1. AEROSOL THERAPY

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

3. 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.

4. 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

5. 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

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

7. 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

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

9. 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

10. Spacers Disadvantages large contamination some assembly
increased treatment time

11. 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

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

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

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

16. 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

17. 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

18. 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)

20. DRUGS Bronchodilatators ICS Adrenaline Mucolitics Antibiotics Saline
Dornaze alfa

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

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

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

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

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

26. ADRENALINE
1-4 mg + 0,9% NaCl