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There is some evidence that quadrupling the maintenance dose of inhaled corticosteroids, 73 or treating with a high dose of inhaled corticosteroids, 74 , 75 , 76 reduces the severity of asthma flare-ups. For patients taking inhaled corticosteroid/long-acting beta 2 agonist combinations, this can be achieved by adding a separate high-dose inhaled corticosteroid inhaler to the patient’s usual maintenance treatment for 7–14 days. This strategy may be useful for patients who experience clinically important side-effects with oral corticosteroids, but may not be suitable for patients who cannot afford the extra medicine or who experience hoarseness with high dose inhaled corticosteroid.
Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.