Inhaled medication

Adverse effects of the inhaled P2-agonists include tachycardia, tremor, and hypokalemia, which are usually not problematic. Because of increased adverse effects, oral (i2-agonists should be avoided in patients who are able to use inhaled medications. 

Theophylline is a non-specific phosphodiesterase inhibitor that increases intracellular cAMP within airway smooth muscle resulting in bronchodilation. It has a modest bronchodila-tor effect in patients with COPD, and its use is limited due to a narrow therapeutic index, multiple drug interactions, and adverse effects. Theophylline should be reserved for patients who cannot use inhaled medications or who remain symptomatic despite appropriate use of inhaled bronchodilators. 

If performed appropriately airway clearance techniques provide similar clearance results, so choice should be based on patient preference and compliance. Airway clearance therapy is typically performed once or twice daily for maintenance care and is increased to three or four times per day for acute exacerbations. Inhaled medications are usually given with the therapies and will be discussed in a later section. 

Assess adherence to the prescribed regimen, including timing of inhaled medications with respect to airway clearance therapies and timing of enzymes and insulin with regard to meals. Is the patient taking any medications not prescribed by the CF center team ... 

An inhalable medication that relaxes the muscles in the airways (bron-chodilator) is frequently administered when airways obstruction is identified. In this bronchodilator trial test, the spirometry test is subsequently repeated and compared to the results from the initial spirometry test. If there is substantial improvement in lung function with the administration of the bronchodilator, the airways obstruction is reversible. An example of a lung disease with reversible airways obstruction is asthma, in which s)nnptoms occur episodically when airways obstruction occurs. If there is little or no improvement after the administration of the bronchodilator, the airways obstruction is fixed. An example of a limg disease with fixed airways obstruction is BO, where there is scarring of the airways. 

Snell, N.J.C., and Ganderton, D., Assessing lung deposition of inhaled medications, Resp. 

Coughing/Bronchospasm Inhaled medications can cause coughing and bronchospasm in some patients. 

There are a number of corticosteroids that are used in pulmonology as inhalation medications. For rhinitis sprays may be used which also contain corticosteroids. Coricosteroids in these topical medications include beclometasone, fluticasone, mometa-sone and also budesonide. 

Aerosolized medications are available as pressurized or breath-actuated metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulized or wet aerosols. Most inhaled medications currently used are available as metered-dose inhalers (Table 3). For the patient who has difficulty to coordinate activation of a MDI, a spacer improves delivery. Spacers reduce deposition of the drug in the... 

Rogers, D. F., and Ganderton, D. (1995), Determining equivalence of inhaled medications, consensus statement from a workshop of the British association for lung research, held at Royal Brompton National Heart Lung Institute, London 24 June 1994, Respir. Med., 89,253-261. 

Instruct patients about the proper techniques for inhaling medications. 

Over-the-counter medications to avoid include cough and cold preparations, including those containing dextromethorphan, nasal decongestants (tablets, drops, or spray), hay-fever medications, sinus medications, asthma inhalant medications, anti-appetite medications, weight reducing preparations, pep pills... 

Newman, S.P. Brown, J. Steed, K.P. Reader, S.J. Kladders, H. Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medications. Chest 1998, 113, 957-963. 

For the use of an inhaled medication (e.g., p2-agonists, corticosteroids, antivirals, cromolyn, etc.), it is crucial for the child and parents to understand the mechanism of the metered dose inhaler (MDI) or nebulizer, if used. The package insert should also be reviewed for information about the specific drug product. A decision may also need to be made as to whether a spacer may be needed for use with the medication canister. 

Wysowski DK, Swann J. Use of inhalant medications with and without chlorofluorocarbon propellants in the United States, 1996-2000. J Allergy Clin Immunol 2002 110(l) 51-3. 

Hoffman A 1997 Inhaled medications and bronchodilator use in the horse. Veterinary Clinics of North America Equine Practice 13 519-530... 

The inhalation route administers medication using an inhaler. Medication is absorbed in the bronchioles. 

What should you ask the patient to do after inhaling medication ... 

If more than one type of inhaled medication is taken it is important to take them in the correct order. Bronchodilating inhalers are used first to help open the airways. These are followed by corticosteroid inhalers. This ensures that the airways are open when the corticosteroid is administered, allowing as much of the dose as possible to be absorbed. 

If more than one type of inhaled medication is taken it is important to take them in the correct order. 

Snell NJ, Ganderton D. 1999. Assessing lung deposition of inhaled medications . Consensus statement from a Workshop of the British Association for Lung Research, Institute of Biology London, UK, April 17, 1998. Resp Med 93 123-133. 

Some of the diseases caused by inhaled toxins and antigens are treated with inhaled medications. Inhalation therapy has been a mainstay of the treatment of lung disease for centuries [1], Although most such early therapies were worthless, a few were effective. The inhalation of smoke from plants containing stramonium has been used since antiquity to treat asthma [2]. 

The site and quantity of particle deposition in the respiratory tract depend mainly on particle size but are also affected by respiratory pattern and airway pathology. Understanding the terminology of particle deposition is essential. Deposition is the capture of particles on a surface. Some inhaled particles are deposited by the respiratory epithelium, and others are exhaled. Clearance is the removal of any deposited particles by any process and is not a major topic of this discussion, although it may be important for the efficacy of inhaled medications. Total deposition is the difference between the inhaled and exhaled mass of the substance of interest. Regional deposition defines mass in various anatomic levels... 

Because of the uncertainty in dose delivery and the relatively benign nature of many inhaled medications used in past years, large quantities were often delivered from nebulizers to assure results. The term dose overkill will... 

There are two subjects areas I will include in this discussion (1) the administration of inhaled medications for systemic delivery, and (2) new aerosol applications for the treatment of lung diseases. 

Better education of physicians and clinic/hospital staff is necessary if the new methods for aerosol delivery are to be brought to the patient. Good patient education is a time-consuming but necessary final part of the application of inhaled medications to the therapeutic armamentarium. These efforts should allow the clinician to bring to the patient the best evidence-based management, which will really change performance and lengthen life. 

Pbarmaceutical PropeUants Many inhaled medications used to treat asthma contained chlorofluorocarbon (CFC). However, the Montreal Protocol called for a ban ofCFCs as a propellant in pharmaceutical products by 2008. Two hydro-fluoroalkanes (HFAs) appear to be effective in delivering asthma medications to the lungs. However, the medication dosage had to be cut in half with the new HFA propellents. 

The treatment of respiratory disorders such as bronchial asthma has varied greatly. Therapies have included hot and cold compresses or baths, concentrated showers to the back of the head, as well as dried fox lungs, owl blood in wine, and chicken soup (1). In this chapter we outline the history of inhaled medications in the treatment of respiratory disease. 

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