Inhalers for COPD

Metered-dose inhalers for COPD

A metered-dose inhaler (MDI) is a handheld device that delivers medication in aerosol form to the lungs. The canister is attached to a mouthpiece. When you press on the canister, a chemical propellant pushes a puff of medication into your lungs.

With an MDI, you have to time your breathing with the release of the medication. If you have trouble doing this, you can use a device called a spacer. A spacer can help coordinate your inhaled breath with the release of the medication.

Several kinds of COPD drugs can be administered in an MDI.

Steroids for COPD available as MDIs include:

• beclomethasone (Beclovent, QVAR)
• ciclesonide (Alvesco)
• fluticasone (Flovent HFA)

Bronchodilators for COPD available as MDIs include:

• albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
• levalbuterol (Xopenex HFA)

Combination steroid/bronchodilators for COPD available as MDIs include:

• budesonide-formoterol (Symbicort)
• fluticasone-salmeterol (Advair HFA)
• formoterol-mometasone (Dulera)

How to use

Every MDI comes with its own instructions. In general, here’s how to use one:

• Remove the cap from the inhaler.
• With the mouthpiece facing down, shake the inhaler for about 5 seconds to mix the medication.
• Then use one of these techniques:
  • Open-mouth technique: Hold the mouthpiece 1 1/2 to 2 inches from your mouth.
  • Closed-mouth technique: Put the mouthpiece between your lips and close your lips tightly around it.
  • With a spacer: Place the MDI inside the spacer and close your lips around the spacer.
• Gently breathe out.
• Press the inhaler and take a deep breath in through your mouth at the same time. Keep breathing in for 3 to 5 seconds.
• Hold your breath for 5 to 10 seconds to get the medication into your airways.
• Relax and breathe out slowly.
• Repeat the process if you need more puffs of the medication.

Pros and cons

Pros of using MDIs include:

• They’re easy to use.
• They can be used with many different types of COPD drugs, including steroids, bronchodilators, and combination drugs.
• They provide the same dose of medication each time you use them.

Cons of using MDIs include:

• MDIs require you to coordinate between activating the medication and breathing it in. It’s also necessary to breathe in slowly and deeply. If you breathe in too quickly, the medication will hit the back of your throat, and much of it won’t reach your lungs.
• You may also need to use a spacer to get the medication into your lungs.

Dry powder inhalers for COPD

A dry powder inhaler (DPI) delivers medication to your lungs when you breathe in through the device. Unlike an MDI, a DPI doesn’t use a propellant to push medication into your lungs. Instead, your inward breath activates the medication.

DPIs come in single-dose and multiple-dose devices. Multiple-dose devices contain up to 200 doses.

Steroids available as DPIs include:

• budesonide (Pulmicort Flexhaler)
• fluticasone (Flovent Diskus)
• mometasone (Asmanex Twisthaler)

Bronchodilators available as DPIs include:

• albuterol (ProAir RespiClick)
• salmeterol (Serevent Diskus)
• tiotropium (Spiriva HandiHaler)

Combination drugs available as DPIs include:

• fluticasone-vilanterol (Breo Ellipta)
• fluticasone-salmeterol (Advair Diskus)

How to use

Every DPI comes with its own instructions. In general, here’s how to use one:

• Remove the cap.
• Turn your head away from the device and breathe out all the way. Don’t exhale into the device, or you might scatter the medication.
• Place the mouthpiece into your mouth and close your lips around it.
• Breathe in deeply for a few seconds until you fill your lungs.
• Take the device out of your mouth and hold your breath for up to 10 seconds.
• Breathe out slowly.

Pros and cons

Pros of using DPIs include:

• They’re easy to use.
• You don’t need to coordinate pressing the device and breathing in the medication.
• You don’t need to use a spacer.

Cons using of DPIs include:

• You have to breathe in harder than you would with an MDI.
• It’s hard to get the exact same dose each time you use the inhaler.
• DPIs can be affected by humidity and other environmental factors.

Soft mist inhalers for COPD

The soft mist inhaler (SMI) creates a cloud of medication that you inhale without the help of a propellant. Because the mist contains more particles than MDIs and DPIs, and the spray leaves the inhaler more slowly, more of the drug gets into your lungs.

Tiotropium (Spiriva Respimat) and olodaterol (Striverdi Respimat) are bronchodilator drugs that come in a soft mist. Stiolto Respimat combines the drugs.

How to use

To use an SMI:

• Open the cap after you’ve prepared the device following the manufacturer’s instructions.
• Breathe out slowly and fully.
• Close your mouth around the mouthpiece. Do not cover the air vents on the side of the device.
• Take a slow deep breath while you press the dose release button. Inhale the mist.
• Hold your breath for 10 seconds.
• Repeat if necessary to get the dose your doctor prescribed.

Pros and cons

Pros of using SMIs include:

• More of the medication gets into your lungs than with an MDI or DPI, so you can use a lower dose.
• The mist comes out slowly, and the device doesn’t require any coordination.
• You don’t need to use a spacer.

Cons of using SMIs include:

• It’s harder to load the dose into the device compared to other devices.

Read more about COPD drugs and inhalers for COPD.

The bottom line

When used correctly, inhalers can help relieve your COPD symptoms. Ask your doctor to show you how to use your specific inhaler.

Be sure to keep track of the expiration dates on your medication and get a new prescription if it expires.

Take your medication exactly as your doctor prescribes. If you need a daily controller medication, take it every day, even if you feel well. Let your doctor know if you experience side effects, but never stop taking the medication unless otherwise advised.

Learn about nebulizers for COPD.