Is anyone else confused about all those inhalers?

Posted by Sue, Volunteer Mentor @sueinmn, Jul 18, 2022

Is Anyone Else Confused by all the inhalers prescribed for our lungs?

After a lengthy visit with my pulmonologist yesterday, I came away with a new set of medications and a whole lot of confusion!

This morning, I sat down and made list of all the drugs I use/have used, all the drugs we talked about yesterday, and several that have been suggested or mentioned here on Connect. Then I got busy and figured out what they are and why we use them.

Here is a summary…incomplete for sure, listing the classes of drugs with a short explanation of each class, and individual drug names (not the Brand Name or Combo name).

“Rescue” drugs – may be inhalers, or in some cases nebulizer solutions
Short Acting Beta Agonist (SABA) Opens airways quickly, relaxes airways, but doesn’t last long
• Albuterol (Common Brand Names: ProAir, Ventolin, Proventil)
• Levalbuterol (Xopenex)
• Salbutamol

Short Acting Muscarinic Agonist (SAMA) Like SABA, opens airways, or prevents bronchospasm. Less often used than SABA
• Irpatropium Bromide (Atrovent)
• Tiotropium Bromide (Spiriva)

Long Term or Daily Use Medications
Inhaled Steroids Direct dosage to lungs compared to oral steroids which are systemic. Reduces inflammation which helps keep airways open.

Inhaled Corticosteroid (ICS)
• Budosenide (Pulmicort, Entocort, Rhinocort)
• Mometasone (only in combinations)

Inhaled Glucosteroid (IGS)
• Fluticasone Propionate (Flovent, Allerflo)

Long Acting Beta Agonist (LABA) Acts to keep airways open – usually used in combination with an inhaled steroid
• Formoterol Fumarate (Foradil)
• Salmeterol Xinafoate (Serevent)
• Vilanterol (only in combinations)

Long Acting Muscarinic Agents (LAMA) Relaxes muscles around airways for 12-24 hours to reduce asthma attacks
• Tiotropium bromide (Spiriva)
• Umeclidinium bromide (Incruse)

Here is a summary of the most commonly prescribed Name Brand medications and what drugs are in each one.
Advair - Fluticasone propionate (IGS), Salmeterol (LABA)
AirDuo - Fluticasone propionate (IGS), Salmeterol (LABA)
Anoro- Umeclidineum (LAMA), Vilanterol (LABA)
Breo - Fluticasone Furoate(ICS), Vilanterol (LABA)
Combivent - Irpatropium Bromide (SAMA), Albuterol (SABA)
Dulera - Mometasone (ICS), Formoterol (LABA)
DuoNeb - Irpatropium Bromide (SAMA), Albuterol (SABA)
Nebulizer Solution
Symbicort - Budosenide (ICS), Formoterol (LABA)
Trelegy - Fluticasone (IGS), Umeclidinium (LAMA), Vilanterol
(LABA) Explanation

This is not a list of inhalers you should use, just a list of those that are often used for Asthma, Bronchiectasis & COPD - some of us have only one of these diseases, some of us have several.
I have attached a PDF file if you would like to print this list.
Sue

Shared files

Inhalers (Inhalers.pdf)

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

onana | @onana | Jul 21, 2022

@nana43. I'm so glad you brought up his question about a corticosteroid inhaler enhancing the environment in the lungs that encourages NTM infection. I recently came across a study that reported this finding. I had been using Arnuity Ellipta (an inhaler similar to Trelegy) for the last 5 years. It was originally prescribed for me by a pulmonologist I later found to be incompetent (knew absolutely nothing about bronchiectasis and MAC). Now I work with very competent doctors (pulmonologist and Infectious disease docs), and I brought the article to my ID doc and expressed my concern about the inhaler -- do I need it and is it the wrong thing for my condition? He knew about the finding and said this question often comes up and it's a tough call. If the inhaler helps you breathe, we don't want to take it away, but it's true that it could be making treatment for MAC more difficult. I question whether I needed the inhaler in the first place. I wasn't wheezing and don't have serious asthma. The whole thing is confusing and frustrating. The only lesson I draw from the experience is to always question a prescription: Do I really need this, and, if so, why? The pre-requisite however is that the prescribing doctor be competent and knowledgable about your condition.

Sue, Volunteer Mentor | @sueinmn | Jul 20, 2022

In reply to @nana43 "Hi Sue! I just jumped on site to ASK a questions about inhalers -and this popped..." + (show)

My pulmonologist and I discussed the combos. Her opinion is that the amount of steroid in am inhaler will not cause or worsen MAC, but oral steroids can because the dose is much greater.

nana43 | @nana43 | Jul 20, 2022

Hi Sue! I just jumped on site to ASK a questions about inhalers -and this popped up! My question: Are inhalers needed for Bronchiectasis AND/OR MAC? ( I can’t find anything that says it is medically needed)
I have been on Trelegy for a little over a year for Bronchiectasis because prior Pulmonary doc said my wheezing was because I had an asthma component to my Bronchiectasis. When I started the inhaler- the wheezing stopped- so I believed him. Now I find out I have/ had MAC and that the steroid inhaler could have actually been a factor in getting the NTM disease.
Current specialist said we would talk about at next visit in 3 months. I quit taking about a week ago. No wheezing but I have had to hit rescue inhaler a couple time for shortness of breath. SO, There’s the back story….back to my original question, Is an Inhaler even needed?

nannette | @nannette | Jul 19, 2022

@sueinmn Wow, Sue. Thanks for that! I've ALWAYS been confused by all the inhaler names and what they do or don't do! I saved that list in my files for future reference! You rock! Nan

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