A List of All Inhalers Part II: Combination Inhalers

Editor's note: This is part 2 of a two-part series. Part 1 is titled 'A List of All Inhalers Part I: The Bronchodilators.'

There are tons of inhalers for COPD. In an earlier post, I listed the bronchodilators. Here, I will list all the combination inhalers approved by the FDA.

Inhaled Corticosteroids (ICS)

ICS molecules reduce some types of airway inflammation. They are top-line asthma medicines. But, are not as effective for the type of airway inflammation present in COPD. For this reason, they are not usually prescribed alone for COPD. For this reason, I will not list them here.

Still, there are 9 that are presently available in the U.S. market. They are available should you and your doctor choose to go this route. When ICS is prescribed for COPD, it’s recommended they be taken with a bronchodilator. So, these two medicines are usually available in combination inhalers as seen below.

Combination inhalers

These are inhalers that contain 2 or 3 medicines. Combining two medicines has many advantages. It improves compliance, as you don’t have to mess with too many inhalers. It also allows you to pay for one inhaler as opposed to two or three. So, this is nice too.

So, here’s the inhalers.

Short-Acting Beta Agonist (SABA) plus Long-Acting Beta Agonist (LABA).

These are all listed in my post, “List Of Bronchodilator Inhalers.” So, I won’t go over them again here.

LABA plus ICS

There are 5 inhalers available to choose from.

• Advair Diskus. This contains the ICS fluticasone and the LABA salmeterol. The dose is one inhalation twice daily.
• Advair HFA. This also contains fluticasone and salmeterol. The dose is 2 puffs twice daily.³
• Breo Ellipta. This contains the ICS fluticasone and the LABA vilanterol. It only requires one inhalation daily.
• Dulera. It’s an inhaler that contains the ICS mometasone and the LABA formoterol. It requires 2 puffs twice daily.

Triple combination inhalers

These are inhalers that contain three different medicines. At the present time, there is only one on the market.

• Trelegy. It contains the ICS fluticasone plus the LABA vilanterol plus the LAMA umeclidinium. The dose is one inhalation once daily.⁴

Advantages of combination inhalers?

Combination inhalers are nice. They are nice for convenience. Almost all of them are long-acting medicines. This means they require only 1-2 puffs 1-2 times daily. This makes it easier to remember to take them. I usually suggest to my patients to keep their controller inhaler in the bathroom. When you go to brush your teeth you’ll see them. You puff and then brush. This is also nice because when you brush you’re also rinsing out your mouth and spitting. This also helps to reduce your risk for medicinal side effects.

Trelegy is one of the newest inhalers on the market. It was approved in September of 2018.⁵ I imagine that before this post is published, or soon thereafter, there will be more combination inhalers available. So, this is good for the COPD community. It gives us more options. It makes puffing so much more convenient. It makes puffing so much easier.