Chronic obstructive pulmonary disease, or COPD, is a group of inflammatory lung diseases that disrupt airflow from the lungs. COPD includes emphysema and chronic bronchitis. Some people treat these conditions with an inhaler that delivers medication straight to the lungs.
COPD is a disease that worsens over time. However, treatment can help alleviate symptoms, provide relief, and make breathing easier.
Medication that an individual inhales can be highly effective for managing COPD symptoms. Additional treatments may also be necessary, especially in the later stages.
In this article, we explain the different types of inhalers, their possible side effects, and other devices and treatments for people with COPD.
Inhalers deliver medication directly to the lungs, where many COPD symptoms start.
The medications that inhalers contain work at different speeds. A doctor may prescribe both fast acting and long acting inhalers, depending on the severity of COPD symptoms.
How severe a person’s COPD is will also help a doctor determine whether the individual needs a single medication or a combination of drugs.
The inhalers available for people with COPD help improve breathing by opening up the airways. Inhalers are often effective for rapid symptom relief and to minimize episodes of breathlessness.
People typically inhale drugs known as bronchodilators to treat COPD symptoms. Those with frequent symptoms also inhale steroids to reduce exacerbations.
A third type of medication combines these two treatments.
Bronchodilators relax the muscles around the airways. This helps to expand the airways and make breathing easier.
For people with mild COPD, a doctor may prescribe a short acting bronchodilator to use when symptoms flare or to relieve mild symptoms.
People should take short acting bronchodilators every 4–6 hours, as necessary.
In more severe cases of COPD, a doctor may prescribe both a short and long acting bronchodilator.
Depending on the type, long acting bronchodilators are taken every 12 hours or once a day. This dosage provides a more extended period of relief but is slower to take effect. People can take short acting bronchodilators as well.
There are two main drug classes of bronchodilator.
Beta2-agonists relax tensed muscles around the airways to assist breathing.
Anticholinergics prevent muscles around the airways from tightening in the first place, helping a person clear mucus more easily.
Steroid treatments help reduce inflammation and open up the airways. A doctor may prescribe steroids alongside bronchodilators in severe cases of COPD.
While people usually inhale steroids through an inhaler, a doctor might prescribe them as a pill to be taken orally. People taking steroids to treat COPD require careful monitoring.
For more severe COPD, a doctor might prescribe a combination inhaler solution that contains different bronchodilators, steroids, or both.
There are several inhalers available for COPD.
Short term inhalers include:
Long acting inhalers include:
People should speak with a healthcare professional about the best options in their case.
Inhaled COPD medications are available for use as inhalers and nebulizers. Steroids, however, are not available for use in nebulizers.
Nebulizers and inhalers are devices that turn medication into a mist to help treat breathing disorders.
While most inhalers are available on prescription only, some are available over the counter (OTC). However, a person with COPD should consult a doctor before trying an OTC inhaler.
Inhalers offer the medication in three forms:
- MDI: This is a liquid medication that a person inhales slowly in single bursts by using a spacer
- DPI: This is a dry, powdered medication that a person inhales without a spacer by wrapping their lips around the mouthpiece.
- SMI: This is a newer form of inhaler that delivers the medication in a slow mist. The effectiveness of delivery does not depend on the speed of inhalation.
Nebulizers turn the medication into a fine mist that a person breathes in gently rather than forcefully inhaling.
Unlike inhalers, nebulizers are bulky and not easily portable. Also, people may need around 20 minutes to inhale all the medication from a nebulizer.
Nebulizers require the user to measure out the medication and add it directly to the machine. Inhalers, however, contain a predetermined amount per puff.
Choosing an inhaler or a nebulizer comes down to the severity of symptoms and frequency of exacerbations a person experiences. People must use the device they choose to administer the correct amount of medication.
It is helpful for a doctor to know whether an individual has a history of smoking, if they are currently smoking, and whether they have undergone exposure to certain pollutants for extended periods.
These considerations help the doctor determine the best inhaler or inhalers to manage COPD symptoms.
As with any medication, inhaled bronchodilators and steroids can cause side effects.
Some of the most common side effects of inhaled medications are as follows:
This type of medication can cause the following adverse effects:
- dry mouth
- worsening glaucoma if a person with the eye condition get the drugs in their eyes from an inhaler or nebulizer
These can lead to:
- trembling, mainly in the hands
- nervous tension
- heart palpitations
- cramps in the muscles
However, these side effects tend to resolve after a few weeks of taking beta-2 agonists.
Taking steroids can lead to side effects, including:
- sleep problems, such as insomnia
- mood and behavior changes, such as greater anxiety or irritability
- higher risk of infections, including shingles, chickenpox, and measles
- Cushing’s syndrome, which can lead to easy bruising, stretch marks on the thighs, and fat deposits in the face
- eye problems, including cataracts and glaucoma
- depression and suicidal ideation
These effects should stop after the end of treatment.
People experiencing worrying or severe side effects that do not resolve should speak to their doctor about changing medications.
There is no cure for COPD besides a lung transplant.
Although inhalers are among the most common treatments of COPD, a doctor might recommend other treatment to help manage the condition.
Oral medications a doctor may prescribe to help manage COPD include:
- Phosphodiesterase-4 inhibitors. These help to relax the airways and reduce inflammation.
- Theophylline. This medication may improve breathing and prevent exacerbations.
These drugs may have unwanted side effects, including nausea, fast heartbeat, headaches, and tremors.
Lung therapies, such as pulmonary rehabilitation, may also help improve quality of life and reduce exacerbations.
For some people with severe COPD, surgery to remove damaged parts of the lung or an entire lung may be an option.
There are also some lifestyle recommendations a doctor may make to help with symptoms of COPD. These include stopping smoking, exercising, and maintaining a balanced, nutritious diet.
Doctors commonly prescribe inhaled drugs for people with COPD. These usually consist of bronchodilators, steroids, or a combination of the two. Several different types of inhaler deliver fixed doses. Some turn the medication into a mist before a person inhales it.
Nebulizers are also available. These turn the medication into a fine mist for gentler inhalation, although these devices are less portable than inhalers.
People with COPD should speak to both their doctor and insurance provider about which inhaler and medication are best for them.
Is asthma a part of COPD?
Asthma and COPD are different diseases.
The airway obstruction in asthma is often reversible, and people with asthma can have normal lung function in between exacerbations. On the other hand, the airway obstruction in COPD is fixed and is progressive.
Some individuals have features of both asthma and COPD.
Adithya Cattamanchi, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.