My Opinion of Many Asthma Inhalers
We asthma experts often say that finding what asthma inhalers work best for you is a matter of trial and error. This is true even for us asthma experts who have asthma. My quest to learn what works best for me began during the 1970s. Since then, I have tried nearly every asthma inhaler. Here is my personal opinion of all the ones currently on the market.
Rescue inhalers
These are short-acting bronchodilators, also known as beta 2 adrenergic agonists. Once inhaled, the medicine attaches to beta 2 receptors lining bronchial airways to dilate them, thereby making breathing easier. Every asthmatic must have one nearby at all times.
Albuterol (Ventolin). Let me just say there’s a reason this is the best selling asthma medicine of all time. Approved by the FDA in 1981, it quickly gained the favor of both physicians and asthmatic because It offers quick relief with negligible side effects. It continues to be my favorite rescue inhaler.
Levalbuterol (Xopenex).It’s basically albuterol without the s-isomer, and is marketed as offering fewer side effects than albuterol. Whether it’s better tolerated continues to be debated. My opinion so far is that it’s no different than albuterol. Still, it offers a second option for those with a real or perceived intolerance to albuterol.
Inhaled corticosteroids
They prevent and control asthma by reducing underlying airway inflammation. Most physicians will start newly diagnosed asthmatics on one of these before moving on to combination inhalers.
Beclomethasone (Qvar). This medicine has been around since 1982, and only recently was rebranded as Qvar. The new formula lasts up to 12 hours. For me, it turned out that this inhaler did not help me obtain ideal asthma control. Still, it works great for many asthmatics.
Fluticasone (Flovent). It was approved by the FDA in 1996, and it was the first long acting inhaled corticosteroid. This was a neat convenience, as older inhaled corticosteroids required 2 puffs four times a day. This inhaler worked great for me until Advair entered the market.
Mometasone (Asmanex). It was approved by the FDA in 2008 as another long acting inhaled corticosteroid. I have never tried this medicine (unless you count my trial with Dulera, detailed below). Still, it’s another option for asthmatics in your quest to see what medicine works best.
Combination inhalers
These are inhalers that combine an inhaled corticosteroid along with a long acting beta adrenergic (LABA). They offer the combination effect of controlling underlying airway inflammation while keeping airways open at the same time.
Fluticasone/Salmeterol (Advair). It was approved by the FDA in 2000, and has since gone on to become the best selling asthma controller medicine. It lasts up to 12 hours, meaning only 2 daily puffs. In my opinion, this medicine controls asthma with negligible side effects. My doctor and I continue to be open minded about trialing newer medicines, although I always seem to end up back on this.
Budesonide/ Formoterol (Symbicort). The medicine worked great for controlling my asthma. Formoterol is stronger than salmeterol and opens up airways within seconds, as opposed to salmeterol taking up to 15 minutes. So, for this reason, many asthmatics prefer this medicine. I have many asthmatic friends who love it. Still, for me personally, formoterol makes me too jittery and nervous. For this reason, my experiment with Symbicort ended after only a few months and I went back to Advair.
Mometasone/ Formoterol (Dulera). Like Advair and Symbicort, it worked great for controlling my asthma. In fact, like Symbicort, it was nice that if offered quick relief when I used it. Still, I do not tolerate formoterol, as it again made me feel jittery and nervous. For this reason, my experiment with Dulera ended after only a few months and I went back to Advair.
Fluticasone/Vilanterol (Breo). It contains the same inhaled steroid as Advair, although with a newer and stronger LABA that lasts up to 24 hours. I did a trial of this medicine for all of 2015. It worked great for controlling asthma. As a bonus, Vilanterol offers quick relief similar to formoterol. However, near the end of this trial I realized vilanterol, like formoterol, made me jittery and nervous. For this reason, my experiment with Breo ended and I went back to Advair.
How would you review your asthma inhalers?
As should you, my doctor and I are always on the lookout for newer and better asthma medicines. Still, for the time being, the controller medicine that works best for me is Advair. And, as should you, I continue to keep a rescue inhaler -- in my case albuterol -- nearby just in case it’s needed. Enough about me. What asthma medicines work best for you. Let us know in the comments below.
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