Asthma Inhalers - Types and Side Effects

What Is the Meaning of an Asthma Inhaler?

Asthma is a condition in which the patient experiences respiratory difficulties because the airways become narrow due to swelling. The patient presents with shortness of breath, chest pain, and cough. Sometimes, the situation becomes so severe that it becomes difficult for them to sleep at night. The most characteristic feature of asthma is a whistling sound that is heard when the patient breathes. The signs and symptoms of asthma might flare up after exercise, exposure to dust, pollen, and chemical fumes. The medications available to treat asthma can be taken orally or through an inhaler.

An asthma inhaler is a device that delivers medications to the airways that have become narrow. When this medication reaches the lungs, the patient is able to breathe normally and feels relaxed. The advantage of an asthma inhaler is that only a small amount of medication reaches the body, and there are no systemic side effects. However, when the patient takes the drug orally, the chances of systemic side effects increase. There are a variety of inhalers available in the market, but choosing the right one is difficult. Always consult the doctor before using the inhaler to know about the right one.

How Do Asthma Inhalers Work?

Asthma is a respiratory disorder in which the air passages become swollen and narrow. As a result, the patient is unable to breathe and makes a whistling noise while breathing and coughing (wheezing). Asthma inhalers work by the following mechanism:

1. There are a number of units present in the lungs, which look like the branches of a tree.

2. These units or bronchioles help the person breathe as they allow the free flow of air into and out of the body.

3. However, in an asthmatic patient, these units get blocked due to the deposition of mucus, and the air is unable to enter or leave them.

4. Asthma inhalers help to overcome this problem.

5. They contain drugs that enter the bronchioles and widen them. When these bronchioles or air passages get widened, the air enters and leaves the lungs easily.

What Are the Different Types of Asthma Inhalers?

Inhalers are usually preferred by people suffering from asthma because they are of small size, can be held in hand, and be easily carried from one place to another. The different types of asthma inhalers have been described below:

• Metered-Dose Inhaler - A metered-dose inhaler contains a canister that fits into a plastic mouthpiece. When the patient presses on the canister, the medication is released and reaches the lungs. There are different types of metered-dose inhalers. In some, the patient needs to press on the canister, while in some of them, the medication is released as soon as the patient brings it near the mouth. Sometimes, a holding chamber is attached to the metered dose inhaler to allow the better delivery of medication into the lungs. Before the inhaler is used, make sure to spray one or two puffs in the air to check the working of the inhaler. This procedure is known as priming. The inhaler consists of a spacer that holds the medicine until it is released into the lungs. The inhaler is used in the following way:

  • Remove the cap and shake the inhaler properly.

  • Place the mouthpiece of the inhaler between the teeth and close the lips tightly.

  • Exhale completely and press the canister.

  • If a “horn-like” sound is heard, it means the patient is breathing too fast and needs to slow down his breath.

  • Hold your breath as the medication reaches the lung.

  • Repeat the steps and keep a time gap of one minute between each puff.

  • The patient needs to rinse his mouth or gargle if the Corticosteroids are used in the inhaler.

• Dry Powder Inhalers - A dry powder inhaler is used as an alternative to a metered-dose inhaler. The medication is already present as a powder in a chamber, and the patient needs to only inhale them. The medications need not be sprayed, but the patients suffering from chronic obstructive pulmonary disease find it difficult to use this inhaler.

• Soft Mist Inhalers - As the name suggests, these devices produce a soft mist that lasts for a long duration and allows more drug particles to reach the lungs. They can be used in children with the help of a face mask or a valve holding chamber.

• Nebulizers - Nebulizers are devices that convert asthma medications into fine mist or aerosols. A mouthpiece or a face mask helps to breathe in the medication. Nebulizers are commonly used by people who are unable to use the inhaler, including infants, children, and patients who remain breathless and sick every time. They also help to deliver a large dose of the drug when severe attacks of asthma occur in hospitals. The biggest advantage of a nebulizer is that the patient only needs to breathe in and out, and the medication gets delivered to the body.

What Are the Different Types of Long-Acting Asthma Inhalers?

Long-acting asthma inhalers contain medications that help to treat the causes of asthma. These inhalers are to be used even when the patient is asymptomatic. They do not work against asthma attacks but help to prevent them. The long-acting asthma inhalers have been described below:

• Steroid Inhalers - They are long-acting asthma inhalers that contain Corticosteroids. During asthma, the airways become narrow due to inflammation. These steroids reduce inflammation and widen the air passages to allow the patient to breathe. Steroid inhalers are generally used twice a day or more, depending upon the symptoms. The difference between the steroid and a reliever inhaler is that the effects of the steroids are seen after one to two weeks. They do not provide immediate relief from the symptoms. However, the symptoms will either subside or get reduced to a large extent after one week. The steroid inhalers need to be used with caution because the long-term use of steroids reduces the calcium levels of the body. The bones might become weak in the absence of calcium. Make sure to have calcium-rich food items like milk, spinach, okra, and apricots. The drugs that are commonly used in steroid inhalers are listed below:

  • Beclomethasone Dipropionate.

  • Budesonide.

  • Mometasone Furoate.

  • Fluticasone Propionate.

• Reliever Inhalers - Bronchodilator inhalers are also known as reliever inhalers and can be taken as when required. The drugs used in these inhalers take around 12 hours to show their effects. The medications present in the inhalers relax the muscles of the airways and allow the person to breathe. They are named bronchodilators because they dilate or widen the air passages (bronchioles). The drugs used as bronchodilators are listed below:

  • Salbutamol.

  • Terbutaline.

  • Theophylline.

  • Tiotropium.

• Combination Inhalers - As the name suggests, these inhalers use a combination of steroids and bronchodilators to treat asthma. Using a combination inhaler rather than multiple inhalers reduces the chances of hospitalization due to asthma. The drugs used in combination inhalers are listed below:

  • A combination of steroid Fluticasone Propionate and long-acting beta two Adrenergic Receptor Agonist (LABA) Salmeterol.

  • A combination of steroid Budesonide and Long-Acting beta 2 Adrenergic Receptor Agonist (LABA) Salmeterol.

What Is a Spacer Device?

A spacer device is like a reservoir that holds the drug when the inhaler is pressed. They are attached to the inhaler at one end and a mouthpiece at the other. The mouthpiece has a valve attached to it that keeps the drug in the spacer until the person breathes in. As the person breathes out, the valve gets closed. If the inhaler has to be used in children, a face mask can be attached to it, and the child just needs to breathe in and out through the mask. The advantage of the spacer is that it allows only the required amount of medication to reach the body. As a result, there is no systemic absorption of the drug, and the side effects are also fewer.

What Are the Side Effects of Inhalers?

The side effects of inhalers are minimal as only a small amount of the drug reaches the body. However, the patients using steroid inhalers are likely to present with the following side effects:

1. Sore Throat - If the patient takes a high dose of steroids through the inhaler, soreness in the throat might occur. Along with sore throat, oral thrush is commonly seen due to steroids. Thrush is a fungal infection caused by Candida albicans. The patient presents with creamy-white lesions on the tongue and the inner lining of the oral cavity. Steroids disturb the balance of microorganisms in the oral cavity and increase the risk of fungal infections. The patient must rinse his mouth each time after the steroids are used.

2. Osteoporosis - Osteoporosis or reduction in bone density is commonly seen in people taking steroids for a long time. The steroids reduce the calcium levels of the body and make the bones weak. The patient needs to have a calcium-rich diet to protect the bones.

3. Delayed Growth - The children suffering from asthma and using steroid inhalers show delayed growth. It is because a small amount of steroids enters the blood through the lungs and affects the organs that regulate growth. These children need to be continuously monitored to know about their growth.

Conclusion:

Asthma inhalers are portable devices that are used by the patient during an asthmatic attack. These devices are preferred by the patients compared to oral medications because they are easy to use and cause minimal side effects. They can be used by people of any age group, including young children, adults, and the elderly. There are numerous asthma inhalers available on the market, but they should not be used unless prescribed by a doctor. The patient must consult the doctor to learn about the right inhaler, the number of times it has to be used, and the correct method of using it.