Although there is still no cure for chronic obstructive pulmonary disease (COPD), certain inhaled medications can prove helpful when used along with other treatments in COPD. The 2 main methods through which inhaled medicine is used is with an inhaler or a nebulizer. Both inhalers and nebulizers aim to get the medicine into the lungs, deliver the same type of medicine, and work equally well when used properly in COPD. Nebulizers and inhalers are only available by prescription. Although some bronchodilator inhalers are sold over the counter, one should not use them unless recommended by a doctor. This is because such inhalers can be dangerous for people with certain health conditions, like heart problems. Read on to know more about COPD inhalers.
What are Inhalers?
Inhalers are small, handheld devices which deliver a puff of medicine into the airways. There are three basic types of inhalers, namely Hydrofluoroalkane Inhalers (HFA), Dry Powder Inhalers (DPI) and Soft Mist Inhalers (SMI).
Hydrofluoroalkane Inhalers (HFA): Hydrofluoroalkane Inhalers or HFAs contain a liquid medication which one gets through an aerosol spray. Hydrofluoroalkane Inhalers are one of the commonly used inhalers in COPD treatment. The COPD medicine is present in a pressurized canister, which has a metering valve. One would need to close their lips around the mouthpiece or place the mouthpiece 1 to 2 inches from their mouth and breathe slowly while pressing down on the inhaler. Many people also like using a spacer, which is basically a hollow plastic tube that is attached between the mouthpiece and the canister of medicine for making it easier to get the full dose of COPD medication all the way to the lungs.
Dry Powder Inhalers (DPI): A Dry Powder Inhalers or DPI is similar to an HFA, but it releases a puff of dry powder instead of a liquid mist. A DPI should not be used with a spacer. Instead, one should close their mouth tightly around the mouthpiece of the DPI inhaler and inhale steadily and rapidly. It is important to remove the device from the mouth before exhaling to ensure that humid air does not get into the device and cause powder clumping. Dry Powder Inhalers are used by many people for COPD.
Soft Mist Inhalers (SMI): A Soft Mist Inhalers or SMI is the latest type of inhaler, which is used by COPD patients, that provides a pre-measured amount of medicine in a slow-moving mist that helps one inhale the medicine more efficiently. The individual would need to put their lips on the mouthpiece while holding the inhaler device horizontally. When using this inhaler, one should never cover the air vents. This kind of device actively delivers medicine in a way that does not depend on the speed at which one inhales the air from the inhaler.
Inhaler users should remember that even though all inhalers use the same general principle, all of them do not work the same way. For example, one must shake an HFA before using it, but should never shake a DPI. Each device needs to be cleaned differently and the way of tracking when a inhaler device is empty, also differs. Users should always follow the instructions for the specific inhaler device when using it in COPD or any other medical condition.
What the Types of COPD Inhalers?
COPD inhalers can contain either a single medication or a combination of medications. A COPD inhaler can include a:
- Corticosteroid, which helps in reducing inflammation in the airways.
- Bronchodilator, which helps in opening up the airways and increasing the air flow.
- Combination of different bronchodilators.
- Combination of bronchodilator and corticosteroid.
What Are Some Commonly Used COPD Inhalers?
Some of the most commonly COPD inhalers today are:
Advair: Advair is a combination of salmeterol, a long-acting bronchodilator, and fluticasone, a corticosteroid. Advair is used as part of the maintenance treatment of COPD.
Symbicort: Symbicort was originally used to treat asthma. It was only in 2009 that FDA approved the use of Symbicort for treating stable COPD. Symbicort contains a corticosteroid called budesonide, and a long-acting bronchodilator called formoterol.
Combivent Respimat: Combivent contains 2 bronchodilators, albuterol and ipratropium. While the former is a beta-agonist, the latter is an anticholinergic. Both these drugs help the muscles around the airways to relax. This combination bronchodilator inhaler helps to increase the bronchodilator effect of the medications with fewer side effects in patients with COPD.
Pulmicort: Used in maintenance treatment for COPD, the inhaler Pulmicort contains the corticosteroid called budesonide, which helps in reducing inflammation in the airways and making it easier for the COPD patient to breathe.
Spiriva: Spiriva COPD inhaler contains a medication called tiotropium, which is an anticholinergic bronchodilator. This COPD inhaler opens and relaxes the airways making it lot easier for the user to breathe. This inhaler is used in maintenance treatment for COPD.
Proventil: Proventil is a rescue inhaler, which contains the short-acting beta-agonist bronchodilator called albuterol. This COPD inhaler helps to bring immediate relief from breathing problems. Proventil is often used for sudden episodes of breathlessness related to bronchospasm in both COPD and asthma patients.
Atrovent: This COPD inhaler contains an anti-cholinergic bronchodilator, called ipratropium, and is used in maintenance treatment of COPD.
Brovana: This long-acting bronchodilator should be taken twice a day, i.e. in the morning and in the evening. Brovana is not a rescue inhaler and nor can it treat asthma.
Arcapta Neohaler: The Arcapta Neohaler is the brand name for indacaterol inhalation, a very long-acting beta-agonist bronchodilator used in COPD. This medication comes in capsule form and is administered through a dry powder COPD inhaler. This should be used once daily for effective results in COPD. However, it should be remembered that this is not a rescue inhaler and should not be used to treat asthma.
Breo Ellipta: Breo Ellipta COPD inhaler is a combination of two medications – fluticasone furoate and vilanterol. The former is an inhaled corticosteroid, while the latter is a long-acting beta2-adrenergic agonist. Breo Ellipta is used for treating airflow obstruction in patients with COPD, including chronic bronchitis and emphysema. This inhaler should be used once daily for most effective results in COPD.
Inhalers are the base of treatment for chronic obstructive pulmonary disease. But understanding the difference between various inhalers can be a tricky task. When one feels that they might benefit from a different type of inhaler than what they have been prescribed, they should get their concern addressed by their doctor.
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