Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases, including emphysema and chronic bronchitis. COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2021. Inhalers are the mainstay treatment for COPD and there are many different formulations that may be prescribed. As COPD gradually gets worse, the symptoms of shortness of breath makes the use of some inhalers very difficult. Here is a breakdown of the three different types of inhalers and why some formulations over others may be beneficial for people with COPD.
Meter Dose Inhaler:
A metered-dose inhaler (MDI) is a handheld device that delivers medication to the lungs in aerosol form. The canister is attached to the mouthpiece. With an MDI, you have to coordinate your breath with the release of the medication.
Technique: Gently breathe out, press then canister down and at the same time, take a deep breath in through your mouth. The deep breath should be slow and take around 3-5 seconds and then hold your breath for 5-10 seconds to allow the medicine to get into your airways. Last, breathe out slowly and repeat the process if your prescription requires more puffs of the medicine.
MDIs are the most common inhaler type. They require coordination and to be able to breathe in deeply and slowly in order to correctly deliver the medication. If you are having trouble breathing in deeply due to your COPD, you might not be getting the full effect of the medicine, and another formulation may be better for you.
Dry Powder Inhalers:
A dry powder inhaler (DPI) delivers medication to your lungs when you breathe in through the device. Unlike an MDI that uses a propellant, a DPI uses the force of your own inward breath to deliver the medicine. DPIs come in many different forms (i.e. Diskus, Twisthaler, Flexhaler, Handihaler, etc.).
Technique: Turn your head away from the device and breathe out all the way. Place the mouthpiece into your mouth and close your lips around it. Breathe in quickly and forcefully. Take the inhaler out of your mouth, hold your breath for 5-10 seconds, and then exhale slowly. If your prescription calls for a second dose, reload and repeat the steps.
As mentioned above, there are many different forms of DPIs. Pay close attention and follow the device instructions on how to load each dose, as it will be specific to the brand you use. DPIs are very common with COPD inhalers, if you are having difficultly with quick and forceful inward breaths, it is possible your medication is not working to its full effect, and another form of inhaler might work better for you.
Soft Mist Inhalers:
Soft Mist Inhalers (SMI) are the newest type of inhaler. These inhalers create a “soft mist” or cloud of medication that you inhale without the help of a propellant. SMI’s have a higher fraction of drug particles that release more slowly and for longer duration which allows more drug to be delivered to your lungs.
Technique: Exhale fully, put the inhaler mouthpiece into your mouth and close your lips around it. Start a slow inhalation and press the dose release button. Continue to breath in slowly and deeply. Remove the inhaler from your mouth, hold your breath for 10 seconds, then exhale.
If you are having any issues with MDIs or DPIs, a soft mist inhaler is probably the best bet for you. As always, if you feel like you COPD symptoms are not being well controlled, follow up with your doctor and if you have any questions regarding inhaler technique and the different types of inhalers check in with your local pharmacist.
Prepared by Adam Taniguchi PharmD
Resources:
- https://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm
- https://my.clevelandclinic.org/health/diseases/8709-chronic-obstructive-pulmonary-disease-copd
- https://www.uspharmacist.com/article/a-review-of-the-2019-gold-guidelines-for-copd
- https://dearpharmacist.info/knowledge-library/how-to-use-your-inhaler/
- https://allergyasthmanetwork.org/what-is-asthma/how-is-asthma-treated/how-to-use-a-dry-powder-inhaler/
- https://allergyasthmanetwork.org/health-a-z/chronic-obstructive-pulmonary-disease/how-to-use-a-slow-moving-mist-inhaler/#:~:text=Exhale%20fully%3B%20put%20the%20inhaler,for%2010%20seconds%2C%20then%20exhale.
- nlm.nih.gov/pmc/articles/PMC2707154/