Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine最新文献

{"title":"The effect of a first-generation antihistamine on sputum viscoelasticity in cystic fibrosis.","authors":"Douglas N Homnick,&nbsp;John H Marks,&nbsp;Bruce K Rubin","doi":"10.1089/jam.2006.0593","DOIUrl":"https://doi.org/10.1089/jam.2006.0593","url":null,"abstract":"<p><p>Tenacious airway secretions are responsible for much of the lung damage in cystic fibrosis (CF). Label warnings on potential secondary effects of some antihistamines include possible drying or thickening of lower airway secretions, suggesting that they are detrimental to individuals with airway disease. We studied the effects of cyproheptadine hydrochloride (CH) on sputum weight, viscoelasticity, and transportability in CF patients participating in a pilot trial of CH as an appetite stimulant to assure no potential adverse secondary effects on mucus clearance. Sixteen clinically stable subjects were randomized to receive either CH (2 mg QID for 1 week followed by 4 mg QID for 11 weeks) or placebo. Sputum was obtained by voluntary forced cough and expectoration prior to starting CH or placebo and at 4 weeks. Viscoelasticity was measured by rheometry and cough transportability by simulated cough machine. Sufficient paired sputum for rheologic analysis was obtained on four placebo and seven CH subjects and for cough transportability analysis on three placebo and six CH subjects. Weight on all specimens was obtained prior to both analyses. There were no significant differences in sputum weight wet, measures of mucus viscoelasticity (rheology), or cough transportability of mucus between baseline and 4 weeks in patients on placebo or CH. From this limited study, CH, a first-generation antihistamine, appears to have no adverse effects in sputum viscoelasticity or cough transportability in CF patients.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 1","pages":"45-9"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.0593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26628326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formoterol turbuhaler is as effective as salbutamol diskus in relieving adenosine-induced bronchoconstriction in children.","authors":"Israel Amirav,&nbsp;Renata Yacobov,&nbsp;Anthony S Luder","doi":"10.1089/jam.2006.0561","DOIUrl":"https://doi.org/10.1089/jam.2006.0561","url":null,"abstract":"Salbutamol diskus (SD) and formoterol turbuhaler (FT) are both fast-acting beta(2) agonists delivery systems used to relieve bronchoconstriction, such as that which accompanies acute exacerbations of asthma. Although SD (which is used only on an as-needed basis) is flow independent, the FT (currently recommended for regular therapy) requires a forceful deep inspiration. Thus, the efficacy of FT in children with bronchoconstriction may be inferior to that of SD. We have studied the bronchodilatation response induced by FT after a standard adenosine-5-monophosphate (AMP) bronchial challenge, and compared it to that induced by SD, and placebo. Seventeen children (mean age +/- SD 10.3 +/- 1.7 y) with asthma underwent three AMP challenges, each time followed by inhalation of either placebo, SD (200 mug) or FT (9 mug), in random order. Patterns of bronchodilatation (forced expiratory volume in 1 second recovery) to 90% of baseline levels were compared. Both SD and FT were significantly better than placebo. FT was slightly better than SD, but this difference was not statistically significant. FT and SD are both effective bronchodilators and may be of comparable efficiency during acute bronchoconstriction in young children with asthma.","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.0561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26628321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of asthmatic pulmonary function test data to predict lung deposition.","authors":"Risa J Robinson,&nbsp;Richard L Doolittle,&nbsp;John N Diflorio","doi":"10.1089/jam.2007.0582","DOIUrl":"https://doi.org/10.1089/jam.2007.0582","url":null,"abstract":"<p><p>Asthma is a complex disease that alters both breathing patterns and airway morphology. Lack of experimental data or model simulations utilizing realistic in vivo breathing conditions severely limit the ability to assess the relative risk of inhaled pathogens for asthmatics. In this study, a one-dimensional Eulerian modeling approach was used to simulate particle deposition in both asthmatic and healthy subjects. The model was based on the hypothesis that the component reactions of bronchial smooth muscle spasms, submucosal connective tissue swelling, and exudation into the airway lumen manifest themselves as altered lung function, which can be quantified by the parameters measured in subject pulmonary function tests. The asthmatic airway morphology was simulated by altering two parameters, functional residual capacity (FRC) and airway resistance (Raw), which are increased in asthmatic subjects. The amounts in excess of the healthy case were uniquely distributed in the airway generations based on knowledge of the changes in the anatomy and physiology of the airway walls during an asthmatic episode. Specifically, increased Raw was distributed preferentially in the bronchioles and excess FRC was distributed in the pulmonary region. Lung volumes, Raw, and breathing conditions of healthy and asthmatic subjects were compiled from 18 clinical studies. Significant differences were found between healthy and asthmatic Raw, FRC, and tidal volume (TV). In vivo flow fields were simulated using population average TV, breathing frequency, and cycle time fractions. Results showed that using asthmatic conditions in the simulation increased particle deposition over the healthy case by an average of 54% for the range of particles tested. This deposition increase was large compared to the difference due to intersubject variability of the healthy case. Comparisons to experimental data were limited by the number of unreported parameters. This study showed that using asthmatic breathing conditions resulted in significantly different particle deposition compared to using the controlled breathing patterns reported in experimental studies. Therefore, caution should be taken when using experimental data to assess particle deposition in vivo if realistic subject breathing is not used.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 2","pages":"141-62"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26749041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical side effects during aerosol therapy: cutaneous and ocular effects.","authors":"David E Geller","doi":"10.1089/jam.2007.0585","DOIUrl":"https://doi.org/10.1089/jam.2007.0585","url":null,"abstract":"<p><p>Aerosolized medications maximize clinical benefit by targeting the airways and minimize side effects by reducing (though not eliminating) systemic exposure. Aerosolized drugs delivered with a facemask may inadvertently deposit on the face and in the eyes, raising concerns about cutaneous and ocular side effects with these drugs. Cases of anisocoria have been reported from exposure of the eyes to aerosol bronchodilators. Whether inhaled corticosteroids (ICS) can cause skin and eye problems like those seen with systemic or topical steroids is more difficult to answer. Patients who take ICS may have other corticosteroid exposures, or have other conditions that predispose them to side effects, making the analysis of the ICS risk challenging. Also, many studies were not designed to search for cutaneous or ocular effects, or may have been too short to detect these effects. Nevertheless, ICS have been associated with an increased risk of skin thinning, bruising, cataracts and possibly glaucoma in adults, but not in children. The risks increase with advanced age, higher doses, and longer duration of use. In children, the risks of cataracts and glaucoma were negligible with ICS, whether a mouthpiece or a mask interface was used. Side effects like skin rash and conjunctivitis occurred at low frequencies similar to placebo or comparator drugs. We do not know whether exposed children will have increased risks from ICS later in life. Therefore, it is wise to avoid face and eye deposition when possible, and to use the minimally effective dose.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 Suppl 1 ","pages":"S100-8; discussion S109"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26645663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchial challenge test in asthmatics sensitized to mites: role of particle size in bronchial response.","authors":"Anne Casset,&nbsp;Ashok Purohit,&nbsp;Emile Birba,&nbsp;Marie-Pierre Chenard,&nbsp;Béatrice Uring Lambert,&nbsp;Siamak Bahram,&nbsp;Pierre Meyer,&nbsp;Gabrielle Pauli,&nbsp;Frédéric De Blay","doi":"10.1089/jam.2007.0591","DOIUrl":"https://doi.org/10.1089/jam.2007.0591","url":null,"abstract":"<p><p>Although major house dust mite allergen (Der p 1) is carried mainly on large particles (>10 microm), standard bronchial challenge tests (BCT) use nebulizers that deliver smaller particles (sizes from 1 to 5 microm) and may therefore not reflect actual domestic exposure. The objective of this study was to evaluate the influence of particle size of Dermatophagoides pteronyssinus extract on bronchial response. Specific BCT were performed with different mass median aerodynamic diameters (MMAD): 1.1, 5.6, and 9.7 microm. Each of the 19 mite-sensitized patients underwent mite BCT three times, once with each nebulizer. IL-5 levels were assessed in induced sputum and blood samples. The PD(20) for Der p 1 differed substantially with particle size, with less Der p 1 (11.2 ng) needed to produce a PD(20) with the largest particles (9.7 microm), compared to 18.1 ng for the 5.6 microm particles and 142.5 ng for the 1.1 microm particles (p < 0.0001). Large particles also induced an early phase response significantly more often than small particles (100% vs. 63%). Although the late phase reaction (LPR) frequency was similar with all three particle sizes, lower mean oral corticosteroid doses were needed to treat LPR with the largest particles (23 mg), compared to the smaller particles, with 34 mg for the 5.6 microm particles and 51 mg for the 1.1 microm. The 1.1 microm particles produced a significantly greater increase in IL-5 concentrations in sputum and blood compared to the larger particles. Large particles clearly play a role in the immediate bronchial response in asthmatics sensitized to mites and, therefore, should be included in pharmacological studies in humans.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 4","pages":"509-18"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27191720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An in vitro study to assess facial and ocular deposition from Respimat Soft Mist inhaler.","authors":"Stephen P Newman,&nbsp;Karen P Steed,&nbsp;Sandie J Reader,&nbsp;Demetri Pavia,&nbsp;Anil K Sohal","doi":"10.1089/jam.2006.0563","DOIUrl":"https://doi.org/10.1089/jam.2006.0563","url":null,"abstract":"<p><p>Respimat Soft Mist() inhaler (SMI) is a novel multidose propellant-free inhaler device for delivery of inhaled drugs to patients with asthma and chronic obstructive pulmonary disease. In vitro studies have been undertaken to assess facial and ocular deposition from Respimat SMI in several potential misuse situations. A placebo aqueous drug formulation in Respimat SMI was radiolabeled by addition of (99m)Tc. Deposition was quantified by gamma camera on a removable facemask that was fitted over the head of a resuscitation mannequin. The eyes were simulated by adhesive plaster patches. When Respimat SMI was fired in three preselected positions away from the head, total face deposition (% ex-valve dose) averaged 7.3%, 7.8%, and 9.1%, and eye deposition averaged 0.6%, 0.1%, and 0.3%. When the inhaler was fired into a simulated exhalation, upper face deposition (mean 3.8%) and eye deposition (mean 0.1%) were also small. It is concluded that low deposition on the face, and especially in the eyes, is to be expected when Respimat SMI is fired accidentally outside the body, or is fired at the same time as the patient exhales. When Respimat SMI is misused in the ways described in this study, there is likely to be little potential for unwanted side effects resulting from ocular deposition.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.0563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26628322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of biphasic inhalation profiles on the deposition and clearance of coarse (6.5 microm) bolus aerosols.","authors":"Andrew R Clark,&nbsp;Carole B Chambers,&nbsp;David Muir,&nbsp;Michael T Newhouse,&nbsp;Steven Paboojian,&nbsp;Carlos Schuler","doi":"10.1089/jam.2006.0557","DOIUrl":"https://doi.org/10.1089/jam.2006.0557","url":null,"abstract":"<p><p>The influence of particle size upon deposition in the human airways is well understood. Pharmaceutical aerosol formulators strive to generate fine aerosols with the potential to penetrate into the deep lung. However, flow rate can also have a major influence on deposition, particularly with coarse aerosols. This study investigated the use of biphasic flow profiles with low flow in the proximal conducting airway as a means of effecting efficient delivery of a coarse aerosol. The study shows that 6.5-microm MMAD aerosol droplets can be deposited in the lung with high efficiency. The delivery technique achieved greater than 70% of the inhaled dose deposited in the whole lung and greater than 50% deposited in the lung periphery. Furthermore, the biphasic flow profiles used, with initial low flow segments of between 300 mL and 900 mL inhaled volume at 8 L/min, are practical flow regimens that should be acceptable to patients and that can be applied to single-breath dry powder inhalers. Twenty-four-hour clearance and Penetration Index measurements were used as a marker for peripheral deposition, and the data show a clear correlation between Penetration Index and 24-h retention.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 1","pages":"75-82"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.0557","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26629377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling of aerosol deposition with interface devices.","authors":"W H Finlay,&nbsp;A R Martin","doi":"10.1089/jam.2007.0554","DOIUrl":"https://doi.org/10.1089/jam.2007.0554","url":null,"abstract":"<p><p>Various approaches can be used to mathematically model the performance of different masks, mouthpieces, and aerosol delivery devices. The sophistication of such models can vary widely, from the use of simple algebraic empirical correlations to advanced computational fluid dynamics simulations. Bench-top testing is also often used to model aspects of devices, since it is difficult to capture certain aspects of device behavior with mathematical models. These various approaches to modeling differ in their limitations. Empirical correlations exist for predicting the effects of varying mouthpiece diameter and mouth-throat dimensions on extrathoracic losses, but are restricted to stable, nonballistic aerosols in certain flow rate ranges. Computational fluid dynamics (CFD) simulations that solve the Reynolds-averaged Navier-Stokes (RANS) equations typically require near-wall turbulence corrections in order to adequately model mouth-throat deposition, while Large Eddy Simulation (LES) removes this deficiency. Bench-top models that use replicas of the extrathoracic airways vary in their accuracy and generality in replicating the filtering properties of these airways. Choosing and using these various modeling approaches for evaluating patient-device interfaces requires knowledge of their merits and pitfalls, a brief discussion of which is given here.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 Suppl 1 ","pages":"S19-26; discussion S27-8"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26645664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability in the assessment of videotaped inhalation technique.","authors":"Geert N Rootmensen,&nbsp;Anton R J van Keimpema,&nbsp;Elske E Looysen,&nbsp;Letty van der Schaaf,&nbsp;Henk M Jansen,&nbsp;Rob J de Haan","doi":"10.1089/jam.2007.0623","DOIUrl":"https://doi.org/10.1089/jam.2007.0623","url":null,"abstract":"<p><p>Inhalation medication is essential in the treatment of asthma and chronic obstructive pulmonary disease (COPD) patients. Incorrect inhalation technique reduces the effects of medication and has been reported to range from 22% to 95% from optimal. The objective of this study was to determine inter- and intraobserver reliability in inhalation technique assessment. For interobserver reliability three observers scored after three times viewing a total of 49 video recorded inhalation demonstrations using device-specific checklists and mutually agreed scoring rules. Intraobserver reliability was assessed for two observers after 8 months by scoring inhalation demonstrations a second time. Both inter- and intraobserver reliability were expressed by mean percent agreement and mean Kappa scores. All inhaler devices revealed a high mean percent agreement and a substantial or almost perfect Kappa scoring for both inter- and intraobserver reliability. Only one item, \"exhale to residual volume,\" showed poor intraobserver reliability. Assessment of video recorded inhalation technique using device-specific checklists, triple viewing, and mutual agreed scoring rules is reliable. This method enables blind observation of inhalation technique.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 4","pages":"429-33"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27191206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of nebulizer droplet size distribution: a method based on impactor refrigeration.","authors":"Elna Berg,&nbsp;Jan Olof Svensson,&nbsp;Lars Asking","doi":"10.1089/jam.2007.0556","DOIUrl":"https://doi.org/10.1089/jam.2007.0556","url":null,"abstract":"<p><p>Size distributions of droplets generated by nebulizers are difficult to determine because of evaporation after aerosolization. We describe a method whereby a Next Generation Pharmaceutical Impactor (NGI; MSP Corporation, Shoreview, MN) is refrigerated at 5 degrees C before connecting it to the nebulizer in order to ensure an environment inside the NGI at close to 100% relative humidity (RH). This, in turn, reduces droplet evaporation between the nebulizer and impaction. The method development was performed with a Pari LC Plus jet nebulizer operated at 2.0 bar, with the NGI set at a flow rate of 15 L/min and with salbutamol 5.0 mg/mL as the test solution. The droplet size distributions were expressed in terms of mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD). Variation in test conditions showed that the NGI should be cooled for at least 90 min, that nebulization should be started within 5 min after removal from the refrigerator, and that coating of collecting cups to prevent \"bouncing\" is not necessary. Variation of ambient temperature and humidity had no relevant effect on results. MMAD and GSD results showed that refrigeration of the NGI resulted in droplet size distributions that are likely to reflect those originally delivered at the mouthpiece by the nebulizer. The method was shown to be robust, accurate with recovery of test solutions exceeding 99%, reproducible, and to be suitable for use with a wide range of commercially available nebulizers.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"20 2","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2007.0556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26749037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}