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7/30/2019 Devices and Drugs
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INHALED MEDICATIONS AND DRUGS FOR
ASTHMA AND COPD
DR. VISHNU SHARMA .M.
PROFESSOR AND HEADDEPT OF PULMONARY MEDICINE
A. J. INSTITUTE OF MEDICAL SCIENCES
MANGALORE
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WHY INHALED MEDICATION
Inhaled
Small amount of dosage used
Lesser side effects
Fast onset of action(e.g. bronchodilators)
Useful in acute symptoms
ORAL
Large dosage used
Greater side effects
Slow onset of action
Not useful in acute symptoms
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Devices
MDI
DPI
NEBULIZER
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The Best route for Asthma and COPD
Medication is the
Inhaled Route
The same holds true for
ACUTE ASTHMA ATTACK and AECOPD
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Why Nebulisation
Immediate relief is requiredwhich can be achieved only
from inhalation therapy.
Patient is critical hence unable
to co-ordinate with inhaled
devices.
Nebulisation is the best resort
to give optimal dose and
targeted drug delivery
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Nebulizer
Fill volume-2 to 4ml
Time 8-10mt
End point-Spluttering sound
O2 flow rate 6-8li/mt
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Instructions to the Patient
Sit upright
Take normal steady breaths
Breath hold if possible for 5-8 seconds
Not to talk during the nebulisation
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Mask / Mouth piece
Mask for those who cant co-operate
Mouthpiecesless chance to eye irritation
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Precautions
Aseptic precautions to prevent infection
Proper disinfection
Hand hygiene
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Respule/Respiratory solution
Respule -ready to use
Respiratory solution needs to be diluted
Respule cost is more
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RESPIRATORY SOLUTION RESPULE
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Metered dose inhaler
Quick to use
Compact
Disadvantage
Technique is difficult
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Why use a Spacer ?
Ensures correct use of an MDI by
correcting co-ordination problems.
Reduces incidence of throat infections
with inhaled steroid
As good as nebuliser for acute
exacerbations ( with MDI )
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Then do we need nebulizers ?
YES
Acute severe asthma with impendingrespiratory failure
Intensive care / Hospital / Clinic /Ambulances
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Easy to use
Compact
More oropharyngeal deposition
Dry powder inhaler
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Which inhalation Device?
Inhalers
MDI DPI Nebuliser
(acute severe
episodes only)
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When you can not use a DPI?
Patient not able to inhale-Child below 3, or Elderly
Use:
MDI + Spacer
MDI + Spacer + Baby Mask
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Disadvantages OF Inhaled medications
Needs patient co-operation
Technique should be correct
Oropharyngeal deposition
Irritation to eye with nebulization
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Inhalation Drugs in Asthma and COPDBeta 2 agonists
Anti cholinergics
Gluco-corticosteroids
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Long acting beta agonists
Salmeterol
Formoterol
Indacaterol
Arfomoterol
Bambuterol
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Formetrol
Rapid onset of action
Short duration of side effect
Response increase with dose
No cumulative side effect.
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Salmetrol
Slower onset
Long duration of side effect
No such effect
Cumulative side effect
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ADVERSE EFFECTS
Uncommon with inhalation
Tremor, dyspnoea, weakness, headache
Palpitations, tachycardia, arrhythmias
Tolerance
Hypokalemia with high doses
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PRECAUTIONS
Use with cautions in patients with diabetes,hypertension
Severe paradoxical bronchoconstr iction
Administered cautiously in cardiac patients
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DRUG INTERACTIONS
Combination of salmeterol - f luticasone &
formoterol-budesonide have synergistic
action
I ncreased risk of hypokalemia with high dose
of corticosteroid with2 agonists
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Anticholinergic drugs
Ipratropium bromide is a quaternary
ammonium derivative of atropine.
Tiotropium bromide the most recently
developed, has a longer duration of action.
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AdvantagesMinor side effects
Used in COPD
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Disadvantages
Slow onset of action
Less effective than2 agonist
No anti -inf lammatory action
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High topical low systemic activity
Suppress bronchial inflammation, increase peak
expiratory flow rate
Inhaled corticosteroids
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Modulation of cytokine and chemokine production
Inhibition of eicosanoid synthesis
Inhibition of accumulation of leucocytes in the lungs
Decreased vascular permeability
Mechanism of action
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MDIs
DPIs
Nebulization
Methods of administration
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Equivalent dosages
E i l d
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200mg beclomethasone
200mcg budesonide
80mcg cic lesom ide
100mcg f lut icasone
200mcg mometasone
Equivalent dosages
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Beclomethasone
Budesonide
Flut icasone
Ciclesonide
Mometasone
Preparations
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Hoarseness- steroid induced myopathy
Dysphonia
Oropharyngeal candidiasis
LOCAL Adverse effects
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Systemic Adverse effects Mood changes
Osteoporosis
Bruising, hyperglycemia
HPA suppression
Ad ff t
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HPA suppression- dosages above 1500mcg of
beclomethasone
Children 400mcg beclomethasone
Children with asthma even though there may be pre-
pubertal growth delay, they tend to catch up later
Thinning of skin and striae especially elderly
Adverse effects- concerns
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ICS+LABA
Potentiate each other
Equivalent to double the dosage of steroid
Interactions
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THANK YOU
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