"The big clue that we've learned over the years is that if you have to use a rescue inhaler often -- waking up more than two nights a month or having to use it more than two times a week -- you ought to be on something that gives you more protection," says Honsinger. "These drugs just help you for the moment -- they don't keep the increased mucus away or the scarring of the lung away. For that you need something that gives you better protection and longer action that decreases the inflammation of the lung, like an inhaled corticosteroid or a leukotriene inhibitor."
"First, it is doubtful that the order of administration regarding the types of inhalers used makes a great deal of difference. It has been postulated that bronchodilators should be administered prior to inhaled corticosteroids based on the rationale that “opening the bronchial tubes” would permit enhanced deposition of an inhaled corticosteroid. However, adequate bronchodilatation takes time. It is usually not achieved until 15 to 20 minutes after the inhalation of a short acting bronchodilator or formoterol (Symbicort, Dulera) and takes longer after salmeterol (Advair).
American Academy of Asthma, Allergy & Immunology: "Asthma" and "Allergy and Asthma Drug Guide."
National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)."
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, but Costlier."
Children's Hospital Boston: "Allergy Treatment."
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.