Are Asthma Inhalers Safe?

Inhalers are the primary means through which asthmatics take medicines for asthma. They have a great advantage in allowing the medicines to reach the exact place where the medicines are required. However, inhalers can also have limitations and even potential adversities, so being aware of them can be helpful in optimizing their use.
Are Asthma Inhalers Safe?
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Asthma inhalers are the mainstay of long term treatment of asthma. There are different types of medicines, with very different actions and side effects used for inhalation. Knowing their characteristics and the potential adversity that they can result in can help in having a better control of the disease and keeping those suffering from asthma safe and healthy.


Asthma inhalers are an essential ingredient of asthma treatment. They offer the advantage of delivering the medicine right into the respiratory airways, where they are actually required. Thus, unlike oral medication, the medicines do not reach other parts of body. It means that

the side effects of treatment are minimized. More importantly, it also means that the medication reaches the place it is required, far more quickly and easily, thereby resulting in faster relief of symptoms.

Asthma Inhalers

Asthma inhalers can be divided into four major categories of medication.

(i) INHALER FOR IMMEDIATE RELIEF - These consist of short acting bronchodilators like albuterol (Proventil, Ventolin) and pirbuterol (Maxair). They provide immediate relief by causing dialtation or opening up of smaller airways in the lung. These are actually beta-2 agonists which relax the smooth muscles surrounding the bronchioles (smaller airways). Typically their action is short-lived. They provide immediate relief, but their effect is not prolonged.

(ii) LONG ACTING BETA-2 AGONISTS (LABA) - These also act by relieving the bronchospasm caused by the smooth muscles around the bronchioles, but they take much longer to provide relief and their effect is more persistent. They include salmeterol (Serevent) and formoterol (Foradil). Whenever so required they are taken for a longer duration, and are usually taken along with steroids, to improve their efficacy. The combination of LABA and steroids are the most common prescription for chronic asthma that requires persistent or long term treatment on a regular basis.

(iii) STEROIDS - Steroids prevent inflammation within the airways, and so reduce the swelling and blockage of the airways. By doing that they also open the airways and provide relief. Usually, they take some time to reach their full effect. They are usually taken for a longer durations, in patients who require regular medication. Steroids used as inhalation include fluticasone (Flovent), beclomethasone dipropionate (Qvar), budesonide (Pulmicort) and flunisolide (Aerobid).

(iv) MAST CELL STABILIZERS - They include Cromolyn and nedocromil. These are medications which act in a long term by reducing the hypersensitivity of the bronchial mucosa, and prevent the development of asthma attacks in the long run. They are usually taken as a regular treatment. They are most effective when taken along with a steroid.

Safety of Inhalers

Asthma inhalers are actually a safer treatment than oral or injectable medicines, because they do not burden

other parts of the body with medicines. The popularity of asthma inhalers is primarily due to their safety and lesser side effects compared to oral and injectable medication.

However, there are some adverse side effects that can also result from asthma inhalers. Knowing them can help the patient in reducing the side effects as well as prevent the anxiety when faced with such effects.

Recently there have been some concerns regarding the safety of Long acting beta agonists or LABAs like salmeterol (Serevent). The Salmeterol Multi-Center Research Trial (SMART) to study the effects of salmeterol suggested that use of LABA alone can exaggerate the risk of sudden exacerbation of asthma and death. However, subsequent analysts have not fully endorsed the findings, though it is accepted that there is a very small risk of exacerbation of asthma when LABA inhalers are used alone. This risk is not seen when salmeterol is used in conjunction with steroids.

One common side effects often seen with steroid inhalers administered through a metered dose inhaler are infection of throat, particularly fungal infection. This happens because of the direct deposition of the steroid medication on the throat when it is inhaled. This problem can be taken care of by using an inhaler with a spacer or an auto-inhaler which allows easy synchronization with breathing.

Other uncommon adverse side effects that can result from asthma inhalers include increased upper respiratory infections, lower bone density, eye problems including glaucoma and cataracts, slowed growth in children, increased blood pressure, fast and irregular heartbeat, tremors, nervousness, throat irritation, allergic reactions on the face and headache. Most of these side effects are minor and infrequent, and rarely dangerous. However, when they do happen, they may require consultation with your physician and a change of medication.

Though adverse effects can happen, their severity and frequency is not enough to stop or avoid their use. Asthma inhalers are an important ingredient in our fight with asthma, and safe enough for long term use in most cases.

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