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Advantages and Disadvantages of The Types of Inhalers

Table 1: Advantages and disadvantages of the different types of inhalers. 

Inhaler Type

pMDI

SMI

DPI

Advantages

  • Wide range of medications available.

  • Drug delivery independent of inspiratory flow.

  • Suitable for children when used with a spacer.

  • ​Appropriate for emergency use.

  • ​Generally less expensive.

  • Less coordination required.

  • Improved lung deposition.

  • Reduced oropharyngeal deposition.

  • Spacer not required.

  • ​Built-in dose counter.

  • Lower carbon footprint.

  • ​Reusable device.

  • No coordination required.

  • Spacer not required.

  • ​Some devices include a built-in dose counter.

  • Low carbon footprint.

Disadvantages

  • Requires coordination between inhalation and actuation.

  • Higher oropharyngeal deposition. 

  • Not all devices include a dose counter

  • Higher carbon footprint.

  • ​Requires shaking, priming, and regular cleaning.

  • Requires priming before first use and after prolonged periods of non-use.

  • Limited number of medications available.

  • Requires manual dexterity.

  • Need to replace cartridges.   

  • Requires moderate to high inspiratory flow.

  • ​Not suitable for young children.

  • May not be suitable during emergencies.

  • ​Requires dose preparation.

  • Sensitive to moisture.

Information in Table 1 is adapted from Rigby¹.

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Patient Suitability 

Table 2: Patient Suitability for the Different Types of Inhalers. 

Inhaler Type

pMDI

SMI

DPI

Best suited for

  • Children <6 years (with a spacer).

  • Elderly or frail patients (with a spacer).

  • Patients with low inspiratory flow.

  • Acute asthma or COPD exacerbations and emergency use.

  • Patients who cannot generate a strong inspiratory effort.

  • Patients requiring a wide range of medication options.

  • Patients with reduced inspiratory flow who cannot effectively use a DPI.

  • Patients with poor hand–breath coordination.

  • Elderly or frail patients,

  • Patients wanting a lower carbon footprint.

  • Patients requiring minimal inspiratory effort.

  • Patients who may benefit from improved lung deposition and reduced oropharyngeal deposition.

  • Adults and older children ≥ 6 years with good inspiratory flow.

  • Patients able to perform a quick, deep inhalation. 

  • Patients wanting a lower emission inhaler. 

  • Patients with poor coordination between inhalation and actuation.

  • Patients with stable asthma or COPD who can consistently generate adequate inspiratory flow.

Less suitable for

  • Patients with poor hand–breath coordination if used without a spacer.

  • Patients unable to perform a slow, steady inhalation (3–5 seconds).

  • Patients unlikely to use a spacer correctly when indicated.

  • Patients wanting the lowest environmental impact.

  • Young children <6 years.

  • Patients with severe hand weakness or poor dexterity (cartridge insertion, twisting and priming required).

  • Patients with significant cognitive impairment who cannot perform the preparation steps.

  • Patients requiring medications not available as an SMI.

  • Patients unwilling or unable to prime and maintain the device.

  • Young children < 6 years. 

  • Patients with low inspiratory flow or severe airflow limitation.

  • Patients experiencing an acute asthma/COPD exacerbation.

  • Patients unable to exhale fully before inhalation.

  • Patients with poor manual dexterity (capsule-loading DPI).

  • Patients with cognitive impairment who may struggle with dose preparation or loading.

Information in Table 2 is adapted from Rigby¹, National Asthma Council Australia² and Cataldo et al³.

GPs should consider the advantages and disadvantages of each inhaler type alongside patient suitability and preference when deciding what inhaler to prescribe for a patient. 

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Reference list

  1. Rigby D. Inhaler device selection for people with asthma or chronic obstructive pulmonary disease. Aust Prescr. 2024;47(5):140-147. doi:10.18773/austprescr.2024.046

  2. National Asthma Council Australia. Selecting inhalers for adults and adolescents. Australian Asthma Handbook, The National Guidelines for Health Professionals. Version 3.0. 2026. Accessed June 28, 2026. https://www.asthmahandbook.org.au/management/adults-and-adolescents/principles-of-management/selecting-inhalers-for-adults-and-adolescents

  3. Cataldo D, Hanon S, Peché RV, Schuermans DJ, Degryse JM, De Wulf IA, et al. How to choose the right inhaler using a patient-centric approach? Adv Ther. 2022;39(3):1149-1163. doi:10.1007/s12325-021-02034-9

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