Say you’re asthmatic and have been for years. That should make you an expert on asthma inhalers, right?
Not likely. In decades of experience as a family physician I have found that patients tend to forget the specifics of inhaler use, especially once they’re feeling better.
Or say you’re new to inhalers. Your doctor probably explained their use and purpose, but by the time you got home you weren’t certain which medicine was for what purpose.
Inhalers are divided into two classes: ‘rescue inhalers’ and ‘controller inhalers’. Here is the essence of what you should know about the first and most common type, the so-called ‘rescue inhalers.’
Rescue inhalers are intended for immediate relief, or ‘rescue’ from a serious or bothersome asthma problem. Symptoms of asthma include shortness of breath, wheezing, tightness in the chest, and cough. Rescue inhalers should provide relief within a few to several minutes. Nearly every asthmatic should have a rescue inhaler available for emergency or urgent use.
The most common rescue inhaler is albuterol (Proventil, Ventolin, Proair). Of these, Ventolin is the only one with a dose counter, making it much easier to know how much medication remains in the canister. The most common dosage is 2 inhalations (separated by at least a breath or two), at least a few hours apart. I generally prescribe them every 4 to 6 hours as needed, although in a bad case of asthma they may be needed more frequently.
Also generally speaking, the intention is that the rescue inhaler won’t be needed more than a few times a week, unless a patient is experiencing an acute attack due to a respiratory infection, allergy, or other transient situation. Patients who required a rescue inhaler more often than this should also be on a controller inhaler. One exception to this may be exercise-induced asthma. Athletes who only need a rescue inhaler prior to exercise should discuss the possibility of adding a controller drug with their doctor. It may or may not be advisable.
Ipratropium bromide (Atrovent) is another rescue inhaler, often used with asthma, but more frequently with COPD (chronic obstructive lung disease, generally due to tobacco use). It is somewhat more effective in older patients than younger patients. A therapeutic trial may help you decide whether this drug is beneficial for you.
Combivent is a rescue inhaler that contains both albuterol and iptratropium. Anyone needing this inhaler should probably be on a controller drug as well.
Maxair (pirbuterol) is less commonly used, especially now that albuterol comes in generic form at low cost. The beauty of Maxair is the delivery system in the form of the Maxair Autohaler, which delivers the medication automatically when the patient inhales through the mouthpiece.
Dosing any of these medications more frequently than prescribed may lead to side effects of a tremor, jitteriness, wakefulness, insomnia, anxiety, palpitations, or nervousness. The drugs resemble adrenalin – the hormone which courses through your body when someone jumps out and surprises you. Some patients experience these side effects even at low dosages. A higher dose probably will not help you breathe any better, but is more likely to induce side-effects.
Both albuterol and ipratropium come in an inexpensive nebulizer form as well, but patients requiring a nebulizer should generally be on a controller medication.
The primary danger of the rescue inhalers lies in not using them when they are needed, or in using them too much, and thereby avoiding seeking needed medical care.
All of these rescue inhalers are effective for asthmatic patients, although individuals may find that one product works significantly better than another. The expected effect is relief from wheezing, shortness of breath, coughing, and chest tightness. They will not help head cold symptoms. If you use your rescue inhaler and are still having trouble breathing, you should seek medical attention promptly – call 911 if needed.
Copyright 2010 Cynthia J. Koelker, M.D.