EC Pulmonology and Respiratory Medicine

We have three categories of inhalers for asthma and COPD: Dry powder inhaler (DPI), pressurised meter dose inhalers (PMDI), and nebulizer.

PMDI is the most important: However mastering Inhaler technique is crucial, use of spacer make it better than DPI and nebulizer for severe attacks and in children under 5 years.

The discovery of pMDI in 1956 changed lives of asthma patients. pMDI becomes first line method of treatment for asthma, pMDI helped to deliver the inhaled medication directly to airways. Avoiding side effects of systemic treatment.

We can reduce the need of OCS if we optimize asthma care as following: good inhaler technique, adherence to ICS-LABA daily treatment in moderate and severe asthma.

Also in GINA track 1 the use of as needed anti-inflammatory reliever (ICS-Formoterol), was proved to reduce the risk of exacerbation requiring OCS when compared to as needed SABA reliever alone. SABA Reliever alone should only be used in case there is no access to ICS, because it leads to a higher risk of morbidity and mortality.

Unfortunately, in many LIC we treat only with SABA as needed and OCS [3,5]. We need a WHO resolution for ICS to be available for all, like which was done for Diabetes.

Inhaler recycling programs should be established to reduce environmental harm of inhalers. And consider to prescribe higher strength puffs, which should permit lower numbers of puffs.

 Keywords: Dry Powder Inhaler (DPI); Pressurised Meter Dose Inhalers (PMDI); Nebulizer; Asthma

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