An inhaler is a device that contains a medicine taken by inhalation (inhalation). Inhalers are often used to treat chronic obstructive pulmonary disease (COPD). There are many different types of inhaler, which may be confusing. The purpose of this booklet is to provide information about: drugs (medicines) that are inside inhalers, the different types of inhaler device, and some general information about inhalers. This booklet is about inhalers for COPD. Another booklet in this series, called "Chronic Obstructive Pulmonary Disease ', gives more general information about COPD. Separate booklets are also called' Asthma 'and' Asthma inhalers.
On this page
- The drugs (drugs) within inhalers
- Inhaler devices
- The most common questions and more information
- More help and information
The drugs (drugs) within inhalers
The drug inside an inhaler goes directly to the airways when inhaled This means that it takes a much lower dose if the drug is taken in tablet or liquid by mouth. The bronchi and lungs treated but little of the drug enters the rest of the body (through the bloodstream).
The name of the appropriate medication is called the generic name. Different pharmaceutical companies can use the generic drug and produce different brands – the names of patented drugs. There are many different brands of inhalers. Inhalers can be generic and can be produced by different pharmaceutical companies as well. For some drugs are different inhalers that deliver the same drug. This means that there are many types available on prescription inhaler, all of which are produced in different colors. This can be confusing.
Because there are a lot of different colors available inhalers, it is useful to remember their names, and the color of the device. This can be important if you need to see a doctor who does not have your medical records (as in A + E, if you are on vacation or out of normal opening hours of GP surgery). It may be helpful to keep a list of the names of your medications and inhalers in your wallet or purse. This information will avoid mistakes and confusion.
In the treatment of COPD medications within inhalers can be grouped into short-acting bronchodilators, long-acting bronchodilators and steroids. There are also combination inhalers containing two types of drugs.
Short-acting bronchodilator inhalers
An inhaler with a bronchodilator medication is often prescribed. These relax the muscles in the airways (bronchi) to open (dilate them) as wide as possible. People often call relievers. They include:
- Beta-agonist inhalers. Examples are salbutamol (brand names include Airomir ®, Asmasal, Salamol ®, ® Salbulin, Pulvinal Salbutamol Ventolin ® and ®) and terbutaline (Bricanyl ® brand). These inhalers are often (but not always) blue. Other inhalers that contain different medicines may be blue too. Always read the label.
- Inhalers antimuscarinics. For example, ipratropium (Atrovent ® brand).
These inhalers work well for some people, but not so well in others. Generally, the symptoms of wheezing and dyspnea improved in 5-15 minutes with a beta-agonist inhaler, and within 30-40 minutes with an antimuscarinic inhaler. The effect of both types typically lasts for 3-6 hours. Some people with mild or intermittent symptoms only need an inhaler as needed for dyspnea or wheezing when produced. Some people need to use an inhaler regularly.
Beta-agonist inhalers and antimuscarinic work in different ways. The use of two, one of each type, can help some people better than a single type.
Long-acting inhaled bronchodilators
These work in a similar manner to short acting inhalers, but each dose lasts for at least 12 hours. Long-acting bronchodilators may be an option if symptoms remain troublesome despite taking a short-acting bronchodilator.
- Beta-agonist inhalers. Examples include formoterol (brand names Atimos ®, Foradil and Oxis ®) and salmeterol (Serevent ® brand – a green inhaler). You can continue your short-acting bronchodilator inhalers with these drugs.
- Inhalers antimuscarinics. The only long-acting inhaler called antimuscarinic tiotropium (Spiriva ® brand name). The inhaler device is green. If you start this medication, stop ipratropium (Atrovent ®) if you were taking this beforehand. No need to stop any other inhalers.
A steroid inhaler may help, plus a bronchodilator inhaler if you have more severe COPD or periodic asthma attacks (exacerbations) of symptoms. Steroids reduce inflammation.
. Steroid inhalers are used only in combination with a long-acting beta-agonist inhaler (this may be two separate inhalers or a single inhaler that contains two drugs) Major inhaled steroid medications are:
- Beclomethasone. Brands include Asmabec ®, Beclazone, Becodisks ® Clenil Modulite ®, ® and Qvar Beclomethasone Pulvinal. These inhalers are usually brown, sometimes red.
- Budesonide. Brands include Easyhaler ® Budesonide, Budesonide Novolizer ® and Pulmicort.
- Ciclesonide. Alvesco ® Brand.
- Fluticasone. Flixotide ® Brand. This inhaler is a yellow or orange.
- Mometasone. Brand Asmanex Twisthaler ®.
A steroid inhaler may not have much effect on the usual symptoms, but can help prevent asthma attacks. Thus, steroid inhalers are often referred to as preventers.
Combination inhalers are available, typically containing a steroid drug and either a short-acting or long-acting beta-agonist. Examples of combination inhalers are:
- Fostair ® (formoterol and beclomethasone).
- Seretide ® (salmeterol and fluticasone). This is a purple inhaler.
- Symbicort ® (formoterol and budesonide).
Combination inhalers are useful if people have symptoms severe or frequent outbreaks. Sometimes it is more convenient to use a single inhaler device.
Different inhalation devices adapted to different persons. They can be divided into four groups.
- Pressurized metered dose inhalers (MDIs).
- Breath activated inhalers – MDIs and DPIs.
- Inhalers with spacers.
The standard MDI
A standard MDI is shown at right. MDI has been used for over 40 years and is used to deliver various types and brands of drugs. Contains a pressurized gas propelling inactive dose of drug in each "puff". Each dose is released by pressing the top of the inhaler. This type of inhaler is quick to use, small and convenient to carry. Good coordination is needed to push the package, and while fully breathe. Sometimes, these are known as evohalers.
The MDI is the most widely used standard inhaler. However, many people do not use it to its best effect. The errors include: not shake the inhaler before use, inhaling too sharply or at the wrong time or not hold their breath long enough after inhalation of the contents.
Until recently, the propellant in the MDI has been a chlorofluorocarbon (CFC). However, CFCs damage the ozone layer, thus being eliminated. The new CFC-free inhalers work as well, but the use of a propellant that does not damage the ozone layer.
These are the alternatives to standard MDI. Some are still pressurized metered dose inhalers, but not require you to press a container on top. The Autohaler the right is an example. Another example of a breath-actuated MDI is the Easi-Breathe Inhaler ®.
Other breath-activated inhalers are also known as dry powder inhalers. These inhalers do not contain pressurized gas to propel the medicine inactive. You do not have to push the boat to release a fix. Instead, one dose is activated by inhalation at the mouthpiece. Accuhalers, clickhalers, easyhalers, novolizers, turbohalers, and twisthalers diskhalers all inhalers are activated dry powder puff. It is necessary to inhale hard enough to get the dust in the lungs. Some types are shown below.
The individual devices have some differences in the way they are operated, but in general, they require less coordination standard MDI. They tend to be slightly larger than the standard MDI.
The use of spacers are used with pressurized metered dose inhalers. There are various types – shows a counter example. The spacer between the inhaler and the mouth holds the drug as a deposit when you press the inhaler. A valve at the mouth end ensures that the drug is kept within the spacer until you exhale breathing in. When the valve closes. You do not need good coordination to use a spacer.
There are several different types of spacer. Some examples are: Able Spacer ®, Aerochamber Plus ®, Nebuchamber, Optichamber ®, Pocket Chamber ®, and Vortex ® Volumatic. Some of the devices spacers fit all MDIs, others only support (work) with specific brands of inhalers.
Tips on using a spacer device are some tips if you are prescribed a spacer of exploitation. These have a valve at the mouth end of – the spacer in the previous image is an example.
- If your dose is more than a breath, then do one download at a time.
- Shake the inhaler before firing each puff.
- Start breathing nozzle as soon as possible after firing the shot on the device.
- Try to hold your breath for a moment when she breathed in.
- Inhale and exhale several times before firing the next breath. Try to hold your breath for a few seconds each time you inhale
- Check that the valve opens and closes with each breath.
- Static charge can accumulate within the plastic chamber. This may attract drug particles, and reduce the output when the spacer is used. To avoid this, the plastic standoff washed as indicated in the manufacturer's instructions. This is usually before first use, and then once a month and with detergent and water. Allow to air dry without rinsing or cleaning.
Nebulizers are machines that turn liquid form of short-acting bronchodilators in a fine mist, as an aerosol. You breathe in this with a face mask or mouthpiece. Nebulizers are no more effective than inhalers normal but are very useful for people who are tired (tired) with breathing, or people who are very out of breath. Nebulizers are used mainly in hospital for severe attacks of COPD when high doses of inhaled drugs are needed. They are used less frequently than in the past as modern devices spacers are generally as good as nebulisers for administration of high doses of inhaled medications. No coordination necessary to use a nebulizer – you just inhale and exhale, and breathe the medication in.
The most common questions and more information
Do you get the side effects of inhalers?
In Standard dose inhaled quantity of drug is small compared to tablets or liquid medicines. Therefore, side effects tend to be much less of a problem with the tablets or liquid medicines. This is one of its main advantages. However, there are some side effects in some people. Read the package insert for details of possible side effects.
One of the problems that can occur when using a steroid inhaler (especially if you are taking a high dose) is that the back of the throat may be sore. Yeast infection in the mouth can develop. This can usually be easily treated with a course of tablets or liquid you suck you have in your mouth. You might also notice that your voice becomes hoarse.
If you rinse your mouth with water and brush your teeth after using a steroid inhaler that are less likely to develop a sore throat or thrush. In addition, some inhaler devices (such as separators) are less likely to cause problems in the throat. A change to a different device can help if problems occur or canker sores.
Note: a persistently hoarse voice that does not solve the needs for further research. For example, it may be a sign of cancer of the larynx (voice box). If you have this symptom should inform your doctor.
If you use a high dose of inhaled steroids for a long time can be a risk factor for osteoporosis. You can help prevent osteoporosis by exercising regularly, not smoking and eating a diet with enough calcium. See separate leaflet called 'Osteoporosis' for more information.
What is the best device to use inhaler?
This depends on several factors such as:
- Convenience. Some inhalers are small, you can go easily into a pocket, and are quick to use. An example is the standard MDI.
- Your age. Some seniors are MDI inhalers difficult to use.
- Coordination. Some devices (in particular, the standard MDI) coordination needs more than others.
- The side effects. Some of the inhaler drug hits the back of the throat. Sometimes this can cause problems such as mouth sores. This tends to be more of a problem with higher MDI steroid. Less drug reaches the throat when using a spacer device. Therefore, a spacer may be advised if you have throat problems, or if you need a high dose of inhaled steroids.
Often, the choice of inhaler is just personal preference. Most doctors and practice nurses have a wide range of devices to demonstrate, and let you have a feel for them. If not satisfied with the person who is using, then it is reasonable to consider a different type after taking the advice of your doctor or nurse.
More help and information
British Lung Foundation
73-75 Goswell Road, London EC1V 7ER
Tel (Helpline): 08 458 50 50 20 Web: www.lunguk.org