Aerosol Therapy: Traditional & New Drugs in Aerosol Medicine
Aerosol therapy in the past decade has evolved faster than its initial years after emerging as a primary form of treatment in respiratory diseases involving both congenital and acquired diseases. This type of inhalation therapy focuses on the delivery of the medications that have been directly or indirectly injected into the lower and upper airways for either local or systemic effects. The greatest advantage of aerosol therapy is the ability to treat patients with smaller doses which, over time, yields minimal adverse effects for non-specific drugs, along with being the most rapid in treatment response time. Modern aerosol medications are made to be compatible with certain devices, such as metered dose inhalers, dry powered inhalers, and nebulizers, each of which have certain advantages and disadvantages depending on appropriateness of delivery and treatment. The particle size of these different applicators are crucial in deciding the location in the body in which the drug is to be delivered.
An aerosol is a suspension of liquid or solid particles in a carrier gas. Aerosol therapy is the delivery of an aerosol drug to the body via the airways by delivering it in an aerosolized form. The advantages of this form of drug delivery is that
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The key mechanisms that affect pulmonary depositions of aerosols are inertial impaction, sedimentation and diffusion. These three mechanisms operate within a range of various combinations when certain aerosol drugs that affect different areas within the lung are used. Inertial impaction occurs when a large particle size aerosol, usually three microns and over, are inhaled and settled at the process of the oropharynx and larger airways. Aerosols that are smaller in size diffuse within the lower airways, making it the dominant mechanism if the aerosol particles make it
For Ventolin to work optimally, situations that may trigger an asthma attack must be avoided. These situations include exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur or pollens. Relating to the case study, a few of these may apply to the patient, such as exercising in the cold morning air and perhaps breathing in dust and allergens such as pollens or maybe from the eucalyptus in the Blue Mountains might have had an effect on his condition.
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Pneumonia is an inflammatory response that results in an excess amount of fluid in the interstitial spaces, the alveoli, and the bronchioles. It is caused by the inhalation of organisms or irritants that move into the alveoli when the immune system is not strong enough to combat it. Once these organisms or irritants enter the lungs, they reach the alveoli where they begin to multiply. This multiplication of these organisms results in white blood cells traveling into the area subsequently causing local capillaries to become edematous, leaky, and to create exudate. The combination of this results in thickening of the alveolar wall due to fluid collection within and around the alveoli. Impaired gas exchange, which is the ...
Only the smallest particles of the coal dust make it past the nose, mouth, and throat into the alveoli found deep in the lungs. The alveoli, or air sacs, are responsible for exchanging gases with the blood, and are located at the end of each bronchiole. Microphages, a type of blood cell, gather foreign particles and carry them to where they can either be swallowed or coughed out. If too much dust is inhaled over a long period of time, some dust-laden microphages and particles collect permanently in the lungs causing black lung disease.
The surface area for gas exchange decline and lung mass decrease, residual volume increases as the alveoli enlarge. In addition, the speed of breathing out with maximal effort gradually diminishes, and coughing becomes less effective which also increase the risk of pulmonary illness (Bickley &Szilagyi, 2016). There is a decrease in arterial pO2, but the O2 saturation normally remains above 90% (Bickley &Szilagyi, 2016). When the patient has COPD - a disease state characterized by the presence pf airway obstruction that is not fully reversible , with chronic inflammation found in the airways, lung parenchyma, and blood vessels- as they age the disease becomes more progressive due to the natural changes of aging to the pulmonary system (Lewis, 2007). The defining features of COPD are irreversible airflow limitation during forced echalation caused by loss of elastic recoil and airflow obstruction caused by mucus hypersecretion, mucosal edema, and brochospasm (Lewis, 2007). Gas exchange abnormalitites result in hypoxemia and hypercarbia (Lewis, 2007). Air trapping worsen and alveoli are destroyed (Lewis, 2007).There is a siginificant ventilation/perfusion mismatch and hypoxemia resutlts (Lewis, 2007). Pulmonary hypertension may occur late in the course of COPD leading to hypertrophy of the right ventricle
One of the common diseases in the respiratory system that many people around the world face is emphysema or also known as chronic obstructive pulmonary disease (COPD). It is a chronic lung condition where the alveoli or air sacs may be damaged or enlarged resulting in short of breath (Mayo Clinic, 2011). If emphysema is left untreated, it will worsen causing the sphere shaped air sacs to come together making holes and reduce the surface area of the lungs and the amount of oxygen that travels through the bloodstream, blocking the airways of the lungs (Karriem- Norwood, 2012). The most common ways a patient can get emphysema are by cigarette smoking or being exposed to chemicals, dust or air pollutants for a long period of time. Common physical exams reveal a temperature of 100.8 Fahrenheit, 104 beats per minute, a blood pressure of 146/92, and a respiratory rate of 36 breaths per min (Karriem- Norwood, 2012). (see appendix A.1,A.2, A.3, A.4 for complete proof.)
Duerden, M. & Price, D. (2001). Training issues in the use of inhalers. Practical Disease
By entering the field of respiratory therapy, one is entering a growing field of opportunity. There are continually emergent job opportunities in this field whereas there is also a rise of growth in the technology and developments in the field such as medicines, techniques, and other aspects.
Combination agents containing inhaled corticosteroids along with long-acting beta agonists are considered appropriate step-up therapy for patients experiencing COPD exacerbations while taking long-acting bronchodilators.
In the 1940’s, respiratory therapists were called oxygen technicians. The only thing they did was set up oxygen tanks, masks, and nasal catheters. In the 1950s, respiratory therapists were known as inhalation therapists because they were able to deliver aerosol meds. In the 1960s, therapists were responsible for ventilator setup, ABGs, and PFTs. The term “respiratory therapist” became designated in 1974. Another part of respiratory therapy that has advanced is oxygen therapy. It was produced in large scale in 1907 where it was used for nasal catheters, oxygen tents, and oxygen mask. In the 1940’s, it was widely prescribed in hospitals. In the 1960’s, the modern versions of the nasal cannula, oxygen mask, partial rebreathing and nonrebreathing mask were available. In the 2000’s, home therapy oxygen and concentrators were developed. The first aerosolized medications were given in 1910. In the 1940’s, bronchodilators were introduced to help with asthma. Since then, newer delivery devices such as dry powder inhalers have been introduced. The first negative pressure tank ventilator was developed in
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Lung surfactants reduce the surface tension of alveoli and are naturally occurring compounds in the healthy lung. Artificial
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
Comunicación de la Comisión al Parlamento Europeo y al Consejo de 23 de octubre de 1998: Eliminación progresiva de los CFC de los inhaladores - dosificadores.
. Irritation can be reduced by applying aerosol medicaments without even touching the skin of effected area. (7)