From the Mailbag: Question About Batch Treatments

Mark Stuckwish sent us a note:

I am a manager w/30 yrs experience and am very concerned about “batching treatments” with masks. Most patients are nose breathers and the turbinates are giant baffling systems.I cannot find a single recommendation for delivering bronchodilators through the nose, neb or MDI.It’s like throwing pills at a patients. open mouth and hoping some make it in! How long would that practice last? Any studies/concerns from CMS, JCAHO, anybody? I could not access the GB study, just the brief article.thanks. Mark

Anyone care to answer?

Maybe this blog needs to turn into something more like a forum?

MD Turbo: MDI Add-on

MD Turbo:

Improper inhaler use is very common. In fact, most asthma and COPD patients use inhalers incorrectly. The two most common errors are failure to coordinate breathing with inhaler activation, and failure to track doses. MD Turbo is a breath-activated, dose-counting companion to metered dose inhalers (MDIs). It is coming soon, so sign up and be the first to know how MD Turboâ„¢ can help MDI users.

Electrohydrodynamic Aerosol Delivery

An aerosol type I had not heard of before, from a company called Ventaira:

Pulmonary Drug Delivery Using Mystic Technology
Ventaira’s pulmonary devices, which are based on electrohydrodynamic (EHD) aerosol delivery, enable efficient, safe and consistent delivery of drugs to and through the lungs.

Ventaira inhalation devices utilizing Mystic technology (EHD), deliver a low velocity, soft (isokinetic) cloud of uniformly sized particles with over 80 percent of the drug getting to the lungs. This is accomplished without the need for liquid propellants or other pressurized systems.

The aerosol mist is delivered using the patient’s own breath (inspiration), meaning that the patient can easily control the drug delivery. The delivery mechanism is especially suited for use with young children, seniors, and patients with impaired respiratory function.

New York Times on Ventilator Shortage for Bird Flu Crisis

This is all the talk of the AARC disaster preparedness mailing lists. Even I, so many years out of practice in the RT game feel like I could provide help with mechanical ventilation if bird flu hits in earnest. This is assuming of course, I myself am not put down by the flu!

Hospitals Short on Ventilators if Bird Flu Hits – New York Times
No one knows whether an avian flu virus that is racing around the world might mutate into a strain that could cause a human pandemic, or whether such a pandemic would cause widespread illness in the United States. But if it did, public health experts and officials agree on one thing: the nation’s hospitals would not have enough ventilators, the machines that pump oxygen into sick patients’ lungs.

Right now, there are 105,000 ventilators, and even during a regular flu season, about 100,000 are in use. In a worst-case human pandemic, according to the national preparedness plan issued by President Bush in November, the country would need as many as 742,500.

To some experts, the ventilator shortage is the most glaring example of the country’s lack of readiness for a pandemic.

Consumer Reports On Roomba – DME?

Roomba and Respiratory Care… a connection I never would have imagined. Maybe Roomba needs DME (durable medical equipment) status.

Consumer Reports On Roomba
Several people with respiratory problems like allergies were extremely happy because the Roomba tirelessly cleans their rooms even when they are too tired to vacuum.

Inhaled Insulin to Treat Diabetes

This is interesting. I had not heard that you could deliver insulin in a nebulized / aerosolized form. Intriguing. Pulmonary insulin delivery – which products will triumph?

The big companies currently pioneering pulmonary delivery of insulin are Pfizer, Eli Lilly/Alkermes and Novo Nordisk/Aradigm.Leading the pack is Exubera, which Pfizer now owns after buying the rights off Sanofi-Aventis for $1.3 bn this month.

Exubera is a fast-acting powdered insulin that is inhaled into the lungs before each meal, using a device the size of a torch. Both the formulation and device were developed by Nektar Therapeutics.

With a 2–3 year lead on other such products in clinical development, Exubera should make it to the market first, proving to be a sure-fire blockbuster for Pfizer.

In clinical trials Exubera was as effective as injected insulin, however, it has been shown to cause a short-term decrease in lung function and concerns over the long-term affect of inhaling insulin into the lungs has led to ongoing delays in US Food and Drug Administration (FDA) approval of the product.

In September 2005, an FDA Advisory Committee finally recommended approval of Exubera for the treatment of adults with type 1 (insulin-dependent) and Type 2 diabetes (non-insulin-dependent).

However, in October, the FDA extended its original review period of the drug by three months while it considers additional data submitted on its potential to decrease users’ lung capacity.

More on Exubera, it’s a “an inhaled, rapid-acting, dry-powder insulin”, and more about the Nektar delivery device. And this is what it looks like.

Update: LA Times Article on Exubera.

Hyperbaric Chambers

Inside Bay Area – San Mateo County Times – Local News
It’s called a hyperbaric chamber and it outputs oxygen at much higher pressure than what we normally breath. Eden is the only Sutter health care facility with such a chamber, and according to staff at Eden, it has improved the health of many.

High concentrations of oxygen help keep oxygen-starved tissues alive. It is used to treat more than a dozen illnesses including carbon monoxide poisoning, decompression sickness, severe anemia, sports injuries and stubborn wounds. Advocates of alternative healing believe the chamber is also useful for brain healing in dementia, cerebral palsy, stroke and Lyme Disease patients.