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This page is about what the drugs in an inhaler do — which ones open the airways, which ones settle inflammation, how fast each works and how long it lasts. It does not cover how to use the devices; each device has its own step-by-step guide in Puffers & Inhalers.
Inhaled medicines are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease (COPD) because they deliver the drug straight to the airways at low dose, with fewer whole-body side effects than tablets.1,2 They divide into relievers — short-acting bronchodilators taken for symptoms — and preventers or maintenance therapies, which are taken regularly whether or not the patient feels unwell: long-acting bronchodilators (long-acting beta-2 agonists, LABA, and long-acting muscarinic antagonists, LAMA) and inhaled corticosteroids (ICS), alone or combined. The distinction matters clinically because a patient who treats a preventer as something to take “when bad” is undertreated, and one who relies on a reliever alone is at risk.
Inhaled drug classes
| Class | Action & duration | Examples | Typical use | Notes for physiotherapy |
|---|---|---|---|---|
| SABA (short-acting beta-2 agonist) | Bronchodilator — rapid onset, 4–6 h duration | Salbutamol (Ventolin, Asmol), terbutaline (Bricanyl) | Reliever for acute symptoms; pre-exercise prophylaxis | Over-reliance on SABA without ICS is a marker of poor asthma control |
| SAMA (short-acting muscarinic antagonist) | Bronchodilator — onset 15 min, duration 4–6 h | Ipratropium (Atrovent) | COPD acute exacerbation | Primarily acute care role |
| LABA (long-acting beta-2 agonist) | Bronchodilator — 12 or 24 h duration | Salmeterol (Serevent); formoterol (component of Symbicort, DuoResp); indacaterol, olodaterol, vilanterol (24 h) | Maintenance therapy | LABA monotherapy in asthma is contraindicated — must be combined with ICS |
| LAMA (long-acting muscarinic antagonist) | Bronchodilator — 24 h duration | Tiotropium (Spiriva), umeclidinium (Incruse), glycopyrronium (Seebri), aclidinium (Bretaris) | Maintenance in COPD; add-on in severe asthma | Dry mouth most common. Caution in narrow-angle glaucoma |
| ICS (inhaled corticosteroid) | Anti-inflammatory — controller therapy | Beclomethasone (QVAR), budesonide (Pulmicort), fluticasone propionate (Flixotide), fluticasone furoate, ciclesonide (Alvesco), mometasone | Daily controller therapy. Rinse mouth after use | Oral candidiasis and dysphonia common — rinse and spit |
| ICS/LABA combinations | Combined controller + bronchodilator | Symbicort; Seretide; Breo, Relvar; DuoResp Spiromax | Maintenance and (Symbicort/DuoResp only) MART regimens | MART regimens use Symbicort/DuoResp as both daily maintenance and as-needed reliever |
| LAMA/LABA combinations | Dual bronchodilation | Anoro (umeclidinium/vilanterol); Ultibro (glycopyrronium/indacaterol); Spiolto (tiotropium/olodaterol) | COPD maintenance | Dual bronchodilation preferred over ICS/LABA in COPD without elevated eosinophils |
| Triple therapy (ICS/LABA/LAMA) | Combined controller + dual bronchodilation | Trelegy Ellipta; Trimbow; Breztri | COPD with continuing exacerbations; severe asthma uncontrolled on ICS/LABA | Single-inhaler triple therapy improves adherence |
Under GOLD 2026, a single moderate exacerbation — one requiring antibiotics and/or oral corticosteroids — is enough to prompt escalation of inhaled therapy, replacing the earlier threshold of two or more events (or one hospitalisation).2 These are guidelines, not rules — a clinician should still apply clinical judgement to the individual patient.
Inhaler technique assessment and correction at every patient contact is one of the highest-value interventions in respiratory physiotherapy. Patients in acute exacerbation often cannot generate adequate flow through a DPI and should be switched temporarily to pMDI-with-spacer or nebuliser.3
Order of inhaled therapy in patients on multiple agents — standard sequence: (1) SABA ± SAMA → wait 5 minutes → (2) airway clearance → (3) hypertonic saline or mannitol if prescribed → (4) inhaled antibiotic if prescribed → (5) ICS and other maintenance inhalers. Dornase alfa (CF only) typically 30 minutes before airway clearance.4
References & evidence base
- Global Initiative for Asthma. Global strategy for asthma management and prevention: 2026 update. GINA; 2026. Available at: ginasthma.org
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of COPD: 2026 report. GOLD; 2026. Available at: goldcopd.org
- Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev 2012;64(3):450–504.
- Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2026.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use. For drug-specific detail, including full product information, consult MedsInfo.
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