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When people with asthma receive their medication for the first time they are sometimes confused about their asthma pumps. Why are there two? How do you use them? “The doctor said something about a controller and a reliever… which is which?” In order to understand asthma medication and how it works, it helps to understand where the medication works and what it does.

The breathing tubes (or airways) in the lung have a membrane lining the inside of them. This membrane becomes inflamed in asthma sufferers, causing the airway to narrow and fill with mucous.

Anti-inflammatory medication is used to control the airway inflammation. This medication can be given as a pump and is referred to as controller medication. The delivery device (or pump) is often brown or reddish in colour and should be taken every single day without fail even when the person is well. It will not have much effect once there is severe inflammation in the airway for example when a person is having an asthma ‘attack’ or exacerbation. It is there to keep the inflammation consistently under control every day to prevent an exacerbation.

The reliever medication does not work on the mucous membrane lining the airway. Instead it works on the tiny smooth muscles that are found in the walls of the airways. When the airways become inflamed these muscles contract causing narrowing of the airways and difficulty breathing. The ‘reliever pump’ (which is often blue, or white and blue in colour) is helpful in providing immediate relief from acute bronchospasm by relaxing these tiny smooth muscles, and should be used on an as-needed basis only for a ‘tight chest’.

Advanced use and combination therapy

Two puffs of a reliever pump prior to exercise may be helpful for people who suffer from exercise-induced asthma. In an asthma exacerbation multiple doses of a reliever pump can be used with a spacer to ‘open the chest’. This can be as effective as a home nebuliser. If a patient’s condition does not improve following treatment with a bronchodilator they should seek urgent medical attention, preferably at a unit where they can receive inhaled oxygen.

Sometimes controller medications and reliever medications are mixed together in the same pump. This type of ‘combination medication’ is used on a daily basis to prevent exacerbations and to provide daily relief from bronchospasm.

Author: Dr. S. Emanuel

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