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PubMed1997

Systemic levels of 6-keto-prostaglandin F1 alpha following administration of inhaled aerosolized prostacyclin.

A case is described where systemic levels of prostacyclin metabolite were measured during inhaled aerosolized prostacyclin (IAP) therapy for severe hypoxaemia in a patient with the acute respiratory distress syndrome. Comparable levels of prostacyclin metabolite have been associated with a marked platelet aggregation defect in vitro. A platelet aggregation defect was also demonstrated in vivo in this patient. Haemodynamic and gas exchange data during the IAP therapy are described.

6-Ketoprostaglandin F1 alpha↗

PubMed1988

Frequent administration by inhalation of salbutamol and ipratropium bromide in the initial management of severe acute asthma in children.

A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma. A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide. Twenty-five children ranging in age from 5 to 15 years were enrolled in the study. Children with FEV1 less than or equal to 55% predicted were eligible to participate in the study. Subjects were randomized in a double-blind fashion into one of two treatment groups. Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg (0.03 cc/kg), followed by six consecutive doses of 50 micrograms/kg (0.01 cc/kg) at 20-minute intervals. In one group of subjects, 250 micrograms (1.0 ml) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation, and at 40 and 80 minutes, whereas the remaining subjects received a placebo with salbutamol at those times. Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period. There was no significant difference in side effects reported in the two groups. Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group.

Administration, Inhalation↗

PubMed1987

"Aerosol-in-bag" administration of inhaled bronchodilators.

Many patients fail to use metered dose inhalers (MDI) correctly even after receiving tuition, as the technique requires hand-lung coordination, and breath-holding. The article describes the various Auxiliary Delivery Systems designed to circumvent the problem, compares them with MDI, and reports a new "Aerosol-in-Bag" method which is home-made, easy for the patient to assemble, and hardly adds to the cost of the MDI. It could be particularly useful in third-world countries where cost and availability are serious considerations. The new method was found to be as effective as a correctly used MDI, in spite of its extreme case of use, as it requires no coordination or special breathing techniques.

Administration, Inhalation↗

PubMed2004

[Administration of inhaled nitric oxide in newborns].

The use of inhaled nitric oxide (iNO) in newborn hypoxemic respiratory failure is based on the evidence of selective pulmonary vasodilation, without systemic side effects. It is use in more than 34 weeks old newborns, with severe acute pulmonary hypertension and right-left extrapulmonary shunt. In the other cases (i.e. pneumonia, sepsis, ARDS), the therapeutic effect is less evident; no final data are available on the use of iNO in pre-term babies. The recommended dosage is 20 ppm, scaling down until 5 ppm and the 40 ppm should never be reached. The length of treatment is variable, usually no more than 7 days and the weaning should be progressive. In conclusion,the use of iNO in newborns with persistent pulmonary hypertension reduces the need of ECMO, but does not substantially modify the outcome.

Administration, Inhalation↗

PubMed1988

Turbuhaler: a new powder inhaler for administration of drugs to the airways.

A metered-dose powder inhaler system has been developed. It is a multidose system that is easy to load and handle for the patient and that does not demand coordination between activation and inhalation. In addition, the new inhaler system is free of propellants, carriers, and other drug additives. Terbutaline sulfate has been selected as a suitable compound for evaluation of this inhaler. Clinical tests with the Turbuhaler have been performed and it has been compared with the conventional terbutaline pressurized metered-dose inhaler (MDI). The new powder inhaler can even be used at low inspiratory flow rates such as those present during acute asthma attacks.

Asthma↗

PubMed2004

Managing COPD in LTC: focusing on administration of inhaled medications.

In summary, all three types of aerosol therapy have a place in patient care. While MDI and DPI use is more efficient, less costly, and less time consuming, nebulization is still indicated under certain circumstances. As the length of hospitalization for COPD patients decreases and the cost burden shifts, nurses in the LTC setting are caring for more acute COPD residents. Prevention of exacerbations is an important focus of care in the LTC setting. With a good understanding of aerosol devices, the nurse can greatly impact the goals of respiratory disorder management. It is important for the nurse to be well versed in the use of aerosol therapies to provide adequate instruction to residents. Many nurses and other staff in the long-term care facility are unaware of proper inhalation technique with MDI use, and staff education is essential. Accurate care and use of aerosol medications will prevent medication errors and help the LTC facility comply with CMS regulations. The nurse can use resident teaching time to assess the resident's condition and capabilities with the device. If a resident is having difficulty with a device for any reason, the efficacy of the device may be greatly impacted. In such cases, the nurse can provide reinforcement teaching or recommend a change in the type of aerosol therapy. Not only must the nurse teach and continually evaluate the appropriateness of the therapy and its use, but also assess the resident for any side effects. Through continual assessment, implementation, and evaluation, the nurse has the opportunity to affect the resident's condition, and quality of life. [table: see text]

Administration, Inhalation↗

PubMed2002

A new HFA-134a propellant in the administration of inhaled BDP via the Jet spacer: controlled clinical trial vs the conventional CFC.

This study was carried out with the aim of demonstrating the efficacy and tolerability of beclomethasone dipropionate (BDP) aerosol spray 500 microg b.i.d. via a spacer device (Jet, Chiesi Farmaceutici S.p.A.) using a new HFA-134a formulation or chlorofluorocarbon (CFC) propellant. After having completed a 2-week run-in period, 154 adult patients (77 in each group) with mild-to-moderate persistent asthma were randomised into two groups to receive the study treatment for a duration of 12 weeks in a double-blind, multinational, multicentre, parallel-group design. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of day- and night-time asthma attacks, number of night-time awakenings due to asthma and clinical symptoms were recorded daily by patients on diary cards. Pulmonary function tests (FEV1, FVC, PEFR, FEF25-75%, MEF50 and FEF25) and vital signs were measured at the clinic at study entry, at the start of treatment and every 2 weeks thereafter. Morning serum cortisol (8.00-10.00 a.m.) was measured at the start and at the end of the treatment period. Adverse events were recorded throughout the total study period. Significant improvements over baseline were reported in both groups in terms of lung function, symptoms and use of rescue inhaled salbutamol. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1. No statistically significant differences in the comparisons between groups, except for FEF25 (P=0.044), were observed in any of the other efficacy variables. Adverse events were reported in 31% of patients in the BDP-HFA group and in 32% in the CFC group. Adverse drug reactions were 4 and 2 in the two groups, respectively. No drug-related serious adverse events were reported in either of the groups. No signs of relevant adrenal suppression were observed in both groups: 2 patients in each group had final values below the normal range. In conclusion, the BDP-HFA-134a formulation proved to be equivalent in efficacy and comparable in safety to the standard BDP-CFC product over 12 weeks in adult patients with mild-to-moderate persistent asthma.

Administration, Inhalation↗

PubMed2004

Xenon improves recovery from myocardial stunning in chronically instrumented dogs.

In this study we tested the hypothesis that inhalational administration of xenon improves recovery from myocardial stunning. Ten dogs were chronically instrumented for measurement of heart rate; left atrial, aortic, and left ventricular pressure; coronary blood-flow velocity; and myocardial wall-thickening fraction. Regional myocardial blood flow was determined with fluorescent microspheres. Catecholamine plasma levels were measured by high-performance liquid chromatography. An occluder around the left anterior descending artery (LAD) allowed the induction of a reversible LAD ischemia. Animals underwent 2 experimental conditions in a randomized crossover fashion on separate days: (a) 10 min of LAD occlusion under fentanyl (25 microg. kg(-1). h(-1)) and midazolam (0.6 mg. kg(-1). h(-1)) (control) and (b) a second ischemic episode under the same basal anesthesia with concomitant inhalational administration of 75 +/- 1 vol% xenon (intervention). Anesthesia was induced 35 min before LAD occlusion and was discontinued after 20 min of reperfusion. Dogs receiving xenon showed a significantly better recovery of wall-thickening fraction up to 12 h after ischemia. The increase in plasma epinephrine during emergence from anesthesia and in the early reperfusion period was significantly attenuated in the xenon group. There were no differences between groups concerning global hemodynamics, blood-flow velocity, or regional myocardial blood flow. In conclusion, inhalational administration of 75 vol% xenon improves recovery from myocardial stunning in chronically instrumented dogs under fentanyl/midazolam anesthesia.

Animals↗

PubMed1976

[Effectiveness of the inhalatory administration of chlolincocin in experimental staphylococcal pneumonia].

Administration of chlolincocin (7-chlor-7-desoxylincomycin) in the form of inhalation aerosol to albino mice in a dose of 200 Units/mouse provided the drug therapeutic concentrations in the lung tissue. The antibiotic was well adsorbed and detected in the blood, liver, kidneys and other biological substrates. Penetration of chlolincocin and lincomycin from the lungs into the blood was better in healthy animals. In animals with experimental staphylococcal infection their blood levels were 1.5--2 times lower. Repeated inhalations of chlolincocin resulted in an increase resulted in its levels in the lung tissue up to 8--10 Units/ml, however, its blood levels increased insignificantly. When chlolincocin and lincomycin were administered intravenously, their concentrations in the lung tissue were lower and detected for a shorter period of time than after the inhalation administration. The aerosols of chlolincocin markedly inhibited the growth of Staph. aureus in the lungs. The drug was 3--5 times more active than lincomycin. Inhalation administration of chlolincocin aerosol is supposed to be expedient for the treatment of inflammatory diseases of the respiratory organs caused by lincomycin sensitive flora.

Animals↗

PubMedDate not supplied

Hepatotoxicity of N, N-dimethylformamide in rats following intraperitoneal or inhalation routes of administration.

Male Sprague-Dawley rats were administered a single intraperitoneal injection of N, N-dimethylformamide (DMF, 0.01-1.5 g kg-1) or were exposed for 4 h to DMF vapours (75-900 ppm). The serum activities of the enzymes sorbitol deshydrogenase and glutamate deshydrogenase were used as indicators of liver damage, and were determined at 24, 48 or 72 h post-treatment. Following either route of administration DMF caused concentration-dependent elevations in enzyme activities, the maxima of which occurred later after administration of higher concentrations of DMF than after lower concentrations.

Administration, Inhalation↗

PubMed2002

Model-based administration of inhalation anaesthesia. 4. Applying the system model.

BACKGROUND: We developed and tested a simple dosing strategy for rapid induction with isoflurane followed by maintenance under minimal-flow conditions, that is 0.5 litre min(-1) total fresh gas flow (FGF). An end-expired concentration was to be achieved within 5 min in a desired therapeutic window, that is 0.8-1.1 vol%, and to be maintained within it for at least 30 min. METHODS: With our new model we computed a three-stage regimen using one fixed vaporizer setting: 3 vol% isoflurane in a FGF of 3 and 1.5 litre min(-1), each for 3 min, and 0.5 litre min thereafter. The ratio of nitrous oxide:oxygen was, consecutively, 2:1, 2:1, and 2:3. We evaluated this scheme in 58 adult patients (body mass 74 (SD 13) kg), mostly during eye and ear, nose, and throat surgery. RESULTS: Measured oxygen (33-45 vol%) and nitrous oxide concentrations (66-50 vol%) evolved in accordance with those computed. In five patients with a median of body mass 92 kg (range 76-126 kg), inspired oxygen concentrations decreased to less than 30 vol%. End-expired isoflurane concentration entered the window after 2 min (range 1.0-5.67 min) and attained its maximum, that is 0.96 vol% (0.8-1.2 vol%), after 3.45 min (1.67-6.33 min). The mean end-expired concentration was in the desired window from 3-60 min and an average of 72% of individual measurements were within the window from 3-30 min. The scheme was adapted in six patients (excluded from analysis) because of hypotension. CONCLUSION: The regimen is easily remembered, reliable, and lends itself to alternative strategies, but must be guided by the monitoring of gas and vapour concentrations and haemodynamic variables.

Adolescent↗

PubMed2003