An inhaler (puffer, asthma pump or allergy spray) is a medical device used for delivering medicines into the lungs through the work of a person's breathing. This allows medicines to be delivered to and absorbed in the lungs, which provides the ability for targeted medical treatment to this specific region of the body, as well as a reduction in the side effects of oral medications. There are a wide variety of inhalers, and they are commonly used to treat numerous medical conditions with asthma and chronic obstructive pulmonary disease (COPD) being among the most notable. Some of the common types of inhalers include metered-dose inhalers, dry powder inhalers, soft mist inhalers, and nebulizers. Each device has advantages and disadvantages and can be selected based on individually specific patient needs, as well as age, pathological conditions, coordination, and lung function. Proper education on inhaler use is important to ensure that inhaled medication creates its proper effects in the lungs. Using a spacer can ensure that more medicine reaches the lungs, thus providing the most optimal treatment.
Medical uses Inhalers are designed to deliver medication directly to the lungs through a person's own breathing. This may benefit a patient by providing medicines directly to areas of disease, allowing medication to take a greater effect on its intended target, and limit side effects of medications when administered locally. Inhalers are used in a variety of different medical conditions with diseases of the lungs and respiratory system being among the most common. Individuals with these diseases/conditions need medications designed to decrease airway inflammation and obstruction to allow for easier and comfortable breathing. Antibiotic medications have even been developed for inhalers to allow for direct delivery to areas of infection within the lungs. Two of the most common conditions that warrant inhaler therapy are asthma and chronic obstructive pulmonary disease.
Asthma Asthma is a condition of intermittent airway obstruction due to inflammatory processes in the lungs. Inhaled medications are used to calm down the inflammation present in the lungs and allow for relief of the airway obstruction. Common inhaled medications used for treatment of asthma include long term inhalational steroidal anti-inflammatory drugs (most commonly inhaled corticosteroids, also called ICS) and fast-relieving bronchodilators such as salbutamol (known commonly as "Ventolin") and salmeterol. These medications allow for patients to have relief of airway obstruction symptoms and reduced inflammation. If some people are unable to use inhalers, non-steroidal anti-inflammatory drugs (NSAIDs) may be used, but with caution since they may cause immunological hypersensitivity to NSAIDs, resulting in respiratory-related symptoms such as bronchospasms, acute asthma exacerbation, and severe asthma morbidity.
Chronic obstructive pulmonary disease (COPD) COPD is an obstructive lung disease due to long-term damage to the airways of the lungs. The long-term damage leads to the inability of the airways to open properly, causing airway obstruction. Inhaled medications allow patients to see improvement in symptoms and better function of daily living. Some commonly used inhaled medications in patient's with COPD are ipratroprium, salmeterol, and corticosteroids. Inhalers that combine two or three different medications including inhaled corticosteroids, long-active muscarinic medications (LAMA) and long acting beta2 agonists (LABA) for treating COPD may be associated with improvements in some quality of life variables and small improvements in lung function and respiratory symptoms, however, may also be associated with an increase in the risk of pneumonia.
Types of inhalers
Meter-dosed inhaler (MDI) The most common type of inhaler is the pressurized metered-dose inhaler (MDI) which is made up of 3 standard components- a metal canister, plastic actuator, and a metering valve. The medication is typically stored in solution in a pressurized canister that contains a propellant or suspension. The MDI canister is attached to a plastic, hand-operated actuator. On activation, the metered-dose inhaler releases a fixed dose of medication in aerosol form through the actuator and into a patient's lungs. These devices require significant coordination as a person must discharge the medication at or near the same time that they inhale in order for the medication to be effective. This problem is mitigated by the use of a spacer chamber, which allows the fine particle suspension to slow down and be more effectively inhaled into the lower airways . It is preferable that a spacer chamber is used for delivering medication by MDI for all age groups.
Dry powder inhaler (DPI)
Dry powder inhalers release a metered or device-measured dose of powdered medication that is inhaled through a DPI device. This device usually contains a chamber in which the powdered medication is deposited prior to each dosage. The powder can then be inhaled with a quick breath. This allows for medication to be delivered to the lungs without the need for use of propellant/suspension.
Soft mist inhaler (SMI) Soft mist inhalers release a light mist containing medication without the need for a propellant/suspension. Upon pressing a button, the inhaler creates a mist of medication, allowing for inhalation into the lungs. SMIs suspend inhaled medications for roughly 1.2 seconds, which is longer than the average MDI inhaler suspension time period. This requires less coordination when using and may be helpful for young patients or patients that find the MDI inhalers difficult to use.
Nebulizer
Nebulizers are designed to deliver medications over an extended period of time over multiple breaths through a mouthpiece or face mask. They generate a continuous mist with aerosolized medication, allowing a patient to breathe normally and receive medications. They are commonly used in infants and toddlers requiring inhaled medications or in patients in the hospital who require inhaled medications.
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