Combination inhalers have made up the majority of COPD medicines for the last 25 years. You can find many brands, but they all contain 2-3 medicines.
Download Combination Inhalers as a PDF.
Doctors prescribe one brand over another based on their cost to a particular hospital or health system. Those costs change often. And, your doctor may ask you to switch brands just as often. So, it’s important to understand the types of medicines in your inhaler.
Types of medicines included in combination inhalers
Most combination (combo) inhalers are long-acting preparations. They include a combination of two or three types of medicines:
LABA (long-acting beta-agonists): These bronchodilators open your airways for 12-24 hours.
LAMA (long-acting muscarinic antagonists): These bronchodilators decrease mucus production.
ICS (inhaled corticosteroids): These drugs decrease airway inflammation. They prevent COPD flare-ups or exacerbations and are very important in asthma.
Common short-acting combination inhalers
The most common short-acting combination inhaler contains a mixture of albuterol and ipratropium. Albuterol is a short-acting beta-agonist (SABA). Ipratropium is a short-acting muscarinic antagonist (SAMA). We call this combination SABA/SAMA. It comes as a metered-dose inhaler (CombiventTM ) and as a nebulizer solution (DuonebTM). (Note: DuoNeb is inexpensive, so it’s the one hospitals use most.)
These medicines are often called “rescue medicines.” That’s because you can take them with long-acting agents for more bronchodilation.
Common long-acting combination inhalers
These inhalers take advantage of the properties of each medicine class they contain.
ICS/LABA
Since the 1980s, doctors have treated asthma with an ICS/LABA combination. But, these are helpful for COPD, too. In fact, until recently they were one of the first recommended treatments after diagnosis. So, your doctor can prescribe an ICS/LABA combination if you have asthma, COPD, or both.
LAMA/LABA
This combination improves lung function more than taking one drug on its own. These are the first choice for people with COPD who don’t have frequent flare-ups or exacerbations. They come in dry powder, mist, and metered dose inhaler preparations.
LAMA/LABA/ICS
This combination improves mortality in COPD patients with frequent flare-ups or exacerbations, compared to those who use inhalers with two medicines. It improves lung function and suppresses flares best. If you’re hospitalized for COPD, you may leave with a prescription for this triple combination. Usually, more medications mean that inhalers will cost more.
Should I try a combination inhaler?
There are many brands of inhalers. And, it can be difficult to know which one to take. But there are only three classes of long-acting medicines — LABA, LAMA, and ICS. To narrow your choices, ask your health care practitioner which classes you need.
When should you use a LABA/LAMA/ICS inhaler?
- If you’re short of breath after trying other inhalers.
- If you’ve had a flare-up or exacerbation despite being on other long-acting inhalers.
Remember: To decrease flare-ups (exacerbations), you need to take these inhalers every day.
When should you avoid using a LABA/LAMA/ICS inhaler?
Your health care practitioner may remove the ICS component if you’ve had pneumonia. That’s because ICS increases the rate of pneumonia. In this situation, using a LAMA/LABA inhaler may be best.
Note: Never use an ICS/LABA with a LAMA/LABA inhaler. A double dose of LABA can cause more side effects. Never use a LAMA/LABA with a LAMA inhaler. A double dose of LAMA can cause more side effects. Short-acting beta-agonist (SABA) inhalers (like albuterol) can be used in combination with any of the long-acting inhalers. Some individuals taking a short-acting muscarinic antagonist (SAMA) (ipratropium or Duoneb) with a long-acting muscarinic antagonist (LAMA) will note more side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, difficulty urinating, abdominal cramping, constipation, memory problems, and glaucoma.
What about cost?
Some of these inhalers are expensive, and your health plan may not cover them. But, you can substitute two inhalers (a LAMA and an ICS/LABA) for a LAMA/LABA/ICS combination.
In summary, it’s important to know about the types of inhalers you use. This will help you talk to your doctor about them.
For more in-depth information on this topic, please visit the Big Fat Reference Guide (BFRG). If you are enrolled in AlphaNet’s Subscriber Portal, you can access the BFRG here.
Download Combination Inhalers as a PDF.
