Combination inhalers

A combination inhaler contains two or more medicines in one inhaler. This could be a dry powder inhaler (DPI) or a pressurised metered dose inhaler (pMDI). A few combination inhalers are soft mist inhalers.

Your doctor or nurse may prescribe a combination inhaler to help you:

• reduce your COPD symptoms and lower your risk of flare ups
• lower your risk of asthma symptoms and asthma attacks.

Some people find using a combination inhaler helps them manage their lung condition better, because it’s easier to remember taking one inhaler.

If you’re taking your combination inhaler as prescribed and using the right inhaler technique, your symptoms should start to improve after a few days.

You should notice:

• you do not need to use your reliever, or extra puffs of your MART inhaler, as often
• you’re less wheezy and breathless
• you’re able to breathe more easily
• you’re coughing less during the day and night

Ask your GP, nurse or other healthcare professional about combination inhalers for asthma and COPD, and if they think you could benefit from using one. 

Dr Andy Whittamore, Asthma + Lung UK’s GP.

There are different types of combination inhalers with different medicines in them.

Some are suitable for asthma. Others are suitable for COPD, or COPD with asthma-like symptoms.

ICS/LABA combination inhalers

An ICS/LABA combination inhaler contains an inhaled corticosteroid, and a long-acting bronchodilator (LABA).

The steroid medicine helps prevent inflammation in your airways, and the LABA helps keep your airways open.

You may need a blue reliever inhaler too, to deal with asthma symptoms and attacks. This is because the LABA in your combination inhaler may not be able to open your airways quickly if you have symptoms or an asthma attack.

An ICS/LABA combination inhaler is mainly prescribed to people with asthma. But some people who have COPD with asthma-like symptoms may also be prescribed one. Find out more about treatments for COPD.

Some examples of ICS/LABA combinations are Fostair and Symbicort.

ICS/LABA inhalers used for MART and AIR for asthma

The type of ICS/LABA combination inhalers used for anti-inflammatory reliever (AIR) and MART inhaler (maintenance and reliever therapy) treatment plans can be used as your reliever inhaler too. This is because they contain a fast-acting LABA called formoterol.

Latest asthma guidelines recommend an AIR or MART ICS/LABA combination inhaler.

Using an AIR or MART inhaler treats the inflammation in your airways.   After a few weeks you should notice that you’re less sensitive to your usual asthma triggers, and you’re able to do more physical activity without symptoms.

Find out more about AIR and MART inhalers, and why your GP, nurse or other healthcare professional may suggest you change your treatment plan to help manage your asthma better.

LABA/LAMA combination inhalers

A LABA/LAMA combination inhaler contains two different types of long-acting bronchodilator, a long-acting beta-agonist (LABA) and a long-acting muscarinic receptor antagonist (LAMA)

A LABA/LAMA combination inhaler keeps your airways open for longer and makes it easier for you to breathe. 

You may be prescribed a LABA/LAMA alongside a fast-acting reliever inhaler to help with COPD symptoms.

• The LABA relaxes the muscles around your airways. This helps to keep your airways open.
• The LAMA stops the muscles of your airway tightening and reduces mucus in your airways.

Some examples of LABA/LAMA inhalers are Spiolto, Ultibro and Bevespi.

If you have asthma, or COPD with asthma-like symptoms, you’ll also need a steroid preventer inhaler (oral corticosteroid) to use alongside your LAMA/LABA combination inhaler and your reliever.

The steroid medicine is essential in keeping down inflammation in your airways and lowering your risk of asthma symptoms and attacks.

Always carry a reliever inhaler with you to treat symptoms and flare ups quickly.

ICS/LABA/LAMA triple combination inhalers

An ICS/LABA/LAMA combination inhaler, known as a triple inhaler, contains:

• an inhaled corticosteroid (ICS)
• a long-acting bronchodilator (LABA)
• a long-acting muscarinic receptor antagonist (LAMA).

Some people with asthma, or with COPD with asthma-like symptoms, may benefit from a combination inhaler which contains all three medicines in one inhaler.

The inhaled corticosteroid (ICS) alongside the two different bronchodilators can work together to lower your risk of asthma symptoms and attacks.

Before prescribing a triple combination inhaler, your healthcare professional will want to review all your symptoms and treatments, including how you take your inhalers.

Some examples of triple combination inhalers are Trimbow, Trelegy, and Trexeo.

You should also have a fast acting reliever inhaler (SABA) to treat symptoms and flare ups quickly.

If you’re not sure what kind of combination inhaler you have, ask your GP, nurse or pharmacist. It’s important to know what medicines are in your inhaler, when you use it, and if you need to use either a steroid preventer inhaler or a blue reliever inhaler alongside your combination inhaler. Write this in your asthma action plan or COPD self-management plan.

Dr Andy Whittamore, Asthma + Lung UK’s GP. 

All medicines have side effects, but not everyone gets them. You can get more information on side effects from the patient information leaflet that comes with your inhaler.

Side effects of combination inhalers can include:

• a change in your voice due to irritation in your throat
• a sore throat
• a mouth infection, called oral thrush.

You can lower your risk of these side effects by using the right inhaler technique, using a spacer if you have a pressurised metered dose inhaler (pMDI), and rinsing your mouth out after using your inhaler. 

Check your inhaler technique now by watching the how to use your inhaler videos.

Some people also notice palpitations, which can be a side effect of some types of LABA in your combination inhaler. 

Whenever you start any new medicine, your GP or nurse should check how you’re getting on with the medicine after 8 to 12 weeks. But you can talk to them before then if you’re worried about any side effects. They can check your inhaler technique, and talk about other inhaler types that could work better for you.  

Dr Andy Whittamore, Asthma + Lung UK’s GP.