Using Inhalers For COPD

If COPD is affecting your breathing, you'll usually be given an inhaler. This is a device that delivers medicine directly into your lungs as you breathe in.

But knowing how to use an inhaler correctly is essential for persons with COPD, said Sanjeev Kumar, a registered respiratory therapist at Franciscan Health Indianapolis.

“We often don't care because we are breathing unless and until we are really in the problem, feeling, ‘I can't breathe,’” said Kumar, who works with patients with COPD. “So we take it for granted.”

Read on for tips for improving the effectiveness of your inhalers for treating chronic obstructive pulmonary disease.

Key Takeaways: COPD Inhaler Use

• Inhalers are the primary treatment for COPD because they deliver medicine directly into the lungs where it is needed most, rather than traveling through the bloodstream.
• Patients often use two types of inhalers: short-acting and long-acting. Short-acting (rescue) inhalers for immediate relief during sudden shortness of breath, and long-acting (maintenance) inhalers that are used daily to provide consistent, 12-hour symptom control.
• Using an inhaler correctly is more important than the medicine itself. Many patients inhale too quickly or fail to coordinate their breath, which causes the medicine to hit the back of the throat instead of reaching the lungs.
• Long-acting bronchodilators are considered more effective for long-term management. Even when you feel like you are breathing well, staying consistent with your daily maintenance inhaler helps prevent future flare-ups and hospitalizations.

What Are The Types Of Inhalers?

Inhalers deliver medications to treat COPD. Often these are used with medications called bronchodilators to open up airways, relieve shortness of breath and help prevent COPD flare-ups.

Bronchodilators include both beta-2 agonists (for example, albuterol or salmeterol) and anticholinergics (tiotropium and ipratropium) and come in two basic types -- short-acting and long-acting. These drugs, usually taken with an inhaler, are the same type that people with asthma use during an asthma attack.

"Even if they don't have asthma, the inflammation drivers in the COPD are variable," said Faisal Khan, MD, a pulmonologist with Franciscan Health Indianapolis, "and some people with COPD have the same cells that drive their COPD and bronchoconstriction as the asthmatics. So, the key is to identify those individuals that have COPD and are on regular inhaler and they're adhering to it, and still not getting control, then to identify whether these immunologic or biologic options are valid for them or not."

Short-Acting Bronchodilators

Short-acting bronchodilators acts quickly and for shorter use, and these inhalers are often prescribed to patients in initial stages of COPD. Lasting from 4 to 6 hours, the short-acting bronchodilators are used only when necessary to ease breathing.

“They are also called quick relief, or rescue inhalers,” Kumar said.  “When a patient gets the feeling that it's a rescue inhaler, ‘I should use it when I'm really short of breath,’ that's where the confusion begins.”

Long-Acting Bronchodilators

If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler may be recommended. Long-acting bronchodilators last about 12 hours and are used every day. According to the Global Initiative on Chronic Obstructive Pulmonary Disease (GOLD), long-acting bronchodilators are more effective and convenient for treating COPD.

Steroid Inhalers

If you're still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups (exacerbations), your physician may suggest including a steroid inhaler as part of your COPD treatment.

Steroid inhalers contain corticosteroid medicines, which can help to calm down the inflammation inside the airways. The GOLD guidelines do not recommend corticosteroids as a stand-alone therapy, but suggest that they may work as a step-up therapy in combination with long-acting beta agonists. A study published in the journal Chest found that these drugs may help prolong the lives of people with COPD. However, there is some risk that long-term use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.

Taking your medicine as directed is also critically important. Missed doses can hamper your breathing and give your disease a chance to gain ground. If you have any doubts or concerns about your treatment, talk to your doctor.

What Type of Inhalers Will I Need For My COPD?

“The way inhalers work depend upon the staging of COPD,” Kumar said. “One shoe cannot fit all of the patients, similarly, one inhaler cannot fit all the patients, just like any other disease. Consult your physician, if you feel that you your current inhaler is not helping you.”

Your provider may discuss whether you are understanding how to use your inhaler correctly, breathing techniques, or compliance with using oxygen, CPAP or BiPAP machines if prescribed. That may be discussed in the office or through an appointment with an outpatient respiratory therapist.

Am I Using My Inhaler Correctly?

Different inhalers require different techniques. Follow the instructions exactly and talk to your doctor if you have any questions or problems.

“Before you go and talk to your physician about switching your inhaler, ask, ‘Do I use my inhalers the way I should use it? Is the technique right?’” Kumar said. “If you have any doubt about how to use my inhaler, please consult the specialist. Ask them how to use it, and there should be no shame in asking again and again. When you take it, give it a moment or two and then slowly breathe up. Slow and deep and hold."

The power of slow breathing 

Slow breathing has its benefits for the body.

“One, you are getting more air because you’re being slow. It just like on the highway; one car slows down, there’s a cascade and the cars start slowing down,” Kumar said. “The moment I breathe slowly, it is heard by the other organs per se. The heart realizes, ‘Hey, I should slow down.’ Then our brain feels it, and the brain comes down. You breathe even calmer. The slower I breathe, the calmer I get.”

Ensure proper technique

"One of the biggest areas where we find challenge, especially in older patients, is their technique of using the inhalers," Dr. Khan said. "You may be using it in your mind, but you're not delivering the drug to the lungs because your technique is wrong. Some folks have dexterity issues, whereas arthritis and all that, and the inhaler may not be a good option for them. Then, a nebulizer may be a good option for that.

"So, take some time with your provider, with your respiratory therapist to know what's the best way how to deliver the drug in your lung, how to use the inhaler. "