Inhaler Therapies Used to Treat COPD

You may need more than one type of inhaler to manage your COPD

Woman with short hair using an inhaler
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Inhaler therapies are an important part of managing chronic obstructive pulmonary disease (COPD). Inhaled medications used for treating COPD include bronchodilators and steroids.

There are three categories of inhalers used in COPD:

  • Short-acting bronchodilators
  • Long-acting bronchodilators
  • Inhaled steroids

Each of these medications affects COPD differently. Some inhalers contain only one medication (monotherapy) and others contain multiple drugs (each with a different mechanism of action).

Because they are inhaled directly into the airway, these medications generally work quickly and tend to cause fewer systemic side effects than pills or injections. Your doctor may prescribe one or more inhalers for you, as well as oral (by mouth) or injectable medications for your COPD.

Short-Acting Bronchodilators

You may experience COPD symptoms (e.g., shortness of breath, wheezing) when you physically exert yourself or when you have an infection. A short-acting bronchodilator, also known as a rescue inhaler, can quickly alleviate your COPD symptoms when you experience an exacerbation.

Bronchodilators work by opening (dilating) the air sacs (bronchioles) that become constricted during a COPD flare-up. Short-acting bronchodilators are "fast on and fast off"—i.e., they work quickly and provide relief for around four to six hours.

Short-acting bronchodilators should only be used when needed. You should carry one with you wherever you go in case of an emergency.

There are two classes of bronchodilators. Beta-agonists bind to receptors in the lung to relax the bronchi. Anticholinergics block acetylcholine, the neurotransmitter that triggers spasm (sudden narrowing) of the muscles of the bronchi.

The short-acting anticholinergic used for the treatment of COPD is Atrovent (ipratropium).

There is also a combination short-acting inhaler that contains ipratropium and albuterol (Ipratropium/salbutamol).

Long-Acting Bronchodilators

When you have COPD, your doctor may prescribe a long-acting inhaled bronchodilator for you to take every day, whether you have symptoms or not.

The effects of long-acting bronchodilators can last between 12 to 24 hours. As with short-acting bronchodilators, they contain either a beta-agonist or anticholinergic drug.

Long-acting beta-agonists (LABAs) include:

  • Salmeterol
  • Performomist (formoterol)
  • Bambec (bambuterol)
  • Arcapta Neohaler (indacaterol)
  • Brovana (arformoterol)

Long-acting anticholinergics include:

  • Spiriva (tiotropium)
  • Tudorza Pressair (aclidinium bromide)
  • Seebri Neohaler (glycopyrronium)
  • Incruse Ellipta (umeclidinium)

Using a Bronchodilator

Whether you use a short- or long-acting bronchodilator, it is important that you use it the right way. You should also familiarize yourself with possible side effects, so you can report any you experience to your doctor:

  • Inhaled beta-agonist therapy may cause palpitations, muscle cramps, upset stomach, and a nervous/shaky feeling.
  • Anticholinergic therapies can cause a dry mouth, urinary retention, blurred vision, drowsiness, and an increased risk of glaucoma.

Inhaled Steroids

Inhaled steroids work differently than bronchodilators. Inhaled steroids function in the same way as oral steroids, but they work faster. Steroids reduce inflammation in the lungs, and they can quickly decrease the airway swelling and mucus build-up that occur in COPD.

Your doctor will prescribe a schedule for you to follow when using your steroid inhaler. A twice-daily schedule is fairly typical for COPD.

Even though they are fast-acting, steroid inhalers often require a two-week loading period before they take full effect.

The inhaled steroids commonly used to treat COPD are:

Side effects of inhaled steroids may include a sore mouth or throat, hoarse voice, and oral candidiasis (thrush). Long-term use is associated with an increased risk of glaucoma and osteoporosis.

Combination Inhalers

Inhalers are also available as combination formulations that contain steroids and bronchodilators.

Combination inhalers used for the treatment of COPD include:

A Word From Verywell

If you are prescribed a short-acting bronchodilator and a steroid inhaler, your doctor may recommend that you use your rescue bronchodilator first, and then your steroid inhaler. This is because your bronchodilator will rapidly open your airways, allowing the steroid to reach deeper into your lungs. Be sure to follow the instructions provided to you.

Also check to see if you have duplicates of the same inhaler (the same drug may have different brand names). You can experience serious side effects if you use a high dose of the same drug all at once.

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