COPD Treatment Don’t Combine These COPD Medicines Check this table to make sure you can use your COPD inhalers together By Lauren Van Scoy, MD Lauren Van Scoy, MD Facebook Twitter Lauren Van Scoy, MD, is a board-certified physician in internal medicine, pulmonary medicine, and critical care. Learn about our editorial process Updated on February 09, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Sanja Jelic, MD Medically reviewed by Sanja Jelic, MD Sanja Jelic, MD, is board-certified in sleep medicine, critical care medicine, pulmonary disease, and internal medicine. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Nick Blackmer Fact checked by Nick Blackmer LinkedIn Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content. Learn about our editorial process Print Table of Contents View All Table of Contents Classes of Inhalers Possible Concerns Safe or Unsafe? Most people with chronic obstructive pulmonary disease (COPD) use an inhaler every day to control shortness of breath and other symptoms of this progressive lung disease. There are many different kinds of inhalers. Some are used once or twice a day to manage COPD and prevent acute exacerbations (attacks). Others are used as needed when an exacerbation occurs. As a result, most people with COPD use several different inhalers as part of the treatment plan. Cultura RM / JPM / Getty Images This article describes some of the concerns related to the use of different inhaler medications. It also lists the inhalers that should not be used together as well as several that may be OK. Classes of COPD Inhaler Medications There are different classes of inhaled medications used in the treatment of COPD. Among them: Antimuscarinic drugs reverse airway narrowing by acting on a nerve transmitter called acetylcholine. Long-acting beta-agonists (LABAs) relax airways by acting on receptors in the lungs, called beta-2 adrenergic receptors. Short-acting beta-agonist (SABAs) work similarly to LABA but are used as a rescue inhaler rather than for daily use Inhaled steroids improve breathing by reducing inflammation. Recap There are four main groups of inhaled drugs used in the treatment of COPD: antimuscarinic drugs, long-acting beta-agonists (LABAs), short-acting beta-agonists (SABAs), and inhaled steroids. Possible Concerns Although more than one inhaler may be prescribed to treat COPD, that shouldn't suggest that they can all be used together. In fact, using some together can pose health risks. Possible concerns include: Overdosing: Some inhalers contain a single drug, while others contain two or three drugs. This increases the risk of overdosing if the same drug is included in two different inhalers. Increased side effects: Inhalers of the same drug class can cause many of the same symptoms. Using two inhalers of the same class can increase the risk or severity of side effects Interactions: There are certain inhaler drugs that can interact with other inhaler drugs, causing severe drops in blood potassium (hypokalemia) and heart rhythm problems (cardiac arrhythmia). Recap Not all COPD inhalers can be used together. Using inhalers of the same class can be lead to overdosing as well as an increased risk of side effects. Other inhaled drugs may interact and lead to abnormal drops in blood potassium and heart rhythm problems. Combinations That Are Safe or Unsafe There are certain inhalers that can be used together and others that cannot. Here are some you need to watch out for if you or someone you love is being treated for COPD: Antimuscarinic Inhalers Controller medications are those used to control symptoms of COPD and prevent exacerbations. Antimuscarinic drugs are controller medications used once or twice daily. Drug Class Consideration Reason Atrovent HFA (ipratropium) Antimuscarinic Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Incruse Ellipta (umeclidinium) Antimuscarinic Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Spiriva (tiotropium) Antimuscarinic Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Tudorza (aclidinium) Antimuscarinic Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Anoro Ellipta (umeclidinium/vilanterol) Antimuscarinic, LABA Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Bevespi Aerosphere (glycopyrrolate/formoterol) Antimuscarinic, LABA Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Breo Ellipta (fluticasone/vilanterol) Antimuscarinic, LABA Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Stiolto Respimat (tiotropium/olodaterol) Antimuscarinic, LABA Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) Antimuscarinic, LABA, inhaled steroid Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Combivent Respimat (ipratropium/albuterol) Antimuscarinic, SABA Should not be used with other medications containing antimuscarinic drugs Increased risk of side effects Beta-Agonists Beta-2 adrenergic agonists (also known as beta-agonists) are a mainstay treatment for COPD. There are short-acting versions used as rescue inhalers and long-acting versions that are used to control COPD. Class Consideration Reason Albuterol (generic) SABA OK to take with LABAs N/A Brovana (arformoterol) LABA OK to take with SABAs N/A Foradil (formoterol) LABA OK to take with SABAs N/A Perforomist (formoterol) LABA OK to take with SABAs N/A Serevent (salmeterol) LABA OK to take with SABAs N/A Striverdi Respimat (olodaterol) LABA OK to take with SABAs N/A Inhaled Steroids Inhaled glucocorticoids (also known as inhaled steroids) are commonly used in combination with other inhaled drugs to control COPD. They are mainly used in people with a history of exacerbations. Class Consideration Reason Advair (fluticasone/ salmeterol) Inhaled steroid and LABA OK to take with SABAs N/A Symbicort (budesonide/formoterol) Inhaled steroid and LABA OK to take with SABAs N/A Flovent (fluticasone) Inhaled steroid May be used with Advair or Symbicort for severe COPD Increased risk of hypokalemia and heart rhythm problems QVAR (beclomethasone) Inhaled steroid May be used with Advair or Symbicort for severe COPD Increased risk of hypokalemia and heart rhythm problems Summary People with COPD are commonly treated with more than one inhaler. Some are used as controller medications and others are used as “rescue inhalers” when you have a COPD attack. As effective as these drugs are, not all can be used together. While it is common to use more than one inhaler for COPD, problems can occur if you use two drugs of the same class. Doing so can expose you to double the medication, leading to overdosing and an increased risk of side effects. Other drugs are known to interact, causing severe drops in blood potassium and heart rhythm problems. A Word From Verywell 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 13 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. National Library of Medicine, DailyMed. Atrovent HFA- ipratropium bromide aerosol, metered [drug label]. National Library of Medicine, DailyMed. Incruse Ellipta- umeclidinium aerosol, powder [drug label]. National Library of Medicine, DailyMed. Spiriva Respimat- tiotropium bromide inhalation spray spray, metered [drug label]. National Library of Medicine, DailyMed. Tudorza Pressair- aclidinium bromide powder, metered [drug label]. National Library of Medicine, DailyMed. Anoro Ellipta- umeclidinium bromide and vilanterol trifenatate powder [drug label]. National Library of Medicine, DailyMed. Bevespi Aerosphere- glycopyrrolate and formoterol fumarate aerosol, metered [drug label]. National Library of Medicine, DailyMed. Breo Ellipta- fluticasone furoate and vilanterol trifenatate powder [drug label]. National Library of Medicine, DailyMed. Stiolto Respimat- tiotropium bromide and olodaterol spray, metered [drug label]. National Library of Medicine, DailyMed. Combivent Respimat- ipratropium bromide and albuterol spray, metered [drug label]. National Library of Medicine, DailyMed. Advair Diskus- fluticasone propionate and salmeterol powder [drug label]. National Library of Medicine, DailyMed. Symbicort- budesonide and formoterol fumarate dihydrate aerosol [drug label]. National Library of Medicine, DailyMed. Flovent Diskus- fluticasone propionate powder, metered [drug label]. National Library of Medicine, DailyMed. QVAR Redihaler- beclomethasone dipropionate HFA aerosol, metered [drug label]. By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies