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Key takeaways
Inhalers fall into one of two categories: preventive or maintenance inhalers for daily use to control symptoms and rescue inhalers for quick relief of symptoms.
The main types of inhalers include bronchodilators, inhaled corticosteroids, or a combination of both.
Bronchodilators can be short-acting or long-acting. These inhalers usually belong to one of two drug classes, including beta agonists or antimuscarinics.
Chronic obstructive pulmonary disease, more widely known as COPD, is an extremely common lung disease. Globally, it’s the fourth leading cause of death, causing approximately 3.5 million deaths in 2021 alone. In higher-income countries, like the United States, the World Health Organization estimates that 70% of these cases are attributed to tobacco smoking.
Despite the prevalence, there is currently no cure for COPD. However, there are several options to treat it and lessen the symptoms, including oxygen therapy, lifestyle changes—especially for those who need to quit smoking—and medication. For those managing this condition, inhalers are one of the most commonly prescribed drugs.
Inhalers and their role in COPD management
“COPD is a progressive lung disease that makes it difficult to breathe,” explains Sneha Samant, MD, a respiratory care specialist with LCMC Health in Louisiana.“Treatment focuses on relieving symptoms and improving quality of life. The cornerstone of therapy is inhaled medications.” Inhalers deliver medication directly to where you need it most: the lungs.
Two conditions can cause COPD: chronic bronchitis and emphysema. Many people will be diagnosed with both. The difference between these two forms is where the damage occurs in the lungs.
- Chronic bronchitis refers to inflammation in the bronchi, which are the airways of the lungs. Bronchitis can be acute and go away after time, but persistent and long-lasting bouts can develop into incurable chronic bronchitis.
- Emphysema refers to damage to the air sacs of the lungs, or alveoli. With too much damage, these sacs can break, reducing the lungs’ elasticity and making it harder to breathe.
The most common symptoms of COPD include:
- Coughing and wheezing
- Difficulty taking deep breaths
- Chest tightness
- Frequent respiratory infections
- Tiredness
There are three main treatment options:
- Lifestyle changes: Since COPD is frequently caused by smoking, it’s vital for patients to quit. Staying up to date on vaccines—such as flu, COVID, or pneumonia—can help prevent respiratory illnesses that exacerbate COPD. Pulmonary rehabilitation therapy can help teach exercises to improve breathing and increase exercise tolerance.
- Medicines: Many medicines help treat COPD. These can include inhalers, nebulizers, oral steroids to reduce airway inflammation, and antibiotics when infections occur.
- Oxygen therapy: Extra oxygen inhaled via a mask or canula can help those who have continuous difficulty breathing.
Types of inhalers for COPD
COPD inhalers fall into two treatment categories:
- Preventer (maintenance) inhalers are taken at the same time each day to prevent symptoms of COPD before they begin.
- Reliever (rescue) inhalers provide quick relief of symptoms and are used as needed throughout the day within the dosing guidelines.
The medication can be delivered in different types of inhaler devices, such as:
- Metered-dose inhalers (MDIs): These inhalers use liquid medication sprayed out as an aerosol. Patients must deeply inhale as the inhalers are dispensed, which can be difficult for those with severe COPD or frequent shortness of breath.
- Dry powder inhalers (DPIs): With these inhalers, dry powder is inhaled from the mouth into the lungs. They require less precise timing than MDIs, but still require a deep inhale.
- Soft mist inhalers (SMIs): A spring-based mechanism shoots medication out from the device. Since it’s self-propelled, patients don’t need to deeply inhale when using them.
Now let’s go into the different types of inhaled medications commonly prescribed for COPD treatment.
Bronchodilators
Bronchodilators are a popular type of COPD inhaler that relaxes the muscles in the lungs to widen airways (bronchi) and make breathing easier. They belong to either the antimuscarinic (a type of anticholinergic drug) or beta agonist class of drugs and can be short-acting or long-acting. Some may be prescribed a short-acting and a long-acting bronchodilator.
“Albuterol is one of the most commonly prescribed bronchodilators,” says Lindsey Hudson, a family nurse practitioner practicing in Charleston and a member of the SingleCare Medical Review Board. “However, a provider should personalize each treatment, considering factors like manual dexterity or past adherence to medications.”
Bronchodilator inhalers for COPD |
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|---|---|---|
| Type | What to expect | Coupons |
| Short-acting beta2-agonists (SABAs) | Typically begin working in 5 to 15 minutes. | ProAir HFA (albuterol) coupons |
| Xopenex (levalbuterol) coupons | ||
| Bricanyl (terbutaline) coupons | ||
| Short-acting muscarinic antagonists (SAMAs) | Improve symptoms within 30 to 40 minutes. The effects will last from three to six hours on average. | Atrovent (ipratropium) coupons |
| Long-acting beta agonists (LABAs) | Typically provide a minimum of 12 hours of symptom relief | Perforomist (formoterol) coupons |
| Striverdi Respimat (olodaterol) coupons | ||
| Long-acting muscarinic antagonists (LAMAs) | Typically provide a minimum of 12 hours of symptom relief | Serevent (salmeterol) coupons |
| Spiriva Handihaler (tiotropium) coupons | ||
| Tudorza Pressair (aclidinium) coupons | ||
| Incruse Ellipta (umeclidinium) coupons | ||
Inhaled corticosteroids
Inhaled corticosteroids, sometimes abbreviated as ICS, improve your ability to breathe by reducing inflammation in the lungs and airways. Typically used in conjunction with a LABA or LAMA inhaler, inhaled corticosteroids are mostly prescribed to those with more severe COPD.
Bronchodilators are preferred over this type of medication because they have better success treating COPD and fewer side effects. Additionally, inhaled corticosteroids are only FDA-approved for the treatment of asthma and are used off-label when given to patients with COPD.
Inhaled corticosteroids for COPD |
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|---|---|
| Arnuity Ellipta (fluticasone) | Coupons |
| Pulmicort Flexhaler (budesonide) | Coupons |
Combination inhalers
For some individuals with severe COPD, a combination inhaler with a mix of medications may be a better fit. This also reduces the number of inhalers a person would need to take each day. These can include:
Combination inhalers for COPD |
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|---|---|---|
| Type | Active ingredients | Coupons |
| Long-acting bronchodilators (LAMA + LABA) | Glycopyrrolate / formoterol | Bevespi Aerosphere coupons |
| Aclidinium / formoterol | Duaklir Pressair coupons | |
| Tiotropium / olodaterol | Stiolto Respimat coupons | |
| Umeclidinium / vilanterol | Anoro Ellipta coupons | |
| Long-acting bronchodilators (LABA) with a corticosteroid | Fluticasone / salmeterol | Advair Diskus coupons |
| Fluticasone / vilanterol | Breo Ellipta coupons | |
| Budesonide / formoterol | Symbicort coupons | |
| Short-acting bronchodilators (SAMA +SABA) | Ipratropium / albuterol | Combivent Respimat coupons |
| Three-ingredient inhalers (corticosteroid + LAMA + LABA) | Fluticasone / umeclidinium /vilanterol | Trelegy Ellipta coupons |
| Budesonide / glycopyrrolate / formoterol | Breztri Aerosphere coupons | |
Choosing the right inhaler
“Long-acting bronchodilator inhalers are typically a first line of treatment, but short-acting bronchodilators may also be prescribed additionally as a rescue inhaler,” Hudson says. This is because long-acting bronchodilators can provide longer symptom relief, but for those needing something more immediate, short-acting options will be more helpful.
A healthcare professional will take a variety of factors into account before choosing the right inhaler for you. According to Dr. Samant, this can include:
- Severity of symptoms and how frequently the patient experiences exacerbations of symptoms
- Results of lung function testing
- Ability to use the inhaler device properly, as some inhalers require more coordination or inhalation strength
- Presence of asthma or allergies, which may influence the use of inhaled steroids
- Cost and insurance coverage, which can affect access and adherence to inhaler use
“Ultimately, the goal is to tailor treatment to the individual to optimize symptom control and prevent flare-ups,” Dr. Samant explains.
Cost of inhalers for COPD
The cost of inhalers for COPD can quickly add up, especially for those who already have other medications to pay for on top of this expense. There are a few easy ways to save:
- Implement lifestyle changes, mainly smoking cessation, which may lessen the symptoms of COPD and prevent them from worsening.
- Use a SingleCare coupon at the pharmacy. Even if you have prescription coverage with your medical insurance plan, SingleCare coupons may have better prices than your local pharmacy with insurance.
- Ask about generic prescriptions. If you’re using name-brand inhaler medications, talk to your healthcare provider or pharmacist about lowering costs by switching to a generic option.
If the price of medication is a barrier to treatment, don’t give up. Your pharmacist can help you find an option that controls your symptoms at a price you can afford.
- Chronic obstructive pulmonary disease (COPD), World Health Organization (2024)
- Choosing the right inhaler for your asthma or COPD patient, Ther Clin Risk Manag. (2019)