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Inhalars for bronchial asthma

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ppt on asthma inhalational therapy

ppt on asthma inhalational therapy

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  • 1. INHALARS FOR BRONCHIAL ASTHMA Prepared by. Dr.Afnan Shamraiz PGr.1. Paeds.ATH
  • 2. Asthma Symptoms Result from Inflammation and Bronchoconstriction Reduced airway opening Thick Muscle Layer Excess Mucus BRONCHIOLE Tightened muscle Alveolus filled with trapped air Inflammation Bronchoconstriction
  • 3. PATHOPHYSIOLOGY OF ASTHMA
  • 4. Lung function during early and late phases of allergic response BEFORE STIMULUS BRONCHOSPASM LATE PHASEEARLY PHASE INFLAMMATION
  • 5. History of Inhaled Therapy 4000 years ago: the smoke of ephedra sinica was used for asthma therapy
  • 6. Modern age  Metered dose inhaler 1956 Medihaler  Dry powder inhaler 1960  Multidose dry powder inhaler 1970  440 million boxes aerosols per year are manufactured in the world
  • 7. Why Inhalation Therapy?  Targeted delivery of medication to the lungs  Rapid onset of action  Smaller doses  Less systemic and GI adverse effects  Relatively comfortable
  • 8. Definition of an aerosol  Aero air  Sol solution  Liquid or solid suspensions into gas medium  Particles which are sufficiently small so as to remain airborne for a considerable period of time
  • 9. Aerosol Size
  • 10. PHARMACOKINETICS OF INHALED DRUGS
  • 11. Lung deposition of drug  Particle  size  shape  particle density  solid or liquid phase  Type of inhalation device  Technique  Airway obstruction  Drug molecule
  • 12. Device dependent factors Device dependent factors Patient dependent factors  Device  pMDI:  Portability,Treatment time, Drug preparation, Reproducibility, Coordination, Actuation, Drug availability, Holding chamber, Propellant  DPI:  Breath-actuation, Coordination, Portability,Treatment time, Dose counters, Flow requirement, Drug availability, Resistance, Costs.  Aerosol 1. Particle size,Velocity, Physico- chemical characteristics  Age  co-operation  compliance  airway anatomy  breathing patterns  Disease
  • 13. Deposition of particles
  • 14. Lung Deposition of ICS  Dose to the lungs  MDIs  Ciclesonide 52%  Fluticasone 16%  Budesonide 5-12%  BDP HFA MDI 51%  DPIs  Different flow rates  Budesonide Turbuhaler 17-39%  Budesonide Novelizes 19-32%  BudesonideAirmax 28-30%  One flow rate  Budesonide Clickhaler 27%  Fluticasone Diskus 13%
  • 15. Inhalation Devices  Aim  To make aerosol from the drugs solution or solid particles  1-Metered dose inhaler  2-Dry powder inhaler  3-Nebulizer
  • 16. Asthma Medications and Supplies Dry Powder Inhaler - DPIMeter Dose Inhalers - MDI
  • 17. Asthma Medications and Supplies Spacers (use with MDIs Nebulizer / Compressor
  • 18. Inhaled treatment for asthma  Preventers- inhalers coloured in various shades of brown, orange or purple depending on their strength) Should be used twice each day to prevent inflammation and long term lung damage.  Most Preventers are taken morning and evening .
  • 19. Reliever inhalers-(normal dose, 2 puffs of blue)  To be given as and when necessary to relieve cough, wheeze, breathlessness and chest tightness.  Take 5-10 mins work by relaxing the tightness if the muscles causing constriction in the bronchioles.  Can be used before exercise .  You should expect 2 puffs of blue reliever inhaler, when taken properly, to last for 4 hours.  For the duration of a cold an asthmatic child is advised to take up to 2 puffs of their blue inhaler every 4 hours
  • 20. Medications Rescuers  Relax tightened muscles  Short-Acting  Nebulizer or Puffer  Treat acute episodes and symptoms  Reduce inflammation in airways  Long-Acting  Take on a regular basis Controllers:
  • 21. Metered dose inhalers  Metered dose inhalers.These inhalers consist of a pressurized canister containing medication that fits into a boot-shaped plastic mouthpiece.With most metered dose inhalers, medication is released by pushing the canister into the boot. One type of metered dose inhaler releases medication automatically when you inhale. Some metered dose inhalers have counters so that you know how many doses remain.
  • 22. Metered Dose Inhalers (pMDI  Canister  Propellent gas (liquid under pressure)  Drug  Dissolved or solid microparticules into the gas  Surfactant  Physical stabilisation  Prevent clustering
  • 23. Propellant Chloro fluoro carbon (CFC Hydro fluoro alcan (HFA)  CFC (freon gas)  CFC not flammable  Not include chloride  Not disturbe Ozone layer
  • 24. Freon (CFC)  Oropharyngeal irritation, cough and bronchospasm  Harmfull for ozone layer  Cardiac arrhytmia  Less effective in cold climate
  • 25. MDI advantages Disadvantages  Rapid application  Handling  Multidose  Hand-breathe coordinations  İneffective use in poor ventilated patients  Oropharyngeal deposition and local side effects  Not include dosimeter
  • 26. Not include dosimeter
  • 27. How Should a Child Use an Inhaler? If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-
  • 28. MDI with HFA (CFC-free)
  • 29. Bronchodilator drugs  open up the airways in the lung within minutes of inhalation of the drug, by relaxing the smooth muscle that surrounds the airways. Stimulate adenyl cyclase and increasing cAMP Short-acting bronchodilators: The effect of the usual type of bronchodilator lasts for 3-4 hours and these short-acting drugs (e.g. albuterol, metaproterenol, terbutaline) are used as needed or before exercise to prevent wheezing. The short-acting drugs provide rapid relief during a mild or moderately severe asthma attack, but they do nothing for the cause of the attack - inflammation. These "rapidrelievers" or "rescue inhalers" may be needed repeatedly until the attack subsides spontaneously or is controlled by an anti- inflammatory drug. Long -acting bronchodilators: Although bronchodilators do not prevent asthma attacks, certain long-acting bronchodilators (e.g. Serevent and Foradil) can improve lung function over 10-12 hour periods. This drug must NEVER be used for the emergency rescue from an acute attack of asthma. Salmeterol and formoterol 
  • 30. Albuterol(generic)  Generic: Albuterol  Type: MDI; fast/short acting beta-2 agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache , metallic taste (rinse mouth)  Similar to:Ventolin, Proventil
  • 31. Ventolin®  Generic: /salbutamol  Type: MDI; fast/long acting beta-2 agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Also available in:Ventolin rotahaler  Similar to: Proventil, Alupent, Maxair, Brethaire, Metaprel
  • 32. Salbutamol  ••Salbutamol:preparationa nddoses– Availableas2,4and8mgtabl ets–Syr.As 2mg/5ml– Asmetereddoseinhaler– 100μg–200μ
  • 33. Ventolinrotahaler®  Generic: /salbutamol (?)  Type: rotahaler; fast/long (?) acting beta-2 agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Also available in:Ventolin inhaler  Similar to: Proventil, Alupent, Maxair, Brethaire, Metaprel
  • 34. Alupent®  Generic: metaproterenol sulfate  Type: MDI; fast/short acting beta-2 agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Similar to: Metaprel, Ventolin, Proventil, Maxair, albuterol, Brethaire
  • 35. Brethaire®  Generic: terbutaline sulfate  Type: MDI, fast/short acting beta2-agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Similar to:Ventolin, Alupent, Maxair, Proventil, Metaprel
  • 36. Foradilaerolizer®  Generic: formoterol fumarate  Type: formoterol aerolizer  Class: controller/preventer  Functions: long-acting bronchodilator; acts w/in 3 mins, effective for at least 12 hrs.  Side Effects/Suggestions: tremors,  heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief  Similar to: Oxeze (and related to Serevent)
  • 37. Maxair®inhaler  Generic: perbuterol acetate  Type: MDI; fast/short acting beta2-agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Also available in: Maxair autohaler  Similar to:Ventolin, Alupent, Brethaire, Metaprel, Proventil
  • 38. Proventil®  Generic: albuterol  Type: MDI; fast acting beta-2 agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Similar to:Ventolin, Alupent, Maxair, Brethaire, Metaprel
  • 39. Serevent®   Generic: salmeterol xinafoate  Type: MDI; long acting beta2- agonist  Class: controller/preventer  Functions: prevents tightening of muscles around lung tubes; takes 10-20 mins to work, effective for at least 12 hrs.  Side Effects/Suggestions: tremors,  heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief  Also available in: Serevent discus  Similar to: related to Foradil & Oxeze
  • 40. DOSES DRUG FORM DOSE Salmeterol MDI 21ug/puff DPI 50 ug/blister 1 to 2 puffs bd 1 blister bd Formeterol DPI 12ug/single use capsule 1 cap bd Albuterol MDI 90 ug/puff 2 to 8 puffs every 20 minutes for 3 doses than every 1 to 4 hr as needed
  • 41. Anti-inflammatory drugs  work to reduce the irritability of the lung airways by controlling the activities of inflammatory cells in the airway walls. They are used to reduce asthma severity over a period of time, and must be used on a regular basis, usually 2-3 times per day. These drugs do not provide immediate relief from an asthma attack because they do not act as bronchodilators. However, it is often advised to temporarily increase the dose of the anti-inflammatory drug during an acute attack. Two types of anti-inflammatory drugs exist -mast cell stabilizers, and corticosteroids.
  • 42. Inhaled corticosteroids  are the most effective means of controlling asthma and are the usual type of drug given in the routine anti-inflammatory management of moderate asthma. Combined preparations containing a corticosteroid and a long acting bronchodilator (Advair, Dulera and Symbicort) are proving to be useful in limiting the amount of corticosteroid needed for control of asthma.  MOA  Reduces the synthesis of arachidonic acid by phospholipase A2  Inhibit the expression of COX-2 (anti- inflammatory action)  Postulated that: this drugs increases the responsiveness of beta agonists in the airway
  • 43. DRUGS USED IN ASTHMA Arachidonic acid Lipooxygenase Cyclooxygenase Hydroxypeptidase Endoperoxidase Leukotrienes Prostacycline Thromboxane A2 Prostaglandin Membrane Lipid Phospholipase A2
  • 44. Aerobid®  Generic: flunisolide  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Also available in: mint flavor  Similar to:Azmacort, Beclovent, Flovent, Pulmicort,Vanceril
  • 45. Flunisolide Strength Low Dose Medium Dose High Dose 250 ug/puff 500-750 μg (2-3 puffs) 1000-1250 μg (4-5 puffs) > 1250 μg (>5 puffs)
  • 46. Aerobidmintflavor®  Generic: flunisolide  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions:anti- inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Also available in: regular  Similar to:Azmacort, Beclovent, Flovent, Pulmicort,Vanceril
  • 47. Azmacort®  Generic: triamcinolone acetonide  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Similar to: Aerobid, Beclovent, Flovent, Pulmicort,Vanceril
  • 48. Triamcinolone Strength Low Dose Medium Dose High Dose 100 μg/puff (MDI with spacer 400-800 μg (4-8 puffs 800-1200 μg (8-12 puffs >1200 μg (> 12 puffs
  • 49. Beclovent®  Generic:beclomethasone dipropionate  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow- acting; reduce hypersensitivity in airways; long-term control medication  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Similar to: Aerobid, Azmacort, Pulmicort, Vanceril
  • 50. Vanceril®  Generic:beclomethasone dipropionate  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow-acting; reduce hypersensitivity in airways  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Also available in: double strength  Similar to:Azmacort, Beclovent, Aerobid, Pulmicort
  • 51. Vancerildoublestrength®  Generic:beclomethasone dipropionate  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow-acting; reduce hypersensitivity in airways  Side Effects/Suggestions: hoarseness;  Also available in: regular strength  Similar to:Azmacort, Beclovent, Aerobid, Pulmicort
  • 52. Beclomethasone Strength Low Dose Medium Dose High Dose 42, 84 μg/puff cfc 40,80 μg/puff HFA- propellant 84-336 μg (2-8 puffs of 42 μg/puff or1-4 puffs of 84 μg/puff) 336-672 μg (8-16 puffs of 42 μg/puff or 4-8 puffs of 84 μg/puff) >672 μg (> 16 puffs of 42 μg/puff or> 8 puffs of 84 μg/puff)
  • 53. Flovent®  Generic: fluticasone propionate  Type: corticosteroid MDI  Class: controller/preventer  Functions: anti- inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Similar to: Aerobid, Azmacort, Beclovent, Pulmicort,Vanceril
  • 54. Fluticasone Strength Low Dose Medium Dose High Dose 44, 110, 220 μg/puff (MDI) 88-176 μg (2-4 puffs of 44 μg/puff 176-440 μg (4-10 puffs of 44 μg/puff or2-4 puffs of 110 μg/puff or1-2 puffs of 220 μg/puff 440 μg (>4 puffs of 110 μg/puff or > 2 puffs of 220 μg/puff) DPI 50,100,150ug./in halation 100 to 200 ug 200 to 400 ug More than 400 ug
  • 55. fluticasone Flovent 220 - fluticasone 220 mcg/ puff Flovent 110 - fluticasone 110 mcg/puff Flovent 44 - fluticasone 44 mcg/puff Flovent Rotadisks 50 fluticasone,50mcg 100mcg 250mcg Flovent Rotahaler
  • 56. Pulmicort®  Generic: budesonide  Type: corticosteroid (Metered Dose Inhaler)  Class: controller/preventer  Functions: anti- inflammatory; slow- acting; reduce hypersensitivity in airways  Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use  Similar to: Aerobid, Azmacort, Beclovent, Vanceril
  • 57. Budesonide Strength Low Dose Medium Dose High Dose Turbuhaler (DPI200 μg /inhalation 200-400 μg (1-2 inhalations) 400-800 μg (2-4 inhalations) > 800 μg (>4 inhalations) Respules (nebulizer 0.5 μg 1μg 2μg
  • 58. MUSCARINIC ANTAGONISTS  Useful in 1/3 to 2/3 of asthmatic patients (especially children)  No effect on the inflammatory aspects of asthma  Useful in many COPD patients More effective and less toxic than β agonists MUSCARINIC ANTAGONISTS  Ipatropium  Quaternary antimuscarinic drug  Delivered to the airways by pressurized aerosol  Have little systemic action  Tiotropium  Newer longer-acting analog
  • 59. Atrovent®  Generic: ipratropium bromide  Type: anti-cholinergic MDI  Class: rescue/reliever  Functions: bronchodilator (relaxes smooth muscle bands around bronchial tubes), works in 5-15 minutes  Side Effects/Suggestions: dryness of mouth, metallic taste, avoid contact with eye
  • 60. Mast cell stabilizers • Inhaled medications that work to prevent bronchial tube swelling as part of a regular maintenance plan • Also taken before exercise MOA Decrease in the release of mediators (leukotrienes and histamine) from mast cells Prevents both early and late responses to challenge Intal cromolyn sodium inhalation aerosol Metered dose 800 mcg/inhalation Metered dose 1.75 mg/actuation Tilade nedocromil sodium
  • 61. Intal®  Generic: Cromolyn sodium  Type: non-steroidal MDI  Class: controller/preventer  Functions: anti- inflammatory, inhibits immediate & non- immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication  Side Effects/Suggestions: throat irritation, cough; use before exercise or contact with a known trigger  Also available in: nebulizer form, Intal Forte  Similar to:Tilade
  • 62. Tilade®  Generic: Nedocromil sodium  Type: non-steroidal MDI  Class: controller/preventer  Functions: anti- inflammatory, inhibits immediate & non- immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication  Side Effects/Suggestions: unpleasant taste, may cause stomach upset  Similar to: Intal
  • 63. IntalForte®  Intal Forte ®  Generic: Cromolyn sodium  Type: non-steroidal MDI  Class: controller/preventer  Functions: anti- inflammatory, inhibits immediate & non- immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication  Side Effects/Suggestions: throat irritation, cough; use before exercise or contact with a known trigger  Also available in: nebulizer form, regular strength Intal  Similar to:Tilade ®
  • 64. Doses. Drug form dose chromyl MdI 1mg/puff Nebulizer 20mg/amp 1to2puffs tid/qid 1 amp tid/qid nedocromil MDI 1.75 mg/puff 1to 2 puffs bid/qid
  • 65.  COMBINATIONS…
  • 66. Combivent®  Generic: ipratropium bromide & albuterol sulfate  Type: anticholinergic & beta2-agonist MDI  Class: combination  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: tremors,  heart rate, headache, dizziness, nausea, cough, dry mouth  Similar to: (kind of similar to Advair)
  • 67. Symbicort  Generic: budesonide, a steroidal anti- inflammatory agent, and formoterol, a bronchodilator  Type: steroid & beta2- agonist MDI  Class: combination"controller  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: tremors,  heart rate, headache, dizziness, nausea, cough, dry mouth
  • 68. Xaltide Inhalar  Albuterol:50mcg/actu, Beclomethasone (Dipropionate):100mcg /actu  Indicated for the long- term management of asthma only when the need for inhaled corticosteroid and bronchodilator therapy has been established
  • 69. Autohaler  This is a breath activated device, and thus had the advantage that breathing and pressing don’t need to be co-ordinated.  Shake the device  Remove the cap  Prime the device – pull the red lever up so that it clicks  Whilst sat upright, take a normal breath out.  Inhale slowly and deeply – don’t be put off by the click. Keep breathing in to a full inspiration, and then hold your breath for 10 seconds  Push the red lever back down. Replace the cap  Remember the tell the patient they wont feel the spraying sensation at the back of the throat and that this is normal. They may still be able to taste the drug though.
  • 70. Maxairautohaler®  Generic: pirbuterol acetate  Type: autohaler; fast/short acting beta2-agonist  Class: rescue/reliever  Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs  Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)  Also available in: Maxair inhaler  Similar to:Ventolin, Alupent, Brethaire, Metaprel, Proventil
  • 71. MDI spacer Decrease of oropharyngeal deposition Proposing inhaled CS
  • 72. MDI Spacer  A spacer not only allows for better co- ordination of breathing and dispensing the drug, but it also has a molecular effect. Larger molecules of drug are the ones that normally deposit themselves on the mucosa, and thus these are the ones that can lead to candida, hoarseness of the voice or systemic effects if swallowed. But in a space, the larger molecules remain in the spacer, and only the smaller drug molecules are actually inhaled
  • 73. How Should a Child Use an Inhaler – with a Spacer? • Ask child to breathe out • Have child place spacer in mouth • Press down on inhaler • Ask child to take a slow deep breath • Encourage child to hold breath for five (5) seconds • Remove spacer for exhalation • Wait one minute before repeating the process if there is a second puff ordered
  • 74. MDI spacer
  • 75. With a spacer  Need to be replaced every couple of months  Need to be washed every day in soapy warm water, and only let them dry by evaporation (drip drying) – do not wipe it dry! –this causes build up of static electricity  They reduce the velocity of the drug particles, and thus reduce the number of particles being deposited on the mouth and pharynx
  • 76. Washing the mouth  If you rinse out your mouth with water after using the inhaler this reduces the risk of thrush and irritation to the mucosa of the mouth and pharynx.
  • 77. Dry powder inhaler (DPI)
  • 78. Dry-powder inhaler – Breath- activated inhalers  This kind of inhaler uses just dry-powder and no propulsion system at all. All you have to do is take a deep, fast breath which will make you inhale a single dose. they usually rely on a manual mechanism to insert one dose of dry- powder drug into the mouthpiece. The most common systems are the turbohaler and the diskhaler. In both systems, you have to turn or twist the body until a “click” sound signals that a dose has been inserted and is ready to be inhaled
  • 79. DRY POWDERED INHALERS (DPIs  With DPIs the patient's breath (rather than hand action) actuates delivery of the medication.You cannot see the spray because the only way to get the medication is to inhale it from the mouthpiece. Within the DPI category, there are two broad types:DPIType 1): the medication is contained within the inhaler device at all times, until inhaled, or DPIType 2): the medication comes in a separate capsule that must be placed into the inhaler device at the time of use.
  • 80. Type 1 medication is contained within the inhaler device ..eg pulimcort DPIType 2. Medication is separate from the inhaler, in a capsule eg he widely used drug Spiriva (tiotropium bromide) •Turbuhaler
  • 81. Classification of Dry Powder Inhalers, Based on Design and Function  Single-Dose Devices  Aerolizer formoterol capsule single  HandiHaler tiotropium capsule single
  • 82. Multiple-Dose Devices  Turbuhaler budesonide reservoir 200  Turbuhaler budesonide/formoterol reservoir 120  Diskus salmeterol blister strip 60  Diskus salmeterol/fluticasone blister strip 60
  • 83. Dry powder inhaler (DPI) Multi doses
  • 84. Sereventdiscus®  Generic: salmeterol xinafoate  Type: dry powder discus; long acting beta2-agonist  Class: controller/preventer  Functions: prevents tightening of muscles around lung tubes; takes 10-20 mins to work, effective for at least 12 hrs.  Side Effects/Suggestions: tremors,  heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief  Also available in: Serevent inhaler  Similar to: related to Foradil & Oxeze
  • 85. Combination (fluticasone and salmeterol) SereventFlovent + = Advair Inhaled Corticosteroids with Long-acting Bronchodilator
  • 86. Advair®  Generic: fluticasone & salmeterol  Type:combination, powder discus  Class: controller/rescue  Functions: anti- inflammatory; open airways for at least 12 hours  Side Effects/Suggestions: hoarseness; rinse mouth with water after use; never increase the puffs unless directed  Also available in: purple, blue; 100, 250, 500 mcg  Similar to: Combivent (ipratropium bromide & albuterol sulfate)
  • 87. DOSES DRUG FORM DOSE Fluticasone/salme terol DOI 100,250,or 500ug/50 ug 1 Inhalation bid
  • 88. Adverse Effects LOCAL SYSTEMIC INH CS Candidiasis Dysphonia Adrenal suppression Growth retardation (large doses) INH B2 AGONIST Sympathetic stimulation- tremor Tachicardia Hypokalemia
  • 89. PROPELLANT-FREE "SOFT MIST" INHALERS  This is the latest type of inhaler for asthma and COPD. At this writing there is only one soft mist inhaler marketed in the United State  COMBIVENT budesonide + formoterol  RESPIMAT does not contain any of these harmful propellants and uses a spring mechanism to release the medication
  • 90. Nebulizer  Compressor nebulizer is the most commonly used and this consists of an air compressor that is connected to a cup provided for medication. This cup is attached to a mouthpiece or face mask.The compressor produces compressed air that is passed through the cup with liquid medicine.As the air comes in contact with the liquid medicine, an aerosol mist is formed and this mist is inhaled by the patient through the mouthpiece or face mask. In case of nebulizer treatments for infants, usually a face mask is used and not the mouthpiece.  in short, nebulizer converts liquid medicine to aerosol mist that can go deep into the airways and alleviate inflammation.
  • 91. VENTOLIN® Respirator Solution VENTOLIN NEBULES  Respirator Solution/  5 mg salbutamol  base/ml  The average dose for a single treatment is 0.25 to 0.5 mL of  VENTOLIN®  Respirator Solution (1.25 to 2.5 mg of salbutamol) diluted in 2 to 5 mL or  more of sterile normal saline. For more refractory cases, the single dose ofVENTOLIN®  Respirator Solution may be increased to 1 mL (5 mg of salbutamol). Treatment may be  repeated four times a day if necessary.  Nebules/unit dose/  2.5 or 5.0 mg  salbutamol base/ 2.5 mL  Children requiring a single dose of 2.5 mg may be administered  the contents of a singleVENTOLIN®  Respirator Solution unit dose (VENTOLIN  NEBULES®  P.F. 2.5 mg of salbutamol). For more refractory cases children may use a  5 mg unit dose (see dosage above). Treatment may be repeated 4 times a day if necessary
  • 92. Dose (mg) of Salbutamol (per treatment) Volume (mL) of Ventolin respirator Solution (per treatment) Volume* (mL) of Sterile Normal Saline to be added as diluen 1.25 0.25 2-5 mL or mor 2.5 0.50 2-5 mL or mor 5 1.00 2-5 mL or mor
  • 93. THANKYOU