BACKGROUND:
MANY OF THE PATIENTS SUFFERING FROM BRONCHIAL ASTHMA (BA) AND COPD DO NOT USE THE INHALERS PROPERLY, INSPITE OF ADEQUATE EDUCATION, RESULTING IN INADEQUATE RELIEF. THE EXTERNAL SPACER (ES) WITH THE INHALER NEEDS AN INSPIRATORY RATE OF 25LTSMT, NOT PORTABLE AND COSTLY. ALSO THE AEROSOL DEPOSITION IN THE AIRWAYS RANGES FROM 20-40%ONLY. WHEEZY PATIENTS WITH INDADEQUATE USAGE OF THE INHALERS, CLEFT LIP AND CLEFT PALATE, GERIATRIC AND ODENTULOUS CATEGORY, OBESE ASND SHORT NECK INVIDUALS CANNOT TAKE THE INHALERS PROERLY. HENCE AN INSPIRATORY EFFORT INDEPENDENT-TRANSOROPHARYNGEAL SPACER (TOPS) IS DEVELOPED.
INCLUSION CRITERIA:
1. ADULTS AND CHILDREN ABOVE 5 YEARS OF AGE OF BOTH SEX
2. SUBJECTS OF BRONCHOSPASM WITH OR WITHOUT COMORBID CLEFT LIP AND CLEFT PALATE
EXCLUSION CRITERIA:
1. PATIENT WITH EXAGGERATED GAG REFLUX
2. UNCONSCIOUS PATIENT
APPARATUS: 1. MINI WRIGHT’S PEFR METER 2.TOPS: IT IS A PATENTED DEVICE MADE UP OF ETHYLENE VINYL ACETATE COPOLYMER. IT HAS A RECEPTACLE FOR THE INHALERS, BODY WITH AN ANGULATION OF 110 DEGREES BENT AND A CURVED TAIL PIECE 15O DEGREES. LENGTH - 10 CMS ,INTERNAL DIAMETER - 10MM, SNUGLY FITTING IN THE OROPHARYNX, THE DISTAL END OVERLYING THE EPIGLOTTIS AS SEEN IN MRI PHARYNX. 3. EXTERNAL SPACER 4.SALBUTAMOL MDI
PROCEDURE
150 SUBJECTS (M: F 95:56), WITHIN THE AGE RANGE OF 8-81YEARS WERE ENROLLED IN THE STUDY FROM 1ST FEB 2007TO1APRIL2007. PEFR WAS MEASURED BEFORE AND AFTER THE AEROSOL DELIVERY USING TOPS AND EXTERNAL SPACER AS CONDUITS AT AMPM RESPECTIVELY, COINSIDING WITH DIURNAL VARIATION OF BRONCHOMOTOR TONE. FOUR CHILDREN HAD CLEFT LIP AND PALATE.
RESULTS: THE PEFR IN LT/MT WAS GRADES AS: BELOW 200L (SEVERE), 200-300(MODERATE), 300-400(MILD), ABOVE 400(VERY MILD).THERE WERE 80(53. %) IN THE SEVERE,50(33%)) IN MODEARATE,15 (10%)MILD 5 (4%)VERY MILD.WITH THE TOPS+INHALER 80% HAD IMPROVEMENT BY 60% INCREMENTOF PEFR(ONE PUFF-100MCG) .WITH THE ES(2PUFFS-200MCG) PLUS INHALER THERE WAS ONLY 10% INCREMENT. THUS THE IMPROVEMENT WITH THE FORMER WAS SIGNIFICANT (P=0.9641, r=.9660)
RADIOACTIVE ISOTOPE SCAN SHOWED 80% DEPOSITION IN THE LUNGS WITH TOPS VERSUS ES (40%). A LATERAL STUDY FOUND ADVANTAGE OVER ROTAHALER AND NEBULISER
CONCLUSION:
INHALER WITH TOPS IS A BETTER DEVICE FOR DELIVERING AEROSOL.