slide terapi inhalsi
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Slide Terapi InhalsiTRANSCRIPT
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KELAINAN PARU YANG MEMBUTUHKAN PENANGANAN
FISIOTERAPI DADA DAN TERAPI INHALASI
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Respiratory Diseases
Respiratory Care
Respiratory-Care Graduates Address the Changing Job Market
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Respiratory Diseases
Pulmonary emphysema
Chronic bronchitis
Asthma
Bronchiectasis
Post tuberculosis
Respiratory care
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Respiratory Care
Oxygen therapy
Inhallation therapy
Chest physiotherapyMechanical ventilation/
non invasive
Breathing retraining
Airway managementNutrition and diet
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Respiratory Care
Physician
Respiratory care practitioner
Family
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Rationale For Pulmonary Care
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Variety of Physiologic Clinical Manifestation
Chronic Lung Disease
Pulmonary Care
•Increase airways resistance•Hyperinflation
•Decreased lung and chest wall compliance•Disadvantaged respiratory muscles
•Decreased exercise capacity and endurance•Arterial desaturation during exercise
•Reduced oxygen consumption
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INHALATION THERAPY
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MINIMUM SYSTEMICSIDE EFFECT
RAPID ONSET OF ACTION
1st LINE DRUG DELIVERY SYSTEM INOBTRUCTIVE PULMONERY DISEASES
INHALATION THERAPY
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PHARMACOKINETICS PROPERTIES OF THE DRUG
INHALATION THERAPY
• SLOW ABSORPTION FROM THE LUNG• LOW ORAL BIOAVAILABILITY
• RAPID SYSTEMIC CLEARANCE
WIDER THERAPEUTIC INDEX
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THE FACTORS CONTRIBUTE TO VARIATIONIN DOSAGE COMPATIBILITY
• ROUTE OF ADMINISTRATION• THE KIND OF INHALATION DEVICE
• AGE OF THE PATIENT• SEVERITY OF THE DISEASE
• INDIVIDUAL VARIATION IN PARTICLE DISTRIBUTION
• PATIENT COMPLIANCE
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Particle deposition in the airways
Particle deposition in the airways
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CHARACTERISTICS OF PARTICLE DEPOSITION
>10 µm(Trachea,
large bronchi)
1-5 µmLower airways
< 0.5 µm
To be exhaled
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Particle deposition in the airwaysParticle deposition in the airways
•
•
•Gravity
( < 2 mm & alveoli)
Inertial movement ( 2 mm)
Brownian movement
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Device factors affecting drug deliveryDevice factors affecting drug delivery
in aerosol therapyin aerosol therapy
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Device factorsmetered dose inhaler (MDI)
Lung
Oropharynx
Exhaled
Drug deposition
80%
10%
(Newman, 1985)
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Device factorsDevice factors• Particle size generated by device:
0.5-10 µm
• characteristics of particle disposition:
– > 10 µm : trachea, large bronchi
– 1-5 µm : lower airways
– < 0.5 µm : to be exhaled
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Device factorsmetered dose inhaler (MDI)
• Most popular aerosol device
• initial particle size: 45 MMAD evaporation 2.8-5.5 µm
• 30-50% of the patients cannot coordinate actuation and inhalation
• CFCs are banned now
• attachment of a spacer could be helpful
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Device factorsspacer
Advantages:
• enhances lung delivery
• obviates the need of hand-lung coordination (allows a delay of 5-7 seconds after actuation)
• reduces oropharyngeal deposition of large drug particles
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Device factorsBreath-actuated MDI
• does not need hand-lung coordination
• requires forceful inspiratory flow to activate drug release
• still utilizes propellants
• not better than MDI if used properly
• may startle children
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Device factorsjet nebulizer
• particle size depends on gas flow rate (5-12 l/min particle size: 4-8 MMAD)
• does not need hand-lung coordination or patients’ cooperation
• lung deposition: 10%
• lost in the apparatus: 60-80%
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Device factorsjet nebulizer
• equally effective to MDI+spacer
• more expensive
• bulky
• cumbersome
• noisy
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Device factorsdry powder inhaler (DPI)
0
20
40
60
80
100
MDI DPI
Device
Upper
Lung
(Timsina,1994)
Mean % deposition of SCG
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Device factorsdry powder inhaler (DPI)
• Contains micronized active drugs (ideal particle size of 0.5-8 µm)
• does not need hand-lung coordination
• requires deep and forceful inspiration
• lower airway deposition: 30%
• mouth rinsing after use of steroid DPI
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Patient factors affecting drug deliveryPatient factors affecting drug delivery
in aerosol therapyin aerosol therapy
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Patient factorsPatient factors• When is a bronchodilating effect
obtained?
• The effect of inspiratory flow rate
• controllable factors (not always):
– speed and depth of breathing
– breath holding
– hand-lung coordination for inhaler
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Patient factorsPatient factors• Uncontrollable factors:
– bronchoconstriction– edema– mucus hypersecretion– parenchymal defect
• Impact of bronchial narrowing:
velocity central airway deposition
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Which device for which patients?Which device for which patients?
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Which device for which patients?
• Metered-dose inhaler (MDI):
– most adults
– children > 7 years old
• MDI+ spacer
– the elderly or disabled
– children from 3-7 years old
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Which device for which patients?
• dry powder inhalation (DPI):
– > 7 years old
• nebulizer:
– severe asthma
– any age
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How to improve drug delivery How to improve drug delivery
in aerosol therapyin aerosol therapy
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How to improve aerosol drug delivery?• select a suitable device for an
individual patient
• an MDI requires shaking prior to use
• a complete exhalation is needed before drug inhalation
• use spacer with an MDI, if needed
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How to improve aerosol drug delivery?
• in an asthma attack, MDI / DPI should be used immediately before broncho-spasm becomes more severe
• for multiple inhaler users: use the bronchodilator first
• breath deeply and slowly (3-5 seconds)
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How to improve aerosol drug delivery?
• hold breath for 10 seconds
• repeat administration after 1 minute
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FARMAKOKINETIK OBAT
TERAPI INHALASI
• ABSORPSI OBAT YANG LAMBAT DARI PARU • KETERSEDIAANHAYATI ORAL YANG RENDAH
• BERSIHAN SISTEMIK YANG CEPAT
INDEKS TERAPI YANG LEBAR
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Thank you