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NTP Toxicology and Carcinogenesis Studies of Talc (CAS No. 14807-96-6)(Non-Asbestiform) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Talc ore may contain several other minerals including calcite, dolomite, magnesite, tremolite, anthophyllite, antigorite, quartz, pyrophyllite, micas, or chlorites. Talc products are sold in a multitude of grades which have physical or functional characteristics especially suited for particular applications, so occupational and consumer exposures to talc are complex. Epidemiology studies have suggested an association between non-fibrous talc and lung cancer risk. Talc was nominated by the National Institute of Occupational Safety and Health (NIOSH) for study by the NTP because of widespread human exposure and because of the lack of adequate information on its chronic toxicity and potential carcinogenicity. Toxicology and carcinogenicity studies of talc (non-asbestiform, cosmetic grade), a finely powdered hydrous magnesium silicate, were conducted by exposing groups of F344/N rats to aerosols for 6 hours per day, 5 days per week for up to 113 weeks (males) or 122 weeks (females). Groups of B6C3F1 mice were exposed similarly for up to 104 weeks. LIFETIME STUDY IN RATS: Groups of 49 or 50 male and 50 female rats were exposed to aerosols of 0, 6, or 18 mg/m(3) talc until mortality in any exposure group reached 80% (113 weeks for males and 122 weeks for females). These exposures were selected based on 4-week inhalation studies of the terminal lung talc burden in F344/N rats; concentrations greater than 18 mg/m(3) were expected to overwhelm lung clearance mechanisms and impair lung function. These exposure concentrations provided a dose equivalent of 0, 2.8, or 8.4 mg/kg per day for male rats and 0, 3.2, or 9.6 mg/kg per day for female rats. In a special study, additional groups of 22 male and 22 female rats were similarly exposed and examined for interim pathology evaluations or pulmonary function tests after 6, 11, 18, and 24 months and lung biochemistry and cytology studies after 24 months. The talc aerosols had a median mass aerodynamic diameter of 2.7 mm in the 6 mg/m(3) chamber and a median diameter of 3.2 mm in the 18 mg/m(3) chamber, with geometric standard deviations of 1.9 mm. However, there was a 7-week period beginning at study week 11 during which the chamber concentration for the 18 mg/m(3) rats varied from approximately 30 to 40 mg/m(3) because of difficulties with the aerosol concentration monitoring system. Further, there was a 12-week period beginning at approximately week 70 during which there were difficulties in generating the talc aerosol, and the chamber concentrations for rats and mice were substantially lower than the target concentrations. Survival, Body Weights, and Clinical Findings: The survival of male and female rats exposed to talc was similar to that of the controls. Mean body weights of rats exposed to 18 mg/m(3) were slightly lower than those of controls after week 65. No clinical findings were attributed to talc exposure. Pathology Findings: Absolute and relative lung weights of male rats exposed to 18 mg/m(3) were significantly greater than those of controls at the 6-, 11-, and 18-month interim evaluations and at the end of the lifetime study, while those of female rats exposed to 18 mg/m(3) were significantly greater at the 11-, 18-, and 24-month interim evaluations and at the end of the lifetime study. Inhalation exposure of rats to talc produced a spectrum of inflammatory, reparative, and proliferative processes in the lungs. Granulomatous inflammation occurred in nearly all exposed rats and the severity increased with exposure duration and concentration. Hyperplasia of the alveolar epithelium and interstitial fibrosis occurred in or near foci of inflammation in many exposed rats, while squamous metaplasia of the alveolar epithelium and squamous cysts were also occasionally seen. Accumulations of macrophages (histiocytes), most containing talc particles, were found in the peribronchial lymphoid tissue of the lung and in the bronchial and mediastinal Iymph nodes. In female rats, the incidences of alveolar/bronchiolar adenoma, carcinoma, and adenoma or carcinoma (combined) in the 18 mg/m(8 mg/m(3) group were significantly greater than those of controls. The incidences of pulmonary neoplasms in exposed male rats were similar to those in controls. Minor alterations attributed to talc exposure were also observed in the upper respiratory tract. Hyperplasia of the respiratory epithelium of the nasal mucosa in males and accumulation of cytoplasmic, eosinophilic droplets in the nasal mucosal epithelium in male and female rats occurred with a concentration-related increased incidence in the exposed groups. Adrenal medulla pheochromocytomas [benign, malignant, or complex (combined)] occurred with a significant positive trend in male and female rats, and the incidences in the 18 mg/m(3) groups were significantly greater than those of controls. Although adrenal medulla hyperplasia occurred with similar frequency among exposed and control females, the incidences of hyperplasia in exposed males were significantly lower than in controls. Lung Talc Burden: Lung talc burdens of male and female rats exposed to 6 mg/m(3) were similar and increased progressively from 6 to 24 months. Lung talc burdens of females exposed to 18 mg/m(3) also increased progressively from 6 to 24 months, while those of males exposed to 18 mg/m(3) remained about the same after 18 months. Lung burdens were generally proportional to exposure concentration at each interim evaluation. Pulmonary Function, Bronchoalveolar Lavage, and Lung Biochemistry: In exposed male and female rats there was a concentration-related impairment of respiratory function which increased in severity with increasing exposure duration. The impairment was characterized by reductions in lung volume (total lung capacity, vital capacity, and forced vital capacity), lung compliance, gas exchange efficiency (carbon monoxide diffusing capacity), and nonuniform intrapulmonary gas distribution. After 24 months, males exposed to 6 mg/m(3) talc had a significant increase in beta-glucuronidase and polymorphonuclear leukocytes; males exposed 18 mg/m(3) had significant increases in b -glucuronidase, lactate dehydrogenase, alkaline phosphatase, and total protein in bronchoalveolar lavage fluid. All exposed females had significantly increased a-glucuronidase, lactate dehydrogenase, alkaline phosphatase, total protein, and polymorphonuclear leukocytes; 18 mg/m(3) females also had significantly increased glutathione reductase. Viability and phagocytic activity of macrophages recovered from lavage fluid were not affected by talc exposure. Total lung collagen was significantly increased in rats at both exposure concentrations after 24 months, while collagenous peptides in lavage fluid and the percentages of newly synthesized protein from females, but not males, were also significantly increased at the 6 or 18 mg/m(3) levels. In addition, lung proteinase activity, primarily cathepsin D-like activity, was significantly greater in exposed males and females. Rats exposed to talc also had significant increases in collagenous peptides and acid proteinase in lung homogenates. 2-YEAR STUDY IN MICE: Groups of 47 to 49 male and 48 to 50 female mice were exposed to aerosols containing 0, 6, or 18 mg/m(3) talc for up to 104 weeks. These exposures were selected based on 4-week inhalation studies of the terminal lung talc burden in B6C3F1 mice; concentrations greater than 18 mg/m(3) were expected to overwhelm lung clearance mechanisms and impair lung function. These exposure concentrations provide a dose equivalent of 0, 2, or 6 mg/kg per day for male mice and 0, 1.3, or 3.9 mg/kg per day for female mice. In a special study, additional groups of 39 or 40 male and 39 or 40 female mice similarly exposed were examined for interim pathology evaluations, lung biochemistry, and cytology studies after 6, 12, and 18 months of exposure. The talc aerosols had a median mass aerodynamic diameter of 3.3 mm with a geometric standard deviation of 1.9 mm in the 6 mg/m(3) chamber, and a median diameter of 3.6 mm with a geometric standard deviation of 2.0 mm in the 18 mg/m(3) chamber. Further, there was a 12-week period beginning at approximately week 70 during which there were difficulties in generating the talc aerosol, and the chamber concentrations for rats and mice were substantially lower than the target concentrations. Survival, Body Weights, and Clinical Findings: Survival and final mean body weights of male and female mice exposed to talc were similar to those of the controls. There were no clinical findings attributed to talc exposure. Pathology Findings: Inhalation exposure of mice to talc was associated with chronic active inflammation and the accumulation of macrophages in the lung. In contrast to rats, hyperplasia of the alveolar epithelium, squamous metaplasia, or interstitial fibrosis were not associated with the inflammatory response in mice, and the incidences of pulmonary neoplasms in exposed and control groups of mice were similar. Accumulations of macrophages (histiocytes) containing talc particles were also present in the bronchial Iymph node. In the upper respiratory tract, cytoplasmic alteration, consisting of the accumulation of cytoplasmic eosinophilic droplets in the nasal mucosal epithelium, occurred with a concentration-related increased incidence in exposed male and female mice. Lung Talc Burden: Lung talc burdens of mice exposed to 6 mg/m(3) were similar between males and females and increased progressively from 6 to 24 months, except for males at 18 months. The lung talc burdens of mice exposed to 18 mg/m(3) were also similar between the sexes at each interim evaluation. Although the talc burdens of males and females increased substantially from 6 to 24 months, the values at 12 and 18 months were similar. Generally, lung burdens of mice exposed to 18 mg/m(3) were disproportionately greater than those of mice exposed to 6 mg/m(3), suggesting that clearance of talc from the lung was impaired, or impaired to a greater extent, in mice exposed to 18 mg/m(3) than in mice exposed to 6 mg/m(3). Bronchoalveolar Lavage and Lung Biochemistry: Increases in total protein, beta-glucuronidase, lactate dehydrogenase, glutathione reductase, total nucleated cells, and polymorphonuclear leukocytes in bronchoalveolar lavage fluid were observed primarily in mice exposed to 18 mg/m(3), although some parameters were also increased in mice exposed to 6 mg/m(3). The amount of collagenous peptides in lavage fluid and total lung collagen were increased in male and female mice exposed to 18 mg/m(3). Acid proteinase activity, principally cathepsin D-like activity, of lung homogenate supernatant fluid was also significantly increased in mice at the 18 mg/m(3) exposure concentration. CONCLUSIONS: Under the conditions of these inhalation studies, there was some evidence of carcinogenic activity of talc in male F344/N rats based on an increased incidence of benign or malignant pheochromocytomas of the adrenal gland. There was clear evidence of carcinogenic activity of talc in female F344/N rats based on increased incidences of alveolar/bronchiolar adenomas and carcinomas of the lung and benign or malignant pheochromocytomas of the adrenal gland. There was no evidence of carcinogenic activity of talc in male or female B6C3F1 mice exposed to 6 or 18 mg/m(3). The principal toxic lesions associated with inhalation exposure to the same concentrations of talc in rats included chronic granulomatous inflammation, alveolar epithelial hyperplasia, squamous metaplasia and squamous cysts, and interstitial fibrosis of the lung. These lesions were accompanied by impaired pulmonary function characterized primarily by reduced lung volumes, reduced dynamic and/or quasistatic lung compliance, reduced gas exchange efficiency, and nonuniform intrapulmonary gas distribution. In mice, inhalation exposure to talc produced chronic inflammation of the lung with the accumulation of alveolar macrophages. Synonyms: talcum; agalite; emtal 596; non-asbestiform talc; non-fibrous talc; steatite; hydrous magnesium silicate

Journal Article↗

[Effects of norepinephrine on the therapeutic effect of nitric oxide inhalation in the treatment of acute respiratory distress syndrome in goat].

OBJECTIVE: To observe effects of norepinephrine (NE) on the therapeutic effects of nitric oxide (NO) inhalation in goats with endotoxin-induced acute respiratory distress syndrome (ARDS). METHODS: A model of septic ARDS was reproduced by an intravenous infusion of low dose endotoxin in six goats, and then these animals were treated with 40 x 10(-6) NO inhalation. After 30 minutes, intravenous infusion of NE in dose of 0.5 microg x kg(-1) x h(-1) was given. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter and arterial blood gas analysis before and after the onset of ARDS, 30 minutes after NO inhalation and administration of NE. RESULTS: Inhalation of NO rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO(2), decreased alveolar-arterial partial pressure of oxygen difference (P (A-a) O(2)) and intrapulmonary shunt fraction (Qs/Qt) in septic ARDS goats. These changes were more pronounced when NE was given compared with NO inhalation alone. The combination of NO inhalation and NE infusion resulted in an increase in mean arterial pressure. CONCLUSION: Norepinephrine enhances the beneficial effect of nitric oxide inhalation on lung gas exchange in goats with endotoxin induced acute respiratory distress syndrome.

Animals↗

[Five fatalities due to inhalation of "asphyxiant gases": pathophysiological analysis in autopsy cases].

Five autopsy cases were examined to investigate fatal factors involved in inhalation of "asphyxiant gases": carbon monoxide (CO, n=3), fluorocarbons (n=1) and butane (n=1). In all cases, there was severe pulmonary edema and congestion in all viscera, suggesting advanced circulatory failure. The airway was filled with bloody froth in cases of fluorocarbons and butane inhalation. In CO intoxication, a marked increase in serum cardiac troponins suggested severe myocardial damage. There were also biochemical findings of respiratory distress (an evident increase in intra-alveolar pulmonary surfactant protein A), alveolar injury (an increase in serum surfactant protein A and D), rhabdomyolysis (myoglobinuria) and prolonged hypoxia (myogenic hyperuricemia) in cases of inhaling incomplete combustion gases. In a case of fluorocarbons gas inhalation, biochemical findings suggested respiratory distress, myocardial ischemia (an increase in serum CK-MB) and advanced hypoxia. Similar findings were observed in a case of butane inhalation, although cardiac troponin levels were low in the peripheral blood. These observations suggested that myocardial damage was prominent in CO intoxication, accompanied by respiratory distress in cases of inhaling incomplete combustion gases, whereas respiratory distress and hypoxia were major findings in cases of fluorocarbons and butane gas inhalation.

Aged↗

Assessment of inhalation technique in children with asthma, Abha, Saudi Arabia.

UNLABELLED: The inhalation technique of asthma in children was assessed using the criteria defined by the standardized inhaler checklist of the Netherlands Asthma Foundation and Dutch asthma foundation. Four hundred and thirty seven newly referred patients to chest clinic, department of pediatric, Assir Central Hospital, Southwestern Saudi Arabia were instructed to demonstrate their inhalation technique and to fill out a questionnaire related to the inhalation instructions received before their referral. RESULTS: Four hundred and thirty seven patients newly referred for evaluation of their asthma (5-12 years of age with mean age of 7.16+1.69 years, 202 (46.2%) girls, 235 (53.8%) boys were included in the study. Two hundred two (46.2%) patients use MDI. The remaining (53.8%) patients use the DPI, 123 (52.35%) of them use turbohalers while 112 (47.65%) use diskhalers. Only 36 patients (8.2 %) completed the assessment without making any mistake. Of the remainders, 399 (91.8%) made one or more mistakes. Of the MDI users, eleven patients (5.4%) performed correctly all the steps, and 54 (26.7%) performed correctly four or more steps. Ten (8.9%) of the diskhaler users performed all the steps correctly and forty nine (43.8) performed correctly four or more steps. Fifteen (12 2%) of the turbohaler users performed correctly all the steps and ninety five (77.2%) performed correctly four or more steps. One hundred five of the male patients (44.7%), performed correctly more than three steps as compared to 93 of the female patients (46.5) with p value=0.704. One hundred and one patients (67.3%) between the age of 8-12 years performed more than three steps correctly as compared to 97 (33.8%) of patients aged 5-7 years (p=0.001). CONCLUSION: In conclusion, many asthmatic children use their inhaler devices too poorly with the result of an unreliable drug delivery. Turbohaler device inhalation technique was the easiest, followed by diskhaler then lastly the MDI. Education of asthmatic children and their families is highly needed to make sure the patient perform the correct inhalation technique.

Asthma↗

Consistency of evaluators assessing inhaler technique.

Since correct inhaler technique is vital for maximum efficacy, the evaluation of technique in patients or health care professionals involved in education programs or research projects is essential. Inconsistency could lead to confused patients and inaccurate research findings. This study is the first to determine interrater consistency with assessing recitation and demonstration of inhaler technique and, if needed, was designed to improve consistency until 95% agreement was achieved. A checklist for correct inhaler technique was constructed by consolidating information from the literature and package inserts. Initially three evaluators were used, however, a fourth evaluator was added for the last two trials to create teams to improve consistency. Percent agreement, probability and kappa scores were calculated. Six trials evaluating inhaler technique of 56 health care professionals at five different sites, revisions of the checklist, and evaluator teams were required to increase overall percent agreement from 81% to 98%. Agreement increased substantially on the verbal component because of specific changes made in the checklist and the objective nature. Demonstration steps consistently had lower agreement than verbal steps. Agreement on the demonstration component was more difficult because of subjectivity involved in observing a subject actuate the inhaler at the correct time, inhale or exhale slowly, and hold one's breath. The relative rankings of percent agreement and kappa scores were the same, however, kappa scores allowed differentiation of agreement due to chance and ability. To achieve interrater consistency, training and practice are required. Interrater consistency should be achieved to ensure accurate reporting of research results on inhaler technique and education of patients.

Clinical Trials as Topic↗

In vitro inhalation behaviour and therapeutical response of salbutamol particles administered from two metered dose aerosols.

In this study the particle size, as well as the in vitro deposition and the immediate bronchodilating effect on asthmatic patients, of two salbutamol inhalation aerosol preparations (Ventoline, Glaxo, UK, and salbutamol inhalation aerosol, Orion Pharmaceutica, Finland) were compared. The in vitro deposition study was performed using the modified Sierra Andersen cascade impactor. The bronchodilating effect of inhaled aerosol doses were monitored by measuring peak expiratory flow (PEF) values. In the clinical study, the pulse and blood pressure of the patients, as well as the side effects, were also recorded. Due to the anatomy and physiology of human lungs, the accepted optimum size for inhaled drug particles is under 5 microns, and preferably under 2 microns. Over 95% of the drug particles in both aerosol preparations were under 5 microns. 30% of the salbutamol particles in the Ventoline inhalation aerosol were under 2 microns, whereas in Orion salbutamol aerosol 14% of the drug particles were under 2 microns. Respectively 23% of Ventoline and 19% of the Orion salbutamol preparation penetrated into the therapeutically most significant imitated alveolar stages of the modified cascade impactor. Both salbutamol aerosols showed a clear clinical efficacy in the bronchodilating test. In addition, no significant differences existed in the bronchodilating effect of these inhalation aerosols. In conclusion, although there seemed to be a slight difference in the particle size distribution and in the in vitro inhalation behaviour, this variation did not have any effect on the clinical response.

Adult↗

Pressurised aerosol inhalers: the cost of misuse.

Bronchodilator aerosols, if used correctly, have many advantages over other therapies in patients with chronic airflow limitation caused by asthma or chronic bronchitis. The use of pressurized aerosol inhalers was examined in a district general hospital: of 57 patients on these inhalers, 39 were unable to use the inhaler effectively, and 23 had never received any advice on inhaler technique. A single demonstration of correct technique decreased the failures to 21 patients and, after two demonstrations, to ten. The cost of the misused inhalers in this relatively small population was 450 pounds, and obviously this figure escalates when the prescription for these inhalers is repeated monthly. It is also increased when the total numbers of misused inhalers in the country are accounted for. The cost in terms of finance, in these days of medical audit and drug budgets, and, more importantly, in terms of patient health, is unacceptable and can be avoided by repeated tuition of technique.

Adult↗

[Development of a spacer for inhaled corticosteroid. Evaluation using flunisolide metered dose aerosol].

As optimal therapy with inhaled steroids invariably demands the use of a spacer (Nolte, 1989), a specific inhalation device adapted to flunisolide metered dose inhaler was required. For this purpose, various inhalation chambers varying in geometry and material were investigated. The decisive criterion was the percentage of inhalable particles (diameter less than 8 microns) dispensed by the device. Separation of larger particles was possible in spacers with a relatively small volume. The highest dispensing rate being achieved with conical or pear-shaped inhalation chambers. An increase in spacer volume beyond 320 ml failed to improve the percentage of inhalable active substance. The results demonstrate that the spacer, dimensioned to the smallest possible volume, specially developed for Inhacort MDI has optimal dispensing characteristics for flunisolide.

Adrenal Cortex Hormones↗

Inhalation provocation test with house dust allergen using tidal breathing.

Using the modified 3-Hz oscillation method, the inhalation challenge test was performed with house dust allergen upon subjects while tidal breathing throughout the test. Their total respiratory resistance (Rrs) was continuously monitored with the inhalation of saline as a control, and 250-, 50-, and 10-fold diluted allergen solution to the inhalation of aerosolized metaproterenol. The starting point of the induced bronchoconstriction was checked and as soon as Rrs increased up to twice the base-line value, the subjects inhaled the aerosolized metaproterenol. From the dose-response curve of Rrs, the dose of inhaled allergen (minimum dose) as bronchial sensitivity was determined; also the decreasing rate of respiratory conductance, which was calculated from the slope of elevation of Rrs, as bronchial reactivity. It was found that the more diluted allergen required for a positive skin reaction, the more likely the patients were to have a subsequent positive bronchial inhalation challenge to house dust allergen. There was a relationship between the increased bronchial reactivity and the increased RAST score. These results indicate that this inhalation challenge test is specific, safe, and time-saving.

Airway Resistance↗

Human cigarette smoking: effects of puff and inhalation parameters on smoke exposure.

This study determined effects of three smoking behavior components: puff volume, inhalation volume and lung exposure duration on biological measures of smoke exposure. A microcomputer-based auditory feedback system allowed subjects (N = 9 or 10 per experiment) to control puff and inhalation parameters as they smoked usual brand cigarettes. In each of four experiments, one smoking parameter was manipulated across sessions while two other parameters were held constant. Biological samples were obtained before and after each 8-puff smoking session conducted under a given set of behavioral parameters for analysis of plasma nicotine and expired air carbon monoxide (CO) levels. In Experiment I, both nicotine and CO levels were influenced systematically as puff volume was varied from 15 to 60 ml (inhalation volume = 50% of vital capacity, lung exposure time = about 9 sec). Nicotine boost (post- minus presession levels) increased 4-fold and CO boost increased 9-fold over this range of puff volume values. In Experiment II, nicotine levels were unaffected when average lung exposure times varied from 5 to 21 sec (puff volume = 50 ml, inhalation volume = 50% of vital capacity), suggesting that all the nicotine available may be absorbed during a normal smoking inhalation cycle with no breathholding. CO levels increased systematically with longer breathholds. In Experiments III and IV, inhalation volumes from 10% and 20% to 60% of vital capacity had no effect on either nicotine or CO levels, and this was true whether lung exposure time was about 8 sec (Experiment III) or about 4 sec (Experiment IV). This series of studies has shown that puff volume is an important determinant of tobacco smoke exposure, but that inhalation components of smoking behavior, at least within the range of parameters tested, have no effect on nicotine exposure levels.

Adult↗

How should a pressurized beta-adrenergic bronchodilator be inhaled?

Although the manufacturers of pressurized aerosol bronchodilators issue instructions for using the inhalers, little or no experimental verification exists. Furthermore, the instructions often fail to take into account known facts about aerosol deposition. We have reviewed the evidence for the most effective mode or modes of inhalation of pressurized aerosol bronchodilators, some of which has arisen from experiments performed in our laboratory. In order to achieve a maximal effect following inhalation of terbutaline sulphate bronchodilator aerosol (Bricanyl, Astra Pharmaceuticals), the canister should be actuated during a slow (25 l min-1), deep inhalation and breath held subsequently for 10 s. Bronchodilatation may be reduced if aerosol is inhaled rapidly (80 l min-1) or if breath is held for 4 s. We have considered the applicability of these simple rules to other types of bronchodilator and to all patients, irrespective of their diagnosis or degree of airway obstruction. The lung volume at which aerosol is released into the airstream, the importance of coordinating inhalation with aerosol actuation, and the relative merits of "open" and "closed" mouth inhalation techniques are also discussed.

Adrenergic beta-Agonists↗

Assessment of a new combination inhaler containing salbutamol and beclomethasone dipropionate in the management of asthmatic patients.

Fifteen patients with chronic asthma completed a double-blind cross-over trial during which they were treated with the same daily doses of salbutamol and beclomethasone dipropionate (BDP) from either a combination inhaler or two separate inhalers. Lung function was measured at the end of each treatment period and each patient kept a diary card throughout. Daily assessments of patients' symptoms and additional medication requirements were similar during both treatment periods. Peak expiratory flow rate (PEFR) recordings taken four times a day showed little diurnal variation during both periods. Mean PEFRs for the groups during a period of 2 weeks were similar for both treatments at all times. Overall daily mean PEFRs showed a trend in favour of the combination inhaler. There was a suggestion of greater variability in airway obstruction during the period when the separate inhalers were used, as assessed by the number of occasions that the PEFR was outside the range (overall daily mean +/- 15%). Lung function measurements at the end of each period showed a trend in favour of the combination inhaler which was clinically significant in terms of the forced expiratory volume in the 1st second and forced vital capacity. The combination inhaler provides an alternative in the management of asthma which is at least as effective as treatment with salbutamol and BDP from two separate inhalers.

Adolescent↗

[Fenoterol in chronic obstructive bronchitis--comparison of the efficacy of various application forms. Advantages and disadvantages of metered dose inhalers with a small or large expander and a mechanical atomizer].

After an initial inhalation of 1,25 mg fenoterol in 2 ml 0,9% NaCl by means of Pari Privat randomized on the following two days, two groups of ten respectively eleven patients with relatively stable respiratory tract obstruction were tested for the reversibility of the obstruction with a metered dose inhaler as follows: Group 1 (10 patients) received the metered dose inhaler with a small expander alternatively on even days and on the odd days without the expander. Group 2 (11 patients) received the metered dose inhaler with the large expander (130 mm X 35 mm) alternatively on the even days and with the small expander (100 mm X 30 mm) on the odd days. All patients showed a significant improvement of the bronchial obstruction regardless of the type of inhalation. Auxiliary appliances (inhalation appliances, expanders for the metered dose inhaler) are therefore only necessary, when the patients cannot cope at all or cannot cope optimally with the simple metered dose aerosol.

Adult↗

[Estimation of inhalation volume in rats].

The present study was carried out to develop the inhalation system possible to measure the respiratory volume in rats during the inhalation. The conventional body plethysmography was confirmed to be able to measure the respiratory volume of anesthetized rats accurately. Consequently, this method made it possible to measure the respiratory volume of rats during the inhalation studies by using animal restraint holders combined with the inhalation chamber as body plethysmography boxes. The practical availability of this inhalation system was proved in the inhalation studies of latex particles, in which the number of particles inhaled by each rat could be estimated by measuring the air concentration of latex particles as well as the respiratory volume of each animal.

Air↗

Quantitative measurement of the exhalation rate of volatile N-nitrosamines in inhalation experiments with anaesthetized Sprague-Dawley rats.

Volatile N-nitrosamines have been detected in the human environment--in work places, such as the rubber, leather and chemical industries, in tobacco smoke and also inside new cars. In order to make risk assessments on the basis of inhalation experiments with animals at dose levels relevant to the human situation, it is important to know the actual absorption rate in the respiratory tract. In this study, 63 female Sprague-Dawley rats were exposed to four nitrosamines (N-nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosopyrrolidine and N-nitrosomorpholine) in air. Respiratory parameters were monitored by pneumotachography. After 10 min of inhalation, the exhaled air was collected for 10 min in steps of 2 min intervals and analysed for its content of nitrosamines with a Thermal Energy Analyzer. Inhalation and exhalation were maintained by endotracheal intubation under narcosis with Thalamonal. The influence of this anaesthetic on the urinary excretion of N-nitrosodimethylamine after gavage and inhalation was tested: in comparison with unanaesthetized animals and with a group under ether narcosis, the excretion of the nitrosamine by the Thalamonal-anaesthetized animals was drastically reduced (factor of 20 to 60). Independent of the concentration of inhaled nitrosamine, ranging from 1-450 micrograms/L in air, the relative amounts of exhaled substance 10 min after inhalation were 0.9% N-nitrosodimethylamine, 0.4% N-nitrosodiethylamine, 6% N-nitrosopyrrolidine and 5% N-nitrosomorpholine. Extrapolation of these data back to the first exhalation (i.e., following the last inhalation) revealed that a remarkable amount of substance may be exhaled (up to 30% N-nitrosodimethylamine).

Air Pollutants↗

Alteration in osmolarity of inhaled aerosols cause bronchoconstriction and cough, but absence of a permeant anion causes cough alone.

To determine whether cough and bronchoconstriction result from alterations in the osmolarity or alterations in the ion concentration of inhaled aerosols and to determine if the specific ions in the aerosol are important, we had 9 subjects with mild asthma inhale various solutions while we recorded cough and measured specific airway resistance. To evaluate the effects of altering osmolarity and ion concentration separately, we administered aerosols of hypo-osmolar distilled water (0 mosm), iso-osmolar sodium chloride (308 mosm), iso-osmolar dextrose in water (308 mosm), hyperosmolar sodium chloride (1,232 mosm), and a hyperosmolar solution of dextrose and sodium chloride (1,232 mosm). To evaluate cough without bronchoconstriction, we had the subjects inhale metaproterenol before inhaling the same aerosols. To determine whether the absence of a specific ion was important in causing cough or bronchoconstriction, we had the subjects inhale iso-osmolar solutions of sodium bromide, sodium gluconate, and lysine monohydrochloride. We found that alteration in osmolarity away from iso-osmolarity of inhaled aerosols is a stimulus for bronchoconstriction in subjects with mild asthma. Absence of ions in the presence of iso-osmolarity is not a stimulus for bronchoconstriction, but the absence of a permeant anion is a stimulus for cough. Thus, we found that the responses of cough and bronchoconstriction to inhaled aerosols can be separated.

Adult↗

The effect of oxygen inhalation on temporary threshold shift in humans.

To examine the effects of an increased oxygen supply on the establishment of noise-induced TTS in humans, 20 Ss were exposed for 10 min to a narrow band of noise centered at 3 kc/s at 100 db SPL, while inhaling either a 60% or a 90% oxygen-air mixture. In a control condition, these Ss inhaled air only while being subjected to the same noise. In the 10 Ss who had inhaled the 90% mixture, TTS was less than when they had inhaled air (delta TTS - 2.06 db, p less than 0.25). Delta TTS (0.07 db) for the 10 Ss who inhaled the 60% mixture was not significant. A further 5 Ss inhaled the 90% mixture for 10 min with no noise exposure; there was no effect on the hearing threshold levels. It was concluded that inhalation of at least 90% oxygen-air for 10 min does not affect HTLs but does reduce TTS. A re-examination was suggested of the possibility that there is a relationship between auditory fatigue and supply of oxygen to cochlear structures.

Auditory Fatigue↗

Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations.

The aim of the study was to assess the prevalence of throat and voice symptoms in asthma patients using pressurized aerosol, metered-dose, inhaled corticosteroid preparations. A questionnaire was administered to hospital out-patients in an asthma clinic and to a control group attending a diabetic clinic. Two hundred and fifty five consecutive out-patients using pressurized aerosol inhaled corticosteroids and 100 controls were surveyed. One hundred and forty seven (58%) patients taking inhaled steroids reported voice dysphonia or throat symptoms compared with 13% of control patients. Women admitted to symptoms more frequently than men. Throat symptoms were more prevalent in patients using higher doses of inhaled steroid. Aerosol inhaler-induced cough was reported by 87 (34%) patients. Local side-effects were equally prevalent both with beclomethasone dipropionate and budesonide aerosol inhalers. The use of a large volume spacing device with either steroid aerosol did not appear to protect against these symptoms. Local side-effects are common in asthmatics taking pressurized aerosol, metered-dose, inhaled steroids.

Aerosols↗