Immunology Review Corner

Prepared by Thao N. Tran, M.D., Stony Brook University Hospital–SUNY; Karla Lowe, M.D., Walter Reed Medical Center; and Todd Levin, M.D., Medical College of Georgia.

Chapter 46: Aerosols

1. Peripheral airway deposition is reduced and central airway deposition is increased when the aerosolized particle’s diameter is greater than which of the following?
a. 0.5 micrometers
b. 3 micrometers
c. 4.5 micrometers
d. 8 micrometers

2. Which breathing pattern can facilitate deposition of aerosolized particles to the peripheral portions of the lung?
a. Slow inspiratory flow rate
b. Rapid expiratory flow rate
c. Rapid inspiratory flow rate
d. Minimize the time in which the breath is held after inspiration

3. Spacer devices have been shown to decrease oropharyngeal deposition of aerosolized medications and compensate in part for the delay in inhalation after actuation of the device. Which of the following is also true about spacer devices?
a. With coordinated use, parenchymal deposition of drug within the lung is similar with or without a spacer.
b. Spacers with two-way valves can improve compliance due to greater ease-of-use.
c. Enhanced drug delivery is obtained with spacer chambers of 75-100 mL volume.
d. A spacer with sonic feedback will “whistle” if the patient inhales too slowly.

4. Which of the following devices requires rapid inhalation to generate the aerosol?
a. CFC (chlorofluorocarbons) pressurized metered-dose inhaler (pMDI)
b. HFA (1,1,1,2, tetrafluoroethane) pMDI
c. Dry-powder inhaler (DPI)
d. Nebulizer

5. Oral bioavailability of a drug is defined as:
a. The level of drug activity that remains after it is ingested
b. The percentage of an oral dose that reaches the systemic circulation
c. The initial dose of the inhaled drug minus the amount of alveolar deposition
d. The percentage of the aerosolized drug that is deposited on the oropharynx

6. With respect to most pMDI, which of the following ratios best describes the amount of medication deposited in the oropharynx, as compared to the lung?
a. 1/4 oropharynx: 1 lung
b. 1/2 oropharynx: 1 lung
c. 2 oropharynx: 1 lung
d. 4 oropharynx: 1 lung

7. The oral bioavailability of which of the following corticosteroids, if aerosolized, approaches 100 percent?
a. Dexamethasone
b. Budesonide
c. Flunisolide
d. Triamcinolone

8. Which of the following corticosteroids, when given by pMDI or DPI, has the lowest oral bioavailability?
a. Beclamethasone
b. Budesonide
c. Fluticasone
d. Triamcinolone

9. Beyond which age are children generally able to use a DPI device?
a. 3 years
b. 4 years
c. 5 years
d. 6 years

10. Which of the following statements about mucociliary clearance is the most accurate?
a. Beta agonists and theophylline decrease rates of mucociliary clearance.
b. Corticosteroids improve mucociliary clearance acutely.
c. In healthy subjects, mucociliary clearance is usually completed within 3-5 days of deposition.
d. In healthy subjects, the fastest rate of mucociliary transport is in the trachea.

Answers:
1. c, page 759
2. a, pages 759-760
3. a, page 761
4. c, page 762
5. b, page 767
6. d, page 767
7. a, page 767
8. c, page 768
9. b, page 769
10. d, pages 771-772