Inhaled drug therapy - non bronchodilator

Inhaled drug - Inhaled(Non-bronchodilator non-steroid pharmacologic therapeutics-rationale approaches and limitations Dr Basanta Hazarika Senior

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Inhaled (Non-bronchodilator/ non-steroid) pharmacologic therapeutics-rationale, approaches and limitations Dr. Basanta Hazarika Senior Resident Department of Pulmonary Medicine PGIMER, Chandigarh
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Introduction ± The use of aerosolized medications for treatment of the respiratory diseases has a long history in medical therapy ± 17th-century Ayurvedic literature- smoking of Datura group of herbs for dyspnea ± Inhaled Datura for asthma was recorded in 1802 in Britain ± Asthma cigarettes were widely used in the 19th century as “fuming asthma remedies”
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Advantages of the Inhalation Route ± Aerosol doses are generally smaller than systemic dose ± Onset of effect is faster with inhalation than with oral administration ± The drug is delivered directly to the target organ with minimized systemic exposure ± Systemic adverse effects are less severe and less frequent ± Inhaled drug therapy is painless and relatively comfortable
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Inhaled (Non-bronchodilator/ non- steroid) pharmacologic therapeutics ± Inhaled antibiotics ± Inhaled anti fungal ± Inhaled Antitubercular drugs ± Inhaled insulin ± Inhaled Vaccines ± Inhaled gene therapy
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Antimicrobial inhaled therapy Aerosolized Tobramycin ± 80% of CF patients colonized with P. aeruginosa ,and 90% of all CF patients die due to progressive pulmonary disease. (Koch C et al. Lancet 1993; 341:1065–1069) ± Inhalation tobramycin offers high concentrations of antibiotic to the site of infection while minimizing systemic bioavailability (Touw DJ et al. Eur Respir J 1995; 8:1594–1604)
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Antimicrobial inhaled therapy Aerosolized Tobramycin Rationale for aerosol Tobramycin ± High concentrations in the lung can be obtained ± Only a small fraction of the inhaled antibiotics is absorbed ± Less disturbance of the host micro-organism
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Antimicrobial inhaled therapy Aerosolized Tobramycin ± Inhaled tobramycin used IV preparations which may cause bronchoconstriction ± High-dose, preservative-free tobramycin (600 mg thrice daily) delivered by an ultrasonic nebulizer improving PFT and decreasing the sputum density of P aeruginosa ± Jet nebulizer could achieve high sputum levels of tobramycin in most CF patients with only a 300-mg nominal dose (Eisenberg J et al. Chest 1997; 111:955–962)
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Tobramycin Inhalation Severe Bronchiectasis ± TSI therapy significantly improve in respiratory symptoms and HRQL in subjects with severe bronchiectasis ± But some subjects did not tolerate TSI therapy. ± Bronchiectasis patients receiving this therapy should be monitored for signs of intolerance. ( Paul Scheinberg et al. CHEST 2005; 127:1420–1426)
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Tobramycin Inhalation Severe Bronchiectasis (Leslie A. Couch et al. Chest 2001;120;114-117)
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Antimicrobial inhaled therapy Aerosolized Tobramycin Long-term treatment with TSI for upto 2 years resulted in ± Sustained improvement above baseline values in FEV1 ± Fewer hospitalizations ± Increased weight gain ± Lesser need for IV anti-pseudomonal therapy (Bonnie WR et al. NEJM 1999;340:23-30)
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Inhaled drug - Inhaled(Non-bronchodilator non-steroid pharmacologic therapeutics-rationale approaches and limitations Dr Basanta Hazarika Senior

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