My Opinion of Every Asthma Inhaler

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 (Azmanex): 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.

So, what now? 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (18)
  • SusieQB
    8 months ago

    Just wanted to add that I started having problems with Advair similar to problems with Symbicort. It occurred to me that perhaps the delivery system was the problem so just started with Advair HFA as opposed to the diskus. Wondering if anyone has had same issue?

  • SusieQB
    9 months ago

    This article has been a game changer for me and I’m so happy I came across this site. I didn’t realize my asthma was out of control and had been for years. It was just found out this month and so my inhaler was changed to Symbicort but I was experiencing a lot of coughing with it not to mention heartburn. This article explained other options and I went with Advair which has been amazing. Can’t believe the difference. But, glad the government covers the cost because I wouldn’t be able to afford it ~ I’m in Canada. Thank you John for a well written article. S.

  • John Bottrell, RRT moderator author
    9 months ago

    Thank YOU. Glad the article was helpful for you. And also glad the government pays for your inhaler. That certainly helps. Advair is a great inhaler. Used it for years. Now I’m experimenting with Symbicort again. Neat to have options. John. Site Moderator.

  • Mandysdad
    11 months ago

    My doctor has me on flovent and Albuterol to control my asthma. Mine is mostly set off by my allergies, which is hard to control, since I live in Fla which has a lot of my allergy triggers.
    The flovent works, but, a lot of the time I feel like I have a build up of mucus in my lungs. I might be part of my allergies or a symptom of the flovent. The Albuterol works when I need it, which thankfully is not as much as I used to need it. After spending a week on the hospital after my last major attack, I don’t want to go back.

  • John Bottrell, RRT moderator author
    11 months ago

    I don’t blame you for not wanting to go back. And your asthma seems like it’s similar to mine. I have allergic asthma (https://asthma.net/living/what-is-allergic-asthma/). You may want to talk to your doctor about this. It may be time to make a tweak in your asthma treatment regimen. Flovent works nice. But, you might want to try a combination inhaler like Advair. Advair contains Flovent and a long acting beta adrenergic (like albuterol, but lasts 12 hours). Your doctor may like this idea. Or, perhaps have an even better one. Whatever you decide to do, keep us posted.

  • cauley
    1 year ago

    Would like to know if anyone has or is using Alvesco inhaler? If so tell me how you are doing on it. I had some bad side effects from Aerospan (Flunisolide). I read that Alvesco doesn’t have as many side effects as some of the other cortiocosteroids. My doctor didn’t know or does not know about side effects of any of the inhalers. I do not have prescription coverage so I can not just try one for $200-300 dollars and not be able to use it b/c of side effects.

  • Richard Faust
    1 year ago

    Hi cauley. Hopefully others with direct experience with Alvesco will chime in with their thoughts. This article from our editorial team gives and overview of Alvesco, including info on how it works, evidence, and side-effects: https://asthma.net/treatment/alvesco/. Best, Richard (Asthma.net Team)

  • cauley
    1 year ago

    Has anyone used Spiriva and if so please tell me how it worked for you. Side effects, etc.
    What were you using b/4 Spiriva and if you stopped using it why.
    Thank you for any information you can give me

  • FeelingShy
    1 year ago

    I like Spiriva. I take 2 puffs a day along with symbicort 80. Symbicort 80 wasn’t enough alone, but I couldn’t tolerate Symbicort 160. I haven’t noticed any side effects from Spiriva and am sleeping MUCH better..as well as just being generally better controlled. (I also tried Breo, but that didn’t work out)

  • John Bottrell, RRT moderator author
    1 year ago

    Great Question!!! I have not personally used Spiriva. But, I have had many patients who have had success with it. They like it because they only need one puff of it every day — easy to remember. It’s not a top-line asthma medicine, but it still works well for some. Looking forward to hearing what other community members have to say. https://asthma.net/treatment/spiriva/

  • John Bottrell, RRT moderator author
    1 year ago

    breathenweezy. Hi again. You are welcome. It’s certainly nice that you have a proper diagnosis. It often takes some time working with your doctor to obtain ideal asthma control. So, don’t give up. Allergies (https://asthma.net/living/what-is-allergic-asthma/), GERD (https://asthma.net/living/subgroups-gerd/), sinus problems (https://asthma.net/living/asthma-subgroups-rhinitis-induced-asthma/#), and anxiety (https://asthma.net/living/anxiety-and-asthma-whats-the-deal/) can all contribute to asthma. So, working with your doctor to control these may also help. I think it’s a great idea that you are seeing an ENT. If problems in your nose or sinuses are causing your symptoms, that should definitely help. In either case, keep working with your doctors(s). If you need some tips to obtain good asthma control, here’s another nice article for you to read if you want: https://asthma.net/living/5-tips-for-better-asthma-control/. Thanks for sharing. Keep us posted how it’s going. John.

  • breathenweezy
    1 year ago

    Well am a glad to read this blog.The author mentions lot of similarities to my asthma journey.

    For instance the story about the baseball card and how his asthma rolls, like gets itchy and then tickle in chest and then to the short of breath feeling, but especially about how it takes him up to 1 hr to not feel shot of breath after rescue puffer… can’t find anon else with this so glad it might be normal.

    Now my doctor has tried flovent for 3 months and now it’s been 2 months on symbicort. I notice and improvement but still mild but daily symptoms. maybe problem is more in smaller airways so I might ask to try qvar. Problem is doctor says they are all the same these drugs and not going to work switching them around. well that sucks as it was my last hope as this hit 1 year ago i was hoping the puffers were going to mostly get me to intermittent. Maybe hyperventalion too. possible post nasal drip (that i though or think could also be asthma mucus.

    So confused and with i wasn’t so remote as i could try different docs or a respiratory theorist. wonder if there is any online serves ?

  • John Bottrell, RRT moderator author
    1 year ago

    Hi. breathenweezy. It does sound like your asthma is similar to mine. It’s kind of neat on my end too to see that I’m not the only one to experience this. Sounds like you’re on the right track to gaining good asthma control. I have been told the same thing as you, that I may my asthma may be in the smaller airways. I’ve been told Qvar gets deeper into airways, according to studies. However, it’s neat to keep in mind that Qvar has been around a while, so that’s why it’s usually the inhaler involved in studies. New evidence seems to suggest that it’s not just Qvar that gets deeper into airways, that it’s HFA inhalers. So, if this is true, Symbicort would be equally effective — or be equally distributed into airways — as Qvar. That’s why I recently talked to my doctor about switching from Advair to Symbicort. I am currently undergoing this experiment — kind of like you are. It’s been a few months for me too, and I’m not sure I’m seeing the results I was expecting. But, I personally am going to give it a chance for a while longer. Who knows, it may take a while for the medicine to do what you want it to do. It may take several months to get that deep. If it works, great! If not, there are other options worth trying. Now, as far as all inhalers being the same, I’ve just given one example of how they are not. Dry Powder Inhalers tend to have advantages too. For instance, they are less likely to cause thrush. I wrote about these in more detail in the following post (with references in case you need them). I hope this information helps. If you have more questions let us know. And good luck with your asthma. It sounds like you are on the right track to better asthma control.

  • breathenweezy
    1 year ago

    Hi John, thanks for the reply.

    I guess it’s only been 2 months on the symbicort and if i look at my symptom tracking chart I have improved, for instance i barely used my rescue puffer, 3 times this month, and those horrible super tight chests just aren’t there anymore. My one and only symptom last year at this time was that belt around the chest…

    I wish i had typical big wheeze and then t

    Now my symptoms are

    – most of the time rescue puffer doesn’t do to much for me.

    1. ocassoinally when i am sort of excited and talk fast I feel a tension in my lungs, like hyperventilation/hyperinflation or somoething I guess. In the past many times (before asthma) people would tell me to breathe when i am talking like that. It have never happened when i sing cover songs for long periods, that is why i think it might be bad speaking habits. it is similar to normal asthma tight chests but slightly different.

    2. a Mucus feeling that comes and goes for maybe a 5 per month now, I though this was normal asthma mucus after reading about it, but lately I have really wondered if this could be my sinus so a post nasal drip / allergy thing. Its hard to tell where this comes from an I now notice a pattern maybe happens more when i have my thermos of tea (with milk) as it maybe loosens or causes it. I also suspect post nasal drip as my tonsils have been noticed to be swollen. Going to try to see a ear nose throat doc. I also have regular heart burn (gerd) so who knows could be either or could be old fashioned asthma congestion.

    3. Have a peak flow meter now. My peak flow is pretty consistent from day to day. I really expected it to spike durning symptoms but not. Not sure to be relieved or not lol

    4. I seem to get out of breath kind of slightly, sometimes just sitting there like when I wake up or am just lightly moving something around in the basement. Meanwhile i do go to the gym and no SOB from running, sometimes when using weight machines i do though. I am considering that this SOB might actually stem from aniexty and over breathing and noticing my breathing to much because there has been times i feel fine then notice i do, then have a bit of aniexty about asthma or other things and notice i start to feel SOB, but might be just sitting on the couch. Meanwhile i can run 5 miles with 1/2 slightly uphill with running partner reporting more or equal normal SOB symptoms expected. I have had a rough last couple years mentally and do have a problem with stress in general. Of course this whole asthma thing is very much adding to the cycle. I sort of wonder if some symptoms of hyperventilation and or aniexty in general is triggering or even mimicking some asthma symptoms.

    5. Sometimes when i have a tight chest rescue puffer doesn’t help much maybe even makes me worse. Doc things i don’t use it right or clam enough to breath deep to get it deep.. i wonder if it that i am over breathing so when i puff it make me even more over breath.. as peak flow meter shows no change.

    I was diagnosed this year after over a decade of this thight chest/cough thing coming and going. had regular spinority test that didn’t show asthma but after specialist did methocaline challenge was show this summer to have “mild asthma” although pretty much daily symptoms. went for allergy testing and reacted huge to dust mites and showed reaction to pets and other things too. recently when to see specialist and he said moderate persistent as i have daily symptoms but you know i feel better than i did the first time we met. i guess just a label.

    I don’t know what to think, i have a mixed bad of being in a stressful period of life that make me on the fight or flight mode in my body (learning to control that) , I think i might have bad breathing habits from that, I learned I have allergies (explains the hives and itchy eyes) I have a noticeable asthma in test so explains this dry hacking morning cough and those horrible tight chests i complained to the doctors for about 15 or more years, some acid..

    At this point my hope is to have most days like say 5 days per week symptom free. I work a lot around dust and basements so wearing a good repirator now and being more careful. Avoiding smoke a bit. Sauna helps a lot !

    Other than that I am also learning to cope, my symptoms so far are not sending me in the hospital , or seem dangerous, more like make me feel a little weak and tired or make me feel a bit down about the situation, for sure hard to let lose or plan evening fun but at the same time i am trying to learn to cope i know lots of people with things like MS or in wheelchairs that have a much better outlook and humour, so big think is I am trying to accept this all and push on and try to transiend this thing. I do wish i had 0 symptoms some days but i am accepting that i have daily mild symptoms, maybe it’s a blessing…

    maybe once i get away from allergens, maybe my stress and breathing patter is improved, maybe even another month on symbicrot and i might start to mostly symptom free on most days, maybe i will get lucky on some other asthma med or find out post nasal drip or stomach acid is the root (having changed diet and eating habits yet or tried proper acid meds)

    It could be worse ! thanks for reading !

  • John Bottrell, RRT moderator author
    1 year ago

    Oh, I forgot to put a link in that last comment. Here it is: https://asthma.net/living/5-inhaler-tidbits-you-may-find-interesting/

  • markyarte
    1 year ago

    Greetings,

    I won’t share my whole trip down asthma lane since it isnt pertinent to the toppic.
    I had been on advair forever, since its inception to the market, without fail. No tightness in chest, no attacks, no apparent symptoms. To the point i thought my asthma had declined, yay!…No.
    About 1 month ago, not so surprisingly, after purchasing a convertible, that all changed, the coughing, and tightness of my chest was the worst for me. Went to the doctor who prescribed a new rescue inhaler since mine was 15 years old, steroid tablets to take for 6 days , and montelukast.
    1 weel later, no change. I had an epiphany that my Advair May no longer be working. I went back to the doctor and she gave me samples Symbicort and something else I haven’t tried yet. I wanted to try Breo but they had no samples and it turns out it would cost me about $250 a month for prescription and that I cannot afford. So now I’m on the journey for the maintenance inhaler.
    So far I’ve used the Symbicort for 3 days no tightness of breath, almost started feeling it work immediately. I even felt this coolness in my chest with the first inhalation. But as everybody else says it gives you the jitters. I honestly don’t know where to go from here and was hoping that maybe in a week or two the Jitters might stop and I will have found an answer.
    Keep up your research I’m right there with you.

  • Richard Faust
    1 year ago

    Thanks for sharing markyarte, but sorry that Advair stopped being effective. You mention the expense of Breo, you may want to look into coupons or copayment assistance programs from the manufacturer. Your doctor may be able to help with this or look up the product web site. The jitters you are experiencing with Symbicort may diminish (that can happen). Hopefully others with some experience can chime in. Keep us posted on how it goes. Best, Richard (Asthma.net Team)

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