COPD Inhalers and Medications

A Guide to Treatment For COPD

When you have shortness of breath, one of the hallmark symptoms of COPD, the first thing that you probably run to is your COPD inhaler. And that's a good thing, because a COPD inhaler, when used correctly, can open blocked airways, provide prompt symptom relief, and in some cases, relieve inflammation.

Treatment can become confusing, however, as there are different medications used in inhalers as well as different types of inhalation devices. Add to that the fact that some medications have several different brand names and some inhalers contain more than one medication, and you may feel like you need a degree in pharmacy to care for your health.

Yet, whatever medications you are prescribed and whether you use a nebulizer or a metered-dose inhaler, the following guide to COPD inhalers and medications will help make your COPD treatment more manageable.

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List of Common COPD Medications

Woman taking asthma inhaler
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If you are living with COPD or a caregiver to someone who has COPD, learning all you can about common COPD medications can help you feel more empowered in your journey.

Some of these medications are used through inhalers or nebulizers, some are taken in pill form, and some may also be given intravenously. The major categories of medications used in treatment include:

  • Antibiotics: Medications which treat secondary infections when they develop.
  • Bronchodilators: Medications which dilate your airways to improve airflow.
  • Corticosteroids: Medications which reduce inflammation in your airways.
  • Phosphodiesterase-4 (PDE4) Inhibitors: Medications which inhibit inflammation and help relax smooth muscle in the airways.
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A Closer Look at Bronchodilators

Bronchodilators are a mainstay of treatment for COPD and work by relaxing your airways to improve the flow of air to your lungs. 

There are three types of bronchodilators, including:

  • Beta-agonists: Beta-agonists may be used in an inhaler or given by tablet or IV. There are both short-acting (SABAs) and long-acting beta-agonists (LABAs). Short-acting beta-agonists include Proventil/Ventolin/ProAir/AccuNeb (albuterol), Xopenex (levalbuterol), Maxair (pirbuterol), and metaproterenol. LABA's include Performomist (formoterol), bambuterol, indacaterol, and Brovana (arformoterol).
  • Anticholinergics/muscarinic antagonists: Anticholinergics are only available by inhalation and also come in short-acting and long-acting forms. Atrovent (ipatropium) is a short acting anticholinergic (SABA) whereas medications such as Spiriva (tiotropium) and Tudorza Pressair (aclidinium) are long acting anticholinergics (LAMAs).
  • Methylxanthines: Methylxanthines are not available in an inhaled form.

For people who have moderate to severe COPD and experience shortness of breath and/or exercise intolerance, a combination of both a long-acting beta-agonist (LABA) and a long-acting anticholinergic (LAMA) is recommended over either of these medications alone.

Bronchodilators may be combined with another medication, such as the inhaler Bevespi Aerosphere which combines a long-acting beta-agonist and a long-acting anticholinergic, or the inhaler Symbicort which combines a long-acting beta-agonist with a corticosteroid.

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Glucocorticoids

If you've been living with COPD for awhile, you're likely familiar with some of the pros and cons of glucocorticoids.

Glucocorticoids can reduce inflammation, although glucocorticoid inhalers are not recommended for people with stable COPD. These inhalers have been shown to reduce the number of COPD exacerbations and improve quality of life for people with advanced COPD, but they don't change the mortality. In addition, they are associated with an increased risk of developing pneumonia, and withdrawing from these medications can result in exacerbations.

That said, inhaled corticosteroids can be helpful for those who also have asthma or experience one or more COPD exacerbations each year.

Examples of inhalers in this category include Flovent (fluticasone), Beclovent/Qvar (beclomethasone), Aerobid/Aerospan (flunisolide), and Pulmicort (budesonide).

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List of Common COPD Inhalers

COPD inhalers are commonplace in the treatment of COPD, so much so that there are many types available and understanding which-is-which and what-does-what can sometimes be confusing. In order to simplify this discussion, you can take a moment to learn more about the most common types of COPD inhalers on the market in the U.S.

5

The Difference Between Metered-dose Inhalers and Wet Nebulizers

Not only are there a number of differences in the medications which can be inhaled to treat COPD but there are differences in how they can be inhaled as well.

Is it better to receive a medication through a metered dose inhaler or a nebulizer?

Historically, it's often been thought that a nebulizer works better than a metered dose inhaler, but there is some evidence to the contrary. Overall, the battle of metered dose inhalers vs nebulizers is still going strong.

There is a role for both of these devices. Metered dose inhalers are less expensive and result in fewer side effects (such as anxiety). They may also result in faster improvement in the emergency room setting. That said, there is more room for error with a metered dose inhaler and a large number of people prescribed these devices use them incorrectly.

The addition of a spacer chamber, which holds the medication until the patient is ready to inhale, can reduce some of this error (this can especially help children).

Nebulization treatments are often used in the hospital setting and are more versatile as they can be given through a mask or even an endotracheal tube. They require less coordination to maximize effectiveness.

It's likely that some people will find one device or the other better for their particular symptoms, and it may come down to individual preference.

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How to Use a Metered-Dose Inhaler

Using a metered-dose inhaler (MDI) can prove more challenging than using a nebulizer, especially for patients with compromised physical ability. Yet even if you have good coordination and follow the directions perfectly, you may not get the full benefit of the inhaler. Studies have found that the majority of people use their inhalers incorrectly.

Whether you have only recently been prescribed a metered dose inhaler or a veteran user having used these for years, take a moment to review how to use your inhaler properly

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Bottom Line on Inhaled Medications for COPD

Inhaled medications are a mainstay for many people with COPD. These medications may include one of the types of bronchodilators, a corticosteroid, or a combination of the two. There are also differences in inhalation methods with inhalers, nebulizers, and many varieties of each to choose from. Taking the time to learn about your medications is a huge step in being an active part of your COPD care. 

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Article Sources
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Additional Reading
  • Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

  • Tashkin, D. A Review of Nebulized Drug Delivery in COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2016. 11:2585-2596.