Metered dose inhaler final

1997

European Respiratory Journal, 1998

Pressurized metered dose inhalers (pMDIs) with spacers adapted for use in young children have gained wide popularity. To provide optimal drug delivery, spacer design is critical . The spacer causes important changes in the output in terms of total dose, as well as in terms of small-droplet mass. The mass of drug in small droplets of less than approximately 5 µm is traditionally considered to be the dose fraction most likely to reflect the dose available to the lungs [2]. Effects, side-effects and cost-effectiveness are mainly related to the lung dose and are, therefore, strictly dependent on the combination of pMDI and spacer. The unity of pMDI plus spacer should consequently be stressed, and it would be desirable to relate dose recommendations to the output from the pMDI and spacer rather than simply to the nominal dose of the pMDI. However, until recently only limited information has been available on the small-droplet mass provided by different combinations of pMDI and spacer for young children.

Expert Review of Respiratory Medicine, 2014

aarc.org

Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2013

Background: Metered-dose inhalers (MDIs) have become a firsthand therapeutic strategy for the management of respiratory diseases, mainly for chronic obstructive pulmonary disease (COPD) and asthma. It has been determined, however, that patients do not always use these devices correctly. Our primary goal was to establish the level of technical knowledge of patients with COPD and/or asthma on the use of MDIs, as well as other associated factors related to the effective use of this delivery method. Methodology: This study was performed with 191 patients (49.2% male, 50.8% female) diagnosed with COPD and/or asthma at Hospital Universitario Mayor (Bogotá, Colombia). The agreement between different observers on nine aspects of the use of the inhaler was assessed by testing the unweighted kappa correlation coefficient and its significance. The correlations between demographic variables, risk factors, and proper knowledge of the adequate use of inhalers were established by means of the Pearson chi-square test (also called Fisher exact test) (expected values less than 5). Statistical tests were evaluated at a significance level equivalent to 5% (p < 0.05). Results and Conclusions: The study detected deficiencies in educational factors, specifically regarding the initial contact with the patient and regular follow-up by the team of health professionals. It also showed insufficient strategies for the training of patients in the use of the inhalers. There were no significant differences by gender (p > 0.05) in the implementation of the various aspects of the proper use sequence for MDIs. However, there were significant differences related to education levels, socioeconomic status, age, and current occupation. A worse inhaler technique was associated with lower education level (0.034), higher age (p¼0.003), and absence of job (p¼0.005). Changes in the education of patients on the issue, together with the use of the spacer/valved holding chamber proved to be valid strategies that, with the support of the patients' health-care team, were able to improve the MDI technique of the studied group.

AAPS PharmSciTech, 2013

Pressurized metered dose inhalers (MDIs) were first introduced in the 1950s and they are currently widely prescribed as portable systems to treat pulmonary conditions. MDIs consist of a formulation containing dissolved or suspended drug and hardware needed to contain the formulation and enable efficient and consistent dose delivery to the patient. The device hardware includes a canister that is appropriately sized to contain sufficient formulation for the required number of doses, a metering valve capable of delivering a consistent amount of drug with each dose delivered, an actuator mouthpiece that atomizes the formulation and serves as a conduit to deliver the aerosol to the patient, and often an indicating mechanism that provides information to the patient on the number of doses remaining. This review focuses on the current state-of-the-art of MDI hardware and includes discussion of enhancements made to the device's core subsystems. In addition, technologies that aid the correct use of MDIs will be discussed. These include spacers, valved holding chambers, and breath-actuated devices. Many of the improvements discussed in this article increase the ability of MDI systems to meet regulatory specifications. Innovations that enhance the functionality of MDIs continue to be balanced by the fact that a key advantage of MDI systems is their low cost per dose. The expansion of the health care market in developing countries and the increased focus on health care costs in many developed countries will ensure that MDIs remain a cost-effective crucial delivery system for treating pulmonary conditions for many years to come.

Pneumon, 2021

Inhalation therapy has an ancient history and has been recognized as the most effective and safe way of delivering pharmaceutical compounds directly to the airways for the treatment of respiratory diseases. Nowadays, a great variety of devices exist; nebulizers, soft mist inhalers (SMIs), pressurized Metered Dose Inhalers (pMDIs) and single-or multi-dose Dry Powder Inhalers (DPIs). The choice for the optimal device is patient-specific and depends on the advantages and disadvantages of each device category, and the patients' age and capacity to use them correctly. Factors that determine therapeutic success, apart from the previously mentioned, are: the physician-patient relationship, the patient's opinion, willingness, and preferences for certain medical devices, and proper training on device use. Various sources of evidence indicate that frequent change of devices is associated with treatment failure and should be avoided in order to achieve good therapeutic outcomes. The most frequently used types of inhalation devices for management of chronic and acute obstructive respiratory diseases are the pMDIs. Despite having some environmental footprint and requiring a good technique by the users to achieve reliable therapeutic effects, these devices are essential tools for primary care physicians and pulmonologists. In the COVID-19 era, and despite diametrically opposed opinions on the appropriateness of using nebulizers, most experts recommend against their use in order to reduce the potential risk of spreading the SARS-CoV-2 virus. If required, most experts recommend the use of pMDI via a spacer, except for life threatening exacerbations. The ongoing research, to improve the underlying technologies of these devices, introduce environmentally friendlier propellants and combine these devices with modern applications of telemedicine and artificial intelligence, creates new pathways for the continuous utilization of these inhalation devices in everyday clinical practice.

Journal of Gandhara medical and dental sciences, 2023

Most obstructive airway disease medications are used via inhalers, and their proper use is signicant for eectively treating these diseases. Most patients misuse it. However, some studies showed that many physicians also do not know the proper meter dose inhaler with the spacer technique. This study aimed to assess metered-dose inhalers with spacer technique among postgraduate trainee doctors. METHODOLOGY This cross-sectional study was carried out in the Khyber Teaching Hospital Peshawar. The total time was six months, from Dec 6 2020, to Jun 5 2021. Postgraduate trainee (PGT) doctors of either gender with an age range of 25 to 35 years were included in the study from dierent departments. Those with every use of inhalers were excluded from the study. Demographic details of PGTs, like age and gender, were recorded. RESULTS Among 96 patients, males were 85 (88.54%), and females were 11 (11.46%). The mean age was 30.02±1.84 years, and the mean training experience was 2.0521 ±0.89. Inhaler technique was Proper in 20 (20.83%), Improper in 51 (53.13%) and Poor in 25 (26.04%) doctors. Those with more training periods, pulmonology rotation, attended workshops on inhaler techniques and with relatives using inhalers were more acknowledged of proper meter dose inhalers (MDIs) with spacer technique. CONCLUSION Only one-fth of the postgraduate trainees know proper MDIs techniques. The attendance of workshops and pulmonology rotation is encouraged to enhance the knowledge of physicians regarding MDIs techniques.

ERJ Open Research

We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential risks and benefits of ancillaries such as valves, and the evidence that they contribute tangibly to the delivery of therapy.We also reiterate practical recommendations for the correct usage and maintenance of spacers/VHCs, which we trust offer practical help and advice to patients and healthcare professionals alike.

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