540 Trans oro Pharyngeal Spacer for Inhalers

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 25 ltsmt, not portable and costly. Also the aerosol deposition in the airways ranges from 20 to 40%only. Wheezy patients with inadequate usage of the inhalers, cleft lip and cleft palate, geriatric and odentulous category, obese asnd short neck individuals cannot take the inhalers properly. 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, 150 degrees. Length - 10 cms, internal diameter - 10 mm, snugly fitting in the oropharynx, the distal end overlying the epiglottis as seen in mri pharynx. 3. External spacer. 4. Salbutamol mdi. PROCEDURE: One hundred and fifty subjects (m: f 95:56), within the age range of 8 to 81 years were enrolled in the study from 1st Feb 2007 to 1 April 2007. 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 to 300 (moderate), 300 to 400 (mild), above 400 (very mild). There were 80 (53%) in the severe, 50 (33%) in moderate,15 (10%) mild, 5 (4%) very mild. With the tops + inhaler 80% had improvement by 60% increment of pefr (one puff-100 mcg). With the es (2 puffs–200 mcg) plus inhaler there was only 10% increment. Thus the improvement with the former was significant (P = 0.9641, r = 0.9660); radioactive isotope scan showed 80% deposition in the lungs with tops versus es (40%). A lateral study found advantage over rotahaler and nebulizer. CONCLUSION: Inhaler with tops is a better device for delivering aerosol.