Patient-Related Factors when Selecting a Device
- Age
Very young children are not physically able to use all device types. Puffers can be used together with spacers with mask attachments to maximise drug delivery. - Type of medication
The availability of medication in different device type may vary; ask your Doctor what is most suitable for you. - Mobility / Convenience
The size of the devices vary and patients may find it inconvenient to carry large spacers when outdoors.; treatment can be enhanced with knowledge of the use of their current devices. - Patient's preference
Patient's may be more confident/comfortable with using a certain type of devices as they have better knowledge or control in doing so. - Inspiratory flow rate / Drug formulation
Some devices require deep inhalation to extract powder from the device. Patient's ability to do so may be limited, thus affecting the maximal benefit of the device. - Other health conditions of the patient
Patients with weaker hand strength (e.g arthritis) may not fully maximise the use of their devices; thus should select devices which require little hand strength, such as the Autohaler, or obtain a Haleraid with their puffers. - Cost
Some devices are more expensive than others; cost may be an issue to some patients.
Accuhaler
- Require inspiratory rate 30 - 90L/min
- Not recommended for children under 8 years of age
Autohaler
- Require inspiratory flow of about 27mL/min
- Not recommended for children under 7 years of age
Nebuliser
- For patients who are having an acute asthma attack and trouble breathing (in hospitals, A&E)
- For patients with extra mucous in their lungs (the extra moisture from this device helps to clear the mucus)
- For patients who cannot use an inhaler correctly (E.g. mentally impaired, confused, hand problems)
- For patients with severe respiratory disease such as cystic fibrosis, COPD.
pMDI
- Require inspiratory flow rate of 25L/min
- Require coordinating your breath with depression of the medication canister for drug release
Spacer
- Recommended for all ages, especially very young children and elderly
- For patients who are unable to hold their breath for more than 4 seconds
- For patients who cannot make a tight seal of lips around mouthpiece (e.g. facial paralysis, cognitive deficit), use a spacer with mask attachment
- For patients with poor coordination of inhaling & depressing the puffer simultaneously
Turbuhaler
- Inspirational volume of 60 L/min required
- Not recommended for children under 7 years of age
Authors: Loren Mundy, Uma Mageswari Sellvaraj, Ng Victoria, Nikhil Jotsingani