Video Inhaler Part 1 Versi 3

Inhalation Therapy and Inhaler Types

Inhalation delivers medication directly to the lungs. Compared with systemic treatment, it can have a faster onset, require a smaller dose, and provide better efficacy.

The lecture lists six qualities of an ideal inhaler: effective, efficient, engaging, error-tolerant, easy to teach, and easy to switch.

Four commonly used inhaler types are introduced: nebulizers, Respimat soft-mist inhalers, metered-dose inhalers (MDIs), and dry-powder inhalers (DPIs). This video focuses on nebulizers and Respimat; later parts are said to cover MDIs and DPIs.

Nebulizers

Nebulizers, usually powered by electricity or batteries, turn liquid solutions or suspensions into aerosols for the lower respiratory tract. They require little coordination from the patient and allow normal breathing during treatment.

They are used mainly in hospitals and ambulatory care rather than for long-term chronic-disease management because they are relatively large, less portable, and deliver aerosol over an extended period.

Types of nebulizers

The lecture describes three types, distinguished by how they generate aerosol:

• Jet (pneumatic) nebulizers: A gas stream draws up liquid and shears it into a film. Surface tension breaks the unstable film into droplets, and a baffle helps produce smaller particles.
• Ultrasonic nebulizers: A transducer converts electrical energy into high-frequency vibrations that create a standing wave on the liquid surface and generate aerosol. The lecture cautions against using small-volume ultrasonic devices with suspensions such as budesonide because the medication is heated, raising concerns about protein disruption.
• Mesh nebulizers: A vibrating piezoelectric element forces liquid through fine apertures. Active vibrating-mesh and passive-mesh designs use different methods to move liquid through the plate. Particle size can be adjusted by changing the aperture size, and these devices leave little residual liquid.

Four jet-nebulizer designs are mentioned: reservoir-tube, collection-bag, breath-enhanced, and breath-actuated. The video focuses on the reservoir-tube jet nebulizer, described as common and affordable.

Reservoir-tube jet nebulizer: advantages and limitations

Advantages:

• Inexpensive and relatively easy to use
• Useful for drugs that cannot be delivered by MDIs or DPIs
• Associated with good patient compliance

Limitations:

• Produces aerosol continuously during inhalation, exhalation, and breath-holding, so medication is lost between breaths and to the surrounding air
• Less portable and harder to clean
• Requires compressed air or gas

Preparing and using the jet nebulizer

1. Ensure the power switch is off and connect the machine to its power source.
2. Remove the inhalation top and baffle from the medication cup.
3. Add the prescribed amount of medication to the cup.
4. Replace the baffle, positioning it correctly over the nozzle, then replace the inhalation top.
5. Attach the chosen accessory: a mouthpiece, child mask, or adult mask. The lecture says not to attach the cap when using a mask.
6. Connect the air tube to the machine and the bottom of the nebulizer kit.
7. Switch the machine on. When mist begins:
   • With a mask, place it over the mouth and nose and breathe normally through it.
   • With a mouthpiece, place it in the mouth and breathe normally in and out through it.
8. When treatment is complete, switch the machine off and disconnect the tubing. If moisture remains in the tube, the lecture describes turning the machine on briefly to blow it out, then switching it off and disconnecting it.
9. Clean the kit and accessories with hot water, let them dry, and disinfect them with 70% alcohol.

Respimat Soft-Mist Inhaler

Respimat is presented as a handheld, multidose, propellant-free device that produces a slow-moving soft mist. It is described as a separate type of inhaler, rather than an MDI or DPI.

Its mist is said to contain a high fraction of fine particles and travel more slowly and for longer than aerosol from many MDIs and DPIs. The lecture associates this with increased lung deposition and reduced deposition in the mouth and throat, allowing lower nominal doses without loss of efficacy.

The device is compact and portable, holds medication for about a month, and includes a dose indicator. When the indicator enters the red zone, approximately seven days of medication remain.

Medication is stored as a solution in a collapsible bag inside a cartridge. Turning the clear base winds a spring and draws medication into a capillary. Pressing the dose-release button sends the measured dose through a nozzle system that creates the soft mist.

Respimat is not breath-actuated: the patient must coordinate pressing the release button with a slow, deep inhalation. The lecture notes it is available in Indonesia, though not in every country.

Assembling the device and recording the discard date

1. Remove the transparent base and insert the cartridge into the inhaler until it clicks into place. Avoid touching the sharp piercing element inside.
2. Reattach the clear base until it clicks. Once assembled, the cartridge and outer device should not be separated.
3. Write down the discard date, 90 days after assembly. Discard the whole device when the medication runs out or that date is reached.

Priming a new device

1. Hold the inhaler upright with the cap closed.
2. Turn the clear base in the direction of the arrow until it clicks, then open the cap.
3. Point the device away from yourself and press the dose-release button.
4. If no mist appears the first time, repeat the sequence until mist appears; then repeat the sequence three more times. The device is then ready for use.

Routine use

1. Hold the inhaler upright with the cap closed and turn the clear base until it clicks.
2. Open the cap and breathe out gently, away from the inhaler.
3. Put the mouthpiece in the mouth and close the lips around it. Do not cover the air vents.
4. Begin breathing in slowly and deeply through the mouth while pressing the dose-release button; continue inhaling.
5. Hold the breath for about 10 seconds if possible, remove the inhaler, and breathe out gently away from it. Close the cap.

If the inhaler has not been used for three days, prime it once. If it has not been used for more than 21 days, repeat the full new-device priming procedure.

Main Takeaway

• Nebulizers are convenient for patients who have difficulty coordinating inhalation because they allow normal breathing, but their size and limited portability make them less suitable for routine chronic use.
• Respimat is portable and designed to deliver medication efficiently to the lungs, but it requires coordination between pressing the dose button and inhaling slowly and deeply.

Speakers and Sources

• Speaker: One unnamed narrator/presenter delivering the instructional lecture; no other speakers are identifiable in the subtitles.
• Source/channel: Departemen Farmakologi dan Terapi FKKMK UGM (channel information supplied in the video metadata).