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At least 901 records · Page 50Linked to original sources
PubMed2005

Variability of fine particle dose and lung deposition of budesonide delivered through two multidose dry powder inhalers.

OBJECTIVE: To assess the reliability of dosing through two budesonide multidose dry powder inhalers (DPI) as derived from the in-vitro variability of the fine particle dose (FPD) and the in-vivo variability of the lung deposition at different flow rates. METHODS: The same two DPIs [device N (Novolizer) and device T (Turbuhaler)] were compared in both studies. In the in-vitro study, the variability of the FPD, measured at flow rates of 30-100 L/min, was determined for equal flow rates and at comparable maximal inspiratory pressures (MIP). In the in-vivo study in healthy subjects (scintigraphic, randomised, crossover design) the variability of the lung deposition was determined at targeted flow rates of 45, 60 and 90 L/min for device N, and at 60 L/min for device T. RESULTS: The variability of the FPD was lower with device N than with device T by 34%-86%. The differences were statistically significant for flow rates of 60, 70, 90 and 100 L/min (not significant for 40, 50 and 80 L/min) in the in-vitro study. Results for comparable MIPs showed analogous differences (79%, p = 0.004, at the clinically relevant MIP of 4.5 kPa). The variability of the lung deposition was clearly lower with the device N than with the device T. The difference was statistically significant (p = 0.029) at a comparable targeted flow rate of 60 L/min. CONCLUSIONS: Thus, this study showed that device N is likely to improve the reliability of inhalation therapy by reducing both the variability of the delivered drug and that of the lung deposition. The reliability of inhalation therapy and consequently the quality of long-term control of asthma and the patient's compliance might improve when choosing the DPI with the better characteristics.

Administration, Inhalation↗
PubMed2001

[Inhaled corticosteroid therapy in childhood asthma].

Asthma has been recognized as a chronic inflammatory disorder of the airway. The early use of antiinflammatory agents, one of which is inhaled corticosteroids, is advocated in the treatment of chronic asthma. Beclomethasone dipropionate (BDP) is effective in childhood asthma. CD4 T-cell activation correlate with the values of the coefficient variation (CV) of peak expiratory flow (PEF) in asthmatic patients, suggesting that CV of PEF is a good marker for assessing not only the variability of airway obstruction but also the degree of airway inflammation. PEF monitoring is useful for better controlling asthma, because some patients treated with inhaled corticosteroid may still remain undertreated.

Administration, Inhalation↗
PubMed2002

Invasive pulmonary filamentous fungal infection in a patient receiving inhaled corticosteroid therapy.

We report a case of invasive pulmonary filamentous fungal infection in a patient with chronic obstructive pulmonary disease who was treated with a conventional dose of inhaled fluticasone in the absence of other causes of immunosuppression. This case demonstrates the potential risk for opportunistic fungal infections in patients treated with high-potency lipophilic inhaled corticosteroids.

Administration, Inhalation↗
PubMed2001

Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics.

Elderly patients with asthma have relatively high rates of hospitalization and mortality. Although inhaled corticosteroids have been shown to improve outcomes among younger patients with asthma, their usefulness in elderly patients has not been established. Therefore, a population-based study of patients 65 yrs of age or older, who have been hospitalized at least once with asthma in Ontario, Canada was conducted to determine the impact of inhaled corticosteroids on rehospitalization for asthma and all-cause mortality rates. Data from the Canadian Institute of Health Information was used to capture all patients 65 yrs of age and older who were hospitalized at least once, with the most responsible diagnosis of asthma in Ontario, Canada between fiscal year 1992 and 1996. This database was then linked with drug claims, physician billing and mortality databases. In total, 6,254 consecutive elderly patients with asthma were identified. Sixty percent of these patients were given at least one prescription for inhaled corticosteroids within 90 days postdischarge from their index hospitalization for asthma. Users of inhaled corticosteroids postdischarge were 29% (95% confidence interval (CI) 20%-38%) less likely to be readmitted to hospital for asthma and 39% (95% CI, 20%-53%) less likely to experience all-cause mortality compared to those who did not receive these drugs postdischarge over a one year follow-up period. These findings suggest that inhaled corticosteroids are beneficial in reducing the risk for rehospitalization and all-cause mortality in elderly patients with asthma who have recently been hospitalized for their disease.

Administration, Inhalation↗
PubMed2005

[The investigation of isoflurane therapy for status asthmaticus patients].

Status asthmaticus is defined as an attack of bronchial asthma that resists conventional treatment and continues for more than 24 hours. We report here about patients with status asthmaticus who were successfully treated with isoflurane inhalation. Of the 19 patients who were transferred to the intensive care unit (ICU) and underwent mechanical ventilation from January 1996 to May 2001, eleven patients who were first treated by isoflurane inhalation were targeted in this study. Their improvement was assessed 6 and 24 hours after anesthesia compared with their condition before anesthesia. The tidal volume, pH, and PaCO2 improved within 6 hours after anesthesia. For the next step, among the patients who were transferred to the critical care center soon after an attack of bronchial asthma and underwent mechanical ventilation, 8 patients who were treated by isoflurane inhalation anesthesia (Group I) and another 4 patients who were not treated by isoflurane (Group NI) were compared to assess the usefulness of isoflurane inhalation therapy. The patients in Group I stayed in the ICU and underwent mechanical ventilation for a shorter period. These patients had hypotension and liver dysfunction after the inhalation anesthesia, but these symptoms were improved by decreasing the concentration of isoflurane. Isoflurane inhalation therapy seemed useful for intractable status asthmaticus, and earlier introduction of this therapy is expected to achieve a greater therapeutic effect.

Administration, Inhalation↗
PubMedDate not supplied

Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial.

CONTEXT: Long-acting beta(2)-agonists are prescribed for patients with persistent asthma and are sometimes used without inhaled corticosteroids (ICSs). No evidence exists, however, to support their use as monotherapy in adults with persistent asthma. OBJECTIVE: To examine the effectiveness of salmeterol xinafoate, a long-acting beta(2)-agonist, as replacement therapy in patients whose asthma is well controlled by low-dose triamcinolone acetonide, an ICS. DESIGN AND SETTING: A 28-week, randomized, blinded, placebo-controlled, parallel group trial conducted at 6 National Institutes of Health-sponsored, university-based ambulatory care centers from February 1997 to January 1999. PARTICIPANTS: One hundred sixty-four patients aged 12 through 65 years with persistent asthma that was well controlled during a 6-week run-in period of treatment with inhaled triamcinolone (400 microg twice per day). INTERVENTIONS: Patients were randomly assigned to continue triamcinolone therapy (400 microg twice per day; n = 54) or switch to salmeterol (42 microg twice per day; n = 54) or to placebo (n = 56) for 16 weeks, after which all patients received placebo for an additional 6-week run-out period. MAIN OUTCOME MEASURES: Change in morning and evening peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV(1)), self-assessed asthma symptom scores, rescue albuterol use, asthma-specific quality-of-life scores, treatment failure, asthma exacerbation, bronchial reactivity, and markers of airway inflammation, compared among the 3 treatment groups. RESULTS: During the 16-week randomized treatment period, no significant differences between the salmeterol and triamcinolone groups were observed for conventional outcomes of clinical studies of asthma therapy-morning PEF, evening PEF, asthma symptom scores, rescue albuterol sulfate use, or quality of life. Both active treatments were superior to placebo. However, the salmeterol group had more treatment failures than the triamcinolone group (13/54 [24%] vs 3/54 [6%]; P =.004), as well as more asthma exacerbations (11/54 [20%] vs 4/54 [7%]; P =.04), greater increases in median (interquartile range) sputum eosinophils (2.4% [0.0% to 10.6%] vs -0.1% [-0.7% to 0.3%]; P<.001), eosinophil cationic protein (71 [-2 to 430] U/L vs -4 [-31 to 56] U/L; P =.005), and tryptase (3.1 [2.1 to 7.6] ng/mL vs 0.0 [0.0 to 0.7] ng/mL; P<.001). The duration of benefit when patients were switched from active treatment to placebo after 22 weeks of randomized treatment was not significantly longer in the triamcinolone group than in the salmeterol group. CONCLUSIONS: Patients with persistent asthma well controlled by low doses of triamcinolone cannot be switched to salmeterol monotherapy without risk of clinically significant loss of asthma control.

Administration, Inhalation↗
PubMed1994

Inhalation-based therapies in the treatment of cystic fibrosis.

As most of the morbidity seen in cystic fibrosis (CF) is related to pulmonary complications, new therapies are being developed that seek to ameliorate these debilitating sequelae. Recently, there has been intense effort into the development of new aerosol-based therapies for CF. This review summarizes much of this recent investigation, with particular emphasis on therapies described in the literature within the past year. Agents that act on the airway epithelium to alter ionic fluxes, namely amiloride and uridine 5'-triphosphate, are outlined. The effects of tobramycin delivered via nebulizer in a cohort of stable CF patients is reported. Recombinant human DNase and distearoyl phosphatidylglycerol liposomes, agents that alter the adhesiveness of CF mucus, are outlined as possible strategies for CF treatment. Finally, antiprotease therapy is considered as a possible addition to the CF armamentarium.

Administration, Inhalation↗
PubMed1996

[A case study of metastatic renal cell carcinoma in lungs showing complete response to continuous subcutaneous injection of interferon alpha and gamma].

Previously, we reported a case of complete response (CR) of metastatic renal cell carcinoma with inhalant interferon-gamma. This inhalant therapy was considered effective against metastatic lung hilar tumors. On the other hand, metastatic tumors of the peripheral lung field tumor did not respond to the inhalation therapy. We report, a case of metastatic renal cell carcinoma in peripheral lungs showing complete response to continuous subcutaneous administration of interferon alpha and gamma. A 53-year-old woman was admitted to our hospital because of a large palpable mass in the left upper quadrant in March, 1994. Computerized tomographic (CT) scan disclosed a huge renal tumor. To reduce the tumor size, transarterial embolization, and subcutaneous administration of interferon-gamma were performed. In April 1994, the tumor was completely excised. In the post-operative course, multiple metastases were recognized in the lower peripheral lung field, subcutaneous administration of IFN-gamma and inhalation of IFN-gamma were begun, but the tumor size increased in October 1994. She underwent continuous subcutaneous administration of IFN-alpha and gamma. Three months later, the lung tumor disappeared. She has remained tumor-free as of October 1995. We concluded that this therapy may be effective against metastatic renal cell carcinoma in the lungs.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Pharmacokinetic optimisation of inhaled steroid therapy in asthma.

The recognition that asthma has a large inflammatory component has led to the use of steroids in its treatment. The adverse systemic effects of the drugs have promoted the development of inhaled steroids with a high topical to systemic potency ratio. The 2 most widely used agents are beclomethasone dipropionate and budesonide. Budesonide has a longer plasma elimination half-life than beclomethasone dipropionate but a higher topical to systemic potency ratio. These agents have been shown to be equipotent with respect to their anti-asthma effects but budesonide may have a slightly more favourable adverse effect profile. At low dosages (up to 400 micrograms/day) these drugs are well tolerated. At higher dosages (> 1000 micrograms/day) adverse effects on bone metabolism and adrenal function have been noted. Other agents such a triamcinolone or flunisolide have no obvious advantages. We recommend that inhaled steroids should be prescribed at the lowest dose required to control symptoms, with the dose being increased or decreased in a stepwise manner in parallel with asthma severity.

Administration, Inhalation↗
PubMed1996

[A new trend of inhaled corticosteroid therapy in Japan].

Bronchial asthma is characteristic of chronic airway inflammatory disorder which many inflammatory cells play a role, BDP therefore has become a basic drug (controller) in the treatment of asthma. Recently new dry powder inhalation systems of corticosteroid such as fluticasone propionate (Diskhaler) and budesonide (Turbuhaler) have been studied to examine the dose response clinical efficacy to BDP. Clinical efficacy of both drugs are equivocal to double dose of BDP. These excellent drugs will be soon available for clinical use in Japan.

Administration, Oral↗
PubMed1998

Inhalation devices in childhood asthma.

Inhalation therapy is currently the most appropriate way to treat asthma also in childhood. This route of administration provides the best clinical effect with the least systemic side effects. The use of inhalative therapy in childhood involves special considerations. The age of the child is a major determinant of the method which can be used. The accuracy of dosing and the technically perfect use of devices are extremely important, especially when drugs with potential systemic side effects are administered. Successful therapy needs a good partnership between the patient, their parents, the family doctor and the pulmologist.

Administration, Inhalation↗
PubMed1992

[Oral and inhaled corticoid therapy. Rivals or partners?].

Although steroids have been prescribed as antiinflammatory preparation for the treatment of asthma for many years, fear of side effects has limited their wider use. The development of new steroid derivatives administered by inhalation has reduced these risks. Oral and inhaled steroids can be used in a separate way, oral steroids being reserved for the control of acute exacerbations and inhaled steroids for the baseline treatment of chronic asthma. Inhaled and oral steroids can also be used concurrently in the same patient. Studies have shown a reduction in the dose of oral steroids in patients taking inhaled steroids. Works carried out by the Canadian research worker Toogood have addressed the question of the equivalent clinical dosing potency of inhaled and oral steroids. Finally, the reversibility of airway obstruction in subjects affected by non-specific chronic obstructive diseases might worth be assessed by using an inhaled steroid preparation.

Administration, Inhalation↗
PubMed2005

Effect of inhaled combination therapy on asthma management.

The growing use of guidelines to manage asthmatic patients prompted us to evaluate their impact on clinical practice. This study was performed in two similar groups of asthmatic patients. A retrospective and prospective review of medical records in an asthmatic population was performed. The patients were followed up for a mean period of 2 years before (group 1 [G1]) and after the publication of the Guideline for Asthma Treatment (group 2 [G2]). After evaluation of objective/clinical measurements we noticed a significant difference between both groups. There were 23 and 40 patients who did not complain of any respiratory symptoms in G1 and G2, respectively. The total number of visits to the emergency department decreased by more than 75%, from 26 (G1) to six (G2). The forced expiratory volume in 1 sec improved by a mean of 4% in G1 and 9% in G2. After application of the guidelines there was a redistribution of the degree of disease severity. In G2, there was a 12% increase in the use of long-acting beta2-stimulating sprays; 40% of the patients were using a combination of a long-acting beta2-stimulating drug and an inhaled steroid. In our experience, the use of the Global Initiative for Asthma (GINA) guidelines leads to better management of asthma patients with different degrees of severity. These findings suggest the need to perform a similar analysis in a broader setting such as a national multicenter survey in order to collect information on the challenges of putting these theoretical difficulties into practice and to compare their implementation in distinct centers.

Administration, Inhalation↗