How to choose the right inhaler device for my patient: low-carbon respiratory care

This is the sixth and final part in a six-part e-news series presented by Sophie Timmins (Respiratory and Sleep Medicine Consultant), Katrina Tonga (Respiratory & Sleep Medicine Physician) and Mellissa Batger (Pharmacist) – Net Zero leads in the Northern Sydney Local Health District. Each month we have presented a new focus topic. This month’s topic is how to choose the right inhaler device.

The availability of various inhaler drug/device combinations can be overwhelming, making it challenging for clinicians to make informed prescribing decisions. Opting for the most suitable inhaler device can significantly enhance patient outcomes and minimise medication wastage.

Despite randomized controlled trials showing no difference in efficacy among inhaler devices, the effectiveness of the device heavily depends on patients’ proficiency in using the inhaler and their adherence to treatment1,2,3. Physicians must consider patient preferences (e.g. dose frequency) and practical issues such as patients’ ability to use the device correctly, manual dexterity, and inhalation ability.

Key considerations for selecting the appropriate device are outlined in the table below. Where possible, an inhaler with a reduced global warming impact should be highly considered for patients who are able and happy to use them.

Pressurised metered dose inhaler (MDI)

Requires SLOW and STEADY inhalation
Quick and easy to use for individuals with good coordination.

Can be used with spacer and facemask.

Preferred device for young children.
Requires precise coordination between inhalation and actuation.

Spacer can be bulky to transport.

Uses a propellant which is a potent greenhouse gas.
Slow and steady inhalation needed to avoid high oropharyngeal drug deposition.

Some devices do not have a dose counter.
Dry powder inhaler (DPI)

Requires QUICK AND DEEP inhalation

Can the patient take a quick and deep breath over 2-3 seconds?
Quick and easy to use. 

Does not require precise coordination between pressing device and inhalation.

Has a lower carbon footprint. 

All devices have a dose counter.
DPIs require a forceful inhalation, which can be challenging for some individuals.
Soft mist inhalerSuitable for individuals who may have difficulty generating a forceful inhalation. 

Dose is delivered over a more extended period, improving lung deposition.
Limited medications available in this device option.


It’s crucial for healthcare professionals to assess individual patient needs and preferences when prescribing inhaler devices. Proper education and training on the correct use of the chosen device is essential to ensure effective medication delivery and optimal management of respiratory conditions.

For more information, please see this algorithm3 for choosing the best inhaler device.

  1. Dolovich, M.B. et al. (2005) ‘Device selection and outcomes of aerosol therapy: Evidence-based guidelines’, Chest, 127(1), pp. 335–371. doi:10.1378/chest.127.1.335.
  2. Ram, F.S. et al. (2001) ‘Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other handheld inhaler devices for delivering beta 2 agonists bronchodilators in asthma’, BMJ, 323(7318), pp. 901–901. doi:10.1136/bmj.323.7318.901.
  3. EMJ Respir. 2022;10[Suppl 2]:2-7. Website: The Greenest Inhaler: A Patient-centric Approach – European Medical Journal (emjreviews.com) 2-EFFECTIVENESS-OF-INHALER-DEVICES-IN-ADULT-ASTHMA-AND-COPD.pdf (emjreviews.com)