A Guide to COPD Inhalers

Chronic obstructive pulmonary disease (COPD) is a common lung condition. It affects over 6% of the population in the U.S., where cigarette smoking is the leading cause of COPD. Symptoms of COPD include breathlessness, cough, and chest infections. It may also affect quality of life, mood, and life expectancy.

Inhalers are the main treatment for COPD. These are medications that you breathe into your lungs. Inhalers for COPD come in many different shapes and sizes. They vary in cost and type of medication and device. With so many different types of inhalers, it can be overwhelming to find those that work best for you, your lifestyle, and your wallet. 

Read on for our in-depth guide to COPD inhalers. 

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COPD inhalers: The basics

To understand how inhalers help COPD, we first need to cover some basics about what happens to the lungs with COPD. 

COPD stands for “chronic obstructive pulmonary disease.” Let’s break down what that means:

• Chronic: This means that the disease can’t be cured, so it’s a lifelong condition.

• Obstructive: This refers to how the airways in the lungs are blocked, meaning that the lungs struggle to move air in and out of the body.

• Pulmonary: This refers to the airways.

People with COPD typically have two lung problems: 

• Emphysema: This is damage to the air sacs in the lungs (alveoli), usually from cigarette smoking. The main symptom is breathlessness. 

• Chronic bronchitis: This is damage to the lung airways, again, usually from cigarette smoking. This inflammation causes cough, mucus, and frequent chest infections.

What is an inhaler, and how does it work?

Inhalers are the most common way to use or receive medications for COPD. By using an inhaler properly, the medication gets right where it’s needed — into the lungs. Other devices, like spacers and nebulizers, can also help (more on those later).

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There are a few different types of inhalers, and we’ll go through each of them in this guide. 

Inhalers for COPD vary by:

• Medication: They contain different active ingredients.

• Dosage: There are differences in dose delivered in each puff.

• Device: Inhalers work in different ways.

• Affordability: The cost and availability of generic alternatives vary.

Types of inhalers for treating COPD

There are a couple of different ways to categorize COPD inhalers: the medication it contains and the type of device. 

Types of COPD inhaler medications 

You may hear your primary care provider refer to an inhaler as a “preventer” or “reliever.” These terms refer to the type of medication in the inhaler:

• Preventer (maintenance) inhaler: A preventer inhaler helps prevent symptoms and exacerbations of COPD. Maintenance inhalers like Advair are used once or twice a day, at the same time for each dose.

• Reliever (rescue) inhaler: A rescue inhaler offers quick relief from symptoms. Reliever inhalers may be used a few times a day as needed — or not at all. How often you use it depends on your symptoms. For instance, Airsupra works as a rescue inhaler but it shouldn't be used daily to prevent asthma.

Be careful not to confuse COPD inhalers—Advair and Airsupra are not the same. Advair is a daily maintenance inhaler that helps prevent symptoms, while Airsupra is used only as needed for quick relief during flare-ups.

Types of COPD inhaler devices

Different devices deliver medication to the lungs in different ways. You can choose between:

• Metered dose inhalers (MDIs): MDIs contain medication in a liquid form. The liquid medication is propelled out of the inhaler as an aerosol, like a spray can. When using an MDI, you need to inhale deeply right as you push a button on the inhaler. The timing of this can be tricky for some people.

• Dry powder inhalers (DPIs): DPIs contain medication in dry powder form. You inhale the powder straight into the lungs through the mouth. DPIs can be easier to use for some people, since you don’t have to time your inhalation with pressing the button. But you need to be able to inhale deeply for it to work.

• Soft mist inhalers (SMIs): SMIs use a mechanical spring to propel medication out, and it doesn’t rely on inspiration. They are more effective at delivering medication into the lungs and reduce issues with timing and coordination.

All types can deliver both types of medication (relievers and preventers). 

Nebulizers

COPD medication can also be inhaled as a nebulizer. A nebulizer is a machine that turns a liquid medication into a mist that you can breathe into the lungs through a mask. Nebulizers can be easier to use for some people. For example, they’re often used in the hospital when someone is very breathless. Some people have nebulizers available for use at home — either daily or for emergencies, depending on their needs.

Bronchodilators

Bronchodilators are medications that help open the airways by relaxing the muscles around them. The bronchodilator medications used in COPD inhalers are beta agonists and antimuscarinics. These medications can be short or long acting, for either immediate relief of symptoms or managing symptoms longer term:

• Short-acting beta agonists (SABAs)

• Long-acting beta agonists (LABAs) 

• Short-acting muscarinic antagonists (SAMAs)

• Long-acting muscarinic antagonists (LAMAs)

Short-acting beta agonists (SABAs)

SABAs act on beta-2 receptors in the lungs, which help relax and expand the airways and make it easier to breathe. SABAs are a commonly used bronchodilator inhaler. They’re available as MDIs, DPIs, and nebulizer solutions. 

SABAs aren’t the type of inhaler that you use every day, regardless of symptoms. You’ll typically use it when your symptoms flare up. That’s because they work quickly but only offer temporary relief. They are often used in the hospital through a nebulizer, too.

Common examples include:

• Albuterol (ProAir Respiclick, Ventolin HFA)

• Levalbuterol (Xopenex HFA)

Precautions

Call your healthcare team right away if you need to use your SABA more than every 4 hours — either because your symptoms come back or because the inhaler isn’t working as it usually does. Administering these medications more often than every 4 hours can be a sign that you are seriously unwell and may need emergency medical care. This inhaler can cause shaking of the hands (tremors), noticeable heartbeats (palpitations), or feelings of excitement or stress.

Long-acting beta agonists (LABAs) 

Like SABAs, LABAs also help open the airways by relaxing the muscles around them. The difference is that LABAs work for a longer period of time than SABAs. LABAs are one of the main treatments for COPD.

LABAs are long-acting medications that are administered once or twice a day to prevent symptoms or to keep symptoms steady. They’re available as DPIs, MDIs, and nebulizer solutions. 

Common examples include:

• Salmeterol (Serevent Diskus)

• Formoterol (Perforomist)

• Arformoterol (Brovana)

• Olodaterol (Striverdi Respimat)

Precautions

LABAs may cause shaking of the hands (tremors), noticeable heartbeats (palpitations), or feelings of excitement or stress.

Short-acting muscarinic antagonists (SAMAs)

Like SABAs, SAMAs also act on receptors in the lungs to make it easier to breathe. Ipratropium (Atrovent) is one example.

SAMAs are short-acting medications that can help relieve symptoms of breathlessness — especially when used together with a SABA. In practice, SAMAs are used more along with inhalers than on their own. And they shouldn’t be used if you already use a LAMA every day. They are available as MDIs and also used in nebulizers in the hospital.

Precautions

If your inhaler isn’t relieving your symptoms, or you’re using it more often than every 6 hours, you should call a healthcare professional.

Long-acting muscarinic antagonists (LAMAs)

These medications are a long-acting version of SAMAs, meaning they help to relieve symptoms for longer.

LAMAs are long-acting medications that are used every day to prevent symptoms or keep symptoms steady. They’re available as MDIs, DPIs, and nebulizer solutions. Examples include:

• Tiotropium (Spiriva HandiHaler, Spiriva Respimat)

• Umeclidinium (Incruse Ellipta)

• Aclidinium (Tudorza Pressair)

• Glycopyrrolate

• Revefenacin (Yupelri)

Precautions

LAMAs can cause a dry mouth.

Inhaled corticosteroids

Inhaled corticosteroids are medications that help reduce inflammation of the airways, making it easier to breathe. They should only be used to treat COPD in people who still have symptoms, despite taking a LABA or LAMA — or both. Put another way, inhaled corticosteroids are a treatment for people with more advanced COPD. 

Inhaled corticosteroids should be prescribed in combination with a LABA and/or LAMA, either as an additional inhaler or in a combination inhaler (see below). That’s because bronchodilators work better for treating COPD — with fewer side effects than steroids. On their own, inhaled corticosteroids are available as MDIs and DPIs, and they are actually only FDA approved for treatment of asthma.

Examples include:

• Budesonide (Pulmicort Flexhaler)

• Fluticasone (Arnuity Ellipta)

• Mometasone (Asmanex HFA, Asmanex Twisthaler)

Precautions

Using these inhalers with a spacer and rinsing your mouth thoroughly afterward will help avoid side effects like voice change and fungal infection in the mouth (oral thrush).

Combination inhalers

Your healthcare team may prescribe you a combination inhaler. This is a mix of two (or sometimes three) medications in one inhaler. The medications work better for relieving breathlessness when you use them together than when you use either medication alone.

Combination inhalers make it easier to take multiple medications at once and are often used in people with more severe COPD.

Long-acting bronchodilators (LAMA + LABA)

The most common combination inhalers used in COPD have two long-acting bronchodilators (LAMA + LABA):

• Umeclidinium/vilanterol (Anoro Ellipta)

• Tiotropium/olodaterol (Stiolto Respimat)

• Glycopyrrolate/formoterol (Bevespi Aerosphere)

• Aclidinium/formoterol (Duaklir Pressair)

Short-acting bronchodilators (SAMA + SABA)

Sometimes, the combination is two short-acting bronchodilators (SAMA + SABA):

• Ipratropium/albuterol as an inhaler (Combivent Respimat)

• Ipratropium/albuterol as a nebulizer

Long-acting bronchodilator (LABA or LAMA) with a corticosteroid

You can also get a corticosteroid with a long-acting bronchodilator (LABA or LAMA):

• Fluticasone/salmeterol (Advair Diskus, Wixela Inhub)

• Budesonide/formoterol (Symbicort, Breyna)

• Fluticasone/vilanterol (Breo Ellipta)

• Mometasone/formoterol (Dulera)

Three-ingredient inhaler (corticosteroid + LAMA + LABA)

One type of inhaler has three ingredients: corticosteroid, LAMA, and LABA. An example is:

• Trelegy Ellipta (fluticasone/umeclidinium/vilanterol)

• Breztri Aerosphere (budesonide/glycopyrrolate/formoterol)

COPD inhaler comparison

Here’s how they all compare.

*Not if already taking a LAMA

Affording your COPD inhalers

The cost of inhalers can add up, especially if you’re taking more than one. Here are some options for how to save on COPD inhalers:

• Try a GoodRx coupon. A discount can help you save up to 80% on your out-of-pocket cost.

• Switch to a more affordable alternative. Some inhalers have authorized generics, which are the same as brand-name inhalers — but without the brand name on the label. And oftentimes, authorized generics cost less than their brand versions. Speak to your pharmacist or healthcare team to see if an authorized generic is available for your inhaler.

• Try a manufacturer copay card or patient assistance program. Many inhalers, especially brand-only ones, will have options to save through the medication manufacturer. To see the programs available for your inhalers, simply search for your medication on the GoodRx website or mobile app. Then scroll down to “Ways to save” on your prescription, which are suggestions on how to lower your costs beyond just the GoodRx coupons.

• If your inhaler isn’t covered by your insurance, submit an appeal. Even if your plan doesn’t cover medication, that doesn’t mean you have to pay the full cost of it. Speak with your healthcare team or call your insurance company to start an appeal process. Persistence is key here!

Tips for getting the most out of your COPD inhalers

Your inhalers will work best when the medication you suck out of the inhaler gets right into the lungs, where it’s needed. 

You can get the most of your COPD inhalers by following these recommendations:

• Know which inhaler to use at what time. Being clear on how and when to use your different inhalers will help you keep ahead of your symptoms and make sure that each inhaler is doing its job.  

• Perfect your inhaler technique. Follow these tips on how to use your inhalers properly.   

• Use a spacer chamber. A spacer is a mouthpiece that’s connected to your inhaler with a plastic tube. It helps the medication reach your lungs effectively. Without a spacer, the medication is more likely to stay in your mouth instead of reaching your lungs. When this happens, the medication won’t work as well and will be more likely to cause side effects. Spacers only work with MDIs — and they make them much easier to use properly. For help on how to use a spacer with an MDI, check out this article or this video.

• Stop smoking. If you smoke, quitting smoking is the single most effective step you can take to improve your COPD. It also helps the medications you take work better.

• Attend pulmonary rehabilitation. This structured program of education, counseling, and physical therapy is one of the most effective ways of improving COPD symptoms and helping you get the most out of your medication treatment.  

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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