Inhalers used to treat COPD

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Inhalers are the mainstay of treatment for chronic obstructive pulmonary disease (COPD) . These medications are inhaled through the mouth, so they can go directly to the lungs. There are several types and brands of inhalers that are used to treat COPD symptoms.

Laura Porter / Get Medication Information

Your doctor may prescribe a combination of inhalers – some should be taken daily to fight the disease, while others can be used when the disease worsens. Using different types of inhalers can improve treatment, but many COPD inhalers have effects that overlap with other inhalers or oral medications used to treat COPD. Therefore, the combination of drugs requires careful planning and medical advice to avoid potentially dangerous side effects.

Types of COPD inhalers

A COPD inhaler can contain a single drug or a combination of ingredients. Bronchodilators open the airways, anticholinergic / muscarinic antagonists) prevent the muscles lining the airways from contracting to keep them open, and glucocorticoids reduce inflammation. All of these actions can help reduce the narrowing of the airways so that air can pass more efficiently into the lungs during breathing.

You may be advised to use an inhaler at specific times during the day and / or also use an inhaler if your COPD becomes severe.

Some inhalers work immediately, while others take longer to work. And long-acting inhalers have a long-lasting effect, while the effects of short-acting inhalers tend to wear off sooner.

The inhaler may include :

  • A bronchodilator that helps open the airways and increase air flow.
  • Corticosteroid that reduces inflammation of the airways.
  • Combination of different bronchodilators.
  • A combination of bronchodilators and corticosteroids.

Some inhalers are designed for daily use over a long period of time, while others, called " rescue inhalers, " are only used in emergency situations.

Inhaler Recommendations for COPD

It can be extremely confusing to learn about the different types and combinations of inhalers available for COPD, but this can be simplified by looking at current guidelines and using a few examples of when the different types are used individually or together.

When choosing the best inhaler or inhalers, healthcare professionals pay attention to several basic questions:

  • Spirometry: Forced expiratory volume in 1 second (FEV1) describes the degree of airflow restriction. The GOLD Guide divides people into four different groups (A to D) based on the FEV1 reading.
  • Symptoms: Symptoms of shortness of breath (shortness of breath) or exercise intolerance are very important when choosing a treatment. Dyspnea can be described using the British Medical Research Council 's Modified Dyspnoea Scale (mMRC Dyspnea Scale ) or the COPD Assessment Test (CAT). Exercise intolerance can be assessed by the 6-minute walk test .
  • COPD exacerbations . There are different options to choose from for those who have one or more outbreaks per year and those who do not.
  • Coexisting conditions: Different options may be considered if the person has a history of asthma or other medical conditions .

For mild COPD, an inhaler may not be needed, but research shows that treatment can often improve quality of life. A long-acting beta agonist (LABA) can be used prophylactically, a short-acting beta agonist (SABA) can be used to control symptoms, or both can be used together.

For those with moderate to severe COPD and shortness of breath or exercise intolerance, the 2020 guidelines suggest using a combination of a long-acting beta agonist (LABA) and a long-acting anticholinergic (LAMA), rather than both of them. only these.

People with asthma or high levels of eosinophils (a type of elevated white blood cell with allergies) may or may not use a corticosteroid inhaler. Otherwise, it is recommended that corticosteroid inhalers be used only for those with moderate to severe COPD and one or more flare-ups per year. Those without asthma and without flare-ups for a year should stop taking corticosteroid inhalers because the risks (increased risk of pneumonia) are likely to outweigh the benefits of treatment (fewer flare-ups).

Of course, the recommendations are only recommendations and there are exceptions. It is important to work with your healthcare provider to develop a treatment plan that is right for you and the individual.

COPD Doctor Discussion Guide

Get our printed guide to your next doctor's appointment to help you ask the right questions.

Advair

Advair is one of the most widely used inhalers for the maintenance treatment of COPD. It is a combination of fluticasone, a corticosteroid, and salmeterol, a long-acting bronchodilator. Advair is used on a regular basis for the maintenance treatment of COPD and is usually taken twice a day.

Advair is available as Advair Diskus , a powder for inhalation, or Advair HFA, an aerosol inhaler. The dose is represented by two numbers and is recorded as μg fluticasone / μg salmeterol per inhalation. Discus is available in doses of 100/50, 250/50, or 500/50, and HFA is available in doses of 45/21, 115/21, and 230/21 .

Please note that there are other dosage combinations for this drug.

Side effects

When used to treat COPD, the most common side effects include pneumonia, fungal infections of the mouth, sore throat, respiratory infections, headaches, and muscle aches .

Expenses

Advair Diskus generally provides one month of medication, at actual prices ranging from $ 100 for the generic version to $ 430 for the brand-name version.

The cost of one bottle of Advair HFA out of pocket is approximately $ 400. There is no universal version of this form.

Albuterol

Proair-HFA, Ventolin HFA, Proventil HFA, Accuneb and Proair RespiClick (Albuterol) is an emergency inhaler used for urgent breathing problems. It contains albuterol, a short-acting beta agonist.

Albuterol helps to immediately relax the airways, making it easier to breathe. It is often used to treat sudden attacks of breathlessness associated with bronchospasm in both asthma and COPD.

This inhaler can be used approximately 15 to 30 minutes before exercise to prevent exercise-induced symptoms. It can also be used to relieve symptoms with one or two inhalations every four to six hours.

Each brand of this medicine comes in a package with instructions for use, as the doses are slightly different. For example, Ventolin HFA and Proventil HFA are supplied in an aerosol can containing 200 metered inhalations and equipped with a counter (a 60 dose container for Ventolin HFA is also available). Each inhalation provides 90 mcg of albuterol.

Proair HFA is available as a metered dose powder inhaler or a metered dose aerosol inhaler that delivers a 90 mcg dose. The inhaler is an 8.5 g canister containing 200 doses .

Since you may not be using albuterol on a regular basis, it is recommended that you prime your inhaler. For example, if you have not used Proair HFA for more than two weeks, apply foundation in Proair HFA three times away from your face .

Side effects

The most common side effects include headaches, tachycardia (heart palpitations), pain, dizziness, sore throat, and runny nose .

Expenses

A standard 200-dose container without insurance costs about $ 32, although it can cost more depending on the brand. Total albuterol costs around $ 25 for the same 200 doses.

Arkapta Neohaler

Arkapta Neohaler (indacaterol) is a long-acting beta-agonist bronchodilator. It is used for the long-term maintenance treatment of airway obstruction in COPD, including emphysema and chronic bronchitis, once daily.

It is administered through a dry powder inhaler at a dose of 75 μg. This medicine should only be used with Aracpta Neohaler .

Side effects

The most common side effects include cough, sore throat, upper respiratory infections, headaches, and nausea .

Expenses

The standard package, which includes a one-month supply, costs around $ 250 and is not available in the standard version.

Atrovent

Atrovent (ipratropium) is an anticholinergic bronchodilator. It is used in the supportive treatment of chronic COPD, including bronchospasm, emphysema, and chronic bronchitis.

You can take two inhalations of 17 mcg each. It is usually used three or four times a day. Atrovent comes in a 12.9g bottle containing 200 doses .

Side effects

Side effects of Atrovent include bronchitis, COPD exacerbation, shortness of breath, and headaches .

Expenses

The cost for a month's pot is around $ 400 and there are no generics available.

Bevespi Aerosphere

Bevespi Aerosphere is a combination of two long-acting bronchodilators, glycopyrrolate and formoterol. It is intended to be a supportive treatment for chronic COPD and is taken to help open the airways and keep them open.

Bevespi Aerosphere is not an emergency inhaler and is not used to treat sudden symptoms of COPD.

It is taken in two inhalations twice a day, each of which contains 9 mcg of glycopyrrolate and 4.8 mcg of formoterol fumarate .

Side effects

The most common side effects include urinary tract infection and cough .

Expenses

The metered-dose inhaler contains a one-month supply of medicine and costs about $ 350 without insurance. There is no universal version.

Breo Ellipt

Breo Ellipta is a combination of fluticasone furoate, a corticosteroid, and vilanterol, a long-acting beta agonist. Breo Ellipta is a once-daily maintenance medicine for the treatment of airway obstruction in COPD, including emphysema and chronic bronchitis .

The drug is available in two double-foil ampoules and a powder formulation for oral inhalation. Each contains ampoules containing 100 mcg of fluticasone furoate or 25 mcg of vilanterol .

It is taken in doses of 25 mcg of vilanterol / 100 mcg of fluticasone once a day.

Side effects

Side effects include upper respiratory tract infections, headaches, and yeast infections in the mouth .

Expenses

The standard package, which can serve as a two-month supply for some patients, costs about $ 350. There is no universal version of this drug combination, although fluticasone furoate is available as a generic nasal spray.

Brovana

Brovana (arformoterol) is a long-acting beta-agonist bronchodilator. It is used for the long-term maintenance treatment of chronic COPD to relax the airways and make breathing easier.

It should be taken twice a day, in the morning and in the evening. It is available as a nebulizer solution in a dose of 15 μg / 2 ml for use with a standard jet nebulizer with a mask or mouthpiece connected to an air compressor .

Brovana is not an emergency inhaler and does not treat asthma.

Side effects

Side effects include chest and back pain, diarrhea, sinusitis, leg cramps, shortness of breath, rash, flu, leg swelling, and lung disease .

Expenses

The standard package includes a two-month supply and costs about $ 1,000 or more in cash. There is no universal version of Brovana.

Respimat Combivent

The combination contains albuterol, a short-acting beta-agonist, and ipratropium, an anticholinergic. It is used for COPD as a second inhaler when symptoms persist with a conventional aerosol bronchodilator .

This medicine is available as a metered dose aerosol inhaler with a dose of 100 mcg albuterol / 20 mcg ipratropium or as a nebulizer solution with a dose of 2.5 mg albuterol / 0.5 mg ipratropium / 3 ml solution. It can be taken three or four times a day .

Side effects

The most common side effects include upper respiratory tract infections, cough, bronchitis, headaches, and shortness of breath .

Expenses

A standard inhaler generally includes a month's supply and is expected to cost around $ 450. There is no universal version of this combination, although both albuterol and ipratropium are available separately as generic.

Executor

Performomist (formoterol) is a long-acting beta agonist that is taken twice a day to treat chronic COPD.

It is available as an inhalation solution at a dose of 20 μg / 2 ml. The solution is used with a standard jet nebulizer with a mask or mouthpiece connected to an air compressor. The inhalation solution should always be stored in an aluminum bag and removed immediately before use .

Side effects

Side effects include diarrhea, nausea, throat infection, dry mouth, vomiting, dizziness, and trouble sleeping .

Expenses

The cost for a standard solution, which includes a two-month supply, is approximately $ 1,000; there is no universal version.

Pulmicort

Pulmicort (budesonide) is a corticosteroid that helps reduce inflammation in the airways, making it easier for you to breathe. Pulmicort is used in the maintenance therapy of COPD.

This medication is available as an inhaled powder in doses of 90 mcg and 180 mcg, or as a suspension in a nebulizer in doses of 0.25 mcg / 2 ml, 0.5 mcg / 2 ml, or 1 mg / 2 ml. It is usually taken twice a day .

Side effects

Side effects include nasal congestion, upper respiratory infection, nausea, gastrointestinal infection, ear infection, and yeast infection in the mouth .

Expenses

The monthly shipping price is approximately $ 40 and there is no universal version.

Dosage measures

'mcg' = micrograms

'mg' = milligrams

Spiriva

Spiriva contains tiotropium, an anticholinergic bronchodilator. It opens and relaxes the airways, making breathing easier.

Spiriva (tiotropium) is used as a supportive treatment for COPD, especially if bronchospasm is a major part of your condition. It is considered prophylactic for exacerbations of COPD .

The inhalation solution is available in doses of 1.25 mcg or 2.5 mcg and is given as two puffs once a day. It is also available in 18 mcg powder capsules for use with HandiHaler, which can also be taken as two puffs once a day .

Side effects

Side effects include upper respiratory infection, cough, dry mouth, urinary tract infection, and heartburn .

Expenses

Monthly stock costs around $ 450 and there is no universal version.

Symbicort

Symbicort contains formoterol, a long-acting bronchodilator, and budesonide, a corticosteroid. It is used in the treatment of stable COPD and is usually taken twice a day.

The dose is presented as budesonide mcg / formoterol mcg and is available in doses of 80 / 4.5 and 160 / 4.5 and is taken as two inhalations twice daily .

Side effects

When used to treat COPD, the most common side effects are upper respiratory tract infections, yeast infections in the mouth, and bronchitis .

Expenses

The cost of an inhaler for this drug is about $ 204; there is no universal version.

Trelegy ellipta

Trelegy Ellipta contains three active ingredients: fluticasone furoate (inhaled corticosteroid), umeclidinium (long-acting anticholinergic), and vilanterol (long-acting beta agonist). It is designed to open the airways, reduce inflammation, and improve lung function. It is used for chronic COPD, especially in patients who have improved after taking fluticasone furoate and vilanterol, but who need additional treatment to control symptoms and prevent flare-ups.

This medicine is used once a day and comes in the form of an inhaler that contains two blister strips of aluminum powder (100 mcg of fluticasone furoate, 62.5 mcg of umeclidinium and 25 mcg of vilantero) .

Side effects

The most common side effects include headaches, back pain, difficulty swallowing, diarrhea, cough, sore throat, and gastrointestinal infections .

Expenses

The cost of an inhaler is approximately $ 580 and this combination is not available in the universal version.

Tudorza Pressair

Tudorza Pressair (aclidinium bromide) is a long-acting bronchodilator that must be used twice a day. It is used for chronic COPD with bronchospasm. Like other long-acting bronchodilators, it is not used as a life-saving inhaler.

It is available in a device containing a dry powder dispenser and is used to deliver 400 mcg of aclidinium bromide by inhalation .

Side effects

Side effects include headaches, upper respiratory infections, and coughing .

Expenses

The device, which contains a one-month supply of drugs, costs about $ 360 and there is no universal version.

Xopenex

Xopenex (levalbuterol) is a short-acting beta-agonist bronchodilator that is used three to four times a day in one or two puffs. It is used to treat chronic COPD and can also be used as a life-saving inhaler.

It is available as a 45 mcg spray or nebulizer (0.31 mcg / 3 ml, 0.63 mcg / 3 ml, 1.25 mcg / 3 ml, or 1.25 mcg / 0.5 ml). Each inhalation dose of Xopenex HFA releases 67.8 mcg of levalbuterol and 59 mcg of levalbuterol tartrate from the actuator mouthpiece. It comes in a 15g pressure bottle containing 200 doses or an 8.4g bottle containing 80 doses .

If you haven't used the medicine for three days, the manufacturer recommends that you spray four sprays into the air and away from your face to apply it.

Side effects

Side effects include an increased risk of accidental injury, bronchitis, dizziness, pain, sore throat, runny nose, and vomiting .

Expenses

The cost for a 24-day supply is approximately $ 24 for the generic version and $ 75 for the brand-name version.

Get the word of drug information

Knowing your COPD inhaler can help ensure the best quality of life by minimizing the chance of medication errors. Make sure your healthcare provider explains the benefits and risks of any treatment they recommend and answers any questions you may have.

A 2019 study found that errors with inhaler use can occur in 87% of people. While it may seem intimidating, the risk of errors can be greatly reduced if you learn how to use your inhaler correctly and check both the brand and generic name of your medications to make sure you are not duplicating any medications (especially if you visit multiple centers. health care). suppliers.).

Advocating for your health care yourself can not only help you better manage your condition, it can also affect your quality of life and outcomes.

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