Respiratory Medicines and Inhalers

Respiratory medicines are commonly used in primary care to help manage symptoms such as wheeze, breathlessness, cough, and chest tightness. They may be used for conditions such as asthma, chronic obstructive pulmonary disease (COPD), and other long-term lung problems.

Many respiratory medicines are delivered by inhaler. Inhalers work best when the diagnosis is clear, the correct inhaler type is chosen, and technique is reviewed. Treatment plans are individual and may change over time depending on symptoms, triggers, and response.

This page explains the main types of respiratory medicines used in general practice, what they are used for, and what follow-up is usually needed.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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Why inhaler treatment matters

Breathing symptoms can have different causes, including asthma, COPD, infections, anxiety, and heart problems. Inhalers can be very effective when used for the right condition, but they are not always the correct treatment for every cough or breathing symptom.

In primary care, inhaler treatment is usually guided by:

symptom pattern and triggers
history of wheeze or breathlessness
smoking history and occupational exposures
response to treatment
tests such as peak flow or spirometry where needed

Main Types of Respiratory Medicines

Reliever inhalers

Reliever inhalers open the airways quickly and are used for sudden symptoms such as wheeze, chest tightness, or breathlessness. They are designed for short-term symptom relief.

Common examples include salbutamol.

Needing a reliever frequently can be a sign that overall control is not optimal and treatment should be reviewed.

Preventer inhalers

Preventer inhalers reduce airway inflammation and help prevent symptoms and flare-ups. They are usually taken regularly, even when you feel well.

Most preventers contain inhaled corticosteroids.

Common examples include beclometasone, budesonide, and fluticasone.

Preventers are often a key part of long-term asthma control. For many people, improving preventer use reduces the need for reliever inhalers.

Combination inhalers

Combination inhalers include two medicines in one device, usually:

an inhaled corticosteroid to reduce inflammation
a long-acting bronchodilator to keep airways open for longer

Common long-acting bronchodilator components include formoterol or salmeterol, depending on the inhaler.

Combination inhalers are often used when symptoms are not controlled on a preventer alone or when flare-up risk is higher.

Long-acting bronchodilators and COPD inhalers

Some inhalers are used mainly in COPD and other long-term airway conditions to improve breathlessness and reduce flare-ups.

These may include long-acting bronchodilators, including medicines from different classes.

A common example includes tiotropium.

In primary care, COPD inhaler choice is guided by symptoms, flare-up history, inhaler technique, and tolerance.

Steroid tablets and acute flare management

Oral steroids may be used for significant flare-ups of asthma or COPD when symptoms are severe or not improving with usual inhalers.

Short courses can be effective but are prescribed carefully due to side effects and infection considerations.

You can read more in: Steroids explained

Antibiotics and respiratory symptoms

Not all coughs or chest symptoms need antibiotics. Many respiratory infections are viral and settle with time. Antibiotics may be considered when there is concern about bacterial infection, complications, or higher risk.

You can read more in:

Inhaler Technique and Spacers

Correct technique is as important as the medication itself. Poor technique is a common reason inhalers do not work as expected.

A spacer device can improve delivery for certain inhalers and can reduce local side effects for steroid inhalers.

In general practice, inhaler technique is often reviewed during medication reviews or if symptoms are not controlled.

Monitoring and Long-Term Review

Respiratory medicines usually require periodic review to ensure treatment remains effective and safe. This may include:

review of symptom control and flare-ups
reliever use frequency
inhaler technique review
peak flow or spirometry where appropriate
side effect review

You can read more in:

Common Side Effects

Most people tolerate inhalers well. Potential issues include:

hoarse voice or throat irritation with steroid inhalers
oral thrush if steroid inhalers are used without good technique
tremor or palpitations with reliever inhalers
dry mouth with some COPD inhalers

Side effects can often be reduced by adjusting technique, using a spacer, and reviewing the treatment plan.

Common Inhaler Terms Explained

Understanding common inhaler terminology can make treatment clearer.

Metered Dose Inhaler (MDI)

An MDI is a pressurised inhaler that delivers a measured spray of medication. It requires coordination between pressing the device and breathing in slowly. A spacer device can improve delivery and reduce side effects.

Dry Powder Inhaler (DPI)

A DPI delivers medication as a dry powder. It is breath-activated and requires a strong, deep inhalation to work effectively. Technique is important to ensure adequate dose delivery.

Spacer

A spacer is a plastic chamber that attaches to certain inhalers, usually MDIs. It helps more medication reach the lungs and reduces deposition in the mouth and throat. Spacers are particularly helpful with steroid inhalers.

Maintenance and Reliever Therapy (MART)

Some combination inhalers are used both as a daily preventer and as a reliever when symptoms occur. This approach simplifies treatment but should only be used under medical guidance.

Inhaler Technique Review

Even small errors in technique can reduce medication effectiveness. Regular review of inhaler use is an important part of respiratory care.

Respiratory Medicines in Remote GP Care

Many respiratory medication reviews can be done remotely, particularly when symptoms are stable and home readings are available.

However, if symptoms are new, severe, or worsening, examination and oxygen saturation checks may be needed. If remote assessment is not appropriate, this will be explained and the safest next step advised.

Frequently Asked Questions

1. What is the difference between a reliever and a preventer inhaler?

A reliever inhaler is used for quick symptom relief. A preventer inhaler is taken regularly to reduce airway inflammation and prevent symptoms and flare-ups. Many people need both as part of a long-term plan.

2. Why does my inhaler not seem to work?

Common reasons include incorrect technique, using the wrong type of inhaler for the underlying condition, or needing a review of the treatment plan. A GP can review symptoms, technique, and whether further assessment is needed.

3. Can I stop my preventer inhaler when I feel well?

Preventer inhalers are usually intended for regular use to maintain control and reduce flare-up risk. Changes to inhaler treatment should be discussed with a clinician, as stopping abruptly can increase symptoms or risk of exacerbation.

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When to contact a GP

You should consider contacting a GP if:

you are using a reliever inhaler more frequently than usual
symptoms are not controlled despite preventer use
you have repeated flare-ups or worsening breathlessness
you develop side effects or are unsure about inhaler technique
you are unsure whether review is due

If you have severe breathlessness, blue lips, confusion, chest pain, or you are struggling to speak in full sentences, seek urgent or emergency care immediately.