COPD Inhalers vs. Nebulizers: Which Is Right for You?

COPD is best treated with inhaled medicine. However, there are 2 ways of delivering this medication:

• Via a handheld device called an inhaler, with or without a spacer
• Via a machine called a nebulizer

There are pros and cons to both methods and no one right answer for everyone. Both methods get the same type of medication into your airways, where it is needed, better than taking a pill.

Facts about inhalers

Inhalers are small, plastic handheld devices that deliver a puff of medication in aerosol form to your airways. There are 3 different types of inhalers:

• Hydrofluoroalkane inhalers or HFAs. HFA inhalers convert a liquid medication, such as a bronchodilator or steroid, into a mist. You squirt the mist into your mouth as you breathe in. It can be hard to use correctly, especially when you are supposed to hold your breath for a few seconds afterward. You can attach a hollow tube to an HFA that makes it easier to get a full dose of the medication into your airways. This tube is called a spacer.
• Dry powder inhalers, also called DPIs. DPIs are similar to HFAs, but they release the medication in a fine dry powder rather than a moist mist. This type of inhaler does not use a spacer. You have to be sure not to exhale back into the inhaler or the powdered medicine could clump.
• Soft mist inhalers, of SMIs. This is the newest type of inhaler and as of this writing, only one kind of medication is available as an SMI -- Respimat or Spiriva. This type of inhaler doesn't use a propellant. Instead, the pre-measured dose of medication streams out of the mouthpiece in a slow-moving mist. Because the mist lasts longer than either an HFA or DPI type of inhaler, it can be easier to breathe the full dose into your airways. This is especially true for people who have COPD and may not have the lung power to breathe in strongly and quickly.

All of the inhalers work similarly. Their effectiveness depends greatly on how well you are able to follow the correct technique for using them. Many studies have shown that most people do not use the correct method, however.

On the other hand, inhalers are convenient to use and health insurance usually covers most of the costs. When insurance doesn't cover the costs, inhalers are generally affordable.

Facts about nebulizers

Nebulizers also transform medication into a mist that you can inhale. The difference is, the mist must be inhaled over a longer period of time, usually 15 to 20 minutes.

Just as with inhalers, there are different types of nebulizers:

• Jet nebulizers. This is the traditional type of nebulizer where you measure a small amount of medication into a cup that is then attached to a breathing tube and mouthpiece. Compressed air transforms the liquid into a fine mist. They can be loud and must be plugged in to an electric source. They are also not usually too portable.
• Ultrasonic nebulizers. This device uses an ultrasonic vibration to generate the mist. While they are quieter and perhaps more portable than the jet type, they are also more costly. In addition, they generate heat that can destroy certain types of COPD medications.
• Vibrating mesh nebulizers. This is the newest and most expensive type of nebulizer. Quiet and portable, they are also more delicate and have to be cleaned very carefully.

While nebulizers can be easier to use than inhalers, they may also be more expensive and not always covered by insurance. They may also not be as convenient, depending on what type you use.

Which one is right for you?

So which type of device is best for you? The answer to that depends on a number of factors, including:

• Your health status and ability to use the device correctly
• What your doctor recommends
• Your own personal preferences
• The type of medication prescribed for you
• Your health insurance benefits

The best thing to do is to discuss all of the options with your health care team, including a respiratory therapist who can evaluate your abilities to use the devices.

In addition, understanding what medication you're on and how it is supposed to work will help you know what to expect.

Pros and cons of each

The right decision of inhaler vs. nebulizer will vary among different COPD sufferers. You might also try one and then try another to see what works best for you over time. Treatments for most health conditions often require some trial and error to find the right approach for you. The following summarizes the pros and cons of inhalers vs. nebulizers for people who have COPD.

Pros of Inhalers

• Effective delivery of medication when used correctly
• Fairly inexpensive
• Most types of COPD medications are available
• Covered by insurance
• Convenient
• Fast to use

Pros of Nebulizers

• Easier to use, especially for large doses
• May be more effective delivery of medication
• Some meds are only available via nebulizer

Cons of Inhalers

• Can be hard to use correctly
• Medicine is easily wasted
• Ineffective medication delivery for people with limited airflow

Cons of Nebulizers

• Can be expensive
• Not always covered by insurance
• Need more maintenance
• Less convenient & portable
• Take longer to use
• May require a power source