UNIT I CARDIAC AND RESPIRATORY

THERAPY EQUIPMENT
• Cardiac Pacemaker: Internal and External
Pacemaker– Programmable pacemakers. Cardiac
Defibrillators: AC and DC Defibrillator- Internal and
External Defibrillators - Protection Circuit,
Defibrillator analyzers. Cardiac ablation catheter.
Types of Ventilators – Pressure, Volume, and Time
controlled. Basic principles of electromechanical,
pneumatic and electronic ventilators, Patient Cycle
Ventilators, Ventilator testing. Humidifiers,
Nebulizers, Inhalators
 Need for Pacemakers
• Rhythmic beating of heart is due to the triggering pulsed
generated at the SA node.
• If the SA node ceases to function, or if pulses do not reach the
heart muscles, the normal heart action gets disturbed.
• An external electrical stimulation can regulate the heart rate.
These pulses are given by an electronic instrument called
pacemaker.
• A pacemaker is a small device that's placed in the chest or
abdomen to help control abnormal heart rhythms.
• This device uses electrical pulses to prompt the heart to beat at
a normal rate.
• Pacemakers are used to treat arrhythmias
 CARDIAC PACEMAKER

• pacemaker is a cardiac assist devices

• A device capable of generating artificial pacing impulses and
delivering them to the heart is known as a pacemaker system
• Pacemaker consists of a pulse generator and electrodes.
Types of cardiac pacemakers
1. Internal pacemakers : entire pacemaker system is inside the body
- SA nodes have failed to function properly due to permanent heart
block
2. External pacemaker : external pulse generator connected to
electrodes located within the myocardium.
- used on patients with temporary heart irregularities
• All cardiac pacemakers have:
• a pulse generator - a device that gives off an electrical impulse
at prescribed intervals),
• electrical leads -which transmit the impulse to the myocardium
• a battery - usually made of lithium iodide) encased in titanium
and implanted surgically in a subcutaneous pocket (usually in
the chest).
• A small incision (cut) is made, most often on the left side of the
chest below the collarbone.
• The pacemaker generator is then placed under the skin at this
location.
Cardiac Pacemakers

unit-iii
External pace maker Internal pace maker
Placed outside the body Pacemaker is implanted
beneath the skin near the chest
Electrode is called endocardiac Electrode is called myocardiac
electrode electrode
No need for open heart surgery Require a minor open heart
surgery
 External Pacemakers
• External pacemakers are a temporary means of pacing a
patient's heart during a medical emergency.
• It is accomplished by delivering pulses of electric current
through the patient's chest, which stimulates the heart to
contract.
• During external pacing, pads are placed on the patient's
chest, either in the anterior/lateral position or the
anterior/posterior position.
• The anterior/posterior position is preferred as it minimizes
transthoracic electrical impedance by "sandwiching" the
heart between the two pads.
The pads are then attached to a monitor/defibrillator, a heart
rate is selected, and current (measured in milliamps) is
increased until electrical capture (characterized by a wide QRS
complex with tall, broad T wave on the ECG) is obtained, with a
corresponding pulse.
Adjustable from 50 to 150 bpm and produce fixed duration short duty cycle pulses
of 1.5 to 2.0 msec; Peak curent amplitude adjustable from 100 Microamps to 20
mamps
 internal pacemaker
• An internal pacemaker is one in which the electrodes into the
heart, the electronic circuitry and the power supply are
implanted (internally) within the body.
 Programmable pacemakers
• Programmable pacemaker is an implantable
pacemaker together with a physician's console
containing the programmer and a data printer
• main feature of the programmable
pacemakers is to change pacing modes non-
invasively.
• programmable pacemaker functions with
varied pulse rate, energy output, refractory
period and sensing threshold
Pacing Modes and Pulse Generators
Types of pacing modes.
1. Competitive(Asynchronous)
2. Non competitive(synchronous)
[Link]
fixed-rate impulses may occur along with natural
pacing impulses generated by the heart and there
would be a competition between them in controlling
the heartbeat.
[Link] Competitive(
Non Competitive does not compete with the
natural heart activity
Types of non competitive
[Link]-programmed
-sense the presence or absence of naturally occurring R wave
used when venricles are able to depolarize but the impulse fails to
depolarize the atria
2. Atrial-programmed(P wave synchronized)
-sense the presence or absence of naturally occurring P wave

-usedwhen atria are able to depolarize but the

impulse fails to depolarize the ventricles
Types of ventricular-programmed
1a. R wave inhibited(demand)
-pacing stimulation delivered only if the heart rate falls below the
preset limit.
-No output pulses are present as long as natural R waves are present
- If the natural heart(intrinsic) rate falls below the preset rate of the
pacer (70 BPM), the unit will automatically provide an output to pace
the heart
1b. R wave Triggered(standby)
-delivers stimuli in response to (sensing )cardiac event
-emits an impulse with the occurrence of each sensed R wave.
-less frequently than inhibited-mode pacing
 Types of programmable pacemaker

1. ventricular R wave inhibited(demand type)

2. ventricular R wave Triggered(stand by)
3. Arterial P wave synchronous pacemaker
 ventricular R wave inhibited(demand)

pacing stimulation delivered only if the heart rate falls below the preset
limit.
-No output pulses are present as long as natural R waves are present
- If the natural heart(intrinsic) rate falls below the preset rate of the
pacer (70 BPM), the unit will automatically provide an output to pace
the heart
 - The circuit consists of three parts pulse generator , Compensation
circuit and feedback circuit
pulse generator consists of timing circuit pulse width circuit and rate
limit circuit
- Pulses generated are rectangular in shape with a duration of from
0.15 to 3 msec,
- pulse amplitudes may range from 5 to 15 mA
timing circuit consists of an RC network, a reference voltage source, and
a comparator -determines the basic pacing rate of the pulse generator.
pulse width circuit
-It is a second RC network, which determines the stimulating
pulse duration of the signal coming from the timing circuit

• Rate-limiting circuit
It is the third RC network, that disables the comparator for a preset
interval and thus limits the pacing rate to a maximum of 120 pulses
per minute.
• output circuit
provides a voltage pulse to stimulate the heart.
Compensation circuit
• voltage monitor circuit senses cell depletion and send
signals to rate slowdown circuit and energy compensation
circuit of this event.
• The rate slowdown circuit shuts off some of the current to
the basic timing network to cause the rate to slow down 8 ±
3 beats per minute when cell depletion has occurred.
• The energy-compensation circuit causes the pulse duration
to increase as the battery voltage decreases, to maintain
nearly constant stimulation energy to the heart.
• Feedback circuit
• Refractory circuit, - provides a period of time following an
output pulse or a sensed R-wave during which the amplifier
will not respond to outside signals.
• The sensing circuit detects a spontaneous R wave and resets
the oscillator timing capacitor.

• The reversion circuit allows the amplifier to detect a

spontaneous R wave in the presence of low-level continuous
wave interference.
- In the absence of an R wave, this circuit allows the oscillator
to pace at its preset rate ± 1 beat per minute.
 ventricular R wave Triggered(stand by)
-delivers stimuli in response to (sensing )cardiac event
-emits an impulse with the occurrence of each sensed R wave.
-less frequent than inhibited-mode pacing

Explanation same as ventricular R wave inhibited(demand) type

 Defibrillators
• Heart pumping is the synchronized action of the heart muscle fibers.
Fibrillation -ventricular muscles are synchronously activated after the
activation of atria to pump blood. Loss of these synchronization leads
to irregular twitching of muscles is known fibrillation.
Types
1. atrial fibrillation-fibrillation of the atrial muscles
2. ventricular fibrillation- fibrillation of the ventricles
-more dangerous than atrial fibrillation
Defibrillation - application of electric shock(counter shock) to the heart
muscle simultaneously for a brief period of time to resynchronize the
heart(normal function)
defibrillator is a device that delivers electric shock to the heart muscle
undergoing a fatal arrhythmia.
Types of Defibrillators
– AC Defibrillator
 Circuit diagram of DC Defibrillator

Principle
capacitor is charged to a high dc voltage and then rapidly discharged
through electrodes across the chest of the patient.
-capacitor discharge voltage - 100 to 400 W /sec, duration-5msec
 Circuit diagram of DC Defibrillator

• A variable auto-transformer T1 forms the primary of a high voltage

transformer T2.
• The output voltage of the transformer is rectified by a diode rectifier
and is connected to a vacuum type high voltage change-over switch.
• In position A, the switch is connected to one end of an oil-filled 16
micro-farad capacitor.
• In this position, the capacitor charges to a voltage set by the
positioning of the auto-transformer.
• When the shock is to be delivered to the patient, a foot switch or a
push button mounted on the handle of the electrode is operated.
• The high voltage switch changes over to position ‘B’ and the
capacitor is discharged across the heart through the electrodes.
• capacitor stores energy, WA, which develops a
voltage, V, across its metal plates.
– The amount of energy in units of joules is given by
V2
WA C
2
• C is capacitance in farads
• V is the voltage across the capacitor.
• The energy stored in the capacitor is proportional to the
square of the voltage between its plates.
Discharge waveform(monophasic) Dual-peak monophasic Truncated waveform.

Discharge wave is monophasic-most of its energy is above the baseline.

-area under the curve is proportional to the energy delivered.
-peak value of current is 20 A, peak voltage-6000V
-The waveform then decays back to zero within 5 ms
-An inductor is used to eliminate the undesirable current spike that
occurs at the beginning of the discharge.
-High peak voltage may damage the myocardium, therefore dual-peak
low voltage(50 to100W) waveform of longer duration (10 msec) or
truncated waveform of constant amplitude , with required amount of
energy(varying the duration) is used
AC Defibrillators
 AC Defibrillators
• In AC defibrillation, a shock of 50 Hz a.c frequency is
applied to the chest for a time of 0.25 to 1 second
through electrodes.
• An AC defibrillator consists of a step-up transformer
with primary and secondary winding, and two switches.
• A.C supply is given through switches and fuse to
primary winding of the transformer.
• The timing circuit is connected with switch, which is
used to preset the time for the defibrillator to deliver
shock to the patient.
 AC Defibrillators
• For safety reasons, secondary coil should be isolated from
earth to avoid shock.
• For internal fibrillation voltage values between 60 V to
250 V is applied.
• To produce uniform and simultaneous contraction of
heart muscles large currents are used for external
defibrillation.
• However, this results in skin burn under electrodes and
violent contraction of heart muscles.
• It also results in atrial fibrillation and stops ventricular
fibrillation.
 Defibrillator Electrodes

Electrode (paddles )– used to deliver large discharge current

to the heart muscles
• Electrodes for external (transthoracic) use are large metal
disks of diameter 8 to 10 cm
• a pair of electrodes is firmly pressed against the patient's
chest through conductive jelly or a saline-soaked gauze pad
to prevent burning.
• two electrodes are either anterior-anterior (both paddles
are to the chest) or anterior-posterior paddles(.paddles are
applied to both the patient's chest wall and back )
• For internal use (direct contact with the heart) smaller
paddles are applied.
Defibrillator Electrodes

unit-iii
 cardioversion
• cardioversion :This process of using defibrillators to
reduce the effect of dangerous arrhythmias(fast heart rate
with normal rhythm)
-sometimes when defibrillator is used for arrhythmias,
ventricular defibrillation may occur.
-To avoid this, the discharge to be synchronized with the
ECG
-The optimum time for discharger is during the occurrence
of R wave when the heart is in absolute refractory period
-The synchronization ensures that the discharge is not
delivered during the T wave to prevent ventricular fibrillation
.
 Internal defibrillator
• This is a small match box sized device that can be
implanted in the body: in the chest or abdomen.
• It can constantly monitor the heart rhythms, and
deliver the necessary electrical impulse before the
disrupted rhythms translate to a cardiac arrest.
• device is hermetically sealed, bio-compatible, and
able to survive 500 G’s over a temperature range of –
30°C to 60°C.
• These devices allow the physician to non-invasively
programme the therapy rate threshold.
 Internal defibrillator
• An implantable defibrillator is continuously monitors a
patient’s heart rhythm.
• If the device detects fibrillation: the capacitors with in the
device are charged up to 750 V.
• The capacitors are then discharged into the heart to bring
it into normal rhythm.
• most devices limit the number of high energy shocks to 4
or 5 during any single arrhythmic episode.
• The shock duration for efficient defibrillation is
approximately 4-8 ms which results in the delivery of
approximately 30–35 J at 750 volts
 Internal defibrillator
Basic components of an implantable defibrillator.
1. Battery,
2. Capacitor- to store and deliver charges,
3. Microprocessor and integrated circuits -for ECG
sensing, data capture, storage and control the
therapy delivery
4. Header – to connect the endocardial leads used for
sensing, pacing and defibrillation.
• All these components together are called a pulse
generator and are encased in a titanium can.
Implantable defibrillator system architecture
 Internal defibrillator
• ROM -provides non-volatile memory for system start-up
tasks and some program space,
• RAM is required for storage of operating parameters, and
storage of electrocardiogram data.
• The system control part includes support circuitry for the
microprocessor like a telemetry interface.
• DC to DC converter used to convert the 6 volt battery voltage
to 750 V
• storage capacitors are typically aluminum electrolytics
• peak currents of the order of 40A are common in output
circuits
External defibrillator
External defibrillator
 External defibrillator

• captures ECG signals from the electrodes, runs an ECG

analysis algorithm to identify shockable rhythms, and
then advises the operator necessity of defibrillation
• A basic defibrillator contains the components such as
a high-voltage power supply,storage capacitor,
inductor, and patient electrodes.
• It develops an electrical charge in the capacitor to a
desired voltage, creating the potential for current flow.
• The higher the voltage, the more current can
potentially flow.
 External defibrillator

• The Automatic External Defibrillator outputs audio

instructions and visual prompts to guide the operator
through the defibrillation procedure
• If shockable rhythm detected the capacitor is charged
according to energy stored in the capacitor, W = ½ CV2
• operator presses the shock button to deliver the high
voltage pulse; so current begins flowing through the
body to depolarize most of the heart cells, which
often re-establishes coordinated contractions and
normal rhythm
 External defibrillator

• front-end signals of the AED come from the

ECG electrodes
• an instrumentation amplifier amplifies the very
small amplitude (<10mV)
• other front-end signal of the AED is the
microphone input for recording the audio from
the scene of a cardiac arrest
• Both ECG and microphone input are digitized
and processed by DSP
 Defibrillator analyser
• measures the energy content in the discharge
pulse.
• energy contained in a pulse of arbitrary shape
and time duration is given by
Defibrillator analyser
 Defibrillator Analyser
• The defibrillating pulse is applied across a standard 50 W load
and the voltage developed across it is given to a squaring
circuit.
• The squaring circuit consists of a four-quadrant multiplier
followed by an operational amplifier.
• The output of this device is a current which is proportional to
the product of the two inputs.
• In the squaring mode, the two inputs are connected together
so that the output is a square of the input voltage.
• The operational amplifier acts as a current to voltage
converter producing an output voltage which is proportional to
the output current, from the multiplier.
 Cardiac ablation Catheter
• This procedure is performed to treat heart rhythm
disorders, also known as arrhythmias.
• The catheter is a thin, flexible tube that is inserted
into the heart through a blood vessel, and threaded
up to the heart's chambers.
• Ablation procedure eliminate abnormal electrical
pathways in the heart that cause arrhythmias.
• These abnormal pathways can disrupt the heart's
normal electrical signals, leading to irregular
heartbeats.
unit-iii
 Cardiac ablation Catheter
• During the procedure, the tip of the cardiac
ablation catheter emits energy, such as
radiofrequency (heat)to create controlled
lesions or scars in the heart tissue.
• These lesions disrupt the abnormal electrical
pathways and prevent the abnormal electrical
signals from traveling through the heart.
• By doing so, the heart's rhythm can be restored
to a more normal pattern, reducing fibrillation
 Ventilators
• Mechanical Ventilation is ventilation of the
lungs by artificial means usually by a ventilator.
• A ventilator delivers gas to the lungs with either
negative or positive pressure
• To maintain or improve ventilation, & tissue
oxygenation.
• To decrease the work of breathing & improve
patient’s comfort

unit-iii
 Ventilators(Respirator)
-Device to improve continuous or intermittent ventilation of
the lungs and to supply humidity and medications to the
pulmonary tree.
Principle
-use positive pressure during inhalation to inflate the lungs
with various gases or mixtures of gases (air, oxygen, carbon
dioxide, helium, etc.).
-Expiration is passive
Modes of operation of ventilator
1. assist mode
2. control mode
3. assist-control mode
Assist mode
-used for patients who are able to control their breathing but are
unable to inhale a sufficient amount of air without assistance
-The negative pressure created by the patient’s attempt to inhale is
measured by a pressure sensor
-This triggers the apparatus to begin inflating the lungs
control mode
-used for patients who are unable to breathe on their own.
-breathing is controlled by a timer set to provide the desired
respiration rate.
assist-control mode
-apparatus is normally triggered by the patient's attempts to
breathe, as in the assist mode.
-if the patient fails to breathe within a predetermined time, a timer
automatically triggers the device to inflate the lungs.
 Ventilator

• Negative-pressure ventilator patient body is in

a sealed chamber  chamber pressure is
reduced negative pressure within the
thorax inhale  return chamber pressure to
atmosphere  lungs recoil and exhale.
• Positive-pressure ventilator: blow air into the
lungs by increasing the pressure in the trachea
(inhale)  lungs recoil when the positive
pressure is removed (exhale)
Classification of positive-pressure ventilators

• Ventilators are classified according to how the

inspiratory phase ends.
• 1- Pressure controlled ventilator
• 2- Volume controlled ventilator
• 3- Time controlled ventilator
 pressure-controlled (positive-pressure assistor controller)

• A ventilator designed in such a way that predetermined pressure cannot

be exceeded during inspiration.
• Flow is shut off when a preset amount of pressure in the lungs is reached
• Includes all the necessary equipment
-to control the flow of gas(control unit),
- mix air and oxygen(Blender),
-sense the patient's effort to inspire(sensor),
- terminate the inspiration when the desired pressure is
reached(valve),

• - device is powered pneumatically from a source of gas or permit

ventilation with compressed ambient air.
• - In assist mode, valve that incorporates a magnet, senses the small
negative pressure created by a patient when he attempts to inhale.
 Volume-controlled ventilator
• A ventilator in which pre-determined volume cannot
be exceeded during inspiration.
• Volume limit normally refers to tidal volume.
• tidal volume -is the amount of air the patient
receives with each breath
• the ventilator delivers breaths with a predetermined
tidal volume,
• uses either a piston or bellows to dispense a
precisely controlled volume for each breath with
adjustable pressure units .
unit-iii
 Volume-controlled ventilator
• inspiratory, expiratory times can be used in
conjunction with the volume setting
• always supplied with a spirometer to permit
accurate monitoring of the patient's
ventilation.
• electrically operated

unit-iii
 Time –controlled ventilators

• A ventilator in which predetermined phase time cannot be

exceeded.
• Time-controlled ventilation involves delivering breaths at a
fixed rate or frequency, regardless of the patient's effort to
breathe.
• TCV is commonly used for patients who have limited
respiratory drive and require complete ventilatory support.
• Used with negative-pressure ventilator 
• Time period for negative pressure is controlled by
microprocessor and solenoid valves.
• They are used in pediatric intensive care areas
unit-iii
 ventilator Classification based on
operating principle
[Link] ventilators,
2. pneumatic ventilators,
3. electronic ventilators

unit-iii
 Electromechanical Ventilators:

• Electromechanical Ventilators:
• Principle: Electromechanical ventilators use mechanical
components and motors to deliver breaths to the patient.
• Operation: These ventilators typically have a set of bellows
or pistons driven by an electric motor. The motor controls
the movement of the bellows or pistons, which in turn,
generate the airflow to deliver breaths to the patient.
• Control: The ventilator's settings, such as the respiratory
rate and tidal volume, can be adjusted using mechanical
knobs and dials.

unit-iii
 Pneumatic Ventilators:

• Principle: Pneumatic ventilators use pressurized gas to

control the delivery of breaths to the patient.
• Operation: These ventilators rely on compressed gas
sources, such as oxygen and air, to create pressure
differentials that control the airflow. The flow of gas is
directed by valves and regulators to generate the
desired pattern of breathing.
• Control: Pneumatic ventilators often have mechanical
control knobs and dials to adjust various settings,
including the inspiratory time, expiratory time, and
pressure levels.
unit-iii
unit-iii
• Electronic Ventilators:
• Principle: Electronic ventilators are driven by electronic controls
and sensors to deliver breaths to the patient.
• Operation: These ventilators use microprocessors and sensors
to monitor and regulate the patient's respiratory parameters.
The sensors measure variables like airflow, pressure, and patient
effort, which are processed by the microprocessor to determine
the appropriate ventilatory support.
• Control: Electronic ventilators have digital interfaces that allow
healthcare providers to input specific settings, such as tidal
volume, respiratory rate, and positive end-expiratory pressure
(PEEP).
unit-iii
 Patient Cycle Ventilators
• Cycling control of a ventilator is the device which
determines the change from the inspiratory phase
to the expiratory phase and vice versa.
• The cycling of a ventilator may be based upon
different factors such as pressure, volume, time
and the inspiratory effort made by the patient
1. Cycling from Inspiration to Expiration
2. Cycling from Expiration to Inspiration

unit-iii
unit-iii
 Cycling from Inspiration to Expiration

• Volume Cycled: A ventilator which starts the expiratory phase

after a preset tidal volume has been delivered into the patient
circuit.
• This device has a pressure over-ride valve so that if, while the
machine is in the process of administering the set volume, the
pressure exceeds a pre-determined maximal value, the
ventilator will cycle whether or not the appropriate volume has
been administered
• Pressure Cycled: A ventilator which begins the expiratory phase
after a preset pressure hasbeen attained.
• Time Cycled: A ventilator which initiates the expiratory phase
after a preset time period for the inspiratory phase has passed.
unit-iii
 Cycling from Expiration to Inspiration

• Pressure Cycled: A ventilator which begins the

inspiratory phase after a preset end expiratory
pressure has been attained.
• Time Cycled: A ventilator which initiates the
inspiratory phase after a preset time period for
the expiratory phase has passed.
• Patient Inspiratory Effort Cycled: A ventilator
which starts the inspiratory phase in response
to the inspiratory effort.
unit-iii
 PRESSURE-VOLUME-FLOW DIAGRAMS
• performance of a ventilator--- pressure-time, flow-
time and volume-time diagrams
• The ventilated system – [Link] circuit, [Link] airway
and the alveoli, each having its own compliance.
• during inspiratory phase, a certain gas volume is
delivered into the system, this gradually increases the
pressure in the patient circuit, the airway and the
alveoli
• the airway pressure is always higher than the alveolar
pressure
unit-iii
Pressure, flow and volume pattern in A ventilated
system with and without pause

unit-iii
• The equal pressure of the patient circuit and alveoli
determines the end of the inspiratory flow and
beginning of the expiratory flow,
• . The expiratory flow is determined by the
difference between alveolar pressure and pressure
in the patient circuit.
• – an airway pressure higher than the alveolar
pressure characterizes an inspiratory flow
• – an airway pressure lower than the alveolar
pressure characterizes an expiratory flow
unit-iii
unit-iii
• it is necessary to provide a time delay (pause time)
between the cycling of the ventilator and the
change from inspiratory flow to expiratory flow in
the airway.
• During this pause time, the flow becomes zero
when the alveolar pressure equals the airway
pressure and constant volume is maintained in the
lungs.
• Ventilators producing a pause time are more
beneficial over the other..
unit-iii
 Humidifier
• The main task of a humidifier is to replace humidity in
the upper air passages which has been lost by
intubation.
• The humidity should be as close to 100% as possible
regardless of environmental conditions.,
• the air or oxygen applied during respiratory therapy
must be humidified.
• Thus, all ventilators include arrangements to humidify
the air, either by heat vapourization (stream) or by
bubbling an air stream through a jar of water
unit-iii
 Types of Humidifier
Revolving wicks humidifier Atomizing humidifiers
• Compressed air and water
• As the drum rotates, the wetted intersect to create a mist that
wicks come in contact with air absorbs heat from the air stream
and water in the wick vapourizes. for evaporation into a vapor.
The water vapours so formed are • The droplets need to be small as
mixed with air. to float in the air long enough to
be absorbed.

unit-iii
 Ultrasonic nebulizers
• A device used to administer water or a type of medication
suspended in the inspired air as an aerosol to the patient, is
called as nebulizer
• In this device, the water or medication is picked up by a high
velocity jet of air/oxygen and made to impact against one or
more baffles to break the substance into controlled-sized
droplets which are then applied to the patient via a ventilator
• More effective and efficient nebulizers are based on the use
of high intensity ultrasound energy which vibrates the
substance (water or medication) to produce a high volume of
minute particles.
• Ultrasonic nebulizers do not depend upon breathing gas for
operation unit-iii
Ultrasonic nebulizers

unit-iii
Inhalers
The device contains a canister (the
cylinder)and an actuator (operator of
the device), and sometimes a spacer.
The canister is connected with a
metering dose valve with the actuator.
The formulation of the drug present in
the canister is a liquefied gas
propellant.
Actuation of the device releases a
single metered dose of liquid
propellant that contains the drug
formation.
The microparticles/microdroplets are
delivered
unit-iii into the lungs.
unit-iii