17. 17
Controllers =
Medications taken
daily on a long-term
basis to keep
asthma under
control due to
antiinflammatory
effects
Relievers =
Medications used on
an as-needed basis
reverse
bronchoconstriction
and relieve its
symptoms that act
quickly
Controllers Vs Relievers
71. What are the advantages of inhaled therapy?
Direct delivery of drug to site of action
Rapid onset of action
Lower dose (than systemic administration) to
produce desired effects
Minimizes systemic adverse effects
74. Particle dynamics in respiratory tract
The physical mechanisms
governing the movement
and deposition of aerosol
particles in the air are:
1. Impaction
2. Sedimentation
3. Diffusion
75. Inertial impaction occurs in either the oropharynx or at bifurcations
of main branches of the bronchial tree, particularly in the large
central airways.
It occurs mainly with large particles or high velocity particles,
where they are unable to follow the airstream when it changes
direction, thus impacting on the airway wall.
76
76. Gravitational sedimentation occurs for smaller particles that are able to
follow the airstream and penetrate the more peripheral bronchioles.
Particles to settle on to the airway surfaces either during the course of slow
steady breathing or during breath-holding.
Breath-holding is important for smaller particle sizes, owing to the
increased chance of exhalation of the drug, because they can remain
airborne for a considerable time, Breath-holding increases gravitational
sedimentation.
77. Particle size is important, those that are too small may be exhaled; those
that are too large experience inertial impaction in the oropharynx and
large conducting airways.
Increased aerosol particle speed increases the probability of deposition
by impaction in the oropharynx and large conducting airways .
Slow aerosol particle speed allows more particles to settle on to the
airway surfaces i.e Gravitational sedimentation .
78
82. The observed clinical effect is dependent on the amount of drug
reaching the lungs at inhalation, lung deposition
The amount of drug reaching the lungs at inhalation, lung deposition, is
dependent on the fine particle dose = Fine particle fraction (FPF) .
Fine-particle fraction (FPF) is percentage of the aerosol between 1–5
μm that deposit in the lung.
83. MMAD
The calculated aerodynamic diameter that divides the particles of an
aerosol in half, based on the weight of the particles.
Mass Median Aerodynamic Diameter (MMAD) is defined as the
diameter at which 50% of the particles by mass are larger and 50%
are smaller .
By weight, 50% of the particles will be larger than the MMAD and 50%
of the particles will be smaller than the MMAD.
84. MMAD of 5 μm =?
50 % of the total sample mass will be present in particles having
diameters less than 5 μm, and that 50 % of the total sample mass will be
present in particles having an diameter larger than 5 μm.
89. 1) Sub optimal communication between HCP & patient
2) Lack of opportunity to discuss fear of side effects
3) Patients under-estimate the severity
4) Over-estimate their level of control
5) Technique
Barriers for using inhalers
94. 95
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
95. 96
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
95%
5%
Schematic representation of potential dose distributionAdapted from Barnes et al. AJRCCM 1998;157:S1-S53
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Fate of inhaled drugs – Poor Technique
96. 97
Inhaled medications is a waste of money if not used properly
Poor technique is a barrier to good asthma control
Check at each visit
Don’t rely on patient’s knowledge – ask them to demonstrate
97. BTS/SIGN 2011 Recommend
Prescribe inhalers only after patients have received training
in the use of the device And have demonstrated a
satisfactory technique.
103. Q1 .Which of the following is/are not a correct combination?
a) Salbutamol-blue MDI inhaler
b) Salmeterol-turbuhaler
c) Tiotropium Bromid-white MDI inhaler
d) Budesonide- MDI inhaler
e) Formoterol-Handihaler
104. Q2 .The Accuhaler can contain the following :
a) Fluticasone Proprionate
b) Salbutamol
c) Budesonide
d) Salmeterol
e) Tiotropium Bromide
105. Q3 . Which of these is/are not a correct combination?
a) Blue MDI-short acting beta agonist
b) Purple MDI-anticholinergic
c) Red MDI-inhaled Corticosteroid
d) Handihaler-anticholinergic
e) Aerolizer-Long acting beta agonist
106. Q4 . Which of the following comes as a dry powdered inhaler?
a) Fluticasone/Salmeterol (Seretide Diskus)
b) Albuterol HFA (Ventolin HFA )
c) Tiotropium (Spiriva Respimat )
d) Tiotropium (Spiriva Handihaler )
e) A & D
107. Q5 . The optimal delivery method of albuterol for a typical 16-
year-old asthma patient is:
a) A. Nebulization
b) B. Oral solution
c) C. MDI with a valved-holding chamber and mask
d) D. MDI
e) E. Oral tablet
