Chapter 9 - Clinical Application of Aerosols in Ambulatory Patients
Chapter 9.1 Asthma
by Omar S. Usmani, MB BS, PhD, FHEA, FRCP
Asthma is a chronic inflammatory disease of the airways characterised by reversible airflow obstruction. Current asthma guidelines encourage a “step-up” approach in pharmacological treatment to achieve disease control and a “step-down” strategy when asthma is under control. In this strategy, inhaled drug therapy remains the foundation in managing patients with asthma. This chapter considers the pathophysiology and clinical assessment of patients with asthma, the types of inhaler devices used for managing asthma, and the pharmacology of drugs used in treating asthmatic patients.
Chapter 9.2 Inhalation Therapy for COPD
by Ruben D. Restrepo, MD, RRT, FAARC and Andrew Tate, BS, RRT
Inhaled therapy is an important component of the management of patients with chronic obstructive pulmonary disease (COPD). Inhaled agents provide immediate relief of symptoms and aid in restoring the functional capacity of patients with COPD. Current clinical guidelines are oriented to provide clinicians with a stepwise approach to treating the disease effectively. This manuscript will review the most current evidence regarding the use of inhaled therapy in the treatment of COPD and summarize some of the emergent inhaled therapies.
Chapter 9.3 Cystic Fibrosis and Bronchiectasis
by Paula J. Anderson, MD
Bronchiectasis is a lung disease characterized by irreversible dilatation and destruction of bronchi associated with recurrent infection and inflammation. It is seen in patients with cystic fibrosis (CF) but can also be caused by a large number of non-CF disorders. Inhaled drugs are a mainstay of chronic therapy for patients with CF and are increasingly used in non-CF bronchiectasis. There is much less evidence, however, about the use of inhaled treatments in non-CF bronchiectasis, and it cannot be assumed that a therapy effective in CF will also be effective in other types of bronchiectasis. nhaled mucoactive drugs are used to both liquefy mucus and increase its volume so it can be cleared from the airways during daily treatments.
Chapter 9.4 Aerosol Therapy in Pulmonary Hypertension
by Benoit Roch, Pascal Magro, MD, Sylvain Marchand-Adam, MD, PhD and Patrice Diot, MD, PhD
The first effective treatment for pulmonary hypertension was prostacyclin in continuous intravenous infusion, but its lack of pulmonary selectivity, its side effects, and infectious concerns made the inhaled route a viable alternative. The first inhaled treatment was inhaled nitric oxide (INO), which had the advantage of being selective towards the pulmonary vascular bed but with a huge risk of rebound pulmonary hypertension when discontinued. Inhaled epoprostenol had the same pulmonary vasodilator potency as intravenous prostacyclin, but it improved ventilation-perfusion matching. An abrupt withdrawal of inhaled epoprostenol caused rebound pulmonary vasoconstriction, and for that reason, analogues of prostacyclin began to be used, namely, iloprost and treprostinil.
