Equipment
DPIs: loading, inhalation, and device care
Different DPI designs use different loading mechanisms. Identify the exact device before teaching its preparation, inhalation, and cleaning steps.
Dry powder inhalers by BrettMontgomery. CC BY-SA 4.0. View larger.
A dry-powder inhaler (DPI) uses the patient’s inhalation to disperse medicine into an aerosol. There is no pressurized spray to coordinate with a finger press, but correct loading and adequate inspiratory effort are still essential.
Recognize the design
| Design | Example and key distinction |
|---|---|
| Single-dose capsule | Spiriva HandiHaler: load its capsule into the matching device and pierce as directed. The capsule is for inhalation through the device, not swallowing. |
| Premeasured blisters | Ellipta: opening the cover prepares a dose. Opening and closing it without inhaling can waste that dose, even though the counter advances. |
| Multidose reservoir | Pulmicort Flexhaler: a turning mechanism meters powder from a reservoir. Initial priming and loading each dose are different steps. |
Devices that look similar may have different loading, orientation, and inhalation instructions. Identify the exact medicine and device before teaching.
Work through the dose
- Check the prescription, expiration date, dose indicator or capsule, and mouthpiece.
- Prepare the device and load the dose exactly as its instructions describe. Keep the required orientation and leave air vents clear.
- Breathe out away from the inhaler before sealing the lips around the mouthpiece. Exhaling into it can introduce moisture or disturb the dose.
- Inhale using that device’s technique, then hold and exhale as directed. Do not attach a spacer or holding chamber.
- Check any required second inhalation, remove a used capsule when applicable, and close the device.
Inhalation instructions are not identical
- Fluticasone furoate Ellipta: take a long, steady, deep inhalation; its label describes a breath hold of about 3–4 seconds, or as comfortable.
- Spiriva HandiHaler: inhale deeply until full, with capsule vibration; hold for a few seconds, then take a second inhalation from the same capsule as instructed.
- Pulmicort Flexhaler: inhale deeply and forcefully after correctly loading the dose.
The necessary effort depends on device resistance and powder formulation. There is no single inspiratory-flow threshold that proves every DPI will work well. Assess the patient’s ability to use the actual device, especially during illness.
Keep care instructions separate
Protect the powder from moisture. Ellipta and Flexhaler instructions use dry wiping; HandiHaler permits specified warm-water rinsing followed by 24 hours of air drying. Do not apply one device’s washing or priming instructions to another.
After an inhaled corticosteroid such as fluticasone or budesonide, rinse the mouth and spit. The device format alone does not tell you whether a medicine is a controller or reliever.
Study example
A patient cannot taste powder and immediately loads another dose. Lack of taste does not establish failed delivery. Review the device instructions and observe a return-demonstration rather than assuming another dose is needed.
Compare with pMDI and holding-chamber technique.
Sources
- American Association for Respiratory Care. Pulmonary Disease Aerosol Delivery Devices, 4th edition. Dry-powder inhalers. 2023.
- DailyMed. Fluticasone furoate Ellipta prescribing information and instructions for use.
- DailyMed. Spiriva HandiHaler prescribing information and instructions for use.
- DailyMed. Pulmicort Flexhaler prescribing information and instructions for use.
Last updated October 28, 2026.