Your health care professional should prescribe the right medications for your COPD in the right type of inhaler. Your unique abilities should be considered – such as your cognitive function (are you able to understand and follow instructions on how to use?), hand dexterity (can you handle the device correctly?), and peak inspiratory flow (do you have enough ability to breathe in “hard and fast” with a dry powder inhaler?). Shared decision-making is a communication process in which you and your health care professional work together to arrive at the best treatment decisions.

Current recommendations are for the health care professional to select an inhaler based on "access, cost, prescriber, and most importantly, patient’s ability and preference.” For various reasons, inhaler choice is typically a decision by the health care professional. Unfortunately, studies show that individuals with COPD have frequent errors using whatever inhaler device has been prescribed. Another approach to inhaler device selection is "shared decision-making" which enables patients to participate in the process of deciding on which inhaler device "is best for me."

In November 2018, the FDA approved Primatene Mist for the treatment of mild intermittent asthma. As it is the only over-the-counter inhaler approved by the FDA, some individuals with COPD may consider using it. The active ingredient is epinephrine which plays an important role in the fight-or-flight response; it stimulates the heart to beat faster and harder. Misuse and overuse of Primatene have been well documented and has been associated with people dying. Also, patients may self-medicate with Primatene Mist, thereby delaying effective care. I advise against use of Primatene Mist because of safety concerns. Albuterol is a safer alternative, but requires a prescription.