Inhaler Health Dictionary

A method of applying drugs in a ?nely divided or gaseous state, so that, when breathed in, they may come into contact with the nose, throat and lungs. There are two chief means by which drugs are mingled with the air and so taken in by breathing: these are traditional steam inhalations, and modern aerosol devices which deliver a ?ne spray direct into the mouth. (See INHALANTS; INHALER.)... inhalation

A corticosteroid drug that is used in the treatment of asthma and hay fever (see rhinitis, allergic). Beclometasone, which is prescribed as an inhaler or nasal spray, controls the symptoms by reducing inflammation and mucus production in the lining of the nose or, in asthma, inflammation of the airways. The drug is often given with bronchodilator drugs in the management of asthma. A severe asthma attack may require the dose to be increased. The action of beclometasone is slow, however, and its full effect takes several days to occur. Adverse effects of the drug may include hoarseness, throat irritation, and, on rare occasions, fungal infections in the mouth. Beclometasone is also prescribed in the form of a cream or ointment to treat inflammation of the skin caused by eczema.... beclometasone

Substances that can be inhaled into the body through the lungs. They may be delivered in traditional form dissolved in hot water and inhaled in the steam, or as an aerosol – a suspension of very small liquid or solid particles in the air. The latter are now usually delivered by devices in which the aerosol is kept under pressure in a small hand-held cylinder and delivered in required doses by a release mechanism.

Aerosols Asthmatic patients (see ASTHMA) ?nd aerosol devices to be of value in controlling their attacks. They provide an e?ective and convenient way of applying drugs directly to the bronchi, thus reducing the risks of unwanted effects accompanying SYSTEMIC therapy. BRONCHODILATOR aerosols contain either a beta-sympathomimetic agent or ipratropium bromide, which is an ANTICHOLINERGIC drug.

ISOPRENALINE was the ?rst compound to be widely used as an aerosol. It did however stimulate beta1 receptors in the heart as well as beta2 receptors in the bronchi, and so produced palpitations and even dangerous cardiac arrhythmias. Newer beta-adrenoceptor agonists are speci?c for the beta2 receptors and thus have a greater safety margin. They include SALBUTAMOL, TERBUTALINE, rimiterol, fenoterol and reproterol. Unwanted effects such as palpitations, tremor and restlessness are uncommon with these, more speci?c preparations. In patients who get insu?cient relief from the beta-adrenoreceptor agonist, the drug ipratropium bromide is worth adding. Salmeterol is a longer-acting choice for twice-daily administration: it is not intended for the relief of acute attacks, for which shorter-acting beta2 stimulants such as salbutamol should be used. Salmeterol should be added to existing corticosteroid therapy (see CORTICOSTEROIDS), rather than replacing it.

Patients must be taught carefully and observed while using their inhalers. It is important for them to realise that if the aerosol no longer gives more than slight transient relief, they should not increase the dose but seek medical help.... inhalants

A nebuliser makes an aerosol (see under INHALANTS) by blowing air or oxygen through a solution of a drug. Many inhaled drugs such as SALBUTAMOL, ipratropium and beclomethasone can be given in this way. It has the advantage over a metered dose inhaler (MDI) that no special e?ort is required to coordinate breathing, and a nebuliser allows a much greater volume of the drug to be delivered to where it is needed (the airways) compared with that of MDIs. The use of higher doses of bronchodilator drugs made possible by the nebuliser means that the risk of unwanted side-effects is also increased. Fortunately the safety pro?le of anti-asthmatic drugs such as salbutamol is extremely high and overdose is generally well-tolerated.... nebulisers

A short-acting selective beta2-adrenoceptor stimulant delivered via a metered-dose aerosol inhaler, a powder inhaler or through a nebuliser to control symptoms of ASTHMA. If stimulant inhalation is needed more than twice a day to control asthma attacks, prophylactic treatment should be considered including, in severe cases, oral CORTICOSTEROIDS. Salbutamol relaxes the muscles which cause bronchial spasms in the lungs – the prime symptom of asthma. There are other similar preparations such as terbutaline.... salbutamol

Preparations containing nicotine that are used in place of cigarettes as an aid to stopping smoking.

Nicotine products are available in the form of sublingual tablets, chewing gum, skin patches, nasal spray, or inhaler.

Side effects may include nausea, headache, palpitations, cold or flu-like symptoms, hiccups, and vivid dreaming.

Nicotine replacement therapy should be used as part of a complete package of measures, including the determination to succeed.... nicotine replacement therapy

A drug given by inhaler to control mild asthma in children and allergic or exercise-induced asthma in adults; as a nasal spray to treat allergic rhinitis; in eye-drops for allergic conjunctivitis; and orally for food allergy.

Side effects include coughing and throat irritation on inhalation.... sodium cromoglicate

n. a plastic container with a mouthpiece at one end and a hole for an aerosol inhaler at the other. The dose from the inhaler is sprayed into the spacer, from which it can be inhaled without needing to coordinate breathing. It is particularly useful for babies and small children who do not have this coordination. Paediatric spacers also have a small mask that fits onto the mouthpiece of the spacer and is placed over the child’s nose and mouth. Spacers help to deliver a greater proportion of the dose to the airways while reducing the proportion absorbed into the body (which is the usual cause of unwanted side-effects)... spacer

A group of drugs that widen the bronchioles (small airways in the lungs) to increase air flow and improve breathing, especially in the treatment of asthma and chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive). There are 3 main types of bronchodilator: sympathomimetic drugs (such as salbutamol), anticholinergic drugs, and xanthine drugs (such as aminophylline). Sympathomimetic drugs are used primarily for the rapid relief of breathing difficulty. Anticholinergic and xanthine drugs are more often used for the long-term prevention of attacks of breathing difficulty. Drugs can be given by inhaler, in tablet form, or, in severe cases, by nebulizer or injection.

The main side effects of sympathomimetics are palpitations and trembling.

Anticholinergics may cause dry mouth, blurred vision, and, rarely, difficulty in passing urine.

Xanthines may cause headaches, nausea and palpitations.... bronchodilator drugs

An inhaled corticosteroid drug used in the treatment of bronchial asthma to prevent asthma attacks. It is administered using an inhaler. Side effects of budesonide, which include hoarseness, throat irritation and, rarely, fungal infections, can be reduced by rinsing the mouth after administration.

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Buerger’s disease A rare disorder, also called thromboangiitis obliterans, in which the arteries, nerves, and veins in the legs, and sometimes those in the arms, become severely inflamed. Blood supply to the toes and fingers becomes cut off, eventually causing gangrene. The disease is most common in men under the age of 45 who smoke heavily. bulimia An illness that is characterized by bouts of overeating usually followed by self-induced vomiting or excessive laxative use. Most sufferers are girls or women between the ages of 15 and 30. In some cases, the symptoms coexist with those of anorexia nervosa. Repeated vomiting can lead to dehydration and loss of potassium, causing weakness and cramps, and tooth damage due to the gastric acid in vomit. Treatment includes supervision and regulation of eating habits, and sometimes, antidepressant drugs and/or psychotherapy. bulk-forming agent A substance that makes stools less liquid by absorbing water: a type of antidiarrhoeal drug. bulla A large air- or fluid-filled bubble, usually in the lungs or skin. Lung bullae in young adults are usually congenital. In later life, lung bullae develop in patients with emphysema. Skin bullae are large, fluid-filled blisters with a variety of causes, including the bullous disease pemphigus.... budesonide

A group of drugs that are similar to the corticosteroid hormones produced by the adrenal glands. Corticosteroids are used as hormone replacement therapy in Addison’s disease and when the adrenal glands or pituitary gland have been destroyed or removed. They are also used to treat inflammatory intestinal disorders such as ulcerative colitis and Crohn’s disease and as an urgent treatment for inflammation in the artery supplying the retina in temporal arteritis. Other uses include treatment of autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis, and treatment of asthma, eczema, and allergic rhinitis. Corticosteroid drugs are also used to prevent organ rejection after transplant surgery and in the treatment of some types of cancer, such as a lymphoma or leukaemia. Corticosteroid injections may relieve pain in disorders such as tennis elbow and arthritis.

Side effects are uncommon when corticosteroids are given as a cream or by inhaler, but tablets taken in high doses for long periods may cause oedema, hypertension, diabetes mellitus, peptic ulcer, Cushing’s syndrome, inhibited growth in children, and, in rare cases, cataract or psychosis. High doses also impair the body’s immune system. Long-term treatment suppresses production of corticosteroid hormones by the adrenal glands, and sudden withdrawal may lead to adrenal failure.... corticosteroid drugs

A chemical substance that alters the function of one or more body organs or the process of a disease. Drugs include prescribed medicines, over-thecounter remedies, and substances (such as alcohol, tobacco, and drugs of abuse) that are used for nonmedical purposes. Drugs normally have a chemical name, an officially approved generic name (see generic drug), and often a brand name. Drugs for medical use are either licensed for prescription by a doctor only or can be bought over the counter at a chemist’s or supermarket.

Most drugs are artificially produced to ensure a pure preparation with a predictable potency (strength). Some drugs are genetically engineered. A drug is classified according to its chemical make-up or the disorder it treats or, according to its specific effect on the body. All new drugs are tested for their efficiency and safety. In the UK, drugs are licensed by the Medicines Control Agency (MCA). A licence may be withdrawn if toxic effects are reported or if the drugs causes serious illness.

Drugs can be used to relieve physical or mental symptoms, to replace a deficient natural substance, or to stop the excessive production of a hormone or other body chemical. Some drugs are given to destroy foreign organisms, such as bacteria. Others, known as vaccines, are given to stimulate the body’s immune system to form antibodies.

Drugs are given by mouth, by injection, or applied directly to the affected site via transdermal, nasal, and other direct routes (for example, to the lungs through an inhaler). Injected drugs have a more rapid effect than drugs taken by mouth because they enter the bloodstream without passing first through the digestive system. Unabsorbed drugs taken by mouth are excreted in the faeces. Drugs that have entered the bloodstream are eliminated in urine. Some drugs interact with food or alcohol or other drugs. Most drugs can produce adverse effects. These effects may wear off as the body adapts to the drug. Adverse effects are more likely if there is a change in the absorption, breakdown, or elimination of a drug (caused, for example, by liver disease). Unexpected reactions sometimes occur due to a genetic disorder, an allergic reaction, or the formation of antibodies that damage tissue.

Many drugs cross the placenta; some affect growth and development of the fetus. Most drugs pass into the breast milk of a nursing mother, and some will have adverse effects on the baby.... drug

n. the condition of subjects with widespread narrowing of the bronchial airways, which changes in severity over short periods of time (either spontaneously or under treatment) and leads to cough, wheezing, and difficulty in breathing. Bronchial asthma may be precipitated by exposure to one or more of a wide range of stimuli, including *allergens, drugs (such as aspirin and other NSAIDs and beta blockers), exertion, emotion, infections, and air pollution. The onset of asthma is usually early in life and in atopic subjects (see atopy) may be accompanied by other manifestations of hypersensitivity, such as hay fever and dermatitis; however, the onset may be delayed into adulthood or even middle or old age. Treatment is with *bronchodilators, with or without corticosteroids, usually administered via aerosol or dry-powder inhalers, or – if the condition is more severe – via a nebulizer. Oral corticosteroids are reserved for those patients who fail to respond adequately to these measures. Severe asthmatic attacks may need large doses of oral corticosteroids (see status asthmaticus). Selection of treatment for individual cases is made using stepped guidelines issued by respiratory organizations, e.g. the British and American Thoracic Societies and the European Respiratory Society. A new group of drug treatments, using *monoclonal antibodies to target components in the allergic response, have recently become available (see omalizumab). Avoidance of known allergens, especially the house dust mite, allergens arising from domestic pets, and food additives, will help to reduce the frequency of attacks, as will the discouragement of smoking.

Cardiac asthma occurs in left ventricular heart failure and must be distinguished from bronchial asthma, as the treatment is quite different. —asthmatic adj.... asthma

treatment directed to curing genetic disease by introducing normal genes into patients to overcome the effects of defective genes, using techniques of *genetic engineering. The most radical approach would be to do this at a very early stage in the embryo, so that the new gene would be incorporated into the germ cells (ova and sperm) and would therefore be inheritable. However, this approach is not considered to be either safe or ethical, because the consequences would affect all descendants of the patient, and it is not being pursued. In somatic cell gene therapy the healthy gene is inserted into *somatic cells (such as the *haemopoietic stem cells of the bone marrow) that give rise to other cells. All the surviving descendants of these modified cells will then be normal and, if present in sufficient numbers, the condition will be cured (the defective gene will, however, still be present in the germ cells).

At present, gene therapy is most feasible for treating disorders caused by a defect in a single recessive gene, so that the deficiency can be overcome by the introduction of a normal allele (therapy for disorders caused by dominant genes (e.g. Huntington’s disease) would require the modification or replacement of the defective allele as its effect is expressed in the presence of a normal allele). Examples of such recessive disorders include *adenosine deaminase (ADA) deficiency and *cystic fibrosis. Gene therapy trials for the former condition have already begun: lymphocyte stem cells are isolated from the patient, using *monoclonal antibodies, and incubated with *retroviruses that have been genetically engineered to contain the normal ADA gene (see vector). This gene thus becomes integrated into the stem cells, which – when returned to the patient’s bone marrow – can then produce normal lymphocytes. A similar technique has been used in treating patients with *severe combined immune deficiency and is feasible for other blood disorders, such as sickle-cell anaemia and thalassaemia.

Clinical trials for the gene therapy of cystic fibrosis involve using *liposomes to introduce the normal gene into the lungs of sufferers via an inhaler.

Gene therapy for certain types of cancer is also undergoing clinical trials. Here the approach is aimed at introducing into the cancer cells tumour-suppressing genes, such as *p53 (which prevents uncontrolled cell division), or genes that direct the production of substances (such as *interleukin 2) that stimulate the immune system to destroy the tumour cells.... gene therapy