94642 Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis

Name of the Procedure:

Aerosol inhalation of pentamidine, also known as aerosolized pentamidine therapy.

Summary

Aerosol inhalation of pentamidine is a treatment or preventive therapy for Pneumocystis carinii pneumonia (PCP), where the medication pentamidine is inhaled through a nebulizer to deliver it directly to the lungs.

Purpose

The procedure is used to:

• Treat active Pneumocystis carinii pneumonia infection.
• Prevent Pneumocystis carinii pneumonia in individuals at high risk, such as those with weakened immune systems or HIV/AIDS.

Indications

• Patients diagnosed with Pneumocystis carinii pneumonia.
• High-risk patients (e.g., HIV-positive individuals with low CD4 counts) requiring prophylaxis to prevent PCP.

Preparation

• The patient may need to fast for a few hours before the procedure.
• Pre-procedure screening to ensure no contraindications, including a review of medical history and current medications.
• Baseline lung function tests may be performed.

Procedure Description

1. The patient is seated comfortably, and the nebulizer device is prepared with the correct dosage of pentamidine.
2. The patient breathes in the medication through the mouthpiece or mask over a period of about 30-45 minutes.
3. The healthcare provider may monitor the patient's breathing and vital signs during the procedure.
4. Post-treatment, patients are observed for any immediate reactions.

Duration

Typically, the aerosol inhalation procedure takes about 30-45 minutes.

Setting

The procedure is usually performed in an outpatient clinic, specialized treatment center, or hospital.

Personnel

• A respiratory therapist, nurse, or trained healthcare provider administers the treatment.
• Physician oversight may be required, especially for initial treatments.

Risks and Complications

Common:

• Coughing and throat irritation.
• Bronchospasm or wheezing.

Rare:

• Allergic reactions.
• Development of secondary infections.

Benefits

• Effective in treating and preventing Pneumocystis carinii pneumonia.
• Direct delivery to the lungs reduces systemic side effects.
• Benefits can be realized within a few days for active infections, or serve as ongoing prevention.

Recovery

• Patients can generally resume normal activities shortly after treatment.
• Follow-up appointments to monitor progress and manage any side effects.
• Regular treatments may be necessary for prophylaxis.

Alternatives

• Oral or intravenous administration of pentamidine or other anti-PCP medications such as trimethoprim-sulfamethoxazole.
• Pros: Oral/IV treatments may be easier to administer for some patients.
• Cons: Increased risk of systemic side effects compared to inhaled therapy.

Patient Experience

During the procedure:

• Patients might feel a metallic taste in their mouth.
• Some mild discomfort from the nebulizer mask or mouthpiece.

After the procedure:

• Patients may experience mild coughing or throat irritation that typically resolves quickly.
• Pain management is generally not necessary due to the non-invasive nature of the procedure.