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Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 242

A syringe-actuated metered-dose inhaler for patients with tracheal intubation: A comment

1 Department of Critical Care Medicine, RIMS, Ranchi, Jharkhand, India
2 Department of Intensive Care Medicine, RIMS, Ranchi, Jharkhand, India

Date of Submission28-Feb-2020
Date of Acceptance28-Feb-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Dr. Jay Prakash
C/O R. P. Sinha, HI-166, Harmu Housing Colony, Ranchi - 834 002, Jharkhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijrc.ijrc_16_20

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How to cite this article:
Prakash J, Khan MS, Kharwar RK. A syringe-actuated metered-dose inhaler for patients with tracheal intubation: A comment. Indian J Respir Care 2020;9:242

How to cite this URL:
Prakash J, Khan MS, Kharwar RK. A syringe-actuated metered-dose inhaler for patients with tracheal intubation: A comment. Indian J Respir Care [serial online] 2020 [cited 2022 Nov 26];9:242. Available from: http://www.ijrc.in/text.asp?2020/9/2/242/287300


In a letter to the editor by Dubey et al. made for interesting reading.[1] We congratulate the authors for reporting this. In this article, it is mentioned that metered-dose inhaler (MDI) is considered more effective than nebulizers. We would really like to make the following comments:

  1. The spray emerging from MDI can have velocity in excess of 30 m/s,[2] and when this high-velocity spray is delivered directly into the mouth, most of the spray impacts the posterior wall of the oropharynx which is not inhaled. This inertial impaction is reduced by using a spacer device or holding chamber (HC) to reduce the velocity of aerosol delivery. Hence, when the MDI is used alone, 80% of the drug aerosol is deposited in the oropharynx, but when an HC is used with the MDI, drug deposition in the mouth is almost completely eliminated. Hence, HC is recommended for all bronchodilator treatments with MDIs.[3]
  2. The notable features of aerosol drug therapy is the equivalent bronchodilator responses produced by nebulizers and MDIs despite a large drug dosage [Table 1] which shows that dose of albuterol deposited in the lungs would be 12% of 2.5 mg (250 μg) for the nebulizer whereas 9% of 360 μg for MDI (MDI dose of 180 μg represents two puffs) and 20% of 360 μg for MDI with HC. Thus, despite the 3.5-fold difference in drug dose in the airways, the bronchodilator responses produced by nebulizer and MDIs are equivalent.[4],[5],[6],[7] Equivalent responses have also been observed in ventilator-dependent patients.[8],[9]
  3. The response or effectiveness of MDIs is optimal when it is used with HC.[9]
    Table 1: Distribution of inhaled albuterol by the delivery system

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Conflicts of interest

There are no conflicts of interest.

  References Top

Dubey PK, Dubey P, Kumar N. A syringe-actuated metered dose inhaler for patients with tracheal intubation. Indian J Respir Care 2019;8:66-7.  Back to cited text no. 1
  [Full text]  
Clarke SW, Newman SP. Differences between pressurized aerosol and stable dust particles. Chest 1981;80:907-9.  Back to cited text no. 2
Fink J. Aerosol drug therapy. In: Wilkins RL, Stoller JK, Kacmarek RM, editors. Egan's Fundamentals of Respiratory Care. St. Louis, MO: Mosby, Inc.; 2009. p. 801-39.  Back to cited text no. 3
Fink JB. Metered-dose inhalers, dry powder inhalers, and transitions. Respir Care 2000;45:623-35.  Back to cited text no. 4
Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1993;103:665-72.  Back to cited text no. 5
Delgado A, Chou KJ, Silver EJ, Crain EF. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med 2003;157:76-80.  Back to cited text no. 6
Batra V, Sethi GR, Sachdev HP. Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma. Indian Pediatr 1997;34:497-503.  Back to cited text no. 7
Dhand R, Tobin MJ. Pulmonary perspective: Inhaled bronchodilator therapy in mechanically ventilated patients. Am J Respir Crit Care Med 1997;156:3-10.  Back to cited text no. 8
AARC Clinical Practice Guideline. Selection of device, administration of bronchodilator, and evaluation of response to therapy in mechanically ventilated patients. Respir Care1999;44:105-13.  Back to cited text no. 9


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