Fostair MDI v DPI

[rmros]

Hi. I was recently switched from Clenil to Fostair and it's already made an improvement.

I was prescribed the Fostair MDI. I was expecting to be given the DPI, just because I don't know anyone on Fostair who doesn't have a DPI - I thought that was the norm.

Is there any reason why an MDI might be chosen over DPI, other than cost? Is there a reason a DPI might be unsuitable for some?

The MDI is fine, I suppose I just thought there was a move to switch to DPIs for environmental reasons.

Thanks.

[Troilus]

The manufacturer reckons they are equivalent. The next inhaler contains lactose; not good for people with a lactose allergy.

[rmros in reply to Troilus]

Equivalent in what, environmental impact or efficacy? I mean with the pressures to switch to DPIs for environmental reasons, I was wondering if there was a clinical reason to keep some people on an MDI. It's probably a cost thing though?

[andy121 in reply to rmros]

It is partly down to cost but MDI require the patient to coordinate breath and actuation, which can be a problem for patients with low grip strength or arthritis and are required to use with a spacer.  DPI are breath-actuated (breath-dose coordination is unnecessary) and easier to use. Patients need sufficient respiratory force to inhale the powder, and this can be a barrier for elderly patients. 

Hope that helps.

[rmros in reply to andy121]

Thanks - yes, the only clinical reason for not using a DPI that I've heard of is if someone doesn't have sufficient respiratory force. I don't think that's the case for me and I understand it's quite rare, so I can only assume the reason is cost. Anyway, I'm not having any issues with the MDI so I was wondering more out of curiosity.

[Wheezycat in reply to andy121]

If you use a spacer with an MDI you can use tidal breathing, and the needing to coordinate effectively is no longer an issue.

[Wheezycat in reply to Wheezycat]

An MDI with a space, that is.

[Wheezycat in reply to rmros]

2-3 years ago i was switched from a DPI (Symbicort) to an MDI (Fostair). The reason was my proneness to oral thrush. The powder can more easily leave a residue in the mouth or throat. I use the MDO with a spacer which was also thought to reduce the chances of thrush.

[Homely2 Administrator]

I very much like the fostair mdi, though it took a couple of months for me to get the full benefit.

[Nanto4]

I was put on Fostair Nexthaler by the hospital but had problems with my throat/voice and also my asthma became unstable so my GP switched me back to a MDI, although i have had 2 chest infections 1 after the other my asthma seems in a better place now .

[Giraffe91]

it’s probably to keep consistency between what you have been on previously.

[rmros in reply to Giraffe91]

Possible, though surely that applies to everyone put on a DPI. I checked the BNF and the MDI and the NEXThaler at exactly the same price, so it's probably not a cost thing after all.

[peege]

Hi, I've been on Fostair MDI (MART) I wouldn't change it for the world as its been a absolute life changer. I understand the issues re carbon footprint so ensure I lead a life to compensate. Powder inhalers have always given me a sore throat & the sweetness makes me gag (lactose I presume). Plus I much prefer to use my inhalers with a spacer. Recycling used mdi is one thing we can do, this went down the pan after Brexit however I believe its beginning again. At my Recycling centre I can put the container in hard plastics and aerosol in the aerosols bin. I expect in the future they'll change mdi as they have Ventolin. P

[Chip_y2kuk]

There are pluses and minuses to both

DPI

requires much greater inhalation force

Contains lactose

Has a higher equivalency over the MDI (by about 50mcg)

Can't be used with a spacer

Can't get wet or the powder is ruined

MDI

Doesn't require as greater inhalation force

If inhaled with too much force ends up in the back of the throat and not the airways

It is recommended to use with a spacer

Can be washed

They are both technically "extra fine particles" and should get deep down into the lungs

As for the environmental impacts of MDI's I think that it's the pressurised container and the propellant.... I thought this was specifically targeted at ventolin however

[Homely2 Administrator]

I asked my asthma nurse on this. Her understanding is that where asthma is unstable she would put the person on an mdi, when the asthma stabilises, she looks to switch to a dpi.

[rmros in reply to Homely2]

Ah, thanks. That does make sense.