Medication

Inhalers are devices that deliver medication into your lungs. They are used to help treat the symptoms of COPD, such as breathlessness or cough, and reduce the chances of having flare-ups or exacerbations. Inhalers are just as vital as any of your other medication, and it is important that you take them as prescribed.  

COPD inhaler treatment usually comprises of:  

• a short-acting (reliever) inhaler taken when you need it for breathlessness or chest tightness symptoms 

• and one or two longer-acting (preventer) inhaler(s), that should be taken regularly each day 

What are the different types of inhaled medications that can be used to treat COPD symptoms?  

Bronchodilators – these types of inhaled medications relax the muscles in the airways, opening the airways and making it easier to breathe.  

There are short-acting bronchodilators found in reliever or as required inhalers, which work in a few minutes to open the airways and stop symptoms.  
E.g. salbutamol or terbutaline. 

There are also longer-acting bronchodilators found in preventer inhalers, which can take longer to have an effect when you first use them but help the breathing for 12 to 24 hours. These can come in separate or combination inhalers. 

Steroid inhalers – these types of inhaled medications work by reducing inflammation and swelling in the airways over time. They are usually given in a combination inhaler that has both bronchodilator and steroid medications in it. Steroid inhalers are often given to people who have frequent flare-ups of their COPD or have asthma-like features to their symptoms (e.g. suffer with allergies, or a higher type of white blood cells called eosinophils). Not everybody with COPD needs to be on a steroid inhaler.  

You should rinse your mouth after using a steroid inhaler.  

What are the different types of inhaler devices?

There are different types of inhaler device available.  

Dry powder inhalers (DPIs) - take these inhalers by breathing in as hard as you can, then hold your breath for up to 10 seconds 

Soft mist inhalers – these inhalers turn liquids into a mist that you can breathe in  

Pressurised metered dose inhalers (MDIs) - these inhalers produce a puff of medication like an aerosol. Take a slow deep breath in whilst using the inhaler and then hold your breath for up to 10 seconds. Using a spacer with an MDI inhaler can help you breathe in the medicine more effectively. 

It is important that you understand how to take your inhalers correctly so that they deliver the medication to the right parts of your lungs. If you are unsure ask your GP practice nurse, respiratory nurse or pharmacist about how to take your inhaler correctly.

The following videos from Asthma + Lung UK show you how to use the different types of inhaler devices: How to use your inhaler  - Asthma + Lung UK

Click here to view additional information about the safe use of inhalers, from Chest Heart and Stroke Scotland CHSS Safe Use Of Inhalers And Nebulisers

A spacer device can be used with an MDI inhaler to give you more time to use the inhaler and removes the need for pressing the inhaler and breathing in the medication at the same time. This means that you inhaler a greater amount of the medicine into the lungs. 

This video from Asthma + Lung UK shows you how to use a spacer device - How to use a pMDI inhaler with a spacer – tidal breathing | Asthma +   Lung UK

A nebuliser works by changing liquid medication into a fine mist which is then breathed in through a face mask or mouthpiece. It can help deliver medication more quickly and easily than an inhaler so is often used as a short-term treatment during a flare-up or exacerbation of COPD. Nebulisers are more commonly used in hospital, but some people may be prescribed a nebuliser at home if they have more severe COPD or if inhalers are not helping to manage their symptoms. 

Medication given via a nebuliser includes short-acting bronchodilators (e.g. salbutamol) to open the airways or Saline-saltwater solution to help loosen and clear secretions. 

Click here to view additional information about the safe use of nebulisers, from Chest Heart and Stroke Scotland CHSS Safe Use Of Inhalers And Nebulisers

Additional medications may be recommended for people with COPD where symptoms are particularly problematic or troublesome. These include:

Mucolytics – e.g. carbocisteine, NACSYS or Acepiro. These medications help to thin down thick, sticky phlegm and sputum, making it easier to cough up and clear. They should be taken regularly as prescribed and can be used in conjunction with airway clearance techniques.  

Long term antibiotics – e.g. azithromycin or co-trimoxazole. These medications may be recommended by your respiratory doctor or nurse if you are having recurring chest infections. They are usually prescribed to be taken three times a week.  

Oramorph – form of liquid morphine which is used in small doses to help with immediate relief of severe and distressing breathlessness. It is normally taken as required, up to four times a day.  

Lorazepam – a tablet used in small doses to help with immediate relief of breathlessness or anxiety relating to breathlessness. It is normally taken as required, up to twice a day.  

You can discuss whether a trial of these additional medications may be appropriate for you with your GP or respiratory specialist team.