1. Aerosols Dr. Aws Alshamsan Department of Pharmaceutics Office: AA87 Tel: 4677363 aalshamsan@ksu.edu.sa

2. Respiratory tract characteristics Large surface area, good vascularization, immense capacity for solute exchange, ultra-thinness of the pulmonary epithelium Conducting region : Nasal cavity, nasopharynx, bronchi, bronchioles Respiratory region : respiratory bronchioles, alveolar ducts and sacs

3. Why and why not? Advantages: - Less systemic toxicity - Rapid onset of medication - Delivery to target of action - Higher concentrations available in the lung Disadvantages: - Time and effort consuming - Limitation of delivery device

4. Methods Of Delivery Medications may be given by: Medications may be given by:  Metered Dose Inhaler (MDI)  Dry Powdered Inhaler (DPI)

5. Respiratory Aerosols

6. Particle Size MMAD: mass median aerodynamic diameter MMAD <1μm:exhaled MMAD 1~5μm: target MMAD >5μm:oropharynx Strict control of MMAD of the particles ensures the reproducibility of aerosol deposition and retention.

7. How MDI Technology Works

8. Inhaler Hold upright, remove the dustcap.Hold upright, remove the dustcap. Shake well.Shake well. Breathe out fully and tip chin up.Breathe out fully and tip chin up. Place puffer in mouth or three fingers distance from mouth.Place puffer in mouth or three fingers distance from mouth. Start to breathe in and press the canister.Start to breathe in and press the canister. Continue to breathe in for 5 seconds.Continue to breathe in for 5 seconds. Hold breath for 10 seconds (or as long as comfortably possible).Hold breath for 10 seconds (or as long as comfortably possible). Breathe out gently. For additional doses repeat steps 1 – 8.Breathe out gently. For additional doses repeat steps 1 – 8.

9. Addition of Spacers

10. Aerosol Metered Dose Inhalers and Chambers / Spacers Use a spacer with an aerosol inhalerUse a spacer with an aerosol inhaler Gets more medication into the lungs (~5 x more than MDI alone) Gets more medication into the lungs (~5 x more than MDI alone) Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27 Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27

11. Turbuhaler  Need deep, forceful inhalation  May use Turbutester to help determine if an individual is able to use  Counter (dots in window) turns red when doses running out

12. Turbuhaler

13. Turbuhaler Remove cap.Remove cap. Hold upright (coloured base at the bottom) and twist the coloured base as far as possible to the right (anti- clockwise) and then left (clockwise) until it clicks.Hold upright (coloured base at the bottom) and twist the coloured base as far as possible to the right (anti- clockwise) and then left (clockwise) until it clicks. Place mouthpiece in mouth.Place mouthpiece in mouth. Suck in deeply and forcefully.Suck in deeply and forcefully. Breathe out gently.Breathe out gently. For next dose repeat steps 2 – 5.For next dose repeat steps 2 – 5.

14. Diskus