Airway Drug Delivery Systems (8)

What are the 3 major types of delivery devices for inhaled medications?

MDI - Metered dose inhalers

DPI - dry powder inhalers

Soft mist devices (nebulizers, respimat)

A metered dose inhaler contains the drug…

in the form of a solution or suspension and a liquefied gas propellant

Metered Dose Inhalers have 3 standard components which are

Canister (contains the propellant and drug)

Metering valve (ensures a fixed amount of drug leaves the canister

Mouthpiece (actuator - delivers specific dose to the patient)

Almost all MDIs can be used with

Spacers

MDIs have a __ which requires _

propellant; shaking before use and priming on the first use or after extended periods of non-use

What are examples of MDI inhalers?

Ventolin

Symbicort

Dulera

QVAR Redihaler

Airsupra

QVAR redihaler is not to be used with what?

spacer

How is the dose in a QVAR Redihaler released?

as the patient breathes in

Even though the Redihaler looks like a dry powder inhaler system (Respiclick) why is not?

the drug is an aerosol (propellant HFA)

DPIs and soft mist inhalers do not have a chemical propellant

What are some advantages of an MDI?

portable, compact, ready to use after shaking

short treatment time

relatively inexpensive

available for a wide variety of drugs

What are some disadvantages of MDIs?

Hand-breath coordination

Potential for high oropharyngeal deposition due to high spray velocity

What is a dry powder inhaler?

an inhaler that contains the dry powder drug in either a single dose or multi-dose format where it is dispersed and inhaled through the device into the lungs.

How is a single dose DPI loaded?

as it is time for the dose

How is a multi-dose DPI loaded?

via the specific design of that DPI (Ellipta: opening lid)

DPIs are designed how?

Either a sealed blister or a reservoir format

What is required for the inhalation of DPIs?

higher inspiratory flows

What is the only single-dose DPI available?

Handihaler

How is the Handihaler loaded?

through the elliptical viewing window

How many puffs is recommended with a Handihaler?

2

What are examples of multi-dose DPIs?

Dry powder blister packets in device

Dry powder in a reservoie

What are examples of the DPIs that use a blister packet?

Diskus

Ellipta

Wixela Inhub

What are examples of dry powder DPIs in a reservoir?

Pressair

Twisthaler

Flexhaler

Respiclick

What is the dosing for all ellipta devices?

1 puff once daily

What are some pros of DPI usage?

Easy to use, does not require hand-breath coordination

Cons of using a DPI

may require higher inspiratory flow to “pull” medicine from device

Humidity and heat may affect the dose

have to positioned correctly to be administered correctly

What is a nebulizer?

a type of atomizer inside a chamber using compressed air

Pro of nebulizers

simple resting tidal breathing to get medicine into a patients lungs

Cons of nebulizers

takes longer to administer. takes 5-15 minutes to breath in vs seconds of an albuterol MDI

What is a soft mist inhaler?

produces a fine, soft mist similar to nebulizer, but using a different path to create it

There is no chemical propellant in device

How do you operate a soft mist inhaler?

turning a device coils a spring that will push the medicine through the inhaler when the dosing button is pressed

The canister must be loaded into the inhaler before the first use and PRIMING is required

Pro of a soft mist inahler

great for lower inspiratory flow

Con of a soft mist inhaler

can be hard to turn and assemble the device