Considerations in older adults

Device choice in older adults should consider the patient’s maximal inspiratory flow, dexterity, coordination and ability to form a lip seal around the mouthpiece; see Managing common problems with inhalational devices for older adults.

Table 1. Managing common problems with inhalational devices for older adults

Problem

Management strategies

Reduced maximal inspiratory flow

Consider pMDI alone or with spacer

Avoid DPI or breath-actuated pMDI

Reduced manual dexterity (eg due to osteoarthritis)

Consider breath-actuated pMDI, breath-actuated DPI or pMDI with spacer

Consider an assistant device such as a Haleraid (used with a manually actuated pMDI)

Consider leaving the pMDI attached to the spacer

Inability to coordinate actuation and inhalation

Consider pMDI with spacer, breath-actuated pMDI or breath-actuated DPI

Avoid pMDI without spacer

Inability to form effective lip seal around mouthpiece

Consider using pMDI with spacer and face mask

Note:

pMDI = pressurised metered dose inhaler; DPI = dry powder inhaler

Adapted from the Australian Asthma Handbook © 2020 National Asthma Council Australia. Accessed 31 August 2020.