Preventer Inhalers: Asthma Causes, Treatment and Prevention

Preventer inhalers are daily asthma medicines that calm the swelling and sensitivity inside your airways, so attacks happen less often and are milder when they do. Unlike relievers, which open tight airways within minutes, a preventer works slowly and only while you keep taking it. Most contain an inhaled steroid, and all are only available on prescription in Australia. This guide explains how they work, the kinds of device, how to use them well, their side effects, and when to see a doctor.

Key takeaways

• A preventer treats the inflammation behind asthma; a reliever eases symptoms in the moment.
• Take a preventer every day, even when you feel well, and rinse your mouth afterwards.
• Needing quick relief more than two days a week means your asthma needs a review.
• In a severe attack, call 000 and start asthma first aid straight away.

How Dry Powder Inhalers Are Used

A dry powder inhaler holds the medicine as a fine powder that you breathe in with a quick, deep breath, so it needs no spacer and no shaking. Many preventer inhalers come in this form, alongside pressurised puffers used with a spacer and soft mist devices. Breathe out away from the mouthpiece, seal your lips around it, breathe in fast and hard, then hold your breath for about ten seconds. The table compares the main devices, which are also used as COPD inhalers.

Check the dose counter each week so you never run out, and keep a dry powder device dry, wiping the mouthpiece rather than washing it.

Telling a Preventer From a Reliever for Symptoms

A reliever is the inhaler you use when symptoms start, such as wheeze, cough, chest tightness or breathlessness, while a preventer is taken every day to stop them building up. Relievers are usually blue or grey and work within minutes. Preventer inhalers come in other colours, such as brown, orange, purple, red or yellow, but colours vary, so the label is the surest guide.

Some combination inhalers can act as both: they pair an inhaled steroid with formoterol, a medicine that opens the airways fast and keeps them open for hours, so for some adults one inhaler does both jobs, used in the way their doctor sets out; all are only available on prescription in Australia. Relying on a reliever alone, without any preventer medicine, is linked to more severe attacks, so Australian guidelines advise that every adult with asthma has a treatment that includes an inhaled steroid.

What Causes the Need for Preventer Inhalers?

Asthma is long term inflammation of the airways, which leaves them swollen and twitchy, so triggers such as colds, pollen, dust, smoke, cold air or exercise make them tighten. Preventer inhalers are needed when that inflammation keeps causing symptoms: if you need quick relief more than two days a week, wake at night coughing or wheezing, or have had a flare needing urgent care.

Asthma puffers that prevent attacks work on the inflammation itself, which is why the dose is taken daily rather than when you feel tight. Instead of learning asthma preventer inhaler names, look at the medicine class on the label, which tells you whether a device is a preventer, a reliever or a combination.

Types of Asthma Inhalers

There are three different types of asthma inhalers: relievers, which open the airways quickly; preventers, which calm inflammation over time; and combination inhalers, which hold a preventer and a long-acting airway opener together. These types of treatment are used in steps, matched to how often you have symptoms.

For milder asthma in adults, one approach uses a combination inhaler with formoterol only when symptoms appear, so each puff taken for relief also delivers a dose of preventer. Where more is needed, a daily preventer or a daily combination inhaler is used, with relief medicine for symptoms. People with severe asthma may add other medicines on top. A long-acting airway opener on its own is never used, because it can mask worsening inflammation; it is always paired with a preventer.

Your doctor chooses the type and dose for you, and reviews it when your control changes. Asthma preventers are only available on prescription in Australia, and many are subsidised under the Pharmaceutical Benefits Scheme.

Using Preventer Inhalers Well Every Day

A preventer works only if you take it every day, usually morning and night or once a day, even when your asthma feels settled. Its benefit builds over days to weeks, so keep going even when nothing seems to change at first. Use a spacer with a puffer, as it sends more medicine into the lungs and less onto your throat.

After each dose, rinse your mouth with water, gargle and spit, which lowers the chance of a hoarse voice or oral thrush. Link your medication to a daily habit, such as brushing your teeth, and keep it where you will see it. Never stop asthma preventers suddenly because you feel well; talk to your doctor first, as stepping down is done slowly. Bring your inhaler to each review so your technique can be checked, and tell your doctor if you also use COPD inhalers or other lung medicines.

Preventer Medicines That Are Not Inhaled

A few preventer medicines come as tablets or injections, used when inhalers alone do not control asthma. One is a daily tablet that blocks leukotrienes, chemicals involved in allergic airway swelling; it can affect mood or sleep in some people, so any change should be reported. For severe asthma, injected medicines called biologics target the specific type of inflammation driving it, and are started by a specialist after tests.

All of these are only available on prescription in Australia, and none replaces a well used inhaler for most adults. Some people with severe asthma also need short courses of steroid tablets for a flare, a medication a doctor prescribes for a set number of days, with a review afterwards to stop the next one.

When to See a Doctor About Preventer Inhalers

See a doctor when you need your reliever more than two days a week, wake at night coughing or wheezing, cannot exercise as usual, or have needed urgent care for a flare. These are signs your asthma is not well controlled, and inhalers with a preventer are for exactly this: they work by calming the inflammation, so symptoms come less often. A doctor can check whether combination inhalers that include a preventer would suit you better, and review your technique and any side effects.

See your doctor for a review at least once a year, and to make or update your written asthma action plan, which is made with your own doctor. A child's asthma plan and medicines are for the child's own GP, in person.

In a severe attack, with breathing that is hard and getting worse, lips turning blue, or no relief from your puffer, call 000 and start asthma first aid: sit upright, take four separate puffs of your blue or grey reliever through a spacer, one puff at a time with four breaths each, wait four minutes, and repeat until help arrives.

Choosing an Inhaler Device for Asthma or COPD

The right device is the one you can use well every time, because good technique matters as much as the medicine. Using your asthma inhaler correctly means following each step for your device, and many people make small mistakes without knowing, such as breathing in too slowly from a dry powder device or firing a puffer at the wrong moment.

If your hands are weak or stiff, a spacer or a breath activated device can help; if you cannot breathe in hard, a puffer with a spacer or a soft mist device may suit you better than dry powder. COPD inhalers mostly open the airways with long-acting medicines, with an inhaled steroid added for some people, so if you have both conditions your doctor will match the devices. Ask your pharmacist or GP to watch you use your inhaler at each review.

Summary

This guide has explained what preventer inhalers do, the kinds of device and treatment, how to use them well, and when your asthma needs a review. A Medio GP can talk preventer inhalers through with you by phone consult, review your symptoms and plan, and provide an eScript where the doctor thinks it right.

Frequently asked questions

Which inhalers are preventers?

Preventers are the inhalers that contain an inhaled steroid, either on its own or combined with a long-acting airway opener such as formoterol. They are often brown, orange, purple, red or yellow, but the label's medicine class is the surest guide, and your pharmacist can confirm it. Searching asthma preventer inhaler brands will show many names for the same few medicines.

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

A reliever opens tight airways within minutes and is used when symptoms start, while a preventer calms the inflammation behind asthma and is taken every day. Some combination inhalers do both. If you need quick relief more than two days a week, your asthma needs a review.

Can a doctor help with preventer inhalers?

Yes, a GP can assess your asthma by phone, review how often you need your reliever, talk through your action plan, and provide an eScript for a preventer where the doctor thinks it right. A doctor can also arrange breathing tests through a referral when they would help.

What is the best asthma preventer inhaler?

No single asthma preventer inhaler is best for everyone. The best inhaler for adults with asthma is the one that suits their level of asthma and that they can use correctly every day, chosen with their doctor. How long you use a preventer inhaler for depends on your condition: most adults need one for years, with the dose reviewed and lowered when it has been well controlled for some months.

Can I buy a preventer inhaler over the counter?

No, in Australia a preventer inhaler is only available on prescription, so you cannot buy one over the counter. Blue or grey relievers can be bought from a pharmacist without a prescription. For each asthma inhaler, spacers and other devices help, and a pharmacist can show you how to use your inhalers, devices and spacers well.

What are the side effects of preventer inhalers?

Most people have few side effects at usual doses. The commonest are a hoarse voice, a sore throat and oral thrush, which a spacer and rinsing your mouth after each dose help prevent. Higher doses over many years can affect the bones and eyes, so your doctor aims for the lowest dose that keeps your asthma controlled.