asma inhalers

1. Inhaler
For other uses, see Inhaler (disambiguation).
An inhaler (or puffer) is a medical device used for
A metered-dose inhaler (MDI)
delivering medication into the body via the lungs. It is
mainly used in the treatment of asthma and Chronic Ob-
structive Pulmonary Disease (COPD). Zanamivir (Re-
lenza), used to treat influenza, must be administered via
inhaler.
To reduce deposition in the mouth and throat, and to
reduce the need for precise synchronization of the start
of inhalation with actuation of the device, MDIs are
sometimes used with a complementary spacer or holding
chamber device.
Decongestant inhalers are popular over-the-counter
remedies for nasal congestion in the upper respiratory
tract.
1 Types
1.1 Metered-dose (MDI)
The most common type of inhaler is the pressurized
metered-dose inhaler (MDI). In MDIs, medication is typ-
ically stored in solution in a pressurized canister that con-
tains a propellant, although it may also be a suspension.[1]
Two MDIs displaying no. of doses remaining (house key for
scale)
The MDI canister is attached to a plastic, hand-operated
actuator. On activation, the metered-dose inhaler re-
leases a fixed dose of medication in aerosol form. The
correct procedure for using an MDI is to first fully exhale,
place the mouth-piece of the device into the mouth, and
having just started to inhale at a moderate rate, depress
the canister to release the medicine. The aerosolized
medication is drawn into the lungs by continuing to inhale
deeply before holding the breath for 10 seconds to allow
the aerosol to settle onto the walls of the bronchittus and
other airways of the lung. Some inhalers are made to act
instantly in case of an asthma attack, and others are made
to act later.
1.2 Dry powder (DPI)
Dry powder inhalers release a metered or device-
measured dose of powdered medication that is inhaled
through a DPI device.
1

2. 2 3 HISTORY
1.3 Nebulizers
Nebulizers — supply the medication as an aerosol created
from an aqueous formulation.
1.4 Nasal
Nasal inhalers contain decongestant drugs to relieve nasal
congestion in the upper respiratory tract. The active in-
gredient in most decongestants is either pseudoephedrine
or phenylephrine. Many are sold over-the-counter with-
out a prescription.
2 Propellants
In 2009, the FDA banned the use of inhalers that
utilize chlorofluorocarbons (CFC) as propellants for
hydrofluorocarbons (HFA) inhalers; HFA is not environ-
mentally inert as a greenhouse gas but does not affect the
ozone layer.[2]
While some asthma sufferers and advo-
cacy groups contend that the latter are not as effective,[3]
published clinical studies indicate equivalent control of
asthma is achieved with use of HFA inhalers.[4]
Inhalers
used to treat asthma contains dry powder spin inhalers
and aerosoles containing suspending liquid medicament,
but in both the cases the size of suspended particles or
powder particles must be less than 5 micrometres so as to
increase the surface area and deliver the drug to the inner
most areas. Such a sufficiently small size of particles is
necessary for dispersion and also for rapid action.
While the impact of CFC of inhalers on the ozone layer
had been minuscule, the FDA in its interpretation of the
Montreal Protocol mandated the switch in propellants.[2]
Patients expressed concern about the high price of the
HFA inhalers as there is no generic version, which had
been available in the CFC inhalers for many years.[3]
The
elimination of generics from the market led to a price in-
crease in inhalers that is expected to cost American con-
sumers, insurances and the government about $8 billion
by 2017.[2]
3 History
The idea of directly delivering medication into the lungs
was based on ancient traditional cures that involved the
use of aromatic and medicinal vapours. These did not in-
volve any special devices beyond the apparatus used for
burning or heating to produce fumes. Early inhalation
devices included one devised by John Mudge in 1778. It
had a pewter mug with a hole allowing attachment of a
flexible tube. Mudge used it for the treatment of coughs
using opium. These devices evolved with modifications
by Wolfe, Mackenzie (1872) and better mouth attach-
ments such as by Beigel in 1866. Many of these early in-
Penetro brand inhaler from mid 20th century Mexico, part of the
permanent collection of the Museo del Objeto del Objeto.
Inhaler designed by John Mudge in 1778.
halers needed heat to vapourize the active chemical ingre-
dient. The benefits of forced expiration and inspiration to
treat asthma were noted by J. S. Monell in 1865. Chemi-
cals used in inhalers included ammonia, chlorine, iodine,
tar, balsams, turpentine camphor and numerous others in
combinations.[5]
Julius Mount Bleyer used a variation in
1890 in New York.[6]
A mouthpiece for an inhaler designed by Dr Beigel (1867).

3. 3
In 1968, Robert Wexler of Abbott Laboratories devel-
oped the Analgizer, a disposable inhaler that allowed the
self-administration of methoxyflurane vapor in air for
analgesia.[7]
The Analgizer consisted of a polyethylene
cylinder 5 inches long and 1 inch in diameter with a 1
inch long mouthpiece. The device contained a rolled
wick of polypropylene felt which held 15 milliliters of
methoxyflurane.
Because of the simplicity of the Analgizer and the
pharmacological characteristics of methoxyflurane, it was
easy for patients to self-administer the drug and rapidly
achieve a level of conscious analgesia which could be
maintained and adjusted as necessary over a period of
time lasting from a few minutes to several hours. The 15
milliliter supply of methoxyflurane would typically last
for two to three hours, during which time the user would
often be partly amnesic to the sense of pain; the device
could be refilled if necessary.[8]
The Analgizer was found to be safe, effective, and sim-
ple to administer in obstetric patients during childbirth,
as well as for patients with bone fractures and joint dis-
locations,[8]
and for dressing changes on burn patients.[9]
When used for labor analgesia, the Analgizer allows la-
bor to progress normally and with no apparent adverse
effect on Apgar scores.[8]
All vital signs remain normal
in obstetric patients, newborns, and injured patients.[8]
The Analgizer was widely utilized for analgesia and
sedation until the early 1970s, in a manner that foreshad-
owed the patient-controlled analgesia infusion pumps of
today.[10][11][12][13]
The Analgizer inhaler was withdrawn
in 1974, but use of methoxyflurane as a sedative and anal-
gesic continues in Australia and New Zealand in the form
of the Penthrox inhaler.[14][15][16][17][18][19]
4 Manufacturers
The largest manufacturers of inhalers are Cipla,
GlaxoSmithKline (makers of the Advair Discus, a
DPI), Midascare Pharmaceuticals Pvt Ltd, Merck,
AstraZeneca (makers of Pulmicort and Symbicort) and
Boehringer-Ingelheim (makers of Atrovent, Combivent,
and Spiriva). BI, GSK, Merck, and AstraZeneca man-
ufacture the medication being delivered via inhaler.
However, 3M Drug Delivery Systems does some of the
finished product manufacturing, as they are one of the
leaders of MDI canisters, metering valves and other
components.
5 See also
• List of medical inhalants
• Decongestant
6 References
[1] Hickey, A.J., ed. (2004). Pharmaceutical Inhalation
Aerosol Technology (2nd ed.). NY: Marcel Dekker.
[2] Nick Baumann (July–August 2011). “Why You're Paying
More to Breathe”. Mother Jones.
[3] “Asthma Group Concerned “Green” Inhalers May Not be
as Effective | ksdk.com | St. Louis, MO”. ksdk.com. Re-
trieved 2010-11-21.
[4] Hendeles L, Colice GL, Meyer RJ (March 2007).
“Withdrawal of albuterol inhalers containing chloroflu-
orocarbon propellants” (PDF). N. Engl. J. Med. 356
(13): 1344–51. doi:10.1056/NEJMra050380. PMID
17392304.
[5] Cohen, J. Solis (1876). Inhalation in the treatment of dis-
ease: its therapeutics and practice. Philadelphia: Lindsay
& Blakiston.
[6] Bleyer, J. Mount (1890). “A new method of larygeal
and bronchial medication by means of a spray and
tube during the act of deep inspiration. Read in
the Section of Laryngology and Otology at the Forty-
first Annual Meeting of the American Medical Asso-
ciation, Nashville, Tenn., May, 1890.”. Journal of
the American Medical Association 15 (18): 634–636.
doi:10.1001/jama.1890.02410440006001a.
[7] Wexler RE (1968). “Analgizer: Inhaler for supervised
self-administration of inhalation anesthesia”. Abbott
Park, Illinois: Abbott Laboratories. Retrieved 2010-11-
21.
[8] Romagnoli A, Busque L, Power DJ (1970). “The
“analgizer” in a general hospital: a preliminary report”
(PDF). Canadian Journal of Anesthesia 17 (3): 275–8.
doi:10.1007/BF03004607. PMID 5512851.
[9] Packer KJ, Titel JH (1969). “Methoxyflurane analge-
sia for burns dressings: experience with the Analgizer
(subscription required)". British Journal of Anaesthesia
41 (12): 1080–5. doi:10.1093/bja/41.12.1080. PMID
4903969.
[10] Major V, Rosen M, Mushin WW (1966).
“Methoxyflurane as an obstetric analgesic: a com-
parison with trichloroethylene”. BMJ 2 (5529): 1554–61.
doi:10.1136/bmj.2.5529.1554. PMC 1944957. PMID
5926260.
[11] Dragon A, Goldstein I (1967). “Methoxyflurane: prelimi-
nary report on analgesic and mood modifying properties in
dentistry (subscription required)". Journal of the Ameri-
can Dental Association 75 (5): 1176–81. PMID 5233333.
[12] Firn S (1972). “Methoxyflurane analgesia for burns dress-
ings and other painful ward procedures in children (sub-
scription required)". British Journal of Anaesthesia 44 (5):
517–22. doi:10.1093/bja/44.5.517. PMID 5044082.
[13] Josephson CA, Schwartz W (1974). “The Cardiff Inhaler
and Penthrane. A method of sedation analgesia in rou-
tine dentistry”. Journal of the Dental Association of South
Africa 29 (2): 77–80. PMID 4534883.

4. 4 8 EXTERNAL LINKS
[14] Babl F, Barnett P, Palmer G, Oakley E, Davidson A
(2007). “A pilot study of inhaled methoxyflurane for pro-
cedural analgesia in children (subscription required)". Pe-
diatric Anesthesia 17 (2): 148–53. doi:10.1111/j.1460-
9592.2006.02037.x. PMID 17238886.
[15] Grindlay J, Babl FE (2009). “Efficacy and safety of
methoxyflurane analgesia in the emergency department
and prehospital setting”. Emergency Medicine Australasia
21 (1): 4–11. doi:10.1111/j.1742-6723.2009.01153.x.
PMID 19254307.
[16] Babl FE, Jamison SR, Spicer M, Bernard S (2006).
“Inhaled methoxyflurane as a prehospital analgesic in
children (subscription required)". Emergency Medicine
Australasia 18 (4): 404–10. doi:10.1111/j.1742-
6723.2006.00874.x. PMID 16842312.
[17] McLennan JV (2007). “Is methoxyflurane a suitable bat-
tlefield analgesic?" (PDF). Journal of the Royal Army
Medical Corps 153 (2): 111–3. doi:10.1136/jramc-153-
02-08. PMID 17896540.
[18] Medical Developments International Pty. Ltd. (2009).
“PENTHROX (methoxyflurane) Inhalation: Product In-
formation” (PDF). Springvale, Victoria, Australia: Medi-
cal Developments International Limited. Retrieved 2010-
11-21.
[19] National Prescribing Service (2010). “Methoxyflurane
(Penthrox) for analgesia (doctor’s bag listing)" (PDF).
NPS RADAR. Canberra, Australia: National Prescribing
Service, Department of Health and Ageing. Retrieved
2010-11-21.
7 Further reading
• Patton J (February 1998). “Breathing life into
protein drugs — Inhalation of therapeutic macro-
molecules is a feasible, natural, more people-
friendly, delivery system”. Nat. Biotechnol. 16
(2): 141–3. doi:10.1038/nbt0198-141. PMID
9487516.
8 External links
• Basics aspects of inhaled pharmaceutical aerosols
• Recent advances in spray medication technology
• Discrete simulation of powder dispersion in phar-
maceutical aerosol inhalers

5. 5
9 Text and image sources, contributors, and licenses
9.1 Text
• Inhaler Source: https://en.wikipedia.org/wiki/Inhaler?oldid=717360510 Contributors: Shyamal, Fuzheado, Raul654, Zandperl, Bkell, Jfd-
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Brown, Thumperward, Roscelese, JonHarder, Psellis, Radagast83, Dcamp314, Joseph Solis in Australia, LadyofShalott, Rsteif, Thatbox,
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bot, Amirobot, Quantumclimber, DiverDave, Daniele Pugliesi, Piano non troppo, Jmarchn, ArthurBot, TechBot, Nitrxgen, Twirligig,
Nikhilpatel25132, Steven.huffer, FrescoBot, Suenica, I dream of horses, HRoestBot, World wide wilson, Tinton5, Gladheart, Whisky
drinker, Danish Expert, Wham Bam Rock II, ChuispastonBot, ClueBot NG, Peter James, Gilderien, Djhinds, Mark Arsten, Silvrous, Je.rrt,
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9.2 Images
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main Contributors: Cohen, J. Solis (1876) Inhalation in the treatment of disease: its therapeutics and practice, invalid ID: Lindsay & Blakiston
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