Inhalers For COPD: Metered-Dose Inhalers (MDIs) Or HFAs vs Dry-Powder inhalers (DPIs)

Inhalers are pretty nifty — by getting your medication directly to your lungs, they minimize systemic side effects and are more effective right where they're needed. They can also be tricky to learn to use, however, and not all patients can use all kinds of inhalers. Inhalers can also be rather pricey — if you're paying out of pocket, some kinds can set you back more than $300! It's really important, then, that you know how to use the inhaler you've got, and that your doctor makes sure you've got the right inhaler(s) for you.

Inhalers can come as: 

• Metered-dose inhalers (MDIs), also called hydrofluoroalkane inhalers (HFAs)
• Dry powder inhalers (DPIs)
• The much less used Respimat, or soft-mist inhaler.

What should COPD patients know about metered-dose inhalers (MDIs or HFAs)?

The steps for use include:

• Shaking the inhaler before use
• Placing your lips around the mouthpiece
• Pressing the canister to release the medicine, once or multiple times
• Inhaling it well, at a slow and steady pace
• Holding your breath for a few seconds so the medicine can do its job

Some people will use a spacer in combination with their MDI inhaler. These plastic tubes make for easier use in some people, and help you not waste any of the medicine.

​Medications prescribed for COPD that are delivered with the help of MDIs include:

• Bronchodilators like albuterol/salbutamol (ProAir, Proventil, Ventolin) and levalbuterol (Xopenex).
• Steroids like fluticasone (Flovent), abeclomethasone (Beclovent, QVAR), and ciclesonide (Alvesco).
• Combination medications that contain both a steroid and a bronchodilator, like budesonide/formoterol (Symbicort), formoterol/mometasone (Dulera), and fluticasone/salmeterol (Advair).

Some advantages of metered-dose inhalers are that they are:

• Extremely portable
• Less expensive
• Quick

MDIs also have some disadvantages, though. If you use them incorrectly, you won't get the mecidine you need. If you suffer from arhritis or otherwise have a poor grip, pressing the canister can be extremely hard. People who are unable to breathe in slowly or hold their breath for a few seconds may miss out on their dose. (Using a spacer can help with this.)

What COPD patients need to know about dry-powder inhalers (DPIs)

The world of dry-powder inhalers can, on the other hand, be a little confusing. There are many different types — like Turbuhalers, Diskus systems, and Handihalers, to name but a few — and they are all activated in slightly different ways. Because DPIs do work in slightly different ways, we'd advise you to get detailed instructions from your doctor and/or pharmacist to familiarize yourself with the process. You can also find instructional videos on the internet. There are a few general rules, however:

• As with HFAs, put your mouth around the mouthpiece and inhale steadily
• Hold your breath for the advised amount of time or for as long as you can
• Exhale slowly
• DO NOT exhale into the device itself, as the fact that the medication is delivered in powder form means that getting it moist can compromise your medicine.

COPD medications that can be delivered to you through a DPI include:

• Bronchodilators like salbutamol/albuterol (ProAir RespiClick), ​tiotropium (Spiriva HandiHaler), and salmeterol (Serevent Diskus).
• Steroids like fluticasone (Flovent Diskus), mometasone (Asmanex Twisthaler), and  budesonide (Pulmicort Flexhaler).
• Combination medications, like fluticasone/salmeterol (Advair Diskus) and fluticasone/vilanterol (Breo Ellipta)

While DPI inhalers offer convenience to many patients, you do need adequate respiratory strength to be able to breathe in the medicine. This means that elderly or especially weak patients may have trouble. Learning to use the different kinds of DPIs can also be intimidating, though you will quickly get used to a new inhaler. Where necessary, a caregiver or relative can help you set your inhaler up for use. Do note that moist conditions can compromise your DPI, as well, and breathing into your inhaler should be avoided at all costs for the same reason. Talk to your doctor or pharmacist about taking care of your dry-powder inhaler if you live somewhere with high humidity levels.