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    Aerosoltherapy Nebu 120503115712 Phpapp01

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    Aan Ika Sugathot
    This document discusses aerosol therapy and nebulizers. It begins by defining aerosols and describing their use in drug delivery. Factors that influence aerosol deposition include particle size, respiratory anatomy, and breathing patterns. The two main types of nebulizers are jet and ultrasonic. Jet nebulizers use venturi pressure to generate aerosols while ultrasonic nebulizers use piezoelectric vibrations. Common medications nebulized include bronchodilators, steroids, and mucolytics. Proper technique and the role of nebulizers in chest physiotherapy is also outlined.

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    Aerosoltherapy Nebu 120503115712 Phpapp01

    Uploaded by

    Aan Ika Sugathot
    109 views65 pages
    This document discusses aerosol therapy and nebulizers. It begins by defining aerosols and describing their use in drug delivery. Factors that influence aerosol deposition include particle size, respiratory anatomy, and breathing patterns. The two main types of nebulizers are jet and ultrasonic. Jet nebulizers use venturi pressure to generate aerosols while ultrasonic nebulizers use piezoelectric vibrations. Common medications nebulized include bronchodilators, steroids, and mucolytics. Proper technique and the role of nebulizers in chest physiotherapy is also outlined.

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    Aerosol Therapy-Nebulizer

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    This document discusses aerosol therapy and nebulizers. It begins by defining aerosols and describing their use in drug delivery. Factors that influence aerosol deposition include particle size, respiratory anatomy, and breathing patterns. The two main types of nebulizers are jet and ultrasonic. Jet nebulizers use venturi pressure to generate aerosols while ultrasonic nebulizers use piezoelectric vibrations. Common medications nebulized include bronchodilators, steroids, and mucolytics. Proper technique and the role of nebulizers in chest physiotherapy is also outlined.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    109 views65 pages

    Aerosoltherapy Nebu 120503115712 Phpapp01

    Uploaded by

    Aan Ika Sugathot
    This document discusses aerosol therapy and nebulizers. It begins by defining aerosols and describing their use in drug delivery. Factors that influence aerosol deposition include particle size, respiratory anatomy, and breathing patterns. The two main types of nebulizers are jet and ultrasonic. Jet nebulizers use venturi pressure to generate aerosols while ultrasonic nebulizers use piezoelectric vibrations. Common medications nebulized include bronchodilators, steroids, and mucolytics. Proper technique and the role of nebulizers in chest physiotherapy is also outlined.

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    of 65

    BY-Vinod Ravaliya, MPT

    Dept. of Physiotherapy

    AIM OF AEROSOL THERAPY


    To deliver a therapeutic dose of the selected
    agents to the desired site of action.
    Choice of route for drug delivery
    -Directly to the site of action
    -Therapeutic action with side
    Effects: high therapeutic index,
    greater efficacy & safety

    AEROSOL
    Definition
    A suspension of very fine liquid or solid
    particles in a gas.

    Key to aerosol therapy is aerosol particle


    Respirable range:1-5 micron
    80%drugs deposited in oropharynx
    10% in walls of inhaler
    10% in the lungs
    ( SP Newman et.al.1985 )

    In mechanically ventilated patients


    -51%within nebulizer unit
    -2.2%IN Rt LUNG &0.9% IN Lt LUNG
    (SH Thomas M fiddler et.Al.1993)
    In clinical settings, medical aerosols are
    generated with atomizer, nebulizer or inhalers
    devices that physically disperse matter into
    small particles & suspend them into a gas.

    AEROSOL DELIVERY SYSTEMS


    The three principle types of devices widely
    used are :
    1.MDI-metered dose inhalers
    2.DPI-dry powder inhalers
    3.Nebulizers

    METERED DOSE INHALERS


    Most widely used
    Aerosol flow rate 30
    m/s or 100 km/h
    Propellants were
    CFC

    ADVANTAGES OF MDI
    Inexpensive
    Light, compact
    Quick delivery of drugs
    Precise and consistent doses

    DISADVANTAGES OF MDI
    Difficulty in coordination of activation &
    inspiration
    Time consuming to teach
    Contains CFC
    Cannot be used in children & elderly
    Cannot be used in seriously ill patients
    Cannot be used in mechanically ventilated
    patients

    SPACERS

    SPACERS
    Holding chambers or reservoirs
    Attachment to a MDI
    Advantages :
    1.No need to activate coordination
    With inspiration
    2.Increases drug deposition in lung
    3.Reduces drug deposition in mouth
    4.Used in children with face mask
    5.Decreases incidence of oral
    thrush

    DRY POWDER INHALERS


    Introduced in 1960s
    No propellants
    Requires patients own Inspiratory effort
    to form aerosol
    Powder is delivered only when patient
    inhales

    ADVANTAGES OF DPI
    Light weight
    No hand breath coordination
    Quick delivery of drugs
    Useful in children above 5 yrs of age

    Disadvantages of DPI
    Require high inspiration flow >28 l/min

    COMPARISION BETWEEN MDI &DPI


    High velocity aerosols

    Requires coordination

    Aerosol velocity
    depends on inspiratory
    flow rate
    No coordination
    needed

    Time consuming to
    teach

    Easy to teach

    Requires slow & deep


    breathing only

    Requires high insp


    flow >28 l/min

    CHARACTERISTICS OF THERAPEUTIC
    AEROSOLS
    Effective use of aerosols requires an
    understanding of characteristics of the
    aerosols.
    Aerosol output (wt /minute)
    Emitted dose
    This tells little about the amount of
    drug reaching the targeted site of action.

    A substantial proportion of particles that leave


    a nebulizer may never reach the lungs.
    Effectiveness of medical aerosols depends on
    amount of aerosol particles deposition to the
    lower respiratory tract & deposition of aerosol
    influenced by many other factors.

    FACTORS INFLUENCING DEPOSITION


    Physical & chemical properties of
    aerosols
    Anatomy of the respiratory tract
    Physiological factors

    (J E Agnew, D Pavian, S W Clarke et.al.1984)

    PHYSICAL & CHEMICAL PROPERTIES


    OF AEROSOLS
    GRAVITY
    Aerosol size must be >1 microns because at this
    mass gravity loses its influence on particles.
    ( Chantal Darquenne , G Kim Prisk et.al.2000 )
    Gravity influence is in direct relation with particle
    mass
    Greater masstendency to undergo proximal
    airway deposition

    INERTIAL IMPACTION

    Water particles
    Gas molecules

    PARTICLE SIZE
    Aerosol particle size depends upon :
    -- nebulizer chosen
    --Method used to generate aerosol
    It is not possible to visually determine whether a
    nebulizer is producing an optimal size
    particles
    Aerosols traverse tubular strs in which turbulent
    flow is the rule
    >Particle size---- gravity influence

    1-5 micron MMAD important determinant of its


    deposition efficacy in LRT
    1-3 micron greater deposition

    TONICITY OF THE FLUID

    Hypertonic fluid tend to absorb water.


    Hypotonic aerosols may evaporate
    Normally, mucous membrane is neutral in
    relation to electrical charges

    ANATOMY OF THE RESPIRATORY TRACT


    Diameter
    Infants and children have small diameter of an
    airway suggest that having low level of drug
    deposition , even that is adequate when
    considered in terms of body weight (mg of
    drug deposited per kg of BW ).
    (Fok T F , S.Monkman , M Dolvich et.al.1996 )
    Length
    Branching angles of airway segments

    PHYSIOLOGICAL FACTORS
    Airflow
    Increasing flow 6,8,10 L / min increased the
    mass output of particles in the respirable
    range of 1-5 microns.
    ( D Hess , P Williams , S Pooler et.al. 1996 )
    Breathing pattern
    Deposition of particles are directly related
    to inhaled volume & inversely related to
    ventilatory rate.
    Inspiratory hold

    NEBULIZER

    1872 - NEBULIZER derived from the Latin


    nebula meaning mist
    1874 definition as an instrument for converting
    a liquid into a fine spray, especially for medical
    purposes
    The logic of creating a vapor or aerosol for the
    inhalation treatment of lung disease is at least as
    old as written records of medicine.

    The Ayurvedic tradition of medicine in India


    which dates back perhaps 4,000 yrs or more ,
    used inhaled substances for managing
    respiratory disorders.

    19th century-inhalation devices were described

    1930-atomizers

    1940-collison nebulizer
    It used baffle to filter out larger particles,
    thus distinguishing a nebulizer from
    atomizer.
    1950-wright nebulizer
    Much more compact than collison, closely
    resembled todays pneumatically powered neb.
    1960-ultrasonic nebulizer
    A diff method of creating liquid aerosols .

    TYPES OF NEBULIZERS
    1. Jet nebulizer
    2. Ultrasonic nebulizer

    JET NEBULIZER

    It is a system in which high velocity gas flow


    is directed into a tube that is immersed in a
    water reservoir.
    It operates from a pressurized gas
    working mechanism :
    Venturi Principle : As the gas flow
    through the tube, water is drawn up in
    between the surfaces and come across the
    way of gas flow through fine spore. this gas
    stream impacts upon the fluid surface and
    dispersing liquid as an aerosol.

    FEATURES OF JET NEBULIZER

    Cools during operation


    Less expensive
    More noise
    More Rx time
    small particle size
    Small output rate

    ULTRASONIC NEBULIZER

    It is an electric nebulizer
    Working principle : piezoelectric effect
    ultrahigh frequency current
    piezoelectric transducer
    ultrahigh frequency vibrations
    disk vibration
    couplant (water bath)

    FEATURES OF ULTRASONIC NEBULIZER


    More expensive
    Heats up during operation , Less noise
    Less Rx time
    Large average particle size ( Joseph L Rau
    et.al.2002 )
    Large output rate
    0.5 to 3 microns 90 % of particles within
    effective range

    INDICATIONS FOR NEBULIZER


    Useful in children ,
    Handicapped person ,
    Seriously ill patients
    Ventilated patients
    Elderly individuals
    High doses can be given
    Combination drugs can be given

    Enhancement of secretion clearance


    Sputum induction
    Humidification of respired gases
    Prevent dehydration
    Prevent or relieve bronchospasm

    HAZARDS OF NEBULIZER
    Bronchospasm
    Over hydration
    Delivery of contaminated aerosols
    Tubing condensation
    Swelling of retained secretions

    DRUGS FOR NEBULIZATION


    Distilled water or normal saline
    Mucolytics : mesna , acetylcysteine
    Beta 2 agonists : salbutamol , terbutalin ,
    fometerol , salmeterol
    Antimuscarinic : ipratropium bromide
    Steroids : budesonide
    Antibiotics
    Antifungal

    Distilled water/NS
    Cheapest / very economical
    Easily available
    Effective Mucolytic
    Free of ions (distilled water)
    Routinely used in practice

    Mucolytic agents
    Mucomyst
    Drug action
    Side effects
    How to counteract

    Beta-2 agonists
    Mechanism of action
    beta receptor stimulation
    adenylcyclase
    IC ATP
    IC cAMP
    smooth muscle relaxation

    salbutamol
    Short acting
    Selective beta 2 agonist
    Peak of action
    Long term use effects
    Side effects

    Epinephrine
    Classic catecholamine
    Strong alpha & beta-1 beta-2 action
    Available 1:100 solution
    0.25 to 0.5 ml in 4ml NS
    Lasting effect , side effects

    Anticholinergic agent
    Ipratropium bromide
    Site of action
    Usually given through mouthpiece

    Nebulizer as an adjunct to chest


    physiotherapy
    Nebulized NS enhances mucociliary clearance ,
    given thrice in a day before chest physiotherapy
    & also salbutamol before NS to prevent
    bronchoconstriction
    ( J.Morton , J.A.Douglass , J.Reidler et.al.1996 )
    With the patient resting in an upright position;
    chest physiotherapy, by the forced expiration
    technique with postural drainage; and chest
    physiotherapy following five minutes' inhalation
    of either nebulized normal saline or nebulized
    terbutaline 5 mg

    Use of both nebulized saline and nebulized


    terbutaline immediately before chest
    physiotherapy gave a significantly greater yield
    of sputum than did physiotherapy alone, and
    terbutaline.

    (Sutton PP, Davidson J , Smith FW et.al.1988 )


    In mechanically ventilated patients , those
    having low lung volume chest PNF technique
    should be used to improve lung volume & thus
    maximum aerosols can be administered.
    Lung segment which is to be drained out
    require to positioned up so that aerosols reach
    to upper area.

    TECHNIQUE FOR USING NEBULIZER

    1. Place drug solution in nebulizer,


    employing a fill volume 2-6 ml
    2. Place nebulizer in Inspiratory line
    3. Ensure airflow of 6-8 L/min through the
    nebulizer.
    4. Ensure adequate tidal volume ( 500 ml in
    adults). Attempt to use duty cycle > 0.3, if
    possible.

    5. Observe nebulizer for adequate aerosol


    generation throughout use.
    6. Disconnect nebulizer when all medication is
    nebulized or when no more aerosol is being
    produced.

    CONCLUSION
    Nebulizer is the key component as a rule for
    gaining chest clearance on mech.vent Pts.
    physiotherapist must give chest physiotherapy
    following neb to augment secretion drainage
    Ensure proper position for nebulization.
    Choice of a nebulizer on the basis of need of
    therapeutic effectiveness & availability of a
    device.
    Only about <10% drug reaches to the desired
    site , so try to optimize drug deposition.
    use cleaned nebulizer & prepare fresh solution.

    Adjust adequate oxygen flow 6-8 L/min to


    produce particles in respirable range.
    Aerosol particle deposition is directly related to
    inhaled volume & inversely related to
    ventilatory rate , so maintain inspiration for 3-5
    sec & breath holding for 2-4 sec or as long as
    possible.
    Determine the therapeutic effectiveness
    following nebulization + chest physiotherapy.

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