What medicines are delivered by inhalers used in COPD treatment?

A fellow caregiver asked...

What kinds of medicines are delivered by inhalers used in COPD, and are COPD inhalers always necessary for treatment?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

Most medicines used to manage chronic obstructive pulmonary disease (COPD) are inhaled; this allows the medicine to target the lungs while having minimal side effects on the rest of the body. Sometimes during exacerbation (severe attacks also known as "flare-ups"), oral or even IV medications may be used for short periods of time.

The purpose of treating COPD with inhalers is to minimize symptoms, especially shortness of breath, and to slow the progression of the disease. The medicines doctors prescribe usually depend on a person's symptoms and the stage of disease.

Early COPD

Doctors usually first prescribe a short-acting bronchodilating inhaler to be used on an as-needed basis when a person feels short of breath. These medicines help relax and open the bronchial tubes (large air passages), allowing air to come in and out of the lungs more easily.

There are two main types of bronchodilating medicines: beta-agonists and anticholinergics. Either type is a good choice in early COPD. Short-acting beta-agonists include albuterol and levalbuterol. The most commonly used short-acting anticholinergic is ipratropium. Often physicians prescribe Combivent, which conveniently combines albuterol and ipratropium in a single inhaler.

Stage II or higher COPD

By stage II, people usually need to use a longer-acting inhaled bronchodilator to manage their symptoms. Long-acting bronchodilators include salmeterol and formoterol (both beta-agonists) and tiotropium (an anticholinergic). The person should also still use the short-acting bronchodilator on an as-needed basis for shortness of breath.

Stage III or IV COPD

If symptoms can't be controlled with a combination of short- and long-acting bronchodilators, COPD has usually progressed to stage III or IV. At this point, doctors usually add a glucocorticoid inhaler. These are also referred to as "steroid" inhalers, and they act by reducing inflammation in the lungs. At this point, a person may be using three or more inhalers regularly.

During a COPD exacerbation

Other medications, such as an oral steroid, antibiotics, and/or medicines to reduce lung mucus, are sometimes prescribed for use during a COPD exacerbation. But studies have shown that it's generally not beneficial to use these medicines on a daily basis.

About inhalers used at any stage

Inhalers are very good at delivering medicine to the lungs, provided one uses proper technique. Unfortunately, it's not always obvious what the proper technique is, so it's very important to review one's technique with a pulmonary specialist, or with a pharmacist.

Inhalers themselves come in two types: metered-dose inhalers and dry powder inhalers.

Many people assume that the way COPD medications are often delivered in hospitals, by nebulizer (a small machine that mixes medication with water, creating a mist that is breathed in through a mask), must be more effective. In fact, an inhaler used with correct technique works just as well to get medicine into one's lungs.