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At least 1,099 records · Page 61Linked to original sources
PubMed2006

The effect of smoking cessation and subsequent resumption on absorption of inhaled insulin.

OBJECTIVE: To assess the absorption profile of inhaled insulin in healthy, actively smoking subjects at baseline, after smoking cessation, and after smoking resumption and compare it with nonsmoking subjects. RESEARCH DESIGN AND METHODS: Insulin pharmacokinetics and glucodynamics were measured in 20 male smoking subjects (10-20 cigarettes/day) and 10 matched nonsmoking subjects after receiving inhaled insulin (1 mg) or the approximate subcutaneous insulin equivalent (3 units) in a randomized cross-over fashion. All smokers then received inhaled insulin 12 h, 3 days, and 7 days into a smoking cessation period. They then resumed smoking for 2-3 days before again receiving inhaled insulin 1 h after the last cigarette. RESULTS: Before smoking cessation, maximum insulin concentration (Cmax) and area under the curve (AUC) for insulin concentration time (AUC-Insulin(0-360)) with inhaled insulin were higher, and time to Cmax (t(max)) shorter, in smokers than nonsmokers (Cmax 26.8 vs. 9.7 microU/ml; AUC-Insulin(0-360) 2,583 vs. 1,645 microU x ml(-1) x min(-1); t(max) 20 vs. 53 min, respectively; all P < 0.05), whereas with subcutaneous insulin, systemic exposure was unchanged (AUC-Insulin(0-360) 2,324 vs. 2,269 microU x ml(-1) x min(-1); P = NS). After smoking cessation, AUC-Insulin(0-360) decreased with inhaled insulin by up to 50% within 1 week and approached nonsmoker levels. Cmax decreased and t(max) increased relative to baseline but were still not comparable with nonsmoker values. Smoking resumption completely reversed the effect of smoking cessation. Glucodynamics corroborated the observed findings in insulin pharmacokinetics. CONCLUSIONS: Cessation and resumption of smoking greatly altered the pharmacokinetics of inhaled insulin. As rapid changes in systemic insulin exposure increase hypoglycemia risk, inhaled insulin should not be used in people with diabetes who choose to continue smoking. This is consistent with recommendations that people with diabetes refrain from smoking altogether.

Absorption↗
PubMed2001

Pulmonary and systemic effects of inhaled endotoxin in control and heaves horses.

To investigate whether inhaled endotoxin contributes to airway inflammation and dysfunction in stabled horses, control (n = 6) and asymptomatic heaves (previously termed chronic obstructive pulmonary disease)-susceptible (n = 7) horses were given inhalation challenges with 20, 200 and 2,000 microg of soluble Salmonella typhimurium Ra60 lipopolysaccharide (LPS). LPS inhalation induced a dose-dependent neutrophilic airway inflammatory response in both groups. Inhalation with 2,000 microg of LPS also induced detectable lung dysfunction in the heaves group. LPS inhalation did not alter clinical score, tracheal secretion volume or airway reactivity in either group. The no-response thresholds were lower for the heaves group (<20 microg for airway inflammation; 200 to 2,000 microg for lung dysfunction) than for the control group (20 to 200 microg for airway inflammation; >2,000 microg for lung dysfunction). To enable comparison of these threshold levels with airborne endotoxin concentrations in stables, horses also received a 5 h duration hay/straw challenge, during which the total and respirable airborne endotoxin concentrations were determined. Comparison of the effects of acute LPS inhalation and hay/straw challenges suggest that inhaled endotoxin is not the sole cause of heaves. However, it is likely that it contributes to airway inflammation, both in heaves horses in concert with other inhalants, and in normal horses when they are exposed to high levels in poor stable environments.

Air↗
PubMed1990

Effect of verapamil inhalation on bronchial asthma.

The effect of inhaled verapamil 20 mg on pulmonary functions and arterial blood gases in 15 patients with extrinsic bronchial asthma was studied in single-blind fashion. A significant decrease (p less than 0.05) in airway resistance and a significant increase (p less than 0.01) in specific conductance was observed after verapamil inhalation. A small increase (p less than 0.1) was observed in forced vital capacity and peak expiratory flow rate after verapamil inhalation; however, this was not statistically significant. None of the parameters of pulmonary function tests showed a significant change after normal saline inhalation. A significant fall in PaO2 (p less than 0.05) and PaCO2 (p less than 0.05) was noted after normal saline inhalation. PaCO2 showed a significant fall (p less than 0.01) after verapamil inhalation. Alveolar arterial oxygen gradient P(A-a)O2 widened significantly (p less than 0.001) after normal saline inhalation. A larger dose (20 mg) of verapamil inhalation produces a significant bronchodilator effect on large airways, but does not produce a significant change in arterial oxygen tension from the baseline value in patients with bronchial asthma.

Administration, Inhalation↗
PubMed1998

Comparison of a new multidose powder inhaler (Diskus/Accuhaler) and the Turbuhaler regarding preference and ease of use.

Many patients with asthma or chronic obstructive pulmonary disease (COPD) use their inhaler ineffectively. Several studies revealed that inhaler-specific design features contributed significantly to the failure rate, which clearly demonstrates the need for developing more "foolproof" inhalers. This study compared ease of use and patient preference of the Diskus/Accuhaler (DA) with the Turbuhaler (TH). Fifty patients with asthma or COPD aged 15 years and older were included in a randomized, crossover comparison of DA with TH regarding patient preference and ease of use. All had to be naïve to DA and TH, but currently had to be using inhaled medication with another device. Inhalation technique was assessed using inhaler-specific checklists and patients had to state a preference for DA or TH regarding various aspects, as well as overall preference. With DA 46 patients (92%) made no errors regarding essential inhalation maneuvers, compared to 37 patients (74%) using TH (p = 0.023). This difference is exclusively caused by not loading the TH properly. When patients were asked which inhaler they would prefer, 17 wanted the DA, 25 the TH, and 8 did not state a preference. The difference was not significant. TH was favored over DA regarding factors related to size and the number of available dosages. The counting mechanism of the DA was preferred over the TH. It seems that patients have a clear, although not statistically significant, preference for TH, but with the DA fewer patients make crucial errors.

Administration, Inhalation↗
PubMed1995

Inhaled nitric oxide therapy.

OBJECTIVE: To review the basic science, physiology, toxicity, and delivery of inhaled nitric oxide (NO). DESIGN: A literature review of inhaled NO is presented, and a brief discussion of current clinical applications is included. RESULTS: Inhaled NO is a new investigational drug used for selective vasodilation of the pulmonary vasculature. It mimics the effects of endogenously produced endothelium-derived relaxing factor. In addition to selective pulmonary vasodilation, inhaled NO can improve hypoxemia by improving ventilation-perfusion relationships within the lung. The doses of inhaled NO that produce improvements in oxygenation are lower than those needed to produce maximal vasodilation. Inhaled NO is being used in the intensive-care unit to treat critically ill patients with pulmonary hypertension or hypoxemia associated with ventilation-perfusion imbalance. It is also being used in the cardiac catheterization laboratory as a diagnostic tool. Few adverse effects have been associated with the use of inhaled NO. CONCLUSION: Despite a lack of randomized, controlled studies that show improved outcome in comparison with traditional treatments, inhaled NO seems to be an effective new therapy for patients with pulmonary vasospasm or hypoxemia associated with ventilation-perfusion imbalance. It may also prove to be a valuable diagnostic tool in the cardiac catheterization laboratory.

Administration, Inhalation↗
PubMed2005

Inhaled foreign bodies in adolescents and adults.

BACKGROUND: Accidental foreign body inhalation is not uncommon. The incidence is high in children, especially the very young ones. We evaluated the management of inhaled foreign bodies in an adult respiratory medical unit, highlighting circumstances leading to inhalation, associated complications and difficulties encountered at bronchoscopic retrieval. METHODS: We reviewed all cases of inhaled foreign bodies presenting over a period of 12 years (1991-2003). RESULTS: 5 of 8 cases were teenagers whereas 3 were aged over 55 years. The older patients had co-morbidities and had aspirated food particles. In 2 cases, a bronchoscopy was performed primarily to exclude lung cancer, and the discovery of a foreign body was a surprise. Pulmonary complications related to foreign body inhalation were common among this group. All 5 teenage patients presented after inhalation of small objects. 4 patients from the teenage group had general anaesthesia; in 2 of them a laryngeal mask airway was employed, whilst 2 had endotracheal intubation. Only one patient was given a rigid bronchoscopy following failure of the fiberoptic instrument. Difficulties at retrieval of foreign body were frequently encountered. CONCLUSIONS: In the adolescent and adult patients, most inhaled foreign bodies are retrievable by flexible bronchoscopy. However, facilities for rigid bronchoscopy should be available as a back-up. Pulmonary complications are common after foreign body inhalation especially in the older patients. Difficulties at bronchoscopic removal may occur due to late presentation or to the site and/or position of the foreign body within the tracheobronchial tree.

Adolescent↗
PubMed1999

[Changes in specific airway resistance after powder inhalation of formoterol or salmeterol in moderate bronchial asthma].

Formoterol and salmeterol are two long acting beta 2 agonists available for the treatment of asthma which show differences in onset of action. In a multicentre parallel group study, patients with moderate asthma were investigated by measuring the specific airway resistance (sRaw), a more sensitive parameter than FEV1. A total of 99 patients were randomised for open treatment with either 12 micrograms formoterol delivered via Turbohaler or 50 micrograms salmeterol via Diskus. The patients were between 18 and 66 years of age, had a medium FEV1 of 68.8% (+/- 17.8%) predicted and showed a medium reversibility of 28.8% (+/- 16.5%). The patients response to one inhalation of the study drug was investigated by sRaw measurements 2, 5, 10, 20 and 60 minutes after inhalation of the formulation. Additionally, FEV1 was measured. The results show a significant decrease in specific airway resistance of 29% within the first two minutes in patients who had received 12 micrograms formoterol via Turbohaler. However, patients on salmeterol showed no change (sRaw +/- 1%). This difference is statistically highly significant (p < 0.0001). Furthermore, in 49% of the patients treated with salmeterol an increase in sRaw was seen immediately after inhalation of the drug. This increase was +16.4% in an average of 2 minutes after inhalation. One hour after inhalation the differences between the groups were small and not significant neither between formoterol and salmeterol-treated patients nor within the salmeterol group. In the following week patients were treated with 12 micrograms formoterol Turbohaler b.i.d. or 50 micrograms salmeterol Diskus b.i.d., respectively. A further sRaw measurement was performed 11 +/- 1 hours after the last inhalation of the drug. The results for sRaw and FEV1 show no differences between both study drugs indicating a similar duration of action for both formoterol Turbohaler and Salmeterol Diskus in moderate asthma. No serious adverse events were reported. The adverse event profile observed in both study groups was comparable. Thus, this study shows once again that formoterol delivered via Turbohaler has a more rapid onset of bronchodilating action compared with salmeterol Diskus. Furthermore the inhalation of salmeterol via Diskus in one-half of the patients led to an increase in specific airway resistance within the first minutes after inhalation. It is worth discussing whether an unspecific reaction to the relatively large lactose particles which are components of the salmeterol Diskus formulation are responsible for this observation.

Administration, Inhalation↗
PubMed2000

Pharmacokinetics of a model organic nitrite inhalant and its alcohol metabolite in rats.

Volatile organic nitrites were originally used to relieve the chest pain that is associated with angina pectoris. Today, these inhalants are predominantly used as drugs of abuse. Little is known regarding the bioavailability and disposition of volatile nitrites. In this study, the pharmacokinetics of a major organic nitrite inhalant, isobutyl nitrite (ISBN), and its primary metabolite, isobutyl alcohol (ISBA), were investigated after inhalation and i.v. administration. ISBN blood concentrations in the rat declined mono-exponentially with a half-life of 1.4 min and a blood clearance of 2.9 l/min/kg that vastly exceeded cardiac output (0.3 l/min/kg). Approximately 98% of ISBN was metabolized to ISBA, which declined monoexponentially with a half-life of 5.3 min when the infusion of ISBN was terminated. The bioavailability of inhaled ISBN, over a range of 300 to 900 ppm, was estimated to be 43%. After inhaled ISBN, the half-life of ISBA decreased approximately 4-fold (t(1/2) inh = 1.5 min versus t(1/2) i.v. = 5.3 min; P <.001), whereas no pharmacokinetic difference was observed for ISBN. Inhalation of another nitrite, isoamyl nitrite, accelerated the apparent clearance of ISBA, suggesting that nitrite inhalation could change the disposition of another compound. A pharmacokinetic model was developed to describe the concentration-time profile of ISBA and ISBN after inhalation and i.v. administration.

Administration, Inhalation↗
PubMed2000

Discrimination of prohibited oral use of salbutamol from authorized inhaled asthma treatment.

BACKGROUND: The administration of salbutamol is permitted only by inhalation by the International Olympic Committee (IOC) for the management of asthma and exercise-induced asthma in athletes. The establishment of criteria to distinguish between the (IOC) authorized use (inhaled) and the (IOC) prohibited use (oral) of salbutamol appeared possible using simultaneous evaluation of variables based on the concentration of nonconjugated enantiomers of salbutamol excreted in urine. METHODS: Urine was collected from asthmatic and nonasthmatic swimmers who had received various preexercise doses of oral (five doses of 4 mg) or inhaled (two doses of 100 microgram) salbutamol. Urine was also obtained from subjects who had received the maximum dosage of inhaled salbutamol advisable for competing athletes to provide protection from exercise-induced asthma and treatment of asthma (1600 microgram in 24 h, 800 microgram being in the last 4 h). All samples were analyzed to determine the total amount of unchanged salbutamol excreted in urine and the ratio between the S: and R: enantiomers. RESULTS: The discriminant function D = -3.776 + 1.46 x 10(-3) ([S:(+)] + [R:(-)]) + 1.012 ([S:(+)]/[R(-)]) can be used to classify data into two groups, inhaled and oral. The confirmatory criterion suggested (cutoff at D = 1.06, 4 SD from the mean D value of the inhaled distribution) has been verified in different sets of samples showing suspicious concentrations by conventional screening procedures in doping control. An 11.8% false-negative (oral classified as inhaled) rate is assumed with the confirmatory criterion proposed, but virtually no false positives (inhaled classified as oral) are obtained (<1 in 33 000). CONCLUSIONS: The overall procedure recommended is to screen all samples and to apply the confirmation criterion proposed to samples showing free racemic salbutamol concentrations >500 microgram/L by gas chromatography-mass spectrometry or free + conjugated racemic salbutamol concentrations >1400 microgram/L by ELISA.

Administration, Inhalation↗
PubMed2000

Inhaled flow and handling of fluticasone diskhaler by asthmatic patients.

We investigated the inhaled flow and handling of a Fluticasone Diskhaler (FDH) by patients familiar with the beclomethasone dipropionate inhaler (BDI), a metered dose inhaler. Before the FDH was introduced in our hospital, 174 patients were instructed in the use of the Diskhaler and measured the flow of Diskhaler inhalation. Three months after the introduction of the FDH, approximately 95 patients were using them. During their regular visit to the hospital, we checked the patients' handling of FDH and the flow of FDH inhalation (n=81). It was found that only 22% of the patients correctly handled the FDH. The major erros concerned breath-holding and disk rotation after use, but 9.9% of the patients handled the inhaler with serious error, e.g., incomplete puncturing of the blister. The mean FDH flow was 86.5 L/min, which was significantly higher than that recorded at the first FDH trial (69.1 L/min). In 9.9% of the patients, the inhaled flow was inappropriately low (<50 L/min), in 29.6% of the patients, it was unnecessarily high (>100 L/min). In conclusion, handling the FDH is easy for patients who are already familiar with the BDI. However, in 40% of the patients, the inhaled flow rate was not sufficient.

Administration, Inhalation↗
PubMed1998

[L-arginine prolonged the efficacy of inhaled nitric oxide on the inhibition of pulmonary hypertension].

OBJECTIVE: The aim of this study is to investigate the effects of L-arginine, the substrate of nitric oxide (NO) on the duration of nitric oxide selective decrease of pulmonary hypertension. To assess whether combined use of inhaled nitric oxide and venous administered L-arginine can improve the efficacy of inhaled NO on the inhibition of hypoxia induced pulmonary hypertension. METHOD: Eight pigs with hypoxic pulmonary hypertension received either inhaled NO(12-15 ppm) for 10 minutes or inhaled NO plus venous administrered L-arginine(10 g), then hemodynamic parameters were recorded. RESULT: NO inhalation significantly inhibited hypoxic induced pulmonary hypertension with pulmonary arterial pressure decreasing from 4.2 +/- 0.4 kPa to 2.5 +/- 0.5 kPa(P < 0.01) and pulmonary vascular resistance from 56 +/- 25 kPa.s.L-1 to 31 +/- 13 kPa.s.L-1(P < 0.01), but this just lasted for 3-5 minutes after stopping inhalation; combined use of L-arginine infusion did not further decrease pulmonary arterial pressure, but significantly prolonged the inhibitory effect of inhaled NO on pulmonary hypertension (20 times) as compared with inhaled NO only. CONCLUSION: With the existence of exogenous NO, supplement of NO substrate L-arginine produced a synesgetic inhibition effect on hypoxic induced pulmonary hypertension.

Administration, Inhalation↗
PubMed2001

[Assessment of techniques and errors in the use of metered dose inhalers in the adult patient].

BACKGROUND: Not all the techniques for the correct use of metered dose inhalers are used by patients and health care professionals. AIM: To assess the techniques and errors in the use of metered dose inhalers among patients and health care professionals. MATERIAL AND METHODS: Evaluation of the inhaling technique, using a validated questionnaire, used by 68 patients, 30 physicians and 30 nurses working in a hospital at Concepción, Chile. RESULTS: The "closed mouth" technique is used by 84% of patients, 40% of physicians and 73% of nurses. The rest uses the "open mouth" technique. The aerochamber is used by 12% of patients, 37% of physicians and 27% of nurses. The most frequent inhaling errors detected were not shaking the inhaler (26% of patients, 30% of physicians and 7% of nurses), not applying the puff at the start of inspiration (28% of patients, 7% of physicians and 13% of nurses), and not maintaining an apnea after the inhalation (41% of patients, 7% of physicians and 10% of nurses). Sixty percent of patients, 67% of physicians and 40% of nurses have not received instructions about the inhaler use. CONCLUSIONS: There is a high frequency of errors in the use of inhalers and most users have not been trained in its use.

Administration, Inhalation↗
PubMed2001

Income-based drug benefit policy: impact on receipt of inhaled corticosteroid prescriptions by Manitoba children with asthma.

BACKGROUND: Drug benefit policies are an important determinant of a population's use of prescription drugs. This study was undertaken to determine whether a change in a provincial drug benefit policy, from a fixed deductible and copayment system to an income-based deductible system, resulted in changes in receipt of prescriptions for inhaled corticosteroids by Manitoba children with asthma. METHODS: Using Manitoba's health care administrative databases, we identified a population-based cohort of 10,703 school-aged children who met our case definition for asthma treatment before and after the province's drug benefit policy was changed in April 1996. The effects of the program change on the probability of receiving a prescription for an inhaled corticosteroid and on the mean number of inhaled corticosteroid doses dispensed were compared between a group of children insured under other drug programs (the comparison group) and 2 groups of children insured under the deductible program: those living in low-income neighbourhoods and those living in higher-income neighbourhoods. All analyses were adjusted for a measure of asthma severity. RESULTS: For higher-income children with severe asthma who were covered by the deductible program, the probability of receiving an inhaled corticosteroid prescription and the mean annual number of inhaled corticosteroid doses declined after the change to the drug policy. A trend toward a decrease in receipt of prescriptions was also observed for low-income children, but receipt of prescriptions was unaltered in the comparison group. Before the policy change, among children with severe asthma, the mean annual number of inhaled corticosteroid doses was lowest for low-income children, and this pattern persisted after the change. Among children with mild to moderate asthma, those covered by the deductible program (both low income and higher income) were less likely to receive prescriptions for inhaled corticosteroids than those in the comparison group, and this difference was statistically significant for the higher-income children. INTERPRETATION: The change to an income-based drug benefit policy was associated with a decrease in the use of inhaled corticosteroids by higher-income children with severe asthma and did not improve use of these drugs by low-income children.

Administration, Inhalation↗
PubMed2002

[Clinical effect of high inhalation flow from a fluticasone diskhaler in chronic asthma].

The optimal inhalation flow of dry powder formula fluticasone dipropionate (DFP) is not known. This study investigated the clinical effects of inhaling a flow of DFP. A randomized cross-over trial was applied to 13 patients with chronic persistent asthma. After a 2-week run-in period using the current dose of beclomethasone from a metered dose inhaler (BDP-run), BDP was replaced with an equipotent amount of DFP. The patients entered either an 8-week run with high-flow (> 100 L/min) inhalation followed by a 4-week run with medium-flow (70 L/min) (HM group) or a medium-flow run followed by a high-flow run (MH group). The peak inhaling flow from DFP was measured daily. The mean of the inhalation flow in the high-flow run (111.4 +/- 3.6 (SE) L/min) was significantly higher than that (77.3 +/- 0.6 L/min) in the medium-flow run. In both groups, morning and evening peak expiratory flows (PEFs) increased in the first week of change from BDP to DFP, peaking in the first 8-week run, then maintained this level until the end of the following 4-week run. When PEFs in the last week of the 3 runs were compared, those during the DFP-run of either flow were significantly larger than those during the BDP-run, but the PEFs during the high-flow and medium-flow runs were not significantly different. The asthma symptoms also improved with a change from BDP to DFP, but the symptoms did not change with a change in the inhalation flow rate. An inhaled flow of up to 111 L/min is acceptable in terms of clinical efficacy for the use of DFP.

Administration, Inhalation↗
PubMedDate not supplied

Inhaled nitric oxide in persistent pulmonary hypertension of the newborn: four-year experience in a single medical center.

Forty-eight infants with persistent pulmonary hypertension of the newborn (PPHN) from July, 1997 to June, 2001 were enrolled for a prospectively study to determine the role of inhaled nitric oxide (NO) treatment and to determine an appropriate weaning strategy of NO. The initial dose of NO was started at 10 ppm for 10 minutes. If the infant's symptoms did not improve, we used a rapid dose ladder schedule for increasing the dose of NO to 20, 40 and 80 ppm every 10 minutes until we achieved the desired response. When oxygenation improved for 30 minutes, NO was decreased by 5 ppm every 10 minutes until reaching 5 ppm which was maintained for 2-3 hours. During the NO weaning period, if the SpO2 decreased by 10% or fell below 85%, the NO was increased to the previous higher dose and maintained this lowest effective dose for 2-3 hours. During this period, FiO2 was decreased by 10% every 10 minutes and peak inspiratory pressure was decreased gradually as the infant tolerable to avoid a decrease in saturation; we then tried to repeat the weaning procedure of NO. Inhaled NO was discontinued at 5 ppm if the infants were stable for 2-3 hours, and at the same time FiO2 was permitted to raise 10-20%. If SpO2 decreased by 10% or fell below 85% within 5 minutes, NO was reinstated at 5 ppm. A second attempt at weaning NO was made 2-3 hours later when the infants were stable. Thirty-four infants (70.8%) survived. Forty infants (83.3%), including 34 who survived and 6 who died, had good responses to inhaled NO. The mean effective NO concentration was 37 (5-80) ppm. The mean duration of inhaled NO treatment was 43 (6-153) hours. This study has demonstrated that inhaled NO is an effective rescue treatment for infants with severe PPHN, but the final outcome of infants depends not only on the response to inhaled NO but also on the associated complications. Using our weaning strategy, we shortened the duration of inhaled NO treatment as compared with a previous study (43 vs. 87 hours). Beginning inhaled NO therapy early in severe PPHN may be an important factor in shortening the duration of NO therapy. Further controlled trials of this weaning strategy are warranted.

Administration, Inhalation↗
PubMed2002

Comparison of innovator and generic salbutamol inhalers: a double-blind randomized study of efficacy and tolerance.

Preliminary feedback from physicians and pharmacists in Trinidad suggests that generic pressurized metered dose inhalers (pMDIs) of salbutamol are not as effective as Ventolin and that they have poor patient acceptance. This study was designed to compare the clinical efficacy and tolerance of two generic inhalers available in Trinidad (Asthalin and Salomol) with Ventolin in stable asthmatics. Twenty-one physician-diagnosed stable asthmatics were administered the inhalers in a Latin-square randomized double-blind study with 80% power to identify differences in forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) before and 0.25, 0.5, 1, 2 and 3 h after inhalation. Pulse and blood pressure were recorded at similar time points. Seventeen patients completed the study. Within 15 min basal respiratory function significantly increased following inhalation from all three inhalers with a gradual decline over the observation period. Asthalin produced the highest changes in FEV1, PEFR and the longest duration of effect (p < 0.001). Respiratory function tests did not differ between Ventolin and Salomol. Pulse was not affected by treatments and mean arterial blood pressure fell after Asthalin. Ventolin was not superior to the generic pMDIs in improving pulmonary function. Fifteen patents reported cough sensation after Asthalin. Throat irritation and cough sensation after inhaling Asthalin may negate patient compliance. We suggest that optimizing particle size and cascade impact in the Asthalin inhaler may improve patient tolerance and acceptance with enhanced treatment outcome with cost-efficacy.

Adult↗
PubMed1992

Burn edema is accentuated by a moderate smoke inhalation injury in sheep.

We determined the lung and systemic response of a moderate smoke inhalation injury combined with a 15% total body surface third-degree burn compared with a burn alone and inhalation alone. Adult sheep were prepared with chronic lung and bilateral prefemoral soft tissue lymph fistula. The burn was confined to one side. Physiologic parameters, lymph flow (QL), and lymph/plasma protein ratio were monitored. Oxidant changes were measured as lipid peroxidation by circulating and lymph-conjugated dienes and lung tissue malondialdehyde. Animals were resuscitated with lactated Ringer's solution during the 24-hour study period to restore and maintain vascular filling pressures and cardiac index. We found net 24-hour fluid balance for burn-inhalation injuries to be 4.1 +/- 1.2 L compared with burn alone of 2.9 +/- 0.9 L and inhalation alone of 2.4 +/- 0.5 L, a significant difference. Protein-rich burn tissue QL increased by fivefold to sixfold with burn alone compared with more than tenfold with burn-inhalation injury. A twofold increase in both lung and nonburn soft tissue QL was also seen in the combined injury not seen with burn alone. Arterial blood gases decreased only at 12 hours. Plasma conjugated dienes were increased in all groups, whereas burn lymph values were increased only in combined insult. In addition, lung malondialdehyde content at 24 hours was 155 +/- 11 nmol/gm with burn-inhalation injury compared with 62 +/- 8 nmol/L for burn alone, 55 +/- 9 nmol/L in inhalation alone, and 45 +/- 4 nmol/L for controls. However, no alveolar flooding was noted in any group. We conclude that a modest smoke inhalation (carboxyhemoglobin of 25%) added to a 15% total body surface burn markedly increases the degree of burn edema, as well as nonburn soft tissue and lung QL, compared with burn alone, indicating increased plasma to interstitial fluid transport in these tissues as well. Increased burn tissue lipid peroxidation products corresponded with the increased burn fluid losses. The increased lung lipid peroxidation also indicates further lung oxidant activity as well.

Animals↗
PubMed2003

Pitfalls of inhalation technique in chronic asthmatics. Effect of education program and correlation with peak expiratory flow.

OBJECTIVE: To determine the pattern of pitfalls of inhalation technique in chronic asthmatics; to assess whether an educational program can reduce the pitfalls of inhalation technique; and to evaluate whether reduction of the pitfalls could have a positive correlation with peak expiratory flow (PEF) measurements. METHODS: The pitfalls of inhalation technique in 106 chronic asthmatics using either metered dose inhaler (MDI) (65%) or turbuhaler (35%) were studied prospectively. The pitfalls of inhalation technique and PEF measurement were recorded before and after an educational program at first and second visit. It was performed in the outpatients asthma clinic of the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2001 until March 2002. RESULTS: Among the MDI group; failure to breath hold for 5-10 seconds (52.2%) and failure to breath in slowly and deeply after inhaler activation (46.4%) were the most common pitfalls that have been reduced after education (20.3%, 21.7%). While in the turbuhaler group; failure to breath hold for 5-10 seconds (23.1%) and failure to twist the grip forward and backward before use (21.1%) were the most common pitfalls that have been reduced after education (0%, 0%). In both groups, the education program has been significantly contributed in reducing the mean number of pitfalls among MDI and turbuhaler users with p<0.001 and p=0.002. Moreover, the mean PEF has been improved significantly from 312.4 +/- 109.9 l/minute to 331+/- 105.8 l/minute (p=0.003). CONCLUSION: An educational program used in the outpatients asthma clinic has been significantly reduced the pitfalls of inhalation technique. The reduction of the pitfalls correlated positively with an increase in the PEF measurement. Therefore, we recommend such an education to be used in patients using such inhalers.

Administration, Inhalation↗