Focus sulle malattie respiratorie: Esiste il dispositivo ideale?Daniela Marchesini
Il Distretto come Driver dell'appropriatezza: focus sulle malattie respiratorie
Distretto 43 Asl Napoli 2 Nord
Presentazione convegno 17 Maggio 2014
Aula Convegni Distretto 43 Casoria
Il successo della terapia inalatoria: dal counceling alla interrogazione dei ...Daniela Marchesini
Progetto NET : Percorsi formativi di ricerca, di presa in carico e trattamento del paziente con asma scarsamente controllato e/o grave. Ospedale s. maria della pieta' casoria (na) 27 ottobre 2018
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.
Focus sulle malattie respiratorie: Esiste il dispositivo ideale?Daniela Marchesini
Il Distretto come Driver dell'appropriatezza: focus sulle malattie respiratorie
Distretto 43 Asl Napoli 2 Nord
Presentazione convegno 17 Maggio 2014
Aula Convegni Distretto 43 Casoria
Il successo della terapia inalatoria: dal counceling alla interrogazione dei ...Daniela Marchesini
Progetto NET : Percorsi formativi di ricerca, di presa in carico e trattamento del paziente con asma scarsamente controllato e/o grave. Ospedale s. maria della pieta' casoria (na) 27 ottobre 2018
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.
Nebulization involves administering drugs by inhalation through an electric or ultrasonic nebulizer that breaks liquid medications into fine mist. It is commonly used to deliver bronchodilators for asthma attacks. Other indications include administering antibiotics or analgesics to infants/children, aiding expectoration, and providing local lung analgesia. Proper preparation of the nebulizer, medications, patient, and environment is required. During treatment, the patient sits upright and breathes slowly and deeply through the mouthpiece for 15-20 minutes while monitored for complications like increased heart rate or wheezing. Outcomes such as loosened secretions are documented.
Inhalation is the administration of drugs through the nasal or oral respiratory route. It has several advantages over other routes of administration including lower systemic toxicity, more rapid onset of action, and higher drug concentrations delivered directly to the target site in the lungs. Common conditions treated with inhalation therapy include asthma, chronic bronchitis, and emphysema. There are various types of inhalation devices that deliver drugs to the lungs including metered dose inhalers, dry powder inhalers, nebulizers, and spacers. Proper inhalation technique is important for optimal drug delivery to the lungs from these devices.
In medicine, a nebuliser or nebulizer (see spelling differences) is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases.
The Top Skills That Can Get You Hired in 2017LinkedIn
We analyzed all the recruiting activity on LinkedIn this year and identified the Top Skills employers seek. Starting Oct 24, learn these skills and much more for free during the Week of Learning.
#AlwaysBeLearning https://learning.linkedin.com/week-of-learning
La immunoterapia "aspecifica" e la flora intestinaleeventslearnig
This document discusses the relationship between the intestinal flora and non-specific immunotherapy. It begins with an overview of innate and adaptive immunity as it relates to the flora, macrophages, dendritic cells, and regulatory and effector T cells. It then discusses research questions around the microbiome-host organism relationship, the microbiota's role in intestinal immune system maturation, the impact of diet on microbiota composition, and translational research. Methods for microbiota characterization are also reviewed. The document then discusses intestinal dysbiosis and its links to inflammatory diseases. It reviews probiotic administration studies related to allergy prevention and their effects on eczema and IgE levels. Finally, it summarizes the effects of probiotics like LGG
Nebulization involves administering drugs by inhalation through an electric or ultrasonic nebulizer that breaks liquid medications into fine mist. It is commonly used to deliver bronchodilators for asthma attacks. Other indications include administering antibiotics or analgesics to infants/children, aiding expectoration, and providing local lung analgesia. Proper preparation of the nebulizer, medications, patient, and environment is required. During treatment, the patient sits upright and breathes slowly and deeply through the mouthpiece for 15-20 minutes while monitored for complications like increased heart rate or wheezing. Outcomes such as loosened secretions are documented.
Inhalation is the administration of drugs through the nasal or oral respiratory route. It has several advantages over other routes of administration including lower systemic toxicity, more rapid onset of action, and higher drug concentrations delivered directly to the target site in the lungs. Common conditions treated with inhalation therapy include asthma, chronic bronchitis, and emphysema. There are various types of inhalation devices that deliver drugs to the lungs including metered dose inhalers, dry powder inhalers, nebulizers, and spacers. Proper inhalation technique is important for optimal drug delivery to the lungs from these devices.
In medicine, a nebuliser or nebulizer (see spelling differences) is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases.
The Top Skills That Can Get You Hired in 2017LinkedIn
We analyzed all the recruiting activity on LinkedIn this year and identified the Top Skills employers seek. Starting Oct 24, learn these skills and much more for free during the Week of Learning.
#AlwaysBeLearning https://learning.linkedin.com/week-of-learning
La immunoterapia "aspecifica" e la flora intestinaleeventslearnig
This document discusses the relationship between the intestinal flora and non-specific immunotherapy. It begins with an overview of innate and adaptive immunity as it relates to the flora, macrophages, dendritic cells, and regulatory and effector T cells. It then discusses research questions around the microbiome-host organism relationship, the microbiota's role in intestinal immune system maturation, the impact of diet on microbiota composition, and translational research. Methods for microbiota characterization are also reviewed. The document then discusses intestinal dysbiosis and its links to inflammatory diseases. It reviews probiotic administration studies related to allergy prevention and their effects on eczema and IgE levels. Finally, it summarizes the effects of probiotics like LGG
4. Monza, 25° Congresso Nazionale ACP 10-12 ottobre 2013
Dei 525 bambini che hanno iniziato lo studio, 521 sono stati visitati alla fine dei 10 giorni di terapia.
5.
6. Despite the availability of highly effective
therapies and evidence-based guidelines,
many patients with asthma continue to suffer
symptoms and exacerbations, with
considerable disruption to their daily life.
This may reflect under-diagnosis and poor
adherence to therapy, as well as incorrect
use of inhalers.
Primary Care Respiratory Journal (2009); 18(4):
241-242
EDITORIAL Inhaler choice and inhalation
technique:
7. ADERENZA AL TRATTAMENTO
Pillola anticoncezionale: 97%
Farmaci antiasmatici: <50%
la causa più comune di insuccesso della terapia è … che “non viene fatta”
9. “…pMDIs è efficace almeno quanto il nebulizzatore…”. Linee guida BTS-SIGN 2012
Rev. Cochrane 2009
10. Le scelte cliniche devono derivare
Esperienza
individuale
Fonti bibliografiche:
Linee guida SIGN rev.jan 2012
Rev. Cochrane 2009
Linee guida SIP 2008
Linee guida NICE rev 2005
Linee guida NCCHTA 2002
Rev stematiche
Studi clinici randomizzati
Miglior evidenza
della letteratura
Valori e
preferenze
del paziente
Sackett DL. 1998
11. Costo
torte peppe.pptx
Tempo di inalazione
Difficoltà di trasporto ed utilizzo
Mantenimento in efficienza
Dispersione di aerosol ed espirato nell’ambiente
Erogazione continua
Farmaco residuo in ampolla
13. Lo spray predosato (pMDI) è il
metodo più pratico ed economico di
somministrare i farmaci in forma
di aerosol
Difetti
• indicatore dose residua spesso manca
• velocità > 120 km/ora
• necessita buona coordinazione Linee guida SIAIP 2008
16. >5 anni
2 – 5 anni
DOSE EROGATA VS DOSE EFFICACE
1 – 2 anni
<1 anno
17. Nebulizzatore VS pMID con distanziatore
Salbutamolo:
=
Nebulizzazione: 1,5-2,0 mg/10Kg/dose (max 5 mg)
Spray: 2 puff /10Kg/dose = 200 mcg/10 Kg/dose (max 1 mg).
ASMA MEDIO-GRAVE
ASMA LIEVE
4-10 PUFF
2-4 PUFF
Mazahr SH et al. Relative lung deposition of salbutamol following inhalation from a spacer
Sidestream jet nebulizer following an acute exacerbation. Br J Cin Pharmacol 2008
and a
18. Distanziatore
valvola
Respir Care. 2006 Feb;51(2):140-4.
Force-dependent static dead space of face masks used with holding chambers.
Shah SA, Berlinski AB, Rubin BK.
22. Mymensingh Med J. 2012 Jan;21(1):66-71.
Efficacy of salbutamol by nebulizer versus metered dose inhaler with home-made nonvalved spacer in acute exacerbation of childhood asthma .
24. Per ottenere una dose di
polvere, basta ruotare una
volta la ghiera alla base del
dispenser e aspirare dal
boccaglio
Il funzionamento del disco è
simile al turboinalatore. La
dose si prepara premendo la
levetta sul lato e si aspira
attraverso l'apposito boccaglio
Linee guida SIGN rev.jan 2012
25. Da “manuale di allergologia, immunologia e broncopneumologia pediatrica
F. Cardinale; EN. Nettis
Marzo 2013
polmoni
bocca
apparecchio
esalato
nebulizzatore
5%
5%
70%
20%
pMDI
10%
75%
10%
5%
pMDI + spacer
20%
10%
69%
1%
DPI
25%
65%
5%
5%
Distribuzione dell’aerosol con i diversi tipi di device
26. Asma acuto:
indagine in 22 U.O di Pediatria del Nord Est Italia
Utilizzo preferenziale
95%
Spacer
Nebulizzatore
Radzik, Boner et al Allergy Asthma Proc 2005
27. Asma acuto:
131 Pediatri di famiglia del Nord Est Italia
Utilizzo preferenziale
30%
Spacer
Nebulizzatore
Radzik, Boner et al Allergy Asthma Proc 2005
28. Le competenze tecniche dei pazienti
256 bambini asmatici età 4-16 anni che usavano abitualmente lo spacer
Pedersen 1986
non scuotevano lo spray 34%
inalazione troppo veloce 29%
trattenevano il respiro < 7 sec 39%
erogavano gli spruzzi in sequenza 10%
29. E’ opportuno che medici ed infermieri seguano
dei corsi di training che devono essere
ripetuti nel tempo, e che periodicamente
testino la tecnica dei propri pazienti
servendosi di uno spray esaurito e di un
distanziatore dismesso
Linee Guida SIAIP 2008
Linee guida SIGN rev.jan 2012
Editor's Notes
Motivazioni e percezione di irreversibilità dell’errore.
La scarsa aderenza al trattamento è tipica di tutte le malattie croniche: dal diabete alla FC: la causa è legata: all’adozione di piani terapeutici complicati, scarsa fiducia nella terapia inalatoria vs sistemica, incomprensione dell’uso dei dispositivi inalatori, paura degli effetti collaterali (es. steroidi inalatori), sottovalutazione della gravità. Su quest’ultimo punto..