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DOI: 10.1055/s-2004-831845
© Georg Thieme Verlag Stuttgart · New York
Pulverinhalationssysteme
Dry powder inhalers - a reviewPublication History
eingereicht: 28.1.2004
akzeptiert: 8.7.2004
Publication Date:
22 September 2004 (online)

Zusammenfassung
Die medikamentöse Inhalationstherapie ist ein Hauptpfeiler in der Behandlung sowohl von Asthma als auch chronisch obstruktiven Lungenerkrankungen (COPD). Die durch den FCKW-Ausstieg ausgelöste stürmische Entwicklung auf dem Gebiet der Pulverinhalationssysteme (engl: dry powder inhaler, DPI) erschwert jedoch Arzt und Patient die Auswahl. Pulverdosieraerosolgeräte (DPI) stehen als Einzeldosis- und Multidosissysteme in wiederbefüllbaren oder nicht wiederbefüllbaren Systemen zur Verfügung. DPI unterscheiden sich von Treibgasaerosolen (MDI) im Wesentlichen durch Atemflussabhängigkeit von Dosisabgabe und Teilchengrößenverteilung, sowie der damit verbundenen höheren Variabilität der applizierten effektiven Medikamentendosis. Idealerweise sollte das therapeutisch relevante Partikelspektrum einen aerodynamischen Teilchendurchmesser (engl. mass median aerodynamic diameter, MMAD) von 2 - 5 µm aufweisen. Neben dem inspiratorischen Atemfluss des Patienten sind der Eigenwiderstand des Inhalationsgerätes und die Umgebungsfeuchtigkeit (bei unsachgemässer Behandlung) weitere potenzielle Einflussfaktoren auf die Dosisabgabe von Pulverinhalatoren. Für die Notfallbehandlung des schweren bis lebensbedrohlichen Asthmaanfalls sind Pulverinhalatoren nicht geeignet. Bei 92 - 96 % der Patienten kann jedoch auch bei Exazerbationen einer obstruktiven Lungenerkrankung, die noch spirometrische Messungen zulässt, mit einem Pulverinhalationssystem eine wirksame Bronchodilatation erreicht werden. Trockenpulverinhalatoren sind mit herkömmlichen treibgasgetriebenen Dosieraerosolen in der Effizienz der Inhalationstherapie vergleichbar. In der Präparateauswahl im klinischen Alltag stehen Kostenerwägungen, Patientencompliance und Bedienungskomfort im Vordergrund. Eine korrekte Einweisung zur Handhabung des Inhalationsgerätes sowie wiederholte Überprüfung der Inhalationstechnik ist von großer Bedeutung.
Summary
Inhalation of bronchodilators and corticosteroids is the mainstay treatment for patients with obstructive lung diseases. Many dry powder inhaler devices and drug combinations are now available, and competing promotional claims can confuse both prescribers and patients. The appropriate dose of a given drug may be different for a pressurized metered dose inhaler (pMDI) and a dry powder inhaler (DPI). DPIs create aerosols by drawing air through an aliquot of dry powder. The powder contains either micronized (< 5 µm in diameter) drug particles bound into loose aggregates, or micronized drug particles that are loosely bound to large (> 30 µm in diameter) lactose or glucose particles. Usually, the drug particles are bound to carrier particles and are stripped form the carrier particles by the energy provided by the patientŽs inhalation. The release of respirable particles of the drug requires inspiration at relatively high flow rates (30 - 120 L/min). Other important factors influencing aerosol generation and lung deposition are device design (resistance to airflow) and environmental conditions (humidity, temperature).
Preferably, patients should employ only one type of aerosol-generating device for inhalation therapy. The technique of use varies among devices, and repeated instruction is highly advisable, to ensure that the patient uses the device appropriately. At present, DPIs are recommended for prophylactic and maintenance therapy in patients with asthma and chronic obstructive pulmonary disease, but not for patients with acute severe bronchoconstriction or children less than 5 years of age.
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Priv.-Doz. Dr. med. M. Kohlhäufl
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