際際滷

際際滷Share a Scribd company logo

INHALAR TECHNIQUES IN OBSTRUCTIVE AIRWAY DISEASE.pdf

Dr. Chandan Kumar Sheet
Dr. Chandan Kumar Sheet

INHALATION TECHNIQUE

1 of 25
Inhalation Therapy in OAD Dr. Chandan Kumar Sheet MD (Pulmonary Medicine), Fellowship In Interventional Pulmonology Consultant Pulmonary Medicine, Critical Care & Sleep Disorders Calcutta Heart Clinic & Hospital, Saltlake, Kolkata
Particle size and drug deposition
Pharmacokinetics of inhaled drugs
INHALAR TECHNIQUES IN OBSTRUCTIVE AIRWAY DISEASE.pdf
Inhalation Devices MDI DPI Breath Actuated Devices (BAI)
MDI
MDI- SPACER
pMDIs (Pressurised Metered Dose Inhalers) Designed to emit a fixed amount of drug with each actuation. The drug is in a suspension form along with a propellant hydrofluoroalkane (HFA) Stored in the MDI canister under high pressure (35 atmosphere) With each actuation, aerosol particles are released at a high velocity of >120 Km/Hour. Particle size of the emitted drug is usually between 2 and 4 袖m.
Spacers Holding chambers that allow the patient to take some extra time (220 seconds) to inhale the drug after it has been released from the PMDI Spacer Shape: pear-shaped or tubular spacer should be preferred Valves in Spacers: Recommended Anti-Static Spacers: - Improve Lung Deposition - Recommended Spacer Size/Volume: - Medium-volume spacers (100300 ml) for all age groups
Spacers Breathing Pattern for Spacer Use: - A single, slow and deep inhalation followed by breath holding for about 10 seconds Timing of Inhalation after Actuation - time lag of 2 seconds between actuation and inhalation is acceptable Interval between Two Actuations: - 30 seconds Cleaning of spacer: - Spacers should be washed at least once a week if being used by a single patient - Anti-static spacers should be washed with plain room temperature water. - Static spacers should be washed with a mild detergent.
Remember before describing pMDI Priming of the Inhaler - done by spraying several times into the air (about 2 to 4 doses). - New inhaler - Re-used after a gap of 4 or more days Interval between Two Actuations - 30 seconds
Remember before describing pMDI Rinsing the mouth as well as gargling with water and spitting out after the use of inhaled corticosteroids even when using a spacer Cleaning the Actuator Mouthpiece The actuator mouthpiece should be cleaned with a soft cloth or a tissue paper after each actuation. Indicators that the Inhaler may be Empty Irrespective of whether a pMDI has a dose counter or not, the patient should mark the date of initiating the inhaler for use on the inhaler carton.
Inhalation Techniques- MDI
Use of Face Masks with Spacers - HUF-PUF Kit Age below 4 years: pMDI + spacer with face mask
Local Side Effects of pMDIs Dysphonia Oropharyngeal Candidiasis Cold-Freon Effect When the propellant, which is under pressure in the canister, is released out through the nozzle, the temperature of the aerosol drops to around 30属C and by the time it hits the throat, the temperature is around 0属C. When the propellant, which is moving at around 100140 km/hr, hits the throat at 0属C, it causes pharyngeal spasm and stimulates cough in some subjects. This is described as the cold-freon effect and occurs only in a few people and can easily be overcome with the use of a spacer
Breath Actuated Devices (BAI)
BAIs (Breath-Actuated Inhalers) BAIs are pMDIs that have been developed to over come the coordination problems faced with a PMDI The inspiratory pressure generated by inhalation triggers the release of a unit dose of the drug
Inhalation Techniques-BAI
DPI
Inhalation Techniques-DPI
DPIs Principles of the Working of a DPI The performance of a DPI is affected by the particle size and flow properties of the formulation, inspiratory flow rate, drug carrier adhesion, and design of the DPI. During inhalation, the inspiratory flow creates turbulence in the DPI and deagglomerates the drug particles from the carrier lactose molecules. The effort required to generate the inspiratory flow to de-agglomerate is different for different DPI devices but generally varies between 37 - 111 L/min
DPIs It is, therefore, important to inhale rapidly and deeply when using a DPI The inhalation volume required to completely empty the dose out of the DPI should be at least 500 ml. Patients who have reduced inspiratory lung volumes and inspiratory flow rates may, therefore, not be able to achieve the required lung deposition
Use of DPIs in COPD Patients: - DPIs can be successfully used in most patients with COPD. - Most COPD patients can generate an inspiratory flow rate 2695 L/ min - Only 2030% of patients with advanced COPD may be unable to use a DPI effectively Managing Cough after Using a DPI: The carrier molecule in a DPI is lactose. In comparison with the active drug molecule, lactose has a larger particle size ranging between 10 and 40 microns. Particles with a mean diameter of over 5 microns get deposited in the oropharynx. Moreover, high inspiratory flow rates are needed when inhaling through a DPI, leading to greater oropharyngeal deposition of the particles. The deposition of the larger lactose molecules through rapid impaction stimulates the oropharyngeal epithelium, inducing cough in some patients. Rinse or gargle after any drug inhalation as this will also serve the purpose of washing out the deposited lactose particles. DPIs to be used for not more than 6 months
MDI Propellent Driven Aerosolization Faster aerosol delivery Nonaqueous formulation within the canister Slow steady Inhalation (4-5 sec ) Needs synchronised breathing High speed drug delivery (70-80 miles/ Hour) Cold free-on effect Vocal cord Myopathy in ICS use MDI + SPACER Always use with SPACER improves hand mouth coordination / avoid Cold free-on Spacer should be of Valved & of ZEROSTAT technology Reduce oropharyngeal particle deposition DPI Patient inhalation driven aerosolization Capsules or blisters Deposits as dry particle Rapid deep inhalations (2-3 sec) Inspiratory flow >30 Lit /Min is crucial No need of synchronised breathing Inadequate flow = inadequate delivery Particulate irritation may cause cough (rare) High humidity may cause clumping of powder
Thank You! Dr.Chandan

More Related Content

INHALAR TECHNIQUES IN OBSTRUCTIVE AIRWAY DISEASE.pdf

  • 1. Inhalation Therapy in OAD Dr. Chandan Kumar Sheet MD (Pulmonary Medicine), Fellowship In Interventional Pulmonology Consultant Pulmonary Medicine, Critical Care & Sleep Disorders Calcutta Heart Clinic & Hospital, Saltlake, Kolkata
  • 2. Particle size and drug deposition
  • 5. Inhalation Devices MDI DPI Breath Actuated Devices (BAI)
  • 6. MDI
  • 8. pMDIs (Pressurised Metered Dose Inhalers) Designed to emit a fixed amount of drug with each actuation. The drug is in a suspension form along with a propellant hydrofluoroalkane (HFA) Stored in the MDI canister under high pressure (35 atmosphere) With each actuation, aerosol particles are released at a high velocity of >120 Km/Hour. Particle size of the emitted drug is usually between 2 and 4 袖m.
  • 9. Spacers Holding chambers that allow the patient to take some extra time (220 seconds) to inhale the drug after it has been released from the PMDI Spacer Shape: pear-shaped or tubular spacer should be preferred Valves in Spacers: Recommended Anti-Static Spacers: - Improve Lung Deposition - Recommended Spacer Size/Volume: - Medium-volume spacers (100300 ml) for all age groups
  • 10. Spacers Breathing Pattern for Spacer Use: - A single, slow and deep inhalation followed by breath holding for about 10 seconds Timing of Inhalation after Actuation - time lag of 2 seconds between actuation and inhalation is acceptable Interval between Two Actuations: - 30 seconds Cleaning of spacer: - Spacers should be washed at least once a week if being used by a single patient - Anti-static spacers should be washed with plain room temperature water. - Static spacers should be washed with a mild detergent.
  • 11. Remember before describing pMDI Priming of the Inhaler - done by spraying several times into the air (about 2 to 4 doses). - New inhaler - Re-used after a gap of 4 or more days Interval between Two Actuations - 30 seconds
  • 12. Remember before describing pMDI Rinsing the mouth as well as gargling with water and spitting out after the use of inhaled corticosteroids even when using a spacer Cleaning the Actuator Mouthpiece The actuator mouthpiece should be cleaned with a soft cloth or a tissue paper after each actuation. Indicators that the Inhaler may be Empty Irrespective of whether a pMDI has a dose counter or not, the patient should mark the date of initiating the inhaler for use on the inhaler carton.
  • 14. Use of Face Masks with Spacers - HUF-PUF Kit Age below 4 years: pMDI + spacer with face mask
  • 15. Local Side Effects of pMDIs Dysphonia Oropharyngeal Candidiasis Cold-Freon Effect When the propellant, which is under pressure in the canister, is released out through the nozzle, the temperature of the aerosol drops to around 30属C and by the time it hits the throat, the temperature is around 0属C. When the propellant, which is moving at around 100140 km/hr, hits the throat at 0属C, it causes pharyngeal spasm and stimulates cough in some subjects. This is described as the cold-freon effect and occurs only in a few people and can easily be overcome with the use of a spacer
  • 17. BAIs (Breath-Actuated Inhalers) BAIs are pMDIs that have been developed to over come the coordination problems faced with a PMDI The inspiratory pressure generated by inhalation triggers the release of a unit dose of the drug
  • 19. DPI
  • 21. DPIs Principles of the Working of a DPI The performance of a DPI is affected by the particle size and flow properties of the formulation, inspiratory flow rate, drug carrier adhesion, and design of the DPI. During inhalation, the inspiratory flow creates turbulence in the DPI and deagglomerates the drug particles from the carrier lactose molecules. The effort required to generate the inspiratory flow to de-agglomerate is different for different DPI devices but generally varies between 37 - 111 L/min
  • 22. DPIs It is, therefore, important to inhale rapidly and deeply when using a DPI The inhalation volume required to completely empty the dose out of the DPI should be at least 500 ml. Patients who have reduced inspiratory lung volumes and inspiratory flow rates may, therefore, not be able to achieve the required lung deposition
  • 23. Use of DPIs in COPD Patients: - DPIs can be successfully used in most patients with COPD. - Most COPD patients can generate an inspiratory flow rate 2695 L/ min - Only 2030% of patients with advanced COPD may be unable to use a DPI effectively Managing Cough after Using a DPI: The carrier molecule in a DPI is lactose. In comparison with the active drug molecule, lactose has a larger particle size ranging between 10 and 40 microns. Particles with a mean diameter of over 5 microns get deposited in the oropharynx. Moreover, high inspiratory flow rates are needed when inhaling through a DPI, leading to greater oropharyngeal deposition of the particles. The deposition of the larger lactose molecules through rapid impaction stimulates the oropharyngeal epithelium, inducing cough in some patients. Rinse or gargle after any drug inhalation as this will also serve the purpose of washing out the deposited lactose particles. DPIs to be used for not more than 6 months
  • 24. MDI Propellent Driven Aerosolization Faster aerosol delivery Nonaqueous formulation within the canister Slow steady Inhalation (4-5 sec ) Needs synchronised breathing High speed drug delivery (70-80 miles/ Hour) Cold free-on effect Vocal cord Myopathy in ICS use MDI + SPACER Always use with SPACER improves hand mouth coordination / avoid Cold free-on Spacer should be of Valved & of ZEROSTAT technology Reduce oropharyngeal particle deposition DPI Patient inhalation driven aerosolization Capsules or blisters Deposits as dry particle Rapid deep inhalations (2-3 sec) Inspiratory flow >30 Lit /Min is crucial No need of synchronised breathing Inadequate flow = inadequate delivery Particulate irritation may cause cough (rare) High humidity may cause clumping of powder