Asthma affects over 300 million people worldwide. Inhaled medications are the cornerstone of treatment because they deliver drugs directly to the airways, maximizing local effect while minimizing systemic side effects. Yet studies consistently show that 70–90% of patients use their inhalers incorrectly, dramatically reducing drug delivery to the lungs.

Short-acting beta-2 agonists (SABAs) like salbutamol (albuterol) are the primary rescue medications. They relax airway smooth muscle within minutes, providing quick relief from acute symptoms — wheezing, chest tightness, shortness of breath. They should be used on an as-needed basis; needing a reliever more than twice a week suggests inadequate asthma control and the need for a controller inhaler.

Inhaled corticosteroids (ICS) — fluticasone, budesonide, beclomethasone — are the most effective controller medications. They reduce airway inflammation and hyperresponsiveness, preventing symptoms and exacerbations. They must be used daily, even when feeling well. It takes 1–3 weeks for full anti-inflammatory effect. Long-acting beta-2 agonists (LABAs) like salmeterol and formoterol are combined with ICS in moderate-to-severe asthma but should never be used alone (increased risk of severe asthma events).

Fluticasone/salmeterol, budesonide/formoterol, and fluticasone/vilanterol combine an ICS with a LABA in one device. Budesonide/formoterol has a unique advantage: it can be used both as maintenance therapy and as a reliever (MART regimen), simplifying treatment and reducing exacerbation risk.

Not shaking the MDI before use. Failing to exhale fully before inhalation. Actuating the inhaler before starting to inhale (poor coordination). Breathing in too fast (should be slow and steady, 3–5 seconds). Not holding breath for 10 seconds after inhalation. Not using a spacer with MDIs. Not rinsing the mouth after ICS use (risk of oral thrush and hoarseness).

Montelukast (a leukotriene receptor antagonist) is an oral add-on therapy, particularly useful in exercise-induced asthma and concurrent allergic rhinitis. Tiotropium (a long-acting muscarinic antagonist) can be added in severe asthma not controlled by ICS/LABA. Biologic therapies (omalizumab, mepolizumab, dupilumab) target specific inflammatory pathways in severe eosinophilic or allergic asthma.

Call emergency services if your reliever inhaler provides no relief within 15 minutes, if you can't speak in full sentences, if your lips or fingertips turn blue, or if your peak flow reading falls below 50% of your best. An asthma action plan — created with your doctor — helps you recognize when your asthma is worsening and what steps to take.