global respiratory health technology where there is …tecnologia_salud/2019/...nebulizer design...
TRANSCRIPT
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Global Respiratory Health Technology where there is no electricity
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Outline
Respiratory health in low and lower-middle
income countries.
Nebulizer treatments and designs
Clinical trials and field studies
Enterprise: Cortinamed
Future devices
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CLICK TO EDIT MASTER TITLE STYLE
Earth at night
Lower Respiratory Infection Deaths
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EL SALVADOR AND GUATEMALA IN 2003-2004
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A side debate about global health technologies…
High Tech Solutions: trickle-down from developed world healthcare.
Low Tech Solutions: low cost, electricity free “appropriate technology.”
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Low cost solutions
Simple solutions
Electricity-free solutions
• Many developing countries spend less than $1 per year per capita on health care
• Highly trained professionals are rarely available
• Electrical power is not always available
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HUMAN POWERED NEBULIZER
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What is a Nebulizer?
Compressed air (7l/min) is forced throughan orifice submersed in liquid medicine.The medicine is aerosolized into smalldroplets (approx 5μm dia.) that can be Inhaled deep into the lungs.
Compressed air nebulizers use approx. 1.3 Amps.MDI’s with spacers can also be used, and are lessexpensive in fixed cost, but more drug is wasted.Patient compliance is an issue.
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• InhalersRequires high degree of patient coordination. Patient compliance is suspect.
• Inhalers with SpacersMuch of the drug gets lost on the spacer walls and is wasted.Overall cost may be higher.
Advantages of a Nebulizer over…
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Nebulizer Design Constraints• Low-cost
• Rugged, zero maintenance
• No need for electricity
• Portable
• Highest quality performance(equivalent to electric nebulizer)
• Ability to be built in-country or indeveloping contexts.
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Benchtop Experiments
Pulmo-Aide Human Powered Nebulizer
1.092±0.116 grams 1.097±0.107 grams
Mass of water delivered in 5 minutes (n=13)
Particle size data as measured with a MOUDI
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Bench-top Experiments
Pulmo-Aide Human-Powered Nebulizer
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CLICK TO EDIT MASTER TITLE STYLEDiagnosis
Treatment
Prevention
APPLICATIONS
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Applications of Human Powered Nebulizers
Diagnosis
Treatment
Prevention
– TB – MDR TB/HIV
– COPD and asthma
– TB – antibiotics
– LRIs—antibiotics and hypertonic saline
– Vaccine delivery
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CLICK TO EDIT MASTER TITLE STYLETuberculosis
DIAGNOSIS
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TB Study with the Desmond Tutu HIV Centre, LSHTM, and Northwestern U in Cape Town – Summer 2010
Scoring system
HPN Pulmo-Aide P value for test for
difference in
proportionsProportion of good
sputum samples
Proportion of good
sputum samples
McCarter 83.5% 74.3% 0.05
Van Scoy 26.5% 22.9% 0.27
Geckler 86.2% 78.0% 0.06
Murray 61.5% 59.6% 0.28
Barlett 27.5% 17.4% 0.04
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Larger Scale Study
• TB Diagnosis/Intensified case-finding in Guatemala:
• Guatemala has the highest prevalence of TB in the Americas.
• Ministry of Health has a large grant from Global Fund to fight TB in Guatemala.
• Children of TB+ parents in rural areas are not getting tested.
• 2000 children in the state of Suchitepeque will get a sputum sample collected and tested in regional centers.
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CLICK TO EDIT MASTER TITLE STYLELower Respiratory Infections, COPD, and Asthma
TREATMENT
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El Salvador Studies with Ministry of Health
• Perceptional Studies – Summer 2010
– Interviews of health professionals, community promoters and community members.
– Led to molino and treadle designs
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El Salvador Studies: CHWs
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Clinical Trial of HPN in El Salvador
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Field Study in El Salvador
• Integration into Ministry of Health
– ECOS teams
– Normas for reactive airway diseases.
Dra. Rodríguez
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Deployment Study in El Salvador
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Deployment Study in Guatemala
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New Design
Much less expensive
Easier to use
Easier to assemble
Works at high altitude
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Scale Up: Assembly in Suchitoto
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Other Technologies
Suction device for lower respiratory
infections for babies
Low cost ventilator that can run overnight on
batteries
Oxygen concentrator for rural areas
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Importance of Place