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The use of inhaler devices in adults

William Bailey, MD
Dean Hess, RRT, PhD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


Inhaler devices are the major method for delivery of asthma medication, but their effectiveness can be compromised if the patient uses the inhaler device incorrectly [1]. The magnitude of this problem has been well documented; in several studies less than half of the patients used their inhaler correctly [2-9].

The use of inhaler devices by adults will be presented here. More general discussions of the delivery of inhaled medication via nebulizers and what patients need to know about their asthma are presented separately (table 1). (See "Delivery of inhaled medication in adults" and "What do patients need to know about their asthma?".)


Inhaler devices are used to deliver a variety of inhaled medications, including beta-agonists, anticholinergics, glucocorticoids, tobramycin, and insulin. Three main types of inhaler devices are available, the pressurized metered dose inhaler (MDI), the dry powder inhaler (DPI), and the soft mist inhaler (SMI).

Metered dose inhalers with CFC and HFA — MDI devices consist of a pressurized canister, a metering valve and stem, and a mouthpiece actuator (picture 1). The pressurized canister contains the drug suspended in a mixture of propellants, surfactants, preservatives, flavoring agents, and dispersal agents. Following adoption of the Montreal protocol, an international agreement to ban chlorofluorocarbons (CFCs), the CFC-free propellant hydrofluoroalkane (HFA)-133a has replaced CFC-containing devices [10-22]. Delivery of most aerosol medications to the lungs is comparable between HFA and traditional CFC devices, although a few of the HFAs deliver a greater portion of the dose than the comparable CFC MDI [19,23-28].

Dry powder inhalers — DPIs are breath-actuated devices that deliver micronized drug particles with a mass median aerodynamic diameter (MMAD) of less than 5 µm, which usually are aggregated with carrier particles (such as lactose or glucose) of greater diameter [29,30]. Drug is delivered to the airways by the inhalation of air over a punctured capsule, blister, or reservoir [29,30]. Inspiratory flow rates of 30 to 60 L/min are required to disaggregate and aegrosolize the drug when using a DPI device [31-33].


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Literature review current through: Sep 2016. | This topic last updated: Jul 8, 2016.
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