Asthma and Airway Centre

AEROSOL MDI

Advantages

• convenient size for portability
• canisters contain many doses (100-300 puffs)
• available for relief and preventive use
• easily used by most patients
• low inspiratory flow required (20-25 L/min)
• choice of open or closed mouth method
• can be used by most individuals with suitable added device
• newer MDI inhalers e.g. Airomir or Qvar are CFC free

Disadvantages

• aerosol has freon (CFC) propellants
• breath coordination can be a problem for some
• may be difficult to use for those with restricted hand / arm movement
• some disadvantages with closed mouth method vs open mouth method

MDI with

a) AeroChamber Plus™

Advantages

• easy to coordinate spraying then inhaling
• choice of one or more breath
• flow signal warning
• increases drug delivery for those with poor inhaler technique
• prevent hoarseness and oral thrush from inhaled steroids
• fits most MDIs
• available with mouthpiece or mask
• mask size vary for infants / children / adults
• size smaller than some spacers
• clear chamber allows assessment of valve opening by care giver
• reusable

Disadvantages

• must be replaced periodically because of wear and tear
• can be costly unless covered by insurance plan
• the device is bulky
• some patients troubled by a lack of spray sensation when using aerosol drugs

b) Ventahaler®

Advantages

• eliminates coordination problems
• increases drug delivery for those with poor inhaler technique
• reduces the possibility of oral thrush and hoarseness from inhaled steroids
• long-lasting, clear chamber
• lower cost compared to other spacers

Disadvantages

• no flow signal
• cannot be used with all MDIs
• large size may decrease compliance

c) ACE® (Aerosol Cloud Enhancer)

Advantages

• eliminates coordination problems
• increases drug delivery for those with poor inhaler technique
• prevents hoarseness and oral thrush from inhaled steroids
• flow signal warning
• can be adapted for use with intubated / ventilated / resuscitation bag / incentive spirometer and portable MDI therapy
• reasonable cost
• replaceable mouthpiece and flow signal
• long lasting, clear chamber with universal adapter

Disadvantages

• interchanging canisters may cause misuse when more than one type of MDI is used

d) Haler Aid®

Advantages

• used by those with good MDI technique with some restricted finger or hand movement
• eliminates need to change device
• can also be used with an Aerochamber or Ventahaler
• low cost

Disadvantages

• cannot be used with ACE spacer
• cannot be used with all MDIs e.g. Intal, Tilade, Atrovent, Flovent, or Serevent

All dry Powder inhalers are propellant free

All powdered inhalers require deep forceful inspiration

a) Turbuhaler®

Advantages

• easy to use
• convenient size
• little or no taste of medication
• relief and preventive medication available
• breath coordination not needed
• mutiple dose capacity
• whistle adapter to assess adequate inspiratory flow available
• also available, trainer usage device to assess inspiratory flow rate (30-60 L/min)
• grip attachment for arthritic or restricted finger movement to load dose

Disadvantages

• some patients mistakenly interchange covers of Bricanyl and Pulmicort turbuhalers causing misuse
• no definite guide as to when inhaler is completely empty
• some patients hearing the dessicant mistakenly think they still have medication and continue to use it when empty
• exhaling into the device can affect the delivery of medication
• some patients are doubtful that they are getting their dose (don't feel or taste anything)
• not suitable for all ages (required flow rate)
• unless held upright when loading the Turbuhaler, the correct dose may not be delivered

b ) Diskus®

Advantages

• easy to use
• powder form of medication
• has a dose counter indicating how many doses are left or if the inhaler is empty

Disadvantages

• mouthpiece too shallow
• has lactose additive
• dose counter can reset after the inhaler is empty allowing some patients to use the inhaler while it is empty.
• some patients may have insufficient inspiratory force for drug deposition.

c) Diskhaler®

Advantages

• disks are available for relief and preventive medications
• convenient size and design
• easy to use by most individuals
• breath coordination not needed
• multiple dose

Disadvantages

• only 4-8 doses per disk (limited)
• may require more than one inspiration per dose
• not suitable for all ages
• requires forceful inspiration (60-110 L/min)
• disks cost more than MDI equivalent
• loading disks can be cumbersome

d) Rotahaler®

Advantages

• small convenient size
• can be used by most individuals
• breath coordination not needed
• Rotacaps available for relief and preventive use

Disadvantages

• each dose must be loaded
• requires carrying extra supply of Rotacaps
• difficult for those with restricted finger or hand movement to load the Rotahaler
• not suitable for all ages (Insp. flow 60-110 L/min)
• Rotacaps cost more than MDI equivalent
• may require more than one inspiration per dose
• Rotacaps can be affected by humidity

SOLUTIONS

Nebulizer / Compressor

Advantages

• can be used at home, school, clinics or hospital in emergency
• can also be used for maintenance therapy at home
• available in electric or battery powered
• some costs may be covered by government and/or private insurance plans
• can be used with mask or mouthpiece  

Disadvantages

• can be expensive without assistance
• over reliance on relief medication can delay appropriate treatment
• treatment takes longer to administer
• eyes may be affected by nebulized medications escaping poor fitting masks (inhaled steroids or Atrovent)
• the need for regular daily use may cause some patients to become home bound
• neglect to change or clean mask / tubing set-up may increase the risk of chest infection

* Most of these advantages and disadvantages are observations and comments from patients

Acknowledgement for the permission to use the diagrams of devices from: Glaxo Wellcome / DHDs / Fisons / Boehringer Ingelheim and Astra Pharma