Page 50 - IJSA, Vol. 6, No 1, 2023

International Journal of Science Annals, Vol. 6, No. 1, 2023
рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa

Introduction
Respiratory diseases such as asthma, chronic obstructive According to Newman et al. (1991), ideal technique to
pulmonary disease (COPD) and post tuberculosis use MDI would be: shake before use, then remove the
obstructive disease (PTOD) is affecting large population cape, breath out slowly to functional residual capacity
globally. These diseases cause the third most frequent (FRC), wide open the mouth holding the device in
cause of death worldwide (EBSCO, 2020). The between lips in upright position starting with slow
abundance presence of beta-adrenergic, cholinergic and breathing and actuate MDI simultaneously, till total lung
glucocorticoid in lungs, which lead to concept evolution capacity (TLC) continue inspiration, for 5-10 sec hold
of inhalation therapy. The inhalation therapy holds breath, at last exhale for next puff, at least wait for a
many advantages such as lower dosage needed, fast minute, after done washing and rinsing mouth is
response and minimum side effect over systemic therapy important.
as in even in pregnancy, hypertension, cardiac diseases Dry powder inhaler (DPI) contains medicine in powder
and diabetes mellitus they are considered safe. form in which particle size is in respirable size and these
Inhalation therapy is also known as aerosol drug therapy are present with carriers such as lactose or glucose with
in which special device is used to deliver drug in a form which they make loose bound. Separation could happen
of fine mist particles directly to the lungs, which may easily among micro sized individual respirable particles;
use in treating various type of respiratory diseases. The carriers are needed to decrease cohesive forces in micro
particle ideal size ranges from 1 to 5 microns as smaller sized medicine powder. Patient’s inspiratory flow
particles acts as gas and passes though lungs like gas. provides all the energy needed to disaggregation (Prime
Particles travelling speed (travelling very fast or very et al., 1997). In 1960s, the DPI was introduced since then
slow) might damage the walls of the upper airways. The there are many types of DPI available in India market
particle hit the target site when moves in right speed. some are single dose, some are multidose.
The oral inhalation of medications is the first-line Single dose inhales are Lupihaler, Revolizer,
treatment for lung diseases; inhaler technique comprises Respihaler, Rotahaler; and some of multidose inhalers
a set of procedures for drug delivery to the respiratory are Diskhaler, Turohaler and Multihaler. In multidose
system (Chorao et al., 2014). The advantages offered by inhalers, numbers of doses are inserted in the inhaler
this method are financial affordability, convenience, already (Atkins, 2005).
portability, quick and local action, and negligible Dry powder inhalers have many advantages, as they are
systemic side effects (Virchow et al., 2008). portable, easy to carry with you due to their small size.
The therapeutic index will be maximized, with direct They can be used easily with some training, but they do
delivery of drug to the respiratory tract by inhale not need any hand breath coordination. They are
devices. There are many anti-asthma drugs out there but ecofriendly because they do not have any cold freon
efficiency depends on selection of right drug, device effect as propellant is not required in them.
used and technique used. There are wide range of Despite all these advantages, they do hold few
inhaling devices available in market, selecting the right disadvantages too, as they are quite expensive. They are
one is very important, which is done on the bases of not ideal for acute situations and severe respiratory
disease severity, patient type, and pricing or distress. They also need quite high inspiratory flow rate
reimbursement controls (Pritchard & Giles, 2014). that is about 60L/min or even more. Lactose might cause
There for it is necessary to have a proper study of device, some irritation cough mostly in lactose intolerant
drug and patient education for the success of inhaler. patients. If not kept in dry area, the humidity might cause
Metered dose inhalers, dry powder inhalers, and powder to aggregate and soften of capsule (Crompton,
nebulizers are the most common inhaler devices used to 1991).
administer aerosolized medication in routine respiratory In the opinion of Newman et al. (1991), ideal technique
practice (Cochrane et al., 2000; Pritchard et al., 2015). of using DPI is: device assembling, if single, no shaking
Metered dose inhaler (MDI) is most commonly used of the device, slowly exhale to FRC, around the mouth
inhaler device. When it is activated, it releases fixed seal it, forcefully and deeply inhale, need to hold the
amount of drug dose from multidose canister. Some breath for 4 to 8 sec, repeat the process if needed, after
important elements of MDI are protective cover; finish gargle and rinsing mouth is important.
medicine mixed with surfactant and propellant in Inhaler technique comprises a set of procedures for drug
canister, which is fitted with valve; device body and delivery to the respiratory system. The technique of oral
mouthpiece for the release of medicine. inhalation of medications is a major factor governing the
Metered dose inhalers are inexpensive, compact, and efficiency of the inhaled medication. Using the proper
portable, can be hold multidose. It can have fixed and inhaler technique ensures sufficient drug deposition in
defined dose (Newman, 2005). the distal airways, optimizing therapeutic effects and
Although after all these advantages MDI does have few reducing side effects (Usmani et al., 2018). Although
disadvantages too such as they are not eco-friendly as metered dose inhalers are considered more difficult to
chlorofluorocarbon (CFC) causes ozone depletion, use than dry powder inhalers, errors in inhaler technique
patient need good coordination of hand and breath and are very common among COPD and asthma patients in
needs training for hand breath coordination daily real-life practice. Inhaler mishandling is very
(Tsangarides et al., 2018). common in patients with chronic airflow obstruction
(Melani et al., 2011).

48