What Are COPD Devices?
Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that limit air flow into your lungs, making it hard for you to breathe. These diseases include emphysema and chronic bronchitis. Although there's no cure for COPD, there are treatments that can help you cope, including devices. One device is inhaled medication. Another is portable oxygen therapy. A third is mobility aids.
Inhalers and Nebulizers
Inhalers and nebulizers have the same purpose: to get the medicine into your lungs. Both deliver the same type of medicine, and they work equally well when you use them the way you should.
Inhalers and nebulizers are available only by prescription. You might see some bronchodilator inhalers sold over the counter, but don't use them unless your doctor recommends it. They could be dangerous for people with certain health conditions, such as heart problems.
These handheld devices deliver a puff of medicine into your airways. There are three basic types:
- Hydrofluoroalkane inhalers (HFA, formerly metered dose inhaler, or MDI)
- Dry powder inhalers (DPI)
- Soft mist inhalers (SMI)
HFAs contain a liquid medication that you get through an aerosol spray. The medicine is in a pressurized canister that has a metering valve. You close your lips around the mouthpiece or place the mouthpiece 1 to 2 inches from your mouth, and breathe in slowly as you press down on the inhaler.
Many people like to use a spacer. It’s a hollow plastic tube that is attached between the mouthpiece and the canister of medicine. A spacer makes it easier to get the full dose of medication all the way to your lungs.
A DPI is similar to an HFA, but it releases a puff of dry powder instead of a liquid mist. You shouldn’t use a DPI with a spacer. Instead, close your mouth tightly around the mouthpiece of the DPI inhaler and inhale rapidly and steadily. It’s important to remove the device from your mouth before you exhale so that humid air doesn’t get into the device and make the powder clump.
An SMI is a newer type of inhaler that provides a measured amount of medicine in a slow-moving mist that helps you inhale the medicine. You put your lips on the mouthpiece while you hold the device horizontally. Be careful not to cover the air vents. This type of device actively delivers medicine in a way that doesn’t depend on how fast you breathe in the air from the inhaler.
Though inhalers use the same general principle, they don’t all work the same way. For instance, you should shake an HFA before using it, but you never shake a DPI.
Each device is cleaned differently and has a different way of tracking when it’s empty. Always follow the instructions for your specific device.
To use it, measure out the medicine into a cup and attach the cup with tubing to the machine. Then turn it on, relax, and breathe the mist in deeply through a mouthpiece or mask.
Depending on the medication, it usually takes 20 minutes or less to inhale the medicine. Afterward, you need to clean the nebulizer and mouthpiece or mask with water (and soap every now and then) before you use it again.
Inhaler vs. Nebulizer
Which approach is better: a nebulizer or an inhaler? It depends on what your doctor recommends, your own preference, and what your insurance will cover. The key is to make sure you feel comfortable with whichever one you choose and use it the right way.
Most people with COPD use an inhaler. One big advantage is that they're portable. While you have to use a nebulizer at home (or in a medical facility), you can carry an inhaler in your pocket. Inhalers also deliver medication more quickly. After a few puffs, perhaps taken a minute or 2 apart, you're done.
If you have trouble with inhalers, nebulizers can be the best choice for you. They also can help temporarily if you have a COPD flare-up. Some people just prefer nebulizers and feel that they work better.
Because nebulizers are expensive and need maintenance, insurance companies might be less likely to cover them for long-term use. Check your plan.
PEP stands for positive expiratory pressure. With a PEP, you breathe through a mask or a small mouthpiece attached to a device called a valve. Air flows in easily but not out. The PEP creates pressure in the lungs that you must breathe against. The aim is to keep your airways open by getting air behind the mucus buildup and moving it from your lungs. It takes around four times as long to breathe out as to breathe in. PEP devices are prescribed by a doctor.
- To use, sit up straight with your elbows resting on table.
- Make a tight seal around the mouthpiece with your mouth or, if using a mask, make sure it's fitting properly over your face.
- Breathe in deeply through your nose.
- Hold your breath for 2-3 seconds to allow the air to move through your lungs.
- Breathe out into the PEP valve, keeping your cheeks flat. As you breathe out, you'll feel resistance. This creates positive air pressure.
- Breathe out three to four times as long as you breathe in.
- Repeat this until you've blown through the PEP valve 20 times.
- Remove the mouthpiece and do a “huff cough.” This means to take a deep breath and hold it for 1-3 seconds. Then force the air out with your mouth open as if you were trying to fog a mirror. Making a "huff" sound gives you the same effect.
- This process makes up one cycle. Your doctor will tell you how many cycles you need to do.
An oscillating PEP device is similar to a PEP, except that in addition to the resistance breathing, the oscillating PEP creates vibrations when you breathe out to help move mucus.
The PEP needs to be cleaned at least twice weekly with warm soap and water, followed by a soak in rubbing alcohol and a rinse in sterile water (water that has been boiled for 5 minutes and cooled). Your device will have cleaning instructions.
Portable Breathing Machines
Many people with COPD need extra oxygen. But some are anxious about traveling with oxygen tanks, so they stay home instead of enjoying time away. There’s another option: Portable oxygen concentrators (POCs) take air from the room and convert it into concentrated oxygen. Most are lightweight, compact and, unlike traditional tanks, do not need refilling.
POCs run on batteries. Some can last more than 12 hours. POCs also have AC/DC adapters, so you can plug them into your car or any outlet.
Although some over-the-counter models are available, these may not meet your oxygen needs if you have COPD. Have your doctor write you a prescription for your POC.
CPAP (continuous positive airway pressure) is a machine that helps you sleep better by using mild air pressure to keep your airways open. It's often used by people who have sleep apnea, but people with COPD can get benefits too.
The CPAP consists of:
- A small machine that fits on your bedside table that has a motor that blows air into a tube
- A humidifier, attached to the machine, to provide moisture; continuous airflow causes dryness to the nose and throat
- A mask that fits over your nose or your nose and mouth
- A tube to connect the mask to the machine’s motor
- Straps to keep the mask in place
The CPAP continually puts pressurized air into your lungs as you sleep, via the mask and tube. This keeps your airways open and allows you to breathe properly, with no pauses in your breathing (the main symptom of sleep apnea). It often takes some time to get used to the machine. CPAPs are available in travel sizes as well as in sizes for at-home use.
CPAPs need regular cleaning and sanitizing to get rid of mold and bacteria. Respiratory illnesses have been traced back to breathing into unclean CPAPs. Also, the machine's life is shortened if it's not properly cleaned as facial oils and dirt will degrade the mask, and mold will clog the hose and humidifier. Your CPAP will come with cleaning instructions for you to follow.
Bilevel positive airway pressure (BiPAP) machines are a type of CPAP. The biggest difference is that instead of a continuous air pressure (which some CPAP users don't like because it makes them feel like they are choking), the BiPAP has two air pressure settings: inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP). The EPAP offers a lower pressure setting than the IPAP, and the machine can be set up to time the switch between IPAP and EPAP to your breathing patterns.
The BiPAP costs more than the CPAP, and insurance will often not pay for it until after you've tried the CPAP and found it wasn't right for you. The BiPAP is available for home use only. Cleaning is similar to cleaning a CPAP.
5 Tips for Using Inhaled COPD Medicine
- Know how to use it. If you don’t use inhaled medicine correctly, it won't help you. When you get the prescription, go over the instructions with your doctor or pharmacist – or, if you have a nebulizer, with a representative from the medical supply company. After that, check in sometimes to make sure that you're still using it properly.
- Know when to use it. If your doctor prescribes a nebulizer or inhaler, make sure you understand when to use it. Is it only for times when you have a COPD flare-up? Or do you need it every day?
- Know how much you need. Always follow the prescription exactly. Never take more or less than your doctor recommends. If you have a COPD flare-up and your normal dosage doesn’t help, don't keep taking more. Instead, get medical help right away.
- Know what the drug does. You might need more than one kind of inhaled medication. The most common treatment for COPD is a bronchodilator, which relaxes the muscles around the airways, allowing them to open up. There are many types of bronchodilators. Some people with COPD need treatment with inhaled corticosteroids, which can curb swelling in the air passages. Some of these medications are short-acting. Others are long-acting. And some kick in quickly, while others take time to work.
- Keep track of your medication. Since it’s so important to control your COPD, make sure you always know how much medicine you have left. Get refills on time. You never want to run out unexpectedly. And if you take more than one prescription, take care to keep them straight.
Traveling With Oxygen
First, ask your doctor if it’s safe for you to travel. Let them know about your travel destination, especially if you are going to higher altitudes or other countries.
Here are a few pointers to keep in mind:
- Never store tanks in your car’s trunk or in direct sunlight. Keep them away from intense heat.
- Secure the oxygen tank in your car on the car floor or on the seat with a seat belt.
- Make sure your tanks have more than enough oxygen for the whole trip and to get you back home. Or plan ahead to get refills. Your supplier can help you with this.
- Avoid smokers.
- Keep the windows open a crack, at least, so air can circulate.
- Make sure your equipment works well before heading out.
- If traveling by train, bus, or cruise ship, ask about their policies on portable oxygen beforehand.
You must make arrangements ahead of time when flying. When you make your reservation, ask the airline about its policies on portable oxygen.
- Most U.S. airlines require at least a 48-hour notice, but others need longer. Always check with your airline well before your travel date. Foreign airlines may have different requirements.
- Find out which POCs are approved by the Federal Aviation Administration (FAA). You can’t bring your POC on the plane unless your airline approves it.
- If you don’t have an FAA-approved POC, ask if you can rent one.
- Try to get a nonstop or direct flight to prevent worries about layovers or missing a connecting flight.
- Some airlines may provide oxygen for a fee. But this is only on the plane and not in the airport.
- Ask your insurance company whether you need supplementary coverage for traveling with oxygen.
- Get a prescription for supplemental oxygen from your doctor, and keep this with you – always. This prescription should state your medical condition and your need for in-flight oxygen and also give specifics on how long oxygen should be used and on the oxygen flow rate.
- The airlines may have their own forms for your doctor to fill out, so be sure to get these back from your doctor in plenty of time.
- You might need an increase in the oxygen flow rate during air travel; your doctor will know. Be sure to talk to the doctor about this so you have no discomfort breathing during the flight.
- The airlines may require you to bring ample batteries to power your POC. Most airlines require that your batteries last 50% longer (or 3 hours longer, in the case of some airlines) than the total time of your trip – from the time you leave your home until you get to your final destination.
- Some airlines may allow empty tanks to be stowed, but filled ones are not allowed aboard.
When COPD makes day-to-day activities hard, there are devices that could help. Support tools and aids to help you move around and handle chores can save you energy. You’ll have more strength for your lungs to do their job: breathing.
A shopping cart can provide support as you walk through the aisles.
Like a cart, a basket with wheels can make tasks easier. Use one when you do the laundry. Slide the basket full of clothes from room to room.
Chairs, Stools, and Grabbers
Place chairs and stools around your home and cut back on the energy you spend on household chores and activities. For instance:
- Sit in a chair or on your bed when you get dressed in the morning.
- Use a waterproof chair or stool in the shower.
- Try sitting on a tall stool in the kitchen when you cook.
- Put on makeup at a vanity in your bedroom or sit in a chair in the bathroom to shave.
Use grabbers to avoid bending down to pick up things off the floor. Keep a pair of long-handled grabbers handy. These devices can help you get things that are too high or too low to comfortably reach.
If you’re out of breath when you go to the store or on a stroll, you may want a walker.
A standard walker supports your weight as you walk. It has four rubber-tipped legs to help with your balance. Grip the top with both hands as you lift it and move it forward a full step or a few inches. Line up your steps in the center of the walker. Since you lift this 6-pound device with every step, it may tire you out if you have severe COPD.
A rolling walker has two wheels in front and two flat-tipped legs in back that slide along the ground. You don’t pick it with each step you take, and you can use it on different surfaces. This walker moves more naturally. Its front wheels are usually fixed, so it’s less stable than a standard one and you need more coordination to use it.
Rollators and Scooters
Studies show that rollators, or four-wheeled walkers, can improve energy and exercise level in people with severe COPD. They are easier to move forward and around corners than a walker, but they are also less sturdy. Rollators often come with brakes, a basket, and a seat that allows you to rest when you need it.
Your doctor can prescribe battery-powered, or electric, scooters. They’re simple to use, and you can travel much farther on them than on foot.
Scooters are made for one person to ride in a seated position. They have a horn, lights, and space for your personal items. Unlike a wheelchair, you may not be able to take one into a building.