The distinction between the controller and reliever inhaler is the most important thing I explain to every family of a child with asthma, because the confusion between the two is the single most common cause of poor asthma control. A reliever inhaler, typically a short-acting bronchodilator like salbutamol, relaxes the muscle around the airways within minutes of use. It provides fast relief of symptoms but it does not treat the underlying airway inflammation - the inflammation that makes the airways prone to narrowing remains completely unchanged. A controller inhaler, typically containing inhaled corticosteroid, works by reducing airway inflammation over time when taken daily even when the child has no symptoms. It has no immediate effect - the child will not feel any different thirty minutes after using it - but with consistent daily use over two to three weeks it reduces the frequency and severity of symptoms, reduces reliever use, and reduces the risk of serious asthma attacks. The pattern I see most often in poorly controlled asthma is a child who uses the reliever every other day, rarely uses the controller, and whose family concludes the controller 'doesn't work' because it provides no immediate relief. If your child needs their reliever inhaler more than twice a week, their asthma is not well controlled and the controller treatment needs review.
Written by Dr. Abinaya, MBBS, MD Pediatrics, Consultant Paediatrician, Allergy and Asthma Specialist, Tamil Nadu (also serving patients in Andhra Pradesh). Phone: +91 7373097759.
