Treatment with inhalation medication in laryngectomized patients
In patients who still need inhalation medication, the application of such a drug is often problematic. The standard dose inhalers are specially designed for oral use, and the size of the nebulized particles should allow them to ‘stay airborne’ during transoral, -pharyngeal, and -tracheal passage. Even than, often a considerable amount of the drug will become deposited on the pharyngeal and laryngeal mucosa and not reach the trachea and bronchi, where the medication is supposed to exert its effect. Although there are no data available on the delivery of inhalation medication through the stoma, it is conceivable that in this case the results are even less ideal. Also, a good hand-breathe coordination, which is a prerequisite for optimal delivery of the drug in oral application, is probably more cumbersome for laryngectomized individuals. Therefore, delivery right out of the dose-inhaler through the stoma, as shown in the top figure, is probably suboptimal. Preliminary data in our clinic suggest that delivery through a spacer (shown in the lower figure; Babyhaler, Glaxo-Welcome), connected to the peristomal area through a Provox HME adhesive, gives better results. Further clinical studies are needed to substantiate this, but in the mean time, it seems logic to add a spacer to the prescription of a dose inhaler for laryngectomized patients.