Do dry powder inhalers like Anoro Ellipta (umeclidinium/vilanterol) require a spacer?

Inhaler Types and Spacer Requirements: Dry Powder Inhalers vs. Metered Dose Inhalers

Dry powder inhalers (DPIs) like Anoro Ellipta (umeclidinium/vilanterol) do NOT require a spacer, while metered dose inhalers (MDIs) often benefit from spacer use. 1

Types of Inhalers and Spacer Requirements

Inhalers That Require Spacers

• Metered Dose Inhalers (MDIs): These pressurized inhalers benefit from spacers to improve drug delivery and reduce oropharyngeal deposition 1
• MDIs with spacers decrease risk of topical side effects (e.g., thrush) and improve lung delivery in patients with poor inhaler technique 1
• For adults using an MDI with a spacer (valve-holding chamber), approximately 10-20% of the medication dose is deposited in the lungs, compared to less deposition without a spacer 1
• Spacers are particularly indicated for patients who have difficulty performing adequate MDI technique 1

Inhalers That Do NOT Require Spacers

• Dry Powder Inhalers (DPIs) including:
  • Ellipta devices (such as Anoro Ellipta) 2, 3
  • Other DPIs (HandiHaler, Diskus, etc.) 1
• Breath-activated inhalers 1
• Soft mist inhalers 1

Specific Information About Anoro Ellipta

• Anoro Ellipta is a dry powder inhaler (DPI) that delivers umeclidinium/vilanterol 4, 5
• It has moderate resistance to airflow and does not require a spacer for effective medication delivery 2
• The Ellipta DPI has been designed to be simple to use with only three principal operating steps: open, inhale, close 2
• Clinical studies show that ≥98% of patients used the Ellipta DPI correctly, and 99% found it easy or very easy to use 4
• The Ellipta inhaler performs consistently with respect to dose delivery at a range of flow rates (≥30 L/min) that can be achieved by the target population 2

Differences Between DPIs and MDIs

• Dry Powder Inhalers (DPIs):

  • Breath-activated, requiring the patient's inspiratory effort to deliver medication 1
  • No propellant - medication is delivered as a dry powder 2
  • No coordination of actuation and inhalation required 4
  • Not used with spacers as this would impede the delivery mechanism 1
  • Pulmonary deposition from DPIs is device-specific 1

• Metered Dose Inhalers (MDIs):

  • Use propellants to deliver medication 1
  • Require coordination between actuation and inhalation 1
  • Benefit from spacers to improve delivery and reduce oropharyngeal deposition 1
  • Without a spacer, deposition is less and heavily technique-dependent 1

Clinical Considerations

• For patients who cannot use inhalers correctly, nebulizers may be considered as an alternative delivery method 1
• Elderly patients or those with cognitive impairment, weak fingers, or poor coordination may benefit from DPIs like Ellipta due to their ease of use 1
• When choosing an inhaler device, consider the patient's ability to use the device correctly, as this affects therapeutic response 3
• In studies comparing patient preferences, the Ellipta DPI was preferred over other inhalers including HandiHaler, Diskus, and MDIs due to its ergonomic design, ease of use, and simple operation 6, 4

Remember that proper inhaler technique is crucial for optimal medication delivery regardless of the type of inhaler used. For Anoro Ellipta specifically, no spacer is required or recommended.