Understanding Your Medications - Part IV

Health Professional

This is the fourth and final part of our series on COPD Medications.
  - Dry Powder Inhalers (DPI's)
  - Nebulizers
  - Timing and sequencing of inhaled medicines

Dry Powder Inhalers (DPIs)
A dry powder inhaler (DPI) is different from a metered dose inhaler (MDI), because the medicine is not taken as a spray - but a very fine powder. The advantage of using a dry powder inhaler is that it is breath-activated. You don't have to coordinate releasing the medicine from the inhaler while at the same time breathing it in.

There are several types of dry powder inhaler delivery systems, each with a different operating method. Some have to be loaded with a capsule each time they are used, some have a set number of doses (4 or 8). Still others have as many as 200 doses stored in the device.

To get the full benefit from your DPI:

  • See the choice of videos, below, find your type of DPI, and follow the     instructions
  • Never blow into the DPI
  • Don't swallow the capsule as you would with an oral medication.
  • Rinse your mouth and spit the water out - do not swallow it.

Video Resources:
How to use a Spiriva ® Handihaler

How to use a disc dry powder inhaler (such as Advair ®)

How to use a single dose dry powder inhaler (such as Foradil ®) ** How to use a dry powder tube inhaler (such as Pulmicort ®)**

Is it better to use an inhaler or a nebulizer?

Advantages of Using a Nebulizer

  • Medicine is delivered through a mouthpiece or facemask and does not depend as much on breathing technique. Synchronizing the release of medication and breathing in is NOT necessary.
  • May provide better relief during respiratory attacks because medicine is delivered constantly for 10 to 15 minutes.
  • Some medications used in the nebulizer are inexpensive and more likely to be covered by health insurance.

Disadvantages of Using a Nebulizer

  • Side effects of feeling jittery with an increased heart rate are more likely.
  • Take more time to complete.
  • Require special equipment, limiting access when you are away from home, possibly resulting in missed doses.
  • Strict cleaning is required. Water left in the nebulizer when it is not in use allows bacteria to grow.

Timing and Sequencing of Multiple Inhalers

If I have more than one inhaler, can I take them one right after the other?
Yes, you can, if each of your inhaled medications is in a different category (Corticosteroid, Anticholinergic, Long-acting bronchodilator, or Fast (short)-acting bronchodilator.) However, if you have two inhalers in the same category, you should not take them within four hours of each other - this may be overdosing. Check with your doctor or pharmacist to make sure.

If I can take one inhaler right after the other, which one should I take first?
The common answer is: If you take a fast (short) acting beta-agonist, take that one first.

The idea behind this is that this type of medication goes in and opens up your airways right away - and then the inhaled medications you take after that can go deeper into your lungs.

On the other hand, remember what we learned about receptors in Part II? When a medicine has latched onto a receptor, that receptor is "taken" and nothing else can latch onto it. Some lung health professionals believe that if your receptors are already occupied with one medicine, it does no good to take another one that may need to latch onto those same receptors. Check with your doctor or pharmacist to know the best sequencing and timing for you regarding the specific inhalers you take, so you can get the best possible benefit.

This brings us to the end of our series on Understanding and Using Your COPD Medications. I'm sure we all agree - it would be great to not have to take any daily medications However, many of us have to do just that, so we must make the best of it! I hope you were able to learn something about your COPD medications so you can get the maximum benefit to stay and well and maintain stability in spite of COPD. If you have any questions or comments on any part of this series, feel free to comment. I'd love to hear from you!

Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of http://www.Breathingbetterlivingwell.com   and the author of Live Your Life With COPD: 52 Weeks of Health, Happiness and Hope and Breathe Better, Live in Wellness: Winning Your Battle Over Shortness of Breath.