Aerosol drug administration

Definition

Aerosol drug administration is the administration of a drug via air particles delivered by an appropriate device that is inhaled and absorbed into the patient's body via the lungs .

Purpose

Aerosol administration of drugs is indicated in circumstances where rapid absorption and localization effects of the drug are required to produce the appropriate response. Aerosol administration methods are most commonly used in asthmatic conditions or specific lung conditions that cause difficulty in breathing. Diseases including emphysema , asthma , chronic obstructive pulmonary disease (COPD), and other similar conditions warrant and necessitate the use administration of drugs by this route of administration.

Precautions

Aerosol administration in itself is generally a safe practice, as long as the health care provider or client is well educated in its use. It is contraindicated in conditions where complete obstruction of the airway is present, as the administration route is completely blocked. Such conditions, however, are usually resolved rapidly in emergency situations.

Description

Aerosol drug administration, also known as inhalation therapy, or in some cases, nebulized drug therapy, is the method by which drugs are dispersed into the lungs or bronchial airways in the form of tiny droplets—often bound to water, oxygen, or another gaseous substance. Drugs are generally delivered by two means. The first is via a device called a nebulizer. The nebulizer is a mechanical pump (of which there are many types) that produces a fine mist in which the drug is dispersed via an appropriate nebulizer-compatible face mask. This fine mist is inhaled deep into the lungs for maximum effect. The second method of delivery is via a hand-held, nebulized aerosol device. These devices, also known as "puffers," use the effects of a pressurized gas to create and disperse the drug into a fine mist or spray, which is then inhaled.

Both methods of aerosol inhalation are very effective when used correctly. In cases of extreme breathlessness or dyspnea (labored or difficult breathing), the mechanical pump nebulizers are generally more effective, as they disperse the drug over a longer time period; this, in turn, gives the recipient a longer time period, allowing the airways to open more effectively.

In terms of medical treatment costs and medication costs, aerosol drug administration is relatively inexpensive. Nebulized therapy via a mechanical pump is usually completed within five to ten minutes. Delivery of drug via hand-held devices is completed within a few seconds.

Procedure for effective mechanical pump nebulization

• The nebulizer solution and equipment specific to the type of pump being used should be prepared. If necessary, the instruction guides should be consulted. (Detailed instruction is beyond the scope of this guide due to the vast number and variety of pumps available.)
• An appropriate face mask is obtained.
• The recipient should be placed in a comfortable, upright position that is greater than 45 degrees. This will enable maximum breathing efficiency. A hospital bed with an adjustable backrest, or a chair with good back support, is adequate. The comfort of the recipient should be ensured and maintained throughout the procedure.
• The client should be reassured. Often, when a patient is suffering from breathing difficulty, he or she becomes anxious and frightened. The nurse should do his or her best to relax and reassure the patient as much as possible. When relaxed, the airway has the best chance of recovery, and inhalation of the nebulized drug is assured.
• When patient is comfortable and in a suitable position, the nebulizer pump can be turned on. The nurse must confirm that a steady mist is flowing from the mask or application device.
• When a steady flow of mist is achieved, the nurse should fit the mask or application device correctly to the patient's face or trachea (if applicable).
• While nebulization and delivery of drug is occurring, the patient should be monitored for signs of reaction to the drug and for improvements or deterioration in breathing patterns.
• Once the procedure is complete, the patient's oxygen saturation level should be measured, if equipment is available. This measurement should be recorded and reported along with any other documentation.
• The recipient should be asked if the medication has had a positive effect. If not, further advice or orders should be sought from the physician.
• The nurse should provide education about delivery of the drug by inhalation to the recipient. He or she should also answer questions the recipient may have.

Procedure for inhalation from hand-held devices

• Again, there are many devices available that operate in different manners. A detailed description of each, however, is beyond the scope of this guide.
• For effective delivery of drug from these type of devices, it is essential that the medication is prepared properly, using the instructions supplied with the device.
• Once the medication has been prepared, the recipient must hold his or her lips one to two inches (3-5 cm) from the open mouth. The patient needs to breathe in deeply (powdered-drug-type devices), or breathe in deeply while depressing the canister (for canister/barrel type devices); this will allow the drug to be inhaled deeply into the airways and lung tissue.
• Positive responses should be observed or measured by the nurse.
• All data, as appropriate, must be recorded by the nurse. If treatment is note effective, further advice or orders should be sought.

Preparation

Generally, there are no specific pretreatment procedures, except for the set-up of equipment used for the procedure. The recipient generally requires no personal preparation in common use of this procedure.

Aftercare

Recipients should be monitored for signs of positive response to the drug. It is important to rinse the mouth following inhalation therapy, as drug residue can remain in the mouth and cause oral problems and tooth decay in some instances.

Complications

Complications are almost always related to the type of drug being delivered. Complications may also arise due to drug overdose . It is important in a hospital or clinic emergency environment, particularly with asthma sufferers, that the health care provider assess how much, and what type of medication, has been administered prior to the patient's arrival in the emergency department, to avoid such complications.

Results

Anticipated outcome for symptom-relieving drugs

In a lung or breathing condition, the desired outcome from symptom-relieving aerosol drugs is a complete cessation of such symptoms or at least an improvement in symptoms following completion of the treatment. Failure to relieve symptoms indicates ineffective drug delivery, incorrect drug choice or strength, or deterioration of the patient's condition.

Anticipated outcome for preventive drugs

While more difficult to measure (as effects can be both short- or long-term), the goal of using preventive medications via this specific delivery route is to prevent or reduce presentation of symptoms. A reduction in the occurrence of symptoms, or a complete cessation of associated symptoms, indicates a successful preventive treatment regime.

Health care team roles

The health care team roles for successful treatment include:

• All equipment used in the procedure should be maintained and used according to the manufacturers' specifications.
• All treatment options must be explained to the patient.
• The recipient should be monitored during delivery of inhalation therapy.
• All events and observations for the procedure should be recorded.
• The recipient must be educated in all aspects of his or her condition, including the reasons for the use of specific treatments and drugs.

Resources

BOOKS

Potter, Patricia, and Anne Perry. Fundamentals of Nursing. Mosby, 2001.

"Primatene Mist." In PDR Nonprescription Drug Reference. Montvale, NJ: Medical Economics, 2001.

OTHER

"Bronchodilators, Adrenergic (Inhalation)." In United States Pharmacopeia Dispensing Information. Rockville, MD: Micromedex, 2000. <http://my.webmd.com/content/asset/uspdi.202095>.

"Medication and Delivery System Options for Asthma and Allergy Are Expanding." Asthma and Allergy Foundation of America. <http://www.aafa.org/asthmaandallergyinformation/aboutasthmaandallergies/articlesofinterest/Medication_Delivery.cfm>.

Dean Andrew Bielanowski, R.N., B.Nurs(QUT)