Understanding the Turbohaler Device
Unlike traditional metered-dose inhalers (MDIs) that use propellants, a Turbohaler is a breath-activated device, meaning the medication is released when the user inhales through the mouthpiece. This makes it a popular choice for many patients, as it eliminates the need for the hand-breath coordination required with MDIs. The device's design is engineered for user-friendliness and efficacy, delivering a precise and consistent dose of medication with each use.
Key Components of a Turbohaler
- Body and Cap: The main body houses the medication, while a securely twisted-on cap protects it from moisture, which is crucial for a dry powder formulation.
- Colored Dosing Wheel: A colored wheel at the base of the device is twisted to load a new dose of medication into the mouthpiece. A distinct click sound confirms the dose is ready.
- Dose Counter: Many Turbohaler models feature a dose counter to help patients keep track of their remaining doses, indicating when a replacement is needed.
- Mouthpiece: This is where the patient inhales the powdered medication. It's designed to promote high lung deposition.
How Does a Turbohaler Work?
- Loading the Dose: The patient first removes the cap and, holding the inhaler upright, twists the colored wheel. This action loads a pre-measured dose of dry powder medication from a reservoir.
- Activating the Dose: The device is breath-activated. When the patient places the mouthpiece to their lips and inhales forcefully and deeply, the inhalation creates a turbulent airflow.
- Powder Delivery: This airflow disperses the powdered medication, separating the microscopic particles from a lactose carrier (or as a pure agglomerate), and carries them deep into the patient's lungs where they are most effective.
Proper Use of a Turbohaler
Incorrect inhaler technique is a major cause of ineffective treatment. To ensure proper delivery with a Turbohaler, the following steps are vital:
- Unscrew the cap and remove it.
- Hold the inhaler upright. Twist the colored grip at the base as far as it will go in one direction, then twist it back until it clicks. The dose is now loaded.
- Breathe out gently, away from the inhaler.
- Place the mouthpiece between your lips, ensuring a tight seal. Do not chew or bite the mouthpiece.
- Breathe in quickly and deeply through your mouth.
- Remove the inhaler and hold your breath for up to 10 seconds, or for as long as is comfortable.
- If a second dose is prescribed, repeat the steps.
- Replace the cap firmly.
- If the medication contains a corticosteroid, rinse your mouth with water and spit it out to prevent oral thrush.
Medications and Conditions Treated
Several medications are formulated for use in a Turbohaler, primarily for chronic respiratory diseases. The specific medication determines the inhaler's therapeutic purpose, whether it's a controller medication for daily management or a reliever for symptom relief.
- Budesonide (Pulmicort Turbohaler): An inhaled corticosteroid (ICS) that reduces inflammation in the airways, used for long-term asthma control.
- Formoterol (Oxeze Turbohaler): A long-acting beta2-agonist (LABA) that relaxes the airway muscles, providing rapid and sustained relief from bronchoconstriction.
- Budesonide/Formoterol (Symbicort Turbohaler): A combination of an ICS and LABA for both maintenance and reliever therapy in asthma and COPD.
- Terbutaline Sulfate (Bricanyl Turbohaler): A short-acting beta2-agonist (SABA) used as a reliever medication for the rapid relief of symptoms.
Turbohaler vs. Other Inhalers: A Comparison
The choice of an inhaler depends on the patient's condition, dexterity, and ability to use the device correctly. Here is a comparison of the Turbohaler and the Diskus, another common type of dry powder inhaler.
| Feature | Turbohaler | Diskus | Other Dry Powder Inhalers | Metered-Dose Inhalers (MDIs) |
|---|---|---|---|---|
| Activation | Breath-activated | Breath-activated | Breath-activated | Pressurized canister, requires coordination |
| Medication Form | Pure dry powder (often agglomerated) | Dry powder blended with lactose carrier | Dry powder | Fine mist/aerosol with propellant |
| Dose Counter | Yes, typically in a window | Yes, shows number of doses remaining | Yes or No, varies by device | Yes, on some newer models |
| Ease of Use | Generally easy, no coordination needed | Relatively easy, though requires specific technique | Varies by design | Can be difficult due to hand-breath coordination |
| Lung Deposition | Higher deposition and lower variability in lung deposition compared to Diskus. | Lower lung deposition compared to Turbohaler. | Varies by device | Can be low if technique is poor; improved with a spacer |
| Moisture Sensitivity | Protected by an internal drying agent and a tight cap. | Sensitive to humidity, which can reduce fine particle dose. | Varies by design | Propellant formulation is less affected by moisture |
Advantages and Considerations for Use
The Turbohaler offers several benefits, especially for patients who struggle with the technique required for MDIs. Its breath-activated mechanism ensures that the medication is delivered when the patient is ready to inhale, which is a significant advantage. The high lung deposition efficiency means more medication reaches the target airways, potentially leading to better control of symptoms. Furthermore, the lack of a propellant makes it a more environmentally friendly choice compared to older MDIs.
However, there are also considerations for proper use. The patient must be able to generate a strong, deep breath to draw the powder out of the device effectively. This can be a challenge for young children, the elderly, or those with very severe airway obstruction. Some users may not perceive the taste or feel of the powder, leading to uncertainty about whether they have successfully taken a dose. The dose counter, while helpful, can lead to confusion if the user thinks they have not received a dose and attempts to take another, though the device's design prevents double dosing. A healthcare provider can offer training and assurance regarding proper technique.
Conclusion
The Turbohaler is an effective and reliable dry powder inhaler that provides a valuable option for managing chronic respiratory conditions like asthma and COPD. By delivering medication in a fine, dry powder activated by a patient's own breath, it removes the coordination challenges associated with other inhaler types. Its high efficiency in delivering medication directly to the lungs, coupled with the built-in dose counter, helps ensure consistent and effective treatment. While it may not be suitable for every patient, particularly those unable to produce a strong inhalation, a healthcare provider can assess whether a Turbohaler is the right fit. Proper training and understanding of the device are essential for maximizing its therapeutic benefits and improving overall respiratory health. For more information, patients should consult their healthcare provider or pharmacist, or visit reputable medical resources like the Canadian Lung Association.
