Inhalation Therapy In Patients Research Articles

Lung deposition of inhaled alpha-1-proteinase inhibitor (alpha 1-PI) - problems and experience of alpha1-PI inhalation therapy in patients with hereditary alpha1-PI deficiency and cystic fibrosis.

Alpha-1-proteinase inhibitor (α1-PI) is the most relevant protease inhibitor in the lung. Patients with hereditary deficiency of α1-PI suffer from an impaired hepatic synthesis of α1-PI in the liver and in consequence an insufficient concentration of the protease inhibitor in the lung followed by development of lung emphysema due to an impaired protease antiprotease balance and a local relative excess of neutrophil elastase (NE). In contrast, patients with cystic fibrosis (CF) are characterised by a normal synthesis of α1-PI and a severe pulmonary inflammation with a strong excess of NE in the lung followed by progressive loss of lung function. In principle, both patient groups may benefit from an augmentation of α1-PI. Intravenous augmentation, which is established in patients with α1-PI deficiency only, is very expensive, subject to controversial discussions and only about 2% of the administered protein reaches lung interstitium. Inhalation of α1-PI may serve as an alternative to administer high α1-PI doses into the lungs of both patient groups to restore the impaired protease antiprotease balance and to diminish the detrimental effects of NE. However, prerequisites of this therapy are the reproducible administration of sufficient doses of active α1-PI into the lung without adverse effects. In our review we describe the results of studies investigating the inhalation of α1-PI in patients with α1-PI deficiency and CF. The data demonstrate the feasibility of α1-PI inhalation for restoration of the impaired protease antiprotease balance, attenuation of the inflammation and neutralisation of the excess activity of NE. Likely, inhalation of α1-PI serves as cheaper and more convenient therapy than intravenous augmentation. However, inhalation will be further optimised by use of novel nebulisers and optimised breathing techniques.

The important points of re-instruction on the inhalation therapy in patients with bronchial asthma and COPD

The important points of re-instruction on the inhalation therapy in patients with bronchial asthma and COPD

Long-term echocardiographic follow-up of a patient with primary pulmonary hypertension receiving iloprost inhalations

Iloprost inhalation has recently emerged as an alternative therapy for severe primary pulmonary hypertension. In the studies documenting the effect of iloprost inhalation therapy, hemodynamic variables have been measured invasively. We have followed a patient with primary pulmonary hypertension receiving iloprost inhalation therapy for 5 years using echocardiography to monitor changes in pulmonary artery pressure and right ventricular function. Echocardiography was also used to evaluate the initial response to iloprost inhalation therapy. This case illustrates the feasibility and utility of echocardiography in the testing and follow-up of iloprost inhalation therapy in patients with pulmonary hypertension.

Psychosomatic study of inhalation therapy in patients with bronchial asthma. I. Evaluation by questionnaire

We investigated the use of metered-dose beta agonist inhalers (MDIs) by means of 17-item questionnaires from the standpoint of psychosomatic medicine in 56 subjects with bronchial asthma. The results can be summarized as follows: 1) Many asthmatics with neurotic characters used MDIs frequently; Thirteen percent of them suffered adverse effects. The number of times the inhalers were used increased in proportion to the severity and the duration of illness. Fifteen percent of the subjects used MDIs frequently because of anxiety. 2) Fifty percent of the subjects, most of them had neurotic or alexithymic characters, used MDIs without suffering from dyspnea or wheezes; the subjects who used MDIs because of anxiety increased in proportion to the duration of illness. 3) Seventy eight percent of the subjects were anxious about asthmatic attack when they did not carry any MDI; sixty two percent of the subjects, most of them had neurotic or alexithymic characters, actually experienced asthmatic attack. 4) Seventy three percent of the subjects used MDIs secretly; sixty percent of the subjects did not like to inhale in the presence of others. 5) There were some subjects who acted incorrectly on or after asthmatic attack when MDIs were not effective.

REMISSIONS IN BRONCHIAL ASTHMA AND HYPERTROPHIC PULMONARY EMPHYSEMA

Patients with bronchial asthma and the broncho-spastic type of chronic hypertrophic pulmonary emphysema occasionally manifest spontaneous remissions without discernible cause. Commonly, these periods of freedom from symptoms have followed unusual events in their lives, such as operations with ether anesthesia, sustained fever due to foreign protein reaction or infection (except virus caused), a critical emotional upheaval, or abrupt transfer to a new regimen involving the elimination of the accustomed medication. The purpose of this paper is to describe (1) the approach to remissive therapy, the aim of which is to initiate a prolonged period of freedom from wheezing, cough, and dyspnea, with utilization of the insights yielded by spontaneous remissions in patients, and (2) the measures for which a sound physiological argument may be presented. In some of the early studies on inhalation therapy in patients with intractable bronchospasm it was surprising how often substantial benefit followed a physiologically directed