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    Aerosol Therapy TMK 1

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    Inna Doroshkevych
    1. Aerosol therapy involves suspending fine liquid or solid particles in air for inhalation. Only about 10% of the drug reaches the lungs, with most depositing in the oropharynx or being lost in the inhaler. Particle size is important, with smaller particles able to reach deeper into the lungs. 2. Common aerosol delivery systems include metered dose inhalers, dry powder inhalers, and nebulizers. Metered dose inhalers are most widely used but require coordination and can cause irritation. Dry powder inhalers avoid propellants but require strong inhalation. Nebulizers are useful for children and severe asthma. 3. Dr

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    Aerosol Therapy TMK 1

    Uploaded by

    Inna Doroshkevych
    292 views34 pages
    1. Aerosol therapy involves suspending fine liquid or solid particles in air for inhalation. Only about 10% of the drug reaches the lungs, with most depositing in the oropharynx or being lost in the inhaler. Particle size is important, with smaller particles able to reach deeper into the lungs. 2. Common aerosol delivery systems include metered dose inhalers, dry powder inhalers, and nebulizers. Metered dose inhalers are most widely used but require coordination and can cause irritation. Dry powder inhalers avoid propellants but require strong inhalation. Nebulizers are useful for children and severe asthma. 3. Dr

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    AEROSOL_THERAPY_TMK_1_

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    1. Aerosol therapy involves suspending fine liquid or solid particles in air for inhalation. Only about 10% of the drug reaches the lungs, with most depositing in the oropharynx or being lost in the inhaler. Particle size is important, with smaller particles able to reach deeper into the lungs. 2. Common aerosol delivery systems include metered dose inhalers, dry powder inhalers, and nebulizers. Metered dose inhalers are most widely used but require coordination and can cause irritation. Dry powder inhalers avoid propellants but require strong inhalation. Nebulizers are useful for children and severe asthma. 3. Dr

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    292 views34 pages

    Aerosol Therapy TMK 1

    Uploaded by

    Inna Doroshkevych
    1. Aerosol therapy involves suspending fine liquid or solid particles in air for inhalation. Only about 10% of the drug reaches the lungs, with most depositing in the oropharynx or being lost in the inhaler. Particle size is important, with smaller particles able to reach deeper into the lungs. 2. Common aerosol delivery systems include metered dose inhalers, dry powder inhalers, and nebulizers. Metered dose inhalers are most widely used but require coordination and can cause irritation. Dry powder inhalers avoid propellants but require strong inhalation. Nebulizers are useful for children and severe asthma. 3. Dr

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    Aerosol therapy

    A review
    AEROSOLS
    Suspension of fine liquid or solid particle in air
    Key to aerosol therapy is aerosol particle
    Aerosol emerge at a velocity of 100km/h
    80% drugs deposited in oropharynx
    10% in the walls of the inhaler
    10% in the lungs
    Particle size important :2-5µ undergo impaction &
    sedimentation in the lungs & submicronic
    particles go in and out
    Indications
    Deposition of bronchoactive aerosols
    Enhancement of secretion clearance
    Sputum induction
    Humidification of respired gases
    Prevent dehydration
    Prevent or relieve bronchospasm or upper
    airway inflammation
    Hazards of therapy
    Bronchospasm
    Over hydration
    Overheating of inspired gases
    Delivery of contaminated aerosol
    Tubing condensation draining into the
    airway
    Aerosol delivery systems
    The three principle types of devices widely
    used are:
    MDI: Metered dose inhalers
    DPI: Dry powder inhalers
    Accuhalers
    Nebulizers
    Metered dose inhalers

    Most widely used


    Propellants were chlorofluorocarbons[CFC]
    May be freon/archon
    Aerosol flow rate 30m/s or 100km/h
    Advantages of MDI
    Inexpensive
    Light,compact,resistant to moisture
    Quick delivery of drugs
    Precise and consistent doses
    Available with most anti asthmatic drugs
    Disadvantage of MDI
    Difficulty in coordination of activation&
    inspiration
    Time consuming to teach
    Cold freon effect i.e. inability to continue to
    breathe when propellant is released into
    mouth
    Contains CFC
    Spacers
    Holding chambers or reservoirs
    Attachment to a MDI
    2 Types:
    1. small volume spacer-tube spacer
    2. large volume spacer-conical spacer
    Advantages 1.no need to activate coordination with
    Advantages:
    inspiration 2.increases drug deposition in the
    lungs[130%]. 3.reduces drug deposition in the mouth.
    4.used in children with face mask 5.eliminates cold
    freon effect 6.decreases the incidence of oral thrush
    7.multiple doses can be given.
    Dry powder inhalers
    Introduced in 1960’s
    No propellent
    Requires patient’s own inspiratory effort to form aerosol
    Powder is delivered only when the patient inhales
    Useful in children above 5 years, teenagers & arthritic
    patients
    Advantages: 1. light weight 2. no hand breath co-
    ordination 3. no CFC 4. quick delivery of drugs
    Disadvantages: 1. Require high inspiration
    flow>28/l/min 2. available with only few anti asthma
    drugs
    Comparison between MDI & DPI
    contains CFC No CFC
    High velocity aerosols Aerosol velocity depends
    on inspiratory flow rate
    Requires hand breath co
    No hand breath co
    ordination ordination needed
    Delivery of medicines Delivery of medication
    independent of external largely dependent on
    factors external factors
    Time consuming to teach Easy to teach
    Requires deep& slow Requires high inspiratory
    breathing only flow>28L/min
    Nebulizers
    Turns an aqueous solution of drug into fine
    mist
    Drug will be inhaled with normal
    respiration
    Medication reaches lower airways more
    effectively
    Two types: jet & ultrasonic
    Differences between jet nebulizer
    & ultrasonic nebulizer

    JET ULTRASONIC
    Cools during operation Heats up during
    Small aerosol particle operation
    size Larger aerosol particle
    Less expensive More expensive
    More noise Less noise
    Indications for nebulizers
    Useful in children
    Handicapped person
    Acute severe asthma
    Bronchial challenge tests
    Lung ventilation scans
    Ventilated patient
    High doses can be given
    Combination drugs can be given
    Disadvantages: nebulizer
    Expensive
    Requires regular maintenance
    High doses result in toxicity
    Airborne infections may be transmitted
    Produces lot of noise
    Requires a power source
    Choice of inhalation therapy
    Infants Nebulizer
    Children
    < 4 years Nebulizer
    4 year DPI/MDI/Spacer
    7 years DPI/MDI
    Adults MDI/DPI
    Acute episodes Nebulizer
    Drugs available:MDI
    ß agonists
    Salbutamol, terbutalin, fenoterol, salmetrol,
    pibuterol, veproterol, fometerol, nimeterol
    Steroids
    Beclomethazone, budesonide, flucoticasone
    • Antimucarinics:
    Ipratropium bromide/oxitropium bromide
    • Mast cell stabilizers:
    Diisodium cromoglycoate, nedocromial sodium
    DRUGS AVAILBLE FOR NEBULIZATION

    Beta 2 agonists:salbutamol, terbutalin, feneterol


    Antimuscaranics: ipratropium bromide
    Steroids:budoneside
    Sodium cromoglycoate
    Antibiotics
    Antifungals: pentamidine
    Mucolytics: acetyl cysteine, mistabron
    Beta 2 adrenergic agonists
    Mechanism of action
    • Beta receptor stimulation- increased C
    AMP in bronchial muscle cell –relaxation

    • Increased C AMP in mast cells- reduced


    Ag:Ab reaction induced mediater release
    Albuterol
    Short acting
    A high selective beta 2 agonist
    Selectively increased by inhalation route
    Peak bronchodilation in 10 min
    Long term use leads to decreased
    responsiveness
    Terbutalin

    Similar to salbutamol in properties & use


    Are all short acting albuterol preparations same?

    Commonly used beta 2 agonist is racemic


    albuterol
    Mixture of R mirror image isomers R albuterol &
    S albuterol
    R has rapid bronchodilator effect & S has no
    bronchodilator effect
    Pharmokinetics of both are different
    S metabolized 10 times slowly & decreased
    responsiveness in long term use
    Long acting beta 2 agonists : Fometerol &
    salmeterol

    Both are potent & selective


    Duration of action >12 hours due to lipophilicity
    Salmeterol has delayed onset of action
    Fometerol rpid onset of action
    Fometerol in a dose dependent fashion more
    protective against bronchospasm than salmeterol
    Fometerol produce more finger tremor than
    salmeterol
    More helpful in nocturnal asthma
    Why combine beta 2 agonists & steroids ?

    Complementary effects
    Steroids increase beta 2 receptor gene expression
    and decrease the potential for desensitization
    Long acting beta 2 agonists prime the
    glucocorticoid-receptors making them more
    sensitive to steroid dependent activation
    In steroid responsive systems the addition of long
    acting beta 2 agonist increases steroid potency
    Proven or widely accepted beneficial effects of steroids

    Improvement in pulmonary function


    Decrease in diurnal variation of lung
    function
    Decreased requirement of oral steroids
    Protection against antigen induced
    bronchoconstriction when used chronically
    Decrease in exacerbation rate
    Beneficial effects of inhaled steroids

    Probable decrease in hospital admission rate


    Possible decrease in asthma death rate
    Possible prevention of long term lung
    damage leading to irreversible airflow
    obstruction
    Possible decrease in rate of decline of lung
    function in asthma of long duration
    Side effects of inhaled steroids

    Depression of adrenocortical function


    Effects on bone metabolism
    Effects of growth in children
    Easy bruising & skin thinning
    Cataract formation
    Inhaled steroids
    Most widely used are beclamethasone &
    budesonide.
    Both are potent & absorbed from GIT and partial
    first-pass metabolism in liver
    When used up to 1000 µg –day no adrenocortical
    function effects
    Fluticasone propionate highly selective, poorly
    absorbed from GIT, subject to 100% first pass
    metabolism in liver. Safer in children
    Treatment strategies in children
    The step up strategy The step down strategy
    • Uses inhaled steroids late in • Inhaled steroids early in all
    treatment children with chronic
    • Reserves steroids in severe cases symptoms
    only
    • Inhaled steroids up to 800µg
    • Only minority of children (10-
    day with inhaled beta-2
    20%) are on steroids
    agonists up to 6-8 weeks. then
    • Starts with beta-2 agonists
    gradual reduction depending
    increasing in doses adding
    theophyllin or oral beta-2 agonists on pulmonary function
    or sodium cromoglycoate / long • Improved quality of life
    acting beta-2 agonists • Most children end up with
    • Lastly inhaled steroids long term steroids.
    Chronic management of asthma

    Step1: mild symptoms - <1-2 times a week,


    nocturnal asthma, asymptomatic between
    exacerbations, PEF or FEV1>80%
    Short acting inhaled beta-2 Agonist not
    more than 3 times a week
    Sodium cromoglycoate or beta-2 agonists
    before exposure to antigen or exercise
    Chronic management of asthma
    Step 2: moderate - exacerbations >2 times a week,
    affects activity & sleep, nocturnal asthma >2 times
    a month, requires short acting beta-2 agonists
    daily, PEF or FEV1 60-80% predicted
    Inhaled anti inflammatory therapy daily: initially
    corticosteroid 200-600µg /day or sodium
    cromoglycoate (children)- if not controlled , long
    acting beta-2 agonist
    Step3: moderate - add sustained release theophyllin
    or inhaled cholinergics or inhaled beta 2 agonist
    Chronic management of asthma
    Step 4 : severe -frequent exacerbations, continuous
    symptoms, frequent nocturnal asthma, PEF or
    FEV1 <60%
    Inhaled steroids daily 800-1000µg
    Sustained release theophyllin and or oral beta 2
    agonist or long acting
    Oral steroids (alternate day or single daily dose)
    with short or long acting beta-2 agonists
    Particle deposition
    Thank you
    Thank you

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