Treatment for Chronic Obstructive Lung Disease

Administering Inhaled Drugs

Most COLD drugs are inhaled using metered dose inhalers, dry powder inhalers, or nebulizers.

Metered-Dose Inhaler. The standard device has been the metered-dose inhaler (MDI). This device, particularly when used with a holding chamber, allows precise doses to be delivered directly to the lungs. MDI-delivered drugs must be used regularly as prescribed and the patient carefully trained in their use in order for them to be effective and safe. Some patients hold the MDI too close to their mouths, or even inside them. Others may exhale too forcefully before inhalation. The holding chamber, or spacer, allows the patient additional time to inhale the medication and so improves delivery. Spacers vary, however, in their ability to deliver medication. For example, in one study the AiroChamber-Plus was more effective than the EasiVent in delivering an inhaled steroid. It should be noted that MDIs often continue to deliver propellant after the drug has been used up. Patients should track their medicine and throw the device away when the last dose has been given.

Breath-Actuated Inhalers. Breath-actuated rotary inhalers (e.g., Easi-Breathe and Autohaler) deliver the drug directly to the back of the throat as the user inhales. Their primary advantage over the MDI is their ease of use. They also do not use CFCs as propellants. In comparison studies, patients have been very successful with the breath-actuated inhalers.

Dry Powder Inhalers. Dry powder inhalers (DPIs) deliver a powdered form of beta2-agonists or corticosteroids directly into the lungs. They also do not use CFCs. Such devices include Rotahaler, Spinhaler, Turbohaler, Clickhaler, Easyhaler, Diskhaler, Discus, Twisthaler, Spiros, and others. DPIs are as effective as the older devices, and generally have a better taste and are easier to manage. They may differ, however, in their ability to deliver drugs into the airways. In one study, for example, the Turbohaler was easier to use than the Diskhaler and so achieved better delivery. The Discus is another effective DPI; it has a dose counter and protects against exhalation effects.

Humidity or extreme temperatures can effect DPI performance, so these devices should not be stored in humid places (e.g., bathroom cabinets) or locations subject to high temperatures (e.g., glove compartments during summer months).

Other Hand-Held Inhalers. Respimat delivers a fine-mist spray that is created by forcing the liquid medication through nozzles. It does not use any propellant.

Nebulizers. A nebulizer is a device that administers the drug in a fine spray that the patient breathes in. Nebulizers are often used in hospital settings or when the patient cannot use an inhaler.