Chronic obstructive pulmonary disease (COPD) is a group of lung diseases — including chronic bronchitis, asthma, and emphysema — that make it hard to breathe. Medicines such as bronchodilators and inhaled steroids bring down swelling and open up your airways to help you breathe easier.
An inhaler is a handheld device that delivers a puff or spray of these medicines straight into your lungs through a mouthpiece. Inhalers work faster than pills, which have to travel through your bloodstream to get to work.
Inhalers come in three main types:
- metered-dose inhaler (MDI)
- dry powder inhaler (DPI)
- soft mist inhaler (SMI)
A metered-dose inhaler (MDI) is a handheld device that delivers asthma medicine to your lungs in aerosol form. The canister is attached to a mouthpiece. When you press on the canister, a chemical propellant pushes a puff of medicine into your lungs.
With an MDI, you have to time your breathing with the release of the medicine. If you have trouble doing this, you can use a device called a spacer. A spacer can help coordinate your inhaled breath with the release of the medicine.
COPD drugs that come in an MDI include steroids such as Flovent HFA and combination steroid/bronchodilators such as Symbicort.
|Beclomethasone (Beclovent, QVAR)||Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)||Budesonide-formoterol (Symbicort)|
|Ciclesonide (Alvesco)||Levalbuterol (Xopenex HFA)||Fluticasone-salmeterol (Advair HFA)|
|Fluticasone (Flovent HFA)||Formoterol-mometasone (Dulera)|
Every MDI comes with its own instructions. In general, here’s how to use one:
- Remove the cap from the inhaler.
- With the mouthpiece facing down, shake the inhaler for about five seconds to mix the medicine.
- Then use one of these techniques:
- Open-mouth technique: Hold the mouthpiece 1 1/2 to 2 inches from your mouth.
- Closed-mouth technique: Put the mouthpiece between your lips and close your lips tightly around it.
- With a spacer: Place the MDI inside the spacer and close your lips around the spacer.
- Gently breathe out.
- Press the inhaler and, at the same time, take a deep breath in through your mouth. Keep breathing in for 3 to 5 seconds.
- Hold your breath for 5 to 10 seconds to get the medicine into your airways.
- Relax and breathe out slowly.
- Repeat the process if you need more puffs of the medicine.
Pros: MDIs are easy to use and can be used with many different types of COPD drugs, including steroids, bronchodilators, and combination medicines. You also get the same dose of medicine each time you use them.
Cons: MDIs require you to coordinate between activating the medicine and breathing it in. It’s also necessary that you breathe in slowly and deeply. If you breathe in too quickly, the medicine will hit the back of your throat, and much of it won’t reach your lungs. You may also need to use a spacer to get the medicine into your lungs.
A dry powder inhaler (DPI) delivers medicine to your lungs when you breathe in through the device. Unlike an MDI, a DPI doesn’t use a propellant to push medicine into your lungs. Instead, your inward breath activates the medicine.
DPIs come in single-dose and multiple-dose devices. Multiple-dose devices contain up to 200 doses.
COPD dry powders that can be used with a DPI include steroids such as Pulmicort and bronchodilators such as Spiriva:
|Budesonide (Pulmicort Flexhaler)||Albuterol (ProAir RespiClick)||Fluticasone-vilanterol (Breo Ellipta)|
|Fluticasone (Flovent Diskus)||Salmeterol (Serevent Diskus)||Fluticasone-salmeterol (Advair Diskus)|
|Mometasone (Asmanex Twisthaler)||Tiotropium (Spiriva HandiHaler)|
Every DPI comes with its own instructions. In general, here’s how to use one:
- Remove the cap.
- Turn your head away from the device and breathe out all the way. Don’t exhale into the device. You could scatter the medicine.
- Place the mouthpiece into your mouth and close your lips around it.
- Breathe in deeply for a few seconds until you fill your lungs.
- Take the device out of your mouth and hold your breath for up to 10 seconds.
- Breathe out slowly.
Pros: Like MDIs, DPIs are also easy to use. You don’t need to coordinate pressing the device and breathing in the medicine, and you don’t need to use a spacer.
Cons: On the other hand, you have to breathe in harder than you would with an MDI. Moreover, it’s hard to get the exact same dose each time you use the inhaler. This type of inhaler can also be affected by humidity and other environmental factors.
The soft mist inhaler (SMI) is a newer type of device. It creates a cloud of medicine that you inhale without the help of a propellant. Because the mist contains more particles than MDIs and DPIs and the spray leaves the inhaler more slowly, more of the drug gets into your lungs.
The bronchodilator drugs tiotropium (Spiriva Respimat) and olodaterol (Striverdi Respimat) both come in a soft mist. Stiolto Respimat combines the drugs tiotropium and olodaterol.
To use an SMI:
- Open the cap, after you’ve prepared the device following the manufacturer’s instructions.
- Breathe out slowly and fully.
- Close your mouth around the mouthpiece. Don’t cover the air vents on the side of the device.
- Take a slow deep breath while you press the dose release button. Inhale the mist.
- Hold your breath for 10 seconds.
- Repeat if necessary to get the dose your doctor prescribed.
Pros: There are many benefits that come with using an SMI. More of the medicine gets into your lungs than with an MDI or DPI, so you can use a lower dose. The mist comes out slowly, and the device doesn’t require any coordination. A spacer is also unnecessary if you use an SMI.
Cons: However, research has linked the tiotropium mist inhaler to a higher risk for death in people with COPD. It’s also harder to load the dose into the device.
If you use it correctly, your inhaler will relieve your COPD symptoms. Ask your doctor to show you how to use it. Keep track of the expiration dates on your medicine, and get a new prescription if your medicine expires.
Take your medicine exactly as your doctor prescribed. If you need a daily controller medicine, take it every day — even if you feel well. Let your doctor know if you experience side effects, but never stop taking the medicine unless otherwise advised.
Terms like HFA, Diskus, and Respimat appear in the names of many inhalers. What do they mean?
HFA is an abbreviation for hydrofluoroalkane, which is a safer propellant for the atmosphere than older propellants used in original MDIs. Diskus is a trademark that helps describe the delivery device shape and rotating mechanism used to move a dry-powder dose compartment into the chamber. Respimat is a trademark that helps describe the SMI mechanism developed by the pharmaceutical company Boehringer Ingelheim.Alan Carter, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.