Inhalant Research Articles

Reinke's Edema and Risk Factors, A Case-Control Study.

Reinke's edema (RE) is a benign pathological non-inflammatory disorder of the vocal folds with a wide range of clinical manifestations. We aim to investigate the relationship between Reinke's edema and some common inhalant abuse. In this case-control study, subjective consisted of 23 patients with RE (the cases), and 50 patients with sinusitis (control) who underwent surgery in the Department of Otolaryngology, between 2015 and 2020. Demographic characteristics, history of some related disease, methods, and the duration of cigarette, and opium consumption were collected through the patients' files. The chi-square (χ²) test was run to analyze the differences in the categorical and, and the Independent Sample T-test was used to compare two sample means from unrelated groups. A significant level (p-value) was considered less than 0.05. The mean age was 54 ± 12 years, and 42 ± 11 years, respectively for Reinke's edema and sinusitis. More women had been recorded in the RE group, compared to men. Allergy, unprincipled use of voice and talkativeness, history of laryngeal surgery, and type of disease were correlated to RE (p < 0.05). Also, cigarette smoking was significantly correlated with Reinke's edema. The average number of cigarettes per day, the duration of smoking, and opium consumption were more frequent in RE (P < 0.05). 90% of the RE and 4% of sinusitis patients were opium consumers. There was a statistically significant difference in the methods of substance use in the two groups of cases and control (p < 0.0001). Among the different methods, the poker and stone method was the most common (69.6%), and the opium smoking pipe was the second most common method. This study also confirmed the hazardous effects of smoking and inhaling opiates in the formation of lesions of the pharynx and larynx. In particular, longer use of these substances will be associated with more serious side effects. Therefore, it seems that people who are addicted to opiates should undergo periodic visits and counseling to reduce and stop their use.

Task-shifting in asthma and chronic obstructive pulmonary disease management: A review of the obstructive lung disease program.

Task shifting, an approach to address physician shortage through redistribution of clinical tasks, may help address the high burden of chronic respiratory diseases like asthma and COPD. We aimed to measure its utility and impact in the Obstructive Lung Disease program (OLD). A retrospective, cross-sectional study was conducted at five integrated outpatient departments of Primary Care Program within Indus Hospital & Health Network, Pakistan, from January 2018 to March 2023. After a formative evaluation, registered nurses were trained as Lung Health Nurses (LHNs) to perform spirometry, collect Patient Reported Outcome Measures (PROMs) including Asthma Control Test (ACT), modified Medical Research Council (mMRC) dyspnea score and COPD Assessment Test (CAT), counsel on inhaler use and tobacco cessation, and refer to pulmonary rehabilitation (PR). Data was collected online contemporaneously on REDCap and later analyzed using Excel and STATA 14. Pre-implementation, a monthly average of 126 asthmatics and 33 COPD patients visited primary care centers. Medical records of 147 OLD patients showed 8% received inhaler education, 3% completed ACT and 2% had mMRC documented. Implementation included capacity building of nine LHNs. Of 7427 referrals to the program, 86% underwent nurse-led assessments. LHNs performed spirometry (92%), PROMs assessments [ACT (89%), CAT (91%), mMRC (85%)], inhaler education (97%), tobacco cessation advice (85%) and made PR referrals (94%). Trained nurses can play a role in providing holistic and timely care for patients with CRDs and strengthen existing healthcare systems. Future directions may include expanding nurse clinical counselling roles through telehealth monitoring and home management.

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.

Cyclodextrin-based nanosponges as promising carriers for active pharmaceutical ingredient.

Effective drug distribution at the intended or particular location is a critical issue that researchers are now dealing. Nanosponges have significantly increased in importance in medication delivery using nanotechnology in recent years. An important step toward solving these problems has been the development of nanosponges. Recently created and proposed for use in drug delivery, nanosponge is a unique type of hyper-crosslinked polymer-based colloidal structures made up of solid nanoparticles with colloidal carriers. Nanosponges are solid porous particles that may hold pharmaceuticals and other actives in their nanocavities. They can be made into dosage forms for oral, parenteral, topical, or inhalation use. The targeted distribution of drugs in a regulated manner is greatly aided by nanosponge. The utilization of nanosponges, their benefits, their production processes, the polymers they are made of, and their characterization have all been covered in this review article.

Factors associated with SARS-COV-2 positive test in Lifelines.

Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) can affect anyone, however, it is often mixed with other respiratory diseases. This study aimed to identify the factors associated with SARS-COV-2 positive test. Participants from the Northern Netherlands representative of the general population were included if filled in the questionnaire about well-being between June 2020-April 2021 and were tested for SARS-COV-2. The outcome was a self-reported test as measured by polymerase chain reaction. The data were collected on age, sex, household, smoking, alcohol use, physical activity, quality of life, fatigue, symptoms and medications use. Participants were matched on sex, age and the timing of their SARS-COV-2 tests maintaining a 1:4 ratio and classified into those with a positive and negative SARS-COV-2 using logistic regression. The performance of the model was compared with other machine-learning algorithms by the area under the receiving operating curve. 2564 (20%) of 12786 participants had a positive SARS-COV-2 test. The factors associated with a higher risk of SARS-COV-2 positive test in multivariate logistic regression were: contact with someone tested positive for SARS-COV-2, ≥1 household members, typical SARS-COV-2 symptoms, male gender and fatigue. The factors associated with a lower risk of SARS-COV-2 positive test were higher quality of life, inhaler use, runny nose, lower back pain, diarrhea, pain when breathing, sore throat, pain in neck, shoulder or arm, numbness or tingling, and stomach pain. The performance of the logistic models was comparable with that of random forest, support vector machine and gradient boosting machine. Having a contact with someone tested positive for SARS-COV-2 and living in a household with someone else are the most important factors related to a positive SARS-COV-2 test. The loss of smell or taste is the most prominent symptom associated with a positive test. Symptoms like runny nose, pain when breathing, sore throat are more likely to be indicative of other conditions.

Intranasal immunotherapy with M2 macrophage soluble factors in post-COVID hyposmia: A pilot study

Olfactory dysfunction is an early marker of COVID-19 infection. However, individuals may develop chronic olfactory impairment for more than six months in 1–10 % of cases. The study's objective is to evaluate the efficacy and safety of intranasal immunotherapy using bioactive substances produced by M2 macrophages for the treatment of people with long-term post-COVID-19 hyposmia. Seven individuals with long-term persistent hyposmia (7 to 24 months), associated with PCR-confirmed coronavirus infection were evaluated for olfactory function at baseline, one, and six to twelve months after therapy. The intranasal inhalation of M2 macrophage conditioned medum (one time per day for 28–30 days) was well tolerated. Furthermore, olfactometry demonstrated that the patients restored their capacity to perceive (Kruskal-Wallis H test 14.123, p = 0.0009) and recognize odours (H = 11.674, p = 0.0029). In addition, the subjective evaluation of smell significantly improved (H = 11.935, p = 0.0026). At the 6- to 12-month follow-up, the majority of patients (5/7) reported extremely high levels of satisfaction with the outcomes, and the remaining two patients also felt generally positive about the therapy's success. Overall, our study showed that the use of intranasal inhalations as a method of delivering bioactive factors and the conditioned medium of M2 macrophages as a therapeutic agent are both safe, well tolerated and, according to preliminary data, clinically effective in the treatment of patients with long-term post-COVID-19 hyposmia.

Rats chasing the dragon: A new heroin inhalation method

BackgroundDespite extensive human use of inhalation for ingesting opioids, models in rodents have mostly been limited to parenteral injection and oral dosing. Methods using electronic drug delivery systems (EDDS; “e-cigarettes”) have shown efficacy in rodent models but these do not faithfully mimic the most popular human inhalation method of heating heroin to the point of vaporization. New methodMiddle aged rats were exposed to vapor created by direct heating of heroin HCl powder in a ceramic e-cigarette type atomizer. Efficacy was determined with a warm water tail withdrawal nociception assay, rectal temperature and self-administration. ResultsTen minutes of inhalation of vaporized heroin slowed response latency in a warm water tail withdrawal assay and increased rectal temperature in male rats, in a dose-dependent manner. Similar antinociceptive effects in female rats were attenuated by the opioid antagonist naloxone (1.0 mg/kg, s.c.). Female rats made operant responses for heroin vapor in 15-minute sessions, increased their response rate when the reinforcement ratio increased from FR1 to FR5, and further increased their responding when vapor delivery was omitted. Anti-nociceptive effects of self-administered volatilized heroin were of a similar magnitude as those produced by the 10-minute non-contingent exposure. Comparison with existing methodsInhalation of directly volatilized heroin successfully produces heroin-typical effects, comparable to EDDS inhalation delivery. ConclusionsThis study shows that “chasing the dragon” methods of inhalation of heroin can be modeled successfully in the rat. Inhalation techniques may be particularly useful for longer term studies deep into the middle age of rats.

Skills in handling Turbuhaler, Diskus in the west of China

ObjectiveThe purpose of this study was to evaluate the inhaler skills of patients with asthma and chronic obstructive pulmonary disease in a hospital in western China after receiving one medication education by pharmacists and the factors related to these skills.MethodsWe included 96 subjects using Turbuhaler and 74 subjects using Diskus in a hospital in western China. They were educated once by pharmacists before medication, and then their skills of operating these inhalers were visually evaluated the next time they were used. Using the seven-step inhalation administration method designed by AnnaMurphy, a clinical pharmacist at GLENFIELD Hospital in the UK, the inhaler use technique score scale was established and scored in turn. The age, sex, time of first illness, smoking status, education level and type of health insurance purchased by each patient were recorded to assess their relationship with overall inhaler skills.Results19.8% of the subjects who used Turbuhaler could not use it correctly, and 43.2% of the subjects who used Diskus could not use it correctly. The step with the highest error rate with Turbuhaler and Diskus is to "exhale slowly to residual volume". Chi-square test was carried out for each step of the operation of the two kinds of inhalers, and it was found that there was a significant difference in the operation accuracy of the two kinds of inhalers in the first, third and eighth steps. In univariate analysis, advanced age, female and low educational level were related to the lack of inhaler technology, but in multivariate analysis, only low educational level was a significant independent risk factor.ConclusionAmong the patients with asthma and chronic obstructive pulmonary disease in western China, some patients have good inhaler operation skills, but there are still many patients who can not use inhalers correctly, and the lower education level is significantly related to the incorrect use of inhalers.

The new trend of some inhalant use: Risks and warnings of false harmlessness

The new trend of some inhalant use: Risks and warnings of false harmlessness

Asthma and the risk of cardiac events among patients with long QT Syndrome after age 40

Abstract Background The effect of asthma on the clinical course of long QT syndrome (LQTS) in the middle and old age population has not been studied. Purpose The present study was designed to investigate the association between asthma comorbidity, β2-agonist treatment and cardiac events among LQTS subjects after age 40 years. Methods The risk of cardiac events (comprising syncope, aborted cardiac arrest, implantable defibrillator shock, or sudden cardiac death) from age 40 through 75 years, by the presence of asthma and time-dependent β2-agonist use was assessed among 1020 LQTS patients from the LQTS Registry. Results Asthma was identified in 162 (16%) study patients and 63% of asthma patients received β2-agonist inhalers. Patients with asthma vs. no asthma had a higher cumulative rate of cardiac events during follow-up (44% vs. 26%, respectively; p&amp;lt;0.001 [Figure: left panel]). Consistently, multivariate analysis demonstrated that asthma was a powerful predictor of cardiac events with an associated 2-fold (HR=1.97, p=0.001) increased risk for cardiac events as compared to patients with no asthma. β2-agonist inhalers use was associated with a similar increased risk for cardiac events (HR =1.90, p=0.035) among all study patients (Figure: right panel]). Subgroup analysis did not show a statistically significant difference in the association of asthma with cardiac events by risk subsets of LQTS patients, including QTc duration, syncope prior to age 40 years, beta-blocker use, sex, and the LQTS genotype (all p-values for risk subset-by-asthma interaction &amp;gt;0.10). Conclusion The presence of asthma and β2-agonist treatment are associated with an increased risk of cardiac events among middle and old age patients with LQTS.

Co-Delivery of a High Dose of Amphotericin B and Itraconazole by Means of a Dry Powder Inhaler Formulation for the Treatment of Severe Fungal Pulmonary Infections.

Over the past few decades, there has been a considerable rise in the incidence and prevalence of pulmonary fungal infections, creating a global health problem due to a lack of antifungal therapies specifically designed for pulmonary administration. Amphotericin B (AmB) and itraconazole (ITR) are two antifungal drugs with different mechanisms of action that have been widely employed in antimycotic therapy. In this work, microparticles containing a high dose of AmB and ITR (20, 30, and 40% total antifungal drug loading) were engineered for use in dry powder inhalers (DPIs) with an aim to improve the pharmacological effect, thereby enhancing the existing off-label choices for pulmonary administration. A Design of Experiment (DoE) approach was employed to prepare DPI formulations consisting of AmB-ITR encapsulated within γ-cyclodextrin (γ-CD) alongside functional excipients, such as mannitol and leucine. In vitro deposition indicated a favourable lung deposition pattern characterised by an upper ITR distribution (mass median aerodynamic diameter (MMAD) ~ 6 µm) along with a lower AmB deposition (MMAD ~ 3 µm). This offers significant advantages for treating fungal infections, not only in the lung parenchyma but also in the upper respiratory tract, considering that Aspergillus spp. can cause upper and lower airway disorders. The in vitro deposition profile of ITR and larger MMAD was related to the higher unencapsulated crystalline fraction of the drug, which may be altered using a higher concentration of γ-CD.

Candida Albicans CT Value in Asthmatics with Prolonged Corticosteroid Inhaler Uses

Corticosteroid inhaler is one of the first-line drugs given for the control and prevention of asthma attacks in the long term and continuously. The use of corticosteroid inhalers for a long time has systemic side effects in the oral cavity which can be a predisposing factor for normal fungal infection of Candida albicans microflora, an increase of Candida albicans’s amount in the oral cavity can cause oral candidiasis. Candida albicans detection using q-PCR to detect specific genes in oral swab specimens can provide an indirect picture of the amount of Candida albicans in the samples taken. The purpose of this study was to determine the relationship between the length of use of corticosteroid inhalers and the cycle threshold value in oral swab samples of asthma patient. This type of research is correlational research with data collection techniques using a purposive sampling technique on 30 respondents at the Lung Polyclinic at Bhayangkara Hospital H.S Samsoeri Mertojoso Surabaya who fit the inclusion criteria. Samples were examined using q-PCR to detect specific genes in the ITS-2 region to detect Candida albicans. This research was conducted at the Molecular Biology Laboratory of the Ministry of Health Surabaya Polytechnic during the period April – May 2023. The results showed that there were 26 samples (86.7%) positive for the ITS-2 gene and 4 samples (13.3%) negative for the ITS-2 gene. with sig. 0.307 so that it can be concluded that there is no relationship between the length of use of corticosteroid inhalers and the cycle threshold value of C. albicans in asthmatic’s oral swab sample.

Accuracy of Inhaler Use in COPD Patients and Factors Affecting It

Background: An inhaler is a type of dosage form used in the treatment of chronic obstructive pulmonary disease (COPD). The inhaler has a unique technique for use; however, the percentage of accuracy in inhaler use is still low. Proper inhaler use is expected to improve quality of life and decrease the occurrence of exacerbations. This study aimed to observe the percentage of accuracy in using inhalers and the factors that influence it.Method: This study was conducted with a cross-sectional design on COPD patients in two different hospitals. Primary data were collected using a questionnaire. The accuracy of inhaler use was assessed using a checklist.Results: The total number of patients in this study was 110, with an average age of 62 years. Patients were given single inhaler therapy, which included Dry Powder Inhalers (DPI) for 34 patients with 70.7% accuracy, Pressurized Metered-Dose Inhalers (pMDI) for 9 persons with 45.74% accuracy, and Soft Mist Inhalers (SMI) for one person with 66.67% accuracy. Furthermore, patients who used a combination of pMDI and DPI inhalers had an accuracy value of 68.53%, while a combination of pMDI and SMI had an accuracy value of 72.72%. The stage with the lowest level of accuracy in the pMDI-type inhaler used alone was exhaling before the inhaler was supplied.Conclusion: According to the findings, the accuracy of inhaler use in COPD patients is still relatively low. Furthermore, gender is a factor that has a statistically significant relationship with inhaler accuracy.

Inhalation technique assessment and evaluation for the need of pharmaceutical intervention in respiratory pathologies patients

ObjectiveTo evaluate rate and type of errors in inhalation technique of patients seen in hospitals at the observation area in the emergency department, as well as patients seen in the outpatients clinic at the primary care pharmaceutical consultation, and at the community pharmacy. MethodDescriptive observational study carried out by a hospital pharmacist, along with a primary care pharmacist and a community pharmacist. An anonymous survey was performed in order to collect different analyzed data. Each patient was asked to execute a complete demonstration on how they used their inhalers, to actively check the inhalation technique. Two checklists regarding the type of inhaler were established in order to assess said technique. Results were tabulated through Microsoft Excel® 2010 software and analyzed through R 3.5 statistical program. ResultsA total of 66 patients (42 male, 24 female; mean age 67) were recruited. Out of all patients, 48.5% used more than one inhaler, which 34.4% used different types of inhaler, and 65.6% used different systems. A total of 39 patients were under dry powder inhaler therapy, and 38 were using pressurized metered dose inhalers. The most frequent errors –both in dry powder inhalers and pressurized metered dose inhalers– were: not performing a 10 second apnea and not slowly expelling air from the lungs. Around 50% of patients needed new learning after assessing their inhalation technique, even though 88.5% had already received previous training. Older aged patients performed a worse inhalation technique. ConclusionsThere is a high rate of errors in the use of inhaled therapy, being even higher among older aged patients. The inhalation technique training by the medical staff seems inadequate, as it is crucial to raise awareness about the importance of health education for patients and their use of inhalers, to which a scheduled follow up and a technical and feedback obtained from the patient assessment is required.

Education on Inhaler Technique by Pharmacists To Improve The Quality of Life of COPD Patients: A Systematic Review and Meta-Analysis

Background: This systematic review aimed to analyze the importance of education on using inhalers by pharmacists in improving quality of life, correct inhaler use steps, and medication adherence in patients with Chronic Obstructive Pulmonary Disease (COPD).Methods: The databases used to search for articles in this systematic review include Scopus, ScienceDirect, and Pubmed. The papers submitted were published between 2009 and 2022, with the most recent search being conducted in December 2022. This review included a randomized controlled trial evaluating education on inhaler use techniques by pharmacists to improve COPD patients' quality of life in inpatient and outpatient settings. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) writing guidelines.Results: This systematic review used six articles from five different countries. The articles involved share similar characteristics so that analysis can be carried out. The total number of research subjects included was 913 subjects. Most studies show an increase in the quality of life among COPD patients who are given education on how to use inhalers by pharmacists using print or digital media. Measurements using the St. George's Respiratory Questionnaire (SGRQ) showed a decrease in scores at the 6-month and 12-month periods (-0.75 [95% CI (-1.46 - (-.005)]. Furthermore, two articles reported that education on the technique of using inhalers by pharmacists can also increase the accuracy of using inhalers, and three articles reported increasing medication adherence.Conclusion: Interventions such as education on using inhalers by pharmacists in inpatient and outpatient settings can improve the quality of life of COPD patients, the accuracy of the steps in using inhalers, and medication adherence.

Cost-effectiveness of budesonide-formoterol vs inhaled epinephrine in US adults with mild asthma

BackgroundThe management of mild asthma has lacked an over-the-counter (OTC) option aside from inhaled epinephrine, which is available in the United States. However, inhaled epinephrine use without an inhaled corticosteroid may increase the risk of asthma death. ObjectiveTo compare the cost-effectiveness of OTC as-needed budesonide-formoterol as a plausible alternative to inhaled epinephrine. MethodsWe developed a probabilistic Markov model to compare OTC as-needed budesonide-formoterol inhaler use vs inhaled epinephrine use in adults with mild asthma from a US societal perspective over a lifetime horizon, with a 3% annual discount rate (2022 US dollars). Inputs were derived from the SYmbicort Given as-needed in Mild Asthma (SYGMA) trials, published literature, and commercial costs. Outcomes were quality-adjusted life-years (QALY), costs, incremental net monetary benefit (INMB), severe asthma exacerbations, well-controlled asthma days, and asthma-related deaths. Microsimulation was used to evaluate underinsured Americans living with mild asthma (n = 5,250,000). ResultsInhaled epinephrine was dominated (with lower QALYs gains at a higher cost) by both as-needed budesonide-formoterol (INMB, $15,541 at a willingness-to-pay of $100,000 per QALY) and the no-OTC inhaler option (INMB, $1023). Adults using as-needed budesonide-formoterol had 145 more well-controlled asthma days, 2.79 fewer severe exacerbations, and an absolute risk reduction of 0.23% for asthma-related death compared with inhaled epinephrine over a patient lifetime. As-needed budesonide-formoterol remained dominant in all sensitivity and scenario analyses, with a 100% probability of being cost-effective compared with inhaled epinephrine in probabilistic sensitivity analysis. ConclusionIf made available, OTC as-needed budesonide-formoterol for treating mild asthma in underinsured adults without HCP management improves asthma outcomes, prevents fatalities, and is cost-saving.

A Case Series of Butane Intoxication Fatalities in the Southeastern Anatolia Region of Türkiye

Aim: Volatile solvent abuse (VSA), is the third most common form of substance abuse after alcohol and cigarettes. The aim of this study was to determine the incidence of fatalities due to butane gas. &#x0D; Material and Methods: From 8,075 autopsies conducted in our center in Şanlıurfa, Türkiye in a 10-year period, 10 deaths were determined to be due to butane gas intoxication. &#x0D; Results: All the fatalities were males (mean age: 17.6 years). Friends reported chronic use of lighter gas by the fatalities prior to the incident. In contrast, close relatives stated that it was the first instance of VSA. The preferred inhalation methods were bagging (i.e., inhaling gas from a plastic bag, n=4) and direct inhalation (i.e., spraying the gas directly in the mouth, n=6). The scene of incident findings revealed more than one lighter gas cartridge at the scene in nine cases and many lighters at the scene in one case. The autopsy examinations revealed minimal grazing on the body in three cases and no traumatic findings in seven cases. Butane was detected in blood samples in all 10 cases and in lung tissue samples in eight cases. In all 10 cases, there were areas of intra-alveolar swelling, edema, and bleeding in the lungs. &#x0D; Conclusion: The actual incidence of VSA-related deaths is likely much higher than the number of reported cases, as our center is located near the Syrian border and has one of the highest populations of children and young people in Türkiye.

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023).

Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.

Effect of Broncho-Vaxom (OM-85) on the frequency of chronic obstructive pulmonary disease (COPD) exacerbations

BackgroundEfforts have been made to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations using a variety of measures. Broncho-Vaxom (BV) is an immunomodulating agent that has shown potential benefit by balancing between immune stimulation and regulation in patients with COPD. In this study, we evaluated the clinical efficacy of BV for reducing the risk of COPD exacerbations.MethodsThis study was based on the Korean National Health Insurance database, which contains reimbursement information for almost the entire population of South Korea. We extracted data from 2016 to 2019 for patients started on BV during 2017–2018. We collected baseline data on demographics, comorbidities, inhaler use, hospital type, and insurance type 1 year before starting BV. We also analyzed exacerbation history, starting from the year before BV initiation.ResultsIn total, 238 patients were enrolled in this study. Their mean age was 69.2 ± 9.14 years, 79.8% were male, and 45% experienced at least one exacerbation. BV reduced the risk of moderate (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.38–0.91) and moderate-to-severe exacerbations compared to pre- and post-BV (OR = 0.571, 95% CI: 0.37–0.89). BV use also reduced the incidence of moderate and moderate-to-severe exacerbations (incidence rate ratio [IRR] = 0.75, p = 0.03; and IRR = 0.77, p = 0.03, respectively). The use of BV was significantly delayed moderate exacerbations (hazard ratio = 0.68, p = 0.02), but not with moderate-to-severe or severe exacerbations.ConclusionThe use of BV was associated with fewer moderate and moderate-to-severe exacerbations. Additionally, BV was associated with a delay in moderate COPD exacerbations.

Personal exposure to fine particulate matter (PM2.5) and self-reported asthma-related health

PM2.5 (fine particulate matter ≤2.5 μm in diameter) is a key pollutant that can produce acute asthma exacerbations and longer-term deterioration of respiratory health. Individual exposure to PM2.5 is unique and varies across microenvironments. Low-cost sensors (LCS) can collect data at a spatiotemporal resolution previously unattainable, allowing the study of exposures across microenvironments. The aim of this study is to investigate the acute effects of personal exposure to PM2.5 on self-reported asthma-related health.Twenty-eight non-smoking adults with asthma living in Scotland collected PM2.5 personal exposure data using LCS. Measurements were made at a 2-min time resolution for a period of 7 days as participants conducted their typical daily routines. Concurrently, participants were asked to keep a detailed time-activity diary, logging their activities and microenvironments, along with hourly information on their respiratory health and medication use. Health outcomes were modelled as a function of hourly PM2.5 concentration (plus 1- and 2-h lag) using generalized mixed-effects models adjusted for temperature and relative humidity.Personal exposures to PM2.5 varied across microenvironments, with the largest average microenvironmental exposure observed in private residences (11.5 ± 48.6 μg/m3) and lowest in the work microenvironment (2.9 ± 11.3 μg/m3). The most frequently reported asthma symptoms, wheezing, chest tightness and cough, were reported on 3.4%, 1.6% and 1.6% of participant-hours, respectively. The odds of reporting asthma symptoms increased per interquartile range (IQR) in PM2.5 exposure (odds ratio (OR) 1.29, 95% CI 1.07–1.54) for same-hour exposure. Despite this, no association was observed between reliever inhaler use (non-routine, non-exercise related) and PM2.5 exposure (OR 1.02, 95% CI 0.71–1.48).Current air quality monitoring practices are inadequate to detect acute asthma symptom prevalence resulting from PM2.5 exposure; to detect these requires high-resolution air quality data and health information collected in situ. Personal exposure monitoring could have significant implications for asthma self-management and clinical practice.