Asthma: The Rescue Inhaler -- Now a Cornerstone of Asthma Treatment

From the WebMD Archives

When asthma symptoms are in high gear and the wheezing and coughing sets in, it's the inhaler to the rescue -- the rescue inhaler, to be exact. If you have asthma, your rescue inhaler should be among the first things you reach for when you leave the house, along with your wallet and car keys.

How do rescue inhalers work, and why are they such a crucial part of managing asthma? WebMD consulted the experts to learn more about rescue inhalers, and the important role they play in asthma treatment.

The Basics of Rescue Inhalers

The most common class of rescue inhalers is the beta-agonist bronchodilator. Beta-agonist drugs provide short-acting, quick relief when symptoms like wheezing, coughing, and chest tightness flare -- whether it's from a friend's cat, summer pollen, a dusty house, or a run on a cold day.

"Standard albuterol is probably one of the most frequently used beta-agonists," says Richard Honsinger, MD, a spokesman for the American Academy of Allergy, Asthma and Immunology. Along with albuterol, other short-acting beta-agonists are available by prescription, including levalbuterol, metaproterenol sulfate, pirbuterol, and terbutaline. These drugs work by relaxing the bronchial smooth muscle in the lung, opening the airways and allowing more oxygen in as you breathe.

Rescue Inhalers: Squeeze and Breathe

While it sounds simple, when you puff and how you puff are important components of managing asthma symptoms. When symptoms rear their ugly heads, one or two inhalations can be taken every four to six hours for the quick-relief of wheezing, coughing, and chest tightness. But it is important that you take your asthma medication the correct way.

"When I see a patient, I ask them to use an inhaler for me," says Honsinger. "I find that 1 out of 4 use it incorrectly. They're putting it in their mouth and they're not squeezing it when they breathe in so they don't get a full dose. Or they squirt in their mouth and then they breathe in through their nose, so the medicine doesn't get into the lungs."

According to Honsinger, when you use your inhaler, you need to take a slow breath in, while simultaneously squeezing the inhaler to deliver a dose, then hold the breath for several seconds. And if doing both at the same time is still tricky -- like patting your head and rubbing your belly at the same time -- try using a "spacer" to help you get it right.

"Spacers squeeze the medicine into a tube and then you use the tube to breathe in the dose," says Honsinger. "It has a one-way valve so you have to breathe in to get the medicine out, and it helps get the medicine into your lungs instead of onto the back of your mouth."

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Rescue Inhalers: Don't Overdue It

While it may be tempting for a person with asthma to use a rescue inhaler as a crutch -- taking two or more puffs several times a day to curb symptoms and manage the disease -- rescue inhalers provide only temporary relief.

Research has shown that for many, asthma is a chronic, damaging, inflammatory condition that needs to be treated with chronic, anti-inflammatory inhaled treatment.

"The big clue that we've learned over the years is that if you have to use a rescue inhaler often -- waking up more than two nights a month or having to use it more than two times a week -- you ought to be on something that gives you more protection," says Honsinger. "These drugs just help you for the moment -- they don't keep the increased mucus away or the scarring of the lung away. For that you need something that gives you better protection and longer action that decreases the inflammation of the lung, like an inhaled corticosteroid or a leukotriene inhibitor."

Longer-acting asthma medications prevent symptoms before they occur by reducing airway inflammation. With asthma under control, there's a reduced dependency on the rescue inhaler. And when the one-two punch of long-term therapy and rescue inhalers fails, it's time to see a doctor.

"With a rescue inhaler, the key word is rescue," says Christopher Randolph, MD, a clinical professor at Yale University and a physician at the Center for Allergy and Immunology in Waterbury, Conn. "If you're on long-term therapy like inhaled coritcosteroids, and you still have to use your rescue inhaler more than several times in a period of an hour or two, especially overnight, you need to consult a physician and probably go on oral steroids for a short period of time."

It is also important to note that rescue inhalers can carry side effects, including nervousness, increased heart rate, restlessness, and insomnia

The Evolution of the Rescue Inhaler

Treating asthma symptoms with beta-agonist bronchodilators has been a standard part of asthma care since the 1980s -- providing new hope for people who, up until that time, had few ways to manage their symptoms.

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"When I first came into practice many, many years ago, people would light a flame under a powder [from the plant extract, scopolamine] and they'd inhale it, and this would help relieve some of their symptoms," says Honsinger.

In the 1960s, medications like isoproterenol were approved for use for asthma patients, but while they were a vast improvement over a burning powder, they still had drawbacks.

"These drugs were stimulating, making people shaky and making their hearts pound," says Honsinger. "They would carry around a glass bulb and they'd squeeze the rubber end that was attached to it, and it made a mist and they'd inhale."

When the first beta-agonist, albuterol, was approved by the FDA in 1980, under the trade name Ventolin, it introduced a new lease on life for people with asthma.

"When albuterol came out, we knew it was more convenient -- a better drug with fewer side effects and less risk," says Honsinger. "But it also allowed asthmatics to do the things they'd always wanted to do but never been able -- like exercise and outdoor activities."

Rescue Inhalers: Never Leave Home Without One

Rescue inhalers work so quickly and so well in reducing asthma symptoms that there's no reason a person with asthma should leave home without one. But if the rescue inhaler does get left behind and you're in the middle of nowhere with no access to medical care, you can resort to old-fashioned remedies.

"A cup of coffee or tea can help reduce asthma symptoms, but it takes a long time to work and it only last two or three hours," says Randolph, who is a Fellow with the American Academy of Allergy, Asthma and Immunology. "If you're without your inhaler, take slow deep breaths, relax, take a hot shower, and breathe in the warm, humid air, which will help open the airways."

Home remedies, however, are no substitute for the real deal.

"You should remember that none of these remedies are nearly as good as rescue medication," says Randolph. "You should always have your inhaler nearby if you have asthma."

WebMD Feature Reviewed by Louise Chang, MD on May 04, 2010

Sources

SOURCES: Richard Honsinger, MD, FAAAAI, Los Alamos Medical Care Clinic; clinical professor, University of New Mexico, Los Alamos. Christopher Randolph, MD, FAAAAI, Center for Allergy and Immunology; clinical professor, Yale University, Waterbury, Conn. American Academy of Allergy, Asthma and Immunology web site. FDA web site.

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