Inhalers & Bronchodilators

Inhalers & Bronchodilators


Bronchodilators are medications that relax the muscles that wrap around your breathing tubes, allowing the tubes to become larger and easier to breathe through. Each bronchodilator is different, based on 1. the chemical make up, 2. how fast it works and 3. how long it lasts. Your health care provider will work with you to decide which of these medications or combinations work best for you.

Types of bronchodilators:

  • beta2-agonists
  • anticholinergics
  • theophyllines
  • Beta2-Agonists

Inhaled beta2-agonists can be fast-acting (start to work within 3 to 5 minutes), or slow acting (take 20 minutes to work). These medications can also be short- or long-lasting. Short- lasting beta2-agonists (albuterol, pirbuterol, salbutamol, terbutaline) last for 4-6 hours, while long-lasting (salmeterol, formoterol) can last for up to 12 hours. Indacaterol and vilanterol last up to 24 hours. Albuterol and terbutaline are available in both inhaled and pill forms. The pill form can cause more side effects than the inhaled form. Beta2-agonists that are fast-acting are also known as reliever medicines because they bring quick relief for breathlessness, but do not last long enough to provide 24- hour relief. Using your reliever medication before an activity that you know makes your breathing worse (exercise, showering, or going out into the cold air) may help lessen or prevent your breathing difficulty. Long-lasting beta2-agonists are taken every 12 to 24 hours, providing more convenient treatment of COPD than short acting drugs.

How to Use an Inhaler

If you have a lung disease such as chronic obstructive pulmonary disease (COPD) or asthma, you are probably using an inhaler. There are several different types of inhalers, all of which deliver medicine into your lungs. However, if you have never been taught to use your inhaler correctly, then you may not be getting the full benefit of your inhaled medicine. At your next visit with your health care provider, bring your inhaler(s) and ask them to check that you are using them correctly.

Using Your Metered Dose Medication Inhaler (MDI)

A metered dose inhaler (MDI) is a small device used to deliver medicine that you breathe into your lungs. A dose of medicine comes out with each spray (puff). It can be hard to coordinate taking a breath into your lungs and activating the spray at the same time. In fact, using the best technique, you may only get 15% of what comes out of the inhaler into your lungs. Your healthcare provider may recommend that you use a device called a spacer/ chamber, which stores the puff in the chamber until you breathe it in, giving you a better chance of getting the medicine into your lungs. Some spacer/chambers can increase the amount of medicine that comes out of the inhaler into your lungs to 20-25%, but not all spacers can increase delivered dose to this percentage. When choosing a spacer/chamber, ask for one that has a one- way valve, which keeps the medicine in the chamber until you breathe it in. You should get fewer side effects from the medicine if it goes into your lungs and does not get sprayed into the back of your throat or on your tongue.

What is an HFA inhaler?

There are several substances in the inhaler in addition to the medication. The substance that causes the medication to spray (the propellant) has been chlorofluorocarbon (CFC) until recently. Since CFC’s have been found to damage the ozone layer, they are banned from production. The new propellant in your inhaler will be hydrofluoroalkane (HFA). HFA is not your medication but helps deliver your medication.

Which inhalers will have HFA?

Any inhaler discharging a liquid such as albuterol, levalbuterol, salmeterol and beclomethasone (in liquid form) now use HFA. Devices that have medication in powdered form such as formoterol, salmeterol, tiotropium, and most combination inhalers, do not require a propellant.

Will my inhaler work the same way with the HFA propellant?

MDI’s using HFA will actually improve your chances of getting a good dose of the medicine.

HFA propellant comes out of the inhaler in a softer manner and the medicine particles are smaller in size. The finer the spray, the smaller the particles in each puff allowing a better chance of getting the medication into your lungs. Although you may also not feel the same “kick” you received from your CFC inhaler and may wonder if you’re getting enough medication, it’s likely that you are. You should also note that if you can “see” the spray, the particles are too large to get into your lungs.

Using a Spacer/Chamber

A spacer/chamber device should be used with all MDI’s (inhalers that spray liquid, not inhalers with dry powder) to increase the amount of medication that gets into your lungs. If you are inhaling a steroid medication by MDI, it is even more important that you use a spacer/chamber. This will lessen the amount of drug that lands in your mouth. If you do not have a spacer/chamber, use the technique (“open” or “closed” mouth) that works best.