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A Guide to Asthma Treatment and How to Use an Inhaler
There’s no cure for asthma, a chronic lung disease marked by inflammation of the bronchial tubes (airways) in the lungs. But several treatments for asthma are available — both to help prevent symptoms and to treat them when they occur. Here are the top treatment options, including inhalers, and how to use them.
Benefits of Asthma Treatment
Without proper treatment, asthma may get worse as you get older, with asthma attacks increasing in 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
Your doctor will prescribe your treatment depending on your age, the type of asthma, the severity of your condition, and how your body responds to treatment. What works for you may change over time, too.
How Asthma Inhalers Work
Modern inhaler devices for asthma came into widespread use between the 1950s and the 1980s. Today, inhalers are synonymous with asthma treatment.
There are two main types of inhalers, both of which deliver medicine to the airways to prevent attacks and relieve symptoms.
Metered-dose inhalers (MDI) are the most commonly used inhalers. They have a boot-shaped mouthpiece into which a pressurized, medicine-containing canister is inserted. This design has been in use since 1956. To use an MDI, place the mouthpiece in your mouth and press down on the canister while inhaling the medicine. Some MDIs may have a counter that shows how many doses remain in the canister.
Sometimes it’s difficult to coordinate your inhalation with the release of the medication (a necessary step to ensuring that medication reaches your lungs). To help, you can attach something called a spacer to your MDI, which temporarily holds the released medicine, allowing you to inhale slowly and at your own pace.
A type of MDI called a breath-actuated inhaler automatically releases a puff of medicine when you inhale.
MDIs originally used chlorofluorocarbons (CFCs) as their propellant. Since 2008, the U.S. Food and Drug Administration (FDA) has phased out all CFC-based albuterol inhalers due to the environmental damage caused by CFCs. MDIs now use the FDA-approved propellant hydrofluoroalkane.
Dry-powder inhalers don’t use a chemical propellant to launch the medicine into your lungs. Instead, they contain a powdered formula that you draw into your lungs with a deep, fast inhalation.
No matter which type of inhaler your doctor prescribes, confirm that you are using it correctly. Reach out to your doctor or pharmacist if you have questions about usage.
Nebulizers Can Help if Inhalers Don’t Work
While not technically an inhaler, a nebulizer is another option for inhaling medicine, 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, through 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.
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:
- Remove the cap from the mouthpiece and inspect it for residue or blockages.
- Shake the inhaler vigorously for a few seconds.
- Take a deep breath and then exhale completely.
- 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.
- 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.
Other Medications to Control Asthma
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 described above) to relieve flare-ups of asthma symptoms.
Short-acting beta-agonists include medications like albuterol and levalbuterol (Xopenex); they are the first choice for quick relief during attacks. These drugs relax the smooth muscles around the airways and reduce swelling in the lining of the airways.
Anticholinergics like 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:
Inhaled Corticosteroids The standard treatment, and widely considered the most effective type of medicine to prevent attacks, inhaled corticosteroids 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 (Nucala), resulizumab (Cinqair), benralizumab (Fasenra), and dupilumab (Dupixent). 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
The National Asthma Education and Prevention Program (NAEPP) published updated treatment guidelines for people with moderate to severe asthma that’s not well controlled with current medication.
The new guidelines suggest that 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.
This combination may help prevent unexpected trips to the emergency room or your doctor’s office. It may also help avoid larger corticosteroid dosages, which with long-term use, may raise the risk of side effects like osteoporosis and eye issues like cataracts and glaucoma.
Know Your Asthma Action Plan
For most people with asthma, managing the chronic condition involves a multipronged approach tailored to their 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 the following:
- Taking your medication properly
- Avoiding asthma triggers unrelated to physical activity, such as allergens and airborne irritants
- Tracking your asthma control
- Responding to worsening symptoms
- Seeking emergency care when needed
- Quitting smoking or vaping
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 balanced diet and a healthy weight for your body size, as excess weight can worsen asthma symptoms. Research has shown that weight loss and management can help reduce asthma symptom severity.
Taking certain precautions can also help prevent exercise-related asthma symptoms. Specifically, avoid exercising in these conditions:
- 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
Can You Treat Severe Asthma With Natural Remedies?
There aren’t many evidence-backed natural remedies for asthma — particularly when it comes to people with severe symptoms, says Patricia Takach, MD, associate professor of clinical medicine in the allergy and immunology section of 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.
That said, stress is an established asthma trigger, and some research has found that stress-reduction techniques like mindfulness-based meditation may help reduce asthma symptoms.
If your asthma is triggered by allergies to things like pollen, pet dander, and dust mites, the NAEPP says doing all you can to reduce exposure to these allergens is a good idea.
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