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Optimal inhalation technique with terbutaline Turbuhaler.

The bronchodilator response after four different modes of inhalation of 0.25 mg terbutaline from a Turbuhaler was assessed, in a double-blind cross-over study, of 14 asthmatic children aged 8-14 yrs (mean 11.6 yrs). The children inhaled as fast as possible (mean peak inspiratory flow rate = 53 l.min-1), because fast inhalations have been found to be more efficient than slow inhalations when the Turbuhaler is used. Tilting the head back during inhalation and a breath-holding pause of 10 s after the inhalation had no significant effect upon bronchodilation. Furthermore, the response was the same whether the children inhaled from residual volume (RV) or functional residual capacity (FRC). These results suggest that this new inhaler can be used with a very simple inhalation technique without any loss of effect. A simple inhalation technique is likely to facilitate teaching and improve compliance.

Administration, Inhalation↗

[Inhalation lesions in the burn patient].

Inhalation injuries are currently the factor most responsible for mortality in thermally injured patients. Inhalation injuries may occur independently, but generally occur together with skin burn. Smoke inhalation affects all levels of the respiratory system and the extent of the inhalation injury depends on the duration, exposure, amount and toxicity of the fume temperature, concentration and solubility of toxic gases, the occurrence of the accident in a closed space and pre-existing diseases. Smoke inhalation also induces changes in the systemic organs with the need for more fluid for resuscitation. Systemic vasoconstriction, with an elevation in systemic vascular resistance, a fall in myocardial contractility and a great increase in lymphatic flow in soft tissue are the most important changes in systemic organs. On admission of a burn patient there is a high suspicion of inhalation injury when there are signs and symptoms such as hoarseness, strides, dyspnea, carbonaceous sputum, anxiety or disorientation, with or without face burns. The patient with these findings has partial airway obstruction and there is substantial risk complete airway obstruction occurring of secondary to the edema. Patients with suspected inhalation injury should be intubated so as to maintain airway patency and avoid a total obstruction. This group of patients frequently develop respiratory failure with the need for mechanical ventilatory support. Nosocomial infections, sepsis and multiple organ system failure may occur. Late complications of inhalation injury are tracheitis, tracheal stenosis or tracheomalacia and chronic airway disease, which is relatively rare. Early diagnosis of inhalation injury and treatment in a Burn Unit by a group of highly motivated clinicians and a good team of nurses is essential in order to decrease the morbidity and mortality related to inhalation injury.

Burns, Inhalation↗

Dynamic change of the upper airway during inhalation via aerosol delivery devices.

Although it is likely that the upper airway is a major factor in the large inter- and intra-subject variation in deposition of inhaled drug aerosols in the lung, data on the configuration of the upper airway during inhalation is sparse. We have developed a unique method, using magnetic resonance imaging, to reconstruct the upper airway in three dimensions during inhalation from aerosol devices used to deliver medication to patients with asthma, chronic obstructive pulmonary disease, and cystic fibrosis. Ten healthy adults were imaged while inhaling from a pressurized metered dose inhaler (pMDI), a spacer used with pMDI (spacer), and a high-resistance dry powder inhaler, the Turbuhaler (DPI). The mean cross-sectional area of the oropharyngeal region was significantly larger (Wilcoxon's signed-rank test with Bonferroni correction, p < 0.0167) when the DPI (281 [143] mm2, mean [SD]) was used compared to the spacer (205 [32] mm2, p = 0.016) or pMDI (152 [48] mm2, p = 0.013). Considerable variations in the cross-sectional areas of the oral cavity, oropharynx, and larynx were seen when compared to the upper trachea. The main cause for this was the varying position of the tongue during inhalation via the devices. Although differences were observed when comparing the total volume of the upper airway during inhalation via the DPI (70 [17] cm3) to the pMDI (56 [20] cm3, p = 0.037) or spacer (59 [12] cm3, p = 0.022), these did not reach significance. This study shows that there are very significant variations in the configuration of the upper airway when different devices are used for inhalation. These changes are likely to be produced by a number of factors, including tongue position, device airflow resistance, and patient effort.

Administration, Inhalation↗

[Analysis of the factors associated with drugs remaining in the Diskhaler following inhalation of fluticasone propionate].

Because it is well known that drug remains in the fluticasone propionate Diskhaler (FP-DH) following a single inhalation, the following patient information is recommended. "Please inhale more than once or twice if any drug remains in the device after inhalation". It is believed the inspiratory flow rate of the individual patient has an influence on the amount of drug that remains in the device. If the dosing performance of FP-DH is dependent on inspiratory effort, establishment of a method of inhalation that makes it independent of inspiratory flow rate is important in clinical practice. In the present study, we investigated the influence of various methods of inhalation of drug remaining in the FP-DH. No significant differences were observed regarding the drug remaining in the device among the inhalation times examined (range, 0.5-2.5 s) or the number of inhalations (range, 1-3 times). On the other hand, the amount of drug remaining in the device did decrease by tapping the device before the second inhalation. The results suggest that the amount of drug remaining in the device can be decreased by tapping the device after the first inhalation if the patient's inspiratory flow rate is low.

Administration, Inhalation↗

Pharmacokinetic comparison of beclomethasone dipropionate extrafine aerosol from two inhaler devices in children with asthma.

OBJECTIVE: The primary objective was to test the comparability of the pharmacokinetics of beclomethasone dipropionate (BDP) delivered from a pressurized extrafine solution formulation in two inhalation devices in children with asthma. One inhaler was actuated using the press and breathe (P&B) technique and the other was breath-actuated (AH); both inhalers used HFA-134a as propellant. METHODS: Eighteen children aged between 9 years and 12 years entered and completed the study; written informed consent was obtained from all patients and their legal guardians. Each patient received, according to a randomized three-period crossover design, 200 microg BDP as four inhalations from 50 microg/actuation P&B, 200 microg BDP as four inhalations from 50 microg/actuation AH, and 400 microg BDP as four inhalations from 100 microg/actuation AH. Each patient was instructed on the proper use of each device once, at the screening visit. Patients self-administered all inhalations at the same time of day during the study without further coaching. Blood samples were collected for 24 h during each period to assay for the presence of BDP and metabolites. The log-transformed pharmacokinetic data were compared using a confidence-interval approach. RESULTS: Almost all the BDP-derived material in the plasma was the active metabolite beclomethasone 17-monopropionate; pharmacokinetic analyses were only performed for this metabolite. The ratios each of the pharmacokinetic parameters maximum plasma concentration (C(max)) and area under the plasma concentration-time curve (AUC), between the AH and P&B inhaler devices, were 0.94 and 1.1, respectively, and the corresponding 95% confidence intervals demonstrated comparability of the devices. Dose proportionality of C(max) and AUC between the 200-microg and 400-microg doses was similarly shown. About twice as many inhalation errors occurred during the P&B administration as during the AH periods, but the incidence was still low and did not result in any change in pharmacokinetics. CONCLUSION: The rate and extent of drug absorption was comparable from the P&B and AH inhaler devices in children with asthma. Dose proportionality was also observed.

Aerosols↗

Inhaled recombinant interferon gamma in patients with lung cancer: pharmacokinetics and effects on chemiluminescence responses of alveolar macrophages and peripheral blood neutrophils and monocytes.

PURPOSE: A Phase I trial was conducted to investigate clinical toxicity, pharmacokinetics, and chemiluminescence (CL) responses of alveolar macrophages (AM) and peripheral blood neutrophils and monocytes after inhalation of recombinant interferon (r IFN)-gamma. METHODS AND MATERIALS: Eight patients with lung cancer inhaled r IFN-gamma as single doses of 0.1, 0.2, 0.6, 1.8, or 5.4 mg. Bronchoalveolar lavage was performed three times, 21 h before as well as 3 and 27 h after inhalation. RESULTS: Interferon-gamma was detectable in bronchoalveolar lavage fluid (BALF) samples taken 3 h after inhalation in doses of > or = 0.6 mg. Before inhalation, AM in four out of seven patients studied showed vigorous lucigenin-enhanced CL responses to N-formyl-methionyl-leucyl-phenylalanine and opsonized zymosan particles. Furthermore, the responses were markedly increased 3 h after inhalation. In three out of seven patients, AM in the pretreatment BALF samples showed low or no CL responses, and the responses did not increase after inhalation of IFN-gamma, suggesting that the patients were anergic. Postinhalation CL responses did not correlate with the dose of IFN-gamma inhaled. Circulating IFN-gamma was detected in one patient receiving the highest dose. No changes referable to IFN-gamma inhalation were found in the CL responses of blood neutrophils and monocytes. During the 24 h follow-up, two patients developed transient fever-reactions. CONCLUSIONS: The findings suggest that inhalation may provide a way to increase alveolar concentrations of IFN-gamma and to augment respiratory burst capacity of AM without any major side effects. This approach may have clinical implications for the treatment of tumors and infections of the respiratory tract.

Adult↗

Asthma inhaler use and barriers in a population-based sample of African-American and white adolescents.

BACKGROUND: There is little information on inhaler medication and barriers to use among a population-based sample of adolescents and whether possible variations in asthma treatment by ethnic group exist. OBJECTIVE: We describe the prevalence of inhaler use and identify barriers for proper use of asthma medication in a population-based sample of adolescents of which 34% are African-American. METHODS: A cross-sectional survey using the ISAAC (International Survey of Asthma and Allergies in Children) questionnaire was conducted in a school population-based sample (n = 2056) of 13 to 14-year-old eight grade students in the Charlotte-Mecklenburg, North Carolina public school system. Questions were asked about symptom prevalence, asthma diagnosis, inhaler use, and barriers to care. RESULTS: Fourteen percent of the children (296/2056) reported using an inhaler in the last 12 months with no differences among African-American children and white children. Twenty-six percent of inhaler users were not allowed to carry their medication on their person while at school. Girls were more likely to be allowed to carry their inhalers at school and diagnosed asthmatic girls had a higher prevalence of wheezing in the last year (47%) compared with diagnosed asthmatic boys (35%). Smoking prevalence was higher in inhaler users (26%) compared to the study population (19%). CONCLUSIONS: Inhaler use is high in this population. Adolescents using inhalers need to reduce their smoking levels. Schools need to reevaluate their policies on the use of inhalers at school.

Adolescent↗

Effect of salmeterol on patients' adherence to their prescribed refills for inhaled corticosteroids.

BACKGROUND: Optimal treatment for persistent asthma requires multiple classes of medication, including antiinflammatory agents and bronchodilators. Inhaled corticosteroids are the most effective antiinflammatory agents available and are recommended by recent guidelines as first-line treatment. Salmeterol, a long-acting inhaled bronchodilator, is recommended as adjunctive therapy to inhaled corticosteroids. Non-adherence to prescribed medication is prevalent and has been implicated in asthma exacerbations. Salmeterol's benefits in terms of asthma control are readily perceived by patients whereas the benefits of inhaled corticosteroid therapy may be less apparent. OBJECTIVE: To evaluate whether the addition of salmeterol to a medication regimen affects patient adherence to prescription refills for inhaled corticosteroids. METHODS: A retrospective medical chart and pharmacy claims record review before and after the addition of salmeterol was used. Medication adherence rates were calculated for 67 patients requiring inhaled corticosteroids for at least 8 months before and after the addition of salmeterol. RESULTS: Adherence with inhaled corticosteroid therapy before (49.7% +/- 29.3%) and after (56.5% +/- 28.6%) the introduction of salmeterol was not significantly different (P = .0785, pre versus post). Adherence with salmeterol was significantly higher (58.7% +/- 28.3%) than inhaled corticosteroids at baseline (P = .0202), but not with concurrent use. Dosing frequency of inhaled corticosteroid administration was not a significant factor in adherence, but increasing age was (r = 0.41788, P = .0048). CONCLUSIONS: The addition of salmeterol does not adversely affect the adherence rates to prescription refills for prescribed inhaled corticosteroid therapy. On average, important antiinflammatory treatment should not be supplanted with salmeterol if prescribed in combination.

Adolescent↗

Albuterol via Turbuhaler versus albuterol via pressurized metered-dose inhaler in asthma.

BACKGROUND: Inhaled albuterol is most commonly self-administered by patients using a pressurized metered-dose inhaler (pMDI) but patients often have difficulty using the device. Dry powder devices such as the multi-dose, inspiratory flow driven inhaler (Turbuhaler) are often better handled by patients. OBJECTIVE: We sought to compare the efficacy and tolerability of 100 micrograms of albuterol delivered by a multi-dose, inspiratory flow driven inhaler (Turbuhaler) to a standard dose (200 micrograms) delivered by a pMDI (Ventolin) in chronic reversible obstructive airways disease. METHOD: In 6 centers, we studied 37 adults [19 men and 18 women, mean age 39 +/- 12 years; mean baseline forced expiratory volume in one second (FEV1) 72 +/- 13% (% predicted)] with stable but symptomatic reversible obstructive airways disease as demonstrated by 15% or greater increase in FEV1 following two puffs (200 micrograms) albuterol by pMDI. The crossover design comprised a 1-week run-in and two 2-week treatment periods separated by a 1-week washout. At the start and end of each treatment period, FEV1 was measured at the clinic. Patients self-administered albuterol 100 micrograms (2 x 50 micrograms) via Turbuhaler or 200 micrograms (2 x 100 micrograms) via pMDI in a double-blind fashion four times daily. Morning and evening peak expiratory flow (PEF) was noted daily. All non-study bronchodilators were withheld while open-label albuterol pMDI was offered for rescue. RESULTS: Of the 37 patients, 30 used inhaled steroids in constant doses throughout the study, one used inhaled cromoglycate and six used no anti-inflammatory therapy. There was no difference between treatment periods in morning PEF, diurnal fluctuation in PEF, increase in PEF following study drug, baseline FEV1 and FEV1 increase following study drug. Although there was no difference in symptom scores between treatments, the use of rescue beta 2-agonist was slightly but significantly higher during the Turbuhaler treatment period (1.34 versus 1.08 inhalations/ day, P = .04). Compliance with study drug was slightly but significantly lower during the Turbuhaler treatment period (87 versus 95%) such that the total number of beta 2-agonist puffs inhaled (scheduled plus rescue) was similar between treatments. With regard to adverse events, both treatments were well tolerated. CONCLUSIONS: These results suggest that the efficacy and tolerability of albuterol 100 micrograms qid inhaled via Turbuhaler is similar to albuterol 200 micrograms qid, inhaled via pMDI in stable reversible obstructive airways disease.

Adult↗

Effect of deep inhalations after a bronchial methacholine provocation in asthmatic and non-asthmatic subjects.

Deep inhalations cause a transient relaxation of the peripheral airways smooth muscles in non-asthmatic subjects. It has been claimed that the airway response to deep inhalations may be different in asthmatic subjects in whom deep inhalations should rather cause bronchoconstriction. The aim of the present study was to find out whether deep inhalations discriminate between asthmatic and non-asthmatic subjects with pre-constricted airways, using a methacholine provocation test protocol with deep inhalations following the last dose of methacholine. In 164 adults, a methacholine provocation was performed. Directly after the FEV1 measurement at the highest metacholine concentration, the subjects took one deep breath and another three deep inhalations 20 s later. One minute after the inhalation of the highest concentration FEV1 was measured twice. Thirty-three asthmatics PD20FEV1 = 0.24 mg (0.13-0.39) (median, 25-75th 75th percentiles) and 131 non-asthmatics PD20FEV1 = 2.05 mg (0.72-10.1) participated. The mean maximal decrease in FEV1 after the provocation test was 36% in the asthmatics and 27% in the non-asthmatics. Corresponding values after the deep inhalations were 18% in the asthmatics and 12% in the non-asthmatics. In conclusion, deep inhalations attenuate the methacholine-induced bronchoconstriction in both asthmatic and non-asthmatic subjects. Thus, the effect of deep inhalations did not discriminate between asthmatic and non-asthmatic subjects.

Adult↗

Influence of flow rate on aerosol particle size distributions from pressurized and breath-actuated inhalers.

Particle size distribution of delivered aerosols and the total mass of drug delivered from the inhaler are important determinants of pulmonary deposition and response to inhalation therapy. Inhalation flow rate may vary between patients and from dose to dose. The Andersen Sampler (AS) cascade impactor operated at flow rates of 30 and 55 L/min and the Marple-Miller Impactor (MMI) operated at flow rates of 30, 55, and 80 L/min were used in this study to investigate the influence of airflow rate on the particle size distributions of inhalation products. Total mass of drug delivered from the inhaler, fine particle mass, fine particle fraction, percentage of nonrespirable particles, and amount of formulation retained within the inhaler were determined by ultraviolet spectrophotometry for several commercial bronchodilator products purchased in the marketplace, including a pressurized metered-dose inhaler (pMDI), breath-actuated pressurized inhaler (BAMDI), and three dry powder inhalers (DPIs), two containing salbutamol sulphate and the other containing terbutaline sulphate. Varying the flow rate through the cascade impactor produced no significant change in performance of the pressurized inhalers. Increasing the flow rate produced a greater mass of drug delivered and an increase in respirable particle mass and fraction from all DPIs tested.

Aerosols↗

Effect of an inhaled thromboxane mimetic (U46619) on airway function in human subjects.

Thromboxane A2(TxA2) has been implicated in the pathogenesis of airway hyperresponsiveness. The effects of inhaled TxA2 on human airway function have not been studied because of its short half-life. U46619 is a chemical that mimics the effects of TxA2. The purpose of this study was to evaluate the effects of inhaled U46619 on human airway function and methacholine airway responsiveness. Airway responsiveness to methacholine and U46619 was measured in 19 subjects (13 asthmatic and six normal) and expressed as the provocative concentration causing a 20% fall in FEV1 (PC20). On one day, methacholine alone was inhaled. On a second day, U46619 was inhaled, then 1 h later methacholine was inhaled. On a third day, U46619 was inhaled, then repeated 1 h later. In six subjects, the effects of isotonic saline or a subthreshold concentration of histamine or U46619 were examined on methacholine airway responsiveness. U46619 was 178 times more potent as a bronchoconstrictor than was methacholine. Airway responsiveness to methacholine was correlated to airway responsiveness to U46619 (r = 0.87, p = 0.001). Subthreshold concentrations of U46619, but not of histamine, increased methacholine airway responsiveness. The mean maximal fall in FEV1 after inhaled methacholine was 13.2% (SEM, 3.4%) after saline, 12.4% (SEM, 2.4%) after histamine, and 25.7% (SEM, 2.0%) after U46619 (p = 0.0004). This effect lasted less than 1 h. There was no tachyphylaxis to repeated inhalations of U46619. These results indicate that in human subjects inhaled U46619 is a potent bronchoconstrictor that, when present in the airways, can cause airway hyperresponsiveness to inhaled methacholine in asthmatic subjects.

Aerosols↗

Subjective and objective measurement of cigarette smoke inhalation.

The pattern of cigarette smoke inhalation was studied in 19 smokers with respiratory inductive plethysmography, a reliable unobtrusive ventilatory monitoring device. The mean volumes inhaled varied widely from 0.27 to 1.97 L, with a group mean (+/- SD) of 0.79 +/- 0.45 L. Mean duration of smoke inhalation varied from 2.0 to 6.8 seconds, with a group mean of 4.5 +/- 1.3 seconds. An inhalation fraction was derived by dividing the inhaled volume by the vital capacity; this fraction varied from 0.09 to 0.47, with a group mean of 0.20 +/- 0.10. Subjects rated the depth that they inhaled smoke into their lungs on a visual analog scale and on a grading system. Correlation between visual analog scale and inhalation fraction was poor (r = -0.15). Also, inhalation fraction bore no relationship to smoking pack-years or current pulmonary function. The smokers' inaccurate assessment of their inhalation pattern may help to explain the poor correlation reported between cigarette smoke inhalation and severity of obstructive lung disease.

Adult↗

Inhalation therapy in children with asthma.

Current consensus guidelines advocate the use of inhalation therapy for all children with asthma. In this paper, the published evidence on technical and practical aspects of inhalation therapy in children with asthma is reviewed. For children under 6 yr of age, nebulizers and metered dose inhaler (MDI)/spacer combinations can be used. Nebulizers are cumbersome, bulky, and difficult to operate. They require technical and hygienic maintenance. A number of studies has shown that nebulizers are no more effective in delivering bronchodilator therapy than MDI/spacer combinations. Thus, for young children with asthma, MDI/spacer combinations are the device of choice for inhalation therapy. Due to static charge, the output from plastic spacers is lower than that from metal spacers. Static charge on plastic spacers can be reduced by washing the spacer in detergent and allow it to drip dry. Most children aged 6 yr or over can use a dry powder inhaler (DPI) reliably. Modern DPIs require relatively low inspiratory flow rates for proper operation. Lung deposition from the Turbuhaler is twice as high as that from the Diskus, but the former device is slightly more difficult to operate than the latter. Many children with asthma have a poor inhalation technique. Because a reliable inhalation technique is the key to successful inhalation therapy, inhalation technique should be instructed carefully and checked repeatedly in every asthmatic child using an inhaler device.

Adolescent↗

NTP Toxicology and Carcinogenesis Studies of Nickel Oxide (CAS No. 1313-99-1) in F344 Rats and B6C3F1 Mice (Inhalation Studies).

Nickel oxide (NiO) "sinters" are used in stainless steel and alloy steel production. Nickel oxide was nominated by the National Cancer Institute to the NTP for testing because exposure to this form of nickel is prevalent in the nickel industry. Increased incidences of lung and nasal sinus cancers have occurred among workers in certain nickel refining facilities, and nickel oxide was studied as part of a class study of nickel compounds. Male and female F344/N rats and B6C3F1 mice were exposed to nickel oxide (high temperature, green nickel oxide; mass median diameter 2.2 +/- 2.6 &mgr;m; at least 99% pure) by inhalation for 16 days, 13 weeks, or 2 years. Genetic toxicology studies were conducted in peripheral blood of B6C3F1 mice exposed to nickel oxide for 13 weeks. 16-DAY STUDY IN RATS: Groups of five male and five female F344/N rats were exposed to 0, 1.2, 2.5, 5, 10, or 30 mg nickel oxide/m(3)(equivalent to 0, 0.9, 2.0, 3.9, 7.9, or 23.6 mg nickel/m(3)) by inhalation for 6 hours per day, 5 days per week for a total of 12 exposure days during a 16-day period. Additional groups of five male and five female rats were exposed to 0, 1.2, 5, or 10 mg/m(3) for tissue burden studies. All core study rats survived until the end of the study, final mean body weights of exposed male and female rats were similar to those of the controls, and there were no clinical findings related to nickel oxide exposure. Absolute and relative lung weights of male and female rats exposed to 10 or 30 mg/m(3) were significantly greater than those of the controls. Pigment particles in alveolar macrophages or within the alveolar spaces were observed in the lungs of exposed groups of males and females. Chronic-active inflammation and accumulation of macrophages in alveolar spaces of the lungs and hyperplasia in the respiratory tract lymph nodes were most severe in 10 and 30 mg/m(3) males and females. Hyperplasia of bronchial lymph nodes occurred in 30 mg/m(3) rats. Atrophy of the olfactory epithelium was observed in one male and one female exposed to 30 mg/m(3). The concentrations of nickel oxide in the lungs of exposed groups of rats were greater than those in the lungs of control groups (males, 42 to 267 mg nickel/g lung; females, 54 to 340 mg/g lung). 16-DAY STUDY IN MICE: Groups of five male and five female B6C3F1 mice were exposed to 0, 1.2, 2.5, 5, 10, or 30 mg nickel oxide/m(3) by inhalation for 6 hours per day, 5 days per week for a total of 12 exposure days during a 16-day period. Additional groups of five male and five female mice were exposed to 0, 1.2, 2.5, or 5 mg/m(3) for tissue burden studies. No exposure-related deaths occurred among core study mice, and final mean body weights of exposed male and female mice were similar to those of the controls. There were no chemical-related clinical findings. Pigment particles were present in the lungs of mice exposed to 2.5 mg/m(3) or greater. Accumulation of macrophages in alveolar spaces was observed in the lungs of 10 and 30 mg/m(3)males and females. The concentrations of nickel oxide in the lungs of exposed groups of mice were significantly greater than those in the lungs of control animals (males, 32 to 84 mg nickel/g lung; females, 31 to 71 mg/g lung). 13-WEEK STUDY IN RATS: Groups of 10 male and 10 female F344/N rats were exposed to 0, 0.6, 1.2, 2.5, 5, or 10 mg nickel oxide/m(3) (equivalent to 0, 0.4, 0.9, 2.0, 3.9, or 7.9 mg nickel/m(3)) by inhalation for 6 hours per day, 5 days per week for 13 weeks. Additional groups of 18 male and 18 female rats were exposed to 0, 0.6, 2.5, or 10 mg/m(3) for tissue burden studies. No exposure-related deaths occurred among core study rats, final mean body weights of exposed male and female rats were similar to those of the controls, and no clinical findings in any group were related to nickel oxide exposure. Lymphocyte, neutrophil, monocyte, and erythrocyte counts; hematocrit values; and hemoglobin and mean cell hemoglobin concentrations in exposed rats were minimally to mildly greater than those of the controls; these differences were most pronounced ironounced in females. Mean cell volumes in exposed rats were generally less than those in the controls. Absolute and relative lung weights of exposed groups of males and females were generally significantly greater than those of controls. Chemical-related nonneoplastic lesions were observed in the lungs of male and female rats exposed to concentrations of 2.5 mg/m(3) or higher, and the severity of these lesions generally increased with exposure concentration. Accumulation of alveolar macrophages, many of which contained black, granular pigment, was generally observed in all exposed groups of males and females, and increased incidences of inflammation occurred in males and females exposed to 2.5 mg/m(3) or higher. In addition, lymphoid hyperplasia and pigment occurred in the bronchial and mediastinal lymph nodes of 2.5, 5, and 10 mg/m(3) males and females. The concentration of nickel oxide in the lungs of 0.6, 2.5, and 10 mg/m(3)males was greater than in the lungs of controls at 4, 9, and 13 weeks, and nickel continued to accumulate in the lung at the end of the 13-week exposures (4 weeks, 33 to 263 mg nickel/g lung; 9 weeks, 53 to 400 mg/g lung; 13 weeks, 80 to 524 mg/g lung). 13-WEEK STUDY IN MICE: Groups of 10 male and 10 female B6C3F1 mice were exposed to 0, 0.6, 1.2, 2.5, 5, or 10 mg nickel oxide/m(3) by inhalation for 6 hours per day, 5 days per week for 13 weeks. Additional groups of six male and six female mice were exposed to 0, 0.6, 2.5, or 10 mg/m(3) for tissue burden studies. No exposure-related deaths occurred among core study animals, final mean body weights of exposed male and female mice were similar to those of the controls, and no clinical findings in any group were related to nickel oxide exposure. Hematocrit values and erythrocyte counts in 5 and 10 mg/m(3) females were minimally greater than those of the controls, as was the hemoglobin concentration in 5 mg/m(3) females. Absolute and relative lung weights of 10 mg/m(3) males and females were significantly greater than those of controls, and absolute and relative liver weights of 10 mg/m(3) males were significantly less than those of controls. Accumulation of alveolar macrophages, many of which contained pigment particles, occurred in all groups of mice exposed to nickel oxide. Inflammation (chronic active perivascular infiltrates or granulomatous) occurred in 2.5, 5, and 10 mg/m(3) males and females. In addition, lymphoid hyperplasia and pigment occurred in the bronchial lymph nodes of males and females exposed to 2.5 mg/m(3) or higher. The concentration of nickel in the lung was greater than that of controls in 0.6, 2.5, and 10 mg/m(3) males at 13 weeks (42 to 736 mg nickel/g lung). 2-YEAR STUDY IN RATS: Survival, Body Weights, Clinical Findings, and Hematology Groups of 65 male and 65 female F344/N rats were exposed to 0, 0.62, 1.25, or 2.5 mg nickel oxide/m(3) (equivalent to 0, 0.5, 1.0, or 2.0 mg nickel/m(3)) by inhalation for 6 hours per day, 5 days per week for 104 weeks. Survival of exposed male and female rats was similar to that of the controls. Mean body weights of 1.25 mg/m(3) females and 2.5 mg/m(3) males and females were slightly lower than those of the controls during the second year of the study. No chemical-related clinical findings were observed in male or female rats during the 2-year study. No chemical-related differences in hematology parameters were observed in male or female rats at the 15-month interim evaluation. Pathology Findings: Absolute and relative lung weights of 1.25 and 2.5 mg/m(3) males and females were significantly greater than those of the controls at 7 and 15 months. At 2 years, there were exposure-related increased incidences of alveolar/bronchiolar adenomas alveolar/bronchiolar adenoma or carcinoma (combined) in males and females. Incidences of atypical alveolar epithelial hyperplasia in the lungs generally increased with increasing exposure concentration in male and female rats. Chronic inflammation of the lung was observed in most exposed rats at 7 and 15 months and at 2 years; the incidences in exposed males and females at 2 years were significantly greater than those in the controls, and the severity of the inflammation increased in exposed groups. The incidences of pigmentation in the alveolus of exposed groups of males and females were significantly greater than those of the controls at 7 and 15 months and at 2 years. Pigmentation in the bronchial lymph nodes similar to that in the lungs was observed in all exposure groups with the exception of 0.62 mg/m(3)males and females at 7 months. Lymphoid hyperplasia was observed in the bronchial lymph nodes of 1.25 and 2.5 mg/m(3) males and females at 7 and 15 months, and the incidence at 2 years generally increased with exposure concentration. At 2 years, there was an exposure-related increase in the incidence of benign pheochromocytoma in males and females. The incidences of benign pheochromocytoma and adrenal medulla hyperplasia in 2.5 mg/m(3) females and the incidence of benign or malignant pheochromocytoma (combined) in 2.5 mg/m(3) males were significantly greater than those in the controls. Tissue Burden Analyses: Nickel concentrations in the lungs of exposed rats were greater than those in the controls at 7 and 15 months (7 months, 173 to 713 mg nickel/g lung; 15 months, 262 to 1,116 mg/g lung), and nickel concentrations increased with increasing exposure concentration and with time. 2-YEAR STUDY IN MICE: Survival, Body Weights, Clinical Findings, and Hematology Groups of 74 to 79 B6C3F1 mice were exposed to 0, 1.25, 2.5, or 5 mg nickel oxide/m(3) by inhalation for 6 hours per day, 5 days per week for 104 weeks. Survival of exposed male and female mice was similar to that of the controls. Mean body weights of 5 mg/m(3) females were slightly lower than those of the controls during the second year of the study. No chemical-related clinical findings were observed in male or female mice during the 2-year study. No chemical-related differences in hematology parameters were observed in male or female mice at the 15-month interim evaluation. Pathology Findings: At 2 years, the incidence of alveolar/bronchiolar adenoma in 2.5 mg/m(3) females was significantly greater than that of the controls, as was the incidence of alveolar/bronchiolar adenoma or carcinoma (combined) in 1.25 mg/m(3) females. Generally, incidences of chronic inflammation increased with exposure concentration in males and females at 7 and 15 months. Bronchialization of minimal severity in exposed animals and proteinosis were first observed at 15 months. At 2 years, the incidences of chronic inflammation, alveolar epithelial hyperplasia, and proteinosis in exposed groups of males and females were significantly greater than those of the controls. The severity of chronic inflammation increased with exposure concentration in females, and proteinosis was most severe in 5 mg/m(3) males and females. Pigment occurred in the lungs of nearly all exposed mice at 7 and 15 months and at 2 years, and the severity increased with exposure concentration. Lymphoid hyperplasia occurred in two animals after 7 months; at 15 months, lymphoid hyperplasia occurred in males exposed to 2.5 and 5 mg/m(3) and in all exposed groups of females. At 2 years, lymphoid hyperplasia occurred in some control animals, but this lesion was still observed more often in exposed males and females and the incidence increased with exposure concentration. Pigmentation was observed in the bronchial lymph nodes of exposed males and females at 7 and 15 months and in nearly all exposed animals at 2 years. Tissue Burden Analyses: Nickel concentrations in the lungs of exposed mice were significantly greater than those in the controls at 7 and 15 months (7 months, 162 to 1,034 mg nickel/g lung; 15 months, 331 to 2,258 mg/g lung), and nickel concentrations increased with increasing exposure concentration and with time. GENETIC TOXICOLOGY: No increase in the frequency of micronucleated normochromatic erythrocytes was observed in peripheral blood samples from male or female mice exposed to nickel oxide. CONCLUSIONS: Under the conditions of these 2-year inhalation studies, there was some evidence of carcinogenic activity of nickel oxide in male F344/N rats based on increased incidences of alveolar/bronchiolar adenoma or carcinoma (combined) and increased incidences of benign or malignant pheochromocytoma (combined) of the adrenal medulla. There was some evidence of carcinogenic activity of nickel oxide in female F344/N rats based on increased incidences of alveolar/bronchiolar adenoma or carcinoma (combined) and increased incidences of benign pheochromocytoma of the adrenal medulla. There was no evidence of carcinogenic activity of nickel oxide in male B6C3F1 mice exposed to 1.25, 2.5, or 5 mg/m(3). There was equivocal evidence of carcinogenic activity of nickel oxide in female B6C3F1 mice based on marginally increased incidences of alveolar/bronchiolar adenoma in 2.5 mg/m(3) females and of alveolar/bronchiolar adenoma or carcinoma (combined) in 1.25 mg/m(3) females. Exposure of rats to nickel oxide by inhalation for 2 years resulted in inflammation and pigmentation in the lung, lymphoid hyperplasia and pigmentation in the bronchial lymph nodes, and hyperplasia of the adrenal medulla (females). Exposure of mice to nickel oxide by inhalation for 2 years resulted in bronchialization, proteinosis, inflammation, and pigmentation in the lung and lymphoid hyperplasia and pigmentation in the bronchial lymph nodes. Synonyms: Bunsenite; C.I. 77777; green nickel oxide; mononickel oxide; nickel monoxide; nickel oxide sinter 75; nickel protoxide; nickel (II) oxide; nickel (T+) oxide; nickelous oxide

Journal Article↗

NTP Toxicology and Carcinogenesis Studies of Ozone (CAS No. 10028-15-6) and Ozone/NNK (CAS No. 10028-15-6/ 64091-91-4) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

There is widespread concern over the health effects of oxidant air pollutants. The state of California and the Health Effects Institute (HEI) (a nonprofit research institute funded jointly by the U.S. Environmental Protection Agency [USEPA] and combustion engine manufacturers) nominated ozone for evaluation in long-term animal studies. The NTP study designs were a result of a series of meetings at the NIEHS with scientists from NIEHS, USEPA, and HEI, as well as experts from academic institutions working in the area of air pollutants. Male and female F344/N rats and B6C3F1 mice were exposed to ozone by inhalation for 4 weeks, 2 years, or for 124 weeks (rats) or 130 weeks (mice). The oxygen used to generate the ozone was greater than 99.9% pure. Additional groups of male F344/N rats were administered injections of 4-(N-methyl-Nnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (~99% pure) 3 times per week for 20 weeks and exposed to ozone by inhalation for 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium. 4-WEEK OZONE STUDY IN RATS: Groups of five male and five female F344/N rats were exposed to 0, 0.5, or 1.0 ppm ozone by inhalation 6 hours per day, 5 days per week, for a total of 20 days. All rats survived to the end of the study. The final mean body weights and mean body weight gains of 0.5 ppm males and females and of 1.0 ppm females were similar to those of the controls. The final mean body weight of 1.0 ppm males was 7% lower than that of the controls. Clinical findings included hypoactivity in 1.0 ppm males and females and ruffled fur in exposed groups of males. Male and female rats exposed to 0.5 or 1.0 ppm developed multifocal lesions of the lung, which consisted of infiltration of granulocytes and macrophages with extension of the bronchial epithelium into the alveolar ducts. Female rats exposed to ozone developed minimal squamous metaplasia of the laryngeal epithelium at the base of the epiglottis. Absolute and relative lung weights of all exposed groups of males and females were greater than those of the controls, and absolute and relative thymus weights of all exposed groups were generally lower than those of the controls. 4-WEEK OZONE STUDY IN MICE: Groups of five male and five female B6C3F1 mice were exposed to 0, 0.5, or 1.0 ppm ozone by inhalation 6 hours per day, 5 days per week, for a total of 20 days. All mice survived to the end of the study. The final mean body weights and body weight gains of all exposed groups of mice were less than those of the controls. Hypoactivity was observed in 1.0 ppm mice. Male and female mice exposed to 0.5 or 1.0 ppm ozone developed patchy, multifocal lesions of the lung, which consisted of infiltration of granulocytes and macrophages with extension of the bronchial epithelium into the alveolar ducts. The relative lung weight of 1.0 ppm males was significantly greater than that of the controls. There were no other statistically significant differences in absolute or relative organ weights in males or females. 2-YEAR OZONE STUDY IN RATS: The 2-year study was designed to include the present USEPA standard (0.12 ppm), the maximum concentration believed compatible with long-term survival (1.0 ppm), and an intermediate concentration (0.5 ppm). Groups of 50 male and 50 female F344/N rats were exposed to 0, 0.12, 0.5, or 1.0 ppm ozone by inhalation for 6 hours per day, 5 days per week, for 105 weeks. Survival, Body Weights, and Clinical Findings: Survival of exposed groups of rats was similar to that of the controls at the end of the study. The mean body weights of 0.12 and 0.5 ppm males and females were similar to those of the controls throughout the study. The mean body weights of 1.0 ppm males and females were slightly lower than those of the controls throughout the study. Hypoactivity was observed in male and female rats exposed to ozone. Pathology Findings: Increased incidences of ozone-induced metaplasia occurred in the nose and lung of rats exposed to 0.5 or 1.0 ppm ozone. The lesions in the nose were characterized by an increase in the number of goblin the number of goblet cells in the respiratory epithelium with mild squamous metaplasia of the cuboidal epithelium on the lateral wall. The increase in the number of goblet cells was found primarily in level I and II epithelium occurring along the lateral wall and on the maxilloturbinates and nasoturbinates. The metaplasia in the lung was a patchy multifocal lesion consisting of extension of the bronchial epithelium into the alveoli of the centriacinar region. This may represent more an extension of the bronchial epithelium into the pulmonary parenchyma than an actual transition of one epithelial cell type into another. There were increased incidences of squamous metaplasia at the base of the epiglottis characterized by one or more layers of flattened epithelial cells where low cuboidal cells are normally found. There were no increases in the incidences of alveolar/bronchiolar adenoma or carcinoma in either males or females exposed to ozone. LIFETIME OZONE STUDY IN RATS: For this study, rats were exposed to 0.5 and 1.0 ppm ozone for an additional 6 months to determine the effect of extended exposure on neoplasm incidence. Groups of 50 male and 50 female F344/N rats were exposed to 0, 0.5, or 1.0 ppm ozone by inhalation for 6 hours per day, 5 days per week, for 125 weeks. Survival, Body Weights, and Clinical Findings: Survival rates of exposed rats were similar to those of the controls. The mean body weights of 0.5 ppm males and females were similar to those of the controls throughout the study. The mean body weights of 1.0 ppm males and females were slightly lower than those of the controls for the first two years of the study. Hypoactivity was observed in exposed groups of males and females. Pathology Findings: Increased incidences of metaplasia occurred in the nose, larynx, and lung of rats exposed to 0.5 or 1.0 ppm ozone. The lung lesions were multifocal, centriacinar and were characterized by the presence of cuboidal epithelium (ciliated and nonciliated) along the alveolar ducts where type I epithelium is normally present. Inflammation (histiocytic infiltration) and interstitial fibrosis were observed in the lung of exposed males and females, and hyperplasia was observed in the nose of exposed male and female groups. There were no ozone-related increased incidences of neoplasms. 2-YEAR OZONE/NNK STUDY IN MALE RATS: An intermediate concentration of 0.5 ppm ozone was combined with exposure to two levels of a known carcinogen (0.1 and 1.0 mg NNK/kg body weight) in order to determine if ozone promotes the carcinogenic process or acts as a cocarcinogen. Groups of 48 male F344/N rats were exposed to 0 or 0.5 ppm ozone by inhalation, 6 hours per day, 5 days per week for 105 weeks. During the first 20 weeks of the study, these rats were subcutaneously injected with 0, 0.1, or 1.0 mg NNK per kg body weight in trioctanoin three times weekly. Survival and Body Weights: Two-year survival rates of male rats were similar in all groups. Final mean body weights of all males exposed to NNK alone or NNK and ozone were similar to that of the controls, with the exception of rats exposed to 1.0 mg NNK/kg body weight and 0.5 ppm ozone. Hypoactivity was observed in males exposed to NNK and ozone, in those exposed to NNK without ozone, and in those exposed to ozone only. Pathology Findings: Alveolar epithelial metaplasia and interstitial fibrosis occurred in all groups of rats exposed to ozone or to NNK and ozone, but not in those exposed to NNK without ozone. Increased incidences of hyperplasia occurred in groups of rats exposed to NNK or to ozone and NNK. Incidences of hyperplasia were similar among groups of rats exposed to NNK only. An increased incidence of alveolar/bronchiolar adenoma or carcinoma (combined) occurred in rats administered 1.0 mg/kg NNK, with or without ozone. The administration of ozone did not affect the occurrence of pulmonary neoplasms or nonneoplastic lesions in rats administered NNK. 2-YEAR OZONE STUDY IN MICE: The 2-year study was designed to include the present USEPA standard (0.12 ppm), the maximum concentration believed compatible with long-term survival (1.0 ppm), and an intermediate concentration (0.5 ppm). Groups of 50 male and 50 female B6C3F1 mice were exposed to 0, 0.12, 0.5, or 1.0 ppm ozone by inhalation for 6 hours per day, 5 days per week, for 105 weeks. Survival, Body Weights, and Clinical Findings: Survival rates of exposed mice were generally similar to those of the controls; the 2-year survival rate of 1.0 ppm females was greater than that of the controls. The mean body weights of 0.12 and 0.5 ppm males were similar to that of the controls throughout the study; the mean body weights of 1.0 ppm males and of all exposed groups of females were generally lower than those of the controls throughout the study. Hypoactivity was observed in male and female mice exposed to ozone. Pathology Findings: Increased incidences of metaplasia occurred in the nose and lung of mice exposed to 0.5 or 1.0 ppm ozone. The metaplasia in the nose consisted of increased thickening and extension of the squamous epithelium in the anterior portion of the nasal passage. The metaplasia in the lung consisted of extension of the bronchial epithelium into the alveoli of the centriacinar region. There were increased incidences of hyperplasia in the nose characterized by thickening of the noncuboidal (transitional) epithelium. There were increased incidences of hyperplasia in the epiglottis of female mice, a change that was characterized by a minimal increase in the thickness of the epithelium. Incidences of alveolar/bronchiolar adenoma or carcinoma (combined) were marginally increased in 0.5 and 1.0 ppm males (0 ppm, 14/50; 0.12 ppm, 13/50; 0.5 ppm, 18/50; 1.0 ppm, 19/50) and were increased in 1.0 ppm females (6/50, 7/50, 9/49, 16/50). LIFETIME OZONE STUDY IN MICE: For this study, mice were exposed to 0.5 and 1.0 ppm ozone for 30 months to determine the effect of extended exposure on neoplasm incidence. Groups of 50 male and 50 female B6C3F1 mice were exposed to 0, 0.5, or 1.0 ppm ozone by inhalation for 6 hours per day, 5 days per week, for 130 weeks. Survival and Body Weights: Survival rates of exposed mice were similar to those of the controls. The mean body weights of 0.5 ppm males and females were similar to those of the controls throughout the study. The mean body weights of 1.0 ppm males and females were generally lower than those of the controls throughout the study. Hypoactivity was observed in male and female mice exposed to ozone. Pathology Findings: The incidences of alveolar/bronchiolar adenoma and carcinoma (combined) were marginally increased in exposed males (0 ppm, 16/49; 0.5 ppm, 22/49; 1.0 ppm, 21/50) and in exposed females (6/50, 8/49, 12/50). Increased incidences of metaplasia occurred in the nose, larynx, and lung of exposed groups of males and females, and the incidences of hyperplasia were increased in the larynx and nose of exposed mice. The morphology of the lesions was similar to that seen in the 2-year study. There were no ozone-related increases in alveolar epithelial hyperplasia. GENETIC TOXICOLOGY: Ozone was mutagenic in Salmonella typhimurium strain TA102, with and without S9 metabolic activation. CONCLUSIONS: Under the conditions of these 2-year and lifetime inhalation studies, there was no evidence of carcinogenic activity of ozone in male or female F344/N rats exposed to 0.12, 0.5, or 1.0 ppm. There was equivocal evidence of carcinogenic activity of ozone in male B6C3F1 mice based on increased incidences of alveolar/bronchiolar adenoma or carcinoma. There was some evidence of carcinogenic activity of ozone in female B6C3F1 mice based on increased incidences of alveolar/bronchiolar adenoma or carcinoma. There was no evidence that exposure to 0.5 ppm ozone enhanced the incidence of NNK-induced pulmonary neoplasms in male rats. Exposure of male and female rats to ozone for 2 years or 125 weeks was associated with goblet cell hyperplasia and squamous metaplasia in the nose, squamous metaplasia in the larynx, and metaplasia (extension of bronchial epithelium into the centriacinar alveolar ducts) and interstitial fibrosis in the lung. Exposure of male and female mice to ozone for 2 years or 130 weeks was associated with hyperplasia and squamous metaplasia in the nose and inflammation (histiocytic infiltration) and metaplasia (extension of bronchial epithelium into the centriacinar alveolar ducts) of the lung.

Journal Article↗

Minority adolescents and substance use risk/protective factors: a focus on inhalant use.

Despite the fact that inhalant use is a growing problem among youth in the United States, relatively little attention has been paid to the demographic and social factors related to its use. This study used data from a household survey of adolescents in Washington state, and found that race/ethnicity was a strong predictor of lifetime prevalence of inhalant use, with Native-American youth being particularly likely to use inhalants. Comparing the age at initiation of inhalant use to other legal and illegal substances, we found that cigarettes and inhalants showed the lowest age at initiation. We conducted logistic regressions on lifetime prevalence of inhalant use, and compared these models to other substances. In general, we found that attachment to parents. parents' drug use, and school attachment were strong predictors of lifetime use of marijuana, alcohol, and inhalants. However, while peer drug use was a strong predictor of marijuana and alcohol use, it was not a significant predictor of adolescents' use of inhalants. Our final set of analyses included inhalant use in regression models predicting other problem behaviors: these analyses demonstrated that inhalant use was a strong predictor of involvement in problem behavior.

Aerosols↗

[Inhibitory effect of prostaglandin I2 on the increase of airway responsiveness induced by inhaled thromboxane A2 mimetic U-46619 in dogs].

To investigate the effect of prostaglandin I2 (PGI2) on the increase of airway responsiveness induced by inhaled thromboxane A2 (TxA2), we measured the airway responsiveness to inhaled methacholine (Mch) after inhalation of TxA2 mimetic U-46619 alone and after inhalation of U-46619 in combination with PGI2 (U-46619/PGI2) in six dogs. Airway responsiveness to Mch was determined by Astograph (7Hz oscillation method). Inhalation of U-46619 was carried out for five minutes at a half of minimum threshold concentration, and the concentration of PGI2 was double that of U-46619. Inhaled U-46619 significantly increased airway responsiveness to Mch (p less than 0.01). However the airway responsiveness to Mch did not increase following inhalation of U-46619/PGI2, and the increase of airway responsiveness to Mch induced by inhaled U-46619 was inhibited significantly by PGI2 (p less than 0.01). PGI2 inhalation alone did not affect the basal airway responsiveness to Mch. These results indicate that PGI2 protects the hyperresponsiveness induced by TxA2 inhalation in dogs.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗