Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Recent Recommendation For Nasal
Nebulization
Monika V. Pawar
M.Pharm – I
Guided by : Dr.Indira Parab.
1
Nebulization
 Nebulization is means of administering drugs by inhalation.
 Liquid Nebulisation is a common method of med...
Indications of Nebulization
 Delivery of bronchodilator drugs :
On acute attack of asthma Nebulization is the most common...
Contraindications
 In some cases, nebulization is restricted or avoided due to
possible untoward results or rather decrea...
History
 1858- First Pressurised inhaler ,invented in France by Sales
Girons,it used pressure to atomize the liquid medic...
Ideal Nebulizer
 A minimum residual volume(< 0.5 ml)
 Aerosol delivered only during inhalation.
 No waste aerosol relea...
Changes made
OLD NEW
1. Large and bulky 1.Smaller in size
2.Plain on the ouside (white
plastic)
2.Does not look like a mac...
Particle size
 Mass median aerodynamic diameter
≤ 1μm : Reach up to the alveoli,
0.5-5μm: Beyond the 10th generation
of b...
NEBULIZERS
 Solution or suspensions can be nebulized by ultrasonics or an air
jet and administered via a mouthpiece, vent...
Siegle Steam Spray Nebulizer
 A spirit burner in the base boils water in the reservoir which
passes across the top of a t...
 Silbe Atomizer : A hand held nebulizer with a bulb syringe
that had to be squeezed
 Colossol Nebulizer : A glass nebuli...
Air jet Nebulizer
12
• In air jet nebulizer compessed air is
forced through an orifice,an area of low
pressure is formed w...
• Jet nebulizers are the most commonly prescribed because they are
easy to use and inexpensive.
• Disadvantages:
 Less po...
PARI Breath-Enhanced Jet Nebulizers
 Continuous gas flow to neb chamber combined with patients
inspired air.
 Exhaled ai...
ADVANTAGES DISADVANTAGES
High output ,short treatments. Cannot be used in ventilator
circuits.
Higher dose than T-Neb or M...
PARI LCPlus Jet Reusable Nebulizer
 The only Reusable Nebulizer approved for use with TOBI.
 Breath – enhanced delivery
...
PARI LC SPRINT Reusable Nebulizer
 10-20% Faster treatment times than PARI LC PLUS.
 Higher aerosol output.
 Simple,erg...
Breath Actuated Nebulizer
 Breath-actuated devices produce aerosol when the patient
inhales and do not when the patient e...
Bottom Load Aerosol Mask
• Does not directs aerosol towards
the mouth.
• Inefficient because of impaction
of aerosol onto ...
PARI Aerosol Mask
 Adult and Pediatric Masks
 Polyvinylchloride (PVC) soft Plastic
 Efficient and effective
 Directs a...
Ultrasonic Nebulizer
 Ultrasound waves are formed in an ultrasonic nebulizer
chamber by a ceramic piezoelectric crystal t...
 Ultrasonic nebulisers (i.e. aerosonic nebulisers) are
characterised by fast nebulisation of medicine particles into
extr...
Vibrating Mesh Nebulizer
 In this technology a mesh/membrane with
1000-7000 laser drilled holes vibrates at the
top of th...
 The old problems found with the ultrasonic wave
nebulizer, having too much liquid waste and undesired
heating of the med...
PARI eFlow nebulizer
 Advantages :
 A high respirable fraction due to the precisely defined
perforations
 High liquid o...
 Aerosonic MicroMesh Nebulizer HL100 features :
 Portable, pocket sized and easy to carry
 Battery operated with low po...
Beurer IH 50 Ultrasonic Nebulizer
 Beurer IH50 ultrasonic nebulizer is effective and versatile and
can be used at home an...
Schill Mobil Aerosonic Nebulizer
 Schill Mobil Aerosonic Nebulizer utilises innovative advanced
electronic technology to ...
DigiO2 Micro Nebulizer
 Vibrating Mesh Technology
Creates mist-like droplets for better absorption and reduces
medicinal ...
New Generation Nebulizer
 AERx
 Advantages of the AERx System
• Small hand-held devices
• Very short administration time...
Nebulizer Solution Formulations
 Nebulizers are designed primarily for use with aqueous
solution or suspension.
 Drug su...
Method of Administration
 Nebulized aerosol is introduced to the patient by compressed
air from a device known as positiv...
• Face masks should be avoided or sealed very tightly when
anticholinergic drugs are administered to patients with
glaucom...
Nebulizer Design
 Present induction pneumatic nebulizer designs fit into 5
categories:
 1. Concentric:Concentric Nebuliz...
Non-induction nebulizers
 Enhanced parallel path nebulizers :
 This allows the gas and liquid to interact in the center ...
List of Medication
Brand Name Generic Name Category
Proventil Albuterol Bronchodilator
Ventolin Albuterol Bronchodilator
A...
Practical Issues
Cleaning :
 Nebulizers should be cleaned daily in regular usage and after each
use in intermittent use.
...
Physicochemical Aspects and Efficiency of Albuterol
Nebulization: Comparison of Three Aerosol Types in an
In Vitro Pediatr...
 RESULTS:
 The ultrasonic nebulizer was the fastest device based on the
duration of nebulization; the jet nebulizer was ...
CONCLUSIONS
 The in vitro model was effective for comparing nebulizer
types, demonstrating important differences between ...
References
 Anthony J. Hickey,Pharmaceutical Inhalation
Aerosol Technology,Second edition,Vol 134,pp-280-291.
 K.Nikanda...
 Pyung heum yeon, young min cho, and yong-nam
pak,development of an ultrasonic nebulizer using a domestic
humidifier,bull...
43
Upcoming SlideShare
Loading in …5
×

Recent recommendation for nasal nebulization

5,152 views

Published on

Recent Recommendation For Nasal Nebulization

Published in: Healthcare
  • Be the first to comment

Recent recommendation for nasal nebulization

  1. 1. Recent Recommendation For Nasal Nebulization Monika V. Pawar M.Pharm – I Guided by : Dr.Indira Parab. 1
  2. 2. Nebulization  Nebulization is means of administering drugs by inhalation.  Liquid Nebulisation is a common method of medical aerosol generation.  A nebuliser is a device that converts liquid into aerosol droplets (fine mist) suitable for inhalation.  Nebulisers use oxygen, compressed air or ultrasonic power to break up medication solutions and deliver a therapeutic dose of Aerosol particles directly to the lungs. 2
  3. 3. Indications of Nebulization  Delivery of bronchodilator drugs : On acute attack of asthma Nebulization is the most common means of delivery.  Administration of antibiotics and anti antifungal agents: In some cases of resistant chest infections for eg.cystic fibrosis antibiotics may be prescribed to be inhaled directly into the lung.  To aid expectoration : Inhalation of hypertonic saline has been found to increase clearance of bronchial secretions.  Local analgesia: To relieve dyspnea in patients such as those suffering from alveolar carcinoma. 3
  4. 4. Contraindications  In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as:  Patients with unstable and increased blood pressure  Individuals with cardiac irritability (may result to dysrhythmias)  Persons with increased pulses  Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low) 4
  5. 5. History  1858- First Pressurised inhaler ,invented in France by Sales Girons,it used pressure to atomize the liquid medication.  1864-First steam driven nebulizer,invented in Germany known as “Siegles steam spray inhaler”,it used the venturi principle to atomize liquid medication.  1930-First electric nebulizer called a Pneumostat,it used a medical fluid was made to aerosol by the power from an electric compessor.  1956- A technology competing against nebulizer launched by Riker Laboratory it used pressurised metered dose inhalers.  1964- New type of electronic nebulizer was introduced called the ultrasonic wave nebulizer. 5
  6. 6. Ideal Nebulizer  A minimum residual volume(< 0.5 ml)  Aerosol delivered only during inhalation.  No waste aerosol released to the environment.  Small and portable.  Aerosol delivered with a droplet size distribution suitable for pulmonary deposition.  Rapid treatment time,quite and unobtrusive in use.  Finally,perhaps also a means to monitor patient compliance. 6
  7. 7. Changes made OLD NEW 1. Large and bulky 1.Smaller in size 2.Plain on the ouside (white plastic) 2.Does not look like a machine (Design /Patterned exterior) 3.Long cords in the way. 3.Rectangular tubing 4.Large face mask and tube 4.Redesigned mouthpiece that mixes medicine instead of filters. 5.Noisy 5.Less noise 6.Runs on battery 7. Shut off machine by itself 7
  8. 8. Particle size  Mass median aerodynamic diameter ≤ 1μm : Reach up to the alveoli, 0.5-5μm: Beyond the 10th generation of bronchi (respirable particles), ≥ 5 μm : oropharynx 8
  9. 9. NEBULIZERS  Solution or suspensions can be nebulized by ultrasonics or an air jet and administered via a mouthpiece, ventilation mask or tracheostomy. Types of nebulizers :  Jet nebulizer  Ultrasonic wave nebulizer  Vibrating mesh Nebulizers 9
  10. 10. Siegle Steam Spray Nebulizer  A spirit burner in the base boils water in the reservoir which passes across the top of a tube suspended in the medication solution.  The passage of the steam draws the medication into the vapour.  The patient inhales the vapour through the glass mouthpiece. 10
  11. 11.  Silbe Atomizer : A hand held nebulizer with a bulb syringe that had to be squeezed  Colossol Nebulizer : A glass nebulizer with a rubber squeeze ball.  This took a lot of time, coordination, and even muscle strength to get an adequate amount of medicine to be aerosolized. 11
  12. 12. Air jet Nebulizer 12 • In air jet nebulizer compessed air is forced through an orifice,an area of low pressure is formed where the air jet exists. • A liquid may be withdrawn from a perpendicular nozzle (the Bernoulli effect) to mix with the air jet to form droplets. • A baffle within the nebulizer is often used to facilitate the formation of the aerosol cloud. • Carrier gas (oxygen) can be used to generate the “air jet”.
  13. 13. • Jet nebulizers are the most commonly prescribed because they are easy to use and inexpensive. • Disadvantages:  Less portable than inhalers  Delivery may take 5 to 10 mins or longer.  Require power sources, maintanance,cleaning.  Traditional jet nebulizers are often bulky and require an electrical source, which can be a problem in traveling.  Noisy 13
  14. 14. PARI Breath-Enhanced Jet Nebulizers  Continuous gas flow to neb chamber combined with patients inspired air.  Exhaled air does not mix with aerosol, amount of solution wasted is minimized 14
  15. 15. ADVANTAGES DISADVANTAGES High output ,short treatments. Cannot be used in ventilator circuits. Higher dose than T-Neb or MDI is possible. Not cost effective for short term use. Multiple one –way valve reduce waste. Not readily adaptable to tracheostomy masks. Dishwasher safe, may be boiled or autoclaved Cost effective for long -term 15
  16. 16. PARI LCPlus Jet Reusable Nebulizer  The only Reusable Nebulizer approved for use with TOBI.  Breath – enhanced delivery  Balance of fast treatment time and optional treatment efficiency 16
  17. 17. PARI LC SPRINT Reusable Nebulizer  10-20% Faster treatment times than PARI LC PLUS.  Higher aerosol output.  Simple,ergonomic,compact design.  Inspiratory valve cap cantbe lost.  Design prevent medication from spilling.  Easy view medication level indicator.  Robust ,flexible nozzle construction.  Medication cup self-drains when upside down. 17
  18. 18. Breath Actuated Nebulizer  Breath-actuated devices produce aerosol when the patient inhales and do not when the patient exhales.  Because the drug is not constantly being aerosolized, delivery is more efficient and less of the drug is wasted.  Disposable 18
  19. 19. Bottom Load Aerosol Mask • Does not directs aerosol towards the mouth. • Inefficient because of impaction of aerosol onto bridge of mask 19
  20. 20. PARI Aerosol Mask  Adult and Pediatric Masks  Polyvinylchloride (PVC) soft Plastic  Efficient and effective  Directs aerosol to mouth  Prevent impaction of aerosol.  Minimizes eye and face deposition.  Elongated mass “snout” create a “reservoir” where the aerosol velocity slows down and congregated before inhalation by the patients which increases “respirable” dose. 20
  21. 21. Ultrasonic Nebulizer  Ultrasound waves are formed in an ultrasonic nebulizer chamber by a ceramic piezoelectric crystal that vibrate when electrically excited.  These set up high-energy waves in the solution,within the device chamber ,of a precise frequency that generates an aerosol cloud at the solution surface. 21
  22. 22.  Ultrasonic nebulisers (i.e. aerosonic nebulisers) are characterised by fast nebulisation of medicine particles into extra small size for enhanced absorption in the very depth of the respiratory system, helping to increase the effects of medication.  Ultrasonic nebulisers are fast and discreet with reduced noise levels.  They can be used at home and during travel as many modern ultrasonic nebulisers are not only mains powered, but also battery powered for convenience.  Car adaptors are also used for nebulisation on the move or for recharging batteries.  The only drawback is medication restrictions because heat is transferred to the medication 22
  23. 23. Vibrating Mesh Nebulizer  In this technology a mesh/membrane with 1000-7000 laser drilled holes vibrates at the top of the liquid reservoir, and thereby pressures out a mist of very fine droplets through the holes.  This technology is more efficient than having a vibrating piezoelectric element at the bottom of the liquid reservoir, and thereby shorter treatment times are also achieved.  The high nebulization capacity (>0.25 ml/min) device offers short inhalation time. 23
  24. 24.  The old problems found with the ultrasonic wave nebulizer, having too much liquid waste and undesired heating of the medical liquid, have also been solved by the new Vibrating Mesh nebulizers.  A partial list of available VMT nebulizers includes: Pari eFlow, Respironics i-Neb,Omron,Beurer Nebulizer IH50, and Aerogen Aeroneb. 24
  25. 25. PARI eFlow nebulizer  Advantages :  A high respirable fraction due to the precisely defined perforations  High liquid output rate combine to produce a highly efficient and fast administration of inhaled medications.  Portability, ease of handling and noiseless operation have a positive effect on patient compliance,  Reduction of residual drug volumes left in the nebulizer, creating possible cost savings when administering expensive medications. 25
  26. 26.  Aerosonic MicroMesh Nebulizer HL100 features :  Portable, pocket sized and easy to carry  Battery operated with low power consumption  One touch, simple to operate, noiseless and discreet  Can nebulise effectively for up to 10 seconds in all directions (i.e. upside down or rotated to any angle)  Automatically shuts down at the end of inhalation 26
  27. 27. Beurer IH 50 Ultrasonic Nebulizer  Beurer IH50 ultrasonic nebulizer is effective and versatile and can be used at home and during travel, when access to mains power supply is not possible.  Low levels of noise generated by the Beurer IH 50 ultrasonic nebulizer make it pleasant and discreet in use.  It is a perfect nebuliser for adults as well as children. 27
  28. 28. Schill Mobil Aerosonic Nebulizer  Schill Mobil Aerosonic Nebulizer utilises innovative advanced electronic technology to deliver effective and safe inhalation therapy to adults and children.  It can be powered directly from the mains or by rechargeable battery.  effective with optimum droplet size.  suitable for a broad spectrum of medicines  comfortable, simple, quick and quiet  light and mobile for use anywhere 28
  29. 29. DigiO2 Micro Nebulizer  Vibrating Mesh Technology Creates mist-like droplets for better absorption and reduces medicinal waste  Light and easy to clean  USB Power Supply Allows easy charging in cars or traveling  One Button Operation Start and stop medicine delivery with just one button  Unique Capsule Design Stops automatically when delivery is complete 29
  30. 30. New Generation Nebulizer  AERx  Advantages of the AERx System • Small hand-held devices • Very short administration time (typically 1-2 breaths) • Highly efficient, precise aerosol delivery • Breath control to ensure reliable drug delivery to lung • Simple to use. 30
  31. 31. Nebulizer Solution Formulations  Nebulizers are designed primarily for use with aqueous solution or suspension.  Drug suspension use primary particles in the range of 2-5 microns.  Nebulizer solutions are usually formulated in water, although other cosolvent for eg. Glycerin, propylene glycol,and ethanol may be used.  Nebulizer solution pH be greater than 5.0 to show that bronchoconstriction is a function of hydrogen ion concentration. 31
  32. 32. Method of Administration  Nebulized aerosol is introduced to the patient by compressed air from a device known as positive pressure ventilator.  A mouthpiece may be inserted in the mouth may be attached tightly to the face.  A face tent fits more loosely around the patients mouth,allowing speech.  A tracheostomy mask may be fitted to the patients tracheostomy tube directly and require T shaped adapter. 32
  33. 33. • Face masks should be avoided or sealed very tightly when anticholinergic drugs are administered to patients with glaucoma. • Face masks should ideally also be avoided for delivery of nebulized corticosteroids, to prevent contact with the surrounding facial skin and eyes. 33
  34. 34. Nebulizer Design  Present induction pneumatic nebulizer designs fit into 5 categories:  1. Concentric:Concentric Nebulizers have a central capillary with the liquid and an outer capillary with the gas.  2. Cross Flow: Gas flow at right angles to the Liquid flow;  3. Entrained: Gas and Liquid mixed in the system and emitted as a combined flow.  4. Babington and V Groove: Liquid is spread over a surface to decrease the surface tension, and passed over a gas orifice;  5. Parallel Path: Liquid is delivered beside a gas orifice and induction pulls the liquid into the gas stream. 34
  35. 35. Non-induction nebulizers  Enhanced parallel path nebulizers :  This allows the gas and liquid to interact in the center of the gas flow where the gas flow speed is highest, producing a better transfer of energy from the gas to the liquid, and producing a finer droplet size. 35
  36. 36. List of Medication Brand Name Generic Name Category Proventil Albuterol Bronchodilator Ventolin Albuterol Bronchodilator Atrovent Ipratropium bromide Bronchodilator DuoNeb Ipratropium and Albuterol Bronchodilator Mucosil Acetyl Cysteine Mucolytics Intal Cromolyn Sodium Anti-inflammatory agent 36
  37. 37. Practical Issues Cleaning :  Nebulizers should be cleaned daily in regular usage and after each use in intermittent use.  The mask, mouthpiece and chamber should be disconnected, disassembled and washed in a warm detergent and water solution. The components should be left to dry overnight.  Before reuse, the nebuliser should be run for a few seconds before adding medications. Maintenance :  Disposable components such as the mouthpiece, mask, tubing and nebulizer chamber should be changed every three to four months.  Compressors require annual servicing by manufacturer or local service provider. 37
  38. 38. Physicochemical Aspects and Efficiency of Albuterol Nebulization: Comparison of Three Aerosol Types in an In Vitro Pediatric Model  METHODS:  The following nebulizers were tested: Sidestream Disposable jet nebulizer, Multisonic Infra Control ultrasonic nebulizer, and the Aerogen Pro and Aerogen Solo vibrating mesh nebulizers.  Aerosol duration, temperature, and drug solution osmolality were measured during nebulization.  Albuterol delivery was measured by a high-performance liquid chromatography system with fluorometric detection.  The droplet size distribution was analyzed with a laser granulometer. 38
  39. 39.  RESULTS:  The ultrasonic nebulizer was the fastest device based on the duration of nebulization; the jet nebulizer was the slowest.  Solution temperature decreased during nebulization when the jet nebulizer and vibrating mesh nebulizers were used, but it increased with the ultrasonic nebulizer.  Osmolality was stable during nebulization with the vibrating mesh nebulizers, but increased with the jet nebulizer and ultrasonic nebulizer, indicating solvent evaporation.  Albuterol delivery was 1.6 and 2.3 times higher with the ultrasonic nebulizer and vibrating mesh nebulizers devices, respectively, than with the jet nebulizer.  Particle size was significantly higher with the ultrasonic nebulizer. 39
  40. 40. CONCLUSIONS  The in vitro model was effective for comparing nebulizer types, demonstrating important differences between nebulizer types.  The new devices, both the ultrasonic nebulizers and vibrating mesh nebulizers, delivered more aerosolized drug than traditional jet nebulizers.  Different nebulizer/compressor combinations have markedly different performance characteristics which could result in different efficacy and safety profiles of the medications being administered via these devices 40
  41. 41. References  Anthony J. Hickey,Pharmaceutical Inhalation Aerosol Technology,Second edition,Vol 134,pp-280-291.  K.Nikandar,M.Sanders,The early evolution of nebulizers,pp: 1-7  Ruben D Restrepo,Effect of Face Mask Design on Inhaled Mass of Nebulized Albuterol, Using a Pediatric Breathing Model,pp:1-6  Evaluation and Design of Nebulizers,N.Sankagiri,G.A.Ruff,pp:1-5  Mark Sanders,Inhalation therapy : an historical review, Primary care Respiratory Journal(2007),pp: 71-81  LeBrun PP, de Beor AH A review of the technical aspects of drug nebulization.pp:1-7  http://justnebulizers.com/general-nebulizer-information 41
  42. 42.  Pyung heum yeon, young min cho, and yong-nam pak,development of an ultrasonic nebulizer using a domestic humidifier,bull. Korean chem. Soc. 1999, vol. 20, pp:1-4  C.J. Harvey,m.J. O'doherty,comparison of jet and ultrasonic nebulizer pulmonary aerosol deposition during mechanical ventilation,pp:1-5  Siraj Shaikh,recent advances in pulmonary drug delivery system,International journal of Applied Pharmaceutics,pp-1-5.  P.W. Barry,Drug output from nebulizers is dependent on the method of measurement ,pp:1-4  http://www.healthline.com/health/copd/nebulizers-for- severe-copd#1  http://www.webmd.com nebulizer-therapy /asthma/guide/home 42
  43. 43. 43

×