Dry Powder Inhalers: Which One is Best for You?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Half of patients with asthma or COPD aren’t using their inhalers properly. Inhaler mishandling has dire consequences—but inhalers are getting much better. With new ones hitting the market every month, you need to get to know them.

Does it matter if your inhaler is a Diskus, Turbohaler or Ellipta? These are all dry powder inhalers (DPIs) and they all use a dry powder formulation of an active drug. They are different than the classic metered dose inhalers like Proventil HFA or Proair HFA.

What is different about them and which one is best for you? Diskus, Turbohaler and Ellipta are all DPI devices available to you. DPIs have the advantage of direct delivery of the drug into the deep lungs using your respiration (your breath). Let’s talk about the main devices.

Symbicort or Pulmicort are examples. A Turbohaler is a tube shaped inhaler that is breath-activated, meaning you suck in the powder instead of trigger it from firing. Common turbohalers are either a mixture of a steroid (budesonide) and a long-acting bronchodilator (formoterol) like Symbicort or a steroid alone like Pulmicort. In one study comparing Turbohalers with Diskus, the delivery of drug to the lung was better with Turbohalers and they are less affected by factors such as humidity.


Popular inhalers Advair Diskus and Flovent Diskus are examples. The Diskus comes as a mixture of steroid and bronchodilator (Advair Diskus) or steroid alone (Flovent Diskus). Serevent Diskus is an inhaler that is just a long-acting bronchodilator without a steroid.


The Ellipta device, Breo Ellipta, has been designed as a once daily maintenance for asthma or COPD and is a mixture of the bronchodilator vilanterol and a steroid fluticasone. Ellipta is simple to use: open the cover, inhale from the mouthpiece and close the cover. Studies on Ellipta show that patients prefer it over the diskus inhalers for ease of use, dose-counter and the feel and fit. It’s expensive but if you will use it, and use it properly, it may save lives.

Hope this helps . . .

Dr O.

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