context: While there's no cure for chronic obstructive pulmonary disease ( COPD), inhaled medication can help, along with other treatments. There are two main ways inhaled medicine is used: with an inhaler, and with a nebulizer. 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 properly. Inhalers and nebulizers are only available by prescription. While you might see some bronchodilator inhalers sold over the counter, don't use them unless your doctor recommends it. They could be dangerous for people with certain health conditions, such as heart problems. These small, handheld devices deliver a puff of medicine into your airways. There are three basic types: Hydrofluoroalkane inhalers or 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 can 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. Another method that many people like is 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 pre-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. While 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. These machines change a liquid medicine into a mist that you inhale into your lungs. Nebulizers aren't particularly portable, so you keep a nebulizer at home. To use it, you measure out the medicine into a cup and attach the cup with tubing to the machine. Then you 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. Which approach is better: a nebulizer or an inhaler? It depends on what your doctor recommends, your personal preference, and what your insurance will cover. The key is to make sure you feel comfortable with, and correctly use, whichever one you choose. 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 two apart, you're done. It can take some practice to use an inhaler correctly. Many studies have found that fewer than half the people with HFAs for asthma or COPD actually use them properly. 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're more effective. Your doctor will have advice about which approach makes sense in your case. Because nebulizers are expensive and need maintenance, insurance companies might be less likely to cover them for long-term use. Check your plan. Know how to use it. If you don't use inhaled medicine correctly, it won't help you. When you first 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 occasionally 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.