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Inhalers and nebulizers both deliver a wide variety of medications directly into your lungs, but they work in different ways. What should COPD patients know?

Inhaled medications play a crucial role in the treatment of obstructive pulmonary disease (COPD). Inhaled medications all enter your lungs directly, but there's so much more to them than you may think. The two basic modes of delivery ― inhalers and nebulizers — each come with their own subtypes, all of which work in slightly different ways even though they mostly get the same meds to your lungs. 

What should all COPD patients know about inhalers and nebulizers?

COPD treatment: An overview of inhalers

Inhalers, also often called "pumps" and sometimes "puffers", are small plastic delivery systems that are convenient to carry around, easy to learn to use for many people, and not expensive to manufacture. They deliver the appropriate dose of your medication quickly, offer most medications someone with COPD will need, and are usually covered by insurance. Some people will find inhalers hard to use, however, and incorrect use can lead to missing a dose. Inhalers are not that effective for people with severely compromised airflow, either. 

What should COPD patients know about the three different kinds of inhalers — hydrofluoroalkane inhalers (HFAs), dry powder inhalers, (DPIs), and soft mist inhalers (SMIs)?

Hydrofluoroalkane inhalers (HFAs)​

Hydrofluoroalkane inhalers or HFAs  are perhaps the most "stereotypical" kind of inhaler, and certainly the kind most likely to show up in stock photos when you search for "inhaler". The most visible portion, the plastic, has a mouthpiece and a portion that holds the pressurized canister that contains your medication. HFAs get your medication to you in the form of a mist (which is liquid). 

To use one, you put your lips around the mouthpiece, press the canister down (once or more than once, as directed or necessary), and inhale as deeply as you can. You then hold the medication in your lungs by holding your breath for a few seconds, or as long as you can. Patients who need them can use spacers, tubes that facilitate for easier use. 

Dry powder inhalers (DPIs)

Dry powder inhalers may look slightly intimidating to someone who has previously only used a HFA, but they are really not that different. Your device will have a somewhat different look and delivers a very fine dry powder instead of a mist. These come in different forms, but you can expect to press or twist something on the device to release the medication, after which you can inhale it. Make sure not to breathe out into your dry powder inhaler, because this could moisten and thus compromise the remaining supply of your medication. 

Some examples of types of dry powder inhalers — which can deliver different medications — are turbuhalers, handihalers, diskus inhalers, and neohalers.  

Soft mist inhalers (SMIs)

This modern kind of inhaler entered the market more recently, and can be really beneficial for COPD patients who are unable to inhale intensely and quickly, as is required from other kinds of inhalers. Soft mist inhalers release the correct dose of medication over a longer period of time, increasing the odds that you will get the amount of medication you need. The system currently on offer is called Respimat. 

While your doctor should show you how to use any new type of inhaler you are prescribed, patients may also find the YouTube videos available for each inhaler extremely useful. 

COPD treatment: What do you need to know about nebulizers?

Nebulizers serve the purpose of getting medication into patients' lungs in an inhalable form, just like inhalers do. The delivery system is more complex, however, consisting of an air compressor, the nebulizer itself, and a mouthpiece or mask. Medication is placed into the nebulizer and is then delivered over a longer stretch of time, typically up to 20 minutes. Nebulizers can be useful for people who are unable to use inhalers correctly, but they are large and not that portable, and also require careful cleaning and maintenance. Nebulizers will not always be covered by insurance. Not all medications are available by inhaler, so in some cases, a nebulizer is your only option. 

What should you know about the three different kinds of nebulizers — jet nebulizers, ultrasonic nebulizers, and vibrating mesh nebulizers?

Jet nebulizers

Jet nebulizers have been on the market for longest. They require patients (or caregivers) to place the medication into a chamber that resembles a cup, through which the medication mists into a tube-like ending to which a mouthpiece or a mask can be attached. These devices are hard to maintain properly, but keeping them clean is essential for your safety. They are bulky, require an electric outlet, and can be rather noisy.

Ultrasonic nebulizers

Ultrasonic vibration causes the medication to mist in this case. This type of nebulizer is smaller and this more easy to take with you, as well as much less noisy. They can only be used with some medications and are also more expensive.

Vibrating mesh nebulizers

This latest kind of nebulizer is the smallest and most practical — it will fit into a bag. They are, however, less durable and more difficult to clean, as well as much pricier. 

In conclusion

When you first enter the world of COPD and encounter inhalers and nebulizers, it can be overwhelming and confusing. Your doctor is a crucial partner in helping you navigate your options and teaching you how to use your medication, and pulomonary rehabiliation programs can also help educate you about how to maintain your devices. 

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