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

{"title":"Peak inspiratory flow rate after methacholine challenge in asthmatic patients and its impact on the effect of formoterol via different inhalers.","authors":"Peter Haidl,&nbsp;Franziska Schmidt,&nbsp;Cornelia Wiese,&nbsp;Dieter Koehler","doi":"10.1089/jam.2006.19.364","DOIUrl":"https://doi.org/10.1089/jam.2006.19.364","url":null,"abstract":"<p><p>The goal of the present study was to investigate the bronchodilating effects of 6 and 12 microg formoterol delivered by the Turbuhaler, in comparison to salbutamol 200 microg (metered dose inhaler) and to controls without treatment. After inducing acute and severe bronchial obstruction by means of methacholine challenge, peak inspiratory mouth flow (PIMF) was measured through a stenosis, simulating the internal resistance of the Turbuhaler, with the in-check device. In addition the relationship was studied between PIMF and clinical response in the 3 treatment groups. In the 176 patients methacholine caused a mean fall in FEV(1) of 37.1 +/- 6.9% compared to baseline. Ten minutes after bronchodilator inhalation, FEV(1) improved significantly in all three treatment groups. At 30 minutes after bronchodilator administration, only the salbutamol 200 microg and the formoterol 12 microg groups had a significantly greater increase in FEV1 than controls (0.69 +/- 0.43 l and 0.66 +/- 0.37 l vs 0.38 +/- 0.32 l, p < 0.0005), whereas the formoterol 6 microg group showed no significant improvement (0.41 +/- 0.38 l, p = 0.74). Thirteen patients (7.4%) did not reach a minimal PIMF of 30 l/min through the in-check device after challenge. In the four patients in the formoterol 6 microg group with a PIMF below 30 l/min inhalation did not cause bronchodilation. In conclusion, the results demonstrate that 6 microg formoterol via Turbuhaler leads to less and slower onset of bronchodilation compared to the other groups in our setting. If patients fail to generate a PIMF of 30 l/min, 6 microg formoterol via Turbuhaler may provide inadequate relief in a severe asthma attack.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 3","pages":"364-71"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26359397","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":"SPECT Imaging for Radioaerosol Deposition and Clearance Studies.","authors":"Stefan Eberl,&nbsp;Hak-Kim Chan,&nbsp;Evangelia Daviskas","doi":"10.1089/jam.2006.19.8","DOIUrl":"https://doi.org/10.1089/jam.2006.19.8","url":null,"abstract":"<p><p>Planar gamma camera scintigraphy is well established for measuring the deposition and clearance of radioaerosols. Single photon emission computed tomography (SPECT) provides threedimensional (3D) reconstructions of the radioactivity distribution, thus avoiding the compression of 3D data into two-dimensional (2D) images and potentially offering superior assessment of aerosol deposition patterns. However, SPECT has traditionally been associated with long imaging times, making it unsuitable for measuring deposition and clearance of radioaerosols with fast clearance. Multi-detector SPECT systems can collect complete SPECT studies in <1 min, allowing both initial deposition and clearance over time to be assessed by dynamic SPECT. Simultaneous transmission measurement with an external source provides attenuation correction for absolute activity quantification as well as aiding in the definition of the lung volume of interest. A dynamic SPECT imaging protocol has been developed to allow fast imaging from the oropharynx to the abdomen using gamma cameras with limited axial field of views. This allows activity quantification not only in the lungs, but also in areas outside the thorax. However, fast dynamic SPECT imaging is technically and computationally more demanding and provides less scope for reducing the radioactivity administered to the subjects. It has been shown that dynamic SPECT, compared to planar imaging, is more sensitive in detecting changes in deposition as measured by the Penetration Index (PI). Thus, SPECT can better differentiate between large and small airways, which is important for lung regional analysis.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 1","pages":"8-20"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25917465","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":"Regimen and device compliance: key factors in determining therapeutic outcomes.","authors":"Mark L Everard","doi":"10.1089/jam.2006.19.67","DOIUrl":"https://doi.org/10.1089/jam.2006.19.67","url":null,"abstract":"<p><p>The two most important differences between inhaled and oral therapy are (1) the lungs have evolved to exclude foreign material while the gut has evolved to take in large amounts of foreign material, and (2) even if patients adhere to a treatment regimen (regimen compliance or adherence), they may fail to derive any benefit from using an inhaler due to failure of drug delivery (poor device compliance). In other words: True compliance = regimen compliance x device compliance. Aerosol scientists, building on the observations of those working in the field of industrial hygiene, have developed devices that largely address the challenge of bypassing the lung's defenses, in that current devices generate aerosols that contain a significant proportion of particles in the range of 1-5 microm. These have a relatively high probability of entering the lungs and depositing through impaction and/or sedimentation. The development of delivery systems for systemically acting drugs has led to further refinement. The second issue, that of patient behavior, has, until very recently, received very little attention from those developing devices. Regimen compliance involves taking the medication at the suggested times. Device compliance (using the device optimally) is dependent on competence and contrivance. A patient taking a tablet before rather than after a meal is likely to receive some therapeutic benefit even if the effect is suboptimal. A patient whose device compliance is poor because either they are not competent to use the device or contrive to use it in an ineffective manner may derive little or no benefit even if they are scrupulously adhering to their treatment regimen. Lack of precision in the use of the terms \"compliance\" and \"adherence\" has contributed to the failure to build in features that may help address issues relating to patient behavior. The resurgence of interest in developing devices that can be used to deliver potent systemically acting drugs has, out of necessity, led to the development of systems that help minimize the impact of poor competence or contrivance on drug delivery. There are suggestions, that need to be confirmed, that regimen compliance (adherence) can be influenced by providing feedback. In the absence of formal studies, comparison of the high-tech and low-tech approaches to improving device compliance incorporated into novel devices might provide valuable insights into what aspects of feedback are important in the clinical setting.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 1","pages":"67-73"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.67","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25916758","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":"Nasal clearance in health and disease.","authors":"Lisbeth Illum","doi":"10.1089/jam.2006.19.92","DOIUrl":"https://doi.org/10.1089/jam.2006.19.92","url":null,"abstract":"<p><p>This paper reviews the anatomical and physiological factors of importance for nasal drug delivery and discusses in particular the influence of the nasal mucociliary clearance mechanism on the nasal absorption of drugs. The effect of nasal pathological conditions on the mucociliary clearance mechanism and the possible effect of such disease states on nasal drug transport are also discussed. Strategies for the exploitation of bioadhesive drug delivery systems and especially nasal absorption enhancers for the improvement of nasal drug delivery are evaluated to include considerations of the mechanism of action and correlation between the degree of bioadhesion and absorption enhancement and transport of drugs across the nasal membrane. A range of studies involving bioadhesive/absorption enhancer systems are detailed. A selected bioadhesive material, chitosan, which has been shown to have excellent absorption enhancer properties for a variety of drugs is discussed in some detail.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 1","pages":"92-9"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.92","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25916761","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":"Prescription bias and factors associated with improper use of inhalers.","authors":"Piersante Sestini,&nbsp;Vita Cappiello,&nbsp;Maria Aliani,&nbsp;Paola Martucci,&nbsp;Angelo Sena,&nbsp;Adriano Vaghi,&nbsp;Piero Aldo Canessa,&nbsp;Margherita Neri,&nbsp;Andrea S Melani","doi":"10.1089/jam.2006.19.127","DOIUrl":"https://doi.org/10.1089/jam.2006.19.127","url":null,"abstract":"<p><p>Many different inhalers are available for delivering aerosol therapy in respiratory medicine. As a consequence, the prescribing physicians may have some difficulty tailoring the most suitable inhaler to each patient. This multicenter, observational study using a self-administered questionnaire analyzed the characteristics of a large sample of patients (n = 1,305; 55% females; mean age 57.4, with a range of 15-88 years; most suffering from asthma or chronic obstructive pulmonary disease [COPD]) familiar with several different types of inhalers in relation to their most commonly used delivery device. Data on the inhalation technique for 2,057 observations of 1,126 patients using device-specific checklists and factors associated to misuse were also evaluated. Prevalent usage of newer dry powder inhalers (DPIs) was significantly associated with male sex, higher education, better respiratory function, and prescription from a respiratory physician. Patients using DPIs had received less instruction by health caregivers and were more likely to have read the instruction leaflet than users of metered dose inhalers (MDIs). Under these conditions, inhaler misuse was common and similar for both pressurized metered dose inhalers (pMDIs) and DPIs. For both types of inhalers, misuse was significantly and equally associated to increased age, less education, and less instruction by health care personnel. We conclude that many doctors are not familiar with the relevant characteristics of currently available inhalers. The prescription of newer DPIs may be subjected to gender, socio-economic, and instruction bias. The simple change of device from the pMDI to the newer DPIs is not associated with improved inhalation technique.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 2","pages":"127-36"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26108271","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":"In vitro comparison of two delivery devices for administering formoterol: Foradil P and formoterol ratiopharm single-dose capsule inhaler.","authors":"Carl P Criée,&nbsp;Thomas Meyer,&nbsp;Wolfgang Petro,&nbsp;Knut Sommerer,&nbsp;Peter Zeising","doi":"10.1089/jam.2006.19.466","DOIUrl":"https://doi.org/10.1089/jam.2006.19.466","url":null,"abstract":"<p><p>Formoterol, a long-acting beta (2)-agonist with a rapid onset of bronchodilation, is available in various delivery devices. However, differences in the size and uniformity of drug particles generated by different devices may result in variable clinical effects. The present study compared in vitro the aerodynamic particle size distribution, emitted dose and device resistance of formoterol delivered via Foradil Aerolizer (Foradil P) with those a non-proprietary single-dose capsule inhaler (ratiopharm), using an 8-stage Andersen Cascade Impactor set at a flow of 60 L/min. Relative to the formoterol ratiopharm capsule inhaler, Foradil Aerolizer produced particles with a smaller mass median aerodynamic diameter (3.5 vs. 4.1 microm, p = 0.018) and a smaller measured particle diameter distribution (geometric standard deviation 2.2 vs. 2.5, p = 0.048). The Foradil Aerolizer produced a 44% higher fine particle dose than the single-dose capsule inhaler (2.6 vs. 1.8 microg, p = 0.0001). Although the single-dose capsule inhaler produced a higher total emitted dose than that from Foradil Aerolizer (11.2 vs. 10.0 microg, p = 0.155, not significant), the respirable fraction from Foradil Aerolizer was 58% higher (25.7 vs. 16.3%, p = 2 x 10(8)). Both devices had a similarly low airflow resistance. These relative particle size profiles suggest that the Aerolizer may provide a more clinically effective delivery of formoterol to the lungs at the high inspiratory flows such as are typically achieved using this device.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 4","pages":"466-72"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26524977","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":"Ciliary function and the role of cilia in clearance.","authors":"Wendy Stannard,&nbsp;Chris O'Callaghan","doi":"10.1089/jam.2006.19.110","DOIUrl":"https://doi.org/10.1089/jam.2006.19.110","url":null,"abstract":"<p><p>The lungs and the nasal passages are continually exposed to respiratory pathogens, toxins, and particulate matter, and have evolved a very effective defense system to protect themselves. Mucociliary clearance is an essential part of this defence and relies on appropriate interactions between the ciliated epithelium, the height of the periciliary fluid, and mucus. Mucus acts as a physical barrier, trapping inhaled particles and pathogens, whilst cilia move both the mucus layer and fluid in the underlying periciliary layer. These defenses may be disrupted by viral and bacterial infections, by inhaled toxins, and by inherited diseases such as primary ciliary dyskinesia and cystic fibrosis.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 1","pages":"110-5"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25918410","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":"Comparison of lung deposition of amikacin by intrapulmonary percussive ventilation and jet nebulization by urinary monitoring.","authors":"G Reychler,&nbsp;P Wallemacq,&nbsp;D O Rodenstein,&nbsp;J Cumps,&nbsp;T Leal,&nbsp;G Liistro","doi":"10.1089/jam.2006.19.199","DOIUrl":"https://doi.org/10.1089/jam.2006.19.199","url":null,"abstract":"<p><p>The intrapulmonary percussive ventilation (IPV), frequently coupled with a nebulizer, is increasingly used as a physiotherapy technique; however, its physiologic and clinical values have been poorly studied. The aim of this study was to compare lung deposition of amikacin by the nebulizer of the IPV device (Percussionaire; Percussionaire Corporation; Sandpoint, ID) and that of standard jet nebulization (SST; SideStream; Medic-Aid; West Sussex, UK). Amikacin was nebulized with both devices in a group of five healthy subjects during spontaneous breathing. The deposition of amikacin was measured by urinary monitoring. Drug output of both devices was measured. Respiratory frequency (RF) was significantly lower when comparing the IPV device with SST (8.2 +/- 1.6 breaths/min vs. 12.6 +/- 2.5 breaths/min, p < 0.05). The total daily amount of amikacin excreted in the urine was significantly lower with IPV than with SST (0.8% initial dose vs. 5.6% initial dose, p < 0.001). Elimination halflife was identical with both devices. Drug output was lower with IPV than with SST. The amount of amikacin delivered to the lung is sixfold lower with IPV than with SST, although a lower respiratory frequency was adopted by the subjects with the IPV. Therefore, the IPV seems unfavorable for the nebulization of antibiotics.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 2","pages":"199-207"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26108761","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":"Inhaled particle deposition in unsteady-state respiratory flow at a numerically constructed model of the human larynx.","authors":"Hiroshi Takano,&nbsp;Naohiro Nishida,&nbsp;Masayuki Itoh,&nbsp;Noboru Hyo,&nbsp;Yuichi Majima","doi":"10.1089/jam.2006.19.314","DOIUrl":"https://doi.org/10.1089/jam.2006.19.314","url":null,"abstract":"<p><p>To evaluate the clinical effectiveness of aerosol therapy for the lower and upper respiratory airways, particle deposition at the human laryngeal region has been analyzed with various unsteady-state respiratory flow-patterns. The flow profiles and trajectory of aerosol particles were calculated by 3-D thermo-fluid analysis of a finite volume method (FVM) with 8-CPUs parallel computational system. A reconstructed physical model of the real laryngeal airways was modified from 3-D CAM modeling function of Rhinoceros based on the images of Magnetic Resonance Imaging (MRI). By using 104 MRI images taken vertically and horizontally at intervals of 2 mm on the oral cavity and the pharynx-larynx respectively, 3-D physical model of the laryngeal airways was obtained. The numerical results of flow profile analyzed by the unsteady-state respiration model showed that vortex flow was occurred with time at near larynx, showing uniform flow profile in both the oral cavity and upper side of pharynx. The vortex was appeared at the anterior part of the epiglottis and downward of the vocal cord. However, it was confirmed that few particles deposit in the vocal cord. In these cases, the particle deposition was taken place mostly at the oral cavity and the oropharynx. On the other hand, the relationship between the particle deposition efficiency and the impaction in the laryngeal region was well agreement with the data sets of ICRP task group (1993) for the larynx deposition.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 3","pages":"314-28"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26359393","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 optimized in vitro model of the respiratory tract wall to study particle cell interactions.","authors":"Fabian Blank,&nbsp;Barbara M Rothen-Rutishauser,&nbsp;Samuel Schurch,&nbsp;Peter Gehr","doi":"10.1089/jam.2006.19.392","DOIUrl":"https://doi.org/10.1089/jam.2006.19.392","url":null,"abstract":"<p><p>As a part of the respiratory tissue barrier, lung epithelial cells play an important role against the penetration of the body by inhaled particulate foreign materials. In most cell culture models, which are designed to study particle-cell interactions, the cells are immersed in medium. This does not reflect the physiological condition of lung epithelial cells which are exposed to air, separated from it only by a very thin liquid lining layer with a surfactant film at the air-liquid interface. In this study, A549 epithelial cells were grown on microporous membranes in a two chamber system. After the formation of a confluent monolayer the cells were exposed to air. The morphology of the cells and the expression of tight junction proteins were studied with confocal laser scanning and transmission electron microscopy. Air-exposed cells maintained monolayer structure for 2 days, expressed tight junctions and developed transepithelial electrical resistance. Surfactant was produced and released at the apical side of the air-exposed epithelial cells. In order to study particle-cell interactions fluorescent 1 microm polystyrene particles were sprayed over the epithelial surface. After 4 h, 8.8% of particles were found inside the epithelium. This fraction increased to 38% after 24 h. During all observations, particles were always found in the cells but never between them. In this study, we present an in vitro model of the respiratory tract wall consisting of air-exposed lung epithelial cells covered by a liquid lining layer with a surfactant film to study particle-cell interactions.</p>","PeriodicalId":14878,"journal":{"name":"Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine","volume":"19 3","pages":"392-405"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/jam.2006.19.392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26303002","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}