Respiratory Pathology Research Articles

Neonatal Respiratory Distress in a Poor Resource Setting: From Epidemiology to Outcome

Background: Neonatal respiratory distress one of the main causes of neonatal morbidity and mortality. It is a diagnostic and therapeutic emergency whose etiology is dominated by respiratory pathologies.
 Objective: To study the epidemiological, clinical, diagnostic, therapeutic, and outcomes aspects of neonatal respiratory distress in order to help reduce its impact on neonatal morbidity and mortality.
 Methods: A retrospective descriptive cross-sectional study covering the period from 1st January 2017 to 31 December 2018 was conducted in the Neonatology Unit of the Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle of Ouagadougou, Burkina Faso (West Africa). The clinical records of newborns admitted for respiratory distress (n=305) were included in the study. Results: Over the two-year period, the frequency of neonatal respiratory distress was 39.1% (305/780). Factors of respiratory distress were early neonatal period (80%), male sex (60.7%), full-term birth (82.3%), and normal birth weight (66.3%). The Silverman and Andersen score was mild (20.4%), moderate (68.5%), and severe (11.1%). The main causes of respiratory distress were neonatal septicemic infection (59.3%) and perinatal asphyxia (30.5%). Treatment mainly includes cardiopulmonary resuscitation, maintenance of fluid and electrolyte balance, and oxygen therapy. There were 83 deaths, giving a case-fatality rate of 27.2%. Major causes of death were sepsis (13.1%) and perinatal asphyxia (9.8%).
 Conclusion: Neonatal respiratory distress is common in our neonatal unit. In order to reduce neonatal morbidity and mortality linked to this condition, action must be taken to combat neonatal sepsis, perinatal asphyxia, and preterm birth.

Non-specific prevention of respiratory infections during vaccination against COVID-19

The novel coronavirus infection (COVID-19) has a suppressive effect on innate immunity, which is a prerequisite for developing strategies to enhance this non-specific link as a preventive measure to protect against other respiratory infections during the ongoing circulation of mutating strains of the SARS-CoV-2 virus. Despite the currently developed and available preventive measures, it has been noted that in persons who have undergone COVID-19, repeated episodes of both coronavirus infection and diseases caused by other pathogens have been recorded.
 This review analyzes data from the biomedical literature and considers examples of health risks associated with continued infection with pathogens that cause respiratory tract pathologies. It also reflects the ways and approaches of possible preventive measures, the purpose of which is to prevent the development of pathologies of both the respiratory organs and other systems.

Hygienic assessment of the chemical factor of working conditions and respiratory disorders in metalworking workers

The study of the function of external respiration for the purpose of prenosological diagnosis of respiratory pathology related to work is an urgent task in the development of measures for the prevention of health disorders in 
 workers.
 The study aims to conduct a hygienic assessment of the chemical factor of working conditions and indicators of respiratory function in metalworking workers engaged in the metalworking process using lubricant cooling liquids.
 We have examined 250 male workers of the Saratov metalworking enterprise. The main group consisted of 145 people working in contact with lubricants and coolants, the control group consisted of 105 people not in contact with lubricants and coolants. The researchers have conducted a hygienic assessment of the chemical factor of working conditions in the workplace and a spirometric study of the function of external respiration in workers. The results of the study were statistically processed using the Statistica 10 program. The concentrations of chemicals in the workers' breathing zone comply with the hygienic requirements for the air of the working area corresponding to permissible working conditions (Class 2). According to spirometry data, the researchers have identified respiratory function values corresponding to the appropriate values, in the absence of statistically significant differences in spirometric indicators between the main and control groups.
 To identify the etiological contribution of chronic exposure to lubricants and coolants to the formation of respiratory pathology of workers, it is necessary to conduct additional in-depth clinical, laboratory, functional and epidemiological studies taking into account pollutants present in the air of the working area and their combined effects.
 Ethics. The studies were conducted in compliance with Ethical standards and principles of conducting medical research with human participation, set out in the Helsinki Declaration of the World Medical Association (ed. 2013). Written consent of respondents was obtained to participate in the study. The study was approved by the local Ethical Committee of the Saratov Hygiene Research Center of the Federal State Budgetary Institution "Federal Research Center for Medical and Preventive Technologies of Public Health Risk Management" (Protocol No. 10 of 03/16/2023).

Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study

BackgroundChest X-ray (CXR) has typically been the main investigation in children with suspected respiratory pathology. Recent advances in lung point-of-care ultrasound (POCUS) have shown the potential for it to be...

IL-17RA promotes pathologic epithelial inflammation in a mouse model of upper respiratory influenza infection.

The upper respiratory tract (nasopharynx or NP) is the first site of influenza replication, allowing the virus to disseminate to the lower respiratory tract or promoting community transmission. The host response in the NP regulates an intricate balance between viral control and tissue pathology. The hyper-inflammatory responses promote epithelial injury, allowing for increased viral dissemination and susceptibility to secondary bacterial infections. However, the pathologic contributors to influenza upper respiratory tissue pathology are incompletely understood. In this study, we investigated the role of interleukin IL-17 recetor A (IL-17RA) as a modulator of influenza host response and inflammation in the upper respiratory tract. We used a combined experimental approach involving IL-17RA-/- mice and an air-liquid interface (ALI) epithelial culture model to investigate the role of IL-17 response in epithelial inflammation, barrier function, and tissue pathology. Our data show that IL-17RA-/- mice exhibited significantly reduced neutrophilia, epithelial injury, and viral load. The reduced NP inflammation and epithelial injury in IL-17RA-/- mice correlated with increased resistance against co-infection by Streptococcus pneumoniae (Spn). IL-17A treatment, while potentiating the apoptosis of IAV-infected epithelial cells, caused bystander cell death and disrupted the barrier function in ALI epithelial model, supporting the in vivo findings.

Exploring Cinnamoyl-Substituted Mannopyranosides: Synthesis, Evaluation of Antimicrobial Properties, and Molecular Docking Studies Targeting H5N1 Influenza A Virus.

The pursuit of innovative combinations for the development of novel antimicrobial and antiviral medications has garnered worldwide interest among scientists in recent times. Monosaccharides and their glycosides, such as methyl α-d-mannopyranoside derivatives, play a significant role in the potential treatment of viral respiratory pathologies. This study was undertaken to investigate and assess the synthesis and spectral characterization of methyl α-d-mannopyranoside derivatives 2-6, incorporating various aliphatic and aromatic groups. The investigation encompassed comprehensive in vitro antimicrobial screening, examination of physicochemical properties, molecular docking analysis, molecular dynamics simulations, and pharmacokinetic predictions. A unimolar one-step cinnamoylation reaction was employed under controlled conditions to produce methyl 6-O-cinnamoyl-α-d-mannopyranoside 2, demonstrating selectivity at the C-6 position. This represented a pivotal step in the development of potential antimicrobial derivatives based on methyl α-d-mannopyranoside. Subsequently, four additional methyl 6-O-cinnamoyl-α-d-mannopyranoside derivatives were synthesized with reasonably high yields. The chemical structures of these novel analogs were confirmed through a thorough analysis of their physicochemical properties, elemental composition, and spectroscopic data. In vitro antimicrobial assays were conducted against six bacterial strains and two fungal strains, revealing promising antifungal properties of these methyl α-d-mannopyranoside derivatives in comparison to their antibacterial activity. Moreover, cytotoxicity testing revealed that the compounds are less toxic. Further supporting these findings, molecular docking studies were performed against the H5N1 influenza A virus, indicating significant binding affinities and nonbonding interactions with the target protein 6VMZ. Notably, compounds 4 (-7.2) and 6 (-7.0) exhibited the highest binding affinities. Additionally, a 100 ns molecular dynamics simulation was conducted to assess the stability of the complex formed between the receptor 6VMZ and methyl α-d-mannopyranoside derivatives under in silico physiological conditions. The results revealed a stable conformation and binding pattern within the stimulating environment. In silico pharmacokinetic and toxicity assessments of the synthesized molecules were performed using Osiris software (version 2.9.1). Compounds 4 and 6 demonstrated favorable computational and pharmacological activities, albeit with a low drug score, possibly attributed to their higher molecular weight and irritancy. In conclusion, this study showcases the synthesis and evaluation of methyl α-d-mannopyranoside derivatives as promising candidates for antimicrobial and antifungal agents. Molecular docking and dynamics simulations, along with pharmacological predictions, contribute to our understanding of their potential therapeutic utility, although further research may be warranted to address certain pharmacological aspects.

Long COVID-19 Syndrome: Insights From a Major Tertiary Center in the UK on Who Is at Greater Risk.

The COVID-19 pandemic triggered the unprecedented 'long COVID' crisis, with persistent symptoms beyond two months post-infection. This study explores the nexus between long COVID symptoms, patient demographics such as age, gender, and smoking, and clinical factors like vaccination, disease severity, and comorbidities. A retrospective analysis of records was conducted between September 2021 and December 2022. The analysis covered adults with confirmed COVID-19 diagnoses. Data encompassed demographics, medical history, vaccination, disease severity, hospitalization, treatments, and post-COVID symptoms, analyzed using logistic regression. Among 289 participants, the average age was 51.51 years. Around 62.6% were females, and 93% received the COVID-19 vaccination, i.e., primarily the mRNA vaccine (48.4%) and the adenovirus vector-based vaccine (34.8%). Reinfections occurred in 11.76% of cases. Disease severity varied, with 75% having mild, 15% having moderate, and 10% having severe infections. Hospitalization rates were significant (25.6%), including 10.7% requiring intensive care. Thirteen distinct post-COVID symptoms were reported. Fatigue, shortness of breath upon exertion, and brain fog emerged as the most prevalent symptoms. Notably, females exhibited higher symptom prevalence. Significant correlations were established between higher BMI and smoking with augmented symptomatology. Conversely, a link between booster doses and symptom reduction was discerned. Using multinomial regression analysis, gender and smoking were identified as predictors of post-COVID-19 symptoms. The study underscores obesity, smoking, and the female gender's impact on long COVID symptoms; boosters show promise in alleviation. Respiratory pathology might underlie persistent symptoms in cases with radiological abnormalities and abnormal spirometry. Findings contribute to risk stratification, intervention strategies, and further research.

Understanding Bidirectional Water Transport across Bronchial Epithelial Cell Monolayers: A Microfluidic Approach.

Deciphering the dynamics of water transport across bronchial epithelial cell monolayers is pivotal for unraveling respiratory physiology and pathology. In this study, we employ an advanced microfluidic system to explore bidirectional water transport across 16HBE14σ bronchial epithelial cells. Previous experiments unveiled electroneutral multiple ion transport, with chloride ions utilizing transcellular pathways and sodium ions navigating both paracellular and transcellular routes. Unexpectedly, under isoosmotic conditions, rapid bidirectional movement of Na+ and Cl- was observed, leading to the hypothesis of a substantial transport of isoosmotic solution (145 mM NaCl) across cell monolayers. To validate this conjecture, we introduce an innovative microfluidic device, offering a 500-fold sensitivity improvement in quantifying fluid flow. This system enables the direct measurement of minuscule fluid volumes traversing cell monolayers with unprecedented precision. Our results challenge conventional models, indicating a self-regulating mechanism governing water transport that involves the CFTR channel and anion exchangers. In healthy subjects, equilibrium is achieved at an apical potential of Δφap = -30 mV, while subjects with cystic fibrosis exhibit modulation by an anion exchanger, reaching equilibrium at [Cl] = 67 mM in the airway surface liquid. This nuanced electrochemical basis for bidirectional water transport in bronchial epithelia sheds light on physiological intricacies and introduces a novel perspective for understanding respiratory conditions.

Asteraceae Family Species used as Medicinal Plants in the Treatment of Respiratory Diseases in the State of Amapá, Amazon – Brazil: A Systematic Review

Purpose: To conduct a survey of species of the Asteraceae family used to treat respiratory diseases in the state of Amapá. Theoretical framework: The use of plants is part of popular Brazilian phytotherapy. Brazilian authorities have been regulating public policies focused on medicinal plants. Ethnobotanical and ethnofarmacological studies point to traditional knowledge about Asteraceae plants in the treatment of respiratory problems in the state of Amapá. Method/design/approach: The review method was used, and scientific databases such as articles, theses, dissertations, and monographs were used as sources. Portuguese keywords such as "Medicinal Plants," "Respiratory System," "Ethnobotany," "Ethnofarmacology," and "State of Amapá" were used, as well as their English equivalents. Studies conducted in the Amapá territory from 2001 to 2021 were selected. Results and conclusion: Eight species of Asteraceae indicated for respiratory pathologies were found, three of which are native to Brazil. There is a predominant use of herbaceous plants, leaves, and teas, with influenza being the most common illness treated. A. triplinervis (japana) stood out, as it was cited in five studies and is indicated for several diseases. Japana has relevant chemical and pharmacological studies that validate its ethnofarmacological use. Research implications: The study is relevant for the valorization of traditional knowledge regarding the traditional knowledge and biodiversity of the Brazilian medicinal flora. Originality/value: This research provides relevant information for the scientific community, as it provides data on popularly used medicinal plants that can serve as a basis for future chemical and pharmacological studies with the species found.

The use of aromatherapy in pediatric practice

Aromatherapy is a method of treatment using natural essential oils injected into the body through the respiratory tract, skin and (or) mucous membranes. Currently, about 3,000 essential oil plants have been studied, from which over 500 organic compounds have been isolated and identified, the number of which in the composition of one essential oil can vary from 120 to 500, and no essential oil has yet been fully investigated.
 Essential oils are multicomponent organic compounds of terpenes, alcohols, aldehydes, ketones and other hydrocarbons produced by essential oil plants. Biologically active substances of essential oils have a low molecular weight and therefore easily penetrate the skin through the bloodstream. The effect exerted on a person by essential oils is determined in two ways ― neuro-reflex and humoral. Each essential oil is multifunctional. The composition of essential oils can include up to 300 components, so they can have several medicinal properties at the same time, but there is a general trend in the action of essential oils. All of them have immunomodulatory, pronounced bactericidal and antiseptic effects, antiviral and anti-inflammatory properties.
 In medical practice, the method of hardware aromatherapy is used, the active factor of which is a therapeutic respiratory environment that simulates the natural air background over plants. The study of the effect of essential oils in children's institutions showed their positive effect on the general condition of children, emotional tone, immunological reactivity and nonspecific protection factors, the frequency and severity of respiratory pathology, the course of the adaptation period. The beneficial effect of the complex effect of aromatherapy in the sensory room is shown.
 Thus, the high efficiency of hardware aromatherapy, good tolerability, the availability of domestic equipment allows us to recommend the method for wide use in therapeutic and preventive and sanatorium-resort institutions.

COMPARATIVE CHARACTERISTICS OF AUTONOMIC IMBALANCE DIAGNOSTIC METHODS IN SCHOOL-AGE CHILDREN

Introduction. An imbalance in the autonomic nervous system regulation, known as dysautonomia, is one of the most common clinical syndromes that accompany several diseases. The balance between sympathetic and parasympathetic influences on the body can rapidly change during dynamic processes, especially in cases of infectious and acute diseases, where autonomic regulation plays an active role in shaping the immune response. In children with respiratory diseases, the influence of the vagus nerve (n.vagus) on the frequency and depth of breathing is also important but remains relatively understudied. Assessment of vegetative balance in pediatrics is carried out using various methods depending on the child's age and condition, with commonly used approaches including questionnaires, calculation of the Kerdo autonomic index, and orthostatic testing.
 The aim. To compare the diagnostic capabilities of different methods for assessment of the autonomic nervous system state in school-age children on the model of acute bronchitis.
 Materials and methods. The paper presents data from a study that assessed the state of the autonomic nervous system in 52 school-age children (12-16 years old) divided into two groups: 30 children with acute bronchitis in the convalescent period and 22 clinically healthy individuals. Three different methods were used: the A.M. Wayne scale, the Kerdo index, and the orthostatic test.
 Results. The survey based on Wayne's questionnaire did not reveal a significant difference between the groups of healthy children and those affected by bronchitis. Dynamic tests proved to be more suitable for assessing acute pathology, such as Kerdo's autonomic index and the orthostatic test. The autonomic Kerdo index in children with bronchitis was significantly higher (14.2±2.38 points) than in healthy children (6.4±3.18 points, p<0.05). In children with acute bronchitis, dysautonomia with a predominance of sympathicotonia was recorded, which may be attributed to insufficient vagal innervation and a decrease in parasympathetic influence on the formation of an adequate immune response to the inflammatory process in the respiratory tract.
 Conclusions. Determining the autonomic Kerdo index and conducting the orthostatic test is suitable for diagnosing dysautonomia in children with acute respiratory pathology. These tests are dynamic, functionally based, and easy to perform and evaluate.

The Risk of Developing of Malnutrition and the Principles of Correction of Nutritional Status Disorders in Children with Cystic Fibrosis

Cystic fibrosis is a severe hereditary disease with polysystemic manifestations and progressive course. Malnutrition in cystic fibrosis occurs as a result of exocrine insufficiency of the pancreas, an increase in energy losses in chronic inflammation in the bronchopulmonary system, manifested by increased stress on the respiratory system. The presented literature review highlights the modern principles of prevention and correction of malnutrition in children with cystic fibrosis, identifies the most promising methods for further development that correct nutritional status disorders. The review has shown that an active approach to nutrition at any age, the use of aggressive methods of nutritional support against the background of enzyme replacement therapy, timely and adequate therapy of respiratory tract pathology lead to an improvement in the indicators of nutritional status in cystic fibrosis. The most promising is the further development of targeted therapy, which allows, as a result of exposure to the etiopathogenetic mechanisms of the disease, to reduce the frequency and severity of bronchopulmonary exacerbations, partially restore the exocrine function of the pancreas, which is manifested in patients with cystic fibrosis by an increase in body weight and mass-growth index.

Human parechovirus infections in children: modern concepts

This article is a review of modern ideas about human parechovirus infection in children. At this time human parechoviruses are a common cause of infectious diseases in childhood with clinical presentation of acute gastroenteritis, upper respiratory tract pathology, fever, and rash. Severe forms damaging the central nervous system or the development of sepsis are possible in newborns and infants and are almost exclusively associated with parechovirus A type 3 (HPeV-A3). The infection is transmitted mainly via food and droplet routes. The main method of infection diagnosis is the detection of viral RNA by real-time PCR in cerebrospinal fluid, blood, and feces. No treatment for the parechovirus infection has been developed so far.

CLINICAL CASE OF CARDIORESPIRATORY MONITORING TO CONTROL SUPPLEMENTAL OXYGEN THERAPY IN PREMATURE INFANT

One of the most common respiratory pathologies in infants born prematurely is bronchopulmonary dysplasia (BPD). Pulmonary hypertension is considered a formidable and difficult to diagnose complication of BPD. Maintaining the proper level of oxygen saturation is an integral part of nursing such patients. To diagnose respiratory pauses and episodes of desaturation during sleep, children undergo cardiorespiratory monitoring (KRM) aimed at recording episodes of apnea and hypopnea. The article discusses a clinical case of cardiorespiratory monitoring during sleep in a hospital and outpatient setting to monitor additional oxygen therapy in a premature baby suffering from bronchopulmonary dysplasia and BPD-associated pulmonary hypertension.

Cancer-prone Phenotypes and Gene Expression Heterogeneity at Single-cell Resolution in Cigarette-smoking Lungs.

The atlas revealed early carcinogenesis events and defined the alterations of single-cell transcriptomics, cell population, and fundamental properties of biological pathways induced by smoking.

Epidemiological profiles and causes of sudden deaths of various ages in Ethiopia: an autopsy-based study

Background Sudden death is an important global public health issue. An autopsy is an important source of epidemiological data, as the considerable causes of sudden death remain hermetic until postmortem examination. This study is devoted to evaluating the sociodemographic, behavioral, clinical and pathological characteristics of sudden deaths of various ages in Ethiopia. Methods This is an observational, prospective, descriptive study that included all sudden deaths observed over 1 year at St. Paul’s Hospital and Millennium Medical College, Addis Ababa, Ethiopia. Results Sudden death (n = 568) accounted for 11.5% of all autopsied cases. There were 482 males and 86 females (M:F ratio of 5.6:1) and a mean age of 44.81±17.349. The peak age group was the fourth and fifth decades, accounting for 43.9% of the cases. Chronic substance abuse and a history of prior illness were declared in 40.1% and 38% of victims of sudden death, respectively. Cardiovascular (36.1%), respiratory (32.6%), and gastrointestinal system (19.5%) pathologies were the most common causes. The leading underlying causes of sudden death were ischemic heart disease and pneumonia. Most (86.6%) sudden deaths occurred outside of a hospital setting. Conclusions Most of the causes of sudden death in Ethiopia can be prevented and treated. The majority of sudden deaths are silent without preexisting symptoms. Therefore, it is vital to develop public health measures that will help educate the community about the importance of recognizing the manifestation of various clinical conditions and the need to seek immediate clinical help. Furthermore, efforts should be made to make healthcare facilities accessible and affordable with adequate diagnostic and management capacity. Documentation of autopsy-based data could provide important epidemiological information to guide medical services, prevention efforts, and control measures.

Bird ownership and pulmonary outcomes apart from hypersensitivity pneumonitis in European older adults

BackgroundExposure to birds has been linked with several lung pathologies and especially hypersensitivity pneumonitis, but discordant literature exist on the potential effects of this exposure on other respiratory pathologies. AimThis study aims to examine the associations between bird ownership and asthma, lung cancer, and chronic obstructive pulmonary disease (COPD) in older European adults. MethodsA total of 28,109 participants from the Survey of Health, Ageing, and Retirement in Europe were employed and analyzed with multivariate logistic regressions. ResultsNo association was found with asthma or lung cancer. Bird ownership increased the odds for COPD diagnosis (OR=1.30; 95 % CI: 1.12–1.51) and more so in males (OR=1.53; 95 % CI: 1.25–1.87) after adjustment for demographic, respiratory, lifestyle, and socioeconomic factors. Male bird owners who smoke had an even more increased risk compared to non-smokers, as did those who lived in multi-person households compared to those living alone.Conclusion: Bird ownership may be positively associated with COPD in older European males.

Non-malignant occupational respiratory diseases and climate change.

BACKGROUND: Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual susceptibility and other co-factors and comorbidities. Asthma and other respiratory pathologies can be worsened by climate change and exposure to other agents in occupational environments.METHODS: PubMed and Scopus, and several websites on public and occupational health were queried to find publications and documents on work-related respiratory diseases, asthma, rhinitis, chronic obstructive pulmonary disease (COPD), pneumoconiosis and allergic alveolitis in association with climate change.RESULTS: Most of the retrieved articles concerned asthma (75 in Scopus), while the other topics were less frequently covered in the scientific literature, with a maximum of 29 papers for rhinitis and 23 for COPD. The most important terms highlighted by the word clouds were 'health', 'air', 'pollution', and, only for asthma and rhinitis, 'pollen' and 'allergic/allergy'. Website data on public and occupational health, and climate change were reported.CONCLUSIONS: Assessment and management of respiratory diseases that recognise occupational exposures should be improved, and more research into integrated approaches should be favoured. Health surveillance practices for workers exposed to agents that cause respiratory diseases should be implemented. The development of biomarkers of exposure, effect and susceptibility needs further study.

Home hospitalization of the acute patient: a new approach to care

Pediatric hospitalization at home (HAH) aims to provide the patient and his family with an alternative to conventional hospitalization, safely and effectively, improving the quality of life of the patient and his family. The most frequent pathologies in HAH in pediatric acute patients are acute respiratory pathology and bacterial infections that require parenteral antibiotic therapy. The success of an acute patient home hospitalization program relies on the proper selection of patients and exhaustive training of caregivers, as well as good communication and coordination between the different services and levels of care involved.

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.