Table 2 – DPI and MDI devices used in Asthma and COPD. DRUG CLASS
DRUG NAME
Short-acting Beta Agonist (SABA)
Salbutamol
Terbutaline
Eformoterol Long-acting Beta Agonist (LABA)
MDI/DPI
SINGLE DRUG BRAND/DEVICE*
Pressurised MDI
Ventolin® MDI
Breath activated MDI
Airomir ® Autoinhaler ®
Capsule DPI
Ventolin® Rotahaler ®
Dose loaded DPI
Bricanyl® Turbuhaler ®
Capsule DPI
Foradile® Aerolizer ®
COMBINATION FIXED DOSE BRAND/DEVICE
Budesonide: Symbicort® Rapihaler ® Fluticasone propionate: Flutiform® MDI
Pressurised MDI
Indacaterol
Dose loaded DPI
Oxis® Turbuhaler ®
Capsule DPI
Onbrez® Breezhaler ®
Dose loaded DPI
Serevent® Accuhaler ®
Budesonide: Symbicort® Turbuhaler ®
Fluticasone propionate: Seretide® Accuhaler ®
Salmeterol
Fluticasone propionate: Seretide® MDI
Pressurised MDI Short-acting muscarinic antogonist (SAMA) Long-acting muscarinic antogonist (LAMA)
Ipratropium
Pressurised MDI
Atrovent® MDI
Aclidinium
Capsule DPI
Bretaris® Genuair ®
Eformoterol: Brimica® Genuair ®
Glycopyrronium
Capsule DPI
Seebri® Breezhaler ®
Indacaterol: Ultibro® Breezhaler ®
Capsule DPI
Spiriva® HandiHaler ®
Mist MDI
Spiriva® Respimat®
Olodaterol: Spiolto® Respimat®
Dose loaded DPI
Incruse® Ellipta®
Vilanterol: Anoro® Ellipta®
Pressurised MDI
Qvar ® MDI
Breath activated MDI
Qvar ® Autohaler ®
Dose loaded DPI
Pulmicort® Turbuhaler ®
Tiotropium Umeclidinium Beclomethasone
Inhaled corticosteroids (ICS)
Budesonide
Pressurised MDI
Cicleoside
Pressurised MDI
Alvesco® MDI
Pressurised MDI
Flixotide® MDI
Fluticasone propionate Fluticasone furoate
Cromones
Cromoglycate
Nedocromil
Eformoterol: Symbicort® Turbuhaler ® Eformoterol: Symbicort® Rapihaler ®
Eformoterol: Flutiform® MDI
Dose loaded DPI
Salmeterol: Seretide® Accuhaler ®
Pressurised MDI
Salmeterol: Seretide® MDI
Dose loaded DPI
Vilanterol: Breo® Ellipta®
Pressurised MDI
Intal® MDI Intal Forte® MDI
Capsule DPI
Intal® Spincaps®
Pressurised MDI
Tilade® MDI
*Note other generic brands may be available
THE PHARMACIST’S ROLE Although the preferred method of drug delivery for asthma and COPD patients is via inhalation, of which inhalers are specifically designed to assist, approximately 90% of patients have incorrect inhaler technique when using either standard MDIs or DPIs12,13. Worsening asthma, increased use of relievers
and emergency medical services has been linked with the incorrect use of pressurised MDIs for ICS14. Additionally, inefficient inhaler technique for DPIs may also lead to insufficient drug delivery and lung deposition15. Doctors are cited to not have sufficient time to train patients regarding proper inhaler technique and therefore naturally
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this significant role should be played by the pharmacist13. For those patients who do show poor inhaler technique with a pressurised MDI, the addition of a large volume spacer or education from a health professional such as a pharmacist is suggested as the first line option (rather than simply changing inhalers)16.