What are the different types of inhalers (puffers) and their corresponding colors?

Types of Inhalers and Their Color Coding

There are three main types of inhalers (puffers): metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs), but there is no universal color-coding system across all manufacturers—color schemes vary by brand and medication type, making device identification by color unreliable for clinical decision-making. 1, 2

Main Inhaler Device Categories

Metered-Dose Inhalers (MDIs)

• Pressurized devices that deliver medication as an aerosol spray using propellant gases 3, 2
• Modern MDIs use hydrofluoroalkane (HFA) propellants rather than older chlorofluorocarbon propellants 3
• Two propellant types exist: HFA134a (lower carbon footprint) and HFA227ea (higher carbon footprint, >36 kg CO2 per inhaler) 3
• Examples include Ventolin MDI (28 kg carbon footprint per inhaler) and Flutiform 3
• Require coordination between actuation and inhalation, which many patients struggle with 2, 4
• Should be used with spacer devices to improve drug delivery and reduce coordination requirements 3

Dry Powder Inhalers (DPIs)

• Breath-activated devices requiring no coordination between actuation and inhalation 1, 2
• Contain micronized drug particles attached to larger lactose carrier particles 2
• Require adequate inspiratory flow (typically ≥30 L/min) to extract and disaggregate the drug from carrier particles 2, 5
• Examples include Turbuhaler and Novolizer 6
• Have significantly lower carbon footprint than MDIs due to absence of propellant gases 3
• Are environmentally friendly and easier to use than MDIs 6

Soft Mist Inhalers (SMIs)

• Deliver medication dissolved in aqueous solution without propellant 2
• Dispense medication as a slow aerosol cloud using spring energy 2
• Example: Respimat device 4

Nebulizers

• Convert liquid medication into aerosol droplets suitable for inhalation 3
• Include jet nebulizers (most common), ultrasonic nebulizers, and vibrating mesh nebulizers 3
• Require 5-15 minutes for administration and do not ensure precise dosages 2
• Used for patients unable to use other inhaler types 3, 2

Color Coding Reality

No standardized color system exists across manufacturers—each pharmaceutical company uses different colors for their devices, making color an unreliable identifier. The evidence provided does not establish any universal color-coding scheme for inhalers. 1

Medication Classes by Inhaler Type

Short-Acting Beta-Agonists (SABAs)

• Available in both MDI and DPI formats 3
• Albuterol (salbutamol) is the most common: 90 mcg per puff in MDIs 7
• Onset of action within 5 minutes, duration 4-6 hours 3

Inhaled Corticosteroids (ICS)

• Available in low, medium, and high doses across both MDI and DPI platforms 3
• Examples include budesonide and beclomethasone 3, 4

Combination Inhalers (ICS + LABA)

• Contain both inhaled corticosteroid and long-acting beta-agonist 3
• Available in both MDI and DPI formats 3

Clinical Pitfalls

• Using different inhaler types in the same patient increases risk of handling errors 1
• Many patients demonstrate poor inhaler technique regardless of device type 1, 5
• Telephone prescriptions that change inhaler type without patient instruction are unacceptable 1
• Inhaler technique must be checked and reinforced at every healthcare visit 1
• Consider changing inhaler device before changing medication or dose in treatment failure 1