DPIs are also more susceptible to contamination because of their design and drug delivery method whereas MDIs are not; DPIs also contain lactose, though in small amounts. DPIs are generally more expensive to produce as well. Table 1 compares MDIs and DPIs, describes how to use the inhalers, and gives the name of some drugs that are useful for each kind of inhaler. Usage TechniquesPress down the top of the medication canister and at the same time inhale deeply and slowly through the mouth until the lungs are completely filled, hold the medication for as long as possible and exhale.
Repeat if needed after waiting about 1 minute; can also be used with a spacer see diagram below Differ depending on device but general instructions are: 1 For single use devices, load a capsule into the device as directed.
Using an Inhaler with a Spacer. Articles FAQs Sitemap. Disclaimer: This site is presented for information only and is not intended as a substitute for professional medical advice. All Rights Reserved. Log in or register to post comments. Contact us. Need Help? How can you choose the correct inhaler for your patient?
The Table summarizes the common inhalers and the things health care providers need to know about them. For inhalers that do not appear here, find the complete prescribing information. A final reminder: patients must be reminded and reeducated about inhalers often. Retail health care providers can ask patients to demonstrate how they use their inhalers, and use the teach-back method to ensure they use them correctly. Additionally, this is an area where YouTube comes to the rescue!
It has many videos that show proper technique. Creating a library of the best videos saves time and helps provide appropriate education that patients can refer back to later. For most DPIs, patients need not be able to coordinate breath and actuation. They do need to be able to inhale deeply with good force. Preparation steps could challenge patients with arthritis, low dexterity, or poor grip strength.
All Ellipta DPI inhalers are preloaded with a dose counter integrated into the mechanism. Patients need to take one single step to prepare the device, making it easier for patients with poor grip strength or dexterity.
DPI inhalers have a unique ventilation system at the mouth piece that provides steadier inhalation. Patients with visual impairment may find the dose counter and label information hard to read. MDI users These results are consistent with multiple studies in the literature. These findings can also be explained by the less complex administration of DPIs no coordination needed.
Common errors for both DPIs and MDIs were exhaling before the dose, holding breath after the dose fewer errors with MDIs , waiting between two consecutive doses and finally gargling after a corticosteroid dose.
Previous data have shown that common error for both types of inhalers was to exhale before taking the dose. About On the other hand, A higher percentage of DPIs users found their device easy to use and the inhalation easy to take when compared to MDIs.
Melani et al. Most common errors seen with MDIs use were failure to exhale before the dose, coordinate between pressing on the canister and inhaling, and hold breath followed by failure to shake the inhaler. Our data shows a statistically significant negative correlation between ease of use and age, a positive correlation between ease of use and time of diagnosis, and finally a negative correlation between gargling after taking corticosteroid inhalation and side effects.
As mentioned previously, lack of prior instructions is one of the major risk factors for inadequate inhalation technique. This provides a major area for improvement and highlights once again the importance of appropriate education.
Overall patients preferred DPIs. When asked, most patients on both types of inhalers preferred switching all of their devices to DPIs. After explaining the concept of DPIs devices containing powdered medications where coordination between pressing on the canister and inhalation is not required to patients on MDIs, most patients preferred shifting to DPIs if they were at the same cost.
There are multiple ways to improve inhalation technique. Re-education seems to be one of the most important ones. In other words, previous ability to correctly use a pressurized MDI is not indicative of correct use during subsequent testing thus continuous re-evaluation is a must. The combination of multimedia and personal instructions is suggested as well. For example, MDIs are preferred in those with spontaneous breathing, appropriate coordination, and poor inspiratory flow.
As for those with poor coordination and poor inspiratory flow, a pressurized MDI with a spacer is the most efficient option. There are some limitations to our study. First, an equal weight was given to each of the essential steps although some are more critical than others. This might overestimate the prevalence of the incorrect use of inhaler devices. On the other hand, one error in a critical step might counteract the entire effect and consequently influence the outcome.
Second, results were reported by more than one observer thus interobserver variability cannot be ignored. Finally, our study neither measured compliance nor its relationship with the adequate use of inhaler devices. However, proper administration technique was significantly higher in patients using DPIs.
Also, it showed a high percentage of patients not receiving the needed education about their devices. Accordingly, it is very important for healthcare professionals to appropriately train their patients in order to gain the maximal benefits expected from the devices and to prevent exacerbations and worsening of symptoms. Author note: Duration of the study was 18 months. Data collection type is prospective patient interview—questionnaires. Data collection places are community pharmacies and one hospital in Lebanon.
The authors gratefully acknowledge the assistance of Hamzeh Ramadan, PhD, in applying the statistical tests and reviewing the statistical analysis; Aline Milane, PharmD, PhD, in participating in the development of the questionnaires; and the LAU pharmacy students in collecting data and filling the questionnaires.
National Center for Biotechnology Information , U. Journal List Chron Respir Dis v. Chron Respir Dis. Published online Feb Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Box: F 53, Byblos, Lebanon. Email: bl. Received Jun 2; Accepted Dec 9. This article has been cited by other articles in PMC. Abstract Numerous patients with chronic obstructive pulmonary disease COPD and asthma do not use inhaler devices properly, which can contribute to poor disease control.
Methods Setting and design A concurrent, prospective comparative observational study was conducted at one teaching hospital and 15 community pharmacies in Lebanon in Beirut and Byblos area over a period of 18 months.
Table 1. DPI questionnaire. Demographics A. Age 1. Time of diagnosis 1. Gender 1. Female 2. Male C. Educational level 1.
No school 2. High school graduate or less 3. Some college 4. College graduate 5. Postgraduate studies E. Primary pulmonary diagnosis 1. Asthma 2. COPD 3. Other pulmonary disease F. Patient-perceived severity of pulmonary disease 1. Mild 2.
Moderate 3. Severe 2. Administration techniques G. How do you breathe just before using your inhaler? Inhale 2. Exhale 3. Breath in and out H. How do you tilt your head while using your inhaler? Tilt head forward 2. Keep head level 3.
Tilt head backward I. How do you hold your inhaler while using it? Horizontal 2. Vertical J. How do you position the mouthpiece? In your mouth lips around it 2. Do you load the dose capsule inside the device inhaler. If yes, specify if correct; specify the type of inhaler 1. Yes 2. How do you inhale while taking the dose? Inhale slowly and deeply 2. Inhale quickly M. How do you breathe after taking the dose? Breath out immediately 2. Hold your breath for about 5 to 10 seconds before exhaling N.
How do you exhale after inhaling the medicine? Exhale slowly 2. Exhale quickly 2. Administration techniques O. Press the inhaler twice load two doses before inhalation 2. Press the inhaler once load one dose and inhale, and then wait about a minute before doing it again 3.
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