Using a pressurized metered dose inhaler

A pressurized metered-dose inhaler delivers a specific amount of medication in the form of aerosol spray. It is easy to carry everywhere but requires coordination. The user has to breathe in as they actuate (release the drug) by pressing the canister down.

Using a spacer to improve the delivery of inhaled medications

Not all people can coordinate the sequence of properly using the metered-dose inhaler – pressing down the canister while breathing in, removing the canister and holding the breath. As a result, use of a spacer with a metered-dose inhaler is recommended for children under 5 years old and for seniors to avoid timing issues.

The use of a spacer device allows more of the drug to be inhaled, and keeps large amounts of the medication from being deposited at the back of the mouth and throat. This also means less drug getting into the stomach and being absorbed that way.

Using breath-actuated delivery systems

Breath-actuated systems contain the drug in a dry powder form. Generally, they are easier to use than pressurized metered-dose inhalers because you don't have to coordinate actuation (release of the drug) with inhalation. One drawback with this type of delivery system is that the you have to breathe in quickly and forcefully to effectively inhale the medication.

There are 5 breath-actuated systems that work with specific drugs:

  • The Turbuhaler can be used to deliver a corticosteroid (Pulmicort®), a beta2-agonist (Bricanyl®), a long-acting beta2-agonist (Oxeze®), or a combination therapy (Symbicort®)
  • The Aerolizer Inhaler can be used for a long-acting beta2-agonist (Foradil®).
  • The Diskhaler can be used for a corticosteroid (Beclovent®) or a beta2-agonist (Ventolin®)
  • The Diskus can be used for a corticosteroid (Flovent®), a short-acting beta-2 agonist (Ventolin Diskus®), a long-acting beta2-agonist (Serevent®), or a combination therapy (Advair Diskus®)
  • The Ellipta can be used for a corticosteroid (Arnuity™ Ellipta®), or a combination therapy (Breo® Ellipta®).

Using a nebulizer for the delivery of asthmatic drugs

Because nebulizers deliver larger doses of a drug than metered-dose inhalers, some people find them helpful when they are having a problem taking a deep breath. For example, when a bronchospasm is so severe that more than a few puffs from a metered-dose inhaler or breath-actuated device are needed, the person may benefit from the larger dose provided by a nebulizer. This can sometimes avoid a trip to the hospital.

However, while there are some advantages to using a nebulizer, most people don't need this type of device to deliver bronchodilators or corticosteroids.

Using soft-mist inhalers

A soft-mist inhaler uses liquid formulations to release low-speed mists. While the delivery of the medication is efficient, soft-mist inhalers also require the correct inhalation technique, which resembles the one for pressurized metered-dose inhalers. Soft-mist inhalers can be used for a bronchodilator (Spiriva Respimat®) as add-on therapy.

David Ostrow, MD 
in association with the MediResource Clinical Team