In March 2020, the Food and Drug Administration (FDA) released a safety alert to warn the public that epinephrine auto-injectors (EpiPen, EpiPen Jr., and generic forms) may malfunction. This could prevent a person from receiving potentially life saving treatment during an emergency. If a person has a prescription for an epinephrine auto-injector, they can view the recommendations from the manufacturer here and talk with their healthcare provider about safe usage.
Asthma is a chronic condition that leads to dangerous swelling in the airways that lead to the lungs. It requires ongoing management using medication, and a person will often administer these medications using a range of devices, including inhalers and nebulizers.
These are severe flare-ups of symptoms that might lead to emergency treatment.
This article explores in detail the different medications and devices available for people with asthma.
A range of both quick-relief medications for attacks and long-term control drugs are available for the treatment of asthma.
Take quick-relief medications called bronchodilators at the first sign of asthma symptoms to provide a rapid response.
A doctor prescribes bronchodilators to expand the airway passageways and help clear mucus from the lungs. These drugs can relieve symptoms but do not control the inflammation that drives asthma.
Beta2-agonists are a class of drug that also relieves asthma symptoms quickly. They reduce allergic reactions and form the basis of many allergy medications. As the asthmatic reaction in the airways has links to the mechanisms that cause allergy, they can be helpful in reducing the effects of acute flare-ups.
Do not take these drugs more than twice a week. Taking them more often is a sign of poorly controlled asthma, so visit a doctor to discuss better ways to control the condition. It is important to carry a quick-relief inhaler at all times for urgent relief when the symptoms of an attack first occur.
Using quick-relief medicines to control asthma symptoms long-term is not effective, as they usually do not reduce inflammation
The following medications are effective beta2-agonists for people with asthma:
- metaproterenol (Alupent)
- epinephrine, a powerful anti-allergic medication that an individual might purchase in the form of EpiPen or EpiPen Jr., Adrenalin, and Epinephrine Mist
- albuterol, which stores may sell as Ventolin HFA, Proventil, or Proair
- levalbuterol (Xopenex, Xopenex HFA)
Long-term control medications
The daily use of long-term asthma control drugs is the best way to reduce the risk of a severe attack.
Inhaled corticosteroids are extremely effective for long-term asthma relief. These relieve inflammation and limit sensitivity to allergens that could set off a reaction in the airways.
However, the medicines might lead to certain side effects, including a fungal infection of the mouth known as thrush.
The risk of thrush increases if corticosteroids come into contact with the mouth and throat. Spacers or holding chambers are available as attachments to an inhaler. They can reduce corticosteroid contact with the area and reduce the risk of thrush.
Rinsing the mouth can similarly help to prevent the side effects of corticosteroids.
People with asthma might use the following long-term medications:
- anti-inflammatory drugs, including cromolyn
- immunomodulators, including omalizumab, available as an injection once or twice monthly that reduces immune reactions to allergens, such as pollen and dust mites.
- inhaled long-acting beta2-agonists, which differ from quick-relief beta2-agonists and soothe the airways to support a course of corticosteroids
- medications that block the inflammation reaction in the airways, known as leukotriene modifiers
- theophylline, which a person takes orally to open the airways
People will often use devices to effectively deliver asthma medication to the airways. Inhalers and nebulizers are the most common devices for administering asthma drugs.
A peak flow meter is another device that can help a person with asthma monitor how their lungs are working.
Peak flow meter
Peak flow is a measurement of lung function that records the speed and force of expelled air. A person with asthma can use a peak flow meter at home to monitor the progress of asthma treatment and the risk of an upcoming attack.
Keeping a peak flow diary can help a doctor understand how to adapt doses of medication and management techniques to best suit the person with the disease.
An inhaler is a handheld device that turns asthma medicine into a spray, similar to that of an aerosol can, making it more efficient at reaching the airways.
There are two different types: Metered dose inhalers and dry powder inhalers.
Metered dose inhalers (MDIs)
These released a pre-measured puff of medicine to ensure that a person with asthma gets the exact dose they need. Some machines have a counter that displays the remaining number of doses, but people with those that do not should keep track of how many they use.
Younger inhaler users might also benefit from a spacer attachment. Aside from reducing the risk of side effects from corticosteroids, they can reduce the need to squeeze the inhaler while inhaling. The user can inhale the medication when they are ready.
A spacer can make using an inhaler more effective. The spacer will help the medicine reach the lower airways where it can have the most powerful impact in treating asthma.
Infants and very young children will place a plastic cup called a facemask over the mouth and nose to receive inhaled medicine. Older children may use a smaller mouthpiece.
Taking a dose of asthma medication through an inhaler should take between 2 and 3 minutes.
Dry powder inhalers
A dry powder inhaler delivers asthma medication in the form of a powder, not a spray.
This requires more force when inhaling the medication. Many children can supply enough force by the age of 5 or 6 years.
These are electronic devices that transform asthma drugs into a fine mist and do not require forceful inhalation.
They are generally bulkier than inhalers and sometimes require a power supply. They may also be battery-powered.
An individual takes the mouthpiece and breathes in and out for around 10 minutes.
If a child is distressed or crying during a dose, the nebulizer may reduce in effectiveness, as the child will absorb less medicine.
Using an inhaler or nebulizer in the correct way is vital, as an accurate dose can greatly reduce the frequency and impact of attacks.
There are many different brands of inhaler. Read instructions thoroughly for efficient use.
Apply the following tips:
- Remove the cap of the inhaler, shake it, and “prime” the inhaler by spraying or pumping it. The manufacturer instructions will advise how best to achieve this. Do not shake a dry powder inhaler before use.
- Make sure the person receiving the dose is standing up or sitting up straight.
- Breathe in deeply, tilt back the head a little, and sharply breathe out to empty the lungs.
- Form a close, tight seal by squeezing the lips shut around the mouthpiece.
- Push down on the top of the canister while breathing in slowly for between 3 and 5 seconds.
- Count to 10 while holding a breath.
- Remove the inhaler and breathe out slowly.
- People who need two puffs should wait for one minute between the first and second.
- Rinse the mouth with water if taking corticosteroids through an inhaler.
As inhalers can save lives during respiratory distress, make sure using one becomes second nature. Speak to a doctor if the type of inhaler is causing difficulties.
Peak flow meter
To obtain an accurate peak flow reading, take the following steps:
- Assume a comfortable position, sitting up or standing. Either is fine but do it the same way each time.
- Pull the counter back all the way to reset the meter.
- The meter should be horizontal. Make sure the measurement scale is visible.
- Breathe deeply, filling the lungs completely.
- Bring the meter to the lips, forming a tight seal on the mouthpiece.
- Blow as fast as hard as possible into the device.
- Repeat three times for accuracy and write down the highest figure in a peak flow diary. The three readings should be about the same.
Be sure to take peak flow measurements at the same time each day for consistency. The highest peak flow at this time will indicate the personal best. This will be the target peak flow, and the further the peak flow falls from this figure, the higher the risk becomes of an attack.
When a person replaces their peak flow meter, they should find a new personal best, as different meters might show different readings. Allowing for growth in children is also essential, so find a new personal best every 6 months to represent this change.
This will also come with instructions, which anyone using a nebulizer should read closely.
- Wash the hands thoroughly before use.
- Follow manufacturer instructions to assemble the machine, tube, cup, and mouthpiece.
- Place the medicine into the medicine cup. Open any pre-measured capsules and empty the contents into the cup.
- Seal the lips around the mouthpiece, or make sure a facemask fits closely around the nose and mouth. Avoid holding the mouthpiece away from the face.
- Switch on the machine. A mist should start to form at the base of the tube.
- Breathe normally through the mouth until the medicine cup is empty. This might take around 10 minutes.
- Remove the mouthpiece or mask and power down the machine.
- Rinse the mouth after using corticosteroids.
Wash the hands, medicine cup, and mouthpiece or mask well after use, but do not wash the tubing. Shake off any remaining moisture, and air-dry the components on a tissue or paper towel.
Disinfect the different parts of the nebulizer once a week to sterilize the device. The packaging should provide precise instructions.
Store the nebulizer in a clean, dry plastic bag, and keep mouthpieces or masks separate if more than one person in the house uses the machine to treat asthma. Replace any broken or malfunctioning parts as soon as possible.
A variety of medications are in involved in the long-term management of asthma and the treatment of attacks.
Quick-relief medications, such as bronchodilators, help to address respiratory distress during an asthma attack. Long-term control drugs, such as corticosteroids, help to moderate asthma and reduce airway inflammation.
A variety of devices can help deliver these medications to the lungs. Inhalers turn the medication into a spray or deliver a powder. Some inhalers deliver a specific amount and keep track of remaining doses. Be sure to follow the tips on using each for the most accurate doses and the most efficient delivery.
Nebulizers turn the medications into a fine mist and require less effort on behalf of the person taking the drugs. However, they often require a power a source and are less portable than inhalers. Speak to a doctor about which delivery method would be best.
Monitor the progress of asthma using a peak flow meter and record the highest value in a diary to show the target lung function after asthma treatment.
How do I decide which device is best for me?
The type of medication being delivered dictates the types of device. The device will also depend on the reason for taking the medication.
Your doctor will provide you with a prescription for the type of device needed for administering the medication you are prescribed. For example, they might prescribe a quick-acting bronchodilator for times when you need quick relief. A metered dose inhaler will usually deliver this medication.
For long-term treatment, you may need to attach a spacer to your inhaler for more effective delivery of the medication as part of a daily routine.
The bottom line is that your doctor will provide you with information about the available devices based on the type of medication they are prescribing.
Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.