The Color of Inhalers: Part 1

Ever notice that most asthma inhalers have unique colors? This is actually a safety mechanism so you know what medicine you're taking. Color coding was created when most inhalers were metered-dose inhalers (MDI). They all looked about the same. So the color-coding system was created to make them look different.

The basics: colors of asthma inhalers

So, the basic inhaler color coding system was like this in the early 1980's:

• Blue: Short-acting beta agonist (SABA, rescue medicine), such as albuterol (Ventolin)
• Brown: Inhaled corticosteroids (ICS, controller medicine), such as beclomethasone (Vanceril*)

Of course, then there were inhalers that failed to follow the color scheme.

Color codes for inhaler enhancements

• White inhaler with green and brown on label and green cap. Anticholinergic bronchodilator called ipatropium bromide (Atrovent). It was generally used as a controller medicine.
• White inhaled corticosteroid Azmacort. It violated color code, although the inhaler had a built in spacer and therefore was easily identified.
• White inhaler with blue cap. Mast cell stabilizer called chromolyn (Intal). It was a controller medicine. It violated the color system. But, it was a dry powdered inhaler (DPI). So, it also was easily identifiable.

In 1994 Serevent was added to the market. In 1996, Flovent was added to the market.

• Brown. Inhaled corticosteroid. It was a controller medicine called Fluticasone (Flovent)
• Green. Long-acting beta-adrenergic (LABA, controller medicine), called Salmeterol (Serevent). A bonus feature on Serevent was that it was a short inhaler. It was half the size of albuterol. While this may seem insignificant at first, it was a neat safety feature. It allowed you to distinguish it from Ventolin simply by feel.

By 2005, there was another rescue inhaler on the market.

• Light Blue. Short-acting bronchodilator (rescue medicine), called levalbuterol (Xopenex)

More than the color - the "feel"

The only problem with the color system was the lights had to be on. There were many times I grabbed my rescue inhaler at night. The feel of controller inhalers was the same. So, you had to turn the lights on to tell the difference.

Sometimes, I grabbed Vanceril instead of Ventolin. Of course, this controller medicine won't give you your breath back. So, you had to be careful.

One night I kept grabbing Serevent instead of Ventolin. I had taken many puffs of it during the night. I didn't realize my mistake until morning. My heart was pounding, but I survived. That's when I learned to pay attention to the unique feel of Serevent. You certainly don't want to use this LABA more 2 puffs twice a day.*

At present, there are five rescue inhalers. Some follow the traditional color coding system. Some do not.

• ProAir HFA is red
• ProAir Respiclick is white with a red cap and lettering
• Proventil HFA is yellow with an orange cap
• Ventolin is blue with a dark blue cap

More colors of asthma inhalers

This system was also complicated with the addition of some combination inhalers. These were both DPIs that contained both a LABA and an ICS.

• Purple. Fluticasone/Salmeterol (Advair), available as a Discus.
• Red. Budesonide/Formoterol (Symbicort). The DPI is available as the Turbohaler. The MDI is available as a red inhaler. It looks and feels similar to ProAir HFA.

So, as you can see, pharmaceuticals kind of got away from the color-coding system. The only two inhalers that comply are Ventolin and Qvar. But, there is talk of bringing the color-coding system back. I think this is a good idea. But I would go a step further. I will explain in my next post. Read on to Part 2.

Editor notes: *Vanceril is now called Qvar. **Serevent is now one of the two components of Advair. It is no longer recommended that asthmatics use it by itself. If needed, most experts agree it should be taken with an ICS.