Delivery options

Inhalation device options for COPD medication administration 

Commonly used inhalation devices for COPD medication administration are metered-dose inhalers (MDIs), dry-powder inhalers (DPIs), slow-mist inhalers (SMIs), and nebulizers.1-8

Metered-dose Inhaler

  • Aerosolized by compressed HFA
  • Coordination of breathing and actuation required
  • No drug preparation; device shaking required
  • Administered in 1-2 breaths

HFA, hydrofluoroalkane.


 

 

Slow-mist Inhaler

  • Aerosolized by spring mechanism
  • Requires specific breathing technique 
  • Multiple steps for setup and maintenance
  • Administration in 1-2 breaths



 

 

Dry-powder Inhaler

  • Aerosolized by patient inspiratory flow
  • Breath-actuated
  • May require loading of capsule
  • Administration in 1-2 breaths

 



 

 

 

 

Jet Nebulizer

  • Aerosolized by high-velocity air stream
  • Tidal breathing
  • Multiple steps for setup and maintenance
  • Administration time up to 20 minutes

 



 

 

Vibrating Membrane/Mesh Nebulizer

  • Aerosolized through vibrating perforated material
  • Tidal breathing
  • Multiple steps for setup and maintenance
  • Administration time less than 5 minutes

 


 

References:

  1. Ari A, Fink JB. Aerosol delivery devices for the treatment of adult patients in acute and critical care. Curr Pharm Biotechnol. 2016;17(14):1268-1277.
  2. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384. 
  3. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11(1):2585-2596. 
  4. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest. 2005;127(1):335-371. 
  5. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593-604. 
  6. Al-Showair RA, Tarsin WY, Assi KH, Pearson SB, Chrystyn H. Can all patients with COPD use the correct inhalation flow with all inhalers and does training help? Respir Med. 2007;101(11):2395-2401. 
  7. Virchow JC, Crompton GK, Dal Negro R, et al. Importance of inhaler devices in the management of airway disease. Respir Med. 2008;102(1):10-19
  8. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72.