Related topics: •  Asthma Center •  How to Use an Inhaler •  Revised Standards for Diagnosis and Treatment

After the first few puffs, most people with asthma become comfortable with their inhalers. As long as the device works for them, they see no need for change. But for millions of people with asthma, change is coming.

About 85 percent to 90 percent of today's inhalers are metered-dose inhalers. Just like aerosol cans, these devices contain pressurized gases that propel the medicine. The inhalers work fine for patients, but there's a problem: Almost all of them contain chlorofluorocarbons (CFCs), gases that harm the ozone layer. As part of a worldwide effort to reduce the release of these gases, CFC inhalers will gradually disappear by the end of the decade.

Some patients may have a little trouble adjusting to their new inhalers, but most will make a smooth transition, said Robert J. Meyer, M.D., director of the Food and Drug Administration's Division of Pulmonary and Allergy Drug Products. Patients already have a wide variety of effective, easy-to-use options that are environment-friendly, and more new inhalers are on the way. "We won't take anything off the market until we're sure patients can successfully switch to a new product," Meyer says.

Patients who take certain medications won't have to give up metered-dose inhalers. In 1996, the FDA approved Proventil HFA, the first metered-dose device that uses gases other than CFCs. This inhaler delivers albuterol, a common medication that helps open up airways. QVAR, a similar inhaler approved in 2000, delivers the corticosteroid drug beclomethasone. Both of these inhalers work much the way other metered-dose inhalers do, but patients may notice small differences in the taste of the medicine and the force of the spray. (For instructions on using an inhaler, see below.)

Dry-powder inhalers are an excellent alternative for many patients. These inhalers don't have any gases at all; as with metered dose inhalers, the patient uses his or her own lung power to suck in the medicine. The devices are already widely available and easy to use, but they aren't a good choice for very young children, people with emphysema, or anyone else who can't inhale strongly enough to get the medicine.

Other options are on the horizon. For instance, researchers are currently testing mini-nebulizers, handheld inhalers that deliver a fine spray without the help of pressurized gases.

Whatever type of inhaler you have, follow the instructions exactly and talk with your doctor to make sure you are using it correctly. If you have any doubts, bring it along to your next appointment and demonstrate your technique. And if you're still using a metered-dose inhaler with CFCs, it's not too early to start talking to your doctor about making a switch, Meyer says. Like it or not, a change will be coming. You might as well be ready.

Metered-dose inhalers:

•To prepare a metered-dose inhaler, place the canister, nozzle down, in the plastic holder, then remove the cap from the inhaler. It's important to shake the canister before each dose. Doctors recommend using a spacer, a tube that carries medicine from the inhaler directly to the mouth. A spacer lets patients breathe at their own pace and helps deliver the medicine deep into the airways. Spacers are especially helpful for young children and people taking corticosteroids.

•Tilt your head back slightly and slowly breathe out.

•If using a spacer, attach the spacer to the inhaler, put one hand around the spacer and one hand on the inhaler, and place your mouth firmly around the end of the spacer. If you're not using a spacer, hold the inhaler 1 to 2 inches away from your open mouth. If you have trouble with either of these methods, it is usually all right to put the end of the inhaler directly in your mouth -- but it's best not to use this method if you are taking corticosteroids.

•While breathing in slowly, press down on the inhaler to release the medicine.

•Keep breathing in deeply and evenly for three to five seconds, then hold your breath for 10 seconds.

•If you need another dose, wait for 30 to 60 seconds before repeating the steps.

•If you're using a corticosteroid, rinse your mouth out after each use; this will help lessen your risk of developing thrush or other throat infections.

Dry-powder inhaler:

•Put your mouth around the mouthpiece and inhale quickly and deeply.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Further Resources

American Academy of Allergy, Asthma, and Immunology 800-822-ASMA http://www.aaaai.org

American College of Allergy, Asthma, and Immunology 800-842-7777 http://allergy.mcg.edu

American Lung Association 800-LUNG USA http://www.lungusa.org

Asthma and Allergy Foundation of America 800-7-ASTHMA http://www.aafa.org

References

First published January 23, 2001
Last updated August 24, 2007
Copyright © 2001 Consumer Health Interactive

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