A Guide to Aerosol Delivery Devices for RT-2nd Chinese

Transcription

1 Arzu Ari, PhD, PT, RRT, CPFT Dean Hess, PhD, RRT, FAARC Timothy R. Myers, BS, RRT-NPS Joseph L. Rau, PhD, RRT, FAARC Sam Giordanoxecutive Director of AARC (American Asiation for Respirat Care, AARC) Respironics Inc. () ) 15 (Chia-Chen Chu) 26 ( ) 36 (Yueh-Hua Yuan) 7 ( ) ( Tzu-Ching Ni)

2 Respironics Dean R Hess, PhD, RRT, FAARTimothy R Myers, BS, RRT-NPS Joseph L Rau, PhD, RRT, FAARC 48 4 Sam P. Giordano () () Sam P. Giordano 2008/1/29 (ICRC Governor for Taiwan) 1

3 (International Council for Respiratory Care, ICRC) Arzu Ari Respironics Dean R Hess, PhD, RRT, FAARTimothy R Myers, BS, RRT-NPS Joseph L Rau, PhD, RRT, FAARC Ari48 4 Sam P. Giordano () () Sam P. Giordano Sam O. Giordano 2

4 朱家成編審與喬治亞州州立大學Arzu Ari博士合 影於2009年12月8日世界呼吸照護聯盟會議 朱家成 參予第一版翻譯及編審人員 2010/4/29 (2011/03/01修稿完成 ) 現任 中國醫藥大學附設醫院呼吸治療科技術主任 中國醫藥大學呼吸治療學系講師 世界呼吸照護聯盟執行委員會台灣區代表 (ICRC Governor for Taiwan) 美國呼吸照護會呼吸照護雜誌(Respiratory Care)中文網播審查員 亞太呼吸網誌主編 台灣呼吸治療學會榮譽會員 中華民國呼吸治療師公會全國聯合會第二屆理事 台中市呼吸治療師公會第三屆理事長 曾任 中華民國呼吸照護學會第一屆常務理事 第二屆秘書長 第三屆國際事務理事 中華民國呼吸照護學會第四 五屆理事長 六屆國際事務理事 第七 八屆理事長 台灣呼吸治療學會第八屆理事長 第九屆國際事務理事 台中市呼吸治療師公會第一屆常務理事 中華民國呼吸治療師公會全國聯合會第一屆理事 台北榮民總醫院呼吸治療科技師 fish 2/24/11 10:08 PM Deleted: fish 2/24/11 10:08 PM : Left 3

5 ? (pmdi) (dry powder inhaler) (nebulizer) fish 2/24/11 10:08 PM Deleted: 4

6 Sam Giordano, MBA, RRT, FAARC (American Association for Respiratory Care, AARC) / CRCECRCER /CRCE 24( CRCE// / / 5

7 : fish 2/24/11 10:17 PM : Font:Bold (nebulizer) (pressurized metered-dose inhalers;pmdis) (dry powder inhalers;dpis) (jet nebulizer) (mesh nebulizer) (ultrasonic nebulizer) (metered-dose inhalers) HFACFC 12.pMDI 13.(priming) 14. (hlding chamber) (spacer)( ) 15.holding chamberspacer DPI 19.DPI 20.holding chamber/spacer 21.pMDIsDPIs fish 2/23/11 9:32 PM Deleted: fish 2/23/11 9:33 PM Deleted: 6

8 ? fish 2/23/11 8:49 PM Deleted: 7

9 fish 2/23/11 9:33 PM Deleted: 8

10 CDC CDER CDRH CF CHC DPI FDA FPF GSD HFA IC MMAD MMD pmdi SPAG SVN VHC (Centers for Disease Control and Prevention) (Center for Drug Evaluation and Research) (Center for Devices and Radiological Health) (cystic fibrosis) (chlorofluorocarbon) (dry-powder inhaler) (U.S. Food and Drug Administration) (fine-particle fraction) (Geometric Standard Deviation) (hydrofluoroalkane) (Infection Control) (mass median aerodynamic diameter) (mass median diameter) (pressurized meter-dose inhaler) (small particle aerosol generator) (small-volume nebulizer) (valved holding chamber) 9

11 (pmdi)(pmdidpi) 1 (aerosol)(svn)(pmdi)(dpi) (aerosol deposition) (aerosol generator) (aerosol output (aerosol therapy) (chlorofluorocarboncfc)pmdis (freon) ( (diffusion) (emmited dose) (fine-particle fraction;fpf)1-5 (heterodisperse) (hydrofluoroalkane;hfapmdi CFCs 10

12 (cascade impactor) (monodisperse) (nebulizer) (plume)pmdi (pressurized metered-dose inhaler; pmdi) pmdi (respirable mass) (residual volumeor dead volume) (spacer)pmdi (valved holding chamber) fish 2/24/11 10:11 PM Deleted:

13 (From Reference 2, with permission) (small volume nebulizer; SVN) (pressurized metered-dose inhaler; pmdi) (dry powde inhaler;dpi) (SVN) (pmdi hlding chambers (DPI)? fish 2/24/11 10:31 PM : Font:Times New Roman, 10.5 pt fish 2/23/11 9:35 PM Deleted: fish 2/23/11 9:35 PM Deleted: 12

14 fish 2/23/11 9:40 PM Deleted: fish 2/23/11 9:40 PM : Indent: Left 3.75 ch pmd SVDP (Modified, with permission, from Reference 1 and Reference 7) (Modified, with permission, from Reference 1) 8 fish 2/23/11 9:40 PM Deleted: fish 2/24/11 10:32 PM : Font:10.5 pt fish 2/23/11 9:41 PM Deleted: pmd SVDP (Modified, with permission, from Reference 1 and Reference 7) fish 2/23/11 9:35 PM Deleted: fish 2/23/11 9:36 PM Deleted: fish 2/24/11 10:32 PM : Font:10.5 pt, Italic fish 2/24/11 10:32 PM : Font:(Default) Times New Roman, 10.5 pt, Not Bold fish 2/23/11 9:41 PM Deleted: fish 2/23/11 9:37 PM Deleted: 13

15 ) (agonists)fev 1 fish 2/23/11 9:38 PM : Font:12 pt fish 2/23/11 9:38 PM Deleted: 2. (Modified, with permission, from Reference 1) () () MDI fish 2/24/11 10:32 PM : Font:(Default) Times New Roman, 10.5 pt, Not Bold fish 2/24/11 10:32 PM : Font:10.5 pt, Not Bold 14

16 (From Reference 6, with permission) fish 2/24/11 10:33 PM : Font:Times New Roman, 10.5 pt fish 2/24/11 10:33 PM : Font:10.5 pt ,16,18,19 fish 2/23/11 9:58 PM : Font:Times New Roman fish 2/23/11 9:58 PM : Font:Times New Roman fish 2/23/11 9:59 PM Deleted: fish 2/23/11 9:59 PM Deleted: 15

17 fish 2/23/11 9:59 PM : Indent: Left: 0", First line: 0 ch fish 2/23/11 9:59 PM Deleted: 16

18 17

19 18

20 19

21 (FDA) (Center for Devices and Radiological Health; CDRH) FDA (Center for Drug Evaluation and Research;CDER) 20

22 (SVN)6-12% (5) 5. ( Modified, with permission, from Reference 1) (acetylcysteine) Budesonide (Pulmicort Respules ) Tobramycin (TOBI ) Pari LC Dornase alfa (Pulmozyme ) Hudson T Up-draft II, Marquest Acorn II, Pari LC, Durable Sidestream, Pari Baby TM Pentamadine(NebuPent) Marquest Respirgard II Ribavirin (Virazole ) Small Particle Aerosol Generator Iloprost(Ventavis ) ProDose I-neb /horn nebulizer 200-1, , ( ) (1-3) 4-15 (1-3) fish 2/24/11 10:33 PM : Font:10.5 pt fish 2/24/11 10:33 PM : Font:10.5 pt, Italic fish 2/24/11 10:33 PM : Font:10.5 pt fish 2/23/11 9:54 PM Deleted: Pari Baby Pentamadine(NebuPent) fish 2/23/11 9:54 PM Deleted: Marquest Respirgard II fish 2/23/11 9:51 PM Deleted: Acorn II, fish 2/23/11 9:54 PM Deleted: Small Particle Aerosol Generator fish 2/23/11 9:53 PM : Justified fish 2/23/11 9:55 PM Deleted: fish 2/23/11 9:56 PM Deleted:

23 8.(Modified, with permission, form Reference 1) fish 2/24/11 10:33 PM : Font:10.5 pt fish 2/24/11 10:33 PM : Font:10.5 pt, Italic 22

24 1,33,34 28 L/min 50psi 6-8L /min13psi 2mL 4-5mL 1, ml (heliox)50% fish 2/23/11 9:58 PM : Font:Times New Roman 23

25 35,36 (reservoir tube) (breath-enhanced fish 2/24/11 10:34 PM Deleted: (From reference 1, with permission) A. (4-A) 36,37 10%-20% t 38 5 Misty-Neb TM (Cardinal Health, McGaw Park,IL fish 2/24/11 10:35 PM Deleted: fish 2/24/11 10:33 PM Deleted: fish 2/24/11 10:34 PM Deleted: fish 2/24/11 10:33 PM : Font:Times New Roman, 10.5 pt, Italic 24

26 fish 2/24/11 10:34 PM Deleted: (From Reference 1, with permission) fish 2/24/11 10:38 PM Deleted: fish 2/24/11 10:34 PM : Font:Times New Roman, 10.5 pt, Italic fish 2/23/11 10:00 PM : Font:(Default) Times New Roman, 12 pt From Reference 37, with permission fish 2/24/11 10:38 PM Deleted: fish 2/24/11 10:35 PM : Font:10.5 pt fish 2/24/11 10:35 PM : Font:Times New Roman, 10.5 pt, Italic fish 2/24/11 10:35 PM : Font:10.5 pt 25

27 From reference 37, with permission 37 fish 2/24/11 10:36 PM : Font:10.5 pt fish 2/24/11 10:38 PM Deleted: fish 2/24/11 10:36 PM : Font:Times New Roman, 10.5 pt, Italic fish 2/24/11 10:36 PM : Font:10.5 pt fish 2/23/11 10:01 PM : Font:Times New Roman fish 2/24/11 10:20 PM Deleted: From Reference 7, with permission AeroEclipse (Monagham Medical Corporation, Plattsburgh,NY) 9 fish 2/24/11 10:36 PM : Font:Times New Roman, 10.5 pt, Italic fish 2/24/11 10:36 PM : Font:10.5 pt fish 2/24/11 10:38 PM Deleted: fish 2/24/11 10:36 PM : Font:10.5 pt fish 2/24/11 10:20 PM Deleted: 26

28 fish 2/24/11 10:20 PM Deleted: fish 2/24/11 10:20 PM Deleted: (From Reference 37, with permission) methacholine Prodose AAD Respironics) (Philips (transducer) (standing waves)(10) budesonide MicroAir Ultrasonic Model(Omron Healthcare, Bannockburn, IL)MABISMist TM II(Mabis Healthcare, Waukegan, IL) fish 2/24/11 10:37 PM : Font:10.5 pt fish 2/24/11 10:37 PM : Font:10.5 pt, Italic fish 2/24/11 10:37 PM : Font:10.5 pt 27

29 (From Reference 1, with permission) fish 2/24/11 10:37 PM : Font:10.5 pt fish 2/24/11 10:37 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:37 PM : Font:10.5 pt 11. AAD (Philips Respironics) NE-U22(Omron Healthcare) 3 (adaptive aerosol deliveryaad) (12)AAD AAD50-80% 28

30 12. Philips (From Reference 1, with permission) Pentamidine pentamidine pentamidine fish 2/24/11 10:37 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:37 PM : Font:10.5 pt 39 fish 2/23/11 10:06 PM : Font:(Default) Times New Roman 29

31 Y- (From Reference 1, with permission.) () fish 2/24/11 10:37 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/23/11 10:10 PM : Indent: Left: 0", Numbered + Level: 1 + Numbering Style: 1, 2, 3,... + Start at: 1 + Alignment: Left + Aligned at: 0.25" + Tab after: 0.5" + Indent at: 0.5", Tabs: 0.25", List tab + Not at 0.5" fish 2/23/11 10:10 PM Deleted: fish 2/23/11 10:10 PM Deleted: 30

32 1. () 31

33 (+/-20)12~24 (14) fish 2/23/11 10:11 PM Deleted: fish 2/23/11 10:11 PM Deleted: fish 2/23/11 10:12 PM Deleted: 32

34 14. 33

35 pmdi1995dr. Geroge Maison pmdis pmdi pmdis9 pmdis 9. pmdi (Modified, with permission, from Reference 1) (propellant) fish 2/24/11 10:39 PM : Font:10.5 pt pmdis pmdis: pmdispmdispmdis 10pMDI 10. pmdi (From Reference 1 with permission) (metering valve) (actuator) (dose counter) (dose counter) (elastomeric valve) () pmdis pmdi 34 fish 2/24/11 10:39 PM : Font:10.5 pt fish 2/23/11 10:12 PM Deleted:

36 pmdi pmdi (propellant) (excipient) (15) 42 pmdi1~2% (propellant)/ (excipient)pmdi80% (surfactant) (CFC) pmdis 25~100µL50µg5mg fish 2/23/11 10:15 PM Deleted: 15. (Modified with permission from Reference 42) pmdi - - pmdiscfcs HFAsCFCs CFCsHFAsCFCs pmdiscfcshfascfcs (surfactant) HFAs(surfactant)(alcohol) 16.HFA pmdiscfc pmdis HFA pmdis (16) CFC pmdis(16) pmdi HFA pmdiscfc pmdis pmdi HFAspMDI CFCs(priming)(temperature effect)(tail-off)cfc HFA pmdis (11)HFA pmdicfc pmdi fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:10.5 pt 35

37 16. HFA pmdi() CFC pmdi() (From New York Times, with permission) 11. CFC HFA pmdi (From Reference1, with permission) CFC HFA HFA (-20) (3) CFC fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:10.5 pt fish 2/24/11 10:39 PM : Indent: First line: 2.5 ch fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:10.5 pt pmdi Autohaler (Graceway Pharmaceuticals, Bristol, TN) pmdipmdi pmdiautohaler Autohaler 30L/minpMDI pmdispmdi pmdi 43,44 pmdis 43 Autohaler CFC17.Autohaler 36

38 17. Autohaler (From Reference 2, with permission) fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:10.5 pt pmdi: pmdi(18) MD Turbo (Respirics, Raleigh, NC) and the SmartMist (Aradigm, Hayward, CA)pMDI pmdismd Turbo pmdis MD Turbo pmdissmartmist SmartMist SmartMist 18.pMDIs fish 2/24/11 10:25 PM Deleted: 37

39 pmdis pmdis(14)pmdis-2 (-2 agonists)(anticholinergics-2 pmdis pmdis100µmpmdis 10~20pMDIs µpmdi pmdis pmdi 45 pmdis 12 pmdiscfc pmdis 10HFA pmdis-20~ pmdi 46 <1mm 46 pmdi 47 (terbutaline)(budesonide) 48 1,7,13 p p p pmdi12pmdis fish 2/23/11 10:20 PM Deleted: <sp> 38

40 12. pmdis (Modified, with permission, from Reference 1) Albuterol Sulfate HFA Pirbuterol Levalbuterol HCl Ipratropium Bromide HFA Ipratropium Bromide/ Albuterol Sulfate Combination Beclomethasone Propionate HFA Ciclesonide Fluticasone Propionate Triamcinolone Acetonide Budesonide combined with Formoterol ProAir HFA Proventil HFA Ventolin HFA Maxair Autohaler Xopenex HFA Atrovent HFA Combivent HFA QVAR Alvesco Flovent HFA Azmacort Symbicort HFA fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:39 PM : Font:10.5 pt Fluticasone combined with Salmeterol Advair HFA Cromolyn Sodium Intal HFA 1 39

41 pmdi fish 2/23/11 10:23 PM Deleted: s fish 2/23/11 10:23 PM : Font:, Bold fish 2/23/11 10:23 PM : Indent: Left: 0.33" fish 2/23/11 10:24 PM Deleted: fish 2/23/11 10:24 PM Deleted: fish 2/23/11 10:24 PM Deleted: fish 2/23/11 10:24 PM : Indent: Left: 0.33" 1. p 2. pmdi 3. pmdi ()p 8. pmdi pmdi 40 fish 2/23/11 10:25 PM Deleted: fish 2/23/11 10:25 PM Deleted: s fish 2/23/11 10:25 PM Deleted: s fish 2/23/11 10:25 PM Deleted: fish 2/23/11 10:25 PM Deleted: fish 2/23/11 10:25 PM Deleted: s fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:24 PM Deleted:

42 2. pmdi 3. pmdi pmdi pmdi pmdi pmdi(autohaler ) Autohaler p Autohaler Autohaler (test fire slide) Autohaler (priming spray) Autohaler 3~4 Autohaler pmdi fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:26 PM Deleted: s fish 2/23/11 10:26 PM Deleted: fish 2/23/11 10:27 PM Deleted: MDIs fish 2/23/11 10:27 PM Deleted: MDIs fish 2/23/11 10:27 PM Deleted: s

43 pmdis(autohaler ) Autohaler 20. p p p p p fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:29 PM Deleted: fish 2/23/11 10:28 PM Deleted: fish 2/23/11 10:29 PM Deleted: fish 2/23/11 10:29 PM Deleted: fish 2/23/11 10:29 PM Deleted: 42

44 ,59,60 61 The Ventolin HFA (GlaxoSmithKline, Research Triangle Park, NC) and Flovent HFA (GlaxoSmithKline)(19) Ventolin HFAFlovent HFA , fish 2/23/11 10:31 PM Deleted: fish 2/23/11 10:31 PM Deleted: fish 2/23/11 10:31 PM Deleted: fish 2/23/11 10:31 PM : Font color: Black 43

45 ( fish 2/23/11 10:31 PM Deleted: fish 2/23/11 10:31 PM Deleted: fish 2/23/11 10:32 PM Deleted: 44

46 pmdis. (VHCs) pmdisvhcsspacers( ) (Modified, with permission, from Reference 1) 24pMDI pmdi pmdi spacers pmdi pmdi pmdipmdi fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:40 PM : Font:10.5 pt fish 2/23/11 10:33 PM Deleted: s fish 2/23/11 10:32 PM Deleted: s fish 2/23/11 10:33 PM Deleted: s fish 2/23/11 10:32 PM Deleted: s fish 2/23/11 10:33 PM Deleted: s fish 2/23/11 10:33 PM Deleted: s fish 2/23/11 10:32 PM Deleted: s 45

47 (VHCs)Spacer Azmacort, Abbott Laboratories, North Chicago, IL (VHC) 46

48 3. pmdispacer /VHC fish 2/23/11 10:35 PM Deleted: pmdi spacer/ 1. pmdi 2. pmdi 3. pmdi : apmdi bpmdi c1010 d e f () gpmdi h i spacer/pmdis: spacer/pmdis 47

49 1. pmdispacer/ 2. pmdi 3. pmdispacer/ pmdi(chamber) fish 2/23/11 10:36 PM Deleted: 48

50 (Modified, with permission, from Reference 1) fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt fish 2/24/11 10:40 PM : Font:(Default) Times New Roman, 10.5 pt DPI sdpisdpis DPIs(22)DPIDPIs DPI (blister strips)dpi DPIs (Single-dose DPIs) 49

51 Aerolizer (Schering-Plough, Kenilworth, NJ)HandiHaler (Boehringer Ingleheim) (22)Aerolizer Formoterol HandiHaler tiotropium bromideaerolizer HandiHaler DPIs (Multiple Unit-dose DPIs) Diskhaler (GlaxoSmithKline)DPIs zanamivir Diskhaler 60 (Multiple-dose DPIs) DPIs DPIsTwisthaler (Schering-Plough)Flexhaler (AstraZeneca, Wilmington, DE)Diskus (GlaxoSmithKline)Twisthaler DPImometasone FuroateFlexhaler budesonidediskus salmeterolfluticasone salmeterolfluticasone Twisthaler Flexhale DPI (deagglomeration) Flexhaler Twisthaler Diskus 60 Diskus Twisthaler Diskus fish 2/23/11 10:37 PM : Font:(Default) Times New Roman, 12 pt, Superscript fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:37 PM : Font:14 pt, Superscript fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:37 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: r fish 2/23/11 10:39 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: fish 2/23/11 10:38 PM Deleted: 22DPI( fish 2/23/11 10:39 PM Deleted: fish 2/23/11 10:39 PM Deleted: 50

52 )DPI()DPI( 22. () DPI DPI HandiHaler Diskus DPI/ fish 2/23/11 10:39 PM Deleted: fish 2/23/11 10:40 PM Deleted: DPIs DPI DPI DPIs 51

53 Twisthaler Twisthaler DPI pmdidpis fish 2/23/11 10:40 PM Deleted: fish 2/23/11 10:40 PM Deleted: DPIs 4. (Single-dose DPIs) Aerolizer : (foil blister) both buttons buttons HandiHaler : 1 Handihale fish 2/23/11 10:40 PM Deleted: fish 2/23/11 10:40 PM Deleted: fish 2/23/11 10:40 PM Deleted: 52

54 6. Handihaler Handihaler Handihaler 14. Handihaler 15. Handihaler 16. Handihaler 17. (Multiple Unit-dose DPI) Diskhaler Diskhaler Diskhaler (Multiple-dose DPIs) Diskus fish 2/23/11 10:41 PM Deleted: Handihaler fish 2/23/11 10:41 PM Deleted: Handihaler fish 2/23/11 10:41 PM Deleted: fish 2/23/11 10:41 PM Deleted: Handihaler fish 2/23/11 10:41 PM Deleted: Handihaler fish 2/23/11 10:41 PM Deleted: Handihaler fish 2/23/11 10:41 PM Deleted: fish 2/23/11 10:42 PM Deleted: fish 2/23/11 10:42 PM Deleted: fish 2/23/11 10:42 PM Deleted: 53

55 Twisthaler : () Twisthaler Flexhaler 1 2. Flexhaler () fish 2/23/11 10:42 PM Deleted: fish 2/23/11 10:42 PM Deleted: fish 2/23/11 10:42 PM Deleted: fish 2/23/11 10:42 PM Deleted: 54

56 DPIDPI 1 2. DPI 3. DPI DPI DPI DPIDPI DPI DPI DPI DPI 55

57 DPIAerolizer HandiHaler 66 fish 2/23/11 10:43 PM Deleted: fish 2/23/11 10:43 PM Deleted: Diskhaler DPI DPI fish 2/23/11 10:43 PM Deleted: DPIs 66 DPI DPI Flexhaler Twisthaler Diskus Twisthaler [0] 须 5 [0] fish 2/23/11 10:43 PM Deleted: fish 2/23/11 10:44 PM Deleted: fish 2/23/11 10:44 PM Deleted: 48DPIs 56

58 8 13, / 8, 13, 18, 68, 73, , pmdis (40-60) 75, 81 DPIs , 18,77 8, 18, 85 67, 77 57

59 67,86, / / 58

60 68-71,91 68, 76, 91 pmdis pmdisvhcs 93, 94 DPIs60-90 DPIs 71, 96 fish 2/23/11 10:45 PM Deleted: pmdis , pmdisvhcs 5 69, 70, 96 3pMDIs (holding chamber) 69,93, , 70, /56 68, 69, , 96 pmdidpi fish 2/23/11 10:46 PM Deleted: fish 2/23/11 10:44 PM Deleted: s 59

61 15. (SVN with mask) (SVN with mouthpiece) / (pmdi with holding chamber/spacer and mask / (pmdi with holding chamber/spacer (Dry-powder inhaler) (Metered-dose inhaler) (Breath-actuated MDI Autohaler ) (Breath-actuatednebulizers) 3 3 < fish 2/23/11 10:46 PM Deleted: s fish 2/23/11 10:47 PM Table fish 2/23/11 10:48 PM Deleted: s fish 2/23/11 10:47 PM Deleted: fish 2/23/11 10:47 PM : Indent: First line: 0 ch fish 2/23/11 10:47 PM Deleted: fish 2/23/11 10:48 PM Deleted: p fish 2/23/11 10:48 PM Deleted: s fish 2/23/11 10:48 PM Deleted: 60

62 92, 98, 101, , 70, 102, %75% 105 fish 2/23/11 10:49 PM Deleted: -? 100, , 107, 着? 93, 109, 114, ,117 61

63 (CF) , (CI) 20-22,25,119 (IC) 24,119,120 23,24,121, %(CF) fish 2/23/11 10:50 PM Deleted: (Pressurized Metered-dose Inhaler:)pMDIs 126, pmdi Autohaler pmdi Autohaler Autohaler pmdi Autohaler fish 2/23/11 10:50 PM Deleted: 62

64 (Metered-dose Inhalers Accessory Devices)pMDI 17.pMDI 17. pmdi (Dry-powder Inhaler)DPIs DPI DPI (Nebulizers)

65 : %(isopropyl alcohol)5 3. 3(hydrogen peroxide) :31 CF (Disinfection) : %(isopropyl alcohol)5 4. 3(hydrogen peroxide) :31CF fish 2/23/11 10:52 PM : Bullets and Numbering fish 2/23/11 10:52 PM : Bullets and Numbering fish 2/23/11 10:52 PM Deleted: 18. fish 2/23/11 10:52 PM Deleted:... [1]... [2] (quaternary ammonium compound) 1.25%(quaternary ammonium compound) 10(quaternary ammonium compound)

66 (Final Rinse) (Drying and Maintenance) ,132 CDC 133 (IC)24 134,135 (Inhaled Drugs) (unitdose) 133 (Infection Transmission) 140,141 30,142 (Compliance to IC Management System) (Infection Surveillance) (Occupational Health and Safety of Respiratory Therapists) 65

67 (Health Assessment and Immunization:) (Hand Hygiene) 31,141, , (Protective Equipment) 30 (Ventilation System) % 32 (Filtered Nebulizers) 66

68 (Patient Adherence) (adherence) (adherence) (compliance) β-- 78%pMDI48% (1125) () 67

69 pmdi (spacer)dpispmdi 147,148 (nebulizer) fish 2/23/11 10:53 PM Deleted: holding chamber ,147, (aerosol generator) (1126) pmdi / pmdi pmdi pmdi pmdi pmdi () (boot) pmdi pmdi (Ideomotor dyspraxia) /(Valved Holding Chambers/Spacers) // pmdi/ / fish 2/23/11 10:54 PM Deleted: fish 2/23/11 10:56 PM Deleted: fish 2/23/11 10:56 PM Deleted: fish 2/23/11 10:56 PM Deleted: fish 2/23/11 10:56 PM Deleted: 68

70 (Dry-powder Inhalers) (residual volume) (multi-dose) (N e b u l i z e r s) pmdipmdi (20)pMDI pmdi pmdi 72%pMDI 90 pmdi 120 puff200 puff pmdi (31-32) /(holding chamber/spacer) /20 pmdi/ pmdipmdi / /pmdi puff/ 33,149 / fish 2/23/11 10:56 PM Deleted: fish 2/23/11 10:57 PM Deleted: fish 2/23/11 10:57 PM Deleted: / fish 2/23/11 10:57 PM Deleted: fish 2/23/11 10:57 PM Deleted: fish 2/23/11 10:57 PM Deleted: fish 2/23/11 10:57 PM Deleted: fish 2/23/11 10:57 PM Deleted: 69

71 DPIs (20) pmdisdpis 34 DPIs DPIs 147 (20) (.,DPIs) (checklist) 3. ()

72 1. Hess DR, Myers TR, Rau JL. A guide to aerosol delivery devices for respiratory therapists. American Association for Respiratory Care, Dallas, Texas Rau JL Jr. Respiratory care pharmacology. St. Louis: Mosby; Newman S, Hollingworth A, AR C. Effect of different modes of inhalation on drug delivery from a dry powder inhaler. Int J Pharm 1994; 102: Newman SP, Pavia D, Moren F, et al. Deposition of pressurised aerosols in the human respiratory tract. Thorax 1981; 36(1): Newman SP, Woodman G, Clarke SW, Sackner MA. Effect of InspirEase on the deposition of metered-dose aerosols in the human respiratory tract. Chest 1986; 89(4): Lewis RA, Fleming JS. Fractional deposition from a jet nebulizer: how it differs from a metered-dose inhaler. Br J Dis Chest 1985; 79(4): Fink JB. Humidity and aerosol therapy. In: Mosby s respiratory care equipment. St. Louis MO: Mosby-Elsevier Inc; 2010: Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005; 127(1): Leach CL, Davidson PJ, Hasselquist BE, Boudreau RJ. Influence of particle size and patient dosing technique on lung deposition of HFA-beclomethasone from a metered dose inhaler. J Aerosol Med 2005; 18(4): Geller DE. New liquid aerosol generation devices: systems that force pressurized liquids through nozzles. Respir Care 2002; 47(12): Dulfano MJ, Glass P. The bronchodilator effects of terbutaline: route of administration and patterns of response. Ann Allergy 1976; 37(5): Gardenhire DS. Airway pharmacology. In: Egan s fundamentals of respiratory care. St Louis MO: Mosby Elsevier; 2009: Fink JB. Aerosol drug therapy. In: Egan s fundamentals of respiratory care. St Louis MO: Mosby Elsevier; 2009: Babu KS, Marshall BG. Drug-induced airway diseases. Clin Chest Med 2004; 25(1): Leuppi JD, Schnyder P, Hartmann K, et al. Drug-induced bronchospasm: analysis of 187 spontaneously reported cases. Respiration 2001; 68(4): Steckel H, Eskandar F. Factors affecting aerosol performance during nebulization with jet and ultrasonic nebulizers. Eur J Pharm Sci 2003; 19(5): O Callaghan C, Barry PW. The science of nebulised drug delivery. Thorax 1997; 52(Suppl 2):S31-S Hess DR. Aerosol delivery devices in the treatment of asthma. Respir Care 2008; 53(6): Ip AY, Niven RW. Prediction and experimental determination of solute output from a Collison nebulizer. J Pharm Sci 1994; 83(7): Pitchford K, Corey M, Highsmith A, et al. Pseudomonas species contamination of cystic fibrosis : Font:(Default) Times New Roman, 12 pt yulinmufeng 3/13/11 7:40 AM : Indent: Left: 0", Hanging: 0.75 ch, First line: ch : Font:(Default) Times New Roman, 12 pt yulinmufeng 3/13/11 7:40 AM : Indent: Left: 0", Hanging: 1.5 ch, First line: -1.5 ch... [3]... [4]... [5]... [6]... [7]... [8]... [9]... [10]... [11]... [12]... [13]... [14]... [15]... [16]... [17]... [18]... [19]... [20]... [21]... [22] 71

73 patients home inhalation equipment. J Pediatr 1987; 111(2): Rosenfeld M, Emerson J, Astley S, et al. Home nebulizer use among patients with cystic fibrosis. J Pediatr 1998;132(1): Vassal S, Taamma R, Marty N, et al. Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis. Am J Infect Control 2000;28(5): Barnes KL, Clifford R, Holgate ST, et al. Bacterial contamination of home nebuliser. Br Med J (Clin Res Ed) 1987; 295(6602): Wexler MR, Rhame FS, Blumenthal MN, et al. Transmission of gram-negative bacilli to asthmatic children via home nebulizers. Ann Allergy 1991; 66(3): Jakobsson BM, Onnered AB, Hjelte L, Nystrom B. Low bacterial contamination of nebulizers in home treatment of cystic fibrosis patients. J Hosp Infect 1997; 36(3): Carnathan B, Martin B, Colice G. Second hand (S)-albuterol: RT exposure risk following racemic albuterol (Abstract). Respir Care 2001; 46(10): Dimich-Ward H, Wymer ML, Chan-Yeung M. Respiratory health survey of respiratory therapists. Chest 2004; 126(4): Christiani DC, Kern DG. Asthma risk and occupation as a respiratory therapist. Am Rev Respir Dis 1993; 148(3): Kern DG, Frumkin H. Asthma in respiratory therapists. Ann Intern Med 1989; 110(10): Rhinehart E, Friedman MM. Personal protective equipment and staff supplies. In: Infection control in home care (An official APIC publication). Gaithersburg MD: Aspen Publishers, Inc.; 2006: Gamage B, Moore D, Copes R, et al. Protecting health care workers from SARS and other respiratory pathogens: a review of the infection control literature. Am J Infect Control 2005; 33(2): Segal-Maurer S, Kalkut G. Environmental control of tuberculosis: continuing controversy. Clin Infect Dis 1994; 19(2): Dennis JH. Standardization issues: in vitro assessment of nebulizer performance. Respir Care 2002; 47(12): Hess D, Fisher D, Williams P, et al. Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996; 110(2): Dennis JH. A review of issues relating to nebulizer standards. J Aerosol Med 1998; 11(Suppl 1):S73-S Welch MJ. Nebulization therapy for asthma: a practical guide for the busy pediatrician. Clin Pediatr (Phila) 2008;47(8): Rau JL, Ari A, Restrepo RD. Performance comparison of nebulizer designs: constant-output, breath-enhanced, and dosimetric. Respir Care 2004; 49(2): Alvine GF, Rodgers P, Fitzsimmons KM, Ahrens RC. Disposable jet nebulizers. How reliable are they? Chest 1992; 101(2): [23]... [24]... [25]... [26]... [27]... [28]... [29]... [30]... [31] 72

74 39. Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003; (4):CD Everard ML, Evans M, Milner AD. Is tapping jet nebulisers worthwhile? Arch Dis Child 1994; 70(6): Malone RA, Hollie MC, Glynn-Barnhart A, Nelson HS. Optimal duration of nebulized albuterol therapy. Chest 1993; 104(4): Newman SP. Principles of metered-dose inhaler design. Respir Care 2005; 50(9): Gross G, Cohen RM, Guy H. Efficacy response of inhaled HFA-albuterol delivered via the breath-actuated Autohaler inhalation device is comparable to dose in patients with asthma. J Asthma 2003; 40(5): Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax 1991; 46(10): Everard ML, Devadason SG, Summers QA, Le Souef PN. Factors affecting total and respirable dose delivered by a salbutamol metered dose inhaler. Thorax 1995; 50(7): Niven RW, Kacmarek RM, Brain JD, Peterfreund RA. Small bore nozzle extensions to improve the delivery efficiency of drugs from metered dose inhalers: laboratory evaluation. Am Rev Respir Dis 1993; 147(6 Pt 1): Pedersen S. The importance of a pause between the inhalation of two puffs of terbutaline from a pressurized aerosol with a tube spacer. J Allergy Clin Immunol 1986;77(3): Pedersen S, Steffensen G. Simplification of inhalation therapy in asthmatic children. A comparison of two regimes. Allergy 1986; 41(4): Dolovich M, Ruffin RE, Roberts R, Newhouse MT. Optimal delivery of aerosols from metered dose inhalers. Chest 1981; 80(6 Suppl): Lawford P, McKenzie. Pressurized bronchodilator aerosol technique: influence of breath-holding time and relationship of inhaler to the mouth. Br J Dis Chest 1982; 76(3): Thomas P, Williams T, Reilly PA, Bradley D. Modifying delivery technique of fenoterol from a metered dose inhaler. Ann Allergy 1984; 52(4): Unzeitig JC, Richards W, Church JA. Administration of metered-dose inhalers: comparison of openand closedmouth techniques in childhood asthmatics. Ann Allergy 1983; 51(6): Chhabra SK. A comparison of closed and open mouth techniques of inhalation of a salbutamol metered-dose inhaler. J Asthma 1994; 31(2): Newman S, Clark A. Inhalation techniques with aerosol bronchodilators. Does it matter? Pract Cardiol 1983; 9: Holt S, Holt A, Weatherall M, et al. Metered dose inhalers: a need for dose counters. Respirology 2005; 10(1): Ogren R, Baldwin J, Simon R. How patients determine when to replace their metered dose inhalers. Ann Allergy Asthma Immunol 1995; 75(6 Pt 1): [32]... [33]... [34]... [35]... [36]... [37]... [38]... [39]... [40] 73

75 57. Rubin BK, Durotoye L. How do patients determine that their metered-dose inhaler is empty? Chest 2004;126(4): Schultz RK. Drug delivery characteristics of metered-dose inhalers. J Allergy Clin Immunol 1995; 96(2): Cain WT, Oppenheimer JJ. The misconception of using floating patterns as an accurate means of measuring the contents of metered-dose inhaler devices. Ann Allergy Asthma Immunol 2001; 87(5): Brock TP, Wessell AM, Williams DM, Donohue JF. Accuracy of float testing for metered-dose inhaler canisters. J Am Pharm Assoc (Wash) 2002; 42(4): U.S. Department of Health and Human Services, U.S. Food and Drug Administration. Guidance for industry: integration of dose-counting mechanisms into MDI drug products. Rockville MD, Sheth K, Wasserman RL, Lincourt WR, et al. Fluticasone propionate/salmeterol hydrofluoroalkane via metered-dose inhaler with integrated dose counter: Performance and patient satisfaction. Int J Clin Pract 2006; 60(10): Simmons MS, Nides MA, Kleerup EC, et al. Validation of the Doser, a new device for monitoring metered-dose inhaler use. J Allergy Clin Immunol 1998; 102(3): Julius SM, Sherman JM, Hendeles L. Accuracy of three electronic monitors for metered-dose inhalers. Chest 2002; 121(3): Williams DM, Wessell A, Brock TP. The Doser external counting device. Chest 1999; 116(5): American College of Chest Physicians. Patient instructions for inhaled devices in English and Spanish. Northbrook IL, Rau JL. The inhalation of drugs: advantages and problems. Respir Care 2005; 50(3): Fink JB, Rubin BK. Aerosol and medication administration In: Czerviske MP, Barnhart SL, editors. Perinatal and pediatric respiratory care. St Louis MO: Elsevier Science; Everard ML. Aerosol delivery to children. Pediatr Ann 2006; 35(9): Everard ML. Inhalation therapy for infants. Adv Drug Deliv Rev 2003; 55(7): Ahrens RC. The role of the MDI and DPI in pediatric patients: Children are not just miniature adults. Respir Care 2005; 50(10): Pongracic JA. Asthma delivery devices: age-appropriate use. Pediatr Ann 2003; 32(1): Boe J, Dennis JH, O Driscoll BR, et al. European Respiratory Society Guidelines on the use of nebulizers. Eur Respir J 2001; 18(1): Rubin BK, Fink JB. Optimizing aerosol delivery by pressurized metered-dose inhalers. Respir Care 2005; 50(9): Rau JL. Practical problems with aerosol therapy in COPD. Respir Care 2006; 51(2): Rubin BK. Nebulizer therapy for children: the devicepatient interface. Respir Care 2002; 47(11): Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care 2005; 50(10): [41]... [42]... [43]... [44]... [45]... [46] 74

76 78. Gray SL, Williams DM, Pulliam CC, et al. Characteristics predicting incorrect metered-dose inhaler technique in older subjects. Arch Intern Med 1996; 156(9): Allen SC, Ragab S. Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age.postgrad Med J 2002; 78(915): McFadden ER Jr. Improper patient techniques with metered-dose inhalers: clinical consequences and solutions to misuse. J Allergy Clin Immunol 1995; 96(2): Atkins PJ. Dry powder inhalers: an overview. Respir Care 2005; 50(10): Fink JB, Rubin BK. Problems with inhaler use: a call for improved clinician and patient education. Respir Care 2005;50(10): Lewis RM, Fink JB. Promoting adherence to inhaled therapy: building partnerships through patient education. Respir Care Clin N Am 2001; 7(2): , vi. 84. Fink JB. Inhalers in asthma management: is demonstration the key to compliance? Respir Care 2005; 50(5): van der Palen J, Klein JJ, van Herwaarden CL, et al. Multiple inhalers confuse asthma patients. Eur Respir J 1999;14(5): Castro-Rodriguez JA, Rodrigo GJ. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with metaanalysis. J Pediatr 2004; 145(2): Meadows-Oliver M, Banasiak NC. Asthma medication delivery devices. J Pediatr Health Care 2005; 19(2): Chan PW, DeBruyne JA. Parental concern towards the use of inhaled therapy in children with chronic asthma. Pediatr Int 2000; 42(5): Apter AJ, Reisine ST, Affleck G, et al. Adherence with twicedaily dosing of inhaled steroids. Socioeconomic and healthbelief differences. Am J Respir Crit Care Med 1998; 157(6 Pt 1): Rubin BK. What does it mean when a patient says, my asthma medication is not working? Chest 2004; 126(3): Everard ML. Inhaler devices in infants and children: challenges and solutions. J Aerosol Med 2004; 17(2): Tal A, Golan H, Grauer N, et al. Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996; 128(4): Everard ML, Clark AR, Milner AD. Drug delivery from holding chambers with attached facemask. Arch Dis Child 1992; 67(5): Nikander K, Berg E, Smaldone GC. Jet nebulizers versus pressurized metered dose inhalers with valved holding chambers: effects of the facemask on aerosol delivery. J Aerosol Med 2007; 20(Suppl 1):S46-S [47]... [48]... [49]... [50]... [51]... [52]... [53]... [54]... [55] 75

77 95. Bower L, Barnhart S, Betit P, et al. American Association for Respiratory Care. AARC Clinical Practice Guideline: selection of an aerosol delivery device for neonatal and pediatric patients. Respir Care 1995; 4(12): National Asthma Education and Prevention Program. Expert Panel Report III: guidelines for the diagnosis and management of asthma. Bethesda MD: National Institutes of Health; Everard ML. Guidelines for devices and choices. J Aerosol Med 2001; 14(Suppl 1):S59-S Ritson S JD, Everard ML. Aerosol delivery systems acceptable to young children improve drug delivery. Thorax 1998; 53:A Fink JB. Aerosol delivery to ventilated infants and pediatric patients. Respir Care 2004; 49(6): Nikander K, Agertoft L, Pedersen S. Breath-synchronized nebulization diminishes the impact of patient-device interfaces (face mask or mouthpiece) on the inhaled mass of nebulized budesonide. J Asthma 2000; 37(5): Iles R, Lister P, Edmunds AT. Crying significantly reduces absorption of aerosolised drug in infants. Arch Dis Child 1999; 81(2): Everard ML. Trying to deliver aerosols to upset children is a thankless task. Arch Dis Child 2000; 82(5): Murakami G, Igarashi T, Adachi Y, et al. Measurement of bronchial hyperreactivity in infants and preschool children using a new method. Ann Allergy 1990; 64(4): Janssens HM, van der Wiel EC, Verbraak AF, et al. Aerosol therapy and the fighting toddler: is administration during sleep an alternative? J Aerosol Med 2003; 16(4): Esposito-Festen J, Ijsselstijn H, Hop W, et al. Aerosol therapy by pressured metered-dose inhaler-spacer in sleeping young children: to do or not to do? Chest 2006; 130(2): Restrepo RD, Dickson SK, Rau JL, Gardenhire DS. An investigation of nebulized bronchodilator delivery using a pediatric lung model of spontaneous breathing. Respiratory Care 2006; 51(1): Kishida M, Suzuki I, Kabayama H, et al. Mouthpiece versus facemask for delivery of nebulized salbutamol in exacerbated childhood asthma. J Asthma 2002; 39(4): Lowenthal D, Kattan M. Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol 1992; 14(3): Smaldone GC, Berg E, Nikander K. Variation in pediatric aerosol delivery: importance of facemask. J Aerosol Med 2005; 18(3): Amirav I, Newhouse MT. Aerosol therapy with valved holding chambers in young children: importance of the facemask seal. Pediatrics 2001; 108(2): Janssens HM, Tiddens HA. Facemasks and aerosol delivery by metered-dose inhaler valved holding chamber in young children: a tight seal makes the difference. J Aerosol Med 2007;20(Suppl 1):S59-S Everard ML, Clark AR, Milner AD. Drug delivery from jet nebulisers. Arch Dis Child 1992; : Indent: Left: 0", Hanging: 2.25 ch, First line: ch... [56]... [57]... [58]... [59]... [60]... [61]... [62]... [63]... [64]... [65]... [66]... [67]... [68] 76

78 67(5): Esposito-Festen JE, Ates B, van Vliet FJ, et al. Effect of a facemask leak on aerosol delivery from a pmdi-spacer system. J Aerosol Med 2004; 17(1): Kesser B, Geller D, Amirav I, Fink J. Baby don t cry: in vitro comparisons of baby s breath aerosol delivery hood vs. face mask or blow-by using the Saint infant upper airway model and Aeroneb Go vs. T-piece nebulizer (Abstract). Respir Care 2003; 48(11): Rubin BK. Bye-bye, Blow-by. Respir Care 2007; 52(8): Everard ML. Aerosol therapy: regimen and device compliance in daily practice. Paediatr Respir Rev 2006; 7(Suppl 1):S80-S Everard ML. Regimen and device compliance: key factors in determining therapeutic outcomes. J Aerosol Med 2006; 19(1): Craven DE, Lichtenberg DA, Goularte TA, et al. Contaminated medication nebulizers in mechanical ventilator circuits. Source of bacterial aerosols. Am J Med 1984; 77(5): Hutchinson GR, Parker S, Pryor JA, et al. Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis. J Clin Microbiol 1996; 34(3): Saiman L, Siegel J. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol 2003; 24(5 Suppl):S6-S Cohen HA, Kahan E, Cohen Z, et al. Microbial colonization of nebulizers used by asthmatic children. Pediatr Int 2006; 48(5): Blau H, Mussaffi H, Mei Zahav M, et al. Microbial contamination of nebulizers in the home treatment of cystic fibrosis. Child Care Health Dev 2007; 33(4): Saiman L, Siegel J. Infection control in cystic fibrosis. Clin Microbiol Rev 2004; 17(1): Lester MK, Flume PA, Gray SL, et al. Nebulizer use and maintenance by cystic fibrosis patients: A survey study. Respir Care 2004; 49(12): Rau JL. Determinants of patient adherence to an aerosol regimen. Respir Care 2005; 50(10): Chew NY, Reddel HK, Bosnic-Anticevich SZ, Chan HK. Effect of mouthpiece washing on aerosol performance of CFC-free Ventolin. J Asthma 2004; 41(7): American College of Chest Physicians. Priming and cleaning your MDI and spacer, The Cystic Fibrosis Foundation. Stopping the spread of germs, Chatburn RL, Kallstrom TJ, Bajaksouzian S. A comparison of acetic acid with a quaternary ammonium compound for disinfection of hand-held nebulizers. Respir Care 1988; 33(3): Le Brun PP, de Boer AH, Heijerman HG, Frijlink HW. A review of the technical aspects of drug nebulization. Pharm World Sci 2000; 22(3): Grieble HG, Colton FR, Bird TJ, et al. Fine-particle humidifiers. Source of Pseudomonas aeruginosa infections in a respiratory- disease unit. N Engl J Med 1970; 282(10): : Font:(Default) Times New Roman, 12 pt... [69]... [70]... [71]... [72]... [73]... [74]... [75]... [76]... [77]... [78]... [79]... [80]... [81]... [82]... [83]... [84]... [85]... [86] 77

79 132. Mertz JJ, Scharer L, McClement JH. A hospital outbreak of Klebsiella pneumonia from inhalation therapy with contaminated aerosol solutions. Am Rev Respir Dis 1967; 95(3): Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3): O Malley CA, VandenBranden SL, Zheng XT, et al. A day in the life of a nebulizer: surveillance for bacterial growth in nebulizer equipment of children with cystic fibrosis in the hospital setting. Respir Care 2007; 52(3): American Association for Respiratory Care. AARC Clinical Practice Guideline: selection of an aerosol delivery device. Respir Care 1992; 37(8): (retired August 2006) Estivariz CF, Bhatti LI, Pati R, et al. An outbreak of Burkholderia cepacia associated with contamination of albuterol and nasal spray. Chest 2006; 130(5): Hamill RJ, Houston ED, Georghiou P, et al. An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med 1995; 122(10): Rau JL, Restrepo RD. Nebulized bronchodilator formulations: unit-dose or multi-dose? Respir Care 2003; 48(10): U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Public health advisory: contamination of multi-dose bottles of Albuterol Sulfate Solution for Inhalation (0.5%), Center for Disease Control and Prevention. Clean hands save lives, Center for Disease Control and Prevention. Guideline for hand hygiene in healthcare settings, Larson EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23(4): Paes BA. Current strategies in the prevention of respiratory synctial virus disease. Pediatr Respir Rev 2003; 4(1): Purssell E. Preventing nosocomial infection in paediatric wards. J Clin Nurs 1996; 5(5): Hall CB. Nosocomial respiratory syncytial virus infections: the Cold War has not ended. Clin Infect Dis 2000;31(2): Milgrom H, Bender B, Ackerson L, et al. Noncompliance and treatment failure in children with asthma. J Allergy Clin Immunol 1996; 98(6 Pt 1): Melani AS, Zanchetta D, Barbato N, et al. Inhalation technique and variables associated with misuse of conventional metered-dose inhalers and newer dry powder inhalers in experienced adults. Ann Allergy Asthma Immunol 2004;93(5): McFadden ER Jr. Improper patient techniques with metered-dose inhalers: clinical consequences and solutions to misuse. J Allergy Clin Immunol 1995; 96(2): Wildhaber JH, Devadason SG, Eber E, et al. Effect of electrostatic charge, flow, delay and multiple [87]... [88]... [89]... [90]... [91]... [92]... [93]... [94]... [95]... [96]... [97]... [98]... [99]... [100]... [101]... [102]... [103]... [104]

80 actuations on the in vitro delivery of salbutamol from different small volume spacers for infants. Thorax 1996; 51(10): : Font:(Default) Times New Roman, 12 pt : Font:(Default) Times New Roman, 12 pt : Font:(Default) Times New Roman, 12 pt : Font:(Default) Times New Roman, 12 pt 79