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Biomedical subjects

T Voshaar

Publications and source records attributed to T Voshaar.

16 recordsLinked to original sources
PubMed2006

The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team.

Although the principles of asthma management are well established in Europe, the available data indicate that asthma in patients is not well controlled. Many patients derive incomplete benefit from their inhaled medication because they do not use inhaler devices correctly and this may compromise asthma control. The Aerosol Drug Management Improvement Team (ADMIT), incorporating clinicians from the UK, Germany, France, Italy, Spain and The Netherlands, reviewed published evidence to examine ways to improve the treatment of reversible airways disease in Europe. Data indicate that there is a clear need for specific training of patients in correct inhalation technique for the various devices currently available, and this should be repeated frequently to maintain correct inhalation technique. Devices which provide reassurance to patients and their physicians that inhalation is performed correctly should help to improve patient compliance and asthma control. Educational efforts should also focus on primary prescribers of inhaler devices. ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website which would enable to match the appropriate inhaler to the individual patient. There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful asthma management.

Administration, Inhalation↗
PubMed2005

[Inhalation therapy with Respimat soft inhaler in patients with COPD and asthma].

Developing more effective and convenient inhalation devices for the treatment of obstructive pulmonary diseases is at least as important as designing new drugs. In recent years, existing inhalation systems have undergone many technical modifications and there have also been many new developments. All of these systems have their own particular attributes and characteristics. Two fundamentally different modes of operation are represented by propellant-driven metered-dose inhalers (pMDI) on the one hand and dry powder inhalers (DPI) on the other. However, none of the systems developed so far can be considered ideal. The Respimat Soft Inhaler (Respimat SI) was developed in the light of experience with previous systems and was launched in Germany at the beginning of 2004. The aim in developing this new type of inhaler was to avoid the well-known drawbacks typically associated with pMDI and DPI. The Respimat SI requires neither a chemical propellant nor batteries. The active ingredients are dissolved in water and the solution is atomised using mechanical energy only imparted by a spring which, when released, provides the power to force the solution through an extremely fine nozzle system. Two fine jets of liquid are produced. They converge at an optimised angle and the resulting impact generates a fine mist which is slow-moving and lasts for about 1.5 seconds; moreover, a high proportion of the droplets fall into the fine particle fraction. All of these features allow excellent lung deposition and reduced oropharyngeal deposition. Coordination between actuation and inhalation is less critical as compared with pMDI due to the fact that the mist is both slow-moving and long-lasting. A further advantage is that the mist is generated independently of the patient's inspiratory flow. The Respimat SI meets the requirements for an ideal inhaler better than any other previous device and must therefore be regarded as a significant new development.

Asthma↗
PubMed2004

A review of the development of Respimat Soft Mist Inhaler.

Respimat Soft Mist Inhaler (SMI) is a new generation inhaler from Boehringer Ingelheim developed for use with respiratory drugs. The device functions by forcing a metered dose of drug solution through a unique and precisely engineered nozzle (the uniblock), producing two fine jets of liquid that converge at a pre-set angle. The collision of these two jets generates the soft mist. The soft mist contains a high fine particle fraction of approximately 65 to 80%. This is higher than aerosol clouds from conventional portable inhaler devices, such as pressurised metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). In addition, the relatively long generation time of the aerosol cloud (approximately 1.5s) facilitates co-ordination of inhalation and actuation--a major problem with pMDIs. These features, together with the slow velocity of the soft mist, result in larger amounts of the drug reaching the lungs and less being deposited in the oropharynx compared with either pMDIs or DPIs. Generation of the soft mist from Respimat SMI is purely mechanical, so propellants are not necessary. The innovative design of Respimat SMI, using water-based drug formulations, ensures patients receive consistent and reliable doses of the drug with each actuation. The device was initially tested in scintigraphic lung deposition studies and produced encouraging results when compared with the chlorofluorocarbon-based pMDI (CFC-MDI). Subsequent clinical studies have confirmed that Respimat SMI is effective and safe in delivering bronchodilators to patients with asthma or chronic obstructive pulmonary disease.

Administration, Inhalation↗
PubMed1997

[Ergometry separates sleep apnea syndrome from obesity-hypoventilation after therapy positive pressure ventilation therapy].

In contrast to the obstructive sleep apnoea syndrome (OSA) the obesity-hypoventilation syndrome (OHS) is characterized by persistent hypercapnia during the day. After positive pressure ventilation (PPV) patients with OHS the daytime blood gases normalize after a short time. The aim of this study was to investigate whether blood gases at the end of a standardized exercise test separate both OSA and OHS after 3 months of PPV. Fourteen patients with OHS (12 males, 53.2 +/- 9.5 years, BMI: 41.7 +/- 9.6 kg/m2, PCO2: 50.7 +/- 4.5 mmHg) and 28 patients with severe OSA (27 males, 54.5 +/- 8.3 years, BMI: 35.7 +/- 4.9 kg/m2, PCO2: 37.3 +/- 3.3 mmHg) were studied. Blood gases before and after 4 minutes constant load exercise test were measured. The exercise level for patients with OSA was 2/3 of the predicted maximal work load. Since in OHS the load tolerance was compromised, the exercise test was performed at 2/3 of the maximal exercise level which was investigated before. The identical exercise load was done before and 3 months after beginning the PPV. Compared to the OSA-group the load tolerance of the OHS-group was lower (112 +/- 20 Watt [2/3 of predicted maximal work load] versus 81 +/- 26 Watt [39.9 +/- 8.3% of predicted maximal work load], p < 0.0001). Both before and after 3 months of PPV all patients with OHS showed an exercise induced increase of PCO2 (Before PPV: from 50.7 +/- 4.5 to 56.6 +/- 5.8 mmHg; after PPV: from 39.1 +/- 2.7 to 45.6 +/- 2 mmHg, each p < 0.0001). Correspondingly the PCO2 decreased significantly. In OSA neither before nor after 3 months PPV the blood gases changed significantly during the exercise test. We conclude that the OHS associated hypercapnia during exercise is further on a reliable indicator for the diagnosis despite the daytime normocapnia during rest after PPV. However after PPV the PCO2-values of patients with OHS at rest are in the normal range.

Airway Obstruction↗
PubMed1996

Long-term lung sequelae following accidental chlorine gas exposure.

Acute exposure to sublethal doses of chlorine gas resulted in persistent pulmonary symptoms in 3 patients who had no past history of respiratory disease. The patients complained of intermittent dyspnea in association with respiratory irritants and physical exertion for more than 2.5 years postexposure. Four months after the accident bronchoalveolar lavage showed an inflammatory cell reaction, whereas 16 months later the differential cytology proved nearly normal. Moderate to severe nonspecific bronchial hyperresponsiveness was assessed in intervals of 4, 20 and 30 months after the accident. All patients showed the typical features of the reactive airways dysfunction syndrome defined as an asthma-like occupational illness after an acute exposure to highly concentrated respiratory irritants. We conclude that a single high exposure to chlorine gas may lead both to acute respiratory injury and to long-term reactive airway dysfunction with typical symptoms of inflammatory changes of the airways and nonspecific bronchial hyperresponsiveness.

Accidents, Occupational↗
PubMed1993

[Evaluation of a portable device for measuring maximal inspiratory pressure (Pimax)].

Pimax measurement is useful for quantifying the fatigue of the respiratory muscles (the "respiratory pump" of the mechanics of respiration), for controlling the therapeutic effect of artificial respiration performed at home, and assessment of the possibility of relieving a patient from artificial respiration. So far, such measurement had required complicated set-ups. A portable alternative is now available for Pimax measurement (MPM, distributed by Medanz, Starnberg, Germany). In a prospective study we compared the Pimax values measured via the mouth pressure measuring instrument under test, with the standard laboratory method. Statistical comparison of the measured data yielded a high degree of correlation (r = 0.97) with slight scatter of the individual data around the identity line. The portable instrument tested in this manner thus represents a mobile method yielding reliable Pimax values both on an inpatient and an outpatient basis.

Adult↗
PubMed1990

[Serum theophylline concentrations in patients with chronic obstructive lung diseases: a comparison of 2 methods].

A total of 120 samples of serum were obtained from 8 patients with COPD and submitted to a comparative analysis of serum theophylline levels employing the TDX and the EMIT methods of determination. At the same time, two different slow-release preparations of theophylline were compared, their kinetics investigated, and their effects tested using body plethysmography. For this open, randomized cross-over preliminary investigation, numerous inclusion and exclusion criteria were applied.

Adult↗
PubMed1990

[Morbidity of respiratory and cardiovascular diseases in smog conditions. Studies of 1,995 patients].

On the basis of the five-year study (1984-1988) presented herein, we have been able to demonstrate that, under conditions of smog, an increase in respiratory diseases can occur. Our results also show that cardiovascular diseases decrease simultaneously, an observation that has not so far been reported in the literature. A possible reason for this observation is, perhaps, an information effect, or an influence effect induced by warnings given in the media about the negative health-related consequences for those who leave their homes, in particular those consequences applicable to patients with cardiovascular disorders. The pathological process is traceable to a multifactorial occurrence, the temperature of the air having a decisive influence. To date, the influence of indoor pollution has not yet been clarified.

Air Pollutants↗
PubMed1983

[Cell biology basis of IgE antibody regulation. Immunotherapeutic approaches].

Recent developments as to the IgE-antibody synthesis in rodents and in the human model are summarized and discussed in reference to our own data. It is by now established that the IgE-antibody response is regulated by interdependent interactions of cellular, humoral and genetic factors. The IgE-bearing B-lymphocyte develops from a surface IgM carrying B-lymphocyte. The transformation into an IgE secreting plasma cell requires T-cell help or soluble T-cell factors. Recent advances in the characterization of human lymphocytes as well as more sophisticated cell biological approaches facilitated the analysis of IgE-antibody synthesis in the human in vitro model. In most of the studies at present available the effect of the polyclonal B-cell mitogen (PWM) was analyzed. PWM either enhanced, suppressed or unlike to other Ig-classes did not affect the IgE-antibody synthesis at all. Immunotherapeutic approaches have to consider to establish the allergen induced in vitro model of IgE-antibody synthesis in humans, to modulate the interactions of T-helper and/or suppressor cells or to generate soluble suppressor factors. In any case the analysis of the IgE-antibody synthesis in humans could be a valuable tool to assess IgE-B-cell memory towards various allergens and to determine the IgE-mediated in patients.

Animals↗
PubMedDate not supplied

Regulation of IgE antibody synthesis.

It is well established that IgE-antibodies against allergens are involved in allergic diseases. Thus, the regulation of IgE antibody synthesis appears to be a fundamental approach to its treatment. The mechanisms of the IgE-antibody response are somehow different from IgG production. It appears that the immunocompetent cells involved are distinct and exert a different susceptibility with regard to IgE- and IgG antibody production. A more precise under-standing of the cellular processes involved in IgE-antibody production will lead to novel immunotherapeutic approaches of allergic disease processes.

Adjuvants, Immunologic↗