Asthma and COPD (chronic obstructive pulmonary disease) both narrow the airways and can cause coughing, wheezing and shortness of breath, but they are different diseases. Asthma often starts in childhood, flares with triggers, and the narrowing usually opens up again with treatment. COPD mostly develops after age 40, usually after years of smoking, and causes lung damage that cannot be reversed.

Knowing which one you have matters, because the right daily inhaler is different for each. Here is how doctors tell them apart and how treatment differs.

Asthma vs COPD at a glance

What causes asthma, and what causes COPD?

In asthma, the airways become inflamed, swollen and extra sensitive. Nobody knows the exact cause, but genes and environment both play a part. According to MedlinePlus, the risk is higher with a family history of asthma, allergies, frequent viral respiratory infections in early childhood, secondhand smoke in early life and obesity. Common triggers include pollen, dust mites, mold, pets, cold air, colds, exercise and tobacco smoke.

COPD is an umbrella term for emphysema, where the tiny air sacs are damaged, and chronic bronchitis, where the airways stay inflamed and full of mucus. The NHS explains that smoking is the main cause, and the risk rises the more and the longer you smoke. Long-term exposure to dust or fumes at work can also cause it, as can a rare inherited condition called alpha-1 antitrypsin deficiency.

At what age do asthma and COPD usually start?

Asthma can begin at any age, but it often starts in childhood. COPD usually appears after age 40 and mainly affects middle-aged and older adults who smoke or used to smoke. Doctors see symptoms that began before age 20 as a pointer toward asthma, and symptoms that began after 40 as a pointer toward COPD. Age alone does not settle it, though: a 55-year-old former smoker with new wheezing could have either condition, or both.

How are the symptoms different?

Both conditions can cause cough, wheeze, chest tightness and breathlessness. The pattern usually gives the clue:

• Timing: asthma symptoms tend to come and go, are often worse at night or early in the morning, and may disappear for weeks. COPD symptoms are there most days and creep up slowly over the years, with breathlessness that builds during activity such as climbing stairs.
• Triggers: asthma flares are often clearly linked to allergens, exercise, cold air or a cold. COPD flare-ups are commonly set off by chest infections.
• Cough and mucus: a daily cough that brings up phlegm, often brushed off as a “smoker’s cough,” is typical of COPD.

Is asthma reversible? Is COPD?

This is the key difference. In asthma, the airways narrow because the muscles around them tighten and the lining swells. With the right treatment they usually open up again, and many people breathe close to normally between flare-ups. Years of poorly controlled asthma, however, can leave some narrowing that no longer fully opens.

In COPD, the damage to the airways and air sacs is permanent. COPD cannot be cured or reversed, but treatment can ease symptoms and slow it down, which is why an early diagnosis matters.

How does spirometry tell asthma and COPD apart?

Spirometry is the main breathing test for both conditions. You take a deep breath and blow out as hard and fast as you can into a tube connected to a machine. It measures how much air you blow out in the first second (FEV1) and the total amount (FVC). The test is then repeated after you inhale a reliever such as albuterol (salbutamol).

• Asthma: readings often improve clearly after the reliever. A rise in FEV1 of at least 12% and 200 mL is the usual yardstick, and results may even be normal on a good day. Doctors may add home peak flow readings, a breath test for airway inflammation or allergy tests.
• COPD: the ratio of FEV1 to FVC stays low even after the reliever (below 0.70 is the usual cutoff). Readings may improve a little but do not return to normal.

Doctors combine the results with your symptoms and smoking history, because one test does not always give a clear answer.

What is asthma-COPD overlap?

Some people have features of both, such as someone who had asthma as a child and then smoked for many years. Doctors call this asthma-COPD overlap. A review in the National Library of Medicine notes that it is not a single disease and has no agreed definition, but people with overlap tend to have more frequent and severe flare-ups and a higher risk of hospital stays than people with either condition alone.

Treatment generally follows asthma rules first: guidelines advise that an inhaled steroid should be part of the plan and that long-acting bronchodilators should not be used without one. The review’s authors see a triple inhaler, which combines a steroid with two long-acting bronchodilators, as a suitable option.

How are asthma and COPD treated?

Both conditions use inhalers, but in different ways. The main groups are:

• Relievers (rescue inhalers): short-acting bronchodilators such as albuterol open the airways within minutes and are used in both conditions. In COPD, ipratropium is another short-acting option.
• Inhaled corticosteroids (ICS): budesonide, fluticasone and beclomethasone (beclometasone) calm airway inflammation and are the foundation of asthma treatment. In COPD, they are usually added only for people who keep having flare-ups, partly because they can raise the risk of pneumonia.
• Long-acting beta-agonists (LABA): salmeterol and formoterol keep the airways open for about 12 hours. In asthma they must always be paired with an inhaled steroid: the US label for salmeterol says using it for asthma without one is contraindicated because it raises the risk of asthma-related death. In COPD, the same medicine is approved on its own for twice-daily maintenance.
• Long-acting muscarinic antagonists (LAMA): tiotropium, glycopyrrolate (glycopyrronium) and umeclidinium are a mainstay of COPD treatment. In asthma, a LAMA is an add-on for some people whose symptoms stay uncontrolled on a steroid and a LABA. Our Tiova vs Spiriva guide explains how tiotropium is used.

Many people use combination inhalers. Budesonide/formoterol, for instance, is used for both asthma and COPD; Foracort Inhaler contains the same two active ingredients as Symbicort and is made and licensed in India. Our guide to asthma inhaler types explains how relievers and preventers fit together, and you can browse our asthma medicines and COPD medicines. Your doctor should choose the medicine, strength and device for you.

People with COPD also often benefit from pulmonary rehabilitation, a supervised program of exercise and breathing education.

Why does quitting smoking matter for both?

For anyone with COPD who smokes, stopping is the single most important step. It slows the loss of lung function, and it is worth doing at any age and any stage of the disease.

For asthma, tobacco smoke is a common trigger, and smoking makes asthma harder to control. Nicotine replacement, prescription stop-smoking medicines such as varenicline or bupropion, and counseling all raise your chances of quitting. In the US, the free quitline at 1-800-QUIT-NOW can connect you with support in your state.

When to see a doctor

Book an appointment if you have a cough that will not go away, regular wheezing, breathlessness during everyday activities or frequent chest infections, especially if you are over 35 and smoke or used to. If you already have asthma or COPD, see your doctor if you need your reliever more often than usual or symptoms wake you at night.

Call 911 or go to the emergency room if:

• You are too breathless to speak in full sentences, eat or sleep.
• Your reliever is not helping, or you need it every few minutes.
• Your lips or fingernails look gray or blue.
• You feel confused, very drowsy or have chest pain.

With COPD, contact your doctor the same day if you become more breathless than usual, cough up more phlegm or phlegm that changes color, or develop a fever.

Frequently asked questions

Can asthma turn into COPD?

Asthma does not simply turn into COPD. However, long-standing asthma, especially if poorly controlled or combined with smoking, can leave narrowing that no longer fully reverses, and some people end up with features of both conditions.

Is COPD worse than asthma?

COPD causes permanent damage that tends to get worse over time, while asthma can usually be well controlled. Even so, a severe asthma attack can be life-threatening, so both conditions need regular treatment and follow-up.

Can the same inhaler treat both asthma and COPD?

Some combination inhalers, such as budesonide/formoterol and fluticasone/salmeterol, are used for both. The strength, dose and way they are used can differ, so follow the plan your doctor gives you for your diagnosis.

Can you get COPD if you never smoked?

Yes, although it is less common. Long-term exposure to dust or fumes at work and the inherited condition alpha-1 antitrypsin deficiency can also cause COPD.

This article gives general information only and is not medical advice. Asthma and COPD need a proper diagnosis from a doctor, and prescription medicines should be used under a doctor’s care.

If you have been prescribed a steroid course in the US, it was probably prednisone. In the UK, India and much of the world, doctors usually prescribe prednisolone instead. The names differ by only two letters, and the medicines are closely related. In fact, one turns into the other inside your body. Here is what that means for dosing, when one is preferred over the other, and how to take a steroid course safely.

Prednisolone vs prednisone at a glance

One medicine, two forms

Prednisone has no steroid activity of its own. After you swallow it, enzymes in the liver convert it to prednisolone, which does the work. For people with healthy livers, this conversion is quick and efficient, so prednisone and prednisolone are considered equivalent milligram for milligram: 5 mg of one does the same job as 5 mg of the other. Indian brands such as Omnacortil and Wysolone are prednisolone tablets.

Prednisolone is often chosen when the liver may not convert prednisone reliably, as in severe liver disease, and as a liquid for children because it is available in better-tasting formulations.

Steroid dose equivalents

Doctors use equivalence tables when switching between corticosteroids. These approximate anti-inflammatory equivalents are widely used:

That is why Medrol 4 mg tablets come in that slightly odd strength. Equivalence covers anti-inflammatory effect only; the steroids differ in how long they last and how much salt and water they retain, so switching should always be done by a doctor.

What these steroids are used for

Oral steroids calm inflammation and an overactive immune system quickly. Common reasons for a course include:

• Asthma or COPD flare-ups that do not settle with inhalers
• Severe allergic reactions, hives or hay fever that has not responded to other treatment
• Autoimmune and inflammatory conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease and polymyalgia rheumatica
• Some skin conditions, kidney diseases and blood disorders

For an asthma flare in adults, a typical course is 40 to 50 mg once a day for 5 to 7 days. Children usually receive a dose based on their weight, for a shorter time. Other conditions use very different doses and durations, so always follow your own prescription.

How to take a steroid course

• Take it in the morning, with food. Morning dosing matches the body’s natural cortisol rhythm and causes less sleeplessness.
• Swallow tablets with breakfast to reduce indigestion. Some doctors add a stomach-protecting medicine for longer courses.
• Do not stop suddenly after long use. Courses of more than about three weeks, or frequent repeated courses, suppress the body’s own cortisol production. The dose must then be tapered down gradually. Short courses for a flare can usually be stopped at the end, but follow your doctor’s instructions.
• If you are on long-term steroids, carry a steroid card or wear a medical ID, because extra steroid may be needed during surgery, injury or serious illness.

Side effects

A short course is usually well tolerated. You may notice a bigger appetite, trouble sleeping, mood changes (from feeling energetic to irritable or low), indigestion and higher blood sugar, which matters if you have diabetes. These settle after the course ends.

Long-term use carries more serious risks, which is why doctors aim for the lowest dose for the shortest time: weight gain and a rounded face, thinning bones (osteoporosis), high blood pressure, diabetes, cataracts and glaucoma, thin skin and easy bruising, muscle weakness and a higher risk of infections. People on long-term treatment may need bone protection, eye checks and blood sugar monitoring.

Seek urgent help for black or bloody stools, severe stomach pain, signs of serious infection, sudden vision changes, or severe mood changes including thoughts of self-harm.

Precautions and interactions

• Infections: steroids weaken immune defenses. If you have not had chickenpox or measles, avoid people with these infections and see a doctor promptly after any exposure.
• Vaccines: live vaccines should be avoided during high-dose treatment.
• NSAIDs such as ibuprofen, naproxen and aspirin increase the risk of stomach ulcers and bleeding.
• Diabetes medicines may need adjusting, and warfarin needs closer INR checks.
• Tell your doctor about stomach ulcers, heart failure, high blood pressure, glaucoma, osteoporosis, mental health conditions, tuberculosis or pregnancy.

Frequently asked questions

Is prednisolone stronger than prednisone?

No. At the same milligram dose they have the same effect in most people, because prednisone becomes prednisolone in the liver.

Can I switch from prednisone to prednisolone?

Doctors commonly switch milligram for milligram, for example 20 mg prednisone to 20 mg prednisolone. Confirm with your prescriber, especially if you have liver disease or are tapering.

Is a steroid tablet the same as an anabolic steroid?

No. Prednisolone and prednisone are corticosteroids that reduce inflammation. They are unrelated to the anabolic steroids misused for muscle building.

Can I drink alcohol on a steroid course?

Moderate amounts are usually acceptable on a short course, but alcohol adds to the stomach irritation steroids can cause. Ask your doctor if you are on a long course.

For asthma, inhaled steroids reduce how often oral courses are needed; see our asthma inhaler guide and the allergy range.

This article gives general information and does not replace advice from your doctor. Do not stop a long-term steroid suddenly without medical advice.

Tiotropium is the long-acting bronchodilator at the center of most COPD treatment plans. In the US it is best known as Spiriva, made by Boehringer Ingelheim. In India, Cipla sells it as Tiova, in both capsule and aerosol form. If you are living with COPD and paying for a once-daily inhaler month after month, the cost difference can be large, so it pays to understand how the products compare.

Tiova vs Spiriva at a glance

What tiotropium does

Tiotropium is a long-acting muscarinic antagonist, or LAMA. It blocks acetylcholine, the nerve signal that tightens the muscle around the airways, and its effect lasts a full 24 hours. Taken every day, it makes breathing easier, improves exercise tolerance and, importantly, reduces COPD flare-ups (exacerbations) and the hospital visits that come with them. Large long-term trials have confirmed these benefits.

It does not work fast enough to treat sudden breathlessness. Keep a quick-acting reliever such as albuterol for that, and read our inhaler types guide to see how relievers and maintenance inhalers differ.

Comparing the devices

Capsule inhalers. Tiova Rotacaps contain 18 mcg of tiotropium powder per capsule, the same labeled dose as a Spiriva HandiHaler capsule, and Tiotrop Rotacaps are another capsule option. You load one capsule into the device, pierce it and breathe the powder in. Use each capsule in the device it was designed for, and ask a pharmacist if you are unsure whether your inhaler device suits your capsules.

Spray inhalers. The Tiova Inhaler is a pressurized aerosol that gives 9 mcg per puff; the usual dose is 2 puffs once a day. Spiriva Respimat is a different “soft mist” device with a much smaller labeled dose (2 puffs of 2.5 mcg) because the mist reaches the lungs more efficiently. The numbers are not interchangeable, so never convert between devices on your own.

To see every tiotropium option we carry, with prices, visit our generic Spiriva page.

How to use a tiotropium capsule inhaler

1. Peel open one blister just before use and take out one capsule. Never swallow the capsule.
2. Place it in the chamber and close the device. Pierce or twist as the instructions describe.
3. Breathe out fully, away from the mouthpiece.
4. Seal your lips around the mouthpiece and breathe in deeply. You should hear or feel the capsule rattle as the powder is released.
5. Hold your breath for as long as is comfortable, up to 10 seconds.
6. Breathe in a second time from the same capsule to empty it, then throw it away.

Keep capsules in their blister until the moment you need them; humidity spoils the powder. Store them at room temperature, below 77°F (25°C), and never leave them in a hot car.

Side effects and precautions

Dry mouth is the most common side effect and usually mild. Others include constipation, sore throat, sinus congestion and, rarely, a fast heartbeat. Because tiotropium is an anticholinergic, it can also:

• Worsen urinary retention in men with an enlarged prostate. Report difficulty passing urine or a weak stream.
• Trigger narrow-angle glaucoma. Eye pain, blurred vision, halos around lights or red eyes need urgent attention. Avoid getting the powder or spray in your eyes.
• Build up in kidney disease. People with moderate to severe kidney impairment should be monitored.

Do not use tiotropium with other long-acting anticholinergic inhalers such as umeclidinium, aclidinium or glycopyrrolate, and check with your doctor before using ipratropium at the same time. Stop and get help if breathing gets worse straight after a dose or if you notice swelling of the lips, face or tongue. People with a milk-protein allergy should check the capsule ingredients, since dry-powder capsules often contain lactose.

Getting more from COPD treatment

Medicine is only part of COPD care. These steps make a measurable difference:

• Stop smoking. It is the single most effective way to slow COPD. Free help is available at 1-800-QUIT-NOW in the US.
• Stay up to date with vaccines: flu every year, pneumococcal, COVID-19 and, for older adults, RSV.
• Ask about pulmonary rehabilitation, a supervised exercise and education program that improves breathlessness and stamina.
• Have a written flare-up plan so you know when to start rescue medicines and when to call your doctor.

If tiotropium alone is not enough, doctors often add a long-acting beta-agonist. Duova Rotacaps combine tiotropium with formoterol in one capsule. Browse the full COPD range for other options.

Frequently asked questions

Is Tiova the same as Spiriva?

Both contain tiotropium bromide, and Tiova Rotacaps have the same 18 mcg capsule dose as the HandiHaler. The maker, the devices and the regulatory approval differ.

What time of day should I take tiotropium?

Any time, as long as it is the same time each day. Many people pair it with brushing their teeth in the morning.

Can tiotropium be used for asthma?

Spiriva Respimat is approved in the US as an add-on maintenance treatment for asthma from age 6. Capsule forms are used mainly for COPD. Ask your doctor which applies to you.

What if I miss a dose?

Take it as soon as you remember, but never take two doses in 24 hours.

This article gives general information and does not replace advice from your doctor. If you are too breathless to speak in full sentences, call 911.

Advair is one of the most prescribed controller inhalers in the US, and one of the most expensive. Outside the US, the same GSK product is sold as Seretide, and Cipla in India makes its own version called Seroflo. All three pair fluticasone propionate, an inhaled steroid, with salmeterol, a long-acting bronchodilator. This guide matches up their strengths and devices and explains the rules that keep this combination safe.

Advair, Seretide and Seroflo at a glance

Matching the strengths

The number in each product name refers to the fluticasone content, while the salmeterol dose stays fixed. That makes matching easier than it first looks:

• Dry powder: Advair Diskus 100/50, 250/50 and 500/50 mcg line up with Seretide Accuhaler and with Seroflo Rotacaps or Multihaler 100, 250 and 500, each delivering 50 mcg of salmeterol per inhalation. The dose is one inhalation twice a day.
• Aerosol: each puff of Seroflo Inhaler 50, 125 or 250 contains 25 mcg of salmeterol, like Seretide Evohaler. US Advair HFA labels the amount leaving the mouthpiece instead (45/21, 115/21 and 230/21 mcg), which corresponds to the same products. The dose is two puffs twice a day.

Two puffs of the aerosol and one inhalation of the powder give the same total salmeterol (50 mcg), which is why both devices are taken twice daily and never more often.

What each ingredient does

Fluticasone propionate is a potent inhaled steroid. Used every day, it lowers airway inflammation, cuts the number of asthma attacks and reduces COPD flare-ups. Salmeterol relaxes the airway muscles for about 12 hours. It takes longer to start working than albuterol or formoterol, roughly 10 to 20 minutes, so a fluticasone/salmeterol inhaler is never a rescue inhaler. Keep a fast-acting reliever such as albuterol for sudden symptoms; our Asthalin vs Ventolin guide compares two common options.

Generic Advair in the US

The FDA approved the first generic of Advair Diskus, Wixela Inhub, in 2019, and other generic and authorized generic versions have followed. They are still not cheap for everyone, especially without insurance. Seretide is GSK’s original made for other markets, while Seroflo is manufactured and licensed in India.

All of our fluticasone/salmeterol inhalers are compared with strengths and prices on our generic Advair page.

Which device should you choose?

Seroflo Inhaler is a pressurized aerosol that needs you to press and breathe in at the same moment. A spacer solves timing problems and puts more medicine into the lungs and less in the throat. It suits children, older adults and anyone with a weak breath.

Seroflo Rotacaps are single powder capsules used in a Rotahaler, and the Seroflo Multihaler is a pre-loaded powder device similar to the Diskus. Both are breath-activated, so they need a quick, deep inhalation but no coordination.

The Seretide Accuhaler is GSK’s own powder device, the non-US twin of Advair Diskus.

Dosing rules that matter

• Take it twice a day, about 12 hours apart, even when you feel well.
• Do not take extra doses for symptoms. More salmeterol does not work faster and increases side effects.
• Never use salmeterol, or any long-acting bronchodilator, for asthma without an inhaled steroid. In combination inhalers like these, the steroid is built in.
• Do not combine it with another long-acting bronchodilator such as formoterol, which is found in Foracort and Symbicort.
• For COPD, the US-approved Advair Diskus dose is 250/50 twice daily.
• Rinse your mouth with water and spit after each dose.

Side effects

Common effects include hoarseness, throat irritation, oral thrush, headache and, less often, tremor, palpitations or muscle cramps. People with COPD who use inhaled steroids have a higher risk of pneumonia, so report fever, chills, more mucus or worse breathlessness. High doses used for many years can affect bone density, the eyes (cataracts, glaucoma) and growth in children; your doctor will aim for the lowest dose that keeps you well.

Ritonavir and cobicistat, used in HIV treatment, can raise fluticasone levels enough to cause Cushing’s syndrome and adrenal suppression, a well-documented interaction. Ketoconazole and itraconazole have a similar effect. Tell your doctor about every medicine you take.

When asthma is not under control

If you still need your reliever more than twice a week, wake at night with symptoms or have had a flare needing steroid tablets, your treatment needs review. The answer may be better technique, a higher strength or a different combination. Bring your inhaler to appointments so the nurse can watch you use it. Browse the full asthma range to see other preventer options.

Frequently asked questions

Is Seretide the same as Advair?

Yes, in substance. Seretide is the name GSK uses outside the US for the same fluticasone/salmeterol product.

Can Seroflo replace Advair?

It contains the same ingredients in matching strengths, but it is a different manufacturer’s product. Agree the switch and the device with your doctor.

How soon will I feel better?

Breathing often improves in the first week, but the full preventive effect builds over several weeks of twice-daily use.

Can children use these inhalers?

Advair Diskus 100/50 is approved in the US from age 4. Children usually use the lowest strength, often with a spacer for aerosol inhalers.

This article gives general information and does not replace advice from your doctor. If your reliever is not helping or your lips or fingernails turn blue or gray, call 911.

Symbicort and Foracort are combination inhalers for asthma and COPD that contain the same two medicines: budesonide, an inhaled corticosteroid that calms airway inflammation, and formoterol, a long-acting bronchodilator that keeps the airways open. Symbicort is AstraZeneca’s brand. Foracort is made in India by Cipla. Brand-name Symbicort can cost several hundred dollars a month in the US without insurance, so many people look at alternatives. Here is how the two compare, and what to check with your doctor before switching.

Foracort vs Symbicort at a glance

Why the strengths look different

The numbers on the two labels are counted in different ways. US Symbicort states the amount delivered from the mouthpiece, while Foracort, like most products sold outside the US, states the amount metered by the valve or capsule. As a rough guide, Foracort 100/6 corresponds to Symbicort 80/4.5, and Foracort 200/6 to Symbicort 160/4.5. Foracort 400/6 has no direct US match; in the US, a higher budesonide dose is usually reached by taking two puffs of the 160/4.5 inhaler.

These are close equivalents, not proof that two different devices deliver identical doses to your lungs. Ask your doctor to confirm the strength and number of puffs if you change from one product to the other.

How the two medicines work together

Budesonide reduces the swelling and mucus that make airways twitchy, which prevents attacks over time. It is not felt immediately; the benefit builds over one to two weeks of regular use. Formoterol relaxes the muscle around the airways for about 12 hours and, unlike salmeterol, starts working within a few minutes. That fast start is what allows budesonide/formoterol to be used in a special way called SMART.

SMART: one inhaler as preventer and reliever

With single maintenance and reliever therapy (SMART, sometimes called MART), you take budesonide/formoterol every day and also use extra puffs of the same inhaler when symptoms flare, instead of a separate albuterol inhaler. Each reliever puff then delivers a little more steroid exactly when inflammation is rising. International GINA guidelines and the 2020 US asthma guideline update support this approach for many people with moderate to severe asthma, including children from age 4 in the US guidance.

In the US, using Symbicort as a reliever is off-label, and the approach only works with a written plan from your doctor that sets the daily dose and a maximum number of puffs per day (12 inhalations of 4.5 mcg formoterol for adults and teens in the US guideline). Never start reliever use on your own. If you are not on a SMART plan, keep your albuterol reliever with you; see our guide to asthma inhaler types for how relievers and preventers fit together.

Is there a generic Symbicort in the US?

Yes. The FDA approved the first generic, Breyna, in 2022, and authorized generic versions are also sold. Prices still vary widely by pharmacy and insurance plan. Foracort is made and licensed under Indian regulations.

For every budesonide/formoterol option we carry, with strengths and prices side by side, see our generic Symbicort page.

Choosing a Foracort device

• Foracort Inhaler (100, 200 or 400): a pressurized aerosol like the US Symbicort. Use it with a spacer if your timing is not perfect.
• Foracort Rotacaps: powder capsules loaded into a Rotahaler device. No hand-breath coordination needed, but you must be able to inhale quickly and deeply.
• Foracort Respules: single-dose vials for a nebulizer, mainly for young children and people who cannot use an inhaler.

If you prefer AstraZeneca’s original product, the Symbicort Turbuhaler is the dry-powder version sold outside the US.

How to use a budesonide/formoterol aerosol inhaler

1. Shake the inhaler and remove the cap. Prime a new inhaler, or one unused for a week, by spraying into the air as the leaflet directs.
2. Breathe out fully, away from the mouthpiece.
3. Close your lips around the mouthpiece, press the canister as you begin a slow, deep breath in.
4. Hold your breath for about 10 seconds, then breathe out slowly.
5. Wait 30 seconds before a second puff.
6. Rinse your mouth with water and spit it out after every dose to reduce the risk of thrush and a hoarse voice.

Side effects and precautions

The most common side effects are hoarseness, sore throat, oral thrush (white patches in the mouth), headache, tremor and a fast heartbeat. Mouth rinsing prevents most throat problems. With long-term high doses of inhaled steroid, doctors watch for thinning bones, cataracts, glaucoma, slower growth in children and, in people with COPD, a higher risk of pneumonia.

• Tell your doctor about heart rhythm problems, high blood pressure, an overactive thyroid, diabetes or low potassium, which formoterol can affect.
• Strong CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole and itraconazole can raise budesonide levels enough to cause steroid side effects throughout the body.
• Beta-blockers, including some eye drops, can block formoterol and worsen breathing.
• Do not use another long-acting bronchodilator (such as salmeterol) at the same time.

Seek urgent care if breathing gets worse right after a dose, or if your usual reliever dose stops helping.

Frequently asked questions

Is Foracort the same as Symbicort?

It contains the same two active ingredients, but it comes from a different maker, in different devices and strengths.

Which Foracort strength matches Symbicort 160/4.5?

Foracort 200/6 is the closest match. Confirm the dose and number of puffs with your doctor before switching.

Can I use Foracort for COPD?

Budesonide/formoterol is widely used as maintenance treatment for COPD. It is not meant to replace a rescue inhaler unless your doctor has given you a plan that says so.

How long does an inhaler last?

A 120-puff inhaler lasts 30 days at 2 puffs twice a day. Count your doses if the inhaler has no counter, and store it below 86°F (30°C).

This article gives general information and does not replace advice from your doctor or asthma nurse. Do not stop or change a preventer inhaler without medical advice.

Asthalin and Ventolin are blue reliever inhalers that contain the same medicine, albuterol (also called salbutamol), at the same dose of 100 micrograms per puff. Ventolin is made by GSK and is one of the most widely used inhalers in the world; Asthalin is made by Cipla in India. If you are wondering whether one can replace the other, this guide explains what is the same, what differs, and how to get the most from whichever you use.

Asthalin vs Ventolin at a glance

In India, GSK sells its albuterol inhaler as Ventorlin Inhaler 100 mcg, which we stock alongside the Asthalin Inhaler.

How albuterol works

Albuterol is a short-acting beta-2 agonist (SABA). It relaxes the muscle bands around the airways, opening them within a few minutes and easing wheeze, chest tightness and breathlessness for around 4–6 hours. It is a reliever: it treats symptoms when they happen but does nothing for the underlying inflammation of asthma. That is the job of a preventer inhaler. Our guide to types of asthma inhalers explains the difference.

What is the same and what is different?

The dose and the effect

Both deliver 100 mcg of albuterol per actuation from an HFA-propelled canister, so one or two puffs of either should have the same effect. Switching between them does not normally require a change in how many puffs you take.

Licensing

Ventolin is licensed by regulators including the MHRA, EMA and FDA. Asthalin is licensed in India but not in the US, UK or EU, so it has not been assessed by those regulators.

Look and feel

The canisters, mouthpieces and spray feel slightly different, and not every inhaler has a dose counter. If yours has no counter, keep a note of how many puffs you have used so you are never caught with an empty inhaler.

Price

Indian brands such as Asthalin and Ventorlin usually cost much less than Ventolin bought in the US or UK without insurance.

Every albuterol option we carry, from Asthalin and Ventorlin inhalers to Rotacaps, respules and tablets, is compared on our albuterol inhalers page.

How to use an albuterol inhaler properly

1. Remove the cap and shake the inhaler well.
2. If it is new or has not been used for several days, spray one or two puffs into the air first.
3. Breathe out gently, away from the mouthpiece.
4. Seal your lips around the mouthpiece, start breathing in slowly and press the canister once.
5. Keep breathing in deeply, then hold your breath for up to 10 seconds.
6. Wait about 30 seconds before a second puff.

A spacer makes a big difference, especially for children and during an attack, because it removes the need to co-ordinate pressing and breathing. Wash the plastic actuator weekly and let it air-dry.

How much and how often

The usual adult dose is 1–2 puffs when needed, up to four times a day, or 2 puffs 15 minutes before exercise if exercise triggers symptoms. Follow the plan your doctor or nurse gives you.

If you need your reliever three or more times a week, or it wakes you at night, your asthma is not well controlled and you should see your doctor about a preventer. If your reliever does not help, or you need it every few hours, get urgent medical help.

Side effects

Albuterol can cause a fine tremor in the hands, a fast or pounding heartbeat, headache and muscle cramps. These usually fade within an hour. At high doses it can lower potassium levels. Tell your doctor if you have heart disease, an overactive thyroid or diabetes, and avoid non-selective beta-blockers such as propranolol, which can block its effect.

Keeping your reliever ready

A reliever only helps if it works when you need it. Carry it with you at all times, and keep a spare at home or work if you use it often. Store it below 86°F (30°C) and out of direct sunlight; very cold canisters can give a weaker puff, so warm one in your hand for a minute in winter. Never puncture or burn an empty canister.

Check the expiry date every few months and replace the inhaler before it runs out. If you have an asthma action plan, keep it next to your inhaler so family members know what to do in an attack. Ask your nurse to check your inhaler technique at every review, as small mistakes in timing can halve the dose that reaches your lungs.

Is there an alternative?

Levalbuterol (also called levosalbutamol) contains only the active half of the albuterol molecule. Levolin Inhaler is Cipla’s version. It works in a very similar way; some people notice slightly less tremor, though the evidence for a real difference is limited. Albuterol is also available as Asthalin Rotacaps for those who prefer a dry-powder device. Browse the full asthma range for other options.

Frequently asked questions

Can I use Asthalin instead of Ventolin?

Both contain 100 mcg of albuterol per puff, so they are generally interchangeable. Tell your doctor or asthma nurse if you switch, and check your technique with the new device.

How long does a 200-dose inhaler last?

It depends on use. If a reliever runs out within a month or two, your asthma probably needs a review.

Is Asthalin a steroid?

No. Albuterol is a bronchodilator. Preventers such as budesonide and fluticasone are the steroid inhalers.

Can children use these inhalers?

Yes, with a spacer and at the dose prescribed for their age.

This article gives general information and does not replace advice from your doctor or asthma nurse. If breathing is getting worse or your reliever is not helping, seek emergency care.

Sneezing, a runny or blocked nose, and itchy, watery eyes are the classic signs of allergic rhinitis, better known as hay fever when it’s triggered by pollen. Antihistamine tablets are often the first thing people reach for. But for persistent or moderate-to-severe symptoms, doctors usually recommend a steroid nasal spray as the most effective treatment. This guide explains how nasal sprays for allergies work, the different types available, and how to use them correctly.

What Is Allergic Rhinitis?

Allergic rhinitis happens when the immune system overreacts to harmless particles in the air and releases histamine and other chemicals that inflame the lining of the nose. It comes in two main forms:

• Seasonal: triggered by tree, grass or weed pollen at certain times of year.
• Perennial: year-round symptoms caused by dust mites, pet dander, mold or cockroaches.

Allergic rhinitis is closely linked to asthma. Treating nasal symptoms properly can also help improve asthma control.

How Steroid Nasal Sprays Work

Steroid (corticosteroid) nasal sprays reduce inflammation inside the nose. This eases all the main symptoms: congestion, sneezing, itching and runny nose. Because the medicine works locally in a very small dose, very little is absorbed into the rest of the body.

Common steroid nasal sprays include:

• Fluticasone propionate: for example Flomist Nasal Spray and Flixonase Nasal Spray
• Fluticasone furoate: for example Furamist Nasal Spray
• Budesonide, mometasone and beclomethasone (beclometasone) sprays

Combination Nasal Sprays

Some sprays combine a steroid with an antihistamine such as azelastine. The antihistamine starts working within minutes, while the steroid provides longer-lasting control. This makes combination sprays useful for people whose symptoms aren’t controlled by a steroid spray alone. Furamist AZ Nasal Spray is one such option.

How Long Do Steroid Nasal Sprays Take to Work?

Many people start to notice some improvement within 12 hours, but the full effect can take several days to two weeks of regular use. For best results:

• Use it every day, not just when symptoms flare.
• If you have seasonal allergies, start 1–2 weeks before your usual pollen season begins.
• Don’t give up after a day or two. Consistency is what makes it work.

How to Use a Nasal Spray Correctly

Good technique improves results and reduces side effects like nosebleeds.

1. Gently blow your nose to clear it.
2. Shake the bottle. If it is new or hasn’t been used for a while, prime it by spraying into the air until a fine mist appears.
3. Tilt your head slightly forward, looking at your toes rather than the ceiling.
4. Close one nostril and insert the nozzle just inside the other.
5. Aim the nozzle slightly outwards, towards the outer wall of the nostril and away from the center (septum). A simple trick: use your right hand for your left nostril and vice versa.
6. Spray while breathing in gently through the nose. Don’t sniff hard, or the medicine ends up in your throat.
7. Repeat on the other side, then wipe the nozzle clean.

Possible Side Effects

Steroid nasal sprays are well tolerated by most people. Possible side effects include:

• Nasal dryness, irritation or stinging
• Minor nosebleeds (often reduced by aiming away from the septum)
• Unpleasant taste or smell
• Headache

Unlike decongestant sprays, steroid nasal sprays are not habit-forming and can be used long term under medical advice.

Steroid Sprays vs Decongestant Sprays

Decongestant sprays such as oxymetazoline or xylometazoline unblock the nose within minutes. However, they should be used for no more than 3 days. Longer use can cause “rebound congestion” (rhinitis medicamentosa), where the nose becomes more blocked each time the spray wears off. They don’t treat the underlying allergic inflammation, so they are not a long-term solution.

Other Allergy Treatments

• Non-drowsy antihistamine tablets (such as cetirizine, levocetirizine, loratadine or fexofenadine) help with sneezing, itching and watery eyes.
• Montelukast (for example Montair 10 mg) may be prescribed, especially for people who have both allergies and asthma. Rarely, it can cause mood or sleep changes, so it is usually reserved for when other treatments aren’t suitable.
• Saline nasal rinses help wash allergens and mucus out of the nose.
• Reducing exposure: keep windows closed on high-pollen days, shower after being outdoors, wash bedding hot weekly, and use dust-mite-proof covers.

When to See a Doctor

See a doctor if your symptoms don’t improve after 2–4 weeks of regular treatment, affect your sleep or daily life, or come with wheezing or breathlessness. Also get checked if you have frequent nosebleeds, facial pain, or symptoms on only one side of the nose, as these may point to something other than allergies.

Frequently Asked Questions

Can I use a steroid nasal spray every day?

Yes. Steroid nasal sprays are designed for regular daily use and are generally safe for long-term use under medical guidance.

Which is better for allergies: a nasal spray or tablets?

For blocked nose and persistent symptoms, steroid nasal sprays are generally more effective than antihistamine tablets. Many people use both during peak season.

Why does my nasal spray run down my throat?

This usually happens when you tilt your head back or sniff too hard. Keep your head tilted slightly forward and breathe in gently.

Browse our full range of allergy treatments. If you also have asthma, read our guide to the different types of asthma inhalers.

This article is for general information only and is not a substitute for professional medical advice. Speak to a doctor or pharmacist before starting any new medicine, especially if you are pregnant, breastfeeding or taking other medicines.

If you have asthma, chances are you have more than one inhaler, and it isn’t always obvious which one to use and when. Relievers, preventers, combination inhalers, rotacaps, accuhalers: the terminology can be confusing. Getting it right matters, because using the correct inhaler with the correct technique is one of the biggest factors in keeping asthma under control. This guide explains the main types of asthma inhalers, how each one works, and how to use them properly.

Why Asthma Needs Different Types of Inhalers

Asthma involves two problems happening in the airways:

1. Inflammation: the airway lining becomes swollen and sensitive, reacting to triggers such as dust, pollen, smoke, cold air or exercise.
2. Bronchospasm: the muscles around the airways tighten, narrowing them and causing wheezing, coughing and breathlessness.

Different inhalers target different parts of this process. That is why many people need both a quick-relief inhaler and a daily controller.

1. Reliever Inhalers (Blue Inhalers)

Reliever inhalers contain a short-acting bronchodilator, most commonly albuterol (also called salbutamol), or levalbuterol (levosalbutamol). They relax the tightened airway muscles within minutes, and their effect lasts around 4–6 hours.

Relievers are used when symptoms appear, or before exercise if your doctor recommends it. Examples include Asthalin Inhaler (albuterol) and Levolin Inhaler (levalbuterol).

Important: relievers treat symptoms but not the underlying inflammation. If you need your reliever more than two or three times a week, your asthma is probably not well controlled. Speak to your doctor about a preventer.

2. Preventer Inhalers (Inhaled Corticosteroids)

Preventer inhalers contain a low-dose inhaled corticosteroid (ICS), such as budesonide, fluticasone or beclomethasone (beclometasone). They reduce inflammation in the airways over time, making them less sensitive to triggers and lowering the risk of asthma attacks.

Key things to know about preventers:

• They must be used every day, even when you feel well.
• They don’t give instant relief. The full benefit builds over days to weeks.
• Rinse your mouth and spit after each use to reduce the risk of oral thrush and hoarseness.
• Inhaled steroid doses are far lower than steroid tablets, and are considered safe for long-term use under medical supervision.

An example is Budecort Inhaler (budesonide).

3. Combination Inhalers (Preventer + Long-Acting Reliever)

Combination inhalers pair an inhaled corticosteroid with a long-acting bronchodilator (LABA), such as salmeterol or formoterol. The LABA keeps airways open for around 12 hours, while the steroid controls inflammation. They are prescribed when a preventer alone isn’t enough, and for many people with COPD.

Popular combination inhalers include:

• Seroflo Inhaler: salmeterol + fluticasone in a metered-dose inhaler
• Seretide Accuhaler: salmeterol + fluticasone in a dry-powder device
• Foracort Inhaler: formoterol + budesonide

A long-acting bronchodilator should never be used on its own for asthma without an inhaled steroid. Salmeterol-based inhalers are also not meant for rescuing a sudden attack, so keep your reliever with you.

Tablets Used Alongside Inhalers

Some people also benefit from tablets added to their inhaler treatment:

• Montelukast (for example Montair 10 mg) blocks leukotrienes, chemicals that cause airway swelling. It can help with exercise-induced and allergy-related asthma. Rarely, it has been linked to mood changes, sleep problems or depression. Tell your doctor promptly if you notice any.
• Acebrophylline (for example AB Phylline 200 mg SR) is a bronchodilator that also helps thin mucus. It is prescribed in some countries for asthma and COPD.

Types of Inhaler Devices

The medicine is only half the story. The device matters too.

• Metered-dose inhaler (MDI): the classic “puffer” that releases a measured spray. It requires coordinating pressing and breathing in, and works much better with a spacer.
• Dry-powder inhaler (DPI): devices such as the Accuhaler, or rotacaps used with a Rotahaler. You breathe the powder in with a quick, deep breath. No coordination with pressing is needed, but you need enough breath strength.

How to Use a Metered-Dose Inhaler Correctly

1. Remove the cap and shake the inhaler well.
2. Breathe out gently, away from the mouthpiece.
3. Seal your lips around the mouthpiece (or spacer).
4. Start breathing in slowly and press the canister once at the same time.
5. Keep breathing in slowly and deeply, then hold your breath for about 10 seconds.
6. Wait about 30–60 seconds before taking a second puff, if prescribed.

How to Use a Dry-Powder Inhaler Correctly

1. Load the dose (slide the lever or insert the capsule, depending on the device).
2. Breathe out fully, away from the device. Moisture from your breath can clump the powder.
3. Seal your lips around the mouthpiece and breathe in quickly and deeply.
4. Hold your breath for about 10 seconds, then breathe out slowly.

Warning Signs of Poorly Controlled Asthma

Contact your doctor if you:

• Use your reliever more than 2–3 times a week
• Wake at night with asthma symptoms
• Find symptoms limit your daily activities or exercise

Call emergency services if your reliever isn’t helping, you’re too breathless to speak or walk, or your lips or fingertips look blue or gray.

Frequently Asked Questions

What is the difference between a reliever and a preventer?

A reliever opens the airways quickly during symptoms. A preventer reduces the underlying inflammation when used daily, lowering the chance of symptoms happening in the first place.

Can I stop my preventer when I feel better?

No. Feeling well usually means the preventer is working. Stopping suddenly can let inflammation return. Always discuss changes with your doctor.

Do I need a spacer?

Spacers are strongly recommended with metered-dose inhalers, especially for children and anyone who finds timing difficult. They help more medicine reach the lungs.

Explore our full range of asthma medicines and respiratory care products. If allergies trigger your asthma, you may also find our guide to nasal sprays for allergies helpful.

This article is for general information only and is not a substitute for professional medical advice. Always follow your doctor’s asthma action plan and speak to a healthcare professional before changing any treatment.