evohaler.

Although this is the most commonly used inhaler, the MDI is often used incorrectly. Patients often forget to shake it before pressing, inhale at the wrong time or forget to hold their breath after inhalation. It is now recommended that adults as well as children use a spacer device, described below, as the delivery of the medicine is greatly improved.

Metered-dose inhalers that come with a spacer make it easier to inhale the correct dose. The spacer is an oval plastic container. On one end you insert your MDI and on the other end there is a mouthpiece.

It means that you first release the medication into the spacer and then inhale it slowly from the plastic container through the mouthpiece. This delivers the dose straight to your lungs. The MDI with a spacer has now replaced using the MDI alone as the delivery of the medicine to the lungs is greatly improved.

The spacer should be washed and cleaned regularly as your saliva can make its walls sticky and prevent the medicine from flowing smoothly from one end to the other. The spacer is also known as a chamber, depending on the brand you use.

This kind of inhaler contains dry-powder. You do not need to pump or press for the medication to be released. All you need to do is take a deep breath which will make you inhale a single dose. There are different types of dry powder asthma inhalers and they usually rely on a manual mechanism to release one dose of the powder into the mouthpiece prior to the inhalation.

The most common dry powder inhalers are the turbohaler and the diskhaler. For both systems, you have to turn or twist the body until a “click” sound signals that a dose has been released and is ready to be inhaled.

This is the most common group of inhalers (also called reliever inhalers) which contain bronchodilator drugs (usually salbutamol). Bronchodilator simply means that the drug allows the airways in your lungs to dilate and let more air in.

Blue inhalers are great short-acting treatments: they can relieve the symptoms of an asthma attack within minutes. You should only need to take the blue inhaler when you feel unwell from your asthma. If you are using a lot of your blue inhaler, then you will need an asthma review, to see if there are better ways of managing your asthma.

The brown inhaler (sometimes also red) is a prevention treatment to be taken every day. It contains steroids that reduce the inflammation in your lungs. Depending on how severe your symptoms are, your doctor might prescribe you more or less frequent doses.

An average treatment with the brown inhaler consists of about two doses per day, to be taken for several months. Note that it can take somewhere between 2-6 weeks for the medication to be fully effective, so this is definitely a long-term treatment that can’t be used to relieve the symptoms of an attack.

On the upside, if you correctly follow your prescription, you may not need to use any inhaler later on in your life. However, note that just as with the blue inhaler, early treatment with the brown inhaler is crucial to get rid of asthma.

These are less common and come in a different colour, as they're usually green inhalers. They also belong to the class of bronchodilators and they are effective for up to 12 hours. Salmeterol is one of the most common long-acting bronchodilators, along with Formoterol. In some cases, preventive treatments combine long-acting bronchodilators with steroids, for instance if your symptoms are particularly difficult to control. Some of these combined treatments come as purple inhalers.

The idea with all these colours is to help you choose the right one when you’re experiencing an attack, rather than having to recognise the name of the medication on the inhaler. When you need immediate relief from your symptoms – from breathlessness to acute asthma attack – always go for the blue inhaler.