The Basics of Inhaler Therapies That Treat COPD

Woman with short hair using an inhaler
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In today’s world, it’s hard to avoid seeing a television commercial or online advertisement for inhaler medications that treat chronic obstructive pulmonary disease (COPD). There are inhalers that contain only one medicine (sometimes called ‘monotherapy’) and some that contain two (‘combination therapy’). Though there are many different names and brands of COPD medications, almost all the inhaled medicines fall into simply into one of three categories.

This article will describe the three most common situations for which health care providers prescribe inhaled medications for COPD patients. These situations are 1) emergency use, 2) long-term use, and 3) use for exacerbation-prone patients. 

1) 'Emergency Inhalers' (Short-Acting Bronchodilators)

Some patients with COPD experience shortness of breath only when they exert themselves, and even then, only rarely. For those patients, health care providers may prescribe a ‘short-acting’ bronchodilator only. These medications should be taken only when experiencing symptoms, or perhaps right before exertion (e.g. before going up a flight of stairs).

These medications are ‘fast on’ and ‘fast off’, meaning that it does not take long for them to start working, but that they do not last for very long. These inhalers should be taken ‘as needed’. Health-care providers may instruct patients to keep this medication in their purse or pocket so that if shortness of breath occurs, the medication can be taken quickly.

The short-acting bronchodilators work by helping to dilate airways, which helps the air to be exhaled more effectively and may decrease the amount of air trapped in the lungs and can lessen the sensation of shortness of breath.

The Bottom Line About Emergency Inhalers:

  • There are two major types: beta-2- agonists (e.g. albuterol) or anticholinergics (e.g. ipratropium)

2) Long Term Inhalers (Long-acting Bronchodilators)

Patients who have consistent symptoms of COPD (such as persistent shortness of breath or cough) may be prescribed medications that should be taken every day, regardless of whether of not they have symptoms. These medications are called “long acting bronchodilators”. Just like short-acting bronchodilators, there are two types of long-acting bronchodilators (beta-2 agonists and anticholinergics). Research has shown that patients who take these medications have a lower risk of having a COPD exacerbation.

These medications usually take about 15-30 minutes to take effect and may last 12-24 hours (depending on the medication). Patients who take long-acting bronchodilators that wear off after 12 hours (e.g. salmeterol, formoterol), should use their inhalers twice per day. Other long-acting bronchodilators (e.g. tiotropium) last up to 24 hours and need only be taken once per day.

The long-acting bronchodilators work by helping to dilate airways, just like the short-acting bronchodilators.

The main difference is that it takes longer to take effect and lasts longer than the short-acting medications.

The Bottom Line About Long Term Inhalers:

3) For Exacerbation-prone patients

Some patients continue to have episodes of shortness of breath and worsening symptoms despite taking long-acting bronchodilators.

These patients may experience some benefit from the addition of another medication, called an inhaled steroid (or inhaled glucocorticoids). There are many different types of inhaled steroids, but for the most part, they all work in the same way. Not all patients require inhaled steroids. They are usually prescribed when patients do not respond to the long-acting bronchodilators (above). Patients who require inhaled steroids may have less COPD exacerbations. The decision to add inhaled steroids should be assessed carefully by the health-care provider, however, because inhaled steroids do slightly increase the risk of developing a pneumonia in patients who have COPD.

It’s also important to know that inhaled steroids do not work immediately. In fact, it may take a few weeks for patients to feel the benefits of inhaled steroids. These medications should be taken every day, usually twice per day. Health-care providers should instruct patients to rinse their mouths with mouthwash or toothpaste after using them to prevent mouth infections (such as thrush).

Inhaled steroids work by decreasing inflammation in the airway. Inflammation can cause air to get trapped inside the lung, which is the major problem that causes COPD.

The Bottom Line About Exacerbation-Prone Patients:

  • Not all patients with COPD need inhaled steroids
  • Inhaled steroids should be taken every day, usually twice per day
  • Patients should rinse their mouths immediately after using inhaled steroid inhalers
  • It may take up to two weeks for inhaled steroids to take effect
  • Examples: budesonide, mometasone, fluticasone (for complete list of inhaled steroids, click here)

Other Important Points About COPD Inhalers

  • Many drug companies make ‘combination’ inhalers that combine two medications in a single inhaler. Most combination inhalers contain a long-acting bronchodilator plus an inhaled steroid. Commonly prescribed combination inhalers include Advair, Symbicort or Dulera.  
  • It’s also important to note that many of the inhalers used to treat COPD may also treat asthma. You should always talk to your healthcare provider about which medications are the best choice for you.
  • Always check with your health-care provider or pharmacist about how to use inhalers. Not all inhalers are used the same way, so it is important to make sure you are using the inhaler correctly to receive the full dose of medication. If you’re not sure about how to use your inhaler, click here and also ask your doctor to watch you inhale the medicine to make sure you’re doing it correctly.


American Thoracic Society Patient Website. Medicines Used to Treat COPD.

Niewoehner DE. Clinical Practice. Outpatient Management of Severe COPD. N Engl J Med 2010;362:1407-16.

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