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Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition involving inflammation, lung tissue damage and increased mucus production, which makes it more difficult to...
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition involving inflammation, lung tissue damage and increased mucus production, which makes it more difficult to breathe.
Since COPD is a chronic condition, it requires long-term management, and one of the most common and effective ways to do this is with the use of inhalers.
Inhalers are largely known to treat respiratory conditions like asthma and COPD, and while there are many available options, patients often ask: what inhaler is used for copd or what is the safest inhaler for copd? The answer depends on various factors, including the severity of your symptoms, frequency of flare-ups, personal preference, and the advice of your doctor.
Inhalers are used to administer medication directly into the lungs and make it easier for you to breathe. The medications help to open airways, reduce inflammation, and make breathing in and out easier. Since they work directly on the lungs, inhalers work much faster than pills and less gets into your bloodstream, which minimises systemic side effects.
Two classes of inhalers are typically used to treat COPD: Bronchodilators or Steroid Inhalers
Short-acting bronchodilators are taken as and when needed, for example, during an onset of symptoms such as breathlessness or wheeze.
They grant rapid relief and are referred to as “rescue” inhalers.
Long-acting bronchodilators are taken for the long-term management of COPD, and rather than provide acute relief to sudden symptoms, they help prevent the exacerbation of symptoms.
Steroid inhalers are also known as “maintenance” inhalers. They don’t offer immediate relief of symptoms, but they reduce airway inflammation and prevent flare-ups of symptoms.
Combination inhalers combine a bronchodilator and a steroid, or two long-acting bronchodilators into one inhaler.
Since COPD is characterised by inflammation of the airways (chronic bronchitis), narrowed airways and difficulty breathing, the medications aim to target these factors, restore pulmonary function and treat the symptoms of COPD such as breathlessness, wheeze and chest-tightness.
Here we break down the three main types of inhalers used to treat COPD:
Examples of short-acting bronchodilators:
Beta-agonists such as Salbutamol (brand name Ventolin) are typically the blue inhalers you often see.
Anti-muscarinic agents such as Ipratropium (Atrovent).
These bronchodilators are typically taken as needed. They are fast-acting and provide relief from symptoms such as breathlessness and wheeze.
Examples of long-acting bronchodilators:
Long-acting beta-agonists such as salmeterol (Serevent) and formoterol (Atimos).
Antimuscarinic agents include tiotropium (Spiriva).
These inhalers are typically green-coloured. They have a similar action to short-acting bronchodilators whereby they relax the smooth muscle in your airways, make it easier to breathe and reduce wheeze and breathlessness, however, their effects last for over 12 hours and are taken for long-term management.
Examples of steroid inhalers:
Common examples include
Steroid inhalers are used to reduce inflammation and therefore prevent flare-ups of symptoms, which is why they are often known as maintenance inhalers.
Steroids are used in conjunction with bronchodilators for the long-term management of COPD. These inhalers are typically brown-coloured.
Examples include:
There aren’t any ‘best inhalers for copd’, but the inhaler type that will work best for you depends on your individual need, response to medication and preference. Here we break down the different inhalers for copd to help you understand which inhaler type may suit you best.
Short-acting bronchodilators offer near-immediate relief of sudden symptoms, such as breathlessness and wheeze. They are typically the blue-coloured inhalers you often see.
They work by relaxing and opening up your airways, making it easier for you to breathe.
Common examples are Salbutamol (Ventolin), a beta-agonist, and Ipratropium (Atrovent), an anti-muscarinic.
The table below highlights the comparison between the two classes of bronchodilators.
| Salbutamol (Ventolin) | Ipratropium (Atrovent) | |
| Drug Class | Short-acting beta-2 agonist (SABA) | Short-acting anti-muscarinic |
| How it works | Relaxes the airway lining smooth muscle to open up the airways | Blocks muscarinic receptors in airway smooth muscle to reduce airway constriction |
| Onset of Action | ~5 minutes | ~30 minutes |
| Duration of Action | 3-6 hours | 3-6 hours |
| Method of administration | Inhaler or nebuliser | Inhaler or nebuliser |
| Common Side Effects | – Tremor
– Palpitations – Headache Serious side effects: – Elevated heart rate – Arrhythmias |
– Dry mouth
– Cough – Headache – Nausea |
| Key Advantages | – Provides more rapid relief of sudden onset symptoms
– Useful as a “rescue” inhaler |
– Less systemic side effects
– Can be combined with other SABAs such as Salbutamol for more effective symptom relief |
Hopefully, this demonstrates there is no simple answer to what is the best rescue inhaler for copd? Since the best rescue medication for you depends on your individual case of COPD, response to treatment and potential side effects.
For patients whose symptoms don’t subside after taking short-acting bronchodilators, long-acting bronchodilators may be more effective.
Long-acting bronchodilators are taken daily as a long-term management for COPD.
So, while they don’t act rapidly to treat acute symptoms, they are effective as a preventative treatment and for the long-term symptom control of COPD. They can also be taken before bedtime to offer night-time relief of symptoms.
Long-acting bronchodilators are taken daily and their effects last 12-24 hours. The two main classes are long-acting beta-agonists (LABAs) and long-acting antimuscarinics (LAMAs).
The choice between either class of inhalers depends on your individual symptoms and treatment, therefore it is best to consult your doctor for advice.
Long-acting beta-agonists
Key features: LABAs have a faster onset of action, although their effects don’t typically last as long as LAMAs (12 hours vs 24 hours).
Long-acting antimuscarinics
Key features: Most LAMAs have a longer duration of effects than LABAs (up to 24 hours).
Since LABAs and LAMAs work by different mechanisms, they are often prescribed to be taken together. This maximises the bronchodilation effects and helps treat COPD symptoms. Long-acting bronchodilators can still be taken alongside short-acting bronchodilator inhalers when necessary.
Some patients who experience more severe COPD symptoms or frequent flare-ups may require both steroid and long-acting bronchodilator medications. Steroids work by reducing the inflammation and mucus production underlying COPD symptoms, so while they don’t treat acute symptoms, they are often referred to as ‘preventer’ or ‘maintainer’ inhalers since they prevent the exacerbation of symptoms.
Combination inhalers can be used as two separate inhalers or combined into one for convenience.
Common examples of combination inhalers:
However, recent NICE guidelines now recommend that patients who require combination inhalers should be given two long-acting bronchodilators, and steroid-combination inhalers should be provided to patients with symptoms indicative of asthma.
By now, we hope you can appreciate that there is no clear-cut answer to ‘which inhaler is best for copd?’ Since it is entirely dependent on your individual symptoms, stage of COPD and personal suitability.
As previously mentioned, ‘rescue’ inhalers refer to short-acting bronchodilators, which act rapidly to treat sudden flare-ups of COPD symptoms.
They are effective at providing fast-acting relief, however, their effects aren’t long-lasting.
Examples of rescue inhalers include Salbutamol (beta-agonist) and Ipatropium (antimuscarinic).
They help counteract symptoms like wheeze and shortness of breath by relaxing the smooth muscle lining your airways, making it easier to breathe.
For patients who frequently require their short-acting bronchodilator, or if it doesn’t seem to effectively manage their symptoms, it may be best to consider, with a doctor, the use of a long-acting bronchodilator.
Maintenance inhalers are taken for the long-term management of COPD and help prevent the exacerbation of symptoms. Steroids and long-acting bronchodilators are types of maintenance inhalers. They are generally considered safe for the long-term management of COPD, though side effects may be present (table below).
Examples of long-acting beta-agonists:
Examples of long-acting antimuscarinics:
Steroids reduce inflammation and excess mucus production. Examples include:
Effectiveness & safety
Ultimately, rescue inhalers are effective for providing rapid relief of acute symptoms, but for patients who still experience breathing difficulties, maintenance inhalers may provide effective long-term coverage of symptoms and help prevent the exacerbation of COPD. You may still use rescue inhalers alongside maintenance inhalers if necessary.
While there are fewer systemic effects when using inhaler medications, there are still potential side effects. Steroid inhalers in particular are used with caution.
This table highlights potential side effects of bronchodilators and steroid inhalers, however, it is best to review the medication’s leaflet and consult your doctor for any further advice.
| General bronchodilator side effects | Steroid inhaler side effects |
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Unfortunately, there is no such thing as a best otc inhaler for copd, since there are no safe COPD inhalers available over-the-counter.
Inhalers for COPD must be prescribed by a medical provider. You can do this easily online at Meds for Less.
So to answer any potential queries about OTC options, there is no best over the counter inhaler for copd, since they are only available under prescription.
Nebulisers are devices used to administer larger doses of medicine with the use of a face mask. They convert medication from liquid form into a mist to be inhaled through a face mask for a period of around 10-15 minutes.
Nebulisers are useful for patients who are less able with coordination, i.e older patients or patients with arthritis, since you can simply inhale through the mask.
Nebulisers are also used in hospital settings for patients who are severely fatigued or breathless.
While nebulisers require less coordination, they aren’t portable and take longer to administer medication than inhaler devices.
Inhalers are portable, hand-held devices which administer COPD medications as a fine mist or dry powder. Inhalers are ideal due to their convenience and their being ready-to-use, however, some inhalers (such as metered-dose inhalers) require coordination for effective use.
For patients who struggle with coordination, spacer devices help with inhaling medication, and there are also breath-activated inhalers (most dry powder inhalers), which work simply by inhaling through the device.
If you are struggling with an inhaler, your doctor can help you practice your inhalation technique.
This table summarises the key advantages and disadvantages of nebulisers and inhalers.
| Nebulisers | Inhalers | |
| Advantages | – Easy to use for those with poor coordination, since you simply breathe through the face mask
– Can deliver larger doses – Ideal for older, extremely fatigued, or breathless patients, and hospital use |
– Portable and handheld
– Quick and ready-to-use – Convenient for daily or on-the-go use – As effective as nebulisers |
| Disadvantages | – Not portable
– Takes 10–15 minutes to administer medicines |
– Some types require coordination (e.g. metered-dose inhalers)
– Some inhalers use aerosols, which contribute to greenhouse gases – Typically delivers smaller doses |
Hopefully, by now, we have answered what kind of inhaler is best for copd. The best inhaler for you must be decided between you and your doctor based on: the severity of your symptoms, your response to treatments, the consideration of side effects and your personal convenience or preferences.
In summary:
Short-acting bronchodilators are ideal for managing acute symptoms and flare-ups, whereas long-acting bronchodilators are important if you are having to use your short-acting inhaler too frequently.
Long-acting bronchodilators have long-lasting effects on your lung function and help prevent the exacerbation of symptoms. They are known as ‘maintenance’ inhalers.
Steroid inhalers are mainly recommended for more severe, or asthma-like COPD. They help reduce inflammation and exacerbation of the disease, however, side-effects such as oral thrush or osteoporosis must be monitored.
Combination inhalers can be convenient by combining two classes of medication into one single inhaler. E.g.
It is also important to consider the ease of use of your inhaler device. Inhalers such as metered-dose inhalers require coordination for effective use. Spacer devices and dry powder inhalers, which are breath-activated, are much more user-friendly options, especially for patients with reduced mobility or conditions like arthritis.
Therefore, the best inhaler for copd uk patients is really what best suits your individual needs and which follows the advice of your doctor.