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Delivery of inhaled medication in adults

Dean Hess, RRT, PhD
Rajiv Dhand, MD, FCCP, FACP, FAARC
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


The delivery of therapeutic aerosols is an important component of treatment for many respiratory disorders. The advantages of aerosolized therapy include delivery of medication directly to the site of action, potentially faster onset of action, and reduced systemic availability to minimize adverse effects of the medication.

The types and function of devices available for delivery of therapeutic aerosols are reviewed here. The education of patients regarding optimal inhaler technique and the role of these medications in the management of asthma and chronic obstructive pulmonary disease (COPD) are discussed separately. (See "The use of inhaler devices in adults" and "The use of inhaler devices in children" and "An overview of asthma management" and "Management of stable chronic obstructive pulmonary disease" and "Management of exacerbations of chronic obstructive pulmonary disease".)


The principal types of devices used to generate therapeutic aerosols are pressurized metered dose inhalers (pMDIs), dry powder inhalers (DPIs), soft mist inhalers (SMIs), and nebulizers [1-3]. pMDIs may be used with or without a spacer/valved holding chamber. Some breath actuated pMDIs (available in some countries outside the United States) overcome the problem of incoordination between actuation and inhalation that is commonly observed with pMDIs. Among nebulizers, three basic types have been developed, jet (also known as pneumatic), ultrasonic, and mesh. Jet nebulizer systems are typically less portable than pMDIs and DPIs. In the past, nebulizers were considered more expensive delivery devices; however, in some settings, hydrofluoroalkane (HFA) formulations of pMDIs may be more expensive than the solutions used in a nebulizer.

Inhalation (or aerosol) therapy can be employed with a range of medications and devices. Examples include:

Inhaled beta agonist and anticholinergic bronchodilators for chronic obstructive lung diseases (eg, asthma, COPD, bronchiectasis, bronchiolitis)

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Literature review current through: Nov 2017. | This topic last updated: Jun 22, 2017.
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