Ipratropium Research Articles

Contemporary treatment of children with critical and near-fatal asthma.

Asthma is the most common chronic illness in childhood. Although the vast majority of children with acute asthma exacerbations do not require critical care, some fail to respond to standard treatment and require escalation of support. Children with critical or near-fatal asthma require close monitoring for deterioration and may require aggressive treatment strategies. This review examines the available evidence supporting therapies for critical and near-fatal asthma and summarizes the contemporary clinical care of these children. Typical treatment includes parenteral corticosteroids and inhaled or intravenous beta-agonist drugs. For children with an inadequate response to standard therapy, inhaled ipratropium bromide, intravenous magnesium sulfate, methylxanthines, helium-oxygen mixtures, and non-invasive mechanical support can be used. Patients with progressive respiratory failure benefit from mechanical ventilation with a strategy that employs large tidal volumes and low ventilator rates to minimize dynamic hyperinflation, barotrauma, and hypotension. Sedatives, analgesics and a neuromuscular blocker are often necessary in the early phase of treatment to facilitate a state of controlled hypoventilation and permissive hypercapnia. Patients who fail to improve with mechanical ventilation may be considered for less common approaches, such as inhaled anesthetics, bronchoscopy, and extracorporeal life support. This contemporary approach has resulted in extremely low mortality rates, even in children requiring mechanical support.

To: Contemporary treatment of children with critical and near-fatal asthma.

Asthma is the most common chronic illness in childhood. Although the vast majority of children with acute asthma exacerbations do not require critical care, some fail to respond to standard treatment and require escalation of support. Children with critical or near-fatal asthma require close monitoring for deterioration and may require aggressive treatment strategies. This review examines the available evidence supporting therapies for critical and near-fatal asthma and summarizes the contemporary clinical care of these children. Typical treatment includes parenteral corticosteroids and inhaled or intravenous beta-agonist drugs. For children with an inadequate response to standard therapy, inhaled ipratropium bromide, intravenous magnesium sulfate, methylxanthines, helium-oxygen mixtures, and non-invasive mechanical support can be used. Patients with progressive respiratory failure benefit from mechanical ventilation with a strategy that employs large tidal volumes and low ventilator rates to minimize dynamic hyperinflation, barotrauma, and hypotension. Sedatives, analgesics and a neuromuscular blocker are often necessary in the early phase of treatment to facilitate a state of controlled hypoventilation and permissive hypercapnia. Patients who fail to improve with mechanical ventilation may be considered for less common approaches, such as inhaled anesthetics, bronchoscopy, and extracorporeal life support. This contemporary approach has resulted in extremely low mortality rates, even in children requiring mechanical support.

Off-label drug use in pediatric wards: a prospective study in a tertiary care hospital in Pune

Aim and objectives The aim of this study was to identify the most common off-label drug used in pediatric wards and to classify the age group in which off-label medications were prescribed. Materials and methods A 2-month prospective study was carried out in a tertiary care hospital in Pune. Seventy patient medication charts were reviewed. Two drug databases, the Micromedex drug database and Medscape drug reference, were the secondary sources of reference used and the National Formulary of India (NFI) was also used as the tertiary source of reference to assess and identify off-label drug use. Results Out of 70 patients enrolled in the study, 57 (81%) patients were prescribed off-label medications. The most common off-label prescription were for ipratropium bromide (12%), pantoprazole (12%), salbutamol (11%), and fosphenytoin (10%); it was found that safety and efficacy in the pediatric population were not established on most of the drugs that were prescribed off label, whereas some drugs were prescribed in an indication for which the drug was not approved by the Food and Drug Administration (FDA). The highest proportion of off-label drugs was prescribed in infants. Conclusion Off-label prescribing in the pediatric population was very high; the highest proportion of off-label drugs was prescribed in infants. Use of a drug database and the NFI can be useful in identifying off-label prescribing in pediatrics.

Efficiency of a New Mesh-Type Nebulizer (NE-SM1 NEPLUS) for Intrapulmonary Delivery of Ipratropium Bromide in Surgical Patients.

This study was aimed to evaluate the efficiency of a new mesh-type nebulizer for the intrapulmonary delivery of ipratropium bromide in surgical patients under mechanical ventilation. A total of 20 patients were randomly allocated to receive 0.5 mg ipratropium bromide using either a control (Pariboy SX, Pari, Co., Starnberg, Germany, n = 10) or test (NE-SM1 NEPLUS, KTMED INC., Seoul, Korea, n = 10) nebulizer during general anaesthesia. Ipratropium bromide was nebulized continuously for 20 min. in each group. Plasma concentrations of ipratropium bromide were obtained from blood samples at preset intervals. Non-compartmental analysis of ipratropium bromide was performed to compare the efficiency of pulmonary drug delivery in both nebulizers. Population pharmacokinetic analysis of ipratropium bromide was performed. Additionally, the noise level during the nebulizer operation and the aerosol particle size for each device were measured. The dose-normalized AUC(last) was 0.10 min/L for both nebulizers. The pharmacokinetics of nebulized ipratropium bromide can be described best by a one-compartment model with first-order absorption. The apparent volume of distribution and metabolic clearance were 1340 L and 6.78 L/min, respectively. Type of nebulizer was a significant covariate for absorption rate constant. The equivalent sound level and median aerosol particle diameter were 35.0 dB and 4.52 μm for the test nebulizer, and 60.2 dB and 3.85 μm for the control nebulizer, respectively. From the standpoint of the dose-normalized AUC(last) , a new vibrating mesh-type nebulizer shows similar performance in the intrapulmonary delivery of ipratropium bromide to that of a jet-type nebulizer in surgical patients.

The clinical effect and safety on budesonide combined with ipratropium bromide in the treatment of acute exacerbations of chronic obstructive pulmonary disease

Objective To explore the effect of budesonide combined with ipratropium bromide in the treatment of acute exacerbations of chronic obstructive pulmonary disease, and observe the adverse reactions during treatment.To analyze the treatment of safety and to provide the basis for clinical treatment. Methods 160 cases of acute exacerbations of chronic obstructive pulmonary disease were selected, they were randomly divided into the control group A, B, C and the observation group, with 40 cases in each group.The control group A was treated with prednisone and other conventional, control group B was treated with aminophylline and other conventional treatment, the control group C application included prednisone, aminophylline and other conventional treatment, all the control group were treated with 0.9% sodium chloride solution inhaled as a placebo spray.And the observation group application of budesonide was combined with ipratropium bromide based on the routine treatment.Mainly the effect of treatment was observed, and the blood carbon dioxide partial pressure (PaO2), partial pressure of oxygen (PaCO2), forced expiratory volume in one second (FEV1), forced expiratory volume in one second (FEV1) and forced expiratory volume in one second to forced vital capacity ratio of FVC (FEV1/FVC) before and after treatment were detected.And the adverse reactions were observed to evaluate its safety. Results The total effective rate of the observation group was 95.00% (38/40), which were higher than the control group A, B and C, the differences were statistically significant (χ2=9.68, 9.70, 9.91, all P 0.05). Conclusion It has good clinical curative effect on budesonide combined with ipratropium bromide for the treatment of acute exacerbations of chronic obstructive pulmonary disease patients, which can significantly improve the pulmonary function of patients, shorten recovery time, and has high security.It is worthy of clinical application. Key words: Pulmonary disease, chronic obstructive; Budesonide; Ipratropium bromide

Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease.

Tiotropium and ipratropium bromide are both recognised treatments in the management of people with stable chronic obstructive pulmonary disease (COPD). There are new studies which have compared tiotropium with ipratropium bromide, making an update necessary. To compare the relative effects of tiotropium to ipratropium bromide on markers of quality of life, exacerbations, symptoms, lung function and serious adverse events in patients with COPD using available randomised controlled trial (RCT) data. We identified RCTs from the Cochrane Airways Group Specialised Register of trials (CAGR) and ClinicalTrials.gov up to August 2015. We included parallel group RCTs of 12 weeks duration or longer comparing treatment with tiotropium with ipratropium bromide for patients with stable COPD. Two review authors independently assessed studies for inclusion and then extracted data on study quality and outcome results. We contacted trial sponsors for additional information. We analysed the data using Cochrane Review Manager. This review included two studies of good methodological quality that enrolled 1073 participants with COPD. The studies used a similar design and inclusion criteria and were of at least 12 weeks duration; the participants had a mean forced expiratory volume in one second (FEV1) of 40% predicted value at baseline. One study used tiotropium via the HandiHaler (18 µg) for 12 months and the other via the Respimat device (5 µg and 10 µg) for 12 weeks. In general, the treatment groups were well matched at baseline but not all outcomes were reported for both studies. Overall the risk of bias across the included RCTs was low.For primary outcomes this review found that at the three months trough (the lowest level measured before treatment) FEV1 significantly increased with tiotropium compared to ipratropium bromide (mean difference (MD) 109 mL; 95% confidence interval (CI) 81 to 137, moderate quality evidence, I(2) = 62%). There were fewer people experiencing one or more non-fatal serious adverse events on tiotropium compared to ipratropium (odds ratio (OR) 0.5; 95% CI 0.34 to 0.73, high quality evidence). This represents an absolute reduction in risk from 176 to 97 per 1000 people over three to 12 months. Concerning disease specific adverse events, the tiotropium group were also less likely to experience a COPD-related serious adverse event when compared to ipratropium bromide (OR 0.59; 95% CI 0.41 to 0.85, moderate quality evidence).For secondary outcomes, both studies reported fewer hospital admissions in the tiotropium group (OR 0.34; 95% CI 0.15 to 0.70, moderate quality evidence); as well as fewer patients experiencing one or more exacerbations leading to hospitalisation in the people on tiotropium in both studies (OR 0.56; 95% CI 0.31 to 0.99, moderate quality evidence). There was no significant difference in mortality between the treatments (OR 1.39; 95% CI 0.44 to 4.39, moderate quality evidence). One study measured quality of life using the St George's Respiratory Questionnaire (SGRQ); the mean SGRQ score at 52 weeks was lower in the tiotropium group than the ipratropium group (lower on the scale is favourable) (MD -3.30; 95% CI -5.63 to -0.97, moderate quality evidence). There were fewer participants suffering one of more exacerbations in the tiotropium arm (OR 0.71; 95% CI 0.52 to 0.95, high quality evidence) and there was also a reported difference in the mean number of exacerbations per person per year which reached statistical significance (MD -0.23; 95% CI -0.39 to -0.07, P = 0.006, moderate quality evidence). From the 1073 participants there were significantly fewer withdrawals from the tiotropium group (OR 0.58; 95% CI 0.41 to 0.83, high quality evidence). This review shows that tiotropium treatment, when compared with ipratropium bromide, was associated with improved lung function, fewer hospital admissions (including those for exacerbations of COPD), fewer exacerbations of COPD and improved quality of life. There were both fewer serious adverse events and disease specific events in the tiotropium group, but no significant difference in deaths with ipratropium bromide when compared to tiotropium. Thus, tiotropium appears to be a reasonable choice (instead of ipratropium bromide) for patients with stable COPD, as proposed in guidelines. A recent large double-blind trial of the two delivery devices found no substantial difference in mortality using 2.5 µg or 5 µg of tiotropium via Respimat in comparison to 18 µg via Handihaler.

The curative effect of budesonide combined with mucosolvin and atrovent on acute exacerbation of chronic obstructive pulmonary disease

Objective To evaluated the clinical curative effect of budesonide combined with mucosolvin and atrovent on acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 209 patients with AECOPD were selected and divided into two groups: control group (n=101, patients receiving atomized inhalation of 2 mg budesonide tid, 20 ug atrovent tid, with antibiotic drugs, avoiding drinking water) and observation group (n=108, patients treated with 30 mg mucosolvin iv drops tid additionally on the basis of the treatment in control group). Results The modified British medical research council (mMRC) and COPD evaluation test (CAT) score were lower in observation group than in control group〔(1.51±0.15) vs. (2.93±0.20), (16.80±1.31) vs. (27.14±1.61), t=5.757 and 5.876, both P=0.000〕. The sputum volume and carbon dioxide partial pressure (pCO2) (1 mmHg=0.133 kPa) were lower in observation group than in control group〔(20.12±2.14) vs. (39.86±3.53), (47.34±2.13) vs. (65.36±2.59), t=5.9651 and 6.3507, both P=0.0000〕. Conclusions The treatment of budesonide combined with mucosolvin and atrovent has an obvious therapeutic effect in AECOPD patients, which can significantly improve the symptom of dyspnea and quality of life, and it has a good security. Key words: Pulmonary disease, chronic obstructive; Ambroxol; Ipratropium; Budesonide

Principal findings of systematic reviews of acute asthma treatment in childhood

Objective: The objective of this study is to summarize the principal findings in the literature about acute asthma management in children. Methods: Systematic reviews of randomized clinical trials (SRCTs) with or without meta-analysis in children (1–18 years) admitted to the emergency department (ED) were retrieved using five data bases. Methodological quality was determined using the AMSTAR tool. Results: One hundred and three studies were retrieved. Among those, 28 SRCTs were included: seven SRCTs related to short-acting beta2-agonists (SABA), three to ipratropium bromide (IB), eight to corticosteroids, one to racemic adrenaline, one to leukotriene receptor antagonists (LTRA), four to magnesium sulfate, one to intravenous (IV) SABA, one to IV aminophylline, one to IV ketamine, and one to antibiotics. It was determined that administering SABA by MDI-VHC is superior to using a nebulizer, because it decreases the hospital admission rate, improves the clinical score, results in a shorter time in the ED, and causes fewer adverse effects. Levalbuterol and albuterol were similar. In patients with moderate to severe exacerbations, IB+SABA was superior to SABA, decreasing hospital admission and improving the clinical score. SABA heliox administered by nebulizer decreased exacerbation severity compared to oxygen. Inhaled corticosteroids (ICS), especially administered by nebulizer, showed results similar to oral corticosteroids (OCS) with respect to reducing hospital admission, unscheduled visits, and the requirement of additional systemic corticosteroids. ICS or OCS following ED discharge was similar with regard to relapse. Compared with a placebo, IV magnesium reduced hospital admission and improved lung function. Conclusions: SRCTs are useful for guiding decisions in acute asthma treatment.

Integrated Therapy for Invasive Pulmonary Aspergillosis in a Patient with Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome

Integrated Therapy for Invasive Pulmonary Aspergillosis in a Patient with Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome

Clinical curative effect of ipratropium bromide in combination with ambroxol hydrochoride on ventilator-associated pneumonia in elderly patients

Objective To investigate the clinical curative effect of ipratropium bromide in combination with ambroxol hydrochloride (mucosolvan) on ventilator-associated pneumonia (VAP) in elderly patients. Methods From Jan 2013 to Nov 2014, a total of 46 elderly patients with VAP in our hospital were treated with ipratropium bromide 0.5 mg diluted in 5 ml saline by inhalation with ventilator, and mucosolvan 30 mg by intravenous injection, 3 times/d (treatment group, n=23), and treated with ipratropium bromide 0.5 mg diluted in 5 ml saline by inhalation with ventilator, 3 times/d (control group, n=23). Total clinical effective rate, ventilating time, number of sputum suction by fibre bronchoscope and white cell count were compared between the two groups. Results The total clinical effective rate was higher in treatment group than in the control group〔91% (21/23) vs. 74% (17/23), χ2=11.310, P=0.002〕. The indicators of ventilating time, number of sputum suction by fibre bronchoscope and white cell count were improved in treatment group as compared with control group〔(8.2±1.5) d vs. (13.7±3.1) d, (3.5±0.3) vs. (6.7±1.2), (9.5±2.3) ×109/L vs. (14.2±2.7)×109/L, t=17.510, 2.750, 3.810, respectively, P=0.000, 0.001, 0.001〕. Conclusions Compared with single-drug treatment, ipratropium bromide in combination with ambroxol hydrochloride (mucosolvan) could improve airway humidification, promote cilium to clean secreta, shorten the ventilating time and increase the curative rate of VAP in elderly patients. Key words: Pneumonia, ventilator-associated; Ambroxol

Assessment of Drug Prescribing Pattern in Chronic Obstructive Pulmonary Disease Patients at a Tertiarycare Hospital

INTRODUCTION : The management of COPD is symptomatic and as it requires long-term treatment. The irrational use of drugs may lead to certain consequences. OBJECTIVE : To analyze drug prescription pattern in COPD patients using GOLD treatment guidelines. METHODOLOGY : A prospective observational study was conducted in General Medicine department of a tertiary care hospital for a period of 6 months. All COPD Patients with tobacco smoking, along with co morbidities and those who visited the hospital for acute exacerbation of the disease inclusive of both genders aged above 18 years were enrolled in the study. Upon prior consent from the patients, data was collected which includes the patient demographics and medications prescribed. The medication charts were analysed using GOLD treatment guidelines. RESULTS : A total of 100 patients of either sex who fulfilled our inclusion criteria were evaluated. Among them, COPD was reported more in male patients(78%) as compared to females(22%). 35% were in the age group of 61-70 years while 1% were below 20 years of age as well as between 20-30 year age group. Antibiotics (42%) were the most prescribed class of drug in which Ceftriaxone (44%) and Azithromycin (25%) were mostly preferred. Parentral steroids were used in 20% of the patients and all of them received Hydrocortisone (50%) whereas 19% were prescribed with Methyxanthines in which Doxofylline (56.89%) was the most preferred drug. The most prescribed combination therapy was salbutamol+ ipratropium bromide and budesonide (40%). The most preferred route of administration was oral route (44.5%). 89% of the drugs were written in trade names, while 11% of the drugs were mentioned with their generic name. DISCUSSION&CONCLUSION : It was found that majority (89.7%) of the drugs were given in accordance with Global Initiative for Chronic Obstructive Lung Disease criteria recommendations. This study reveals that generic prescription is very low and suggests that efforts must be made to encourage prescribers for generic prescribing which may have a multitude of benefits.

Observation of the effect and the influence on PCT,CRP in the treatment of patients with acute exacerbation pulmonary disease by Budesonide and ipratropium bromide

Objective To observe the effect and the influence on PCT,CRP in the treatment of patients with acute exacerbation pulmonary disease by Budesonide and ipratropium bromide. Methods 80 patients with acute exacerbation pulmonary disease were randomly divided into 40 cases of the control group and 40 cases of the observation group, the two groups were given routine treatment, the control group then had been given ipratropium bromide for 7d, and the observation group had been given Budesonide and ipratropium bromide for 7d,the blood gas indicators (PaO2,PCO2), pulmonary function(FEV1,PEF,FEV1/FVC),dyspnoea and exercise tolerance score, serum PCT levels, serum CRP levels and clinical efficacy were compared, Adverse reactions were recorded. Results (1)the PaO2, FEV1,PEF,FEV1/FVC of the observation group and the control group after treatment were(70.7±2.3)mm Hg and (62.5±3.0)mm Hg,(2.15±0.63)L and(1.76±0.56)L,(3.49±0.82)L/s and(3.06±0.75)L/s,(68.52±6.53)% and(60.14±6.03)%, These indicators were significantly higher than those before treatment,all P<0.05,the PCO2, PCT,CRP were(51.4±1.7)mm Hg and(56.6±2.3)mm Hg,(1.75±1.20)μg/L and(2.58±1.17)μg/L,(10.25±6.77)mg/L and(19.07±5.75)mg/L,These indicators were significantly lower than those before treatment,all P< 0.05,the PaO2,FEV 1,PEF,FEV 1/FVC of the observation group were significantly higher than those of the control group,the PCO 2,PCT,CRP were significantly lower than those of the control group, all P<0.05;(2)The dyspnoea and exercise tolerance score of the observation group and the control group after treatment was significantly lower than those before treatment, the dyspnoea and exercise tolerance score of the observation group was significantly lower than those of the control group;(3)The clinical total effective rate of the observation group was 90%,which was higher than 65%of the control group(χ2=7.312,P<0.05). Conclusion The method containing Budesonide and ipratropium bromide Inhalation has exact effect, and can effectively improve respiratory function, which is an effective treatment of choice for acute exacerbation of COPD. Key words: Pulmonary disease, chronic obstructive; Budesonide; Compound ipratropium bromide; Procalcitonin; C-reactive protein

168 Combining inhalation by a breath-actuated nebulizer (BAN) and exhalation with oscillating positive expiratory pressure device (OPEP) offers potential for simultaneous therapy: A laboratory study

Objectives Mobilization of secretions by OPEP is often given separately to aerosol delivery. Combining a nebulizer [AeroEclipse®-II, Trudell Medical International (TMI)] with OPEP (Aerobika*, TMI), both therapies can be delivered concurrently. We investigated if the BAN output is affected by use with the Aerobika* device, or by substituting another OPEP product (acapella® duet, Smiths Medical). Methods A Next Generation Cascade Impactor operated at 15 L/min was used in accordance with United States Pharmacopeia (USP) ‘Products for Nebulization' to make droplet size measurements of the BAN-aerosol (3×3 replicates/device) operated by compressed air at 50 psig. The BAN was filled with 4 mL ipratropium bromide anticholinergic solution (0.5 mg/ml, TEVA), and connected directly to the USP induction port. Measurements were made (a) with the Aerobika* OPEP device inserted between the BAN and induction port, and (b) substituting the acapella® duet OPEP device. The BAN was run to sputter, and the therapeutically beneficial fine particle mass FMipr ) determined. Results FMipr (mean±SD) via the BAN alone, with the BAN-Aerobika*, and the BAN-acapella® duet OPEP devices were 452±28, 426±27 and 308±23 mg respectively. The BAN-Aerobika* combination marginally reduced delivery (paired t-test, p=0.043), whereas the BAN-acapella® duet configuration resulted in substantial losses (p Conclusion An AeroEclipse®-II BAN-Aerobika* OPEP combination offers combined aerosol/OPEP therapy with minimal medication loss. Substitution with the acapella® duet OPEP results in substantial reduction in BAN-output that may have adverse clinical implications.

Pharmacologic Agents That Promote Airway Clearance in Hospitalized Subjects: A Systematic Review.

Pharmacologic agents to promote mucus clearance may reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of pharmacologic agents for mucus clearance in hospitalized or postoperative subjects without cystic fibrosis and over 12 months of age. We searched MEDLINE and other databases from January 1970 to July 2014 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes and assigned overall quality ratings. The 9 studies meeting review criteria included 5 randomized controlled trials, 3 crossover randomized controlled trials, and one retrospective cohort study. Studies were small and together included a total of 379 subjects (mean of 42 subjects per study). N-acetylcysteine, heparin plus N-acetylcysteine, albuterol, ipratropium bromide, and saline were assessed. Studies reported no benefit of studied agents on expectoration, pulmonary function, and atelectasis and little effect on changes in sputum volume, weight, or viscosity. Adverse effects of agents were not consistently reported. Nausea was reported in 2 studies of N-acetylcysteine (one paper reported 2 experiments and did not clearly identify in which experiment adverse effects occurred), 3 studies reported that there were no adverse events, and 3 studies did not address adverse effects at all. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and adverse effects of mucoactive agents.

Study of Prescribing Pattern and Impact of Pharmaceutical Care in Bronchial Asthmatic Paediatric Patients in a Tertiary Care Teaching Hospital

Background: Asthma is a chronic inflammatory disease of increasing prevalence that is a result of genetic predisposition and environmental interaction and one of the most common chronic diseases of childhood. Aim and Objective: The aim is to study the prescribing pattern and impact of pharmaceutical care in bronchial asthmatic paediatric patients. The present study was conducted in RMMCH, Chidambaram. Over a six month period patients who were diagnosed with Bronchial asthma was enrolled and the information was gathered using validated data collection form. The overall asthma cohort included in the study based on inclusion criteria. Subjects under 12 years of age, and who are newly diagnosed and admitted in paediatric wards for Bronchial asthma. Results: A total of 61 patients were included out of which 43 (70.4%) are boys and 18 (29.6%) are girls. β-agonists (Salbutamol, Ipratropium bromide) accounts for highest number of 51 out of 61 prescriptions. Among antibiotics crystalline penicillin was present in highest number of prescriptions (86.8%). Drugs used in RMMCH were compared to various EDL (Essential drug list) which complied with national EDL. The pharmaceutical care outcomes was measured and a significant difference was observed between the lung functions tests (FVC; P=<0.001) and (FEV; P=<0.008). Which indicates the improvement of pharmaceutical care from control (30 without intervention) to test (31 with intervention) group. There is a statistically significant difference between the test and control group at (P=<0.001). Conclusion: Patient education produced a substantial improvement in patient counselling, understanding of their illness and role of medication and its treatment. Pharmaceutical care services provided by the pharmacist improved quality of life, medication adherence in test subjects. Interventions aimed at improving therapeutic outcomes in bronchial asthma.

The current role of ipratropium bromide in an acute exacerbation of asthma.

The current role of ipratropium bromide in an acute exacerbation of asthma.

The Effect of Active Pharmaceutical Ingredients on Aerosol Electrostatic Charges from Pressurized Metered Dose Inhalers.

This study investigated the effect of different active pharmaceutical ingredients (API) on aerosol electrostatic charges and aerosol performances for pressurized metered dose inhalers (pMDIs), using both insulating and conducting actuators. Five solution-based pMDIs containing different API ingredients including: beclomethasone dipropionate (BDP), budesonide (BUD), flunisolide (FS), salbutamol base (SB) and ipratropium bromide (IPBr) were prepared using pressure filling technique. Actuator blocks made from nylon, polytetrafluoroethylene (PTFE) and aluminium were manufactured with 0.3 mm nominal orifice diameter and cone nozzle shape. Aerosol electrostatics for each pMDI formulation and actuator were evaluated using the electrical low-pressure impactor (ELPI) and drug depositions were analysed using high performance liquid chromatography (HPLC). All three actuator materials showed the same net charge trend across the five active drug ingredients, with BDP, BUD and FS showing positive net charges for both nylon and PTFE actuators, respectively. While SB and IPBr had significantly negative net charges across the three different actuators, which correlates to the ionic functional groups present on the drug molecule structures. The API present in a pMDI has a dominant effect on the electrostatic properties of the formulation, overcoming the charge effect arising from the actuator materials. Results have shown that the electrostatic charges for a solution-based pMDI could be related to the interactions of the chemical ingredients and change in the work function for the overall formulation.

Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults

Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment. The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled β-agonist, antimuscarinic, and corticosteroid therapy. We undertook a cross-sectional study with 3 phases. In phase 1, 1,264 participants aged 18 to 75 years with self-reported current wheeze and breathlessness were identified from a random population sample of 16,459. In phase 2, 451 participants attended for detailed assessment, including responsiveness to inhaled salbutamol and ipratropium bromide. In phase 3, 168 steroid-naive participants were enrolled in a 12-week trial of inhaled budesonide. Cluster analysis was performed in 389 participants who completed phase 2 with full data. Treatment responsiveness was compared between phenotypes. Cluster analysis identified 5 phenotypes: moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, obese-comorbid, mild childhood-onset atopic asthma, and mild intermittent. Bronchodilation after salbutamol was equal to or greater than that after ipratropium for all phenotypes. The moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, and obese-comorbid phenotypes had greater efficacy with inhaled corticosteroid treatment than the mild intermittent group. Cluster analysis of adults with symptomatic airflow obstruction identifies 5 disease phenotypes, including asthma-COPD overlap and obese-comorbid phenotypes, and provides evidence that patients with the asthma-COPD overlap syndrome might benefit from inhaled corticosteroid therapy.

Asthma changes at a pediatric intensive care unit after 10 years: Observational study.

OBJECTIVES:To describe the change in the management, and outcome of children with acute severe asthma (ASA) admitted to Pediatric Intensive Care Unit (PICU) at tertiary institute, as compared to previously published report in 2003.METHODS:This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort) was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort).RESULTS:In comparison to previous 2003 Cohort, current Cohort (2013) revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001), higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007), less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03), less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001). There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001), intravenous magnesium sulfate (68.2% vs. none), intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015), and noninvasive ventilation (NIV) (35.8% vs. none) while no patients were treated with theophylline (none vs. 62.5%). The median length of stay (LOS) was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality.CONCLUSION:We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.

Perioperative acupuncture in asthma patients under general anesthesia

Background and objective The incidence of asthma has increased in the last few years. Acupuncture was found to have a bronchodilating effect in asthmatic patients. The aim of this study was to evaluate the perioperative bronchodilator effect of acupuncture in comparison with regular inhalation asthma treatment. Patients and methods The study was conducted at Kasr AL Ainy Teaching Hospital. Forty patients of both sexes, aged 20-40 years, classified as ASA 2, with mild partially controlled asthma [determined from forced expiratory volume in the first second (FEV 1 ), forced expiratory volume/forced vital capacity (FEV 1 /FVC), peak expiratory flow rate (PEFR) ranging from 70 to 79%] were allocated to two groups. Group A ( n = 20) received preoperative acupuncture for 30 min, and if there was clinical improvement on the basis of spirometer tests patients were allowed to proceed with their operation, followed by intraoperative acupuncture until fully awake. Group B ( n = 20) received a 30 min preoperative treatment with 10 drops of nebulized salbutamol (1 mg, 1 ml) and 500 mg ipratropium bromide diluted in 2 ml normal saline inhaled through a nebulizer. FEV 1 , FEV 1 /FVC, PEFR, SPO 2 , and hemodynamic data were collected before treatment T(0) and 30 min after the end of treatment T(30). The onset of bronchodilation as marked by the disappearance of wheezing and improvement in patient symptomatology, the success rate of treatment (improved pulmonary function tests >12%, disappearance of wheezing) recorded at T(30), intraoperative hemodynamic changes, peripheral oxygen saturation, end tidal CO 2 levels, peak airway pressure, and any complications related to the different treatments used were also recorded. Results Wheezing disappeared after 9.5 ± 1.67 min, recorded from T(0), in group A compared with 14.4 ± 2.80 min in group B. At T(30), pulmonary function tests improved by more than 12% and wheezing disappeared in 16 (80%) patients in group A and in 18 (90%) patients in group B. This was statistically significant ( P 1 , FEV 1 /FVC, and PEFR peripheral oxygen saturation (SpO 2 ) within each group compared with T(0). Intraoperatively, the peak airway pressure was clinically comparable in both groups, although it was statistically significant ( P = 0.04). In group A there were no complications related to the use of acupuncture. Two (10%) patients in group A and 14 (70%) patients in group B experienced an increase in heart rate by more than 10%. Conclusion Perioperative acupuncture seemed to improve respiratory functions without serious side effects.