Table 1.
Overview and comparison of COPD inhaler devices
| Dry powder inhaler | Soft mist inhaler* | Metered-dose inhaler | ||||||
|---|---|---|---|---|---|---|---|---|
| Turbuhaler | Ellipta | Diskus | Genuair | Handihaler | Breezhaler | Respimat | ||
| Available drugs/combinations | SABA Terbutaline (Bricanyl) LAMA Formoterol (Oxeze) LABA + ICS Formoterol + budesonide (Symbicort) |
LAMA Umeclidinium (Incruse) LAMA + LABA Umeclidinium + vilanterol (Anoro) LABA + ICS Vilanterol + fluticasone (Breo) LAMA + LABA + ICS Umeclidinium + vilanterol + fluticasone (Trelegy) |
SABA Salbutamol (Ventolin) LABA Salmeterol (Serevent) LABA + ICS Salmeterol + fluticasone (Advair) |
LAMA Aclidinium (Tudorza) LAMA + LABA Aclidinium + formoterol (Duaklir) |
LAMA Tiotropium (Spiriva) |
LAMA Glycopyrronium (Seebri) LABA Formoterol (Oxeze) LAMA + LABA Glycopyrronium + indacaterol (Ultibro) |
SAMA + SABA Ipratropium + salbutamol (Combivent) LAMA Tiotropium (Spiriva) LAMA + LABA Tiotropium + olodaterol (Inspiolto) |
SAMA Ipratropium (Atrovent) Salbutamol (Ventolin) LAMA + LABA + ICS Glycopyrronium + formoterol + budesonide (Breztri Aerosphere) |
| Inspiratory capacity11,12 | High inspiratory capacity required (30-60 L/min) | Moderate inspiratory capacity required (30 L/min) | Moderate-high inspiratory capacity required (50 L/min) | Low inspiratory capacity required (minimum 10-20 L/min) | ||||
| Require “hard and fast” inhalation | Require “slow and steady” inhalation | |||||||
| Device use/handling | Breath-actuated (timing of actuation and breath not required) | Timing of actuation and breath required | ||||||
| Low dexterity required to load dose | Feedback mechanism (window colour changes and audible click when dose taken) | Multistep process to load, requires the most dexterity | Spring loading requires dexterity and strength (if loaded by pharmacy, low strength and dexterity required) | Actuation requires hand strength | ||||
| Priming not required | Priming required | |||||||
| Cannot be used with a spacer | Can be used with a spacer | |||||||
| Dose counter | Yes—every 20 doses | Yes | Yes | Yes—every 10 doses | Not required—capsules loaded with each dose | Yes | No (Breztri—yes) |
|
| Climate9,13,14 | Lowest carbon footprint (~25 times lower than MDI)*
|
Moderate carbon footprint (~18 times lower than MDI)*
|
Highest carbon footprint—choose brands with lower HFA content if possible (such as Teva-salbutamol or Airomir [salbutamol sulphate]) | |||||
COPD, chronic obstructive pulmonary disease; HFA, hydrofluoroalkane; ICS, inhaled corticosteroid; LABA, long-acting beta2-agonist; LAMA, long-acting muscarinic antagonist; MDI, metered-dose inhaler; SABA, short-acting beta2-agonist; SAMA, short-acting muscarinic antagonist.
*
Indicates the most climate-friendly option if clinically appropriate.