COPD - control drugs
Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - control drugs; Corticosteroid inhaler - COPD - control drugs
Anticholinergic Inhalers
Anticholinergic inhalers include:
- Aclidinium (Tudorza Pressair)
- Glycopyrronium (Seebri Neohaler)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
- Revefenacin (Yupelri)
Use your anticholinergic inhalers every day, even if you do not have symptoms.
If you have a chronic lung disease, like asthma or COPD, a metered-dose inhaler is often your main type of therapy. An inhaler is a small, hand-held device that delivers medicine in the form of a spray that you breathe in. Using an inhaler may seem easy, but many people don't use them the right way. You need to know how to use your inhaler correctly for the medicine to get to your lungs and work effectively. In general, using the inhaler without a spacer requires more coordination in order to ensure that medicine reaches your lungs. So, when possible, it's best to use a spacer. These are instructions for using an inhaler without a spacer. First off, if you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for when and how to do this. Take the cap off the mouthpiece, and look inside the mouthpiece to make sure there is nothing in it. Shake the inhaler 10 to 15 times to mix the medicine with the propellant. Hold the inhaler upright. Stand or sit upright. Breathe out all the way to empty your lungs. Place the mouthpiece in your mouth so that it fits just past your teeth and above your tongue. Close your lips around the inhaler so that you form a tight seal. Tilt your head back slightly. As you slowly begin to breathe in through your mouth, press down once on the top of the inhaler. Keep breathing in slowly, as deeply as you can. Take the inhaler out of your mouth. Hold your breath for 5 to 10 seconds. This lets the medicine reach deep into your lungs. Breathe out slowly through your mouth. If you need a second puff, wait about 1 minute before you take your next puff. Put the cap back on the inhaler and make sure it is firmly closed. After using your inhaler, gargle and rinse your mouth with water. Do not swallow the water. This helps reduce side effects from your medicine. To keep your inhaler operating correctly, follow the manufacturer's instructions for when and how often to clean your inhaler. Using your inhaler the right way ensures you get the medicine you need. It's a good idea to bring your inhaler to your medical appointments. That way your health care provider can make sure you are using it correctly.
Beta-agonist Inhalers
Beta-agonist inhalers include:
- Arformoterol (Brovana)
- Formoterol (Foradil; Perforomist)
- Indacaterol (Arcapta Neohaler)
- Salmeterol (Serevent)
- Olodaterol (Striverdi Respimat)
Do not use a spacer with beta-agonist inhalers.
If you have a chronic lung disease, like asthma or COPD, a metered-dose inhaler is often your main type of therapy. An inhaler is a small, hand-held device that delivers medicine in the form of a spray that you breathe in. Using an inhaler may seem easy, but many people don't use them the right way. You need to know how to use your inhaler correctly for the medicine to get to your lungs and work effectively. A spacer device will help. The spacer connects to the inhaler mouthpiece, and the medicine goes into the spacer tube first. This allows you to breathe in the medicine more easily. Using a spacer wastes a lot less medicine than spraying the medicine directly into your mouth. It also makes it less important to get the exact timing for activating the inhaler while taking in a breath. These are instructions for using an inhaler with a spacer. First off, if you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for when and how to do this. Take the caps off the inhaler and spacer. Look inside each mouthpiece to make sure there is nothing in it. Shake the inhaler 10 to 15 times to mix the medicine with the propellant. Attach the inhaler mouthpiece to the open end of the spacer and hold it upright. Stand or sit upright. Breathe out all the way to empty your lungs. Place the spacer mouthpiece in your mouth so that it fits just past your teeth and above your tongue. Close your lips around the spacer so that you form a tight seal. Tilt your head back slightly. As you slowly begin to breathe in through your mouth, press down once on the top of the inhaler. Keep breathing in slowly, as deeply as you can. Your spacer may have a whistle that sounds if you breathe in too fast. Take the spacer out of your mouth. Hold your breath for 5 to 10 seconds. This lets the medicine reach deep into your lungs. Breathe out slowly through your mouth. If you need a second puff, wait about 1 minute before you take your next puff. Put the caps back on the inhaler and spacer. After using your inhaler, gargle and rinse your mouth with water. Do not swallow the water. This helps reduce side effects from your medicine. To keep your inhaler and spacer operating correctly, you need to keep them clean. Follow the manufacturer's instructions for when and how often to clean your inhaler and spacer. Using your inhaler with a spacer the right way ensures you get the medicine you need. It's a good idea to bring your inhaler and spacer to your medical appointments. That way your health care provider can make sure you are using them correctly.
Inhaled Corticosteroids
Inhaled corticosteroids include:
- Beclomethasone (Qvar)
- Fluticasone (Flovent)
- Ciclesonide (Alvesco)
- Mometasone (Asmanex)
- Budesonide (Pulmicort)
- Flunisolide (Aerobid)
After you use these drugs, rinse your mouth with water, gargle, and spit.
Combination Inhaled Medicines
Combination medicines combine two or three drugs and are inhaled. They include (list is not complete):
- Albuterol and ipratropium (Combivent Respimat; Duoneb)
- Budesonide and formoterol (Symbicort)
- Fluticasone and salmeterol (Advair)
- Fluticasone and vilanterol (Breo Ellipta)
- Formoterol and mometasone (Dulera)
- Tiotropium and olodaterol (Stiolto Respimat)
- Umeclidinium and vilanterol (Anoro Ellipta)
- Glycopyrrolate and formoterol (Bevespi Aerosphere)
- Indacaterol and glycopyrrolate (Utibron Neohaler)
- Fluticasone and umeclidinium and vilanterol (Trelegy Ellipta)
- Budesonide and glycopyrrolate and formoterol (Breztri Aerosphere)
For all these medicines, some generic brands have just become or will become available in the near future, thus different names might also exist.
Phosphodiesterase Inhibitor
Roflumilast (Daliresp) is a tablet that is swallowed.
Antibiotics
Azithromycin is a tablet that is swallowed.
References
Anderson B, Brown H, Bruhl E, et al. Institute for Clinical Systems Improvement website. Health Care Guideline: Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). 10th edition.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report.
Han MK, Lazarus SC. COPD: clinical diagnosis and management. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 64.
Waller DG. Asthma and chronic obstructive pulmonary disease. In: Waller DG, ed. Medical Pharmacology and Therapeutics. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 12.
Version Info
Last reviewed on: 1/20/2022
Reviewed by: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
