This document discusses various inhalation delivery systems used for asthma and COPD treatment. It describes pressurized metered dose inhalers, dry powder inhalers, nebulizers, and the drugs commonly used with each. The advantages and disadvantages of each delivery system are provided. For asthma, inhaled glucocorticoids, long-acting beta-agonists, cromolyn, and short-acting beta-agonists are discussed. For COPD, long-acting beta-agonists, anticholinergics like tiotropium, and inhaled corticosteroids alone or in combination are covered. Proper inhaler technique is emphasized for optimal treatment.
History, Pharmacokinetics and Drug Deposition, Types, Techniques, Differences between different inhalers, Pitfalls and Errors of use, and Drugs used by inhalation
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 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/
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.
Metered Dose Inhaler or MDI is a common type of anti-asthmatic drug device that being used around the world for many years. It helps to treat immediate asthmatic attack and some types of them can help prevent recurrent attack. Aero-chamber helps children and elderly use MDI to deliver the drugs to the lungs efficiently by attach it to the MDI only.
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.
Metered Dose Inhaler or MDI is a common type of anti-asthmatic drug device that being used around the world for many years. It helps to treat immediate asthmatic attack and some types of them can help prevent recurrent attack. Aero-chamber helps children and elderly use MDI to deliver the drugs to the lungs efficiently by attach it to the MDI only.
Anatomical localisation of function is a fundamental principle in the neurosciences. This presentation highlights the basics neuroanatomy and correlate major brain structure with their functions.
AI and Machine Learning Demystified by Carol Smith at Midwest UX 2017Carol Smith
What is machine learning? Is UX relevant in the age of artificial intelligence (AI)? How can I take advantage of cognitive computing? Get answers to these questions and learn about the implications for your work in this session. Carol will help you understand at a basic level how these systems are built and what is required to get insights from them. Carol will present examples of how machine learning is already being used and explore the ethical challenges inherent in creating AI. You will walk away with an awareness of the weaknesses of AI and the knowledge of how these systems work.
Chronic Obstructive Pulmonary Disease (COPD) called as Chronic Obstructive Airway Disease.
COPD is characterized by difficulty in exhaling air.
It is slowly progressive disease and irreversible.
The most common cause of COPD is Cigarette Smoking.
COPD may include diseases that cause airflow obstruction (eg., Emphysema, Chronic Bronchitis) or combination of these disorders.
Introduction
Anatomy and physiology of lungs
Advantage and disadvantage of Pulmonary Drug Delivery system.
Aerosols , propellants & container types.
Current technologies for pulmonary drug delivery.
New technologies for pulmonary drug delivery.
Evaluation of Pharmaceutical Aerosols & PDDS.
Pulmonary drug delivery is primarily used to treat conditions of the airways, delivering locally acting drugs directly to their site of action.
Delivery of anti-asthmatic and other locally acting drugs directly to their site of action reduces the dose needed to produce a pharmacological effect, while the low concentrations in the systemic circulation may also reduce side-effects.
The drugs which are administered by pulmonary route are not only for lungs delivery but it goes to systemic circulation and produce the effect where it is desired through out the body. For Eg. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler for the treatment of migraine & Volatile anesthetics, including, halothane, are also given via the pulmonary route.
Used for inhalation and topical aerosols .
Manufactured by impact extrusion process.
Light in weight, less fragile, Less incompatibility due to its seamless nature.
Greater resistance to corrosion .
Pure water and pure ethanol cause corrosion to Al containers.
Added resistance can be obtained by coating inside of the container with organic coating like phenolic , vinyl or epoxy and polyamide resins.
, on 7 January, Chinese authorities confirmed that they had identified a new virus. The new virus is a coronavirus, which is a family of viruses that include the common cold, and viruses such as SARS and MERS.
This new virus was temporarily named “2019-nCoV
Bacterial flora in sputum and antibiotic sensitivity in exacerbations of bron...Dr.Aslam calicut
http://jmscr.igmpublication.org/home/index.php/current-issue/5487-bacterial-flora-in-sputum-and-antibiotic-sensitivity-in-exacerbations-of-bronchiectasis
http://jmscr.igmpublication.org/v6-i8/65%20jmscr.pdf
Muhammed Aslam et al JMSCR Volume 06 Issue 08 August 2018
Obstructive Sleep Apnoea and the Metabolic SyndromeDr.Aslam calicut
Introduction
OSA and the Metabolic Syndrome
OSA and Obesity
OSA and Hypertension
OSA and Insulin Resistance
OSA and Dyslipidemia
Pathogenesis
Effect of Treatment
Conclusion
Napcon 2014 presentation abstract Page 14 - Presentation28
High Dose Rate Endobronchial Brachytherapy for Palliative Treatment of Lung Cancer – A Case Report Muhammed Aslam N K , Rajeev Ram , Achuthan V , Manoj D K ,Rajani M Pariyaram medical colleg , kannur
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
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. Propellants
Provides the force to generate the aerosol cloud and is also the
medium in which the active component must be suspended or
dissolved. Propellants in MDIs typically make up more than 99% of
the delivered dose
7. • Chlorofluorocarbons (CFCs)
most commonly used propellants were the
chlorofluorocarbons CFC-11, CFC-12 and CFC-114.
Banned due to adverse effect on ozone layer
• hydrofluoroalkanes (HFA)
HFA 134a (1,1,1,2,-tetrafluoroethane)
These new devices are more effective. The HFA
propellant produces an aerosol with smaller particle size,
resulting in improved deposition in the small airways and
greater efficacy at equivalent doses compared with CFC
MDIs.
8. • When the valve is actuated propellant
and drug leave the inhaler at high
velocity
• Majority of drug impacts in
oropharynx
• Less than 25% reaches the lung
9. Most efficient way of using MDI- steps
• Shake the canister
• Place the mouthpiece of actuator between
the lips
• Breathe out steadily
• Release the dose while taking a slow
deep breath in
• Hold the breath in while counting to 10
10. Advantages of MDIs
• Compact, portable ,convenient
• Multidose delivery capability
• Lower risk of bacterial contamination
• Suitable for emergency situation
11. Disadvantages of MDIs
• Needs correct actuation and inhalation
coordination- difficult for children and
elderly patients
• Cold freon effect
• High pharyngeal drug deposition
• Flammability possibility of new HFA
propellants
• Remaining dose –difficult to determine
13. Steps for Using a Spacer with an MDI
• Insert the inhaler/canister into spacer and
shake.
• Breathe out.
• Put the spacer mouthpiece into your
mouth.
• Press down on the inhaler once.
• Breathe in slowly (for 3-5 seconds).
• Hold breath for 10 seconds.
14. Advantages of MDI with spacer
• Compensate for poor technique/coordination
with MDI
• Spacers slow down the speed of the aerosol
coming from the inhaler, meaning that less of
drug impacts on the back of the mouth and
somewhat more may get into the lungs.
Because of this, less medication is needed for
an effective dose to reach the lungs, and there
are fewer side effects from corticosteroid residue
in the mouth.
15. Disadvantages
• Large size and volume of device
• Bacterial contamination is
possible; device needs to be
cleaned periodically
• Electrostatic charges may reduce
drug delivery to the lungs
21. Advantages
• Breath-actuated
• Less patient coordination required
• Spacer not necessary
• Compact Portable
• No propellant
• Usually higher lung deposition
than a pMDI
22. Disadvantages of DPI
• Work poorly if inhalation is not forceful enough
• Many patients cannot use them correctly (e.g.
capsule handling problems for elderly
• Most types are moisture sensitive
Humidity potentially causes powder clumping
and reduced dispersal of fine particle mass
• Need to reload capsule each time
24. Pneumatic Jet Nebulizer
• Delivers compressed gas through a jet, causing an area
of negative pressure and drawing the liquid up the tube
by the Bernoulli effect. The solution is entrained into the
gas stream and then sheared into a liquid film that is
unstable and is broken into droplets by surface tension
forces. The fundamental concept of nebulizer
performance is the conversion of the medication solution
into droplets in the respirable range of 1-5 micrometers
25.
26. Ultrasonic Nebulizer
• Generates high-frequency ultrasonic waves
(1.63 MHz) from electrical energy via a
piezoelectric element in the transducer. These
ultrasonic waves are transmitted to the surface
of the solution to create an aerosol. Aerosol
delivery is by a fan or the patient’s inspiratory
flow; particle sizes may be larger with this
device. A limitation of ultrasonic nebulizers is
that they do not nebulize suspensions efficiently
27. Advantages Of Nebulizers
• Provide therapy for patients who cannot
use other inhalation modalities (eg, MDI,
DPI)
• Allow administration of large doses of
medicine
• Patient coordination not required
• Effective with tidal breathing
• Dose modification possible
• Can be used with supplemental oxygen
28. Disadvantages Of Nebulizers
• Decreased portability
• Longer set-up and
administration time
• Higher cost
• Electrical power source
required
• Contamination possible
32. Inhaled Glucocorticosteroids
• Most effective anti inflammatory
medication for the treatment of persistent
asthma
• Reduces asthma symptoms
• Improves quality of life
• Decrease Airway hyper responsiveness
• Improve lung function
• Control airway inflammation
• Decrease frequency and severity of
exacerbations
• Decrease mortality
35. • Most of the benefit – dose equivalent of
400 microgram budesonide per day
• Increasing dose – Little benefit & more
side effect
• Add-on therapy with another class
controller is preferred over increasing dose
of steroids
• Tobacco smoking decreases
responsiveness to inhaled glucocorticoids
36. Local Side effects
• Oropharyngeal candidiasis
• Dysphonia
• Cough (upper airway irritation)
• s/e reduced by –spacer,mouth
washing, prodrug(ciclesonide,beclom
ethasone)
37. Systemic side effect
• Depends on dose , potency, delivery
system, systemic bio availability ,half
life, first pass metabolism, treatment
duration
• Easy bruising, adrenal suppression,
decreased bone mineral density
,cataract, glaucoma
38. Long acting inhaled beta2 agonists
• Salmeterol and formoterol
• Not as monotherapy
• Most effective when combined
with inhaled glucocorticoids
39. Advantages of combination therapy
• Improve symptoms scores
• Decreases nocturnal asthma symptoms
• Improve lung functions
• Decreases use of rapid acting inhaled b2
agonists
• Reduces no: of exacerbation
• Rapid control
• Reduces dose of inhaled glucocorticoids
40.
41. • Salmeterol and Formoterol has
similar duration of action , but
formoterol has more rapid onset
• Formoterol Budesonide
combination can be given for both
rescue and maintenance
42. Side effects
• Less than oral treatment
• Cvs stimulation , skeletal muscle
tremor
• Hypokalemia
• Refractoriness to beta 2 agonists
43. Cromones
• Sodium cromo Glycate , Nedocromil
sodium
• Limited role
• Mild persistent asthma and exercise
induced bronchospasm
• Less effective than low dose inhaled
glucocorticoids
• s/e – cough, sore throat , unpleasant taste
47. Rapid acting inhaled beta 2 agonist
• Salbutamol , terbutaline, fenoterol,
levalbuterol,reproterol,pirbuterol
• Medication of choice for relief of bronchospasm during
acute exacerbation of asthma and pre treatment of
exercise induced broncho constriction
• Should be used only on an as needed basis at lowest
dose and frequency
• s/e – tremor, tachycardia
48. Anti cholinergic broncho dilators
• Ipratropium bromide, oxitropium
bromide
• Less effective than beta 2 agonists
• Combination with b2 agonist-
significant improvement
• S/e dryness, bitter taste
52. Inhaler Therapy For COPD
Taken from Global Initiative for Chronic Obstructive Lung Disease
(GOLD) Guidelines 2011
53.
54.
55.
56. Beta2 Agonists
• Effect of short acting b2 agonist- 4to 6 hrs
• Improves FEV1 and symptoms
• Long acting beta2 agonist -12 hr or more
• Formoterol and salmeterol improves FEV1 ,lung
volumes,dyspnoea,health related quality of
life,exacerbation rates
• Indacaterol – duration of action 24hrs
57. Anti cholinergic
• Ipratopium bromide , oxitropium bromide,
tiotropium bromide
• Broncho dilator action last longer than
SABA- upto 8 hrs
• Tiotropium – >24 hrs
58. Inhaled corticosteroids
• Long term treatment with inhaled CS
improves symptom , lung function
,quality of life, and reduces frequency
of exacerbations in COPD patients
with FEV1 < 60%
• Does not decline the long term
decline of FEV1 nor mortality
59. Combination Therapy
• Inhaled Coticosteroid with Long
Acting B2 Agonist is more
effective
• A triple therapy by adding
tiotropium may furthur improves
61. Conclusion
• A number of inhalation devices are
available for the treatment of
pulmonary diseases, each with its
own advantages and disadvantages.
None has proven to be superior to the
others in any of the clinical situations
tested. Whichever device is
chosen, the key to successful
treatment lies at a proper inhaler