Interfaces to connect the HandiHaler and Aerolizer powder inhalers to a tracheostomy tube.
BACKGROUND
Patients with respiratory failure are often unable to inhale powdered aerosol medications such as long-acting beta agonists and long-acting anticholinergics, which are important treatments for chronic obstructive pulmonary disease and asthma.


OBJECTIVE
To explore delivery of aerosolized powder medications via tracheostomy tube.


METHODS
We designed interfaces to connect the HandiHaler and Aerolizer devices to tracheostomy tubes, and to connect the HandiHaler to a manual resuscitator bag. With these interfaces, in 23 patients, we assessed the clinical ease/difficulty of delivery and delivery time of the first 3 administrations of powder-aerosol long-acting beta agonists and long-acting anticholinergics from the HandiHaler and the Aerolizer.


RESULTS
The powder aerosols were readily delivered to all the patients. Nineteen of the 23 patients (83%) were able to inhale the medication on their own. In the 4 patients who were unable to effectively inhale the medication on their own, bag-assist was successful. The aerosol delivery time was usually < 3 min.


CONCLUSIONS
With a proper interface, powdered long-acting beta agonists and long-acting anticholinergics can be easily delivered via tracheostomy tube, even if the patient cannot inhale on his or her own. Further studies are needed to assess particle size, dose delivery, and clinical efficacy with these interfaces and device modifications.
Johnson
Douglas C
DC
Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA. djohnson5@partners.org
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004983:Ethanolamines / Q000008:administration & dosage; D000068759:Formoterol Fumarate; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011208:Powders / Q000008:administration & dosage; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012602:Scopolamine Derivatives / Q000008:administration & dosage; D000069447:Tiotropium Bromide; D014139:Tracheostomy / Q000295:instrumentation*
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D004983:Ethanolamines; D011208:Powders; D012602:Scopolamine Derivatives; D000068759:Formoterol Fumarate; D000069447:Tiotropium Bromide