If you have asthma, your healthcare provider may prescribe a long-acting inhaler to use regularly for overall asthma control and/or a short-acting (rescue) inhaler to use as needed for asthma attacks.
This article explains what types of long-acting and short-acting asthma inhalers are available, including when and why they are used. It also explains how the different types of inhalers work.
Long-Acting Inhalers
The medications in long-acting inhalers are used to prevent asthma symptoms on an ongoing basis. They are often described as controllers and work by counteracting the underlying causes of asthma.
If you are prescribed a long-acting inhaler, you need to use it consistently even when you don’t have symptoms. They are not used to treat asthma attacks but rather to help prevent them. If you do not use them regularly, asthma symptoms are more likely to occur.
In some cases, long-acting asthma inhalers are used on a daily basis. At other times, they are used regularly but not every day.
There are three types of long-acting inhalers commonly used for people with asthma:
Steroid Inhalers
Long-acting inhalers containing corticosteroids (steroids) target the inflammation that contributes to asthma symptoms by narrowing the airways.
Asthma attacks often occur when inhaled particles or an infection triggers excessive inflammation and spasms in the larger airways (called the bronchi). Inhaling a steroid on a regular schedule can help prevent acute inflammation.
Steroid inhalers commonly used for asthma include:
Asmanex Twisthaler (mometasone furoate) Pulmicort Flexhaler (budesonide) Qvar Redihaler (beclomethasone dipropionate)
Bronchodilator Inhalers
Some asthma controller inhalers contain a long-acting bronchodilator. This is a type of drug that widens the airways for around 12 hours to help you breathe.
Many long-acting bronchodilators are long-acting beta-agonists (LABAs) that act directly on receptors in the lungs that control the constriction (narrowing) of the airways. Others are anticholinergics that block chemical messages that cause airway constriction.
Bronchodilator asthma controllers include:
Spiriva (tiotropium), an anticholinergic bronchodilator, is more commonly used for chronic obstructive pulmonary disease (COPD) than for asthma. It is considered an option for asthma treatment, especially when the goal is to reduce the steroid dose. Elixophyllin (theophylline) is in a class of drugs called methylxanthines that functions as a muscle relaxant in the airways. With the introduction of newer asthma medication, the use of theophylline has fallen away but may still be an option for certain people.
Combination Inhalers
Combination inhalers are those that contain both a steroid and a bronchodilator. Studies suggest that using a single combination inhaler instead of multiple inhalers may reduce hospitalizations for asthma attacks.
Combination inhalers used for asthma include:
Advair, which combines the steroid fluticasone propionate with the LABA salmeterol Symbicort (and branded generic version Breyna), which combines the steroid budesonide with the LABA formoterol
Short-Acting Inhalers
Short-acting inhalers, also known as rescue inhalers, are a type of bronchodilator that contains drugs known as short-acting beta-agonists (SABAs). Because SABAs rapidly counteract the constriction of the airways, they are used when a person experiences an asthma attack.
Short-acting inhalers used for acute asthma symptoms include:
Ventolin (albuterol), which contains a mixture of two chemicals called R-albuterol and S-albuterol Xopenex (levalbuterol), which contains only R-albuterol, the more active of the two chemicals
While effective, both can cause jitteriness and heart palpitations.
Types of Inhalers
Different types of inhaled asthma medications are delivered in different forms. Some are delivered in powdered form, while others are inhaled as a spray or mist.
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Learning how to use the different inhalers is important as it ensures that you are getting the right amount of medication with each dose.
There are four types of inhalers commonly used for the treatment of asthma.
Metered-Dose Inhalers (MDIs)
Metered-dose inhalers (MDIs) are canisters with a mouthpiece that deliver the drug to the lungs under pressure. The drug is dissolved in a chemical known as hydrofluoroalkane (HFA) that acts as a propellant.
Each dose contains a measured dose of medication. MDIs require a high degree of hand-breath coordination for effective treatment, which is the major disadvantage of these devices.
Ventolin and Xopenex are both MDIs.
Dry Powder Inhalers (DPIs)
Dry powder inhalers (DPIs) were developed to overcome the problems of hand-breath coordination. The device delivers a measured dose of powdered medication that you need to inhale from a preloaded chamber.
People who lack inhaling strength, such as those with COPD, may find these devices difficult to use.
Advair, Asmanex, Pulmicort, Qvar, and Symbicort are all DPIs.
Soft Mist Inhalers (SMIs)
Soft mist inhalers (SMIs) are handheld devices that generate a soft mist that lasts longer and delivers more drug particles than an HFA propellant. It is ideal for people with limited inhaling strength, although the device still requires a bit of hand-breath coordination.
Soft mist inhalers can be used with a mouthpiece or a face mask for children.
Spiriva is an SMI.
Nebulizers
A nebulizer is a small machine that turns liquid medicine into a mist. The medicine goes into your lungs as you take slow, deep breaths for 10 to 15 minutes. The device is ideal for younger children or older adults who lack hand-breath coordination or inhaling strength.
Many different asthma drugs can be nebulized, including LABAs, SABAs, and anticholinergics.
Prevention of Asthma Flare-Ups
As effective as asthma inhalers are, they are not the only components of an informed treatment plan. To reduce your need for inhalers, particularly rescue inhalers, it is important to identify and avoid asthma triggers that can set off an attack.
These are just some of the common asthma triggers and ways you can avoid them:
Tobacco smoke: If you have asthma and smoke, you need to quit. Also, avoid secondhand smoke by creating smoke-free zones in your home, car, or anywhere that you spend a lot of time. Dust mites: To avoid dust mites, use hypoallergenic bedding and avoid down-filled pillows, duvets, and quilts. Vacuum regularly, ideally with a cleaner equipped with a HEPA filter. Dust mites thrive in high humidity, so keep the humidity in your house low (between 30% and 50%). Pollen and air pollution: Watch the daily news or download an air quality app to keep track of pollen and pollution levels in your area. When levels are high, close doors and windows and stay indoors as much as possible. Mold: Mold can be found indoors in damp areas such as kitchens, bathrooms, and basements. Always repair leaks, and get an air conditioner or dehumidifier to keep the humidity down. Empty and clean drip pans from air conditioners or refrigerators to prevent mold. Pets: Wash furry pets regularly to remove dander. Keep pets out of rooms you spend a lot of time in, such as your bedroom. Install a HEPA filter air cleaner to remove airborne dander.
Summary
There are many different asthma inhalers that your healthcare provider may prescribe, some of which are used to treat attacks and others of which are used to prevent them.
These include long-acting asthma inhalers that contain drugs called corticosteroids (steroids), long-acting beta-agonists (LABAs), or anticholinergics, each of which works differently. Short-acting asthma inhalers, also known as rescue inhalers, contain drugs known as short-acting beta-agonists (SABAs).
These inhaled drugs are delivered in different ways. Some are inhaled with a pressurized propellant (metered-dose inhalers, or MDIs), while others are inhaled in powdered form (dry powder inhalers, or DPIs). Others like soft mist inhalers (SMIs) and nebulizers deliver the drugs in mist form.
Inhalers are part of an asthma treatment plan that also involves the avoidance of asthma triggers such as pollen, tobacco smoke, dust mites, and pollution.
A Word From Verywell
Skipping your long-acting asthma medication because you have a “backup”—in the form of a rescue inhaler—is not safe. An asthma attack can be life-threatening, and recurrent attacks (even if mild) can worsen your condition by causing scarring and stiffening of your lungs.
It’s important to understand the intended use of every inhaler you use. If you are not sure if a medication is working (or if you are using an inhaler correctly), speak with your healthcare provider.
