What is an inhaler
Inhalers are commonly associated with asthma, but asthma inhalers aren’t the only ones available. These devices are used for treating many lung diseases like COPD, cystic fibrosis, and more. Inhalers can deliver medication in an aerosol or dry powder form which can be orally inhaled. There is a wide range of medication that is available as inhalers which may differ depending on the condition or the disease type.
While inhalation therapy has been around for a long time and can be traced back to 4,000 years ago in India, inhalers as devices were only introduced in the 19th century. The first type of inhaler was actually a glass bulb nebulizer. These were large devices typically used in physician’s offices that generated a mist of medication that could be inhaled, much like the nebulizers in use today which went on to be developed from this technology. In 1938, a hand bulb nebulizer was introduced which was much smaller in size but still had some flaws along with being inconvenient to use. But the modern inhaler technology of compact inhaler devices would not have been possible without these early devices. The first breakthrough inhaler device was the metered-dose inhaler (MDI) that was launched in 1956, which was the first truly effective and portable inhaler device. While improvements have been made to the device over the years, especially with the introduction of a pressurized canister resulting in pMDIs (pressurized metered-dose inhalers), the basic mechanism remains the same and a lot of similarities can be seen in the designs.
Improvements have been made over time and now inhalers even come with dose counters. There are many different types of inhalers available today and they are used widely across the world. Inhalers are one of the highest recommended devices for diseases that affect the lungs since they are one of the most effective forms of delivering medication. As for the future of inhalers, research continues to find ways to make them even more effective.
Why to use Inhalers
Inhalers are used for treating and managing symptoms of both acute and chronic diseases which includes asthma, COPD (Chronic Obstructive Lung Disease), emphysema, and bronchitis. If you are diagnosed with a respiratory condition like these, your doctor might prescribe you an inhaler to manage the symptoms. If you are wondering why you have to use a special device for medication instead of just having pills taken orally, this is because, with inhalers, the medicine goes directly to the parts of the body where it needs to have an effect - the airways and the lungs. Because of this, a less dosage of medicine is also required than compared to pills, leading to fewer side effects. Doctors can prescribe you inhalers depending on your condition and how severe it is. You might be prescribed inhalers as a long-term treatment option that you might have to use regularly (eg. for asthma) or only for a few days if you have a treatable illness like pneumonia. Inhalers can also have medication that is quick-acting so you can get immediate relief when needed. This is especially important for those diagnosed with asthma because an asthma attack can be quite serious and it is in this situation when a quick-acting asthma inhaler comes in handy, which can make a lot of difference.
Types of inhalers
There is now a wide variety available today when it comes to inhaler types. There are mainly three types of inhalers that are classified based on the way that they work.
Pressurized metered-dose inhalers (pMDIs)
This is the most commonly used inhaler which consists of a pressurized canister that contains medication mixed with aerosol propellants that are released as a spray with the press of a button. Chances are when you think of asthma inhalers, the device you picture is a metered-dose inhaler. Metered-dose inhalers are also commonly referred to as an inhaler pump or asthma pumps since they act just like a pump. So, if you hear someone talking about inhaler pumps or a pump for asthma, you should know that they are most likely talking about the metered-dose inhaler.
While simple in nature, a metered-dose inhaler requires some coordination of actuation and inhalation (hand with breath) which can be difficult to perform for most people who use it across all age groups and especially with kids and the elderly. If there is poor coordination, the proper dose of the medication may not reach the lungs and instead, a larger proportion of the medication might get deposited in the mouth or throat, which can lead to fungal infections. This is also why doctors recommend rinsing your mouth after using inhalers. This challenge of coordination can be overcome by using a spacer.
A spacer, which is a tube-like device that is attached to the inhaler where medication can be sprayed into. Spacers are generally recommended to make the use of metered-dose inhalers easier and more effective to use so the medication can be inhaled properly without much of the dose going to waste. When it comes to an inhaler with spacer, the need for coordination reduces as there is more time to inhale the medication and receive the proper dosage.
Dry powder inhalers
Dry powder inhalers are quite different from metered-dose inhalers in the way they deliver the medication. Instead of the medication being an aerosol, these inhalers contain the medicine in a dry powder form which can be inhaled. If you are wondering why dry powder inhalers were designed, this was because of the coordination issues mentioned for metered-dose inhalers. They also gained attention when popular aerosol propellants CFCs were banned for environmental reasons as many metered-dose inhalers at the time still used them to deliver the spray (MDIs have now switched to another propellant called HFAs). Dry powder inhalers themselves can be of many types. These include DPIs that deliver a single dose, multi-dose or contain a reservoir-type system that stores the dry powder in bulk.
However, dry powder inhalers have their own advantages and limitations. Their advantages include being easier to use and being environmentally friendly. But since the formulation comes in a dry powder form, it is prone to contamination and damage in humid conditions or if there is a large change in temperature leading to a lesser dosage of medication being delivered.
Breath-actuated inhalers (BAIs)
Breath-actuated inhaler refers to inhalers that can release the medication when you breathe in. Breath-actuated metered-dose inhalers combine the benefits of MDIs like the compactness, portability, and the ability to have multiple doses while overcoming the major disadvantage of pMDIs, the need for coordination. Once ready for use, you can simply breathe in and the breath-actuated metered-dose inhaler will release the medication. Among all the types of inhalers for asthma, studies have found this one to be easier to use both in hospital settings and by patients on their own.
While it has its advantages, the breath-actuated inhalers do have their limitations too. Since they are activated by inhaling, if the force of inhalation isn’t strong enough, which can be the case for some people with breathing conditions, the medication isn’t released. BAIs can be used with a minimal inspiratory flow (force of inhalation) of around 23-35 L/min, making them suitable for use across all age groups including children and the elderly.
Why proper use of inhalers matters
While we have discussed the many options available thanks to the development of different inhaler types over the years, talking about proper inhaler use is equally important. There have been many studies over the years about incorrect inhaler use which show why knowing the correct technique to use inhalers is important. Improper inhaler use has also been linked with poor control of diseases, more frequent emergency room visits, and even with greater risk of hospitalization. This is because if your inhaler is used incorrectly, the proper medication fails to reach the airways and lungs and they don’t receive the treatment that they are supposed to receive. So, no matter what inhaler types you end up using for your treatment, be sure to also be aware of proper inhaler techniques so you can get the full effect of the medicine.
Why to use inhalers
Inhalers are not the last but the first resort medicine for treating breathing problems such as asthma and COPD. Across the globe, inhalers are considered to be the most effective, safe and convenient way of treating most of the breathing problems.
With inhalers, the medication reaches the airways in the lungs directly, exactly where it has to act, in a matter of seconds and provides relief. On the other hand, tablets and syrups need to be ingested, which means they reach the stomach and bloodstream first, and the lungs later. Thus, they do not provide quick relief.
Moreover, a large dose is required to produce the same effect as the inhaled medication.
Since inhaler medication reaches the problem area directly, the dose that needs to be taken is significantly lower than that of tablets and syrups.
Unlike what many people believe, inhalers have minimal side effects, because a very low quantity of the medication enters the body. So, you or your child can use inhalers without worrying and continue to do everything you love and enjoy.