COPD inhalers are the backbone of COPD treatment. Not only can they help relieve your COPD symptoms, but, used as directed, they can reduce the frequency and severity of your COPD exacerbations and improve your ability to tolerate exercise.

Rescue vs Maintenance Inhalers

Some COPD inhalers are short-acting and prescribed for sudden symptoms. These are called rescue inhalers. Your doctor may also prescribe a long-acting COPD inhaler that you’ll use daily as maintenance treatment. It’s important to note that rescue inhalers should not to be used regularly for maintenance treatment and inhalers used for daily maintenance should not to be used as rescue inhalers.

Types of Inhalers

COPD inhalers may contain a single medication, or a combination of two or more medications, each prescribed with the purpose of easing your breathing difficulties. For example, an inhaler may contain:

  • a single bronchodilator – medication to relax and widen the airways.
  • a corticosteroid – medication to reduce swelling and inflammation in the airways.
  • a combination of two bronchodilators with different actions – such as a short-acting and long-
    acting bronchodilator combined.
  • a combination of one or more bronchodilators and corticosteroid

Your doctor will talk with you about which inhaler is right for you based on your medical history, symptoms and insurance plan.

Top 13 COPD Inhalers

Although newly developed COPD inhalers are always on the horizon, the following are the top 13
currently available in the United States (US) listed in alphabetical order:

  1. Advair combines two medications – fluticasone, a corticosteroid and salmeterol, a long-acting beta-agonist bronchodilator (LABA) – for maintenance treatment of COPD. Advair comes in capsule form and is administered through a dry-powder inhaler (DPI). It is breath-activated, meaning the medication is only released when you take a fast, deep breath through the inhaler’s mouthpiece.
  2. Arcapta Neohaler contains the LABA medication indacaterol. Beta-agonists work on smooth muscle causing dilation of the bronchial passages. As the bronchial passages relax and widen, air flows more freely through them allowing you to breathe easier. The Arcapta Neohaler is used once each day for long-term, maintenance treatment of COPD, including chronic bronchitis and
    emphysema.
  3. Atrovent is the brand name for ipratropium bromide, a medication that belongs to a class of drugs known as antimuscarinic receptor agonists. Antimuscarinics prevent the muscles in your airways from tightening making it easier to clear mucus from your lungs. Atrovent is a short-acting muscarinic agent (SAMA), it’s duration of action lasting 6 to 8 hours.
  4. Bevespi Aerosphere contains two medications – glycopyrrolate, an anticholinergic and formoterol fumarate, a LABA. Anticholinergic bronchodilators block the parasympathetic nerve reflexes that cause your airways to constrict, allowing the air passages to relax and widen. This COPD inhaler is a long-term, twice daily medication that works two ways to open your airways. It’s approved for maintenance treatment of COPD, including chronic bronchitis and emphysema. Studies show the combined effects of this inhaler’s two medications on lung function are greater than either medication used alone.
  5. Breo Ellipta combines two medications – fluticasone, an ICS and vilanterol, a LABA – to provide once-daily maintenance treatment for COPD, including chronic bronchitis and emphysema. It improves lung function for a full 24 hours and works in as little as 15 minutes. Studies show that using Breo Ellipta is associated with a 20% reduction in the risk of COPD exacerbations. Users may also experience more rescue inhaler-free days/nights and more symptom-free 24-hour periods when using this inhaler.
  6. Brovana, which contains arformoterol titrate (LABA), is an inhalation solution meant to be used with a nebulizer. It’s indicated for long term, maintenance treatment of bronchospasm in COPD, including chronic bronchitis and emphysema. Used twice daily, it improves lung function and provides consistent bronchodilation over 12 hours.
  7. Combivent Respimat contains two bronchodilators – albuterol, a SAMA and ipratropium bromide, an anticholinergic. It’s intended for people with COPD who are currently using a regular aerosol bronchodilator, but who continue to have evidence of bronchospasm and require a second bronchodilator. Studies show that using these two medications together may increase the bronchodilator effect of the medications with fewer side effects. For many people, this COPD inhaler works in as little as 15 minutes.
  8. Proventil is a rescue inhaler used for sudden onset shortness of breath related to bronchospasm (constriction of the airways) in COPD. Proventil contains albuterol, a short-acting, beta 2 -agonist bronchodilator (SAMA).
  9. Spiriva contains tiotropium bromide, the only once-daily, long-acting muscarinic antagonist (LAMA) that reduces the risk of COPD exacerbations and exacerbation-related hospitalizations in COPD. It controls bronchospasm related to COPD by opening the airways and keeping them open.
  10. Stiolto Respimat is on of the newer COPD inhalers recommended for steroid-free maintenance treatment of COPD. It contains two drugs – tiotropium bromide (LAMA) and olodaterol (LABA). Together, these two medications complement each other; one by opening the airways and the other, by keeping them open. This inhaler works in as little as 5 minutes and can help reduce your use of a rescue inhaler.
  11. Symbicort was originally approved by the Food and Drug Administration (FDA) for asthma, however, in 2009, it was approved for maintenance treatment of stable COPD. Symbicort contains two medications – formoterol, a LABA, and budesonide, an inhaled corticosteroid (ICS). This COPD inhaler is meant to treat people with stable COPD, including chronic bronchitis and emphysema. Symbicort is meant to be used long-term for improved breathing and fewer COPD exacerbations.
  12. Trelegy Ellipta is the only FDA approved COPD inhaler in the United States that contains three separate, long-acting medications in one inhaler: fluticasone, an ICS, umeclidinium, a LAMA and vilanterol, a LABA. Working together, these medications reduce bronchoconstriction, open your airways, reduce inflammation and improve lung function.
  13. Tudorza Pressair contains aclidinium bromide, a LAMA that improves your breathing on the very first day of use (although it may take longer to experience this inhaler’s full effect). Tudorza Pressair is indicated as a long-term, maintenance medication for COPD. It keeps your airways open over time and helps reduce your daily use of a rescue inhaler.

To find out which COPD inhaler, or combination of COPD inhalers, is best for you, make an appointment today with your primary care provider or lung specialist.