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Aerosol drug therapy is a type of treatment that uses a special device to deliver medication directly to the lungs in the
form of a ne mist. This type of therapy is also sometimes called inhalation therapy and can be used to treat a wide
range of respiratory diseases.
In this article, we will discuss how aerosols are used to treat respiratory conditions, how the therapy works, and what
the possible side effects are. We included helpful practice questions for your bene t as well.
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An aerosol is a suspension of ne particles dispersed in air or gas. They are generated by nebulizers and inhalers,
which break up liquid or powder medications into particles small enough that can be inhaled into the lungs.
This is known as aerosol drug therapy, which can be used to treat a variety of respiratory conditions, including:
Asthma
Chronic obstructive pulmonary disease (COPD)
Bronchitis
Cystic brosis
The primary goal of aerosol drug therapy is to deliver a dose of a speci c drug to the lungs in order to achieve a
therapeutic effect. The effectiveness of aerosol therapy depends on several factors, including aerosol output, particle
size, deposition, and delivery.
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A specialized device is required to generate aerosols in order for this type of therapy to occur. There are three primary
types of aerosol delivery systems, including the following:
There are pros, cons, advantages, and disadvantages of each type. The technique for drug delivery is also different for
each device.
One of the primary advantages of this type of inhaler is that they’re portable and easy to use. They’re also consistent in
the amount of medication that is delivered with each inhalation.
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MDIs are the preferred aerosol delivery method for the maintenance delivery of bronchodilators and steroids in
spontaneously breathing patients.
However, they are highly technique-dependent. This means that you must instruct the patient on how to properly use
the device. Otherwise, they may not receive the full dose of the desired medication.
To reduce oropharyngeal deposition and the need for hand-breath coordination, spacers and valved-holding
chambers can be used.
They’re accessory devices that attach to the inhaler and hold the medication in a chamber with one-way valves. This
makes it easier for the patient to inhale the medication and reduces waste.
Dry powder inhalers are advantageous because they do not require a propellant for use. In addition, the patient does
not need hand-breath coordination in order to receive a drug dose from this type of device.
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One of the primary disadvantages of dry powder inhalers is that their operation depends on turbulent ow and the
patient’s inspiratory ow rate.
In other words, the patient must be able to perform a deep and fast inhalation in order to receive a drug dose from this
device.
Nebulizer
A nebulizer is a device that uses compressed air or ultrasonic waves to break up liquid into aerosol particles that can be
inhaled into the lungs. It requires the use of a face mask or mouthpiece in order for drug delivery to occur.
Nebulizers are the preferred drug delivery method for patients who are unable to use an inhaler or for those who
require high doses of medication.
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Types of nebulizers:
1. Jet nebulizers
2. Ultrasonic nebulizers
3. Vibrating Mesh nebulizers
Each type has its own advantages and disadvantages. Jet nebulizers are the most common type. This includes small-
volume nebulizers (SVN) and large-volume nebulizers (LVN), which are commonly used in the acute care setting.
Ultrasonic nebulizers (USN) use a piezoelectric crystal to generate aerosol particles by converting electrical signals into
high-frequency vibrations. USNs have the ability to generate a higher aerosol output than jet nebulizers.
Vibrating mesh nebulizers (VMN) use a mesh with tiny holes that vibrate at a high frequency to produce aerosol
particles. VMNs have the advantage of being able to generate a consistent particle size and have a higher respirable
fraction than jet nebulizers.
Most of the hazards that occur when delivering aerosol drugs involve an adverse reaction to the medication that is
being administered to the patient. However, some other hazards include:
Infection
Airway reactivity
Pulmonary effects of the drug
Systemic effects of the drug
Eye irritation
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Secondhand exposure
Infection can be avoided by using sterile equipment and techniques when administering aerosol drugs. Airway
reactivity can be avoided by monitoring the patient closely during therapy.
Adverse pulmonary and systemic effects of a drug can be minimized by using the proper dose and delivery method.
Eye irritation can be avoided by using eye shields or by avoiding direct contact with the eyes. Secondhand exposure
can be minimized by using ventilation systems and by avoiding close contact with others while administering aerosol
drugs.
This book (in paperback format) has sample TMC Practice Questions
on the topic of Pharmacology.
11. What factor is most crucial in developing an effective program of aerosol drug self-administration in an adult
patient requiring maintenance bronchodilator therapy?
Good patient education
15. What are the medication delivery issues for infants and children?
They have smaller airway diameters, faster breathing rates, lower minute volumes, and their nose breathing lters out
large particles.
20. What are two methods used to measure medical aerosol particle distribution?
(1) Cascade impaction and (2) Laser diffraction
41. What is the relationship between GSD and the range of particle sizes?
The greater the GSD, the wider the range of particle sizes and; therefore, a more dispersed aerosol
42. What is the difference between a spacer and a holding chamber?
A spacer is valve-less and just adds distance from the point of discharge to the mouth. A holding chamber Free
has valves
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46. What are the two most common laboratory methods used to measure medical aerosol particle size
distribution?
Cascade impaction and laser diffraction
55. Before the initial use and after storage, what should happen to every MDI device?
Each MDI should be primed by shaking and actuating the device to the atmosphere one to four times. Without the
priming, the initial dose actuated from a new pMDI canister contains less active substances.
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60. When assessing a patient’s response to bronchodilator therapy, you notice a decrease in wheezing
accompanied by an overall decrease in breath sounds. What’s most likely the cause of this?
Increasing airway obstruction
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64. How often should you clean holding chambers and spacers?
They should be cleaned monthly or as recommended by the manufacturer.
65. Which part of the lung is preferred for deposition of beta-adrenergic bronchodilators?
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67. What are the concerns of patients using disposable nebulizers at home?
There may be degradation of the performance over multiple uses.
73. Drugs for nebulization that escape from the nebulizer into the atmosphere, or are exhaled by the patient, can
be inhaled by who?
They can be inhaled by the caregiver or anyone in the vicinity of the treatment.
74. When used in conjunction with high-frequency oscillatory ventilation, the administration of albuterol sulfate by
a vibrating mesh nebulizer placed between the ventilator circuit and the patient airway has been reported to do
what?
It has been reported to deliver greater than 10% of the dose to both infants and adults.
75. When using a 50-psi owmeter to drive an SVN, you would normally set the ow at what?
6-8 L/min
76. Exhalation into the device before inspiration can result in what?
It can result in a loss of drug delivery to the lungs.
78. Poor patient response to bronchodilator therapy often occurs because of what?
An inadequate amount of the drug reaches the airway
85. What is the risk for caregivers and bystanders when administering aerosol drug therapy?
They are at risk of hazards from exposure to secondhand aerosol drugs.
87. What is the most commonly used device for medical aerosol therapy?
Small-volume nebulizer (SVN)
90. What are spacers and valved holding chambers designed to do?
They are designed to reduce both oropharyngeal deposition and the need for hand-breath coordination.
91. Is the mouthpiece better than the mask for delivering aerosol drugs?
As long as the patient is mouth breathing, there is little difference in clinical response between therapy given by
mouthpiece and therapy given by mask.
94. In order to avoid an oral yeast infection, the patient should do what after inhaling a corticosteroid drug?
Rinse their mouth
95. What problems are associated with using a SPAG to deliver ribavirin?
(1) Caregiver exposure, and (2) Drug precipitation can jam the breathing valves or occlude the ventilator circuit
This book (in paperback format) has sample TMC Practice Questions
on pathology and diseases.
101. When ribavirin and pentamidine are administered, where should the treatment be provided?
They must be administered in a private room that is equipped for negative pressure ventilation with adequate air
exchange.
109. How should drug dosages be adjusted when they’re being administered via SVN to patients receiving
mechanical ventilation?
Administer 2 to 5 times the normal dose
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110. What is the optimal ow rate when using an SVN?
6 to 8 L/min
116. The mass of aerosol particles produced by a nebulizer in a given unit of time best describes which quality of an
aerosol?
Output
118. What is used to identify the particle diameter, which corresponds to the most typical settling behavior of an
aerosol?
Mean mass aerodynamic diameter (MMAD)
119. What is the primary mechanism for the deposition of large particles in the respiratory tract?
Inertial impaction
123. What term describes the primary mechanism for the deposition of small particles?
Brownian diffusion
124. Where do most aerosol particles that are less than 3 μ m deposit?
Alveoli
125. How can you monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy?
Measure pre and post peak ow and the %forced expiratory volume in 1 second; auscultate for adventitious breath
sounds; observe the patient’s response; and communicate with the patient during therapy
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126. What is the preferred method of delivering a bronchodilator to spontaneously breathing patients who are
intubated and receiving mechanical ventilation?
Metered-dose inhaler (MDI)
127. When red inside the mouth, what percentage of the drug dose delivered by an MDI deposits in the
oropharynx?
About 80%
128. Before inspiration and actuation of an MDI, the patient should exhale to which of the following?
Functional residual capacity
129. To ensure delivery of proper drug dosage with an MDI, which of the following must be done rst?
The canister should be warmed to hand or body temperature, and the canister should be vigorously shaken.
130. What type of patients are most likely to have dif culty using an MDI inhaler?
Those who are in acute distress, infants and young children, and elderly patients
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132. Which type of patient would you recommend against using a ow-triggered MDI as the sole bronchodilator
delivery system?
A patient that is likely to develop acute severe bronchospasm
133. The key difference between an MDI holding chamber and a spacer is that the holding chamber incorporates
what?
A one-way inspiratory valve
134. What device would you select to deliver an aerosolized bronchodilator to a young child?
MDI with a holding chamber and mask
135. The proper use of a dry powder inhaler requires that the patient is able to do what?
Generate inspiratory ows of 60 L/min or higher
136. What device depends on the patient’s inspiratory effort to dispense a dose?
Dry powder inhaler (DPI) Free Book Test Bank TMC Exam 3 Resources 3 About 3 Blog Contact U
137. For what patient groups is the DPI for bronchodilator administration NOT recommended?
Infants and children under 5 and patients with an acute episode of bronchospasm
138. Exhalation into which device can result in a loss of drug delivery?
Dry powder inhaler (DPI)
139. SVN output drops after lowering the patient’s bed while giving a treatment, but there is 3 mL of solution still
left in the reservoir. How can you correct this problem?
Reposition the patient so that the SVN is more upright
140. What should you do to minimize a patient’s infection risk between drug treatments with an SVN?
Rinse the SVN with sterile water and air dry
141. The physician has ordered ribavirin (virazole) to be administered by aerosol to an infant with bronchiolitis.
Which device would you use for delivery?
Small particle aerosol generator (SPAG)
142. What problems are associated with the delivery of virazole using a SPAG?
Caregiver exposure and drug precipitation in the ventilator circuit
143. For maintenance administration of bronchodilators to adult patients with adequate inspiratory ows, which
aerosol devices would you recommend?
DPI and MDI with a holding chamber
144. What aerosol drug delivery systems would you not recommend for a toddler or small child?
MDI and SVN
145. What is the best way to con rm that a patient can properly self-manage a newly prescribed form of aerosol
drug therapy?
Have the patient provide a return demonstration
FAQ
What is Aerosol Output?
Aerosol output is a term that refers to the total mass or weight of the particles that are produced by an aerosol
generator for dispersion. In general, the aerosol output will vary greatly depending on the drug delivery system that is
used.
It is measured by collecting an aerosol particle on a lter once it is dispersed and analyzing the weight or quantity.
If you measure the weight, this is referred to as the gravimetric analysis, which is typically less reliable because of the
weight changes that occur due to evaporation. Analyzing the quantity is a more reliable way of measuring aerosol
output.
This could be due to the aerosol particle size or the patient’s breathing pattern. As a practitioner, understanding how to
control these variables is important for improving the overall delivery of aerosol therapy to your patients.
What is an Atomizer?
An atomizer is a device that is used to generate an aerosol. It typically consists of a cup or reservoir for the liquid
medication, a power source, and a nozzle.
The most common type of atomizer is the piezoelectric crystal atomizer, which uses a piezoelectric crystal to generate
vibrations that create an aerosol.
What is a Ba e on a Nebulizer?
A baf e is a device that is used to direct the air ow in a nebulizer. It is typically placed between the compressor and
nozzle to help control the direction of the air ow.
They play a key role in the ability of a nebulizer to generate aerosol particles.
When a patient takes a breath in, negative pressure is created, which activates the device so that medication is drawn
into a reservoir and aerosols can be generated.
When a patient takes a breath in, there is an inspiratory vent that allows air to move into the nebulization chamber
where aerosols are generated.
Then, as the patient exhales, the inspiratory vent closes so that the drug aerosols can only exist through a one-way
valve that is located near the mouthpiece of the device.
The spread of aerosol particles in air is due to Brownian diffusion. The size and shape of the particles will affect the rate
of diffusion.
Hydro uoroalkanes (HFAs) are the most common type of propellant used in inhalers today. They are less harmful to
the environment than CFCs but can still contribute to greenhouse gas emissions.
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Final Thoughts
Aerosol drug therapy has many variables that can affect the overall ef cacy of the therapy. Respiratory therapists are
responsible for understanding how these variables work in order to optimize the delivery of aerosol drugs to their
patients.
We also have a similar guide on airway clearance therapy that I think you will nd helpful. Thanks for reading and, as
always, breathe easy, my friend.
Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a
substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any
questions that you may have regarding a medical condition. Never disregard professional medical advice or
delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur,
and medications, protocols, and treatment methods may change over time.
References
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