BRONCHIAL

The Standard MDI Inhaler

Also known as EVOHALERS.
The MDI has been used for over 40 years and is
used to deliver various types and brands of
drugs.
It contains a pressurised inactive gas that
propels a dose of drug in each 'puff'.
This type of inhaler is quick to use, small, and
convenient to carry. It needs good coordination to press the canister, and breathe in
fully at the same time.

 The standard MDI is the most widely

used inhaler.
Common Errors include:
not shaking the inhaler before using it;
inhaling too sharply or at the wrong
time;
not holding your breath long enough
after breathing in the contents.
Ex: Azmacort

Advantages
They deliver a reliable, consistent dose of medication
directly to the lungs.
Most medicines are available in this form.

Disadvantages
Need for good coordination to combine taking a deep
breath in with pressing the MDI
No built-in dose counter
Not very efficient as a delivery device unless used with a
spacer device (see Holding chambers and spacers)

Breath-Activated Inhalers
These are alternatives to the standard
MDI.
Some are still pressurised MDIs, but don't
require you to press a canister on top.
Other breath-activated inhalers are also
called dry powder inhalers.

 These inhalers do not contain the

pressurised inactive gas to propel the
drug.
Accuhalers,
clickhalers,
easyhalers,
novolizers, turbohalers, diskhalers and
twisthalers are all breath-activated dry
powder inhalers.
You need to breathe in fairly hard to
get the powder into your lungs.

Advantages
It is easy to use because there is no need to combine
taking a deep breath with activating the MDI.
It contains 400 doses.

Disadvantages
Requires a more rapid inspiration (breath in) than the
standard MDI.
Activating lever may be hard to use for people with
dexterity or strength issues.
Pirbuterol is not indicated for children under 12 years.
No built-in dose counter
Only pirbuterol (Maxair) is available in this device.

Aerolizer
Medicine is held in a gel capsule on a foil blister card.
Immediately prior to use, one gel capsule is removed
from its blister and placed in the base of the Aerolizer.
The Aerolizer is not meant to be washed. A new
device is dispensed monthly.
Ex: Formoterol

 The Aerolizer is breath activated. This means when

you inhale, the Aerolizer automatically releases the
medication. When inhaled correctly, the medication
has a better chance to reach the small airways. This
increases the medication's effectiveness. The
portable size, efficiency and convenience make the
Aerolizer a desirable method for inhalation
treatment.

Advantages
Doses are external to the device so are easy to count.
Easy to use for most people
May take repeated puffs in order to inhale all medication
in the capsule.
Long, small mouthpiece may be easier to use for some
persons.

Disadvantages
The capsules are moisture sensitive.
The device is difficult to use if person has problems with
hand movement/coordination
The medicine and device are separate.

Diskus
Medicine is held in caps or blisters on a tape
inside the device. Each Diskus has 60 doses.
This medication must be used regularly to be
effective. It does not work immediately and should
not be used to relieve sudden shortness of breath
or asthma attacks. If sudden breathing problems
occur, use your quick-relief inhaler (such as albuterol,
also called salbutamol in some countries) as
prescribed.

Advantages
Has dose counter
Easy to teach and to use

Disadvantages
Can lose doses by playing with activation lever
Ex: Fluticasone/Salmeterol

Turbuhaler
Medicine is held in a reservoir in the bottom of the
device. Each Turbuhaler contains 200 doses. To clean,
just wipe the mouthpiece with a clean cloth. Keep dust
cover on when not in use.
Turbuhalers are a tube-shaped inhaler which has the
medication inside in the form of a dry powder. They
have a removable cover and a twisting base. The
device is breath-activated which means the dry
powder medication is sucked from the device rather
than fired like it is from other devices.
Ex: Budesonide

Advantages

Breath actuated
Indicator tells when 20 doses left
Easy to teach and to use
No taste, which many persons prefer
Indicated for once-daily dosing in stable asthma
Is safe for use in pregnancy

Disadvantages
Only one medicine currently available in this device
Can lose doses by playing with device
Moisture sensitive
No taste, so persons think theyre not getting anything

Spacer Devices

Spacer devices are used with pressurised MDIs.

The spacer between the inhaler and the
mouth holds the drug like a reservoir when the
inhaler is pressed. A valve at the mouth end
ensures that the drug is kept within the spacer
until you breathe in. When you breathe out,
the valve closes.
You don't need to have good co-ordination to
use a spacer device.

Nebulizers
Nebulizers are machines that turn the liquid
form of your short-acting bronchodilator
medicines into a fine mist, like an aerosol.
You breathe this in with a facemask or a
mouthpiece. Nebulisers are no more effective
than normal inhalers but they are extremely
useful in people who are very fatigued (tired)
with their breathing, or people who are very
breathless.

 Nebulizers are used mainly in hospital for

severe attacks of asthma when large doses
of inhaled drugs are needed.
They are used less commonly than in the
past as modern spacer devices are usually
just as good as nebulisers for giving large
doses of inhaled drugs. You do not need any
co-ordination to use a nebuliser - you just
breathe in and out, and you will breathe the
drug in.

Advantages
It is applicable to more varieties of drug solutions
It has the ability to aerosolize drug mixture (more
than one drug) as long as testing of drug activity is
done to ensure no interference
Minimal coordination for inhalation is needed
It can be used in very young or very old, debilitated
patients or those in acute distress
It works with low inspiratory flows or volumes
Breath-hold is not required for efficacy
Drug concentration can be adjusted if desired

Disadvantages
The equipment can be expensive and cumbersome
For traditional nebulizers, treatment times are
somewhat lengthy compared with other types of
inhalers and other routes of administration
With inadequate cleaning, medicine can be easily
contaminated
The spray is wet and cold
An external power source is needed, either electricity
or compressed gas, making it less portable