AEROSOL THERAPY

AEROSOL THERAPY pMDI pMDI + Spacer pMDI + Spacer + facial mask DPI NEBULIZERS

Metered Dose Inhalers A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases.

pMDI (pressurised metered dose inhaler) Indications for use: ability to follow instructions stable ventilatory pattern adequate inspiratory capacity (>900 mL) ability to mechanically coordinate actuation and breathing

pMDI – procedure Shake canister, prime according to drug being used Place MDI between lips, mouth closed, tongue out of the way Exhale to end tidal volume Start inhaling slowly, actuate canister Inhale slowly to TLC 5-10 sec breath hold Exhale normally Repeat after 1 minute

pMDI - Advantages portable and compact efficient, reproducible aerosol dose delivery short treatment time no drug preparation or contamination some are breath-actuated

pMDI - disadvantages coordination and instruction required fixed drug concentrations,more actuations airway irritation from propellant may occur high oropharyngeal loss if spacer is not used environmental release of chloroflourocarbons Not all medications available

pMDI + Spacers - Indications for use Inhalation of drugs from an MDI: optimal lung delivery and minimizes oropharyngeal deposition Patients with poor hand-breathing coordination

Spacers Advantages increases time and volume to allow aerosol particle ageing which reduces particle size evaporation of propellant reduced oropharyngeal particle deposition removes the need for hand-breath coordination

Spacers Disadvantages large contamination some assembly increased treatment time

DPI - Dry Powder Inhaler Use: load dose/capsule as instructed exhale fully away from the device lips on mouthpiece inhale quickly repeat if powder remains in the device

DPI - Advantages small and portable short prep and admin times Breath actuated Less coordination Dose counter

DPI - disadvantages high inspiratory flowrate needed requires coordination to load capsule not all medications available

Nebulizers Indications: person unable to follow instruction for MDI poor inspiratory capacity cannot inspiratory hold rapid/unstable ventilatory pattern non-standard drug concentration/solution

Nebulizers Use: 3-5 mL, 6-8 L/min air flow < 10 mm. treatment time slow deep breaths, insp. hold if possible, but any breathing pattern is probably effective

Nebulizers - Advantages any drug solution, concentration or mixture, air or oxygen uncoordinated, very young, or in acute distress effective with low inspiratory flows or volumes inspiratory pause not required

Nebulizers - Disadvantages equipment is cumbersome and expensive longer treatment time requires cleaning, equipment contamination possible facemask gives a cold wet spray, face and nasal deposition requires compressed gas source (oxygen or compressor)

DRUGS Bronchodilatators ICS Adrenaline Mucolitics Antibiotics Saline Dornaze alfa

VENTOLIN (SALBUTAMOL) pMDI: 100ug/single inhalation dose Typical dosing: 3x2 inhalation + 2 inhalation if necessery Nebulizer 2,5mg/2,5ml

BERODUAL (FORMETREOL + IPRATROPIUM BROMIDE) Nebulizer 1 ml = 20 drops Dose: 1 drop/kg maximum: 40 drops (2ml) + 3ml 0,9% NaCl

PULMICORT, NEBBUD (BUDESONIDE) Nebulizer 250ug/2ml 500ug/2ml 1000ug/2ml

FLIXOTIDE (FLUTICAZON) pMDI 50 ug/inhalation dose 125 ug/inhalation dose 250 ug/inhalation dose

MUCOSOLVAN (AMBROSOL) Nebulizer: 7,5mg/ml

ADRENALINE 1-4 mg + 0,9% NaCl