Inhalation Treatment Research Articles

Behavioral interventions to reduce particulate matter exposure in patients with COPD.

Introduction:Chronic obstructive pulmonary disease (COPD) is commonly affected by particulate matter (PM) exposure. In this study, we aimed to evaluate whether behavioral interventions to reduce PM exposure improve clinical outcomes in patients with COPD.Methods:A multicenter randomized controlled trial will be conducted involving 120 participants recruited from 3 hospitals in the capital region of the Republic of Korea. Patients aged 40 to 80 years with a diagnosis of COPD and a forced expiratory volume at 1 s <80% of the predicted value are eligible for inclusion. The participants will be randomized to either the intervention group or the usual care group (2:1). The behavioral interventions will comprise the following activities: checking air quality forecast; operating indoor air cleaners and regular check-ups of filters; ventilating the home regularly by opening windows; adhering to inhaler treatment; and refraining from going out on high air pollution days. “Internet-of-things”-based, gravimetric, and light-scattering methods will be used to measure indoor and outdoor PM concentrations. To estimate the degree of individual PM exposure, a time-activity diary and land use regression modeling will be used. The efficacy of the behavioral interventions on the following outcomes will be analyzed: amount of PM exposure, changes in forced expiratory volume at 1 s from the baseline, changes in respiratory symptoms and quality of life, risks of exacerbation, hospitalization, and death.Discussion:Given the harmful effect of air pollutants, individual-level interventions to reduce exposure may be significant. However, there is a lack of evidence on how effective such interventions are to date. This study will be able to provide physicians and patients with evidence-based strategies to reduce PM exposure in daily life.Trial registration number:NCT04878367

Nebulisation therapy in patients with cystic fibrosis - consensus of the Polish Cystic Fibrosis Society.

Nebulisation therapy plays a key role in the treatment of cystic fibrosis (CF). Its effectiveness depends on obtaining a high concentration of drugs in the respiratory tract. Particle deposition is determined by many factors resulting, inter alia, from the essence of the lung disease (mucus, structural changes such as bronchiectasis, fibrous changes, cirrhosis) and the quality of the aerosol and breathing techniques during the procedure. A large variety of available drugs that can be used in the form of aerosols (bronchodilators, mucolytics, antibiotics), a wide range of devices for their delivery, and a different approach to the practical aspect related to the use of inhalation, makes it necessary to systematize knowledge in order to optimize nebulisation therapy. The paper presents an overview of inhaled drugs used in cystic fibrosis and their administration devices. The principles of inhalation antibiotic therapy, which constitute the basis for the treatment of primary and chronic respiratory tract infections of Pseudomonas aeruginosa etiology, are discussed in detail. A very important issue was raised related to the proper selection of devices and their proper operation. In the context of the key role of nebulisation therapy in cystic fibrosis, a huge problem is the limited availability of inhaled antibiotics in Poland. The possibility of choosing an antibiotic and using alternating therapy increases the effectiveness of inhalation treatment, which results in slowing down the progress of bronchopulmonary disease and extending the life of patients.

A Randomized Controlled Trial to Evaluate the Safety and Efficacy of a Novel Inhaled Biologic Therapeutic in Adults with Respiratory Distress Secondary to COVID-19 Infection

IntroductionInhaled therapeutics may act to directly target and attenuate lung inflammation due to COVID-19. An inhalation form of a novel biologic drug, AMP5A, is being developed as an immunomodulatory agent to treat dysregulated immune responses and is being studied in hospitalized patients to treat respiratory complications due to COVID-19.MethodsA randomized, controlled, phase I trial was conducted to evaluate hospitalized adults with respiratory distress secondary to COVID-19. Patients received the standard care (SOC) for COVID-19, including respiratory therapy, corticosteroids, and antiviral therapies such as remdesivir. Patients were randomized 1:1 to inhalation treatment with AMP5A as an adjunct to SOC or to SOC alone (control). AMP5A was administered via inhalation daily for 5 days via hand-held nebulizer, non-invasive ventilator, or mechanical ventilation. Safety and clinical efficacy endpoints were evaluated.ResultsForty subjects were enrolled and randomized (n = 19 AMP5A, n = 21 control). Remdesivir was used in fewer AMP5A subjects (26%) than control (52%), and dexamethasone was administered for most subjects (84% AMP5A, 71% control). The study met its primary endpoint with no AMP5A treatment-related adverse events (AEs), and the incidence and severity of AEs were comparable between groups: 18 AEs for control (8 mild, 1 moderate, 9 severe) and 19 AEs for AMP5A (7 mild, 7 moderate, 5 severe). Notably, subjects treated with AMP5A had fewer deaths (5% vs. 24%), shorter hospital stay (8 days vs. 12 days), fewer ICU admissions (21% vs. 33%), and a greater proportion with improved clinical outcomes than control.ConclusionThe phase I clinical results indicate inhaled AMP5A is safe, is well tolerated, and could lead to fewer patients experiencing deterioration or death. Based on the treatment effect (i.e., reduced mortality), a phase II trial has been initiated.Trial RegistrationClinicaltrials.gov identifier: NCT04606784.

Nebulizer systems: a new frontier for therapeutics and targeted delivery.

Drug delivery via the pulmonary route is a cornerstone in the pharmaceutical sector as an alternative to oral and parenteral administration. Nebulizer inhalation treatment offers multiple drug administration, easily employed with tidal breathing, suitable for children and elderly, can be adapted for severe patients and visible spray ensures patient satisfaction. This review discusses the operational and mechanical characteristics of nebulizer delivery devices in terms of aerosol production processes, their usage, benefits and drawbacks that are currently shaping the contemporary landscape of inhaled drug delivery. With the advent of particle engineering, novel inhaled nanosystems can be successfully developed to increase lung deposition and decrease pulmonary clearance. The above-mentioned advances might pave the path for treating a life-threatening disorder like severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is also discussed in the current state of the art.

Steam inhalation: COVID-19 and pregnancy

African Journal of Midwifery and Women's HealthVol. 15, No. 3 EditorialSteam inhalation: COVID-19 and pregnancyUnice GoshomiUnice GoshomiCorrespondence to: E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:10 Oct 2021https://doi.org/10.12968/ajmw.2021.0049AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References la Marca G, Barp J, Frenos S et al. Thermal inactivation of SARS COVID-2 virus: Are steam inhalations a potential treatment? Life Sci. 2021;265:118801. https://doi.org/10.1016/j.lfs.2020.118801 Crossref, Google ScholarLarson L, File TM. Treatment of respiratory infections in pregnant patients. 2019. https://www.uptodate.com/contents/treatment-of-respiratory-infections-in-pregnant-patients (accessed 4 September 2021) Google ScholarSwain SK, Lenka S, Das S. Steam inhalation in treatment of the COVID-19 patients: a review. Univ J Pharmaceut Res. 2021;13. https://doi.org/10.31838/ijpr/2021.13.02.321 Google Scholar FiguresReferencesRelatedDetails 2 October 2021Volume 15Issue 3ISSN (online): 2052-4293 Metrics History Published online 10 October 2021 Published in print 2 October 2021 Information© MA Healthcare LimitedPDF download

Effectiveness and safety of adjunctive inhaled antibiotics for ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials.

The efficacy and safety of adjunctive inhaled antibiotic therapy for ventilator-associated pneumonia (VAP) was systematically reviewed based on updated studies. We searched four databases and four clinical trial registration platforms to identify relevant studies published prior to May 19, 2020. Randomized controlled trials (RCTs) assessing adjunctive antibiotic inhalation treatment for VAP patients were eligible for this review. Two reviewers independently screened the articles and extracted the data. Information on inhaled therapy and clinical outcomes was collected. Study quality was assessed with the Cochrane risk of bias tool. The meta-analysis was conducted with Review Manager and R software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines were used to evaluate the quality of evidence for each pooled outcome. Eleven RCTs and 1210 patients were included in this analysis after the application of the inclusion and exclusion criteria. Compared with the use of intravenous injection alone, the use of adjunctive inhaled antibiotic therapy improved the rates of clinical cure (relative risk (RR) 1.13, 95% CI [1.02,1.26]) and microbiological eradication (RR 1.45, 95% CI [1.19,1.76]) in VAP patients. However, despite these improvements, mortality was not reduced (RR 1.00, 95% CI [0.82,1.21]). Adjunctive antibiotics delivered through the respiratory tract were not associated with a higher risk of renal impairment but were associated with an increased risk of bronchospasm (RR 2.74, 95% CI [1.31,5.73] during treatment. Adjunctive inhaled antibiotics improved the clinical outcomes in VAP patients, but the increased rates clinical cure and microbiological eradication were not associated with reduced mortality. The use of nebulized antibiotics is not supported by the currently available evidence as a routine therapeutic strategy for VAP. CRD42020186970.

Associations between pediatric intensive care procedures and urinary free-BPA levels.

Bisphenol A (BPA) is found in many medical materials used in the paediatric intensive care unit (PICU). Our aim was to evaluate how the urinary free-BPA(fBPA) and total-BPA(tBPA) levels were associated with the use of medical devices in the PICU in a prospective study. The procedures applied to the patient were recorded during the follow-up period. Three urine samples were taken on the first day of hospitalization; the seventh day, and after 30 days or when the patients were discharged. Urinary tBPA and fBPA levels were determined using high-pressure liquid chromatography. Generalized estimating equations with repetitive measures were used to determine the associations between PICU procedures and BPA levels. A total of 115 urine samples of 40 children were studied. Mean urinary levels were 189.2 μg/g-creatinine for tBPA and 27.8 μg/g-creatinine for fBPA, and the fBPA/tBPA ratio was 27.9%. Endotracheal intubation, catheter, and haemodialysis procedures caused higher urinary fBPA levels. External drains, inhaler treatment, and the use of four or more medical devices were associated with considerably higher values of fBPA%. The increase in tBPA was positively correlated with fBPA. fBPA levels and the fBPA/tBPA ratio varied according to the procedure and level of BPA exposure in children.

Meta-analysis of efficacy and safety of inhaled ciprofloxacin in non-cystic fibrosis bronchiectasis patients.

No antibiotic therapies have been approved for reducing exacerbations and preventing disease progression in non-cystic fibrosis bronchiectasis (NCFB) patients. Several recent clinical studies have investigated the feasibility of inhaled ciprofloxacin in NCFB, whereas the results were controversial. No antibiotic therapies have been approved for reducing exacerbations and preventing disease progression in non-cystic fibrosis bronchiectasis (NCFB) patients. Several recent clinical studies have investigated the feasibility of inhaled ciprofloxacin in NCFB, whereas the results were controversial. We conducted the present meta-analysis to comprehensively evaluate the feasibility of inhalation of ciprofloxacin in NCFB. Electrical databases Medline and Cochrane library were retrieved from inception through December 2019. Randomised controlled trials (RCT) comparing inhaled ciprofloxacin and placebo were selected. The primary outcomes were time to first exacerbation, frequency of exacerbations and the change in sputum Pseudomonas aeruginosa density. A total of five articles involving six RCT was finally included in the analysis. The time to first exacerbation was significantly prolonged by inhaled ciprofloxacin (hazard ratio: 0.72, 95% confidence interval (CI): 0.63-0.82), with low heterogeneity (I2 = 23%). Inhalation of ciprofloxacin significantly reduced frequency of exacerbations (risk ratio: 0.70, 95% CI: 0.61-0.79) and decreased density of sputum P. aeruginosa (weighted mean difference: -2.11 log10 CFU/g, 95% CI: -2.96 to -1.27 log10 CFU/g) compared with placebo. No significant between-group differences in mortality, adverse events and discontinuation rate were observed. Further indirect treatment comparison showed no differences between the two types of inhaled ciprofloxacin in all outcomes of interest. Ciprofloxacin inhalation treatment significantly prolonged the time to first exacerbation, reduced the frequency of exacerbations and decreased sputum P. aeruginosa density and was well tolerated. Ciprofloxacin inhalation is promising in the treatment of NCFB.

Relationship of inhaled ipratropium and inhaled salbutamol with pupil dilation: A prospective observational study

This prospective randomized study aimed to compare the effects of nebulizer drugs on unilateral or bilateral dilation of the pupil that may develop due to mask incompatibility or patient incompatibility in patients receiving inhaled therapy. Following the approval of the local ethics committee, this study was carried out prospectively and observationally in the period from October 1, 2018 to April 1, 2019 in an emergency clinic with an annual capacity of 600,000 patients in a tertiary education and research hospital. The patients were divided into three groups: those given salbutamol alone (200 mcg), those given ipratropium alone (250 mcg/2ml), and those receiving both salbutamol and ipratropium. The pupil diameters of the patients included in the study were measured twice using a pupilometer device at hours 0 and 2 of treatment. Ninety- one patients that received inhaler treatment in the emergency department were included in the study. The process of treatments given to patients with indications was not interrupted. Ipratropium and salbutamol (49.5%) were used together in 45 patients, ipratropium alone in 38 (41.7%), and salbutamol alone in eight (8.8%). When the absolute delta ratios were compared, a statistically significant difference was observed between the patients given salbutamol and those given ipratropium, and between the patients that received salbutamol and those given salbutamol and ipratropium (p=0.001, 95% CI: 1.36-6.11 and p&lt;0.001, 95% CI: 1.51- 6.19, respectively). Salbutamol caused statistically significantly greater pupil diameter changes than the other drugs. Although neurological diagnoses are considered in patients with anisocoria, it should be kept in mind that anisocoria may also be due to the current or the treatment being given.

Two different methods of lidocaine inhalation before diagnostic flexible bronchoscopy: effects on post-bronchoscopy respiratory symptoms

Use of topical anesthesia before flexible bronchoscopy for the evaluation of the upper airways prevents cough and stridor during and after the procedure while reducing the need for sedation. In practice, lidocaine is the medication of choice before bronchoscopy. There various types of nebulizers used for inhalation treatments. In this study, we compared the respiratory tract symptoms after flexible bronchoscopy between children who received pre-procedure topical lidocaine with mesh or jet nebulizers. We enrolled 4–18 years old subjects that underwent flexible bronchoscopy due to treatment-resistant asthma in this retrospective case-control study. Twenty subjects received topical lidocaine with jet nebulizers while 20 received it with mesh nebulizers. Age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were recorded as well as cough and laryngospasm scores after flexible bronchoscopy. Severe cough after flexible bronchoscopy was not encountered in the mesh nebulizers group but was seen in 10% of the jet nebulizers group (p = 0.027). On the other hand, age, sex, duration of bronchoscopy, duration of anesthesia, time to awaken, and time to recovery were not significantly different between the mesh and jet nebulizer groups (p = 0.44, 0.34, 0.51, 0.88, 0.88, and 0.22, respectively). Moreover, croup and laryngospasm scores between the two groups were similar (p = 0.62, 0.50 respectively). Cough score was significantly worse jet nebulizers group (p = 0.03). Topical lidocaine application with mesh nebulizers decreases the most common complication, cough, after flexible bronchoscopy in children more effectively compare to jet nebulizers. Thus, mesh nebulizers may be a faster way of nebulization before flexible bronchoscopy as an alternative to jet nebulizers.

Aerosol inhalation delivery of cefazolin in mice: Pharmacokinetic measurements and antibacterial effect

Aerosol inhalation delivery of cefazolin, a broad-spectrum first-generation cephalosporin antibiotic, was investigated. Inhalation system based on ultrasonic nebulizer was developed for the generation of dry cefazolin aerosol within mean particle diameter range 0.5–3.0 μm and mass concentration 0.01–3 μg/cm3. Pharmacokinetic measurements were carried out for the aerosolized form of cefazolin delivered in mice using nose-only chamber. Cefazolin concentrations in blood serum and in the lungs of mice were measured as a function of time by means of high performance liquid chromatography. Body-delivered dose depending on particle size, concentration and inhalation time as well as other pharmacokinetic parameters were determined. The antibacterial effect of aerosolized cefazolin was assessed through the aerosol inhalation treatment of mice infected with Klebsiella pneumoniae. Survival rate for infected mice after the treatment with cefazolin aerosol demonstrated high antibacterial efficiency of the inhalation delivery of cefazolin in comparison with intraperitoneal delivery.

Viscero-somatic integration: new therapeutic proposals through integrated thermal cures (CIT)

Traditional thermal medicine, gold standard for some pathologies, focuses its therapeutic target mainly on a sectoriallevel, focusing only on the pathological symptom and neglecting man as a whole.The importance of the whole, of the phenomena of systemic, viscero-somatic and somato-visceral interrelation, hasled to the creation of a new approach called “CTI” - Integrated Thermal Care, which uses all the thermal therapies,integrated and administered according to the individual needs to enhance their therapeutic effect.235 subjects have received, on average, 40 treatments within about a year. They were treated with hydropinictreatment, inhalation treatments, hydrokinesitherapy, vascular pathways, mud therapy and manual neuromusculartherapy associated with the previous treatments.The results obtained in all the FIM, VAS, TINETTI, EUROQOL scales are positive and statistically significant, whichsuggests that a modification of the treatment protocols, which provides for a unique and integrated stimulation, is thenew objective of thermal medicine for serious disabilities.

Viscero-somatic integration: new therapeutic proposals through integrated thermal cures (CIT)

Traditional thermal medicine, gold standard for some pathologies, focuses its therapeutic target mainly on a sectorial level, focusing only on the pathological symptom and neglecting man as a whole. The importance of the whole, of the phenomena of systemic, viscero-somatic and somato-visceral interrelation, has led to the creation of a new approach called "CTI" - Integrated Thermal Care, which uses all the thermal therapies, integrated and administered according to the individual needs to enhance their therapeutic effect. 235 subjects have received, on average, 40 treatments within about a year. They were treated with hydropinic treatment, inhalation treatments, hydrokinesitherapy, vascular pathways, mud therapy and manual neuromuscular therapy associated with the previous treatments. The results obtained in all the FIM, VAS, TINETTI, EUROQOL scales are positive and statistically significant, which suggests that a modification of the treatment protocols, which provides for a unique and integrated stimulation, is the new objective of thermal medicine for serious disabilities.

New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region. Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4-82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7 ±1.0 vs. 1.1 ± 0.5 respectively; р &lt; 0.001). The mean age of the hospitalized children was 8 years (7.4-9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3-83.0), cough (66.1%; 95% CI 57.1-74.4]), fatigues (38.7%; 95% CI 30.1-47.9), and hyposmia (33.9%; 95% CI 25.6-42.9). The severe disease course was rare (2.4%; 95% CI 0.5-6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р &lt; 0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide / fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of &gt; 5 days duration can be a predictor of pneumonia in a pediatric patient with COVID-1 9 (odds ratio 4.55 (2.1-9.9), sensitivity 61.4%, specificity 74.1%).Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-1 9.

Effect of Aprotinin and Avifavir® Combination Therapy for Moderate COVID-19 Patients.

COVID-19 is a contagious multisystem inflammatory disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied the efficacy of Aprotinin (nonspecific serine proteases inhibitor) in combination with Avifavir® or Hydroxychloroquine (HCQ) drugs, which are recommended by the Russian Ministry of Health for the treatment therapy of moderate COVID-19 patients. This prospective single-center study included participants with moderate COVID-19-related pneumonia, laboratory-confirmed SARS-CoV-2, and admitted to the hospitals. Patients received combinations of intravenous (IV) Aprotinin (1,000,000 KIU daily, 3 days) and HCQ (cohort 1), inhalation (inh) treatment with Aprotinin (625 KIU four times per day, 5 days) and HCQ (cohort 2) or IV Aprotinin (1,000,000 KIU daily for 5 days) and Avifavir (cohort 3). In cohorts 1–3, the combination therapy showed 100% efficacy in preventing the transfer of patients (n = 30) to the intensive care unit (ICU). The effect of the combination therapy in cohort 3 was the most prominent, and the median time to SARS-CoV-2 elimination was 3.5 days (IQR 3.0–4.0), normalization of the CRP concentration was 3.5 days (IQR 3–5), of the D-dimer concentration was 5 days (IQR 4 to 5); body temperature was 1 day (IQR 1–3), improvement in clinical status or discharge from the hospital was 5 days (IQR 5–5), and improvement in lung lesions of patients on 14 day was 100%.

Nebulization of emergency medications in the south German rescue service

HintergrundIn der Notfallmedizin ist die Durchführung der inhalativen Therapie auch durch Rettungsfachpersonal vorgesehen. Standard Operating Procedures (SOP) und Handlungsempfehlungen zum Einsatz sind nicht bundeseinheitlich und liegen im Falle der Vernebelung von Notfallmedikamenten nicht in allen Bundesländern und Rettungsdienstbereichen vor. Es existieren auch keine Empfehlungen, welcher Verneblertyp genutzt werden soll. Die Medikamentendepositionsraten von Jet- und Mesh-Verneblern unterscheiden sich aber erheblich; klinisch ist die Verwendung von Mesh-Systemen mit einem besseren Patienten-Outcome assoziiert.Ziel der ArbeitDie vorliegende Umfrage sollte die Praxis des Vernebelns von Notfallmedikamenten im süddeutschen Rettungsdienst evaluieren. Ein besonderes Augenmerk wurde auf den eingesetzten Verneblertyp sowie den Einfluss von SOP und Handlungsempfehlungen auf die Anwendung gelegt.Material und MethodenInsgesamt 4800 in Baden-Württemberg, Bayern und Rheinland-Pfalz tätige Notfallsanitäter*innen und Rettungsassistent*innen erhielten insgesamt 17 Fragen zur Durchführung der Medikamentenvernebelung in ihrer alltäglichen Praxis.ErgebnisseDer Jet-Vernebler ist mit Abstand der am häufigsten eingesetzte Verneblertyp. Die Depositionsraten sowohl des Jet- als auch des Mesh-Verneblers werden deutlich überschätzt. Nur 67,3 % aller Befragten vernebelten im Rahmen von SOP oder Handlungsempfehlungen. Das Vorhandensein dieser war allerdings maßgeblich für den Einsatz der Vernebelung ohne Beisein eines*er Notarzt*ärztin und die gefühlte Sicherheit beim Vernebeln.DiskussionDer flächendeckende Einsatz von Mesh-Verneblern könnte die Therapie von Notfallpatient*innen homogenisieren und möglicherweise das Outcome verbessern. SOP und Handlungsempfehlungen zur Anwendung von Vernebelung in der Notfallsituation könnten die inhalative Therapie verbessern und homogenisieren.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00101-021-00992-x) enthält den der Studie zugrunde liegenden Fragebogen.Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

New triple combination of beclomethasone dipropionate, glycopyrronium bromide and formoterol fumarate in the treatment of chronic obstructive pulmonary disease

Therapeutical options for the treatment of chronic obstructive pulmonary disease (COPD) have significantly expanded in recent years, primarily due to market entry of new combination drugs. One of the commonly used therapeutic options for patients with frequent exacerbations of COPD is a triple combination, including LABA, LAMA and ICS, however, prescribing such therapy, doctors often face a decrease in treatment adherence, which ultimately leads to lack of effectiveness, as well as with an increased risk of adverse events. This article presents the current information on the clinical efficacy and safety profile of a fixed triple combination of beclomethasone dipropionate, glycopyrronium bromide and formoterol fumarate, available as extrafine aerosol inhaler, allows to optimize inhalation treatment for patients with frequent exacerbations of COPD.

Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?

Abstract Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome. Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage. Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.

Silencing of SARS-CoV-2 with modified siRNA-peptide dendrimer formulation.

BackgroundFirst vaccines for prevention of Coronavirus disease 2019 (COVID‐19) are becoming available but there is a huge and unmet need for specific forms of treatment. In this study we aimed to evaluate the anti‐SARS‐CoV‐2 effect of siRNA both in vitro and in vivo.MethodsTo identify the most effective molecule out of a panel of 15 in silico designed siRNAs, an in vitro screening system based on vectors expressing SARS‐CoV‐2 genes fused with the firefly luciferase reporter gene and SARS‐CoV‐2‐infected cells was used. The most potent siRNA, siR‐7, was modified by Locked nucleic acids (LNAs) to obtain siR‐7‐EM with increased stability and was formulated with the peptide dendrimer KK‐46 for enhancing cellular uptake to allow topical application by inhalation of the final formulation – siR‐7‐EM/KK‐46. Using the Syrian Hamster model for SARS‐CoV‐2 infection the antiviral capacity of siR‐7‐EM/KK‐46 complex was evaluated.ResultsWe identified the siRNA, siR‐7, targeting SARS‐CoV‐2 RNA‐dependent RNA polymerase (RdRp) as the most efficient siRNA inhibiting viral replication in vitro. Moreover, we showed that LNA‐modification and complexation with the designed peptide dendrimer enhanced the antiviral capacity of siR‐7 in vitro. We demonstrated significant reduction of virus titer and lung inflammation in animals exposed to inhalation of siR‐7‐EM/KK‐46 in vivo.ConclusionsThus, we developed a therapeutic strategy for COVID‐19 based on inhalation of a modified siRNA‐peptide dendrimer formulation. The developed medication is intended for inhalation treatment of COVID‐19 patients.

Study of efficacy, safety, and patient satisfaction with inhaled tobramycin (Tobramycin-Gobbi) in children with cystic fibrosis and pseudomonas infection

Study of efficacy, safety, and patient satisfaction with inhaled tobramycin (Tobramycin-Gobbi) in children with cystic fibrosis and pseudomonas infectionAim of the study was to assess efficacy and safety of Tobramycin-Gobbi in CF, as well as the patients’ satisfaction with the treatment.Methods. 35 children from 6 to 18 years with CF were enrolled in this non-interventional prospective cohort multicenter study. All children had P. aeruginosa in the respiratory tract (newly diagnosed, recurrent, or chronic infection). The children received inhalation treatment with Tobramycin-Gobbi in the following cycles: 28-day treatment/28-day break, for 6 months. The studied parameters included respiratory function, bacterial cultures of the respiratory tract with a bacterial count, growth and body weight, antibiotic therapy for the respiratory episodes. The children and parents filled in a questionnaire “Treatment satisfaction assessment” and assessed their state of health on the visual-analog scale before and after each treatment cycle.Results. P. aeruginosa was eradicated in 17.7% of cases (6 patients, including 2 newly diagnosed, 3 recurrent infections, and 1 chronic infection), reduced bacterial count, decreased number of courses of antibiotic therapy, improvement of FEV1. Adverse reactions were reported by one patient.Conclusion. The efficacy, safety, and tolerability of Tobramicine Gobbi were confirmed in the patients with newly diagnosed, recurrent, and chronic infection caused by P. aeruginosa.