COPD Inhalers: Understanding the Different Types

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The GOLD* standard for treating COPD is to use handheld inhalers to deliver needed medication. Sometimes the medication is used to control and prevent symptoms of COPD. Other times the medication is used to relieve a worsening of symptoms, which is called an exacerbation or flare-up.

However, there are several different categories of inhalers and that can get confusing. It's important to understand the similarities and differences, so that you are sure to take your medication correctly and, therefore, keep your health under the best control you can. GOLD* is an acronym that is short for Global Initiative for Chronic Obstructive Lung Disease, an organization that works to raise awareness worldwide about COPD and to improve treatment and prevention. They also set standards for the treatment of COPD.

Controller vs. Rescue Inhalers

From the perspective of how an inhaler is used to treat COPD, there are two different types:

  • Controller, or preventer inhalers
  • Rescue inhalers

Controller medications delivered via a handheld inhaler are long-acting substances that work to protect your airways by reducing or preventing inflammation, mucus production and swelling. And some relax and expand the opening in the airways, to help you breathe easier. There are various forms of controller medicines:

  • Corticosteroids, such as budesonide or beclamethasone
  • Long-acting broncodilators, such as formoterol or tiotropium
  • PDE4-inhibitors, such as Dalliresp
  • Methylxanthines, such as theophylline, which are only used for severe COPD

Rescue inhalers on the other hand are used to treat "out of control" COPD symptoms, where the controller medicine is not enough to prevent all of your symptoms. Rescue medications are short-acting and include these types:

  • Beta-2 agonists, such as albuterol
  • Anticholinergics, such as ipatropium

Dry Powder vs. Metered Dose Inhalers

Another way to classify inhalers is by how they deliver the medicine into your airways. In the past, all handheld inhalers were the metered dose type (called MDI, for short). With this type of inhaler, the medicine is contained in a pressurized metal canister that attaches to a plastic L-shaped tube that you close your lips around. When you press down on the canister, the pressurized air converts the medication in it into a fine mist that sprays into your airways. MDIs can be tricky to use, and if you don't use them correctly, then you might not get all the medication you need. Some people will get a better effect by attaching an additional tube to the mouthpiece, called a spacer.

Examples of MDI medications include:

  • Qvar
  • Flovent   On the other hand, dry powder inhalers (DPI, for short) deliver the medicine into your airways as a fine powder, rather than a mist. In addition, they are breath-activated, rather than pressure-activated. So, it's not as hard to use them and to get the full dose of medication with each puff.

Examples of DPI medications are:

  • Advair
  • Pulmicort Flexhaler
  • Asmanex

Which type of inhaler is best for you is a decision best made in conjunction with your personal physician.

Single Medication vs. Combination Inhalers

Another way to look at types of inhalers is by what types of medications are in them. Traditionally, COPD treatment took a single track type of approach. As described in the first section under controller vs. rescue medication, there are different actions on the airways that can help prevent and control symptoms.   Some medications reduce the inflammation, mucus and swelling, while others relax the airway walls. Some people will respond well to just one approach, so an inhaler with only one type of medication is effective. Rescue inhalers are another example of a single medication inhaler. Other people, usually those with a more severe stage of COPD, will need a combination approach. Newer controller inhalers contain two types of medication for a double-pronged attack against COPD symptoms. They'll have both a corticosteroid and a broncodilator (beta-2 agonist). Advair and Symbicort are examples of combination inhalers.

You and your doctor can work together to decide if a single medication inhaler or one of the combinations is best for you.

In Summary

Your COPD treatment plan may include several classifications of inhaler. You may have an MDI inhaler that is also a single controller medication. Or you might use a combination inhaler that is also a DPI type. What's important here is that you understand what each of your inhalers does and how to use it most effectively. If you're not sure, ask your doctor or your pharmacist

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GOLD Guidelines for COPD

When to Seek Help for COPD

7 COPD Myths