Most people with chronic obstructive pulmonary disease (COPD) use an inhaler every day to control shortness of breath and other symptoms of this progressive lung disease.

There are many different kinds of inhalers. Some are used once or twice a day to manage COPD and prevent acute exacerbations (attacks). Others are used as needed when an exacerbation occurs. As a result, most people with COPD use several different inhalers as part of the treatment plan.

This article describes some of the concerns related to the use of different inhaler medications. It also lists the inhalers that should not be used together as well as several that may be OK.

Classes of COPD Inhaler Medications

There are different classes of inhaled medications used in the treatment of COPD.

Among them:

  • Antimuscarinic drugs reverse airway narrowing by acting on a nerve transmitter called acetylcholine.
  • Long-acting beta-agonists (LABAs) relax airways by acting on receptors in the lungs, called beta-2 adrenergic receptors.
  • Short-acting beta-agonist (SABAs) work similarly to LABA but are used as a rescue inhaler rather than for daily use
  • Inhaled steroids improve breathing by reducing inflammation.

Possible Concerns

Although more than one inhaler may be prescribed to treat COPD, they can’t all be used together. In fact, using some together can pose health risks.

Possible concerns include:

  • Overdosing: Some inhalers contain a single drug, while others contain two or three drugs. This increases the risk of overdosing if the same drug is included in two different inhalers.
  • Increased side effects: Inhalers of the same drug class can cause many of the same symptoms. Using two inhalers of the same class can increase the risk or severity of side effects
  • Interactions: There are certain inhaler drugs that can interact with other inhaler drugs, causing severe drops in blood potassium (hypokalemia) and heart rhythm problems (cardiac arrhythmia).

Combinations That Are Safe or Unsafe

There are certain inhalers that can be used together and others that cannot. Here are some you need to watch out for if you or someone you love is being treated for COPD:

Antimuscarinic Inhalers

Controller medications are those used to control symptoms of COPD and prevent exacerbations. Antimuscarinic drugs are controller medications used once or twice daily.

Beta-Agonists

Beta-2 adrenergic agonists (also known as beta-agonists) are a mainstay treatment for COPD. There are short-acting versions used as rescue inhalers and long-acting versions that are used to control COPD.

Inhaled Steroids

Inhaled glucocorticoids (also known as inhaled steroids) are commonly used in combination with other inhaled drugs to control COPD. They are mainly used in people with a history of exacerbations.

Summary

People with COPD are commonly treated with more than one inhaler. Some are used as controller medications and others are used as “rescue inhalers” when you have a COPD attack. As effective as these drugs are, not all can be used together.

While it is common to use more than one inhaler for COPD, problems can occur if you use two drugs of the same class. Doing so can expose you to double the medication, leading to overdosing and an increased risk of side effects. Other drugs are known to interact, causing severe drops in blood potassium and heart rhythm problems.

A Word From Verywell

To make sure your inhalers are OK to take together, look at the class of medications. If you notice that you take more than one medicine in the same class, ask your physician or pharmacist to review your prescriptions.

  • National Library of Medicine, DailyMed. Atrovent HFA- ipratropium bromide aerosol, metered [drug label].
  • National Library of Medicine, DailyMed. Incruse Ellipta- umeclidinium aerosol, powder [drug label].
  • National Library of Medicine, DailyMed. Spiriva Respimat- tiotropium bromide inhalation spray spray, metered [drug label].
  • National Library of Medicine, DailyMed. Tudorza Pressair- aclidinium bromide powder, metered [drug label].
  • National Library of Medicine, DailyMed. Anoro Ellipta- umeclidinium bromide and vilanterol trifenatate powder [drug label].
  • National Library of Medicine, DailyMed. Bevespi Aerosphere- glycopyrrolate and formoterol fumarate aerosol, metered [drug label].
  • National Library of Medicine, DailyMed. Breo Ellipta- fluticasone furoate and vilanterol trifenatate powder [drug label].
  • National Library of Medicine, DailyMed. Stiolto Respimat- tiotropium bromide and olodaterol spray, metered [drug label].
  • National Library of Medicine, DailyMed. Combivent Respimat- ipratropium bromide and albuterol spray, metered [drug label].
  • National Library of Medicine, DailyMed. Advair Diskus- fluticasone propionate and salmeterol powder [drug label].
  • National Library of Medicine, DailyMed. Symbicort- budesonide and formoterol fumarate dihydrate aerosol [drug label].
  • National Library of Medicine, DailyMed. Flovent Diskus- fluticasone propionate powder, metered [drug label].
  • National Library of Medicine, DailyMed. QVAR Redihaler- beclomethasone dipropionate HFA aerosol, metered [drug label].

By Lauren Van Scoy, MD

Lauren Van Scoy, MD, is a board-certified physician in internal medicine, pulmonary medicine, and critical care.

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