Delivery systems for COPD, asthma, and severe asthma medication take many different forms. There are multiple types of inhalation devices, in addition to drugs that are delivered orally or by injection. This brochure provides a review of some of the common types of medicine delivery systems used to manage COPD and asthma.
If you are a health care professional affiliated with an employer, institution, or committee, or practicing in a state that restricts what items you may receive from manufacturers, we ask that you not accept or download any restricted items from this site. If you are a health care provider practicing in Vermont, we are required by state law to deny you permission to download any items or review any journal articles made available on this site.
FOR CARE TEAMS
Medication Administration for COPD, Asthma, and Severe Asthma
Delivery systems for COPD, asthma, and severe asthma medication take many different forms. There are multiple types of inhalation devices, in addition to drugs that are delivered orally or by injection.1,2
Below are examples of the different types of inhalation delivery systems:
Pressurized Metered-Dose Inhalers (pMDIs)3
A pMDI delivers a measured amount of medication into a patient's lungs with each spray or puff. pMDIs use a chemical propellant to produce the puff and deliver the medicine to the lungs. Many pMDIs have a dose counter to let patients know how many puffs are left.
Small and convenient to carry; doesn't require a deep, fast, inhaled breath; humidity doesn't affect medication2
Medication may stick to the back of the throat or tongue; requires shaking and priming2
pMDIs With a Spacer3
A spacer can be used with a pMDI and may help to coordinate inhalation with the actuation. The inhaled medication is sprayed into the spacer, which holds the puff from the pMDI for a few seconds so that a patient doesn't have to both breathe in and spray the pMDI at the same time.
Helps deliver more medication into the lungs; may reduce the risk of corticosteroid side effects such as hoarseness or thrush2
Spacers make pMDIs less portable3
Dry Powder Inhalers (DPIs)4
A DPI delivers medications in a dry powder form. DPIs are breath activated. The medication is only released when a patient takes a deep, fast breath in through the inhaler.
Small and convenient to carry; doesn't require the coordination of breathing with medication release; may use single dose capsules of medication so it is easy to tell how many doses are left2
Requires a deep, fast, inhaled breath which some patients may not be able to do (especially the elderly); some medication can get stuck to the back of the throat or tongue; high humidity can cause medication to clump2
Breath-Actuated Inhalers (BAIs)5
BAIs automatically release a spray of medication when a patient inhales.
Does not require coordination of inhalation and actuation5
Slightly larger than a pMDI5
A nebulizer delivers medicine in a fine, steady mist. The nebulizer machine connects to a tube that, in turn, connects to a medicine cup and mouthpiece or mask.
May be used at any age, no specific inhalation technique is needed; may disperse drugs not available in an inhaler7
More expensive than inhalers alone; treatment time may be long; possibility of bacterial contamination from unsterile chambers or tubing; drug is wasted when mist comes out from the sides of the mask7
Peak Flow Monitor8
This is a portable, inexpensive, hand-held device that is used to measure how quickly a patient is able to push air out of the lungs. Patients can use the monitor at home and record the results. Why use a peak flow monitor? The results can help healthcare providers see if a patient's medication needs to be adjusted. A peak flow monitor can also determine whether a patient's asthma is worsening.
References: 1. National Heart, Lung, and Blood Institute. How is asthma treated and controlled. https://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment. Accessed November 21, 2017. 2. Mayo Clinic. Asthma inhalers: which one is right for you? https://www.mayoclinic.org/diseasesconditions/asthma/in-depth/asthmainhalers/art-20046382?pg=2. Accessed November 21, 2017. 3. American Thoracic Society. Using your metered dose inhaler (MDI). https://www.thoracic.org/patients/patient-resources/resources/metered-dose-inhaler- mdi.pdf. Accessed November 21, 2017. 4. American Academy of Allergy, Asthma and Immunology. Dry powder inhaler. https://www.aaaai.org/conditions-and-treatments/conditions- dictionary/dry-powder-inhalers. Accessed November 21, 2017. 5. Gupta S. How to ensure the correct inhaler device is selected for each patient. Clin Pharm. 2009;1(4):322-323. https:// www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp200907_inhaler-322.pdf. Published July/August 2009. Accessed January 8, 2018. 6. National Heart, Lung, and Blood Institute. Asthma tipsheets: how to use a metered-dose inhaler. https://www.nhlbi.nih.gov/files/docs/public/lung/asthma_tipsheets.pdf. Accessed November 21, 2017. 7. Jaggi V. What is a nebulizer? What are it's advantages and disadvantages? Asthma Chest and Allergy Centre. https://www.acac.in/what-is-a-nebulizer-what-are-its-advantages-and-disadvantages/. Accessed November 21, 2017. 8. American Lung Association. Measuring your peak flow rate. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing- asthma/measuring-your-peak-flow-rate.html. Accessed November 21, 2017.