Dornase Alfa

used to reduce the number of lung infections and to improve lung

function in patients with cystic fibrosis.

ALbuterol

also known as salbutamol, used to prevent and treat wheezing and

shortness of breath caused by breathing problems (such as asthma,
chronic obstructive pulmonary disease).
 hypertonic saline 7%
used in people who have difficulty clearing phlegm from their
chest
including conditions such as bronchiectasis and cystic fibrosis.

bronchitol

used for the treatment of cystic fibrosis

Levalbuterol
used to prevent and treat wheezing and shortness of breath caused
by breathing problems (such as asthma, chronic obstructive
pulmonary disease).

Seretide accuhaler
used to reduce inflammation in the lungs and open the airways in
asthma and COPD.

Aerosols
Patches
Tinctures
 Foams
aerosol [ār´o-sol″]
a colloid system in which solid or liquid particles are suspended in a gas, especially a suspension
of a drug or other substance to be dispensed in a cloud or mist. See also aerosol therapy.

aerosol clearance removal of particles that have been deposited in the respiratory tissues.
Clearance may occur by ciliary transport, by phagocytosis, by encapsulation and immobilization in
a deposit of fibrous tissue (in which case the particles remain in the body), and by dissolving in
tissue fluid and subsequently diffusing into the general circulation where the particles are
metabolized.

aerosol deposition the depositing of aerosol particles onto a nearby surface, especially deposition
or retention of the particles within the respiratory system. Closely related to aerosol penetration
and affected by the same factors.

aerosol penetration the maximum distance aerosol particles can be carried into the respiratory tract
by inhaled air. Depth of penetration increases as particle size decreases. Factors affecting where
aerosol particles will be deposited and how deeply they can penetrate are: gravity, kinetic activity
of gas molecules, inertial impaction, physical nature of the particle, and the ventilatory pattern.

aerosol therapy use of an aerosol for respiratory care in the treatment of bronchopulmonary
disease. The major purpose of this is the delivery of medications or humidity or both to the mucosa
of the respiratory tract and pulmonary alveoli. Agents delivered by aerosol therapy may act in a
number of ways: (1) to relieve spasm of the bronchial muscles and reduce edema of the mucous
membranes, (2) to render bronchial secretions more liquid so that they are more easily removed,
(3) to humidify the respiratory tract, and (4) to administer antibiotics locally by depositing them in
the respiratory tract.

Physical and chemical substances used as medical aerosols include drugs that act as
bronchodilators and decongestants, such as epinephrine, ephedrine, isoproterenol, atropine, and
the steroids. Wetting agents administered as aerosols to render the bronchial secretions more
liquid include tyloxapol and acetylcysteine. The choice of antibiotics to be given as aerosol therapy
is determined by the patient's specific condition and the preference of the health care provider.
Most standard antibiotic drugs are available in aerosol form.

In general, the respiratory therapist is concerned with factors that affect how deeply aerosol
particles can penetrate into the bronchial tract and the locations at which these particles are
deposited on the bronchial mucosa and alveolar tissues. Depth of penetration is affected by
particle size. Particles as large as 100 μm and as small as 5 μm are trapped in the nose. Those 2
to 5 μm in size are deposited somewhere in the respiratory tract proximal to the alveoli. Deposition
in the alveoli is 90 to 100 per cent for particles 1 to 2 μm in size.

Because aerosol particles are so small, they present the phenomenon of brownian movement as
they are bombarded by the molecules of the gas in which they are carried. The velocity with which
these particles move about directly affects their diffusion and deposition onto nearby surfaces.
Thus the type of aerosol generator used in aerosol therapy is of primary importance.

Another factor affecting penetration and deposition of aerosol particles that should be of concern to
respiratory therapists and other members of the health team who are teaching patients the
techniques of effective aerosol therapy is that of ventilatory pattern. The ideal pattern of breathing
for optimum delivery of aerosol particles is that of slow, moderate deep breathing with breath
holding at the end of each inhalation.

What are Seretide inhalers used for?

Seretide evohaler and Seretide accuhaler are combined corticosteroid and bronchodilator inhalers
used to reduce inflammation in the lungs and open the airways in asthma and COPD. They are
purple in colour.

Asthma.
Seretide is prescribed for people whose asthma isn't controlled by using a regular preventer inhaler
(a corticosteroid) with a reliever inhaler (eg salbutamol) used when needed to open the airways.

Seretide doesn't cure asthma - it's used to help manage and control your asthma. Seretide should
be used regularly, even when you have no asthma symptoms, to reduce the inflammation in the
lungs and to help keep the airways open. You should still keep your reliever inhaler with you at all
times in case you do have an asthma attack.

Chronic obstructive pulmonary disease.

Seretide is used for people with severe COPD who have repeated attacks of breathlessness,
despite using long-acting bronchodilators such as formoterol or salmeterol on a regular basis. Only
the Seretide 500 accuhaler is suitable for treating COPD.

How do Seretide inhalers work?

Seretide accuhaler and evohaler both contain two active ingredients, a corticosteroid called
fluticasone propionate and a bronchodilator called salmeterol xinafoate.

Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many
important functions, including control of inflammatory responses. Fluticasone is a man-made
derivative of the natural hormones and is used to decrease inflammation in the lungs.
(Corticosteroids are often simply called steroids, but note they are not the same as anabolic
steroids, which are abused by some athletes and body builders.)

When you breathe in fluticasone it's absorbed into the cells of the lungs and airways. It stops these
cells from releasing chemicals that normally cause immune and allergic responses resulting in
inflammation. By stopping these chemicals being released, fluticasone reduces inflammation in
lungs that tightens the airways and makes it difficult for air to get in and out. Used regularly,
fluticasone helps prevent asthma attacks and shortness of breath.
Asthma: what to tell your doctor

Salmeterol is a type of medicine called a long-acting beta 2 agonist. It works by relaxing the
muscles in the airways and allowing the airways to open, making it easier to breathe.

Salmeterol doesn't open the airways as quickly as short-acting beta 2 agonists such as salbutamol
or terbutaline, however, it does keep the airways open for much longer. The effects of salmeterol
last for about 12 hours, whereas those of salbutamol or terbutaline last for about 3 to 5 hours. This
means salmeterol is used to prevent asthma attacks, wheezing, chest tightness and shortness of
breath, rather than to relieve them.

How do you use Seretide inhalers?

You must use your Seretide inhaler regularly every day, usually twice a day but sometimes
reducing to once a day if your asthma is well controlled. You should always follow the instructions
given by your doctor regarding when to use your inhaler and how many inhalations you should use
each day. Don't exceed the prescribed dose.

Don't suddenly stop using Seretide, even if you don't currently have any breathing problems,
unless your doctor tells you otherwise. Stopping treatment is likely to make your breathing
problems flare-up again.

It's very important to learn how to use your inhaler correctly, as otherwise you won't be breathing
the right dose of medicine into your lungs. Instructions will be provided with your inhaler. However,
your doctor, nurse or pharmacist can also show you how to use your inhaler and can check that
you are using it correctly.

Seretide is available as two different types of inhaler device; the evohaler and the accuhaler.

Seretide evohaler is a metered dose inhaler (sometimes called an MDI or aerosol inhaler) that
delivers the medicine as a fine spray or mist. With this inhaler you have to co-ordinate pressing
down the canister and breathing in the spray.
image
How to use your metered dose inhaler
Seretide evohaler can be used with a spacer device such as the Volumatic or AeroChamber Plus if
you have trouble pressing down the canister at the same time as breathing in. If you do use a
spacer it's important that you always use the same make of spacer with Seretide evohaler,
because changing makes can change the amount of medicine that is delivered to your lungs.
Seretide accuhaler is a dry powder inhaler. It comes pre-loaded with blisters containing individual
doses of the medicine as a powder. To take a dose you have to slide the lever on the inhaler. This
opens a blister inside the inhaler, making a dose ready for you to inhale. You then breathe out fully,
put the mouthpiece to your lips and breathe in steadily and deeply through your mouth. More
detailed instructions are provided with the accuhaler.

XOPENEX HFA®
(levalbuterol tartrate) Inhalation Aerosol

DESCRIPTION
The active component of XOPENEX HFA inhalation aerosol is levalbuterol tartrate, the
(R)enantiomer of albuterol. Levalbuterol tartrate is a relatively selective beta2-adrenergic receptor
agonist [see CLINICAL PHARMACOLOGY]. Levalbuterol tartrate has the chemical name (R)-
α1[[(1,1-dimethylethyl)amino]methyl]-4-hydroxy-1,3-benzenedimethanol L-tartrate (2:1 salt), and it
has the following chemical structure:

XOPENEX HFA®(levalbuterol tartrate) Structural Formula Illustration

The molecular weight of levalbuterol tartrate is 628.71, and its empirical formula is (C13H21NO3)2
• C4H6O6. It is a white to light-yellow solid, freely soluble in water and very slightly soluble in
ethanol.

Levalbuterol tartrate is the generic name for (R)-albuterol tartrate in the United States. XOPENEX
HFA inhalation aerosol is a pressurized metered-dose aerosol inhaler (MDI), which produces an
aerosol for oral inhalation. It contains a suspension of micronized levalbuterol tartrate, propellant
HFA-134a (1,1,1,2-tetrafluoroethane), Dehydrated Alcohol USP, and Oleic Acid NF.

After priming with 4 actuations, each actuation of the inhaler delivers 67.8 mcg of levalbuterol
tartrate (equivalent to 51.6 mcg of levalbuterol free base) from the valve and 59 mcg of levalbuterol
tartrate (equivalent to 45 mcg of levalbuterol free base) from the actuator mouthpiece. Each 15 g
canister provides 200 actuations (or inhalations) and each 8.4 g canister provides 80 actuations (or
inhalations).