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Inhalation therapy
- 1. INHALER THERAPY DR.MUHAMMED FASEED CH MBBS;MD Respiratory medicine
- 2. INTRODUCTION • Inhaler is a device used for delivering medication into body via the lung. • Delivers directly to the lungs • Higher Bio-availability • Rapid onset of action • Lower dose • Minimise the systemic effect
- 4. TYPES • DRY POWDERED INHALER (DPI) • METERED DRUG INHALER (MDI) • MDI WITH SPACER • NEBULISER
- 5. DPI
- 6. USING A DPI • Load a capsule into the device as directed • Breath out slowly and completely • Place the mouthpiece between front teeth and seal the lips around it • Breath in through the mouth quickly and deeply over 2-3 seconds • Remove the inhaler from the mouth.Hold your breath for 6-10 seconds
- 7. • Breath out slowly through the nose • Gargle after every dose to wash off drug deposited on oro-pharyngeal mucosa
- 8. ADVANTAGES OF DPI • Compact • portable • Short treatment time • Less patient coordination required • Propellent free
- 9. DISADVANTAGES OF DPI • Dependence on patients inspiratory flow • High oropharyngeal impaction • Moisture sensitive • Need to reload capsule each time
- 10. MDI
- 11. USING A MDI • Shake the canister(3-4 times) • Breath out steadly away from inhaler • Remove the cap • Place the mouthpiece between the teeth and close your mouth around it. • Release dose while you taking a slow breath in • Keep breathing In slowly until you’ve taken a full breath
- 12. • Remove the inhaler from the mouth • Hold for 10 seconds • Exhale through the nose • If you need 2nd puff wait for 30 seconds and follow same steps. • Gargle after every dose to wash off drug deposited on oro-pharyngeal mucosa
- 13. ADVANTAGE OF MDI • Portable • compact • Efficient drug delivery • Short treatment time • Lower risk of bacterial contamination
- 14. DISADVANTAGE OF MDI • Difficult for elderly and children • Reactions to propellants • Actuation and inhalation coordination required • Cold freon effect • Difficult to determine the remaining dose(few devices) • Cannot change drug concentration
- 15. MDI WITH SPACER
- 16. USING A MDI WITH SPACER • Shake the inhaler well before use • Remove cap from inhaler and spacer • Put the inhaler into the spacer • Breath out away from the spacer • Put the spacer mouthpiece into your mouth • Press the inhaler once • Breath in slowly until you’ve taken full breath • Remove the spacer • Hold breath for 5-10 seconds • Exhale through the nose
- 17. Tidal Breathing Technique • Shake the inhaler well before use • Remove cap from inhaler and spacer • Put the inhaler into the spacer • Breath out away from the spacer • Put the spacer mouthpiece into your mouth • Press the inhaler once • Gently breath in and out for five times • Remove the device from mouth
- 18. ADVANTAGES • Easy to use for elderly and children. • Actuation inhalation coordination not required • Overcomes Cold freon effect
- 19. DISADVANTAGES • Large size • expensive • Bacterial contamination is possible • Need to be cleaned
- 20. NEBULISER • Ultrasonic nebulisers utilize the vibration from piezoelectric crystal to produce aerosol clouds. • Jet nebulisers utilize compressed gas or electric compressor to generate aerosol clouds.
- 21. ADVANTAGES • Nebuliser can be used in ay age group • You can mix more than one medicine • High doses of medicine can be used • No special breathing techniques required
- 22. DISADVANTAGES • Needs an electrical power source • Larger device • Less portable • Long treatment time
- 23. RESPULES • Respule is an ampoule containing the pre- diluted drug,which can be used directly for nebulisation. • It is Expensive • Lower risk of contamination
- 24. RESPIRATORY SOLUTION • Respiratory Solution contains concentrated drug ,it is important to dilute with normal saline. • Asthalin 0.5 ml diluted with 1.5 ml of saline. • Ipravent 1ml in diluted with 3ml of saline. • It is cheaper • High chances of contamination
- 25. MEDICATIONS USED IN INHALER THERAPY
- 26. BETA 2 AGONIST • Relaxaion of smooth muscle In the Respiratory tract leads to Bronchodilatation. Commonly used:- • Short acting – Salbutamol, Levo-salbutamol(6 hrs) • Long acting- Salmeterol (12hr) • Short onset and long acting-Formoterol • Ultra long acting -Indacaterol
- 28. ADVERSE EFFECTS • Tremors • Tachycardia • Palpitation • Hypokalemia • Paradoxical bronchoconstriction(rare)
- 29. GLUCO-CORTICOSTEROIDS Commonly used:- • Beclomethasone • Budesonide • Fluticasone • Ciclesonide • Mometasone
- 30. MECHANISM OF ACTION • They bind to steroid receptor in the cytoplasm • Drug-receptor complex binds to dna • Induce the synthesis of specific mrna • Decreases formation of Prostaglandins,Cytokines,Leukotrienes, Eosinophils and Interleukin 3 • Reducing both airway inflammation and bronchial hyperresponsiveness.
- 31. ADVERSE EFFECTS • Dysphonia • Oral candidiasis • Sore throat • Cough due to irritation Systemic effect at dose >600ug/day • Osteoporosis,Growth Retardation(children),Hyperglycemia,Bruises, Adrenal crisis(rare)
- 32. ANTICHOLINERGIC • Smooth muscle relaxation within air way leading to Bronchodilatation Commonly used:- • Ipratropium(4-6hrs) • Tiotropium bromide(24hrs) • Glycopyrronium
- 33. MECHANISM OF ACTION • Anticholinergic drug blocks muscarinic recepotor and leads to Bronchodilatation. • Competitive antagonists of acetylcholine
- 34. ADVERSE EFFECT • Dryness of mouth • Scratching sensation in trachea • Dry cough • Unpleasant taste • Worsening glaucoma(if it comes contact with the eyes) • Blurred vision(if it comes contact with the eyes)
- 36. BRAND FORMULATION FORMS DOSE SALBAIR LEVO SALBUTAMOL MDI DPI RESPULES 50mcg 50mcg,100mcg 0.31mg,0.63mg,1.25 mg in 2.5 ml SALBAIR-I LEVOSALBUTAMOL and IPRATROPIUMBROM IDE MDI DPI RESPULES 50mcg/20mcg 100mcg/40mcg 0.63mg/500MCG,1. 25mg/500MCG in 2.5 ml
- 38. BRAND FORMULATION FORMS DOSE ASTHALIN SALBUTAMOL MDI DPI RESPULES RESP.SOLUTION 100mg 200mcg 2.5mg/2.5ml 5mg/1ml COMBIMIST L LEVOSALBUTAMOL and IPRATROPIUM BROMIDE MDI DPI RESPULES 50mcg/20mcg 100mcg/40mcg 1.25mg/500ug in 2.5ml
- 39. BRAND FORMULATION FORMS DOSE DUOLIN LEVOSALBUTAMOL and IPRATROPIUM BROMIDE DPI MDI RESPULES 100MCG/40mcg 50mcg/20mcg 1.25mg/500mcg in 2.5ml FORMOFLO FORMOTEROL and FLUTICASONE PROPRIONATE DPI MDI 250mcg/6mcg 100mcg/6mcg 250mcg/6mcg 125mcg/6mcg 50mcg/6mcg
- 40. BRAND FORMULATION FORMS DOSE BUDAMATE BUDESONIDE and FORMOTEROL MDI DPI 100MCG/6mcg 200MCG/6mcg 400MCG/6mcg SAME AS ABOVE IPRAVENT IPRATROPIUM BROMIDE MDI DPI RESPULES RESP.SOLUTION 20mcg 40mcg 500mcg/2ml 500mcg /2ml
- 41. THANK YOU