KELAINAN PARU

YANG MEMBUTUHKAN PENANGANAN

FISIOTERAPI DADA DAN TERAPI INHALASI

Respiratory Diseases

Respiratory Care

Respiratory-Care Graduates Address

the Changing Job Market

Asthma
Bronchiectasis

Chronic bronchitis

Respiratory Diseases

Pulmonary emphysema

Post tuberculosis

Respiratory care

Chest physiotherapy
Inhallation therapy

Mechanical ventilation/
non invasive

Respiratory Care

Oxygen therapy

Nutrition and diet

Breathing retraining

Airway management

Respiratory care
practitioner

Family

Respiratory Care

Physician

Rationale For Pulmonary Care

Chronic Lung Disease

Variety of Physiologic

Clinical Manifestation

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

Pulmonary Care

INHALATION THERAPY

INHALATION THERAPY

1st LINE DRUG DELIVERY SYSTEM IN

OBTRUCTIVE PULMONERY DISEASES

MINIMUM SYSTEMIC
SIDE EFFECT

RAPID ONSET
OF ACTION

PHARMACOKINETICS
PROPERTIES OF THE DRUG
INHALATION THERAPY
SLOW ABSORPTION FROM THE LUNG
LOW ORAL BIOAVAILABILITY
RAPID SYSTEMIC CLEARANCE
WIDER THERAPEUTIC INDEX

THE FACTORS CONTRIBUTE TO VARIATION

IN 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

Particle deposition
in the airways

CHARACTERISTICS OF
PARTICLE DEPOSITION

>10 m
(Trachea,
large bronchi)

1-5 m
Lower airways

< 0.5 m
To be exhaled

Particle deposition in the airways

Gravity

( alveoli)
< 2 mm &

Inertial
movement
( 2 mm)

Brownian
movement

Device factors affecting drug delivery

in aerosol therapy

Device factors
metered dose inhaler (MDI)
Drug deposition

10%

80%
(Newman, 1985)

Device factors
Particle size generated by device:
0.5-10 m
characteristics of particle disposition:
> 10 m : trachea, large bronchi
1-5 m
: lower airways
< 0.5 m : to be exhaled

Device factors
metered dose inhaler (MDI)
Most popular aerosol device
initial particle size: 45 MMAD
evaporation 2.8-5.5 m
30-50% of the patients cannot
coordinate actuation and inhalation
CFCs are banned now
attachment of a spacer could be helpful

Device factors
spacer
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

Device factors
Breath-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

Device factors
jet 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%

Device factors
jet nebulizer

equally effective to MDI+spacer

more expensive
bulky
cumbersome
noisy

Device factors
dry powder inhaler (DPI)
Mean % deposition of SCG

(Timsina,1994)

Device factors
dry powder inhaler (DPI)
Contains micronized active drugs (ideal
particle size of 0.5-8 m)
does not need hand-lung coordination
requires deep and forceful inspiration
lower airway deposition: 30%
mouth rinsing after use of steroid DPI

Patient factors affecting drug delivery

in aerosol therapy

Patient 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

Patient factors
Uncontrollable factors:
bronchoconstriction
edema
mucus hypersecretion
parenchymal defect

Impact of bronchial narrowing:

velocity central airway deposition

Which device for which patients?

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

Which device for which

patients?
dry powder inhalation (DPI):
> 7 years old
nebulizer:
severe asthma
any age

How to improve drug delivery

in aerosol therapy

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

How to improve aerosol

drug delivery?
in an asthma attack, MDI / DPI should
be used immediately before bronchospasm becomes more severe
for multiple inhaler users: use the
bronchodilator first
breath deeply and slowly (3-5 seconds)

How to improve aerosol

drug delivery?
hold breath for 10 seconds
repeat administration after 1 minute

FARMAKOKINETIK OBAT
TERAPI INHALASI

ABSORPSI OBAT YANG LAMBAT DARI PARU

KETERSEDIAANHAYATI ORAL YANG RENDAH
BERSIHAN SISTEMIK YANG CEPAT

INDEKS TERAPI YANG LEBAR

Thank
you