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PubMed2003

[An effective case of nitric oxide inhalation therapy in pulmonary hypertensive crisis in cardiopulmonary bypass following palliative operation for ventricular septal defect with pulmonary hypertension].

A 4-month-old female with ventricular septal defect (VSD) and severe pulmonary hypertension (PH) underwent a patch closure for VSD. She could not be weaned from cardiopulmonary bypass (CPB) after the intracardiac repair due to PH crisis. Nitric oxide inhalation therapy during partial CPB enabled her to be weaned from CPB. This therapy could be gradually taped off and quit 7 days after the operation. Nitric oxide inhaled therapy is considered to be an excellent treatment for PH crisis during CPB in congenital cardiac surgery. The causes of PH crisis were also discussed in reference to the date of endothelin-1 (ET-1) measured during the operation.

Administration, Inhalation↗
PubMed2001

Advances in Inhalation Therapy: IBC Conference.

A 2-day conference on Advances in Inhalation Therapy drew together 16 speakers, experts in their respective fields, to summarize recent developments in delivery device design, drug formulation, in vitro and in vivo assessment, and to provide a clinical overview of the future of drug aerosol therapy. Concurrent advances are being made in the design of aerosol delivery devices in all areas. Reformulation of non-CFC pressurized metered dose inhalers (pMDIs) is overcoming technical, legal and engineering obstacles, although whether the new hydrofluorocarbon (HFA) products will already be limited and dated is a distinct possibility. New 'soft mist inhalers' offer a viable alternative for drug aerosol delivery that has potential advantages in efficiency in design and aerosol delivery compared to conventional pMDIs and DPIs. The reproducible generation and delivery of micronized macromolecules to the peripheral lung offers an efficient and novel means for the effective and safe delivery of peptides and proteins, with notable successes in delivery of analgesics and insulin. Novel means of designing 'smart drugs' through supercritical fluid engineering promises to further enhance the advantages of inhalation for routine drug administration.

Journal Article↗
PubMed2000

Assessment of the effects of sugar cane plantation burning on daily counts of inhalation therapy.

This study was designed to evaluate the association between sugar cane plantation burning and hospital visits in Araraquara in the state of São Paulo, Brazil. From June 1 to August 31, 1995, the daily number of visits of patients who needed inhalation therapy in one of the main hospitals of the city was recorded and used as health impairment estimation. Sedimentation of particle mass (the amount of particles deposited on four containers filled with water) was measured daily. The association between the weight of the sediment and the number of visits was evaluated by means of Poisson regression models controlled for seasonality, temperature, day of the week, and rain. We found a significant and dose-dependent relationship between the number of visits and the amount of sediment. The relative risk of visit associated with an increase of 10 mg in the sediment weight was 1.09 (1-1.19), and the relative risk of an inhalation therapy was 1.20 (1.03-1.39) on the most polluted days (fourth quartile of sediment mass). These results indicate that sugar cane burning may cause deleterious health effects in the exposed population.

Agriculture↗
PubMed2000

Asthma severity, recommended changes of inhaled therapy and exhaled nitric oxide in children: a prospective, blinded trial.

Orally exhaled nitric oxide (ENO) correlates with several variables of airway inflammation and might be useful to direct asthma therapy. If this is true, ENO should correlate with disease severity and the therapeutic decisions made. - In 74 children with allergic asthma (age 9.7 years, range 4-16) disease severity was determined by history, clinical symptoms, and lung function and inhaled therapy was adjusted according to the NIH criteria. ENO was also measured, but the patients, their parents and the physicians who made the therapeutic decision were left unaware of the results. 31 healthy children served as controls. ENO was higher in asthmatics than in controls, but did not differ with asthma severity. ENO was weakly correlated with the changes in asthma therapy recommended (r = 0.303, P = 0.009). ENO values above normal (> 13 ppb) had a sensitivity of 0.67 and a specificity of 0.65 to predict a step up in therapy. Due to the non-normal distribution of ENO there was a substantial overlap between the different groups. The lack of correlation with disease severity and the weak prediction of physician recommended inhaled therapy, suggest that ENO may be of some value to guide asthma therapy. Studies using ENO to direct therapy are necessary for a definite answer.

Asthma↗
PubMed1989

[Indomethacin inhalation therapy for patients with excessive sputum].

We studied the effect of indomethacin (INDO) inhalation therapy on patients with excessive sputum due to chronic respiratory infection. INDO (3.5 x 10(-2) M) reduced sputum production from 211 +/- 43 to 106 +/- 22 ml/day (p less than 0.05, n = 7), the effect that was more remarkable in patients with diffuse panbronchiolitis (DPB). The prostaglandin E2 (PGE2) levels in sputum were also decreased significantly. In addition, to elucidate the mechanism of action of INDO on epithelial ion transport, we measured short-circuit current (Isc) of canine tracheal epithelium in response to 3 x 10(-6) M INDO under short-circuit conditions in vitro. Addition of INDO to mucosal medium decreased Isc from 42.8 +/- 6.0 to 8.2 +/- 3.5 microA/cm2 (p less than 0.01, n = 6). The increases in Isc produced by PGE2 and PGF2 alpha were abolished by furosemide, a Cl-transport blocker. These results suggest that INDO inhalation is a promising therapy in improving excessive sputum production, and that this effect may be attributed to inhibition of PGE2-dependent Cl-secretion into the airway lumen.

Administration, Inhalation↗
PubMedDate not supplied

Knowledge of pediatricians in Rio de Janeiro, Brazil, about inhalation therapy in asthmatic children.

BACKGROUND: Despite the numerous guidelines on the diagnosis and treatment of asthma, there are data that indicate that general pediatrician's knowledge of the disease and its preferred treatment is limited, which may influence the quality of care given to asthmatic children. The purpose of this study was to describe pediatrician's knowledge of spacers and of concepts of chilhood asthma, as well as their prescribing habits concerning inhalation therapy, in the public health system of the city of Rio de Janeiro. METHODS AND RESULTS: A descriptive cross-sectional study was performed in a sample of 72 pediatricians from the public health system of Rio de Janeiro. A questionnaire was used to assess prescriptions for spacers, the reasons whay spacers were not used, the models employed, classification of asthma according to clinical severity and symptom frequency, recommendation for the correct spacer volume according to age group, and the concept of asthma as an inflammatory disease. Seventy percent (51/72) of the physicians did not routinely prescribe the spacer. The reasons given were as follows: a) lack of spacer availability in the public health system in 55 % (28/51); b) high cost in 57 % (29/51); c) the complexity of their use in 35 % (18/51); d) unwillingness to use aerosol type medication in 15 % (8/51), and e)lack of knowledge of their function and utilization in 59 % (30/51). Of the 30 % (21/72) who reported they regularly and routinely prescribed the spacer in daily practice, 48 % (10/21) stated that this routine prescription, even when indicated, was below 25 % of what was expected and makeshift models were preferred by 24 % (5/21) of the pediatricians. Six percent of the pediatricians chose the appropriate spacer volume according to age group, 62.5 % (45/72) reported that they classified asthma according to severity, 16 % (7/45) gave the correct answers when classifying asthma according to national consensus, and 22 % (16/72) considered asthma to be an inflammatory disease. CONCLUSIONS: The results of this study suggest that pediatrician's knowledge of inhalation therapy with dosed aerosol spacers and of asthma-related concepts in the public health system in Rio de Janeiro is limited. This may restrict the quality of care given to the asthmatic children in the city and suggests the need for training programs for the management of asthmatic children.

Adult↗