Quick Relief Inhalers
Today I would like to discuss quick-relief inhalers.
Asthma patients, even if on a good combination of medications, need quick-relief medicines to help them breathe better when they wheeze. There are many medicines in this class, 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. Others are concerned that they may become psychologically dependent on their inhalers. I will address these important concerns about ‘getting used to’ quick-relief asthma medicines in this entry.
Technically, ‘getting used to’ medicine has two parts which do NOT apply to all medicines: tolerance and dependence. Tolerance occurs if the same dose of a medicine does not lead to the same effect. For example, to get the same benefit from medicine ‘X’, a patient needs to take twice as much each time. This can happen in patients taking a class of medicine called nitrates for cardiac angina. Dependence occurs if a patient is taking a medicine and feels poorly (even worse than before they started taking the medicine) if they don’t take it. For example, people can become dependent on over-the-counter nose decongestant sprays (e.g. oxymetalozine, neosynephrine). This is why the directions on these products say not to use them for more than 3 days.
For quick-relief asthma medicines that are used as instructed, tolerance and dependence do NOT develop. As a rule, these medicines are prescribed to be taken as needed, and not on a scheduled basis. Some patients may ask themselves (as I did once, in fact), "if I take my albuterol 4 times a day regularly, can’t I prevent wheezing?" This question has been studied in large clinical studies, and this strategy turns out not to work. Quick-relief (and all asthma medications) should be taken as directed by your doctor. If you are needing to use your quick-relief medication more than 4 times a day, contact your doctor to let him/her know that your asthma is not well controlled - your medication regimen may need to be adjusted.
The issue of psychological dependence is more complicated, as it depends more on a particular individual’s asthma severity and personality. In general, patients are not psychologically dependent on their quick-relief inhaler, but may be anxious or concerned about starting to wheeze and not having their inhaler available. As stress can be a trigger for wheeze, the stress of ‘not having my inhaler with me’ can itself lead to chest tightness. Anyone with asthma should always have their medicines readily available, whether they are for relief of acute wheeze or for optimal long term control.
Most importantly, no one with asthma should ever be afraid of taking their inhaler when they are wheezing because they are worried that they will become dependent.
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Frederic Little is an Assistant Professor in the Department of Medicine at Boston University. He attends on the Allergy Consultation Service as well as the Medical Intensive Care Unit and Pulmonary Consultation Service at Boston Medical Center. He wrote for HealthCentral as a health professional for Asthma and Allergy.