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PubMed2006

[Changes in the calcitonin content after inhalation injury in dogs].

OBJECTIVE: To investigate the changes in the serum content of immunoreactive calcitonin (iCT) after burns or inhalation injury, and to explore its diagnostic significance. METHODS: Twenty-four dogs were randomized into 4 groups, i. e. A (n = 6, with moderate degree inhalation injury) , B ( n = 6, with severe inhalation injury), C (n = 6, with most severe inhalation injury) and D (n = 6, with severe burns) groups. The serum content of iCT and blood gas analysis before and after injury were determined at different time points. The degree of inhalation injury was determined with fibrobronchoscopic examination at 6 post-inhalation injury hour (PIH). RESULTS: (1) Fiber bronchoscopic examination showed that the degree of inhalation injury in each group was coincident with the anticipation. (2) The serum content of iCT in each group at 1 PIH was obviously higher than that before injury, and it was evidently higher in A, B and C groups than that in D group at 4 PIH. The peak value of iCT in group A at 24 PIH was (453+/-224) ng/L, and it increased gradually in B and C groups at 48 PIH. The serum content of iCT increased continually from 2 PIH on, and it reached (125+/-41) ng/L at 48 PIH. (3) Compared with PaO2 value before injury (109+/-8) mmHg, there was no obvious difference of the PaO, in A and D groups. PaO2 value in B and C group began to descend continually at 8 PIH (65+/-6) mmHg, and that in C group began to descend at 4 PIH (71+/-9) mmHg. PaCO2 value in C group began to increase at 24 PIH(52+/-11) mmHg when compared with that before injury(38+/-5 ) mmHg. CONCLUSION: The changes in the serum level of iCT within 8 PIH occurred much earlier than PaO2 and PaCO2, thus it has the same diagnostic significance as fibers bronchoscopic examination.

Animals↗
PubMed1990

[Methods for administration of anti-asthma inhalation drugs].

Inhalation of aerosols is an established treatment of asthma. There are different delivery systems such as metered-dose inhalers, spacer devices, powder inhalers and nebulizers. The prescribing physician must be familiar with the variety available so that he can choose the device that suits the patient's needs. Teaching and supervising the method of inhalation is important. The metered-dose inhaler is still the most commonly prescribed inhalation system, but powder inhalers are now used by an increasing number of patients.

Administration, Inhalation↗
PubMed1990

Separation of cough and reflex bronchoconstriction by inhaled local anaesthetics.

Cough and airway constriction are common features of respiratory diseases. Both can be caused by stimulation of airway nerves. We have studied the effects of airway anaesthesia on these reflexes, stimulated by inhaled capsaicin, in order to determine whether they are controlled by the same sensory nerves. Ten volunteers had capsaicin cough dose responses performed before and at 10 min after inhaling placebo (ascorbic acid in saline), and the topical anaesthetics lignocaine 40 mg, and dyclonine 8 and 4 mg. The effect of the drugs on respiratory resistance (Rrs), measured using a forced oscillation technique, was measured both before and after the inhalation of a dose of capsaicin which caused less than two coughs. Lignocaine (40 mg) and dyclonine (8 mg) caused significant reports of oral anaesthesia but only lignocaine reduced the cough response to inhaled capsaicin, increasing the log dose of capsaicin causing three or more coughs by 162%. None of the treatments altered basal Rrs or its increase after inhaled capsaicin. Thus, the cough and reflex bronchoconstriction caused by inhaled capsaicin have different sensitivities to inhaled local anaesthesia, suggesting that the effect may be mediated by different sensory pathways.

Administration, Inhalation↗
PubMed1988

Indian youth and inhalants: an update.

There is some basis for the perception that Indian youth are more susceptible to inhalant use than their non-Indian peers. Many Indian youth live in disadvantaged and often stressful environments that set the stage for turning to drugs for relief or to seek excitement. Inhalants are cheap and available even to very young children. While levels of inhalant use are comparatively high, the tendency to overrate this use and to label all Indian youth as inhalant abusers must be avoided. By the time Indian youth reach their senior year, only around 4 percent are using inhalants seriously enough to warrant concern. On the other hand, those 4 percent cannot be ignored and, for them, prevention efforts at earlier ages could avert a great deal of needless suffering. Furthermore, there are a significant number of school dropouts who are likely to be chronically inhalant involved. The age pattern of inhalant use indicates that such use by Indian youth begins when they are very young--the predisposing factors are well in place by the 4th and 5th grades. Prevention efforts may need to start very early if they are to succeed.

Administration, Inhalation↗
PubMed1987

Extracellular killing of inhaled pneumococci in rats.

Early clearance of inhaled Staphylococcus aureus is believed to be caused by phagocytosis by alveolar macrophages. In murine models inhaled pneumococci are cleared even more rapidly than S. aureus. Conventional opsonins appear to play no role in this clearance, and recently it has been shown that murine alveolar lining material contains free fatty acids and other soluble factors that are directly bactericidal for pneumococci. To determine whether non-phagocytic factors are involved in pneumococcal clearance, we compared the site of killing of inhaled pneumococci and S. aureus in rats using histologic methods and bronchoalveolar lavage. Spontaneous lysis of pneumococci was prevented by use of autolysin-defective pneumococci or by substitution of ethanolamine for choline in the cell wall. Histologic studies showed that the percent of inhaled staphylococci associated with alveolar macrophages always exceeded the percent of staphylococci cleared, whereas there was little association of pneumococci with macrophages during clearance. Analysis of the intracellular or extracellular location of iron 59 in bronchoalveolar lavage fluid of rats that had inhaled aerosols of 59Fe-labeled bacteria suggested that staphylococci were killed predominantly in macrophages and pneumococci in the extracellular space. When 59Fe-labeled pneumococci or staphylococci were ingested and killed by macrophages in vitro, the 59Fe remained with the macrophages, suggesting that the extracellular location of 59Fe during pneumococcal killing in vivo was not caused by rapid turnover of 59Fe in macrophages. Studies of the site of killing of inhaled type 25 pneumococci labeled exclusively in the cell wall with carbon 14-ethanolamine confirmed the results obtained with 59Fe-labeled pneumococci. Thus, early killing of inhaled pneumococci, unlike staphylococci, appears to take place outside of macrophages.

Administration, Inhalation↗
PubMed1994

Inhibitory effect of aerosol administration of a sulfidopeptide leukotriene antagonist on bronchoconstriction induced by antigen inhalation in guinea pigs.

The effects of inhalation of the sulfidopeptide leukotriene antagonist AS-35 (9-[(4-Acetyl-3-hydroxy-2-n-propyl-phenoxy)methyl]-3-(1H- tetrazol-5-yl)-4H-pyrido [1,2-a]pyrimidin-4-one, CAS 108427-72-1) on bronchoconstriction induced by aerosol antigen, histamine, and leukotriene C4, D4 (LTC4, D4) were investigated in anesthetized and artificially ventilated guinea pigs. The increase in pressure at the airway opening (P(ao)) was measured as an index representing the grade of bronchial response. The bronchoconstriction induced by aerosol antigen was suppressed dose-dependently by pretreatment with inhaled AS-35 (0.1 mg and 1 mg) through a pressurized meter-dosed inhaler in the passively sensitized animals pretreated with diphenhydramine hydrochloride. But the histamine-induced bronchoconstriction was not altered by the pretreatment with AS-35 inhalation. On the other hand, LTC4- and LTD4-induced bronchoconstriction was inhibited by the pretreatment with aerosol AS-35 in a dose-dependent manner. The deposited dose of inhaled AS-35 in the peripheral airways was 3.5 micrograms and 6.5 micrograms when 0.1 mg and 1 mg of the drug was inhaled, respectively. These results suggest that sulfidopeptide leukotrienes (s-LTs) play an important role in the allergic bronchoconstriction in guinea pigs pretreated with antihistamine, and AS-35 inhalation may be beneficial in the treatment of asthma.

Administration, Inhalation↗
PubMed1995

[The characteristics of inhalation injury and pulmonary infection in burn patients and the influence on their mortality].

940 patients with thermal injury during the past 14 years were reviewed. Of them, inhalation injury was diagnosed in 75 patients, including 15 mild injury who all survived, 25 moderate injury, of whom 13 died with a mortality rate of 52.0% and 35 severe injury, of whom 31 died with a mortality rate of 88.6%. The data showed that 70% of burn that caused inhalation injury occurred in a closed space and 96% of which also caused facial injury. With the burn extent increasing, the incidence of inhalation injury and pulmonary infection rise correspondingly. The time and incidence of pulmonary infection in the patients with inhalation injury was earlier and higher than that in those without inhalation injury (P < 0.01). With similar burn area and age, the risk of death in the patients with inhalation injury was 17.2 times of the patients without inhalation injury (P < 0.001). Pulmonary infection further increased mortality of the patients (P < 0.001).

Adolescent↗
PubMed1995

Current status of nitric oxide inhalation.

Nitric oxide (NO) is an important endothelium-dependent relaxing factor. In some pulmonary hypertensive states such as ARDS, the production of endogenous NO may be impaired. Nitric oxide inhalation selectively dilates the pulmonary circulation. Significant systemic vasodilation does not occur because NO is inactivated by rapidly binding to hemoglobin. In an injured lung with pulmonary hypertension, inhaled NO produces local vasodilation of well-ventilated lung units and may "steal" blood flow away form unventilated regions. This reduces intrapulmonary shunting and may improve systemic arterial oxygenation. Several observations require further study: 1. The hemodynamic and respiratory effects of NO inhalation vary, both among patients and within the same patient over the course of an illness. 2. Occasionally, sudden discontinuation of inhaled NO produces problematic pulmonary vasoconstriction. 3. NO inhalation may affect pulmonary structure and function and endogenous NO synthesis and transduction. Inhaled nitric oxide may have both beneficial and detrimental effects. 4. The safety and clinical efficacy of long-term NO administration remain unclear. Several randomized prospective clinical trials are beginning to address these issues. Potentially, inhaled NO may be a valuable therapy in a wide variety of patients with pulmonary hypertension and/or lung injury.

Administration, Inhalation↗
PubMed1996

Inhalation exposure to volatilized opioids produces antinociception in mice.

The goal of this study was to determine whether opioids of varying potencies are pharmacologically active via the inhalation route of administration in mice. The opioids evaluated included heroin, morphine, codeine, fentanyl and meperidine; each of these drugs has the potential for abuse in humans. Inhalation exposure to each of these compounds produced antinociception in a dose-dependent manner as assessed in the tall-flick test. No pyrolysis products were detected after heating either morphine or codeine at 250 degrees C for 5 min. Although 6-acetylmorphine was found after heating heroin, it accounted for less than 5% of the recovered sample. Heroin was somewhat less potent by inhalation administration than i.v. injection, with ED50 values of 1.6 and 0.69 mumol/kg, respectively. In contrast, the relative potency of morphine was substantially greater when inhaled than when injected, with respective ED50 values of 0.77 and 3.9 mumol/kg. Whereas the body to brain ratios of [3H]morphine were approximately 8 and 20 for inhalation exposure and i.v. injection, respectively, the ratio for heroin was approximately 5 regardless of administration route. This pattern of results suggests that the increase in morphine potency upon inhalation may have resulted from an increased accessibility to the brain compared with i.v. injection. Finally, naloxone reversed the antinociceptive effects of volatilized heroin, but neither the kappa selective antagonist nor-binaltorphimine nor the delta selective antagonist naltrindole blocked this antinociception, which suggests the involvement of mu opioid receptors. These findings taken together suggest the potential for the abuse of a variety of opioids, in addition to heroin, through the inhalation route of administration by humans.

Administration, Inhalation↗
PubMed1996

[Effect of on-demand inhalation of dry oxygen on nasal mucociliary clearance].

AIM: To determine whether nasal mucociliary clearance is affected by dry oxygen delivered on demand. METHODS: Saccharin nasal transit time was measured as an index of nasal mucociliary clearance. One group of patients was given dry oxygen via a nasal cannula and a demand delivery system, and another group was given dry oxygen by continuous inhalation. In each group, continuous inhalation of humidified oxygen served as the control. Saccharin transit time was measured before and after 8 hours of oxygen inhalation. SUBJECTS: The subjects were 25 patients with chronic respiratory failure who were receiving home oxygen therapy via nasal cannula. All the subjects were clinically stable (age 72.1, mean +/- SE), %VC 46.6 +/- 3.0. FEV/FVC% 9.0 +/- 1.5, PaO2 55.7 +/- 2.0 Torr. PaCO2 53.9 +/- 1.9 Torr). RESULTS: Saccharin transit time after inhalation of dry oxygen on demand did not differ from that after continuous inhalation of humidified oxygen (15.6 +/- 1.5 vs 14.9 +/- 1.4 min). Saccharin transit time after continuous inhalation of dry oxygen was significantly lower than that after continuous inhalation of humidified oxygen (26.6 +/- 5.4 vs 16.7 +/- 2.6 min. p > 0.05). CONCLUSION: We conclude that using the demand oxygen delivery system with a nasal cannula for 8 hours had no adverse effects on nasal mucociliary clearance.

Aged↗
PubMed1997

Compliance with inhaled medication and self-treatment guidelines following a self-management programme in adult asthmatics.

Two of the principal components of self-management are compliance with medication and adherence to self-treatment guidelines. The aim of this study was to evaluate compliance objectively. Twenty two adult asthmatics attended a self-management programme. During a 2 week run-in period, compliance with inhaled steroids and peak expiratory flow (PEF) were electronically-registered. For PEF this resulted in a personal best value (PBV). Subsequently, patients attended four educational group sessions. During the four weeks of follow-up, patients were instructed to measure their PEF on a fixed day of the week and when they experienced an increase in symptoms. If PEF fell below 80% of PBV, patients had to double their use of inhaled steroids; if PEF fell below 60%, they had to start a short course of oral steroids. During run-in, mean compliance was 83% and compliance per patient varied from 6 to 106%. During follow-up, on days without exacerbation, compliance with inhaled steroids increased by 12% (95% confidence interval (95% CI) 3-21%) compared to run-in, ranging 21-200%. On days when patients should have doubled their inhaled steroids, compliance decreased by 28% (95% CI -39 to -17), and compliance ranged 46-94%. Of the 10 patients who should have doubled their medication, only three did so, whilst four increased the use of inhaled steroids but only by one or two puffs; three patients did not alter their behaviour. In five patients (24%) PEF fell below 60% of their PBV, after which four started prednisolone (self-report). In conclusion, even after a formal self-management programme, patients with asthma comply only partially to self-treatment guidelines. Most are willing to increase, but not double, their inhaled steroids. This suggests that more emphasis is needed to reassure patients about the safety of inhaled steroids.

Administration, Inhalation↗
PubMed1997

Effects of inhaled nitric oxide in patients with hypoxemia and pulmonary hypertension after cardiac surgery.

BACKGROUND: Cardiopulmonary bypass can increase pulmonary vascular tone and decrease ventilation-perfusion matching by impairing the pulmonary endothelial production of nitric oxide. OBJECTIVES: We tested the hypothesis that inhalation of exogenous nitric oxide decreases the ratio of mean pulmonary arterial pressure to mean system arterial pressure and the intrapulmonary shunt fraction and increases the ratio of arterial blood oxygen tension to fraction of inspired oxygen in patients in whom the ratio of mean pulmonary arterial pressure to mean systemic arterial pressure is more than 0.50, and the ratio of arterial blood oxygen tension to fraction of inspired oxygen is less than 300 mm Hg in the first 24 hours after cardiopulmonary bypass surgery. METHODS: Only those patients who had estimates of the ratio of mean pulmonary arterial pressure to mean systemic arterial pressure and the ratio of arterial blood oxygen tension to fraction of inspired oxygen determined preoperatively were enrolled. Hemodynamic variables were recorded, and blood samples were obtained for oximetric analysis 5 minutes before and 30 minutes after inhalation of nitric oxide began. The concentration of nitric oxide inhaled was maintained at 20 parts per million. The data were analyzed by using Friedman's repeated measures analysis of variance. RESULTS: Thirteen patients were enrolled in the study. The mean preoperative ratio of mean pulmonary arterial pressure to mean systemic arterial pressure was 0.63 +/- 0.08 (standard error of the mean), and the mean preoperative ratio of arterial blood oxygen tension to fraction of inspired oxygen was 131 +/- 15 mm Hg. No differences between preoperative and postoperative values were detected. Inhalation of nitric oxide decreased the ratio of mean pulmonary arterial pressure to mean systemic arterial from 0.53 +/- 0.07 to 0.39 +/- 0.5 and increased the ratio of arterial blood oxygen tension to fraction of inspired oxygen from 167 +/- 35 mm Hg to 235 +/- 45 mm Hg. Inhalation of nitric oxide also decreased the intrapulmonary shunt fraction from 0.29 +/- 0.05 to 0.19 +/- 0.04. CONCLUSIONS: Inhalation of nitric oxide selectively decreases pulmonary vascular tone and increases ventilation-perfusion matching in patients with persistent pulmonary hypertension and hypoxemia after surgery requiring cardiopulmonary bypass. Inhalation of nitric oxide may be a valuable adjunctive therapy for these patients.

Administration, Inhalation↗
PubMed1997

[Evaluation of the everyday use of a metered dose aerosol triggered by inhalation (the "Autohaler" system)].

Although corticosteroids or beta2-agonists administered by inhalation are recommended as a first line treatment of asthma, standard pressurized metered dose inhalers are used correctly in only 3-% of cases. This study on the new breath-actuated inhaler Autohaler fulfils two objectives: first, to evaluate the respective influence of the reading of the instruction notice and the prescriber's explanations on the correct use of the Autohaler and second, to determine the profile of subjects most refractory to its correct use. The study was conducted by general practitioners in 2,467 asthmatic subjects with poor inhaler technique. The Autohaler was used correctly right from the start in 42.8% of subjects simply after reading the instruction notice (phase I) and in 68% of subjects after receiving the prescriber's explanations (phase II). At the end of phases I and II, correct use was performed by 82% of subjects. After stratification and adjustment, the probability of incorrect use, derived from the odds ratio: i) increased by 80% between 35 and 64 years of age and by 280% beyond 65 years; ii) was 30% higher in cases of severe asthma; iii) was 50% higher in cases of regular use of a pMDI and 80% higher in the absence of previous treatment with inhalers; iv) was 2.5 times lower in subjects who had a secondary education and 5 times higher in those with a university education; v) was not correlated with either sex or habitation. We conclude that the breath-actuated inhaler Autohaler allow correct treatment in 82% of poor inhaler technique patients after reading the instruction notice and brief prescriber's explanation, but some patients, elderly or low level of education, must be given clear, detailed and continuing information.

Administration, Inhalation↗
PubMed1996

[Multiple organ failure in burn patients combined with inhalation injury].

To define the clinical features and prevention and treatment of multiple organ failure (MOF) developed in burn patients combined with inhalation injury, a retrospective clinical study on 4834 burn patients admitted into the Institute from Jan, 1977 to Aug, 1991, in which 366 cases sustained inhalation injury, was performed. It was shown that postburn MOF occurred in 115 cases among the 4834 victims, with an incidence of 2.38%. However, of the 366 cases with inhalation injury 76 were complicated with MOF, an incidence as high as 20.77%, approximately occupying two-thirds of the postburn MOF. The incidence and mortality of MOF were higher when there was inhalation injury. It occurred earlier. More respiratory complications, higher incidence of lung and cardiac failure as well as severe shock were observed. Moreover, hypoxemia and acidosis were found to be more severe in MOF patients with inhalation injury than those without. It is suggested that good control of inhalation injury and burn shock, as well as the ischemic-hypoxic damage of visceral tissues might be of great importance for the prevention and treatment of MOF in burn patients combined with inhalation injury.

Adult↗
PubMed1998

[Clinical and pathophysiologic problems associated with smoke inhalation injury].

Smoke inhalation injury is one of the primary determinants of survival following major burn injury. The primary site of injury in smoke inhalation appears to be the small airway rather than the alveoli, and thus small airway occlusion caused by edema and pseudomembrane formation are the primary mechanisms of progressive hypoxia. Ventilation-perfusion (VA/Q) alterations after smoke inhalation are characterized by increased blood flow to low VA/Q compartments, although an increase in true shunt (VA/Q = 0) was not a consistent finding. This differs considerably from most adult respiratory distress syndrome (ARDS) patients or oleic acid-induced lung edema models, in which an increase in true shunt is the major mechanism of hypoxia. Such differences lead to different responses to nitric oxide (NO) inhalation therapy, and NO does not improve oxygenation and outcome in patients with smoke inhalation injury. In the treatment of inhalation injury, meticulous removal of pseudomembrane by fiberoptic bronchoscopy is essential, the use of high concentrations of oxygen should be avoided since it can cause absorption atelectasis. High-frequency percussive ventilation is a suitable treatment for inhalation injury, as it improves oxygenation and facilitates removal of pseudomembrane.

Burns, Inhalation↗
PubMed1998

[Effect of pharmacist's instruction on the treatment of asthmatics with inhaled steroid].

Pharmacist's instruction is provided to asthmatic patients who received an inhaled steroid in Hamamatsu University Hospital. We studied influences of pharmacist's instruction on the repeutic effects of an inhaled steroid, beclomethasone dipropionate (BDP). In 29 patients who had been treated with inhaled BDP under the physician's instruction for more than 3 months, we examined drug compliance, correctness of inhalation procedure and treatment score, symptom score, peak expiratory flow (PEF) values, and compared these before and after the instruction. The instruction was repeatedly provided at an interval of about one month. Patients who followed the indicated regimen were 55.2 and 93.1% before and after the instruction, respectively. An appropriate inhalation maneuver was respectively. An appropriate inhalation maneuver was performed in 24.1 and 93.1% of patients before and after the instruction, respectively. PEF values increased by 12.9 +/- 9.3% (mean +/- standard deviation, p < 0.01) after the instruction. In conclusion, pharmacist's repeated instruction enhanced the therapeutic effects of inhaled BDP in patients with asthma.

Administration, Inhalation↗
PubMed1997

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement].

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

Burns, Inhalation↗
PubMed1998

[Inhalation therapy in children younger than two years. I. From theory to practice].

Effective inhalation of drugs, even by small children under 2 years, is often faster, simpler, cheaper and better with metered dose inhalers with small antistatic (metal) inhalation chambers than with nebulisation. This is also true during considerable bronchial obstruction. It is mandatory that the inhalation chamber has a small dead space and well functioning valves opening at low flows. Effective dosing in small children is enhanced by more doses, given separately, while choosing the highest dose per spray available. Important factors determining bronchial deposition in small children are breathing frequency, tidal volume and the degree of bronchial obstruction and nasal obstruction, since inhalation goes primarily through the nose. If well-performed medication with a small inhalation chamber is clinically ineffective, it is better to start systemic medication, e.g. a corticosteroid, or even to consider artificial ventilation, rather than to try nebulisation. Better effective deposition is possible with inhalation of drugs in hydrofluoroalkane (HFA) aerosols, which will replace chlorofluorocarbon (CFC) aerosols in the near future.

Administration, Inhalation↗