The exact cause of one of the most common respiratory disorders, asthma, is not known. In most cases, it appears that a family history of allergies and environmental factors play an important role. The immediate cause is inflammation of the walls of the bronchi which allows air to the alveoli part of the lungs. As these tube walls get inflamed, the muscles of the wall thicken and narrow the passage inside. This leads to the typical asthma symptoms which include tightness of chest and a high-pitched wheezing sound when breathing and coughing. One may even have a running nose and closed nose too. Some asthma symptoms may be seasonal or may depend on the allergen that one is sensitive to.

The approach to asthma treatments usually depends on the severity of the symptoms. In chronic cases, the treatment is basically to control the symptoms on day to day basis. A good control of the day to day symptoms reduces the chances of the periodic exacerbation the disease is prone to have. Inhalers are the cornerstone of the treatment of asthma symptoms like wheezing, tightening of chest etc Those used to check day to day symptoms are called preventers. These are nasally administered steroids and are a long acting beta agonist. They deplete calcium in the bones as a side reaction on long term continuous use and are therefore recommended for short term use, only usually a week at a time. Therefore, it is important patients stick to the recommendations and report any side reactions immediately to the concerned doctor. Beta agonists can precipitate a severe attack in some cases. In consultation with an allergy specialist or immunologist can identify the triggers. One may be able to desensitize oneself and probably get rid of the problem altogether, or devise ways to avoid coming in contact with them.

Preventer inhalers have been long-standing solutions to asthma and contain nasal drugs. These have lesser side effects on long term usage than oral drugs. Relievers are medicines needed to give quick relief in sudden flare ups. In rare cases, these may produce some uncomfortable symptoms like aggression, agitation and depression etc. Inform the doctor promptly in such cases. Long-acting beta agonists are inhaled medication which keep the bronchi open for long time. There is some chance of a severe attack with these. It is better to take them in conjunction with a nasal drug.

Asthma is one of the respiratory disorders of the lungs and has a periodic aggravation. Very quick-acting medicines are needed to control these episodes and provide relief to the patient. These are called rescue medications. This group contains quick, short-acting bronchodilators called short-term beta agonists.

Asthma treatments usually consist medications that are normally used to treat acute emphysema but has been found to be useful to control severe asthma symptoms like tightness in chest, wheezing, cough, etc. Oral and intravenous drugs are used for short spells and they have side effects on long, continuous use. The use of emergency medication becomes very rare when long-term medicines work well. It is important to keep a record of the number puffs and times one uses these drugs and inform the doctor.

In allergic asthma, one can get relief from the use of desensitizing medicines. One needs to take a shot every two to four weeks. As the sensitivity of the immune system reduces, these shots are lessened. Another specialized treatment is Bronchial thermoplastic. This is no more widely available and is not useful to all. In the course of three or four sessions in the outpatient setting, the insides of the air passage are heated up using an electrode. This reduces the smooth muscles inside the bronchi. This limits the ability of the bronchi to contract to keep them open. This reduces the asthma symptoms.

Great improvements have taken place in the field of inhaler technology. The earliest is the Standard Measured Dose Inhaler SMDI. The L-shaped contraption had a pressurized cylinder in its long arm containing an inert carrier. On pressing the piston, this gas is released which carries a fixed amount of medicine to the patient through the mouthpiece. The efficiency of the device depends on the coordinated inspiration by the patient which many found difficult. The current model has a spindle-shaped storage in between the cylinder and the mouthpiece. The mouthpiece/mask has a valve which opens and closes in sync with breathing. Once a measured quantity of medicine is released into the reservoir, the patient breaths as usual till all the medicine is taken in. When a large amount of medicine is to be inhaled, a nebulizer is used where a liquid bronchodilator is converted into a mist and the patient breaths the mist till the dose is breathed in completely. This is ideal for patients with feeble breathing and in cases where a large amount of medicine is required. Inhalers with spacers are fast catching up.

The asthma inhaler market has many options for their users. Different companies produce and market inhalers with generic names of the medicine and their own brand names across a variety of colors. It is better that one knows the details like the generic name of the medicine in the inhaler and the color, also especially if one is meeting a doctor who doesn’t possess one’s medical records.

Inhalers are the mainstay of asthma patients. These are used for daily use for controlling the disease; they are used as a preventer as well as a rescuer in acute severe exacerbation of asthma symptoms. Depending on their use, they are put in different medicine categories as well as classified into different groups.

Preventers
These are inhalers that are used on daily basis, generally twice a day, to keep the condition under control. Keeping the symptoms under control usually reduces the acute episodes. These inhalers contain nasally-administered corticosteroids. Steroids reduce the inflammation of the bronchi and keep the air passage clear to reduce breathing difficulties. It takes about two weeks for these to be fully effective. Beclometasone, Asmabec, Qvar, Beclazone, Pulvinal Beclometasone, Clenil Modulite, and so on are the brands that use this medicine.

• Budesonide: Brands that use this steroid are Easyhaler, Novolizer Budesonide, Pulmicort, Budesonide and so on.
• Non-steroids like sodium cromoglicateor nedocromil: Intal and Tilade are some of the brands that use these medicines. These are not as effective as the steroids nor do they have the same side effects. Ciclesonide Alvesco is another brand that uses this drug.
• Fluticasone: Brand such as Flixotide use this. This is a yellow-colored or orange-colored inhaler.
• Mometasone: Asmanex Twisthaler is one of the brands that uses this.

Relievers
Relievers are another group of inhalers and have a rapid, short duration of action and are used to get relief from sudden exacerbation of symptoms. There are two types in this. One is of very short duration while the other has about 24 hours of duration.

The long duration ones are a combination of a steroid and a Beta agonist. These are bronchodilators which keep the bronchi dilated. Brands like Fostair contain a combination of a beta agonist and a steroid, formoterol and beclometasone. Seretide have salmeterol and fluticasone. This is a purple-colored inhaler. Symbicort is another brand which contains beta agonist formoterol and steroid budesonide. Steroids on long term usage depletes calcium from bones. Consult a physician before using any of these inhalers. Any acute side reaction should be informed to the physician who is treating the patient.

Asthma inhalers are classified into different types depending on the mechanisms of their working. The various types include pressurized metered dose inhalers, breath actuated inhalers, inhalers with spacer devices and nebulizers. Each of these have their own merits and demerits.

Pressurized metered dose inhalers or SMDI: This type of inhaler was very popular and was unchallenged for about 40 years. Its biggest advantage is its simple operation. It can be used with almost all medicines. It consists of a pressured, inactive, carrier gas that propels the medicine in each puff when the piston is depressed. It is an L-shaped equipment with the longer arm containing the carrier gas and the shorter arm the mouthpiece. The common factors that made this inhaler less popular are listed below.

• The inhaler should always be well shaken before use.
• Inhalation and pressing the cylinder were not synchronized.
• The breath could not be held for long enough after the puff was taken in.

Breath-activated inhalers: Some of them are still MDIs but pressing of the canister is eliminated. One inhales hard at the mouth piece to get the medicine powder released and into the lungs. One needs to breathe in fairly hard to get all the medicine released and into the lung. This is its important drawback as many may not have the suction power required, and they are somewhat bigger, while the advantage is that it requires little or no coordination.

Inhalers with spacer devices: It consists of the pressurized carrier gas cylinder like the SMDI. It has a spindle like attachment at the mouthpiece of which a face mask can be attached for the use of babies and the really old and fragile patients. The medicine, on release, is held in the spacer which is a reservoir. The mask has a valve which opens and closes with the breathing. One has to breathe till the medicine is completely used up before pressing the piston again if more than one puff is recommended. There are several brands in this type. Usual guidelines of SMDIs hold good for this type too. The spacer needs to be cleaned as per manufacturer’s instructions.

Nebulizers: Nebulizers are machines that turn the liquid bronchodilators into a mist and this is to be breathed. These are used in hospitals for severe attacks of asthma and needs large quantities of medicine. It is also useful for frail patients who have weak breathing.

Asthma is one of the respiratory disorders of the lungs and has a periodic aggravation. Very quick acting medicines are needed to control these episodes and provide relief to the patient. These are called rescue medication. This group contains quick, short acting bronchodilators called short-term beta agonists. Another group of medicines used for asthma treatments give relief within minutes. These are is normally used to treat acute emphysema but has been found to be useful to control severe symptoms of asthma like tightness in chest, wheezing, cough etc.

Oral and intravenous medications are used for short spells and they have side effects on long, continuous use. The use of emergency medication becomes very rare when long term medicines work well. It is important to keep a record of the number puffs and times one uses these drugs and inform the doctor. In allergic asthma, one can get relief from the use of desensitizing medicines. One needs to take a shot every two to four weeks. As the sensitivity of the immune system reduces, these shots are lessened. Another specialized treatment is bronchial thermoplasty. This is no more widely available and is not useful to all. In the course of three or four sessions in the outpatient setting, the insides of the air passage are heated up using an electrode. This reduces the smooth muscle inside the bronchi. This limits the ability of the bronchi to contract keeping them open. This reduces the asthma symptoms.

Great improvements have taken place in the field of inhaler technology. On pressing the piston of the inhaler, gas is released which carries a fixed amount of medicine to the patient through the mouthpiece. The efficiency of the device depends on the coordinated inspiration by the patient which many found difficult. The current model has a spindle shaped storage in between the cylinder and the mouth piece. The mouthpiece/mask has a valve which opens and closes in sync with breathing. Once a measured quantity of medicine is released into the reservoir, the patient breaths as usual till all the medicine is taken in. When a large amount of medicine is to be inhaled, a nebulizer is used where a liquid bronchodilator is converted into a mist and the patient breaths the mist till the dose is breathed in completely. This is ideal for patients with feeble breathing and in cases where large amount of medicine is required. Inhalers with spacerare fast catching up.

The exact cause of one of the most common respiratory disorders, asthma, is not known. In most cases, it appears that a family history of allergies and environmental factors play an important role.

The immediate cause of asthma is the inflammation of the walls of the bronchi which allows air to the alveoli part of the lungs. As these tube walls get inflamed, the muscles of the wall thicken and narrow the passage inside. This leads to the typical asthma symptoms which include tightness of chest and a high-pitched wheezing sound when breathing and coughing. One may even have a running nose and closed nose too. These symptoms may be seasonal depending on the allergen that one is sensitive to.

Asthma treatment
The approach to treatment depends on the severity of the symptoms. In chronic cases, the treatment is basically to control the symptoms on day-to-day basis. A good control of the day-to-day symptoms reduces the chances of the periodic exacerbation the disease is prone to have. Inhalers are the cornerstone of the treatment of asthma symptoms like wheezing, tightening of chest etc.

Those used to checking the day-to-day symptoms are called preventers. These are nasally administered corticosteroids and are a long-acting beta agonist. They deplete calcium in the bones as a side reaction on long-term continuous use and are therefore recommended for short term use, only usually a week at a time. Therefore, it is important that patients stick to the recommendations and report any side reactions immediately to the concerned doctor. Beta agonist can precipitate a severe attack in some cases. In consultation with an allergy specialist or immunologist, one can identify the triggers. One may be able to desensitize oneself and probably get rid of the problem altogether, or devise ways to avoid coming in contact with them.

Preventer inhalers have been long-standing solutions to asthma and contain nasal corticosteroids like fluticasone, flunisolide, ciclesonide, budesonide, beclomethasone, mometasone, and fluticasone furoate. These have lesser side effects on long term usage than oral corticosteroids. Relievers are medicines needed to give quick relief in sudden flare ups. In rare cases, these may produce some uncomfortable symptoms like aggression, agitation and depression etc. Inform the doctor promptly in such cases.

Long-acting beta agonists are inhaled medication which keep the bronchi open for long time. There is some chance of a severe attack with these. It is better to take them in conjunction with a nasal corticosteroid.