Resp Care
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Randomized Controlled Trial Comparative Study Clinical Trial
Bronchodilator therapy with metered-dose inhaler and spacer versus nebulizer in mechanically ventilated patients: comparison of magnitude and duration of response.
Four-hour comparison of the bronchodilator response of albuterol administered via metered-dose inhaler (MDI) with spacer versus small-volume nebulizer (SVN) to mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). ⋯ The airway response to albuterol administration via MDI and SVN to mechanically ventilated patients was similar in magnitude and duration, returning to baseline by 240 minutes. In stable, mechanically ventilated COPD patients, albuterol may be administered via MDI with spacer or via SVN every 4 hours.
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The aerosol route is attractive for the delivery of mucoactive medications. Mucoactive medications include mucolytics, which depolymerize polymers of mucin (classic mucolytics) or DNA/actin (peptide mucolytics), mucokinetic agents, which increase cough clearance, mucoregulatory medications, which decrease abnormal mucus secretion, and expectorants and ion channel modifiers. ⋯ This will change as our understanding of mucociliary physiology and pharmacology increases and as well designed and well powered clinical trials are conducted with appropriate outcome measurements. Effective mucoactive therapy should make a profound impact on the care of patients with chronic bronchitis, asthma, cystic fibrosis, and inflammatory airways disease, and will be essential for the effective delivery of gene therapy vectors and bioactive peptides to the airway epithelium.
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Therapeutic aerosols are generated by pneumatic jet nebulizers, ultrasonic nebulizers, pressurized metered-dose inhalers, and dry powder inhalers. Some of the drug preparations used in these devices are formulated to work with specific devices. Although design improvements in aerosol devices have led to improved lung deposition, decreased oropharyngeal deposition, decreased waste of drug, greater ease of use, and lower environmental impact, optimizing the use of aerosol devices requires patient and caregiver instruction, in combination with proper device use and maintenance. Optimizing aerosol delivery requires knowledge of a number of technical details, and caregivers should stay abreast of the continuing advancement of technologies and techniques associated with aerosol delivery, especially in light of emerging devices and formulations.