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16:18:41 That's about one‐tenth of the speed of a bullet16:18:45 coming out of a gun. Within 0.1 seconds, that16:18:49 speed decreases by half. These particles come out16:18:53 in a rapid string. They become smaller over time16:18:55 and then this is delivered to the airways.16:18:5916:19:01 So the problem, as I just mentioned, and the16:19:04 particles coming out in a rapid stream, there is16:19:08 multiple issues with putting the inhaler directly16:19:10 in your mouth. You have to coordinate pressing16:19:13 down and breathing at the same time. You don't16:19:14 have that much distance between the mouthpiece and16:19:17 the posterior pharynx and most of the particles16:19:20 will just impact against the posterior pharynx.16:19:23 And particularly if you inhale quickly, you may16:19:26 not give the particles time for them to get16:19:28 smaller in size, which does happen with time. So16:19:32 there's really a ballistic quality of metered dose16:19:37 inhalers.16:19:3816:19:38 To combat that, valved holding chambers were16:19:42 developed. There are different brands. This one16:19:44 is the Opti‐Chamber. These are the Aero Chambers.16:19:47 This allows having the particles slow down in the16:19:54 holding chamber.16:19:5516:19:56 Some studies have been done taking radioactive
16:19:59 labeled aerosols in these metered dose inhalers,16:20:02 comparing, giving the inhaler, just directly16:20:05 placing it in your mouth, compared to using the 1416:20:07 holding chamber. There is a 10‐ to 17‐fold16:20:10 decrease in radioactivity in the posterior pharynx16:20:13 when you use valved holding chambers.16:20:1716:20:18 There certainly are issues of using valved holding16:20:21 chambers, somewhat similar to issues with the16:20:24 nebulizer treatments. These are somewhat bulky.16:20:28 They're big and teenagers may not want to carry16:20:31 these around.16:20:3116:20:31 There's also somewhat of a more practical issue,16:20:35 which we normally don't think of. When you take16:20:38 these plastic inhalers right out of the box,16:20:41 there's a static electric charge on the walls of16:20:44 these inhalers, and you can have patients you16:20:47 start on a medication, they call you a week later16:20:49 and say, I'm not any better. That static electric16:20:52 charge can attract the medication to be on the16:20:56 walls of the inhaler. You can easily avoid that16:20:59 by, when you first take these devices right out of16:21:03 their box, you wash it with a dishwasher solution16:21:07 and that gets rid of the static electric charge16:21:09 for at least 30 days.16:21:11
Page 1 and 2: WAITING TO INHALE: 115:48:07 DELIVE
Page 3 and 4: 15:50:56 past medical history is si
Page 5 and 6: 15:53:30 About the only time I coul
Page 7 and 8: 15:56:11 pentamidine once a month.
Page 10 and 11: 15:59:55 central distribution of th
Page 12 and 13: 16:02:58 or the physics behind this
Page 14 and 15: 16:05:43 that tells you the manufac
Page 16 and 17: 16:08:14 months of age. Certainly i
Page 18: 16:11:04 medications to the lower a
Page 22 and 23: 16:15:59 delivered about the Omron
Page 26 and 27: 16:21:11 Alternatively, there's thi
Page 28 and 29: 16:23:57 chlorofluorocarbons. Now,
Page 30 and 31: 16:26:3416:26:36 And lastly, we hav
Page 32 and 33: 16:29:07 And after they sifted thro
Page 34 and 35: 16:31:37 polarizing. There are cert
Page 36 and 37: 16:34:2116:34:22 I put another ques
Page 38 and 39: 16:36:52 mathematician, postulated

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