Are Powder or Spray Bronchodilators Better?

Dear Dr.Mahler: My doctor has prescribed different inhalers for my COPD,  but I am not sure which ones work best for me. I have been tried on a couple different powder inhalers as well as various sprays. Of all the inhalers, Combivent seems to help me the most. I was diagnosed with COPD about 6 years ago, and still work 4 days a week at a pay booth collecting tolls. What are your thoughts? Pete from Shelton, CT Dear Pete, The different inhaled medications and the different delivery devices can  be quite confusing for those with COPD and even health care providers. In fact, several new inhalers have been approved by the Food and Drug Administration this year. Here is a simple (hopefully) way to think about inhaled bronchodilators. First, bronchodilators relax the muscle that wraps around the breathing tubes to open them up and make it easier to breathe. Second, there are two types of bronchodilators based on how they work: beta-agonists and muscarinic antagonists. It is not important for you to remember this information, but you should know that we frequently prescribe both types to gain the best benefit for your breathing. Third, the medicines are either liquids or powders. The key thing is that the sprays from the liquid and the particles from the powder have to be inhaled deep into the breathing tubes to effectively open them up. If the spray or powder does not get into the lower parts of the lungs, it can not open the airways completely. Fourth, these different bronchodilators are contained in various delivery devices. They are called metered-dose inhalers (puffers), soft mist inhalers, and dry powder inhalers.
Metered-dose Inhaler

Metered-dose Inhaler

Soft mist inhaler

Dry-powder Inhaler

Dry-powder Inhaler

The reason for the variety is that different pharmaceutical companies have developed the different inhaled bronchodilators, all of which are patented for a period of time. Good inhalation technique (how you actually inhale the medication) is key to successful use. In my medical practice, I ask each individual how he/she uses the inhaler and whether the medication “makes it easier to breathe.” If the specific inhaler does not seem to help your breathing, the first thing to check is how you are inhaling the spray or powder. You should ask your health care provider or her/his nurse to watch you use the inhaler. If you are doing it correctly, then a trial of a different bronchodilator inhaler is reasonable. So, there is no advantage of spray or powder bronchodilators. It is most important that you inhale the medication correctly. Sincerely, Donald A. Mahler, M.D.    

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.