The treatment for asthma, chronic obstructive pulmonary disorder (COPD) or allergies is not in the form of tablets but through a metered puff that directly enters the lungs on inhalation. The puffed medicines open the airways, relax the muscles that tighten the airways and help people breathe easier. The instruments that deliver these medicines are known as inhalers. However, these little L-shaped devices have been a subject of debate. Are they safe? This is the oft-asked question.
Dr K S Sathish, a senior pulmonologist from Bengaluru believes that asthma inhalers are one of the greatest discoveries of the last century. He says that they not only act fast but also are safe.
Inhalers vs oral medication
Oral medications get absorbed in the stomach, pass through the liver, circulate to the rest of the body through the bloodstream and then reach the organ where they are intended to act, says Dr Sathish. “But inhalers take the shortcut. They send medicines directly to the lungs and act faster,” he adds.
Dr V V Ramana Prasad, consulting pulmonologist at KIMS hospital Hyderabad poses a very logical question. “Why should medicines meant to treat a specific organ travel around the body to reach that organ?”
The safety factor
Dr Sathish clarifies the primary concern about inhalers and their steroid content. He says the dosage of oral steroids is in milligrams(mg). They enter the blood-brain barrier and cause multiple physical and psychological side effects. “Inhalers contain steroids in micrograms(mcg) and only 30 to 40 per cent reaches the lungs. They don’t enter the blood and cause any side effects,” he assures.
Dr Sathish adds that the inhalers are safe for pregnant women as the medicine doesn’t enter the baby’s blood through the mother’s placenta.
Types of inhalers
“There are three different kinds of inhalers prescribed, depending on the severity of the condition, the lung capacity and the ability of people to use them correctly,” says Dr Prasad.
- Metered dose inhaler (MDI) pushes a measured dose of medicine into the lungs after manual pressure.
- Dry powder inhaler (DPI) requires placing a capsule in a device. With manual pressure, this capsule is converted into powder form and released. An example of the DPI is the Rotahaler. The latest version of the DPI, the Turbohaler, releases a measured dose from the capsule automatically upon inhalation.
- A nebulizer uses air or oxygen to convert the medication into a mist form. It is delivered through a mask.
Dr Sathish says that based on the effect on the body, the inhalers can also be broadly categorised as:
- Short-acting bronchodilators or relievers – For immediate symptomatic relief.
- Controllers – For treating the root cause They control and cure the inflammation (swelling in the air passage) due to allergens. The dosage depends on the frequency and severity of the condition.
Ameera Modi, an 18-year-old design student from Ahmedabad was diagnosed with dust allergy and prescribed the use of DPIs to manage her blocked nose, persistent cough and breathlessness. This came after a month of suffering when antibiotics did not help her. Within two weeks of taking both the reliever and controller inhaler, she says she began to feel much better. Now she says she can enjoy the aroma of her mom’s cooked food again.
The side-effects
Although Dr Prasad confirms that inhalers have no systemic side effects, osteoporosis, cataract and elevated sugar levels can occur in rare cases.
Hence, he stresses following the prescribed dosage and correct technique.
He recalls treating a 56-year-old person who was required to use the ‘Rotahaler’ but was given only the capsules without the device by the pharmacist. The person started taking the capsules orally and experienced no relief in his symptoms or condition. During the follow-up visit, the doctor discovered that the man wasn’t using any device when asked to demonstrate how he was using the machine.
Similarly, he adds that MDI inhalers also should never be used without a spacer which is an attachment that makes the usage of the inhaler easier and more effective.
Dr Sathish explains that on inhalation, some percentage of medicine gets lodged in the mouth and throat before it enters the lungs. Therefore, it is necessary to gargle after usage to avoid fungal colonisation, throat irritation or hoarseness in the voice.
Dr Sathish insists that the dosage of nebulizers is in milligrams and they are meant only for people who cannot use MDIs and DPIs. These include small babies, the elderly, people with severe lung conditions, bedridden people and those with tremors or who are mentally incapable of using the device on their own.
Dr Prasad adds that a nebulizer is ideal in people whose larynx gets affected due to inhalation. “When the puff [from the inhaler] is released, it hits the larynx and causes coughing. If the cough is persistent then a change of device is in order,” he says.
