Dry-powder inhalers (DPI)

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  • Each device will have different priming, and preparation requirements – which may lead to health care practitioner and patient confusion
  • Breath-actuated – which means a minimal inspiratory flow will be required with each device
  • A breath hold is required to optimize medication delivery.
  • May result in higher oropharyngeal drug deposition, which can lead to increased medication side effects and poor clinical effectiveness
  • If exposed to moisture, some clumping of the powder may occur in the inhaler
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Does the patient have the ability to generate the minimal inspiratory flow for adequate medication delivery?

Will the patient have any issues remembering the multiple steps required to use the device adequately?

How comfortable are they using this system to dispense their own medication?  

Because inspiratory muscle weakness may change overtime, inspiratory flow requirements should be re-evaluated at each patient health care practitioner interaction.3

Metered-dose inhalers (MDI) with or without a spacer

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  • Requires priming with first use and after several days of not being used
  • MDI requires hand and breath coordination
  • A breath hold is required to optimize medication delivery
  • MDIs that are used without a spacer may result in high oropharyngeal deposition, which can lead to medication side effects and poor clinical effectiveness
  • Often used with a spacer to improve drug delivery for patients with hand-breath coordination issues
  • The spacer removes the larger particles that would be deposited in the mouth and throat
  • The spacer may have an auditory cue to alert patients if their inspiratory flow is too high
  • Actuator on inhaler and spacer require periodic cleaning
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How comfortable are they dispensing their own medication?

 

How coordinated are they in taking their MDI? Is a spacer required?

Nebulizers

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  • Old-style nebulizers that are big and bulky have given way to portable, streamlined, battery-operated, portable devices such as mesh nebulizers
  • Treatment times are shorter than in the past and require less preparation
  • No special breathing maneuver or breath hold is required—tidal breathing is effective for medication delivery
  • Choice of mask or mouthpiece
  • Require cleaning and may require maintenance
  • Tubing and nebulizer cups require replacement to optimize medication delivery
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Does the patient prefer nebulized treatments?

 

Does their cognitive functioning limit the use of other medication devices?

 

Though treatment times have reduced with newer technology, are they willing to spend a minimum the 3-4 minutes required to deliver their therapy? *times may vary depending on nebulizer

 

How comfortable are they using a nebulizer?

 

If frequent treatments are required, the patient is mobile and nebulizer is preferred, consider a small portable mesh nebulizer for use when the patient is away from home.

Soft-mist inhalers

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  • Newer type of inhaler that uses mechanical features to actuate the medication
  • Still requires some coordination (press and breathe)
  • Requires priming for first use and after periods of not being used
  • No studies have been completed to support use of a spacer with these devices
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Does the patient have the dexterity to use the device correctly?

 

How comfortable are they using this system to dispense their medication?