Formoterol inhalers aren’t just another asthma or COPD medication-they’re a lifeline for people who struggle to breathe. If you’ve been prescribed one, you probably want to know: which type is right for me? And more importantly, how do I actually use it so it works?
Too many people use their inhalers wrong. Studies show up to 90% of users don’t get the full dose because of poor technique. That means your symptoms don’t improve, your doctor thinks the medicine isn’t working, and you end up with more flare-ups than you need. This isn’t about following rules-it’s about staying out of the hospital.
What Is Formoterol?
Formoterol is a long-acting beta-agonist (LABA). That means it relaxes the muscles around your airways for up to 12 hours, helping you breathe easier. It’s not a rescue inhaler. You don’t use it when you’re wheezing or gasping. Instead, it’s taken daily to keep your airways open and prevent attacks.
It’s always combined with a corticosteroid-like budesonide, fluticasone, or mometasone-in a single inhaler. That’s because using formoterol alone increases the risk of serious asthma-related events. The steroid reduces inflammation, while formoterol opens the airways. Together, they work better and safer.
Formoterol starts working in about 1 to 3 minutes, which is faster than other LABAs like salmeterol. That’s why it’s sometimes used for exercise-induced breathing problems, even though it’s not meant for sudden attacks.
Types of Formoterol Inhalers
There are two main types of formoterol inhalers you’ll likely encounter: metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). They look different, feel different, and work differently.
Metered-Dose Inhalers (MDIs) are the classic canister with a mouthpiece. You press down and breathe in at the same time. Common brands include Symbicort (formoterol + budesonide) and Dulera (formoterol + mometasone). These need shaking before use and often require a spacer for better delivery, especially for kids or older adults.
Dry Powder Inhalers (DPIs) don’t need a propellant. You breathe in deeply and quickly to pull the medicine into your lungs. Examples include Foradil Aerolizer and Perforomist. These are easier for some people because there’s no timing trick-just a strong, fast breath. But if you can’t inhale hard enough, you won’t get the dose.
There’s also a newer version called multidose dry powder inhalers like Symbicort Turbuhaler. It combines formoterol and budesonide in a single device that you twist to load the dose. It’s popular because it’s simple, doesn’t need a spacer, and gives you a counter to track doses.
How to Use a Formoterol Inhaler: Step-by-Step
Using your inhaler right matters more than the brand. Here’s how to do it properly, whether you have an MDI or a DPI.
For Metered-Dose Inhalers (MDIs)
- Remove the cap and shake the inhaler well for 5 seconds.
- Breathe out fully-away from the inhaler.
- Place the mouthpiece between your lips and seal your lips around it.
- Start breathing in slowly and deeply through your mouth. As you begin to inhale, press down on the inhaler to release one puff.
- Keep breathing in deeply until your lungs feel full.
- Hold your breath for 10 seconds, then breathe out slowly.
- If you need a second puff, wait 30 seconds and repeat.
- Rinse your mouth with water and spit it out. Don’t swallow. This prevents thrush and hoarseness.
If you’re using a spacer, attach it to the inhaler first. Spray the puff into the spacer, then breathe in slowly through your mouth. Spacers help even the most rushed or shaky users get the medicine where it needs to go.
For Dry Powder Inhalers (DPIs)
- Remove the cap. Some devices require you to twist or slide to load a dose-follow your device’s instructions.
- Breathe out fully, away from the inhaler. Never exhale into the mouthpiece.
- Put the mouthpiece in your mouth and close your lips tightly around it.
- Breathe in quickly and deeply through your mouth. You should hear a click or feel the powder moving.
- Hold your breath for 10 seconds.
- Breathe out slowly.
- If you need another dose, reload the device as directed and repeat.
- Rinse your mouth with water and spit it out.
DPIs are sensitive to moisture. Don’t store them in the bathroom. Keep them dry. If the device gets wet, it might not deliver the full dose.
Common Mistakes People Make
Here’s what usually goes wrong:
- Breathing in too slowly with a DPI-this means the powder doesn’t reach deep into your lungs.
- Pressing the inhaler too early or too late with an MDI-you miss the puff entirely.
- Not holding your breath after inhaling-half the medicine just leaves your lungs.
- Forgetting to rinse your mouth-this leads to oral thrush, a fungal infection that causes white patches and soreness.
- Using it only when symptoms appear-formoterol doesn’t work as a rescue inhaler. It’s preventive.
One patient I spoke with in Adelaide told me she used her Symbicort only when she felt tightness. She ended up in the ER twice last year. After learning to use it daily-even when she felt fine-her flare-ups dropped by 80%.
When to Use Formoterol vs. Rescue Inhalers
Don’t confuse formoterol with albuterol (salbutamol). Albuterol is your quick-relief inhaler. It works in seconds and lasts 4 to 6 hours. You use it when you’re coughing, wheezing, or short of breath.
Formoterol is for daily control. You take it every morning and evening, even if you feel fine. If you’re using your rescue inhaler more than twice a week, your asthma or COPD isn’t well controlled. Talk to your doctor. You might need a different combo or a higher dose.
There’s one exception: Symbicort Maintenance and Reliever Therapy (MART). In some countries, including Australia, doctors prescribe Symbicort as both your daily controller and your rescue inhaler. That means you use the same device for both. But you still follow specific dosing rules-you never use more than 12 puffs in a day. Your doctor will tell you if this approach is right for you.
Side Effects and Warnings
Most people tolerate formoterol well. But here’s what to watch for:
- Tremors or shakiness (usually mild and fades after a few days)
- Headache or nervousness
- Fast or irregular heartbeat
- Throat irritation or hoarseness
- Oral thrush (white patches in the mouth)
Rare but serious side effects include worsening breathing right after use, chest pain, or high blood sugar. If you feel your breathing getting worse after taking it, stop using it and call your doctor immediately.
Formoterol isn’t safe for everyone. Don’t use it if you’ve had a severe allergic reaction to it or any of its ingredients. If you have heart problems, high blood pressure, thyroid issues, or diabetes, talk to your doctor first. It can affect your blood sugar and potassium levels.
How to Know If It’s Working
You won’t feel a dramatic change right away. But over time, you should notice:
- Fewer daytime symptoms
- Less nighttime waking from coughing or wheezing
- More ability to walk, climb stairs, or exercise without getting winded
- Less need for your rescue inhaler
Keep a symptom diary for the first month. Note when you use your rescue inhaler, how often you wake up at night, and if you’ve had any flare-ups. Bring this to your next appointment. It’s the best way to see if your treatment plan is working.
Storage and Maintenance
Store your inhaler at room temperature. Avoid extreme heat or cold. Don’t puncture or burn it-even if it’s empty. The canister is under pressure.
For MDIs, clean the mouthpiece once a week. Remove the metal canister, rinse the plastic cap and mouthpiece in warm water, and let them air-dry overnight. Don’t wash the canister.
DPIs don’t need cleaning. Just keep them dry and replace them when the dose counter hits zero. Most DPIs have built-in counters. MDIs usually don’t, so track your puffs manually.
What to Do If You Miss a Dose
If you forget a dose, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed one. Never double up. Taking too much can cause a fast heartbeat or tremors.
Set a daily alarm on your phone. Or link it to a habit you already do-like brushing your teeth in the morning or before bed. Consistency is everything.
When to See Your Doctor
Call your doctor if:
- Your symptoms get worse despite using your inhaler daily
- You need your rescue inhaler more than twice a week
- You experience chest pain, rapid heartbeat, or dizziness
- You develop white patches in your mouth or a sore throat that won’t go away
- You’re using more than one inhaler per month
Don’t wait for an emergency. Your treatment plan can be adjusted. You don’t have to live with constant breathing trouble.
Can I use formoterol alone without a steroid?
No. Formoterol should never be used alone for asthma or COPD. The FDA and global health agencies warn that using a long-acting beta-agonist without a corticosteroid increases the risk of severe asthma attacks and death. Always use it in combination with an inhaled steroid, unless your doctor specifically prescribes a dual-use regimen like Symbicort MART under close supervision.
How long does it take for formoterol to start working?
Formoterol starts working in about 1 to 3 minutes after inhalation, which is faster than other long-acting bronchodilators like salmeterol. But it’s not meant for sudden symptoms. It’s designed to provide steady, long-term control. For sudden attacks, you still need a short-acting rescue inhaler like albuterol.
Is formoterol the same as albuterol?
No. Albuterol (salbutamol) is a short-acting bronchodilator that works fast but lasts only 4 to 6 hours. It’s your rescue inhaler for sudden symptoms. Formoterol is a long-acting bronchodilator that lasts 12 hours and is taken daily to prevent symptoms. They serve different roles-using one instead of the other can be dangerous.
Can children use formoterol inhalers?
Yes, but only under a doctor’s supervision and usually starting at age 6 or older. Formoterol combinations like Symbicort are approved for children as young as 6 for asthma. Younger children often need a spacer with a mask to ensure proper delivery. Never give formoterol to a child without a prescription and clear instructions.
What happens if I stop using formoterol suddenly?
Stopping formoterol suddenly can cause your airways to tighten again, leading to worsening symptoms or an asthma attack. Always talk to your doctor before stopping. If you need to discontinue it, your doctor will likely taper you off slowly and may switch you to another controller medication to avoid rebound symptoms.
If you’re using your formoterol inhaler correctly, you’re not just managing symptoms-you’re reclaiming your life. You can walk farther, sleep better, and breathe without fear. It takes practice, but getting it right is worth every minute.