Types of COPD inhalers and how to use them
Doctors prescribe inhalers as a method for taking chronic obstructive pulmonary disease (COPD) medication. That allows you to take a lower dose and have fewer side effects. They can relieve symptoms, such as breathlessness, and improve your quality of life.
Inhalers for COPD contain either:
- a single type of medication, e.g., a bronchodilator that includes beta2-agonists or anticholinergics
- a combination of medications, e.g., a bronchodilator plus an anti-inflammatory medication, such as a corticosteroid like Symbicort
What is a COPD inhaler?
COPD inhalers are a method for delivering medication into your lungs. They come in various shapes, colors, and sizes.
It’s important to follow the instructions for your specific inhaler carefully. You can find these on the Patient Information Leaflet (PIL) that comes with the medication.
You use inhalers to relieve symptoms as they happen (reliever inhalers) or reduce the likelihood of a flare-up of symptoms (preventer inhalers).
Depending on how they work, there are five different types of inhalers.
1. Metered dose inhalers (MDIs)
This is the most common type of inhaler. It delivers the medication in an aerosol spray from a handheld, pressurized canister.
The Food and Drug Administration (FDA) recommends that all MDIs have a dose counter to help you track when to take your medication, and when you need to get a new one.
You need to prime MDIs before first use, or if you haven’t used them for a week. This usually involves giving the inhaler a vigorous shake for 5 to 10 seconds, then pressing the canister down one to four times away from your face. Check your inhaler’s PIL for what you should do with yours.
The American Lung Foundation lists the following general steps for using an MDI:
- Shake the inhaler for 10 seconds.
- Take the cap off the inhaler and make sure it is clean and there is nothing inside the mouthpiece.
- Breathe out away from the device.
- Put the inhaler mouthpiece in your mouth.
- Press the canister of the inhaler down once as you take a deep and steady breath.
- Hold your breath for 10 seconds, then breathe out slowly. If you need another puff of medication, wait 1 minute, and repeat steps 3–6.
- Rinse your mouth with water and spit.
The Centers for Disease Control and Prevention (CDC) has a helpful video — “Using a metered dose inhaler” — to demonstrate the process.
Spacers and volumizers
Research shows that it’s best to use a spacer or volumizer with your MDI because they reduce the risk of side effects, such as oral thrush. They also increase the amount of medication that reaches your lungs.
If you have a spacer, make sure it’s clean and attach it to your inhaler after step 2 (above). The CDC has a separate video to help with this: “Using a metered dose inhaler with a spacer.”
2. Breath-actuated inhalers (BAIs)
BAIs, like the QVAR RediHaler, are a type of inhaler that doesn’t require you to press down on the canister. This can be helpful if you find it difficult to get the timing right when pressing down and breathing in with an MDI.
These inhalers deliver the medication to the lungs as an aerosol spray or a dry powder.
You can often prime them by opening the cap. They then activate automatically when you breathe in through the mouthpiece. Be careful not to put your fingers over the air vents when you inhale.
As always, check the specific instructions for your inhaler. You can find them in the PIL that came with your medication.
The American Lung Association (ALA) has a helpful instructional video called “How to Use a Redihaler Aerosol Inhaler.”
The Asthma and Allergy Foundation of America (AAFA) has a leaflet with useful instructions in the section “How Do You Use a Breath Actuated Inhaler?“
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3. Dry powder inhalers (DPIs)
This type of inhaler is not pressurized, and it releases the medication by the action of your breathing in.
These come as either:
- single-dose DPIs, such as Tyvaso DPI
- multi-dose DPIs, such as ProAir RespiClick
General instructions for using a DPI:
- Make sure the DPI is clean and in good condition.
- Prime the inhaler according to the manufacturer’s instructions.
- With your face away from the inhaler, breathe all the way out.
- Put your mouth to the mouthpiece, and take a long, firm breath in.
- Hold your breath for as long as you can to allow the medication to be absorbed.
- Breathe out slowly.
- If your healthcare professional prescribed more than one puff of medication, wait 1 minute, and repeat steps 2–6.
The ALA has made a helpful instructional video called “How to Use a RespiClick Dry Powder Inhaler.”
If you are vegan or lactose intolerant, it’s important to note that most DPIs contain a small amount of lactose along with the medication.
4. Soft mist inhalers (SMIs)
There is some assembly required, though, and they are more expensive than older types of inhalers, if cost is a factor.
Once you assemble the SMI, with the cartridge inserted, you need to prime the inhaler. See your medication’s PIL for specific instructions on how to do this for your inhaler.
Remember to point the inhaler to the back of your throat when you press the release button. It’s important to keep your head and neck straight when using an SMI.
The AAFA recommends these steps for using your SMI.
You can find an instructional video from the ALA here: “How to Use a Respimat Softmist Inhaler.”
Nebulizers are another type of device that allows you to inhale COPD medication.
If your symptoms are severe, and you find it very difficult to breathe, nebulizers might be helpful. They can deliver large doses of medication to the lungs in a short period of time.
They are electrical and require a battery or AC power to create air pressure or soundwaves that turn the medication into a fine mist. You then inhale it, breathing as usual through a mouthpiece or while using a face mask.
The ALA provides a helpful video called “How to Use a Nebulizer.”
Tips for using an inhaler for COPD
The following tips can help you use your COPD inhaler:
- Check instructions: Always check and follow the instructions that come with your particular inhaler.
- Stand up: When using your inhaler, stand, or sit upright. This will help open up your lungs.
- Allow your medication to settle: Wait 1 minute between puffs to allow your medication to settle in your lungs.
- Take another puff: You may need to take another puff if you cough in the middle of using your inhaler.
- Have a spare inhaler: Always make sure that you have a spare inhaler, in case yours is lost or damaged.
- Rinse your mouth: Rinse your mouth with water after using your inhaler, remembering not to swallow.
Even within each type of inhaler, there are differences in how you should use them. This means it’s very important to read the instructions in the PIL that comes with your particular inhaler.
Research shows it’s essential to use your inhaler properly to get the maximum benefit from your medication.
If you are finding your inhaler difficult to use, talk with a healthcare professional to see whether a different type of inhaler will work better for you.
- Çakmaklı S, et al. (2023). An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease. https://www.sciencedirect.com/science/article/pii/S165836122300001X
- Metered dose inhaler (MDI) and dry powder inhaler (DPI) products – Quality considerations: Guidance for industry. (2018) https://www.fda.gov/media/70851/download
- How to correctly use your asthma devices. (2022) https://www.aafa.org/wp-content/uploads/2022/08/asthma-care-for-adults-lesson-4-how-to-properly-use-your-asthma-devices.pdf
- How to use a metered-dose inhaler without a valved holding chamber or spacer. (2022) https://www.lung.org/getmedia/1aa45911-f79f-44ef-a348-08e089e1a57c/MDI-one-pager.pdf?ext=.pdf
- How to use a nebulizer. (2022) https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/patient-resources-and-videos/how-to-use-a-nebulizer
- Iwanaga T, et al. (2019). The Respimat Soft Mist Inhaler: Implications of drug delivery characteristics for patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800401/
- Miravitlles M, et al. (2017). Factors affecting the selection of an inhaler device for COPD and the ideal device for different patient profiles. Results of EPOCA Delphi consensus. https://pubmed.ncbi.nlm.nih.gov/29031616/
- ProAir RespiClick (albuterol sulfate) inhalation powder, for oral inhalation use. (2016). https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/205636s006lbl.pdf
- QVAR RediHaler (beclomethasone dipropionate HFA) inhalation aerosol, for oral inhalation use. (2021). https://www.qvar.com/globalassets/qvar/qvar-redihaler-pi.pdf
- Spiriva Respimat (tiotropium bromide) inhalation spray, for oral inhalation. (2019). https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021936s012lbl.pdf
- Tyvaso DPI (treprostinil) inhalation powder, for oral inhalation use. (2022). https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/214324s000lbl.pdf
- Vincken W, et al. (2018). Spacer devices for inhaled therapy: Why use them, and how? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004521/