Inhaler vs. Nebulizer: Which One is Better for COPD?

Health Professional

One of the best ways of controlling COPD is by inhaling COPD medicine.  To do this, some use an inhaler with a spacer, some use a nebulizer, and some use both.  So which one is the best way to deliver COPD medicine to your lungs?

To learn about inhalers, check out my post “What is an inhaler?”  To learn about nebulizers, check out my post “What is a nebulizer?”

Both inhalers and nebulizers allow patients to inhale a low dose of a medicine to receive a more rapid response (sometimes immediate), with fewer side effects than taking the medicine systemically.  So they both work great for people with lung disease.

That said, let’s delve into this subject a little deeper and compare the two.

Medicine Distribution.  Many studies have been done comparing inhalers with nebulizers. Most suggest that, when used properly, inhalers used with a spacer work equally well as nebulizers.  So, it would appear at first that there’s no difference between the two, as far as getting the most medicine.

Cost.  Your first nebulizer will cost anywhere from $50 on up.  It includes the nebulizer and the air compressor used to power it.  You’ll need to purchase supplies a few times a year, plus the medicine each month.  Albuterol inhalers cost about $50, although other inhalers (such as Advair), may cost upwards to $200 plus each month.  However, any cost for COPD medicines can usually be picked up by co-pays and Medicare.

Medicinal Waste.  Most people who use inhalers don’t realize this, but most of the medicine is wasted. Furthermore, it does not matter whether you are using an inhaler or a nebulizer.  Studies suggest that when an inhaler with a spacer is used, only 15 percent of the medicine gets to the airways.  When a nebulizer is used, only 12 percent of the medicine gets to the airways.  However, this fact is accommodated for by the dosing.

Convenience.  Nebulizers require an air compressor and a power source and about 10-20 minutes of your time.  Inhalers with spacers are small, compact devices, are convenient for travel, can be used anywhere, and require no power source.

Coordination.  Studies show most people don’t use inhalers correctly.  This has been confirmed by many studies.  Age, and disease severity, may also impact your ability to use inhalers correctly.  Poor technique means less medicine gets to your lungs, resulting in less benefit from the medicine. Inhalers often require training and practice to get it right.  Nebulizers require less training.  They simply require breathing normal through a mouthpiece.  This assures an ideal dose and ideal benefit.

Airflow Limitation.  Some people cannot generate enough flow to operate inhalers.  This may occur during asthma attacks, COPD flare-ups, and during the end stages of COPD.  Nebulizer treatments allow you to inhale the medicine over a period of time regardless of flare-ups or disease severity. Nebulizers, therefore, appear to work better during flare-ups, and for severe COPD.

Decision.  There really is no winner or loser here.  The convenience of inhalers makes them ideal for most people.  However, if you have severe COPD, or frequent flare-ups, nebulizers may work better. Still, the best way of learning which one is better for you is by talking to your physician.

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