Aerosol Therapy and Delivery Devices – Vocabulary Review

Vocabulary flashcards covering key terms and concepts from the aerosol therapy lecture notes, including indications, hazards, devices (nebulizers, MDIs, DPIs, SMIs), and usage/maintenance tips.

Aerosol therapy

Delivery of medications as an aerosol to the respiratory tract for therapeutic effect.

Indications for aerosol therapy

Reasons to use aerosols: relieve bronchospasm/bronchoconstriction, reduce upper airway edema, anesthesia during procedures, rhinitis relief, bronchial hygiene, sputum induction, and humidify dry gas.

Relieve bronchospasm

One primary goal of aerosol therapy to reduce airway smooth muscle constriction.

Relieve upper airway edema

Aerosols can reduce inflammation and edema in the upper airway.

Anesthesia during procedures

Aerosols may help control pain and gag reflex during endoscopic procedures.

Rhinitis relief

Aerosols reduce inflammation and vascular congestion in rhinitis.

Bronchial hygiene

Aerosol therapy aids in clearing secretions and improving mucous clearance.

Sputum induction

Nebulization used to stimulate coughing to obtain a sputum specimen.

Humidify dry gas

Aerosol therapy adds moisture to dry inhaled gases.

Primary hazard

Adverse reaction to the medication being given.

Adverse reaction

Unwanted or harmful effects from a medication.

Airborne infection

Spread of bacteria via airborne droplets during aerosol therapy.

Bronchospasm (hazard)

Increased airway reactivity that can be triggered by therapy; monitor closely.

Systemic side effects

Nonlocal drug effects (e.g., tachycardia); stop therapy if HR rises by ≥20 bpm.

Stop criteria: HR increase

Immediately stop aerosol therapy if heart rate increases by 20 bpm or more.

Overhydration

Excess water intake from therapy risks fluid overload.

Hypernatremia

Elevated blood sodium from excessive fluid administration.

Assessment of therapy outcomes

Evaluation of goals: improved breathing work, vitals, ABGs, SpO2, and sputum quality.

Decreased work of breathing

Clinical sign of effective bronchodilation and airway relief.

Improved vital signs

Stabilization or improvement in heart rate, blood pressure, and overall status.

Improved arterial blood gases

ABGs show better oxygenation/ventilation after therapy.

Improved oxygen saturation

Higher SpO2 indicating better oxygenation.

Adequate sputum sample

Quality sputum collected for diagnostic testing after therapy.

Patient monitoring

Close observation for adverse effects and therapeutic response.

Heart rate and rhythm

Monitor HR and rhythm during therapy; notify if abnormalities occur.

RR and breathing pattern

Assess respiratory rate and pattern for signs of improvement or distress.

SpO2 (pulse oximetry)

Noninvasive measure of oxygen saturation.

Sputum characteristics

Note quantity, color, consistency, and odor of sputum.

Skin color

Assess for perfusion and oxygenation changes (cyanosis, flushing).

Breath sounds

Evaluate lung sounds for improvements or new adventitious sounds.

Nebulizers (overview)

Devices that convert liquid medication into an aerosol for inhalation.

Baffle

Internal turbine/plate in nebulizers that separates larger from smaller particles.

Jet nebulizers

Nebulizers using a jet of gas to create aerosol; include SVN types.

Ultrasonic nebulizers

Nebulizers using piezoelectric vibration to generate aerosol; generally higher output.

Standard jet nebulizer

Jet nebulizer without a collection bag; uses power gas and a reservoir.

Nebulizer with aerosol collection bag

Jet nebulizer with a larger reservoir bag to extend output.

Breath-enhanced jet nebulizer

Enhances output by entraining air during inspiration.

Breath-actuated nebulizer

Nebulizer that releases aerosol during inhalation, increasing inhaled dose.

Technical factors (nebulizers)

Factors include device type, powering gas, fill volume, liquid properties, and design.

Flow used to power nebulizer

Typical flow range around 6–10 L/min, affects particle size and output.

Fill volume

Recommended nebulizer fill volume around 3–5 mL for optimal output.

Particle size and deposition

Optimal sizes: ~1–3 μm for alveoli; ~2–5 μm for lower airways.

Nose vs. mouth breathing

Mouth breathing is preferred for better aerosol delivery; nose filters.

Proper patient position

Sitting in high Fowler’s position or upright to optimize deposition.

Administering an SVN

Assemble, fill 3–5 mL, power on, breathe normally, stop when sputtering ends, keep vertical, rinse after.

Sputter (nebulizer)

End of aerosol production; indicates completion of their dose.

Dead volume

Medication left trapped in nebulizer (~0.5–1 mL) after treatment; must be discarded.

Vertical orientation

Nebulizer should be held vertically for proper aerosol output.

Cleaning SVN (vinegar method)

Wash 1–2x weekly with warm soapy water; soak parts in 5% vinegar solution, rinse and air dry.

Large Volume Nebulizer (LVN)

Nebulizer for bland aerosols; may include heating and air entrainment for FiO2 control.

Air entrainment device

Device in LVN to adjust FiO2 by entraining ambient air into mist.

Troubleshooting LVN (not misting)

Check for clogs, insufficient flow, or low water; use condensation bag as needed.

Ultrasonic nebulizers (operation)

Use piezoelectric crystal to generate aerosol; high output, may require cleaning with vinegar.

SPAG (Small Particle Aerosol Generator)

Device delivering Ribavirin for RSV; not to be used with other meds.

Ribavirin (RSV)

Antiviral used with SPAG for RSV infection.

Gas Injection Nebulizer (GIN)

High-output aerosol device injecting second gas to achieve desired FiO2.

Misty Ox

Brand/type of GIN used to deliver high FiO2 aerosols.

Delivery devices: Aerosol mask

Mask for LVN/SVN delivery of aerosol meds.

Face tent

Delivery device used for patients with facial trauma.

T-piece adaptor

Delivers aerosol from a ventilator or tube system; helps wean from ventilation.

Trach collar/mask

Device fitted around a tracheostomy tube to deliver aerosol.

Metered Dose Inhaler (MDI)

Inhaler delivering a measured dose via a propellant-based spray.

Dry Powder Inhaler (DPI)

Breath-actuated inhaler delivering powder; requires adequate inspiratory effort.

Respimat

Soft Mist Inhaler; spring mechanism; no shaking or spacer needed.

MDI components

Drug/propellant mix, canister, metering valve, mouthpiece/actuator.

Propellants: CFC vs HFA

CFCs were phased out; HFAs replaced them due to environmental concerns.

MDI administration steps (basic)

Shake, prime if needed, exhale, place 1–2 inches from mouth, press and inhale slowly, hold 10 seconds.

Puff spacing when bronchodilator

If multiple puffs: wait about 1 minute between puffs.

Spacers/valved chambers

Adapters that improve delivery and coordination for MDIs.

Spacer advantages

Reduce oropharyngeal deposition; easier coordination; allow use during obstruction.

Spacer disadvantages

Larger and more expensive; possible cleaning/ contamination risk.

MDI with spacer administration steps

Prime if needed, actuate once per breath, perform several breaths per actuation.

DPI advantages

Small/portable; no propellants; breath-actuated; rapid use.

DPI dosing (unit vs multidosing)

Unit-dose devices deliver one dose per use; multidose devices deliver multiple doses from a reservoir.

Aerolizer (DPI)

Unit-dose DPI using capsule-based delivery.

HandiHaler (DPI)

Unit-dose DPI using a capsule; requires patient inspiratory effort.

Diskus (DPI)

Unit-dosing blister-pack DPI with a dose per actuation.

Turbuhaler (DPI)

Multi-dose DPI with a rotating dosing disk.

Twisthaler (DPI)

Multi-dose DPI delivering one dose per inhalation.

DPI limitations

Sensitive to humidity and inspiratory flow; possible dose mis-timing.

Soft Mist Inhaler (SMI/Respimat)

Spring-driven inhaler delivering a soft mist; no shaking required.

SMI administration

Hold upright, prime if needed, breathe out, deliver dose, inhale deeply and hold.

Cleaning and storage of MDIs/DPIs/SMI

Wipe mouthpiece and store in a cool, dry area; follow device-specific cleaning.