Inhalation Therapy- Basics

(Target oriented drug delivery by inhalation root to the airways is an effective way of treating many respiratory diseases e.g. asthma, rhinitis & COPD. This method is safe, as it needs less amount of drug to produce desired effect & relief from disease as compared to drugs given by mouth or through injections. It is important to learn the correct teqnique by the patient to use the devices for inhalation therapy. In this writeup Dr. Luhadia has nicely explained the basic principles and technique in simple language.

Editor

What is Inhalation therapy?

Inhalation therapy is delivery of drug directly into upper or lower respiratory tract via normal breathing. It is the Ideal therapy now a days for bronchial asthma and COPD.

Why aerosol therapy?

Like medicines for eyes, ears & skin diseases, drugs should be given directly to wind pipe or lungs to avoid systemic side effects or fast relief and therapeutic effect with lower doses. The medicines of asthma via inhalation therapy are safe in pregnancy and patients with hypertension, diabetes, Heart diseases.

Devices for aerosol therapy

The commonly available & being used devices are :-
• Nebulizer
• Metered dose inhaler (MDI)
• Dry powdered inhaler (DPI)
Nebulizer :- is a machine which is power operated and converts the solution of medicine into aerosol. It costs about Rs. 2000 /- and takes about 5 – 10 mints for delivery of one dose.
Metered dose inhaler (MDI):- is a very handy & compact device containing drug & propellant in a canister. It delivers a fixed metered dose of the drug as a spray when the canister is pressed. It is the most commonly used device and is also cost effective. The effectivity of this device may be enhanced by adding spacer with or without baby mask.
Dry Powdered Inhaler (DPI):- are devices in which drug is used in the powdered form. These may be single dose or multiple doses device. These devices are most easy to use and ecofriendly.
Selection of device:-
• Acute attack & severe asthma
• MDI with spacer
• Nebulizer
• New born & Infant Nebulizer
• Preschool children less than 4 years.
• MDI with spaces with Baby mask
4. Children 4 – 6 Years
– MDI with spacer
5. Children above 6 years and adults
– DPI or Breath Actuated MDI
Technique :- The effectivity of aerosol therapy depends upon correct technique of using device.

M D I

• Shake the device
• Remove mouth cap
• Exhale Completely & keep Neck tilted back
• Keep mouth Piece between Lips
• Press canister
• Simultaneously slowly inhale as deep as much possible
• Hold Breath from 4 – 10 seconds.
• Wait for at least 1 Minute before next dose
• Rinse mouth & throat with water after steroids

D P I

• Load the dose
• Exhale completely
• keep the neck tilted back
• keep the mouth piece of device between lips tightened
• Inhale rapidly & deeply as fast & deep as possible
• Remove the device and close mouth
• Hold breath for 4 – 10 Secs.
• The step 2 – 7 may be repeated
• Rinse mouth & throat with water after steroids

Precautions

• Neck should be tilted back
• The inspiration should be slow & deep with MDI while Rapid & deep with DPI
• Always Rinse mouth & Throat after inhaling steroids

Common Complications

• Oral Thrash or stomatitis
• Hoarseness or Heaviness of voice
• Irritant cough
• Feeling of cold at Throat
There complications can be avoided by good technique and using spacer with MDI.

Future of Aerosol therapy

The aerosol therapy is well established in bronchial asthma and COPD. It is going to be applied in diabetes mellitus for insulin delivery and in infective diseases and immunomodulators.

Myths about aerosol therapy

It is a popular myth that inhalation therapy is habit forming and it should be used in severe cases of asthma rather it can be stopped if asthma is controlled and It is more effective & safe in the beginning of the disease and oral & Injectable medicines should be used only in severe cases of asthma & COPD.