Inhalers are a mainstay of treatment for chronic obstructive pulmonary disease (COPD). These medications are inhaled through your mouth so they can directly reach your lungs. There are several types and brands of inhalers used for managing symptoms of COPD.
Your doctor may prescribe a combination of inhalers for you to use—some are taken on a daily schedule for disease control and others can be used if you have an acute flare-up. Using different types of inhalers can enhance treatment, but many COPD inhalers have effects that overlap with other inhalers or with oral medications used to treat COPD, so combining medications can be dangerous and requires careful planning.
Types of COPD Inhalers
A COPD inhaler can contain either a single medication or a combination of ingredients. Bronchodilators open the airways, while glucocorticoids reduce inflammation. Both of these actions help reduce airway constriction so air can pass into your lungs more effectively as you breathe.
Jav sex You may be instructed to use your inhaler at scheduled times throughout the day and/or to also use an inhaler when you have a COPD exacerbation.Should You Use Your Bronchodilator or Steroid Inhaler First?
Some inhalers begin to have effects immediately, while others take longer to start working. And long-acting inhalers have lasting effects, while the effects of short-acting inhalers tend to wear off sooner.
An inhaler can include:
- A bronchodilator, which helps to open up your airways and increase airflow
- A corticosteroid, which reduces inflammation in your airways
- A combination of several different bronchodilators
- A combination of bronchodilator and corticosteroid
Some inhalers are meant to be used daily over the long term, while others, called rescue inhalers, are used only in emergency situations.
Bronchodilators are not all the same, but they all work to widen the bronchi (airways) in your lungs. Categories of bronchodilators include beta-agonists and anticholinergics.
Beta-agonists act on the airway muscles to relax them and open the bronchi.
- Short-acting beta-agonists include Proventil/Ventolin/ProAir/AccuNeb (albuterol) and Xopenex (levalbuterol).
- Long-acting beta-agonists (LABA’s) include Performomist (formoterol), indacaterol, Serevent (salmeterol), and Brovana (arformoterol).
Anticholinergics prevent contraction of the airway muscles, relaxing the bronchi. Some anticholinergics used for COPD include Atrovent (ipratropium), Spiriva (tiotropium), and aclidinium bromide.
Advair 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.
Advair is available as Advair Diskus, an inhaled powder, or Advair HFA, an aerosol inhaler. The dose is represented with two numbers and written as fluticasone mcg/salmeterol mcg per puff. The Diskus is available in doses of 100/50, 250/50, or 500/50, and the HFA is available in doses 45/21, 115/21, and 230/21.
Symbicort contains formoterol, a long-acting bronchodilator, and budesonide, a corticosteroid. It is used in the treatment of stable COPD and it is usually taken twice per day. The dose is represented as budesonide mcg/formoterol mcg and it is available in doses of 80/4.5 and 160/4.5.
Combivent contains albuterol (a short-acting beta-agonist) and ipratropium (an anticholinergic).
This medication is available as an aerosol metered-dose inhaler with a dose of 100mcg albuterol/20mcg ipratropium or as a nebulizer solution with a dose of 2.5 mg albuterol/0.5mg ipratropium/3mL of solution. It can be taken three or four times per day.
Pulmicort (budesonide) is a corticosteroid that helps reduce inflammation in the airways, making it easier for you to breathe. Pulmicort is used in the maintenance treatment of COPD.
This medication is available as an inhaled powder in doses of 90 mcg and 180 mcg or a nebulized suspension at doses of 0.25 mcg/2mL, 0.5 mcg/2mL or 1 mg/2ml. It is usually taken twice per day.
Performomist (formoterol) is a long-acting beta-agonist that is taken twice daily for management of COPD. It is available as a solution for inhalation at a dose of 20 mcg/2mL.
Serevent (salmeterol) is a long-acting beta-agonist used for COPD maintenance treatment. It is taken twice daily and is available in a powder with a dose of 50 mcg per inhalation.
Used as a maintenance treatment for COPD, Spiriva contains tiotropium, an anticholinergic bronchodilator. It opens and relaxes the airways, making it easier to breathe. The inhaled solution comes in a dose of 1.25 mcg or 2.5 mcg and is taken once per day.How to Correctly Use and Maintain a Spiriva HandiHaler
Atrovent (ipratropium) is an anticholinergic bronchodilator. It’s used in the maintenance treatment of COPD and is available in a dose of 17 mcg. this medication can be taken three or four times per day.
Brovana (arformoterol) is a long-acting beta-agonist bronchodilator. It’s used for long-term maintenance treatment in COPD to relax the airways and make it easier to breathe. It should be taken twice a day, in the morning and in the evening. It is available as a nebulizer solution at a dose of 15 mcg/ 2 mL.
Brovana is not a rescue inhaler, nor does it treat asthma.
The Arcapta Neohaler (indacaterol) is a long-acting beta-agonist bronchodilator. It is administered via a dry powder inhaler at a dose of 75 mcg. It’s used for once-daily, long-term maintenance treatment of airflow obstruction in COPD, including emphysema and chronic bronchitis.
Breo Ellipta is a combination of fluticasone furoate, a corticosteroid, and vilanterol, a long-acting beta-agonist. Breo Ellipta is a once-daily maintenance medication for the treatment of airflow obstruction in patients with COPD, including emphysema and chronic bronchitis.
It is available as a powder for inhalation and comes in doses of 25 mcg vilanterol/100 mcg fluticasone or 25 mcg vilanterol/200 mcg fluticasone.
Trelegy Ellipta contains three active ingredients—fluticasone furoate (an inhaled corticosteroid), umeclidinium (a long-acting anticholinergic), and vilanterol (a long-acting beta-agonist).
Bevespi Aerosphere is a combination of two long-acting bronchodilators, glycopyrrolate and formoterol. It is intended as a maintenance treatment and is taken twice a day to help open airways and keep them open.
Bevespi Aerosphere is not a rescue inhaler and is not used to treat sudden COPD symptoms.
Tudorza Pressair (aclidinium bromide) is a long-acting bronchodilator and is meant to be used twice daily. Like the other long-acting bronchodilators, it is not used as a rescue inhaler.
Proventil (albuterol) is a rescue inhaler that is used to help with urgent breathing problems. It contains albuterol, a short-acting beta-agonist.
Proventil helps immediately relax the airways, making it easier to breathe. Proventil is often used for managing sudden episodes of shortness of breath related to bronchospasm in both asthma and COPD. It comes in a powdered metered dose inhaler or an aerosol metered-dose inhaler at a dose of 90 mcg.
Xopenex (levalbuterol) is a short-acting beta-agonist bronchodilator that is available as a 45 mcg aerosol or a nebulizer (0.31 mcg/3mL, 0.63 mcg/3 mL, 1.25 mcg/3 mL, or 1.25 mcg/0.5 mL). It is used three or four times per day for the management of COPD and it can be used as a rescue inhaler as well.