The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

DELIVERY OF INHALED DRY POWDERS VIA TRACHEOSTOMY TUBE

R. Dalbec, R.R.T., A. Riendeau, R.R.T., R.N., D.C. Johnson, M.D. Spaulding Rehabilitation Hospital, Boston, MA.

Background: Patients with respiratory failure are often unable to take inhaled powder medications, yet these medications (long-acting beta-agonist (LABA) and long-acting anti-cholinergic (LAAC)) are important treatments for patients with COPD and asthma. The aim of this study was to explore a novel method of delivering encapsulated dry powder medications via tracheostomy tube.

Methods:
We designed interfaces to connect the Handihaler and Aerolizer devices to tracheostomy tubes. The connector fits securely between the oral side of the inhaler and a 22 mm tracheostomy tube. We also designed a "bag-assist" interface between a manual-assist resuscitator bag and the Handihaler device that allows the powder to be delivered to patients unable to generate a deep breath. We studied patients with tracheostomy tubes from our ventilator weaning program needing LABA and/or LAAC, who could not take them orally. The ease of delivery and time of delivery for the first three administrations of LABA (formoterol) and LAAC (tiotropium) via the tracheostomy interface were collected.

Results:
We studied 77 medication doses in 23 patients. LABA and LAAC could be delivered readily to all patients using our interfaces, with 19 (83%) able to inhale the medication on their own, and 4 (17%) needing "bag-assist". Tiotropium was delivered to 22 patients and formoterol to 7 patients with 6 patients receiving both. Delivery by inhalation was attempted in 22 of the 23 patients, with successful delivery in 58 of 63 (92%) administrations on the first attempt. There were 7 unsuccessful first attempts in 4 patients. One of the patients was confused and uncooperative and was easily successful on their first attempt on other days. The other three patients were unsuccessful despite good cooperation due to very severe lung disease/respiratory muscle weakness. In all 4 patients unable to get effective delivery by inhalation, bag-assist was successful. The time for inhalation delivery was 2.5 ± 1.7 (mean ± std dev) minutes, with 20 being 1 minute or less, 37 2.5 min or less, and all 5 min or less. The time for bag-assist delivery was 5.6 ± 8.1 min, with most times 2 to 3 minutes, but one time of 20 minutes including initial setup.

Conclusions:
With a proper interface, encapsulated dry powder LABA and LAAC can be easily delivered to patients with tracheostomy (or endotracheal) tubes even if they cannot inhale on their own. This should allow more effective treatment of respiratory failure patients with obstructive lung disease. Funding: None.

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