COPD (chronic obstructive pulmonary disease) is a lifelong condition where lung tissue and airways have been damaged. An inhaler helps by delivering targeted medications to your lungs, relieving symptoms and preventing flare-ups. Inhalers come in a wide range of devices and modes of delivery. Your doctor will select the right one for you, and consider alternatives if it doesn’t suit you, but it helps to be informed on the different options out there. Our medical team will talk you through it.
Firstly, let’s get to grips with terminology. A spacer device is a plastic tube that fits to your inhaler at one end and your mouth at the other, allowing you to administer a dose of medicine from your inhaler and breathe freely: medicine reaches your lungs more easily.
Inhalers differ in how they deliver medicine to your lungs. Most inhalers are metered-dose inhalers (MDIs), which give a spray of medicine once you’ve pressed on the canister at the top, and these can be used with a spacer. Breath activated inhalers (BAIs) release a spray of medicine when you start to inhale, rather than pressing on the canister. Dry powder inhalers (DPIs) come as a powder rather than a spray, and you need to breathe in fairly hard to activate the inhaler. They’re often called Turbohalers or Accuhalers.
Certain factors may influence which inhaler is right for you. BAIs need the respiratory muscles to be strong to forcefully breathe in, so if you have little lung capacity or are feeling weak, MDIs via a spacer my be the best choice for you.
Side effects may be important – higher dose steroids can cause thrush in the mouth, but the chance of this is reduced by using a spacer, which limits you to MDIs.
If you have little strength in your fingers or difficulty co-ordinating, a MDI may be difficult to operate, in which case a BAI may be more suitable.
Convenience and ease of portability may be a high priority, such as putting your inhaler in your pocket or handbag, therefore MDIs can be less bulky than some BAIs.
Your doctor may have demonstration inhalers for you to have a look at.
Everyone with COPD will be prescribed a reliever inhaler, which is a short-acting bronchodilator. It works within minutes to relax and widen the airways, relieving cough and shortness of breath for between 3 and 6 hours.
Beta-agonist inhalers are one type, containing either salbutamol, as a brand called Ventolin, or terbutaline, often as the brand Bricanyl. These get to work within 5 to 15 minutes.
Antimuscarinic inhalers are another type, and Atrovent is a common brand, containing ipratropium. This takes 30 to 40 minutes to ease symptoms.
It’s a temporary relief when you need it, so keep it with you at all times, and it may be all that’s needed for the mildest cases. Most people with COPD need a preventer inhaler, too, which provides ongoing treatment to keep symptoms at bay in the long term.
Long-acting bronchodilators work in a similar way but aim to settle symptoms for at least 12 hours. They are useful for those with ongoing or more severe symptoms, and can be used alongside a short-acting inhaler.
Long-acting beta-agonist inhalers contain medications such as salmeterol, such as the brand Serevent, or formeterol.
Long-acting antimuscarinic inhalers include tiotropium, of which Spiriva is a common brand, among others.
Your preventer inhaler has medication to reduce swelling in your airways, but takes one to two weeks to reach full benefit. This is your long-term treatment to keep symptoms and flare-ups at bay.
If a long-acting bronchodilator is not enough, your doctor may add in a steroid inhaler as a preventer. This works to dampen down inflammation and reduce frequent flare-ups of more severe symptoms. You may use two inhalers or a combined inhaler.
Steroid inhalers include those containing beclometasone (like Clenil or Qvar), budesonide (like Pulmicourt or Easyhaler Budesonide) or fluticasone (like Flixotide).
An inhaler combining steroids with long-acting bronchodilators, includes the brands Fostair, Symbicort and Seretide.
Whichever inhaler you use, make sure you have learned the correct technique to get the required medication to the right place, and use your inhaler as prescribed on your personalised COPD plan. If this isn’t getting on top of your symptoms, your doctor can make an assessment and tweak the dose or change the type of inhaler.
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