Relievers

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Reliever Medications

Short-acting bronchodilators are called “relievers” or “rescue medications”. They provide fast but temporary relief of bronchospasm (tightening of the airways) by relaxing the muscles that have tightened around the bronchiole tubes, but they do nothing to reduce the inflammation in the airway. Most bronchodilators open the airway and help restore normal breathing within 10 to 15 minutes. The effect lasts for about four hours. If a short-acting bronchodilator is not effective, another reliever strategy may be the combination of a longer lasting but rapid acting medication (LABA) in combination with an inhaled corticosteroid (ICS).

Relievers are safe but, as with any medication, you should never take more than you need. Some of the possible side effects of short-acting bronchodilators are headache, shaky hands (tremor), nervousness, and fast heartbeat. There have been some reports of hyperactivity related to these medications.

Use your reliever only when you have asthma symptoms. Carry it with you at all times and use it when necessary. Note how often you need to use your reliever. If you need it more than twice a week for relief, your asthma is not well controlled.

Talk to your health care provider about how often you use your reliever inhaler. They may prescribe one or more controller medications, or may change the dose or type of controller that you are currently using to get the asthma under control.

Are you over-relying on your reliever?

Your asthma reliever plays an essential role in managing your asthma: it’s there to be a rescue inhaler for when you are experiencing asthma symptoms or an asthma attack. You should always carry your reliever medication with you wherever you go. That being said, if you are taking your reliever more than twice a week (exclusing use before exercise) your asthma is not properly controlled.

It’s important to ensure that you aren’t overly reliant on your reliever medication to manage your asthma. Many people living with asthma use their reliever medication to provide fast relief when they have symptoms, and think that their asthma is well managed — but a reliever medication only treats the immediate symptoms, not the underlying inflammation in the airways, which is why a controller medication is often needed. Over-reliance on your rescue inhaler is a sign of poor asthma control and puts you at higher risk of experiencing asthma attacks.

If you think that you are using your reliever medication too often, speak with your healthcare provider about your treatment plan. You can take this short test to see if your asthma is under control.

How can my doctor and I figure out if my reliever medication is working?

Within 10 to 15 minutes of taking your reliever medication, you should be able to feel your breathing becoming easier. You can use your Asthma Action Plan or asthma diary to track your symptoms and how they change after taking your medication.

If you or your doctor want to get a more specific measure of how your lungs are working, you could try using a small, simple device called a peak flow meter. This is a handheld, tube-like device that you blow into. It measures how well air is moving in and out of your lungs. If you use a peak flow meter regularly, it provides useful information about how your asthma is affecting your lungs and how well your reliever medication is working to get things back to normal after an attack. It’s especially helpful for people with moderate to severe asthma. It’s also useful for people who have recently been diagnosed with asthma, to help them and their healthcare team figure out the best doses and combinations of controller and reliever medications.

How should I use my reliever medication if I have Exercise-Induced Asthma (EIA)?

Relievers can be used for short-term prevention of Exercise-Induced Asthma (EIA). If this is prescribed for you, take the dose 10 to 15 minutes before exercising. Learn more about exercise and sports with asthma.

 

How to use your medication

How to Use a Metered-Dose Inhaler “Puffer”

A metered-dose inhaler, called an MDI for short, is a pressurized inhaler that delivers medication by using a propellant spray.

To use an MDI:

You should follow the instructions packaged with your medication. Asthma Canada recommends using a spacer with your puffer if possible, but if you must use it without a spacer, the following is a recommended method:

  1. Shake the puffer well before use (three or four shakes) Remove the cap
  2. Breathe out, away from your puffer
  3. Bring the puffer to your mouth. Place it in your mouth between your teeth and close your mouth around it
  4. Start to breathe in slowly. Press the top of your puffer once, and keep breathing in slowly until you’ve taken a full breath
  5. Remove the puffer from your mouth, and hold your breath for about 10 seconds, then breathe out

If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-5. After you’ve used your MDI, rinse out your mouth and if your puffer doesn’t have a built-in dose counter, always write down the number of puffs you’ve taken so that you can anticipate when you need to refill your prescription.

Store all puffers at room temperature and keep them out of places that get hot, like the glove compartment of your vehicle.

Cleaning Your MDI

There are many types of puffers, and they may have slightly different cleaning and storage instructions. Please refer to the instructions that came with your device. Store all puffers at room temperature and keep the top on when not in use. If you are using your spacer every day, you should replace it about every 12 months.

Important Reminders About MDIs

Always follow the instructions that come with your MDI. As well:

  • Keep your reliever MDI somewhere where you can get it quickly if you need it, but out of children’s reach.
  • Show your doctor, pharmacist or asthma educator how you’re using your metered-dose inhaler.
  • Store your MDI at room temperature. If it gets cold, warm it using only your hands.
  • Never puncture or break the canister, or try to warm it using anything except your hands.
  • When you begin using an MDI, write the start date on the canister.
  • Check the expiry date on the MDI before you use it.
  • If you’re having trouble using your MDI, ask your doctor for tips or to recommend another device.
  • Many doctors recommend the use of a spacer, or a holding device to be used with the MDI.
  • Do not float the canister in water.

A DISKUS® is a dry-powder inhaler that features a built-in counter, so that you always know how many doses you have left in it.

Use your DISKUS®:

  1. Open your DISKUS®: Hold it in the palm of your hand, put the thumb of your other hand on the thumb grip and push the thumb grip until it “clicks” into place
  2. Slide the lever until you hear a click. Your medication is now loaded
  3. Breathe out away from the device
  4. Place the mouthpiece gently in your mouth and close your lips around it
  5. Breathe in deeply until you have taken a full breath
  6. Remove the DISKUS® from your mouth
  7. Hold your breath for about ten seconds, then breathe out slowly

If you drop your DISKUS® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.

Do not use a spacer with the DISKUS®, Turbuhaler®, Twisthaler®, or any other dry powder inhaler.

The dial in the dose-counter window tells you how many doses are left – always check it after using your DISKUS.

How to clean and maintain your device

Make sure to keep the device dry, at room temperature, and closed when not in use. Do not wash the device or get it wet. If you want to clean the mouthpiece, wipe it with a clean, dry tissue.

A Turbuhaler® is a dry-powder inhaler available in an easy-to-use format.

Some Turbuhalers® feature a dose counter that shows the exact amount of medication left. If your Turbuhaler® doesn’t have a dose counter, then check for a red indicator in the windows on the side of the device. When you see red in the window, there are approximately 20 doses left and it’s time to order a refill.

Use your Turbuhaler®:

  1. Unscrew the cap and take it off. Hold the inhaler upright
  2. Twist the coloured grip of your Turbuhaler® as far as it will go. Then twist it all the way back. You have done it right when you hear a “click”
  3. Breathe out away from the device
  4. Put the mouthpiece between your teeth, and close your lips around it. Breathe in forcefully and deeply through your mouth
  5. Remove the Turbuhaler® from your mouth before breathing out
  6. Always check the number in the side counter window under the mouthpiece to see how many doses are left. For the Turbuhalers® that do not have a dose counter window, check the window for a red mark, which means your medication is running out. When finished, replace the cap.

If you drop your Turbuhaler® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.

How to clean and maintain your device

Keep the cap on when you are not using your inhaler. Store it at room temperature in a dry place. Clean the outside of the mouthpiece once a week with a dry tissue. Never use water or any other fluid when cleaning the mouthpiece.

How to Use a Diskhaler®

A Diskhaler® is a dry-powder inhaler that holds small pouches (or blisters), each containing a dose of medication, on a disk. The Diskhaler® punctures each blister so that its medication can be inhaled.

Use your Diskhaler®:

  1. Remove the cover and check that the device and mouthpiece are clean.
  2. If a new medication disk is needed, pull the corners of the white cartridge out as far as it will go, then press the ridges on the sides inwards to remove the cartridge.
  3. Place the medication disk with its numbers facing up on the white rotating wheel. Then slide the cartridge all the way back in.
  4. Pull the cartridge all the way out, then push it all the way in until the highest number on the medication disk can be seen in the indicator window.
  5. With the cartridge fully inserted, and the device kept flat, raise the lid as far as it goes, to pierce both sides of the medication blister.
  6. Move the Diskhaler® away from your mouth and breathe out as much as you can until no air is left in your lungs.
  7. Place the mouthpiece between your teeth and lips, making sure you do not cover the air holes on the mouthpiece. Inhale as quickly and deeply as you can. Do not breathe out.
  8. Move the Diskhaler® away from your mouth and continue holding your breath for about 10 seconds.
  9. Breathe out slowly.
  10. If you need another dose, pull the cartridge out all the way and then push it back in all the way. This will move the next blister into place. Repeat steps 5 through 9.
  11. After you have finished using the Diskhaler®, put the mouthpiece cap back on.

If you drop your Diskhaler® or breathe into it after its dose has been loaded, you may cause the dose to be lost. If either of these things happens, reload the device before using it.

Your Diskhaler® should always be cleaned according to its instructions and before you insert a new medication disk into it.

Aermony RESPICLICK™ is an ICS/LABA combination inhaler. Aermony RespiClick is offered as prophylactic therapy for patients aged 12 years and older, in a simple-to-use inhaler. The device features a cap that integrates the opening and priming steps, with a ‘click’ sound that confirms the dose is ready.

How to Use Aermony RespiClick™

To use your Aermony RESPICLICK™ do the following for one dose:

1. When you are ready to use your Aermony RESPICLICK for the first time, remove the inhaler from the foil pouch. There are two main parts of your Aermony RESPICLICK inhaler: the white inhaler with the mouthpiece and the green cap that covers the mouthpiece of the inhaler.

2. Make sure the cap is closed. Hold the inhaler upright. Open the green cap all the way back until you feel and hear a ‘click’. Once the cap is opened and it clicks, one dose is ready to be inhaled. Do not open the green cap unless you are taking a dose.

3. Before inhaling, hold the inhaler away from your mouth and breathe out through your mouth as much air as you can and as is comfortable. Never breathe out into the inhaler mouthpiece.

4. Place the mouthpiece in your mouth and close your lips around it so you form a good seal. Breathe in quickly and deeply through your mouth, until your lungs feel completely full of air. Do not block the vent above the mouthpiece with your lips or fingers.

5. Remove the inhaler from your mouth. Hold your breath for about 10 seconds or for as long as you comfortably can. Important note: Your Aermony RESPICLICK inhaler delivers your dose of medicine as a very fine powder that you may or may not taste or feel. Do not take an extra dose from the inhaler even if you do not taste or feel the medicine.

6. Close the green cap after inhaling so that the inhaler will be ready for your next dose.

7. Rinse your mouth with water after taking your dose. Spit out the water. Do not swallow it.

8. Throw the inhaler away 30 days after you have opened the foil pouch, or when the counter reads ‘0,’ whichever comes first.

An Atectura® Breezhaler® inhaler belongs to the class of medications called long-acting beta agonist bronchodilators. It works by relaxing the muscles in the walls of the small air passages in the lungs. This helps open up the airways, making breathing easier, preventing symptoms such as wheezing and shortness of breath.

How to use your Atectura® Breezhaler® Inhaler:

To use your ATECTURA® BREEZHALER® inhaler, do the following for one dose:

1. Pull off the cap, open the inhaler, and remove a capsule. Separate one of the blisters from the blister card. Peel open the blister and remove the capsule. Do not push the capsule through the foil. Do not swallow the capsule.

2. Insert the capsule into the chamber. Never place a capsule directly into the mouthpiece. Close the inhaler.

3. Pierce the capsule once. Hold the inhaler upright. Pierce the capsule by firmly pressing both side buttons at the same time. You should hear a noise as the capsule is pierced. Only pierce the capsule once. Release the side buttons.

4. Breathe out fully. Do not blow into the inhaler. Inhale medicine deeply. Place the mouthpiece in your mouth and close your lips firmly around it. Do not press the side buttons. Breathe in quickly and as deeply as you can. During inhalation you will hear a whirring noise. You may taste the medicine as you inhale.

5. Hold your breath for up to 5 seconds. Rinse your mouth with water and spit it out.

6. Check that the capsule is empty. Open the inhaler to see if any powder is left in the capsule. If there is powder left in the capsule, close the inhaler, and repeat steps four and five.

7. Remove empty capsule. Put the empty capsule in your household waste. Close the inhaler and replace the cap.

Enerzair® Breezhaler® is a combination of a long-acting beta2-adrenergic agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS). It is used as a maintenance treatment for asthma in adults whose asthma is not being adequately controlled with a maintenance long-acting beta2-agonist (LABA) and a medium or high dose of an inhaled corticosteroid (ICS), and those who have experienced one or more asthma attacks in the previous year.

This medication is not intended for the relief of the sudden (acute) symptoms of asthma (i.e. as rescue therapy for the treatment of sudden episodes of bronchospasm).

How to use your Enerzair® Breezhaler® Inhaler:

To use your Enerzair® Breezhaler® inhaler, do the following for one dose:

1. Pull off the cap, open the inhaler, and remove a capsule. Separate one of the blisters from the blister card. Peel open the blister and remove the capsule. Do not push the capsule through the foil. Do not swallow the capsule.

2. Insert the capsule into the chamber. Never place a capsule directly into the mouthpiece. Close the inhaler.

3. Pierce the capsule once. Hold the inhaler upright. Pierce the capsule by firmly pressing both side buttons at the same time. You should hear a noise as the capsule is pierced. Only pierce the capsule once. Release the side buttons.

4. Breathe out fully. Do not blow into the inhaler. Inhale medicine deeply. Place the mouthpiece in your mouth and close your lips firmly around it. Do not press the side buttons. Breathe in quickly and as deeply as you can. During inhalation you will hear a whirring noise. You may taste the medicine as you inhale.

5. Hold your breath for up to 5 seconds. Rinse your mouth with water and spit it out.

6. Check that the capsule is empty. Open the inhaler to see if any powder is left in the capsule. If there is powder left in the capsule, close the inhaler, and repeat steps four and five.

7. Remove empty capsule. Put the empty capsule in your household waste. Close the inhaler and replace the cap.

About Spacers

The most basic spacer is a tube that attaches to a puffer, so that you breathe the medication in from the tube instead of directly from the puffer. This makes it easier to “aim” the medication and breathe it right into the deepest part of your lungs, instead of having the spray end up in your mouth. If sprayed into your mouth, the medication can cause side effects like thrush (yeast infection). You can buy spacers from a pharmacy.

Also known as aerosol-holding chambers, add-on devices and spacing devices, spacers are long tubes that slow the delivery of medication from pressurized MDIs.

Spacers should always be used with MDIs that deliver inhaled corticosteroids. Spacers can make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat, where it can lead to irritation and mild infections.

While a spacer can make it easier to co-ordinate breathing in and activating an MDI, it can also make the MDI less portable because a spacer takes up extra space in a purse or a bag. However, inhaled corticosteroids are usually prescribed to be taken twice a day, so the spacer can be left at home for morning and evening use.

There are several other types of spacers available for people with specific needs. A large-volume spacer is useful for people who need to take their medication dose more slowly, over the space of five or six breaths. For young children, a spacer with a breathing mask attachment is often used. If you need to use one of these types of spacers, please ask your healthcare team how to use and maintain them.

Should I be using a spacer?

Asthma Canada recommends that anyone, of any age, who is using a puffer should consider using a spacer. A pharmacist, respiratory therapist, asthma educator, or doctor can assess how you use your puffer and will recommend the best device for you.

It is recommended that children use a spacer device with their puffer.

Spacers should not be used with dry powder inhalers — only with puffer-style devices. Puffers with either a rectangular or a round mouthpiece should be able to fit into a spacer — ask your healthcare provider for a demonstration if you are unsure how to set it up.

To Use your Puffer with a Spacer:

  1. Shake the inhaler well before use (3-4 shakes)
  2. Remove the cap from your inhaler, and from your spacer, if it has one
  3. Put the inhaler into the spacer
  4. Breathe out, away from the spacer
  5. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
  6. Press the top of your inhaler once
  7. Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast.
  8. Hold your breath for about ten seconds, then breathe out.
  9. If you need to take more than one puff at a time, wait a minimum of 30 seconds between puffs and be sure to shake the puffer (as in step 1) before each puff. Only put one puff of medication into the spacer at a time.

Cleaning Your Spacer

To clean your spacer, follow the instructions that come with it. In most cases, they will advise you to:

  1. Take the spacer apart.
  2. Gently move the parts back and forth in warm water using a mild soap. Never use high-pressure or boiling hot water, rubbing alcohol or disinfectant.
  3. Rinse the parts well in clean water.
  4. Do not dry inside of the spacer with a towel as it will cause static. Instead, let the parts air dry (for example, leave them out overnight).
  5. Put the spacer back together.

If you are using your spacer every day, you should replace it about every 12 months.

Important Reminder about Spacers

Always follow the instructions that come with your spacer. As well:

  • Only use your spacer with a pressurized inhaler, not with a dry-powder inhaler.
  • Spray only one puff into a spacer at a time.
  • Use your spacer as soon as you’ve sprayed a puff into it.
  • Never let anyone else use your spacer.
  • Keep your spacer away from heat sources.
  • If your spacer has a valve that is damaged, or if any other part of the spacer is damaged, do not use it. The spacer will have to be replaced.
  • Some spacers have a whistle. Your technique is fine if you do not hear the whistle. However, if you hear the whistle, this means you should slow your breath down.
  • It is very important that you consult your  healthcare professional to review proper inhaler technique.

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