Quick-relief inhalers II: Prescription medications

Readers of this site have asked several important questions about the use of quick relief medications - both over-the-counter (OTC) and prescription. This entry follows the previous entry on OTC quick relief medications to address this question: When is the right time (and how often) to use prescription quick relief inhalers?

Using quick relief (rescue) inhalers: regularly or as needed

Some patients with asthma feel the need to use their rescue inhaler several times a day in addition to their scheduled long-term controller medications. Many wonder whether it might be better to use rescue inhalers on a schedule -- to ‘prevent' wheezing from starting and ‘nip it in the bud.'

To many patients and scientists, this makes so much sense that National Institutes of Health-funded researchers decided to study this issue directly. Patients with asthma needing rescue medication were split into two groups -- one used their rescue inhaler only as needed and the other on a schedule throughout the day.

Both groups were followed over months, and their degree of asthma control and quality of life were assessed. Somewhat unexpectedly, the group that used scheduled rescue inhalers had no better asthma control nor quality of life. In addition, the as-needed group used significantly less rescue inhaler over the course of the study.

The conclusion of the study was that patients with asthma should use their rescue inhalers only as needed. This conclusion also addresses the concern by many doctors taking care of asthma patients that overuse of quick-relief inhalers can be detrimental to asthma control, especially if patients with more severe asthma should have their long-term controller medications adjusted.

Being ‘addicted' to quick-relief inhalers

There are many rescue inhalers, with albuterol being the most common. Many people are concerned that if they use their quick-relief inhaler frequently, it will not work as well. ‘Getting used to' medications can be related to the medication not working as well if it used often or developing a psychological dependence -- ‘I get worried if I don't have my rescue inhaler on me at all times.'

It is quite clear from long-term studies on quick-relief inhalers for asthma that patients do not develop tolerance to the beneficial effects of their rescue inhalers. This means that the relief from taking your inhaler for the first time in days is typically the same as if you took it twice earlier in the day.

However, if someone with asthma needs to use their rescue inhaler more than 3 to 4 times in a day, his or her asthma is under poorer control, so that the relief may be less -- not because the medication isn't working as well, but because an asthma exacerbation may be brewing.

The issue of psychological dependence is more complicated; this depends more on a particular individual's asthma severity and personality. Understandably, individuals with asthma may be concerned or anxious about not having their inhaler available in case they start wheezing. The stress of ‘not having my inhaler with me' can itself lead to asthma symptoms such as wheeze. To minimize this, asthmatics should have their medicines (especially their quick relief inhaler) around at all times. This sometimes means keeping a main and ‘backup' inhaler handy.