Common concerns about asthma medicines

What do my inhalers do?

Most people with asthma have two inhalers, a preventer and a reliever.

• You take your preventer inhaler every day. It keeps the inflammation down in your airways and prevents symptoms.
• You take your reliever inhaler (usually blue) when symptoms come on. It quickly opens your airways if you react to triggers or have an asthma attack.

Find out more about other types of asthma medicines in inhalers, like long-acting bronchodilators (LABAs), combination inhalers, and Maintenance and Reliever Therapy (MART) inhalers.

Ask your GP, asthma nurse, or pharmacist to explain what your different inhalers are for and when you should take them. Write it down in your asthma action plan.

How do I know which type of inhaler is best for me?

Your GP or asthma nurse can help you find the inhaler device that works best for you.

There are three main types of inhaler device:

• Breath-actuated inhalers (BAI)
• Dry powder inhalers (DPI)
• Pressurised metered dose inhalers (pMDI) used with a spacer.

When choosing the best type for you, you and your GP or asthma nurse need to consider:

• The type of medicine you need
• The dose of medicine you need
• How easy is it for you to use
• Does it tell you how many doses are left?
• Is it easy to clean?
• Is it easy to carry around?
• How does its carbon footprint compare to other inhalers?

Talk to your GP or asthma nurse if you’re not happy with the inhaler device you’re using. You can get help with your inhaler technique, or see if there is another inhaler type that would suit you better. We also have some short inhaler videos to help you learn how to use your inhalers correctly.

Do I have to use inhalers for the rest of my life?

Asthma is a long-term condition, so you do need to carry on treating it to keep symptoms away.

It’s worth going for regular asthma reviews so you can make sure you’re on the lowest dose possible to control your symptoms.

If your asthma’s well managed, and you’ve had no symptoms for three months, your doctor or asthma nurse may say you can cut down your treatment.

But you’ll still need to keep an eye on things and go straight back to your GP or asthma nurse if you notice you’re getting symptoms, or you’re using your reliever inhaler more often.

Do I need to use a preventer inhaler every day?

Yes. Using your preventer inhaler every day is essential to managing your asthma well. Your preventer inhaler keeps down the inflammation in your airways so you’re less likely to react to your triggers. Once you’re in a good routine of taking your preventer inhaler every morning and evening, it can work away in the background while you get on with your life.

Taking it routinely, even when you feel well, is essential for lowering your risk of symptoms and asthma attacks.

Can't I just use a reliever inhaler?

No. Your reliever inhaler cannot deal with the inflammation in your airways. It’s only for when you get symptoms or if you have an asthma attack. You need to use your preventer inhaler, every day, to keep the inflammation down in your airways and lower your risk of an asthma attack.

A major study into asthma deaths (the National Review of Asthma Deaths 2014) which looked at patient data from hospitals and GP practices found that people using their reliever inhaler three times a week or more, or needing more than 12 reliever inhalers in a year, have asthma that is not well controlled.

I keep forgetting to use my preventer inhaler every day

The best way to make sure you’re taking your asthma preventer inhaler every day is to tie it into something else you do every day.

For example, lots of people use their inhaler after brushing their teeth. This makes it easy to remember to rinse out and gargle afterwards too, which helps with side effects like oral thrush.

The NHS has a Health Medication Reminder Service and there are plenty of apps for your phone. You can even use digital assistants like Alexa, Cortana, or Siri to remind you.

Keep your preventer inhaler close to something else you do every morning and evening, so it’s easier to remember to use it.

I’m not sure how to use my inhaler properly 

To get all the benefits from your asthma medicines, you need to use your inhaler in the best way. If you’re not sure how to use your inhaler properly, check with your GP, asthma nurse, or pharmacist. You can also watch our inhaler videos.

If you have a pressurised metered dose inhaler (pMDI) it’s easier to use it correctly with a spacer.

If you’re still finding your inhaler difficult to use, your GP or asthma nurse can talk to you about different types of inhaler devices you may find easier.

Ask your GP or asthma nurse to check your inhaler technique every time you go for an asthma review. You can also ask your pharmacist.

Do I always have to use a spacer?

If you have a pressurised metered dose inhaler (pMDI) it’s a good idea to use a spacer. A spacer helps make sure the medicine gets into your airways where it’s needed. They only work with pressurised metered dose inhalers – these are the ones that are aerosol, not powder.

Spacers are also helpful if you find it difficult to get the timing right when using your inhaler.

When you have symptoms or an asthma attack and are finding it hard to breathe, the spacer makes it easier to get the rescue medicine you need.  

Ask your GP, asthma nurse, or pharmacist about spacers that are easy to use and carry around.

My preventer inhaler’s not working

When you first start using a preventer inhaler, it takes a few days for the medicine to start working. And it may be a few weeks before you see the full benefits.

It’s important to keep taking it every day as prescribed so the protective effects start to build up. After a few weeks, you should notice you have fewer symptoms and do not react to your triggers so much.

Whenever you start any new medicines, you should get a review appointment six to eight weeks later so your doctor or asthma nurse can check how well they’re working for you.

If your preventer inhaler is not dealing with symptoms, even after a few weeks, go back to see your GP or asthma nurse to review your treatment. It’s also a chance to check you’re using your inhalers in the right way.

I find it embarrassing using my inhalers in front of people

People often tell us they feel self-conscious and embarrassed using their inhaler in public, or in front of friends and family.

If you need to use your reliever inhaler (usually blue) whether it’s at work, on a bus, or at a party, it’s important to use it as soon as you get symptoms. Try not to let your embarrassment get in the way.

It might help to remember that asthma is very common and lots of people use inhalers.

And if you’re using your preventer medicine every morning and evening as part of your daily routine, you’re less likely to need to use your reliever inhaler (usually blue) when you’re out and about.

If you need to use your reliever inhaler often (three or more times a week), see your GP or asthma nurse for a review. It could be that your asthma is not well controlled.

How do I know when there’s no medicine left in my inhaler?

Some inhalers have a dose counter on the side of the inhaler which tells you how many doses you have left. Dry Powder Inhalers (DPIs) also have an indicator that changes colour when it needs replacing.

If your inhaler does not have a counter on the side, you need to work out yourself how many doses you have taken, and how many you have left.

You can do this by:

1. Reading the patient information leaflet that came with your inhaler to see how many doses your inhaler has in total.
2. Working out how many doses, or puffs, you will be taking every day. For example, two puffs morning and evening is four puffs a day of your preventer inhaler.
3. Dividing the total number of puffs in your inhaler by the number of puffs you use every day. This will give you the number of days your inhaler will last for.

For example:

An inhaler with 200 puffs in total, where four puffs are taken every day will last you 50 days (200 divided by 4).

Take note of the expiry date, especially if you do not use your reliever inhaler that often. Do not use it after the expiry date.

How bad is my inhaler for the environment?

Dry powder inhalers have a lower impact on the environment than breath-actuated or pressurised metered dose inhalers. This is because they do not use a propellant. Propellants used in inhalers contain greenhouse gases and can add to global warming.

The NHS is encouraging everyone on a Metered Dose Inhaler (MDI) to switch to a Dry Powder Inhaler (DPI) if they can.

But do continue to use your inhaler as prescribed until you’re given a new one.

What do I do with my empty inhalers?

Return your used inhalers to your local pharmacy. Although there may not be a recycling scheme, your pharmacist can dispose of them safely and in an environmentally friendly way.

Unfortunately, your spacer cannot be recycled. You need to dispose of it in your normal household waste.

I’m concerned about taking steroids for my asthma

A lot of people worry about taking steroids, so you’re not alone. It’s important to remember that the steroids used to treat asthma are completely different to the anabolic steroids that some athletes and bodybuilders take to improve their physical performance. The steroids found in asthma medicines are corticosteroids, which are a copy of substances the body makes naturally.

Inhaled corticosteroid medicine is the best way to treat asthma and lower the risk of symptoms and asthma attacks.

Talk to your GP or asthma nurse about your concerns, and go to regular asthma reviews to make sure you’re on the lowest dose of steroid medicine to keep you well with your asthma.

Does my preventer inhaler contain steroids?

The preventer inhaler you take every day does contain steroids, called corticosteroids. It’s the steroids in your preventer inhaler that keep the inflammation down in your airways.

If you’re taking your inhaler in the right way, using a good technique, it’ll be easier for the medicine to get straight to your airways. This means it’s less likely to cause any side effects and very little medicine is absorbed into the rest of your body.

Your GP or asthma nurse will always aim for the lowest possible dose of steroid medicine to keep you well with your asthma.

Watch our inhaler videos, and ask your GP or asthma nurse to check your inhaler technique when you go for your asthma review. You can also ask your local pharmacist to check your inhaler technique.

Why do I need extra steroids?

If you’ve been prescribed a higher dose of steroids, either in your inhaler or as steroid tablets, it is because you need extra help to deal with your asthma symptoms.

Extra steroids are usually only prescribed short term until you’ve fully recovered from a flare up of your asthma symptoms.

If your asthma is still not well controlled after a high dose of inhaled steroids, talk to your GP or asthma nurse. You may need to be assessed for difficult to control or severe asthma in a specialist centre.

Will I put on weight if I take steroid tablets?

If you’re on high doses of steroid medicine for a long time, one of the possible side effects is an increase in appetite, which could mean you put on weight.

Talk to your doctor or specialist if you’re worried about your weight, and make sure you’re sticking to a healthy, balanced diet, and getting some exercise.

Will the steroids from my preventer inhaler get into the rest of my body?

Inhalers are the best way to get asthma medicines directly into the lungs where they are needed, and a good inhaler technique lowers the risk of any steroids getting into the rest of your body.

However, if you’re on a high dose of corticosteroids in your preventer inhaler, particularly over a long period of time, there is some risk of systemic side effects (side effects from the medicine getting to the rest of your body) such, bruising, increased risk of diabetes or thinning bones (osteoporosis). Not everyone gets these side effects.

You can lower your risk by:

• using a good inhaler technique
• using a spacer with your metered dose inhaler (MDI) inhaler
• gargling and rinsing your mouth out afterwards
• checking with your GP or asthma nurse that you’re on the lowest dose possible to keep your asthma well controlled

Go to regular asthma reviews with your GP or asthma nurse, to talk about your medicines, see how well you are taking your inhaler, and check that you’re taking the lowest dose of steroid medicine to keep you well.

Why have I been given a steroid card?

A steroid card lets other healthcare professionals know you take steroids. This is important information if you ever need to go to hospital.

Your GP or healthcare professional should give you a steroid card if you’re taking high doses of steroid medicine, either in your inhaler, or as tablets.

Find out more about steroids and steroid cards.

Side effects are putting me off taking my asthma medicines

Most medicines have side effects, but not everyone will get them. The patient information leaflet that comes with your medicine lists all the side effects for that medicine that have been reported to the MHRA (The Medicines and Healthcare products Regulatory Agency).

These are reports collected from real people with asthma, and health professionals, through the Yellow Cards scheme.

You’ll be able to see that people with asthma report some side effects more than others. These are the side effects listed as ‘common’.

Tell your GP or asthma nurse about the side effects you’re getting. There could be a simple way to reduce or treat the side effects, so you can carry on taking the medicine and getting the benefits for your asthma. If this isn’t possible, there may be different asthma medicines you can try.

But remember that your asthma medicines lower your risk of an asthma attack so it’s important to keep taking them.

See your GP, asthma nurse, or pharmacist if you’re worried about any side effects.

I get a hoarse voice, sore mouth, or oral thrush from taking my preventer inhaler

People with asthma often say they get a hoarse voice, sore mouth, or oral thrush from using their steroid preventer inhaler. So these are listed as common side effects in the patient information leaflet.

The good news is, side effects like these can be avoided with good inhaler technique.

If you’re taking your inhaler in the right way, the medicine does not stay in your mouth and throat but goes down into your airways where it’s needed.

It’s also important to rinse your mouth out and gargle after using your inhaler.

Every time you go for an asthma review ask your GP or asthma nurse to check your inhaler technique. You can also watch our inhaler videos.

My heart beats faster when I take my reliever inhaler

Some people notice that they feel a bit shaky or their heart beats faster than normal when they use their reliever inhaler (usually blue). This is usually when they have taken more than one puff. This side effect usually passes quickly and is not dangerous.

It is important to take your reliever inhaler when you need to, to deal quickly with symptoms getting worse, or an asthma attack.

See your GP or asthma nurse if you’re getting uncomfortable side effects from taking your reliever inhaler. They can review your preventer treatment so you do not need to use your reliever as often. If you’re taking it three or more times a week it’s a sign that your asthma is not well controlled.

I’m worried about osteoporosis

The long-term use of high doses of steroids has been linked to a risk of osteoporosis (a condition that weakens bones).

At your annual asthma review, your GP or asthma nurse can talk to you about your individual risk of osteoporosis, and things you can do to lower your risk, such as exercise, diet, and giving up smoking.

You can get lots of information and support from the Royal Osteoporosis Society.

Nightmares, sleepwalking, and mood changes

There have been reports of some people taking montelukast having side effects such as nightmares, sleepwalking, anxiety, depression, or irritability. If you notice any of these changes talk to your GP or asthma nurse as soon as possible.

Find out more about Montelukast, its benefits, and possible side effects.

I’m worried about taking my asthma medicines alongside medicines I need for other conditions

Always talk to your GP, asthma nurse, or pharmacist before taking any new medicines. This includes any over-the-counter medicines or any complementary treatments, such as herbal or homeopathic remedies.

Some medicines, when taken together, may interact with each other. This means one medicine may affect how the other one works. Or if one medicine is taken with another medicine it may increase the risk of side effects.

For example, some types of beta-blockers, given to help conditions such as high blood pressure and heart conditions, are not recommended for people with asthma. This is because they interact with asthma medicines and can cause your airways to get narrow (bronchoconstriction). Some beta-blockers affect the airways more than others. Talk to your GP about beta-blockers you can use safely.

If you’re on any other prescribed medicine, your GP will monitor you and decide whether the benefits of taking both medicines outweigh the risks, or whether it’s better to consider an alternative.

Although it can be expensive, it's important to carry on taking your asthma medicines. It can help you stay well and reduce your risk of an asthma attack.

Don’t be tempted to skip doses so your medicines last longer; you’ll be putting yourself at risk of an asthma attack. Talk to your GP or asthma nurse if you’re worried about how to pay for your asthma medicines.

The good news is that lots of people qualify for free prescriptions. If you don’t, and you’re struggling with the costs of your medicine, pre-payment certificates can save you money.

Find out more about managing the costs of your asthma medicines.