Reliever and preventer inhalers: what is the difference?

What is the difference between a reliever and a preventer inhaler?

A reliever inhaler is used when symptoms appear. Blue reliever inhalers contain salbutamol, a short-acting bronchodilator, which is a medicine that quickly opens the airways. A preventer inhaler is taken every day, even when a person feels well, and works over time to reduce airway inflammation. The two do different jobs. NHS Inform says a person with asthma should not be given a blue reliever inhaler to use on its own and should always have a preventer inhaler. Asthma + Lung UK adds that relying only on a reliever makes symptoms and asthma attacks more likely.

How are they used, and what else is there?

Salbutamol is the usual blue reliever. A preventer such as beclometasone is an inhaled steroid. Asthma + Lung UK says a GP or nurse should discuss switching from a blue-only reliever to an anti-inflammatory reliever, known as an AIR inhaler, which combines a reliever with a low-dose steroid. The NHS says steroid inhalers should not be stopped without medical advice. In COPD, the NHS says short-acting bronchodilator inhalers are usually the first treatment. A steroid inhaler may be suggested if breathlessness continues on a long-acting inhaler or flare-ups stay frequent, and it is usually combined with a long-acting medicine in one inhaler.

What does a spacer do?

A spacer is a chamber used with a pressurised metered-dose inhaler, the kind that sprays out a puff of medicine. Asthma + Lung UK says using a spacer can also prevent side effects from steroid medicines in preventer or combination inhalers. It also says a tight seal around the mouthpiece helps make sure the full dose is received, and that a whistling sound from the spacer means the person is breathing in too fast.

Should the mouth be rinsed after a steroid inhaler?

The NHS says to rinse the mouth with water or brush the teeth after each dose of a beclometasone inhaler, to help prevent thrush. Asthma + Lung UK gives similar advice, saying to rinse the mouth with water and spit it out after using an inhaler that contains steroid, to reduce the chance of side effects. The NHS steroid inhaler page also advises using a spacer. The rinsing advice applies to inhalers that contain steroid.

What are the side effects?

The NHS lists shakiness, a faster heartbeat and headaches as the typical side effects of salbutamol. It says serious side effects are rare. Muscle pain or weakness, muscle cramps, or an irregular or more noticeable heartbeat can be a sign of low potassium levels, and the NHS says to call a doctor or NHS 111 straight away if these happen. For beclometasone, the NHS lists oral thrush and a dry or sore throat as common side effects, and its steroid inhaler page also lists a hoarse or croaky voice. If thrush develops, the NHS says a pharmacist can recommend an antifungal mouth gel, and the beclometasone inhaler is kept up while the gel is used. The NHS says to call 999 for swelling of the lips, mouth, throat or tongue, fast or struggling breathing, or skin, lips or tongue turning blue, grey or pale, and for chest pain after using more than the recommended dose. If more than the recommended dose has been used and the heartbeat is fast or noticeable, the NHS says to contact NHS 111.

What can needing a reliever more often mean?

The NHS says needing a salbutamol inhaler more often than usual could be a sign that the condition is not well controlled. Asthma + Lung UK says regularly needing a reliever inhaler points to asthma that is not under control, and advises speaking to a GP, asthma nurse or pharmacist.

When is it urgent?

Asthma + Lung UK says an asthma attack is an emergency, and that 999 should be called for an ambulance if the reliever is not helping. It says to call 999 if a person feels worse at any point, and to call 999 straight away if there is no reliever inhaler to hand. It adds that even a person who feels able to get to A&E should call 999 for an ambulance, so they can be treated on the way to hospital, and that the call handler should be told it is an asthma attack. After an attack treated with the reliever alone, Asthma + Lung UK advises asking for an urgent same-day GP or nurse appointment.