Inhalers Used for Treating COPD

Common ingredients and proper use

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.

Woman using inhaler
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Your doctor may prescribe a combination of inhalers for you to use—some are taken on a daily schedule for disease control, while 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 oral medications used to treat COPD. As such, combining medications requires careful planning and medical advice to avoid potentially dangerous side effects.

Types of COPD Inhalers

A COPD inhaler can contain either a single medication or a combination of ingredients. Bronchodilators open the airways, anticholinergics/muscarinic antagonists) prevent the contraction of muscles lining the airways to keep them open, and glucocorticoids reduce inflammation. All of these actions can help reduce airway constriction so that air can pass into your lungs more effectively as you breathe.

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.

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 different bronchodilators
  • A combination of bronchodilator(s) and a corticosteroid

Some inhalers are meant to be used daily over the long term, while others, called rescue inhalers, are used only in emergency situations.

Inhaler Recommendations for COPD

It can be extremely confusing to learn about the multiple different types and combination of inhalers available for COPD, but this can be simplified by looking at current guidelines and using a few examples about when the various types are used alone or together.

When choosing the best inhaler or inhalers, physicians look at a few primary issues:

  • Spirometry: Forced expiratory volume in 1 second (FEV1) describes the degree of airflow limitation. The GOLD Guide separates people into four different groups (A through D) based on FEV1 readings.
  • Symptoms: Symptoms of either shortness of breath (dyspnea) or exercise intolerance are very important in selecting treatment. Shortness of breath can be described by the Modified Medical British Research Council dyspnea scale (mMRC dyspnea scale) or COPD Assessment Test (CAT). Exercise intolerance can be estimated using the 6 minute walk test.
  • COPD exacerbations: Different choices may be made for those who have one or more exacerbations per year and those who do not.
  • Co-existing conditions: Different choices may be considered if a person has a history of asthma or other medical conditions.

For mild COPD, an inhaler may not be required, but studies suggest that treatment can often improve quality of life. A long-acting beta agonist (LABA) may be used preventively, a short-acting beta agonist (SABA) to control symptoms, or both may be used together.

For those who have moderate or severe COPD and also have shortness of breath or exercise intolerance, 2020 guidelines suggest that a combination of both a long-acting beta agonist (LABA) and a long-acting anticholinergic (LAMA) be used rather than either of these alone.

For people who also have asthma or a high eosinophil count (the type of white blood cell that tends to be elevated with allergies), a corticosteroid inhaler may or may not be used. Otherwise, it's recommended that corticosteroid inhalers only be used for those who have moderate to severe COPD and one or more exacerbations per year. For those who do not have asthma and have not had an exacerbation for a year, corticosteroid inhalers should be discontinued as the risks (increased risk of pneumonia) would likely outweigh the benefits of treatment (fewer exacerbations).

Certainly, guidelines are only recommendations and there are exceptions. It's important to work with your doctor to design a treatment plan that is right for you and an individual.

COPD Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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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.

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.

Keep in mind that there are other dosing combinations for this medication as well.

Side Effects

When used for COPD, the most common side effects include pneumonia, fungal mouth infections, throat irritation, respiratory infections, headaches, and muscle aches.

Cost

The Advair discus generally supplies one month of medication, with out-of-pocket prices ranging from approximately $100 for the generic version to $430 for the brand version.

The out-of-pocket cost of one canister of Advair HFA is about $400. There is no generic version of this form available.

Albuterol

Proair-HFA, Ventolin HFA, Proventil HFA, Accuneb, and Proair RespiClick (albuterol) is a rescue inhaler that is used to help with urgent breathing problems. It contains albuterol, a short-acting beta-agonist.

Albuterol helps immediately relax the airways, making it easier to breathe. It is often used for managing sudden episodes of ​shortness of breath related to bronchospasm in both asthma and​ COPD.​​

This inhaler can be used about 15 to 30 minutes prior to exercise to prevent exercise-induced symptoms. And it can also be used for symptomatic relief taken as one or two inhalations every four to six hours.

Each brand of this medication comes in a package with instructions for use, as the doses are slightly different. For example, Ventolin HFA and Proventil HFA come in an aerosol canister containing 200 metered inhalations and fitted with a counter (a container with 60 doses is available for Ventolin HFA as well). Each inhalation delivers 90 mcg albuterol.

Proair HFA comes in a powdered metered dose inhaler or an aerosol metered-dose inhaler that delivers a dose of 90 mcg. The inhaler is an 8.5-g canister containing 200 doses.

Because you might not use albuterol, on a regular basis, it is recommended that you prime the inhaler. For example, you would prime Proair HFA by spraying three times in a direction away from your face if you haven't used it in over two weeks.

Side Effects

The most common side effects include headaches, tachycardia (rapid heart rate), pain, dizziness, sore throat, and runny nose.

Cost

The cost without insurance of a standard brand container, which provides 200 doses, is approximately $32, although it can cost more depending on the brand. Generic albuterol costs approximately $25 for the same supply of 200 doses.

Arcapta Neohaler

The Arcapta Neohaler (indacaterol) is a long-acting beta-agonist bronchodilator. It's used for once-daily, long-term maintenance treatment of airflow obstruction in COPD, including emphysema and chronic bronchitis.

It is administered via a dry powder inhaler at a dose of 75 mcg. This medication is only to be used with the Aracpta Neohaler.

Side Effects

The most common side effects include cough, throat pain, upper respiratory infections, headaches, and nausea.

Cost

The out-of-pocket cost of a standard package, which includes a one-month supply, is approximately $250, and it is not available in a generic version.

Atrovent

Atrovent (ipratropium) is an anticholinergic bronchodilator. It's used in the maintenance treatment of chronic COPD, including bronchospasm, emphysema and chronic bronchitis.

It can be taken as two inhalations of 17 mcg each. It is typically used three or four times per day. Atrovent is supplied in a 12.9 g canister containing 200 doses.

Side Effects

Side effects of Atrovent include bronchitis, COPD exacerbation, shortness of breath, and headaches.

Cost

The out-of-pocket cost of a canister containing a one-month supply is approximately $400 and there is no generic.

Bevespi Aerosphere

Bevespi Aerosphere is a combination of two long-acting bronchodilators, glycopyrrolate and formoterol. It is intended as a maintenance treatment for chronic COPD and is taken to help open airways and keep them open.

Bevespi Aerosphere is not a rescue inhaler and is not used to treat sudden COPD symptoms.

It is taken as two inhalations twice per day, each supplying 9 mcg glycopyrrolate and 4.8 mcg formoterol fumarate.

Side Effects

The most common side effects include urinary tract infection and cough.

Cost

The pressurized metered-dose inhaler contains a one-month supply of the medication and costs approximately $350, without insurance. There is no generic version.

Breo Ellipta

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 with COPD, including emphysema and chronic bronchitis.

The medication comes in two double-foil blister strips of powder formulation for oral inhalation. Each contains blisters that have either fluticasone furoate 100 mcg or vilanterol 25 mcg.

It is taken in doses of 25 mcg vilanterol/100 mcg fluticasone once daily.

Side Effects

Side effects include upper respiratory infections, headaches, and fungal mouth infection.

Cost

The cost of a standard package, which can serve as a two-month supply for some patients, is approximately $350. There is no generic version of this drug combination, although fluticasone furoate is available as a generic nasal spray.

Brovana

Brovana (arformoterol) is a long-acting beta-agonist bronchodilator. It's used for long-term maintenance treatment in chronic 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 to be used with a standard jet nebulizer with a face mask or mouthpiece, connected to an air compressor.

Brovana is not a rescue inhaler, nor does it treat asthma.

Side Effects

Side effects include chest pain and back pain, diarrhea, sinusitis, leg cramps, shortness of breath, rash, flu, leg swelling, and lung disease.

Cost

A standard package contains a two-month supply and costs approximately $1,000, or more, out-of-pocket. There is not a generic version of Brovana.

Combivent Respimat

Combivent contains albuterol, a short-acting beta-agonist, and ipratropium, an anticholinergic. It is used in COPD as a second inhaler when symptoms are not controlled with a regular aerosol bronchodilator.

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.

Side Effects

The most common side effects include upper respiratory infections, cough, bronchitis, headaches, and shortness of breath.

Cost

A standard inhaler generally includes a month supply and is expected to cost approximately $450. There is no generic version of this combination, although albuterol and ipratropium are both available separately in generic formulations.

Performomist

Performomist (formoterol) is a long-acting beta-agonist that is taken twice daily for the management of chronic COPD.

It is available in a solution for inhalation at a dose of 20 mcg/2mL. The solution is used with a standard jet nebulizer with a facemask or mouthpiece connected to an air compressor. The inhalation solution should always be stored in the foil pouch and removed right before you will use it.

Side Effects

Side effects include diarrhea, nausea, throat infection, dry mouth, vomiting, dizziness, and trouble sleeping.

Cost

The cost of a standard solution, which includes a two-month supply, is about $1,000; there is no generic version.

Pulmicort

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.

Side Effects

Side effects include nasal congestion, upper respiratory tract infection, nausea, gastrointestinal (GI) infection, ear infection, and fungal mouth infection.

Cost

The price of a one-month supply is approximately $40, and there is no generic version.

Dosing Measures

"mcg" = micrograms

"mg" = milligrams

Spiriva

Spiriva contains tiotropium, an anticholinergic bronchodilator. It opens and relaxes the airways, making it easier to breathe.

Spiriva (tiotropium) is used as a maintenance treatment for COPD, especially if bronchospasm is a major part of your disease. It is considered preventative for COPD exacerbations.

The inhaled solution comes in a dose of 1.25 mcg or 2.5 mcg and is taken as two inhalations once per day. It is also available in an 18 mcg powder-filled capsule to be used with a HandiHaler device, which is also taken as two inhalations once per day. 

Side Effects

Side effects include upper respiratory infection, cough, dry mouth, urinary tract infection, and heartburn.

Cost

The cost of a one-month supply is about $450, and there is no generic version.

Symbicort

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 and it is taken as two inhalations twice per day.

Side Effects

When used for COPD, the most common side effects include upper respiratory infections, fungal mouth infection, and bronchitis.

Cost

The cost of one inhaler of this medication is approximately $204; there is no generic version.

Trelegy Ellipta

Trelegy Ellipta contains three active ingredients: fluticasone furoate (an inhaled corticosteroid), umeclidinium (a long-acting anticholinergic), and vilanterol (a long-acting beta-agonist). It is intended to open your airways, reduce inflammation, and to improve lung function. It is used for chronic COPD, especially for patients who have improved with fluticasone furoate and vilanterol, but need additional treatment for control of symptoms and prevention of exacerbations.

This medication is used once a day and comes as an inhaler containing two foil blister strips of powder (100 mcg fluticasone furoate; 62.5 mcg umeclidinium and 25 mcg vilantero).

Side Effects

The most common side effects include headaches, back pain, trouble swallowing, diarrhea, cough, throat pain, and GI infections.

Cost

The cost of one inhaler is approximately $580, and this combination is not available in a generic version.

Tudorza Pressair

Tudorza Pressair (aclidinium bromide) is a long-acting bronchodilator and is meant to be used twice daily. It is used for chronic COPD with bronchospasm. Like the other long-acting bronchodilators, it is not used as a rescue inhaler.

It is available in a device containing dry powder metering and used to deliver 400 mcg aclidinium bromide per inhalation.

Side Effects

Side effects include headaches, upper respiratory infection, and cough.

Cost

The cost of a device, which contains a one-month supply of medication, is about $360, and there is no generic version.

Xopenex

Xopenex (levalbuterol) is a short-acting beta-agonist bronchodilator that is used three or four times per day in one or two inhalations. It is used for the management of chronic COPD and it can be used as a rescue inhaler as well.

It 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). Each inhaled dose of Xopenex HFA delivers 67.8 mcg levalbuterol and 59 mcg levalbuterol tartrate from the actuator mouthpiece. It is supplied in either a 15 g pressurized canister containing 200 doses or an 8.4 g canister containing 80 doses.

If you have not used the medication in three days, the manufacturer recommends that you spray four sprays in the air and away from your face to prime it.

Side Effects

Side effects include an increased risk of accidental injury, bronchitis, dizziness, pain, sore throat, runny nose, and vomiting.

Cost

The cost of a 24-day supply is about $24 for generic and $75 for the brand version.

A Word From Verywell

Learning about your COPD inhalers can help ensure that you have the best quality of life possible while minimizing the chance for medication errors. Make sure your doctor explains the benefits and risks of any treatment she recommends and answers any questions you may have.

A 2019 study suggested that errors may occur with inhaler use for up to 87% of people. While this may seem frightening, the risk of errors can be reduced greatly by learning how to properly use your inhaler, and checking both the brand name and generic names of your medications to make sure you aren't doubling up on any one drug (especially if you see more than one doctor).

Being your own advocate in your medical care can not only help you feel more in control of your condition, but may affect your quality of life and outcome as well.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Nannini LJ, Lasserson TJ, Poole P. Do combined inhalers (steroid plus bronchodilator) offer additional benefits or harms in people with COPD compared with the bronchodilator alone? In: Cochrane. Updated September 12, 2012.

  2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2020 report).

  3. Singh D, D’Urzo AD, Donohue JF, et al. Weighing the evidence for pharmacological treatment interventions in mild COPD; a narrative perspectiveRespiratory Research. 2019. 20:141 doi:10.1186/s12931-019-1108-9

  4. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2020. 201(9):e56-e69. doi:10.1164/rccm.202003-0625ST

  5. Food and Drug Administration, Advair Discus label. Updated April 2008.

  6. Food and Drug Administration. Ventolin. Updated December 2014.

  7. Food and Drug Administration. Proair HFA (albuterol sulfate). Updated February 2019.

  8. Food and Drug Administration. Aracapta. Updated July 2011.

  9. Food and Drug Administration. Atrovent. Updated 2012.

  10. Food and Drug Administration. Bevespi Aerosphere. Updated April 2016.

  11. Food and Drug Administration. Brio Ellipta. Updated 2013.

  12. Food and Drug Administration. Brovana. Updated February 2014.

  13. Food and Drug Administration. Combivent Respimat label. Updated August 2012.

  14. Food and Drug Administration. Perforomist label. Updated May 2010.

  15. Food and Drug Administration. Pulmicort label. Updated April 2010.

  16. Food and Drug Administration. Spiriva Respimat. Updated September 2015.

  17. Food and Drug Administration. Spiriva Handihaler. Updated December 2009.

  18. Food and Drug Administration. Symbicort label. Updated January 2017.

  19. Food and Drug Administration. Trelegy Ellipta. Updated September 2017.

  20. Food and Drug Administration. Tudorza Pressair. Updated November 2018.

  21. Food and Drug Administration. Xopenex HFA.Updated July 2012.

  22. Lavorini F, Janson C, Braivo F, Stratelis G, Lokke A. What to Consider Before Prescribing Inhaled Medications: A Pragmatic Approach for Evaluating the Current Inhaler Landscape. Therapeutic Advances in Respiratory Disease. 2019. 13:1753466619884532. doi:10.1177/1753466619884532

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