Why We Inhale Asthma Medications
On occasion when I’m standing in front of the counter taking my asthma medications, I lament the fact that I just can’t take a pill or two and be done with my asthma. While taking inhalers is certainly not time-consuming by most standards, the only way I can multi-task those is by listening to podcasts at the same time—with pills, I can swallow two (or more, if needed) at once, and be done with it. With inhalers, there are far more steps involved. Shake. Take the puff. Hold your breath for 10 seconds. Repeat—at present, x3 at night, x5 in the morning. It gets old, right?
There are, of course, really good reasons why asthma medications are inhaled. I mean, possibly you’re saying “Well, duh.” Hey, it may be a basic question, but it doesn’t mean we’ve considered it!
Better medication delivery
The first reason why we inhale most asthma medications is that simply, it gets the medication right where it needs to go. Instead of having to travel throughout our whole body, the medication goes right where it needs to be and starts working right away. As well, the 10-second breath hold allows medications to settle on the airway surfaces so they don’t just float away when you exhale.1
Faster speed of action
Even if it takes a while to “kick in”, most asthma medications work fast because they’re already right where they need to be. While some controller inhalers take longer to begin working, like salmeterol (in Advair) at 10-20 minutes 2 and Spiriva between 30 minutes and 1 hour3—to name two examples—delivering medications to the lungs allows them to work more quickly than pills that must take a journey through your stomach first!
Fewer side effects
Asthma medications are relatively safe and generally have few side effects because, while there is some transfer to different body systems, most of the drug is absorbed and used in the lungs. Side effects of bronchodilator asthma medicines are usually minimal and tolerable and include increased heart rate and feeling “shaky”4, most noticeably in the hands.
Inhaled corticosteroids may cause thrush, a yeast infection in the mouth and throat5—this can often be prevented by rinsing your mouth with water and spitting it out or brushing your teeth after you take your inhalers.6 Taking inhaled medications using a spacer can prevent thrush and may help with other side effects—it will certainly help maximize the amount of medication that gets into your lungs!6
Does device matter?
Solid maybe! Even if you are able to use your inhaler device correctly, some research shows that based on particle size and mechanism of action, dry powder inhalers may deposit more medication in the throat and upper airway as opposed to in the lungs.7 Metered dose inhalers may be harder to coordinate, but deposit smaller particles than dry powder inhalers, allowing for more of a “chance” for them to get into the lungs—the larger the drug particle size, the less likely it is to get where it needs to go.7 The most important thing is to take your medication as prescribed!
I suppose while it would be nice to take a pill or two to keep my asthma in control, I now have a whole list of ways to convince myself that inhalers are still the best way to treat asthma!
Have you ever gotten "moon face" as a side effect of prednisone?