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ABSTRACT
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Dajanje zdravila v obliki aerosola je pomemben del ]GUDYOMHQMD PQRJLK SOMXþQLK EROH]QL .HU DHURVRO YGLKQHPR WDN QDþLQ YQDãDQMD ]GUDYLOD LPHQXMHPR LQKDOLUDQMH9REOLNLLQKDODFLMODKNRGDMHPRUD]OLþQH YUVWH]GUDYLONRWVRRODMãHYDOFLEURQKRGLODWDWRUML SURWLYQHWQD ]GUDYLOD JOXNRNRUWLNRLGL DQWLELRWLNL LQPXNROLWLNL9SULKRGQRVWLODKNRSULþDNXMHPRGD VHERGRLQGLNDFLMH]D]GUDYOMHQMH]LQKDOLUDQMHPãH UD]ãLULOHWRQDPUHþREHWDUD]YRMQRYLKPDNURPROH- NXODUQLK]GUDYLONLERGR]GUDYLODWDNRGLKDOQHNRW WXGLVLVWHPVNHEROH]QL3ULL]YDMDQMXLQKDOLUDQMD XSRUDEOMDPRUD]OLþQHYUVWHLQKDODWRUMHYNL]GUDYLOR YREOLNLVXVSHQ]LMHDOLUD]WRSLQHUD]SUãLMRQDUD]OLþ- QRYHOLNHGHOFHNLMLKODKNRYGLKQHPR
,QKDODWRUML VR PDMKQH QDSUDYH NL ]DJRWDYOMDMR GD ]HOR PDMKQH NROLþLQH ]GUDYLOD GRVWDYLPR QHSRVUH- GQRYSOMXþD3RPHPEQRMHGDLQKDODWRUMLYHGQR]D- JRWDYOMDMRYQRVXVWUH]QHNROLþLQH]GUDYLODYGLKDOQH SRWL2EVWDMDMRUD]OLþQHYUVWHLQKDODWRUMHY
• SUãLOQLNL LQKDODFLMVND VXVSHQ]LMD DOL UD]WRSLQD SRGWODNRP
• vdihovalniki (zdravilo v obliki prahu brez poti- VQHJDSOLQD
• QHEXOL]HUMLQDSUDYH]DUD]SUãHYDQMH]GUDYLODY REOLNLUD]WRSLQH
3UL RGORþDQMX NDWHUL LQKDODWRU ERPR XSRUDELOL ]D ]GUDYOMHQMH ] DHURVRORP MH RGYLVQR RG UD]OLþQLK GHMDYQLNRY,QKDODWRUQDMELSRVNUEHO]D]DJRWDYOMD- QMH ]DGRVWQH NROLþLQH ]GUDYLOD Y SOMXþLK PDMKQH GHSR]LFLMH]GUDYLODYRURIDULQNVXLPHOQDMELPDOR VLVWHPVNLKQHåHOHQLKXþLQNRYXVWUH]DOQDMELEROQL- kovim potrebam in zagotavljal enostavno uporabo LQFHQRYQRSULPHUQRVW'HMDYQLNLNLYSOLYDMRQDGH- SR]LFLMR]GUDYLODYSOMXþLKVRODVWQRVWLLQKDODWRUMD YHOLNRVWGHOFHYDHURVRODODVWQRVWL]GUDYLODWHUERO- QLNRYR]GUDYVWYHQRVWDQMHVWDQMHEROH]QLY]RUHFLQ QDþLQGLKDQMDWHUWHKQLNDYGLKRYDQMD]GUDYLOD Prednosti zdravljenja z zdravili v obliki aerosola JOHGHQD]GUDYOMHQMHVVLVWHPVNLPL]GUDYLOLMHYHþLQ VRSUHFHMãQMH]DJRWDYOMDMRYQRV]GUDYLODQDPHVWR GHORYDQMD NDU ]PDQMãD SRWUHEQL RGPHUHN ]GUDYLOD ]D GRVHJDQMH WHUDSHYWVNH XþLQNRYLWRVW LQ RPRJRþD KLWUHMãH GHORYDQMH ]GUDYLOD 0DQMãL VR WXGL QHåHOH-
QLXþLQNL]GUDYLOD1DMEROM]DKWHYQDVNXSLQD ]D]GUDYOMHQMH]LQKDOLUDQMHPVRGRMHQþNLLQPDOþNL NLLPDMRPDQMãHGLKDOQHSRWLKLWUHMãRIUHNYHQFRGL- KDQMDWHUPDQMãLLQVSLUDWRUQLYROXPHQNDU]PDQMãD depozicijo zdravila v perifernih delih dihalnih poti LQDOYHROLK9]URNVODEHJDRGJRYRUDQDSUHG- pisano zdravljenje je najpogosteje nepravilna teh- QLND YGLKRYDQMD SRJRVWR SD WXGL SRPDQMNOMLYRUD- zumevanje navodil zdravstvenih delavcev ali slabo VSUHMHPDQMH]GUDYLONLSRY]URþDWDGDRWURNLQVWDUãL SUL]GUDYOMHQMXQHVRGHOXMHMR9HOLNRVWRGPHUND zdravila je tako odvisna od tehnike vdihovanja in URNRYDQMD ] LQKDODWRUMHP ]DWR PRUDPR RE XYHGEL ]GUDYLODRWURNDLQQMHJRYHVWDUãHXVWUH]QRVH]QDQL- WLVSRVWRSNRPLQKDOLUDQMD]GUDYLODWDNRWHRUHWLþQR NRWWXGLSUDNWLþQR
PRŠILNIK IN VDIHOVALNIK
3UãLOQLN MH SULSRPRþHN V NDWHULP UD]SUãLPR ]GUD- YLOR Y REOLNL VXVSHQ]LMH DOL UD]WRSLQH V SRPRþMR SRWLVQHJD SOLQD 2E VSURåLWYL SUãLOD VH L] ãREH QD SUãLOQLNRYHPGQXVKLWURVWMRNPKSRNDGLPH- ãDQLFDGHOFHY]GUDYLODLQSRWLVQHJDSOLQD3UãLOQLN YNDWHUHPMH]GUDYLORYREOLNLVXVSHQ]LMHSUHGXSR- UDERSUHWUHVHPRGDVHYSUDYLOQHPUD]PHUMX]PH- ãDMR GHOFL ]GUDYLOD LQ SRWLVQHJD SOLQD 3UãLOQLNRY z zdravilom v obliki raztopine ni potrebno pretre- VDWL1HNDWHULGHOFLVRYHOLNLWXGLGRPLNURQRY
=DSUDYLOQRXSRUDERMHSRWUHEQDGREUDXVNODMHQRVW PHGVSURåLWYLMRLQYGLKRP+LWHUYGLKL]SUãLO- QLNDODKNRSRY]URþL]DGUåHYDQMHDHURVROQLKGHOFHY YFHQWUDOQLKGLKDOQLKSRWHKLQ]DWR]PDQMãDGHSR]L- FLMR]GUDYLODYSOMXþLK6PLVHOQRMHGDXSRUD- EOMDPRSRGDOMãNHPDVNRSULGRMHQþNLKLQPDMKQLK RWURFLK WHU XVWQLN ]D YHþMH RWURNH LQ PODGRVWQLNH
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9GLKRYDQMH SUHNR XVWQLND ]DKWHYD GREUR VRGHOR- YDQMH 2WURN QDM VWRML DOL ± þH UHV QH PRUH í VHGL YY]UDYQDQHPSROVHGHþHPSRORåDMX1DWRXJUL]QH XVWQLNXJUL]QHLQJDREMDPH]XVWQLFDPL9GLKQDM ERJORERNSRþDVHQL]GLKQHSDQDMVNR]LQRV3UL- SRURþDPRGD]DþQHPRXVWQLNXSRUDEOMDWLþLPEROM ]JRGDMRGOHWDQDSUHMVDMMHGHSR]LFLMD]GUDYLOD
]YGLKRYDQMHPSUHNRXVWQLNDGYDNUDWYHþMD 9HGQRSUHYHULPRDOLMHRWURNPODGRVWQLNVSRVREHQ pravilnega vdihovanja.
9HþLQDRWURNSUHGOHWRPVWDURVWLãHQHPRUHSUD- YLOQR YGLKRYDWL SUHNR SRGDOMãND ] XVWQLNRP ]DWR XSRUDEOMDPR SRGDOMãHN ] PDVNR 3RGDOMãHN ] PDVNR GHOXMH NRW YPHVQD NRPRUD NMHU VH RGORåL ]GUDYLOR WR RWURNX RPRJRþD GD JD SRGLKD ] YHþ YGLKL %LVWYHQHJD SRPHQD MH GD PDVND GREUR WHVQL NDU SRPHQL GD PRUD REMHPDWL QRV LQ XVWD ýHPDVNRRGGDOMLPRRGREUD]D]DFPVHYGLKDQL RGPHUHN]GUDYLO]PDQMãD]DSULEOLåQRRGPLN ]DFPSDFHOR]D7RUHMODKNRåHPDQMãHSX- ãþDQMHSRY]URþL]PDQMãDQLSUHMHWLRGPHUHN]GUDYLOD YYHOLNRVWLGRVNXSQHJDRGPHUND2WURN PRUDLPHWLRGSUWDXVWDVDMVHVLFHUYHþLQD]GUDYLOD RGORåLYQRVXýHMHPRJRþHQDMRWURNREYGLKR- YDQMXQHXSRUDEOMDGXGH1RVMHQDPUHþ]HORXþLQ- NRYLW¿OWHU]DGHOFHDHURVROD3ULXSRUDELSRGDOMãND z masko je torej dihanje preko nosu povezano z YLVRNR GHSR]LFLMR ]GUDYLOD Y ]JRUQMLK GLKDOLK NDU ODKNR]DUDGLYHþMHDEVRUSFLMHSUHNR]JRUQMLKGLKDO SRY]URþLSRPHPEQHVLVWHPVNHQHåHOHQHXþLQNH1H QD]DGQMHSDWXGLPDQMãRGHSR]LFLMR]GUDYLODYVSR- GQMLKGLKDOLK
1DNROLþLQRYGLKDQHJD]GUDYLODYSOLYDMRWXGLSRJRML VKUDQMHYDQMD]GUDYLOD3UHGSUYRXSRUDERDOLþHSU- ãLOQLNDQLVPRXSRUDEOMDOWHGHQGQLDOLGOMHSUãLOQLN QDMSUHM GREUR SUHWUHVHPR LQ Y ]UDN VSURåLPR í RGPHUNDGDVHSUHSULþDPRDOLSUDYLOQRGHOXMH2EL- þDMQDQDYRGLODSURL]YDMDOFD]DVKUDQMHYDQMHVXVSHQ- zije ali raztopine pod tlakom v kovinskem vsebniku RSLVXMHMR SRJRMH VKUDQMHYDQMD SUãLOQLN PRUDPR VKUDQMHYDWLSULWHPSHUDWXULGR&LQ]DãþLWHQHJD SUHGPUD]RPWHUQHSRVUHGQRVRQþQRVYHWORER7H- UDSHYWVNLXþLQHN]GUDYLODVH]PDQMãDþHMHYVHEQLN KODGHQNDUYHOMD]DYHþLQRLQKDODFLMVNLK]GUDYLOY YVHEQLNLKVSUãLORP1DYRGLODUD]OLþQLKSURL]YD- MDOFHYVHUD]OLNXMHMR]DWRMLKPRUDPRSUHGXSRUDER vedno pozorno prebrati in z njimi seznaniti bolnika.
9GLKRYDOQLNMHSULSRPRþHNNLRPRJRþDYGLKRYD- nje zdravila v prahu. Deluje brez pogonskega pli- QD=GUDYLORMHYREOLNLPOHWHJDSUDKXVWLVQMHQRY YGLKRYDOQLNXLQãHOHPRþDQWRN]UDNDNLJDRWURN XVWYDUL ] YGLKRP JD UD]ELMH QD PDMKQH GHOFH NL
QDWR SRWXMHMR Y SOMXþD 3ULPHUHQ MH ]D ãRODUMH NL LPDMR]DGRVWHQLQVSLUDWRUQLYROXPHQ'DQHVMH QDWUJXQDYROMRYHþYUVWYGLKRYDOQLNRYNRWVRWXU- ERKDOHU WZLVWKDOHU GLVNXV QRYROL]HU KDQGLKDOHU UHVSLPDWWRELSRGKDOHUEUHH]\KDOHULQGUXJL3UHG XSRUDER YHGQR RFHQLPR DOL RWURN R] PODGRVWQLN zmore pravilno vdihovati zdravilo iz vdihovalnika.
'D VH R WHP SUHSULþDPR XSRUDELPR W L SODFHER YGLKRYDOQLNVSLãþDONRNLRWURNXSRPDJDUD]XPHWL NDNãHQQDMERYGLK
ýLãþHQMHSRGDOMãNRYYGRPDþHPRNROMX
Odmerek zdravila oziroma depozicija zdravila v SOMXþLK VH ODKNR ]QDWQR VSUHPLQMD JOHGH VWDWLþQR QDSHWRVW SRGDOMãND ]D YQDãDQMH ]GUDYLOD 3RGDOM- ãHNQDMEL]DWRþLVWLOLYEODJLUD]WRSLQLNXKLQMVNHJD GHWHUJHQWDQDWRSDJDWHPHOMLWRVSLUDOLSRGWHNRþR toplo vodo. Ob nevarnosti kontaktnega dermatitisa SULSRPRþNH þLVWLPR VDPR SRG WHNRþR WRSOR YRGR 3RGDOMãNHRVXãLPRQD]UDNXQHGDELGUJQLOLQRWUDQMH SRYUãLQHVDMVWHPSRYHþXMHPRVWDWLþQRQDSHWRVWLQ YSOLYDPRQDPDQMãRGHSR]LFLMR]GUDYLOD ýHSRGDOMãNDQHþLVWLPRVHQDVWHQLSRGDOMãNDSR- VWRSQRQDEHUHSODVWDHURVROQLKGHOFHY]GUDYLODNLJD RWURN QH YGLKQH LQ QD VWHQR VH RGODJD YHGQR YHþ ]GUDYLOD 9 SRGDOMãNX VH QDEHUHMR WXGL PLNURRUJD- nizmi ter alergeni iz bivalnega okolja.
2KLãMH SUãLOQLND þLVWLPR YVDM HQNUDW QD WHGHQ7R VWRULPR WDNR GD L]YOHþHPR NRYLQVNL YVHEQLN L]
SUãLOQLNRYHJDSODVWLþQHJDRKLãMDLQ]XVWQLNDVQH- PHPR SRNURYþHN 1DWR SODVWLþQR RKLãMH LQ SR- NURYþHN VSODNQHPR Y WRSOL YRGL 3UHYHULPR WXGL DOLMHãRED]DUD]SUãHYDQMHSRSROQRPDSUHKRGQD VLFHU ] VSODNRYDQMHP QDGDOMXMHPR 1DWR RKLãMH LQ SRNURYþHN SXVWLPR QD WRSOHP GD VH SRVXãLWD SUHGWHPSDMXGREURRWUHVHPR1HL]SRVWDYOMDMPR MX SUHWLUDQL YURþLQL QSU UDGLDWRUMX .R MH RKLãMH VXKRQDPHVWLPRYVHEQLNYRKLãMHSRNURYþHNSD na ustnik. Kovinskega vsebnika ne potapljamo v YRGR3ULYGLKRYDOQLNLKVVXKRNUSRRþLVWLPR samo ustnik.
.RMXQHXSRUDEOMDPRSUãLOQLNLQYGLKRYDOQLNQXM- QR]DãþLWLPRVSRNURYþNRP1DWDQDþLQSUHSUHþLPR GRVWRSSUDãQLKGHOFHYVPHWLYODJHLQDOHUJHQRYL]
bivalnega okolja.
NEBULIZERJI
1DWUJXMHYHOLNRLQKDODWRUMHYNLRPRJRþDMRLQKDOD- cije v obliki raztopine. Pri izbiri inhalatorja moramo XSRãWHYDWLQDYRGLODSURL]YDMDOFD]GUDYLODNLVNXSDM ] ]GUDYLORP SULSRURþL WXGL QDMXVWUH]QHMãL WLS LQKD- ODWRUMDWMLQKDODWRUNLMHQDPHQMHQXSRUDEL]]DQM UHJLVWULUDQLP]GUDYLORPLQ]DJRWDYOMDGDMH]GUDYL- ORNDUQDMEROMXþLQNRYLWR3UL]GUDYOMHQMXEROQLNRY V FLVWLþQR ¿EUR]R Y 6ORYHQLML QDMSRJRVWHMH XSRUD- EOMDPR VWDQGDUGQL HOHNWULþQL LQKDODWRU W L MHW QH- bulizer (Pari®WHULQKDODWRUVWHKQRORJLMRªPHVK©
H )ORZ® 6OHGQML LPD QHNDM SUHGQRVWL SUHG HOHN- WULþQLP LQKDODWRUMHP QSU ]HOR KLWUR UD]SUãHYDQMH ]GUDYLODWHUQHVOLãQRGHORYDQMHNDURPRJRþDEROMãH sodelovanje bolnikov pri inhalacijskem zdravljenju.
'RND]RYRPRUHELWQLEROMãLNOLQLþQLXþLQNRYLWRVWLMH PDORYHQGDUSDVRYQHNDWHULKUD]LVNDYDKSRWUGLOL EROMãRGHSR]LFLMR]GUDYLOD.RWXþLQNRYLWLVRVH L]ND]DOL LQKDODWRUML NL PHG L]GLKRP QH L]JXEOMDMR zdravila oziroma aerosol aktivirajo z vdihom (npr.
,1HE® YHQGDU MLK XSRUDEOMDPR VDPR Y SULPHUX ]GUDYOMHQMDV3URPL[LQRP®8OWUD]YRþQLLQKDOD- WRUMLQLVRSULPHUQL]DUD]SUãHYDQMH'RUQDVHDOIDNHU XQLþLMRVWUXNWXURPROHNXOH
1DSUDYHLPDMRRPHMHQRåLYOMHQMVNRGRER3RVNUEHWL moramo za redno servisiranje vsaj enkrat na leto oz.
SR SULSRURþLOX SURL]YDMDOFD 9 RNYLUX VHUYLVLUDQMD ]DPHQMDPRSRãNRGRYDQHGHOHLQL]PHULPRL]KRGQL SRWLVQLWODNNLUD]SUãL]GUDYLOR-HQDPUHþRGORþLOHQ ]D XþLQNRYLWRVW LQKDODFLM R] SULPHUQR UD]SUãHQLK GHOFHY1DSUDYHVKUDQMXMHPRQDVXKHPPHVWXLQ]D- ãþLWHQHSUHGSUDKRP6VHUYLVQLPSRURþLORP]DJRWD- YOMDPRNDNRYRVWQRLQKDOLUDQMH-HWQHEXOL]HUMLLPDMR ]UDþQH¿OWUHNLVUNDMR]UDNL]RNROMD)LOWUHPRUDPR ]DPHQMDWLYVDMGYDNUDWQDOHWRVLFHUSDSRQDYRGLOLK SURL]YDMDOFD9QDVSURWQHPSULPHUXVH¿OWUL]DPD- ãLMRLQXPDåHMRNDUSUHGVWDYOMDYHOLNRWYHJDQMH]D YQRVPLNURRUJDQL]PRY
5H]HUYRDU]D]GUDYLOR
Rezervoar za zdravilo uporabljamo z masko ali XVWQLNRP ýH LPD UH]HUYRDU ]D ]GUDYLOR VWUDQVNH RGSUWLQH VNR]QMH YGLUD ]UDN L] RNROMD NL WDNR SR- YHþDXþLQNRYLWRVWLQKDOLUDQMD'HOXMHSR9HQWXULMH-
YHPQDþHOX3ULL]ELULUH]HUYRDUMDMHSRPHPEQRGD LPDþLPPDQMVHVWDYQLKGHORYVDMJDWDNRODåMHLQ XþLQNRYLWHMH þLVWLPR ýH XSRUDEOMDPR UH]HUYRDUMH ]DHQNUDWQRXSRUDERPRUDPRYHGHWLGDQLVRQDPH- QMHQLYHþNUDWQLXSRUDELVDMVHQDWDQDþLQ]PDQMãD XþLQNRYLWRVWLQKDOLUDQMDSRGDOMãDþDVLQKDOLUDQMDLQ PRþQR SRYHþD YHUMHWQRVW RQHVQDåHQMD .HU MH QD WUJX QD YROMR YHOLNR UD]OLþQLK UH]HUYRDUMHY YHGQR XSRãWHYDPR SULSRURþLOD SURL]YDMDOFD /H SULPHUHQ VLVWHP]DJRWDYOMDQDMYHþMRXþLQNRYLWRVW
ýLãþHQMHLQUD]NXåHYDQMHUH]HUYRDUMD]D ]GUDYLORYGRPDþHPRNROMX
=D XþLQNRYLWRVW ]GUDYOMHQMD ] LQKDOLUDQMHP MH SR- PHPEQRGDSUHSUHþXMHPRSUHQRVDPLNURRUJDQL]- PRYSUHNRVDPHJDLQKDODWRUMDDOLSUHNRRQHVQDåHQH- JDUH]HUYRDUMD]D]GUDYLOD1HYDUQRVWMHWHPYHþMD þLP GOMH UH]HUYRDU XSRUDEOMDPR SUL HQHP EROQLNX EUH]YPHVQHJDUD]NXåHYDQMD9WDNHPUH]HUYRDUMX QDMYHþNUDW ]UDVWHMR EDNWHULMH NL MLK RE LQKDOLUDQMX UD]SUãLPR Y GLKDOD 3ULSRURþDPR þLãþHQMH ] UD]WR- pino blagega detergenta ter temeljito splakovanje s WHNRþRWRSORYRGRSRYVDNHPLQKDOLUDQMX1DPHVWX MHWXGLUHGQRGH]LQIHFLUDQMHVSUHNXKDYDQMHPXþLQ- kovito pa je tudi namakanje v izopropilalkoholu in íHWDQROX3RPHPEQRMHGDSULSR- PRþNHGREURRVXãLPRLQVKUDQLPRYSODVWLþQLYUHþNL DOL]DSUWLSRVRGLFLVþLPHUSUHSUHþLPRRQHVQDåHQMH ]PLNURRUJDQL]PLL]RNROMD]YHþMLPLGHOFLVPHWLLQ DOHUJHQL L] ELYDOQHJD RNROMD 6 þLãþHQMHP LQ ] RVXãHYDQMHP UH]HUYRDUMD ]D ]GUDYLOD PHG SRVDPH- ]QRXSRUDER]PDQMãDPRWYHJDQMH]DSRUDVWSDWRJH- QLK RUJDQL]PRY YNOMXþQR V SRY]URþLWHOMHP% &H SDFLDFRPSOH[9UD]LVNDYLVR2¶0DOOH\LQ VRGHODYFLSUHXþHYDOLUDVWEDNWHULMYUH]HUYRDUMX]D HQNUDWQRXSRUDERRERGVRWQRVWLYPHVQHJDþLãþHQMD LQUD]NXåHYDQMDYXUDK8JRWRYLOLVRGDMHQH- YDUQRVW]DUDVWEDNWHULM]QRWUDMUH]HUYRDUMDYXUDK ]HORQL]ND*OHGHQDWHUH]XOWDWHELELOLQDMEROM SULPHUQHUD]SUãLOQHSRVRGLFH]DHQNUDWQRXSRUDER kar pa za bolnike cenovno ni sprejemljivo.
1HRþLãþHQ UH]HUYRDU ]D ]GUDYLOD SR GDOMãL XSRUDEL ]PDQMãDXþLQNRYLWRVWUD]SUãHYDQMDGHOFHY]DWRPR- ramo funkcionalnost rezervoarja za zdravila oceniti ]RSD]RYDQMHP,ãþHPRPHKDQVNHSRãNRGEHUH]HU-
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