Inhalation Procedure Research Articles

Penerapan Kolaborasi Pemberian Inhalasi dengan Close Suction untuk Bersihan Jalan Napas Tidak Efektif pada Pasien Ny. R Terpasang Endotracheal Tube di Ruang ICU RSUD Sidoarjo

Ineffective airway clearance is a condition where the patient is unable to cough effectively, often caused by thick or excessive secretions due to infection. The objective of this intervention is to address ineffective airway clearance in patients with an endotracheal tube in the ICU of RSUD Sidoarjo. After inhalation and close suction procedures, observations showed improvements in vital signs and respiratory rate, along with significant reduction of secretions. This led to an increase in peripheral oxygen saturation (SpO2), improving oxygen supply to the body. Based on the case study, the nursing intervention for ineffective airway clearance conducted over 2 x 8 hours showed partial success in resolving the issue. Following a thorough nursing assessment, the diagnosis for patient Mrs. R was determined as ineffective airway clearance related to airway spasms, evidenced by inability to cough, excessive sputum, and ronchi sounds.

Adolescent alcohol exposure promotes mechanical allodynia and alters synaptic function at inputs from the basolateral amygdala to the prelimbic cortex.

Binge drinking is common among adolescents despite mounting evidence linking it to various adverse health outcomes that include heightened pain perception. The prelimbic (PrL) cortex is vulnerable to insult from adolescent alcohol exposure and receives input from the basolateral amygdala (BLA) while sending projections to the ventrolateral periaqueductal gray (vlPAG) - two brain regions implicated in nociception. In this study, adolescent intermittent ethanol (AIE) exposure was carried out in male and female rats using a vapor inhalation procedure. Assessments of mechanical and thermal sensitivity revealed that AIE exposure induced protracted mechanical allodynia. To investigate synaptic function at BLA inputs onto defined populations of PrL neurons, retrobeads and viral labelling were combined with optogenetics and slice electrophysiology. Recordings from retrobead labelled cells in the PrL revealed AIE reduced BLA driven feedforward inhibition of neurons projecting from the PrL to the vlPAG, resulting in augmented excitation/inhibition (E/I) balance and increased intrinsic excitability. Consistent with this finding, recordings from virally tagged PrL parvalbumin interneurons (PVINs) demonstrated that AIE exposure reduced both E/I balance at BLA inputs onto PVINs and PVIN intrinsic excitability. These findings provide compelling evidence that AIE alters synaptic function and intrinsic excitability within a prefrontal nociceptive circuit.

Usability of inhaler devices: a parameter currently misused.

Inhalation represents the most convenient route for delivering respiratory drugs. Delivery systems showed a huge technological progress and several pocket inhalers had been engineered over the last decades for clinical use. Despite the growing technological efforts aimed to simplify the inhalation procedures and optimize the therapeutic outcomes, the effectiveness of drug inhalation through inhalers still represents a major challenge in respiratory medicine. Patients may actually incur in different types of critical errors when using all inhalers and are not capable to inhale throughout all devices equally well. Therefore, the choice of the most suitable and convenient device to prescribe still is a critical issue in real life. Usability is the only comprehensive parameter consenting the effective and objective assessment of pocket inhalers' performance, and allowing their objective comparison and ranking. Unpredictable discrepancies are in fact easily detectable between inhalers (even belonging to the same class) in terms of Usability, independently of the patient's awareness. The reasons were described and discussed for each class of inhalers presently available. Usability is a multidimensional parameter that is much more multifaceted and complex than usually presumed. Usability takes origin from the integrated, balanced and objective assessment of the role played by several factors from different domains, such as: factors related to patient's beliefs, to patients' behavioural components, to device engineering and to the overall cost. Usability is the key parameter for assessing and optimizing the appropriateness of any inhalation treatment through whatever device. Usability would also represent a key investigational instrument for supporting the future development of -innovative and more performing inhaler devices objectively.

Visualization of the obscure inhalation stage in inhalation therapy

The flow of the inhalation procedure during inhalation therapy can be divided into three successive stages: a pre-inhalation preparatory stage, a drug inhalation stage, and a post-inhalation stage. Among these, the second stage, drug inhalation, is the most important and obscure. Using ambiguous verbal expression, the drug inhalation method is communicated to the patient using terms such as strongly, deeply, and slowly. Patients usually determine their optimal method of drug inhalation device independently, based on their own interpretation and understanding of the verbal instructions. This may make the precise inhalation using an inhalation device unpredictable. The Tokico Inhalation Monitor TM (TIM) was developed to resolve the unpredictability of this second (drug inhalation) stage. The TIM can simultaneously measure the inhalation flow rate, duration, and total volume, and display them on the screen in real-time. This mini-review demonstrates the effects of inhalation instruction using TIM, which allows the second stage of therapy, drug inhalation, to be displayed on a screen in real-time.

Some histological and biochemical evaluation on commercial hair dyes

The use of hair dyes as a means of beautification is currently increasing. This study aimed at evaluating the toxicity of different commercial hair dyes on the histology of the skin and biochemical parameters of the liver of Albino rats. This study was carried out in the Pathology Department, University of Calabar Teaching Hospital Calabar and College of Medical Sciences, University of Calabar, Calabar between May, 2019 and October, 2019. Four different colours of hair dyes were obtained from a cosmetic store in Watt daily market in Calabar, Cross River State. Twenty male Albino rats with average weight of 55g were used for this study. The rats were randomly divided into five (5) groups of four (4) rats each. Group 1 to 4 served as the test groups while group 5 served as the control group. Different colours of hair dye were applied topically on selected area of the back of Albino rats daily for 30 days after which, the rats were sacrificed using chloroform inhalation procedure. The skin of the rat was harvested for histology while heart puncture was used to collect 5 milliliters of blood from each rat for biochemical analysis. Plasma Alkaline phosphatase (ALP) was determined using Kind and King's method. Plasma Alanine amino transferase (ALT) and Aspartate Amino transferase (AST) were determined by Reitman and Frankel method. Serum protein (TP) was determined by Biurette's method while bilirubin was estimated using Powell's method. Liver tissues were processed using routine paraffin wax tissue processing method for histological analysis. The serum levels of ALP, AST, TP, Total bilirubin (TB) and conjugated bilirubin (CB) in all the test groups were significantly increased when compared with the control (P=0.001). Histological evaluations indicated evidence of cellular injury in all the test groups. Prolonged use of commercial hair dyes caused adverse effects to the skin and liver as seen in the Albino rat used in this study.

Targeted dose delivery of Mycobacterium tuberculosis in mice using silicon antifoaming agent via aerosol exposure system.

Mycobacterium tuberculosis (Mtb) is an intracellular pathogen that forms aggregates (clumps) on solid agar plates and in liquid media. Detergents such as Tween 80/Tyloxapol are considered the gold standard to disrupt clump formation in Mtb cultures. The presence of detergent, however, may generate foam and hinder Mtb aerosolization thus requiring addition of an antifoam agent for optimal Mtb aerosol-based procedures. Aerosol inhalation can be technically challenging, in particular to achieve a reproducible inhaled target dose. In this study, the impact of an antifoam, the silicon antifoaming agent (SAF), on Mtb aerosolization and whole-body mouse aerosol infection was investigated. A comparative study using SAF in a liquid suspension containing Mycobacterium bovis BCG (M. bovis BCG) or Mtb H37Rv did not cause any adverse effect on bacterial viability. Incorporation of SAF during mycobacteria inhalation procedures revealed that aerosolized mycobacterial strains were maintained under controlled environmental conditions such as humidity, temperature, pressure, and airflow inside the aerosol chamber. In addition, environmental factors and spray factors were not affected by the presence of SAF in mycobacterial cultures during aerosolization. Spray factor was significantly less during aerosol procedures with a low-input dose of mycobacteria in comparison to high-dose, as predicted. The mycobacterial load recovered in the biosampler (AGI) was ~2–3 logs lower than nebulizer or input bacterial load. A consistent Mtb bacillary load determined in mouse lungs indicates that SAF does not affect mycobacteria aerosolization during the aerosol generation process. These data confirmed that 1) SAF prevents formation of excessive foam during aerosolization, 2) SAF had no negative impact on mycobacterial viability within aerosol droplets, 3) Mtb droplets within aerosol-generated particles are well within the range required for reaching and depositing deep into lung tissue, and 4) SAF had no negative impact on achieving a target dose in mice exposed to Mtb aerosol.

Опыт применения препарата «Аква Марис Стронг для Горла» в комплексном лечении воспалительных заболеваний гортани

Currently, the treatment of patients with inflammatory diseases of the larynx in most cases is multi-stage, long-term, and requires numerous techniques using specialized equipment. In the daily work of an otorhinolaryngologist with inflammatory diseases of the larynx, drugs are most often used in the form of injections or oral use. Aerosol therapy enables fast and effective therapeutic action with the use of a relatively small dose of the drug and a significant reduction in the negative systemic effect. An effective means of treating diseases of the upper respiratory tract is irrigation and inhalation therapy using sea water, which moisturizes dry mucous membranes, promotes rapid softening and removal of crusts. To establish the therapeutic efficacy of the use of Aqua Maris Strong for Throat in the complex treatment of inflammatory diseases of the larynx, 76 patients suffering from inflammatory diseases of the larynx were selected, who were divided into the main and control groups of the study. Patients of the main group as part of complex therapy for inflammatory diseases of the larynx received inhalation administration of the drug "Aqua Maris Strong for Throat ". The inhalation procedure consisted of 2 inhalations lasting 10 minutes, 2 times a day. The control group of patients – 37 patients received traditional etiotropic treatment of inflammatory diseases of the larynx. As the study showed, in patients who received inhalation administration of the Aqua Maris Strong for Throat preparation as part of the complex therapy of inflammatory diseases of the larynx, positive dynamics of complaints, normalization of the laryngostroboscopic picture were noted faster than in patients of the control group. The advantage of therapy using Aqua Maris Strong for Throat was also confirmed by the restoration of cytopathological changes in local cellular protection, in the form of a decrease in signs of deepithelialization, mucociliary insufficiency, phagocytosis of cellular elements, a decrease in the concentration of pathological flora on the laryngeal mucosa in a shorter period of time than in patients in the control group.

Evaluating Particle Emissions and Toxicity of 3D Pen Printed Filaments with Metal Nanoparticles As Additives: In Vitro and in Silico Discriminant Function Analysis

The emergence of low-cost 3D printing (particularly with 3D pens) in the home and school environment is a matter of concern since there is a lack of data confirming its safe application. The filament washed with water and the particle emission during printing (captured in water) were analyzed. In this report, we provide important insights about toxicity, intracellular mitochondrial stress, and cellular metabolic alterations as a mechanistic response after exposure of emissions released during 3D pen printing with polylactic acid (PLA) and PLA filaments with additives (carbon nanotubes (CNTs), copper, or steel). We adopted the design and exposure of a realistic inhalation procedure of aerosols via introducing mist-containing particles released during 3D pen printing processes of filaments with/without additive (CNTs, steel, copper) to A549 cells in a cloud chamber. The filaments with or without additives appear benign except for copper, which causes higher changes in stress, cell death, and metabolic perturbations. Albeit live/dead cell assay fluorescence-activated cell sorting analysis revealed little or no toxicity, time-of-flight secondary ion mass spectrometry bimolecular imaging and chemical mapping show insightful changes in cell membrane lipid compositions. Biochemical profiles obtained based on ion m/z signature peaks exhibit membrane and lipoprotein metabolism alterations which are similar to those adopted by A549 cells while developing drug resistance and their activation of the expression of their efflux pump. The results sought in this report suggest the cautious use of 3D pen printers for filaments embedded with redox active metals as additives in a home environment.

The effect of balneotherapy on the oxidative system and changes in anxiety behavior, enhanced by low doses of radon

Purpose The aim of our research was to study the effect of radon hormesis balneotherapy using natural thermal waters of Tskaltubo spring, practically, its effect on oxidant and antioxidant systems and anxiety reactions in rats. Radon is a natural gas with radioactive properties, which can have a hermetic effect when used in small doses. Radon was used to activate antioxidant mechanisms in rats, which resulted an anxiolytic effect and positively enhanced the effect of balneotherapy. Materials and methods To study the effect of radon in balneotherapy, groups of experimental animals (rats) were exposed to three different treatments. The radon-containing waters of Tskaltubo spring were inhaled in one group and 5 after taking the water in another group. Saline was used for inhalation in animals of the saline group. In animals of the control and sham control groups, inhalation was not used. To assess the anxiolytic effect of radon inhalation, the anxiety was induced and behavioral tests were performed (the open field and the elevated plus-maze test) after 24 h and 5 days of inhalation procedures. Results The anxiety test results showed that exposure to low doses of radon led to a decrease in the level of anxiety in rats. The data show that the total distance traveled by rats in the open field test after inhalation of radon was significantly greater than that by animals in the sham control and control groups. During the open field and elevated plus-maze tests, rats that had inhaled radon spent more time in the central part of the open field and on the open arms of the maze than did the other groups of rats. In the group of rats that had not inhaled radon, an increase in anxiety was observed. The basis of this reaction was an increase in the glutathione concentration. Conclusion Based on our research, it can be concluded that the inhalation of small doses of radon, associated with treatments of waters from the Tskaltubo spring, activated the antioxidant systems of the body and enhanced the positive effect of balneotherapy. Clinically, this is expressed as a decrease in anxiety. Inhalation of small doses of radon activated antioxidant processes in the brain, causing an increase in glutathione/glutathione disulfide ratio in the brain.

Handling Errors in the Use of Inhalation Devices: Inhalation Technique Skills and Knowledge in Pediatric Nurses.

Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices. We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients. An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge. Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide. We found that education on inhalation procedures including practical training is required to increase patient safety.

Long-term clinical effects of an inhaler guidance DVD in patients with bronchial asthma.

Erroneous use of inhalers is a serious problem. Given the multitude of devices currently available, it can be difficult to convey the correct methods for their efficient use to patients. We previously generated an educational DVD that visually and audibly explains the proper use of all inhaler types available in Japan to provide inhalation guidance to patients. Herein, we report the 1-year follow-up of patients who received or did not receive the DVD guidance. Sixty-nine bronchial asthma patients undergoing outpatient treatment who received inhalation guidance from a pharmacist using a standard package insert were randomly allocated to a DVD group (n=35) or a no-DVD group (n=34). Their current oral or inhalant drug regimens were unchanged. Various parameters were measured 12 months later. Frequencies of aggravation during the 12-month period were also determined. Compared with the no-DVD group, there were significant improvements in asthma control test scores, forced vital capacity, FEV1, impulse oscillometry, resonant frequency, induced sputum eosinophil count, and FeNO in the DVD group after 12 months. Pulmonary function and inflammation parameters improved significantly with the use of the instructive DVD in addition to the package inserts. The frequency of asthma aggravation significantly decreased in the DVD group during the 12-month study period, likely because inhalation procedures were performed accurately. A DVD that provides accurate inhalation guidance enhances the quality of life of asthma patients and has substantial clinical ramifications. Thus, this tool would be beneficial for patients in Japan and worldwide.

A comparison of the costs of bronchodilator delivery methods in children with asthma exacerbations treated in hospital. The first Polish study in children.

IntroductionRecommended methods of administering bronchodilator drugs in children with asthma exacerbations in a hospital include the pressurized metered-dose inhaler (pMDI) and nebulization (NEB). These methods differ in clinical effectiveness, safety and, as some studies indicate, the cost of their use in a child.AimTo calculate the direct costs of hospital therapy conducted with the use of short-acting β2-agonist (SABA) or its combination with short-acting muscarinic antagonist (SAMA) administered via pMDI with valved holding chamber (VHC) versus the same drugs in NEB in children with asthma exacerbation.Material and methodsA retrospective analysis of the costs of SABA (salbutamol) and SABA + SAMA (fenoterol + ipratropium bromide) inhalation therapy was performed. Based on the data obtained from the financial department, the pharmacy, and the sterilization department of the university hospital, the direct unit cost of the inhalation therapy in the child was calculated.ResultsThe results of the analysis indicate that in a hospital setting the cost of one-time SABA or SABA + SAMA administration via pMDI+VHC is 1.5–2.4 times lower compared to NEB. The payer incurred the lowest costs during anti-obstructive treatment using SABA with pMDI + VHC (PLN 9.39 for one inhalation procedure). The working time of medical staff during the inhalation treatment is the component generating the highest cost for the hospital (up to 40% of direct costs).ConclusionsIn hospital conditions, the supply of SABA or SABA + SAMA with the use of pMDI + VHC in a child with asthma exacerbation is more beneficial financially than the supply of the same drugs in NEB.

Repetitive instructions at short intervals contribute to the improvement of inhalation technique.

BackgroundInhaled medicines are key drugs for the treatment of asthma or chronic obstructive pulmonary disease. However, the variety of inhaler devices and complicated inhalation procedures have created confusion among patients, affecting their correct understanding of inhalation. Recent studies reported that up to 80% of patients made technical errors in inhalation and emphasized the necessity for patient education.ObjectiveWe aimed to assess the importance of inhalation-related instructions and to find clinical factors associated with improvements in the inhalation technique.MethodsWe conducted a retrospective, single-center study at a regional core hospital in Japan. Physicians and community pharmacists constructed an interactive instruction system and shared a common inhalation procedure manual. Patients who received instructions for the inhalation technique at least 3 times were recruited.ResultsA total of 125 patients were analyzed in this study. The median age was 73 years (interquartile range, 67–80 years). At the second visit, 67 patients (53.6%) failed to correctly perform the technique despite being guided at the first visit. At the third visit, 48.8% of patients made some errors. After excluding 40 patients who were not subjected to analysis, the remaining 85 were divided into “improvement” and “no-improvement” groups. The total improvement rate was 57.6%. The median time interval between consecutive instructions in the “improvement” groups was 84 days, whereas that in the “no-improvement” group was 128 days (p < 0.05, U test). No significant difference in the age, sex, or primary disease was seen between these groups.ConclusionRepetitive instructions at shorter intervals may be helpful for patients to develop and maintain an improved inhalation technique.

SPECIFIC FEATURES ANALYSIS OF INHALATION MEDICATION USE TO TREAT BRONCHIAL ASTHMA IN CHILDREN

&#x0D; &#x0D; &#x0D; The article focuses on analysis of the main system types to deliver aerosol medication. They have their advantages and disadvantages and used in different age range patient. The main specific features of using different inhalers and medications have been determined. The algorithm to choose an inhaler type for children with bronchial asthma has been suggested which can be which can be insured by pharmacists to provide pharmaceutical care. The content analysis of the Instructions to use inhalation medications has been done. The need to enlarge the given information and to provide schematic addition of the inhalation procedure to the instruction has been defined.&#x0D; &#x0D; &#x0D;

Pulmonary and Regional Deposition of Nebulized and Dry Powder Aerosols in Ferrets.

The utilization of ferrets as a non-clinical model for disease is rapidly increasing within drug development. Many of these models include respiratory diseases that involve targeted drug delivery via nose-only inhalation. While the deposition patterns within other non-clinical models (mice, rats, canines, and non-human primates) have been well studied, the local and regional deposition of aerosols in ferrets has not been well characterized. Therefore, inhalation aerosols were developed, radiolabeled and the radiolabeling methods validated to support SPECT-CT imaging and quantification of regional deposition within ferrets. The studies were conducted with one liquid formulation and one dry powder formulation (two concentrations of dry powder). Additionally, both aerosols were polydisperse and therefore reflect the majority of pharmaceutical aerosols. Overall, the studies showed lung deposition fractions between 5 and 10% with median aerodynamic particle sizes of 2.5 and 2.8μm. The lung deposition fraction of the liquid aerosol was ~ 9%, nearly double observed in rats with a similarly sized aerosol. Analysis of respiratory tract (oropharynx, laryngopharynx, trachea, bifurcation area, and lung) deposition indicates increased deposition of the liquid aerosol compared to the dry powder aerosol, however, when this analysis was refined to the pulmonary region (trachea, bifurcation, and lung) the deposition was similar between formulations. These data provide the first description of the regional deposition of inhalation aerosols in ferrets with standard nose-only inhalation procedures. These data can be used for calculations of both total and regional doses within ferret inhalation drug delivery.

A Meta-Analysis of Efficacy of Carbon Dioxide Inhalation as a Challenge Test in Panic Disorder

The objective of this study is to perform a systematic review and meta-analysis on whether patients with panic disorder (PD) and their healthy first-degree relatives have an increased sensitivity to carbon dioxide inhalation test compared to healthy controls (HC) or patients with psychiatric disorders other than panic disorder. The databases of PubMed, EMBASE and PsycNET were searched using Boolean operators "panic AND carbon dioxide" and "panic AND CO2". Selected research articles were classified according to the carbon dioxide concentrations used in testing and the clinical characteristics of the samples. The assumption of heterogeneity across the studies was assessed by chi square based Q and I2 statistics. Publication biases were explored by Begg-Mazumdar's and Egger's tests in addition to funnel graphics. Odds ratios representing effect size of the carbon dioxide inhalation procedure were calculated according to fixed effect and random effect models after obtaining percent weight effects of each study. Meta-Analysis was conducted on 33 research studies that include 2114 participants totally. Participants with PD experienced significantly more frequent panic attacks (PA) compared to HC following in both 5% (OR=14.713, 95% CI 7.532 - 28.739) and 35% carbon dioxide inhalation (OR=11.507, 95% CI 7.775 - 17.031). HC who have a first-degree relative with PD experienced PA approximately 3 times more than HC who have not a first-degree relative with PD (OR=2.658, 95% CI 1.678 - 4.212) following carbon dioxide inhalation test. Participants with PD experienced significantly more frequent PA than the patients with other psychiatric disorders following the carbon dioxide inhalation test (OR = 3.524, 95% CI 1.945 - 6.384). There is an increased sensitivity of carbon dioxide inhalation in patients with PD and their healthy first-degree relatives. The role and possible mechanisms of carbon dioxide in etiology and physiopathology of PD should be studied extensively.

Effects of magnesium sulfate infusion on clinical signs and lung function of horses with severe asthma.

OBJECTIVE To evaluate whether MgSO4 solution administered IV would improve the clinical signs and lung function of horses with severe asthma and potentiate the effects of salbutamol inhalation in those horses. ANIMALS 6 adult horses with severe asthma. PROCEDURES Asthmatic horses were used in 3 crossover design experiments (6 treatments/horse). Clinical scores for nasal flaring and the abdominal component associated with breathing and lung function were determined before and after administration of salbutamol (800 μg, by inhalation), MgSO4 solution (2.2 mg/kg/min, IV, over 20 minutes), and combined MgSO4-salbutamol treatment. The data were collected during experimental procedures to assess salbutamol inhalation versus mock inhalation, MgSO4 infusion versus infusion of saline (NaCl) solution (adjusted to the same osmolarity as the MgSO4 solution), and the combined MgSO4-salbutamol treatment versus salbutamol inhalation alone. RESULTS Infusion of MgSO4 significantly improved clinical scores when administered alone or in combination with salbutamol inhalation. With the combination treatment, lung function improved, albeit not significantly. Tidal volume also increased following combined MgSO4-salbutamol treatment. Salbutamol alone significantly improved lung function, whereas saline solution administration and a mock inhalation procedure had no effect on the studied variables. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MgSO4 infusion alone or in combination with salbutamol inhalation improved the clinical signs of severely asthmatic horses. The effects of MgSO4 were not associated with significant lung function improvement, which suggested that the changes observed were attributable to alterations in the horses' breathing patterns. Infusion of MgSO4 solution at the studied dose offers little advantage over currently used medications for the treatment of severe equine asthma.

The use of an alternate side lying positioning strategy during inhalation therapy does not prolong nebulisation time in adults with Cystic Fibrosis: a randomised crossover trial

BackgroundInhalation of nebulised medications is performed in upright sitting to maximise lung volumes. The pattern of deposition is poor for inhaled medications in people with Cystic Fibrosis. The pattern tends to be non-uniform and typically the upper lobes receive a reduced dose compared to the rest of the lung. One strategy that has been proposed as having the potential to improve homogeneity of deposition is to adopt an alternate side lying position for the inhalation procedure. This study sought to determine whether, among adults with Cystic Fibrosis, there is any disadvantage to delivery time of nebulised medications with a strategy of alternate side lying, compared to upright sitting.MethodsA randomised crossover trial with concealed allocation, intention-to-treat analysis and blinded assessors was undertaken. The participants were 24 adults with stable Cystic Fibrosis. They inhaled 4 mL of normal saline via an LC Star™ nebuliser twice within 24 h. In random order, participants sat upright throughout nebulisation, or alternated between left and right side lying at each minute during the nebulisation period. The nebuliser was stopped and weighed each minute until the residual volume was reached. The primary outcome was the time required for 3.5 mL to be delivered. The secondary outcomes were: respiratory rate; ratio of the volume delivered on right and left sides; and calculation of how long the periods in side lying can be extended without causing greater than 20% discrepancy in dose delivered in the two positions.ResultsThe delivery time did not significantly differ between sitting and side lying (mean difference 0.58 min, 95% confidence interval (CI) -1.40 to 0.24). There was no significant correlation between delivery time, lung function or subject height (all R2 < 0.4). Increasing side lying duration from 1 to 2 min did not significantly impact the dose delivered on each side. Turning each 3 min however, significantly worsened the disparity (mean ratio 1.32, 95% CI 1.24 to 1.40).ConclusionSide lying during inhalation therapy does not prolong nebulisation time. 2-min periods should provide an equal dose in the two side lying positions.Trial registrationProspectively registered on 4 July 2011; ACTRN12611000672954.

Effects of inhalation procedure on particle behavior and deposition in the airways analyzed by numerical simulation

Abstract The therapeutic effect of dry powder inhaler (DPI) formulations can be enhanced by understanding several factors that control the behavior or deposition of inhaled particles in the airways. Computational fluid dynamics (CFD) simulation was performed to predict the behavior and deposition of DPI formulations using a pulmonary model generated on the basis of computed tomography scans of a subject's airway. The effects of inhalation procedures and characteristics, such as flow rate and breath holding, on particle behavior and deposition in the airways were examined. The rate of airflow in the bifurcation area of bronchi was reduced to under 28.3 L/min because, in general, the diameter of the right bronchus is larger than that of the left bronchus in human bronchi. The region of particle deposition differed depending on the rate of airflow. The number of particles deposited in the bronchi decreased upon performing exhalation without breath holding. The results indicated that the turbulence following breath holding promoted particle deposition in the airways. CFD simulation suggested that breath holding is one of the most important factors for enhancing the therapeutic effect of DPI formulations.

Risk of Acute Asthma Attacks Associated With Nonsteroidal Anti-inflammatory Drugs: A Self-Controlled Case Series.

Although asthma attacks are known adverse events associated with nonsteroidal anti-inflammatory drug (NSAID) use, few studies have quantified these risks. The objectives of this study were to utilize an epidemiological approach to quantitatively evaluate the risk of acute asthma attacks associated with NSAID prescription in Japan and to compare the risks among NSAIDs according to their cyclooxygenase (COX)-2 selectivity. We conducted a self-controlled case series study using Japanese health insurance claims data. Exposed cases were identified as those who had experienced both NSAID prescription and acute asthma attack, which was defined as the combination of an inhalation procedure and the prescription of any inhaled β2-agonist. The incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for NSAID prescription periods compared with baseline periods were calculated using conditional Poisson regression models; COX-2 selective and nonselective NSAIDs were similarly compared. We identified 9769 subjects, more than 95% of whom were younger than 60 years. There was a significantly higher risk of acute asthma attacks during the NSAID prescription period when compared with the baseline period. The quantified IRRs were, in descending order, 93.94 (95% CI, 90.10-97.95) for the prescription start date, 3.96 (95% CI, 3.63-4.33) for 1 to 9 days after the prescription start date, 3.01 (95% CI, 2.78-3.25) for 7 days after the prescription end date, 2.19 (95% CI, 1.82-2.65) for >9 days after the prescription start date, and 1.44 (95% CI, 1.29 -1.61) for 7 days before the prescription start date. There were lower asthmatic risks for COX-2 selective NSAIDs compared with nonselective NSAIDs. The use of NSAIDs in Japan was associated with an increased risk of acute asthma attacks. However, this risk was lower in COX-2 selective NSAIDs.