Asthma and chronic obstructive pulmonary disease (COPD) are long-term respiratory conditions that make it difficult for a person to breathe.

The Centers for Disease Control and Prevention (CDC) estimate more than 25 million people in the United States had asthma as of 2019, including 5 million children under 18 years.

There is no cure for either condition, but treatments are available. The most common treatment option involves using a handheld inhaler or a nebulizer to inhale medication directly into the airways. These medicines help reduce inflammation, open up the airways, and clear any mucus build-up in the lungs.

Some of the most common inhaler types for asthma and COPD include corticosteroids, beta-agonists, anticholinergics, and combination inhalers.

This article looks at the different types of inhaler devices, what medication they contain, and how they work.

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Most inhaler types are small enough to fit in a pocket. Types of inhalers include metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs).

Each handheld inhaler type works in the same fundamental way. They deliver medication through inhalation. To use an inhaler, a person closes their mouth around the mouthpiece and inhales the medicine from the canister.

However, there are a few differences. For example:

  • MDIs contain medicine in aerosol form. The person must press the canister to activate the propellant and inhale at the same time.
  • DPIs deliver medication without a propellant. The person inhales the medicine into their lungs with their inward breath.
  • SMIs are similar to DPIs because the person uses their inward breath to inhale the medicine. However, SMIs have more particles than MIDs and DPIs, and the medication enters the lungs more slowly, which means the person can get more of the medicine into their lungs.

Each type of inhaler has advantages and disadvantages, and its effectiveness depends on how much medication gets into the person’s lungs.

Some researchers suggest that doctors consider a person’s characteristics when deciding which inhaler type to prescribe, including:

  • age
  • cognitive status
  • manual dexterity
  • ability to coordinate inhalation with activation of the canister

However, when treating children under 5 with asthma, a doctor will typically prescribe a valved holding chamber with a mask. The mask allows the child to take several breaths to get the same amount of medication as breathing in one large puff. They may also prescribe a nebulizer for young children.

Learn more about types of inhalers here.

Nebulizers

Nebulizers are another type of inhaler that involves breathing through a mask. They consist of an air compressor, a container of liquid medicine, and a tube that connects the two. A person uses a mouthpiece or a mask above the medicine container to inhale the mist.

Nebulizers are available in battery-powered and electric versions. While they are larger than handheld inhalers, they are ideal for people who might not use an inhaler effectively, including young children.

Learn more about nebulizers and how to use them here.

When a person has an asthma attack, the airways in their lungs become inflamed, narrow, and produce mucus, which restricts the air supply.

Asthma inhalers deliver medication to the lungs to manage long-term asthma symptoms and provide relief during an asthma attack.

The medications in these inhaler types depend on a person’s needs.

Corticosteroids

Corticosteroids decrease inflammation in the airways and prevent asthma flare-ups. They are long-term and controller medicines. Controller asthma medication aimsto prevent asthma symptoms from developing by reducing inflammation of the airways over time.

Common types of corticosteroids include:

  • beclomethasone (Qvar)
  • budesonide (Pulmicort Flexhaler)
  • ciclesonide (Alvesco)
  • fluticasone (Flovent Diskus, Flovent HFA, Arnuity Ellipta)
  • mometasone (Asmanex)

Starting doses of inhaled corticosteroids vary.

During a meta-analysis on the efficacy and safety of inhaled corticosteroids, researchers found no significant clinical benefit to a high starting dose compared to low and moderate doses. Additionally, a high starting dose may have safety concerns.

Typically, starting doses will depend on the severity of a person’s symptoms.

Learn more about inhaling steroids here.

Long-acting beta-agonists (LABAs)

LABAs help relax the muscles that line the lung’s airways and keep them open, which helps make breathing easier.

A doctor may combine a corticosteroid with a long-acting beta-agonist (LABA) for people with severe asthma.

The current recommendation from the American Academy of Allergy, Asthma, & Immunology (AAAAI) is for doctors to prescribe LABAs with a corticosteroid in a “combination inhaler” and not alone. This is because using LABAs by themselves has associations with a higher risk of asthma-related death.

Common combination inhalers include:

  • fluticasone and salmeterol (Advair Diskus, Advair HFA)
  • fluticasone and vilanterol (Breo Ellipta)
  • budesonide and formoterol (Symbicort)
  • mometasone and formoterol (Dulera)

Learn more about LABAs for asthma here.

Anticholinergics

Anticholinergics are another type of long-term, controller medicine. They help reduce mucus production, relax the lung muscles, and widen the airways.

Tiotropium bromide (Spiriva Respimat) is an asthma controller medicine that doctors often prescribe with other controller therapies.

Learn more about anticholinergics here.

Short-acting beta-agonists

Short-acting beta-agonists, or quick-acting beta-agonists, are quick-relief and rescue medicines. They work to open the airways and relieve symptoms quickly during an asthma flare-up.

The medical term for these medicines is bronchodilators. They relax the airway muscles, allowing them to open up so a person can breathe more easily.

Common short-acting beta-agonists include:

Short-acting beta-agonists are not the same as controller medications and do not replace them. If a person with asthma regularly relies on a rescue inhaler, they should talk to their doctor.

Learn more about rescue inhalers here.

COPD refers to multiple respiratory conditions that affect a person’s ability to breathe, including chronic bronchitis, emphysema, and asthma.

The CDC estimate around 16 million people in the U.S. have COPD and that millions more have it without knowing.

People with COPD may use inhalers to deliver medicine directly into their airways.

Similar to asthma inhalers, COPD inhaler types include long-term and controller medicines and quick-relief and rescue medications.

They also include corticosteroids, beta-agonists, anticholinergics, and combination inhalers.

Corticosteroids

Common inhaled corticosteroids for COPD include:

  • beclomethasone (Qvar)
  • fluticasone (Flovent)
  • ciclesonide (Alvesco)
  • mometasone (Asmanex)
  • budesonide (Pulmicort)
  • flunisolide (Aerobid)

Beta-agonist inhaler types

The most common inhaled beta-agonists are LABAs, which last anywhere from 6–12 hours.

These include:

Additionally, three ultra-long-acting beta-agonists (ULABAs), which can last up to 24 hours, have received approval for clinical treatment of COPD. These are:

  • olodaterol (Striverdi),
  • indacaterol (Arcapta Neohaler)
  • vilanterol

Researchers are working on combining all three approved ULABAs with corticosteroids and antimuscarinic agents to create dual and triple agent inhalers. The clinical trials for these inhalers could help researchers begin developing trait-specific COPD therapies.

Anticholinergics

Inhaled anticholinergics for COPD include:

Combination inhalers

There are several combination inhalers for COPD, including:

  • albuterol and ipratropium (Combivent Respimat; Duoneb)
  • budesonide and formoterol (Symbicort)
  • fluticasone and salmeterol (Advair)
  • fluticasone and vilanterol (Breo Ellipta)
  • formoterol and mometasone (Dulera)
  • tiotropium and olodaterol (Stiolto Respimat)
  • umeclidinium and vilanterol (Anoro Ellipta)
  • glycopyrrolate and formoterol (Bevespi Aerosphere)
  • indacaterol and glycopyrrolate (Utibron Neohaler)
  • fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)

Some studies suggest that combining a corticosteroid with a ULABA for once-daily treatment may be as effective as twice-daily treatments with corticosteroids and LABAs.

For example, after a 24-week randomized controlled trial involving 423 adults with asthma, researchers found that the once-daily combination of fluticasone and vilanterol provided similar results as regular twice-daily combination inhalers.

Learn more about inhalers for COPD here.

Short- or quick-acting beta-agonists, or bronchodilators, provide fast relief when a person has symptoms of a COPD flare-up, such as wheezing, coughing, and difficulty breathing.

Common bronchodilators include:

  • albuterol (ProAir HFA; Proventil HFA; Ventolin HFA)
  • levalbuterol (Xopenex HFA)
  • albuterol and ipratropium (Combivent)

Generally, quick-acting beta-agonists come in an MDI inhaler, but sometimes the person may use a nebulizer.

These medicines may cause side effects such as:

Anyone experiencing severe side effects should seek immediate care.

Learn more about bronchodilators here.

While there is no cure for asthma or COPD, treatment options are available to make it easier for the person to breathe.

Common treatment options are inhaled medications, such as corticosteroids, beta-agonists, anticholinergics, and combination inhalers. These medicines work to reduce inflammation and narrowing in the airways, as well as remove any mucus.

Typically, people take these medications using a handheld inhaler or a nebulizer. These devices help deliver the medicine directly to the airways to control symptoms.