Asthma: which inhaler does what
Most poorly controlled asthma comes down to two fixable things — using the preventer only when unwell, and poor inhaler technique.
Reliever and preventer are not interchangeable
Almost everything about managing asthma follows from understanding that inhalers do two completely different jobs.
A reliever such as salbutamol (inhaler) (Ventolin) opens tightened airways within minutes. You feel it work. It treats the attack and does nothing about the underlying inflammation that caused it.
A preventer such as beclometasone (Beclate) is a low-dose inhaled steroid that reduces that inflammation. You feel nothing when you take it, and that is the problem — it is taken every day, whether or not you have symptoms, and it is the medicine that actually keeps you out of hospital.
Technique matters as much as the medicine
A large share of people using a metered-dose inhaler get little of the dose into their lungs. The medicine ends up in the mouth and throat instead. This is the single most common reason asthma looks treatment-resistant when it is not.
- Shake the inhaler and take the cap off.
- Breathe out gently, away from the inhaler, emptying your lungs comfortably.
- Seal your lips around the mouthpiece.
- Start to breathe in slowly, and press the canister once as you begin breathing in — the timing is what people get wrong.
- Keep breathing in slowly and deeply.
- Hold your breath for about ten seconds, or as long as is comfortable, then breathe out gently.
- Wait about 30 seconds before a second puff if one is prescribed.
Knowing when an attack is serious
Between attacks, ask your clinic for a written action plan setting out your daily medicines, what to do when symptoms worsen, and the point at which you seek help. Having it written down while you are well is the point.
Triggers worth knowing about here
- Smoke — cigarettes, and indoor fires or paraffin stoves used for cooking and heating.
- Cold, dry air, and the sharp temperature swings of a Highveld winter morning.
- Dust mite, mould, cockroach allergen and pets.
- Grass pollen in season, and windy days that carry it.
- Colds and flu, which are the most common trigger of a serious attack.
- Anti-inflammatory painkillers, in a minority of people — mention your asthma when buying them.
Common questions
- Are inhaled steroids dangerous long term?
- Inhaled preventer doses are very small and act mainly in the airways, which is quite different from steroid tablets. The risks of leaving asthma inflammation untreated are substantially greater than the risks of a daily preventer.
- Can I stop the preventer once I feel well?
- Feeling well while taking a preventer is the preventer working. Stopping allows inflammation to build back over days to weeks, often with no warning until an attack. Any step down should be planned with a clinician.
- Why did I get thrush from my inhaler?
- Inhaled steroid settling in the mouth is the cause. Rinsing and spitting after each dose, and using a spacer, largely prevents it. Tell your clinician if it keeps happening — technique or device may need changing.
Sources
- Adult Hospital Level and Primary Healthcare Standard Treatment Guidelines and EMLNational Department of Health, South Africa
- Guideline for the management of chronic asthma in adults and adolescentsSouth African Thoracic Society
Last reviewed 4 August 2026.