Inhalation Treatment Research Articles

SARS-COV-2 treated with oral nirmatrelvir–ritonavir in children: A case report

Rationale: Nirmatrelvir/ritonavir is an effective drug for preventing the 2019 coronavirus disease epidemic from becoming a serious disease in adults. However, its efficacy in pediatric cases remains unknown. This study aimed to analyze the feasibility, safety, and efficacy of nirmatrelvir ritonavir in the treatment of 6 to 14 year old children with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Patient concerns: A child was admitted to the hospital for treatment of 2019 coronavirus disease, and his disease worsened. Based on oxygen inhalation and supportive treatment, the patients were treated with nirmatrelvir/ritonavir, and improvements in clinical symptoms and negative nucleic acid conversion were observed to evaluate their safety and efficacy. Diagnosis: Phayngeal swab tested positive for severe acute respiratory syndrome coronaviruses type 2 nucleic acids and chest computed tomography access for diagnosis: severe acute respiratory syndrome coronaviruses type 2. Interventions: The patient started taking nirmatrelvir and ritonavir tablets within 6 days of symptom onset. No adverse reactions were noted. On the third day of oral treatment, the nuclear conversion was negative. Outcomes: Based on the current single-sample studies, nimatrelvir and ritonavir are feasible options for treating severe acute respiratory syndrome coronavirus type 2 infections in children aged 6 to 14. That the safety and efficacy. Simultaneously, attention should be paid to comprehensive treatment of the disease. Further large-scale studies are required. Lessons: Acute respiratory syndrome coronavirus type 2 can cause severe in children, and the treatment regimen of nimatrelvir/ritonavir can be chosen. Early treatment may be effective. It is very important to closely observe clinical symptoms, detect serious symptoms, and prevent disease aggravation.

COVID-19-Related Discontinuation Impact on Patient-Reported Outcomes in Long-Term Thermal Therapy: A Single-Center Observational Study at Saturnia Thermal Springs.

Thermal therapy represents a well-established therapeutic approach for chronic musculoskeletal and respiratory conditions. To date, no studies have investigated the clinical effects of treatment interruption in thermal medicine. We aimed to evaluate the clinical impact of COVID-19 lockdown-induced thermal therapy discontinuation through validated patient-reported outcomes. This single-center observational, retrospective study (March 2020-June 2024) evaluated 97 patients receiving standardized thermal therapy at Saturnia Thermal Springs. Treatment protocols included balneotherapy, mud therapy, and inhalation treatments in cycles of 12-15 sessions, with maintenance protocols every 4-6 months. Primary outcomes were assessed through VAS and SF-36 PCS, with EQ-5D and PSQI as secondary outcomes. Significant clinical deterioration occurred during treatment interruption (p < 0.001) in 77.7% of patients. Recovery patterns were duration-dependent, with the 6-7-year cohort showing faster recovery (mean time to baseline: 2.8 months) compared to the 3-5-year cohort (4.6 months). Effect sizes were substantial across all outcomes (Cohen's d > 1.0), with EQ-5D scores showing duration-dependent improvement (mean improvement in 6-7-year cohort: 0.27). Thermal therapy interruption precipitates quantifiable clinical deterioration, with recovery patterns significantly influenced by pre-existing treatment duration. These findings support the essential nature of treatment continuity in thermal therapy protocols.

Parental Perception about use of Inhaler Therapies in Childhood Asthma

Background: Parental attitudes towards the use of inhaled therapy in children with chronic asthma influence treatment adherence and outcome. In the present study, we evaluated the perceptions and concerns of parents of children with chronic asthma towards inhaled therapy. Objectives: The primary objective of this study is to understand how parents perceive inhaler therapies for managing childhood asthma, focusing on factors such as effectiveness, accessibility, and potential side effects. It also seeks to explore the influence of socio-cultural factors on parental acceptance and adherence to prescribed inhaler treatments. Methods: A qualitative approach was used, involving in-depth interviews with 200 parents or caregivers of children aged 5 to 12 years diagnosed with asthma. Participants were selected from Bolan Medical Complex, Quetta, through purposive sampling. The study gathered data through semi-structured interviews that focused on participants' experiences, attitudes, and knowledge regarding inhaler therapies. Results: The findings revealed that the majority of parents were aware of asthma and inhaler therapies, with a significant proportion viewing inhalers as an effective treatment option. However, concerns about side effects and the long-term use of inhalers were common. Cultural beliefs also influenced parents' willingness to embrace inhaler therapy, with some preferring alternative treatments. Conclusion: The study highlights the importance of addressing parental concerns and misconceptions about inhaler therapies. Educational interventions, clear communication from healthcare providers, and culturally sensitive approaches are crucial in improving parental acceptance and adherence to inhaler treatments, ultimately enhancing asthma management in children.

Efficacy and Safety of Aerosol Inhalation of Colistin Sulfate for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infection in the Peri-Operative Period of Liver Transplantation: A Single-Center Retrospective Study.

Objective: This study intended to evaluate the clinical efficacy and safety of colistin sulfate aerosol inhalation in combination with ceftazidime-avibactam for the treatment of pulmonary carbapenem-resistant Klebsiella pneumoniae (CRKP) infection during the peri-operative period of liver transplantation. Materials and Methods: A retrospective analysis was designed to investigate 52 patients who developed pulmonary CRKP infection after liver transplantation between December 1, 2019, and November 30, 2022. On the basis of whether they received colistin sulfate aerosol inhalation, the patients were divided into the treatment group (n = 29) and the control group (n = 23). The baseline information, infection status, CRKP enzyme type, inflammatory markers, liver and kidney function, and prognosis were compared and analyzed. Results: There were no significant differences in patient characteristics, infection status, and drug resistance enzyme type between the treatment group (treated with colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection) and the control group (treated with ceftazidime and avibactam sodium for injection alone). Colistin sulfate aerosol inhalation treatment reduced concentrations of inflammatory markers, with post-treatment white blood cell count, procalcitonin, and C-reactive protein significantly lower than pre-treatment levels (p < 0.05). Except for C-reactive protein at 14 days (p = 0.032), the two groups had no significant differences in other indicators. There were no significant differences in alanine aminotransferase, aspartate aminotransferase, total bilirubin, and glomerular filtration rate after treatment, indicating no discernible alteration in liver and kidney function. In addition, the treatment group took a significantly shorter time to normalize body temperature compared with the control group (p = 0.025), but there were no significant differences in the cure with no colonization rate and all-cause mortality rate between the two groups. Conclusions: The combination of colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection is effective in treating pulmonary CRKP infection during the peri-operative period of liver transplantation. It does not impose an additional burden on liver and kidney function, providing a new treatment option for this type of infection.

Encapsulation of Nanocrystals in Mannitol-Based Inhalable Microparticles via Spray-Drying: A Promising Strategy for Lung Delivery of Curcumin.

Curcumin is well known for its great anti-inflammatory and antioxidant efficacy, representing a potential strategy for the treatment of respiratory disorders. However, several drawbacks, such as chemical instability, poor water solubility and rapid metabolism, result in low bioavailability, limiting its clinical applications. In this study, curcumin nanocrystals were incorporated into mannitol-based microparticles to obtain an inhalable dry powder. A curcumin nanosuspension was produced by wet-ball media milling and thoroughly characterized. Spray drying was then used to produce mannitol microparticles incorporating curcumin nanocrystals. In vitro release/dissolution tests were carried out in simulated lung fluids, and the aerosolization properties were evaluated using a Next-Generation Impactor (NGI, Apparatus E Ph. Eu.). The incorporation of curcumin nanocrystals into mannitol-based microparticles influenced their morphological properties, such as geometric diameters, and flowability. Despite these changes, nebulization studies confirmed optimal MMAD values (<5 µm), while multi-step dissolution/release studies evidenced the influence of mannitol. The developed curcumin nanocrystals-loaded mannitol microparticles show promise as an inhalable treatment for respiratory diseases, combining effective aerodynamic properties with controlled drug release.

Advances in Aerogels Formulations for Pulmonary Targeted Delivery of Therapeutic Agents: Safety, Efficacy and Regulatory Aspects.

Aerogels are the 3D network of organic, inorganic, composite, layered, or hybrid-type materials that are used to increase the solubility of Class 1 (low solubility and high permeability) and Class 4 (poor solubility and low permeability) molecules. This approach improves systemic drug absorption due to the alveoli's broad surface area, thin epithelial layer, and high vascularization. Local therapies are more effective and have fewer side effects than systemic distribution because inhalation treatment targets the specific location and raises drug concentration in the lungs. The present manuscript aims to explore various aspects of aerogel formulations for pulmonary targeted delivery of active pharmaceutical agents. The manuscript also discusses the safety, efficacy, and regulatory aspects of aerogel formulations. According to projections, the global respiratory drug market is growing 4-6% annually, with short-term development potential. The proliferation of literature on pulmonary medicine delivery, especially in recent years, shows increased interest. Aerogels come in various technologies and compositions, but any aerogel used in a biological system must be constructed of a material that is biocompatible and, ideally, biodegradable. Aerogels are made via "supercritical processing". After many liquid phase iterations using organic solvents, supercritical extraction, and drying are performed. Moreover, the sol-gel polymerization process makes inorganic aerogels from TMOS or TEOS, the less hazardous silane. The resulting aerogels were shown to be mostly loaded with pharmaceutically active chemicals, such as furosemide-sodium, penbutolol-hemisulfate, and methylprednisolone. For biotechnology, pharmaceutical sciences, biosensors, and diagnostics, these aerogels have mostly been researched. Although aerogels are made of many different materials and methods, any aerogel utilized in a biological system needs to be made of a substance that is both biocompatible and, preferably, biodegradable. In conclusion, aerogel-based pulmonary drug delivery systems can be used in biomedicine and non-biomedicine applications for improved sustainability, mechanical properties, biodegradability, and biocompatibility. This covers scaffolds, aerogels, and nanoparticles. Furthermore, biopolymers have been described, including cellulose nanocrystals (CNC) and MXenes. A safety regulatory database is necessary to offer direction on the commercialization potential of aerogelbased formulations. After that, enormous efforts are discovered to be performed to synthesize an effective aerogel, particularly to shorten the drying period, which ultimately modifies the efficacy. As a result, there is an urgent need to enhance the performance going forward.

Inhalable cyclodextrin metal-organic framework dry powder enhanced direct pulmonary delivery of paclitaxel for the treatment of lung cancer

Inhalation dry powders are in great demand for the treatment of lung diseases due to their unique advantages such as excellent direct delivery, rapid onset of action, and reduced systemic side effects. Herein, this work highlights the successful development of an inhalable paclitaxel dry powder, which is facilely constructed through the optimization of the formulation between chemotherapy components (paclitaxel) and a metal-organic framework (MOF) carrier (γ-cyclodextrin and KOH). Moderate pore and particle size distribution, as well as low hygroscopicity endow the dry powder with excellent loading efficiency and resistance to degradation. All ingredients and their interactions confer favorable emptying rates, flowability, and pulmonary deposition, as well as direct lung drug delivery and release. These attractive characteristics enable the dry powder to effectively enhance cytotoxicity, improve pharmacokinetics, promote lung accumulation, and reduce the side effects of paclitaxel. Thus, this paclitaxel dry powder may open a new avenue for the inhalation treatment of diseases, greatly advancing its clinical application.

Spa Therapy Efficacy in Mental Health and Sleep Quality Disorders in Patients with a History of COVID-19: A Comparative Study.

The COVID-19 pandemic has left behind mental health issues like anxiety, depression, and sleep disorders among survivors. This study assessed the efficacy of spa therapy in enhancing psychological well-being and sleep quality in individuals with chronic arthro-rheumatic, respiratory, and otorhinolaryngological diseases, including COVID-19 recoverees. Our prospective observational study included 144 Caucasian subjects from three Italian spas who underwent a 2-week spa therapy cycle, involving balneotherapy and/or inhalation treatments. Symptoms were assessed with the Visual Analogue Scale (VAS), psychological well-being with Depression Anxiety Stress Scales-21 items (DASS-21), and sleep quality with the Insomnia Severity Index (ISI). Significant reductions in VAS scores for arthro-rheumatic, respiratory, and otorhinolaryngological symptoms were observed after spa therapy, as well as for DASS-21 and ISI scores for sleep quality, transitioning to less severe insomnia categories. Females had more pronounced improvements in DASS-21 scores and sleep quality. Subjects with and without prior SARS-CoV-2 infection experienced significant reductions in anxiety, depression, and stress, with more pronounced improvements in those without prior infection. COVID-19 survivors also showed significant ISI score improvements. Spa therapy is a promising complementary treatment for improving mental health and sleep quality in chronic disease patients, including COVID-19 survivors.

Evidence-based nursing in oxygen-driven nebulized inhalation treatment in children with asthmatic bronchitis.

Evidence-based nursing in oxygen-driven nebulized inhalation treatment in children with asthmatic bronchitis.

Short-term Tezepelumab effectiveness in patients with severe asthma: a multicenter study

Objective Severe asthma presents significant management challenges, often requiring advanced treatments to control symptoms and reduce exacerbations. The use of monoclonal antibodies has revolutionized the clinical course of patients with severe asthma, showing a significant impact on exacerbations reduction, oral corticosteroids (OCS) cessation and on the improvement of lung function and quality of life. Tezepelumab, an anti-thymic stromal lymphopoietin (TSLP) monoclonal antibody, has emerged as a potential therapeutic option for these patients. Methods We conducted an observational, prospective, multicenter study including 20 patients with confirmed severe asthma according to ERS guidelines and GINA recommendations. Patients received Tezepelumab 210 mg every 4 wk due to uncontrolled asthma despite maximal inhalation treatment with ICS/LABA. Data were collected before treatment initiation (T0) and after three months from the first administration (T3). Results After three months of Tezepelumab treatment, we reported significant improvements in asthma symptoms and quality of life, as well as a consistent reduction in exacerbations and OCS use. We found no statistically meaningful differences among main clinical and functional outcomes according to inflammatory biomarkers, while lung function improved significantly in patients with less allergic sensitization. No serious adverse event was reported during the follow up, while the rates of mild adverse effects were comparable to those from registration trials. Conclusion Tezepelumab demonstrated short-term efficacy in improving asthma control and quality of life, showing a favorable safety profile. Further studies with larger sample sizes and longer follow-up would confirm these findings and identify predictors of response to Tezepelumab.

Inhaled treatment for dyspnea in a rare childhood disease.

Inhaled treatment for dyspnea in a rare childhood disease.

SP-101, A Novel Adeno-Associated Virus Gene Therapy for the Treatment of Cystic Fibrosis, Mediates Functional Correction of Primary Human Airway Epithelia From Donors with Cystic Fibrosis.

Cystic fibrosis (CF) is caused by mutations in the gene encoding the CF transmembrane conductance regulator (CFTR) protein. Although CF affects multiple organs, lung disease is the main cause of morbidity and mortality, and gene therapy is expected to provide a mutation-agnostic option for treatment. SP-101 is a recombinant adeno-associated virus (AAV) gene therapy vector carrying a human CFTR minigene, hCFTRΔR, and is being investigated as an inhalation treatment for people with CF. To further understand SP-101 activity, in vitro studies were performed in human airway epithelia (HAE) derived from multiple CF and non-CF donors. SP-101 restored CFTR-mediated chloride conductance, measured via Ussing chamber assay, at a multiplicity of infection (MOI) as low as 5E2 in the presence of doxorubicin, a small molecule known to augment AAV transduction. Functional correction of CF HAE increased with increasing MOI and doxorubicin concentration and correlated with increasing cell-associated vector genomes and hCFTRΔR mRNA expression. Tropism studies using a fluorescent reporter vector and single-cell mRNA sequencing of SP-101-mediated hCFTRΔR mRNA demonstrated broad expression in all cell types after apical transduction, including secretory, ciliated, and basal cells. In summary, SP-101, particularly in combination with doxorubicin, shows promise for a novel CF treatment strategy and strongly supports continued development.

The Real-World Efficacy of Fixed Triple Inhalation Therapy in the Treatment of Moderate COPD Patients (RATIONALE Study).

COPD affects more than 300 million people worldwide, requiring inhalation treatment. Novel triple formulations of ICS, LABAs and LAMAs are becoming the mainstay of treatment, however there is still a lack of clinical evidence for personalized therapy. RATIONALE was a non-interventional, prospective, 52 week study, assessing the effectiveness of beclometasone/formoterol/glycopyrronium-bromide (BDP/FF/G), in symptomatic COPD patients, with moderate airflow obstruction. The study included 4 visits, where data on demographic parameters, exacerbations, symptoms, quality of life (based on the EQ-5D-3L questionnaire) and lung function were collected. Data on adherence to treatment, based on prescriptions filled was collected from the database of the National Health Insurance Fund, with the patients' consent. The primary objective was the change of adherence to treatment during the study, compared to baseline. Altogether 613 patients had been enrolled. Their average age was 64.56 years and 50.5% were female. The average CAT score was 20.86, and most patients had suffered minimum one exacerbation (82.2%). Average FEV1 was 59.6%. Most patients had some limitation in one or more dimensions of EQ-5D-3L, with an average visual analogue scale score (VAS) of 60.31. After 12 months of treatment, adherence improved significantly - proportion of patients in the highest adherence group increased from 29.8% to 69.7% (p<0.001). The average CAT score improved by 7.02 points (95% CI 5.82-8.21, p<0.001). There was a significant improvement in all dimensions of EQ-5D-3L, with an average increase of 17.91 (95% CI 16.51-19.31, p< 0.001) points in the VAS score. Exacerbation frequency also decreased significantly. Although limitations of observational studies are present, we observed that early introduction of fixed triple combination results in a marked improvement in adherence to treatment, symptom scores, exacerbation frequency and quality of life. The optimal choice of treatment is crucial for reaching the highest possible adherence.

Effect of inhalation therapy on oral health in patients with chronic airway disease

The primary treatment for both chronic obstructive pulmonary disease (COPD) and asthma is inhalation therapy. When utilized over an extended period of time, inhalation treatment serves as both a controller and a relief therapy. Oral adverse effects can result from inhaled medications, particularly bronchodilators and corticosteroids that are deposited in the oropharyngeal region. Reduced saliva flow rate, periodontal disease, oral thrush, dental caries, and dental erosion are just a few of the side effects and difficulties associated with using inhaler therapy that are frequently discovered in the oral region. This problem may arise from improper inhaler use, concomitant diseases and conditions of the patient, inadequate education, and inadequate assessment of oral health during inhalation medication. In order to prevent side effects and complications from inhaler therapy, it is essential to comprehend the different types of inhaler drugs and the pathophysiology associated with oral health complications. This will enable clinicians to modify the components of the drug type, the type of inhaler therapy device, and the appropriate method of use based on the unique characteristics of each patient.

Real-World Treatment Patterns and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease in Japan: The REMIND Study.

Symptom status and treatment changes among patients with chronic obstructive pulmonary disease (COPD) using inhaler treatment in real-world clinical settings are not well understood, particularly according to class of treatment. We investigated the proportion of symptomatic patients among those with COPD using inhaler treatment, based on COPD Assessment Test (CAT) scores in clinical practice, and changes in inhaler treatments and symptoms at 1-year follow-up. This was a retrospective analysis of data from a multicenter, prospective cohort study conducted at medical institutions with respiratory specialists in Japan. The primary endpoint was the proportion of patients with CAT scores ≥ 10 or < 10 in each inhaler treatment group at registration. Of 414 patients in the full analysis set, 76 (18.4%), 261 (63.0%), and 77 (18.6%) were using long-acting muscarinic antagonist (LAMA), LAMA + long-acting β2-agonist (LABA), and inhaled corticosteroids (ICS) + LABA, respectively, at registration. The proportions of patients with CAT scores ≥ 10 or < 10 per inhaler treatment group at registration, respectively, were 32.9% and 67.1% in the LAMA group, 55.0% and 45.0% in the LAMA + LABA group, and 50.0% and 50.0% in the ICS + LABA group. Most patients (> 75%) in each inhaler treatment group showed no change in inhaler treatment at 1year, regardless of their CAT score at registration. Approximately 70-80% of patients with CAT scores ≥ 10 at registration still had CAT scores ≥ 10 at 1year; 10-30% of patients with CAT scores < 10 at registration had CAT scores ≥ 10 at 1year. In real-world Japanese clinical practice, a considerable proportion of patients have persistent symptoms (CAT score ≥ 10) despite using mono or dual inhaler treatment; > 75% of symptomatic patients with COPD using inhaler treatment did not undergo treatment escalation at 1-year follow-up and remained symptomatic. ClinicalTrials.gov identifier, NCT05903989.

Investigating the Efficacy of a Handheld Fan Intervention in Children With Dyspnea: A Randomized Controlled Study

IntroductionDyspnea associated with acute respiratory tract infections is a common cause of emergency admissions and can be distressing for children. This study aimed to evaluate the impact of a handheld fan intervention on physiological parameters in pediatric patients with dyspnea. MethodsA total of 59 children aged 2 to 12 years presenting to an emergency department for upper respiratory tract infection between March 2022 and March 2023 were assigned to the experimental group (n = 32) or control group (n = 27) by urn randomization. Both groups received the hospital’s standard care, including 3 doses of inhaled bronchodilator at 20-minute intervals. The fan intervention consisted of parents applying a handheld electric fan to the child’s face at a distance of 15 cm for 5 minutes after each inhaler treatment. Oxygen saturation, heart rate, and respiratory rate were recorded before treatment and after the 3 inhaler treatments. ResultsThere were no statistical differences in descriptive characteristics between the experimental and control groups (P > .05). Oxygen saturation values were significantly higher in the control group before treatment but showed greater increases in the intervention group after treatment (P < .001). The intervention group also exhibited greater reductions than the control group in both heart rate and respiratory rate after the third treatment than pretreatment values (P < .05). DiscussionThe handheld fan intervention effectively supports inhaler treatment for children with dyspnea. Further studies are recommended to assess its impact across different age groups and clinical conditions.

Therapeutic potential of human stem cell-derived extracellular vesicles in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a lethal and chronic lung disease that occurs due to persistent epithelial cell injury and abnormal extracellular matrix (ECM) deposition. Extracellular vesicles (EVs) have been proposed as a potential therapeutic option of IPF because of their functions, such as anti-inflammation, anti-fibrosis, microenvironment regulation, and tissue repair. In this study, we investigated the therapeutic potential of human adipose-derived mesenchymal stem cell (AD-MSC) EVs in IPF model. AD-MSC EVs were isolated by a multi-filtration system based on the tangential flow filtration (TFF) and characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS), flow cytometry analysis, zeta potential, and small RNA sequencing. In vitro analysis reveals that AD-MSC EVs treatments inhibited migration of pulmonary fibroblasts and myofibroblast differentiation through down regulation of fibrosis-associated TGF-β and WNT signaling. In addition, inhalation treatment of AD-MSC EVs significantly alleviated bleomycin (BLM)-induced pulmonary fibrosis. These results reveal that AD-MSC EVs are highly promising as a treatment option for pulmonary fibrosis.

Inclusion of Anti-COVID-19 Related Research Highlights into the Classroom: Why, What and How?

Bringing recent research highlights into the classroom has drawn an intense amount of interest because it can show students what are being discovered, especially those anti-COVID-19 works. Therefore, we aim to study the feasibility and share the thoughts on the relevant innovation in education during the pandemic of COVID-19. To do so, we first examine participants’ (consisting of bachelor, master and PhD students at different universities) attitudes of towards the inclusion of anti-COVID-19 related research highlights into the classroom via the survey questionnaires. It is found that students mostly preferred such an innovative move. We then feature multiple anti-COVID-19 research highlights, ranging from the anti-fog materials, new inhalation treatment approach, antiviral 2D materials, efficiency enhancement of mask materials, rapid detection methods to vaccine development. Next, we elaborate the class design such as contents, objectives, difficulty level and learning outcomes with two specific examples. Lastly, suggestions for better implementation of including anti-COVID-19 related research highlights into the classroom are provided. The findings of this study can help universities and teachers to further improve the class design, thereby creating strong anti-COVID-19 related theory-practice linkages for students.

Investigating the effect of virtual reality glasses during inhaler therapy use in children: A randomized clinical trial

Abstract Objectives Virtual reality (VR) glasses have been used in the medical field, as they are perceived to be suitable for distracting children. In this study, we aimed to compare patients who received inhaler treatment with VR glasses with those who received treatment without the aid of any device in terms of treatment compliance. Materials and Methods A prospective, randomized controlled study was conducted on pediatric patients aged 2 to 5 years requiring inhaler treatment (salbutamol), with the informed consent of their families. Participating patients who received standard care were divided into three groups via randomization: roller coaster VR group, wild dolphin VR group, and no additional device group. The patients were observed during their 15-minute inhaler treatment, and the groups were compared in terms of crying times, pre- and post-treatment physician and family questionnaire data (Face, Legs, Activity, Cry, Consolabity Scale [FLACC], Modified Yale Anxiety Scale [MYPAS], Modifiye Parents’ Pain Measure [MPMM], Wong–Baker Faces Pain Rating Scale [WBS]), and respiratory rate (RR), peripheral oxygen saturation, and heart rate value changes to determine any differences between them. Results Post-treatment questionnaire scores, RR, crying duration, and efficacy of treatment exhibited significant differences in Groups 1 and 2 compared to the control group. A significant difference was found in the post-treatment RR between groups 1 and 2, but no difference was observed in the other parameters. Conclusions Utilizing VR glasses during inhaler therapy has the potential to minimize adverse effects, such as pain, and enhance the overall comfort of the treatment environment for patients.

Comparison of Forward-Leaning and Fowler Position: Effects on Vital Signs, Pain, and Anxiety Scores in Children With Asthma Exacerbations.

It is essential to relieve bronchospasm or specific asthma symptoms by administering immediate inhaler treatment during an asthma exacerbation. The present study compared the effect of Fowler position and forward-leaning positions during nebulization on heart rate, SpO2 , breathing frequency, pain, and anxiety levels in children experiencing asthma exacerbations. The data originated from a randomized trial that compared 86 participants (study group n = 43, control group n = 43) who presented to the pediatric emergency department with asthma exacerbations between October 2019-February 2020. The subjects were administered nebulization 3 times, during which the study group was placed in the forward-leaning position and the control group in the routine Fowler position. The subjects provided information on chest pain and anxiety levels before and after nebulization, and heart rate, SpO2 , and breathing frequency were measured before and after each nebulization. The difference in the mean SpO2 measured at admission and after the third nebulization was significantly higher (3.2 ± 1.5% vs 2.3 ± 1.9%, P = .01); the difference in the mean breathing frequency was considerably higher (-6.0 ± 1.7 breaths/min vs -3.2 ± 1.8 breaths/min, P < .001), and the difference in the mean pain scores was significantly higher (-3.3 ± 2.5 vs -2.0 ± 2.3, P = .02) in the study group than in the control group. In addition, after the third nebulization, the breathing frequency (22.8 ± 2.8 breaths/min vs 24.2 ± 2.7 breaths/min, P = .02) and pain score of the study group were lower (0.8 ± 1.3 vs 1.5 ± 1.5, P = .01). There was no difference in the mean heart rate (20.6 ± 16.2 beats/min vs 20.0 ± 15.4 beats/min, P = .85) and anxiety levels (-2.0 ± 2.2 vs -1.9 ± 2.2, P = .90) between the groups. Placing children in a forward-leaning position during nebulization was effective in improving SpO2 and reducing breathing frequency and chest pain. The forward-leaning position implemented during nebulization is a non-pharmacologic method that supports recovery in children with asthma exacerbations.