Inhalation Treatment Research Articles

Inhalation Delivery of Interferon-λ-Loaded Pulmonary Surfactant Nanoparticles Induces Rapid Antiviral Immune Responses in the Lung.

The interferon-λ (IFN-λ)-regulated innate immune responses in the airway expand our understanding toward antiviral strategies against influenza A virus (IAV). The application of IFN-λ as mucosal antiviral therapeutic is still challenging, and advanced research will be necessary to achieve more efficient delivery of recombinant IFN-λs to the damaged respiratory mucosa. In this study, we examine the capability of IFN-λ to stimulate the innate immune response, promoting the swift elimination of IAV in the lungs. Additionally, we develop IFN-λ-loaded nanoparticles incorporated into pulmonary surfactant for inhalation therapy aimed at treating lung infections caused by IAV. We found that inhaled delivery of IFNλ-PSNPs significantly restricted IAV replication in the lungs from 3 days after infection (dpi), and IAV-caused lung histopathologic findings were completely improved in response to IFNλ-PSNPs. More significant and rapid attenuation of viral RNA was observed in the lung of mice with inhaled delivery of IFNλ-PSNPs compared to mice with recombinant IFN-λs. Inhalation treatment of IFNλ-PSNPs to IAV-infected mice can result in the increase of monocyte frequency in concert with restoration of T and B cells composition. Furthermore, the transcriptional profiles of monocytes shifted toward heightened IFN responses following IFNλ-PSNP treatment. These results imply that IFN-λ could serve as a robust inducer of innate immunity in the lungs against IAV infection, and inhalation of IFN-λs encapsulated in PSNPs effectively resolves lung infections caused by IAV through rapid viral clearance. PSNPs facilitated improved delivery of IFN-λs to the lungs, triggering potent antiviral immune responses upon IAV infection onset.

Role of Virtual Bronchoscopy in Evaluation of Suspected Foreign Body in Children's Tracheobronchial Tree.

Introduction The presence of foreign bodies in the airways remain a diagnostic challenge to healthcare professionals. They can become life threatening emergencies that require immediate intervention or go unnoticed for weeks and even months. Prevention is best but early recognition remains a critical factor in treatment of foreign body inhalation in children. Objective To study the diagnostic advantages of virtual over rigid bronchoscopy in the evaluation of children with suspected foreign body in the tracheobronchial tree and plan for early management. Methods A crossectional study conducted at a tertiary care hospital & medical college in India. A total 24 patients (0-12-years-old) who presented with complaints of sudden onset of coughing, choking, and breathing difficulty were included during the 2-year duration, from January 2018 to December 2019. All patients underwent virtual and rigid bronchoscopy. Results In 8 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. There was one case in which virtual bronchoscopy showed no foreign body, but rigid bronchoscopy detected it. In 15 cases virtual and rigid bronchoscopy did not show foreign bodies. The sensitivity, specificity, positive and negative predictive value of virtual bronchoscopy were 88.88, 100, 100, and 93.75%, respectively. Conclusions Virtual bronchoscopy is less invasive and does not require general anesthesia but cost and availability are limitations. It can be used as method of investigation in children with suspected foreign body aspiration.

A comparison of GOLD 2019 and 2023 recommendations to contemporaneous real-world inhaler treatment patterns for chronic obstructive pulmonary disease management in Singapore.

In 2019 and 2023, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) provided updated strategies for modifying the therapy of patients with chronic obstructive pulmonary disease (COPD) and high exacerbation risk. A key update since the 2019 guidelines recommends considering blood eosinophil count to guide decisions on inhaled corticosteroid (ICS) treatment. To evaluate the potential impact of these updated recommendations, this study aimed to assess how extensively future practice would diverge from contemporaneous prescribing practices at a single center in Singapore, assuming adherence to the 2019 and 2023 GOLD guidelines. Retrospective cohort analysis of the Changi General Hospital COPD data warehouse involving patients aged ≥40 years hospitalized for a COPD exacerbation (October 2018-April 2020) receiving long-acting muscarinic antagonist (LAMA), LAMA plus a long-acting beta2-agonist (LABA), or an ICS plus LABA at admission. The proportion of patients eligible for treatment escalations per GOLD 2019 and 2023 recommendations was calculated. In total, 268 patients were included (mean age 73 years; 91% male). At admission, 19%, 59%, and 22% of patients were receiving LAMA, LAMA + LABA, and ICS + LABA, respectively. Overall, 226 patients would have been eligible for treatment escalation per GOLD 2019 or 2023 recommendations; 31 (13.7%) had treatment escalations consistent with GOLD 2019 guidelines and 34 (15%) received treatment escalations consistent with GOLD 2023 guidelines. A total of 205 patients (76.5%) remained on the same treatment regimen at hospital discharge as they were receiving at admission. Lower measured post-bronchodilator forced expiratory volume in 1 second was associated with treatment escalations that would have been GOLD-concordant (P=0.028), as was increased number of emergency department/hospital visits in the last year (P=0.048). Compared with real-world clinical practice, a significantly higher proportion of patients may be eligible for treatment escalation under the GOLD 2019 and 2023 eosinophil-directed algorithms.

Neglecting the neglected: Tobacco cessation support is essential for the management of asthma and COPD.

Asthma and COPD management have a broad framework, and smoking cessation plays an essential role. We examine the management of asthma and COPD patients not only for inhaler treatment options but also for essential interventions, such as smoking cessation support. Data were collected cross-sectionally from pulmonology departments of three government hospitals in Türkiye between May and September 2022. Patients aged ≥18 years who had been diagnosed with asthma or COPD for at least a year, were included in the study. The demographic and clinical characteristics of the patients were investigated. Routine cessation interventions were implemented for current smokers, and they were followed via phone calls after one month regarding their quit status and access to cessation clinics. Data from 145 patients with asthma and 148 patients with COPD were analyzed. The rate of current smoking among patients with asthma and COPD was 18.8% and 34.5%, respectively. Current smoking was negatively associated with age (<65 years) and disease duration (years) for both diseases (p<0.05). In addition, for asthmatics, presence of pulmonary disease in the family (OR:0.28, 95% CI: 0.10-0.79) and for COPD patients presence of hospitalization (OR: 0.26, 95% CI: 0.07-0.93) were negatively associated with current smoking. After one month, 85.1% of current asthmatic smokers had not tried to call a quitline, while 14.8% had tried to contact a quitline. Among current smoker COPD patients, only 1.9% had visited a smoking cessation clinic. Tobacco cessation support seems to be neglected in asthma and COPD management. Instead, pulmonologists and patients focus on pharmaceutical treatments, which constitute the other component of care.

3D Baskı Teknolojisi İle Tasarlanan Terapötik Nebülizatör Cihazı İle Yapılan İnhaler Tedavinin Çocukların Psikososyal Semptomlarına Etkisi

Objective: This research was carried out with the aim of minimizing psychosocial symptoms such as fear, anxiety and crying by hospitalized children undergoing inhaler treatment with a nebulizer developed with three-dimensional printing technology, and to examine the effect of this method on parental satisfaction. Methods: The study is of experimental design. 44 children between the ages 2-7 receiving inhaler therapy with a nebulizer and their parents were recruited into the experimental and control groups. The researchers collected the data with “Scale for Identifying Psychosocial Symptoms in Hospitalized Children” and the “PedsQL Healthcare Satisfaction Scale.” Results: In the experimental group, 81.8 percent of the children being treated with a three-dimensional printing therapeutic device who had previously received treatment in the same way were not fearful, while 27.3 percent of those being treated with a standard type of nebulizer in the control group were unafraid (X2=24.246; p&amp;lt;0.001). While those who were not crying at the time of their therapy made up 71.9% in the experimental group (X2=28,686; p&amp;lt;0.001). The t-test performed to compare the pre- and posttests in the experimental group revealed a significant difference of p=0.002. Conclusions: It was concluded that inhaler therapy administered with a therapeutic nebulizer designed with three-dimensional printing technology reduced psychosocial symptoms and positively impacted parental satisfaction. This study highlights that was carried out with the aim of minimizing psychosocial symptoms by hospitalized children undergoing inhaler treatment with a nebulizer developed with three-dimensional printing technology.

СУЧАСНИЙ ПОГЛЯД НА ХОЗЛ: НА ЩО ЗВЕРНУТИ УВАГУ?

Last decade has been marked by the worsening of COPD epidemiology, particularly due to increase of its prevalence and mortality. According to recent data COPD is a cause of more than 3 million or 6 % of all deaths annually. Among the causes of high mortality rate the experts mention the exacerbations of the disease. An exacerbation of COPD is defined as an event, characterized by dyspnea and/or cough and sputum, that worsen over last 14 days. Exacerbations are frequently associated with the increased local and systemic inflammation caused of respiratory tract infection, air pollution or other insults to the lungs. Prevention of exacerbations as a major factor of COPD progression is one of the prerogatives of respiratory medicine. Patients with COPD and cardio-vascular comorbidity is the most vulnerable cohort due to high risk of mortality. Timely initiation of triple inhalation therapy with LAMA/LABA/ICS combination for patients with high risk of unfavorable outcomes is one of effective tools to reduce mortality. Clinical trials proved its statistically significant efficacy. Current understanding of the problem requires individualized approach to management of COPD, based on close contact with the patients, monitoring of availability and accessibility of medications, control of inhalation technique and treatment compliance, psychological and information support of the patients. Key words: chronic obstructive pulmonary disease, GOLD-2024, changes and additions.

The effect of salbutamol sulphate inhalation (an anti-asthmatic medication) on the surfaces of orthodontic Archwires.

This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication. Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests. Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002). Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment.

Effectiveness of a Maintenance and Reliever Digihaler System in Asthma: 24-Week Randomized Study (CONNECT2)

BACKGROUNDDigital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence and short-acting beta2-agonist overuse. The maintenance and reliever Digihaler System (DS) comprises two Digihaler inhalers (fluticasone propionate/salmeterol and albuterol) with an associated patient App and web-based Dashboard. Clinicians can review patients’ inhaler use and Digihaler inhalation parameter data to support clinical decision-making. OBJECTIVECONNECT2 evaluated asthma control in participants using the DS versus standard-of-care (SoC) maintenance and reliever inhalers. METHODSParticipants (≥13 years) with uncontrolled asthma (Asthma Control Test [ACT] score <19) were randomized 4:3 (open-label) to the DS (n = 210) or SoC (n = 181) for 24 weeks. The primary endpoint was the proportion of patients achieving well-controlled asthma (i.e., an ACT score ≥20 or increase from baseline of ≥3 units at Week 24). RESULTSThere was an 88.7% probability that participants using the DS would have greater odds of achieving improvement in asthma control compared with SoC after 24 weeks. Mean odds ratio (95% credible interval) for DS versus SoC was 1.35 (0.846–2.038), indicating a 35% higher odds of improved asthma control with the DS. The DS group had more clinician-participant interactions versus SoC, mainly addressing poor inhaler technique. DS participants’ maintenance treatment adherence was good (Month 1: 79.2%; Month 6: 68.6%); reliever use decreased by 38.2% versus baseline. App and Dashboard usability were rated ‘good’. CONCLUSIONThe positive results in asthma control in this study after 24 weeks demonstrate the effectiveness of the DS in asthma management.

Chinese expert consensus on standardized inhaler device application in stable chronic airway diseases (2023)

Chinese expert consensus on standardized inhaler device application in stable chronic airway diseases (2023)

Efficacy of phentolamine combined with milrinone on severe pneumonia in children, and its effect on serum levels of MMP-9, TIMP-1 and sICAM-1

Purpose: To investigate the effect of the co-administration of phentolamine and milrinone on severe pneumonia in children, as well as on serum MMP-9, TIMP-1 and sICAM-1 levels.&#x0D; Methods: From January 2021 to January 2022, 100 patients diagnosed with severe pneumonia were randomly divided into 2 groups; the control group received oxygen inhalation and other symptomatic treatment, while the study group received phentolamine concurrently with milrinone, Serum MMP-9, TIMP-1, sICAM-1 levels and clinical efficacy were determined in the two groups before and after treatment.&#x0D; Results: After treatment, there were significant differences in IL-6, IL-10, and TNF-α levels between the study group and the control group. Furthermore, IgA, IgG, and IgM levels in both groups were significantly higher after treatment than before treatment (p &lt; 0.05). The study group exhibited significant differences in MMP-9, TIMP-1, and sICAM-1 levels after treatment compared to control group (p &lt; 0.05). Healing and therapeutic effectiveness in the study group was 76 %, which was significantly greater than in the control group (48 %; p = 0.000). Additionally, total treatment effectiveness in the study group was 92 %, which was significantly higher than in the control group (80 %; p = 0.015). After treatment, the PEF, FRC, and TEF25 % in the study group were significantly higher than in the control group (p &lt; 0.05).&#x0D; Conclusion: Co-administration of phentolamine and milrinone is highly effective for the treatment of severe pneumonia in children, and significantly reduces the levels of serum MMP-9, TIMP-1 and sICAM-1. However, multi-center clinical trials should be carried out prior to the adoption of this treatment mode in clinical practice.

Effect of therapeutic play using a toy nebulizer and toy mask on a child's fear and anxiety levels

PurposeThis study aimed to examine the effect of therapeutic play using a toy nebulizer and mask before inhaler treatment on children's fear and anxiety levels in a pediatric emergency department. Design and methodThis randomized controlled clinical trial included 84 children aged 3–8 years who were admitted to the pediatric emergency department with respiratory system disease. This study was registered in the Clinical Trials database.Therapeutic play was applied to the children in the therapeutic play group with a toy nebulizer, toy mask, and amigurumi doll, after which the children received treatment with these devices. The children in the control group received nebular treatment using a standard nebulizer and a mask. The children were required to answer the ‘Children's Fear Scale’ (CFS) and ‘Children's Anxiety Metre–State’ (CAMS) before and after treatment. ResultsFear and anxiety levels were significantly lower in the therapeutic play group than in the control group (p = 0.001). A statistically significant difference was found between the two groups regarding acceptance of the mask used during treatment and adaptation to the treatment (p = 0.001). ConclusionsTherapeutic play with a toy nebulizer and mask effectively reduced fear of hospitals and related anxiety in children. Practice implicationsPlaying therapeutic play with a toy nebulizer and toy mask during nebulization is a promising strategy to reduce children's fear and anxiety.

OS01-04: A new lung-on-chip platform for acute inhalation toxicity assessment and treatment

OS01-04: A new lung-on-chip platform for acute inhalation toxicity assessment and treatment

Clofazimine nanoclusters show high efficacy in experimental TB with amelioration in paradoxical lung inflammation

The rise of tuberculosis (TB) superbugs has impeded efforts to control this infectious ailment, and new treatment options are few. Paradoxical Inflammation (PI) is another major problem associated with current anti-TB therapy, which can complicate the treatment and leads to clinical worsening of disease despite a decrease in bacterial burden in the lungs. TB infection is generally accompanied by an intense local inflammatory response which may be critical to TB pathogenesis. Clofazimine (CLF), a second-line anti-TB drug, delineated potential anti-mycobacterial effects in-vitro and in-vivo and also demonstrated anti-inflammatory potential in in-vitro experiments. However, clinical implications may be restricted owing to poor solubility and low bioavailability rendering a suboptimal drug concentration in the target organ. To unravel these issues, nanocrystals of CLF (CLF-NC) were prepared using a microfluidizer® technology, which was further processed into micro-sized CLF nano-clusters (CLF-NCLs) by spray drying technique. This particle engineering offers combined advantages of micron- and nano-scale particles where micron-size (∼5 μm) promise optimum aerodynamic parameters for the finest lung deposition, and nano-scale dimensions (∼600 nm) improve the dissolution profile of apparently insoluble clofazimine. An inhalable formulation was evaluated against virulent mycobacterium tuberculosis in in-vitro studies and in mice infected with aerosol TB infection. CLF-NCLs resulted in the significant killing of virulent TB bacteria with a MIC value of ∼0.62 μg/mL, as demonstrated by Resazurin microtiter assay (REMA). In TB-infected mice, inhaled doses of CLF-NCLs equivalent to ∼300 μg and ∼ 600 μg of CLF administered on every alternate day over 30 days significantly reduced the number of bacteria in the lung. With an inhaled dose of ∼600 μg/mice, reduction of mycobacterial colony forming units (CFU) was achieved by ∼1.95 Log10CFU times compared to CLF administered via oral gavage (∼1.18 Log10CFU). Lung histology scoring showed improved pathogenesis and inflammation in infected animals after 30 days of inhalation dosing of CLF-NCLs. The levels of pro-inflammatory mediators, including cytokines, TNF-α & IL-6, and MMP-2 in bronchoalveolar lavage fluid (BAL-F) and lung tissue homogenates, were attenuated after inhalation treatment. These pre-clinical data suggest inhalable CLF-NCLs are well tolerated, show significant anti-TB activity and apparently able to tackle the challenge of paradoxical chronic lung inflammation in murine TB model.

New GABA-Targeting Therapies for the Treatment of Seizures and Epilepsy: II. Treatments in Clinical Development.

The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the modulation of neuronal excitability, and a disruption of GABAergic transmission contributes to the pathogenesis of some seizure disorders. Although many currently available antiseizure medications do act at least in part by potentiating GABAergic transmission, there is an opportunity for further research aimed at developing more innovative GABA-targeting therapies. The present article summarises available evidence on a number of such treatments in clinical development. These can be broadly divided into three groups. The first group consists of positive allosteric modulators of GABAA receptors and includes Staccato® alprazolam (an already marketed benzodiazepine being repurposed in epilepsy as a potential rescue inhalation treatment for prolonged and repetitive seizures), the α2/3/5 subtype-selective agents darigabat and ENX-101, and the orally active neurosteroids ETX155 and LPCN 2101. A second group comprises two drugs already marketed for non-neurological indications, which could be repurposed as treatments for seizure disorders. These include bumetanide, a diuretic agent that has undergone clinical trials in phenobarbital-resistant neonatal seizures and for which the rationale for further development in this indication is under debate, and ivermectin, an antiparasitic drug currently investigated in a randomised double-blind trial in focal epilepsy. The last group comprises a series of highly innovative therapies, namely GABAergic interneurons (NRTX-001) delivered via stereotactic cerebral implantation as a treatment for mesial temporal lobe epilepsy, an antisense oligonucleotide (STK-001) aimed at upregulating NaV1.1 currents and restoring the function of GABAergic interneurons, currently tested in a trial in patients with Dravet syndrome, and an adenoviral vector-based gene therapy (ETX-101) scheduled for investigation in Dravet syndrome. Another agent, a subcutaneously administered neuroactive peptide (NRP2945) that reportedly upregulates the expression of GABAA receptor α and β subunits is being investigated, with Lennox-Gastaut syndrome and other epilepsies as proposed indications. The diversity of the current pipeline underscores a strong interest in the GABA system as a target for new treatment development in epilepsy. To date, limited clinical data are available for these investigational treatments and further studies are required to assess their potential value in addressing unmet needs in epilepsy management.

Adherence to inhaled corticosteroids in patients with asthma prior to and during the COVID-19 pandemic

The electronic prescription refill rate (EPRR) of 183 consecutive patients was determined over a 19-month retrospective study period, divided into 7 months PRE (Sep-19 to Mar-20) and 12 months POST pandemic (Apr-20 to Mar-21), in order to compare adherence to inhaled corticosteroids (ICS) in patients with asthma prior to and during the COVID-19 pandemic. Before the pandemic (PRE), an average of 0.58 inhalers/month were refill from the pharmacy; [SD 0.33], very similar to the 0.59 inhalers/month; [SD 0.34] retrieved during the 12 subsequent months since the pandemic (POST) (p = 0.768). EPRR showed no differences (p = 0.784). When EPRR was dichotomous or ordinal categorised no differences were found either (p = 0.851 and 0.928), even when McNemar's test was used (p = 0.949), with prevalences of nonadherence (EPRR < 80%) of 57 and 58% respectively. Our results do not support increased adherence to inhaler treatment in terms of EPRR, comparing before and since COVID-19 pandemic. Compliance with prescription remains suboptimal.

Evolving to a single inhaler extrafine LABA/LAMA/ICS – Inhalation technique and adherence at the heart of COPD patient care (TRIVOLVE)

ObjectiveIncorrect inhaler use and poor treatment adherence have a negative impact on COPD outcomes. This multi-centre, single arm, non-interventional, phase IV study investigated whether inhalation technique, treatment adherence and patient outcomes change in patients who evolve from dual therapy or multiple inhaler triple therapy to single inhaler extrafine triple therapy (beclomethasone dipropionate (BDP, 87 μg), formoterol fumarate (FF, 5 μg) and glycopyrronium (G, 9 μg)) in combination with inhalation technique training. MethodsA total of 126 COPD patients were included in the per protocol set. Inhalation technique and treatment adherence were assessed at baseline and at two visits at approximately 3 and 6 months of treatment with extrafine BDP/FF/G. In addition, lung function, symptom score, patient satisfaction and exacerbations (exploratory) were followed up. ResultsBefore switching to single inhaler extrafine BDP/FF/G (baseline), any device errors and critical errors were detected for 28.8% and 9.6% of patients, respectively. After switching to BDP/FF/G, the percentage of patients with any device errors decreased to 14.0% (visit 2) and 16.3% (visit 3), without critical errors at the two follow-up visits. Treatment adherence increased from 67.5% at baseline to 75.8% (visit 2) and 80% (visit 3). In addition, lung function, symptom and patient satisfaction scores improved, whilst exacerbation rates substantially decreased. ConclusionsThis observational study demonstrates that in eligible COPD patients in a real-life setting, the switch from dual therapy or multiple inhaler triple therapy to single inhaler extrafine BDP/FF/G in combination with inhalation technique training is associated with improved inhalation technique and adherence.

Prevalence, diagnosis, and treatment of chronic obstructive pulmonary disease in a hospitalized lung cancer population: a single center study.

Chronic obstructive pulmonary disease (COPD) often coexists with lung cancer (LC) and has a detrimental effect on the prognosis of LC patients. Presently, there is a lack of adequate assessment regarding the management of COPD in LC patients. This study assessed the screening, prevalence, diagnosis and treatment of COPD in hospitalized LC patients and compared the management practices between two departments at our hospital. We retrospectively assessed the data of 3,578 patients diagnosed with primary LC in the Department of Respiratory and Critical Care Medicine and the Department of Thoracic Surgery from January 2019 to December 2020. We also compared the rate of spirometry, COPD diagnosis and COPD inhalation treatment between the LC patients from both departments, the proportion of patients aware of their COPD diagnosis and adhered to inhaled therapy, and analyzed factors influencing COPD diagnosis and inhalation treatment. A total of 2,762 (77.2%) LC patients underwent spirometry, and the observed spirometry-defined COPD prevalence was 25.0% (690/2,762). The proportion of spirometry performed in the Department of Thoracic Surgery was significantly higher than in the Department of Respiratory and Critical Care Medicine (90.5% vs. 62.9%; P<0.001). The overall COPD diagnosis rate recorded in the discharge diagnosis in the 690 spirometry-defined COPD patients was 46.5% (321/690), and the COPD treatment rate during hospitalization was 45.2% (312/690). In addition, physicians from the Department of Respiratory and Critical Care Medicine had a higher diagnostic rate than surgeons from the Department of Thoracic Surgery (69.1% vs. 7.5%; P<0.001), as well as a better-standardized COPD treatment rate (60.6% vs. 18.6%; P<0.001). Further, the proportion of COPD inhalation treatment was higher among LC patients with COPD recorded in discharge diagnosis (74.8% vs. 19.5%; P<0.001), and multivariate logistic regression analysis showed that COPD recorded in discharge diagnosis significantly increased the proportion of COPD awareness post-hospitalization (P<0.001). This study showed that COPD could be a frequently undiagnosed and undertreated condition among LC patients, especially those hospitalized in a surgical ward. Additionally, a discharge diagnosis of COPD may increase the rate of inhalation treatment and awareness of the condition in LC patients.

Trimannose-coupled antimiR-21 for macrophage-targeted inhalation treatment of acute inflammatory lung damage

Recent studies of severe acute inflammatory lung disease including COVID-19 identify macrophages to drive pulmonary hyperinflammation and long-term damage such as fibrosis. Here, we report on the development of a first-in-class, carbohydrate-coupled inhibitor of microRNA-21 (RCS-21), as a therapeutic means against pulmonary hyperinflammation and fibrosis. MicroRNA-21 is among the strongest upregulated microRNAs in human COVID-19 and in mice with acute inflammatory lung damage, and it is the strongest expressed microRNA in pulmonary macrophages. Chemical linkage of a microRNA-21 inhibitor to trimannose achieves rapid and specific delivery to macrophages upon inhalation in mice. RCS-21 reverses pathological activation of macrophages and prevents pulmonary dysfunction and fibrosis after acute lung damage in mice. In human lung tissue infected with SARS-CoV-2 ex vivo, RCS-21 effectively prevents the exaggerated inflammatory response. Our data imply trimannose-coupling for effective and selective delivery of inhaled oligonucleotides to pulmonary macrophages and report on a first mannose-coupled candidate therapeutic for COVID-19.

Feasibility of Tiotropium Bromide Treatment in Patients with Asthma-COPD Overlap Syndrome and its Effect on Lung Function

Objective: To explore the feasibility of tiotropium bromide therapy and its effect on the lung function of patients with asthma-COPD overlap syndrome (ACOS). Method: The 58 subjects selected in this study were all ACOS patients admitted to our hospital (Hohhot First Hospital) from October 2020 to October 2022. They were grouped according to the random number table method and divided into a control group (29 cases) and an observation group (29 cases). The control group received routine treatment plus salmeterol-fluticasone powder inhalation treatment, and the observation group received tiotropium bromide treatment. The relevant indicators of the two groups were compared. Results: The total clinical effective rate of the observation group was significantly higher than that of the control group. Besides, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) levels, and ACT scores of the two groups increased after treatment, with the observation group having better results than the control group. The residual volume-total lung capacity ratio (RV/TLC), acute exacerbation frequency, and CAT scores all decreased, with the observation group showing smaller values than the control group. The difference between the results of both groups were significant (P &lt; 0.05) Conclusion: Tiotropium bromide has a significant clinical effect in the treatment of ACOS patients and can effectively improve the lung function of patients.

COPD in a basic health unit: an intervention project

Chronic Obstructive Pulmonary Disease (COPD) and asthma are common respiratory diseases, but with complicated definitions. Spacers are devices used for the administration of inhaled medications, aiming to reduce the need for synchronization by the patient, allowing him/her to breathe normally during the administration of the medication. However, due to high cost and low availability, the use of commercial spacers is hampered in developing countries, such as Brazil. To solve this problem, several forms of homemade spacers have been developed. This project aims to expand knowledge on the main lung diseases seen in primary health care and their interventions based on the latest evidence and outpatient therapeutic updates, including the use of home-made inhaler devices. The aim is to promote adherence to inhalation treatment and improve patients' quality of life. The rationale for this project is that the use of spacers facilitates adherence to inhaled medication treatment for asthma and COPD, as well as for patients who have both conditions. The project aims to provide spacers for all patients who use this type of medication, respecting the principles of universality, equity and equality of the Unified Health System. The method used was an intervention project carried out in the health strategy from 05/25/2021 to 07/02/2021. Homemade spacers were manufactured using 500mL PET bottles, both in the adult and pediatric models. The spacers were distributed along with user manuals and guidance on the importance of asthma treatment. Users were randomly selected using a search for patients using the medications salbutamol spray and beclomethasone spray. The results of the project were positive, with the spacers being made and delivered within the stipulated time. This contributed to a better administration of inhalation drugs, enabling a better control of the diseases analyzed and optimizing the treatment of users. In conclusion, the method of administration of inhaled drugs using a spacer reduces oral deposition and optimizes the inhalation of particles of adequate size. There was a good response from users and adherence to treatment with the offer of homemade spacers, in addition to a correlation between the improvement of the profiles of users served in the ESF.