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At least 163 records · Page 9Linked to original sources
PubMed1990

Compliance with inhaled therapy and morbidity from asthma.

Patient compliance with a standardized incremental regimen of inhaled anti-asthma therapy has been assessed in a large, prospective study in general practice. Urine salbutamol estimations were made in 30 patients who had the largest improvement with therapy (mean increase in FEV1 0.45 l above baseline: Responsive) and in 30 patients whose airflow obstruction failed to improve (FEV1-0.14 l: Nonresponsive). The urine salbutamol concentrations rose over the 9 month period in the responsive patients as expected with the incremental doses prescribed, and were significantly higher than urine levels in nonresponsive patients at two dose levels. Poor compliance with prescribed inhaled therapy is an important cause of persistent morbidity from asthma.

Administration, Inhalation↗
PubMed1989

Is inhalation therapy noxious to the ciliated nasal epithelium?

It is well known from in vitro studies that the functional state of the ciliary epithelium is temperature-dependent. The ciliary beat is irreversibly arrested above about 40-45 degrees C. We exposed 30 volunteers to inhalation therapy with hot moist vapour of about 50 degrees C. The functional state of the nasal mucosa was assessed by counting ciliary beat frequency and the percentage of dead and vital ciliated cells from a vital cytological sampling of the nose before and after treatment. The percentage of vital cells was the same whereas the ciliary beat frequency rose significantly. It is discussed that in the mucosal layer temperatures are not as high as in the inhaled vapour due to the air-conditioning capacity of the nose.

Cilia↗
PubMed2001

Effects of amphotericin B gargles on oral colonization of Candida albicans in asthmatic patients on steroid inhalation therapy.

BACKGROUND: Early use of inhaled steroids is recommended for bronchial asthma. The side effects are rare, but oral discomfort and candidiasis are clinically important complications. Most previous studies reported that the use of spacer and water gargling was necessary to prevent oral complications. However, in some patients, this may fail to prevent such complications. OBJECTIVE: To compare the effects of water gargling with those of amphotericin B, in the prevention of oral complications in asthmatics using inhaled steroids. METHODS: Pharyngeal swab samples were obtained aseptically from the posterior pharyngeal wall of 128 asthmatics who have been using inhaled steroids (beclomethasone dipropionate) for more than 1 year. The amount of Candida albicans in cultured swabs was evaluated based on the following criteria: oral symptoms, method of gargling, dose of inhaled steroids, type of spacer and serum cortisol level. RESULTS: The number of isolated C. albicans was significantly higher in asthmatics with oral symptoms than in those free of symptoms. It was also significantly higher in patients who gargled with water or 1,000 times dilution than in those who gargled with 100 or 50 times dilutions of amphotericin B. Moreover, it was significantly higher in patients with low levels of serum cortisol than in those with normal serum cortisol. CONCLUSION: We demonstrated that at least in a subgroup of asthmatics using steroid inhalers, gargling with water or even weak concentrations of amphotericin B does not prevent colonization of the throat with C. albicans. This group at high risk of developing oral candidiasis should gargle with amphotericin B at concentrations higher than 100 times dilution that can prevent clinically detectable oral candidiasis.

Administration, Oral↗
PubMed2005

How to achieve good compliance and adherence with inhalation therapy.

The correct use of inhaler devices is an inclusion criterion for all studies comparing inhaled treatments. However, in real life patients make many errors when inhaling their medication which may negate the benefits observed in clinical trials. A recently published observational study evaluated inhaler handling in 3811 patients for at least 1 month using the Aerolizer, Autohaler, Diskus, pressurised metered dose inhaler (pMDI) or Turbuhaler devices. Inhalation errors were considered critical if they could have substantially affected drug delivery to the lung. The two most common errors made by patients were device-independent errors and included not breathing out before actuation of the device (28.9%) and failure to breath-hold for a few seconds after inhalation (28.3%). These errors were observed in 40%-47% of patients. The number of patients making at least one error with breath-actuated inhalers was high; with less than 50% of patients inhaling correctly. Seventy-six per cent of patients made at least one error with pMDI compared to 49%-55% with breath-actuated inhalers. With respect to device-dependent errors, the pMDI fared worst with 69% of patients exhibiting at least one error, closely followed by the Turbuhaler (32%) and Autohaler (41%). Critical errors were made by only 11%-12% of patients treated with Aerolizer, Autohaler or Diskus compared to 28% and 32% of patients treated with pMDI and Turbuhaler, respectively. Over-estimation of good inhalation by GPs was maximal for Turbuhaler (24%) and lowest for Autohaler and pMDI (6%). Ninety per cent of GPs felt that participation in the study would improve error detection. Compliance may be improved by educating patients and physicians in the correct use of inhaler devices. Inhalers should be easy to use correctly, and have multiple feedback and control mechanisms which would reduce physician over-estimation of a correct inhalation, allow compliance to be monitored, facilitate patient self-education and give reassurance to patients in the real life setting.

Administration, Inhalation↗
PubMed1993

Pulmonary aspergilloma successfully treated with long-term intermittent inhalation therapy with miconazole.

A 63-year-old man developed pulmonary aspergilloma and was given antifungal agents systemically. However adverse reactions, including renal dysfunction and gastric ulcer necessitated discontinuation of the treatment. Transbronchial infusion of miconazole was also unsuccessful because of an asthmatic attack during the procedure. Inhalation of miconazole was started once a week, resulting in remarkable improvement after 6 months of treatment both symptomatically and radiologically without any adverse reactions. We believe that long-term intermittent inhalation therapy with miconazole is well tolerated and useful in patients with aspergilloma, particularly when systemic treatment is difficult because of other underlying diseases or adverse reactions.

Administration, Inhalation↗
PubMed1997

Bench test assessment of dosage accuracy and measurement inaccuracy in nitric oxide inhalational therapy during high frequency oscillatory ventilation.

OBJECTIVE: The objective of this study is to determine the accuracy and precision of chemiluminescence and electrochemical nitric oxide (NO) measurements and accuracy of NO dosage with electronic mass flow controllers (MFC) versus rotameters during NO inhalational therapy. METHODS: NO flow was delivered to a high frequency oscillator and mixed with ventilator flow. NO and NO2 concentrations were measured simultaneously with a standard chemiluminescence analyzer and a modified electrochemical analyzer. Dosage accuracy was assessed with gas flows adjusted with either MFC's or rotameters. Accuracy of both analyzers was validated with both NO and ventilator flow regulated with a MFC. RESULTS: In dry air, without pulsatile pressure, MFC controlled NO and ventilator flow resulted in an accuracy expressed as the ratio of calculated concentration to measured concentration (RCM) of 0.995 (CI: 0.983-0.988) when measured with chemiluminescence. When the ventilator rotameter was used instead of a MFC, RCM was 0.856 (CI: 0.835-0.877). With a rotameter for both NO and ventilator flow, RCM increased to 1.175 (CI: 0.793-1.740) with an increase of confidence interval limits. Chemiluminescence was sensitive to humidification of the ventilatory gases (p < 0.05), slightly sensitive to the addition of oxygen and to pulsatile pressure (not significant). RCM obtained with the modified electrochemical analyzer was in close agreement with chemiluminescence RCM, although 95% CI were wider with electrochemical analysis. CONCLUSIONS: During high frequency oscillatory ventilation (HFOV), standard rotameter flow control of both NO and ventilator flow results in unpredictable NO concentrations that would be clinically unacceptable. When one MFC was used for NO flow control, with ventilator flow controlled with a rotameter, this resulted in moderate dosage accuracy. To achieve a still higher accuracy, MFC flow control for both NO and ventilator flow is indicated. During HFOV, standard chemiluminescence analyzers cannot be considered to be the gold standard for determination of the NO concentration delivered. Measurement of NO concentration may not be mandatory for determination of inhaled NO dose during HFOV, but may be used to monitor for unsafe or unwanted events.

Administration, Inhalation↗
PubMed1999

The problems of treating adolescent asthma: what are the alternatives to inhaled therapy?

The prevalence of asthma in children and adolescents continues to increase world-wide, with asthma remaining the most common chronic illness of childhood. Morbidity is high in the latter age group, indicating that many adolescents with asthma symptoms are not receiving appropriate treatment for their condition. Inadequate symptomatic control should alert the physician to the possibility of non-compliance, which is not limited to those patients with a poor understanding of their condition. Psychosocial problems, such as isolation and low self-esteem, are inherent in adolescents with asthma due, in part, to the highly visible nature of symptoms and the method of delivery of current inhaled therapy. Compliance with therapy in adolescents in particularly low if the dosing regimen is more than twice daily, with poor inhaler technique contributing to ineffective control. Failure to take asthma medication can result in asthma exacerbations and increased disease severity, with the resultant need for powerful medication and hospitalization (incurring substantial patient and healthcare costs). Although better management techniques, such as tailoring medication and individualizing treatment regimens may improve compliance in this group, there is an obvious need for alternative treatment options. An effective and well tolerated oral tablet therapy, with a simple unobtrusive regimen, would provide a potential solution to the high level of non-compliance seen in this age group. The leukotriene receptor antagonists offer a practical alternative amongst existing oral therapies, and their efficacy and simple oral dosing regimen may prove valuable in increasing compliance in adolescents.

Administration, Oral↗
PubMed1999

Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children.

OBJECTIVE: To compare lung deposition from a nebulizer and a pressurized metered-dose inhaler (pMDI)/holding chamber to determine their efficiency in aerosol delivery to children. STUDY DESIGN: Children with stable asthma (n = 17) aged 2 to 9 years inhaled in random order radiolabeled salbutamol from a nebulizer and a pMDI through a nonstatic holding chamber. Body and lung deposition of radiolabeled salbutamol was assessed with a gamma camera. RESULTS: Mean (absolute dose) total lung deposition expressed as a percentage of the nebulized dose was 5.4% (108 microg) in younger children (<4 years) and 11.1% (222 microg) in older children (>4 years). Mean (absolute dose) total lung deposition expressed as a percentage of the metered dose was 5.4% (21.6 microg) in younger and 9.6% (38.4 microg) in older children. CONCLUSIONS: For the same age groups we have shown equivalent percentages of total lung deposition of radiolabeled salbutamol aerosolized by either a nebulizer or a pMDI/holding chamber. However, the delivery rate per minute and the total dose of salbutamol deposited were significantly higher for the nebulizer.

Albuterol↗