If you have chronic obstructive pulmonary disease (COPD) or asthma and your doctor has prescribed an inhaler, you know that using it is essential to help control your lung disease. But that doesn't mean you always use it as prescribed.

The reasons for not following the doctor's instructions are numerous. But there are plenty of good reasons why you should. Proper use of inhaled medications can reduce the need for hospitalization. And if you have asthma, each canister of inhaled medication that you use each year reduces your risk of asthma-related death by more than 20 percent.

Similarly, a three-year study of people with COPD found that those who took more than 80 percent of their prescribed COPD medications had about half the mortality rate of those who didn't; 11 percent and 20 percent, respectively.

Multiple Medications Can Affect Inhaler Use

You might be surprised to learn that the typical person with COPD takes an average of six different medications, three or four of which may be administered via inhaler. Multiple medications are also needed for people with poorly controlled asthma.

Why so many prescriptions? COPD and asthma are complex diseases, often requiring numerous medications from different drug classes, such as long- and short-acting bronchodilators and inhaled corticosteroids. Each class of drug attacks the underlying causes of lung disease in a slightly different way, and the drugs often work better, or in some cases more safely, when used together.

However, it can be difficult to keep track of many different medications, particularly if you need to take them at different times. In many cases, the need for multiple medications increases the likelihood that something may fall between the cracks.

Potential solutions. Switch to a combination product. If you're taking a long-acting beta2 agonist—formoterol (Foradil) or salmeterol (Serevent)—for asthma, it must be taken along with a controller medication, such as a corticosteroid, to reduce the risk of asthma-related death.

Combination therapy may also be appropriate for some people with COPD. Although beta2 agonists and inhaled steroids may be prescribed individually, two combination products are also available: Advair, which contains salmeterol and the steroid fluticasone, and Symbicort, which contains formoterol and the steroid budesonide.

Alternatively, ask your doctor if a once-daily medication is an option. Currently, the only once-a-day bronchodilator available is tiotropium (Spiriva). Although it has been approved by the Food and Drug Administration (FDA) for the treatment of COPD, it has not been approved for asthma. Mometasone (Asmanex), the only FDA-approved once-daily inhaled corticosteroid, is approved for maintenance treatment of asthma.

Publication Review By: Peter B. Terry, M.D., M.A.

Published: 14 Aug 2013

Last Modified: 14 Aug 2013