Inhalers fall into two broad groups that do different jobs and cause different side effects. Knowing which of yours is which explains most of what you might experience.
- Relievers open the airways within minutes and are used when symptoms occur. Their effects are shakiness, a faster heartbeat and restlessness, all short-lived. See salbutamol side effects.
- Preventers contain a steroid, reduce inflammation over time, and are taken daily whether or not you feel unwell. Their effects are mostly local: thrush and a hoarse voice. See steroid inhaler side effects.
Some inhalers combine both in one device.
Common side effects during long-term use
From relievers: trembling hands, a faster heartbeat, headache, muscle cramps and feeling on edge. Dose-related and passing.
From steroid preventers: oral thrush, a hoarse or weakened voice, and sore throat. These are largely preventable by rinsing your mouth and spitting out after each dose, and by using a spacer. See steroid inhalers and thrush.
Inhaled steroids are not the same as steroid tablets. The dose is far smaller and delivered to the airways, so the effects associated with prednisone largely do not apply.
Serious or persistent symptoms to discuss with a clinician
Get emergency help if breathing does not improve after using your reliever, you cannot speak in full sentences, your lips look blue or grey, or breathing worsens straight after using an inhaler.
Warning signs that asthma control is slipping, which need a review rather than simply more reliever:
- Using the reliever more often than usual, or more than your asthma plan allows
- Waking at night with cough, wheeze or breathlessness
- The reliever not lasting as long as it used to
- Getting through inhalers faster than before
- Symptoms interfering with exercise or daily activities
On high-dose long-term steroid inhalers, report unusual tiredness, dizziness or weight loss, and expect growth monitoring for children.
Dose changes, missed doses and monitoring tests
Technique matters more than most people realise. A large proportion of inhalers are used incorrectly, and poor technique looks identical to a medicine that has stopped working. Ask for it to be checked at every review, and ask whether a spacer would help, since it improves delivery and reduces side effects at the same time.
Do not stop a preventer because you feel well. Feeling well is usually evidence it is working, and inflammation returns over days to weeks after stopping.
Ask for a written action plan and an annual review. Keep track of how quickly you get through reliever inhalers, since that is a useful measure of control.
Interactions with OTC medicines and supplements
- Decongestants and stimulant supplements, which add to reliever side effects.
- Beta blockers, which can worsen asthma.
- Anti-inflammatories, which trigger symptoms in some people with asthma.
- Some antifungals and antibiotics, which can raise levels of certain inhaled steroids.
What to ask your doctor before changing treatment
- Which of my inhalers is the preventer and which is the reliever?
- Can you check my technique?
- Would a spacer help?
- How often should I need my reliever before I contact you?
- Am I on the lowest preventer dose that keeps me well?
Related chronic medication guides
- Asthma medication side effects
- Steroid inhaler side effects
- Asthma pump side effects
- Chronic medication side effects
- Report a side effect in South Africa
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.