Professional Documents
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Respiratory Diseases
Respiratory Care
Asthma
Bronchiectasis
Chronic bronchitis
Respiratory Diseases
Pulmonary emphysema
Post tuberculosis
Respiratory care
Chest physiotherapy
Inhallation therapy
Mechanical ventilation/
non invasive
Respiratory Care
Oxygen therapy
Breathing retraining
Airway management
Respiratory care
practitioner
Family
Respiratory Care
Physician
Clinical Manifestation
Pulmonary Care
INHALATION THERAPY
INHALATION THERAPY
MINIMUM SYSTEMIC
SIDE EFFECT
RAPID ONSET
OF ACTION
PHARMACOKINETICS
PROPERTIES OF THE DRUG
INHALATION THERAPY
SLOW ABSORPTION FROM THE LUNG
LOW ORAL BIOAVAILABILITY
RAPID SYSTEMIC CLEARANCE
WIDER THERAPEUTIC INDEX
ROUTE OF ADMINISTRATION
THE KIND OF INHALATION DEVICE
AGE OF THE PATIENT
SEVERITY OF THE DISEASE
INDIVIDUAL VARIATION IN PARTICLE
DISTRIBUTION
PATIENT COMPLIANCE
Particle deposition
in the airways
CHARACTERISTICS OF
PARTICLE DEPOSITION
>10 m
(Trachea,
large bronchi)
1-5 m
Lower airways
< 0.5 m
To be exhaled
( alveoli)
< 2 mm &
Inertial
movement
( 2 mm)
Brownian
movement
Device factors
metered dose inhaler (MDI)
Drug deposition
10%
80%
(Newman, 1985)
Device factors
Particle size generated by device:
0.5-10 m
characteristics of particle disposition:
> 10 m : trachea, large bronchi
1-5 m
: lower airways
< 0.5 m : to be exhaled
Device factors
metered dose inhaler (MDI)
Most popular aerosol device
initial particle size: 45 MMAD
evaporation 2.8-5.5 m
30-50% of the patients cannot
coordinate actuation and inhalation
CFCs are banned now
attachment of a spacer could be helpful
Device factors
spacer
Advantages:
enhances lung delivery
obviates the need of hand-lung
coordination (allows a delay of 5-7
seconds after actuation)
reduces oropharyngeal deposition of
large drug particles
Device factors
Breath-actuated MDI
does not need hand-lung coordination
requires forceful inspiratory flow to
activate drug release
still utilizes propellants
not better than MDI if used properly
may startle children
Device factors
jet nebulizer
particle size depends on gas flow rate
(5-12 l/min particle size: 4-8 MMAD)
does not need hand-lung coordination
or patients cooperation
lung deposition: 10%
lost in the apparatus: 60-80%
Device factors
jet nebulizer
Device factors
dry powder inhaler (DPI)
Mean % deposition of SCG
(Timsina,1994)
Device factors
dry powder inhaler (DPI)
Contains micronized active drugs (ideal
particle size of 0.5-8 m)
does not need hand-lung coordination
requires deep and forceful inspiration
lower airway deposition: 30%
mouth rinsing after use of steroid DPI
Patient factors
When is a bronchodilating effect
obtained?
The effect of inspiratory flow rate
controllable factors (not always):
speed and depth of breathing
breath holding
hand-lung coordination for inhaler
Patient factors
Uncontrollable factors:
bronchoconstriction
edema
mucus hypersecretion
parenchymal defect
FARMAKOKINETIK OBAT
TERAPI INHALASI
Thank
you