| Dry powder inhalers |
| Aclidinium (Tudorza Pressair) | Compact, convenient, no hand-breath coordination required, portable, rapid medication delivery; individually packaged dose or dose counter makes it easy to know how many doses remain | Dependent on peak inspiratory flow; dose loading and activation are necessary for single-dose devices; single-dose devices require dexterity; requires additional device for short-acting agent | Load and activate the dose; exhale fully, not into the mouthpiece of the device; seal lips around the mouthpiece; inhale quickly and deeply for two to three seconds; hold breath for at least six seconds; exhale slowly |
| Fluticasone/salmeterol (Advair Diskus) |
| Formoterol (Foradil) |
| Indacaterol (Arcapta) |
| Salmeterol (Serevent Diskus) |
| Tiotropium (Spiriva) |
| Nebulizers |
| Albuterol | Easy to use, minimal cognition required, no hand-breath coordination required, not dependent on peak inspiratory flow, reimbursed by Medicare Part B, strength and dexterity not required | Device cleaning and maintenance needed, long medication delivery time, not portable or convenient, power source needed | Ensure medication dose is properly measured; seal lips around the mouthpiece or ensure mask is in place; inhale through the mouth slowly and deeply; clean nebulizer after each use; mix only nebulized medications as instructed |
| Arformoterol (Brovana) |
| Budesonide (Pulmicort) |
| Formoterol (Perforomist) |
| Ipratropium |
| Ipratropium/albuterol (Duoneb) |
| Pressurized metered-dose inhalers |
| Albuterol | Compact, convenient, may be used with a spacer or valved holding chamber, not dependent on peak inspiratory flow, portable, rapid medication delivery | Difficult for patients with low cognition, difficult to determine remaining doses if there is no dose counter, inconvenient if spacer/chamber is required, patient must actuate device, requires coordination of device actuation and inhalation unless the patient consistently uses a spacer/chamber (which is uncommon) | Shake well, prime inhaler the first time it is used or if it has not been used for days or weeks; exhale fully, then place inhaler between lips, holding upright; press inhaler once while inhaling slowly and deeply through the mouth; hold breath for at least six seconds; exhale slowly |
| Beclomethasone (Qvar) |
| Budesonide/formoterol (Symbicort) |
| Ciclesonide (Alvesco) |
| Fluticasone (Flovent) |
| Fluticasone/salmeterol (Advair HFA) |
| Ipratropium (Atrovent HFA) |
| Ipratropium/albuterol (Combivent) |
| Levalbuterol (Xopenex HFA) |
| Mometasone/formoterol (Dulera) |
| Soft mist inhaler |
| Ipratropium/albuterol (Combivent Respimat) | Compact, convenient, dose indicator and auto lock when cartridge is empty, more time to coordinate breath to actuation, portable, rapid medication delivery | Expires three months after cartridge is inserted; strength and dexterity required to prepare inhaler | Insert cartridge before initial use; write discard by date on cartridge; prime inhaler the first time it is used or if it has not been used for days or weeks; hold inhaler upright with cap closed, turn clear base in direction of white arrows until it clicks; exhale fully, not into the mouthpiece of the device; seal lips around the mouthpiece without covering the air vents; begin to inhale slowly and deeply through the mouth; press the dose release button and continue to inhale for as long as possible; hold breath for at least six seconds; exhale slowly |
