Medicated Aerosol Therapy Devices

Front 1

Therapeutic Use of Aerosols

Drug Classifications

Back 1

• Bronchodilators
• Anti-inflammatories
• Mucolytics
• Anti-microbials
• Surface-active agents (improve surface tension)
• Anesthetic agents
• Diagnostic agents

Front 2

Asthma and COPD Medications

Back 2

Relievers
• Short-Acting Bronchodilators or SABD’s

Controllers
• Long-Acting Bronchodilators or LABD’s
• Inhaled Corticosteroids

Front 3

Small Volume Nebulizer

Back 3

• Require pressurized gas source

• Modification of drug concentration possible for simultaneous delivery with other drugs

• Contamination of bulk drug bottles

• Pulmonary deposition: 2-10 %

Front 4

Small Volume Nebulizer

Back 4

• Particle size: MMAD 1-5 µm

• Liquid Ventolin® = 5 mg/ml

• Dose: 1.0 mL diluted in 2 mL NaCl

• Tx time: 7-10 minutes @ 6-8 LPM

Front 5

Small Volume Nebulizer

Portable Home Medication Compressor

Back 5

• Provides pneumatic power for small volume
nebulizer

• Maximum pressure generated is 8-10 psi

• Remember that hospital wall outlet is @ 50 psi

Front 6

Small Volume Nebulizer

Portable Home Medication Compressor

Back 6

• May affect MMAD range & deposition into airway

• Maximum flows generated are 5-8 LPM

Front 7

Small Volume Nebulizer

Breath Actuated SVN

Back 7

• Breath actuation is a recent enhancement in SVN

• Matches delivery to demand

• Can deliver the precision of an MDI in a SVN

Front 8

Small Volume Nebulizer

Breath Actuated SVN

Back 8

• Creates aerosol only in precise response to patient’s inspiratory maneuver

• Less medication waste

• Intended dosage delivered to patient

Front 9

Small Volume Nebulizer

Breath Actuated SVN

Back 9

• Ideal particle size and high mass output to maximize respirable dose

• Potentially shorter treatment times

Front 10

Small Volume Nebulizer

Breath Actuated SVN

How it Works

Back 10

1. Air fromt eh compressor breaks the liquid medication into small breathable particles which form a mist (aerosol)

Front 11

Small Volume Nebulizer

Breath Actuated SVN

How it Works

Back 11

2. As the patient breathes in, the value at the top opens, letting air in and speeding up the mist generation

Front 12

Small Volume Nebulizer

Breath Actuated SVN

How it Works

Back 12

3. When the patient breathes out, the top valve closes, slowing down the mist and the mouthpiece flap opens letting the patients breath out

Front 13

Metered Dose Inhaler (MDI)

Back 13

• Cartridges contain 150-300 doses, each
actuation = 1 Metered Dose

• Metering Chamber volume: 30–100 µL

• Ventolin® = 100 Micrograms = 0.1 mg /actuation

Front 14

Metered Dose Inhaler (MDI)

Back 14

• Drug powder suspended in a liquid propellant

- HFA, Hydrofluoroalkane

- CFC (freon) Worldwide Ban - 1995

• Particle size: 3-6 µm

• Pulmonary deposition: ~ 10-20 %

Front 15

Metered Dose Inhaler (MDI)

How it works

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1. Warm MDI to hand or body temperature

2. Shake canister vigorously - mix

3. Patient exhales normally / FRC

4. Hold canister 4 cm away from open mouth

Front 16

Metered Dose Inhaler (MDI)

How it works

Back 16

5. Actuate the MDI immediately after beginning a slow inspiratory flow {30 - 45 LPM}

6. Continue inhaling until total lung capacity

7. Breath-hold of 10 seconds

8. Wait 1 minute between puffs

Front 17

Metered Dose Inhaler (MDI)

Spacers and Chambers

Back 17

• Improve coordination of MDI actuation & breath

• Reservoir holds particles until the patient inspires

• Larger particles rain out or dehydrate and become smaller

Front 18

Metered Dose Inhaler (MDI)

Spacers and Chambers

Back 18

• Particles >5 µm settle out in the chamber

• Significant reduction in oropharyngeal deposition x 10-17 fold

Front 19

Metered Dose Inhaler (MDI)

AeroChamber

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• Reduces drug lost to total body dose by 75%

• Increases pulmonary dose

• Whistle alerts patient if their inspiratory flow exceeds 25 LPM

Front 20

Metered Dose Inhaler (MDI)

AeroChamber

Back 20

• Can be adapted for intubated / ventilated pts

• Manufactured in London, ON – Trudell Medical

Front 21

Metered Dose Inhaler (MDI)

AeroChamber

Holding Chamber Technique

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1. Warm MDI to hand or body temperature

2. Shake canister vigorously, insert into end of chamber

3. Exhale normally ie. to RV

Front 22

Metered Dose Inhaler (MDI)

AeroChamber

Holding Chamber Technique

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4. Place holding chamber in mouth or place mask over nose and mouth

5. Breathe in normally while actuating the MDI at start of inspiration

Front 23

Metered Dose Inhaler (MDI)

AeroChamber

Holding Chamber Technique

Back 23

6. Larger breaths and breath-holding are encouraged but not necessary

7. Wait 30-60 sec between actuations

Front 24

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Back 24

• Another form of MDI but does not use a propellant
- uses carrier substance ie. lactose or glucose

• Eliminates need for hand-breath coordination

• Breath-actuated device

Front 25

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Back 25

• Require high PIF >60 lpm ...may be problem

• Particle size: 1-2 µm

• 40% of particles deposit into pharynx

• Pulmonary deposition: 10%, same as mdi

Front 26

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices

Back 26

• Turbuhaler
• Diskus
• ASMANEX® Twisthaler
• Handihaler
• DISKHALER: Rarely prescribed now.

Front 27

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices: Turbuhlaer

Back 27

• Remove protective cap/cover

• Twist bottom to load the medication chamber with a single dose

• Pt. inspires @ high inspiratory flow

Front 28

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices: Diskus

Back 28

• Slide protective cover to open

• Slide lever to engage & pierce pre-loaded dose packet (60 each)

• Dose-counter for accuracy

Front 29

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices: ASMANEX® Twisthaler

Back 29

• Pre-loaded doses, 2 sizes

• Twist protective cap/cover to load med chamber with single dose

• Dose counter for accuracy

Front 30

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices: Handihaler

Back 30

• Spiriva® for COPD meds

• Flip open protective cover

• Flip open medication chamber cover and load with dose capsule (separate)

Front 31

Metered Dose Inhaler (MDI)

Dry Powdered Inhaler (DPI)

Devices: Handihaler

Back 31

• Close medication chamber cover

• Instruct pt. to breathe at slow inspiratory flows

• COPD pts. unable to generate high insp. flows