Preventer inhalers

Find out how preventer inhalers help reduce your chances of having asthma symptoms.

How do preventer inhalers help asthma?

A preventer inhaler (usually brown) helps the medicine get right into your airways so it can work where it's needed to prevent and reduce the swelling and inflammation in your airways.

This means that when you come into contact with a trigger, your lungs are less likely to react as they will be less sensitive. You may still occasionally need your reliever inhaler (usually blue) to relieve asthma symptoms, but if you’re using your preventer inhaler correctly, it should help stop symptoms when you come into contact with triggers.  

The protective effect of the preventer inhaler builds up over time, so, to get the full benefits, you need to take it every day (usually morning and evening) even when you're feeling well.

What kinds of preventers are there?

There are several kinds of preventers, but they all work in a similar way and usually contain a low dose of steroid medicine to reduce inflammation.

The steroids used to treat asthma are called corticosteroids. These are a copy of those produced naturally in our bodies.  They are completely different to the anabolic steroids associated with bodybuilders and athletes.

  • Metered dose inhalers (MDIs) give the medicine in a spray form (aerosol).
  • Breath actuated inhalers (BAIs), such as Easi-breathe and Autohaler, automatically release a spray of medicine when you begin to inhale.
  • Dry powder inhalers (DPIs), such as Turbohaler and Accuhaler, give the medicine in a dry powder instead of a spray.

Whatever inhaler you're prescribed you need to know how to use it in the best way.  A good inhaler technique helps get as much of the asthma medicine from your preventer inhaler into the lungs as possible. To make it easier to get the best from your asthma medicine, aerosol inhalers can be used with a spacer.

Is everyone with asthma prescribed a preventer inhaler?

If you only have very mild symptoms, for example if you come into contact with a known trigger, and you’re getting symptoms on average less than twice a week, your GP may prescribe you just a reliever inhaler to use just when you get symptoms.

However, there are a very few people who only need to be prescribed just a reliever inhaler for when they get symptoms. Most people with asthma benefit from a regular preventer inhaler taken every day to prevent symptoms coming on. This is because preventer medicine taken as prescribed builds up your asthma protection over time and helps prevent asthma symptoms.  

Your GP will prescribe a preventer inhaler if: your asthma is not in good control - one sign of this is that you need to use your reliever inhaler three times a week or more

  • you're breathless, coughing or have a tight chest during everyday activities three or more times a week
  • your sleep is disturbed by cough or a tight chest each week

Some people are prescribed a preventer inhaler for occasional use if their symptoms are related to hay fever (seasonal allergic rhinitis). "If you get hay fever which triggers your asthma, you should start taking your preventer inhaler ideally two weeks before the pollen you're allergic to comes into season," says our Head of Helpline, Sonia Munde. "You then need to take it regularly while that pollen is in season."

What kind of benefits can you expect?

If you take your preventer inhaler as prescribed and discussed with your GP or asthma nurse, one thing you'll notice is that you'll be less sensitive to your triggers, such as cigarette smoke and viral infections, because your airways are less inflamed.

You might notice you're able to climb stairs or walk up hills more easily, that you're sleeping better, and not coughing at night. You might also notice that you or your child need less time off work or school and that you're more able to take part in exercise and family activities.

You won't notice these improvements straight away, but if you keep taking your preventer inhaler as prescribed and discussed with your GP/asthma nurse, these improvements will just become part of your everyday life and you or your child could be symptom-free. 

How does my preventer inhaler help me manage my triggers?

A trigger is anything that sets off your asthma symptoms or makes symptoms worse. Common triggers include dust, pollen, animals, colds and flu and cold weather. You may sometimes be able to avoid triggers – for example, by exercising indoors when it’s very cold, or by staying away from houses that have pets, if you react to them. But in reality, it’s often impossible to keep away from all your triggers. 

What you can do instead is reduce the risk of triggers setting off your symptoms. Using your preventer inhaler as directed is one of the most important ways of doing this. Your preventer inhaler contains a dose of steroid medicine that controls the inflammation and swelling in your airways.

Over time, this medicine makes your airways less likely to react to any triggers you do come across by building up a protective effect. It’s also important to go for your regular asthma reviews, where your GP or asthma nurse will make sure you’re on the right dose of preventer medicine to help stop symptoms when you’re around triggers.   

When do I need to take my preventer inhaler? 

You need to take your preventer inhaler every day as prescribed, usually morning and evening, even if you're feeling well and aren’t getting any symptoms. This is because the protective effect of the medicine builds up over time.

Once this protection is working, occasionally forgetting to take your inhaler won't usually cause a problem. But if you forget or stop for several days at a time this will mean your protection begins to disappear. If you stop using your preventer inhaler, being exposed to any of your asthma triggers is more likely to bring on an asthma attack.

Get the best from your preventer inhaler:

  1. Help yourself get into a good routine by keeping your preventer inhaler somewhere to help you remember to take it - on your bedside table so it's there in the morning and at night, for example. Put a note up somewhere to remind you or programme a reminder app on your smartphone. Eventually taking your inhaler will become as much as a habit as brushing your teeth every morning and evening

  2. Use your inhaler correctly - your GP, asthma nurse or pharmacist should explain how to use your inhaler so that every dose you take gives you the most benefit and make sure the device you're using is the right one for you. Every time you go to see your GP about your asthma ask them to check your inhaler technique. It’s a good idea to always watch your child take their preventer inhaler so you can make sure they're doing it in the right way and not getting into bad habits, such as taking their inhaler in a rush as they get ready for school or not taking it at all.

  3. Take it even when you feel well. We know that people often worry about taking medicines when they don't have any asthma symptoms. But your preventer medicine is designed to help you stay well rather than give you on-the-spot relief. It works in a different way to your reliever and can help improve your asthma over the long term. If you do feel well and you've been taking your preventer inhaler as prescribed it's a good clue that your medicine is working and will continue to work if you keep taking it.

  4. Discuss it at your annual asthma review. As your symptoms improve, your GP or asthma nurse might suggest you take fewer daily puffs or move you to a lower strength inhaler. Usually if your asthma has been well controlled for three months, and you haven’t had to use your blue reliever inhaler, your GP or asthma nurse may look into stepping down your medicines. A regular asthma review gives you the chance to look at what medicines you need for your asthma and discuss with your GP or asthma nurse if you can lower the dose.

How does a preventer inhaler work alongside a reliever inhaler? 

If you’re prescribed a preventer inhaler, it doesn’t mean you should to stop carrying your reliever inhaler (usually blue) wherever you go. Although they have different jobs, a reliever and preventer are designed to work alongside each other to help reduce your risk of asthma symptoms, and asthma attacks. 

  • A preventer inhaler prevents inflammation and sensitivity in your airways over time. This means if you take your preventer inhaler every day as prescribed, you’re less likely to react to triggers and get asthma symptoms such as breathlessness. A good routine of taking your preventer inhaler can help cut your risk of an asthma attack.
  • A short-acting reliever inhaler (usually blue) relieves symptoms when they come on. It acts quickly when you have an asthma attack. Everyone who has asthma should have a reliever inhaler and have it with them at all times

If you find that you need to take your reliever inhaler three times a week or more while taking a preventer inhaler it may be a sign that your asthma’s not well managed and you should book an appointment with your GP or asthma nurse to have your treatment reviewed. 

What are the possible side effects of preventer inhalers?

Most of us have some concerns about possible side effects from the medicines we take. But recent research has shown that the chance of side effects from taking a low dose of inhaled preventer medicine is very small.  It's worth remembering that the preventer dose will be kept as low as possible to protect you or your child against the inflammation that causes asthma symptoms. Using it every day, as prescribed, means you’re less likely to need your reliever inhaler or a prescription of oral steroid tablets which will mean higher doses of steroids.  Some of the more common side effects are:

  • a sore throat
  • a hoarse voice
  • a mouth infection called thrush

You can avoid these side effects by making sure your medicine gets straight to your lungs and doesn't stay in your mouth and throat, or get absorbed into the rest of the body. You can do this by:

  • using a spacer with your MDI inhaler.
  • finding out if your medicine is available to take in a Breath Actuated inhaler which can reduce side effects without the need of a spacer
  • using good inhaler technique (you can ask your GP or asthma nurse to check your inhaler technique at your asthma reviews)
  • rinsing your mouth out and brushing your teeth after using your inhaler 

If you’re worried about your child taking asthma medicines, we answer all your common concerns.  

Other possible side effects

It is possible that using high doses of inhaled steroids over a long period of time may cause some other side effects For example, some studies show that people over the age of 49 who have used inhaled steroids for some time at quite high doses have a very slight risk of developing cataracts.

In most cases any risk can be reduced by always using the lowest possible dose of medicine to control the condition.  This is why it’s so important to go for an asthma review at least once a year to make sure you’re taking the right medicines for you. Your GP or asthma nurse will always try to keep you on the lowest dose possible to control your symptoms.

Your child will always have their height and weight checked at their asthma review. This is because there's a small link between the long-term use of inhaled steroids and slightly reduced growth.

With the added protection of a preventer medicine you're less likely to need to use your reliever inhaler or to have an asthma attack needing higher dose oral steroid tablets to get your asthma back in control.

Weighing up the benefits

Whatever medicines we're taking, it's often helpful to weigh up the risks versus the benefits. Asthma attacks kill three people every day in the UK. Almost half of these could have been prevented with better routine care, such as taking a regular low dose preventer inhaler every day. The risk of side effects from taking your asthma preventer inhaler as prescribed is much smaller than the risk of a potentially life-threatening asthma attack. 

We don't always feel comfortable taking medicine when we feel well; it makes more sense to us to take it when we've got symptoms. But a preventer inhaler is only effective if it is taken as prescribed and discussed with your GP or asthma nurse, even when you're feeling well. You could be symptom-free if you stick to your preventer medicine routine.

Last updated January 2018

Next review due August 2019