Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

When to Use a Reliever


  • A reliever should be used on an as needed basis for relief of symptoms
  • Best represented by short-acting ß2-agonists
  • Act by relaxing the smooth muscle surrounding the airways
  • Provide quick relief (within 1-2 minutes)
  • Using 4 or more doses (2 puffs/dose) per week (excluding pre-exercise) is an indicator of poor control.


Short-acting ß2-agonists (Sabutamol, Terbutaline)

  • Rapid onset of action (within 1-2 minutes).
  • Children who need a short-acting ß2-agonist several times a day require urgent reassessment with a view to increasing anti-inflammatory therapy (Boulet et al., 2001).


  • Atrovent (ipratropium bromide) is not recommended as first line therapy but may be used as a reliever when short-acting ß2-agonists are not well tolerated due to side effects (Boulet et al., 1999).
  • It is less effective than short-acting ß2-agonists in relieving symptoms and has a limited role in paediatric asthma (Spahn & Szefler, 1998).
  • Atrovent in addition to ß2-agonist is safe and effective during the first 2 hours of a severe acute asthma exacerbation (Boulet et al., 2001; BTS/SIGN, 2003)

Teaching Tips for Nurses:

  • Ask how often the reliever is used on a daily/weekly basis. Other than pre-exercise, relievers should only be used for symptoms.
  • During an asthma exacerbation, coach parents to have their children re-assessed if they are requiring a reliever more than every 4 hours or the reliever is not effective.