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Has your dry powder inhaler plugged and what do you do about it?

When the ICS aerosol canister I used was discontinued "due business reasons", the replacement approved by my insurance plan was a dpi, dry powder inhaler by the same company with the same medication. I was happy to no longer need a spacer and I didn't have to shake it.

But when I got down to 60 doses (half used, 120 doses when unused), something changed. I could slightly feel the powder in my mouth and taste it. I compared the half-used dpi back-to-back with a new one and I'm pretty sure I am not imagining the change. I set the used one aside and switched to the new full one. Again, this time when I got down to 40 doses, I could feel and taste the powder. So again, I switched to a new canister.

I suspect that the dpis were partially plugging but the instructions are "don' clean". The inhaler has an attached lid and stored in a drawer in a room where the humidity is never above 45%. I don't exhale into it, which would add humidity and possibly plug it. I now have 3 partially used dpi and as you know, this stuff is expensive. I want to think I am getting as much as possible from the "medium" dosage I am taking.

I described the situation to the pulmonologist during my 6-month visit. He said no one else had mentioned a problem with the new dpi. I talked to a pharmacist about this and they told me that most of her patients had not switched from the hfa to the dpi yet, but they hadn't heard of any problems. I filled out the FDA complaint form, just in case.

A few months later, I received a reply from the manufacturer acknowledging that they "investigated" my complaint but that there was no action they needed to take. (I had hoped they might want me to send them the used dpis.) So the new year has started with a new deductible, and I'm looking at those 3 partially used dips that still have OK expiration dates and wondering if I should use them.

I understand that readers cannot give medical advice, but have you had anything similar to happen to you as I describe above?

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  1. I have not noticed a problem after being on Advair for a year. Since each click is one dose, before I close it, I inhale one more time to make sure I got all my dose in. I do think keeping the inhaler in a dry space and would help too.

    1. Shellzoo, thank you for taking the time to reply. Good idea on taking a second inhale before closing the dpi. It is worth a try so see if it helps.

    2. I have noticed that I seem to get used to the powdered inhaler so even though I don’t taste or feel the dose I still am getting it.

  2. Shellzoo, Ttat is my dilemma. I barely notice for the first half of the dosages on 3 canisters, but then "something changes" when they are half empty or more. I am guessing that they are partially plugged, but that is only a guess. I tried a bright light and a strong magnifier, but the design is such is that it is impossible to see the opening clearly. My handy spouse offered to try to dismantle them enough to clear the opening but said he couldn't promise that then they would dispense too much.

    I'm not sure if I can persuade the insurance company to let me use a different brand of hfa l since I have no proof, but I guess it wouldn't hurt to try. I would rather not be a "guinea pig". I tried tapering down from medium dose to low dose last year, but didn't do well. I definitely need the full medium dose.

    1. I believe that they are in blister packs and each time you open and click the disc, you pierce the blister pack so that when you inhale, you get your dose. My instructions say you might not notice each time that you got a dose. I don’t know if this means I inhaled differently or just got used to the medicine. Have you talked to your provider? There are so many asthma meds. Maybe there is something else you would be more comfortable with? I am actually starting a new med in 10 days because my insurance won’t pay for my current med. Now I have to get used to a new style of inhaler again.

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