Inhalant Research Articles

Acute exposure to carbon monoxide inhalation and/or hot water immersion transiently increases erythropoietin in females but not in males.

The use of acute carbon monoxide inhalation (COi) and hot water immersion (HWI) are of growing interest as interventions to stimulate erythropoietin (EPO) production. However, whether EPO production is further augmented when combining these stressors and whether there are sex differences in this response are poorly understood. Therefore, we measured circulating EPO concentration in response to acute COi and HWI independently and in combination and determined whether the responses were altered by sex. Participants completed three study visits-COi, HWI, and combined COi and HWI-separated by 1 week in a randomized, balanced, crossover design. Renal blood velocity was measured during all interventions, and carboxyhaemoglobin was measured during and after COi. Serum samples were analysed every hour for 6h post-intervention for EPO concentration. HWI decreased renal blood velocity (46.2cm/s to 36.2cm/s) (P<0.0001), and COi increased carboxyhaemoglobin (1.5%-12.8%) (P<0.0001) without changing renal blood velocity (46.4-45.2cm/s) (P=0.4456). All three interventions increased peak EPO concentration from baseline (COi: 6.02-9.74mIU/mL; HWI: 6.80-11.10mIU/mL; COi + HWI: 6.71-10.91mIU/mL) (P=0.0048) and to the same extent (P=0.3505). On average, females increased EPO while males did not in response to COi (females: 6.17mIU/mL; males: 1.27mIU/mL) (P=0.0010), HWI (females: 6.47mIU/mL; males: 2.14mIU/mL) (P=0.0104), and COi and HWI (females: 6.65mIU/mL; males: 1.76mIU/mL) (P=0.0256). These data emphasize that combining these interventions does not augment EPO secretion and that these interventions may work better in females.

Different Carriers for Use in Dry Powder Inhalers: Characteristics of Their Particles.

In contemporary times, there has been a rise in the utilization of dry powder inhalers (DPIs) in the management of pulmonary and systemic diseases. These devices underwent a swift advancement in terms of both the equipment utilized and the formulation process. In this review, the carrier physicochemical characteristics that influence DPI performance are discussed, focusing its shape, morphology, size distribution, texture, aerodynamic diameter, density, moisture, adhesive and detachment forces between particles, fine carrier particles, and dry powder aerosolization. To promote the deposition of the active principal ingredient deep within the pulmonary system, advancements have been made in enhancing these factors and surface properties through the application of novel technologies that encompass particle engineering. So far, the most used carrier is lactose showing some advantages and disadvantages, but other substances and systems are being studied with the intention of replacing it. The final objective of this review is to analyze the physicochemical and mechanical characteristics of the different carriers or new delivery systems used in DPI formulations, whether already on the market or still under investigation. [Figure: see text].

Dry Powder Inhaler Use in Primary School Aged Children with Asthma: A Systematic Review

ObjectiveAsthma is the most common chronic disease in children. Dry powder inhalers (DPI) are effective for medication delivery in adults and adolescents, and provide a lower environmental footprint and more portability when compared to metered dose inhaler (MDI) with spacer. They require specific technique, and it is necessary to ascertain whether they can be used in younger age groups. We aimed to assess evidence regarding whether primary school aged (5–11 years) children can use DPI with adequate technique both during stable and acute asthma.DesignOvid MEDLINE, Embase and PubMed were searched for studies assessing DPI use in children aged 5–11 years with asthma or wheeze. Results of studies were synthesised by study design and outcome measure.ResultsThirty-eight studies were identified for analysis. These were analysed in three groups: (1) 25 studies assessing children's ability to use DPI by peak inspiratory flow measurement, (2) 10 studies assessing children's ability to use DPI by physician assessment, and (3) three studies measuring efficacy of DPI compared to gold standard (MDI with spacer). Five studies included children during acute exacerbations.ConclusionThe majority of primary school aged children have the ability to use a DPI with adequate training, support and practice. Some younger children may have difficulties, and clinician assessment and ongoing review is crucial in determining which children are likely to benefit from a DPI. Consistent correct use and adherence remains a challenge, but this is also an issue with MDI plus spacer and does not appear to be significantly worse with DPI. Evidence of the use of DPI during acute illness is limited, and more studies are required in this setting.

"K Cramps," Recurrent Abdominal Pain in a Patient with Chronic Ketamine Use: A Case Report.

Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications. A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient self-navigated to addiction treatment. Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services.

Gastroesophageal Disease and Environmental Exposure: A Systematic Review.

Environmental exposure-associated disease is an active area of study, especially in the context of increasing global air pollution and use of inhalants. Our group is dedicated to the study of exposure-related inflammation and downstream health effects. While many studies have focused on the impact of inhalants on respiratory sequelae, there is growing evidence of the involvement of other systems including autoimmune, endocrine, and gastrointestinal. This systematic review aims to provide a recent update that will underscore the associations between inhalation exposures and upper gastrointestinal disease in the contexts of our evolving environmental exposures. Keywords focused on inhalational exposures and gastrointestinal disease. Primary search identified n = 764 studies, of which n = 64 met eligibility criteria. In particular, there was support for existing evidence that PM increases the risk of upper gastrointestinal diseases. Smoking was also confirmed to be major risk factor. Interestingly, studies in this review have also identified waterpipe use as a significant risk factor for gastroesophageal reflux and gastric cancer. Our systematic review identified inhalational exposures as risk factors for aerodigestive disease, further supporting the association between environmental exposure and digestive disease. However, due to limitations on our review's scope, further studies must be done to better understand this interaction.

Effect of inhalation therapy on oral health in patients with chronic airway disease

The primary treatment for both chronic obstructive pulmonary disease (COPD) and asthma is inhalation therapy. When utilized over an extended period of time, inhalation treatment serves as both a controller and a relief therapy. Oral adverse effects can result from inhaled medications, particularly bronchodilators and corticosteroids that are deposited in the oropharyngeal region. Reduced saliva flow rate, periodontal disease, oral thrush, dental caries, and dental erosion are just a few of the side effects and difficulties associated with using inhaler therapy that are frequently discovered in the oral region. This problem may arise from improper inhaler use, concomitant diseases and conditions of the patient, inadequate education, and inadequate assessment of oral health during inhalation medication. In order to prevent side effects and complications from inhaler therapy, it is essential to comprehend the different types of inhaler drugs and the pathophysiology associated with oral health complications. This will enable clinicians to modify the components of the drug type, the type of inhaler therapy device, and the appropriate method of use based on the unique characteristics of each patient.

N-Chlorotaurine Solutions as Agents for Infusion Detoxification Therapy: Preclinical Studies.

N-chlorotaurine (NCT) is a broad-spectrum antimicrobial agent with outstanding tolerability, effective for topical and inhalation use. This paper presents the results of studies of single and repeated intravenous infusions of NCT to laboratory animals. The studies were conducted on female Wistar Han rats. The effect of NCT infusions on the general condition, behavioral reactions, main biochemical and hematological parameters, hemocoagulation system, cardiovascular system, and on the condition of the internal organs was studied. It was found that NCT infusions do not reveal deviations in the studied parameters that could indicate a toxic effect. The estimated LD50 is more than 80 mg/kg. In a subchronic experiment, a statistically significant decrease in cholesterol (by up to 11%), glucose (by up to 15%) and excess bases (up to four times) in the blood, and an increase in heart rate (by up to 31%) and frequency of defecations (by up to 35%), as well as pronounced antiplatelet effect, were found. In animals with simulated endotoxicosis, a decrease in the cytolysis and oxidative stress markers was observed. Such effects are caused by both chlorine-active compounds and taurine.The results obtained indicate broad prospects for the use of NCT solutions as an infusion detoxifying agent.

Reduced Cost Sharing and Medication Management Services for COPD

High out-of-pocket costs and improper use of maintenance inhalers contribute to poor outcomes among patients with chronic obstructive pulmonary disease (COPD). There is limited evidence for how addressing these barriers could improve adherence and affect COPD exacerbations, spending, or racial disparities in these outcomes. To examine the effect of a national program to reduce beneficiary cost sharing for COPD maintenance inhalers and provide medication management services that included education on proper technique for inhaler use. This randomized clinical trial included individuals with COPD. All individuals were enrolled in Medicare Advantage. Data were collected from January 2019 to December 2021, and data were analyzed from January 2023 to May 2024. Invitation to enroll in a program that reduced cost sharing for maintenance inhalers to $0 or $10 and provided medication management services. The random assignment of the invitation was used to estimate the effects of the invitation and program enrollment, overall and by race. Inhaler adherence measured as proportion of days covered (PDC), moderate-to-severe exacerbations, short-acting inhaler fills, total spending, and as an exploratory outcome, out-of-pocket spending. Of 19 113 included patients, 55.2% were female; 9.5% were Black, 81.1% were White, and 9.4% were another or unknown race; and the median (IQR) age was 74 (69-80) years. Program enrollment was higher in the invited group (29.4%) than the control group (5.1%). The PDC for maintenance inhalers was higher in the invited group than the control group (32.0% vs 28.4%; adjusted invitation effect, 3.8 percentage points; 95% CI, 3.1-4.5); the adjusted effect of the program (the local average treatment effect) was 15.5 percentage points (95% CI, 12.8-18.1), a 55% relative increase in adherence. Mean (SD) out-of-pocket spending for prescriptions was lower in the invited group ($619.5 [$863.1]) than the control group ($675.0 [$887.3]; adjusted invitation effect, -$49.5; 95% CI, -68.9 to -30.0; adjusted program effect, -$203.0; 95% CI, -282.8 to -123.2), but there was no statistically significant difference in exacerbations, short-acting inhaler fills, or total spending. Among Black individuals, the adjusted invitation effect on maintenance inhaler PDC was 5.5 percentage points (95% CI, 3.3-7.7), and the adjusted program effect was 19.5 percentage points (95% CI, 12.4-26.7). Among White individuals, the adjusted invitation effect was 3.7 percentage points (95% CI, 2.9-4.4), and the adjusted program effect was 15.1 percentage points (95% CI, 12.1-18.1). The difference between the invitation effects by race was not statistically significant (1.8 percentage points; 95% CI, -0.5 to 4.1; P = .13). Individuals in Medicare Advantage who received an invitation to enroll in a program that reduced cost sharing for maintenance inhalers and provided medication management services had higher inhaler adherence compared with the control group. The difference in the program's effect on inhaler adherence between Black and White individuals was substantial but not statistically significant. ClinicalTrials.gov Identifier: NCT05497999.

Substance Use Among Illinois Farmers

Background: People in agriculture face unique stressors and occupational hazards, and relatively little is known about substance use in this population. The purpose of this study was to describe substance use among farmers in Illinois. Methods: We conducted a mail survey of Illinois farmers that included the Brief ASSIST to assess substance use for lifetime and past three-month use of ten different substances. The survey also included questions about farming characteristics, mental health, stress, coping, social support, and demographic characteristics. We used chi-square and non-parametric tests to assess group differences. Results: Alcohol, tobacco, cannabis, and sedatives were most reported as used for a lifetime and in the past three months. About three-quarters of the sample had recently used alcohol. Recent tobacco use was associated with not being married, less education, and less concern about climate-related farm stress. Recent sedative use was associated with greater concern about isolation-related farm stress. People who reported multiple substance use were at a greater risk for suicide and were more likely to meet the criteria for generalized anxiety disorder. None of the participants reported recent use of cocaine, heroin, inhalants, or hallucinogens. Conclusion: Specific social and cultural aspects of farming and farm communities may contribute to substance use among people working in agriculture. Future research can help to better understand this intersection and make recommendations for programs and resources to promote adaptive coping strategies.

Health literacy demands assessment of web-based COPD inhaler use education video series

Health literacy demands assessment of web-based COPD inhaler use education video series

Changes in Illicit Drug Use Among High School Students in Southeastern U.S. States-2009 to 2019.

To determine if decreasing lifetime use of methamphetamines, cocaine, ecstasy, and inhalants among high school students occurring from 2009 to 2019 in the U.S. also occurred in five southeastern states, Youth Risk Behavior Survey data representative of high school students in grades 9-12 in 2009 and 2019were analyzed. In a classroom setting, lifetime use of methamphetamines, cocaine, ecstasy, and inhalants were self-reported. Students nationwide (n = 30,087) were compared to students in Alabama, Georgia, Louisiana, Mississippi, and South Carolina (n = 18,237). Lifetime methamphetamine use significantly increased from 4.8% in 2009 to 6.2% in 2019 in the southeast but decreased from 4.1 to 2.2% nationwide. Use of cocaine, ecstasy, and inhalants remained stable in the southeast while decreasing significantly nationwide from 2009 to 2019. During a period when use of methamphetamines, cocaine, ecstasy, and inhalants among high school students in the U.S. decreased, use in southeastern states did not change. Culturally specific programs and interventions may be needed to prevent illicit drug use in communities of southeastern states where youth remain at risk.

Association of self-esteem and school connectedness with substance use among street children in southwestern Nigeria

ABSTRACT Objective The study aimed to determine the relationship between substance use, self-esteem and school connectedness among street children in southwestern Nigeria. Methods A cross-sectional survey of 358 street children in Oyo State Nigeria, was carried out. Data was collected using a semi-structured questionnaire. Appropriate scoring systems were used to assess the degree of self-esteem and school connectedness. The 50th centile was used as the cutoff point to define good self-esteem and school connectedness. Results Participants were aged 9–17 years, with a mean age of 16.2 ± 1.3 years; 208 (58.1%) were males. More than three-quarters (77.9%) had used psychoactive substances at some point in their lives, with local (herbal) psychoactive substances being the most frequent, followed by central nervous system depressants. One hundred and eighty (50.3%) of them were currently using psychoactive substances. The females had better self-esteem and school connectedness compared with the males, whereas substance use was more prevalent among the males. Good school connectedness was associated with lower use of psychoactive substances, but good self-esteem was associated only with reduced use of inhalants. Conclusion Promoting good school connectedness among street children may help in reducing the use of psychoactive substances among them.

Impact of Marijuana Use on Lung Health.

The widespread use of marijuana in the context of increasing legalization has both short- and long-term health implications. Although various modes of marijuana use-smoked, vaped, or ingested-may lead to a wide scope of potential systemic effects, we focus here on inhalational use of marijuana as the most common mode with the lung as the organ that is most directly exposed to its effects. Smoked marijuana has been associated with symptoms of chronic bronchitis and histopathologic changes in airway epithelium, but without consistent evidence of long-term decline in pulmonary function. Its role in immunomodulation, both for risk of infection and protection against a hyperinflammatory host response to infection, has been suggested in animal models and in vitro without conclusive extrapolation to humans. Marijuana smoke contains carcinogens like those found in tobacco, raising concern about its role in lung cancer, but evidence is mixed and made challenging by concurrent tobacco use. Vaping may offer a potential degree of harm reduction when compared with smoking marijuana with reduction of exposure to several toxins, including carbon monoxide, and reduction in chronic respiratory symptoms. However, these potential benefits are counterbalanced by risks including vaping-associated lung injury, potentially more intense drug exposure, and other yet not well-understood toxicities. As more states legalize marijuana and the federal government considers changing this from a Schedule I to a Schedule III controlled substance, we anticipate an increase in prospective medical studies concerning the risks related to marijuana use. This review is based on currently available data concerning the impact of inhaled marijuana on lung health.

Real-World Evaluation of Asthma Severity Following Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients.

This study aimed to evaluate the impact of endoscopic sinus surgery (ESS) on asthma severity up to 12 months after surgical intervention. Retrospective cohort. Tertiary care center. Patients with a history of asthma and Chronic Rhinosinusitis (CRS) who underwent ESS between 2013 and 2023 were included. Asthma severity was assessed according to current Global Initiative for Asthma (GINA) guidelines, classifying patients into mild, moderate, and severe based on medication requirements. Asthma severity was evaluated up to 3 months prior to ESS and 1-year post-ESS. Patients with aspirin-exacerbated respiratory disease (AERD) were excluded. Statistical analysis was performed using McNemar test and Wilcoxon signed-rank test to assess differences in asthma severity, medication doses, and number of medications. Sixty-five patients were included, of which 44 (67.7%) had CRS with nasal polyps (CRSwNP) and 21 (32.3%) had CRS without nasal polyps (CRSsNP). No significant differences were found in asthma severity pre- and post-ESS (P = .175). Similarly, no differences were found in ICS doses (P = .999), total number of prescribed medications (P = .157) or presence of exacerbations before and after ESS (P = .078). However, a significant increase in time from last rescue inhaler use was noted after ESS, increasing from a median of 6.71 to 23.1 weeks (P = .004). This study is the first to assess the impact of ESS on asthma severity in a real-world setting. Our findings suggest that ESS does not impact asthma severity classification. However, it might provide relief of asthma symptoms in the early postoperative period.

Comparative Associations between Substances Used with Depression and Anxiety in a Sample of High School Students in Turkey

Objective: To explore the associations between the type and the amount of substances used with depression and anxiety symptoms by high school students. Methods: The study data was collected by the Istanbul Department of Education on 31,604 high school students which was a survey of 66 questions administered in the school setting. The primary questions and sub-questions on anxiety and depression scores were added to generate a scaled score. Specific substances used by the participants were used to explore the relationship between substance use and depression and anxiety scores by using multinomial logistic regression models. Two regression models were analyzed, one for each dependent variable, keeping the significance level at 0.05. Odds ratios were calculated to explore the association between depression and anxiety scores and specific substance use among the youth. Results: The participants with low levels of anxiety were at an increased odds of using heavy amounts of sleep pills (OR=1.6) and alcohol (OR=1.3) as compared to those without anxiety. In addition to sleep pills and alcohol, illicit substances such as LSD and inhalant use were also seen in the participants with higher levels of anxiety. The participants with low levels of depression were found to be at an increased odds of using sleep pills (OR=1.8) and alcohol (OR=1.3). In addition to this pattern of substance use, participants with higher levels of depression were also found to be heavy cocaine users, low inhalant users, heavy steroid users, and low alcohol users. A decrease in the use of homemade brews was seen in the participants with low and high levels of depression as compared to those who didn’t have any depressive symptoms. Conclusion: A unique pattern of drug and alcohol use was found in the participants experiencing varying levels of anxiety and depression.

The hidden crisis: Volatile inhalant substance use disorders in adolescents from Cuttack’s urban slums: A case series

Abstract: Substance abuse has been defined as the use of chemical substances for nonmedical purposes to achieve alterations in psychological functioning. The substances commonly abused in India include nicotine, alcohol, cannabis, and opioids. However, the use of solvents and propellants is also on the rise as these are inexpensive, legally available household, industrial, office, and automobile products; which are more commonly available to children and adolescents. Organic solvents are cheap and relatively easy to obtain, so they carry the risk of becoming a “gateway drug” for users. We hereby describe three cases of volatile substance abuse in the slum areas of Cuttack who were reported in our medical college.

Demographic and Clinical Profile of Persons with Substance Abuse Disorder Attending Happy Life Psychological Services Islamabad, Pakistan

Substance Abuse Disorder is a treatable mental health disorder that influences persons’ brains and behavior. It leads to an inability to control drug use, resulting in moderate to severe addiction. The research aims to study the demographic and clinical profile of persons with substance abuse disorders attending Happy Life Psychological Services (HLPS). A sample of 156 persons with substance abuse disorder was selected who were admitted to HLPS in the past two years. The study showed that 78.8% of persons with substance abuse disorder were males admitted at HLPS. In the reported cases, smoking, tobacco, opioids, cannabis, amphetamines, sedatives, hallucinogens, alcohol, and cocaine use was significantly higher in males, but inhalant use was higher in females. Middle adults were the age group where drug addiction was higher and mental health problems were most evident. Even medical comorbidities and suicidal intentions seem higher in this specific age group. In addition, married persons experienced more personality, anxiety, depression, and psychotic disorders than unmarried persons. The study outcomes can be used at the broader level to control the use of drugs in developing countries like Pakistan. Everyone is responsible for controlling the easy accessibility of drugs within the country especially, the Anti-Narcotics Agency should perform a pivotal role in this regard.

Yonder: Hidden work, inhaler use, step counts, and appendicitis and colorectal cancer

Yonder: Hidden work, inhaler use, step counts, and appendicitis and colorectal cancer

Effect of Inhaler Technique Health Education in Improving Symptoms and Lung Function in COPD Outpatient in a Private Hospital in Gresik, Indonesia: Pilot Studies

Inhalers are the most effective therapy in the treatment of Chronic obstructive pulmonary disease (COPD). Research shows that a large number of COPD patients do not use inhalers properly. Incorrect inhaler use technique can reduce drug delivery and poor disease control. Education on how to use inhalers is an important part of COPD management. The study was conducted to determine the effect of education on symptom assessment, lung function assessment and inhaler use skill assessment in COPD patients. The research was in the form of a pre-experimental one-group pre-test post-test. The results showed that there was a significant difference in the effect of education on how to use the inhaler on the assessment of symptoms (p = 0.000), a significant difference in the assessment of lung function (p = 0.001) and a significant difference in the assessment of skills in using the inhaler (p = 0.000). Education on how to use inhalers has an influence on the assessment of symptoms, lung function and skills in using inhalers in COPD patients.

Development of Inhaled Tuberculosis Microparticle using Polysaccharide Polymers Containing Rifamycin Groups: In-vitro and In-vivo Study

Tuberculosis (TB) is one of the urgent global health problems. TB therapy involves the use of antibiotics, but unwanted side effects often accompany the treatment of TB with high doses and long periods of time. In an effort to increase the effectiveness of TB treatment and reduce side effects, direct drug delivery to the lungs is the focus of research. One of the approaches used is the development of drug delivery systems that use natural polymers in dry powder inhalation (DPI) formulations. Natural polymers, especially polysaccharides, have various advantages, such as biodegradability, biocompatibility and non-toxicity. This review discusses the use of rifamycin microparticle tuberculosis inhalation using polysaccharide polymers and reviews relevant in-vitro and in-vivo studies. The use of natural polymers, especially polysaccharides, is expected to increase the efficiency of TB therapy by reducing drug doses and systemic side effects and increasing direct drug delivery to infected organs.