Salbutamol

• Relief of asthma symptoms — wheeze, cough, chest tightness, breathlessness
• Before exercise where exercise triggers symptoms
• Relief in COPD
• Acute asthma attacks, alongside urgent medical help

Usually one to two puffs when needed.

Technique determines whether it works. Shake the inhaler. Breathe out fully, away from it. Seal your lips around the mouthpiece and press as you begin a slow, steady breath in over four to five seconds. Hold your breath for up to ten seconds.

Use a spacer if you have one — and you should. A spacer removes the coordination problem entirely and substantially increases the proportion reaching your lungs. They are not just for children.

Wash a spacer in warm soapy water and leave it to air dry. Rubbing it dry creates static that attracts the drug to the plastic.

Check the dose counter. Do not wait until it stops working to find out it is empty.

Beta blockers — particularly non-selective ones such as propranolol — oppose salbutamol and can provoke bronchospasm. This combination needs care and is sometimes avoided entirely.

Diuretics, steroids and theophylline all add to the potassium-lowering effect.

Monitoring is about usage, not bloods. How many puffs a week, how many canisters a year, and whether a preventer is being taken properly — those three questions tell you almost everything about how well controlled someone is.

Salbutamol inhalers are inexpensive, and on a private prescription you pay the pharmacy cost plus their fee — usually comparable to the England NHS prescription charge of around £10. NHS prescriptions are free in Wales.

In England, people with asthma do not automatically get free prescriptions, which surprises many — asthma is not on the medical exemption list. If you are paying for several inhalers a year, a Prescription Prepayment Certificate is usually cheaper, and it covers everything you are prescribed, not just the inhalers.

The thing worth buying

A spacer. They cost a few pounds, they are available on prescription, and they get substantially more drug into the lungs and less into the back of the throat.

Almost everyone using a standard metered-dose inhaler would do better with one, not just children — and most adults are never offered one.

Where not to spend

• Salbutamol sold online without an assessment. Needing it often is a marker of poor control, and supplying reliever without reviewing the preventer is how people come to harm
• Nebulisers for home use, unless specifically advised. An inhaler with a spacer is as effective in most situations, and a home nebuliser can mask deterioration that should be sending you to hospital

Salbutamol is a reliever, not a treatment. It opens the airways for a few hours and does nothing about the inflammation underneath.

There is no withdrawal and no taper — but how often you reach for it is the single most useful measure of whether your asthma is controlled.

The number that matters

Needing your reliever three or more times a week is a marker of poor control. Getting through more than about one inhaler a month is associated with a genuinely increased risk of a severe attack.

The answer is not more salbutamol. It is a review of the preventer — and this is the most consistently missed opportunity in asthma care.

Changing inhaler

UK practice has moved away from reliever-only treatment. Combined preventer-and-reliever inhalers taken as needed are now recommended for many people with mild asthma, and are more effective at preventing attacks than salbutamol alone.

If you have been using a blue inhaler alone for years, that is worth reviewing rather than repeating.

Device changes

Never switch inhaler device without being shown the new technique. A dry powder inhaler is used completely differently from an aerosol — fast and deep rather than slow and steady — and a change made at the pharmacy counter without instruction is a common cause of a sudden loss of control.

How often is too often?

Three or more times a week is a sign your asthma is not controlled.

More than one inhaler a month is associated with a higher risk of a serious attack. Both mean the preventer needs reviewing, not the reliever increasing.

Do I really need a spacer?

Almost certainly it would help. A spacer gets more drug into the lungs and less onto the throat, and it removes the need to coordinate pressing and breathing.

They are not just for children, and most adults have never been offered one.

Why does it make me shaky?

Tremor, a racing heart and feeling jittery are expected effects, more noticeable at higher doses.

They are not an allergy and they settle within an hour or so.

Can I use it before exercise?

Yes — taken 10 to 15 minutes beforehand it reliably prevents exercise-induced symptoms.

But needing it before every session suggests the underlying asthma is not controlled, which is worth addressing rather than working around.

Is it safe in pregnancy?

Yes, and it is important. Uncontrolled asthma poses a far greater risk to a pregnancy than the inhaler does.

Do not stop your preventer because you are pregnant — that is a common and dangerous decision.

What should I do in an attack?

Sit upright, take one puff every 30 to 60 seconds up to ten puffs, using a spacer if you have one.

Call 999 if you are no better after ten puffs, if you cannot speak in full sentences, or if you are worsening. Do not drive yourself.

Does it treat my asthma?

No — it relieves symptoms without touching the inflammation causing them.

Relying on it alone leaves the disease untreated, and that is precisely the pattern that precedes serious attacks.

Does the inhaler harm the environment?

Standard aerosol inhalers contain propellant gases with a significant carbon footprint. Dry powder inhalers have a much smaller one.

Only switch with proper instruction on the new technique — control matters more than carbon, and a device used wrongly helps nobody.