Medically Reviewed and Compiled by Dr. Adam N. Khan, MD.

If you are living with severe emphysema, your doctor will likely recommend a Triple Therapy inhaler as the gold standard. These “3-in-1” devices (like Trelegy or Breztri) combine three different medicines to open your airways and stop swelling. For many, this is the most effective way to prevent “flare-ups” and stay out of the hospital.

Understanding Severe Emphysema in 2026

Emphysema is a type of COPD where the tiny air sacs in your lungs are damaged. When this becomes “severe,” your lungs lose their stretch. Air gets trapped inside, making it feel like you can’t take a full breath.

In 2026, medical experts focus on two main goals:

Opening the airways as wide as possible.
Reducing inflammation to prevent your symptoms from getting worse.

The right inhaler is your first line of defense. Here is the deep dive into what works best right now.

The Gold Standard: Triple Therapy Inhalers

For years, patients had to juggle three or four different “puffers.” Today, we use Single-Inhaler Triple Therapy (SITT). Research in 2025 and 2026 confirms that using one device with three medicines works better than using separate ones because it is easier to stay consistent.

Why Triple Therapy Works

These inhalers contain three types of medicine:

LAMA (Long-Acting Muscarinic Antagonist): This relaxes the muscles around your airways to keep them open for 24 hours.
LABA (Long-Acting Beta-Agonist): This provides a second layer of relaxation for the breathing tubes.
ICS (Inhaled Corticosteroid): This reduces the redness and swelling (inflammation) inside the lungs.

Top Rated Inhalers for 2026

Inhaler Name	Type	Best For
Trelegy Ellipta	Dry Powder	Patients who want a simple, once-a-day dose.
Breztri Aerosphere	Metered Dose (Spray)	People who find it hard to take a deep, fast breath.
Trimbow	Extra-fine Mist	Reaching the very small, deep parts of the lungs.

New Breakthroughs: Beyond the Standard Inhaler

As we move through 2026, the medical community has introduced “Biologics” for severe emphysema. While these are not inhalers you buy at a pharmacy, they are changing how we treat the disease.

The Rise of Biologics (Dupixent & Nucala)

If your emphysema is caused by high levels of certain white blood cells (eosinophils), your doctor might add a biologic injection like Dupilumab (Dupixent) or Mepolizumab (Nucala). These target the root cause of lung swelling. When used alongside your daily inhaler, these can cut hospital visits by nearly 30%.

Ohtuvayre (Ensifentrine)

A new “first-of-its-kind” inhaled treatment called Ohtuvayre was recently approved. It works differently than standard bronchodilators by blocking specific enzymes (PDE3 and PDE4). It is often used as a “bonus” treatment for people who are already on a triple-therapy inhaler but still struggle with daily breathlessness.

How to Choose the “Best” Inhaler for You

The “best” inhaler isn’t just about the medicine inside; it’s about the delivery system. If you can’t get the medicine into your lungs, it won’t work.

1. The Dry Powder Inhaler (DPI)

Example: Trelegy Ellipta.
How it works: You must take a sharp, deep breath to pull the powder in.
Who it’s for: People who still have enough “lung power” to inhale strongly.

2. The Metered Dose Inhaler (MDI)

Example: Breztri.
How it works: It sprays the medicine out like an aerosol.
Who it’s for: People with very weak breathing. You can use a “spacer” (a plastic tube) to help the medicine reach your lungs without needing a perfectly timed breath.

4 Expert Tips for Living with Severe Emphysema

To get the most out of your treatment in 2026, follow these “lived-experience” steps:

Check Your Technique: Over 50% of people use their inhaler incorrectly. Ask your nurse to watch you use it at every visit.
Rinse Your Mouth: If your inhaler has a steroid (like Trelegy or Breztri), always rinse with water after use to avoid “thrush” (a mouth infection).
Use a Spacer: If you use a spray inhaler, a spacer can double the amount of medicine that actually reaches your lungs.
Pulmonary Rehab: No inhaler works as well as an inhaler combined with exercise. Ask for a referral to a rehab program to strengthen your breathing muscles.

When Inhalers Aren’t Enough

In severe emphysema, sometimes even the best triple-therapy inhaler needs help. In 2026, doctors are more frequently recommending:

Endobronchial Valves: Tiny one-way valves placed in the lungs to let trapped air out.
Oxygen Therapy: Portable concentrators that help you stay active.
Regenerative Medicine: While still in clinical trials, 2026 research is looking at using a patient’s own cells to repair lung tissue.

Summary: The 2026 Outlook

The best inhaler for severe emphysema is almost always a combination triple-therapy inhaler. However, the “best” choice is the one you can use easily every single day. Talk to your pulmonologist about whether you are a candidate for the newer biologics or the latest PDE inhibitors to give your lungs the extra support they need.