Inhalars for bronchial asthma
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Transcript of Inhalars for bronchial asthma
INHALARS FOR BRONCHIAL ASTHMA
Prepared by.Dr.Afnan ShamraizPGr.1.Paeds.ATH
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
PATHOPHYSIOLOGY OF ASTHMA
Lung function during early and late phases of allergic response
BEFORE STIMULUS
BRONCHOSPASM
LATE PHASEEARLY PHASE
INFLAMMATION
History of Inhaled Therapy4000 years ago: the smoke of ephedra
sinica was used for asthma therapy
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
Why Inhalation Therapy?
Targeted delivery of medication to the lungs
Rapid onset of action Smaller doses Less systemic and GI adverse effects Relatively comfortable
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
Aerosol Size
PHARMACOKINETICS OF INHALED DRUGS
Lung deposition of drug
Particle size shape particle density solid or liquid phase Type of inhalation device Technique Airway obstruction Drug molecule
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
Deposition of particles
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%
Inhalation Devices
Aim To make aerosol from the drugs
solution or solid particles 1-Metered dose inhaler 2-Dry powder inhaler 3-Nebulizer
Asthma Medications and SuppliesDry Powder Inhaler - DPI
Meter Dose Inhalers - MDI
Asthma Medications and Supplies
Spacers (use with MDIs
Nebulizer / Compressor
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 .
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
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:
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.
Metered Dose Inhalers (pMDI
Canister Propellent gas (liquid
under pressure) Drug Dissolved or solid
microparticules into the gas
Surfactant Physical stabilisation Prevent clustering
Propellant
Chloro fluoro carbon (CFC
Hydro fluoro alcan (HFA)
CFC (freon gas) CFC not flammable
Not include chloride Not disturbe Ozone
layer
Freon (CFC)
Oropharyngeal irritation, cough and bronchospasm
Harmfull for ozone layer Cardiac arrhytmia Less effective in cold climate
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
Not include dosimeter
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.
MDI with HFA (CFC-free)
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
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
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
Salbutamol
••Salbutamol:preparationanddoses–Availableas2,4and8mgtablets–Syr.As 2mg/5ml–Asmetereddoseinhaler–100μg–200μ
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
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
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
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)
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
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
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
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
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.
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
DRUGS USED IN ASTHMADRUGS USED IN ASTHMA
Arachidonic acid
Lipooxygenase Cyclooxygenase
Hydroxypeptidase Endoperoxidase
Leukotrienes Prostacycline
Thromboxane A2
Prostaglandin
Membrane Lipid
Phospholipase A2
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
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)
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
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
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
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
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
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
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)
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
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
fluticasone
Flovent 220 - fluticasone 220 mcg/ puff
Flovent 110 - fluticasone 110 mcg/puff
Flovent 44 - fluticasone 44 mcg/puff
Flovent Rotadisks 50 fluticasone,50mcg
100mcg 250mcg
FloventRotahaler
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
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
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
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
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
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
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
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
®
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
COMBINATIONS…
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)
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
Xaltide Inhalar
Albuterol:50mcg/actu, Beclomethasone (Dipropionate):100mcg/actu
Indicated for the long-term management of asthma only when the need for inhaled corticosteroid and bronchodilator therapy has been established
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.
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
MDI spacer
Decrease of oropharyngeal deposition Proposing inhaled CS
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
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
MDI spacer
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
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.
Dry powder inhaler (DPI)
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
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.
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
Classification of Dry Powder Inhalers, Based on Design and Function Single-Dose Devices Aerolizer formoterol capsule
single HandiHaler tiotropium capsule
single
Multiple-Dose Devices
Turbuhaler budesonide
reservoir 200 Turbuhaler
budesonide/formoterol reservoir 120
Diskus salmeterol blister
strip 60 Diskus
salmeterol/fluticasone blister strip 60
Dry powder inhaler (DPI) Multi doses
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
Combination
(fluticasone and salmeterol)
SereventFlovent
+ =
Advair
Inhaled Corticosteroids with Long-acting Bronchodilator
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)
DOSES
DRUG FORM DOSE
Fluticasone/salmeterol
DOI 100,250,or 500ug/50 ug
1 Inhalation bid
Adverse Effects
LOCAL SYSTEMICINH CS Candidiasis
DysphoniaAdrenal suppression Growth retardation (large doses)
INH B2 AGONIST
Sympathetic stimulation- tremorTachicardiaHypokalemia
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
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.
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
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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