fbpx

Controller Medications

Having asthma means having long-term inflammation (swelling) in your airways. Controller medications are used to treat this underyling inflammation to greatly reduce asthma symptoms and help prevent asthma attacks. Your healthcare professional will probably prescribe a controller as part of your long-term treatment plan of asthma. If you have had asthma for some time and it is poorly controlled, your doctor will probably want to add a controller medication if you aren’t already using one.

When you start taking controller medications, you may not notice a difference right away. It may take a few weeks before the inflammation in your airways is reduced. Even if you do not feel better right away, do not stop taking your controller medication unless your doctor tells you to.

Remember, controllers do not immediately relieve wheezing, coughing or chest tightness, and should not be used to treat a severe asthma attack. Make sure you understand the difference between your reliever medication, which provides quick relief during an asthma episode, and your controller medication, which controls your underlying inflammation so that you’re less likely to experience these symptoms in the first place.

Is Your Asthma Well Controlled?

If your asthma is poorly controlled your healthcare professional will probably put you on a controller medication. You have good asthma control if you:

  • Do not have any breathing difficulties, cough or wheeze most days
  • Sleep through the night without wakening with cough, wheeze or chest tightness
  • Can exercise without cough, wheeze or chest tightness
  • Do not miss work or school because of asthma
  • Have a normal breathing (spirometry) test
  • Do not need your reliever inhaler 2 or more times a week (except for use with exercise)

You can check to see if you are over-relying on your reliever (rescue) inhaler by taking this quiz: Rate Your Reliance

Controllers: Inhaled Corticosteroids

Inhaled corticosteroids are a type of medication that are very effective at reducing inflammation in the airway. Corticosteroids are the mainstay of what is called “controller” or “preventer” treatment in asthma. For most people with asthma, a controller corticosteroid will be taken as a puffer (or inhaler). This delivers the medication to the lungs, right to where it is needed.

Most people with asthma achieve good control with a corticosteroid inhaler. Inability to achieve good control with a corticosteroid inhaler should raise a red flag, and your asthma should be reassessed.

Who should take an inhaled corticosteroid?

Everyone with asthma, even mild asthma, benefits from regular use of inhaled corticosteroids. When used regularly, inhaled corticosteroids reduce inflammation and mucous in the airways, making the lungs less sensitive to triggers. They are also the best defence against possible long-term lung damage and airway remodelling.

What do I need to know about inhaled corticosteroids?

It can take weeks for an inhaled corticosteroid to reduce the inflammation in your airways, so be patient. The longer you are using it, the less you will need to use your reliever medication, since your asthma will be better controlled.

Inhaled corticosteroids are not for the relief of sudden-onset asthma symptoms. When you are feeling better, do not stop taking the inhaled corticosteroid. Instead, talk to your healthcare provider about adjusting the dose. The inhaled corticosteroid is keeping your asthma under control. If you stop taking it, the inflammation and your symptoms will return.

Will inhaled corticosteroids used to treat asthma cause dangerous side effects?

The corticosteroids that are inhaled to treat asthma today are considered safe. This is because the medicine, which is breathed in through a puffer, goes directly into the lungs where it reduces inflammation in the airways. A steroid tablet (oral corticosteroids) that is swallowed has more side effects because a large amount goes into the blood stream and is carried to other parts of the body.

Side effects from inhaled corticosteroids are minor when the proper amount is taken. The common side effects of inhaled corticosteroids are hoarse voice, sore throat, and a mild throat infection called thrush (yeast infection). Sore throat and thrush are commonly caused by poor puffer technique. Show your healthcare provider how you use your puffer. You may need a spacer if you are using a type of puffer known as a metered dose inhaler (MDI). Rinsing out your mouth with water after every dose of inhaled corticosteroids will also help reduce these side effects.

What is the difference between anabolic and inhaled corticosteroids?

There are a number of misconceptions about inhaled corticosteroids. For example, some people mistakenly believe that they are the same as the anabolic steroids that are sometimes abused by athletes.

Corticosteroids and anabolic steroids are two completely different medications. The term “steroid” in both names just means that one piece of their chemical structure is similar. The other parts of the two molecules are different from each other, so their effects on the body are also very different.

Anabolic steroids are variations of the male hormone testosterone. On the other hand, the steroids used in asthma are corticosteroids, which are closely related to hormones that your body naturally produces to fight inflammation in the various tissues of the body. Corticosteroids do not produce the same kinds of side effects as anabolic steroids. With inhaled corticosteroids, you are taking a very small dose of the medication that goes exactly to where it is needed in your lungs, so the risk of it producing side effects elsewhere in your body is very low or none at all.

Corticosteroids are the steroids used to treat asthma. Corticosteroids do not build muscle or enhance performance. Corticosteroids are hormones that your body naturally produces. When your doctor prescribes an inhaled corticosteroid, they are giving a very small amount of this same hormone, to reduce the inflammation in the airways.

Other Controller Medications

Sometimes, moderate doses of inhaled steroids alone do not fully control asthma symptoms. You may find that even though you’re taking inhaled steroids regularly, you still experience asthma symptoms, for example, at night or when you exercise.

Long-acting bronchodilators do not work on inflammation directly. Instead, they help the airways relax, allowing more air to pass through.

Long-acting inhaled beta2-agonists (LABAs), long-acting anticholinergic bronchodilators, long-acting muscarinic receptor antagonists (LAMAs), and theophylline are four different types of long-acting bronchodilators. They all work in slightly different ways but produce a similar effect — they relax (dilate) the airway for up to 24 hours. All of these long-acting bronchodilators must always be used together with inhaled corticosteroids. You may be given the inhaled corticosteroid and the bronchodilator in two separate inhalers. If this happens, make sure you use both.

There are several different kinds of long-acting bronchodilators. If you are given the inhaled corticosteroid and LABA in two separate inhalers, make sure you use them both. LABAs are not intended to be used alone for the treatment of asthma. Like any medication, a long-acting bronchodilator should be used only as your doctor advises.

Examples of long-acting bronchodilators are:

  • Formoterol (sold as Oxeze® or Foradil®)
  • Salmeterol (sold as Serevent®)

Possible side effects of long-acting bronchodilators include:

  • Increased heart rate
  • Headache
  • Anxiety
  • Tremor

Some pharmaceutical manufacturers have combined two controller medications into one inhaler. These inhalers are referred to as “Combination Medications”.

Combination medications combine two medications — a corticosteroid plus a bronchodilator (usually a LABA) — in one inhaler. The bronchodilator opens your airways, making it easier for you to breathe. The inhaled corticosteroid reduces inflammation in your airways. Recent studies show that many people with asthma find that combination medications give them better control and are convenient to use.

Examples of combination medications are:

Combination Medications    Corticosteroids    Long-Acting Bronchodilators    
Symbicort®Budesonide (Pumicort®)Formoterol (Oxeze®)
Advair®Fluticasone (Flovent®)Salmeterol (Severent®)


Possible side effects of combination medications include:

  • Rapid heart beat
  • Cough, throat irritation
  • Hoarseness

Leukotriene receptor antagonists, called LTRAs for short, are a class of oral medication that is non-steroidal. They may also be referred to as anti-inflammatory bronchoconstriction preventors. LTRAs work by blocking a chemical reaction that can lead to inflammation in the airways. Although not preferred first choice therapy. LTRAs can also be used when an inhaled corticosteroid cannot, or will not, be used.

If you’ve been taking inhaled steroids and your asthma still isn’t well-controlled, your doctor may prescribe LTRAs instead of increasing the dosage of your inhaled steroids.

LTRAs do not contain steroids; they come in pill formats (including chewable tablets or liquid for children) and have few side effects. LTRAs may also be prescribed to treat allergic rhinitis. If there is no improvement in your symptoms after 4 weeks of use, your doctor will change your treatment.

Examples of LTRAs include:

  • Montelukast (sold as Singulair®)
  • Zafirlukast (sold as Accolate®)

The side effects of LTRAs include:

  • Nausea
  • Headache

Anti-IgE treatment might be recommended if you have allergic asthma and you keep experiencing persistent symptoms despite taking your controller medications.

If you have allergic asthma (about 60% of asthma is caused by allergy), your symptoms are triggered when you inhale certain allergens in the air. These allergens cause a chain reaction that leads to inflammation in the lungs.

While inhaled steroids work by treating and reducing the inflammation, anti-IgE therapy works by keeping inflammation from developing in the first place. It does so by blocking immunoglobulin E, a substance in the body that is one of the underlying causes of inflammation in allergic asthma.

Anti-IgE therapy is only available by prescription. Unlike other asthma medications, it is not administered by pill or by inhaler. It needs to be injected once every two or four weeks by a doctor or other trained healthcare professional.

The only anti-IgE therapy available in Canada is omalizumab (Xolair®).

The most common side effects of anti-IgE therapy are: skin irritation or reaction at the site of the injection, and respiratory tract infections (e.g., common cold).

Who is Anti-lgE therapy for?

Anti-IgE therapy with omalizumab is for adults and adolescents (12 years of age and above) with moderate-to-severe, persistent allergic asthma who continue to have asthma symptoms even though they are taking inhaled steroids.

How quickly does anti-lgE therapy work?

It does take time for the IgE blocking to start working. It is normal not to feel a difference right away. It is important to keep getting your injections until your doctor tells you otherwise. In scientific studies testing omalizumab, the benefits of IgE therapy were shown in most patients by three months.

Does omalizumab (Xolair®) have any serious side effects?

In scientific studies, cancer was seen in a small number of patients receiving omalizumab, as well as in those receiving placebo injections. The rate was higher in patients treated with omalizumab than placebo (0.5% vs. 0.2%). This difference has not been conclusively linked to the omalizumab. Some patients in the studies had a serious allergic reaction called anaphylaxis. This was rare, occurring in less than 0.1% of patients. Doctors have been advised to observe patients for a period after omalizumab injection to make sure that no anaphylaxis develops. If it does, it can be treated.

Will I still need to keep taking my inhalers?

Yes. Anti-IgE therapy is meant to complement, not replace, your existing medications. Although many patients taking IgE therapy have been able to have the dose of their inhaled steroid decreased over time, you will still need to keep taking your other asthma medications as directed by your doctor.

How often is omalizumab given?

Depending on your body’s IgE level and your body weight, omalizumab will be given once every two or four weeks.

Who will administer the injection?

Omalizumab needs to be injected by a trained healthcare professional. You may be able to have it done at your usual doctor’s office. In some cases, your doctor will refer you to another location to have the injection given. There are specialty clinics in many Canadian cities that have been especially set up to give injections of omalizumab.

Occasionally, doctors will prescribe oral (tablet or liquid) corticosteroids for more severe or troublesome asthma symptoms.

Oral corticosteroids can have serious side effects if used for a long time. However, they also have significant benefits that can outweigh their negative side effects. Speak with your healthcare professional who can explain the pros and cons of using oral corticosteroids.

Examples of oral corticosteroids are:

  • Prednisolone (sold as Pediapred®)
  • Prednisone (sold as Deltasone®)

Possible side effects of long-term oral corticosteroid use include:

  • Water retention
  • Bruising
  • Puffy face
  • Increased appetite
  • Weight gain
  • Stomach irritation
  • Mood changes
  • Fractures

Theophyllines are occasionally used to treat asthma. However, their anti-inflammatory properties haven’t yet been conclusively proven and they’re known to have a number of side effects.

Examples of theophyllines are:

  • Slo-Bid®
  • Uniphyl®

Possible side effects of theophyllines include:

  • Headache
  • Insomnia
  • Nausea
  • Vomiting
  • Irritability
  • Stomach upset

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.

Have Questions?

Contact our free Asthma & Allergy HelpLine to speak with a Certified Respiratory Educator who can provide you with expert advice and support.

Relievers

Learn about reliever (rescue) medications/inhalers; what they are, how they should be used, proper asthma management and more.

Biologics

Biologics are a new type of asthma medication used to help people living with Severe Asthma gain long-term control of their asthma symptoms.

Breathe Easy: Medications

Download a copy of our Breathe Easy Booklet Series on asthma treatments and medications. It provides useful information about finding the different asthma treatment options that are available to you. [Click here to download in French].