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PubMed1992

[Electron microscopic structure of mastocytes of the airways and changes in the clinical status during steroid inhalation therapy].

The structure of epithelial mast cells obtained by bronchial biopsy from asthmatic patients reveals characteristic qualitative and quantitative features. Great amount of partly or completely depleted mast cells can be observed in active asthmatic patients, indicating the liberation of bronchoconstrictive mediators. After a two months treatment with inhalative steroid (budesonide) the process of degranulation slows down, the number of depleted mast cells decreases. Parallel with the above described phenomenon, the number of dyspneic attacks, as well as the necessity of other antiasthmatic drugs show a significant decrease. However, in this patient material, during the treatment period, airway hyperreactivity, detected by bronchial provocation, failed to show any remarkable change.

Asthma↗
PubMed1998

[Drug inhalation therapy. Therapy for patients with respiratory disorders].

We detected a high number of patients suffering from respiratory ailments which require successive hospital stays due to acute setbacks in their chronic respiratory ailments. The majority of these patients receive outpatient clinic treatment based on use of an inhaler. Given the direct relationship between the correct use of an inhaler and its effectiveness, we designed our project with the goal to discover the adroitness these patients have with an inhaler. The results of our study showed that 67% of the patients tested did not correctly use their inhaler, there by annulling or diminished the effectiveness of its use.

Administration, Inhalation↗
PubMed1981

[Inhalation therapy of upper respiratory tract diseases in metallurgists at the Ciechocinek health resort].

Since 1972, 265 metallurgists of the Warsaw Steel-works have been treated at the ENT Department, Research Centre in Ciechocinek, for chronic atropic catarrh of upper respiratory tract mucous membrane. The treatment involved saline inhalations, respiratory exercises at a saline pool and in the open air near chimney coolers. Pathological changes were found in the mucous membrane of the metallurgists working over 5 years at high temperature and in great dustiness, and the ailments were getting intensified with the length of employment. The treatment was effective. Analysis of the collected material demonstrates that the treatment should be started already during the first 5 years of metallurgist's work. It should be meant as prophylaxis of upper respiratory tract diseases.

Health Resorts↗
PubMedDate not supplied

[Inhalation therapy in asthma].

Respiratory therapy, consists in the administration of gases or drugs via airways; it includes: oxygen, humidity, aerosol therapy, IPPB, chest physiotherapy and mechanical ventilation. Asthmatic patients frequently require oxygen support which is delivered by low and high flow systems, for best results, gases must be humidified, either by bubble or wick humidifiers, heat increases usefulness. Spray is produced by nebulizers and metered dose inhalers, the last are cheaper but they need a certain grade of coordination. Powder inhalers are easier to use. IPPB is indicated in patients with severe fatigue, this method is used sporadically. Chest physiotherapy teaches utilization of relaxation and inferior thoracic respiration techniques. Thoracic percussion must be avoided in an asthmatic crisis. Mechanical ventilation is delivered through a large bore canule, its goal is to assure an adequate gas exchange and to avoid respiratory muscular fatigue.

Aerosols↗
PubMed1986

Simplification of inhalation therapy in asthmatic children. A comparison of two regimes.

In a placebo-controlled double blind cross-over study of 3 X 3 weeks' duration the effectiveness of a new set of simple instructions for the use of spacer aerosols was compared with that of the rather complicated manufacturer's instructions in the daily treatment of 22 children with severe asthma. All children received inhaled budesonide and terbutaline at the lowest dose possible for satisfactory symptom control. Both the simple and complicated regimes were significantly better than placebo (P less than 0.01), but there was no indication that the complicated regime was superior to the simple regime. On the contrary, the children used significantly more rescue terbutaline and experienced more daytime symptoms when treated according to the complicated regime (P less than 0.01). 19 of 21 children who completed the study preferred to use the simple regime (P less than 0.01). It is concluded that instructions for the use of spacer aerosols should be substantially simplified and that conclusions from laboratory studies should be tested in the day-to-day management of asthmatics before these aerosols become widely used.

Adolescent↗
PubMed1995

Physical properties of aerosolized immunoglobulin for inhalation therapy.

Animal studies suggest that passive immunization by intratracheal application of gammaglobulins may succeed in treating small children and infants with severe lower respiratory tract infection caused by respiratory syncytial virus (RSV). Since proteins foam easily when stirred up or used with compressed air, the feasibility of nebulization of the immunoglobulin solution (IVIG, Sandoglobulin) had to be tested. The therapeutic effect of a drug delivered via inhalation is proportional to the mass of aerosol deposited in the lungs. For a fixed breathing pattern, the amount deposited per unit of time in the thoracic region depends on mass flow rate and distribution of aerosol mass by droplet size. Both these variables were determined in relation to the weight concentration (osmolality), viscosity, and surface tension of the IVIG solution for four compressed air nebulizers. The mass flow rate of the spray decreases as the weight concentration of the solution increases, but droplet size distribution does not change. If the IVIG solution does not exceed 5% and the airflow rate is 6 L/min, a mass flow of about 150 mg to 250 mg (7.5 to 12.5 mg IVIG) per minute is obtained, depending on the physical characteristics of the nebulizer used. Low mass median diameter of about 2 microns and a mass distribution with a high percentage of the droplets below 6 microns will allow optimum intrapulmonary deposition in infants.

Aerosols↗
PubMed1993

[Amiloride inhalation therapy in mucoviscidosis].

The defective regulation of the secretory chloride channel and the accelerated rate of sodium absorption in the airway epithelia of patients with cystic fibrosis (CF) contribute to the dehydration of airway secretions which is responsible for secondary damage in the respiratory tract. The sodium-blocker amiloride inhibits sodium absorption depending on the dosage of the drug. This effect is documented by means of measuring transepithelial potential difference which is decreased following to inhalative amiloride administration in CF patients. Clinical long term efficiency has been shown to be probable, but has to be confirmed. Investigation in this field is difficult, because there are some other important factors which influence viscosity of mucus. The use of amiloride can best be evaluated, if it is given immediately after birth. However, the answer to some important questions has to be found before.

Administration, Inhalation↗
PubMed2006

[A case of severe airflow limitation markedly improved by inhalation therapy in non-smoking woman with chronic obstructive pulmonary disease].

A 67-year old woman who had never smoked presented with dyspnea on effort and general fatigue, which had first appeared 4 years ago. She had lived for 35 years with her husband who was a heavy smoker. Chest roentgenogram showed pulmonary over-inflation, but chest CT scans didn't demonstrate emphysematous changes. Neutrophil-dominant sputum cytology, a PaO2 of 69.5 Torr, and combined ventilatory impairment on respiratory function test were revealed. FEV1.0 improved 80 ml after beta2-agonist inhalation. Although the respiratory symptoms were improved by inhaled anti-cholinergic drug, residual volume increased minimally. After the use of inhaled steroid drug (HFA-BDP) and salmeterol, the symptoms and residual volume were markedly improved. One year later, FEV1.0 increased by 450 ml. The low attenuation area detected by CT scans decreased, mainly in the lower lung field. Passive smoking might have contributed to her airflow limitation.

Aged↗
PubMed2001

Promoting adherence to inhaled therapy: building partnerships through patient education.

Optimal treatment outcomes are dependent upon patient adherence to therapy. Problems in adherence can be overcome by developing a professional-patient partnership that has the goal of developing communication between the partners, mutual accountability, respect for personal values and viewpoints, and shared decision making. The process of patient education is shaped by the needs of this developing partnership rather than a-priori goals established by the professional.

Administration, Inhalation↗
PubMed1982

Clinical use of spacer systems for corticosteroid inhalation therapy: a preliminary analysis.

This is a preliminary report on the first half of a study designed to assess the ability of two different spacer devices to improve the results of aerosol steroid treatment in chronic asthmatic patients given budesonide in low and high dosages. The spacers significantly reduced oropharyngeal candidiasis but did not affect dysphonia - possibly because the incidence of the latter was so low throughout the study. The spacers augmented the airway response to budesonide in these patients without materially increasing systemic absorption of the drug (assessed indirectly in terms of the change in blood eosinophil counts). Pretreatment with inhaled terbutaline did not significantly affect the performance of the spacers, either in terms of the airways responses or the amount of budesonide systemically absorbed. When used properly, these spacers can improve the cost effectiveness of aerosol steroid treatment. Since only adults were studied, it is not known whether these findings apply equally well to children with asthma.

Aerosols↗
PubMed2001

[The physician-pharmacist team in the education of patients concerning inhalant therapy].

The value of educational measures in consideration of the asthmatic patient appeared at first twenty years ago to the eyes of clinical physicians, generalists or specialists. Round about the year 76 the first associations for asthmatic patients were born, under pressure from pneumologists, with the aim of clarifying their illness to asthmatics, to counsel them and especially to enable them to associate their symptoms with their treatment, to assure them of a ready availability of materials more or less onerous to test, aerosolizers, nebulizers, ionizers of the environment, peak flow meters, inhalation chambers, acaricides.... Twenty years after these pioneers of this education of the patient to these responsibilities, the associations devoted to asthma as well as schools of asthma have recently been instigated in order to complete the venture on the ground, often with only feeble means. It is hardly necessary to make an illusion: asthmatic patients, children or adults within these associations are always the same: it is those who are prepared to stir themselves to take part in meetings. There remains the great majority of asthmatics who necessarily need a particular treatment that is adapted to their personal case: it is the duo of physician-pharmacist which is and which constitutes always the best point of impact to devote the time necessary at the best appropriate moment. Such is the aim of this presentation which should not be considered as a return to the past, but an advance towards the individualized formulation of patients by benefitting from the former experiences of corporative formations.

Administration, Inhalation↗
PubMedDate not supplied

[Furosemide long-term inhalation therapy in patients with nasal polyposis].

Study aimed principally at applying the data recently gathered with regard to Bronchial Reactivity to rhinology, with special regard to non-atopic or allergic hyperresponsiveness. In the past decade, Ultrasonic Nebulized Distilled Water (U.N.D.W.) was recognized as one of the best test in Bronchial Reactivity. In allergic and non-allergic rhinitis, the Authors tried to use U.N.D.W. to reproduce symptoms of rhinitis. Results show that U.N.D.W. could be included in the Nasal Hyperreactivity test. Secondly, but not less interesting, is the prevention of experimental rhinitis with U.N.D.W. by using Furosemide, a diuretic administered by inhalation. The prevention of Ca++ penetration into nasal cell can block any mediator-activation. Such procedure may be applied in polyposis after surgery in order to prevention recurrence, data show the complete applicability of this pharmacological treatment in children as well.

Administration, Inhalation↗
PubMed2006

In vitro assessment of transferrin-conjugated liposomes as drug delivery systems for inhalation therapy of lung cancer.

Most human tumours over-express receptors for growth factors and peptide hormones, which are being increasingly studied as a means to selectively deliver cytotoxic agents. An example being the transferrin receptor (TfR, CD71). Here, we studied expression levels and location of TfR in different lung epithelial cell types (i.e., bronchial and alveolar epithelial cells) by flow-cytometry and confocal laser scanning microscopy (CLSM). Furthermore, we assessed uptake levels and cytotoxicity of transferrin (Tf)-conjugated liposomes in vitro. TfR was found to be expressed at a significantly higher level in bronchial epithelial cells compared with their alveolar counterparts. Cells of cancerous origin (i.e., A549 cell line) showed a higher TfR expression level than healthy alveolar epithelial type II cells in primary culture. CLSM revealed TfR to be located primarily at the basolateral aspect of cells, with the exception of cells undergoing mitotic proliferation, which also showed TfR at their apical membranes, due to their loss of cell polarity. Higher expression levels of TfR correlated well with enhanced uptake of Tf-liposomes and increased levels of cytotoxicity. Liposome uptake was temperature-dependent and inhibitable by excess free Tf. Tf-conjugated liposomes appear as good candidates for an approach to deliver cytostatic drugs to sites of lung cancer by inhalation.

Antineoplastic Agents↗
PubMed2003

Chemopreventive therapeutics. Inhalation therapies for lung cancer and bronchial premalignancy.

The lung cancer epidemic is not expected to abate in the next two decades. Smoking cessation campaigns have not been successful in reducing the prevalence of smoking to < 25% of the adult population in the US. Among high school students, the prevalence of smoking is increasing (27.5% in 1991; 36.4% in 1997) (43). In addition, only 1 in 8 heavy smokers develop lung cancer and about 20% of patients with lung cancer have no history of active or passive smoking, thus indicating that genetic predisposing factors and other unidentified carcinogens play a crucial role in the etiology of this disease. The bronchial epithelium is like an internal skin where lung cancer originates after chronic exposure to airborne carcinogens in a predisposed host. Although the bronchial epithelium is not readily examinable, it is easily accessible to therapeutic intervention by using inhaled therapeutics. We hope to extend our findings using direct wild-type p53 gene replacement via intratracheal and aerosolized administrations in mice to NSCLC patients with p53 mutations. We also plan on utilizing aerosolized chemical agents to activate endogenous mechanisms of cytoprotection. If, in clinical trials, evidence of effective cytoprotection is observed in the absence of intolerable side effects, further exploration of this new strategy for the control and prevention of a neoplastic disease that accounts for a third of all cancer-related deaths will be fully justified.

Administration, Inhalation↗
PubMed1985

Inhalation therapy during acute asthma. The role of a combined steroid and beta-stimulant preparation.

A compound consisting of a beta-stimulant, salbutamol (Ventolin; Allen & Hanburys) (100 micrograms/puff), and a steroid, beclomethasone dipropionate (Becotide; Allen & Hanburys) (50 micrograms/puff), was studied to test the hypothesis that the corticosteroid could enhance the bronchodilator properties of the beta-stimulant during chronic asthma and simulated acute attacks (antigen challenge). Conventional doses (200 micrograms and 100 micrograms of salbutamol and beclomethasone respectively) were compared using a schedule which included a second administration 1 hour later. The results obtained on the baseline bronchial responsiveness of chronic asthmatics and during the delayed asthmatic response (simulated acute asthma) were similar. The compound was as effective as salbutamol alone but not more so. A significantly greater bronchodilator response was recorded in all patients after the second administration of both the compound and salbutamol alone. The practical advantages of having one rather than two inhalers are evident, but the appropriate application of this compound agent, probably in a prophylactic role, must be defined.

Acute Disease↗
PubMed1993

Bronchial hyperresponsiveness changes after 5 months of regular procaterol inhalation therapy in asthmatic children.

It is well known that procaterol has more potent antiallergic properties than previous beta-stimulants. Thirteen children with asthma who could be controlled for 2 months with a regular procaterol aerosol given 4 times/day (10 micrograms/dose) were studied. Histamine challenges were performed before and an average of 5 months after the consecutive treatment. No significant differences were seen in peak expiratory flow values. PC20 increased significantly from 132.9 +/- 127.7 micrograms/ml to 762.4 +/- 1205.7 micrograms/ml after 5 months. These results suggest that asthmatic children who can be controlled with regular use of the beta-stimulant procaterol are likely to have a decreased bronchial hyperresponsiveness.

Administration, Inhalation↗
PubMed2004

The influence of relative humidity on the cohesion properties of micronized drugs used in inhalation therapy.

The influence of relative humidity (RH) on the cohesion properties of three drugs: salbutamol sulphate (SS), triamcinolone acetonide (TAA), and disodium cromoglycate (DSCG) was investigated using the atomic force microscope (AFM) colloidal probe technique. Micronized drug particles were mounted in heat-sensitive epoxy resin for immobilization. Multiple AFM force-distance curves were conducted between each drug probe and the immobilized drug particulates at 15, 45, and 75% RH using Force-Volume imaging. Clear variations in the cohesion profile with respect to RH were observed for all three micronized drugs. The calculated force and energy of cohesion to separate either micronized SS or DSCG increased as humidity was raised from 15 to 75% RH, suggesting capillary forces become a dominating factor at elevated RH. In comparison, the separation force and energy for micronized TAA particles decreased with increased RH. This behavior may be attributed to long-range attractive electrostatic interactions, which were observed in the approach cycle of the AFM force-distance curves. These observations correlated well with previous aerosolization studies of the three micronized drugs.

Bronchodilator Agents↗