Drugs for AsthmaCOPD Gillian Tufts DNP APRN FNPBC

Drugs for Asthma/COPD Gillian Tufts, DNP, APRN, FNP-BC

Aerosol Drugs Aerosol delivery of drugs • High local pulmonary concentration • Low systemic Particle size • > 10 um, deposited in mouth/oropharynx • < 0. 5 um • 1 to 5 um delivered to smaller airways Disposition • 2 to 10% in lungs • 90% in mouth

Aerosol Drugs Metered dose inhalers (MDIs) • Delivers specific amount of medication to lungs • Propellant issue • CFC (Chlorofluorocarbons) • HFA (hydrofluoroalkane)

MDI - Technique Stand or sit upright with head straight or tilted slightly back Hold the canister upright and shake well Remove the mouthpiece cap Breathe out normally through mouth With the canister upright, position the inhaler • 1 -2 inches away (open mouth) or • In mouth, lips closed around inhaler mouthpiece (closed mouth) Breathe in slowly, press down on top of inhaler firmly once Continue to breathe in slowly (over 3 -5 seconds) Hold breath for 5 -10 seconds For 2 nd puff, wait 1 minute before taking next puff Repeat above steps Rinse your mouth out with water and spit

Dry powered inhalers (DPIs) • Use sugar (lactose) to carry drug • Come as blisters or capsules • Inserted into device during manufacture or by patient before use • Do not require timing and coordination

DPI - Technique Remove the cover Load single dose according to specific device used Breathe out normally through your mouth Put the inhaler mouthpiece into your mouth, closing your lips tightly around it Inhale deeply and forcefully Hold you breath for 5 -10 seconds, exhale slowly For 2 nd puff, wait 1 minute before taking next puff Repeat above steps Rinse your mouth out with water and spit

Spacers Small extension that attaches to MDI mouthpiece to enhance medication delivery • Advantages • Increases lung deposition 10 -15% • Eliminates need for coordination • Reduces possible adverse effects • Disadvantages • Potential for static • Not compact • Cost

Spacers Insert inhaler mouthpiece into spacer Blow all the air out Place mouth tightly around mouthpiece Spray only one puff from inhaler Take a slow and deep breath in Hold breath for at least 5 to 10 seconds

Nebulizer • Device used to administer medication in form of liquid mist • Pumps air or oxygen through liquid medicine

Assessment And Monitoring Evaluate at each visit the following • Daytime symptoms • Any missed work, school • Decreased activities of daily living • Nocturnal symptoms • Sleep disturbances • Evaluate exacerbations • Frequency, severity, and triggers • Assess inhaled short-acting β-2 agonist usage • Monitor and confirm pharmacotherapy • Peak flows?

Peak Flow Meter To assess the severity of airflow obstruction Small handheld device • Measures peak expiratory flow rate (PEFR) FEV-1 • Forced expiratory volume in 1 sec PEFR • Correlates with FEV-1 • Simple to perform • Used to monitor trends in severity of obstruction

Peak Flow Meter Steps to peak flow monitoring • Set to zero • Stand up or sit upright • Take deep breath, fill lungs completely • Place meter in the mouth and close lips around mouthpiece • Blow out as hard/fast as possible • Repeat above steps 1 through 6 twice more

Peak Flow Meter - Use Green zone: 80 -100% of personal best • “Desirable zone” = No symptoms • Continue routine maintenance medications Yellow zone: 50 -80% of personal best • “Caution zone” = Possible acute exacerbation • May require temporary (24 -48 hours) increase in medication Red Zone: <50% of personal best • “Danger zone” • Immediate bronchodilators