Inhalers & Nebulizers

Chronic obstructive pulmonary disease (COPD) is a condition that results in damage to the lungs and airways, making them rigid and inflexible, and rendering it difficult for you to breathe comfortably. While there is no cure for COPD, many treatments can help ease the symptoms and slow the progression of the illness.

People with COPD may take some oral medications like antibiotics to fight an infection, but the majority of COPD medications work better when they are inhaled directly into the lungs through an inhaler or a nebulizer. 

An inhaler is a handheld disc or tube attached to a mouthpiece. There are two basic types of inhalers,- metered dose inhalers and dry powder inhalers. A nebulizer is a piece of electronic or battery-operated equipment that transforms a liquid solution or suspension into aerosol form that can be inhaled through a mouthpiece.

Metered Dose Inhaler

Metered dose inhalers are commonly used to administer medications like albuterol, fluticasone/salmeterol combinations (Advair), and albuterol/ipratropium combinations (Combivent).

A metered dose inhaler consists of a metal tube containing the medication, a substance that acts as a propellant to help the medication reach deep into the lungs, and a measuring valve. The tube is encased in plastic and attached to a plastic mouthpiece.  

While this may all sound complicated, metered dose inhalers can usually be carried comfortably in a purse or in the pocket of a jacket. 

To use a metered dose inhaler, take a deep breath in and release all the air from your lungs. Then tilt your head back a little, take the mouthpiece between your lips, and inhale as you push the button to release the medication.

Pros: A metered dose inhaler is portable and can be used to deliver several doses of medication quickly in the event of a COPD flare-up.

Cons: Coordination is required to time your breathing to the release of the medicine in your lungs. Because it contains aerosol that is under high pressure, the inhaler is flammable and should not be used around open flames. 

Dry Powder Inhaler

Some of the names you may hear associated with dry powder inhalers include Symbicort (a budesonide/formoterol fumarate dehydrate combination) and Spiriva (tiotropium).

A dry powder inhaler usually comes in the shape of a disc. It has particles of medication enclosed in capsule. When the capsule is penetrated, the particles are released and then inhaled into the airways and lungs. A dry powder inhaler does not have any mechanism that propels the particles towards the lungs. The person using the inhaler must have the strength and lung capacity to inhale deeply to get the full benefit of the medication.

For that reason, dry powder inhalers are rarely given to patients experiencing an exacerbation, or a flare-up, or respiratory symptoms. They also have limited use later on in the disease process when inhaling deeply becomes difficult or impossible for the patient.

Pros: Like the metered dose inhaler, the dry powder inhaler is small enough to fit into small purses and pockets.

Cons: The dry powder inhaler is not helpful if symptoms suddenly become worse. Also, some users complain that if the disc gets wet or is taken outside in humid weather, the particles may clump together so that they cannot be inhaled. 

Nebulizer

A nebulizer is a device powered by batteries or electricity that changes solutions or suspensions (fluids) into aerosols that can be inhaled into the lungs and deposited along the lower airways. A nebulizer may be used either with a mouthpiece or a mask. The machine creates the small aerosol particles permitting the medications to reach deep into the lungs and airways.

Many kinds of medications can be given through a nebulizer including bronchodilators to open the airways, corticosteroids to reduce inflammation in the airways from pollutants or infection, antibiotics to treat upper respiratory infections, and medications to thin out mucus so that you can easily cough it up and get rid of it. People who are in the very late stages of COPD sometimes nebulize an opioid like morphine sulphate (Roxanol) to ease the frightening sensation of “air hunger” or not being able to catch your breath.

Pros: Nebulizers are a good alternative for people who are too ill to manage inhalers. They can also be used to deliver large doses of medication quickly. Since nebulized medications can be delivered via a mask placed over the nose and mouth, nebulizers require no coordination.

Cons: Nebulizers are not huge pieces of equipment, but they are not exactly easily portable, either. Taking them along on an outing requires some planning. Receiving treatment from a nebulizer takes longer than receiving a treatment from an inhaler. Finally, because of the equipment involved, nebulizers may carry a larger upfront expense than do inhalers. If you are on hospice or eligible for Medicare Part B, most of this expense should be covered. If you have private insurance, check with your insurance company to see if they will help you purchase any of the equipment.