Inhale device

Assess whether or not the patient can use an MDI with a spacer or holding chamber. If the patient cannot use the device, determine whether someone can assist the patient with the inhaler device, or whether a nebulizer is necessary. 

Currie GP, Devereux GS, Lee DKC, Ayres JG. Recent developments in asthma management. BMJ 2005 330 585-589. de Benedictis FM, Selvaggio D. Use of inhaler devices in pediatric asthma. Pediatr Drugs 2000 5 629-638. 

The performance of a dry powder inhaler involves evaluation of component compatibility and influence on device performance. The performance of commercial passive inhaler devices is influenced by the pressure drop generated by a patient during an... 

Inhale Device Lactose 1 Blister Gas assist Turbulence, shear force... 

The transportable model has a flow from the sniffing port of 190 1/minute and the portable of 60 1/minute. The inhalation device should be loose enough to hold overpressure during expiration below 5 millibars (France). 

Patient inhalation Advantages No need to coordinate aerosol generation with patient inhalation Device is generally very simple in many eases, no moving parts are involved in powder deagglomeration... 

The underpressure created in the respiratory tract is the driving force for the airflow through an inhalation device. The attainable underpressure and the rate of the airflow both depend on the total resistance in the airways and inhaler. The pressure drop achieved during inhalation is furthermore a function of the anatomy of the lungs, the effort made by the patient, pathological factors and the presence of exacerbations (e.g. in case of asthma). 

Many different techniques are available for flow measurement and for recording of respiratory functions or flow parameters in particular (e.g. [115,116]). However, not all methods are appropriate for measurement of inhalation flows, either because they have low frequency responses or they influence the shape of the inspiratory flow curve by a large volume or by the inertia of the measuring instrument (e.g. rotameters). They may also interfere with the aerosol cloud from the inhalation device during drug deposition studies. 

Laser diffraction is a fast alternative for analysis of the size distribution of particles in an aerosol cloud. The theory of laser diffraction is well understood [124,125]) but this technique requires special measures to test inhalation devices and to interpret the results correctly. One of the major problems is that flow adjustment through the inhaler is not possible. Furthermore, the presence of carrier particles from adhesive mixtures may disturb the measurement of the fine drug particles and the size distribution obtained is of an unknown dehvered mass fraction of the dose. These practical problems and limitations have been solved by the design of a new modular inhaler adapter for the Sympatec laser diffraction apparatus (Figure 3.6). 

With regard to the systemic administration of smaller proteins (<20 kDa), the development of insulin for inhalation has shown that the pulmonary route is a feasible route of administration. However, advanced inhalation devices and formulations were required to obtain a reproducible lung deposition. It will be especially necessary to deal with the problems that occur when drugs with a small therapeutic window are administered. To enable widespread use of the lung as port of entry for these small proteins, future developments should be directed towards more simple inhalation devices which still give a high and reproducible lung deposition. The formulations that will be required for these proteins are likely to be much more complex and advanced than those that are currently used. Examples are formu-... 

Powder In inhalation device of 14, 30, 60, and 120 units. Asmanex Twisthaler (Sobering)... 

Dose Inhalation of the contents of 1 capsule, once daily, with the HandiHaler inhalation device. 

Actions Dissociative anesthetic gas Effects Dizziness, suffocation d/t inhalation device (ie, garbage bag, balloon)... 

HCG human chorionic gonadotropin HCL hairy cell leukemia Hct hematocrit HCTZ hydrochlorothiazide HD hemodialysis HDAC histone deacetylase Hep hepatitis hepatotox hepatotoxicity HER2 type of cancer gene HF heart failure HFA designation for type of inhalation device Hgb hemoglobin HIT/HITTS heparin-mduced thrombocytopenia... 

Several inhaled drugs are used for the relief and management of asthma. The drug, formulated into a solution which can be reduced to fine particles, is inhaled from an inhaler device and most patients over the age of about 6 years can be trained to use the device so as to get an effective dose into the bronchial tree. How far does the drug go Studies have shown... 

Zanamivir has a bioavailability of less than 5% when absorbed through the gastrointestinal tract. It is administered using a breath-actuated inhaler device (Diskhaler)... 

Geriatric Considerations - Summary Ensure that the older adult can adequately use the inhalation device. A spacer maybe beneficial in fhose unable fo coordinate device operation and inhalation. Spacer devices improve drug delivery to the lungs, therefore monitor closely as the patient may also experience increased systemic side effects with improved exposure to albuterol. Monitor cardiac status. 

Chronic ohstructive pulmonary disease (COPD) Inhalation 18mcg( 1 capsule)/dayvia HandiHaler inhalation device. 

Several portable inhalation devices have been developed and are being tested to determine whether they improve protein and peptide delivery via the airways. Aerosolized DNase has been shown in patients with cystic flbrosis to significantly reduce the buildup of mucus in the lung and the incidence of infections. Devices for delivery of therapeutic proteins to deep-lung alveoli to achieve systemic effects are also in development. These products are formulated so that the device aerosolizes the protein in a defined particle size range that cannot be easily achieved by means of conventional metered dose inhalers. 

Carter, P. A., Rowley, G., Fletcher, E. I, and Sylianopoulos, V. (1998), Measurement of electrostatic charge decay in pharmaceutical powdersand polymer materials used in dry powder inhaler devices, Drug Dev. Ind. Pharm., 24,1083-1088. 

By the use of a breath-powered unit dose dry powder inhaler, which was adapted to the physical properties of TI, relative bioavailability was 50% for the first 3 hours and 30% over the entire 6-hour period in 12 healthy volunteers (Pfutzner et al. 2002). However, although the studies demonstrated pulmonary administration of TI has the advantages of fast onset of action, short duration of action, and lower variability over the SC injections of insulin no attempt has been made to compare pulmonary administration of insulin alone with the same inhaler device. This method of encapsulating biomacromolecules has some advantages and must be considered when electing to deliver a molecule. 

Nebulizers are usually prescribed to patients who are unable to operate other inhalation devices, for example because of poor hand-lung coordination (Nikander... 

The concept of the L T ratio in inhalation therapy is a useful one, where L represents the local or lung availability of an inhaled drug and T the total systemic availability. This ratio will be affected by differences in first-pass metabolism. Another important variable that determines the L T ratio is the inhalation device. The L T ratio for budesonide is 0.66-0.85, depending on the method of inhalation (12). 

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