Inhalers

Overview

Inhalers are compact, handheld devices designed to administer medication directly into the lungs. Types of inhalers include metered-dose, dry powder, and soft mist. They are commonly used to manage conditions like asthma and COPD, although healthcare providers may also prescribe them for other medical conditions.

Bronchodilators and corticosteroids are frequently prescribed inhaled medications. Inhaled corticosteroids (ICS) are commonly used to prevent asthma symptoms and are often paired with a rescue inhaler for rapid relief during attacks. If ICS medications alone do not effectively manage asthma, your healthcare providers may supplement them with a long-acting bronchodilator such as a long-acting beta-agonist (LABA) or a long-acting muscarinic antagonist (LAMA).

For managing COPD, healthcare providers often prescribe inhalers that combine medications such as LABA, LAMA, and/or inhaled corticosteroids. Examples of these combinations include fluticasone/salmeterol, budesonide/ formoterol, and fluticasone/ umeclidinium/ vilanterol.

Additionally, rescue inhalers are prescribed for COPD exacerbations, which occur during periods of worsened breathing symptoms.

Types

The following are different types of inhaler devices:

• Metered dose inhalers (MDIs or pMDIs): Often referred to as “puffers,” these inhalers contain medication in a pressurized canister within a handheld device with a mouthpiece. Activating the canister releases a dose of medicine propelled by a propellant, facilitating delivery through the mouthpiece. You breathe the medicine into your lungs as directed. One dose at a time is dispensed by MDIs from a canister that holds several doses.
• Dry powder inhalers (DPIs): Medication is kept as a powder within capsules or other containers for use with DPIs, which you activate when you’re ready to use them. DPIs deliver medication without the use of a propellant, in contrast to MDIs. Rather, you inhale the powder into your lungs by taking a quick, deep breath. DPIs are commonly tube- or disk-shaped, equipped with a mouthpiece and sometimes a loading area for medication. Different styles and brands come with unique instructions for how to activate and use them effectively.
• Soft mist inhalers: These inhalers transform liquid medication into a fine mist that is inhaled through the mouth to deliver the medicine directly to the lungs.

Medication for respiratory conditions is available as inhalers that are customized to meet individual requirements. These include medications taken on a regular basis to control symptoms or prevent attacks, as well as ones used for quick relief during exacerbations or attacks. These medications fall into three categories:

• Inhaled corticosteroids (ICS): These medications help decrease inflammation in the lungs. They are typically used on a daily basis to prevent asthma attacks and, in some cases, are prescribed for COPD or other lung conditions. Inhaled corticosteroids are commonly administered through dry powder inhalers.
• Short-acting bronchodilators: When breathing becomes extremely difficult during an asthma attack or a COPD exacerbation, these inhalers are used to relieve symptoms. Often called “rescue inhalers,” they quickly return breathing to normal, but the effects wear off in a few hours. These medications include short-acting beta-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs or anticholinergics). They function by relaxing the muscles in your airways, providing relief for about four to six hours. They are available in metered-dose inhalers or for use with a nebulizer. Examples include albuterol, levalbuterol, and ipratropium.
• Long-acting bronchodilators: These are commonly used to manage COPD symptoms effectively and may also be prescribed with inhaled corticosteroids to treat asthma. Long-acting bronchodilators, which can last between 12 to 24 hours, are available in dry powder or soft mist inhaler forms. They are used daily to minimize the risk of severe symptoms and decrease reliance on rescue inhalers. This category includes long-acting muscarinic antagonists (LAMAs or anticholinergics) and long-acting beta-agonists (LABAs). Examples of LAMAs include aclidinium, glycopyrrolate, tiotropium, and umeclidinium. Examples of LABAs include formoterol, indacaterol, olodaterol, and salmeterol.

Combination medications: Certain inhalation therapies effectively treat respiratory diseases by combining two or three medications. Some medications combine one or more bronchodilators with an inhaled corticosteroid (ICS), while others mix two long-acting bronchodilators. A medication that combines albuterol and ipratropium, two short-acting bronchodilators, is an example of this. Combination medications can be purchased as soft mist inhalers, dry powder, or metered dose inhalers.

Examples include:

• Long-acting beta-agonists / long-acting muscarinic antagonists: glycopyrrolate/formoterol, indacaterol/glycopyrrolate, tiotropium/olodaterol, umeclidinium/vilanterol.
• Inhaled corticosteroids / long-acting beta-agonists: budesonide/formoterol, fluticasone/salmeterol, fluticasone/vilanterol, mometasone/formoterol.
• Inhaled corticosteroids / long-acting beta-agonists / long-acting muscarinic antagonists: budesonide/glycopyrrolate/formoterol, fluticasone/umeclidinium/vilanterol.

Other inhaled medications: Inhalers are used to treat several diseases besides COPD and asthma. Additional medications available in dry powder inhalers include:

• Antibiotics, such as tobramycin and colistin.
• Antivirals, such as zanamivir.
• Insulin.
• Levodopa.
• Loxapine.
• Mannitol.

Reason for undergoing the procedure

People with chronic lung conditions like asthma or chronic obstructive pulmonary disorder (COPD) primarily use inhalers. Daily inhalers help manage or prevent symptoms, while fast-acting (rescue) inhalers are used during asthma attacks or COPD flare-ups.

Even those without asthma may use inhalers, but they should only use the specific inhaler prescribed by their healthcare provider. Rescue inhalers and inhaled corticosteroids can also be prescribed for other respiratory conditions, but it’s crucial to use only the inhaler designated for your condition.

Inhaled medications are primarily used to treat asthma and COPD. Providers may also prescribe them to manage respiratory infections such as bronchitis. Additionally, healthcare providers utilize inhaled medications to treat:

• Cystic fibrosis.
• Diabetes.
• Flu.
• Parkinson’s disease.
• Schizophrenia.

Risk

The risk associated with inhalers vary depending on the medication and the condition being treated. Potential risks include:

• Long-acting bronchodilators should not be used without an accompanying inhaled corticosteroid for asthma treatment, as using them alone may increase the risk of death from asthma-related events.
• Inhaled corticosteroid (ICS) inhalers used for COPD treatment may increase the risk of pneumonia.

Risks related to inhaler devices typically stem from improper usage.

Procedure

Inhalers are essential devices used to administer medication directly into the lungs. They are primarily utilized for managing respiratory conditions such as asthma and COPD. Your healthcare providers may also prescribe them for treating respiratory infections like bronchitis, among other conditions.

General guidelines in using inhalers typically involve:

• Remove the cap from the inhaler.
• Prime the metered-dose inhaler by shaking it and spraying into the air as directed, or load a dose into dry powder inhalers like Diskus.
• Exhale fully to empty your lungs.
• Place the inhaler in your mouth.
• With a metered-dose inhaler, inhale slowly through your mouth while pressing down on the canister (timing may vary if using a spacer). For dry powder inhalers, inhale quickly and deeply to draw the medicine into your lungs. Soft mist inhalers require a slow inhalation while releasing a dose.
• Hold your breath for 10 seconds to ensure the medicine reaches your lungs.
• To avoid thrush, rinse your mouth and spit out after using an ICS inhaler.

Proper use of metered-dose inhalers (MDIs) can be challenging because medication may not reach your lungs if you don’t coordinate your inhalation with the device’s spray. It’s crucial to follow MDI instructions carefully. Have your healthcare provider demonstrate the correct technique and ask about using a spacer, which attaches to the mouthpiece to help you synchronize your breathing with the medication release.

Dry powder inhalers (DPIs) require a deep and fast inhalation to effectively deliver the medication, which can be difficult for some individuals. If you’re unsure whether a DPI is right for you, ask your healthcare provider to demonstrate its use and address any concerns you may have about using it.

Outcome

Using an inhaler device offers several advantages:

• Targeted delivery: It ensures direct delivery of medication to your lungs, effectively targeting the affected area.
• Symptom management: Daily use helps manage symptoms associated with chronic lung conditions and other medical illnesses, promoting better respiratory health over time.
• Emergency relief: During emergencies or acute episodes, rescue inhalers swiftly open up constricted airways, providing immediate relief until symptoms are under control.

If you have questions or concerns about using your inhaler, it’s important to talk to your healthcare provider. Contact them if your breathing remains uncontrolled despite taking your medications. Signs of inadequate control may include experiencing asthma symptoms during sleep or needing your rescue inhaler more than twice a week unexpectedly.

Avoid using your inhaler more than prescribed. Many inhalers come with a dose counter to help you keep track of your medication intake. If you’re worried about exceeding the recommended dosage or if you feel you need more medication than prescribed to manage your symptoms, consult your healthcare provider. They can offer personalized advice to address your specific needs.