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Biomedical subjects

Dennis M Williams

Publications and source records attributed to Dennis M Williams.

10 recordsLinked to original sources
PubMed2006

Considerations in the long-term management of asthma in ambulatory patients.

PURPOSE: The goals of treatment and drug therapies used for long-term asthma control, classification of the disease by severity, and treatment based on severity are reviewed, with an emphasis on recent controversies in treatment approach and safety concerns. SUMMARY: Patient education and written asthma self-management and action plans are essential components of asthma treatment because of the need for patients to acquire substantial knowledge and skills in self-care. Inhaled corticosteroids are the most effective long-term-control therapy and usually suffice as monotherapy for mild persistent asthma. Adding a long-acting, inhaled beta2 agonist to the inhaled corticosteroid is preferred for moderate and severe persistent disease despite safety concerns. Omalizumab use is limited to selected patients with moderate-to-severe allergic asthma and an inadequate response to inhaled corticosteroids. CONCLUSION: The long-term control of asthma requires substantial patient knowledge and skill. Persistent disease is best managed by inhaled corticosteroids and if it is moderate or severe, long-acting, inhaled beta2 agonists in combination with inhaled corticosteroids.

Adrenal Cortex Hormones↗
PubMed2006

Case studies illustrating the implementation of treatment strategies for acute and chronic asthma.

PURPOSE: Considerations that enter into decisions about treatment strategies for acute and chronic asthma are illustrated in two case studies. SUMMARY: A patient's signs, symptoms, vital signs, laboratory test results, recent history of illness or exposure to substances that can provoke asthma symptoms, and response to recently used asthma medications as well as efficacy, safety, and cost are important considerations in choosing drug therapy in the emergency department to treat an acute exacerbation. The need for a rapid onset of action and patient limitations may influence the choice of a dosage form, delivery device, and route of administration. Treatment strategies for patients with chronic asthma may require resolution of problems with adherence to the treatment plan or inhaler technique. Long-term control of asthma symptoms involves the use of preventive measures, including long-term-control medications, efforts to control asthma triggers, and self-monitoring of pulmonary function. Patient education and a written action plan are important elements of the treatment strategy. CONCLUSION: An individualized approach to treating patients with acute or chronic asthma that takes into consideration patient-specific factors as well as efficacy, safety, and cost of drug therapy is needed when devising and implementing a treatment strategy to optimize patient outcomes.

Acute Disease↗
PubMed2002

Continuing-education programs in pharmacogenomics for pharmacists.

The Notes section welcomes the following types of contributions: (1) practical innovations or solutions to everyday practice problems, (2) substantial updates or elaborations on work previously published by the same authors, (3) important confirmations of research findings previously published by others, and (4) short research reports, including practice surveys, of modest scope or interest. Notes should be submitted with AJHP's manuscript checklist. The text should be concise, and the number of references, tables, and figures should be limited.

Education, Pharmacy, Continuing↗
PubMed2002

Generation of gelatin aerosol particles from nebulized solutions as model drug carrier systems.

PURPOSE: Aerodynamically stable, nebulized aerosols are desirable to achieve optimum asthma therapy. Stabilizing droplet size using gel-forming polymers may assist in achieving this goal. Semisolid particles may be generated through aerosolization of a polymer solution. Gelatin was employed as a model polymer in a process optimization study using the marker, disodium fluorescein, and the drug, budesonide delivered from two commercially available air-jet nebulizers. METHODS: The aerosol delivery system consisted of either of the air-jet nebulizers attached to a 30 cm drying column. The nebulizers employed were the Aerotech II and Salter SL8900. Two gelatin solutions (0.1 and 0.7% w/v) were evaluated following initial density and viscosity measurements. Particle characterization was conducted by scanning electron microscopy, eight-stage cascade impaction (CI), and phase-Doppler analysis. Disodium fluorescein (NaF, 5 and 7% w/v) and budesonide (B, 0.05% w/v) were added to the gelatin solutions in a 2(4)-factorial design study and the follow-up drug formulation study, respectively. The factorial design experiment evaluated the influence of device, operating pressure, marker, and gelatin concentrations on mass median aerodynamic diameter (MMAD) and fine particle fraction (FPF). Spectrophotometry of the CI samples was performed at wavelengths of 486 (NaF) and 254 (B) nm. RESULTS: The factorial design experiment utilizing NaF showed that MMADs were not influenced significantly be the device, operating pressure, marker, or gelatin concentrations (p > 0.05). However, FPFs were significantly influenced by marker concentration and device (p < 0.05). In the presence of budesonide, the MMADs and FPFs for Aerotech and Salter, respectively, were: MMAD = 1.39 +/- 0.30 microns and 1.75 +/- 0.63 microns, FPF = 93.5 +/- 4% and 68.5 +/- 5%, (n = 3). These values were consistent with those predicted in the designed experiment. CONCLUSIONS: A range of semisolid particle sizes were produced (1.3 < MMAD < 1.8 microns) for the 0.7% w/v gelatin formulation using different nebulizers. The budesonide formulation produced FPFs of 69-93%.

Aerosols↗
PubMedDate not supplied

Accuracy of float testing for metered-dose inhaler canisters.

OBJECTIVE: To characterize and evaluate canister floating patterns of three commercially available metered-dose inhalers (MDIs) with varying amounts of medication remaining. DESIGN: Four canisters each of three asthma medications were studied. MDIs were actuated every 30 seconds to 60 seconds, and canisters were weighed and floated at 100%, 75%, 66%, 50%, 33%, 25%, 10%, and 0% of remaining labeled actuations. Position of the canisters and percentage submersion in water were recorded. SETTING: Controlled laboratory. RESULTS: We observed differences among the products with regard to canister floating behavior at varying levels of fullness. All canisters were completely submerged with the nozzle up at two-thirds full and greater. The canisters remained nozzle-up and were submerged to varying levels at the half-full point. When observed at less than half full, canisters inverted and floated nozzle down. Positions of the canisters varied among products at less than half full. No canister was fully tilted when all labeled actuations were used. CONCLUSION: Float characteristics are product-specific and a function of canister size, design, content, and method of testing. Clinicians and asthma educators should not advise patients to use a float test to assess the amount of medication remaining in an MDI. Recommendations from the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute suggest that the only reliable method for determining the number of doses remaining in a canister is to subtract the number of doses used from the number available.

Aerosols↗