Inhalant Research Articles

Improvement in Inhaler Techniques After Training and Counseling in Patients With Chronic Obstructive Pulmonary Disease or Asthma.

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management.

Features of pain sensitivity during premedication with xenon in patients before outpatient dental interventions

BACKGROUND: Premedication in outpatient dental interventions normalizes pain sensitivity and emotional state of patients. Inhalation of xenon-oxygen mixture can be an effective means for it. AIM: To study the effect of xenon premedication on pain sensitivity in patients with outpatient dental interventions. MATERIALS AND METHODS: Twenty patients were studied. Emotional and personal characteristics of patients were determined using the Eysenck test, Spielberger–Khanin personal anxiety scale, and hospital scale of anxiety and depression. Pain sensitivity was assessed using pain thresholds and somatosensory evoked potentials of the brain before and after inhalation of xenon-oxygen mixture at a concentration of 30/70 for 3 minutes. RESULTS: According to the results of psychological testing, all examined patients were characterized by a stable psychological sphere and predominantly lowered anxiety and constituted a group with insignificantly different emotional and personal characteristics. Before inhalation, pain sensitivity in patients varied significantly. After inhalation, multidirectional changes in pain sensitivity occurred, which were expressed in a decrease and an increase in pain sensitivity thresholds and the degree of activation of brain structures. CONCLUSION: Preoperative stress can both exacerbate and reduce pain sensitivity in patients. The use of inhalation of a xenon-oxygen mixture at a concentration of 30/70 for 3 minutes as a premedication causes multidirectional changes in the sensitivity of tissues and organs in the maxillofacial region in patients before outpatient dental interventions, which may be caused by a change in the activity of endogenous antinociceptive (analgesic) system.

Rate of Correct Inhaler Usage and Related Factors in Elderly Patients With Chronic Obstructive Pulmonary Disease

Poor disease control in patients with chronic obstructive pulmonary disease (COPD) is associated with suboptimal inhaler use. This study was designed to explore the accuracy of inhaler use and related factors in elderly patients with COPD. A cross-sectional survey design was used to recruit patients with COPD from a medical centre in southern Taiwan who were over 65 years old and used inhalers regularly. All of the data as well as information on inhaler use accuracy were collected using a self-designed questionnaire and inhaler operation checklist. Multivariable logistic regression was used to analyse significant correlates of correct inhaler operation. The average age of the 150 participants was 75.0 years (SD = 7.5) years. Most used one type of inhaler only (86.0%). The rate of accurate inhaler operation was 40.7% (n = 61) for the sample, with dry powder inhalers associated with the highest accuracy (64%) and pressurized metered-dose inhalers associated with the lowest accuracy (1.6%). Multivariate logistic regression analysis showed that using a soft mist inhaler (adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]), using a dry powder inhaler (AOR =15.60, 95% CI [1.99, 122.26]), and higher satisfaction with the inhaler were positively and independently associated with accurate inhaler use (AOR = 1.94, 95% CI [1.09, 3.44]). Important factors related to inhaler use accuracy include inhaler type and level of patient satisfaction with their inhaler. Healthcare professionals should regularly confirm that older patients are able to use their inhalers correctly and are satisfied with their inhalers.

Climate-conscious inhaler prescribing for family physicians.

To provide family physicians with prescribing and diagnostic strategies that can reduce carbon emissions associated with inhalers. This review is based on the authors' experience developing the climate-conscious inhaler prescribing playbooks and courses for CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis). The approach was refined through patient and provider feedback since the first playbook was published in 2021. PubMed was also searched for relevant publications on inhaler use, asthma management, and chronic obstructive pulmonary disease (COPD) management. Current asthma and COPD guidelines were also reviewed. There is growing acknowledgment of the substantial impact that inhalers have on climate emissions generated by the health sector. Recent surveys indicate that most Canadian patients care about climate change and would be willing to opt for less carbon-intensive treatment and care delivery options where available. Beyond inhaler choice, there are many opportunities to address the climate impacts of respiratory care and enhance quality of care. Working with patients to ensure they are using the right medications in the right ways will produce both carbon savings and better health outcomes. The climate crisis can therefore serve as a catalyst for improving treatment of patients with respiratory conditions. Family physicians may reduce carbon emissions associated with inhalers by reducing unnecessary inhaler prescribing; ensuring patients' control of asthma and COPD is optimized; considering whether a more sustainable inhaler may be appropriate; optimizing dosing technique to reduce emissions and waste; and disposing of inhalers appropriately if possible. Family physicians may reduce carbon emissions associated with inhalers through the following strategies: confirming diagnosis, controlling disease, considering inhaler type, optimizing dosing technique, and encouraging appropriate disposal.

Antibacterial Effect of Nitric Oxide on the Causative Agents of Hospital-Acquired Pneumonia (Experimental Study)

The aim of the study was to evaluate the antimicrobial effect of single and repeated nitric oxide (NO) exposure on the major pathogens of nosocomial pneumonia isolated from the sputum of cardiac surgery patients.Materials and Methods. A 24-hour culture of microorganisms from pan-resistant isolates of Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae from the sputum of inpatient cardiac surgery patients with nosocomial pneumonia, as well as strains of P. aeruginosa and E. coli from the American Type Culture Collection (ATCC), were exposed to 200 ppm NO (experimental sample) or medical air (control sample) in a sealed chamber for 30 minutes. After a single or 4 repeated gas exposure at 4 h intervals, Petri dishes were placed in a thermostat at 37°C and the results were evaluated at 24 and 48 h or at 12, 24, 36 and 48 h, respectively. Grown colonies were counted using an automated colony counter and recorded as CFU/mL.Results. No growth of clinical isolates of P. aeruginosa and E. coli was observed 24 and 48 h after a single exposure to NO. Growth of A. baumannii was lower compared to controls at 24 h but continued at 48 h. No effect of a single exposure to 200 ppm NO on other microorganisms was observed. After 4 exposures to NO, the growth of ATCC E. coli was not detected, the growth of other experimental strains was significantly lower compared to the control (P&lt;0.05).Conclusion. Our results provide a rationale for the use of multiple intermittent inhalation of 220 ppm NO for the treatment of patients with hospital-acquired bacterial pneumonia.

Evidence Against Use of Nitrogen for the Death Penalty

This Viewpoint discusses the recent use of forced nitrogen inhalation as capital punishment in Alabama and describes the body of evidence indicating that forced nitrogen inhalation is an inhumane practice.

Association between the consumption of psychoactive substances and suicidal thoughts in school-age adolescents in Colombia 2016

ABSTRACT Background: Suicidal thoughts are a frequent problem in adolescents and young people. They have been associated with psychoactive substances’ consumption.Objective: To determine the prevalence of suicidal thoughts and its association with the psychoactive substances’ consumption during the last 12 months, in school adolescents in Colombia, in 2016 Materials andMethods: A secondary analysis of the information obtained from the 2016 National Study on Consumption of Psychoactive Substances in Colombian. For this, data from 80,018 adolescents, between 12 and 18 years of age were analyzed. Sociodemographic characteristics, suicidal thoughts’ frequency, and consumption of 12 psychoactive substances were examined. Generalized linear models were used to estimate the association between suicidal thought and different psychoactive substance consumption.Results: The prevalence of suicidal thoughts was 15.7%. All psychoactive substances showed association with suicidal thoughts. The association of greater magnitude was registered with the use of non-prescription tranquilizers (OR 3.66 95%CI 3.06 – 4.31), inhalants (OR 3.65 95%CI 3.08 – 4.33), basuco (OR 3.39 95%CI 2.49 – 4.61), cigarettes (OR 2.70 95%CI 2.49 – 2.93), marijuana (OR 2.34 95%CI 2.11 – 2.59), and alcohol (OR 2.29 95%CI 2.13 – 2.48).Conclusions: Suicidal thoughts show association with all psychoactive substances’ consumption, additionally, polydrug use was found to increase the magnitude of the association.

The effect of budesonide-formoterol powder inhalation on cough and lung function following thoracoscopic pulmonary surgery: a retrospective cohort study.

To explore whether portable budesonide-formoterol powder inhalation can ameliorate cough symptoms and improve pulmonary function recovery in patients who underwent thoracoscopic lung surgery. Clinical data of patients who underwent thoracoscopic pulmonary resection at Henan Provincial People's Hospital between December 2022 and May 2023 were extracted. To evaluate the impact of continuous post-operative use of portable budesonide-formoterol powder inhalation, patients were divided into two groups: the control group and the case group. Next, we compared the Leicester cough score and pulmonary function indexes of the patients before surgery, one month and six month after the operation. A total of 188 cases were included, and the baseline demographic characteristics of both groups were well-balanced. The internal consistency of the LCQ-MC scale, as indicated by Cronbach's α coefficients, were all greater than 0.8, and there was no significant difference in LCQ-MC scores between the two groups before the operation (Z=-1.173, P=0.241). Postoperatively, the LCQ-MC score in the case group was significantly higher than that in the control group (18.66 vs. 16.79, P<0.01), with a notable statistically significant difference in the reduction of LCQ-MC scores between the two groups (1.32 vs. 3.30, P<0.01). Analysis of lung function revealed that patients in the case group exhibited significant improvements in FEV1/FVC, FVC, FEV1, PEF, MMEF75/25, MVV, DLCO and the RV/TLC indexes compared to the control group (P<0.01). Portable budesonide-formoterol powder inhalation can alleviate cough symptoms and promote pulmonary function recovery in patients following thoracoscopic lung surgery.

The role of community pharmacists as oral health advisors in the management of oral effects of asthma medications: an exploratory survey.

To investigate community pharmacists' attitudes, confidence, practice, knowledge, and barriers towards the management of oral side effects of asthma medications. A paper-based questionnaire was developed from previous research, trialled, and validated. Convenience sampling through web search was used to identify pharmacy practices across Cairns, Queensland, Australia. Practices were contacted by email and phone before hand-delivering and collecting questionnaires. Thirty eight community pharmacist responses were descriptively analysed. Community pharmacists surveyed within the Cairns region feel that it is within their role to help manage the side effects of asthma medications. Many feel this is best conveyed during inhaler dispensing and instruction. Current advice is more prompted rather than preventative. Pharmacists routinely advise patients of mouth-rinsing following inhaler use, however the link to preventing side effects is not clearly communicated. Pharmacists are confident in recognizing and managing common side effects such as oral thrush and dry mouth, but fewer are aware of dental decay and gingivitis. Many identify a lack of guidelines as the largest barrier to providing preventive oral health advice. Cairns community pharmacists already self-perceive their role in the management of oral side effects of asthma medications. Advice given to patients is practical but does not clearly convey the causative associations between asthma medications and their potential oral side effects. Patient education is prompted more by enquiry rather than a preventative approach. The development of standardized practice protocols and integration within undergraduate degrees or continuing education may benefit the community-pharmacist delivered care.

The Effect of Educational Intervention on Inhaler Technique of Patients in Asian Countries: A Systematic Review

Background: Inhalation therapy is the main line of treatment for the management of various respiratory diseases due to localized delivery and rapid onset of action. Incorrect inhaler technique is very common and subsequently leads to poor disease management. Pharmacist can have a positive impact on patient’s education about proper inhaler technique that can lead to a significant improvement of asthma and COPD management. Objective: The objective of this study was to determine the effectiveness of pharmacist education program on inhaler technique of asthmatic and COPD patients in South Asian countries. The outcome regarding inhalation technique was reviewed and summarized. Methodology: The outcome regarding inhalation technique was reviewed and summarized. For this systematic review, basic electronic academic databases (Scopus, Science Direct, ProQuest, Web of Science and PubMed) were used for the search, along with a manual search on Google Scholar. This systematic review was conducted by following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines. Moreover, utilizing the framework of the PECO-S (Population Exposure Comparison Outcome Study design), various observational studies were recruited for this review. The ZEE tool was utilized to minimize the risk of bias among extracted cross-sectional studies. Inclusion criteria included studies on inhaler using patients of all ages from South Asian countries along with the influence of educational intervention outcomes. Results: Out of 2191 studies, 24 studies meeting the inclusion criteria were included in the current review. All of the included studies were about pharmacist intervention on inhaler technique in South Asian countries. Conclusion: The systematic literature review summarizes the impact of educational intervention provided to inhaler using patients from South Asian countries. It was assessed that patient education and counselling produced improvement in inhalation technique of various devices especially metered dose inhalers. The primary outcome of most the studies was the improvement in inhaler technique assessment and enhanced quality of life. Therefore, inhaler technique education to patients should be made compulsory by the Health-care authorities to enhance compliance and effectiveness of inhalational therapy by avoiding irrational use of inhalers.

Inhalant abuse among street-involved children and adolescents in India: Case for epistemic recognition and reorientation.

Contextualizing the void of research on inhalant abuse among adolescents as epistemic neglect, in this study, we use mixed-methods action research to understand inhalant abuse in a specific context in the Global South. Focusing on a large metropolitan city in Western India, we surveyed 158 street-involved children and adolescents (110 boys and 48 girls, age range from 5 to 17 years) in a group setting along with follow-up group interviews. Despite finding a high prevalence rate of inhalant abuse, our work suggests an absence of supporting structures and emphasizes the need to revisit our understanding and interpretation of substance-using behavior of street-involved youth. Instead of explaining inhalant-abusing behavior as emerging from pathological deficiencies in individuals or households, we stress the need to critically examine the exploitative environment they are embedded in. In doing so, we join efforts to decolonize conventional ways of understanding "deviant" behavior.

Pulmonologist Education of the Teach-to-Goal Inhaler Technique for Those With Asthma and COPD.

Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to determine changes in clinical outcomes and inhaler use. This was a retrospective study of 296 subjects diagnosed with asthma, COPD, or both that evaluated use of inhaler technique education and its impact on (1) inhaler/dosage change consisting of dosage change in the same class of inhaler and/or change in number of inhalers, (2) forced expiratory volume in one second/forced vital capacity (FEV1/FVC%), (3) disease symptom control, (4) out-patient visits, (5) urgent care visits (6) emergency department visits, and (7) hospital admissions. One group received inhaler technique education by a pulmonologist while the other group did not. The pulmonologist inhaler technique-educated group had significantly decreased relative risk for inhaler/dosage increase (relative risk 0.57 [95% CI 0.34-0.96], P = .03) and significantly increased odds for symptom control (odds ratio 2.15 [95% CI 1.24-3.74], P = .01) at 1-y follow-up as compared to the no education group. No differences occurred for FEV1/FVC%, out-patient visits, urgent care visits, emergency department visits, and hospital admissions. Pulmonologist education of inhaler technique for patients with asthma and patients with COPD was associated with decreased relative risk for inhaler/dosage increase and increased odds for symptom control. We recommend pulmonologists provide education of inhaler technique to patients with asthma and patients with COPD and not rely on non-pulmonologist education alone. Prospective research is needed to confirm the importance of proper inhaler techniques.

Patients’ views and behaviours in relation to asthma inhalers use and their impact on environmental sustainability: a cross-sectional survey study

Abstract Introduction Approximately 60 million inhalers are used annually in England, contributing 3% to the National Health Service (NHS) carbon footprint. Of these, 2 out of 3 are metered-dose inhalers (MDIs) containing greenhouse gas propellants.[1] The carbon footprint of an MDI device is around 500g CO2 equivalent, in contrast with the 20g CO2 equivalent of a dry powder inhaler (DPI).[2] The NHS Long Term Plan introduced measures on environmental sustainability, leading to the National Institute of Health Care and Excellence (NICE) launching a ‘shared decision aid’ to promote the discussion of options for inhaler devices. This landmark policy step could be more effective if received with patient support and informed behaviours of patients with regard to inhalers. Research is therefore needed to identify patients’ views and behaviours on this matter. Aim To identify patients’ views and behaviours related to environmental sustainability aspects of their use of inhalers for the management of asthma. Methods An anonymous self-completion paper-based questionnaire was administered to patients with a clinical diagnosis of asthma. These were recruited opportunistically via 10 community pharmacies in the South of England during the month of February 2020. They were provided information about the study and invited to participate by pharmacy staff when collecting prescriptions. Participants had to be prescribed at least one MDI inhaler and not to be using a DPI, and report on the use, disposal and views regarding their environmental impact. Responses to the questionnaire were coded and analysed using descriptive statistics. Results A total of 149 surveys were completed by patients, of which 47% (n=70) were male and 53% (n=79) were female. The age range of respondents varied with the majority 45.6% being 18-29 years old, followed by 21.5% in the 60-69 years category. Of these, 30.2% (n=48) were aware of MDI inhalers having an impact on carbon footprint, and 53% (n=79) on plastic pollution. A majority (81%) of patients stated that they were involved or partially involved in their inhaler choice. Only 62% (n=92) said they would be willing to switch their MDI to a more environmentally friendly inhaler with equal effectiveness, 15.4% (n=23) reported they would not be willing to do so and 22.1% (n=33) were not sure. Unwanted inhalers were returned by 43% (n=64) of participants for appropriate disposal, with 55% (n=82) of respondents being unaware of this option. A majority (91%, n=136) of participants said they would like further information about their inhalers and their impact on the environment. Conclusion There is scope for a more environmentally friendly management of asthma and the use of inhalers. Healthcare professionals are involving patients in decision making when prescribing, and pharmacists could contribute to this when dispensing. Patients would welcome information on the impact of inhalers on the environment and further research could identify more precisely on what aspects, alongside barriers preventing a switch to more environmentally friendly options. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey.

Chronic Serous Chorioretinopathy: A Case Study

Introduction Chronic central serous chorioretinopathy (CSCR) is characterized by persistent subretinal fluid that disrupts the outer layers of the retina and may lead to complications such as: outer retinal atrophy, increased risk of choroidal neovascularization (CNVM) and the potential for permanent vision loss. This report describes the clinical features of chronic CSCR. Case Presentation A 73-year-old male with a history of systemic steroid and inhaler use presented for a routine eye exam without visual complaints. Examination findings included normal visual acuity in both eyes and multiple areas of retinal hyper and hypopigmentation along the arcades with no macular involvement in the right eye; the left eye was unremarkable. Fundus photography and optical coherence tomography showed localized areas of outer retinal disruption and thinning near the optic nerve head and along the corresponding retinal areas of irregular pigmentation in the right eye; the left eye was unremarkable. Discussion In chronic CSCR, structural changes in the retina can lead to retinal dysfunction and permanent vision loss. Treatment options for chronic CSCR include photodynamic therapy, intravitreal anti-vascular endothelial growth factor therapy, or systemic steroid receptor blockers. Visual prognosis varies depending on the severity of the disease, age of onset, risk of CNVM and the degree of outer retinal degeneration. Conclusion Patients with chronic CSCR are at risk for permanent vision loss. The structural changes in the outer retina also increase the risk for CNVM. Hence, it is important that patients with chronic CSR receive regular eye examinations and are educated on the role of regular Amsler grid testing.

Optimal Inhalation Profile of Pressurized Metered Dry Powder Inhaler Using a Valved Holding Chamber: A Dynamic Analysis.

Background: The combined use of a pressurized metered-dose inhaler and valved holding chamber (pMDI+VHC) is recommended to improve efficiency and safety; however, aerosol release is likely to vary with the inhalation maneuver. This in vitro study investigated the aerodynamic characteristics and aerosol release features of pMDI+VHC (Aerochamber, Trudell Medical International). Methods: The static and dynamic changes in the airway resistance (Raw) during inhalation (withdrawal) through pMDI+VHC were measured. Subsequently, the aerosol released from pMDI+VHC was measured using simplified laser photometry during withdrawal with either fast ramp-up then steady or slow ramp-up followed by gradual decrement at different intensities and times to peak flow (TPWF). Results: Raw increased linearly with changes in the withdrawal flow (WF) rate between 10 and 50 L/min. The slope was steep in the low WF range (<50 L/min) and became milder in the higher range. The aerosol mass tended to increase with an increase in the peak WF (PWF) of slow ramp-up profile. When three different WF increment slopes (TPWF: 0.4, 1.4, and 2.4 seconds) were compared, the released aerosol mass tended to decrease, and the aerosol release time was prolonged at longer TPWF. When the PWF was increased, the aerosol release time became shorter, and the withdrawn volume required for 95% aerosol release became larger; however, it did not exceed 0.4 L at suitable TPWF (0.4 seconds). Conclusion: Raw analysis suggests that inhalation at 30-50 L/min is suitable for pMDI+VHC in this setting. Rapid (TPWF, 0.4 seconds) inhalation, but not necessarily long (maximum 2.0 seconds) and deep (but larger than 0.55 L), is also recommended. Practically, direct inhalation to be weaker than usual breathing, as fast as possible, and far less than 2.0 seconds.

Epidemiology of patients with severe asthma in Japan: a nationwide descriptive study.

The 2014 European Respiratory Society/American Thoracic Society guidelines defined severe asthma based on treatment intensity and estimated the proportion of severe asthma among all asthma cases to be 5-10%. However, data supporting the estimate and comprehensive and sequential data on asthma cases are scarce. We aimed to estimate the national prevalence and proportion of severe asthma during the last decade. Using a Japanese national administrative database, which covers ≥99% of the population, we evaluated the prevalence and proportion of severe asthma in 2013, 2015, 2017 and 2019. Additionally, we elucidated the demographic characteristics, treatments and outcomes of patients with asthma. The national prevalence of mild-moderate and severe asthma in 2019 was 800 and 36 per 100 000 persons, respectively. While the prevalence of mild-moderate asthma remained almost constant in the study years, the prevalence of severe asthma decreased, resulting in a reduction in the proportion of severe asthma from 5.6% to 4.3%. Although treatment modalities have evolved, such as the increased use of combination inhalers and asthma biologics, approximately 15% of mild-moderate and 45% of severe asthma cases were still considered "uncontrolled". The number of deaths from asthma decreased in patients with both mild-moderate and severe asthma. This study revealed that the prevalence of severe asthma in Japan decreased during the study period and fell below 5% in the most recent data. Despite treatment evolution, a substantial proportion of patients with both mild-moderate and severe asthma still have poor asthma control.

Short-term hyperoxia-induced functional and morphological changes in rat hippocampus.

Excess oxygen (O2) levels may have a stimulating effect, but in the long term, and at high concentrations of O2, it is harmful to the nervous system. The hippocampus is very sensitive to pathophysiological changes and altered O2 concentrations can interfere with hippocampus-dependent learning and memory functions. In this study, we investigated the hyperoxia-induced changes in the rat hippocampus to evaluate the short-term effect of mild and severe hyperoxia. Wistar male rats were randomly divided into control (21% O2), mild hyperoxia (30% O2), and severe hyperoxia groups (100% O2). The O2 exposure lasted for 60 min. Multi-channel silicon probes were used to study network oscillations and firing properties of hippocampal putative inhibitory and excitatory neurons. Neural damage was assessed using the Gallyas silver impregnation method. Mild hyperoxia (30% O2) led to the formation of moderate numbers of silver-impregnated "dark" neurons in the hippocampus. On the other hand, exposure to 100% O2 was associated with a significant increase in the number of "dark" neurons located mostly in the hilus. The peak frequency of the delta oscillation decreased significantly in both mild and severe hyperoxia in urethane anesthetized rats. Compared to normoxia, the firing activity of pyramidal neurons under hyperoxia increased while it was more heterogeneous in putative interneurons in the cornu ammonis area 1 (CA1) and area 3 (CA3). These results indicate that short-term hyperoxia can change the firing properties of hippocampal neurons and network oscillations and damage neurons. Therefore, the use of elevated O2 concentration inhalation in hospitals (i.e., COVID treatment and surgery) and in various non-medical scenarios (i.e., airplane emergency O2 masks, fire-fighters, and high altitude trekkers) must be used with extreme caution.

Validation of an Inhaled Therapy Beliefs Questionnaire in Patients with Chronic Obstructive Pulmonary Disease.

Background: To carry out a validation questionnaire that assesses beliefs about inhaled treatments in patients with chronic obstructive pulmonary disease (COPD), as knowing patients' beliefs could help to improve medication adherence and health outcomes. Methods: We evaluated data from 260 COPD patients from electronic medical record databases from five primary healthcare centers, in a descriptive, cross-sectional study with a sample size calculated for a 10-item questionnaire, with an estimated Cronbach's alpha of 0.70 and a 95% confidence level. Study participants were selected via systematic random sampling. Variables: Ten-item Inhaled Therapy Beliefs Questionnaire, CCTI-Questionnaire v.2.0, time for completion, age, sex, educational level, spirometry severity (GOLD criteria), exacerbations (previous year), characteristics of inhaled treatment, and smoking habit. A two-year follow-up in a subsample of 77 patients from one health center was utilized. The Morisky-Green test, pharmacy dispensing data, test-retest (kappa coefficient), and an exploratory analysis of the adherence-belief relationship (ji-squared) were measured. Results: The 10-item questionnaire showed good viability (3 min completion time) when performed face-to-face or telephonically; its psychometric properties were acceptable, with an internal consistency (Cronbach's alpha) score of 0.613. Three factors explained 47.58% of the total variance (p < 0.0001): use (factor 1), effects (factor 2), and objectives (factor 3) of inhalers. The two-year follow-up ultimately considered 58 out of the 77 patients (10 deceased, 4 unlocated, 2 mistakes, 2 no inhaled treatment, and 1 withdrawal). Non-adherence was 48.3% in terms of the Morisky-Green test; 31% in terms of pharmacy dispensing data; and 40.4% considering both methods. There was low test-retest reliability, indicated by items 4, 8, and 9 of the CCTI-Questionnaire (Kappa = 0.4, 0.26, and 0.34; p-value < 0.0001, 0.008, and 0.001, respectively). There was mild correlation between beliefs and adherence. Conclusions: The ten-item CCTI-Questionnaire v.2.0 demonstrated acceptable psychometric properties regarding feasibility, reliability, and content validity.

The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis.

The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever-based therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma. This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with as-needed budesonide/formoterol DPI, as-needed salbutamol pMDI or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO2e) per person-year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint. As-needed budesonide/formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least-squares mean 1.1 versus 26.2 kgCO2e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least-squares mean 1.1 versus 17.3 kgCO2e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm. The as-needed budesonide/formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI.

Suboptimal peak inspiratory flow rate in dry-powder inhaler users for chronic obstructive pulmonary disease in Korea

BackgroundA suboptimal peak inspiratory flow rate (PIFR) in dry-powder inhaler (DPI) users can lead to insufficient therapeutic effects in the treatment of chronic obstructive pulmonary disease (COPD). However, few data on the prevalence of and factors associated with suboptimal PIFR in Korean patients with COPD are available. MethodsWe conducted a cross-sectional study of patients with COPD who had been using DPIs for more than three months. PIFR was measured using an In-Check DIAL G16 device. Suboptimal PIFR was defined as below the resistance-matched threshold. Multivariable logistic regression analysis was used to determine factors associated with suboptimal PIFR. ResultsOf 444 DPI users with COPD, the rate of suboptimal PIFR was 22.0 % (98/444). In a multivariable analysis, significant factors associated with suboptimal PIFR were age (adjusted odds ratio [aOR] = 1.06 by 1-year increase; 95 % confidence interval [CI] = 1.02–1.09), male sex (aOR = 0.28; 95 % CI = 0.11–0.73), body mass index (BMI) (aOR = 0.91 by 1 kg/m2 increase; 95 % CI = 0.85–0.99), post-bronchodilator forced vital capacity (FVC) %pred (aOR = 0.97 by 1%pred increase; 95 % CI = 0.95–0.99), and In-Check DIAL R2-type inhaler [medium-low resistance] use (aOR = 3.70 compared with R1-type inhalers [low resistance]; 95 % CI = 2.03–7.03). ConclusionsIn Korea, more than one-fifth of DPI users with COPD had a suboptimal PIFR. The factors associated with suboptimal PIFR were age, female gender, low BMI, low FVC, and R2-type inhaler use. Therefore, clinicians should carefully evaluate the possibility of suboptimal PIFR when prescribing DPIs.