Don't Combine These COPD Medicines

Most patients with COPD should be taking an inhaler every day to control their symptoms of shortness of breath. While there are many kinds of inhalers, there are some inhalers meant to be taken once or twice a day regardless of symptoms (eg. Spiriva) and some inhalers meant to be taken "as needed", for instance, whenever you have symptom or right before exercise (albuterol, Combivent, Ventolin, etc).

As a result, most patients with COPD use several different inhalers.

Sometimes this can be very confusing, especially because inhalers are often changed due to clinician preference, insurance coverage, or other reasons. Thus, sometimes, patients may end up using inhalers inappropriately or in combination with medications they should not be.

Below is our attempt to help understand which inhalers can and should be used together, and which ones should not be used together. Different classes of medications can be used in combination (for example, combining a beta agonist with an anti-muscarinic inhaler), but in most cases, patients should not take the same class of medicine in more than one inhaler. The following chart helps explain this:

	How often it is taken	Class of Medication	Important to note
Controller medications
Spiriva (tiotropium)	Daily	Anti-muscarinic	Note this medication should not be taken with Combivent
Turdoza	Twice daily	Anti-muscarinic	Note this medication should not be taken with Combivent
As needed inhalers (or nebulizers)
Albuterol (Ventolin, pro air, others)	As needed	Short-acting beta-agonist	Note that it is OK to take this with long-acting beta agonists
Combivent, Duoneb	As needed	Beta-agonist and anti-muscarinic	Note these medications should not be taken with Spiriva.
Inhaled Steroids
Advair, Symbicort		inhaled glucocorticoid and long-acting beta agonist	Note that it is OK to take this with short-acting beta agonists
Flovent, Q-Var		inhaled glucocorticoid	Note that sometimes, in severe COPD, patients may use this inhaler in addition to Advair or Symbicort

To make sure your inhalers are ok to take together, look at the class of medications. If you notice that you take more than one medicine in the same class, ask your physician to review your prescriptions. It is really important to know that the information on this site is meant to be 'in general' and that there are always exceptions to every "rule"– especially in medicine.