El documento detalla los dispositivos de terapia de inhalación utilizados en problemas respiratorios, incluyendo inhaladores de dosis medida, nebulizadores y inhaladores de polvo seco. Se enfatiza la importancia de la técnica de inhalación adecuada para una entrega óptima de medicamentos y se describen ventajas y desventajas de cada tipo de dispositivo. Además, se presentan ejemplos de medicamentos administrados a través de inhaladores y se discute la terapia combinada para mejorar los síntomas del asma.

1. Devices for Inhalation Therapy
used in Respiratory Problems
ECE TEAM

2. Respiratory tract characteristics
✔ Large surface area
✔ Good vascularization
✔ Immense capacity for solute exchange, Ultra- thinness of the
pulmonary epithelium

3. Mass Median Aerodynamic diameter
▪ < 1 µm Reach up to the alveoli
▪ 0.5 – 5 µm Beyond the 10th
generation of the bronchi
▪ > 5 µm Oropharynx

4. Why Inhalers Are used in treatment of
??Respiratory problems
✔ Direct way to Reach Medicines into
lungs (Delivery to target of action)
✔ Quickest way to Relieve Symptoms
(More rapid onset of action)
✔ Small dose required to give better effect
just 1/10th
to 1/20th
of the dose in
tablets/Syrup and higher concentrations
available in the lungs
✔ High Safety profile with less systemic
toxicity
Disadvantages: -
Time and effort consuming
Limitation of delivery device

5. Devices for Inhalation
Therapy

6. Devices for Inhalation Therapy
2. Metered dose inhalers (MDIs)
1. Nebulizer:
- Small volume - large volume - Ultrasonic - Pneumatic
3. Dry powder inhalers (DPIs)
4. MDIs with Spacer

7. Nebulizer
• A nebulizer uses forced air to turn medication
(mainly asthma) into a fine mist so that it can
easily be breathed into the lungs.
• For some people- and with some
medications-nebulizers are the most effective
way of delivering inhaled medications.

8. Facemask
Plastic tubing
Compressed air machine
Medication cup

9. Nebulizer

10. !! The following are all real examples
A man was asked to demonstrate his inhaler
technique
He pointed the inhaler at his chest and sprayed
An elderly man complained that his inhaler was not
relieving his wheeziness
- He was asked to demonstrate his technique.
- He asked for a tablespoon. He shook his inhaler,
sprayed two doses onto the spoon then licked it off!

11. It is important that doctor teach his
patient how to use Inhaler devices

12. Inhalers are hand-held portable devices
that deliver medication directly to the
lungs.
Respiratory Inhalers

13. Antiallergic agents
- Budesonide (glucocortico steroid)
- Cromolyn sodium
Bronchodilators
- Salbutamol (β2
agonist) Ventolin
- Terbutaline (β2
agonist)
- Anti-cholinergic
Mucolytic agents Acetein
- Acetylcysteine
Antimicrobials
- Tobramycin (Anti bacterial) Pentamidine (Anti Fungal)
- Ribavirin (Anti Viral)
Medications Delivered through Inhalers

14. Metered Dose Inhalers (MDI)
✔ A liquid propellant
✔ A metering valve that dispenses a
constant volume of a solution in the
propellant
✔ Inhalation technique is critical for
optimal drug delivery
✔ Hand Actuated model requires hand
breath coordination

15. Using Metered Dose Inhalers (MDI)
✔ Insert the metal canister firmly, Shake the inhaler well
before use (3-4), Remove the cap, Breathe out away from
your inhaler, Place the inhaler in your mouth between your
teeth and close your mouth around it, Start to breathe in
slowly and deeply (like yawning), Press the top of your
inhaler once and keep breathing in slowly until you've taken
a full breath, Remove the inhaler from your mouth, and hold
your breath for about ten seconds, then breathe out.
✔ If you need a second puff, wait 30 seconds, shake your
inhaler again, and repeat steps 3-6.

16. Ventolin Meter Dose Inhaler (MDI)
Generic Name:
• Salbutamol 100 mcg

17. Metered Dose Inhalers
Compact, Portable, convenient
Multi dose delivery capability
Lower risk of bacterial contamination
Suitable for emergency situation
Disadvantages
Advantages
Needs correct actuation and inhalation coordination
So difficult for children and elderly patients
High pharyngeal drug deposition

18. MDI with Spacer
✔ Patient could not required coordinate inspiration
✔ Patient seals lips around the mouthpiece
✔ Depresses the actuator
✔ A spacer is a kind of holding chamber for the medicine,
which eliminates the need to closely coordinate
squeezing the inhaler and inhaling the medicine.

19. MDI with Spacer
• Inhaled without loosing the drug
• The spacer can be cleaned by soaking in a solution of
mild detergent and water for 15 minutes. Shake out
the excess water and allow to air dry. Replace the
device after 24 months of continuous use.

20. Using MDI with Spacer
Shake the inhaler well, Remove the cap from the
inhaler, Insert the inhaler into spacer, Breathe out away
from the spacer, Put the spacer mouthpiece between
your teeth and close your lips around, Press the top of
your inhaler once, Breath in slowly “for 3-5 seconds”,
Hold your breath for about 10 seconds then Breathe out

21. ✔ Compensate for poor techniques/coordination with MDI
✔ Spacer slow down the speed of the Aerosol coming from
the inhaler which will lead to less of drug impacts on the
back of patient’s mouth and delivery the medicine into
the lower airways
✔ Spacer makes the use of MDI more easy and medication
can be inhaled slowly so it is more convenient for young
children to use it
Babies and younger kids use a facemask (a plastic cup that covers the mouth and nose) to inhale
the medication held in the spacer, whereas older kids can use a mouthpiece.
MDI with Spacer
Advantages of using Spacer with MDI

22. ✔ Large size and volume of device
✔ Bacterial contamination is possible “Device needs to
be cleaned periodically”
MDI with Spacer
Disadvantages of using Spacer with MDI

23. Dry Powder Inhalers (DPI)
✔ No propellant
✔ Breath- activated and patient coordination is
not as important issue
✔ The drug is formulated in a filler and contained
in a capsule that is placed in the device and
punctured to release the powder
✔ Easier to use than the conventional pressurized
MDI and require faster inspiratory flow rate
✔ Spacers can't be used with dry powder inhalers

24. Generic Name
• Symbicort Turbuhaler 160/4.5 mcg
- Budesonide 160 mcg + formoterol 4.5 mcg.
• Symbicort Turbuhaler 320/9 mcg
- Budesonide 320 mcg + formoterol 9 mcg.
Using DPI - Turbuhaler® cont.

25. 1. Unscrew the cap and take it off. Hold the inhaler upright
2. Twist the coloured grip of your Turbuhaler as far as it will go, then
twist it all the way back. You've done it right when you hear a
"click"
3. Breathe out away from the device
4. Put the mouthpiece between your teeth, and close your lips
around it. Breathe in forcefully and deeply through your mouth.
5. Remove the Turbuhaler® from your mouth before breathing out
Always check the number in dose counter window
Using DPI - Turbuhaler®

26. DPI - DISKUS®
Generic Name:
Salmeterol xinafoate and fluticasone propionate
1. Open
2. Click
3. Inhale

27. Using Diskus
• Open your DISKUS® hold it in the palm of your hand, put the thumb of
your other hand on the thumb grip and push the thumb grip until it clicks
into place
• Slide the lever away from you as far as it will go to get your medication
ready
• Breathe out away from the device
• Place the mouthpiece gently in your mouth and close your lips around it
• Breathe in deeply until you've taken a full breath
• Remove the DISKUS® from your mouth
• Hold your breath for about ten seconds, then breathe out slowly
• Always check the number in the dose counter window to see how many
doses are left.

28. Advantages of combination therapy (DPI)
Improve symptoms scores
Decreases nocturnal asthma symptomes
Improve lung functions
Decrease use of rapid acting inhaled B2
agonist
Reduces no. of exacerbation
Rapid control
Reduce dose of inhaled glucocorticoids
Symbicort Turbuhaler 160/4.5 mcg
Budesonide 160 mcg + formoterol 4.5 mcg
Seretide Diskus
Salmeterol xinafoate + fluticasone propionate

29. Local side effects of DPI
Orophayngeal candidiasis
Dysphonia
Upper airway irritation
So It important to do mouth washing after
the end of DPI use