Inhaled corticosteroids, also called inhaled steroids, are medications used for long-term management of asthma. They typically are the preferred treatment for people with asthma who need more than a rescue inhaler can offer.
Inhaled steroids help prevent symptoms of asthma, including wheezing, shortness of breath, coughing, and tightness in the chest. These inhalers are not effective for treating an acute asthma attack. Instead, they are to be used daily—symptoms or not—to control asthma over time.
When used as prescribed, inhaled steroids can:
- Reduce the frequency and severity of attacks (exacerbations)
- Decrease the need for rescue inhalers
- Improve lung function
- Decrease hyper-responsiveness of the airways
- Prevent asthma-related ER visits, hospitalizations, and death
- Improve quality of life
Your healthcare provider may recommend an inhaled steroid for your asthma if any of these factors apply:
- You need a ß-agonist inhaler (e.g.,albuterol) more than two days a week.
- Symptoms of asthma recur more than twice a week.
- Asthma interferes with daily activities.
- You've needed oral steroids (such asprednisone) more than once in the previous year.
Types of Inhaled Steroids
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Healthcare providers prescribe steroids for individual patients based on factors such as the severity of their asthma and their overall health:
Some steroid inhalers contain only a corticosteroid, such as:
- Alvesco (ciclesonide)
- Asmanex HFA (mometasone)
- Asmanex Twisthaler (mometasone)
- Flovent Diskus (fluticasone)
- Flovent HFA (fluticasone)
- Pulmicort Flexhaler (budesonide)
- Qvar (beclomethasone)
Others contain a steroid plus a long-term beta-agonist (LABA), a type of bronchodilator that is effective for up to 12 hours. Known as combination therapies, these inhalers typically are prescribed for people with poorly controlled asthma symptoms.
- Advair HFA (fluticasone, salmeterol)
- Advair Diskus (fluticasone, solmeterol inhalation powder)
- Arnuity Ellipta (fluticasone furoate inhalation powder)
- Azmacort (triamcinolone acetonide)
- Dulera (mometasone furoate, formoterol)
- Symbicort(budesonide, formoterol)
Common Misunderstanding
Corticosteroids in medications are sometimes confused with the potentially dangerous anabolic steroids used by some athletes but these are very different drugs. When prescribed and taken as directed, corticosteroids are perfectly safe.
How Inhaled Steroids Work
Asthma is essentially an overactive response of the immune system to something in the environment.
When you come in contact with an asthma trigger (an allergen such as pet dander, smoke, etc.), your immune system releases cells that cause inflammation in your bronchial tubes (airways). This narrows them and makes it hard to breathe.
Inhaled corticosteroids reduce this inflammation. They also reduce the amount of mucus in your bronchial tubes. The result is clear and open airways that allow you to breathe normally.
Corticosteroid drugs reduce inflammation in a couple of ways. The first is by getting the immune system to halt its attack.
Raising Hormone Levels
In asthma, inflammation of the airways can become chronic. Everyday levels are lower than those during an asthma attack, but that constant state of inflammation means it doesn't take much of a response to challenge your breathing.
Your body produces hormones that regulate the immune response and inflammation, and steroids are synthetic versions of those hormones. When you take a corticosteroid, your body detects high levels of the hormone and stops producing it, effectively "taking its foot off the accelerator."
Blocking Allergy Response
Another major contributor to inflammation is allergies, which are common in people with asthma and also are caused by a hyper-responsive immune system.
Steroids block the late-phase immune reaction to allergens, which lowers inflammation, decreases over-responsiveness of the bronchial tubes, and blocks the immune system's inflammatory cells.
The excess mucus associated with asthma comes directly from the bronchial tubes as part of the inflammatory response, so lowering inflammation can help lessen mucus as well.
This anti-inflammatory response is central to achieving long-term control of your asthma.
Asthma and Your Immune System
Effects of Combination Ingredients
ß-agonists, which are found in both long- and short-term inhalers, treat asthma by relaxing the smooth muscles in your airways. Anticholinergics, also used in long-term inhalers, block the action of neurotransmitters associated with bronchial spasms and constriction.
Choosing an Corticosteroid Inhaler
Inhaled steroids come in three different types of devices:
- Metered dose inhalers (MDIs):A small pressurized canister contains the medication and a propellant spray. You push down on the canister and the propellant delivers the medication through a plastic mouthpiece into your lungs. Examples include Asmanex HFA, Flovent HFA, and Alvesco.
- Dry powder inhalers (DPIs):The device may be similar to an MDI or be a disc or oval shape, but it doesn't contain a propellant. The medication is a dry powder, which you release by taking a deep, fast breath. DPIs prescribed for asthma include Flovent Diskus, Pulmicort Flexihaler, Qvar RediHaler, and Asmanex Twisthaler.
- Nebulizer:Nebulizers turn liquid medicine into a mist that you inhale. They come in electric or battery-run versionswith eithera mouthpiece or a mask.
When choosing an inhaler, oneof the main considerations is how much of the drug exiting the inhaler is actually deposited in the air passages of the lungs. By and large, DPIs tend to deliver more active drug than MDIs.This doesn't necessarily mean the therapeutic effects of MDIs are any less than that of the DPIs; they generally aren't. It may only pose a problem if a spacer is used.
In such case, a DPI such as Qvar RediHaler, which delivers 50% of the active drug to the lungs, may be less impacted by a spacer than an MDI like Asmanex HFA, which delivers only 11%.
By comparison, nebulizers can sometimes deliver results that are superior to either type of inhaler. However, their use is limited by the fact that the machine is costly and not portable.
Moreover, some corticosteroids, including Alvesco and Asmanex cannot be delivered by nebulizer. Even so, nebulizers may be a better option for children, people who are unable to operate inhalers comfortably or reliably, and those who require large doses.
Dosages and Use
Dosages of inhaled corticosteroids varies widely depending on the specific drug, age, and the severity of asthma symptoms.
People with asthma who use an inhaled steroid to control symptoms routinely have been instructed to take one to two puffs once or twice a day—sometimes more.
However, in updated recommendations for asthma management issued in December 2020, the National Institutes of Health advised that for some people with mild to moderate persistent asthma, daily inhaler use may not be necessary.If you use an inhaler daily to manage asthma, talk to your healthcare provider about how the new guidelines might affect your treatment.
It's important to follow the instructions provided to you precisely, as the doses need to be spaced just right for the medication to be effective. Also, taking more medication than directed can cause you to have unpleasant side effects.
How Do Inhalers Work?
Duration
It's worth repeating: These are long-term medications for daily use, not rescue inhalers that you used to end an asthma attack. Inhaled corticosteroids are intended to be used regularly, likely over the course of many years.
Talk to your healthcare provider before stopping your medication for any reason.
Side Effects
Generally speaking, inhaled corticosteroids have a relatively low risk of side effects, particularly when compared to oral corticosteroids. The most common ones affect fewer than 5% of people who use them.
Some side effects result when the medication and/or propellant comes in contact with tissues in the mouth and throat. Others are systemic, meaning they stem from the medication circulating through your body.
Mouth and Throat
These common side effects of oral corticosteroids often are easy to manage or even eliminate altogether.
- Thrush (oral candidiasis): This fungal infection of the mouth can be prevented by using a spacer, rinsing your mouth after use, or using a lower dosage (with your healthcare provider's OK). Thrush can be treated with antifungal medications.
- Hoarseness/dysphonia: Potential effects on the voice can be prevented by using a spacer or a temporarily lowered dosage to give the vocal cords a chance to rest.
- Reflex cough and bronchospasm: Using a spacer or inhaling more slowly can help prevent this. If you are having an attack, using a rescue inhaler first can reduce the risk as well.
Systemic
Systemic side effects are possible but uncommon with inhaled steroids. The risk generally is higher with a higher dose.
Poor growth is a concern for children with asthma who use inhaled corticosteroids. When growth is impaired, it's usually by less than half an inch. While noteworthy, this is especially rare at normal doses. Children who go off of the drug generally catch up in height.
Talk to your pediatrician if you have concerns about your child's growth. It's also important to consider, though, that poorly controlled asthma can also impair growth.
Other systemic side effects can include:
- Osteoporosis
- Easy bruising
- Cataracts and glaucoma
Again, these are less common at typical dosages. If you already have a high risk of any of these things, are concerned about them, or suspect you're experiencing one, talk to your healthcare provider.
Serious systemic symptoms may arise when the daily dosage is high—1,000 to 1,500 micrograms (mcg) per day—increasing the risk of the above side effects, plus:
- Weight gain
- Insomnia
- Mood swings
- Thinning of the skin
Most inhaled corticosteroids fall beneath this threshold. Comparatively speaking, a high corticosteroid dose without a spacer is defined as:
- Alvesco: 320 mcg/day
- Asmanex: 440 mcg/day
- Pulmicort Flexihaler: 400 mcg/day
- Flovent HFA: 440 mcg/day
- Flovent Diskus: 440 mcg/day
- QVAR RediHaler: 672 mcg/day
Pregnancy and Breastfeeding
Research suggests inhaled corticosteroids do not increase the risk of birth defects and that they're safe to use in low doses throughout pregnancy.
Healthcare provider generally believe the amount of inhaled steroids excreted into breastmilk is likely too small to have any impact on a nursing baby, so it's also considered safe to use these medications when you're breastfeeding.
Your practitioner may recommend one drug over another based on absorption levels.
A Word From Verywell
You have a lot of factors to weigh when selecting the right inhaled corticosteroid for your asthma. Some may be based on the known differences between the drugs; others may be based on personal preference or other considerations (such as health coverage and available patient assistance programs).
The right inhaler is the one that works for you. It's often necessary to try several to see how they work or if you experience any side effects.
While your first instinct may be to choose the latest drug, remember new doesn't always mean best. Opt for the drug that controls your symptoms with the lowest dose and fewest side effects.
Frequently Asked Questions
What is the difference between Flonase and Flovent?
Flonase and Flovent both contain the same active ingredient, fluticasone. However, Flonase is delivered as a nasal spray used to treat sinus allergies and Flovent is used as an inhaler to treat asthma.
(Video) Which is the best inhaler?What is the difference between Symbicort and Pulmicort?
Pulmicort and Symbicort are two inhaled medications used to treat asthma. Pulmicort contains budesonide, a corticosteroid. Symbicort combines budesonide with formoterol, a long-term beta-agonist (LABA).
Is Pulmicort an inhaler or nebulizer?
Pulmicort (budesonide) comes in both an inhaler and a nebulizer solution. Pulmicort Flexhaler is a portable inhaler. Pulmicort Respules is the nebulizer solution.
The Link Between Asthma and Food Allergies
FAQs
Which inhaled corticosteroid is best for asthma? ›
| Inhaled Corticosteroids: Are considered the most effective long-term usage medication for control and management of asthma. | |
|---|---|
| Generic Name | Brand Name |
| Beclomethasone Dipropionate | Qvar 40 Redihaler Qvar 80 Redihaler Qvar Website |
| Budesonide | Pulmicort Flexhaler 90 mcg Pulmicort Flexhaler 180mcg Pulmicort Flexhaler Website |
- 5 of the most common inhaled steroids for asthma. ...
- Budesonide inhaler. ...
- Fluticasone inhaler. ...
- Beclomethasone inhaler. ...
- Mometasone inhaler. ...
- Ciclesonide inhaler.
- Beclomethasone dipropionate (Qvar)
- Budesonide (Pulmicort)
- Budesonide/formoterol (Symbicort), a combination drug that includes a steroid and a long-acting bronchodilator drug.
- Fluticasone (Flovent)
- Fluticasone inh powder (Arnuity Ellipta)
Inhaled corticosteroids include: Fluticasone (Flovent HFA, Arnuity Ellipta, others) Budesonide (Pulmicort Flexhaler) Mometasone (Asmanex Twisthaler)
Which is better Flovent or Symbicort? ›Flovent has an average rating of 6.3 out of 10 from a total of 34 ratings on Drugs.com. 48% of reviewers reported a positive effect, while 29% reported a negative effect. Symbicort has an average rating of 6.5 out of 10 from a total of 216 ratings on Drugs.com.
Is budesonide stronger than fluticasone for asthma? ›Abstract. Background: Beclomethasone dipropionate (BDP) and budesonide (BUD) are commonly prescribed inhaled corticosteroids for the treatment of asthma, Fluticasone propionate (FP) is newer agent with greater potency in in-vitro assays.
What is the best known corticosteroid? ›Some corticosteroid medicines include cortisone, prednisone and methylprednisolone. Prednisone is the most commonly used type of steroid to treat certain rheumatologic diseases (like rheumatoid arthritis or lupus).
What is the most effective corticosteroid? ›The highest potency topical steroids include: Temovate (clobetasol propionate) 0.05% ointment. Ultravate (halobetasol propionate) 0.05% cream, ointment, or lotion. Psorcon (diflorasone diacetate) 0.05% ointment.
Which is better for asthma oral or inhaled corticosteroids? ›What are the advantages of using inhaled steroids vs oral steroids in treating the asthmatic? Inhaled steroids compared to oral corticosteroids have significantly fewer side effects compared to oral steroids. Hence, inhaled steroids are safe and effective for long term treatment of asthma.
What is the best severe asthma treatment? ›Basic treatment for severe persistent asthma consists of inhaled corticosteroids. Additional long-term controller medicines, such as long-acting beta 2 agonists (LABA), montelukast or theophylline, are added if asthma is still uncontrolled.
What is the new drug for severe asthma article? ›
"Asthma drug 'gamechanger' could revolutionise treatment," The Guardian reports after a new drug called fevipiprant showed promising results in a small study of 61 people with moderate to severe asthma.
What is the most effective treatment in asthma exacerbation? ›Inhaled bronchodilators (beta-2 agonists and anticholinergics) are the mainstay of asthma treatment in the emergency department. In adults and older children, albuterol given by a metered-dose inhaler (MDI) and spacer is as effective as that given by nebulizer.
What are 4 inhaled corticosteroids? ›Inhaled corticosteroids are medicines containing corticosteroids such as beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, or mometasone in a preparation designed to be inhaled through the mouth.
Where can you get inhaled corticosteroids? ›This medicine may be used with other asthma medicines, such as bronchodilators (medicines that open up narrowed breathing passages) or other corticosteroids taken by mouth. Inhalation corticosteroids are available only with your doctor's prescription.
Are all inhaled corticosteroids the same? ›Inhaled Corticosteroids
Depending on the drug used—as well as the user's age and the severity of symptoms—inhaled steroids may be used once or twice daily. Different inhaled steroids use different delivery systems: Metered-dosed inhalers (MDIs) use an aerosolized propellant to deliver the steroids into the lungs.
SABAs are the most commonly prescribed inhaler for quick relief of asthma symptoms.
What works better than Flovent? ›- Symbicort.
- Singulair.
- Montelukast.
- ProAir HFA.
- Xolair.
- Ventolin HFA.
Advair Diskus (fluticasone/salmeterol) and Breo Ellipta (fluticasone/vilanterol) are two examples of Symbicort alternatives. They have similar ingredients to Symbicort, and they also manage asthma and COPD symptoms.
Does budesonide work right away for asthma? ›A budesonide inhaler does not work straight away. You'll usually start to wheeze less after using budesonide for 3 to 7 days. Once your symptoms have improved, you may find you need to use your other inhaler (called a "reliever") less often.
Which asthma inhalers contain budesonide? ›Budesonide sometimes comes mixed with formoterol. This type of inhaler is both a preventer and a reliever, and brand names include Symbicort Turbohaler, DuoResp Spiromax, Fobumix Easyhaler and AirBuFo Forspiro.
What brand is budesonide for asthma? ›
Budesonide inhalers Brand names: Pulmicort, Duoresp.
What is the safest steroid to take? ›Testosterone. Available in both oral and injectable forms, testosterone is widely prescribed to treat low testosterone levels and is considered the safest oral steroid.
What are 3 common corticosteroids? ›Corticosteroid medicines include cortisone, hydrocortisone and prednisone. They are useful in treating rashes, inflammatory bowel disease, asthma and other conditions.
Which is long lasting corticosteroid? ›Dexamethasone and betamethasone are long-acting with the highest glucocorticoid efficacy with a biological half-life of 36 to 54 hours. Cortisone and cortisol are short-acting with a biological half-life of under 12 hours and are not frequently used.
Which corticosteroid is more potent? ›Prednisone and methylprednisolone, which are intermediate-acting products, are four to five times more potent than hydrocortisone. Dexamethasone is a long-acting, systemic corticosteroid; its potency is about 25 times greater than the short-acting products.
What is the rule of 2 in corticosteroids? ›Equivalent Dose (mg)
The Rule of Twos states that adrenal suppression may occur if a patient is taking 20 mg of cortisone or its equivalent daily, for 2 weeks within 2 years of dental treatment (see Table 1). In order to avoid an adrenal crisis, corticosteroid supplementation was advised.
The most abundant glucocorticoid is cortisol.
How safe are inhaled corticosteroids in asthma? ›There is now overwhelming evidence that the doses of inhaled steroids required to control asthma in the majority of adults and children are safe and without systemic side effects. It is important to control asthma with the minimum dose of inhaled steroids possible, however.
How often to take corticosteroids for asthma? ›Adults and children older than 12 years of age—The usual dose is 150 micrograms (mcg) (2 puffs) three to four times per day or 300 mcg (4 puffs) 2 times per day. Then your doctor may reduce the dose, based on your condition. In severe asthma, your doctor may want you to take a higher dose.
How long do inhaled corticosteroids take to work for asthma? ›Inhaled steroids can start working in 24 hours. But you might not notice a change • for 1 or 2 weeks. Even if you do not have any asthma symptoms you should use your inhaled steroid every day. Inhaled steroids can make your voice hoarse or your throat irritated and cause • coughing.
What is the new medication for asthma in 2023? ›
THURSDAY, Jan. 12, 2023 (HealthDay News) -- Adults with asthma now have a new rescue medication to turn to after the U.S. Food and Drug Administration approved Airsupra on Wednesday. The drug is the first approved to combine albuterol (a beta-2 adrenergic agonist) and budesonide (a corticosteroid).
What is the new wonder drug for asthma? ›Dupilumab: 'Wonder drug' for severe asthma approved for use by NHS in England. The monoclonal antibody is approved by England's National Institute for Health and Care Excellence for the treatment of the most serious cases of asthma, to be used when patients don't respond to conventional treatments.
What is main drug of choice for asthma? ›Short-acting beta agonists.
These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex, Xopenex HFA).
- Accolate (zafirlukast)
- Advair (fluticasone propionate and salmeterol)
- Alvesco (ciclesonide)
- Arnuity Ellipta (fluticasone furoate inhalation powder)
- Breo Ellipta (fluticasone furoate and vilanterol inhalation powder)
- Cinqair (reslizumab)
- Dulera (mometasone furoate + formoterol fumarate dihydrate)
These include alternative β2 agonists (such as adrenaline); inhalational anaesthetic agents (such as halothane); intravenous magnesium sulphate; inhaled helium-oxygen mixtures; or non-invasive mechanical respiratory support of various forms such as face mask continuous positive airway pressure (CPAP).
Which medication most effectively reduces the inflammatory response in asthma? ›Corticosteroids: Block late-phase reaction to allergen, reduce airway hyperresponsiveness, and inhibit inflammatory cell migration and activation. They are the most potent and effective anti-inflammatory medication currently available (Evidence A). ICSs are used in the long-term control of asthma.
Why are inhaled corticosteroids better? ›Inhaled corticosteroids are an established treatment for asthma. Their success is based on their ability to improve control of asthma, to allow the reduction of other drugs, such as oral corticosteroids, and perhaps to limit the risk of long term decline in lung function.
What are the names of asthma pills? ›- Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
- Levalbuterol (Xopenex HFA)
- Metaproterenol.
- Terbutaline.
However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts.
Can you buy asthma steroid inhaler over the counter? ›Primatene Mist HFA is the only FDA-approved asthma inhaler available over the counter in the United States. All other inhaler medications require a prescription.
Can you get inhaled corticosteroids over the counter? ›
Yes, there are OTC inhalers available. But they don't contain the same medications found in common prescription inhalers, such as albuterol (ProAir, Ventolin, Proventil).
Is there an OTC steroid inhaler? ›The active ingredient in Flonase Allergy Relief is fluticasone propionate. The product is marketed as the first and only OTC IC indicated to provide 24-hour relief of nasal symptoms and eye-related allergy symptoms.
What is the most common inhaled corticosteroid? ›- Asmanex® (mometasone)
- Alvesco® (ciclesonide)
- Flovent® (fluticasone)
- Pulmicort® (budesonide)
- Qvar® (beclomethasone HFA)
Inhaled steroids need to be taken daily for best results. Some improvement in asthma symptoms can be seen in 1 to 3 weeks after starting inhaled steroids, with the best results seen after 3 months of daily use. Inhaled steroid medications for better asthma control include: Beclomethasone dipropionate (Qvar)
Which is better Flovent or pulmicort? ›When used every day, Flovent (fluticasone) can lower the number and severity of asthma attacks. It's not a rescue inhaler, so it won't help an asthma attack that has already started. Pulmicort Flexhaler (budesonide) is good for controlling and preventing asthma symptoms in children and adults.
Is prednisone better than fluticasone for asthma? ›In conclusion, high-dose inhaled fluticasone appears to have a faster and stronger effect in reducing airway inflammation than oral prednisone and to be at least as effective as prednisone in reducing plasma exudation, bronchial obstruction and symptoms in moderate exacerbations of asthma.
What inhaler is comparable to Flovent? ›Similar to Flovent, the Advair HFA and Diskus inhalers can be used to treat asthma. Both of the Flovent inhalers and the Advair Diskus inhaler can be used by people ages 4 and up.
Is Advair better than Flovent? ›Singulair versus Flovent versus Advair for Mild Persistent Asthma? There is no question that in general Advair is more effective than Flovent and that Flovent is more effective than Singulair for controlling asthma.
Which is stronger Pulmicort or Symbicort? ›Conclusion: According to our observations, Symbicort with the dose of 160/4.5 mg/inhalation two puffs twice daily is significantly more effective than this drug with lower doses or Pulmicort at reducing severe exacerbations and asthma symptoms.
Which is the best COPD inhaler? ›Advair. Advair is one of the most commonly used inhalers for the maintenance treatment of COPD. It is a combination of fluticasone, a corticosteroid, and salmeterol, a long-acting bronchodilator. Advair is used on a regular basis for the maintenance treatment of COPD and it is typically taken twice per day.
What is the strongest asthma treatment? ›
Inhaled corticosteroids are the most effective long-term control medicines. These aren't the same as anabolic steroids that people use to grow muscle. They include beclomethasone (Qvar RediHaler), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco), fluticasone (Flovent HFA), and mometasone (Asmanex Twisthaler).
What can I take instead of prednisone for asthma? ›- Albuterol Inhalation (Ventolin)
- Amoxicillin (Amoxil)
- Azithromycin (Zithromax)
- CoQ10 (Coenzyme Q-10)
- Ibuprofen (Advil)
- Levothyroxine (Synthroid)
- Lexapro (Escitalopram)
- Lipitor (Atorvastatin)
They are effective medications for reducing inflammation. Both medications can produce a range of side effects and complications. Methylprednisolone is more potent than prednisone. Doctors can give methylprednisolone orally or through an injection, while prednisone is only available as an oral treatment.
What is the most common steroid inhaler? ›Steroid inhalers are only available on prescription. Common types include: beclometasone. budesonide.
What is the new inhaler for asthma? ›AIRSUPRA is a first-in-class, pressurized metered-dose inhaler (pMDI), fixed-dose combination rescue medication containing albuterol, a short-acting beta2-agonist (SABA), and budesonide, an anti-inflammatory inhaled corticosteroid (ICS) in the US. It is being developed by AstraZeneca and Avillion.
Which inhaler is better fluticasone or Flovent? ›Flovent HFA has an average rating of 7.0 out of 10 from a total of 15 ratings on Drugs.com. 69% of reviewers reported a positive effect, while 23% reported a negative effect. Fluticasone has an average rating of 6.1 out of 10 from a total of 66 ratings on Drugs.com.
What is an alternative to an asthma inhaler? ›A coffee, soda, tea, or other drink with caffeine can help your airways open. A small amount of caffeine can help you breathe better for up to 4 hours. We need more research to know if caffeinated drinks can permanently help with symptoms of asthma. Use eucalyptus oil.