Inhalation Drug Research Articles

Estudiantes universitarios y su incursión en el alcohol, tabaco y otras sustancias

Introducción: El presente estudio tuvo como objetivo identificar la cantidad de estudiantes en una institución de educación superior en el interior paulista que experimentan su incursión en el alcohol, el tabaco y otras sustancias, y evaluar así la ocurrencia y el nivel de dependencia de los mismos. Materiales y Métodos: Se trata de un extracto de un estudio de levantamiento, exploratorio, descriptivo, de enfoque cuantitativo, realizado con 416 estudiantes universitarios. Los datos fueron recolectados en el transcurso del 3º trimestre de 2017, mediante la aplicación de un cuestionario semi-estructurado, elaborado por los autores y del Cuestionario para Triaje de Uso de Alcohol, Tabaco y otras Sustancias. Los datos fueron analizados a través de un análisis estadístico descriptivo, la prueba de Qui-Cuadrado de Pearson y de acuerdo con las instrucciones para la aplicación del instrumento seleccionado. El estudio fue recibido y aprobado por el Comité de Ética en Investigación. Resultados: Los índices generales de incursión y el tipo de drogas son: 140 (30%) para derivados del cigarrillo, 303 (66%) para bebidas alcohólicas, 89 (19%) para marihuana, 32 (7%) para cocaína/crack, 24 (5%) para anfetaminas o éxtasis, 30 (7%) para drogas inhaladas, 45 (10%) para hipnóticos/sedantes, 36 (8%) para alucinógenos, y nueve (2%) para opioides. Discusión: Los estudiantes demostraron haber estado involucrados con todos los tipos de sustancias, lo que se asocia a la flexibilización con respecto al uso de las mismas en el ambiente universitario y a la facilidad de acceso. Conclusiones: La relación de los universitarios con el alcohol, el cigarrillo y otras sustancias es real e intensa. Además de esa relación, el riesgo de adicción a estas sustancias se configura como un gran problema social y de salud. Como citar este artigo: Silva DA, Junior RJP, Gomes CFM, Cardoso JV. Envolvimento com álcool, tabaco e outras substâncias por estudantes universitários. Rev Cuid. 2019; 10(2): e641. http://dx.doi.org/10.15649/cuidarte.v10i2.641

Multidirectional inhalation therapy of acute rhinosinusitis

In the article is discussed the problem of antibiotic resistance, widespread and not always justified use of systemic antibiotics in the treatment of acute rhinosinusitis. The main spectrum of bacterial pathogens of acute rhinosinusitis, their sensitivity and resistance are showed, including in the Russian Federation. Presents topical inhalational drug Fluimucil IT contains mucolitic and antibiotic as a possible replacement of systemic antibiotics, in conjunction with its better tolerability, including in children, and less pronounced side effects.

Prescriptions for Asthma and COPD in Germany for the Years 2007, 2010, 2013, 2015 - 2017

Numbers of prescriptions of the most important substances/combinations for the treatment of asthma and COPD have been extracted out of the sum of all prescriptions of a statistically relevant number of family physicians, internal medicine specialists and pneumologists and analysed.Prescriptions of inhalation drugs showed an increase and those of oral drugs a decrease in therapy of asthma and COPD over a period of 10 years.With asthma there was a clear increase in the prescription of anti-inflammatory substances and a decrease in that of short-acting bronchodilators. There was an increase in prescriptions of short-acting beta agonists in relation to prescriptions of short-acting muscarine antagonists and short-acting beta agonists/short-acting muscarine antagonists, which showed a decrease. For the therapy of COPD, there was a clear increase in the prescription of long-acting bronchodilators and a very slight tendency towards a decrease of ICS-containing drugs. This decrease was so slight that we still have to fear extensive overuse of ICS in COPD. Prescriptions of short-acting bronchodilators increased minimally, and whereas there was an increase in prescriptions of short-acting beta-agonists, there was a decrease in short-acting muscarine antagonists and short-acting beta agonists/short-acting muscarine antagonists.

Inhalable Nanostructures for Lung Cancer Treatment: Progress and Challenges

Background: Worldwide, lung cancer is the major cause of deaths due to cancer. Most of the lung cancer cases are categorized as 85% cases of non-small cell lung cancer, while remainder 15% cases are known as small cell lung cancer. The long survival time as well as the improved quality of life for patients undergoing lung cancer using conventional chemotherapy is still not satisfactory. Therefore, robust research undergoes development of drug delivery system which increased drug at target side with reduced systemic side effect. Method: Bibliography database reviewed various inhalable nanostructured drug delivery strategies for effective delivery of anticancer drugs to lung cancer which are designed to improve the therapeutic index of anticancer drugs throughout improvement of their stability as well as bioavailability. Results: It has been reported that nanostructure based inhalation chemotherapy is more successful targeting system and also offers reduced side effects than conventional chemotherapy. Conclusion: Thus, the review highlights the critical issues, strategies for delivery and provides detail on various inhalable nanostructures for anticancer drug delivery along with toxicity concerns as well as rationale behind development of inhalable nanostructures.

INSPIRE: A Phase 3 Open-Label, Multicenter Study to Evaluate the Safety and Tolerability of LIQ861 in Pulmonary Arterial Hypertension (PAH) (Investigation of the Safety and Pharmacology of Dry Powder Inhalation of Treprostinil NCT03399604)

Summary of Objectives Inhalational drug delivery to treat PAH is attractive due to enhanced pulmonary specificity and reduced systemic adverse effects. LIQ861 is a dry powder formulation of Treprostinil (TRE) designed to enhance deep-lung delivery and achieve higher tolerated dose levels than current inhaled therapies. LIQ861’s uniform (1µm) particle size with a trefoil, pollen-like shape, enables QID delivery of TRE doses in a convenient, palm-sized, disposable dry powder inhaler (DPI). The primary objective of the INSPIRE study is the safety and tolerability of LIQ861 in subjects transitioning from stable doses of Tyvaso® or as combination therapy with ≤2 approved non-prostacyclin (PGI) oral PAH drugs. The secondary objective is to evaluate the comparative bioavailability (BA) of TRE between LIQ861 and Tyvaso®. Methods Target enrollment is 100 Functional Class (FC) II/III subjects with 18 subjects on Tyvaso® included in a BA sub-study comparing TRE exposure in a one-directional crossover. PGI-naive subjects stable on ≤2 approved, non-PGI oral PAH therapies received LIQ861 at an initial dose of 25mcg QID, increasing in 25mcg increments weekly to tolerance and symptom relief. Subjects transitioning from Tyvaso® received LIQ861 at an initial dose comparable to their Tyvaso® dose, with titration in 25mcg QID increments to tolerance and symptom relief. Endpoints The primary endpoint is the incidence of treatment-emergent Adverse Events and Serious Adverse Events. Safety endpoints: • Changes from Baseline to Month 2 or Early Termination in clinical laboratory, physical exam findings, and vital signs. • Proportion of patients maintaining a stable clinical status from transition through Month 2. Stable clinical status defined as: 1) LIQ861 treatment through at least 2 months beyond transition from Tyvaso® and six-minute walk distance (6MWD) decrease no more than 10%, 2) no interruptions to treatment totaling more than 7 days prior to the end of Month 2, and 3) no treatment with any other PGI analogs or P`GI receptor agonists. Secondary endpoints: NYHA FC, N-terminal B-type natriuretic peptide and Quality of Life will be reported when available. Analysis for the Primary Endpoint and BA sub-study is expected to be completed in 2019.

Effect of particle deposition density of dry powders on the results produced by an in vitro test system simulating dissolution- and absorption rates in the lungs

The surface area of the air/liquid interface in the lungs is substantial, so deposited doses of aerosol medicines per interface surface area when administered via the inhalation route is always quite low. However, in most in vitro systems used for dissolution testing of dry powder inhalables, the dose per surface area is generally much higher.The aim of this study was to investigate in one in vitro lung dissolution system, the DissolvIt, the manner in which the deposited dose per test surface area of drug particles influences the simulated dissolution- and absorption rate.Here we used the dissolution test method DissolvIt to investigate the influence on dissolution behavior by varying the deposited surface density of tested drugs. Dry powders of three different active pharmaceutical ingredients with different solubilities were used; salmeterol, budesonide and fluticasone propionate.It was found that by varying the dose density from 0.23 to 29 µg/cm2 the dissolution- and absorption rate of test particles was affected for all three substances, with decreasing relative dissolution rates above certain dose limits. The effect was much more prominent with the least soluble fluticasone propionate. In contrast, in a real lung it has been shown that a tenfold increase of the even less soluble fluticasone furoate did not affect the pulmonary dissolution- and absorption as measured in the ex vivo isolated perfused rat lung.This indicates that the deposited particle dose on the test surface used must be carefully considered in all in vitro dissolution testing apparatuses used for inhalation drugs, especially when aiming for in vitro-in vivo correlations. Conclusive data show that in the DissolvIt system consistent normalized dissolution- and absorption data can be obtained if the deposition density of test substance are kept below 1 µg/cm2 and the variability between the initial drug doses is smaller than 10–15% expressed as standard deviation.

Bronchial asthma control degree and the temperament structure according to the Eysenck model.

IntroductionAsthma is a disease of a psychosomatic nature. The control of asthma is still poor in approximately 5% of patients, despite introduction of modern inhalant drugs and psychotherapeutic interventions.AimTo evaluate whether the degree of bronchial asthma control is related to the characteristics of temperament according to Eysenck’s concept.Material and methodsThe study was conducted on a group of 111 bronchial asthma patients and 44 healthy subjects. In all of them, the Eysenck temperament questionnaire was administered and the level of asthma control was determined.ResultsIncrease in the scale of neuroticism was associated with an 1.83-fold increase in the likelihood of poor asthma control. Increase in the result on the psychoticism scale and lie scale of about one point was associated with a slightly smaller increased risk of poor asthma control (respectively: 1.49-fold and 1.61-fold).ConclusionsThe structure of temperament of a person with poor control of bronchial asthma can be characterized. Patients with poor asthma control have a higher level of neuroticism, psychoticism and propensity to lie, compared with the healthy population and subjects with good or partial bronchial asthma control.

The Effects of Inhaled Drug Use on Saliva and Dental Plaque in Children

Aim: Develop awareness about the effects of inhaled drugs on saliva and dental plaque and to take precautions against these side effects. Material and Method: Our work is planned prospectively, a total of 48 children aged between 4 and 16 years were enrolled in the study. Salivary flow rate, saliva pH, saliva buffering capacity, saliva viscosity, presence of plaque differences between the study groups and the control group were investigated. The working group is divided into 3 for standardization. Results: It was found that unstimulated salivary flow rate (p=0,2376), saliva viscosity (p=0.3675) was not directly influenced by inhaler drug use. In contrast, inhaler drug use may decrease stimulated salivary flow rate (p = 0.0198), salivary pH (p <0.0001), saliva buffering capacity (p = 0.028). Inhaler drug use increases dental plaque accumulation (p = 0.0048). Conclusion: Many parameters such as stimulated salivary flow rate, saliva pH, saliva buffering capacity and plaque quantity have been found to be influenced by inhaler drugs. Key Words : Inhaler drug, Asthma, Salivary flow rate, Saliva buffering capacity. DOI : 10.7176/JSTR/5-3-10

Evaluation of Bio-relevant Mouth-Throat Models for Characterization of Metered Dose Inhalers.

For inhalation drug characterization, the traditionally used USP induction port provides limited in vivo predictive capability because it does not adequately mimic airway geometry. In this study, various bio-relevant mouth-throat (MT) models, including Alberta Idealized Throat (AIT), and 3D printed large/medium/small-sized VCU (Virginia Commonwealth University) models were evaluated using two metered dose inhaler (MDI) drug products: a solution MDI containing beclomethasone dipropionate (BDP-MDI) and a suspension MDI containing fluticasone propionate (FP-MDI). For BDP-MDI, use of VCU large and small MT models resulted in a significantly higher MT deposition and lower fine particle fraction (FPF) compared with the other MT models. In the case of FP-MDI, the three VCU models resulted in higher MT deposition and lower FPF compared with the USP induction port and AIT. Overall, the in vitro testing results for the suspension MDI were more sensitive to geometric differences of the MT models than those for the solution MDI. Our results suggest that in vitro characterization of MDI products can be influenced by many factors, including the type of formulation, the MT geometry, shape, internal space volume, and the material used to make the MT models.

Aerosol drug delivery to the lungs during nasal high flow therapy: an in vitro study

BackgroundAerosol delivery through a nasal high flow (NHF) system is attractive for clinicians as it allows for simultaneous administration of oxygen and inhalable drugs. However, delivering a fine particle fraction (FPF, particle wt. fraction < 5.0 μm) of drugs into the lungs has been very challenging, with highest value of only 8%. Here, we aim to develop an efficient nose-to-lung delivery system capable of delivering improved quantities (FPF > 16%) of dry powder aerosols to the lungs via an NHF system.MethodsWe evaluated the FPF of spray-dried mannitol with leucine with a next generation impactor connected to a nasopharyngeal outlet of an adult nasal airway replica. In addition, we investigated the influence of different dispersion (20–30 L/min) and inspiratory (20–40 L/min) flow rates, on FPF.ResultsWe found an FPF of 32% with dispersion flow rate at 25 L/min and inspiratory flow rate at 40 L/min. The lowest FPF (21%) obtained was at the dispersion flow rate at 30 L/min and inspiratory flow rate at 30 L/min. A higher inspiratory flow rate was generally associated with a higher FPF. The nasal cannula accounted for most loss of aerosols.ConclusionsIn conclusion, delivering a third of inhalable powder to the lungs is possible in vitro through an NHF system using a low dispersion airflow and a highly dispersible powder. Our results may lay the foundation for clinical evaluation of powder aerosol delivery to the lungs during NHF therapy in humans.

The effect of simulation based education on patient teaching skills of nursing students: A randomized controlled study.

According to the literature, main problem in the education of nursing students in patient teaching about application of inhaler medication is ineffective and inadequate class and cannot be applied to the live patients. Also the literature shows that the main obstacle for teaching nursing students to provide inhaler instruction is inadequate in-class practice. In this study, comparison of the effectiveness between standard patients (SPs) usage and theoretical lecture on improving the patient teaching skills of nursing students for inhaler drug use for live patient is aimed. This study was conducted as a randomized controlled and single-blind trial. Total patient teaching skill score for control group was 26.73 ± 5.63 and 39.08 ± 5.49 for SP group which causes a statistically significant difference (p ≤ 0.01). The students' self-confidence mean score was 8.48 ± 0.88 for SPs group and 7.07 ± 1.33 in the control group for a statistically significant difference (p ≤ 0.01). The patient teaching skill scores of the students included in the group receiving simulation teaching with the SPs were found to be higher than the control group. The students included in SPs group were found to feel more confident while teaching a live patient on inhaler drug use.

Pneumomediastinum in marijuana users: a retrospective review of 14 cases

IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by...

A study of Inhalation Drugs in the Management of Asthma in Northern Parts of Tamilnadu

Abstract Background Asthma, a major problem facing our polluted environment. It is a reversible and curable disease. Symptoms of asthma include episodic breathlessness or dyspnoea (especially at night or early morning, or after some exertion),Wheezing, Cough (especially at night or early morning, or after some exertion) and Chest tightness. Treatment of asthma includes the class of drugs from beta-blockers (Salbutamol, formoterol) and inhaled corticosteroids (beclomethasone, budesonide).Majorly compared with the oral and I.V’s, Inhalation route has more efficacy. Aim A detailed study of inhalation drugs and its socio-economic benefits to asthma in the northern parts of Tamilnadu. Methods A multicenter, noncomparative,random sampling study was conducted in five hundred asthmatic patients in northern parts of Tamilnadu (includes Chennai and suburb districts).Based on treatment patients were grouped as inhalation and oral medication. Inhalation shows more efficacy in the treatment of asthma. currently, inhalation drugs are classified into relievers and controllers. The drugs are administered through inhalation route via. Dry powder inhaler and Pressurized metered dose inhaler. Results A total of 500 asthmatic patients were surveyed in this study. the inhalation drugs were administered through inhalers like DPI, pMDI and nebulizers with 47%, 50% and 3% patients adhered respectively. a combination of Reliever and controller (ICS+LABA) shows significant control in asthma management than other monotherapy. Two hundred seventy-one asthma patients experienced less exacerbation after medication. Conclusion In asthma management, All the inhalation drugs in combination show better control and superior patients response in the management of asthma with more impact on economic aspects of the patients.

The attitude, knowledge, and behavior of family physicians about childhood asthma in Sakarya province.

Aim:This study aimed to determine the knowledge, attitude, and behavior of family physicians working in family health centers in Sakarya province related to childhood asthma.Material and Methods:One hundred seventy-two physicians participated in this study, which was conducted as a survey. The questionnaire included 46 questions that measured the attitude and behavior, sociodemographic characteristics, professional practices, theoretical/clinical knowledge of the family physicians.Results:A total of 172 physicians including 144 certificated general practitioners, 7 family medicine specialists, and 21 contracted family medicine residents were enrolled in the study. Less than half (44.2%) of the participants agreed that family physicians could make a diagnosis of asthma, 61.6% agreed that family physicians could follow up and maintain treatment, and 86% agreed that family physicians could give treatment in cases of mild asthma attack. Some 44.6% of the physicians stated that they always/frequently referred patients with asthma, 92% stated that they always/frequently interrogated if the disease was under control, and 79.7% stated that they always/frequently reminded their patients about triggers and the use of inhaler drugs. The mean number of correct answers was 6.23±1.56 for 10 theoretical questions and 10.33±1.90 for 16 clinical questions. It was observed that age, sex, district of work place, time since graduation, represantative visits, and the frequency of prescriptions were the charcatristics of family physicians that caused significant changes in attitute and behavior. Being a specialist or residents, working in a central district, and absence of poster/brochure in family health center were found to be factors that affected success in questions related to clinical cases. It was observed that general practitioner family physicians interrogated the control status more frequently than specialists and residents, reminded their patients with asthma about triggers and inhaler drug use with a higher rate and exhibited a positive attitude in terms of giving treatment for asthma attacks.Conclusion:In this study, a deficiency was observed in terms of basic information related to asthma and in terms of practical applications. It was observed that family physicians’ attitudes about asthma did not always coincided with their behaviors. No significant correlation was found when the relations of attitude, behavior, and knowledge level were evaluated between themselves.

Numerical Studies of Nanoparticle Transport and Deposition in Terminal Alveolar Models with Varying Complexities

Background: The integration of inhalation drug delivery and nanotechnology offers exciting potentials to enhance the targeting, release, diagnostic, and therapeutic outcomes of drugs. Human lungs provide many advantages over other routers such as noninvasive delivery, a large surface area for absorption, avoiding the first-pass metabolism, and quick therapeutic onset. It is crucial to understand nanoparticle dosimetry in the acinar region to reliably evaluate the therapeutic outcomes of nanomedicines. However, an acinus unit comprises up to 10,000 alveoli and to model a complete acinus is still a prohibitive task. Besides, the presence of inter-alveolar septa creates a labyrinth pathway for inhaled airflow and particles. Methods: The objective of this study is to numerically investigate nanoparticle deposition in three alveolar models with varying physical complexities, which retain 1, 4, and 45 alveoli, respectively. A discrete-phase Lagrangian model was implemented to track nanoparticle trajectories under the influence of rhythmic wall expansion and contraction. Both temporal and spatial dosimetry in the alveoli were computed. Results: Strikingly different behaviors were observed in the dynamic alveolar model between micron particles and nanoparticles. Minimal deposition rates were predicted for 500–600 nm particles for all the three models considered. Consistently lower deposition rates were found in the 45-alveoli model than the other two simplified models for all particles ranging from 1 nm to 1000 nm. Considering the gravitational orientation effect, nanoparticles smaller than 200 nm appears insensitive to the alveolar orientation and only becomes perceivable around 500 nm. For nanoparticles larger than 500 nm, lower doses were predicted in the horizontal alveoli than in the vertical alveoli, regardless of the model complexity. Conclusions: The magnitude of the airflow velocity (depending on ventilated volume) is an essential factor in determining the deposition of inhaled nanoparticles. Future correlation development for acinar deposition should consider the velocity distribution in different regions of the acinus.

Inhalational Drug Delivery in Pulmonary Aspergillosis.

Pulmonary infections have long represented one of the major threats to humans. These vary from acute to chronic conditions, depending upon the underlying disease of the airways. Pulmonary aspergillosis (PMAP) has raised vital concerns in the immunocompromised patients. The fungal infection is difficult to diagnose in the early stages, often making the disease more complicated. Currently, three classes of antifungal agents are available on the market for the treatment of pulmonary infections. These agents are available in oral and intravenous forms only, which limits the availability of therapeutic concentrations of drug in the lungs for longer durations. Consequently, this leads to therapeutic failure and/or resistance of the organism(s) towards the antifungal agents because the optimum amount of drug does not reach the infection site. To combat the issues associated with the conventional regimens, inhalation of antifungal agents is gaining importance because administration to the lungs offers huge advantages of localized and targeted delivery. A wide range of inhalational devices such as nebulizers, dry powder inhalers, and metered dose inhalers are available on the market to deliver drug molecules to the lungs effectively. However, their clinical utility is limited to conditions such as asthma, chronic obstructive pulmonary disease, and cystic fibrosis only. For a few decades, inhalation therapy has also been gaining importance to treat infectious diseases such as tuberculosis and aspergillosis, though more research efforts are required to make the transition from bench to bedside. The current review provides an explicit account of the potential role of inhalation drug delivery in PMAP.

Treatment of horses with asthma syndrome

Treatment of horses with asthma syndrome

Comparative study of the effects of mesenchymal stem cells with different delivery methods in an experimental model of lung fibrosis

Background: Transplantation of mesenchymal stem cells (MSCs) is one of the most promising directions in the treatment of idiopathic pulmonary fibrosis. In experimental small animal studies, intravenous and endobronchial (installation) techniques are used for the cell preparation delivery, while in humans inhalation of drugs is the simplest and most available method.&#x0D; Aim: The aim of the study was to determine the optimal type of a nebulizer for viability of MSCs during nebulization, followed by a comparison of the effects of inhalation and intravenous delivery methods in a standard model of bleomycin pulmonary fibrosis in rabbits.&#x0D; Methods: At the first stage, the survival of MSCs was assessed ex vivo after 10 minutes of compressor, ultrasound and mesh nebulization. Subsequently we used a nebulizer, which showed the best result in the cells, viability. At the next stage аfter bronchoscopic installation of bleomycin, 5 rabbits received intravenous transplantation of 2×106 allogeneic BMMSCs, other 5 rabbits — 2×107 MSCs inhaled via a compressor nebulizer; the control healthy and bleomycin groups included 5 animals each.&#x0D; Results: The highest degree of viability of MSC was maintained after passing via the compressor nebulizer (72%), a significantly lower survival rate was observed in ultrasonic nebulization (20%) and no live cells were detected after mesh nebulization. Both groups treated with MSC had a significantly lower fibrosis index on the Ashcroft morphometric scale than the control group of bleomycin fibrosis. Collagen expression in the lung tissue was significantly higher in all the groups with bleomycin injury, but in animals which underwent MSC inhalation, it was significantly different (0.51 point) from the bleomycin group without treatment (2.1 points). The level of neutrophils in the BAL fluid was significantly lower in animals which received the intravenous MSC therapy. The levels of TNF-α and TGF-β1 in the BAL fluids tended to decrease in the treatment groups, but did not differ significantly from control.&#x0D; Conclusions: The highest survival rate of MSCs is observed when using a compressor nebulizer, which apparently should be considered as the best way for delivering cells to the respiratory tract. Both inhalation and intravenous administration of MSCs cause similar effects of inhibiting the development of bleomycin-induced pulmonary fibrosis, which indicates the possibility of using both ways of cell delivery without loss of effectiveness.

Crystal Engineering: Upcoming Paradigm for Efficacious Pulmonary Drug Delivery.

Pulmonary drug delivery has transformed over a past few decades from being a platform for local pulmonary disease treatment to systemic drug delivery opportunities. In case of pulmonary delivery systems, particle properties are critical as they affect inhalation efficacy, pulmonary deposition, drug delivery and overall performance. With this in view, particle engineering has emerged as an advanced science that helps in designing of efficacious pulmonary delivery systems. Among various particle engineering branches, crystal engineering is being extensively explored as it provides an opportunity to optimize particles at morphological, physicochemical and molecular levels which are essential to understand the role of crystal engineering in pulmonary drug delivery. A thorough literature survey in the field of crystal engineering approaches explored for pulmonary drug delivery was conducted and the collected data was meticulously studied and summarized. In the review, pulmonary system is discussed with respect to various sites for drug deposition in respiratory tract, mechanism of drug deposition and clearance. Further, critical crystal parameters are discussed in-depth and various crystal engineering methods are summarized with emphasis on their impact on pulmonary delivery. Also, inhalation devices are overviewed to understand their performance in relation to crystal based pulmonary formulations. The review enabled a detailed insight on crystal engineering approaches for design of pulmonary delivery systems.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors

ObjectiveTo analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. MethodsThis was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. Results16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR=6.7, 95% CI=3.96; 11.23), use of marijuana (OR=2.2, 95% CI=1.17; 4.31), use of inhalant drugs (OR=3.0, 95% CI=1.98; 4.43), exposure to a drunk relative (OR=2.1, 95% C=1.67; 2.53), practice of bullying (OR=1.8, 95% CI=1.47; 2.17), verbal aggression (OR=1.7, 95%CI=1.40; 2.14), and intermediate/low school grades (OR=1.7, 95% CI=1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR=2.5, 95% CI=1.16; 5.22), use of marijuana (OR=3.2, 95% CI=1.32; 7.72), and physical aggression (OR=2.2, 95% CI=1.36; 3.50). ConclusionsThe analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.