Metered-dose inhalers, dry powder inhalers, and transitions.

Since 1956, the pMDI has become the most commonly prescribed and used aerosol device in the world. While concerns about global warming have led to a worldwide ban of CFCs, new HFA-propelled pMDIs are in development, requiring an evolutionary transition in the technology. The phase-out of CFC-propelled pMDIs has stimulated the development of more efficient DPIs, but issues such as cost of device production, inspiratory flow requirement, and the effects of ambient humidity on drug delivery may limit DPI acceptance, and industry projections suggest that the DPI will not completely replace the pMDI. Holding chambers may perform differently with HFA-propelled pMDIs, but HFA-propelled pMDIs generally appear to cause less oropharyngeal deposition and to improve lung delivery while continuing to provide protection from poor hand-breath coordination. The initial offerings of the emerging HFA-propelled pMDI technology appear to be resulting in an improved pMDI.