Myths About Inhalers

Why Inhalers? Why not Tablets or Syrups?

This is the commonest question asked to me!!
I would always take time to explain in detail the benefits of using an inhaler before writing any prescription. In my experience most parents would accept and prefer to use inhalation therapy after discussion. Inhalers are much better than oral medicines in many ways:

  • Firstly, inhaled medicines directly reach the airways of the lungs where it required. Hence it leads to a better and a quicker relief in the symptoms. This helps in controlling the inflammation earlier and better.
  • Secondly, the medicines used in inhalers are retained in the airways. It does not get absorbed in the body and hence it would not lead to any side effects in the body. If we use syrups or tablets then the medicines would enter the blood from the stomach and circulate in all parts of the body. This might lead to side effects. Only a very limited amount reaches the lungs.
  • Thirdly, the amount of medicine in inhalers is quite less as compared to syrups and tablets. Just compare in the example given below the amount of the medicine used in the commonest medicine used for treatment of asthma or wheezing: Salbutamol
SalbutamolSyrupInhaler
Dose for a 20 kg child5 ml three times a day2 puffs 3-4 times a day
Amount of medicine usedEach 5 ml has 2 mg=6 mg per dayEach puff has 100 microgram=600 microgram per day

For the same medicine used via an inhaler the amount of medicine is 10 times less and more effective.

Are Inhalers used in asthma treatment habit forming?

The medicine used in the inhalers is not habit forming. It should be remembered that inflammation in children with asthma sometimes take a longer time to go and can reappear also. Hence, on early withdrawal of inhalers symptoms can reappear. This has lead to a misconception that inhalers are habit forming.

Hence it is important that inhalers are used for the prescribed duration and should not be discontinued without doctor’s prescription.

Inhalers very strong. They are used as the last resort therapy?

This again a misconception!
It should be clearly understood that the medicine used in syrups and inhalers is almost the same. Hence it means that it’s just a better way of giving the same medicine.

What is the medicine used in the inhalers?

There are 2 types of inhalers:

  • Relievers: These would open up the airways or relieve broncho-constriction. This would give immediate relief to the child. These are required in cases of acute attacks only and not needed on a regular basis. The medicines used are Salbutamol or Levo-salbutamol.
  • Preventers: These are the inhalers which would reduce the swelling inside the airways and hence would prevent further acute attacks to happen. These are required to be given daily and regularly to control the inflammation. The medicines used in these inhalers are steroids. These are different or modified form of steroids which would remain inside the airways and only a negligible amount enters the body.

What are the long term side-effects of the Inhaled Steroids used in Inhalers?

Steroids used in inhalers are very safe since only a very minute amount enters the body. The common side effects observed with oral steroids are almost absent with inhaled steroids. Inhaled steroids have been used for years without any side effects.
There have been questions asked regarding reduced height in children on long term inhaled steroids. It has been shown that children on long term steroids can have 1 cm to 1.2 cm less height in long term. BUT it should be remembered that if asthma remains uncontrolled then the reduction in height can be much more because of the disease itself.

Why do I need a spacer for my child, can’t I use an inhaler directly?

SPACERS SHOULD ALWAYS BE USED WITH INHALERS in children and adolescents. It has many advantages:

  • There is no coordination required in pressing the inhaler and taking a breath. Read more in the section on “How to take your inhalers”.
  • Using a spacer would reduce the amount of medicine deposited in the mouth and hence reduce the amount of medicine absorbed in the body.
  • It also increases the amount of the medicine reaching the lungs and hence would make inhalers more effective.

What are the other types of Inhalation devices available?

There are other types of devices available called as dry powered inhalers. They can also be used instead of inhalers.
These are also effective and safe, but it should be remembered that the MOST EFFECTIVE form of therapy is an INHALER WITH SPACER.