An inhaler is a new device goods and chattels a medicine that you capture by breathing in (inhaling). Inhalers are repeatedly used to treat chronic uncooperative pulmonary disease (COPD). There are many different types of COPD Inhalers, which can be confound. The purpose of this leaflet is to give information on the medicines that are inside COPD Inhalers, the dissimilar types of inhaler device, and some well established information about inhalers.This leaflet is about COPD Inhalers. Another leaflet in this series, called Chronic Obstructive Pulmonary Disease, gives more extensive information about COPD. There are also different leaflets called Asthma and Inhalers for Asthma.
The proper medicine name is called the generic name. Different drug companies can use the generic medicine and produce different brands – the proprietary medicine names. There are many different brands of inhalers. Inhalers can have generic names and be produced by different drug companies too. For some medicines there are different inhaler devices that deliver the same medicine. This means that there are many types of inhaler available on prescription, all of which are produced in different colours. This can be confusing.Because there are lots of different coloured inhalers available, it is helpful to remember their names, as well as the colour of the device.
Short-acting bronchodilator COPD Inhalers:An inhaler with a bronchodilator medicine is often prescribed. These relax the muscles in the airways (bronchi) to open them up (dilate them) as wide as possible. People often call them relievers.these Inhalers work well for some people, but not so well in others. Typically, symptoms of wheeze and breathlessness improve within 5-15 minutes with a beta-agonist inhaler, and within 30-40 minutes with an antimuscarinic inhaler. The effect from both types typically lasts for 3-6 hours. Some people with mild or intermittent symptoms only need an inhaler as required for when breathlessness or wheeze occurs. Some people need to use an inhaler regularly.The beta-agonist and antimuscarinic COPD.
Long-acting bronchodilator COPD Inhalers:These work in a similar way to the short-acting Inhalers, but each dose lasts at least 12 hours. Long-acting bronchodilators may be an option if symptoms remain troublesome despite taking a short-acting bronchodilator.
Steroid COPD Inhalers:A steroid inhaler may help in addition to a bronchodilator inhaler if you have more severe COPD or regular flare-ups (exacerbations) of symptoms. Steroids reduce inflammation.Steroid Inhalers are only used in combination with a long-acting beta-agonist inhaler (this can be with two separate inhalers or with a single inhaler containing two medicines).
Combination COPD Inhalers are useful if people have severe symptoms or frequent flare-ups. Sometimes it is more convenient to use just one inhaler device.
- Pressurised metered dose inhalers (MDIs).
- Breath-activated inhalers – MDIs and dry powder inhalers.
- Inhalers with spacer devices.
The standard MDI:A standard MDI is shown on the right. The MDI has been used for over 40 years and is used to deliver various types and brands of medicines. It contains a pressurised inactive gas that propels a dose of medicine in each ‘puff’. Each dose is released by pressing the top of the inhaler. This type of inhaler is quick to use, small, and convenient to carry. It needs good co-ordination to press the canister, and breathe in fully at the same time. Sometimes these are known as evohalers.The standard MDI is the most widely used inhaler. However, many people do not use it to its best effect. Errors include:
- Not shaking the inhaler before using it.
- Inhaling too sharply or at the wrong time.
- Not holding your breath long enough after breathing in the contents.
Until recently, the propellant gas in MDIs has been a chlorofluorocarbon (CFC). However, CFCs damage the Earth’s ozone layer, and so are being phased out. The newer CFC-free COPD Inhalers work just as well, but use a propellant gas that does not damage the ozone layer.
Breath-activated inhalers:These are alternatives to the standard MDI. Some are still pressurised MDIs, but don’t require you to press a canister on top. The autohaler shown on the right is an example. Another example of a breath-activated MDI is the Easi-Breathe inhaler®.Other breath-activated COPD Inhalers are also called dry powder inhalers. These COPD Inhalers do not contain the pressurised inactive gas to propel the medicine. You don’t have to push the canister to release a dose. Instead, you trigger a dose by breathing in at the mouthpiece. Accuhalers, clickhalers, easyhalers, novolizers, turbohalers, diskhalers and twisthalers are all breath-activated dry powder COPD Inhalers. You need to breathe in fairly hard to get the powder into your lungs.
Spacer devices:Spacer devices are used with pressurised MDIs. There are various types – an example is shown opposite. The spacer between the inhaler and the mouth holds the medicine like a reservoir when the inhaler is pressed. A valve at the mouth end ensures that the medicine is kept within the spacer until you breathe in. When you breathe out, the valve closes. You don’t need to have good co-ordination to use a spacer.
Nebulisers: nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal COPD Inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of COPD when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser – you just breathe in and out, and you will breathe the medicine.
Do you get side-effects from COPD Inhalers?
At standard inhaled doses, the amount of medicine is small compared with tablets or liquid medicines. Therefore, side-effects tend to be much less of a problem than with tablets or liquid medicines. This is one of their main advantages. However, some side-effects do occur in some people. Read the leaflet that comes with the inhaler for details of possible side-effects. The following just highlights the more common and important ones to be aware of.One problem that might occur when using a COPD Inhalers(especially if you are taking a high dose) is that the back of your throat may get sore. Thrush infection in the mouth may develop. This can usually be treated easily with a course of pastilles that you suck or liquid that you hold in your mouth. You might also notice that your voice becomes more hoarse.If you rinse your mouth with water and brush your teeth after using a steroid inhaler you are less likely to develop a sore throat or thrush. Also, some COPD Inhalers devices (such as spacers) are less likely to cause throat problems. A change to a different device may help if mouth problems or thrush occur.
Which is the best device to use from COPD Inhalers?
This depends on various factors such as:
- Convenience. Some inhalers are small, can go easily in a pocket, and are quick to use. An example is the standard MDI inhaler.
- Your age. Some elderly people find the MDI inhalers difficult to use.
- Your co-ordination. Some devices (in particular the standard MDI) need more co-ordination than others.
- Side-effects. Some of the inhaled medicine hits the back of the throat. Sometimes this can cause problems such as thrush in the mouth. This tends to be more of a problem with higher doses of steroid inhalers. Less of the medicine hits the throat when using a spacer device. Therefore, a spacer device may be advised if you get throat problems, or need a high dose of inhaled steroid.