Name of the Procedure:

• Common Names: Pentamidine Inhalation Therapy
• Technical/Medical Terms: Administration of Pentamidine Isethionate via Inhalation, HCPCS Code J7676

Summary

Pentamidine isethionate is a medication used to treat certain types of pneumonia, specifically Pneumocystis jirovecii pneumonia (PJP), which is commonly seen in patients with weakened immune systems. It is inhaled into the lungs using a nebulizer connected to durable medical equipment (DME).

Purpose

This procedure targets Pneumocystis jirovecii pneumonia (PJP), a serious infection in the lungs. By delivering the medication directly to the lungs, it aims to effectively eradicate the pneumonia-causing organism. The expected outcome is the resolution of infection and prevention of complications associated with PJP.

Indications

• Patients diagnosed with Pneumocystis jirovecii pneumonia (PJP)
• Individuals with compromised immune systems, such as those with HIV/AIDS or those undergoing chemotherapy
• Those who are allergic to other primary treatments for PJP

Preparation

• Patients are usually advised to fast for a few hours before the procedure.
• Avoid smoking and exposure to other airborne irritants.
• Doctors may recommend a bronchodilator before inhalation to open the airways.
• Pre-treatment diagnostics may include a chest X-ray and blood tests.

Procedure Description

1. The patient is seated in an upright position.
2. A nebulizer is connected to DME, into which 300 mg of pentamidine isethionate, constituted from a compounded product, is placed.
3. The patient inhales the aerosolized medication through a mouthpiece or mask over approximately 30-45 minutes.
4. The inhalation process may be supervised by a respiratory therapist or nurse to ensure effective drug delivery.
5. Post-inhalation, the equipment is cleaned and the patient is monitored for any adverse reactions.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

Pentamidine inhalation therapy is usually performed in a hospital outpatient clinic or specialized treatment center.

Personnel

• Respiratory Therapist
• Nurse
• Primary Care Physician or Specialist (depending on the patient’s medical history)

Risks and Complications

• Common: Cough, bronchospasm, bad taste, throat irritation.
• Rare: Severe allergic reactions, hypotension, hypoglycemia.
• Management: Use of bronchodilators to reduce bronchospasm, allergy medications for minor reactions, and emergency protocols for severe complications.

Benefits

• Effective treatment for PJP, especially in patients who are intolerant to other therapies.
• Faster delivery and absorption of medication directly into the lungs.
• Symptom relief and infection resolution typically observed within a few days to weeks.

Recovery

• Patients can usually return to their normal activities immediately after the procedure.
• Continue to avoid smoking and other irritants.
• Follow-up appointments may be required to monitor treatment effectiveness and manage any side effects.

Alternatives

• Oral or intravenous antibiotics such as Trimethoprim-sulfamethoxazole (TMP-SMX).
• Alternative inhalation medications like Atovaquone.
• Pros: TMP-SMX is considered a first-line treatment and may be more familiar.
• Cons: Other alternatives may not be suitable for patients with allergies or side effects to these medications.

Patient Experience

Patients might feel a mild discomfort from the taste or sensation of the inhaled medication. Bronchospasm or coughing may occur during inhalation, which can be mitigated with prior use of bronchodilators. Pain management and comfort measures include reassurance and monitoring by healthcare professionals, making the experience as smooth as possible.