10th International Aerosol Conference September 2 - September 7, 2018 America's Center Convention Complex St. Louis, Missouri, USA
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In Vitro Determination of Combivent and Spiriva Respimat Dose Delivery in Simulated Spontaneously Breathing Tracheostomy Patients
RYM MEHRI, Abubakar Alatrash, Edgar A. Matida, Fiorenza Frank, Carleton University, Ottawa, ON, Canada
Abstract Number: 1661 Working Group: Aerosols in Medicine
Abstract Chronic obstructive pulmonary disease (COPD) is a common lung disease that affects the respiratory tract by obstructing the airflow from the lung, hence causing breathing difficulties. Aerosols are commonly used to deliver therapeutic drugs to patient suffering from asthma and COPD. The Spiriva Respimat Soft Mist Inhaler (SMI, Boehringer Ingelheim, Ingelheim, Germany) is capable of delivering a metered dose of aqueous medication (2.5 mcg of tiotropium bromide monohydrate/puff) in the form of aerosols, used in the treatment of COPD. The Respimat SMI is a new generation of inhaler, which generates an aerosol mist suitable for inhalation using mechanical power from a spring in comparison to the liquid-gas propellant typically used in pMDIs. This inhaler was designed to deliver a slow (initial approximate droplet velocity of 10 m/s) but lasting (approximately 1.5 seconds) aerosol mist to facilitate the coordination of actuation with inhalation for proper medication delivery. The inhaled drug efficiency is strongly influenced by the amount of inhaled drug, the aerosol characteristics (particle size distribution), the deposited mass, the delivery method, the flow characteristics and the architecture of airways. For patients with acute or severe COPD, mechanical ventilation is necessary to reduce the patient’s work of breathing. In severe cases (unconscious patients), invasive mechanical ventilation is performed using tracheostomy or endotracheal tube, while simultaneously delivering medication. However, the Respimat SMI is not specifically designed to be used in intensive care, greatly affecting the inhaled drug deposition when using mechanical ventilation for patients with tracheostomy or endotracheal tube.
The purpose of this work is to study the aerosol particle deposition, in an experimental set up (in vitro), using a trachea replica (rapid prototyping). The set up attempts to replicate clinical setting for mechanically ventilated patients with COPD via tracheostomy tube. Tiotropium bromide monohydrate is delivered using the Respimat SMI via a spring loaded T-piece connected to an adapter (ODAPT). The ODAPT adapter was previously tested experimentally in continuous flow and using a mechanical ventilator to determine the effect of the adapter and T-piece on medication losses. Using these results, it is possible to properly estimate the medication lost in the ODAPT adapter and T-piece used in the experimental set up.