Combination inhalers

Find out how combination inhalers can be helpful for people taking long-acting bronchodilators as an add-on treatment, what the medicines in a combination inhaler do, and why you still need your blue reliever inhaler.

What is a combination inhaler?

An asthma combination inhaler combines two kinds of medicine in one device: a corticosteroid preventer and a long-acting bronchodilator.

  • The preventer medicine keeps down inflammation in your airways.
  • The long-acting bronchodilator medicine gives ongoing relief from symptoms such as breathlessness and a tight chest.

Combination inhalers come as either aerosol or dry powder inhalers. Some examples of combination inhalers are Seretide, Symbicort and Fostair. There are combination inhalers suitable for children too.

You need to take your combination inhaler every day as prescribed, even when you’re feeling well.

You still need your usual blue reliever inhaler

Use your blue reliever inhaler if you get symptoms

Most combination inhalers do not give quick relief if symptoms get worse or you have an asthma attack.

Always have your fast-acting blue reliever inhaler with you to deal quickly with symptoms.

Most combination inhalers cannot help if your symptoms get worse or you have an asthma attack.

Even though they contain a bronchodilator (which opens the airways), it’s a long-acting type.

You need the fast-acting bronchodilator in your usual blue reliever inhaler to deal with symptoms quickly.

The only type of combination inhaler that can be used as a fast-acting reliever inhaler is a MART (Maintenance and Reliever Therapy) inhaler used as part of a specific maintenance and reliever therapy treatment plan.

Always use an up-to-date asthma action plan

Your asthma action plan tells you the medicines you need for your asthma and when you should take them. It also tells you what medicines to take if you have an asthma attack.

Always ask your GP or asthma nurse if you’re not sure what your medicines are for or when you should take them.

Who might benefit from a combination inhaler?

A long-acting bronchodilator (LABA) is one of the first add on treatments your GP or nurse is likely to consider if your asthma is not well controlled with a preventer inhaler alone.

A LABA must be taken alongside your usual inhaled corticosteroid preventer, to lower your risk of asthma attacks and hospitalisations. That’s why it’s safer to have a combination inhaler which contains both medicines in one inhaler.

Anyone prescribed a long-acting bronchodilator to take alongside their usual preventer inhaler can benefit from a combination inhaler:

  • Instead of having two separate medicines to take every day, a combination inhaler combines your two medicines in just one inhaler. This works well if you’re someone who finds keeping up with two separate inhalers difficult, and you’re still having asthma symptoms.
  • Combination inhalers can help some people manage their asthma better, because it’s easier to stick to their asthma medicine routine.
  • It's a safer way to make sure you’re taking your inhaled corticosteroid preventer medicine.

Whenever your GP gives you a new medicine for your asthma you should get another appointment four to eight weeks later, either in the surgery or over the phone, to check it's working well for you.

If you and your GP or asthma nurse cannot see any real improvements, you may be able to try a different treatment.

When will I start to see an improvement?

If you're taking your combination inhaler as prescribed, and using the right inhaler technique, you should start to see improvements quickly.

You might notice:

  • you don’t need your blue reliever inhaler as much
  • you’re less wheezy and breathless
  • you’re coughing less during the day and at night
  • you’re sleeping better - this is because the long-acting bronchodilator in your combined inhaler lasts for 12 hours which means you should see an improvement in night-time symptoms.

The preventer part of your combination inhaler builds up protection over time. You should notice things starting to improve after a few days.

And after a few weeks, once your preventer medicine has cut down the inflammation in your airways, you'll really start to get the full benefit of taking it regularly.

For example, you probably won't react as badly to your asthma triggers, you may sleep better, or find you can do things like climb stairs without asthma symptoms.

Are there any side effects?

As long as you’re taking your combination inhaler as prescribed and using the best technique, the risk of side effects is low.

Side effects might include a sore tongue, hoarse voice and/or a mouth infection called oral thrush.

Talk to your GP or asthma nurse if you notice any side effects so they can help you manage these and still get the benefits of your asthma medicine.

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