Asthma

A Guide to Asthma Treatment and How to Use an Inhaler

Joseph Bennington-Castro
By Medically Reviewed by 
Reviewed:
Medically Reviewed
a woman with asthma using an inhaler
Asthma medication can provide quick relief from symptoms and help control the disease in the long term.Depositphotos.com

There’s no cure for asthma, a chronic lung disease marked by inflammation of the bronchial tubes (airways) of the lungs.

But a number of treatments for asthma are available — both to help prevent symptoms and to treat them when they do occur.

Without proper treatment, asthma may get worse as you get older, with asthma attacks increasing in their frequency and severity.

Treatment for asthma aims to do the following:

  • Quickly improve symptoms when they occur
  • Prevent symptoms and attacks
  • Improve your sleep and activity level

The treatment your doctor prescribes for your asthma will likely depend on your age, type of asthma, severity of your condition, and how your body responds to various treatment options. Finding the right treatment to control your asthma symptoms may require trying various methods, and what works for you can change over time.

Asthma Inhalers Help Deliver Medicine to the Airways

Modern inhaler devices for asthma came into widespread use between the 1950s and the 1980s.

Today, inhalers are synonymous with asthma treatment.

There Are 2 Main Types of Inhalers

Inhalers can deliver medicines to the airways that help prevent asthma attacks, relieve symptoms during an asthma attack, or do both. There are two main types of inhaler devices:

Metered-Dose Inhaler (MDI) This is the most commonly used type of inhaler. It has a boot-shaped mouthpiece into which a pressurized, medicine-containing canister is inserted. This design has been in use since 1956.

You deliver a measured dose of the medicine to your lungs by inserting the mouthpiece into your mouth and pushing down on the canister while inhaling.

Your MDI may have a counter that tells you how many doses are left in the canister.

It may be difficult to coordinate your inhalation with the release of medicine from your inhaler. But this step is essential to ensuring that the medicine reaches your lungs (the main goal of inhaled therapy).

To decrease the chance that the medicine stays in your mouth, you can attach a holding chamber called a spacer to your MDI.

Spacers temporarily hold the released medicine, allowing you to inhale slowly, deeply, and at your own pace to get the full dose into your lungs.

Some MDIs, called breath-actuated inhalers, automatically release a puff of medicine when you inhale.

Be sure you know how to use whichever type of inhaler your doctor prescribes to you, and double-check that you are using it correctly (more on how to use an inhaler below). If you have questions about usage or any instructions are unclear, ask your doctor, pharmacist, or healthcare provider.

While MDIs originally used chlorofluorocarbons (CFCs) as their propellant, the U.S. Food and Drug Administration (FDA) phased out all CFC-based albuterol inhalers in 2008 due to the environmental damage caused by CFCs. MDIs now use the FDA-approved propellant hydrofluoroalkane (HFA).

Dry-Powder Inhaler This type of device doesn’t use a chemical propellant to launch medicine into your lungs. Instead, it contains a powdered formula that you draw into your lungs with a deep, fast inhalation.

RELATED: Digital Inhaler With Built-In Sensors Wins FDA Approval

Anyone Having Difficulty Using an Inhaler Can Try a Nebulizer

While not technically an inhaler, a nebulizer is another option for inhaling medicine, and especially if you have severe asthma and are unable to use a regular inhaler.

A nebulizer is a machine that turns liquid medicine into a fine mist that you inhale through a mouthpiece, a mask that fits over your nose and mouth, or into your mouth alone.

Nebulizers let you take your medicine while breathing normally, but they’re more time-consuming to set up and use than inhalers.

Here’s How to Use an Inhaler

Proper technique is essential when using an inhaler to make sure the medicine reaches your lungs as intended.

Follow your doctor’s instructions and use your inhaler either directly in your mouth, 1 to 2 inches away from your mouth, or with a spacer attachment.

Here are the steps for proper inhaler use:

  1. Remove the cap from the mouthpiece and inspect it for residue or blockages.
  2. Shake the inhaler vigorously for a few seconds.
  3. Take a deep breath and then exhale completely.
  4. While standing or sitting upright, begin to breathe in slowly with the inhaler in place and press the button. Continue breathing in after pressing it.
  5. Hold your breath for 5 to 10 seconds, then breathe out slowly through your mouth.
If you’ve successfully inhaled the medicine, you shouldn’t notice a strong chemical taste in your mouth — although a slight aftertaste is normal.

RELATED: 6 Tips for Jazzing Up Your Asthma Inhaler

Medication to Control Asthma Includes Both Quick-Relief and Long-Term Drugs

Asthma medication falls into two general categories: drugs for quick relief and those for long-term control.

Quick-Relief Medication for Asthma

Quick-relief medication, which includes short-acting beta-agonists and anticholinergics, is inhaled (with the devices describe above) to relieve flare-ups of asthma symptoms.

Short-Acting Beta-Agonists Medications such as albuterol and levalbuterol (Xopenex) are the first choice for quick relief of attacks. These drugs relax the smooth muscles around the airways and reduce swelling in the lining of the airways.

Anticholinergics Medications such as ipratropium (Atrovent) also rapidly relax the smooth muscles around the airways, similar to short-acting beta-agonists.

In some cases, usually for severe asthma, corticosteroids (which reduce inflammation) are needed. These drugs are taken either orally at home or intravenously at a hospital.

Long-Term Control Medication for Asthma

Long-term control medication helps prevent asthma symptoms by reducing the inflammation that makes your airways more sensitive to asthma triggers. These drugs are usually prescribed to be taken daily.

Numerous drugs for long-term control are available, including:

Inhaled Corticosteroids Corticosteroids are the standard treatment, and widely considered the most effective type of medicine to prevent attacks. They work by reducing the body’s inflammatory responses.

Inhaled Long-Acting Beta-Agonists These drugs prevent the narrowing of the airways by relaxing the smooth muscles there; they should always be taken in combination with inhaled corticosteroids.

Biologics These drugs are made from cells extracted from living organisms — such as bacteria or mice. They’re then engineered to target molecules in the body that trigger inflammation or other immune system components that produce asthma symptoms. They are injected drugs, taken every two to four weeks, to prevent your body from reacting to allergenic triggers. They include: omalizumab (Xolair), mepolizumab, resulizumab (Cinqair), benralizumab (Fasenra Pen), and dupilumab. They are most commonly prescribed for cases of severe asthma.

Leukotriene Modifiers Taken by mouth, these drugs block either the production or the effect of leukotrienes, chemicals that can lead to asthma attacks and promote inflammation in the lungs.

Methylxanthines Taken by mouth, these drugs help relax and open the airways.

Oral Corticosteroids Taken in pill or liquid form, these drugs are used when other medicines don’t adequately prevent asthma attacks.

They are also used to treat certain cases of severe asthma.

Combination Single Maintenance and Reliever Therapy (SMART)

If you have moderate to severe persistent asthma that’s not well-controlled with your current medication, using a single inhaler with a specific medication combination — a corticosteroid plus the long-acting beta-agonist formoterol — may be more effective than increasing the dose of your current controller medication and using a separate rescue medication, according to updated asthma treatment guidelines released in December 2020 by the National Institutes of Health’s National Asthma Education and Prevention Program (NAEPP) and the National Heart, Lung, and Blood Institute (NHLBI).

The combination medication has been found to be more effective for helping you avoid unexpected trips to the emergency room or your doctor’s office, and can also help you avoid larger corticosteroid doses — which with long-term use raise the risk of side effects such as osteoporosis, high blood pressure, cataracts, and glaucoma.

Knowing Your Asthma Action Plan Is Step One

For most people with asthma, managing the chronic condition involves a multipronged approach tailored to your symptoms and lifestyle.

Step one for everyone, however, is having a firm grasp of your asthma action plan.

Work with your doctor to create an asthma action plan that covers how to:

  • Take your medication properly
  • Avoid asthma triggers unrelated to physical activity, such as allergens and airborne irritants
  • Track your asthma control
  • Respond to worsening symptoms
  • Seek emergency care when needed
  • Quit smoking, if you do

In addition, monitor your symptoms carefully. Keep track of what they are, when they occur, and their severity.

A peak flow meter is an inexpensive, handheld device that can help you monitor your condition. It measures how quickly you can breathe air out of your lungs, an indicator of how well your lungs are functioning.

It’s also important to maintain a healthy diet and weight, as being overweight can worsen asthma symptoms. According to a review published in 2012, weight loss in obese people is associated with a 48 to 100 percent rate of asthma remission.

Taking certain precautions can also help prevent exercise-related asthma symptoms. Specifically, avoid exercising:

  • In cold, dry air
  • Shortly after you get a cold or have an asthma attack
  • During high pollen conditions
  • In environments with airborne irritants, such as cigarette smoke

Treating Severe Asthma Typically Requires a Combination Approach

The same medication or methods used to control milder forms of asthma are also used to help people with severe asthma. In a lot of these cases, a person simply has to use these medicines more often.

But in some people with severe asthma, typical drugs don’t get the job done.

These patients may need a combination of some of the drugs used above — such as inhaled corticosteroids, long-acting beta-agonists, biologics, and long-acting muscarinic antagonists.

Can You Treat Severe Asthma With Natural Remedies? Probably Not, but Things Like Stress Management Can Help

There aren’t many evidence-backed natural remedies for asthma — particularly when it comes to people with severe symptoms, says Patricia Takach, MD, an associate professor of clinical medicine in the section of allergy and immunology at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia. According to the U.S. National Center for Complementary and Integrative Health, there is no conclusive evidence backing the use of herbs or dietary supplements for asthma.

On the other hand, stress is an established asthma trigger. And some research has found that stress-reduction techniques — namely, meditation — can help reduce asthma symptoms.

If your asthma is triggered by allergies to things like pollen, pet dander, and dust mites, doing all you can to reduce exposure to these allergens is a good idea, the updated guidelines say.

Additional reporting by Quinn Phillips, Markham Heid, and Sari Harrar.

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