Table 1.

Advantages and disadvantages of the main types of inhalers.

Inhaler	Advantages	Disadvantages
pMDI	(i) Portable and compact	(i) Require coordination
	(ii) Multidose device	(ii) High deposition in mouth and oropharynx
	(iii) Metered dose	(iii) “Cold Freon” effect
	(iv) Established/familiar	(iv) Contain propellants
	(v) Available for most inhaled medications
pMDI + spacer	(i) Lower dependency on inspiratory effort	(i) Less portable than pMDI
	(ii) Easier to coordinate	(ii) Certain spacers may acquire electrostatic charge
	(iii) Higher lung deposition than pMDI	(iii) Additional cost to pMDI
	(iv) Reduced mouth and oropharynx deposition	(iv) Requires regular maintenance
BA-MDI	(i) Portable and compact	(i) Contain propellants
	(ii) Multidose device	(ii) “Cold Freon” effect
	(iii) Breath-actuated	(iii) Requires a moderate inspiratory effort
DPI	(i) Portable and compact	(i) Requires a minimum inspiratory effort
	(ii) Breath-actuated	(ii) May not be appropriate for emergency situations
	(iii) Does not contain propellants	(iii) Multiple designs (may be confusing for the patient)
	(iv) Multidose devices available	(iv) May be complicated to load
SMI	(i) Portable and compact	(i) Not breath-actuated
	(ii) Multidose device	(ii) Only one device currently available
	(iii) Lower dependency on inspiratory effort
	(iv) High fine-particle fraction
	(v) High lung deposition; low mouth and oropharynx deposition
	(vi) Does not contain propellants
Nebulizers	(i) Can be used at any age	(i) Most lack portability
	(ii) Can be used by acutely ill	(ii) Some require an outside energy source
	(iii) No specific inhalation technique required	(iii) Noisy
	(iv) Can be used to dispense drugs not available as pMDI or DPI	(iv) Can result in longer treatment times
		(v) Can be expensive

Adapted from [28]. BA-MDI, breath-actuated metered-dose inhaler; DPI, dry powder inhaler; pMDI, pressurized metered-dose inhaler; SMI, soft mist inhaler.