Medication Administration for COPD, Asthma, and Severe Asthma

pMDIs With a Spacer

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.
 

Pros:

Helps deliver more medication into the lungs; may reduce the risk of corticosteroid
side effects such as hoarseness or thrush

Cons:

Spacers make pMDIs
less portable

Dry Powder Inhalers (DPIs)

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

Pros:

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 left

Cons:

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 clump
 

Breath-Actuated Inhalers (BAIs)

BAIs automatically release a spray of medication when a patient inhales.

Pros:

Does not require coordination of inhalation and actuation

Cons:

Slightly larger than a pMDI

Nebulizer

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.

Pros:

May be used at any age, no specific inhalation technique is needed; may disperse drugs not
available in an inhaler

Cons:

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 mask