同: MDI

WordNet

travel or traverse (a distance); "This car does 150 miles per hour"; "We did 6 miles on our hike every day"
the syllable naming the first (tonic) note of any major scale in solmization (同)doh, ut
proceed or get along; "How is she doing in her new job?"; "How are you making out in graduate school?"; "Hes come a long way" (同)fare, make_out, come, get along
create or design, often in a certain way; "Do my room in blue"; "I did this piece in wood to express my love for the forest" (同)make
carry on or function; "We could do with a little more help around here" (同)manage
get (something) done; "I did my job" (同)perform
stamp with a meter indicating the postage; "meter the mail"
the basic unit of length adopted under the Systeme International dUnites (approximately 1.094 yards) (同)metre, m
rhythm as given by division into parts of equal duration (同)metre, time
any of various measuring instruments for measuring a quantity
(prosody) the accent in a metrical foot of verse (同)metre, measure, beat, cadence
measure with a meter; "meter the flow of water"
treat with an agent; add (an agent) to; "The ray dosed the paint"
the quantity of an active agent (substance or radiation) taken in or absorbed at any one time (同)dosage
a measured portion of medicine taken at any one time (同)dosage
draw deep into the lungs in by breathing; "Clinton smoked marijuana but never inhaled"
draw in (air); "Inhale deeply"; "inhale the fresh mountain air"; "The patient has trouble inspiring"; "The lung cancer patient cannot inspire air very well" (同)inspire, breathe in
a dispenser that produces a chemical vapor to be inhaled in order to relieve nasal congestion (同)inhalator

PrepTutorEJDIC

《疑問文・否定文を作る》 / 《否定命令文を作る》 / 《助動詞とbe動詞のどちらも含まない文に用いて付加疑問を作る》 / 《強意語として》 / 《文》《助動詞とbe動詞のどちらも含まない文に用いて倒置文を作る》 / 《あいづちを打つ場合に》 / 《先行する動詞またはそれを含む述部の代用》 / 《so,nor,neitherで始まる簡略文で》 / …‘を'『する』,行う,果たす / 《通例have done,時にbe doneの形で》…‘を'『終える』,済ませる / …‘を'作る,作り出す / …‘を'『処理する』,整える,片付ける / 〈学課〉‘を'『勉強する』,専攻する / 〈利益・害など〉‘を'与える,もたらす / 〈人〉‘に'『役立つ』,用が足りる(serve) / …の速度で進む,距離を行く / …‘を'見物する / 〈劇〉‘を'上演する;…‘の'役を演じる / …の役目(仕事)をする / 《おもに英》…‘を'だます,かつぐ / 《話》…をへとへとにさせる / 『する』;活動する / 《通例have done,時にbe doneの形で》(…を)『終える』,済ます《+『with』+『名』》 / 〈事が〉『運ぶ』;〈人が〉暮らしていく,健康である / 〈物が〉(…に)『間に合う』,十分である;〈人が〉(…に)役に立つ,向く《+『for』+『名』》 / 《複数形で》すべきこと / 〈C〉《おもに英》大宴会,大パーティー / 〈C〉《英話》詐欺,ぺてん
ド(全音階の第1音)
(ガス・水・電気などの)『計器』,メーター / (時間・速度・距離・強度などを測定,記録する)メーター,計器
(おもに飲み薬1回分の)『服用量』 / (痛いこと・いやなことの)1回分,一定量 / (人などが受ける放射線の)線量 / 性病 / (…を)…‘に'投薬する,服用させる《+『名』+『with』+『名』》
〈空気など〉‘を'吸い込む / 息(たばこの煙)を吸い込む
(薬などの)吸入器 / [人工]呼吸器 / 吸入する人

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/14 23:52:18」(JST)

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Metered-dose Inhaler

A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases. The medication in a metered dose inhaler is most commonly a bronchodilator, corticosteroid or a combination of both for the treatment of asthma and COPD. Other medications less commonly used but also administered by MDI are mast cell stabilizers, such as cromoglicate or nedocromil.

Description

Deep drawn MDI canister made by Pressteck (Italy)

A metered-dose inhaler consists of three major components; the canister which is produced in aluminium or stainless steel by means of deep drawing, where the formulation resides; the metering valve, which allows a metered quantity of the formulation to be dispensed with each actuation; and an actuator (or mouthpiece) which allows the patient to operate the device and directs the aerosol into the patient's lungs.^[1]^,^[2] The formulation itself is made up of the drug, a liquefied gas propellant and, in many cases, stabilising excipients. The actuator contains the mating discharge nozzle and generally includes a dust cap to prevent contamination.

To use the inhaler the patient presses down on the top of the canister, with their thumb supporting the lower portion of the actuator. Actuation of the device releases a single metered dose of the formulation which contains the medication either dissolved or suspended in the propellant. Breakup of the volatile propellant into droplets, followed by rapid evaporation of these droplets, results in the generation of an aerosol consisting of micrometer-sized medication particles that are then inhaled.^[3]

Uses

Metered-dose inhalers are only one type of inhaler, but they are the most commonly used type. The replacement of chlorofluorocarbons propellants with hydrofluoroalkanes (HFA) resulted in the redesign of metered-dose inhalers in the 1990s. For one variety of beclomethasone inhaler, this redesign resulted in considerably smaller aerosol particles being produced, and led to an increase of potency by a factor of 2.6.^[4]

Asthma inhalers contain a medication that treats the symptoms of asthma.
Dry powder inhalers involve micronised powder often packaged in single dose quantities in blisters or gel capsules containing the powdered medication to be drawn into the lungs by the user's own breath. These systems tend to be more expensive than the MDI, and patients with severely compromised lung function, such as occurs during an asthma attack, may find it difficult to generate enough airflow to get good function from them.
A nicotine inhaler allows cigarette smokers to get nicotine without using tobacco, much like nicotine gum or a nicotine patch. Nicotine inhalers that are marketed as nicotine replacement therapy should not be confused with electronic cigarettes, which produce vapour and which are marketed mainly as devices that smokers can use in non-smoking areas. Nicotine inhalers are also known by their nickname of “the puffer”. These devices are made of thin plastic, sometimes resembling a cigarette, or a cylinder shape. It contains a porous nicotine filled plug, located in the base of the product. When you puff on the inhaler, nicotine vapor is inhaled and absorbed in the mouth’s lining. Every inhaler delivers almost four hundred puffs of this nicotine vapor. It is also considered healthier than the traditional cigarette, as it takes about eighty puffs to get an equal amount of nicotine that is acquired through only one cigarette. The nicotine inhaler is also temperature sensitive. In cooler weather, less nicotine is delivered. The Nicotine Inhaler is considered easier to use than the electronic cigarette as it is usually disposable, and contains fewer parts than the electronic cigarette.

History

Before the invention of the MDI asthma medication was delivered using a squeeze bulb nebulizer which was fragile and unreliable.^[5] The relatively crude nature of these devices also meant that the particles that they generated were relatively large, too large for effective drug delivery to the lungs.^[2] Nonetheless these nebulisers paved the way for inhaltion drug delivery providing the inspiration for the MDI.

MDIs were first developed in 1955 by Riker Laboratories, now a subsidiary of 3M Healthcare.^[5] At that time MDIs represented a convergence of two relatively new technologies, the CFC propellant and the Meshburg metering valve which was originally designed for dispensing perfume.^[6] The initial design by Riker used a glass canister coated with a vinyl plastic to improve its resilience.^[5] By 1956 Riker had developed two MDI based products, the Medihaler-Ept containing epinephrin and the Medihaler-Iso containing Isoprenaline.^[2] Both products are agonists which provide short term relief from asthma symptoms and have now largely been replaced in asthma treatment by salbutamol, which is more selective.

Spacers

Metered-dose inhalers are sometimes used with add-on devices referred to as holding chambers or spacers, which are tubes attached to the inhaler that act as a reservoir or holding chamber and reduce the speed at which the aerosol enters the mouth. They serve to hold the medication that is sprayed by the inhaler. This makes it easier to use the inhaler and helps ensure that more of the medication gets into the lungs instead of just into the mouth or the air. With proper use, a spacer can make an inhaler somewhat more effective in delivering medicine.^[7]

Spacers can be especially helpful to adults and children who find a regular metered dose inhaler hard to use. People who use corticosteroid inhalers should use a spacer to prevent getting the medicine in their mouth, where oral yeast infections and dysphonia can occur.^[8]

Lifespan and replacement

The deposition of the content of drug formulation on the canister surface can result in a shorter shelf life of an MDI inhaler. Applying a suitable surface coating to the components helps to extend this shelf life. Over the years a range of coating processes have been developed that can be applied to both the canister and valve to protect the contents from deposition and degradation. Gas plasma processing is an industrial technique that is carried out in a vacuum to coat the entire MDI inhaler and involves constant or pulsed excitation of gas by either Radio Frequency (RF) or microwave field to produce an energetic plasma. This coating ensures that the drug formulation does not stick to the interior wall of the MD inhaler and results in the patient receiving the prescribed dose of medication, whilst also extending the product's shelf-life.

A metered dose inhaler contains enough medication for a certain number of actuations (or "puffs") which is printed on the canister. Even though the inhaler may continue to work beyond that number of uses, the amount of medication delivered may not be correct. It is important to keep track of the number of times an inhaler was used, so that it can be replaced after its recommended number of uses. For this reason, several regulatory authorities have requested that manufacturers add a dose counter or dose indicator to the actuator. Several inhalation products are now sold with a dose counter-actuator. Depending on the manufacturer and the product, inhalers are sold as a complete unit or the individual canister as a refill prescription.

Propellants

CFC-free Asthalin HFA inhaler made by Cipla (India)

One of the most crucial components of a MDI is its propellant. The propellant provides the force to generate the aerosol cloud and is also the medium in which the active component must be suspended or dissolved. Propellants in MDIs typically make up more than 99% of the delivered dose,^[9] so it is the properties of the propellant that dominate more than any other individual factor. This is often overlooked in literature and in industry because so few propellants are used and their contribution is often taken for granted. Suitable propellants must pass a stringent set of criteria, they must:

have a boiling point in the range -100 to +30°C ^[10]
have a density of approximately 1.2 to 1.5 g cm⁻³ (approximately that of the drug to be suspended or dissolved)^[9]
have a vapour pressure of 40 to 80 psig ^[11]
have no toxicity to the patient ^[9]^[11]
be non-flammable ^[9]^[11]
be able to dissolve common additives. Active ingredients should be either fully soluble or fully insoluble.^[9]

Chlorofluorocarbons (CFCs)

In the early days of MDIs the most commonly used propellants were the chlorofluorocarbons CFC-11, CFC-12 and CFC-114.

Transition to HFA (hydrofluoroalkane) propellants

In 2008 the Food and Drug Administration announced that inhalers using chlorofluorocarbons as a propellant, such as Primatene Mist, could no longer be manufactured or sold as of 2012.^[12] This followed from the U.S. decision to agree to the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer.^[13]

Surfactant lipids

Phospholipids are important natural surfactant lipids ^[14] used in enhancing penetration and bioavailability.^[15] Phospholipids act by reducing the high surface tension forces at the air-water interface within the alveoli, thereby reducing the pressure needed to expand the lungs, Thus, commercially available formulations of phospholipids have been designed to spread rapidly over an air-aqueous interface, thereby reducing what is otherwise a very high surface tension of water.

Colours

For ease of identification MDIs are colour-coded

Name	Use	United Kingdom	New Zealand
Salbutamol	Reliever	Light Blue	Light Blue
Beclometasone	Steroid	Brown	Brown
Seretide	Combination		Purple
Fostair	Combination	Pink

References

^ Pharmaceutical Inhalation Aerosol Technology, ed. A. J. Hickey, 2nd edition, Marcel Dekker Inc., NY, 2004.
^ ^a ^b ^c Swarbrick, James (2007). Encyclopedia of Pharmaceutical Technology (3rd Illustrated ed.). Informa Health Care. p. 1170. ISBN 0-8493-9394-9.
^ Finlay, W. H., The Mechanics of Inhaled Pharmaceutical Aerosols: An Introduction, Academic Press, 2001.
^ Busse W, Colice G, Hannon S. CFC-BDP require 2.6 times the dose to achieve equivalent improvement in FEV1 as HFA-BDP. Am J Respir Crit Med 1998; 157:A405.
^ ^a ^b ^c Purewal, Tol S.; D. Grant (1997). Metered Dose Inhaler Technology (Illustrated ed.). Informa Health Care. ISBN 1-57491-065-5.
^ Clark, A. R (1995). "Medical Aerosol Inhalers: Past, Present, and Future". Aerosol Science and Technology 22 (4): 374–391. doi:10.1080/02786829408959755.
^ Togger, D., & Brenner, P. (2001). Metered dose inhalers. American Journal of Nursing, 101 (10), 29.
^ ""Inhalation Aerosols: Physical and Biological Basis for Therapy"", ed. A. J. Hickey, 2nd edition, Informa Healthcare, NY, 2007.
^ ^a ^b ^c ^d ^e Noakes, T (2002). "Medical Aerosol Propellants". Journal of Fluorine Chemistry 118 (1-2): 35–45. doi:10.1016/S0022-1139(02)00191-4.
^ Dr William Gore, Dr Ian Tansey et al.. "Ensuring Patient Care". IPAC. Retrieved 2009-04-14.
^ ^a ^b ^c Leach, C L (1995). "Approaches and Challenges to Use Freon Propellant Replacements". Aersol Science and Technology 22 (4): 328–334. doi:10.1080/02786829408959750.
^ Saundra Young (September 22, 2011). "No more Primatene Mist in the U.S. after this year". The Chart (blog) (CNN). Retrieved 2011-09-22.
^ "The Montreal Protocol on Substances that Deplete the Ozone Layer". United Nations Environment Programme.
^ Anti-asthmatic combinations comprising surface active phospholipids
^ PHOSPHOLIPID-BASED INHALATION SYSTEM

External links

Metered-dose Inhaler canisters
Presspart Plasma Technology
UpToDate Patient Information: Metered dose inhaler techniques in adults
Using a metered-dose inhaler with a spacer: techniques for children, illustrated
Using a metered-dose inhaler without a spacer: techniques for children, illustrated

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における吸入器の使用 the use of inhaler devices in adults
2. 小児における吸入器の使用 the use of inhaler devices in children
3. 小児の吸入剤の送達 delivery of inhaled medication in children
4. 成人における吸入剤の到達 delivery of inhaled medication in adults
5. 喘息におけるβ刺激剤：急性期投与および予防的使用 beta agonists in asthma acute administration and prophylactic use

English Journal

Aclidinium bromide for the treatment of chronic obstructive pulmonary disease.

Stone LE1, Skelley JW, Kyle JA, Elmore LK.Author information 1Lowell E. Stone, Pharm.D., is Postgraduate Year 1 Community Pharmacy Practice Resident; Jessica W. Skelley, Pharm.D., is Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice; Jeffrey A. Kyle, Pharm.D., BCPS, is Associate Professor of Pharmacy Practice, Department of Pharmacy Practice; and Lindsey K. Elmore, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL.AbstractPURPOSE: The safety and efficacy of the second U.S.-approved long-acting inhaled anticholinergic for controlling bronchospasm in patients with chronic obstructive pulmonary disease (COPD) are reviewed.
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.Am J Health Syst Pharm.2014 Mar 1;71(5):386-93. doi: 10.2146/ajhp130077.
PURPOSE: The safety and efficacy of the second U.S.-approved long-acting inhaled anticholinergic for controlling bronchospasm in patients with chronic obstructive pulmonary disease (COPD) are reviewed.SUMMARY: Aclidinium bromide (Tudorza, Forest Pharmaceuticals) is indicated for long-term maintenanc
PMID 24534593

Demonstrating and assessing metered-dose inhaler-spacer technique: pediatric care providers' self-reported practices and perceived barriers.

Reznik M1, Jaramillo Y, Wylie-Rosett J.Author information 11Children's Hospital at Montefiore, Bronx, NY, USA.AbstractThe National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler-spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient's asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed.
Clinical pediatrics.Clin Pediatr (Phila).2014 Mar;53(3):270-6. doi: 10.1177/0009922813512521. Epub 2013 Dec 12.
The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler-spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric provid
PMID 24336438

Evaluation of MDI-spacer utilization and technique in caregivers of urban minority children with persistent asthma.

Reznik M1, Silver EJ, Cao Y.Author information 1Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore , Bronx, NY , USA.AbstractAbstract Objective: Incorrect Metered-Dose Inhaler (MDI)-spacer technique can result in decreased drug delivery to distal airways and poor asthma outcomes. There is lack of research to examine whether the caregivers utilize proper technique when applying an MDI-spacer delivery system for young minority children with persistent asthma in the United States. The objective of this study was to evaluate MDI-spacer utilization and technique among the caregivers of Bronx minority children with persistent asthma and to determine characteristics associated with correct use. Methods: We analyzed data from 169 caregivers of urban minority children with persistent asthma (aged 2-9 years). MDI-spacer device technique was assessed using a 10-step checklist derived from the national guidelines, literature and manufacturers' instructions. Based on the median MDI-technique score of six steps demonstrated accurately, caregivers were categorized as correct (seven or more) or incorrect (six or less) users. Results: Of the 169 caregivers, 95% were mothers, mean age 32.3 years (SD 7.6), 56% were unemployed; 74% of the children were Hispanic, 87% had either "not well controlled" or "very poorly controlled" asthma, 92% had a spacer at home and 71% used it "all" or "most" of the time. Only one caregiver correctly demonstrated all 10 steps of the MDI-spacer technique. Child's having one or more asthma-related hospitalizations in the past 12 months and higher caregiver educational level were independent predictors of correct MDI-spacer technique. Conclusions and relevance: The caregivers of urban, minority children with persistent asthma lack proper MDI-spacer technique, suggesting the potential value of both targeted short- and long-term educational interventions.
The Journal of asthma : official journal of the Association for the Care of Asthma.J Asthma.2014 Mar;51(2):149-54. doi: 10.3109/02770903.2013.854379. Epub 2013 Oct 22.
Abstract Objective: Incorrect Metered-Dose Inhaler (MDI)-spacer technique can result in decreased drug delivery to distal airways and poor asthma outcomes. There is lack of research to examine whether the caregivers utilize proper technique when applying an MDI-spacer delivery system for young minor
PMID 24131031

Japanese Journal

定量噴霧式吸入器（pMDI）における吸気タイミング評価システムの研究開発

医療機器学 84(5), 543-549, 2014
NAID 130004952576

粉末吸入製剤開発を指向した動態制御学並びに薬剤科学の統合研究

薬学雑誌. 乙号 133(1), 93-98, 2013
NAID 130003361875

Repeated-Dose Pharmacokinetics of Inhaled Ciclesonide (CIC-HFA) in Japanese Children with Bronchial Asthma: A Phase I Study

Allergology International 61(4), 619-624, 2012
NAID 130004873052

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