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Effect of MDI Actuation Timing on Inhalation Dosimetry in a Human Respiratory Tract Model. Pharmaceuticals (Basel) 2022; 15:ph15010061. [PMID: 35056118 PMCID: PMC8777964 DOI: 10.3390/ph15010061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 01/02/2023] Open
Abstract
Accurate knowledge of the delivery of locally acting drug products, such as metered-dose inhaler (MDI) formulations, to large and small airways is essential to develop reliable in vitro/in vivo correlations (IVIVCs). However, challenges exist in modeling MDI delivery, due to the highly transient multiscale spray formation, the large variability in actuation–inhalation coordination, and the complex lung networks. The objective of this study was to develop/validate a computational MDI-releasing-delivery model and to evaluate the device actuation effects on the dose distribution with the newly developed model. An integrated MDI–mouth–lung (G9) geometry was developed. An albuterol MDI with the chlorofluorocarbon propellant was simulated with polydisperse aerosol size distribution measured by laser light scatter and aerosol discharge velocity derived from measurements taken while using a phase Doppler anemometry. The highly transient, multiscale airflow and droplet dynamics were simulated by using large eddy simulation (LES) and Lagrangian tracking with sufficiently fine computation mesh. A high-speed camera imaging of the MDI plume formation was conducted and compared with LES predictions. The aerosol discharge velocity at the MDI orifice was reversely determined to be 40 m/s based on the phase Doppler anemometry (PDA) measurements at two different locations from the mouthpiece. The LES-predicted instantaneous vortex structures and corresponding spray clouds resembled each other. There are three phases of the MDI plume evolution (discharging, dispersion, and dispensing), each with distinct features regardless of the actuation time. Good agreement was achieved between the predicted and measured doses in both the device, mouth–throat, and lung. Concerning the device–patient coordination, delayed MDI actuation increased drug deposition in the mouth and reduced drug delivery to the lung. Firing MDI before inhalation was found to increase drug loss in the device; however, it also reduced mouth–throat loss and increased lung doses in both the central and peripheral regions.
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Ghibu S, Juncan AM, Rus LL, Frum A, Dobrea CM, Chiş AA, Gligor FG, Morgovan C. The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9776. [PMID: 34574698 PMCID: PMC8468206 DOI: 10.3390/ijerph18189776] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022]
Abstract
Nowadays, humanity is confronted with one of the most difficult challenges. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified for the first time in Hubei, China in December 2019 and produced the COVID-19 pandemic, a devastating disease that led to many complications and deaths. The authorities and the global healthcare system have been alerted regarding the prevention and treatment of this pathology. Even though worldwide quarantine was declared, health care professionals, including pharmacists, have been at the frontline in this war. Since the beginning of the pandemic, the authorities relied on the involvement of the community, hospital, or clinical pharmacists in offering support to the entire population. Also, the authorities implemented measures for emergency authorization of the vaccines, or the drugs used in COVID-19 treatment. In order to facilitate the population's access to healthcare services, the authorities have established regulations regarding, the extension of prescriptions by pharmacists, working hours, prevention of shortages and price-increase, drive-thru services, etc. However, several countries have taken financial measures to support the pharmacies' activity. At the same time, pharmaceutical associations elaborated guidelines for the protection of pharmacists and patients alike. Additionally, the pharmacies have come to support the health system and patients by adapting pharmaceutical care to the new needs like preparation and supply of disinfectants, patient care, information, and counseling, especially to COVID-19 patients, as well as the implementation of home drugs-delivery systems. The important roles played by pharmacists were to perform COVID-19 tests and further vaccines, as well as to combat the abundance of misinformation and fake news. The clinical and hospital pharmacy services have also been adapted. Strengthening the role of the pharmacist in the medical team was important for the purpose of providing correct and complete information regarding drugs used in the COVID-19 pathology. In all these activities, pharmacists needed creativity and professionalism, but also the support of pharmacy owners and managers. With this crisis, pharmaceutical care has entered a new phase, demonstrating the ability of pharmacists to be competent and accessible providers of public health. Based on this information, we conducted a narrative review whose purpose was to identify the impact of the authorities' decisions on pharmaceutical practice, the involvement of professional associations, and the responsibilities of the pharmacy owners and management. On the other hand, we performed a global assessment on the pharmaceutical care services provided by community pharmacists as well as by clinical or hospital pharmacists during the COVID-19 pandemic.
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Affiliation(s)
- Steliana Ghibu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 6A Louis Pasteur Street, 400349 Cluj-Napoca, Romania;
| | - Anca Maria Juncan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Luca Liviu Rus
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Adina Frum
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Carmen Maximiliana Dobrea
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Adriana Aurelia Chiş
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Felicia Gabriela Gligor
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
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Cazzola M, Ora J, Bianco A, Rogliani P, Matera MG. Management of COPD patients during COVID: difficulties and experiences. Expert Rev Respir Med 2021; 15:1025-1033. [PMID: 33975511 DOI: 10.1080/17476348.2021.1929176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The role of COPD in COVID-19 is not yet well understood. However, there is increasing evidence showing that COPD patients with COVID-19 have a higher risk of presenting a serious infection, a greater likelihood of requiring ICU support, and a higher mortality than other groups.Areas covered: In this article, we address some critical questions on COVID-19 as they pertain to COPD. In particular, we discuss whether the usual algorithms of pharmacological and non-pharmacological management in COPD still apply.Expert opinion: Patients with COPD must continue their regular therapy, regardless of whether they are affected by COVID-19. Corticosteroids reduce mortality in COVID-19 patients in need of supportive oxygen therapy or invasive mechanical ventilation. It is essential that a COPD patient who has tested positive for SARS-CoV-2 is closely followed over time because any delay in diagnosis and initiation of appropriate therapy could negatively affect his/her prognosis. However, we still do not know if COVID-19 infection occurs and evolves differently in each of the recognized COPD phenotypes and, therefore, whether it needs a different management. There are other open questions concerning COVID-19 and COPD that need to be considered. Future studies are absolutely necessary to answer these questions.
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Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"/Monaldi Hospital, Naples, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Al-Iede M, Waters K, Aleidi SM, Alqutawneh B, Alnawaiseh H, Alshraideh A, Almaaitah S, Mahmoud R, Abualsoud R, Kiswani A, Al-Zayadneh E, Yousef AM. Impact of COVID-19 lockdown on children with asthma in Jordan: a parental questionnaire. BMJ Paediatr Open 2021; 5:e001136. [PMID: 34222681 PMCID: PMC8228568 DOI: 10.1136/bmjpo-2021-001136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/03/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a 10-week lockdown on children with asthma aged 4-17 years in terms of presentations to the emergency department (ED), frequency of admissions, compliance with medications and changes in pulmonary function testing results. DESIGN AND SETTING A questionnaire-based cross-sectional study using Google Forms to collect parents' and caregivers' responses after they consented to participation. RESULTS A total of 374 parents/caregivers were contacted and 297 (79%) responded. The majority of the children were male (188 or 63%) and 49.8% were aged 7-12 years. More than half of the participants (194 or 65%) reported improved compliance with medications and spacer use. There was a significant reduction in the number of presentations to the ED from 137 to 80 and admissions to hospital from 56 to 24 during the 10-week lockdown period compared with the same time period in the previous year (p≤0.0001). Around 25% of the participants used telemedicine by phone and social media applications for communication with their treating physician and 59 (80%) described it as easy and smooth. CONCLUSION The national lockdown in Jordan due to the COVID-19 pandemic was associated with a fall in emergency presentations and hospital admissions for acute asthma exacerbations. Parental responses indicate that fears focused around COVID-19 were associated with enhanced compliance with use preventer medications during the lockdown.
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Affiliation(s)
- Montaha Al-Iede
- Department of Pediatrics, Respiratory and Sleep Medicine Section, Jordan University Hospital, Amman, Jordan.,School of Medicine, The University of Jordan, Amman, Jordan
| | - Karen Waters
- Depatment of Sleep Medicine, The Children's Hospital at Westmead, Sydeny, New South Wales, Australia
| | - Shereen M Aleidi
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Basim Alqutawneh
- Department of Radiology, Blacktown and Mount Druitt Hospital, Sydney, New South Wales, Australia
| | | | | | - Sara Almaaitah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Raghad Mahmoud
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Raya Abualsoud
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Arwa Kiswani
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Enas Al-Zayadneh
- Department of Pediatrics, Respiratory and Sleep Medicine Section, Jordan University Hospital, Amman, Jordan.,School of Medicine, The University of Jordan, Amman, Jordan
| | - Al-Motassem Yousef
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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Pharmacy response to COVID-19: lessons learnt from Canada. J Pharm Policy Pract 2020; 13:76. [PMID: 33298184 PMCID: PMC7724456 DOI: 10.1186/s40545-020-00280-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/29/2020] [Indexed: 12/22/2022] Open
Abstract
When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few front-line health care workers who remained accessible in person for patients, had to rapidly adopt critical changes in their pharmacies to respond in the best interest of their patients and their pharmacy staff. As challenging and demanding as such changes were, they provided pharmacists with invaluable lessons that would be imperative as the country enters a potentially more dangerous second wave. This article seeks to identify and summarize opportunities for improvement in pharmacy as learnt from the pandemic’s first wave. Such areas include but are not limited to handling of drug shortage and addressing drug hoarding and stockpiling, providing physical and mental support for staff, timing of flu vaccine and COVID-19 screening/testing, collaboration between different health care sites as well as collaboration with patients and with other health care professionals, telemedicine and willingness to adopt innovative ideas, need for more staff training and more precise research to provide accurate information and finally the need for more organizational and workplace support. Learning from what went well and what did not work in the early stages of the pandemic is integral to ensure pharmacy professionals are better prepared to protect themselves and their patients amidst a second and possibly subsequent waves.
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