08 Dr Mts Inhalation Therapy Devices and Equipment

8/22/2019 08 Dr Mts Inhalation Therapy Devices and Equipment

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INHALATION THERAPY

DEVICES ANDEQUIPMENT

mts darmawan

Blok Kegawatdaruratan, 27 Oktober 2011 [08]


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Crying

significantly reduces absorption of aerosolized

drug in infants

fighting, non fitted mask

higher respiratory rate

decrease tidal volume

shorter inspiratory phase

longer expiratory phase

Iles R, ADC, 1999


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Inhalation device choice

Age Short

acting

b2-agonist Steroid

LABA

6 yr MDI-hc-mp

DPI

Nebulizer

MDI-hc-mp

Nebulizer


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Introduction

Widely used in respirology

Aerosol therapy : drug form

Inhalation therapy : delivery form

Indonesia : public getting familiar

Pediatric respirology, the last decade Developed countries, mainstream therapy

BPD, wheezy infants, croup, bronchiolitis

Indonesia, raising trend, esp for asthma


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Introduction

> complicated than oral th/

special device, special maneuver

difficult, especially for children children, wide range:

very small neonates to adult size teenager

body surface area: 2m2 12m2

incompetent baby competent teenager

Pediatric aerosol therapy, special challenge


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Pediatric special problems

extrapolation from adult

children # small adults;

many differences


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Pediatric special problems

Growth & Development

Growth: size, quantity Development: quality, maturation

small children: lack of competence


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Includes

1. Nebulizer easiest

2. Dry Powder Inhaler (DPI)

3. Metered Dose Inhaler (MDI)

most difficult.

fortunately: spacer

(addition closed space between device &mouth) extension device

holding chamber


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Umur Alat inhalasi

< 2 tahun Nebuliser

MDI (Metered Dose Inhaler)dengan spacer, Aerochamber, Babyhaler

5-8 tahun Nebuliser

MDI dengan spacerDPI (Dry Powder Inhaler):Diskhaler, Turbuhaler

> 8 tahun NebuliserMDI dengan spacer

DPI

MDI tanpa spacer


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Nebulizer

Continuously change the solution to aerosol bypressured air or ultrasonic wave

Pulmo Aid


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Nebulizer


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Jet nebulizer

Aerosol is generated

with a flow of gas,

provided bycompressor or

compressed gas

Jet neb is the most widely used


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Ultrasonic nebulizer

Aerosol is generated byvibrating fluid placed within it


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Ultrasonic nebulizer


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Jet nebulizer parts

electric compressor connector tube

neb chamber

removable top

liquid reservoir

interface:

mouth piece

face mask


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Schematic figure of jet nebulizer


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Comparison of nebulizer

Parameters Jet nebulizer Ultrasonic nebpower source electric / comp electric

how it works high air flow high freq vibratn

air flow 8L/mnt (+2L) -sound noisy quiet

tool position free quite horizontal

fill volume 3-5 mL >10 mLnebulized drug almost all not steroid

price Cheap expensive

maintenance simple complex


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Fill volume

the volume of drug solution to be fill in thereservoir chamber

Drugs 5mL

bronchodilator + + +

steroid + + +


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Interfacedevice part directly connected to patient


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Interface

device part directly connected to patientmouth piece


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Dry Powder Inhaler


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Dry powder inhaler (DPI)

a tool to inhale drugs in dry powder form

1957: for inhalation of dry powder antibioticstudies: can be used for other respiratory drugs

1970s: 1 DPI contains 1 dose(Spinhaler,Rotahaler)

1980s: 1 DPI contains more doses (Diskhaler 8)

1990-2000s: more doses in 1 DPI

Accuhaler 60 doses Turbuhaler 120 doses

Easyhaler 200 doses

Easyhaler 200 doses


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Dry powder inhaler (DPI)

the power source is the flow ofinspiration / inhalation of thepatient

breath-actuated inhaler, no

propelan effort dependent

less oropharynx deposition

not suitable for under 5 children

for older children easier to usethan MDI

no need of spacer, easy to carry


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2 different kind of DPI

The drug within the

device

Turbuhaler

Easyhaler Swinghaler

The drug separatedfrom the device

Rotahaler

Cyclohaler

Handyhaler


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Turbuhaler design and operation

Mouthpiece is specially

designed with spiral

channels to deaggregatethe dose to respirable

particles

Inhalation channel

transports dosage of drugaggregates to the

mouthpiece

Rotating dosing discdetermines the dose of

medication for delivery to

the inhalation channel

Drug reservoirholds

50,60,100 or 200 doses ofmedication

Dosing scrapers ensures

precise dosing by

removing excess amounts

of drug

Twist grip loads a single

dose when turned

completely in one direction

and then back again


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Easyhaler mechanism


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Dry powder inhaler

advantages

less coordination

required

breath hold not required

breath actuated

disadvantages

requires high inspiratory

flow

Pharyngeal depositionpossible

difficult to deliver high

doses not all medication

available


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DPI use, common mistakes

Not open the cap

Not exhale first

Not inhale forcefully &

deeply No deep / maximal

inhalation

Not hold the breath for 10seconds

Forget to rinse the mouth


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Easyhaler mechanism


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Metered Dose Inhaler


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Components of MDI

Canister, an aluminium can withmetering valve and valve stem, itcontains micronized drugs suspension, with

multiple doses (up to 300)

propellant, CFC or else actuator, usually made from

plastic actuator seat, where the canister is

placed

mouthpiece

the cap


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Schematic diagram of inhalation device


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Metered Dose Inhaler (MDI)

How to use it: shake the canister, open the cap

hold it up right, exhaled slowly

put the canister mouthpiecebetween lips tightly, inhaled

slowly

anytime after the beginning until

the middle of inspiration, pushdown the canister


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Metered Dose Inhaler (MDI)

How to use it: continue the inspiration

gently until max insp

at maximal inspiration,hold the breath for 10 sec

dont forget to rinse themouth and spill out towash out the rest of thedrugs in orophary


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shake well

for 15

before each

use

remove the cap from

the mouthpiece

remove the cap from

the mouthpiece

breath out breath out through the mouth,

place the mouthpiece in the

mouth, & close the lips around it

while breathing deeply &slowly, press the canister

firmly

Alternatively, the

inhaler may be

positioned 1 to 2

inches away from

the open mouth


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MDI use, common mistakes

Not shake the canister Not open the cap

Not hold in vertical position

Up side down position

Not exhale first

Lack of coordination

Too fast and powerfull inhalation

No deep / maximal inhalation Not hold the breath for 10 seconds

Forget to rinse the mouth


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How to measure the MDI contents


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Metered dose inhaler

Advantages

convenient

less expensive

portable

no drug preparation

no contamination

Disadvantages

coordination essential

patient activation required

large pharyngealdeposition

difficult to deliver high

doses not all medication

available


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S


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Spacer


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MDI with spacer

disadvantages of MDI alone

1. direct spray into the mouth: high speed & large

particle oropharynx impaction2. complex maneuver, need superb coordination,

difficult even for adult

to overcome: spacer - add space actuator - mouth

1. extension devices (no valve): solve the 1st

2. holding chamber: solve both problems


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Spacer

extension devices : without valve to lengthen the distance between actuator

mouthpiece and oropharynx

reduce aerosol speed, propellant evaporate, large

particle trapped still need coordination, although less

holding chamber : with valve

drug reservoir with certain volume has valves on both sides, hold the aerosol

no need coordination


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Spacer interface

extension devices : without valve

mouth piece: Volumatic, mini Spacer, Aqua bottle

face mask : plastic cup

holding chamber: with valve

mouth piece: AeroChamber, Pocket Chamber

face mask : AeroChamber, Babyhaler, PocketChamber

S D i


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Spacer Devices

MDI with spacer


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MDI with spacer


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MDI with spacer

Advantages of MDI with extension device:

reduced aerosol speed when inhaled

produced smaller particles

reduced oropharyngeal deposition

Advantages of MDI with holding chamber

advantages of extension device, + less coordination needed

suitable for children, even for baby (olderchildren using mouthpiece, baby using facemask)


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MDI with spacer

Advantages

less coordination

required

less pharyngealdeposition

no drug preparation

no contamination

Disadvantages

more complex for

some patient

more expensive thanMDI alone

less portable than MDI

alone


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Lung deposition of budesonide

MDI

MDI +

spacer

DPI (Turbuhaler)


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Resume Inhalation therapy

Nebulizer DPI MDI

Turbuhaler

RotahalerEasyhaler

Cyclohaler

extension dv

Spacer (+)

holding ch

Spacer (-)

UltraS Neb

Jet Neb


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Terima Kasih

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08 Dr Mts Inhalation Therapy Devices and Equipment