Asthma Management Handbook

Inhaler devices and technique

Overview

The three main types of inhaler devices for asthma and COPD medicines are:

  • manually-actuated pressurised metered-dose inhalers (conventional puffer)
  • breath-actuated pressurised metered-dose inhalers
  • dry powder inhalers (multi-dose and capsule types)
  • mist inhalers.

The correct inhaler technique depends on the device. Poor inhaler technique is extremely common and is associated with worse outcomes in asthma and COPD, including poor asthma symptom control and overuse of relievers and preventers.

Regardless of the type of inhaler device prescribed, all patients need training in correct inhaler technique, including a physical demonstration. As inhaler technique worsens over time, all patients need regular checking to ensure they are using their inhalers correctly.

Table. Types of inhaler devices for delivering asthma and COPD medicines Opens in a new window Please view and print this figure separately: http://www.asthmahandbook.org.au/table/show/75

Table. Considerations for choice of inhaler device type when prescribing inhaled medicines

Clinical situation

Consideration

Acute asthma (all patients) Recommend use of spacer when using reliever via pMDI for acute asthma

Any patient using a pMDI for an inhaled corticosteroid

Recommend use of a spacer every time (except for breath-acuated pMDIs)

Infants and small children

Use a spacer with a facemask

Poor manual dexterity (e.g. weak hands or osteoarthritis)

Consider either of:

  • a Haleraid device with relevant pMDIs (available for salbutamol, fluticasone, fluticasone/salmeterol)
  • a breath-actuated inhaler

Difficulty connecting spacer to pMDI (e.g. elderly patient with weakness or poor coordination)

Consider a breath-actuated inhaler or a spacer with a flexible (universal) connector port

Inability to form a good seal around the mouthpiece of the inhaler or spacer (e.g. person with cognitive impairment or facial weakness)

Consider a spacer plus age-appropriate facemask

Difficulty speaking or reading English

Give a physical demonstration

Use videos

Use an interpreter or provide written instructions in the person’s first language

Using multiple inhalers

Choose the same type for each medicine, if possible, to avoid confusion

If not possible, train person in the correct inhaler technique for each of their devices, emphasising any key differences (e.g. speed of inhalation, shake pMDIs but not dry-powder inhalers)

Source: National Asthma Council Australia. Inhaler technique for people with asthma or COPD. Melbourne: NAC; 2016. Available from: http://www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/information-paper/hp-inhaler-technique-for-people-with-asthma-or-copd

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