INHALER MEDICAL DEVICE

B A S H A R T A L A L S A A D M O H A M M E D 1 S T Y E A R M . P H A R M

P H A R M A C Y P R A C T I C EJ S S U N I V E R S I T Y

P H A R M A C Y C O L L E G E

INHALERSDefinition:Inhalers are hand-held portable devices that

deliver medication directly to the lungs. Particle Size: <1μm: reach up to the alveoli. 1-5μm: beyond the 10th generation of bronchi (respirable

particles),

>5μm: oropharynx

> 5 µm impaction

1-5 µm sedimentation

< 1 µm like gas

DEPOSITION OF PARTICLES

TYPES OF INHALER1-Metered dose inhalers, also

called MDIs or aerosol inhalers.2-Breath activated inhalers 

or dry powder inhalers (eg, Turbuhaler, Accuhaler, Handihaler).

3-Nebulisers.SPACER devices are sometimes recommended for use with

MDIs, to make it easier to use the inhaler and get more medicine into the lungs.

METERED DOSE INHALER

MOST EFFICIENT WAY OF USING MDI- STEPS

- Shake the inhaler well before use (three or four shakes) .

- Remove the cap .- Breathe out, away from your inhaler .- Bring the inhaler to your mouth. Place it in your

mouth between your teeth and close your mouth around it.

- Start to breathe in slowly. Press the top of your inhaler once and keep breathing in slowly until you've taken a full breath .

- Remove the inhaler from your mouth, and hold your breath for about ten seconds, then breathe out .

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

- Always write down the number of puffs you've taken so that you can anticipate when you need to refill your prescription.

- Store all MDI’s at room temperature.

METERED DOSE INHALER USING

ADVANTAGES OF MDIS- Compact, portable ,convenient- Multidose delivery capability- Lower risk of bacterial

contamination- Suitable for emergency situation

DISADVANTAGES OF MDIS - Needs correct actuation and

inhalation. - coordination difficult for

children and elderly. - Cold Freon effect.

- High pharyngeal drug deposition.

- Flammability possibility of new propellants.

- Remaining dose –difficult to determine.

SPACER A spacer is a tube that MDI is placed into

and it holds the medication that is released (with activation of the MDI) until patient can breathe it in.

The spacer can be cleaned by soaking in a solution of mild detergent and water for 15 minutes. Shake out the excess water and allow to air dry. Replace the device after 24 months of continuous use.

MDI WITH SPACER

MDI WITH SPACERCompensate for poor technique/coordination

with MDISpacers slow down the speed of the aerosol

coming from the inhaler, meaning that less of drug impacts on the back of the mouth and somewhat more may get into the lungs.

Because of this, less medication is needed for an effective dose to reach the lungs, and there are fewer side effects from corticosteroid residue in the mouth.

DISADVANTAGES OF SPACER- Large size and volume of device.- Bacterial contamination is possible .- device needs to be cleaned periodically.- Electrostatic charges may reduce

drug delivery to the lungs.

DRY POWDER INHALER (DPI)

SINGLE DOSE DEVICESHad to be reloaded with capsule containing micronized drug in a large particle carrier powder ,usually lactose

ROTAHALERThe Rotahaler is just one of many devices that are

available. It uses special capsules, called Rotacaps, that contain the medication in a very fine powder form that is effectively delivered into the lungs when you inhale through the Rotahaler.

ROTAHALER

MULTIPLE DOSEDEVICES

TURBUHALER DEVICETurbuhalers are a tube-shaped inhaler

which has the medication inside in the form of a dry powder. They have a removable cover and a twisting base. The device is ‘breath-activated’ which means the dry powder medication is ‘sucked’ from the device rather than ‘fired’ like it is from other devices.

Turbuhalers may be difficult to use for young children, or adults who are short of breath. It is recommended to have a puffer and spacer available for emergencies.

HOW TO USE A TURBUHALER:

HOW TO USE A TURBUHALER:

- Unscrew the cap and take it off. Hold the inhaler upright- Twist the coloured grip of your Turbuhaler® as far as it will go.

Then twist it all the way back. You have done it right when you hear a "click"

- Breathe out away from the device- Put the mouthpiece between your teeth, and close your lips

around it. Breathe in forcefully and deeply through your mouth

- Remove the Turbuhaler® from your mouth before breathing out

- Always check the number in the side counter window under the mouthpiece to see how many doses are left. For the Turbuhalers® that do not have a dose counter window, check the window for a red mark, which means your medication is running out. When finished, replace the cap.

ADVANTAGES OF DPIS- Breath-actuated.- Less patient coordination required.- Spacer not necessary.- Compact Portable.- No propellant.- Usually higher lung deposition than

a pMDI.

DISADVANTAGES OF DPIS- Work poorly if inhalation is not forceful

enough.- Many patients cannot use them correctly (e.g. capsule handling problems for elderly.- Most types are moisture sensitive, Humidity potentially causes powder clumping

and reduced dispersal of fine particle mass.- Need to reload capsule each time.

NEBULISERS

A nebuliser is a machine that converts liquid medication into a fine mist that can then be inhaled. They used to be used by many people to take their asthma medications, but these days are much less common as we have easier, faster and less expensive ways to take the medications.

TYPE OF NEBULISER:

Jet nebulizer:-The most commonly used nebulizers are Jet nebulizers, which are also called "atomizers". Jet nebulizers are connected by tubing to a compressor, that causes compressed air or oxygen to flow at high velocity through a liquid medicine to turn it into an aerosol, which is then inhaled by the patient.

Ultrasonic wave nebulizer:-a new type of portable nebulizer. The technology inside an

ultrasonic wave nebulizer is to have an electronic oscillator generate a high frequency ultrasonic wave, which causes the mechanical vibration of a piezoelectric element. This vibrating element is in contact with a liquid reservoir and its high frequency vibration is sufficient to produce a vapor mist.

JET NEBULIZERDelivers compressed gas through a jet,

causing an area of negative pressure and drawing the liquid up the tube by the Bernoulli effect. The solution is entrained into the gas stream and then sheared into a liquid film that is unstable and is broken into droplets by surface tension forces. The fundamental concept of nebulizer performance is the conversion of the medication solution into droplets in the respirable range of 1-5 micrometers

ULTRASONIC NEBULIZERGenerates high-frequency ultrasonic waves

(1.63 MHz) from electrical energy via a piezoelectric element in the transducer. These ultrasonic waves are transmitted to the surface of the solution to create an aerosol. Aerosol delivery is by a fan or the patient’s inspiratory flow; particle sizes may be larger with this device. A limitation of ultrasonic nebulizers is that they do not nebulize suspensions efficiently

ADVANTAGES OF NEBULIZERS- Provide therapy for patients who cannot

use other inhalation modalities (eg, MDI, DPI)

- Allow administration of large doses of medicine

- Patient coordination not required- Effective with tidal breathing- Dose modification possible- Can be used with supplemental oxygen

DISADVANTAGES OF NEBULIZERS- Decreased portability- Longer set-up and administration time

- Higher cost- Electrical power source required- Contamination possible

CONCLUSIONA number of inhalation devices are

available for the treatment of pulmonary diseases, each with its own advantages and disadvantages. None has proven to be superior to the others in any of the clinical situations tested. Whichever device is chosen, the key to successful treatment lies at a proper inhaler technique

Thank you !!