Friday, March 15, 2013

1 A.D. to 1900: The first Dry Powdered Inhalers

Figure 1 -- Gilewski and Rauchfuss Insufflator for
dry powder application. 
A, compressing bulb ;
B, slot covering D, aperture into which the 
is inserted; C, shower of powder leaving the instrument.
 (1, page 340)
While we may think of dry powder inhalers (DPI), with their unique, complicated, and often expensive containers, as relatively new products.  We often think of the Intal Spinhaler, first produced in the 1960s, as the first DPI.  Yet we would be wrong.  

Galen described that the ancient physician Aesculapius blew "astringent powder into the larynx by means of a bent reed" in patients who presented with angina, or chest pain.  The medicines used were nutgall and myrrh.  This is according to John Solis Cohen, the expert of sorts on inhalation devices in the 19th century.  He described the device as "being considered something of a novelty, even at the present day."  His book on inhalation devices was published in 1876. (1, page 340)

The problem with this is the powder would be inhaled back into the oral cavity upon exhalation.  To remedy this "Czermak attached a rubber ball compressor to flexible tubing, which is compressed at the proper moment.  The patient may do this treatment by his self, although most often it's done by the physician, or some assistant. (1, page 340)

F1g. 2.—Powder Inhaler Or Insufflator With Interchangeable Tubes.
It was designed by 
 Lewin and Oertel 
Yet, according to Cohen, these two methods are called insufflation as opposed to inspiration or aspiration.  Insufflation is Latin for "blowing into." The patient must hold his breath after application of the insufflation, and resist the urge to exhale to improve deposition of the medicine.

Gilewski and Rauchfuss composed a good insuflator (Fig. 1), "which consists of a properly shaped tube, with a gum ball for the purpose of propelling the powder forwards. The powder is inserted into a slot in the tube, over which a tubular cover slides after the introduction of the medicine, which can be propelled in any direction desired by arranging the apertures of exit at the distal extremity of the tube"  There were various similar products composed, although none, according to Cohen, was better than the original. (1, page 340)

Cohen described a variety of insufflators, and so did his cohort, Paul Tissier.  Tissier would be our other expert on inhalation devices in the 19th century.

Lewin and Oertel devised an insuflator that, according to Tissier, "consists of a sort of horn furnished with an opening; through this penetrates a glass tube, to the outer portion of which is attached a rubber bulb; gentle manipulation of the bulb produces in the horn a thick cloud of dust, which is propelled toward the narrow end of the instrument, where it is directly breathed by the patient. In the United States there is sold an instrument (Fig. 2) to be used either with a hand-bulb or a current of compressed air from a reservoir." (2, page 446)

Bryant created an "auto-insufflator, consisting of a bent tube, having at one point an opening, which may be closed by a stopper. Through this opening the powder is introduced; one end is placed in the nose, the other in the mouth, and gentle blowing is performed. A simple rubber tube answers the same purpose. For insufflation into the larynx and trachea one uses special curved instruments. (Figs. 114, 115.) For insufflation into the pharynx and upon the tonsils any tube may be employed, such as a reed, quill, glass or rubber tube, or a special instrument," according to Tissier. (Fig. 116).

Various physicians provided various different recommendations for the medicine to be applied to the larynx for various disorders, such as hoarseness, inability to speak, and inflammation of the palate and throat.  Remedies included:  lycopodium, cinchona, acetate of lead, nitrate of silver, and tannin,  Other physicians recommend igniting the powder and inhaling the smoke.  (1 page 340)(page 448)

Two more old DPIs from Tissier's book
  1. Cohen, John Solis, "Inhalation in the treatment of disease," 1876
  2. Tissier, Paul Lois Alexandre, "Pneumatherapy: including Aerotherapy and inhalation," 

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