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A wide spectrum of therapeutic agents is currently employed in the treatment of respiratory disorders, including obstructive lung diseases. This chapter reviews the rationale for, and clinical use of, these agents in current clinical practice.


Inhaled drug administration is preferred for many medical conditions. Advantages of inhaled drug administration include rapid onset of action and the ability to deliver small drug doses directly to the lungs, minimizing systemic drug exposure. Compressed air nebulizers have been in use for more than 150 years; the first metered-dose inhaler (MDI) became available in the 1950s, followed by the first dry powder inhaler (DPI) in the 1960s.1 Many new and innovative devices have been marketed as the result of the phase-out of chlorofluorocarbon-containing MDIs.2

Device selection depends on drug–device availability, patient characteristics (e.g., age, cognitive function, manual dexterity), and patient preference (Tables 144-1 and 144-2).3,4 MDIs and nebulizers share universal designs; other drug delivery devices are unique, individually patented devices.

TABLE 144-1Inhaled Drug–Device Availability
TABLE 144-2Age–Device Guidelines

MDIs are small portable devices that protect the medication from contamination; they are difficult to use correctly. Common drug administration errors include improper timing of actuation and inspiration and failure to inspire slowly and deeply. MDI accessory devices (e.g., spacers, valved holding chambers) decrease oropharyngeal drug deposition and reduce the need for precise “press and breathe” timing, but they are bulky, add to the cost of therapy, and must be regularly cleaned to ...

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