Inhaled Drugs beyond Bronchodilators. China 4000 Years Ago. Bennet’s inhaler. This may be the earliest published image of an inhalation device. In 1654 an English physician, Christopher Bennet, himself suffering with consumption,
Lack of Knowledge
Lack of interestI Will Make This Work
A Guide to Aerosol Delivery Devices for Respiratory Therapists, 2nd Edition
Inertial impaction, - occurs with larger, fast-moving particles > 10 μm that are filtered in the nose and/or oropharynx
Gravitational settling (sedimentation) is a function of particle size and time, with the rate of settling is proportional to particle size generally 5-10 μm reach the proximal generations of the lower respiratory tract.
Diffusion occurs with particles smaller than 1-5 μm reach the lung periphery3 mechanisms usually cited by which an aerosol particle can deposit
A prospective study by Gluck showed heliox reduced peak airway pressure and PaCO2
and helped correct respiratory acidosis in 7 intubated patients with status asthmaticus.
Schaeffer reported that 11 mechanically ventilated for status asthmaticus receiving heliox had improved oxygenation in adult and pediatric patients.
A retrospective study by Abd-Allah heliox was used in 28 mechanically ventilated children with status asthmaticus. Heliox was associated with significantly lower mean peak pressure and mean PaCO2 , and a improved arterial pH.
Gerbeaux retrospectively studied 81 nonrandomized patients who were admitted for exacerbation of COPD and respiratory acidosis. 39 patients received 70:30 heliox and 42 did not receive heliox. There were no significant differences in age, gender, medicalhistory, Among those who received heliox, the intubation rate was lower (8% vs 50%, p 0.01), mortality was lower (3% vs 24%, p 0.01), and intensive-care-unit (ICU) admissions were lower (46% vs60%, p 0.23). Among the survivors, mean ICU stay was shorter (8 vs 18 d, p 0.01).
Gross et al found that in children mechanically ventilated for bronchiolitis, heliox did not improve oxygenation.
Fast acting particles > 10 μm that are filtered in the nose and/or oropharynx
INO produces Selective Pulmonary Vasodilatation
Does not Cause Systemic Vasodilatation
Increases cGMP which causes Vasodilatation
Decrease intrapulmonary shunt
Decreased PVRHow does INO Work
Mark J.D. Griffiths, M.R.C.P., Ph.D., and Timothy W. Evans, M.D., Ph.D
Pulmonary Hypertension Treatment Options Inhaled Nitric particles > 10 μm that are filtered in the nose and/or oropharynxvs.Iloprost and Flolan
Hoeper et al. JACC Vol. 35, No. 1, 2000
Needs experienced Caregivers particles > 10 μm that are filtered in the nose and/or oropharynx
24 in. aerosol
filterAEROSOLIZED PROSTACYCLIN (EPOPROSTENOL, FLOLAN)
The treatment with nitric oxide alone or combined with prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH.
However, nitric oxide plus prostacyclin and nitric oxide plus ADM were more effective than nitric oxide alone.
The combination of aerosolized prostacyclin and ADM with nitric oxide might have a role in the treatment of infants with PH refractory to nitric oxide alone.Possibility of Combined Therapy
2007;42:1048-1056 Carlo Dani, MD
Dyspnea due to Chronic pulmonary disorders prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH.
Minimal Systemic effects
Small sample sizes
Possible Respiratory Depression
Legal issues of administration
may produce bronchospasm
Not recommended as a standard treatment option
May be helpful with refractory cases on patient by patient use
Minimal Systemic effects
Lack of experience in USReason for Inhaled Opioids
OptiNose has developed innovative nasal drug delivery devices that enable nasal administration of CNS (nose to brain), systemic and topical nasal formulations. OptiNose’s unique breath actuated devices deliver intranasal drugs to targeted regions of the nasal cavity, including the sinuses and the olfactory region, without lung deposition, unlike traditional nasal inhalers, nasal sprays or nebulizers. The Company offers both single and multi-use intranasal delivery devices for liquid and powder formulations. Founded in 2000, OptiNose has extensively tested the technology in both in-vitro and in-vivo deposition studies and concluded Phase I studies. The Company has recently completed Phase II clinical studies with rhinosinusitis and migraine therapies.
Pulmozyme is a man-made form of naturally occurring prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH. DNase.
It works by "cutting up" the DNA left by neutrophils.
Standard dose 2.5 mg
Launched in 1994, Pulmozyme was the first new therapeutic drug for the management of CF in more than 30 years.
Take every day, whether they have cystic fibrosis symptoms or not. This may help break the cycle of cystic fibrosis progression.
Must be stored in the refrigerator at 2-8°C (36-46°F) and protected from strong light.
Pulmozyme should not be diluted or mixed with other drugs,.mixing with other drugs could lead to adverse physiochemical and/or functional changes in Pulmozyme or the combined products.
Daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring less antibiotics.
Pulmozyme should not be used in patients with known allergies to dornase alfa, Chinese Hamster Ovary cell products, or any component of the product.Pulmozyme (DNase)
Recipients of autologenous stem cell transplant
Driving Pressure (26 psi)
Nebulizer Flow 6 to 10 Lpm
Drying Chamber flow 3 to 8 Lpm
(Output is 12.5-15 mL/hr)
RELENZA (ruh-LENS-uh) is a medicine that can both treat influenza (flu, infection caused by influenza virus) and help to prevent getting the flu. While some antiviral medicines only protect against influenza A, RELENZA is effective against both influenza A and B. RELENZA belongs to a group of medicines called neuraminidase inhibitors. These medications target the influenza virus and prevent it from spreading inside your body. RELENZA treats the cause of influenza at its source, rather than simply treating the symptoms.
Some patients have had bronchospasm (wheezing) or serious breathing problems when they used RELENZA. Many but not all of these patients had previous asthma or chronic obstructive pulmonary disease.
Pro prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH.
May provide better sedation
Ability to avoid Hypotension
Used as last ditch tx.
EnvironmentInhaled Anesthetics In the ICU
SPIONS-Superparamagnetic iron oxide nanoparticles prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH.
NanobytesAdvanced delivery Technology
Treatment for Bronchiectasis prostacyclin or adrenomedullin (ADM) were effective in decreasing mean PAP and improving oxygenation in a piglet model of PH.
First Patient February
Phase 2b study
96 Patients randomized 100 – 150 mg of Liposomal CiprofloxacinORBIT-1
University of Haifa has found that the hormone oxytocin, the “love hormone", which affects behaviors such as trust, empathy and generosity, also affects opposite behaviors, such as jealousy and gloating. "Subsequent to these findings, we assume that the hormone is an overall trigger for social sentiments: when the person's association is positive, oxytocin bolsters pro-social behaviors; when the association is negative, the hormone increases negative sentiments. Previous studies have shown that the oxytocin hormone has a positive effect on positive feelings. The hormone is released in the body naturally during childbirth and when engaging in sexual relations. Participants in an experiment who inhaled the synthetic form of the hormone displayed higher levels of altruistic feelings, and it is supposed that the hormone plays an important role in the formation of relationships between people. However, in earlier studies carried out by other investigators with rodents, it was found that the hormone is also related to higher levels of aggression. Therefore, it was decided to examine whether the hormone also affects negative social sentiments. The present study, which was published in the journal Biological Psychiatry, included 56 participants. Half of the participants inhaled the synthetic form of the hormone in the first session and were given a placebo in the second session; the others were given a placebo in the first session and oxytocin in the second session. Following drug administration each participant was asked to play a game of luck along with another competitor, who was in fact - and without their knowledge - a computer. Each of the participants was asked to choose one of three doors and was awarded the sum of money that was hidden behind that door. Sometimes the participant gained less money than the other player, and sometimes more, creating conditions in which a person might well develop feelings of envy and gloating. The findings show that those participants who inhaled the oxytocin displayed higher levels of envy when the opponent won more money and of gloating when they were ahead. Another interesting result was that as soon as the game was over, no differences between the participants were evident with regards to these sentiments. This indicates that the negative feelings were empowered only in the course of the game itself. Possible use of the hormone as a medication for various disorders, such as autism but the hormone's undesirable effects must be examined.