The importance of inhaler choice
Inhalers are key to the management of daily symptoms and acute emergencies.[8, 9] However, inhaler choice should not be undertaken only on emotive environmental issues.[16, 18] There are many considerations for choosing an inhaler: drug, dose, technique, cost and environmental impact. Maintaining access to all inhaler types allows the most appropriate inhaler device for optimal asthma and chronic obstructive pulmonary disease management to be prescribed, based on patients’ characteristics and preferences.[15] The greenest inhaler is one that the patient can use correctly.[18, 21] Prescribing a preventer inhaler that the patient uses regularly and correctly means that the disease will be controlled at the lowest effective dose, using less propellant, so lowering the global warming impact of preventer medication.[21] The environmental impact of pressurized metered dose inhalers (pMDIs) may also be significantly reduced through development of new pMDI propellants.[28]
With over 125 inhaler devices available, choosing the right one can present a challenge![29]
​
Pressurized MDIs, as the name suggests, contain medicine stored under pressure. They deliver medication to the lungs in the form of a short burst of aerosolized medicine. These are the most affordable and widely used inhaler devices,[2, 26] and are critical for children, the elderly and during acute respiratory attacks.[11, 12, 25] However, pMDIs require patients to coordinate activation of the device with breathing in.[14, 30]
With dry powder inhalers (DPIs), drug is stored not as an aerosol, but as a powder. These type of inhalers require a quick, deep inhalation, using patients’ own energy of breathing to release a dose of medication.[25] Older people, some children (particularly under 10 years of age) or people with more severe lung conditions may not have sufficient inspiratory effort to use DPIs effectively.[30, 31]
Soft mist inhalers (SMIs) produce a fine, slow-moving mist. Aerosol generation does not depend on the patient’s inspiratory effort.[30] However, there are fewer drug formulations available in SMIs than in pMDI or DPIs.
​
Inhaler devices and the medicines contained within them are not inter-changeable.[15] It is important to avoid multiple different inhaler types where possible to avoid confusion.[8] Patient preference is also important in achieving effective treatment – many patients prefer pMDIs.[32] Switching devices without considering all personal factors leads to loss of asthma control and risk of serious attacks,[15] both of which are associated with higher carbon footprint due to increased use of healthcare resources.[33]
