Types of Asthma Inhalers

Most common asthma treatments use a handheld inhaler or nebulizer. These devices allow medicine to go right to the airway. Then, the medicine works to reduce inflammation, open up the airways, and help control your symptoms.^1-3

Most inhaler types are small enough to carry in a pocket. These include metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs). The type of inhaler right for you depends on factors like your age, hand strength, motor skills (dexterity), and other things unique to you.

Metered-dose inhalers (MDIs)

Metered-dose inhalers (MDIs) contain a pressurized, inactive gas that pushes out a dose of medicine with each puff. These are used for quick-relief (rescue) drugs and long-term (control) drugs. You release each dose by pressing the top while inhaling.^1,2

MDIs are the most common type of inhaler. They are quick, small, and easy to carry. However, some people may find these hard to use. You need to coordinate pressing the canister and breathing in fully at the same time. Some common errors people make include:²

• Not shaking the MDI before using it
• Inhaling too sharply
• Inhaling at the wrong time
• Not holding your breath long enough after inhaling

Dry powder inhalers (DPIs)

Dry powder inhalers (DPIs) do not contain any pressurized gas. Unlike MDIs, DPIs are breath-activated. Instead of pushing the medicine into your lungs, DPIs work when you take a rapid, deep breath in from the mouthpiece.^1,2

DPIs can deliver control drugs and rescue asthma drugs. These cannot be used with valved holding chambers or spacers. Dry powder inhalers require less coordination but you do need to be able to inhale strongly to draw out the medicine.^2,3

Soft mist inhalers (SMIs)

Soft mist inhalers (SMIs) are a newer type of inhaler. They do not require a gas propellant and do not require you to forcefully draw out a dry power medicine. Instead, SMIs release a mist that contains the medicine, similar to nebulizers. SMIs may make it easier for some people to inhale the medicine into their lungs. SMIs cannot be used with spacer devices.^1-3

Spacer devices

A spacer device allows you to use an MDI without having to coordinate pressing and inhaling. It is placed on the mouthpiece of the inhaler. The spacer also keeps the medicine from getting stuck in your mouth or throat.^1,2

There are many types of spacers. For example, one is a valved holding chamber that holds the medicine near your mouth when you press the inhaler. The valve keeps the medicine inside the spacer until you inhale. The valve closes when you breathe out.²

For children under age 5, doctors will often prescribe a valved holding chamber with a mask instead of a mouthpiece. The mask allows the child to take in medicine simply by breathing in and out normally.^2,3

Some devices fit all MDIs, while others work only with certain brands.

Inhaler alternative: Nebulizer

Nebulizers are machines that turn asthma drugs into a fine mist. You then inhale the mist using a face mask or mouthpiece. When using a nebulizer, you can breathe in and out normally. Nebulizers are larger and more expensive, but newer models are more portable and less bulky.²

Nebulizers may be used in different situations, such as:^2,3

• For people who are very tired or breathless, and cannot use an MDI
• In the hospital for severe asthma attacks
• When large doses of inhaled medicines are needed

What is the best inhaler device to use?

There is no one best type of inhaler for everyone. The right type of inhaler depends on many things, such as:²

• Age and breath strength – Young children may not be strong enough to use a DPI, and older children may need a spacer on MDIs
• Convenience – Most inhalers are easy to carry in a pocket
• Coordination – MDIs without a spacer require more physical coordination
• Side effects – MDIs with spacers or SMIs may reduce the amount of medicine hitting the throat, which can lower the risk of a mouth infection (thrush)
• Personal preferences

Your doctor may ask you to try a range of devices to find what works best for you. Your doctor or nurse can show you how to use each type of inhaler or nebulizer correctly. During follow-up visits, check with them to make sure you are still using your inhaler properly.