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Inhalation device

Sinem Koc-Günel, Ralf Schubert, Stefan Zielen, Martin Rosewich
BACKGROUND: Sputum induction is an important noninvasive method for analyzing bronchial inflammation in patients with asthma and other respiratory diseases. Most frequently, ultrasonic nebulizers are used for sputum induction, but breath-controlled nebulizers may target the small airways more efficiently. This treatment may produce a cell distribution similar to bronchoalveolar lavage (less neutrophils and more macrophages) and provide deeper insights into the underlying lung pathology...
July 13, 2018: BMC Pulmonary Medicine
Imco Sibum, Paul Hagedoorn, Anne Haaije de Boer, Henderik Willem Frijlink, Floris Grasmeijer
In recent years there is an increasing interest in the pulmonary delivery of large cohesive powder doses, i.e. drugs with a low potency such as antibiotics or drugs with a high potency that need a substantial fraction of excipient(s) such as vaccines stabilized in sugar glasses. The pulmonary delivery of high powder doses comes with unique challenges. For low potency drugs, the use of excipients should be minimized to limit the powder mass to be inhaled as much as possible. To achieve this objective the inhaler design should be adapted to the properties of the API in order to achieve a compatible combination of the drug formulation and inhaler device...
July 2, 2018: International Journal of Pharmaceutics
Johann Christian Virchow, Gianluigi Poli, Christiane Herpich, Claudius Kietzig, Hilke Ehlich, Daniela Braeutigam, Knut Sommerer, Sabine Häussermann, Fabrizia Mariotti
BACKGROUND: This study evaluated the lung deposition and the distribution pattern in the airways of a fixed combination of beclometasone dipropionate (BDP) and formoterol fumarate (FF) (100/6 μg) delivered as an extrafine dry powder formulation (mass median aerodynamic diameter, MMAD (μm) BDP = 1.5; FF = 1.4) through the NEXThaler® device in healthy subjects, asthmatics, and patients with COPD. METHODS: Healthy subjects (n = 10), asthmatic patients (n = 9; 30%≤FEV1 < 80%), and COPD patients (n = 9; FEV1 /FVC ≤70%, 30%≤FEV1 < 50%) completed this open-label, single administration (inhalation of four actuations) parallel group study...
July 10, 2018: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Fawaz Alasmari, Laura E Crotty Alexander, Christopher A Drummond, Youssef Sari
Pre-clinical studies investigated the effects of chronic exposure to nicotine on lungs, kidneys and brains using animal models. Most of these studies delivered nicotine into the circulatory and central nervous systems (CNS) through intraperitoneal injection or oral consumption methods. Few studies used inhalation machine system for nicotine delivery into brains in rodents to mimic human exposure to cigarettes. However, finding a more accurate and clinically relevant method of nicotine delivery is critical. A computerized inhalation machine has been designed (SciReq) and is currently employed in several institutions...
July 2018: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
Syed Mohammad Tariq
Asthma is a common airways disease. Fortunately most patients respond well to inhaled therapy. Regular use of a combination inhaler delivering corticosteroid and a long-acting beta-2 agonist, is the mainstay of treatment and allows asthmatics to live a relatively normal life. However, management of asthma depends not only on the choice of drug/inhaler but also on patient compliance and optimal inhaler technique. This report describes a patient who continued to deteriorate despite adhering to prescribed treatment and demonstrating a good inhaler technique...
2018: Respiratory Medicine Case Reports
Brandon Nokes, Beeletsega Yeneneh, Jake Maddux, Ryan C Van Woerkom, Amelia Lowell, Hannelisa Callisen, Bhavesh Patel, Fadi Shamoun, F David Fortuin, Patrick DeValeria, Ayan Sen
We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished...
2018: Respiratory Medicine Case Reports
Ryan F LeBouf, Dru A Burns, Anand Ranpara, Kathleen Attfield, Leonard Zwack, Aleksandr B Stefaniak
The use of electronic nicotine delivery systems continues to gain popularity, and there is concern for potential health risks from inhalation of aerosol and vapor produced by these devices. An analytical method was developed that provided quantitative and qualitative chemical information for characterizing the volatile constituents of bulk electronic cigarette liquids (e-liquids) using a static headspace technique. Volatile organic compounds (VOCs) were screened from a convenience sample of 146 e-liquids by equilibrating 1 g of each e-liquid in amber vials for 24 h at room temperature...
July 4, 2018: Analytical and Bioanalytical Chemistry
Gary T Ferguson, Richard N Dalby
Oral inhalation is the recommended delivery method of medications for the treatment of patients with chronic obstructive pulmonary disease (COPD). However, patients may struggle when using the various available inhaler platforms, and, as a result, may fail to achieve the benefit of the prescribed medication. Propellant-based, pressurized metered-dose inhaler and powder-based, dry powder inhaler devices are currently the most commonly prescribed delivery systems. Each of these devices has its own advantages and challenges...
July 4, 2018: Postgraduate Medicine
Wen Zheng, Walter McKinney, Michael L Kashon, Daniel Pan, Vincent Castranova, Hong Kan
BACKGROUND: Heart rate variability (HRV) as a marker reflects the activity of the autonomic nervous system. The prognostic significance of HRV for cardiovascular disease has been reported in clinical and epidemiological studies. Our laboratory has reported alterations in rat heart rate variability (HRV) due to increasing activity of both sympathetic and parasympathetic nervous system after pulmonary exposure to multi-walled carbon nanotubes (MWCNTs). This suggests that pulmonary inhalation of engineered nanoparticles (ENs) may lead to functional changes in the cardiovascular system...
July 3, 2018: Nanoscale Research Letters
Katarzyna Luczak-Wozniak, Marta Dabrowska, Izabela Domagala, Marta Miszczuk, Wojciech Lubanski, Andrzej Leszczynski, Rafal Krenke
BACKGROUND: Pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) is based mainly on inhaled medications. There is a continuous need to examine and train patients in their inhalation technique. The objective of the presented study is to determine whether the errors which patients made during inhalations are repetitive, and therefore easier to eradicate, or rather accidental, hence require more attention and effort from the health care professionals. METHODS: It was a prospective, cohort study which included adults with asthma or COPD, who have used at least one inhaler daily on a regular basis...
June 28, 2018: Pulmonary Pharmacology & Therapeutics
Vanessa Vasconcelos, Hazel Gilbert
BACKGROUND: The introduction of electronic cigarettes (e-cigarettes) has provided smokers with an alternative source of nicotine. Interest and use of the device has increased exponentially in the last decade with an estimated 2.9 m adult users in Great Britain. Research so far on the attitudes and perceptions of smokers to this new product has largely focussed on the views of current e-cigarette users, smokers attempting to quit and former cigarette smokers.AimThis study aimed to explore the views of current tobacco smokers who were not using e-cigarettes and not looking for a cessation method, their understanding and knowledge of e-cigarettes, and their views of e-cigarettes as a smoking cessation aid provided by the National Health Service (NHS)...
July 2, 2018: Primary Health Care Research & Development
Peter J Featherstone, Harshna Ravindran
While cataloguing the historical items in the Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK, we discovered an unusual chloroform inhaler, which incorporated two air-inlet tubes in addition to its main inspiratory valve as well as a funnel on one of its lateral walls. An accompanying card stated that the device was thought to be a modification of Snow's inhaler, by James Robinson. It had been found among some old instruments in a General Practice in Huntingdon, Cambridgeshire, and had probably been acquired by an early practitioner named Dr...
April 2018: Journal of Anesthesia History
David B Price, Vicky Thomas, P N Richard Dekhuijzen, Sinthia Bosnic-Anticevich, Nicolas Roche, Federico Lavorini, Priyanka Raju, Daryl Freeman, Carole Nicholls, Iain R Small, Erika Sims, Guilherme Safioti, Janice Canvin, Henry Chrystyn
BACKGROUND: Incorrect inhaler technique is a common cause of poor asthma control. This two-phase pragmatic study evaluated inhaler technique mastery and maintenance of mastery with DuoResp® (budesonide-formoterol [BF]) Spiromax® compared with Symbicort® (BF) Turbuhaler® in patients with asthma who were receiving inhaled corticosteroids/long-acting β2-agonists. METHODS: In the initial cross-sectional phase, patients were randomized to a 6-step training protocol with empty Spiromax and Turbuhaler devices...
June 28, 2018: BMC Pulmonary Medicine
Lisa Spruce
Surgical smoke is formed when energy-generating devices (ie, electrosurgery units, lasers, powered instruments) raise the intracellular temperature of tissue to at least 100º C (212º F), causing tissue vaporization in the form of surgical smoke. Surgical smoke contains components that are known health hazards, such as benzene, toluene, hydrogen cyanide, formaldehyde, volatile organic compounds, viruses, and bacteria. There have been case reports of human disease tied to the inhalation of surgical smoke; therefore, it is important for perioperative team members to minimize their exposure and patient exposure...
July 2018: AORN Journal
Alan Kaplan, David Price
Poor inhaler technique and nonadherence impair the efficacy of medications for asthma and chronic obstructive pulmonary disease (COPD). A range of factors, including age, dexterity, inspiratory capacity, cognitive ability, health literacy, and ethnicity, can impact a patient's ability and intention to use their device. Treatment success can also be influenced by patient preferences and perceptions. Therefore, it is important that healthcare professionals effectively match inhaler devices to individual patients' needs and abilities and empower patients by including them in treatment decisions...
2018: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Job F M van Boven, Breda Cushen, Imran Sulaiman, Garrett Greene, Elaine MacHale, Matshediso C Mokoka, Frank Doyle, Richard B Reilly, Kathleen Bennett, Richard W Costello
Four inhaler adherence clusters have been identified using the INCA audio device in COPD patients: (1) regular use/good technique, (2) regular use/frequent technique errors, (3) irregular use/good technique, and (4) irregular use/frequent technique errors. Their relationship with healthcare utilization and mortality was established, but the cost-effectiveness of adherence-enhancing interventions is unknown. In this exploratory study, we aimed to estimate the potential cost-effectiveness of reaching optimal adherence in the three suboptimal adherence clusters, i...
June 27, 2018: NPJ Primary Care Respiratory Medicine
Mina Nicola, Ahmed Elberry, Ossama Sayed, Raghda Hussein, Haitham Saeed, Mohamed Abdelrahim
INTRODUCTION: We have investigated the effect of adding a pressurized metered dose inhaler (pMDI) training device to verbal counselling on pulmonary function and inhalation technique. METHODS: A total of 304 adult asthmatic subjects (> 18 years old) were enrolled in a 3-month study of assessment and education. They were divided into an investigation group (Trainhaler plus Flo-Tone and verbal counselling, n = 261, mean age 49.2 years) and a control group (verbal counselling only, n = 43, mean age 48...
June 15, 2018: Advances in Therapy
Kwun Nok Mimi Man, Zhipeng Tian, David Chi-Leung Lam, Jennifer Man Fan Wan, Kian Cheng Tan-Un
Background: Inhaled medication is central to the treatment of COPD. Various types of inhaler devices, which directly deliver medication to the lung, have been developed. However, patients often exhibit incorrect techniques of inhaler usage. Effectiveness of therapy may be affected by the ease of device usage, size, convenience of use, durability, clarity of instructions and device preferences of patients. This study compares the satisfaction and preference, as well as error occurrence, with the use of Genuair® , Ellipta™ and Breezhaler™ by healthy subjects in Hong Kong...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Walter Vincken, Mark L Levy, Jane Scullion, Omar S Usmani, P N Richard Dekhuijzen, Chris J Corrigan
We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential risks and benefits of ancillaries such as valves, and the evidence that they contribute tangibly to the delivery of therapy. We also reiterate practical recommendations for the correct usage and maintenance of spacers/VHCs, which we trust offer practical help and advice to patients and healthcare professionals alike...
April 2018: ERJ Open Research
Tu-Son Nguyen, Thi Lien Huong Nguyen, Thi Thuy Van Pham, Susan Hua, Quy Chau Ngo, Shu Chuen Li
Background: Incorrect use of inhalers is very common and subsequently leads to poor control of COPD. Among health care providers, pharmacists are in the best position to educate patients about the correct use of inhaler devices. Objective: The objective of this study was to evaluate the impact of pharmacist-led training on the improvement of inhaler technique for COPD patients in Vietnam. Patients and methods: For this pre- and post-intervention study, standardized checklists of correct use of metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) were used to evaluate the inhaler technique...
2018: International Journal of Chronic Obstructive Pulmonary Disease
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