Medication Administration: Dry Powder Inhaler (Respiratory Therapy)

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

ALERT

Because high inspiratory flows (greater than 60 L/min) are required when using dry powder inhalers (DPIs), some patients are not good candidates for DPI use.^{undefined#ref2">2} These include infants and young children, as well as patients who are unable to follow instructions, are experiencing bronchospasms, or have chronic obstructive pulmonary disease exacerbations.²

Take steps to avoid interruptions and distractions when getting medications ready.

OVERVIEW

DPIs, which deliver medications to the lungs in a dry powder form, are alternatives to aerosol-based delivery systems for inhaled respiratory medications. DPIs are more portable and may be easier to use than metered-dose inhalers (MDIs) because they do not require a spacer. Therefore, DPIs may improve patient compliance.

Patients with respiratory disorders, such as asthma, bronchitis, and emphysema, may benefit from medication delivery with a DPI. Most older children can produce the inspiratory flow rate needed to use a DPI.²

Because most DPIs use the force of inhalation to deliver the dry powder medication, insufficient flow rates or an ineffective inspiratory hold time can reduce the dosage delivered. DPIs are breath activated (they do not use a propellant to deliver the medication), which makes coordinating inspiration and actuation of the delivery device less necessary.

The correct use of DPIs depends on the type of delivery system used. Three types of devices are available: single-dose, multiple-dose, and multiple unit–dose inhalers (Figure 1).

The disadvantages of DPIs are that fewer drugs are available in this form and the patient must generate a sufficient inspiratory flow rate to acquire the correct dose. DPIs must be kept dry because moisture and humidity can cause the powder to clump. The dose may be lost if the patient inadvertently exhales into the DPI.

If the patient expresses worry about the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.

SUPPLIES

See Supplies tab at the top of the page.

EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Teach the patient and family how to deliver the medication using a DPI containing a placebo, if available.
• Ask the patient to repeat the procedure independently to demonstrate proficiency.
• Teach the patient and family how to assemble and care for the DPI.²
• Teach the patient about the potential side effects and adverse reactions to the medication.
• Instruct the patient to report any adverse reactions, such as increased shortness of breath, to the authorized practitioner.
• Teach the patient to store the medication at room temperature and away from direct sunlight and humidity.²
• Provide the patient with written instructions for use of the device and the frequency of medication administration.
• Encourage questions and answer them as they arise.

ASSESSMENT AND PREPARATION

Assessment

1. Ensure that the patient can achieve a rapid, steady inhalation for sufficient flow.
2. Measure the patient’s baseline vital signs and obtain peak flow measures, if ordered.
3. Determine the patient’s respiratory pattern and auscultate breath sounds.
4. Review the patient’s medication history and identify any drug allergies.
5. Determine if the patient has specific contraindications to receiving the medication and notify the practitioner as needed.
6. If using a single-dose DPI, assess the patient’s ability to manipulate the capsule, including removing the cap, puncturing the foil packet, and placing the capsule in the DPI.¹

Preparation

1. Get the medication, check against the practitioner’s order, verify the expiration date, and check that the medication and container are clean and intact.
2. Review medication reference information pertinent to the medication’s action, purpose, onset of action and peak action, normal dose, and common side effects and implications.
3. Read the written instructions for the DPI, if available.
4. Obtain a placebo device, if available.

PROCEDURE

1. Check the rights of medication safety.
2. Assemble the DPI according to the manufacturer’s instructions.
3. Load and prepare the medication for delivery according to the manufacturer’s instructions.
4. Instruct the patient to exhale completely (to functional residual capacity [FRC]) away from the device.
5. Instruct the patient to put the mouthpiece into the mouth and close the lips tightly around it.
6. Instruct the patient to inhale a rapid and steady breath.¹
7. Instruct the patient to take the DPI out of the mouth.
8. Instruct the patient to hold a breath for 10 seconds, if able.¹
9. Instruct the patient to breathe out slowly.
10. Have the patient repeat steps until the full dose is administered.
11. Allow the patient to rinse the mouth.
12. Wipe the DPI clean.

MONITORING AND CARE

1. Watch the patient for adverse and allergic reactions to the medication. If a reaction occurs, follow the organization’s practice for emergency response.
2. Reassess the patient’s vital signs, including heart rate and respiratory rate.
3. Reassess the patient’s breath sounds and obtain peak flow measures again, if ordered.
4. Return the DPI medication to the medication room and store it at room temperature.

EXPECTED OUTCOMES

• Patient correctly describes and demonstrates techniques for using DPI
• Medication administered per the rights of medication safety
• Improved vital signs
• Improved subjective responses from the patient
• Improved work of breathing
• Prevention of bronchospasm associated with asthma and chronic obstructive pulmonary disease (COPD)
• Reduced inflammatory response and mucus production

UNEXPECTED OUTCOMES

• Patient not able to self-administer medication properly
• Medication not administered per the rights of medication safety
• Airway irritation
• Bronchospasm
• Increased shortness of breath

DOCUMENTATION

• Education
• Success of training
• Medication name, dose, and route
• Mouth rinsed, if applicable
• Patient’s vital signs before and after medication administration
• Peak flow measures, if ordered
• Patient’s effort
• Patient’s response to the medication, including adverse reactions
• Unexpected outcomes and related interventions

OLDER ADULT CONSIDERATIONS

• Older adult patients may be unable to provide sufficient inspiratory effort to obtain the proper dose of the medication from the DPI. In this case, a different delivery device should be used.

REFERENCES

1. Gardenhire, D.S., Nozart, L., Hinski, S.T. (2023). A guide to aerosol delivery devices for respiratory therapists (5th ed.). Irving, TX: American Association for Respiratory Care. Retrieved August 7, 2024, from https://www.aarc.org/wp-content/uploads/2018/03/aersol-guides-for-rts.pdf
2. Li, J., Fink, J.B. (2025). Chapter 40: Aerosol drug therapy. In J.K. Stoller and others (Eds.), Egan’s fundamentals of respiratory care (13th ed., pp. 834-878). St. Louis: Elsevier.

Clinical Review: Genevieve L. Hackney, MSN, RN

Published: September 2024