Aerosol Delivery System

Tugas Sistem Penghantaran Obat

kelas A
Kelompok 1
 Anggota kelompok

Willyandari 1211012002
Arief Chandra Abbas 1211012006
Sally Marcellina 1211013008
Orindia Suarmin 1211013024
Educational components of
Asthma Treatment Strategies
Teaching and monitoring the inhalation technique of
drugs is important.
Short courses of oral corticosteroids are occasionally
needed.
All persons with asthma should avoid exposure to
high allergen concentrations (Gtzsche et al., 2004)
[B] and, for example, sensitizing chemicals at work.
Aspirin and other nonsteroidal anti-inflammatory
drugs (NSAIDs) should be used cautiously, as 10 to
20% of patients with asthma are allergic to these
drugs.
Smoking may wreck the results of asthma care.

Develop an ACTION PLAN for self management

The treatment should be tailored for each patient
according to the severity of the disease and modified
flexibly step-by-step. Self-management of drug
dosing is encouraged (written instructions!).
Allergen immunotherapy may help some patients
(Abramson, Puy, & Weiner, 2003; Malling, 1998) [A].
 Why inhalation therapy?
Oral Inhaled route
Slow onset of action Rapid onset of
action

Large dosage used Less amount of

drug used
Greater side effects
Not useful in acute Better tolerated
symptoms
Treatment of choice
in acute symptoms
Particle deposition
 Uses of Aerosols
THERAPEUTIC Diagnostic use
COPD and Asthma
bronchial aerosol
Beta2-Adrenergic agonists
anticholinergic drugs
challenge
steroids measurement of
cromolyn sodium dimensions of airways
Alveolar diseases and alveoli
emphysema (recombinant alpha1- ventilation
antitrypsin) scintigraphy
interstitial lung diseases (steroids, mucociliary clearance
questionable reports)
Abnormalities of the Mucociliary
alveolar particulate
Transport System clearance
reduce tenacious mucus
widely applied in clinical practice
but may have little scientific basis
Therapeutic Uses of Aerosols

Immunization and Lung infections

pseudomonas infection in cystic fibrosis
pneumocystis infection in HIV infection
Systemic drug delivery
inhaled analgesia with fentanyl or morphine
nasal sprays for calcitonin, oxytocin
 Aerosol delivery equipment

small volume nebulizers

large volume nebulizers
metered dose inhalers
dry powder inhaler
continuous therapy nebulizers
auxiliary spacing devices
*other specialized aerosol delivery equipment to
reduce mass median aerodynamic diameter
of 2-5 um
MDI: metered dose inhaler
Using your MDI correctly:

Remove the cap from the
mouthpiece and shake the MDI well.
Exhale slowly though pursed lip.
Hold the inhaler upright and place it
in front of your mouth. Keep your
mouth slightly open.
Breathe in deeply (and at the same
time) press the inhaler between your
thumb and forefinger. This forces
the medication from the inhaler in a
puff that you then inhale into your
lungs.
Remove the inhaler from your
mouth, holding your breath counting
to 10. Then exhale slowly through
pursed lips.
Most inhaler instructions ask you to
take two puffs. You need to wait
about two minutes before taking the
second puff, using the same
technique as described in steps 1, 2,
3 and 4 above.
 Laryngeal deposit with
MDI
45-95% of the drug
impacts in the
oropharyngeal region
only 5-25% reaches the inertia due to mass cause

lower airways particles to continue their present

trajectory rather than follow
regional deposition
curvature of airways
depends on: impaction is proportional to:
specific drug and MDI velocity
inhalation pattern and diameter of particle
airway geometry sharpness of airway turns
hand-breath coordination inverse of airway radius

deposition improves impaction is dominant in the

dramatically if a holding major and segmental bronchi for
chamber is used rapidly inhaled particles greater
than 4 um
 MDI vs Nebulizer
4-12 puffs by MDI with
spacer achieves same
degree of
bronchodilation
as one 2.5 mg
nebulized
treatment of albuterol
MDI with spacer are
cheaper & faster
delivery
Spacers and Holding Chambers

reduction of drug deposition in the

oropharynx to 3-35% (from 45-95%)
minimizes local side effects of
steroids
amount of systemic drug uptake via
the stomach and intestine is
reduced by 40-80%
demands of coordination when
using a spacer are minimal
asthmatic infant
elderly
Dry Powder Devices
Powder Devices
Dry powder inhalers (DPIs) are
breath activated, multidose or
single dose, portable devices
containing a drug
in general, they deliver a greater
amount of drug as small
respirable particles (<5-6um) if
inhalation flow rate is high
only few patients above 6y.o.
are unable to create large
enough flow rates
 Aerosol Generation and Delivery:
Powder Devices
the usual deposition pattern is
50-70% in the oropharynx and
10-35% in the lungs (not very
different from pMDIs)
deposition rates vary according
to the types of DPI
turbuhaler is among the most
efficient, having a lung
deposition of 25-35%
HOW TO USE TURBOHALERS
Unscrew and lift off the cover.
Hold the inhaler upright with the grip
downwards.To load the inhaler with a dose,
turn the grip as far as it will go in both
directions, listening for a click. Do not hold
the mouthpiece when you load the inhaler.
Breathe out. Do not breathe out through
the mouthpiece.
Place the mouthpiece gently between your
teeth, close your lips and inhale forcefully
and deeply through your mouth.
Remove the inhaler from your mouth
before breathing out.
If more than one dose has been
prescribed, repeat steps 2-5. Replace the
cover.
Rinse your mouth out with water. Do not
swallow.
Mechanisms: Sedimentation
depends on the terminal
velocity of a particle under
the influence of gravity
terminal velocity is
proportional to:
density of particle
diameter of particle
enhanced by breath-
holding or slow steady
breathing
Comparison between MDI &
DPI
High velocity aerosols Aerosol velocity depends
Requires hand breath on inspiratory flow rate
co- ordination No hand breath co-
Delivery of medicines ordination needed
independent of external Delivery of medication
factors largely dependent on
Time consuming to teach external factors
Requires deep& slow Easy to teach
breathing only Requires high inspiratory
flow>28L/min
 Loss in air
Deposition%

Apparatus
GI
Lung
MDI DPI Nebulizer
SMALL VOLUME NEBULIZERS

PORTABLE MODEL SVN

Aerosol Generation and Delivery:
Nebulizers
solutions or suspensions of drugs can
be aerosolized via nebulizers
nebulizers are driven ultrasonically or
by compressed air
most of the drug is retained in the
nebulizer, and only about 2-10%
reaches the lower airways
Nebulizers require few
instructions, less
supervision & coordination
& maybe preferred by the
Patient
new brands work only during
inspiration, so loss from aerosolization
during expiration is reduced
 Mechanisms of Aerosol
Deposition
Inertial impaction
Sedimentation
Diffusion
Electrostatic precipitation
Interception
Mechanisms: Diffusion
important mechanism for
deposition of particles <0.5um in
diameter
extremely small particles are
displaced by the random
bombardment of gas molecules
and collide with the airway walls
does not account for much of
the deposition of therapeutic
aerosols
 Choice of inhalation therapy

Infants Nebulizer
Children
< 4 years Nebulizer
4 year DPI/MDI/Spacer
7 years DPI/MDI
Adults MDI/DPI
Acute episodes Nebulizer
 Hazards of therapy

Bronchospasm
Over hydration
Overheating of inspired gases
Delivery of contaminated aerosol
Tubing condensation draining into the airway
Malfunction of device and/or improper technique may
result in underdosing.
improper technique (inappropriate patient use)
overdosing.
Complications of specific pharmacologic agent may
occur.
CFC: affect the environment by its effect on the ozone
layer
INFECTION CONTROL:
Universal Precautions for body substance isolation.
SVN and LVN are for single patient use or should be
subjected to high-level disinfection between patients.
Published data establishing a safe use-period for SVN and
LVN are lacking; however they probably should be changed
or subjected to high-level disinfection at approximately 24-
hour intervals.
MEDICATIONS:
Medications should be handled aseptically.
Tap water should not be used as the diluent.
Medications from multidose sources in acute care facilities
must be handled aseptically and discarded after 24 hours.
MDI accessory devices are for single patient use only.
Cleaning of accessory devices is based on aesthetic criteria.
There are no documented concerns with contamination of
medication in MDI canisters.
Patient Education in the Clinic

Explain nature of the disease (i.e.

inflammation)
Explain action of prescribed drugs
Stress need for regular, long-term therapy
Allay fears and concerns
Peak flow reading
Treatment diary / booklet
 Patient Education
Consider issuing a peak
flow meter & giving
appropriate education on
peak flow monitoring
Review or develop a
written plan for managing
relapses
Review the patients
understanding of the
causes of exacerbations,
correct uses of medication
& actions to be taken for
worsening symptoms or
peak flow measurement
 Self Management Plan
Keep it simple
If your PEFR falls
below 50-80% of
your personal best
start taking your oral
steroids.
Or if you start waking
at night with
symptoms or develop
a cough on exertion.
 Assessment of efficacy

Proper technique applying device

Patient response to or compliance with
procedure
Objectively measured improvement (eg,
increased FEV1 or peak flow)