Inhalars for bronchial asthma

95
INHALARS FOR BRONCHIAL ASTHMA Prepared by. Dr.Afnan Shamraiz PGr.1. Paeds.ATH

description

ppt on asthma inhalational therapy

Transcript of Inhalars for bronchial asthma

Page 1: Inhalars for bronchial asthma

INHALARS FOR BRONCHIAL ASTHMA

Prepared by.Dr.Afnan ShamraizPGr.1.Paeds.ATH

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Asthma Symptoms Result from Inflammation and Bronchoconstriction

Reduced airway opening

Thick Muscle Layer

Excess Mucus

BRONCHIOLE

Tightened muscle

Alveolus filled with trapped air

Inflammation Bronchoconstriction

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PATHOPHYSIOLOGY OF ASTHMA

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Lung function during early and late phases of allergic response

BEFORE STIMULUS

BRONCHOSPASM

LATE PHASEEARLY PHASE

INFLAMMATION

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History of Inhaled Therapy4000 years ago: the smoke of ephedra

sinica was used for asthma therapy

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Modern age

Metered dose inhaler 1956 Medihaler

Dry powder inhaler1960 Multidose dry powder inhaler 1970

440 million boxes aerosols per year are manufactured in the world

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Why Inhalation Therapy?

Targeted delivery of medication to the lungs

Rapid onset of action Smaller doses Less systemic and GI adverse effects Relatively comfortable

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Definition of an aerosol

Aero air Sol solution Liquid or solid suspensions into gas

medium

Particles which are sufficiently small so as to remain airborne for a considerable period of time

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Aerosol Size

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PHARMACOKINETICS OF INHALED DRUGS

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Lung deposition of drug

Particle size shape particle density solid or liquid phase Type of inhalation device Technique Airway obstruction Drug molecule

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Device dependent factors

Device dependent factors

Patient dependent factors

Device pMDI: Portability, Treatment time, Drug

preparation, Reproducibility, Coordination, Actuation, Drug availability, Holding chamber, Propellant

DPI: Breath-actuation, Coordination,

Portability, Treatment time, Dose counters, Flow requirement, Drug availability, Resistance, Costs.

Aerosol1. Particle size, Velocity, Physico-

chemical characteristics

Age co-operation compliance airway anatomy breathing patterns

Disease

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Deposition of particles

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Lung Deposition of ICS Dose to the lungs

MDIs Ciclesonide 52% Fluticasone 16% Budesonide 5-12% BDP HFA MDI 51%

DPIs Different flow rates Budesonide Turbuhaler 17-39% Budesonide Novelizes 19-32% Budesonide Airmax 28-30%

One flow rate Budesonide Clickhaler 27% Fluticasone Diskus 13%

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Inhalation Devices

Aim To make aerosol from the drugs

solution or solid particles 1-Metered dose inhaler 2-Dry powder inhaler 3-Nebulizer

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Asthma Medications and SuppliesDry Powder Inhaler - DPI

Meter Dose Inhalers - MDI

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Asthma Medications and Supplies

Spacers (use with MDIs

Nebulizer / Compressor

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Inhaled treatment for asthma Preventers -

inhalers coloured in various shades of brown, orange or purple depending on their strength) Should be used twice each day to prevent inflammation and long term lung damage.

Most Preventers are taken morning and evening .

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Reliever inhalers-(normal dose, 2 puffs of blue) To be given as and when necessary to relieve

cough, wheeze, breathlessness and chest tightness.

Take 5-10 mins work by relaxing the tightness if the muscles causing constriction in the bronchioles.

Can be used before exercise . You should expect 2 puffs of blue reliever

inhaler, when taken properly, to last for 4 hours. For the duration of a cold an asthmatic child is

advised to take up to 2 puffs of their blue inhaler every 4 hours

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Medications

Rescuers

Relax tightened muscles

Short-Acting Nebulizer or Puffer Treat acute episodes

and symptoms

Reduce inflammation in airways

Long-Acting Take on a regular

basis

Controllers:

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Metered dose inhalers

Metered dose inhalers. These inhalers consist of a pressurized canister containing medication that fits into a boot-shaped plastic mouthpiece. With most metered dose inhalers, medication is released by pushing the canister into the boot. One type of metered dose inhaler releases medication automatically when you inhale. Some metered dose inhalers have counters so that you know how many doses remain.

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Metered Dose Inhalers (pMDI

Canister Propellent gas (liquid

under pressure) Drug Dissolved or solid

microparticules into the gas

Surfactant Physical stabilisation Prevent clustering

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Propellant

Chloro fluoro carbon (CFC

Hydro fluoro alcan (HFA)

CFC (freon gas) CFC not flammable

Not include chloride Not disturbe Ozone

layer

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Freon (CFC)

Oropharyngeal irritation, cough and bronchospasm

Harmfull for ozone layer Cardiac arrhytmia Less effective in cold climate

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MDI

advantages Disadvantages

Rapid application Handling Multidose

Hand-breathe coordinations

İneffective use in poor ventilated patients

Oropharyngeal deposition and local side effects

Not include dosimeter

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Not include dosimeter

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How Should a Child Use an Inhaler?

If you need a second puff, wait 30 seconds, shake your inhaler again, and repeat steps 3-6.

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MDI with HFA (CFC-free)

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Bronchodilator drugs

 open up the airways in the lung within minutes of inhalation of the drug, by relaxing the smooth muscle that surrounds the airways. Stimulate adenyl cyclase and increasing cAMP    

Short-acting bronchodilators:  The effect of the usual type of bronchodilator lasts for  3-4 hours and these short-acting drugs (e.g. albuterol, metaproterenol, terbutaline) are used as needed or before exercise to prevent wheezing.   The short-acting drugs provide rapid relief during a mild or moderately severe asthma attack, but they do nothing for the cause of the attack - inflammation.  These "rapidrelievers"  or "rescue inhalers" may be needed repeatedly until the attack subsides spontaneously or is controlled by an anti-inflammatory drug.  

Long -acting bronchodilators:  Although bronchodilators do not prevent asthma attacks, certain long-acting bronchodilators (e.g.  Serevent and Foradil) can improve lung function over 10-12 hour periods.  This drug must NEVER be used for the emergency rescue from an acute attack of asthma. Salmeterol and formoterol

 

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Albuterol (generic) Generic: Albuterol Type: MDI; fast/short

acting beta-2 agonist Class: rescue/reliever Functions:

bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache , metallic taste (rinse mouth)

Similar to:Ventolin, Proventil

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Ventolin ® Generic: /salbutamol Type: MDI; fast/long

acting beta-2 agonist Class: rescue/reliever Functions: bronchodilator,

works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Also available in: Ventolin rotahaler

Similar to: Proventil, Alupent, Maxair, Brethaire, Metaprel

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Salbutamol

••Salbutamol:preparationanddoses–Availableas2,4and8mgtablets–Syr.As 2mg/5ml–Asmetereddoseinhaler–100μg–200μ

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Ventolin rotahaler ® Generic: /salbutamol (?) Type: rotahaler; fast/long

(?) acting beta-2 agonist Class: rescue/reliever Functions: bronchodilator,

works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Also available in: Ventolin inhaler

Similar to: Proventil, Alupent, Maxair, Brethaire, Metaprel

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Alupent ® Generic: metaproterenol

sulfate Type: MDI; fast/short

acting beta-2 agonist Class: rescue/reliever Functions:

bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Similar to: Metaprel, Ventolin, Proventil, Maxair, albuterol, Brethaire

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Brethaire ® Generic: terbutaline

sulfate Type: MDI, fast/short

acting beta2-agonist Class: rescue/reliever Functions:

bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Similar to: Ventolin, Alupent, Maxair, Proventil, Metaprel

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Foradil aerolizer ® Generic: formoterol

fumarate Type: formoterol

aerolizer Class:

controller/preventer Functions: long-acting

bronchodilator; acts w/in 3 mins, effective for at least 12 hrs.

Side Effects/Suggestions: tremors, heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief

Similar to: Oxeze (and related to Serevent)

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Maxair ® inhaler Generic: perbuterol

acetate Type: MDI; fast/short

acting beta2-agonist Class: rescue/reliever Functions: bronchodilator,

works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Also available in: Maxair autohaler

Similar to:Ventolin, Alupent, Brethaire, Metaprel, Proventil

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Proventil ®

Generic: albuterol Type: MDI; fast acting

beta-2 agonist Class: rescue/reliever Functions:

bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Similar to:Ventolin, Alupent, Maxair, Brethaire, Metaprel

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Serevent ®

Generic: salmeterol xinafoate

Type: MDI; long acting beta2-agonist

Class: controller/preventer Functions: prevents

tightening of muscles around lung tubes; takes 10-20 mins to work, effective for at least 12 hrs.

Side Effects/Suggestions: tremors, heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief

Also available in: Serevent discus

Similar to: related to Foradil & Oxeze

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DOSES

DRUG FORM DOSE

Salmeterol MDI 21ug/puffDPI 50 ug/blister

1 to 2 puffs bd1 blister bd

Formeterol DPI 12ug/single use capsule

1 cap bd

Albuterol MDI 90 ug/puff 2 to 8 puffs every 20 minutes for 3 doses than every 1 to 4 hr as needed

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Anti-inflammatory drugs

 work to reduce the irritability of the lung airways by controlling the activities of inflammatory cells in the airway walls.  They are used to reduce asthma severity over a period of time, and must be used on a regular basis, usually 2-3 times per day.  These drugs do not provide immediate relief from an asthma attack because they do not act as bronchodilators.   However, it is often advised to temporarily increase the dose of the anti-inflammatory drug during an acute attack.  Two types of anti-inflammatory drugs exist -mast cell stabilizers, and corticosteroids.  

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Inhaled corticosteroids

 are the most effective means of controlling asthma and are the usual type of drug given in the routine anti-inflammatory management of moderate asthma.    Combined preparations containing a corticosteroid and a long acting bronchodilator (Advair, Dulera and Symbicort) are proving to be useful in limiting the amount of corticosteroid needed for control of asthma.

MOA Reduces the synthesis

of arachidonic acid by phospholipase A2

Inhibit the expression of COX-2 (anti-inflammatory action)

Postulated that: this drugs increases the responsiveness of beta agonists in the airway

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DRUGS USED IN ASTHMADRUGS USED IN ASTHMA

Arachidonic acid

Lipooxygenase Cyclooxygenase

Hydroxypeptidase Endoperoxidase

Leukotrienes Prostacycline

Thromboxane A2

Prostaglandin

Membrane Lipid

Phospholipase A2

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Aerobid ® Generic: flunisolide Type: corticosteroid

(Metered Dose Inhaler) Class:

controller/preventer Functions: anti-

inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Also available in: mint flavor

Similar to:Azmacort, Beclovent, Flovent, Pulmicort, Vanceril

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Flunisolide

Strength Low DoseMedium Dose

High Dose

250 ug/puff

500-750 μg (2-3 puffs)

1000-1250 μg (4-5 puffs)

> 1250 μg (>5 puffs)

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Aerobid mint flavor ® Generic: flunisolide Type: corticosteroid

(Metered Dose Inhaler)

Class: controller/preventer

Functions:anti-inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Also available in: regular

Similar to:Azmacort, Beclovent, Flovent, Pulmicort, Vanceril

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Azmacort ® Generic: triamcinolone

acetonide Type: corticosteroid (Metered

Dose Inhaler)

Class: controller/preventer

Functions: anti-inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Similar to: Aerobid, Beclovent, Flovent, Pulmicort, Vanceril

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Triamcinolone

Strength Low DoseMedium Dose

High Dose

100 μg/puff (MDI with spacer

400-800 μg (4-8 puffs

800-1200 μg (8-12 puffs

>1200 μg (> 12 puffs

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Beclovent ® Generic:beclomethasone

dipropionate Type: corticosteroid

(Metered Dose Inhaler)

Class: controller/preventer

Functions: anti-inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Similar to: Aerobid, Azmacort, Pulmicort, Vanceril

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Vanceril ® Generic:beclomethasone

dipropionate Type: corticosteroid (Metered

Dose Inhaler)

Class: controller/preventer Functions: anti-

inflammatory; slow-acting; reduce hypersensitivity in airways

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Also available in: double strength

Similar to:Azmacort, Beclovent, Aerobid, Pulmicort

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Vanceril double strength ® Generic:beclomethasone

dipropionate

Type: corticosteroid (Metered Dose Inhaler)

Class: controller/preventer

Functions: anti-inflammatory; slow-acting; reduce hypersensitivity in airways

Side Effects/Suggestions: hoarseness;

Also available in: regular strength

Similar to:Azmacort, Beclovent, Aerobid, Pulmicort

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Beclomethasone

Strength Low DoseMedium Dose

High Dose

42, 84 μg/puff cfc40,80 μg/puff HFA-propellant

84-336 μg (2-8 puffs of 42 μg/puff or1-4 puffs of 84 μg/puff)

336-672 μg (8-16 puffs of 42 μg/puff or 4-8 puffs of 84 μg/puff)

>672 μg (> 16 puffs of 42 μg/puff or> 8 puffs of 84 μg/puff)

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Flovent ® Generic: fluticasone

propionate Type: corticosteroid MDI Class:

controller/preventer Functions: anti-

inflammatory; slow-acting; reduce hypersensitivity in airways; long-term control medication

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Similar to: Aerobid, Azmacort, Beclovent, Pulmicort, Vanceril

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Fluticasone

Strength Low DoseMedium Dose

High Dose

44, 110, 220 μg/puff (MDI)

88-176 μg (2-4 puffs of 44 μg/puff

176-440 μg (4-10 puffs of 44 μg/puff or2-4 puffs of 110 μg/puff or1-2 puffs of 220 μg/puff

440 μg (>4 puffs of 110 μg/puff or > 2 puffs of 220 μg/puff)

DPI 50,100,150ug./inhalation

100 to 200 ug

200 to 400 ug

More than 400 ug

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Pulmicort ® Generic: budesonide Type: corticosteroid

(Metered Dose Inhaler)

Class: controller/preventer

Functions: anti-inflammatory; slow-acting; reduce hypersensitivity in airways

Side Effects/Suggestions: hoarseness; thrush; rinse mouth with water after use

Similar to: Aerobid, Azmacort, Beclovent, Vanceril

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Budesonide

Strength Low DoseMedium Dose

High Dose

Turbuhaler (DPI200 μg /inhalation

200-400 μg (1-2 inhalations)

400-800 μg (2-4 inhalations)

> 800 μg (>4 inhalations)

Respules (nebulizer 0.5 μg 1μg 2μg

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MUSCARINIC ANTAGONISTS

Useful in 1/3 to 2/3 of asthmatic patients (especially children)

No effect on the inflammatory aspects of asthma

Useful in many COPD patients More effective

and less toxic than β agonists

MUSCARINIC ANTAGONISTS

Ipatropium Quaternary

antimuscarinic drug Delivered to the airways

by pressurized aerosol Have little systemic

action Tiotropium

Newer longer-acting analog

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Atrovent ® Generic: ipratropium

bromide Type: anti-cholinergic

MDI Class: rescue/reliever Functions:

bronchodilator (relaxes smooth muscle bands around bronchial tubes), works in 5-15 minutes

Side Effects/Suggestions: dryness of mouth, metallic taste, avoid contact with eye

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Mast cell stabilizers

• Inhaled medications that work to prevent bronchial tube swelling as part of a regular maintenance plan

• Also taken before exercise

MOADecrease in the release of mediators (leukotrienes and histamine) from mast cellsPrevents both early and late responses to challenge

Intal cromolyn sodium inhalation aerosol

Metered dose 800 mcg/inhalation

Metered dose 1.75 mg/actuation

Tilade nedocromil sodium

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Intal ® Generic: Cromolyn sodium Type: non-steroidal MDI Class: controller/preventer Functions: anti-

inflammatory, inhibits immediate & non-immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication

Side Effects/Suggestions: throat irritation, cough; use before exercise or contact with a known trigger

Also available in: nebulizer form, Intal Forte

Similar to: Tilade

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Tilade ® Generic: Nedocromil

sodium Type: non-steroidal MDI Class:

controller/preventer Functions: anti-

inflammatory, inhibits immediate & non-immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication

Side Effects/Suggestions: unpleasant taste, may cause stomach upset

Similar to: Intal

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Intal Forte ®

Intal Forte ®

Generic: Cromolyn sodium Type: non-steroidal MDI Class: controller/preventer Functions: anti-

inflammatory, inhibits immediate & non-immediate bronchoconstrictive reactions to inhaled antigens; long-term control medication

Side Effects/Suggestions: throat irritation, cough; use before exercise or contact with a known trigger

Also available in: nebulizer form, regular strength Intal

Similar to: Tilade

®

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Doses.

Drug form dose

chromyl MdI 1mg/puffNebulizer 20mg/amp

1to2puffs tid/qid1 amp tid/qid

nedocromil MDI 1.75 mg/puff

1to 2 puffs bid/qid

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COMBINATIONS…

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Combivent ® Generic: ipratropium

bromide & albuterol sulfate

Type: anticholinergic & beta2-agonist MDI

Class: combination Functions:

bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: tremors, heart rate, headache, dizziness, nausea, cough, dry mouth

Similar to: (kind of similar to Advair)

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Symbicort Generic: budesonide, a

steroidal anti-inflammatory agent, and formoterol, a bronchodilator

Type: steroid & beta2-agonist MDI

Class: combination"controller

Functions: bronchodilator, works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: tremors, heart rate, headache, dizziness, nausea, cough, dry mouth

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Autohaler This is a breath activated

device, and thus had the advantage that breathing and pressing don’t need to be co-ordinated.

Shake the device Remove the cap Prime the device – pull the red

lever up so that it clicks Whilst sat upright, take a normal

breath out. Inhale slowly and deeply – don’t

be put off by the click. Keep breathing in to a full inspiration, and then hold your breath for 10 seconds

Push the red lever back down. Replace the cap

Remember the tell the patient they wont feel the spraying sensation at the back of the throat and that this is normal. They may still be able to taste the drug though.

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Maxair autohaler ®

Generic: pirbuterol acetate Type: autohaler; fast/short

acting beta2-agonist Class: rescue/reliever Functions: bronchodilator,

works in 5-15 minutes via inhaler or nebulizer, effects last 4-5 hrs

Side Effects/Suggestions: shakiness of hands or legs, fast heart beat, anxiety, upset stomach, headache, metallic taste (rinse mouth)

Also available in: Maxair inhaler

Similar to:Ventolin, Alupent, Brethaire, Metaprel, Proventil

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MDI spacer

Decrease of oropharyngeal deposition Proposing inhaled CS

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MDI Spacer

A spacer not only allows for better co-ordination of breathing and dispensing the drug, but it also has a molecular effect. Larger molecules of drug are the ones that normally deposit themselves on the mucosa, and thus these are the ones that can lead to candida, hoarseness of the voice or systemic effects if swallowed. But in a space, the larger molecules remain in the spacer, and only the smaller drug molecules are actually inhaled

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How Should a Child Use an Inhaler – with a Spacer? • Ask child to breathe out

• Have child place spacer in mouth

• Press down on inhaler• Ask child to take a slow

deep breath• Encourage child to hold

breath for five (5) seconds• Remove spacer for

exhalation• Wait one minute before

repeating the process if there is a second puff ordered

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MDI spacer

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With a spacer

Need to be replaced every couple of months

Need to be washed every day in soapy warm water, and only let them dry by evaporation (drip drying) – do not wipe it dry! –this causes build up of static electricity

They reduce the velocity of the drug particles, and thus reduce the number of particles being deposited on the mouth and pharynx

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Washing the mouth

If you rinse out your mouth with water after using the inhaler this reduces the risk of thrush and irritation to the mucosa of the mouth and pharynx.

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Dry powder inhaler (DPI)

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Dry-powder inhaler – Breath-activated inhalers This kind of inhaler uses just dry-powder and

no propulsion system at all. All you have to do is take a deep, fast breath which will make you inhale a single dose. they usually rely on a manual mechanism to insert one dose of dry-powder drug into the mouthpiece.

The most common systems are the turbohaler and the diskhaler. In both systems, you have to turn or twist the body until a “click” sound signals that a dose has been inserted and is ready to be inhaled

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DRY POWDERED INHALERS (DPIs With DPIs the patient's breath (rather than

hand action) actuates delivery of the medication. You cannot see the spray because the only way to get the medication is to inhale it from the mouthpiece. Within the DPI category, there are two broad types:DPI Type 1): the medication is contained within the inhaler device at all times, until inhaled, or 

DPI Type 2): the medication comes in a separate capsule that must be placed into the inhaler device at the time of use.

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Type 1 medication is contained within the inhaler device ..eg pulimcort

DPI Type 2. Medication is separate from the inhaler, in a capsule eg he widely used drug Spiriva (tiotropium bromide)

•Turbuhaler 

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Classification of Dry Powder Inhalers, Based on Design and Function Single-Dose Devices Aerolizer formoterol capsule

single HandiHaler tiotropium capsule

single

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Multiple-Dose Devices

Turbuhaler budesonide

reservoir 200 Turbuhaler

budesonide/formoterol reservoir 120

Diskus salmeterol blister

strip 60 Diskus

salmeterol/fluticasone blister strip 60

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Dry powder inhaler (DPI) Multi doses

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Serevent discus ®

Generic: salmeterol xinafoate

Type: dry powder discus; long acting beta2-agonist

Class: controller/preventer Functions: prevents

tightening of muscles around lung tubes; takes 10-20 mins to work, effective for at least 12 hrs.

Side Effects/Suggestions: tremors, heart rate, headache; if sensitive to drug, may develop rash, itchiness, & bronchospasm; don’t use for quick relief

Also available in: Serevent inhaler

Similar to: related to Foradil & Oxeze

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Advair ® Generic: fluticasone &

salmeterol Type:combination,

powder discus Class: controller/rescue Functions: anti-

inflammatory; open airways for at least 12 hours

Side Effects/Suggestions: hoarseness; rinse mouth with water after use; never increase the puffs unless directed

Also available in: purple, blue; 100, 250, 500 mcg

Similar to: Combivent (ipratropium bromide & albuterol sulfate)

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DOSES

DRUG FORM DOSE

Fluticasone/salmeterol

DOI 100,250,or 500ug/50 ug

1 Inhalation bid

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Adverse Effects

LOCAL SYSTEMICINH CS Candidiasis

DysphoniaAdrenal suppression Growth retardation (large doses)

INH B2 AGONIST

Sympathetic stimulation- tremorTachicardiaHypokalemia

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PROPELLANT-FREE "SOFT MIST" INHALERS This is the latest type of

inhaler for asthma and COPD. At this writing there is only one soft mist inhaler marketed in the United State

 COMBIVENT budesonide + formoterol

RESPIMAT does not contain any of these harmful propellants and uses a spring mechanism to release the medication

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Nebulizer

Compressor nebulizer is the most commonly used and this consists of an air compressor that is connected to a cup provided for medication. This cup is attached to a mouthpiece or face mask. The compressor produces compressed air that is passed through the cup with liquid medicine. As the air comes in contact with the liquid medicine, an aerosol mist is formed and this mist is inhaled by the patient through the mouthpiece or face mask. In case of nebulizer treatments for infants, usually a face mask is used and not the mouthpiece. 

in short, nebulizer converts liquid medicine to aerosol mist that can go deep into the airways and alleviate inflammation.

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VENTOLIN®

Respirator SolutionVENTOLIN NEBULES

Respirator Solution/ 5 mg salbutamol base/ml The average dose for a single

treatment is 0.25 to 0.5 mL of VENTOLIN® Respirator Solution (1.25 to 2.5 mg

of salbutamol) diluted in 2 to 5 mL or more of sterile normal saline. For

more refractory cases, the single dose of VENTOLIN®

Respirator Solution may be increased to 1 mL (5 mg of salbutamol). Treatment may be

repeated four times a day if necessary.

Nebules/unit dose/ 2.5 or 5.0 mg salbutamol base/ 2.5 mL

Children requiring a single dose of 2.5 mg may be administered

the contents of a single VENTOLIN® Respirator Solution unit dose

(VENTOLIN NEBULES® P.F. 2.5 mg of salbutamol). For more

refractory cases children may use a 5 mg unit dose (see dosage above).

Treatment may be repeated 4 times a day if necessary

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Dose (mg) of Salbutamol (per treatment)

Volume (mL) of Ventolin respirator Solution (per treatment)

Volume* (mL) of Sterile Normal Saline to be added as diluen

1.25 0.25 2-5 mL or mor

2.5 0.50 2-5 mL or mor

5 1.00 2-5 mL or mor

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