<s>[INST] ak I have asthma which seems allergic because when I change cities, it either gets better or worsens dpending upon city. I have it for the last 25 years. I have been taking salbutamol inhaler but I wish to stop it as it is creating shaking / tremors in my hands etc. What are the alternatives please ? (with less side effects) AK Agarwal [/INST] Hello Mr. Agarwal, Salbutamol is a reliever medication for quick, on the spot relief for asthma. If need of inhaler has been on every day or more than once daily, then you need a ‘preventer’ medication. This prevents an allergic attack, by acting on the inner tubes inside the lungs. They may contain a derivative of steroid or sodium chromoglycate. Preventive drugs are directly given into the lungs in micrograms. So they are not likely to produce the widely known bad effects of steroid consumption. Inhaled steroids are safe in the prescribed doses. Please get evaluated by the nearest chest physician. An x-ray of the chest and lung function tests, plus blood test may be necessary. The doctor will prescribe a suitable preventer medicine (e.g Budesonide inhaler) or a combined preventer cum reliever medicine (e.g. Budesonide with formoterol). Both of these have less chances of producing tremors of hand. Hope you control your asthma without tremors of hand. Thanks a lot for using healthcaremagic.com </s>