Does the patient feel the powder being inhaled when using a QR inhaler like Qvar (beclomethasone)?

Patient Experience with QVAR Inhaler

Patients typically do not feel the medication being inhaled when using a QVAR (beclomethasone) inhaler because it contains an extrafine aerosol formulation rather than powder.

Understanding QVAR's Delivery System

QVAR is a hydrofluoroalkane (HFA)-propelled metered dose inhaler (MDI) that delivers beclomethasone dipropionate as an extrafine aerosol, not a dry powder. This is an important distinction from dry powder inhalers (DPIs):

• QVAR uses HFA propellant to deliver medication as tiny aerosol particles
• The extrafine particles are approximately 1-2 microns in size
• These particles are so small they often cannot be felt during inhalation
• The medication is delivered as a fine mist rather than powder

Patient Sensory Experience

When using QVAR correctly, patients may experience:

• Little to no sensation of the medication entering the lungs
• Possibly a slight cooling effect from the propellant
• No taste or minimal taste
• No powder sensation (as would be felt with dry powder inhalers)

Delivery Mechanism and Efficiency

The extrafine particle formulation of QVAR offers several advantages:

• Higher lung deposition (approximately 50-60% of the dose reaches the lungs) 1
• More uniform distribution throughout the airways, including small airways
• Less oropharyngeal deposition compared to older CFC-propelled inhalers

Research shows that QVAR delivers effective doses even with suboptimal technique. A study demonstrated that patients using the QVAR Autohaler exhibited 60% lung deposition, while even patients with poor inhaler technique still received at least 37% lung deposition 1.

Common Patient Concerns

Patients may express concern about whether the medication is actually being delivered if they don't feel anything. This is a common misconception that should be addressed:

• The lack of sensation does not indicate lack of medication delivery
• The extrafine particles are designed to reach the small airways without creating a noticeable sensation
• Efficacy is maintained despite the lack of sensory feedback

Technique Considerations

For optimal delivery of QVAR:

• Proper inhaler technique remains important despite the high lung deposition
• Patients should be instructed to exhale fully before inhaling
• A slow, deep breath followed by a 5-10 second breath hold is recommended
• Using a spacer device can further improve delivery, especially for those with coordination difficulties 2
• Rinsing the mouth after use helps prevent local side effects like hoarseness 2

Comparison to Dry Powder Inhalers

Unlike QVAR, dry powder inhalers (DPIs):

• Require higher inspiratory flow rates (30-120 L/min) 3
• Often create a more noticeable sensation of powder entering the mouth
• May leave a taste or sensation of powder in the throat or mouth
• Depend more heavily on proper inhalation technique for effective delivery

Monitoring Effectiveness

Since patients cannot rely on sensory feedback to confirm medication delivery with QVAR:

• Symptom control remains the most important indicator of effectiveness
• Regular follow-up with healthcare providers is essential
• Spirometry or peak flow measurements can provide objective assessment of medication effect

By understanding that the lack of sensation with QVAR is normal and expected, patients can be reassured that their medication is being delivered effectively despite not feeling it during inhalation.