Types of Breathing Treatments for COPD

If you’ve been diagnosed with COPD, part of your COPD treatment plan may include using a bronchodilator, a type of medication that helps open up the airways making it easier for you to breathe. Bronchodilator treatments for COPD are most commonly prescribed in the inhaled form using a metered dose inhaler (MDI), a dry powder inhaler (DPI) and/or a nebulizer.

Bronchodilator inhalers can be short acting, long-acting or a combination thereof; some may even contain a steroid. Whichever type of bronchodilator you’ll be using, becoming familiar with the medication’s delivery device will ensure that your breathing treatments for COPD are safe and effective.

Metered-Dose Inhalers (MDI)

An MDI is a hand-held device used to deliver a measured dose of medication in aerosol form directly into your lungs. MDIs have a pressurized canister of medication that fits snugly into a plastic tube called a mouthpiece. Although there are several, the most common type of MDI releases a specified dose of medication once you depress the canister into the mouthpiece. Sometimes, an external device called a spacer is used with the MDI to allow for better drug delivery.

To get the most out of breathing treatments when using an MDI, it’s important that you understand how to use it correctly. Follow the general steps below when using your MDI without a spacer:¹

1. Remove the cap and hold the canister upright with the mouthpiece at the bottom.
2. Shake the canister well for 5 seconds.
3. Place the mouthpiece approximately 1 to 2 finger-widths away from your mouth. You can also use the closed-mouth technique where you seal your lips tightly around the mouthpiece.
4. Tilt your head back slightly and exhale all your air.
5. After you’ve exhaled, start to breathe in slowly. At the same time, press down firmly on the top of the canister to release the medication. Continue to breathe in slowly for 3 to 5 seconds.
6. If possible, hold your breath for 10 seconds to get the maximum benefit out of every puff.
7. Exhale slowly.
8. If a second puff is ordered, wait one minute and repeat steps 1 through 7.
9. Rinse your mouth thoroughly with water, especially when your inhaler contains a steroid.
10. Rinse the plastic case and mouthpiece weekly with warm water.

When using a spacer with your MDI, before you begin, insert the MDI into the open end of the spacer chamber opposite the mouthpiece. For Step 3, place the mouthpiece of the chamber between your teeth and seal your lips securely around it. Tilt your head back slightly, exhale all your air and depress the canister as you breathe in slowly and completely for 3 to 5 seconds. A horn-like sound coming from the chamber indicates you are breathing too fast and need to slow down.  Continue with Steps 6 through 10 as you did with the regular MDI.

Dry-Powder Inhalers (DPI)

If you’ve ever used Advair, Spiriva or Flovent then you’re already familiar with the dry powder inhaler, or DPI. Similar to the MDI, a DPI is a hand-held device that delivers medication to your lungs. The only difference, is that the DPI doesn’t contain a propellant; it is breath-activated and contains only medication.

Here are the general steps for using a DPI:²

1. Remove the cap from the DPI.
2. Load a dose of the medication. The way you do this will depend upon which brand of medication you’re using. Be sure to read the manufacturer’s instructions carefully before proceeding.
3. Tilt your head back slightly and exhale all your air.
4. Place the DPI up to your mouth sealing your lips tightly around the opening.
5. Breathe in once – forcefully and fast – inhaling as deeply as possible. Do not breathe back into the inhaler. Remove your mouth from the inhaler.
6. Hold your breath, if possible, for at least 10 seconds.
7. If your prescription requires a second dose, wait one minute and repeat steps 2 through 6.
8. Replace the cap.
9. Rinse your mouth thoroughly, especially if your DPI contains a steroid.

Nebulizer Treatments

Many patients feel that they get better symptom relief from a nebulizer compared to that of an MDI or a DPI. A nebulizer is a hand-held device that transforms your COPD medication into a fine mist. If you use a nebulizer, your medication will be supplied medication in liquid form.

Most nebulizers are small and easy to use; some are so compact you can easily carry them with you. Nebulizers generally come with an air compressor that helps deliver the medication deep into your lungs. Nebulizer treatments generally take about 10 to 15 minutes to complete.

Here are the general steps to setting up and using a nebulizer:³

1. Connect the hose to the air compressor.
2. Fill the medicine cup with the prescribed dose of liquid medication.
3. Attach the hose and the mouthpiece securely to the medicine cup.
4. Place the mouthpiece in your mouth, sealing your lips tightly around it.
5. Breathe in through your mouth until all the medicine has been inhaled.
6. Wash the medicine cup and mouthpiece thoroughly with water and allow to air dry.
7. Store your nebulizer in a safe place away from pets and children until your next treatment.

Author: Deborah Leader RN, BSN, PHN