Inhaled Medications Used in Respiratory DiseasePASaskatchewan
Inhaled Medications used in Respiratory Disease Donna Turner, BSc, RRT, CRE Community Respiratory Care Program, Cooperative Health Centre, Prince Albert
A presentation on inhaled medication devices new and old. What to consider ensuring maximal drug delivery to your patients and how help choose the best device for each patient. Will also show resources available for clinicians to use in their practice.
Inhaled Medications Used in Respiratory DiseasePASaskatchewan
Inhaled Medications used in Respiratory Disease Donna Turner, BSc, RRT, CRE Community Respiratory Care Program, Cooperative Health Centre, Prince Albert
A presentation on inhaled medication devices new and old. What to consider ensuring maximal drug delivery to your patients and how help choose the best device for each patient. Will also show resources available for clinicians to use in their practice.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
This presentation is designed to promote correct inhaler techniques for people who suffer from asthma outlining what asthma is, the symptoms, how to use different inhalers. To find out more check out our blog section on inhaler techniques
https://www.nationwidepharmacies.co.uk/nwp-news/inhaler-technique/
History, Pharmacokinetics and Drug Deposition, Types, Techniques, Differences between different inhalers, Pitfalls and Errors of use, and Drugs used by inhalation
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
This presentation is designed to promote correct inhaler techniques for people who suffer from asthma outlining what asthma is, the symptoms, how to use different inhalers. To find out more check out our blog section on inhaler techniques
https://www.nationwidepharmacies.co.uk/nwp-news/inhaler-technique/
History, Pharmacokinetics and Drug Deposition, Types, Techniques, Differences between different inhalers, Pitfalls and Errors of use, and Drugs used by inhalation
In recent years, the pulmonary drug delivery system is found to be preferred route of administration for various drugs. It has been divided into three classes: Nebulizers, pressurized metered-dose inhalers, and dry-powder inhaler (DPI). This article focuses on the DPI formulation, principle of working, DPI devices, and evaluation parameters. DPI formulations consist of micronized drug blended with larger carrier particles, which enhance flow, reduce aggregation, and aid in dispersion. DPIs are commonly used to treat respiratory diseases such as asthma, bronchitis, and chronic obstructive pulmonary disease. DPI is formulated using four types of formulation strategies such as carrier-free, drug carrier, drug additive, and drug-carrier additive. The particle size of active pharmaceutical ingredients must be present in size range about 1–5 μm which also guarantee that the patient gets the same dose every time at different airflow rate. A DPI is a device that delivers medication to the lungs in the form of a dry powder. DPI devices can be categorized as capsule-based, blister based, canister/cartridge-based, and other types.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
6. Although evidence based treatments are available in most countries,
asthma control remains suboptimal, and asthma-related deaths
continue to be an ongoing concern.
13. Do healthcare professionals have sufficient knowledge
of inhaler techniques in order to educate their patients
effectively in their use?
70%
7%
23%
Incorrect technique
7 steps and
inspiratory flow
check correct
Correct technique 7
steps
Baverstock et al Thorax 2010;65:A117
19. 19
Controllers =
Medications taken daily
on a long-term basis to
keep asthma under
clinical control due to
antiinflammatory
Relievers =
Medications used on
an as-needed basis
that act quickly to
reverse
bronchoconstriction
and relieve
Controllers Vs Relievers
61. 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
64. 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
68. 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.
69.
70. ‒ Fine-particle fraction (FPF) is percentage of the aerosol
between 1–5 μm that deposit in the lung.
78. 78
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
79. 79
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
83. Three main types of inhaler devices are available:
1. The pressurized metered dose inhaler (pMDI)
2. The dry powder inhaler (DPI)
3. The soft mist inhaler (SMI)
111. 111
The inhaler is called an "Evohaler" - these are just parts of the brand
name, and reflect the fact that the inhalers contains no CFC propellants.
112. Occasionally you may experience a problem when using your pMDI. The most common problem is low
output or no mist following actuation.
113. It is not always possible to determine when your inhaler is empty by
shaking it; because some propellant remains in the canister after
all of the medication has been used,
A few inhalers now have dose counters to track the amount of the
medication used, including Ventolin-HFA.
Determine when an inhaler is empty
116. If you do not have a dose counter, but you use your inhaler on a regular
basis ,another option is to check the package insert to determine the
number of puffs or sprays available in the inhaler.
You can then divide that number by the average number of puffs you
use each day.
117. If you use your rescue inhaler infrequently, write the date you start
using it on the canister in permanent marker and consider refilling
it after three to four months, or sooner if you think it is no longer
effective.
118.
119. • In the past, An old technique called for “floating” the inhaler in a
bowl of water is no longer recommended, this method is not reliable
120. Shaking the Canister:
If your pMDI is left sitting for an extended period of time between uses,
the medication and the propellant can separate. So you will need to
shake the canister before you use the pMDI.
Not shaking the pMDI canister before use can reduce the delivered
dose of medication by as much as 25%.
121.
122. The patient should also be instructed that on first use, and after several
days or weeks of disuse, the pMDI should be primed.
Priming the pMDI involves discharging two to four doses into the
surrounding air (away from the patient) prior to use.
Patients should be encouraged to follow the priming instructions described
in the PIL , pMDIs have extra doses - initial priming.
Priming
123. Priming is Recommended before their initial use - ensure accurate mixing
of propellant and medication
Additional priming –
1) if a period of time has elapsed between uses
2) If pMDI is dropped.
Simply shake the pMDI, depress the canister, and release 1 or more sprays
into the room.
126. Timing of Actuation Intervals:
When you take your treatment, you should allow for a pause between
each puff from the inhaler.
It is recommended that you wait approximately 1 minute between
each puff as this may improve the action of the drug.
The rapid actuation of more than two puffs with the pMDI may reduce
drug delivery because of turbulence and the coalescence of particles.
136. Overcoming challenges- pMDI
Spacers /holding chambers
Eliminates need for coordination
Allow aerosol to expand
Allow more complete evaporation of propellants &
deposition of these particles in the device before
inhalation
Ensure aerosol particles have
A slower velocity
A smaller particle size when they reach patient
↓ Oropharyngeal deposition (from 80% to 30%)
142. Among patients taking ICS by using a pMDI, failure to maintain
meticulous oral hygiene (rinse, gargle and spit) after each dose will
increase the risk of ‘thrush’ (oropharyngeal candidiasis) and hoarseness,
caused by ICS deposited in the mouth and pharynx.
For those using a pMDI, the risk of these local side-effects can also be
reduced by using a valved spacer.
150. There are many spacers on the market, although little is known
about the benefit of one type versus another. In general, larger-sized
spacers appear to be more effective than smaller ones.
Proper technique and frequent cleaning are important to ensure
optimal drug delivery.
155. Cleaning Your Spacers /holding chambers
Spacers should be cleaned before first use and then
monthly by soaking in a solution of warm water with
kitchen detergent for 15 minutes
Spacers should be reviewed every 6–12 months to check
the structure is intact (e.g. no cracks) and the valve is
functioning.
158. Anti-Static Holding Chamber
Introducing the new PARI Vortex™ Non-
Electrostatic Valved Holding Chamber. It's a
revolutionary breakthrough in holding
chamber technology.
The non-electrostatic charge of the PARI
Vortex ensures that patients receive a more
consistent medication dose treatment after
treatment, day after day.
159. Important reminders about Spacers
Only use your spacer with a pressurized metered dose inhaler,
not with a Breath Actuated MDIs or dry-powder inhaler.
Spray only one puff into a spacer at a time.
Use your spacer as soon as you've sprayed a puff into it.
Never let anyone else use your spacer.
161. No… It is a myth!
When the child cries they have
prolonged expiration with very short and fast inhalation
162. Important reminders about Spacers
Only After using ICS , the throat and mouth should be rinsed thoroughly
(gargle deeply, rinse, and spit out) or in young children using a spacer with
face mask, the face should be washed off with plain water.
Multiple doses should be given as separate doses..Never double puff (i.e.
depress canister once, then immediately depress again) because the second
puff contains only propellant; wait at least 30 seconds between puffs to
allow proper medication-propellant mixing.
163. Important reminders about Spacers
1. To overcome difficulties of patients who are unable to use pMDIs correctly
(ie, because of coordination problems, physical or mental handicaps, etc)
2. To reduce the risk of adverse effects with inhaled respiratory medications
(especially when using high doses of ICS)
3. To decrease or eliminate coughing or arrested inspiration experienced by
some patients when using CFC-driven devices
4. To administer inhaled medication during acute severe asthma
exacerbations as recommended by ATS
166. Use and care of spacers
Inhaler devices. Thorax 2003; 58 (Suppl I):
Ensure spacer compatible with pMDI used
Administer drug by repeated single actuations of pMDI
into spacer, each followed by inhalation
Minimise delay between pMDI actuation and inhalation
Tidal breathing is as effective as single breaths
Spacers should be cleaned monthly by washing in
detergent and air drying, with mouthpiece wiped clean of
pMDI + spacer is preferred delivery method in children
aged 0-5 years
pMDI + spacer is as effective as other delivery methods
for other age groups
Choice of inhaler should be based on patient preference
and ability to use
167. Choosing an inhaler device for children with
asthma *-Age group Preferred device Alternative device
Younger than 4 years
Pressurized metered-dose inhaler
plus dedicated spacer with face
mask
Nebulizer with face mask
4-5 years
Pressurized metered-dose inhaler
plus dedicated spacer with
mouthpiece
Nebulizer with mouthpiece
Older than 6 years
Dry powder inhaler or breath
actuated pressurized metered-dose
inhaler or pressurized metered-
inhaler with spacer with
Nebulizer with mouthpiece
168. Dry-Powder Inhalers (DPIs)
DPIs deliver the medication to the lungs as a very fine powdered
form.
Since DPIs have no propellant, the medication is drawn into your
lungs as you take in a breath. This means you need to inhale quickly
and deeply to get the medication from the device way into your
lungs.
169. Dry-Powder Inhalers (DPIs)
DPIs are breath actuated. This means that DPIs do not contain propellant .
Instead, the fine powder is drawn from the DPI when you take a fast, deep
breath through the DPI. So, it is the patient using the DPI who provides the
force to get the medication out of the device.
170.
171.
172.
173.
174.
175. Do not swallow FORADIL capsules.
Never place a capsule directly into the mouthpiece
Hold the mouthpiece of the AEROLIZER Inhaler upright and press both
buttons at the same time. Only press the buttons ONCE.
You should hear a click as the FORADIL capsule is being pierced.
Do not exhale into the AEROLIZER mouthpiece
Tilt your head back slightly. Keep the AEROLIZER Inhaler level, with the
buttons to the left and right (not up and down)
175
Using aerolizer
176. Breathe in quickly and deeply .This will cause the FORADIL capsule to spin
around in the chamber and deliver your dose of medicine.
You should hear a whirring noise and experience a sweet taste in your mouth.
If you do not hear the whirring noise, the capsule may be stuck. If this occurs,
open the AEROLIZER Inhaler and loosen the capsule allowing it to spin freely.
Do not try to loosen the capsule by pressing the buttons again.
176
Using aerolizer
184. Turbuhalers
o Dry powder
o No propellant
o Requires patient effort
o Not compatible with spacer
o Requires breath hold
o Window with dose information
o Twist the base in both directions
to load
197. Tiotropium
FDA approvals
2004: Handihaler® for COPD
2014: Respimat® for COPD
2015: Respimat® for asthma in ≥ 12
2017: Respimat® for asthma in ≥6
GINA 2018 Guidelines
In Steps 4 & 5 :
• Add-on therapy for adults/adolescents with a
history of exacerbations
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm; www.ginasthma.org
198. FOR INTERNAL USE ONLY. STRICTLY CONFIDENTIAL.
DO NOT COPY, DETAIL OR DISTRIBUTE EXTERNALLY.
What is the Respimat® Soft Mist™ Inhaler?
The Respimat® Soft Mist™ Inhaler is a highly
efficient and effective inhaler developed by
Boehringer Ingelheim1,2
It delivers a metered dosage of medication by
mechanical energy, without the use of propellants2,3
The Respimat® Soft Mist™ Inhaler delivers
medication in a slow-moving fine mist and is
designed to overcome problems such as2,3
Limited drug deposition in the lung
Reliance on adequate patient coordination
for effective inhalation
Use once daily in two consecutive puffs
(2.5 mcg per puff)1
198
199. FOR INTERNAL USE ONLY. STRICTLY CONFIDENTIAL.
DO NOT COPY, DETAIL OR DISTRIBUTE EXTERNALLY.
FOR INTERNAL USE ONLY. STRICTLY CONFIDENTIAL.
DO NOT COPY, DETAIL OR DISTRIBUTE EXTERNALLY
Respimat® unique mist
• The Respimat® unique mist has all the properties needed for deep lung deposition
Aerosol velocity: the unique mist is slow-moving, allowing it to
follow the natural curve of the throat, resulting in lower deposition
in mouth and throat1
Aerosol duration: the unique mist cloud is long-lasting (1.5 s).
Patients have enough time to breathe in the medication1
Highly respirable, fine droplets: up to 77% of the droplets are in
the fine particle fraction, helping patients get the medication deep
into the lungs2
Respimat® generates a unique mist leading to deep lung deposition
Features and benefits
1. Hochrainer 2005.
2. Ziegler 2005.
205. FOR INTERNAL USE ONLY. STRICTLY CONFIDENTIAL.
DO NOT COPY, DETAIL OR DISTRIBUTE EXTERNALLY.
The Respimat® Soft Mist™ Inhaler delivers a higher
percentage dose than pMDIs
SLOW INHALATION
FINE
PARTICLES
1–5 µm
Whole lung deposition was higher with Respimat® Soft Mist™ Inhaler than
with pMDI in trained patients (53% of delivered vs. 21% of metered dose)
205
TOTAL LUNG DEPOSITION
Study undertaken in patients with COPD
209. Improving inhaler technique
Physical demonstration is essential
1. Face-to-face or video (van der Palen 1997; Basheti 2005)
2. Written instructions are ineffective (Bosnic-Anticevich 2010)
Education must be repeated
1. Skills drop off within 4-6 weeks for both patients and health professionals
2. Useful to check periodically even for highly experienced patients
Repeated inhaler skills training is highly effective
1. Brief education in community pharmacy leads to improved asthma
outcomes (Basheti JACI 2007)
2. Average 2.5 minutes (Basheti Patient Educ Couns 2008)209
212. BTS/SIGN 2011 Recommend
Prescribe inhalers only after patients have received training in
the use of the device And have demonstrated a satisfactory
technique.
213. 213
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