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PubMed2000

Aerosol device selection: evidence to practice.

Therapeutic aerosols are generated by pneumatic jet nebulizers, ultrasonic nebulizers, pressurized metered-dose inhalers, and dry powder inhalers. Some of the drug preparations used in these devices are formulated to work with specific devices. Although design improvements in aerosol devices have led to improved lung deposition, decreased oropharyngeal deposition, decreased waste of drug, greater ease of use, and lower environmental impact, optimizing the use of aerosol devices requires patient and caregiver instruction, in combination with proper device use and maintenance. Optimizing aerosol delivery requires knowledge of a number of technical details, and caregivers should stay abreast of the continuing advancement of technologies and techniques associated with aerosol delivery, especially in light of emerging devices and formulations.

Aerosols↗
PubMed2001

Aerosolized amikacin in the treatment of Pseudomonas pneumonia in the nursing home setting.

Studies have shown that aerosolized aminoglycosides represent a safe and effective means of treating pneumonia due to Pseudomonas sp. Aerosolized aminoglycosides have been shown to improve clinical outcome, with less risk of nephrotoxicity relative to parenteral aminoglycosides. Apparently, less drug resistance is associated with the use of aerosolized aminoglycosides. Cost factors favor aerosolized delivery methods. The full recovery experienced by the patient in this case study suggests that aerosolized amikacin may be a safe, efficacious, and cost-effective means of treating pseudomonal pneumonia in geriatric patients. Controlled clinical trials should be conducted to further investigate this treatment regimen.

Administration, Inhalation↗
PubMed2001

Sampling and detection of Legionella pneumophila aerosols generated from an industrial cooling tower.

Cooling tower water has frequently been cited as a source of infection in outbreaks of Legionnaires' disease. However, there have been few reports on the presence of legionellae in aerosols from cooling towers. This paper describes our use of an impinger or a six-stage microbial impactor for detecting legionellae in air around a cooling tower contaminated with L. pneumophila (1.2+/-0.3x10(5) CFU/100 ml). Phosphate-buffered saline, Page's saline, 2% yeast extract solution and buffered yeast extract (BYE) broth were tested to evaluate their collection efficiency. These solutions were compared in laboratory experiments using an aerosol of L. pneumophila serogroup (SG) 1. Because BYE broth was the most efficient and storable collecting fluid among them, it was used for outdoor air sampling. In the outdoor air sampling, aerosolized L. pneumophila SG 6 was detected in the air around the cooling tower by the impinger (0.09 CFU/l. air). No legionellae were detected by the impactor with Legionella-selective agar plates (WYOalpha) because the plates were overgrown with fungi. Repetitive element PCR (rep-PCR) and arbitrarily primed PCR (AP-PCR) were employed to assess the epidemiological relationship among Legionella isolates from the air sample and the cooling tower water samples. L. pneumophila SG 6 isolated from the aerosols produced rep-PCR and AP-PCR fingerprints identical to those of L. pneumophila SG 6 strains from the cooling tower water, suggesting that the bacterium was aerosolized from the cooling tower.

Aerosols↗
PubMed1975

Effect of aerosolized dipalmitoyl lecithin on oxygen-toxic rat lungs.

Pulmonary surfactant is reduced in oxygen toxicity but whether this represents a decrease in production or inactivation of surface-active material already present is not known. We divided 200 g male Wister-Lewis rats into different experimental groups. The animals were exposed continuously to 0, 48, 56 or 72 h of close to 100% oxygen at atmospheric pressure. Administration of aerosolized dipalmitoyl lecithin (DPL) in phosphate buffer had no effect on lung deflation compliances or lung stability indices of any group. Exposure to DPL by spontaneous respiration and/or controlled ventilation made no difference. Lung dry/wet weight ratios fell in animals exposed to aerosols of DPL + buffer + O2, buffer + O2, or water + O2, to aerosols of DPL + buffer + O2, buffer + O2, or water + O2, as compared to animals with similar lengths of oxygen exposure not exposed to an aerosol. If the initial pulmonary pathophysiological response to 100% oxygen at 1 atm pressure is capillary logical response to 100% oxygen at 1 atm pressure is capillary endothelial damage with leakage of intravascular fluids into the alveoli, then exogenously administered DPL would not be of benefit in pulmonary oxygen toxicity. Our study suggests that aerosolized DPL administered to normal animals and animals exposed to oxygen for 48-72 h had no effect on lung compliance or stability.

Aerosols↗
PubMed2002

Endothelin-1 in citric acid aerosol inhalation-induced airway constriction of guinea pigs.

Endotheline-1 (ET-1) has been shown to enhance tachykinin-induced airway constriction. This study was designed to test whether ET-1 is involved in citric acid-induced bronchoconstriction. Forty-eight anesthetized-paralyzed guinea pigs were divided into six groups of 8 animals each: saline control; citric acid; ET-1; ET-1 + citric acid; BQ123 + ET-1 + citric acid; and BQ788 + ET-1 + citric acid. BQ123 and BQ788 are specific ETA and ETB receptor antagonists, respectively. Each animal in the saline control group received 50 breaths of 4 ml saline aerosol and in all citric acid-treated groups was given 50 breaths of 4 ml aerosol generated from 0.6 M citric acid. In all ET-1-treated groups, each animal was exposed to aerosol generated from 10(-8) M ET-1. The animal in the ET-1 + citric acid group was exposed to ET-1 5 min prior to the citric acid. For the last two groups, each animal was first exposed to aerosol generated from either 10(-5) M BQ123 or 10(-5) M BQ788. Five min later, the animal was exposed to ET-1; and then 5 min later was followed by citric acid. Dynamic respiratory compliance (Crs), forced expiratory volume in 0.1 sec (FEV(0.1)), and maximal expiratory flow at 30% total lung capacity (Vmax 30) were obtained before and 3-15 min after citric acid. Either citric acid or ET-1 inhalation caused significant decreases in Crs, FEV(0.1), and Vmax 30, indicating airway constriction. Citric acid-induced airway constriction, for most cases, was not significantly augmented by ET-1. However, either BQ123 or BQ 788 significantly attenuated the airway constriction induced by the combination of ET-1 and citric acid. Also, in an additional study, either BQ123 or BQ788 significantly attenuated citric acid-induced airway constriction. These data suggest that endogenous ET-1 plays an important role in citric acid aerosol-induced airway constriction in guinea pigs.

Administration, Inhalation↗
PubMed2002

A laboratory comparison of evacuation devices on aerosol reduction.

PURPOSE: Aerosols are defined as airborne particles that range in size from 0.5 to 10 microns (micron). They are produced during ultrasonic instrumentation, but they can be reduced. Irrigant solutions, which produce the therapeutic effects of lavage, also combine with blood, saliva, and bacteria to produce potentially harmful airborne particulates. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) recommend utilization of high volume evacuation, rubber dam, and patient positioning for aerosol control. But for the non-assisted dental hygienist, these recommendations are difficult to implement. This study was designed to compare the concentration of airborne particulates from ultrasonic scaling, utilizing three different methods of evacuation. METHODS: In a laboratory setting, ultrasonic airborne particulates were generated utilizing a 25,000 cps magnetostrictive ultrasonic scaling instrument. Three evacuation devises were compared for effectiveness: a standard saliva ejector intraorally positioned; and two extraorally positioned, hands-free high-volume evacuation (HFHVE) techniques. One of these devices had a standard attachment, and, the other had a funnel-shaped attachment. Measurement of airborne particles was performed with a DataRAM Real-Time Aerosol Monitor. RESULTS: This study (N = 21) found a significant reduction in the number of airborne particulates with either form of extraoral HFHVE attachment in place. Standard attachments and funnel-shaped attachments to HFHVE resulted in reduction of particulates by 90.8% and 89.7%, respectively, when compared to the intraorally positioned standard saliva ejector. CONCLUSIONS: Utilizing either form of HFHVE during ultrasonic instrumentation significantly reduced the number of aerosolized particulates that reached the breathing space of the client and clinician. This lends support for the ADA and CDC recommendation that HVE be used during aerosol producing procedures. Currently, no preventive measure is 100% effective; therefore, clinicians are encouraged to use additional methods to minimize the number of airborne particulates produced during intraoral instrumentation.

Aerosols↗
PubMed2002

Nebulizers that use a vibrating mesh or plate with multiple apertures to generate aerosol.

Several electronic nebulizer devices that use a vibrating mesh or plate with multiple apertures to generate a fine-particle, low-velocity aerosol have been marketed or will shortly become available for clinical use. These devices have a high efficiency of delivering aerosol to the lung, such that the nominal dose of drugs to be administered could be substantially reduced. Moreover, the volume of drug solution left in these new devices when the nebulization has ceased is negligible, so there is potential to improve the cost-effectiveness of administering expensive medications. Because these devices nebulize at a faster rate than conventional jet or ultrasonic nebulizers, the duration of each treatment could be shortened. These devices efficiently nebulize solutions and suspensions; they have been successfully used for aerosolizing insulin, other proteins and peptides, and fragments of DNA. They could be employed for a wide variety of clinical applications, including the delivery of aerosols for systemic therapy and gene transfer. These devices have overcome many of the limitations associated with conventional jet and ultrasonic nebulizers, and they offer the versatility to modify the aerosol characteristics according to the clinical application for which they are employed. With these devices clinicians will be able to precisely control drug delivery to the respiratory tract.

Administration, Inhalation↗
PubMed1976

Mortality from asthma and bronchodilator aerosols.

The mortality rate from asthma in Australia had a transcient rise between 1960 to 1967. There was a remarkably high correlation between the sales of pressurized adrenergic aerosols in each of the four most populated States and the corresponding asthma mortality rate for two triennia, 1961 to 1963 and 1964 to 1966. This relationship was not found after 1966. From 1965 to 1966, Australians were warned repeatedly of the possible dangers of over-usage of the adrenergic aerosols. The sales pattern of the aerosols altered, showing a slackening of the rate of increase of sales in 1966 and 1967. This and other evidence suggests that the warnings may have reduced the prevalence of over-usage of the aerosols and that before this, over-usage of the adrenergic aerosols could have caused the epidemic of asthma deaths.

Adolescent↗
PubMed2004

Sporicidal efficacy of hydrogen peroxide aerosol.

Because of its high sporicidal activity but low toxicity, hydrogen peroxide (H2O2) is a useful agent for gentle antimicrobial treatment of irritable goods. Above all to optimise practical aspects of H2O2 application, sporicidal efficacy of aerosols based on 1% H2O2 solution was tested. Using commercially available bioindicators with Bacillus subtilis spores immobilized on filter paper strips, a 7 h lasting aerosol treatment at room temperature resulted in a reduction of viable count of 2.5 log10 (median, n = 5). By combined application of 0.3% sorbitan monolaurate (Span 20) and 1% H2O2 aerosol at room temperature, a reduction of viable count of >6.3 log10 (median, n = 5) could be reached within 2 h, already. Following aerosol treatment at 60 degrees C, all bioindicators tested (n = 15) have been found without growth after 10 min, corresponding to a reduction of viable count >6.3 log10. However, this efficacy was possible only if the spores were immobilized on filter paper strips. Changing the carrier materials lower sporicidal activity of H2O2 aerosol was found resulting in a reduction of viable count between >5.4 log10 (median, n = 15) on polyethylene foil and 0.4 log10 (median, n = 15) on glass slides. These differences could not be correlated with surface qualities as porosity or wettability.

Aerosols↗
PubMed2004

Basic techniques for aerosol delivery during mechanical ventilation.

Among the devices employed for aerosol generation (metered-dose inhalers, nebulizers, and dry powder inhalers) only metered-dose inhalers and nebulizers are routinely employed for aerosol delivery to mechanically ventilated patients. The ventilator circuit and artificial airway were previously thought to be major barriers to effective aerosol delivery to mechanically ventilated patients. In the past decade in vitro and in vivo investigations have contributed to a better understanding of the complex array of factors that influence inhaled drug delivery in mechanically-ventilated patients. Several investigators have shown that with careful attention to the administration technique aerosol delivery efficiency in mechanically-ventilated patients is comparable to that in ambulatory patients. The ability to efficiently deliver aerosols should lead to wider clinical application of inhaled therapies in patients receiving mechanical ventilation.

Administration, Inhalation↗
PubMed2004

Aerosolized antibiotics in mechanically ventilated patients.

Aerosolized antibiotics are potentially useful in intensive care. At State University of New York at Stony Brook we developed a human model of tracheobronchitis in intubated patients. The model provides daily specimens of airway secretions, allowing serial studies of airway inflammation and testing of therapy modes. The presence of local infection is defined by a unique method of quantified sputum collection. Bench models have been developed that illustrate the factors that limit aerosol delivery to intubated patients. With those models clinical trials have defined possible indications for targeted aerosol therapy to patients at risk for deep lung infection. An efficient aerosolized-antibiotics method that delivers the aerosol past the endotracheal tube has been established, and with that method the drug levels in pulmonary secretions exceed by several orders of magnitude the levels expected with intravenous therapy. Potential end points of therapy are being evaluated, including the rate of bacterial resistance and the incidence and definition of deep lung infection.

Administration, Inhalation↗
PubMed1991

Inhaled clemastine, an H1 antihistamine inhibits airway narrowing caused by aerosols of non-isotonic saline.

Asthmatic subjects were challenged with aerosols of hyper- and hypotonic saline 15 min (Group A) and 90 min (Group B) after inhaling clemastine. Measurements were made of forced expiratory volume in one second (FEV1) before and after medication and after challenge. When the FEV1 values (% predicted) were compared on the active and placebo days they were higher 15 min after clemastine (p less than 0.05) for both challenges and higher 90 min after clemastine inhalation (p less than 0.05) for the hypertonic challenge. The % fall in FEV1 was compared after the same concentration of saline aerosol had been given on both active and placebo days. In Group A the % fall in FEV1 on the clemastine day was reduced after challenge with hypertonic (p less than 0.02) and hypotonic (p less than 0.03) aerosol. In Group B there was a reduction in the % fall in FEV1 on the clemastine day only after hypertonic challenge (p less than 0.04). The protective effect afforded by clemastine was unrelated to change in baseline lung function. We conclude that histamine is an important mediator of the airway response to non-isotonic aerosols and suggest that the aerosol route of administration may be useful for delivering antihistamines.

Administration, Inhalation↗
PubMed1991

[Aerosol deposit sample in aspecific bronchial provocation test: a nuclear medicine study for quantification].

A method of standardization of inhalation bronchial provocation tests is induced. The distribution of radioactivity of in- and exhaled 99mTc human albumin (Venticoll) enables an exact calculation of intrabronchial aerosol deposition. The investigations were carried out at twelve normal test persons by using the device of bronchial provocation tests of PARI. Linearity exists between nebulized aerosol quantity in the bag and bronchial aerosol deposition. The intrabronchial aerosol deposition is calculated about 100 mg after emptying the ten liter-bag. Slowly inspiratory maneuvers of vital capacity produce a precision of the inhaled aerosol of about 15 percent.

Aerosols↗
PubMed1989

Particle deposition efficiency of therapeutic aerosols in the human maxillary sinus.

The deposition efficiency of therapeutic aerosol particles in the human maxillary sinus is evaluated both in the human body and in a model cast of the upper airway. In the experiments, three sample materials, such as mono-dispersed polystyrene latex particles, aqueous glucose solution and pure water, in the range of particle diameter of from 0.5 to 15.8 microns, are employed in the model cast. The radioactive labelled aerosol particle is also used in the human body. From the results of the experiment, it is confirmed that even though the maxillary sinus is a closed hollow organ, aerosol flow is able to be induced only when the pressure gradient is applied between the nasal cavity and the maxillary sinus. In this case, the particle deposition is is explained in relationship to the inertia impaction of the aerosol particles on the inside wall of the maxillary sinus. The total deposition efficiencies and the deposited particle sizes in the sinus area for both experiments, with the model and in the human body, are almost the same at 3%, and 3-10 microns in diameter, respectively. A physical model for this particle deposition suggests that these experimental values change not only with the size distributions of therapeutic particles and the pressure gradient, but also with the diameter of the sinus ostium. Moreover, since the therapeutic particle might not enter the maxillary sinus when the diameter of the sinus ostium canal is less than 1 mm, some pretreatment to open the sinus ostium canal would be necessary before applying such aerosol therapy in practice.

Aerosols↗
PubMed1988

Bovine parainfluenza-3 virus proteins recognized by antibodies of aerosol-exposed calves.

Bovine parainfluenza-3 (BPI-3) virus proteins were radiolabeled with [35S]methionine. Control serum containing antibodies to BPI-3 virus obtained from calves that had been immunized by aerosol exposure and by IM inoculation and sera of cattle that were exposed to BPI-3 virus by aerosol only were used to immunoprecipitate BPI-3 virus proteins. The immunoprecipitates were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Viral proteins with estimated molecular weights of 72,000, 70,000, and 58,000 were recognized by the control serum and the sera from calves exposed to BPI-3 virus only by aerosol. These proteins were the hemagglutinin/neuraminidase, nucleoprotein, and fusion protein. The results indicated that a single aerosol exposure to BPI-3 virus induces antibodies to the same BPI-3 virus proteins as do combined aerosol and parenteral inoculations with the virus.

Aerosols↗
PubMedDate not supplied

Modification of hypoxic pulmonary vasoconstriction by aerosolized cromolyn sodium.

We have previously demonstrated the role of mast cell degranulation in the mediation of hypoxic pulmonary vasoconstriction, and its prevention by intravenous cromolyn sodium. In the present investigation, we studied the modification of the hypoxic pulmonary vascular response by aerosolized cromolyn sodium. In seven conscious sheep on two separate days, pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output were measured for the calculation of pulmonary vascular resistance (Rpv) along with arterial oxygen tension (Pao2) during room air breathing and breathing a hypoxic gas mixture (13% O2-87% N2), without and with cromolyn sodium administration. Cromolyn sodium (20 mg X kg-1) was administered as an aerosol before and during 13% O2 breathing. The sheep had comparable degrees of hypoxia during low oxygen breathing on both days (mean PaO2: 43 and 46 mmHg). Breathing hypoxic gas mixture caused pulmonary vasoconstriction, with increases in mean Rpv of 89% (p less than 0.05). Aerosolized cromolyn sodium blunted the hypoxic pulmonary vascular response; mean Rpv increased by 27% (p less than 0.05), which was significantly different from the increase during hypoxia without cromolyn sodium treatment (p less than 0.05). We conclude that aerosolized cromolyn sodium (a mast cell membrane stabilizing agent) modifies hypoxic pulmonary vasoconstriction; however, unlike the intravenous form, aerosolized cromolyn sodium (at the dosage used) offers a partial protection.

Aerosols↗
PubMed1988

Pulmonary effects of repeated exposures to paraquat aerosol in guinea pigs.

Exposure to paraquat, a widely used herbicide, has been shown to produce a concentration dependent rapid, shallow breathing pattern in guinea pigs 18 hr following exposure (H. Burleigh-Flayer and Y. Alarie, 1987, Arch. Toxicol. 59(6), 391-396). To further explore the pulmonary effects following exposure to paraquat, two experiments were carried out. The first experiment consisted of exposing a group of guinea pigs for a period of 4 hr to 0.7 mg/m3 paraquat aerosol and monitoring respiratory variables for 2 weeks following the exposure. In the second experiment, three groups of guinea pigs were repeatedly exposed to three concentrations of paraquat aerosol (0.1, 0.4, and 0.8 mg/m3) for 6 hr a day, 5 days a week for 3 weeks. Respiratory variables were measured each day of these 3-week experiments. The respiratory variables evaluated in both experiments were tidal volume (VT) and respiratory frequency (f). These variables were monitored during air breathing and upon challenge with 10% CO2 in 20% O2 and 70% N2 in order to evaluate the pulmonary effects of exposure to paraquat. Following a single exposure to 0.7 mg/m3 paraquat aerosol, a decrease in VT and increase in f were seen during air and 10% CO2 challenge which reached a maximum several days following exposure. After reaching maximal changes, the respiratory variables returned to control values. With repeated 6-hr exposures to paraquat aerosol, guinea pigs exposed to 0.4 and 0.8 mg/m3 also displayed a rapid, shallow breathing pattern. Adaptation to the exposures for these two concentration groups was evidenced by a return of the respiratory variables toward control levels. This adaptation typically occurred during the first 7 days of exposures. A cumulative effect was therefore not detected with repeated exposures to paraquat aerosols.

Aerosols↗
PubMed1987

Ribavirin aerosol treatment of influenza.

In this article we have described the clinical and laboratory features of uncomplicated influenza in college students and its treatment with ribavirin aerosol. The disease presents as an acute febrile systemic illness of short duration that varies little from patient to patient. Peripheral blood cell changes in the infection are also quite specific and very consistent. Polymorphonuclear cell counts are slightly increased above normal early in infection at a time when lymphocyte counts were greatly reduced. As lymphocyte numbers increase at the third day of illness, polymorphonuclear cell counts diminish substantially. Eosinophil counts fluctuate in a pattern similar to that of lymphocytes. Basophil, monocyte, and band cell counts are increased at admission and thereafter decline in numbers. Reticulocytes and platelets are reduced during acute illness. We assume that changes in peripheral white blood cell counts during influenza result from migration of cells to the inflamed respiratory tract and subsequent resupply of the various types of cells to the circulation from other sites in the body. The cellular alterations in the circulation and at the site of infection are of fundamental importance in the pathogenesis of infection, and a better knowledge of them should open new avenues for prevention and treatment. Aerosol treatment was shown to alleviate the symptoms of influenza and to reduce the shedding of influenza virus from the respiratory tract. No evidence of untoward effect of ribavirin treatment on peripheral white or red blood cells was found, and a wide range of clinical chemical tests revealed no toxic effects of treatment. There was no pulmonary irritation detected from the treatment. Reference was made to prompt recovery of four patients with influenzal pneumonia treated with ribavirin aerosol. Ribavirin aerosol must produce its major therapeutic effect through inhibition of virus replication at the sites of infection in the respiratory epithelium. This appears to result mainly from interference with viral messenger RNA initiation and elongation. This is best demonstrated by the prompt decline in viral shedding in treated patients. The associated prompt clinical improvement suggests that illness results from continued virus replication, and when virus replication is retarded, improvement follows. Although treatment promptly reduces illness and virus shedding, antibody response is not reduced in treated patients. We emphasized that ribavirin aerosol had a major therapeutic effect on infections caused by both influenza A and B viruses, and the picture of illness with these types of influenza was not clinically distinguishable.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗