Journal of aerosol medicine and pulmonary drug delivery
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J Aerosol Med Pulm Drug Deliv · Apr 2012
ReviewAerosol therapy in patients receiving noninvasive positive pressure ventilation.
In selected patients, noninvasive positive pressure ventilation (NIPPV) with a facemask is now commonly employed as the first choice for providing mechanical ventilation in the intensive care unit (ICU). Aerosol therapy for treatment of acute or acute-on-chronic respiratory failure in this setting may be delivered by pressurized metered-dose inhaler (pMDI) with a chamber spacer and facemask or nebulizer and facemask. This article reviews the host of factors influencing aerosol delivery with these devices during NIPPV. ⋯ Similarly to invasive mechanical ventilation, careful attention to the technique of drug administration is required to optimize therapeutic effects of inhaled therapies during NIPPV. Assessment of the patient's ability to tolerate a facemask, the level of respiratory distress, hemodynamic status, and synchronization of aerosol generation with inspiratory airflow are important factors contributing to the success of aerosol delivery during NIPPV. Further research into novel delivery methods, such as the use of NIPPV with nasal cannulae, could enhance the efficiency, ease of use, and reproducibility of inhalation therapy during noninvasive ventilation.
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J Aerosol Med Pulm Drug Deliv · Apr 2012
Comparative StudyProAir(®) HFA delivers warmer, lower-impact, longer-duration plumes containing higher fine particle dose than Ventolin(®) HFA.
Inhaler technique and spray characteristics are critical for adequate management of asthma symptoms with pressurized metered-dose inhalers (pMDIs). A lower spray force has been directly associated with a decrease in throat deposition of asthma medication, and a higher spray temperature may alleviate the "cold Freon effect" associated with pMDIs. The objective of the study was to characterize and compare the temperature, maximum spray force, and duration of the emitted plume from two pMDIs: ProAir(®) hydrofluoroalkane (HFA) and Ventolin(®) HFA. ⋯ The ProAir(®) HFA delivers a warmer, lower-impact, and longer-lasting plume compared with Ventolin(®) HFA, which may provide a more consistent, comfortable experience for patients using a pMDI. ProAir(®) HFA produces higher fine particle dose than Ventolin(®) HFA.