Inhaler Therapies Used to Treat COPD

Inhaler therapies are an important part of managing chronic obstructive pulmonary disease (COPD). Inhaled medications used for treating COPD include bronchodilators and steroids.

There are three categories of inhalers used in COPD:

• Short-acting bronchodilators
• Long-acting bronchodilators (beta agonists and anticholinergics/muscarinic antagonists)
• Inhaled steroids

Each of these medications affects COPD differently. Some inhalers contain only one medication (monotherapy) and others contain multiple drugs (each with a different mechanism of action).

Because they are inhaled directly into the airway, these medications generally work quickly and tend to cause fewer systemic side effects than pills or injections. Your healthcare provider may prescribe one or more inhalers for you, as well as oral (by mouth) or injectable medications for your COPD.

It can be very helpful to know not only the name of your medications but the generic names as well (especially if you have combination inhalers), to make sure you do not accidentally receive two doses of the same medication.

Short-Acting Bronchodilators

You may experience COPD symptoms (e.g., shortness of breath, wheezing) when you physically exert yourself or when you have an infection. A short-acting bronchodilator, also known as a rescue inhaler, can quickly alleviate your COPD symptoms when you experience an exacerbation.

Bronchodilators work by opening (dilating) the air sacs (bronchioles) that become constricted during a COPD flare-up. Short-acting bronchodilators are "fast on and fast off"—i.e., they work quickly and provide relief for four to six hours.

Short-acting bronchodilators should only be used when needed. You should carry one with you wherever you go in case of an emergency.

There are two classes of bronchodilators. Beta-agonists bind to receptors in the lung to relax the bronchi. Anticholinergics block acetylcholine, the neurotransmitter that triggers spasm (sudden narrowing) of the muscles of the bronchi.

Short-acting beta-agonists (SABAs) include:

• Ventolin (albuterol)
• Xopenex (levalbuterol)
• Alupent (metaproterenol)
• Bricanyl (terbutaline)

Short-acting anticholinergic/muscarinic antagonists (SAMAs) include:

• Atrovent (ipratropium)

There is also a combination short-acting inhaler, Combivent, that contains ipratropium and albuterol.

Long-Acting Bronchodilators

When you have COPD, your healthcare provider may prescribe one or two long-acting inhaled bronchodilators for you to take every day, whether you have symptoms or not.

The effects of long-acting bronchodilators can last between 12 to 24 hours. As with short-acting bronchodilators, they contain either a beta-agonist or anticholinergic drug.

Long-Acting Beta-Agonists

Long-acting beta-agonists (LABAs) include:

• Serevent (salmeterol)
• Salbutamol
• Performomist (formoterol)
• Bambec (bambuterol)
• Arcapta Neohaler (indacaterol)
• Brovana (arformoterol)
• Striverdi Respimat (olodaterol)
• Vilanterol

Long-Acting Anticholinergics

Long-acting anticholinergics/muscarinic antagonists (LAMAs) include:

• Spiriva (tiotropium)
• Tudorza Pressair (aclidinium bromide)
• Seebri Neohaler, Lonhala Magnair (glycopyrronium)
• Incruse Ellipta (umeclidinium)
• Yupelri (revefenacin)

Combination Bronchodilators

There are also combination long-acting inhalers that contain both a long-acting beta -agonist (LABA) and a long-acting anticholinergic (LAMA):

• Bevespi Aerosphere (formoterol and glycopyrronium)
• Duaklir (formoterol and aclidinium)
• Utibron Neohaler (indacaterol and glycopyrronium)
• Anoro Ellipta (vilanterol and umeclidinium)

Uses

For people who have moderate to severe COPD and experience shortness of breath and/or exercise intolerance, 2020 guidelines recommend a combination of both a long-acting beta-agonist (LABA) and a long-acting anticholinergic (LAMA) rather than either of these classes of medications alone.

Inhaled Steroids

Inhaled steroids work differently than bronchodilators. Inhaled steroids function in the same way as oral steroids, but they work faster. Steroids reduce inflammation in the lungs, and they can quickly decrease the airway swelling and mucus build-up that occur in COPD.

Your healthcare provider will prescribe a schedule for you to follow when using your steroid inhaler. A twice-daily schedule is fairly typical for COPD.

Even though they are fast-acting, steroid inhalers often require a two-week loading period before they take full effect.

The inhaled steroids commonly used to treat COPD are:

• Pulmicort (budesonide)
• Aerospan (flunisolide)
• Flovent (fluticasone)
• Asmanex (mometasone)
• QVAR (beclomethasone)

Uses

Inhaled steroids are not recommended for everyone with COPD. They may be used early on for those who also have asthma or a high eosinophil count. Otherwise (without asthma) they should only be used by people who have one or more COPD exacerbations each year (and for those who have not had an exacerbation in a year, they should be discontinued).

While inhaled steroids can reduce COPD exacerbations, they also increase the risk of pneumonia.

Side effects of inhaled steroids may include a sore mouth or throat, hoarse voice, and oral candidiasis (thrush). Long-term use is associated with an increased risk of glaucoma and osteoporosis.

Combination Inhalers That Contain Bronchodilators and Steroids

In addition to combinations of bronchodilators, there are combination inhalers that combine an inhaled steroid and one or two bronchodilators.

Inhalers are also available as combination formulations that contain steroids and bronchodilators, a combination of two bronchodilators, or combinations of short acting and long acting medications.

Combination inhalers that contain corticosteroids and long-acting beta agonists (LABA) include:

• Symbicort (formoterol and budesonide)
• Advair (salmeterol and fluticasone)
• Brio Ellipta (vilanterol and fluticasone)
• Dulera (formoterol and mometasone)

Combination inhalers that contain a corticosteroid, and both long-acting beta agonists (LABA) and long-acting anticholinergics (LAMA) include:

• Trelegy Ellipta (vilanterol, umeclidinium, and fluticasone)

A Word From Verywell

It's important to discuss your medications frequently with your healthcare provider as they are used in different settings and recommendations can change. Short-acting bronchodilators may be used as "rescue inhalers" as they open airways rapidly, whereas other medications are meant to be preventive. Be sure to follow the instructions provided to you.

Also check to see if you have duplicates of the same inhaler (the same drug may have different brand names). You can experience serious side effects if you use a high dose of the same drug all at once.