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PubMed2002

An exploration of the skills needed for inhalation therapy in schoolchildren with asthma in Taiwan.

BACKGROUND: Clinical observation has shown that many asthma-affected children and their parents are not familiar with appropriate techniques for inhaler use. This may result in misuse, overdose, or diminished response of the administered therapeutic drugs, or may even result in unnecessary, repeated hospitalization. Inappropriate inhalation technique is hazardous to the safety of children with asthma and unnecessarily increases costs resulting from unnecessary rehospitalization. OBJECTIVE: We designed a study to evaluate the skills needed for inhaler use among children with asthma in Taiwan. SUBJECTS AND METHODS: Schoolchildren with asthma, aged 8 to 13 years, were asked to demonstrate their inhalation technique. The inhalers used in this study were either metered-dose inhalers or dry-power inhalers. Assessment of the inhalation technique was made using a standardized inhaler checklist. A higher score indicates greater skill using the inhaler. RESULTS: This study surveyed 132 schoolchildren with asthma. Of those, only 23 (17.4%) asthmatic children who received inhalation therapy revealed good compliance with their medication regimens. No child was observed to have completed all inhaler techniques correctly. Those family members who participated in educational programs and who received instruction from health teams had higher scores for the inhaler checklist (P < 0.05). It was found that children who inhaled medication unaided had a better knowledge of asthma, and their drug inhalation technique was also more skillful (P < 0.03). By multiple regression analysis, we found that determinants of a child's skill at performing the inhalation maneuver included: number of asthma attacks within the preceding year, unaided application of inhaler therapy, older subject age, potential for subjects to receive instructions from parents regarding inhaler use, subjects reading related publications, and the family's degree of satisfaction with the physician's educational program. These variables contributed a total of 23% to variance in the subjects' inhalation technique. CONCLUSION: This study revealed that most asthmatic children being treated with inhaler medication do not use such devices appropriately. More aggressive asthma education is necessary in Taiwan.

Administration, Inhalation↗
PubMed1988

Social and psychological factors underlying inhalant abuse.

There are three distinct types of inhalant users: young inhalant users, adolescent polydrug users, and inhalant-dependent adults. Young inhalant users have a modal age of 12 to 13. They use inhalants and may also use alcohol and marijuana. They are likely to have more emotional problems than nondrug users or young marijuana users. These problems, particularly when they involve feelings of anger and alienation, increase the chances that they will identify with other youth who have similar feelings. When this happens, young people form peer clusters; they find a best friend or form a small gang that has a high potential for getting involved with drugs. Most of these peer clusters use inhalants only a few times a month, although some may become obsessed with inhalant use to the exclusion of nearly all other activities. The data showing that young inhalant users have more emotional problems than either nondrug users or young marijuana users suggest that treatment should involve therapy as well as drug avoidance approaches. Every youth caught using inhalants, however, should not automatically be sent for therapy. Sometimes a youth caught using a drug is not really drug involved and overreaction can be damaging. In addition, the emotional problems of all young inhalant users are not identical. A higher average level of emotional problems only means that some of the young inhalant users have those problems, not all of them. Older adolescents, including those who used inhalants earlier, are not likely to use inhalants. Since young inhalant users seem to be troubled youth, have shown an early penchant for drug use, and have drug-using associates, it seem unlikely that they quit using drugs. They probably move on to other drugs, leaving inhalants behind. The older adolescents who do use inhalants are adolescent polydrug users, with a modal age of around 15 to 16. They take many different drugs, and some of them use inhalants as well. The adolescents who use inhalants are probably using a wider range of drugs than other adolescents and are probably getting high more often. Furthermore, they are likely to be more deviant and may be involved in more aggression and more crime. Inhalant-dependent adults usually have a long history of alcohol and other drug involvement. At some point, inhalants have become their preferred drug. By that time, they are usually in their midtwenties to early thirties. They have serious problems.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Inhalation↗
PubMed2002

Determinants of correct inhalation technique in children attending a hospital-based asthma clinic.

UNLABELLED: Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique. Patient characteristics and the components of inhalation instructions they had received were compared for children demonstrating a correct or incorrect inhalation technique. In addition, the inhalation technique of 47 newly referred patients was followed-up prospectively after repeated comprehensive instruction sessions. Seventy-eight percent of all patients demonstrated a correct inhalation technique. Patients who had received repeated instruction sessions and patients who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely than other children to demonstrate a correct inhalation technique (p < 0.001 and p = 0.03, respectively). Multiple logistic regression analysis showed that repetition of instructions was significantly associated with a correct inhalation technique (odds ratio (OR) 8.2, 95% CI 3.2-21.5; p < 0.0001) irrespective of type of inhaler used. Demonstration of the inhaler use by the patient was significantly associated with a correct inhalation technique for patients using a metered dose inhaler plus spacer device (OR 3.5, 95% CI 1.0-12.6; p = 0.05). but not for patients using a dry powder inhaler (OR 1.6, 95% CI 0.4-6.4; p = 0.54). The number of newly referred patients demonstrating a correct inhalation technique improved from 57.4% to 97.9% after three comprehensive instruction sessions. CONCLUSION: Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children.

Administration, Inhalation↗
PubMed2006

Inhaled human insulin: new drug. No short-term advantages, too many unknowns in the long term.

(1) The standard treatment for type 1 diabetes is intensive insulin therapy, with at least 3 daily subcutaneous injections. Insulin is sometimes useful in type 2 diabetes, in which case the first-line treatment is an injection of isophane insulin at bedtime, in addition to ongoing oral antidiabetic therapy. (2) Pfizer has been granted marketing authorization in the EU for a powdered insulin product for pulmonary inhalation, for the treatment of adults with type 1 or type 2 diabetes. Two dose strengths are available (1 and 3 mg). (3) When inhaled, the insulin powder acts as rapidly as subcutaneous lispro insulin and lasts as long as a standard insulin injection. (4) Inhalation of 1 mg of insulin powder has similar glucose-lowering effects as 3 units of subcutaneous insulin, but inhalation of 3 mg is comparable to 8 units rather than 9 units of injected insulin. Three inhalations of 1 mg each have more glucose-lowering potency than a single inhalation of 3 mg. (5) None of the clinical trials published thus far have assessed the effects of inhaled insulin on clinical complications of diabetes. (6) In patients with type 1 diabetes, 7 randomised trials have compared inhaled insulin plus 1 or 2 subcutaneous injections of long-acting insulin with standard or intensive insulin therapy. They failed to show that intensive insulin therapy consisting of 3 insulin inhalations plus 1 or 2 injections of long-acting insulin reduced the HbA1c concentration or the frequency of hypoglycaemia more effectively than standard insulin therapy consisting of 2 daily subcutaneous insulin injections. (7) In type 2 diabetes, the addition of inhaled insulin has not been compared with the addition of injected insulin in patients whose glycaemia is not controlled by oral antidiabetic therapy. (8) In type 2 diabetes, 3 randomised trials have compared intensive insulin therapy based on inhaled insulin to subcutaneous insulin (2 to 4 daily injections), without oral antidiabetic drugs. The results suggest that glycaemic control is similar with both treatments. (9) The adverse effects of inhaled insulin have been assessed in fewer than 4000 patients participating in clinical trials, fewer than 600 of whom were treated for more than a year. During treatment lasting a few months, the most frequent short-term adverse effects (other than hypoglycaemia) seem to be mild respiratory adverse effects (cough, upper airway infections, etc.). (10) Treatment with inhaled insulin causes a gradual reduction in the peak expiratory flow rate (not convincingly shown to be reversible after the end of treatment) as well as a high incidence of anti-insulin antibodies. The possible long-term clinical consequences of these changes are unknown. The results of planned, long-term comparative trials should be available in 2014-2016. (11) The assessment of inhaled insulin in patients with respiratory disorders is inadequate. The effect of acute respiratory tract infections on the efficacy of inhaled insulin has not been adequately assessed. (12) Smoking (active or passive) and salbutamol, to a lesser extent, have important effects on the efficacy of inhaled insulin. (13) The insulin powder is very sensitive to high humidity, which can occur under normal conditions, leading to a risk of under-dosing. (14) The inhalation device is much larger than an injector pen. It does not permit precise insulin dose adjustment and delivers a maximum of 8 units per inhalation. (15) In practice, the many unknowns concerning the adverse effects of long-term treatment with inhaled insulin powder will probably not be resolved before 2016. In the meantime, subcutaneous injection remains the standard method of insulin delivery.

Administration, Inhalation↗
PubMed2004

Inhaler technique in older people in the community.

BACKGROUND: Good inhaler technique and medication concordance is important for symptom and disease control in chronic airways disease. OBJECTIVES: Establish the prevalence of inhaler use; the main inhaler devices used by older people at home; their ability to use the inhalers they have been prescribed; and the relationship between perceived ease of use and actual performance. DESIGN: Cross-sectional population based study. SUBJECTS: Subjects aged 70 years and over living at home. METHODS: 500 subjects were randomly selected from 5002 subjects aged 70 years and over living at home. Inhalers used over the previous 24 hours were identified by a nurse on home visit. Those with cognitive impairment were excluded. Inhaler system was assessed and graded by a doctor as acceptable (perfect or minor errors) or unacceptable (major errors), using previously published criteria. Perceived ease of use of the device was rated as easy, moderate or difficult. RESULTS: 423 subjects participated in the study. The population prevalence of inhaler use was 15.8% (12.0, 19.7). Of the 91 inhaler devices used, 39 (42.8%) were metered dose inhalers, 34 (37.4%) were metered dose inhalers with large volume spacers, and 18 (19.8%) were breath-actuated devices. Thirty-two subjects (82.1%) using metered dose inhalers had an acceptable technique compared with 33 (97.1%) of those using metered dose inhalers with large volume spacers and 13 (72.2%) of those using breath-actuated devices (P < 0.05). Up to three quarters of inhalers were considered easy to use but 12% of subjects who rated their inhaler device as being easy to use made major errors. CONCLUSION: Metered dose inhaler was the most frequently prescribed inhaler and was used correctly by most subjects especially in combination with large volume spacers. Major errors were more common with breath-actuated devices. Inhaler technique should be checked as patients' perception of their inhaler skills correlates poorly with actual performance.

Administration, Inhalation↗
PubMed2000

Budesonide inhalation suspension: a review of its use in infants, children and adults with inflammatory respiratory disorders.

Budesonide, a topically active corticosteroid, has a broad spectrum of clinically significant local anti-inflammatory effects in patients with inflammatory lung diseases including persistent asthma. In infants and young children with persistent asthma, day- and night-time symptom scores, and the number of days in which beta2-agonist bronchodilators were required, were significantly lower during randomised, double-blind treatment with budesonide inhalation suspension 0.5 to 2 mg/day than placebo in 3 multicentre trials. Significantly fewer children discontinued therapy with budesonide inhalation suspension than with placebo because of worsening asthma symptoms in a study that included children who were receiving inhaled corticosteroids at baseline. Recent evidence indicates that budesonide inhalation suspension is significantly more effective than nebulised sodium cromoglycate in improving control of asthma in young children with persistent asthma. At a dosage of 2 mg/day, budesonide inhalation suspension significantly reduced the number of asthma exacerbations and requirements for systemic corticosteroids in preschool children with severe persistent asthma. In children with acute asthma or wheezing, the preparation was as effective as, or more effective than oral prednisolone in improving symptoms. In children with croup, single 2 or 4mg dosages of budesonide inhalation suspension were significantly more effective than placebo and as effective as oral dexamethasone 0.6 mg/kg or nebulised L-epinephrine (adrenaline) 4mg in alleviating croup symptoms and preventing or reducing the duration of hospitalisation. Early initiation of therapy with budesonide inhalation suspension 1 mg/day appears to reduce the need for mechanical ventilation and decrease overall corticosteroid usage in preterm very low birthweight infants at risk for chronic lung disease. In adults with persistent asthma, budesonide inhalation suspension < or =8 mg/day has been compared with inhaled budesonide 1.6 mg/day and fluticasone propionate 2 mg/day administered by metered dose inhaler. Greater improvements in asthma control occurred in patients during treatment with budesonide inhalation suspension than with budesonide via metered dose inhaler, whereas fluticasone propionate produced greater increases in morning peak expiratory flow rates than nebulised budesonide. Several small studies suggest that the preparation has an oral corticosteroid-sparing effect in adults with persistent asthma and that it may be as effective as oral corticosteroids during acute exacerbations of asthma or chronic obstructive pulmonary disease. The frequency of adverse events was similar in children receiving budesonide inhalation suspension 0.25 to 2 mg/day or placebo in 12-week studies. During treatment with budesonide inhalation suspension 0.5 to 1 mg/day in 3 nonblind 52-week studies, growth velocity in children was generally unaffected; however, a small but statistically significant decrease in growth velocity was detected in children who were not using inhaled corticosteroids prior to the introduction of budesonide inhalation suspension. Hypothalamic-pituitary-adrenal axis function was not affected by short (12 weeks) or long (52 weeks) term treatment with nebulised budesonide. In conclusion, budesonide inhalation suspension is the most widely available nebulised corticosteroid, and in the US is the only inhaled corticosteroid indicated in children aged > or =1 year with persistent asthma. The preparation is suitable for use in infants, children and adults with persistent asthma and in infants and children with croup.

Administration, Inhalation↗
PubMed2005

What plays a role in the choice of inhaler device for asthma therapy?

Inhalation is the preferred route of delivery for anti-asthma drugs. However, in reality inhalers are often prescribed on an empirical basis rather than on evidence-based awareness. Asthma management guidelines also guide inhaler choice, but they offer non-specific advice regarding inhaler choice, are very long and complicated and not conducive to rapid assimilation by a busy GP. In addition, device selection criteria differ according to who you are asking (i.e. the inhalation technologist, the physician or the patient). The ideal inhaler should be small and have a guided sequence of inhalation, leading patients in a logical sequence of events through the inhalation manoeuvre. It should be breath-activated, releasing medication only when all prerequisites for successful inhalation are met. Most importantly, there should be flow-independent deposition of drug in the lungs and feedback on the successfully performed inhalation manoeuvre to reassure the patient that the drug has been successfully released from the inhaler. The ideal inhaler should also have a low intrinsic airflow resistance, making it suitable for use by patients who have a low inspiratory airflow (e.g. children and elderly patients). In order to check for compliance, the ideal inhaler should have an accurate dose counter which is linked to correct inhalation rather than simply to dose release, and patients should be able to use an identical inhaler device to deliver each of their different medications. Finally, from an environmental and cost-effectiveness point of view, the ideal inhaler should be refillable. Among the currently available dry powder inhalers the Novolizer device fulfils several characteristics of an ideal inhaler for the treatment of asthma and chronic obstructive pulmonary disease (COPD).

Anti-Asthmatic Agents↗
PubMed2002

Rapid effect of inhaled fluticasone propionate on airway responsiveness to adenosine 5'-monophosphate in mild asthma.

Inhaled adenosine 5'-monophosphate (AMP) has an "indirect" bronchoconstrictive effect through mast cell degranulation and mediator release, whereas inhaled histamine has a "direct" effect on smooth muscle. Prolonged treatment with inhaled glucocorticosteroids attenuates airway responsiveness (AR) to AMP and histamine. We investigated the early effects of inhaled fluticasone propionate (FP) therapy on AR in 3 consecutive double-blind, randomized, placebo-controlled crossover studies in steroid-naive subjects with mild asthma. In one study, each of 12 subjects received FP 1000 microg or matched placebo for 7 inhalations at 12 hourly intervals; AR to AMP and FEV(1) were measured 2 hours after the 3rd and 7th inhalations. In a second study, each of 12 subjects received FP 100, 250, or 1000 microg or matched placebo for 3 inhalations at 12 hourly intervals; AR to AMP and FEV(1) were measured 2 hours after the 1st and 3rd inhalations. In a third study, each of 8 subjects received a single inhalation of FP 1000 microg or matched placebo; AR to histamine was measured 2 hours later. In the first study, FP 1000 microg significantly attenuated AR to AMP by 2.7 and 2.5 doubling doses after 3 and 7 inhalations, respectively (P < or =.0001). In the second study, FP 100, 250, and 1000 microg significantly attenuated AR to AMP by 1.9, 2.2, and 2.7 doubling doses, respectively, after 1 inhalation and by 2.4, 2.2, and 3.2 doubling doses, respectively, after 3 inhalations (P < or =.0001); a small but significant increase in FEV(1) (>0.15 L) was observed after 3 inhalations but not after 1 inhalation of FP irrespective of dose (P < or =.05). In the third study, a single inhalation of FP 1000 microg had no effect on AR to histamine. We have demonstrated a reduction in AR to AMP but not AR to histamine within 2 hours of a single inhalation of FP. This reflects a rapid, topical anti-inflammatory action of inhaled FP by a mechanism of action that remains unknown.

Adenosine Monophosphate↗
PubMed1999

Effects of equipment dead space and pediatric breathing patterns on inhaled mass of nebulized budesonide.

Inhaled mass, the quantity of aerosolized drug actually inhaled by a patient, can be estimated in vitro by using a piston pump and an inhaled mass filter in a manner that simulates in vivo aerosol delivery. For pediatric patients, measurement with an inhaled mass filter with a large equipment dead space (VDEQ) in relation to a small tidal volume (VT) may underestimate the inhaled mass. The present study investigated the impact of VDEQ on the accuracy of in vitro measured inhaled mass of budesonide suspension for nebulization using Spira Module 1 jet nebulizers (Respiratory Care Center, Hämeenlinna, Finland), inhaled mass filters, VDEQs of different sizes, and pediatric breathing patterns. The VDEQ varied between 14 and 108 mL, and the breathing patterns corresponded to a VT between 50 and 500 mL, to breathing frequencies of 40 to 12 per min-1, to a duty cycle of 0.5 for all breathing patterns, and to a nebulization time of 2 minutes. The results showed that the inhaled mass was a function of the VDEQ for each breathing pattern as defined by the inspiratory minute volume (VI). For a large VT, a small VDEQ affected the inhaled mass of budesonide only marginally, but as the VDEQ increased, the measured inhaled mass decreased to the point that for a VDEQ larger than the VT, the inhaled mass was zero. When the inhaled mass was expressed as a function of an effective volume (VEFF) (i.e., VI corrected for VDEQ), the results showed a linear correlation (R2 = 0.921) between the volume of aerosol inhaled through the nebulizer and the inhaled mass of budesonide. The results of the study indicate that VDEQ has a critical effect on the measurement of inhaled mass in vitro for conventional jet nebulizers using pediatric breathing patterns. This means that the in vitro measured inhaled mass of drug can seriously underestimate the in vivo value. When pediatric breathing patterns are used in vitro, a correction of the VT by the VDEQ should be made in order to more accurately reflect the in vivo inhaled mass of drug.

Administration, Inhalation↗
PubMed1991

Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique.

BACKGROUND The metered dose inhaler is difficult to use correctly, synchronising actuation with inhalation being the most important problem. A breath actuated pressurised inhaler, designed to help patients with poor inhaler technique, was compared with a conventional metered dose inhaler in terms of aerosol deposition and bronchodilator response. METHODS Radioaerosol deposition and bronchodilator response to 100 micrograms salbutamol were measured in 18 asthmatic patients, who inhaled from a conventional metered dose inhaler by their own chosen metered dose inhaler technique, from a conventional metered dose inhaler by a taught metered dose inhaler technique, and from a breath actuated pressured inhaler (Autohaler). RESULTS In the 10 patients who could coordinate actuation and inhalation of the inhaler on their own deposition of aerosol in the lungs and bronchodilator response were equivalent on the three study days. By contrast, in the eight patients who could not coordinate the mean (SEM) percentage of the dose deposited in the lungs with their own inhaler technique (7.2% (3.4%] was substantial lower than those attained by the taught metered dose inhaler technique (22.8% (2.5%] and by Autohaler (20.8% (1.7%]. CONCLUSION Although of little additional benefit to asthmatic patients with good coordination, the Autohaler is potentially a valuable aid to those with poor coordination, and should be considered in preference to a conventional metered dose inhaler in any patient whose inhaler technique is not known to be satisfactory.

Administration, Inhalation↗
PubMed1999

Multiple inhalers confuse asthma patients.

This study investigated the influence of the use of different types of inhalers on the adequacy of inhalation technique among adult asthmatics. Three hypotheses were tested: first, patients using only one type of inhaler will demonstrate adequate inhalation technique more often than those with two or more types. Secondly, patients using a combination of dry powder inhalers (DPIs) will demonstrate correct inhalation technique more often than those using the combination of a metered dose inhaler (MDI) and a DPI. Thirdly, some inhalers or combinations of inhalers are more prone to erroneous inhalation technique than others. Adult outpatients with asthma who regularly used inhaled steroid therapy (n=321) participated in the study. The inhalers investigated were MDIs on the one hand, and the DPIs Turbuhaler, Diskhaler, Cyclohaler, Inhaler Ingelheim and Rotahaler on the other. Of 208 adult asthmatics with only one inhaler, 71% made no inhalation errors versus 61% of 113 patients with two or more different inhalers. Of patients with a combination of DPIs 68% performed all essential checklist items correctly, versus 54% of patients with the combination of "regular" MDI and DPI. Patients using only the Diskhaler made fewest errors. Whenever possible, only one type of inhaler should be prescribed. If a combination is unavoidable, combinations of DPIs are preferable to MDI and DPI. The Diskhaler seems to be the most foolproof device.

Administration, Inhalation↗
PubMed1994

Delivery of beclomethasone dipropionate from a spacer device: what dose is available for inhalation?

BACKGROUND: It is common for inhaled steroids to be delivered through a large volume spacer device. Comparatively little is known about how this practice affects the dose of drug received by patients compared with drug delivered directly from a metered dose inhaler. METHODS: The amount of beclomethasone dipropionate, contained in particles of various size, available for inhalation from a 750 ml polycarbonate spacer (Volumatic) was determined by impinger measurement and high performance liquid chromatography. Three strengths of metered dose inhalers were studied (50 micrograms, 100 micrograms, and 250 micrograms/actuation). The effect of multiple actuations of beclomethasone dipropionate into a Volumatic spacer, and increasing residence times of drug within the spacer before inhalation, on the amount of drug available to the patient for inhalation was determined. RESULTS: The amount of beclomethasone dipropionate in particles < 5 microns when delivered by a spacer device or directly from a metered dose inhaler was similar. The total amount of beclomethasone dipropionate available for inhalation per actuation decreased by 20 micrograms with the 50 micrograms inhaler, 48 micrograms with the 100 micrograms inhaler, and 161 micrograms with the 250 micrograms inhaler, when given via the spacer compared with delivery directly from a metered dose inhaler. There was a progressive decrease in drug available for inhalation per actuation as the number of actuations into the spacer increased, for all strengths of beclomethasone dipropionate tested. A progressive decrease in drug recovered per actuation was also seen with increasing residence times of drug within the spacer before inhalation. CONCLUSIONS: Use of the spacer device significantly reduced the amount of nonrespirable beclomethasone dipropionate available for inhalation. The amount of beclomethasone dipropionate within respirable particles decreased considerably following multiple actuations into the spacer and with increasing residence times within the spacer before inhalation. When given via a spacer device beclomethasone dipropionate should be inhaled immediately after actuation and multiple actuations into the device should be avoided.

Beclomethasone↗
PubMed2006

Psychiatric disorders in inhalant users: results from The National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To examine the prevalence and correlates of mood, anxiety, and personality disorders among lifetime inhalant users. METHODS: Statistical analyses were based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States. RESULTS: Inhalant users (N=664) had high lifetime prevalences of DSM-IV mood (48%), anxiety (36%), and personality (45%) disorders. Of all inhalant users, 70% met criteria for at least one lifetime mood, anxiety, or personality disorder and 38% experienced a mood or anxiety disorder in the past year. Prevalences of comorbid psychiatric disorders varied by gender. Compared with male inhalant users, female inhalant users had higher prevalences of lifetime dysthymia (24% versus 16%), any anxiety disorder (53% versus 30%), panic disorder without agoraphobia (25% versus 11%), and specific phobia (28% versus 14%), but a lower prevalence of antisocial personality disorder (22% versus 36%). Female inhalant users also were more likely than male inhalant users to meet criteria for three or more mood or anxiety disorders (15% versus 8%) in the past year. Among inhalant users with comorbid disorders, those who developed social or specific phobia typically experienced onset of these disorders prior to initiation of inhalant use; all other mood and anxiety disorders usually developed following the onset of inhalant use. Inhalant users who were women, poor, less educated, with early onset of inhalant use, family histories of psychopathology, and personal histories of substance abuse treatment had increased odds of psychiatric disorders. CONCLUSIONS: Psychiatric disorders are highly prevalent among inhalant users nationally and female inhalant users are more likely than male inhalant users to experience multiple psychiatric disorders. Inhalant use and its consequences among females warrant greater research attention.

Administration, Inhalation↗
PubMed2006

Inhalant use and disorders among adults in the United States.

OBJECTIVE: To examine the patterns of adult inhalant use and correlates of inhalant use disorder. METHOD: We drew study data from the 2002 and 2003 National Surveys on Drug Use and Health (NSDUH). We used logistic regression to identify the characteristics associated both with inhalant use and inhalant use disorder. RESULTS: One in 10 of all adults had used an inhalant at least once in their lives, and 0.5% used one in the past year. Among all past year inhalant users, 8% met the criteria for an inhalant use disorder (i.e., 6.6% for abuse and 1.1% for dependence) within that period. We found an increased prevalence of past year inhalant use among young adults aged 18-25 years, Asians, past year alcohol abusers and dependents, lifetime drug users, white women, and men reporting symptoms of serious mental illness. Inhalant-using adults who met the criteria for an inhalant use disorder were predominantly adults aged 35-49 years and were less educated, had received recent professional treatment for emotional or psychological problems, used inhalants weekly, and had a coexisting alcohol use disorder. CONCLUSION: The patterns and consequences of adult inhalant use differ from those of adolescents. Compared with adolescent inhalant users, adult users tend not to initiate inhalant use until adulthood, use inhalants less frequently, use fewer inhalants, and are less likely to engage in criminal activities.

Administration, Inhalation↗
PubMed1996

[Effects of inhaled anticholinergic agents and beta 2-agonists on distilled water induced cough in patients with chronic cough].

The purpose of this study was to evaluate the usefulness of ultrasonically nebulized distilled water (UNDW) inhalation for assessing cough receptor sensitivity and also the effects of inhaled anticholinergic agents and beta 2-agonists on the number of coughs induced by the UNDW inhalation in patients with chronic cough. All patients were non-smokers and had neither bronchial hyperreactivity nor atopic status. We studied the effects of inhaled oxitropium bromide (300 micrograms) and fenoterol hydrobromide (600 micrograms) on the number of coughs induced by UNDW inhalation for 3 minutes in 9 patients with chronic cough and the effects of inhaled fenoterol hydrobromide (400 micrograms) on the number of coughs induced by UNDW inhalation for 1 minute in 8 patients with chronic cough using a randomized, double-blind, cross-over method. There was no significant difference in pulmonary function test results before and after UNDW inhalation. In both the 3-minute and 1-minute UNDW inhalation studies, the number of coughs was greater in the patients than in normal subjects. Patients with chronic cough may have a high level of cough sensitivity, inhaled fenoterol significantly reduced the number of coughs in the patients in both the 3-minute and 1-minute UNDW inhalation studies (p < 0.05). However, compared with control, inhaled oxitropium did not reduce the number of coughs caused by the 3-minute UNDW inhalation in the patients. Tachyphylaxis was observed in normal subjects in the 3-minute UNDW inhalation study when repeated at a 30-minute interval. We conclude that 1-minute UNDW inhalation method may be safe and useful for measuring cough receptor sensitivity of patients with chronic cough and that inhaled beta 2-agonists may have an inhibitory effect on cough induced by irritation of cough receptors through unknown mechanisms other than the bronchodilator effect.

Administration, Inhalation↗
PubMed1993

[Compliance with inhalation therapy in children with respiratory diseases].

Air compressors for inhalation devices were equipped with counters which were activated whenever the inhalation was started. They recorded the time of the activated inhaler. The counters were invisible for the parent and the doctor. 40 outpatients, all children, were randomly given such a device for treatment at home under surveillance of their parents. The duration, dose and frequency of inhalation was explained, and the parents were instructed that if the child should not be well, the inhalation frequency could be doubled. 21 children (age: 3.8 +/- 3.7 years from two months to 14 years), five girls, 16 boys, were on the inhalation devices equipped with the counter; ten had asthma, four acute bronchitis, four mild bronchiolitis, one had pertussis, one cystic fibrosis and one pneumonia. The prescribed inhalation treatment extended over 21 +/- 14 days (3 to 50), the inhalation frequency per day was one to three times. The measured inhalation unit (recorded inhalation time times frequency) amounted to 4.87 +/- 5.01 vs. 4.31 +/- 3.58 (n.s.) for the expected unit (expected inhalation units according to the prescription). The maximum and the minimum differences for the measured vs. the expected unit were significantly different (p < 0.001). Ten children inhaled 80 to 120% of the prescribed inhalation units, six children inhaled more than 140%, and five children less than 70% of the prescribed units. This resulted in an overall inhalation compliance of 47.6%. This is the first double-blind study carried out so far studying inhalation compliance in children with respiratory diseases.

Adolescent↗
PubMed2000

Parental concern towards the use of inhaled therapy in children with chronic asthma.

BACKGROUND: Parental attitudes towards the use of inhaled therapy in children with chronic asthma influence treatment adherence and outcome. In the present study, we evaluated the perceptions and concerns of parents of children with chronic asthma towards inhaled therapy. METHODS: A self-administered standard questionnaire was distributed to parents of children attending the Paediatric Asthma Clinic. All these children required inhaled steroids for treatment. RESULTS: One-hundred and twelve of 170 parents (66%) surveyed were concerned with inhaled therapy. The most common concern with its use was medication side effects (91%), followed by 'inhaler dependency' (86%), cost of the inhaler (34%) and difficulty in using the inhaler (15%). Parental perception that the oral route was superior to the inhaled route, preference for the oral route for asthma prophylaxis and a higher steroid dose required for prophylaxis were more likely to be associated with concerns towards inhaled therapy. More importantly, these children were also more likely to miss > 25% of their prescribed doses of inhaled steroids (46 vs 22% in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.007) and had a higher mean number of nebulization treatments in the last year (3.2 +/- 2.9 vs 1.8 +/- 1.3 in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.01). CONCLUSIONS: A significant proportion of parents whose children were on inhaled prophylaxis had concerns towards the use of inhaled therapy. Parental concern towards inhaled therapy appeared to increase the problem of non-adherence to treatment. Education for these parents will need to be addressed to improve asthma management in our patient population.

Administration, Inhalation↗
PubMed2005

Can patients use all dry powder inhalers equally well?

If patients are unable to use their inhaler, drug delivery may be unsatisfactory and the patients may fail to benefit from the prescribed medication. It is important to consider whether patients can use all dry powder inhalers equally well. Changing a patient from a dry powder inhaler used well to one that the patient is unable to operate effectively could compromise asthma control. The many marketed dry powder inhalers reflect differences in design decisions that could affect lung deposition. Studies using different dry powder inhalers have confirmed that different lung deposition patterns are observed. Furthermore, there may be considerable individual variability in lung deposition. Differences in lung deposition patterns could have clinical effects. Studies may show similar clinical effectiveness with two inhalers, because most products are used at the plateau phase of the dose-response curve, although there may be differences in the adverse event profile. The ideal inhaler does not yet exist. Different dry powder inhalers show some but not all features of the ideal inhaler; hence, patients may prefer some aspects of one inhaler while favouring a different inhaler for other features. The individual balance of features will govern the overall preference for one inhaler over others. The method for operation of dry powder inhalers varies. Ease of use is seen as an important consideration when selecting an inhaler device, which should be evaluated in real-life studies using unselected patient populations. In conclusion, the evidence suggests that patients cannot use all dry powder inhalers equally well.

Administration, Inhalation↗