The Nurse Practitioners’ Perspective on Inhaler Education in Asthma and Chronic Obstructive Pulmonary Disease

Table 1

Summary of advantages and common errors for inhaler devices [12–15].

Inhaler	Mechanism	Advantages	Common errors
pMDI	Drug suspended/dissolved in propellant	(i) Portable; (ii) Multiple metered dose; (iii) No contamination of dose; (iv) Press and breath requires coordination; (v) Quick and easy to use	(i) Inhaler not shaken before use; (ii) Inhaler not primed; (iii) Incorrect positioning (upright); (iv) Full exhalation prior to dosing; (v) Coordination of actuation and inhalation; (vi) Poor inhalation technique; (vii) Breath hold not long enough
pMDI + spacer	Drug suspended/dissolved in propellant	(i) Less coordination required than for pMDI; (ii) Larger doses delivered; (iii) Good lung deposition	(i) Inhaler not shaken before use; (ii) Inhaler not primed; (iii) Incorrect positioning (upright); (iv) Full exhalation prior to dosing; (v) Delay between actuation and inhalation; (vi) Poor inhalation technique; (vii) Breath hold not long enough; (viii) Poor maintenance of spacer
BA-MDI	(i) Drug suspended in propellant; (ii) Breath-actuated delivery	(i) Portable; (ii) Multiple metered dose; (iii) No contamination of dose; (iv) No coordination required; (v) Quick and easy to use	(i) Inhaler not shaken before use; (ii) Inhaler not primed; (iii) Incorrect positioning (upright); (iv) Full exhalation prior to dosing; (v) Poor inhalation technique; (vi) Breath hold not long enough
DPI	Breath-actuated delivery	(i) Portable; (ii) No coordination required; (iii) Quick and easy to use	(i) Incorrect positioning (upright); (ii) Dose not prepared correctly; (iii) Full exhalation prior to dosing; (iv) Inhalation not forceful enough to actuate dose correctly; (v) Breath hold not long enough; (vi) Repeated procedures may be needed to administer full dose; (vii) Inhaler not stored correctly
SMI	(i) Aqueous solution; (ii) Aerosol delivered by compressed spring	(i) Portable; (ii) No coordination required; (iii) Slow-moving aerosol cloud; (iv) Higher lung deposition than pMDI	(i) Full exhalation prior to dosing; (ii) Poor inhalation technique; (iii) Breath hold not long enough
Nebulizers	(i) Aqueous solution; (ii) Aerosol produced by air jet or ultrasonic vibrations	(i) Can be used at any age; (ii) Slow-moving aerosol cloud; (iii) Tidal breathing	(i) Dose not prepared correctly; (ii) Poor maintenance increases risk of bacterial contamination

BA-MDI: breath-actuated metered-dose inhaler; DPI: dry-powder inhaler; pMDI: pressurized metered-dose inhaler; SMI: Soft Mist™ inhaler.