Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology

Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?

Apparatus and methods for delivering an amount of aerosolized medicine for inspiration by a patient in response to the occurrence of appropriate delivery point or points in the patient's detected breath flow. The aerosol medication may be administered as one or more pulses having a pulse width, shape, and frequency that will maximize the respirable fraction of the aerosolized compound being administered. The delivery point or points may be predetermined or determined from a prior inspiratory flow for depositing the selected medication at one or more desired locations in the patient's airway. Determined delivery points are recursively lowered for each inspiratory flow that does not satisfy one of the predetermined and previously lowered threshold. Changes in the patient's breath flow patterns during the course of an aerosolized medication inspiration therapy program may be detected and used to adjust the controlled amount of medication to be delivered in a given administration and/or to inform the patient of the patient's condition or change in condition. The device also may contain a library of administration protocols or operating parameters for different medications and a means for identifying from the canister the medicinal contents of the canister for customizing operation of the apparatus.

Delivery of aerosol medications for inspiration

An inhaler device (100) for aerosol delivery of medication employs a microprocessor (220) and electronic sensors (230) for measuring parameters indicative of a patient's inhalation of airborne medication. The sensors produce output signals representative of parameters which determine the proper delivery of medication to receptor sites in the patient's lungs, such as, the rate of flow of air through the inhaler device to the patient's lungs, the duration of inspiration of the medication, and the volume of medication inhaled. The microprocessor is responsive to the output signals of the sensors and stores a record of inhalation events which can be retrieved remotely or by connecting the microprocessor to a display terminal (108). The microprocessor makes possible a display of data indicative of the delivery of medication for each inhalation event over a course of treatment, thus providing compliance feedback to both the patient and the medical professional.etermined amount and at selected times.

Intelligent inhaler providing feedback to both patient and medical professional

BACKGROUND The metered dose inhaler is difficult to use correctly, synchronising actuation with inhalation being the most important problem. A breath actuated pressurised inhaler, designed to help patients with poor inhaler technique, was compared with a conventional metered dose inhaler in terms of aerosol deposition and bronchodilator response. METHODS Radioaerosol deposition and bronchodilator response to 100 micrograms salbutamol were measured in 18 asthmatic patients, who inhaled from a conventional metered dose inhaler by their own chosen metered dose inhaler technique, from a conventional metered dose inhaler by a taught metered dose inhaler technique, and from a breath actuated pressured inhaler (Autohaler). RESULTS In the 10 patients who could coordinate actuation and inhalation of the inhaler on their own deposition of aerosol in the lungs and bronchodilator response were equivalent on the three study days. By contrast, in the eight patients who could not coordinate the mean (SEM) percentage of the dose deposited in the lungs with their own inhaler technique (7.2% (3.4%] was substantial lower than those attained by the taught metered dose inhaler technique (22.8% (2.5%] and by Autohaler (20.8% (1.7%]. CONCLUSION Although of little additional benefit to asthmatic patients with good coordination, the Autohaler is potentially a valuable aid to those with poor coordination, and should be considered in preference to a conventional metered dose inhaler in any patient whose inhaler technique is not known to be satisfactory.

https://thorax.bmj.com/content/thoraxjnl/46/10/712.full.pdf

Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique.

Although the manufacturers of pressurized aerosol bronchodilators issue instructions for using the inhalers, little or no experimental verification exists. Furthermore, the instructions often fail to take into account known facts about aerosol deposition. We have reviewed the evidence for the most effective mode or modes of inhalation of pressurized aerosol bronchodilators, some of which has arisen from experiments performed in our laboratory. In order to achieve a maximal effect following inhalation of terbutaline sulphate bronchodilator aerosol (Bricanyl, Astra Pharmaceuticals), the canister should be actuated during a slow (25 l min-1), deep inhalation and breath held subsequently for 10 s. Bronchodilatation may be reduced if aerosol is inhaled rapidly (80 l min-1) or if breath is held for 4 s. We have considered the applicability of these simple rules to other types of bronchodilator and to all patients, irrespective of their diagnosis or degree of airway obstruction. The lung volume at which aerosol is released into the airstream, the importance of coordinating inhalation with aerosol actuation, and the relative merits of "open" and "closed" mouth inhalation techniques are also discussed.

How should a pressurized beta-adrenergic bronchodilator be inhaled?

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How should a pressurized beta-adrenergic bronchodilator be inhaled?