It’s a common concern whether an inhaler could paradoxically worsen a cough. While generally effective for conditions like asthma and COPD, a cough might intensify after use. Understanding their function and contributing factors clarifies this experience.
Understanding Inhaler Action
Inhalers are handheld devices that deliver medication directly into the airways, reaching the lungs. This direct delivery method is often more efficient than oral medications for lung conditions. Common types include metered-dose inhalers (MDIs), which use a propellant to spray medicine, and dry powder inhalers (DPIs), which require a quick, deep breath to draw powdered medication into the lungs.
The medications in inhalers typically reduce inflammation, relax tightened airway muscles (bronchodilators), or prevent symptoms. Short-acting bronchodilators provide quick relief during acute symptoms, while long-acting bronchodilators and inhaled corticosteroids are used regularly to manage and prevent symptoms over time. These therapies aim to improve airflow and ease breathing.
Why a Cough Might Worsen
Several factors can contribute to a cough worsening after inhaler use. One reason is irritation from the medication itself or the propellant. The cold spray from metered-dose inhalers or the dry powder from DPIs can cause temporary irritation and cough in the throat or airways. This irritation may also stem from side effects like a dry or sore throat.
Paradoxical bronchospasm, a rare reaction, causes airways to constrict instead of relax after bronchodilator use. This unexpected tightening can lead to an immediate worsening of cough, wheezing, and breathing difficulties. While uncommon, this reaction means the inhaler is having the opposite of its intended effect.
Improper inhaler technique is a frequent cause for a cough to persist or worsen. If the medication does not reach the lungs effectively due to incorrect inhalation, it may deposit in the throat, causing irritation and triggering a cough. Studies indicate that a significant percentage of patients use their inhalers incorrectly, which can lead to insufficient drug delivery and poor symptom control.
If the underlying respiratory condition is not adequately controlled by the inhaler, symptoms like coughing may continue or intensify. This occurs if the prescribed medication or dosage is inappropriate for the condition’s severity. In rare instances, an allergic reaction to an ingredient in the inhaler can manifest as a worsening cough or other symptoms.
Optimizing Inhaler Use
Proper inhaler technique maximizes medication delivery to the lungs and minimizes irritation and cough. Before each use, especially with metered-dose inhalers, shaking the device ensures the medication and propellant are mixed evenly. Exhaling fully before inhaling and then taking a slow, deep breath while actuating the inhaler allows the medicine to reach deeper into the airways. Holding your breath for about 10 seconds after inhalation helps the medication settle in the lungs.
Using a spacer with a metered-dose inhaler can improve drug delivery to the lungs and reduce throat irritation. A spacer is a chamber that holds the medication after it’s released from the inhaler, giving more time to inhale it slowly and deeply. After using certain inhalers, especially those with corticosteroids, rinsing the mouth and gargling with water prevents local side effects like throat irritation and oral thrush, which can contribute to coughing. Regularly cleaning the inhaler mouthpiece according to manufacturer instructions helps maintain its proper function.
When to Consult a Healthcare Provider
Seek medical advice if a cough worsens or persists after inhaler use, even with proper technique. New or increased difficulty breathing, wheezing, or chest tightness after inhaler use requires immediate medical attention. These symptoms could indicate an underlying issue or an adverse reaction.
Symptoms like a rash, swelling of the face or throat, or dizziness are signs of an allergic reaction and require medical evaluation. If the inhaler does not alleviate the original respiratory symptoms or if symptoms are not improving as expected, a healthcare provider can reassess the treatment plan. Consulting a doctor or pharmacist for a demonstration of proper inhaler technique is also beneficial if correct usage is uncertain.