Respiratory Health

Key takeaways

• Respiratory medicines split into relievers (fast-acting, for sudden symptoms), controllers (daily, for inflammation), and a separate group of antifibrotics for lung scarring.
• Salbutamol is the standard quick reliever; inhaled corticosteroids like fluticasone and budesonide are the standard daily controllers for asthma and COPD.
• Salmeterol and formoterol are long-acting bronchodilators (LABAs) that must never be used alone in asthma: without an inhaled corticosteroid, LABAs raise the risk of severe asthma attacks, which is why combination inhalers pair the two.
• Nintedanib and pirfenidone are a separate class of antifibrotics for pulmonary fibrosis (lung scarring), not asthma or COPD relievers.

How respiratory medicines work

Reliever inhalers relax airway muscle within minutes, opening the airways during an attack of wheezing or breathlessness. Controllers, mainly inhaled corticosteroids, reduce airway inflammation over days to weeks so attacks happen less often. Antifibrotics work differently, slowing the scarring process in pulmonary fibrosis instead.

Choosing between salbutamol, salmeterol/formoterol, inhaled corticosteroids, tiotropium/ipratropium, montelukast, theophylline and the IPF antifibrotics

• Salbutamol (and levosalbutamol, a related form): the standard quick-relief inhaler, working within minutes for sudden wheeze or tightness. Needing it more than a few times a week signals your daily controller needs review.
• Salmeterol and Formoterol: long-acting bronchodilators (LABAs) that keep airways open for around 12 hours. In asthma, neither is ever prescribed alone: both come combined with an inhaled corticosteroid in the same inhaler, because LABA-only treatment in asthma raises the risk of serious, sometimes fatal, attacks. In COPD, they are sometimes used without a steroid.
• Fluticasone, Budesonide, Beclomethasone and Mometasone: inhaled corticosteroids, the main daily controllers for asthma and some COPD. Use them every day, not just during symptoms; rinsing your mouth after each dose helps prevent oral thrush and a hoarse voice.
• Tiotropium and Ipratropium: anticholinergic inhalers that relax airway muscle through a different pathway. Tiotropium is long-acting for daily COPD control; ipratropium is shorter-acting and used more for acute relief.
• Montelukast: a once-daily tablet that blocks inflammatory chemicals called leukotrienes. It is an add-on controller, not a reliever, and has been linked to mood changes, nightmares or agitation in some people.
• Theophylline: an older tablet that widens airways, with a narrow gap between an effective dose and a toxic one, so blood levels are checked periodically.
• Nintedanib and Pirfenidone: antifibrotics for idiopathic pulmonary fibrosis, a distinct lung-scarring disease. They slow the scarring; they do not relieve asthma or COPD symptoms and are not bronchodilators.

Roflumilast is a tablet added to inhalers in some COPD cases to reduce flare-ups. Guaifenesin, bromhexine and menthol loosen or ease mucus but do not open airways. Terbutaline is another quick-acting reliever like salbutamol.

Common questions

Why can't I use my long-acting inhaler on its own?

If salmeterol or formoterol is your only asthma inhaler, that is unsafe: LABA medicines used without an inhaled corticosteroid raise the risk of severe asthma attacks. Combination inhalers solve this by putting both medicines in one device.

Do pulmonary fibrosis medicines treat asthma too?

No. Nintedanib and pirfenidone treat pulmonary fibrosis, a lung-scarring disease unrelated to asthma or COPD, and have no role as bronchodilators or anti-inflammatories for either.

Safety essentials

• Never use salmeterol or formoterol as your only asthma treatment; both need to be paired with an inhaled corticosteroid.
• Using a reliever inhaler more than two or three times a week is a sign your asthma or COPD is not controlled and needs medical review.
• Theophylline blood levels need periodic monitoring because the effective dose sits close to the toxic one.
• Seek urgent care for breathlessness that does not ease with your reliever inhaler, a blue tinge to lips or fingers, or difficulty speaking in full sentences.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.