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Aerosol Therapy: Traditional & New Drugs in Aerosol Medicine
Aerosol therapy in the past decade has evolved faster than its initial years after emerging as a primary form of treatment in respiratory diseases involving both congenital and acquired diseases. This type of inhalation therapy focuses on the delivery of the medications that have been directly or indirectly injected into the lower and upper airways for either local or systemic effects. The greatest advantage of aerosol therapy is the ability to treat patients with smaller doses which, over time, yields minimal adverse effects for non-specific drugs, along with being the most rapid in treatment response time. Modern aerosol medications are made to be compatible with certain devices, such as metered dose inhalers, dry powered inhalers, and nebulizers, each of which have certain advantages and disadvantages depending on appropriateness of delivery and treatment. The particle size of these different applicators are crucial in deciding the location in the body in which the drug is to be delivered.
An aerosol is a suspension of liquid or solid particles in a carrier gas. Aerosol therapy is the delivery of an aerosol drug to the body via the airways by delivering it in an aerosolized form. The advantages of this form of drug delivery is that
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The key mechanisms that affect pulmonary depositions of aerosols are inertial impaction, sedimentation and diffusion. These three mechanisms operate within a range of various combinations when certain aerosol drugs that affect different areas within the lung are used. Inertial impaction occurs when a large particle size aerosol, usually three microns and over, are inhaled and settled at the process of the oropharynx and larger airways. Aerosols that are smaller in size diffuse within the lower airways, making it the dominant mechanism if the aerosol particles make it
R.S. has been using the recommended treatment for his condition, which inlcude inhaled short-acting Beta-2 agonist and Theophylline, a bronchodilator, to control his respiratory disease.
Asthma is a chronic inflammatory disease of the airways. It is a reversible airway obstruction, occurring 8 to 10% of the population worldwide. According to a study in 2005, asthma affects over 15 million Americans, with more than 2 million annual emergency room visits. Asthma patients have a hyper-responsiveness in their airways and generally and increase in their airway smooth muscle cell mass. This hyperplasia is due to the normal response to the injury and repair to the airway caused by exacerbations. The main choice of therapy for asthma patients is β2- adrenergic agonists. Racemic albuterol has been the drug of choice for a short acting bronchodilator for a long time, but since the development of levalbuterol, there is the question of which drug is a better choice for therapy. Efficacy and cost of treatment must both be taken into consideration in each study of these therapies to determine which is best for the treatment of asthma.
Most of the time, it is from smoking. The tissue in the lungs will become inflame and produce mucous because of exposure to these chemicals. Theophylline and ß2 agonist will act to relax and dilate the airways and allow more oxygen to enter. They will also decrease the lungs sensitivity so that they do not react so much to inhaled chemicals.
Air then travels to the bronchioles which are narrow (bronchoconstriction) due to the natural defence in keeping irritants out of the airway, causing wheezing breath sounds.(Eldridge, 2016) The air then proceeds to the alveoli, which are weakened and damaged air sacs due to the progression of the disease, that are unable to efficiently move O2 into the blood stream and gas exchange CO2 to be expelled through exhale, causing hypoxemia, lethargy, dyspnoea and high CO2 reading. (“Lung conditions - chronic obstructive pulmonary disease (COPD),”
For Ventolin to work optimally, situations that may trigger an asthma attack must be avoided. These situations include exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur or pollens. Relating to the case study, a few of these may apply to the patient, such as exercising in the cold morning air and perhaps breathing in dust and allergens such as pollens or maybe from the eucalyptus in the Blue Mountains might have had an effect on his condition.
Duerden, M. & Price, D. (2001). Training issues in the use of inhalers. Practical Disease
To better understand how COPD affects an individual you should first know how the lungs function. When you breathe in air it first goes through your trachea then into your bronchioles. Once in the bronchioles the air goes to the air sacs called alveoli. In the alveoli, the gas exchange occurs with the capillaries. Gas exchange is when the oxygen enters the bloodstream and carbon dioxide enters the alveoli. During the breathing process, alveoli will inflate when inhaling and deflate while exhaling.
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Only the smallest particles of the coal dust make it past the nose, mouth, and throat into the alveoli found deep in the lungs. The alveoli, or air sacs, are responsible for exchanging gases with the blood, and are located at the end of each bronchiole. Microphages, a type of blood cell, gather foreign particles and carry them to where they can either be swallowed or coughed out. If too much dust is inhaled over a long period of time, some dust-laden microphages and particles collect permanently in the lungs causing black lung disease.
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
Asthma is a chronic disease that makes it difficult to breathe. The airways to the lungs swell up and become inflamed, which narrows the air passageway to the lungs and the lungs cannot receive the amount of oxygen that it needs. “Mucus builds up inside the airways so you have trouble getting air in and out of your lungs.” (Pope, 2002, p.44). If the lungs do not receive the essential amount of air, it will cause a lot of distress and wheezing to the patient.
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
...st spacecraft. The particles vaporize on impact with solids and pass through gases, but can be trapped in aerogels.
Even though there is no cure for asthma, there are two main types of medication used for the treatment of it. The first is long term medication that aids in decreasing the inflammation of a person’s airways and also serves as a preventative measure for symptoms and asthma attacks. These medicines are usually anti-inflammatory drugs that are taken daily to reduce future symptoms, but do not act as a quick fix...