Salbutamol Inhalation Research Articles

Pulmonary embolism (PE) diagnosed in a 19-year-old lady found to have underlying Antiphospholipid syndrome (APS)

ABSTRACT Background A 19-year-old woman visited a family medicine clinic to obtain her laboratory test results. This case highlights a close call involving a young woman with a potentially serious condition. Pulmonary embolism (PE) is often overlooked during initial assessments in emergency departments or primary care clinics. Case presentation The patient casually mentioned having a cough toward the end of the consultation, revealing she has been using a salbutamol inhaler due to a family history of asthma. Despite appearing well, she had an audible wheezy cough during the examination. Following a chest X-ray (CXR) that indicated a right lung opacity and possible cardiomegaly, an electrocardiogram (ECG) was arranged. The ECG showed an incomplete right bundle branch block (RBBB) and STT changes in leads V3-V6 and lead 3, prompting her transfer to the emergency department for suspected Pulmonary embolism (PE). Further evaluation confirmed acute on chronic PE, with a positive lupus screen leading to the diagnosis of antiphospholipid syndrome (APS) upon detection of anti-phospholipid antibodies in her serology. Discussion The patient’s case was unique, but a basic CXR was performed to investigate their exertional shortness of breath. This led to appropriate action being taken to ensure the patient’s safety. It is important to note that pulmonary embolism can occur in young individuals, highlighting the need for attentive and skilled healthcare professionals. Basic tests such as CXR and ECG can be crucial in cases of ongoing symptoms where uncertainty exists.

Retrospective study of the changes in dynamic compliance and ventilation/perfusion mismatch following salbutamol inhalation in hypoxaemic mechanically ventilated anaesthetized horses

ObjectiveTo study the changes in dynamic compliance (Cdyn), ventilation/perfusion (V˙/ Q˙) mismatch and haemodynamic variables in hypoxaemic anaesthetized horses whose PaO2 increased following salbutamol inhalation. Study designRetrospective, clinical, cohort study. AnimalsA group of 73 client-owned horses treated with salbutamol when PaO2 <100 mmHg (13.3 kPa) during anaesthesia. MethodsHorses were divided into two groups: responders (R), where PaO2 after salbutamol ≥1.2 PaO2 before treatment (i.e. ≥20% increase), and non-responders (NR), where PaO2 after salbutamol <1.2 PaO2 before treatment. Demographic data and intraoperative variables before treatment were compared between R and NR. Cdyn, arterial to end-tidal carbon dioxide difference [P(a-E´)CO2], estimated ratio of dead space to tidal volume (est.VD/VT), estimated shunt fraction (F-shunt), heart rate, systolic, mean and diastolic arterial pressure and dobutamine requirements were compared before and after treatment within R and NR. For each variable, the difference (Δ) between values pre- and posttreatment was calculated and compared between groups R and NR. Numerical data were compared using univariate or bivariate analysis and categorical data were compared using chi-square test; p < 0.05. ResultsOf the 73 horses 50 were classified as R while 23 horses were classified as NR. There was no statistical difference between R and NR for demographic data or initial intraoperative variables except for body weight [R: 531 (170–715) kg, NR: 540 (420–914) kg]. While salbutamol did not alter Cdyn in either group, it significantly decreased P(a-E´)CO2, est.VD/VT and F-shunt in R only. ΔP(a-E´)CO2, Δest.VD/VT and ΔF-shunt were significantly greater in R (−17.8%, −19.0% and −24.1%, respectively) than in NR (11.5%, 6.6% and −0.3%, respectively). Conclusions and clinical relevanceIn hypoxaemic anaesthetized horses responding to inhaled salbutamol by a ≥1.2 increase in PaO2 no change in Cdyn was detected, but indicators of V˙/ Q˙ mismatch improved.

Younger Children with Respiratory Tract Infections Are More Exposed to Off-Label Treatments: An Exploratory Retrospective Study in a Pediatric Emergency Setting.

We performed a retrospective data analysis. All patients aged 0-18 referred to PED from 1 September to 1 October 2022, were included. Further analysis was performed when respiratory tract infections were diagnosed. gender, age, triage group, chronic diseases, vital signs, and PED-prescribed treatment (medications, dosages, methods of administration). Statistical analysis used SPSS 28.0, with significance at p < 0.05. Data from 473 patients were analyzed, median age 3.5 years. Chronic diseases were present in 17.1% of children. 387 medications were prescribed, 47.5% being off-label. Off-label treatment was common for external otitis, acute laryngitis, and acute bronchitis (p < 0.001). There was incorrect administration of tobramycin with dexamethasone for otitis (n = 16, 100%) and inappropriate use of salbutamol inhalations by age (34.8%, n = 16). Some medications were given orally instead of injections (ondansetron n = 5, 62.5%; dexamethasone n = 82, 98.7%) or intranasally instead of intravenously (IV) (midazolam n = 7, 87.5%). IV adrenalin was prescribed for inhalations (n = 46). Younger children were more likely to receive off-label treatment (p < 0.001). Our study highlights the widespread issue of off-label and unlicensed drug prescribing in pediatric emergency care. Further research is necessary, because this reliance on off-label prescribing raises concerns about patient safety and compliance, especially given the limited clinical trials and therapeutic options available.

IMPAIRED BETA-ADRENERGIC VASODILATOR FUNCTION IN HYPERTENSIVE PATIENTS WITH SYMPTOMS OF DEPRESSION

Objective: Hypertension and depression are amongst the most common chronic physical and mental conditions worldwide. The two conditions cluster, however the mechanisms underlying the association are not well understood. Hypertension complicated by affective disorders may be characterised by high sympathetic activity. We investigated whether symptoms of depression may be associated with impaired endothelium-dependent beta2-adrenergic vasodilator responses. Design and method: Hypertensive subjects with no previous history of diabetes or cardiovascular disease were recruited from the hypertension outpatient service at St. Thomas’ Hospital, London. Detailed medical history and baseline characteristics including blood pressure (BP), heart rate (HR), routine biochemistry including C-reactive protein (CRP) and low-density lipoprotein (LDL) were obtained during a single study visit. Plasma concentrations of normetadrenaline were measured as a marker of resting sympathetic activity. Depression symptom severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). The pulse wave response to the beta2-adrenergic vasodilator salbutamol (PWRS) was assessed using radial tonometry to measure the change in augmentation index after inhalation of 200μg salbutamol from a metered dose inhaler with spacer device. Results: 100 subjects (62% male, mean ± SD age 41.0±11.6 years) were recruited. 79% were on pharmacological treatment for hypertension. Mean PHQ-9 depression score was 8.8±6.2, consistent with a high prevalence of depression. After adjusting for confounders (age, sex, smoking status, body mass index, BP, HR, CRP, LDL, treatment for hypertension), PWRS was significantly related to depression score (Beta= 0.447, P=0.002). Depression score was also significantly associated with plasma concentrations of normetadrenaline (Beta= 0.605, P&lt;0.001) and after adjusting for plasma normetadrenaline level, the association between PWRS and depression score was no longer significant (Beta= 0.343, P=0.102). Conclusions: These results suggest that in hypertensive subjects with depression, an impaired endothelium-dependent beta2-adrenergic vasodilator response is mediated by a high level of sympathetic activity which could contribute to cardiovascular complications.

Self-administration of medicines in secondary schools and colleges by students living with medical conditions: content analysis of school medicine policies in England

Abstract Introduction Every school in England is required to have a policy to support students with a medical condition under statutory guidance issued by the Department for Education.[1] The guidance promotes self-administration of medicines where possible, supervised by an adult. Transition from paediatric to adult healthcare during adolescence should be a process of gradually transferring control and responsibility from parents and other responsible adults to the young person taking the medicine. There are several barriers that might prevent autonomy, but effective self-management of long-term conditions at school is essential for wellbeing and learning.[2] Aim To explore secondary school/college medicine policies displayed online for content regarding the self-administration of medicines by students. Methods This was a group project involving six MPharm students. Each student was assigned one or two of the nine regions of England to explore, covering all regions, and they used search engines to find school websites with accessible health/medicine policies. The group employed purposive sampling within their Region to achieve a diverse sample of schools (e.g. nursery age to college; urban and suburban; public and private/fee-paying). An online data collection form was developed by the group to facilitate consistent, directed content analysis of school health/medicine policies (quantitative and qualitative). The topics reflected issues of interest from their literature review e.g. which medicines were mentioned by name in the policy, and arrangements for bringing long-term medicines to school. One topic within the form was to search for content relating to self-administration of medicines. For this abstract, within the wider study, the policies were subjected to directed content analysis to find any statements relating to self-administration. Results The students analysed 50 school policies across England (3 East Midlands; 1 East of England; 8 London; 7 North East; 8 North West; 10 South East; 4 South West; 4 West Midlands; 5 Yorkshire &amp; Humber). Eighteen of the 25 secondary school/college policies included statements about self-administration of medicines. Many (n=13) were comprehensive, stating that young people with medical conditions should assume complete responsibility under parental supervision. Others (n=4) specified partial self-administration for diabetes, asthma or severe allergies. The remaining school, however, specified that their students could not keep or carry any essential medicines, apart from salbutamol inhalers. Conclusion Most schools have adopted a positive approach to self-administration of medicines consistent with the recommendations of statutory guidance. There is, however, some variation in this approach and a minority of schools that do not promote self-medication and thus still prefer to keep medication stored away from the student. This study highlights a context not commonly studied in pharmacy practice, which is a strength, but has a limitation of a small sample that might not reflect the whole situation in England. Another limitation is possible omission of information by the student researchers, where independent validation by another person would be ideal but not practical in the scope of the short-term study. Pharmacists are well-placed to offer support to schools, and to be a resource for teachers, students and families, and this topic merits further exploration.

The Effect of Priming new Plastic Spacers with 20 Puffs Salbutamol on Bronchodilator Response in Asthmatic Children.

The static charge on the plastic body of spacers attracts drug aerosols, reducing the drug available for inhalation from plastic spacers. Some instructions exist to decrease the electric charge on plastic spacers, such as priming them with salbutamol (20 puffs) before use. This study investigates whether priming plastic spacer devices with this method can improve the bronchodilator test result. This study included children with stable mild to moderate asthma. All subjects underwent two pulmonary function tests to evaluate their bronchodilator response on separate days at 24-48 hours intervals. On each day, spirometry was performed at the baseline and 15 min after inhalation of four puffs of salbutamol (100 μg/puff) through either a primed or a new spacer. The change in forced expiratory volumein the first second (FEV1) after inhaling salbutamol was the primary outcome measure. When the patients used a new spacer, the mean baseline FEV1 (% predicted) and FEV1/FVC (forced vital capacity) were 89.56±11.95 and 86.17±6.87, respectively. However, the mean increase in FEV1 from the baseline was 10.87±8.99 in this group. On the other hand, with the primed spacer, the respective mean baseline FEV1 and FEV1/FVC values were 89.41±12.14 and 85.49±6.76, while it increased by 12.1±11.01 after salbutamol inhalation. There were no significant differences between the techniques regarding the variation in FEV1 before and after bronchodilator use via a new spacer or primed spacer. Priming new plastic spacers with 20 puffs of salbutamol did not cause additional bronchodilation in asthmatic children, suggesting this practice is inefficient in clinics.

Rare Case of Completely Healed Pneumomediastinum Due to Asthma Exacerbation in A Young Male Patient

Background: The term pneumomediastinum (PNM) refers to the presence of air within the mediastinal cavity. This illness is uncommon but can arise in adolescents with severe asthma attacks. In children aged 5 to 34, the incidence of pneumomediastinum after an acute asthma attack is 1 in 25,000. Men made up the majority of patients (76 percent of all cases). Pneumomediastinum can be diagnosed with the assistance of a chest CT scan. Case: A young man was diagnosed with pneumomediastinum due to an acute asthma attack in this case report. Symptoms of uncontrolled asthma include shortness of breath that worsens with wheezing, chest tightness, and a nonproductive cough. Since the age of 12, the patient in this instance has been receiving salbutamol inhalers. The physical examination revealed polyphonic lung respiration and subcutaneous crepitus in the neck, shoulders, and anterior chest. With adequate management of an asthma episode, pneumomediastinum recovers spontaneously, followed by recurrent symptomatic status, physical examination, and radiography examination. Discussion: Acute asthma exacerbations are one of the factors that can lead to spontaneous pneumomediastinum, in which mediastinal air can permeate the tissue and generate a pneumothorax, and if there is air in the subcutaneous area, it can lead to subcutaneous emphysema. Conclusion: Pneumomediastinum was a rare incidence, pulmonologists examining young adults with acute asthma exacerbations should evaluate for pneumomediastinum. In usual asthma therapy, a chest CT-scan is essential to screen for pneumomediastinum.

Salbutamol toxicosis in dogs

Salbutamol exposure in dogs typically occurs when they bite and pierce a salbutamol inhaler. Onset of clinical signs can be rapid. Dogs may appear anxious and distressed, and common signs include tachycardia, tachypnoea and hypokalaemia. Transient hyperglycaemia may occur. Potential complications include muscle weakness, flaccid paralysis, arrhythmias, rhabdomyolysis and oral injury from the compressed gas in some inhalers. Any dog exposed to salbutamol requires examination and evaluation. The heart rate, blood pressure, electrocardiogram and electrolytes should be monitored. Treatment is aimed at correcting tachycardia and hypokalaemia, for which the treatment of choice is a non-selective beta-blocker. Salbutamol exposed dogs require hospitalisation until the heart rate and rhythm, central nervous system status and electrolytes normalise. Recovery generally occurs within 24 hours, but there is risk of persistent cardiac injury.

Inhaled salbutamol induces leanness in well-trained healthy females but not males during a period of endurance training: a randomised controlled trial.

Many athletes use short-acting inhaled β2-agonists multiple times weekly during training sessions to prevent exercise-induced bronchoconstriction, but it is unclear if treatment impairs training outcomes. Herein, we investigated performance adaptations in well-trained females and males training with prior inhalation of salbutamol. 19 females and 21 males with maximal oxygen uptake (V'O2max) of 50.5±3.3 and 57.9±4.9 mL·min-1·kg-1, respectively, participated in this double-blinded, placebo-controlled, parallel-group study. We randomised participants to placebo or salbutamol inhalation (800-1600 µg·training day-1) for 6 weeks of combined endurance (1× per week) and high-intensity interval training (2× per week). We assessed participants' body composition, V'O2max and muscle contractile function, and collected vastus lateralis muscle biopsies. Salbutamol induced a sex-specific loss of whole-body fat mass (sex×treatment: p=0.048) where only salbutamol-treated females had a fat mass reduction compared to placebo (-0.8 kg at 6 weeks; 95% CI: -0.5 to -1.6; p=0.039). Furthermore, salbutamol-treated females exhibited a repartitioning effect, lowering fat mass while gaining lean mass (p=0.011), which was not apparent for males (p=0.303). Salbutamol negatively impacted V'O2max in both sexes (treatment main effect: p=0.014) due to a blunted increase in V'O2max during the initial 4 weeks of the intervention. Quadriceps contractile strength was impaired in salbutamol-treated females (-39 N·m; 95% CI: -61 to -17; p=0.002) compared to placebo at 6 weeks. Muscle electron transport chain complex I-V abundance increased with salbutamol (treatment main effect: p=0.035), while content of SERCAI, β2-adrenoceptor and desmin remained unchanged. Inhaled salbutamol appears to be an effective repartitioning agent in females but may impair aerobic and strength-related training outcomes.

Bronchodilator reversibility testing in morbidly obese non-smokers: fluticasone/salmeterol efficacy versus salbutamol bronchodilator

A positive response in reversibility testing is widely used to diagnose patients with airway limitations. However, despite its simple procedure, it doesn’t accurately reflect the exact airway irreversibility. This study aimed to investigate the efficacy of a bronchodilation reversibility test using salbutamol and fluticasone/salmeterol combination in obese non-smoker subjects.The study included patients without a history of obstructive lung disease or bronchodilators. A sub-classification of patients based on body mass index (BMI) was carried out into normal (< 24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI ≥ 30). Spirometry measurements were performed before and after salbutamol or fluticasone/salmeterol administration.The study included 415 (49.9% male) patients with a mean age of 40.92 ± 10.86 years. Obese subjects showed a high prevalence of restrictive patterns (23.4%), with non-significantly lower spirometric values compared to normal and overweight subjects (p > 0.05). The magnitude of bronchodilation, as identified by spirometry, following fluticasone/salmeterol was higher in all participants, with a significant increase in obese subjects with a p-value of 0.013, 0.002, and 0.035 for FEV1, FEV1% predicted, and FEV1/FVC, respectively.Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio than the conventional test using salbutamol inhaler, and it can be a potential candidate for assessment of airway obstruction using reversibility test, especially among the obese population.

Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.

Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs). To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients. This cross-sectional study included patients from 16 health care facilities in British Columbia. ADC reports were run for the period August 2021 to January 2022 to identify salbutamol and ipratropium inhalers removed from ADCs. Over the study period, 8.3% (2180/26 324) of salbutamol and ipratropium inhalers were withdrawn from ADCs unnecessarily for the same patient encounter within a 2-day timeframe, and another 1118 (4.2%) represented instances when multiple inhalers were withdrawn for the same patient at the same time. Overall, 12.5% (3298/26 324) of all salbutamol and ipratropium inhalers were withdrawn unnecessarily. The total cost of these inhalers was about $31 600 over the 6-month period. This evaluation revealed considerable wastage of inhalers, leading to wasted expenditures. Other health authorities should conduct similar analyses to determine whether similar problems exist in their settings.

Salbutamol toxicosis in dogs

Salbutamol exposure in dogs typically occurs when they bite and pierce a salbutamol inhaler. Onset of clinical signs can be rapid. Dogs may appear anxious and distressed, and common signs include tachycardia, tachypnoea and hypokalaemia. Transient hyperglycaemia may occur. Potential complications include muscle weakness, flaccid paralysis, arrhythmias, rhabdomyolysis and oral injury from the compressed gas in some inhalers. Any dog exposed to salbutamol requires examination and evaluation. The heart rate, blood pressure, electrocardiogram and electrolytes should be monitored. Treatment is aimed at correcting tachycardia and hypokalaemia, for which the treatment of choice is a non-selective beta-blocker. Salbutamol exposed dogs require hospitalisation until the heart rate and rhythm, central nervous system status and electrolytes normalise. Recovery generally occurs within 24 hours, but there is risk of persistent cardiac injury.

Formulation and Evaluation of Oral Soft Jelly Containing Salbutamol Sulphate for the Treatment of Asthma

Salbutamol sulphate oral soft jelly in asthma has been formulated and evaluated as the goal of the current investigation. A person with asthma has inflamed, narrowed, swollen, and excess mucus-producing airways, which makes breathing difficult. Salbutamol is used to treat asthma and chronic obstructive pulmonary disease (COPD.It works by relaxing the muscle of the airways into the lungs, which makes it easier to breathe . It functions by loosening the muscles in the lungs' airways, which facilitates breathing. Salbutamol is available as an inhaler, tablets, and certain liquid oral dose forms, but due to patient noncompliance issues, oral jellies containing salbutamol sulphate were developed. This study's aim is to create oral jelly, which by avoiding first pass effect, promotes patient compliance and bioavailability while avoiding many negative effects of conventional dosage forms Salbutamol sulphate oral jelly is simple to swallow and improves patient compliance in paediatric patients. Many paediatric patients find it difficult to swallow tablets and capsules, as well as to use the salbutamol inhalation in cases of asthma. The best In vitro medication release was demonstrated by the salbutamol sulphate oral jelly (F2) batch at 85% in 60 minutes. The drug concentration was discovered to be between 98.23% and 99.25%, which was within the pharmacopoeial range of 98% to 101%. Salbutamol sulphate's UV spectra were examined, and it was discovered that its greatest absorption occurs at 217.50 nm. The cost-effective salbutamol sulphate oral soft jelly also demonstrated improved compliance and an increase in bioavailability.&#x0D; Keywords: Oral Jelly, Asthma, Patient Compliance, Salbutamol Sulphate, Paediatric Patients

Examining pharmacists' anti-doping knowledge and skills in assisting athletes to avoid unintentional use of prohibited substances.

To explore the knowledge and skills of pharmacists practicing in Sydney, Australia, in preventing the use of prohibited medications by athletes. Using a simulated-patient study design, the researcher (an athlete and pharmacy student herself) contacted 100 Sydney pharmacies by telephone requesting advice about taking a salbutamol inhaler (a WADA-prohibited substance with conditional requirements), for exercise-induced asthma, following a set interview protocol. Data were assessed for both clinical and anti-doping advice appropriateness. Appropriate clinical advice was provided by 66% of pharmacists in the study, appropriate anti-doping advice was provided by 68%, and 52% provided appropriate advice across both aspects. Of the respondents, only 11% provided both clinical and anti-doping advice at a comprehensive level. Identification of accurate resources was made by 47% of pharmacists. Whilst most participating pharmacists had the skills to deliver assistance regarding the use of prohibited substances in sports, many lacked core knowledge and resources to enable them to deliver comprehensive care to prevent harm and protect athlete-patients from anti-doping violations. A gap was identified regarding advising/counselling athletes, indicating the need for additional education in sport-related pharmacy. This education would need to be coupled with the incorporation of sport-related pharmacy into current practice guidelines to enable pharmacists to uphold their duty of care and for athletes to benefit from their medicines-related advice.

Difficulties in diagnosing acromegaly, acromegaly with apparently normal GH: Micromegaly

Abstract Introduction Acromegaly results from pathologically increased secretion of growth hormone (GH) from the pituitary somatotroph adenoma. If left untreated, it is associated with increased morbidity and mortality. We present a case of micromegaly, whose diagnosis is challenging for clinicians. Clinical Case A 40-year-old woman presented with complaints of enlarged facial features, hands and feet, and separation between teeth. She was using a salbutamol inhaler with the diagnosis of asthma. Her physical examination was unremarkable except for a body mass index of 28.7 kg/m2 and malocclusion. Insulin-like growth factor (IGF)-1 250 ng/mL (101–234) and GH 2.1 ng/mL was detected. 0, 1. and 2nd hour in oral glucose tolerance test (OGTT)-GH; hour GH/glucose values were 6.7/70, 1.5/98, 0.35 ng/ml /95 mg/dl, respectively. Sella magnetic resonance imaging (MRI) revealed an 8×5mm adenoma in the pituitary gland (Figure). Pseudoacromegaly causes such pachydermoperiostitis, severe insulin resistance, familial mandibular prognathism, use of phenytoin and minoxidil, and causes of false IGF-1 elevation such as pregnancy, puberty/adolescent period, thyrotoxicosis, glucocorticoid use were excluded. It was decided that the patient should be operated on. No adenoma was detected in the pathology tissue of the operated patient, but IGF-1 was detected at 201 ng/ml (101–234) and GH was 1,1 ng/ml in the 3rd postoperative month. The nadir GH was found to be 0.3 ng/ml in the OGTT-GH suppression test. Medical treatment was not started. The case has been followed for 2 years in remission. Conclusion Micromegaly describes a subset of patients with clinically evident acromegaly and elevated IGF-1 with apparently normal basal GH and often &amp;lt;0.4 ng/mL glucose suppressed GH. This condition is relatively rare in patients with acromegaly. As in our case, micromegaly should be considered in diagnosing patients with “normal” GH but with clinical signs, or even patients without clinical signs but with pituitary tumors and elevated IGF-1.

THE INFLUENCE OF SPELEOTHERAPY ON BRONCHI PASSAGE IN CHILDREN WITH BRONCHIAL ASTHMA USING A PHARMACO-FUNCTIONAL TEST WITH SALBUTAMOL.

The aim: To investigate the reaction of the bronchi to inhalation of salbutamol in children with different severity of bronchial asthma under the conditions of speleotherapy. Materials and methods: 40 children aged 6-15 years were examined, 20 of them had an intermittent course of the disease, 20 had a mild course, and the children were in the inter-relapse period. Determining the function of external respiration (FER) with a pharmaco-functional test (PFT) with salbutamol was carried out in the dynamics of observation before and after treatment and compared with the indicators of 40 healthy children. Speleotherapy was performed based on the children's department of the Ukrainian Allergological Hospital of the village Solotvino. Results: A decrease in increased bronchial tone and restoration of bronchial patency at all levels of the bronchi in all patients with an intermittent course of the disease and a partial decrease in bronchial hyperreactivity with the improvement of bronchial patency in children with a mild course of bronchial asthma under the influence of speleotherapy was established. Conclusions: Thus, speleotherapy contributes to a positive reaction of the bronchi to inhalation of salbutamol, which is reflected in the normalization of disturbed bronchial tone and the restoration of bronchial patency at all levels of the bronchi, in all patients with an intermittent course and partially with a mild course of the disease.

A lady with breathlessness

A 55-year-old lady presented to hospital with increasing breathlessness for 2 days and a cough with green phlegm, but no other chest symptoms. She had a past medical history of COPD, was an ex-smoker, CKD 3, and some cardiac surgery in her childhood. Had recurrent admissions for dyspnoea and type 2 respiratory failure, needing NIV on each admission. She mentioned that she’s never been a heavy smoker, stopped smoking more than 10 years back. Her only medication was a PRN Salbutamol inhaler.

Comparison of Effects of Salbutamol Inhalation with Continuous Positive Airway Pressure and Bubble Continuous Positive Airway Pressure Alone in the Management of Severe Transient Tachypnea of the Newborn

Objective: To find the frequency of known risk factors in cases of severe transient tachypnea of the newborn (TTN) and to measure the effect of inhaled Salbutamol to bubble CPAP on required treatment duration.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Jun 2020.&#x0D; Methodology: A total of 60 cases of severe TTN, labelled on a predefined criterion were included in the study. The sample was randomized into two groups using an alternate sampling technique. Group-A was treated with bubble CPAP alone, while in Group-B, inhaled Salbutamol was added. The response was measured regarding the time taken to settle respiratory distress.&#x0D; Results: Out of 60 cases, 54(90.0%) were delivered through Caesarean section. A total of 9(15.0%) cases were born prematurely. Polycythemia was found in 10(16.6%) cases. Maternal asthma and gestational diabetes frequency were 8(13.33%) and 12(20.0%), respectively. A significant reduction was seen in the duration of respiratory distress in the study population receiving bubble CPAP with inhaled Salbutamol in the first 24 hours of illness (p-value&lt;0.001).&#x0D; Conclusion: Caesarean section is the most significant risk factor for developing TTN. Adding Salbutamol nebulization to bubble CPAP resulted in an earlier settlement of respiratory distress.

The Utility of Spirometry in Assessment of Presumptive Diagnosis of Bronchial Asthma in a Nigerian Tertiary Hospital

Context: Spirometry with reversibility testing is the gold standard for definitive diagnosis of bronchial asthma. However, even in those with established bronchial asthma reversibility test result may subsequently become negative. Spirometry results may also be normal during exacerbation-free intervals. Aims: This study assessed the role of spirometry in diagnostic evaluation of bronchial asthma and determined the ventilatory patterns of patients with presumptive diagnosis of bronchial asthma using spirometry and the proportion of those who showed positive reversibility test. Patients and Methods: This was a retrospective study carried out at a teaching hospital in Nigeria. This was an audit of consecutive patients with presumptive diagnosis of asthma referred for spirometry between January 2013 and June 2015. Spirometer with disposable mouthpieces, stadiometer, and salbutamol inhalers were used. The statistical analysis was done with Statistical Package for the Social Sciences version 20. Results: Eighty-nine participants did spirometry of whom 28 (31.5%) had additional postbronchodilator testing. Fifty (56.3%) participants were females (mean age of 42.17 ± 15.48 years). Normal, obstructive, restrictive, and mixed ventilatory patterns were found in 39 (43.8%), 31 (34.8%), 10 (11.2%), and 9 (10.1%) participants, respectively. Positive reversibility test result occurred in 15 (53.6%) participants, 9/19 obstructive (47.4%), and 6/9 mixed patterns (66.7%). Conclusion: Only a few patients with presumptive diagnosis of asthma were confirmed by spirometry. Spirometry is useful in asthma diagnosis, but clinicians should be aware of its limitations in diagnostic assessment. Although asthma is typically associated with obstructive spirometry, other spirometry patterns can occur.

Potential diagnostic role of galactomannan and β-D-glucan in occupational asthmatics in wheat mills

Occupational asthma is defined as variable airway obstruction due to exposure to a specific substance in the workplace environment. The aim of the study was to find out the frequency of occupational asthma in wheat mill workers and to explore the role of fungi biomarkers (galactomannan (GM) and β-D-glucan (βDG)) in occupational asthma. Subjects and methods: Assessment of fungi in air was done. Spirometric function of workers (n=120) were assessed during diurnal (before and 15 minutes after inhalation of salbutamol) and nocturnal time. Blood samples were analyzed to measure serum GM and βDG and allergen specific immunoglobulin E. The workers were asked about asthma symptoms. Results and conclusion: A significant proportion of workers had occupational asthma (25%) and only four workers (3.3%) had non-occupational asthma (excluded from the study). The rest were normal (86 workers). Penicillium and Aspergillus were the only species found in the air environment. Mean GM concentration (GM-c) was significantly higher among occupational asthmatics than normal workers. The estimated risk of occupational asthma (Odds ratio) was 13.3 times higher among workers with high GM-c (>1 pg/ml). Ln (GM) was the only significant predictor of PEFR variability. GM has a potential diagnostic role in occupational asthma due to fungal exposure among wheat mill workers. βDG did not have a role in occupational asthma. We recommend that wheat mill flour workers should do periodic spirometric functions and serum GM every 6 - 12 months for early diagnosis and control of occupational asthma.