Metered dose inhalers, dry powder inhalers and nebulizers are modes of aerosol drug delivery that are used to treat respiratory disorders such as Obstructive Lung Disorders, Asthma, Pulmonary Arterial Hypertension, Cystic Fibrosis and Infectious Pulmonary Disease. A spacer is an external device connected to an MDI, to enhance drug administration through improved actuation and inhalation coordination. To inquire about inhalers, contact Dr. Sheetu Singh, a knowledgeable and experienced healthcare professional specializing in respiratory care. She can offer you professional advice and suggestions that are suited to your unique needs. 

What is a Metered Dose Inhaler?

Metered dose inhalers are tiny devices that propel a medicinal spray into the airways. Dry powder inhalers also administer medication, but the powdered medication needs to be inhaled deeply to reach the airways. 

The advantages of MDIs is as follows:

  • Multidose delivery capability
  • Portability
  • Lower risk of bacterial contamination

The disadvantages of MDIs are as follows:

  • the necessity of coordinated actuation and inhalation
  • Oropharyngeal drug deposition

What are Nebulizers?

Nebulizers are devices that convert liquid medications into a tiny mist that may be inhaled easily. They can be powered by batteries or electricity. A mouthpiece or facemask that is placed over the nose and mouth allows the mist to exit the machine through a tube. Children frequently utilize nebulizers as they don’t need to exert any effort to breathe the drug into their airways. 

Nebulizers have the advantages listed below:

  • Patients who are unable to employ alternative inhalation techniques should receive therapy
  • Permit administering high amounts of medication
  • Patient coordination is not required

The following are the disadvantages of Nebulizers: 

  • Higher cost
  • Decreased portability
  • Longer administration time and set-up
  • A supply of compressed air or oxygen (a jet nebulizer) may be required

What are Spacers?

Spacers are canisters that attach to the mouthpieces of metered dose inhalers making  the inhalers easier to use. Spacers make it easy for the user to use the inhaler and assist with the right dosage of the medication to be delivered.

What are Metered Dose Inhalers, Spacers and Nebulizers Used For?

Breathing diseases like asthma are typically treated with nebulizers, dry powder inhalers, and metered dose inhalers:

  • Asthma
  • Obstructive lung disease (also known as COPD, chronic obstructive pulmonary disease)
    • Chronic bronchitis
    • Emphysema
  • Pulmonary Arterial hypertension
  • Cystic fibrosis
  • Infectious pulmonary disease

Aerosol drug delivery may also be used with some types of non-respiratory therapy. Inhalers can be used to administer medication for:

  • Pain relief
  • Diabetes
  • Genetic diseases
  • Thyroid disorders

What are Metered Dose Inhaler and Nebulizer Medications?

Metered dose inhaler medications include:-

  • Beclomethasone Dipropionate (QVAR)
  • Ventolin, Proventil, Ventolin HFA, Proventil HFA, and Proair HFA are variants of albuterol sulfate
  • Cromolyn sodium (Intal)
  • Ciclesonide (Alvesco)
  • Flunisolide Hemihydrate (Aerospan HFA)
  • Flunisolide (AeroBid, AeroBid-M)
  • Fluticasone Propionate (Flovent HFA)
  • pratropium Bromide/Albuterol Sulfate (Combivent Respimat)
  • Mometasone/Formoterol (Dulera)
  • Triamcinolone Acetonide (Azmacort)

Dry powder inhaler medications include:

  • Budesonide (Pulmicort Flexhaler)
  • budesonide/Formoterol HFA (Symbicort)
  • Fluticasone propionate (Flovent Diskus)
  • Formoterol Furmate (Foradil Aerolizer)
  • Mometasone Furoate (Asmanex Twisthaler)
  • Salmeterol Xinafoate (Serevent Diskus)
  • Tiotropium Bromide (Spiriva Handihaler) 

Nebulizer medications include:

  • Albuterol Sulfate (Proventil, AccuNeb)
  • Arformoterol Tartrate (Brovana)
  • Budesonide (Pulmicort Respules)
  • Formoterol Fumarate (Perforomist)
  • Cromolyn Sodium (Intal)
  • Ipratropium Bromide 
  • Levalbuterol Hydrochloride (Xopenex)

How Do You Use Metered Dose Inhalers, Spacers and Nebulizers?

The thorough method for employing a metered dose inhaler is: 

  • Take off the cap, then hold the inhaler vertically.
  • Shake the inhaler
  • Exhale gently for three to five seconds.
  • Slowly take a breath through your mouth while releasing the medication by pressing the inhaler once.
  • If possible, hold the breath for ten seconds to allow the medicine to reach deep into the lungs
  • If more than 1 puff (actuation) is required, follow the procedure above again, pausing for at least a minute in between each actuation.

The general technique for using a spacer is:-

  • Make sure the spacer is clean and put together properly by the manufacturer’s instructions.
  • Shake the inhaler canister well to mix the medication
  • Take it off the cap from the inhaler mouthpiece
  • Insert the mouthpiece of the inhaler into the open end of the spacer. Make sure it fits tightly
  • Breathe out fully to empty your lungs. This makes it more likely that the drug will be deeply inhaled into your lungs.
  • To inhale medicine into the spacer, press down on the inhaler canister once.
  • Start taking calm, deep breaths via your mouth once the drug has been released into the spacer. It ought to take 5-7 seconds to complete this.
  • Remove the spacer from your mouth after taking the prescription, then hold your breath for ten seconds to help the medicine penetrate your lungs completely.
  • Breath out gently and slowly
  • After use, clean the spacer as per the manufacturer’s instructions and allow it to air dry. 

An air compressor, nebulizer cup, mouthpiece or mask and medicine measuring equipment are all included in a nebulizer kit. The general method for using a nebulizer is:

  • Put together the nebulizer kit and plug in the power source.
  • Close the nebulizer cup after adding the prescribed dosage of medicine.
  • The mouthpiece or mask should be attached to the top of the nebulizer cup.
  • Connect the air compressor with the tubing at the nebulizer cup’s base.
  • activate on the gas pressure source at the reservoir’s mouth.
  • Inhale slowly through your mouth, occasionally taking deep breaths.
  • Confirm that a mist is produced by turning the nebulizer on.
  • If a mask is worn, make sure it is properly fastened.
  • Breathe through the mouth for the duration of the therapy. 
  • If the nebulizer begins to splutter, turn it off.Contact Dr. Sheetu Singh


What is MDI?

A pressurized sprayer known as a metered dose inhaler provides a specific dosage of medication. It is typically used to treat respiratory conditions like COPD and Asthma. Metered dose inhalers are simple to use. It comprises a compact, pressurized container holding medication, a dosage indicator and a mouthpiece or mask used for administering the medication. When the MDI is activated, the patient inhales the small mist or spray of medication that is released in a specific amount into their lungs. MDIs are a practical and efficient approach to delivering medicines straight to the airways, offering rapid relief from bronchospasm and inflammation. 

Advantages of Metered Dose Inhaler:-

  • Compact and portable
  • Cheaper than DPIs
  • Minimal preparation
  • The use of a spacer enhances the administration of drugs 
  • Accurate dose
  • Short delivery time
  • Drug preparation is not required

Disadvantages of Metered Dose Inhaler: –

  • require coordination between the actuation and inhalation if not utilized with a spacer
  • For persons who lead an active lifestyle, spacers may not always be practical or available, and they may not always be covered by drug insurance
  • High oropharyngeal deposition
  • Requires propellants
  • The technique is crucial for drug distribution

How to use a Metered Dose Inhaler?

Managing respiratory diseases like asthma or chronic obstructive pulmonary disease (COPD) requires the appropriate use of a metered dose inhaler (MDI). Start by taking off the cap and shaking the inhaler to make sure the medication is thoroughly mixed before using an MDI. To prepare your lungs, take a deep breath, then slowly exhale while standing or sitting up straight. You should inhale deeply as you gently start to press down on the canister to release a puff of the medication. Hold your breath for around 10 seconds to help the medicine reach your airways deeply. 

What is DPI?

A Dry Powder Inhaler is a type of inhaler commonly used to deliver medications such as inhaled corticosteroids into the lungs. This inhaler is breath-activated. The drug is released only when you take a fast, deep breath in through the inhaler. This is distinct from a metered dose inhaler, which propels drugs into the lungs. Advair Diskus, Asmanex, and Pulmicort Flexhaler are a few examples of dry powder inhalers. DPIs are an effective and feasible method to manage respiratory problems, but for optimal treatment results, patients must maintain adequate inhalation techniques.

Advantages of Dry Powder Inhaler:-

  • Portable and compact
  • No need for a spacer
  • No propellant
  • Actuation is caused by deep inspiration, hence there is no need to coordinate it with inhalation
  • Add dose counters that show how many doses are remaining in the device

Disadvantages of Dry Powder Inhaler: –

  • More costly
  • The released dose could be impacted by both humidity and temperature in the environment
  • Greater inspiratory flow rates are necessary for pulmonary deposition of excellent quality
  • Some certain lactose
  • Some have earlier expiration dates than others

How to use Dry Powder Inhaler? 

A dry powder inhaler is an Asthma treatment option for older teens and kids. A DPI makes it possible for the medication to enter the lungs deeply. These inhalers store the medication as a dry powder, as opposed to other inhalers that puff the medication. You must breathe quickly and deeply to get the medication into your lungs as it is inside a powder. If you have any further queries about dry powdered inhalers, contact Dr. Sheetu Singh, Her passion for improving the lives of individuals with respiratory conditions was truly inspiring. 

What is the Difference Between MDI and DPI 

Metered Dose Inhalers and Dry Powder Inhalers are two common devices used for delivering medication to the lungs, especially for the treatment of respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) and Asthma. They differ in their features and modes of action: 

  • Activation: MDIs necessitate synchronization between squeezing the canister and inhaling the drug. To ensure optimal medicine delivery, users must time their inhalation with the inhaler’s activation. Whereas, DPIs do not require coordination between inhalation and activation. The powder is simply breathed in by users at their leisure.
  • Easy to use: It may be difficult for some users to effectively coordinate the inhalation and activation, particularly for young people and those who have specific physical or cognitive disabilities. Whereas, DPIs are often considered easier to use for some people, including those who have trouble controlling their breathing with MDIs. 
  • Portability: MDIs are typically compact and small, making them easy to carry in a purse or pocket. Whereas, DPIs are also rather portable and small, even though they could be a little bigger than MDIS.
  • Maintenance: The temperature and humidity can have an impact on MDIs and they need to be cleaned frequently. Whereas, DPIs may need less maintenance than MDIs as they don’t use propellants. However, it’s still crucial to handle and store things properly.

Dr. Sheetu Singh, a nationally renowned pulmonologist, Director ILD & Pulmonary Rehab Clinic, is an expert in chest-related conditions. She got her training from SMS Medical College, Jaipur followed by a visit to Cleveland Clinic, USA.

Contact Info

Address: Mahavir Jaipuriya Rajasthan Hospital Milap Nagar, JLN Marg, Jaipur

Mobile: (+91)-8696666380


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