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Inhaled drug delivery: A practical guide to prescribing inhaler devices (11)

by the delivery device chosen. Close follow-up of patients will be required with readjustment of doses at intervals of two to four weeks in order to identify the lowest dose of inhaled corticosteroids that provides optimal control of symptoms and lung function. Given the rapid onset of bronchodilation with the short-acting beta-agonists and their prescription…

Inhaled drug delivery: A practical guide to prescribing inhaler devices (10)

The impending disappearance of conventional CFC propelled pMDIs will require physicians to switch a large number of patients to other delivery devices. At this time it appears wise to choose one of the newer devices for patients whose therapy is being initiated and patients who require changes in their current asthma therapy. This will allow…

Inhaled drug delivery: A practical guide to prescribing inhaler devices (9)

Nonchlorinated propellants to replace CFCs have been developed and consist of hydrofluoroalkanes (HFAs) . These are less reactive and persist in the atmosphere for a much shorter time than CFCs. 3M is the only company, to date, to bring to market a pMDI using an HFA type propellant. This is only recently available in Canada,…

Inhaled drug delivery: A practical guide to prescribing inhaler devices (8)

The frequency of oral candidiasis secondary to the use of inhaled corticosteroids delivered by Turbuhaler is low and similar to that seen with current pMDIs attached to a large volume spacer . Oral candidiasis can be prevented almost completely by thorough mouth rinsing and gargling after use and by bid dosing as opposed to qid.

Inhaled drug delivery: A practical guide to prescribing inhaler devices (7)

In contrast, the Turbuhaler, a multidose (ie, requires no loading) breath actuated DPI, delivers only the active ingredient in powder form. Patients are usually unaware of inhaling anything but air. For this reason they need to be warned lest they think no medication is being delivered. This is of critical importance with budesonide, the inhaled…

Inhaled drug delivery: A practical guide to prescribing inhaler devices (6)

Another way to circumvent problems in coordinating actuation of the inhaler with early inspiration is to use a breath actuated device, most commonly a DPI, though more recently breath actuated pMDIs have become available.

Inhaled drug delivery: A practical guide to prescribing inhaler devices (5)

To be effective, spacers should have a volume of at least 110 mL and, as a result, are bulky ; many patients are therefore unwilling to carry these devices around. Patients must be reminded to shake the pMDI before use, something they tend to forget when the pMDI is left attached to the spacer device….

Inhaled drug delivery: A practical guide to prescribing inhaler devices (4)

Multidose devices, both pMDIs and DPIs, show a tail-off phenomenon in the dose delivered when nearly empty; it therefore appears advisable in patients in whom the dose is critical to advise against the use of these devices past the number of recommended doses, even when the pMDI appears to be producing an adequate plume ….

Inhaled drug delivery: A practical guide to prescribing inhaler devices (3)

The volume of inspiration is important, and drug delivery may be improved if the breath is initiated at functional residual capacity, that is, at the end of a relaxed expiration as opposed to asking the patient to breathe out completely to residual volume that may cause smaller airways to collapse . A breath hold at…

Inhaled drug delivery: A practical guide to prescribing inhaler devices (2)

While there is little doubt as to the efficacy of drug delivery with both the CFC and non-CFC propelled pMDIs and the newer multidose dry powder inhalation devices when they are used properly, inadequate technique, with subopti-mal drug delivery, is very common. Inadequate technique has been reported among anywhere from 12% to 89% of subjects…

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