Are inhalers addictive? Common myths about inhalers

The inhaler is the most important medicine in asthma and a major part of COPD treatment. Even so, many people are afraid of it, use too little or quietly set it aside. Most of these fears come from hearsay, and some are not entirely baseless, only incomplete. Here we go through a few common beliefs. This article does not replace your own doctor’s advice and does not give doses or schedules.

“Inhalers are addictive”

Short answer: a steroid inhaler is not addictive.

In an official guide NHLBI says inhaled steroids are the most effective long-term control medicine for asthma, are generally safe when used long term as prescribed, are not addictive, and are different from the illegal anabolic steroids athletes use to build muscle.

The steroid in an inhaler and the steroids athletes use are both called “steroids”, but NHLBI states plainly that they are not the same. The NHS says a steroid controller inhaler is a “preventer” and reduces swelling in the lungs.

About the reliever inhaler: sometimes a person feels they cannot manage without it. The NHS says there is no evidence that years of using salbutamol cause lasting harm to the body. If you need it more and more, your asthma is not under control and the plan should be reviewed with your doctor. The CDC says the same. The NHS says needing a reliever more than a few times a day, several days a week or at night may be a sign that things are getting worse.

“It’s a steroid and it’s harmful”

Short answer: an inhaled steroid is not the same as a steroid tablet.

The NHS says an inhaler delivers the medicine directly to the lungs and a smaller amount reaches the rest of the body. So, used correctly, “lasting side effects are unlikely”. The more common problem is local, such as a hoarse voice or thrush in the mouth. The ATS says using a spacer lowers the risk of these, and the NHS, NHLBI and ATS say to rinse your mouth after a steroid inhaler.

The NHS says a problem with the adrenal gland or weaker bones is a risk in adults who take a high amount of the medicine for a long time, but it is rare (“only 1 in 10,000 people”). The doctor can keep the amount appropriate and, if needed, give a bone-strengthening medicine. In children and teenagers who take a high amount, the NHS says height and weight should be monitored. If you are worried about your child’s growth, talk to the doctor and do not stop the medicine yourself.

Steroid tablets are a different story. The NHS says higher amounts or long-term use can have more side effects, and the doctor must manage them. Never reduce or stop them on your own, because stopping suddenly has side effects.

“I feel better, so I don’t need it”

Short answer: feeling better is usually the result of the inhaler.

About a steroid controller inhaler, the NHS says it must be used every day, “even if you have no symptoms”, because it “does not work straight away”. Its full effect can take a few weeks. The NHS says not to stop it without talking to your doctor or nurse, because symptoms may come back. The ALA also says you should take controller medicine regularly, even when you have no symptoms, for it to work.

If you think you no longer need it or you have a side effect, say so. The decision to reduce or stop a medicine is for your doctor.

“I only use the inhaler when I can’t breathe”

Short answer: only a reliever inhaler can be used when you have symptoms. A controller must be used regularly.

Two inhalers, two jobs. NHLBI says a reliever medicine eases symptoms for a time but does not treat the underlying inflammation. The NHS says a blue reliever (such as salbutamol) should not be given on its own to a person with asthma. If you use only a reliever and no controller, the inflammation carries on. Ask your doctor or pharmacist about the difference, because some patients have a combination inhaler that is used both daily and when symptoms appear (NHS).

“I used the inhaler, so the medicine got there”

Short answer: not always.

The ATS says that even with the best technique only about a quarter of the medicine may reach the lungs, and many people get less than 15 percent. The biggest mistake is not breathing in at the same time as the puff. A spacer reduces this problem and the ATS recommends it for most people. The NHS also says that if the technique is wrong very little medicine reaches the lungs, and reminds us to ask your doctor, nurse or pharmacist to watch whenever you are unsure or a year has passed since your technique was last checked. Sometimes “the inhaler isn’t working” really means “the inhaler isn’t getting there properly”. The correct technique is explained in the guide “Asthma and COPD inhalers”.

“Inhalers are only for weak or sick people”

On its asthma page, WHO speaks of the need for awareness to reduce myths and stigma about asthma. WHO says inhalers can control the condition and help a person live a normal, active life. Untreated asthma can also lead to disturbed sleep, daytime tiredness and poor concentration. Using an inhaler is a sign of looking after yourself.

“If I get better, should I put all my medicines aside?”

No, and this applies neither to antibiotics nor to steroids:

• Controller inhaler: do not stop it without your doctor’s advice.
• Steroid tablets: do not reduce or stop them on your own.
• Antibiotics: start or stop them only on a doctor’s advice. The NHS says that if a doctor prescribes them, the course should be finished.

If you are worried

Worry about the side effects of a medicine is natural and nothing to be ashamed of. Share these with your doctor or pharmacist:

• What are you afraid of (addiction, a child’s growth, your mouth)?
• How do you use the inhaler? If needed, show them.
• How often do you need a reliever? Keep a note.
• Do you have a written plan? (The ALA describes it as a written sheet that sets out your medicines and what to do.)

If your breathing suddenly gets worse, your reliever does not work or your lips turn blue, see the guide “When to call urgently” and call 115 (Iran’s emergency number).