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Bahlool AZ, Cavanagh B, Sullivan AO, MacLoughlin R, Keane J, Sullivan MPO, Cryan SA. Microfluidics produced ATRA-loaded PLGA NPs reduced tuberculosis burden in alveolar epithelial cells and enabled high delivered dose under simulated human breathing pattern in 3D printed head models. Eur J Pharm Sci 2024; 196:106734. [PMID: 38417586 DOI: 10.1016/j.ejps.2024.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 03/01/2024]
Abstract
Tuberculosis, caused by Mycobacterium tuberculosis (Mtb), is second only to COVID-19 as the top infectious disease killer worldwide. Multi-drug resistant TB (MDR-TB) may arise because of poor patient adherence to medications due to lengthy treatment duration and side effects. Delivering novel host directed therapies (HDT), like all trans retinoic acid (ATRA) may help to improve drug regimens and reduce the incidence of MDR-TB. Local delivery of ATRA to the site of infection leads to higher bioavailability and reduced systemic side effects. ATRA is poorly soluble in water and has a short half-life in plasma. Therefore, it requires a formulation step before it can be administered in vivo. ATRA loaded PLGA nanoparticles suitable for nebulization were manufactured and optimized using a scalable nanomanufacturing microfluidics (MF) mixing approach (MF-ATRA-PLGA NPs). MF-ATRA-PLGA NPs demonstrated a dose dependent inhibition of Mtb growth in TB-infected A549 alveolar epithelial cell model while preserving cell viability. The MF-ATRA-PLGA NPs were nebulized with the Aerogen Solo vibrating mesh nebulizer, with aerosol droplet size characterized using laser diffraction and the estimated delivered dose was determined. The volume median diameter (VMD) of the MF-ATRA-PLGA NPs was 3.00 ± 0.18 μm. The inhaled dose delivered in adult and paediatric 3D printed head models under a simulated normal adult and paediatric breathing pattern was found to be 47.05 ± 3 % and 20.15 ± 3.46 % respectively. These aerosol characteristics of MF-ATRA-PLGA NPs supports its suitability for delivery to the lungs via inhalation. The data generated on the efficacy of an inhalable, scalable and regulatory friendly ATRA-PLGA NPs formulation provides a foundation on which further pre-clinical testing can be built. Overall, the results of this project are promising for future research into ATRA loaded NPs formulations as inhaled host directed therapies for TB.
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Affiliation(s)
- Ahmad Z Bahlool
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, D02 YN77, Dublin, Ireland; Tissue Engineering Research Group, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin, Ireland; Department of Clinical Medicine, Trinity Translational Medicine Institute, St. James's Hospital, Trinity College Dublin, The University of Dublin, Dublin 8, Ireland
| | - Brenton Cavanagh
- Cellular and Molecular Imaging Core, Royal College of Surgeons in Ireland RCSI, Dublin 2, Ireland
| | - Andrew O' Sullivan
- Research and Development, Science and Emerging Technologies, Aerogen Ltd, Galway Business Park, Dangan, Galway, Ireland
| | - Ronan MacLoughlin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, D02 YN77, Dublin, Ireland; Research and Development, Science and Emerging Technologies, Aerogen Ltd, Galway Business Park, Dangan, Galway, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40 Dublin, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Trinity Translational Medicine Institute, St. James's Hospital, Trinity College Dublin, The University of Dublin, Dublin 8, Ireland
| | - Mary P O' Sullivan
- Department of Clinical Medicine, Trinity Translational Medicine Institute, St. James's Hospital, Trinity College Dublin, The University of Dublin, Dublin 8, Ireland
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, D02 YN77, Dublin, Ireland; Tissue Engineering Research Group, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin, Ireland; SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI and Trinity College Dublin, Dublin, Ireland; SFI Centre for Research in Medical Devices (CÚRAM), NUIG & RCSI, Dublin, Ireland.
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Buttini F, Gori L, Morecchiato F, Sorano A, Antonelli A, Rossolini GM, Bartoloni A, Mencarini J, Bettini R, Lavorini F. Effects of saline nebulization on SARS-CoV-2 RNA spreading and exhaled bio-aerosol particles in COVID-19 patients. J Hosp Infect 2024; 145:77-82. [PMID: 38145810 DOI: 10.1016/j.jhin.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Nebulized therapy is the mainstay for treating obstructive airway diseases, but there is heightened concern about the potential risk for SARS-CoV-2 transmission during nebulization in COVID-19 patients. AIM To investigate the effects of 0.9% saline nebulization on SARS-CoV-2 RNA spreading in 11 COVID-19 patients (five females, mean age 62.45 ± 9.31 years); also to ascertain whether saline nebulization changed the number of exhaled bio-aerosol particles in six out of the 11 patients. METHODS Air samples were collected using suction pumps equipped with 0.45 μm PTFE filters and positioned around the patient's bed. Exhaled particles were quantified by using an optical particle counter. FINDINGS At baseline (i.e. before nebulization) SARS-CoV-2 was detected more frequently in the pumps close to the patient than in those far away. After saline nebulization, the detection of SARS-CoV-2 in the pumps close to the patient was comparable to that observed at baseline. In the pumps far from the patient, saline nebulization slightly, but not significantly, increased SARS-CoV-2 RNA detection compared to baseline. Overall, no significant changes in the SARS-CoV-2 RNA detection were observed after saline nebulization. At baseline, exhaled particle emission varied among patients, with two of them showing higher emission of particles than the remaining patients. Saline nebulization induced a marked decrease in exhaled particles in the two patients who displayed high emission at baseline, whereas no changes were observed in the remaining patients. Saline nebulization did not significantly change SARS-CoV-2 RNA spreading. CONCLUSION Saline nebulization does not significantly increase SARS-CoV-2 spreading.
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Affiliation(s)
- F Buttini
- Food and Drug Department, University of Parma, Parma, Italy
| | - L Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - F Morecchiato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Sorano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - A Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - J Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R Bettini
- Food and Drug Department, University of Parma, Parma, Italy
| | - F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Taylor TL, Tukhmetova D, Duong TPT, Böwe AM, Meermann B, Gundlach-Graham A. Comparative study of the vibrating capillary nebulizer (VCN) and commercially available interfaces for on-line coupling of capillary electrophoresis with ICP-MS. Anal Bioanal Chem 2024; 416:1613-1621. [PMID: 38285228 DOI: 10.1007/s00216-024-05162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/31/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
Capillary electrophoresis (CE) is a powerful and sensitive tool for speciation analysis when combined with inductively coupled plasma mass spectrometry (ICP-MS); however, the performance of this technique can be limited by the nature of pneumatic nebulizers. This study compares two commercially available pneumatic nebulizers to a newly introduced vibrating capillary nebulizer (VCN) for on-line coupling of CE with ICP-MS. The VCN is a low-cost, non-pneumatic nebulizer that is based on the design of capillary vibrating sharp-edge spray ionization. As a piezoelectrically driven nebulization source, the VCN creates an aerosol independent of gas flows and does not produce a low-pressure region at the nebulizer orifice. To compare the systems, we performed replicate analyses of sulfate in river water with each nebulizer and the same CE and ICP-MS instruments and determined the figures of merit of each setup. With the CE-VCN-ICP-MS setup, we achieved around 2-4 times lower sensitivity compared to the commercial setups. However, the VCN-based setup provided lower noise levels and better linear correlation from the analysis of calibration standards, which resulted in indistinguishable LOD and LOQ values from the in-house-built VCN-based and commercial setups for CE-ICP-MS analysis. The VCN is found to have the highest baseline stability with a standard deviation of 3500 cts s-1, corresponding to an RSD of 2.7%. High reproducibility is found with the VCN with a peak area RSD of 4.1% between 3 replicate measurements.
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Affiliation(s)
| | - Dariya Tukhmetova
- Division 1.1 - Inorganic Trace Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
| | - Thi Phuong Thanh Duong
- Division 1.1 - Inorganic Trace Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
- Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Anna-Maria Böwe
- Division 4.3 - Contaminant Transport and Environmental Technologies, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
| | - Björn Meermann
- Division 1.1 - Inorganic Trace Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany.
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Larrosa-Garcia M, Terradas Campanario S, Fernández Polo A, Cañete Ramírez C, Parra AP, Campany Herrero D. Characterization and real-live results of nebulized voriconazole: A single-center observational study. Farm Hosp 2024; 48:T29-T33. [PMID: 37858518 DOI: 10.1016/j.farma.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Pulmonary administration of voriconazole involves advantages, including optimization of lung penetration and reduction of adverse effects and interactions. However, there is scarce evidence about its use and there are no commercial presentations for nebulization. We aim to characterize a compounded voriconazole solution for nebulization and describe its use in our center. METHOD This is a retrospective observational study including patients who received nebulized voriconazole to treat fungal lung diseases (infection or colonization). Voriconazole solution was prepared from commercial vials for intravenous administration. RESULTS The pH and osmolarity of voriconazole solutions were adequate for nebulization. Ten patients were included, nine adults and a child. The dosage was 40 mg in adults and 10 mg in the pediatric patient, diluted to a final concentration of 10 mg/ml, administered every 12-24 hours. The median duration of treatment was 139 (range: 26-911) days. There were no reported adverse effects and the drug was not detected in plasma when nebulized only. CONCLUSION Voriconazole nebulization is well tolerated and it is not absorbed into the systemic circulation; further research is needed to assess its efficacy.
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Affiliation(s)
- Maria Larrosa-Garcia
- Departamento de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | | | | | - Carme Cañete Ramírez
- Departamento de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Alba Pau Parra
- Departamento de Farmacia, Hospital Universitario Vall d'Hebron, Barcelona, España
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Larrosa-Garcia M, Campanario ST, Polo AF, Ramírez CC, Parra AP, Herrero DC. Characterization and real-live results of nebulized voriconazole: A single-center observational study. Farm Hosp 2024; 48:29-33. [PMID: 37612182 DOI: 10.1016/j.farma.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Pulmonary administration of voriconazole involves advantages, including optimization of lung penetration and reduction of adverse effects and interactions. However, there is scarce evidence about its use and there are no commercial presentations for nebulization. We aim to characterize a compounded voriconazole solution for nebulization and describe its use in our center. METHOD This is a retrospective observational study including patients who received nebulized voriconazole to treat fungal lung diseases (infection or colonization). Voriconazole solution was prepared from commercial vials for intravenous administration. RESULTS The pH and osmolarity of voriconazole solutions were adequate for nebulization. Ten patients were included, 9 adults and a child. The dosage was 40 mg in adults and 10 mg in the pediatric patient, diluted to a final concentration of 10 mg/ml, administered every 12-24 h. The median duration of treatment was 139 (range: 26-911) days. There were no reported adverse effects and the drug was not detected in plasma when nebulized only. CONCLUSION Voriconazole nebulization is well-tolerated and it is not absorbed into the systemic circulation; further research is needed to assess its efficacy.
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Affiliation(s)
| | | | | | | | - Alba Pau Parra
- Pharmacy Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Cabrera M, Le Pennec D, Le Guellec S, Pardessus J, Ehrmann S, MacLoughlin R, Heuzé-Vourc'h N, Vecellio L. Influence of mesh nebulizer characteristics on aerosol delivery in non-human primates. Eur J Pharm Sci 2023; 191:106606. [PMID: 37832856 DOI: 10.1016/j.ejps.2023.106606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/05/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
Non-Human Primates (NHPs) are particularly relevant for preclinical studies during the development of inhaled biologics. However, aerosol inhalation in NHPs is difficult to evaluate due to a low lung deposition fraction and high variability. The objective of this study was to evaluate the influence of mesh nebulizer parameters to improve lung deposition in macaques. We developed a humidified heated and ventilated anatomical 3D printed macaque model of the upper respiratory tract to reduce experiments with animals. The model was compared to in vivo deposition using 2D planar scintigraphy imaging in NHPs and demonstrated good predictivity. Next, the anatomical model was used to evaluate the position of the nebulizer on the mask, the aerosol particle size and the aerosol flow rate on the lung deposition. We showed that placing the mesh-nebulizer in the upper part of the mask and in proximal position to the NHP improved lung delivery prediction. The lower the aerosol size and the lower the aerosol flow rate, the better the predicted aerosol deposition. In particular, for 4.3 ± 0.1 µm in terms of volume mean diameter, we obtained 5.6 % ± 0.2 % % vs 19.2 % ± 2.5 % deposition in the lung model for an aerosol flow rate of 0.4 mL/min vs 0.03 mL/min and achieved 16 % of the nebulizer charge deposited in the lungs of macaques. Despite the improvement of lung deposition efficiency in macaques, its variability remained high (6-21 %).
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Affiliation(s)
- Maria Cabrera
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Déborah Le Pennec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Sandrine Le Guellec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France; DTF-Aerodrug, Tours, France
| | - Jeoffrey Pardessus
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Stephan Ehrmann
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; CHRU de Tours, Médecine Intensive Réanimation, 2 boulevard Tonnellé, Tours, France
| | - Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen, Galway, Ireland
| | - Nathalie Heuzé-Vourc'h
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France
| | - Laurent Vecellio
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France; University of Tours, Tours, France.
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Hong SW, Chang KH, Woo CJ, Kim HC, Kwak BS, Park BJ, Nam KC. Evaluation of antibody drug delivery efficiency via nebulizer in various airway models and breathing patterns. BMC Pharmacol Toxicol 2023; 24:70. [PMID: 38041207 PMCID: PMC10691028 DOI: 10.1186/s40360-023-00711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Nebulizers are commonly used to treat respiratory diseases, which are a major cause of morbidity and mortality. While inhalation therapy with antibodies has been evaluated in preclinical studies and clinical trials for respiratory diseases, it has not yet been approved for treatment. Moreover, there is limited information regarding the delivery efficiency of therapeutic antibodies via nebulizer. METHODS In this study, the nebulization characteristics and drug delivery efficiencies were compared when immunoglobulin G (IgG) was delivered by five nebulizers using two airway models and five breathing patterns. The study confirmed that the delivered dose and drug delivery efficiency were reduced in the child model compared to those in the adult model and in the asthma pattern compared to those in the normal breathing pattern. RESULTS The NE-SM1 NEPLUS vibrating mesh nebulizer demonstrated the highest delivery efficiency when calculated as a percentage of the loading dose, whereas the PARI BOY SX + LC SPRINT (breath-enhanced) jet nebulizer had the highest delivery efficiency when calculated as a percentage of the emitted dose. CONCLUSION The results suggest that the total inspiration volume, output rate, and particle size should be considered when IgG nebulization is used. We, therefore, propose a method for evaluating the efficiency of nebulizer for predicting antibody drug delivery.
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Affiliation(s)
- Soon Woo Hong
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Kyung Hwa Chang
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Chang Jae Woo
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
- Office of Technology Transfer, National Cancer Center, Goyang-si, 10408, Gyeonggi-do, Korea
| | - Ho Chul Kim
- Department of Radiological Science, Eulji University, Seongnam-si, 13135, Gyeonggi-do, Korea
| | - Bong Seop Kwak
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea
| | - Bong Joo Park
- Department of Electrical & Biological Physics and Institute of Biomaterials, Kwangwoon University, Seoul, 01897, Korea
| | - Ki Chang Nam
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang-si, 10326, Gyeonggi-do, Korea.
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Qu Y, Gong Y, Li L, Song Y, Song Y, Hou D, Hu L. Atomization efficacy of a novel micro-dose mesh nebulizer (CVS-100) versus the traditional mesh nebulizer (M102) in adults with chronic obstructive pulmonary disease: A randomized non-inferiority clinical trial. Respir Med 2023; 219:107434. [PMID: 37879448 DOI: 10.1016/j.rmed.2023.107434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To compare the atomization efficacy of a novel micro-dose mesh nebulizer (CVS-100) versus the traditional mesh nebulizer (M102) in nebulizing a combination of ipratropium bromide and salbutamol for treatment of stable moderate-to-severe chronic obstructive pulmonary disease (COPD). METHODS A randomized, parallel, non-inferiority study was conducted. A total of 64 stable COPD patients were randomly assigned to either the experimental group or the control group in a 1:1 ratio. Each the experimental group received nebulized Combivent (Compound Ipratropium Bromide Solution) with CVS-100, while the control group received Combivent with M102. Lung ventilation function was measured before and 30 min after nebulization, and the difference in percentage of forced expiratory volume in the first second (FEV1) of predicted value (FEV1%pred), the forced expiratory flow at 50% (FEF50%), the forced expiratory flow at 75% (FEF75%), the mid-expiratory flow (FEF25-75%), and maximal voluntary ventilation (MVV) was evaluated. The non-inferiority margin for the lower 95% confidence limit was set at 3.5%. RESULTS The lower limit of the 95% confidence interval for the difference in FEV1%pred between the two groups was -1.83357, which was greater than -3.5. No significant differences were found in FEF50%, FEF75%, FEF25∼75%, MVV before and after nebulization between the two groups. CONCLUSION The novel micro-dose mesh nebulizer (CVS-100) was found to be non-inferior to the traditional mesh nebulizer (M102) in terms of the change in FEV1%pred from baseline after nebulization. Similar results were observed for all other measures of efficacy.
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Affiliation(s)
- Yulan Qu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Ying Gong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Li Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yansha Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Dongni Hou
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China.
| | - Lijuan Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Respiratory Research Institute, Shanghai, 200032, China.
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Samaee HR, Eslami G, Rahimzadeh G, Saeedi M, Davoudi Badabi A, Asare-Addo K, Nokhodchi A, Roozbeh F, Moosazadeh M, Ghasemian R, Alikhani A, Rezai MS. Inhalation phage therapy as a new approach to preventing secondary bacterial pneumonia in patients with moderate to severe COVID-19: A double-blind clinical trial study. J Drug Deliv Sci Technol 2023; 84:104486. [PMID: 37123173 PMCID: PMC10116154 DOI: 10.1016/j.jddst.2023.104486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
Inhalation phage therapy is proposed as a replacement approach for antibiotics in the treatment of pulmonary bacterial infections. This study investigates phage therapy on bacterial pneumonia in patients with moderate to severe COVID-19 via the inhalation route. In this double-blind clinical trial, 60 patients with positive COVID-19 hospitalized in three central Mazandaran hospitals were chosen and randomly divided into two intervention and control groups. Standard country protocol drugs plus 10 mL of phage suspension every 12 h with a mesh nebulizer was prescribed for 7 days in the intervention group. The two groups were compared in terms of O2Sat, survival rate, severe secondary pulmonary bacterial infection and duration of hospitalization. Comparing the results between the intervention and control group, in terms of the trend of O2Sat change, negative sputum culture, no fever, no dyspnea, duration of hospitalization, duration of intubation and under ventilation, showed that the difference between these two groups was statistically different (P value < 0.05). In conclusion, inhalation phage therapy may have a potential effect on secondary infection and in the outcome of COVID-19 patients. However, more clinical trials with control confounding factors are needed to further support this concept.
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Affiliation(s)
- Hamid Reza Samaee
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gohar Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Golnar Rahimzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Davoudi Badabi
- Antimicrobial Resistance Research Center and Communicable Diseases Institute, Department of Infectious Diseases, Ghaem Shahr Razi Hospital, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kofi Asare-Addo
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Ali Nokhodchi
- Pharmaceutics Research Lab, School of Life Sciences, University of Sussex, Brighton, UK
| | - Fatemeh Roozbeh
- Department of Infectious Diseases, Boo Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Department of Infectious Diseases, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Alikhani
- Antimicrobial Resistance Research Center and Communicable Diseases Institute, Department of Infectious Diseases, Ghaem Shahr Razi Hospital, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Swanson CS, Dhand R, Cao L, Ferris J, Elder CS, He Q. Microbiome-scale analysis of aerosol facemask contamination during nebulization therapy in hospital. J Hosp Infect 2023; 134:80-88. [PMID: 36690253 DOI: 10.1016/j.jhin.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/31/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Microbial contamination of aerosol facemasks could be a source of nosocomial infections during nebulization therapy in hospital, prompting efforts to identify these contaminants. Identification of micro-organisms in medical devices has traditionally relied on culture-dependent methods, which are incapable of detecting the majority of these microbial contaminants. This challenge could be overcome with culture-independent sequencing-based techniques that are suited for the profiling of complex microbiomes. AIM To characterize the microbial contaminants in aerosol facemasks used for nebulization therapy, and identify factors influencing the composition of these microbial contaminants with the acquisition and analysis of comprehensive microbiome-scale profiles using culture-independent high-throughput sequencing. METHODS Used aerosol facemasks collected from hospitalized patients were analysed with culture-independent 16S rRNA gene-based amplicon sequencing to acquire microbiome-scale comprehensive profiles of the microbial contaminants. Microbiome-based analysis was performed to identify potential sources of microbial contamination in facemasks. FINDINGS Culture-independent high-throughput sequencing was demonstrated for the capacity to acquire microbiome-scale profiles of microbial contaminants on aerosol facemasks. Microbial source identification enabled by the microbiome-scale profiles linked microbial contamination on aerosol facemasks to the human skin and oral microbiota. Antibiotic treatment with levofloxacin was found to reduce contamination of the facemasks by oral microbiota. CONCLUSION Sequencing-based microbiome-scale analysis is capable of providing comprehensive characterization of microbial contamination in aerosol facemasks. Insight gained from microbiome-scale analysis facilitates the development of effective strategies for the prevention and mitigation of the risk of nosocomial infections arising from exposure to microbial contamination of aerosol facemasks, such as targeted elimination of potential sources of contamination.
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Affiliation(s)
- C S Swanson
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN, USA
| | - R Dhand
- Department of Medicine, The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - L Cao
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN, USA
| | - J Ferris
- Department of Medicine, The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - C S Elder
- Respiratory Therapy Department, The University of Tennessee Medical Center, Knoxville, TN, USA
| | - Q He
- Department of Civil and Environmental Engineering, The University of Tennessee, Knoxville, TN, USA; Institute for a Secure and Sustainable Environment, The University of Tennessee, Knoxville, TN, USA.
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11
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Han Y, Zhu Y, Youngblood HA, Almuntashiri S, Jones TW, Wang X, Liu Y, Somanath PR, Zhang D. Nebulization of extracellular vesicles: A promising small RNA delivery approach for lung diseases. J Control Release 2022; 352:556-69. [PMID: 36341934 DOI: 10.1016/j.jconrel.2022.10.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Small extracellular vesicles (sEVs) are a group of cell-secreted nanovesicles with a diameter up to 200 nm. A growing number of studies have indicated that sEVs can reflect the pathogenesis of human diseases and mediate intercellular communications. Recently, sEV research has drastically increased due to their drug delivery property. However, a comprehensive method of delivering exogenous small RNAs-loaded sEVs through nebulization has not been reported. The methodology is complicated by uncertainty regarding the integrity of sEVs after nebulization, the delivery efficiency of aerosolized sEVs, their deposition in the lungs/cells, etc. This study demonstrates that sEVs can be delivered to murine lungs through a vibrating mesh nebulizer (VMN). In vivo sEV tracking indicated that inhaled sEVs were distributed exclusively in the lung and localized primarily in lung macrophages and airway epithelial cells. Additionally, sEVs loaded with small RNAs were successfully delivered into the lungs. The administration of siMyd88-loaded sEVs through inhalation reduced lipopolysaccharide (LPS)-induced lung injury in mice, supporting an application of this nebulization methodology to deliver functional small RNAs. Collectively, our study proposes a novel method of sEVs-mediated small RNA delivery into the murine lung through nebulization and presents a potential sEV-based therapeutic strategy for human lung diseases.
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12
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Cortez-Jugo C, Masoumi S, Chan PPY, Friend J, Yeo L. Nebulization of siRNA for inhalation therapy based on a microfluidic surface acoustic wave platform. Ultrason Sonochem 2022; 88:106088. [PMID: 35797825 PMCID: PMC9263997 DOI: 10.1016/j.ultsonch.2022.106088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 05/14/2023]
Abstract
The local delivery of therapeutic small interfering RNA or siRNA to the lungs has the potential to improve the prognosis for patients suffering debilitating lung diseases. Recent advances in materials science have been aimed at addressing delivery challenges including biodistribution, bioavailability and cell internalization, but an equally important challenge to overcome is the development of an inhalation device that can deliver the siRNA effectively to the lung, without degrading the therapeutic itself. Here, we report the nebulization of siRNA, either naked siRNA or complexed with polyethyleneimine (PEI) or a commercial transfection agent, using a miniaturizable acoustomicrofluidic nebulization device. The siRNA solution could be nebulised without significant degradation into an aerosol mist with tunable mean aerodynamic diameters of approximately 3 µm, which is appropriate for deep lung deposition via inhalation. The nebulized siRNA was tested for its stability, as well as its toxicity and gene silencing properties using the mammalian lung carcinoma cell line A549, which demonstrated that the gene silencing capability of siRNA is retained after nebulization. This highlights the potential application of the acoustomicrofluidic device for the delivery of efficacious siRNA via inhalation, either for systemic delivery via the alveolar epithelium or local therapeutic delivery to the lung.
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Affiliation(s)
- Christina Cortez-Jugo
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia.
| | - Sarah Masoumi
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia
| | - Peggy P Y Chan
- School of Software and Electrical Engineering, Swinburne University, Hawthorn, Victoria 3122, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia
| | - James Friend
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia
| | - Leslie Yeo
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia.
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13
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Islamitabar S, Gholizadeh M, Rakhshani MH, Kazemzadeh A, Tadayonfar M. Comparison of Nebulized Lidocaine and Intratracheally Injected (Spray-as-you-go) Lidocaine in Pain and Cough Reduction during Bronchoscopy. Tanaffos 2022; 21:348-353. [PMID: 37025311 PMCID: PMC10073944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/13/2021] [Indexed: 04/08/2023]
Abstract
Background Patients undergoing bronchoscopy often suffer from pain, coughing, and suffocation. Therefore, lidocaine is prescribed through various methods to induce local anesthesia. This study aimed to compare nebulized lidocaine and intratracheally injected lidocaine in pain and cough reduction during bronchoscopy. Materials and Methods This clinical trial was performed on 96 patients, divided into two groups of intervention (receiving lidocaine via a nebulizer before bronchoscopy) and control (receiving lidocaine through the working channel of bronchoscope). Then, the patients᾽ cough frequency was recorded during the procedure, and the pain level was measured using a numerical rating scale at the end of the procedure. The data were analyzed with SPSS software (version 16) using the chi-square and Fisher's exact tests. Moreover, the linear and Poisson regression tests were applied to analyze the main variables in this study. Results There was no significant difference between the two groups regarding demographic characteristics (P>0.05). Moreover, the linear regression test revealed that the intervention (nebulized lidocaine) group had significantly lower pain scores (1.54±0.08) than the control (intratracheally injected lidocaine) group (2.5±0.26) (P=0.013). In addition, the Poisson regression test showed a statistically significant difference between the intervention (35.22±2.93) and control (48.85±5.96) groups in terms of cough frequency (P<0.0001). Conclusion This study indicated that nebulized lidocaine has higher efficacy in reducing the patients᾽ pain and cough during bronchoscopy than intratracheally injected lidocaine.
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Affiliation(s)
- Saeid Islamitabar
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Gholizadeh
- Department of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Hasan Rakhshani
- Department of Statistics and Epidemiology, Health Faculty, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Asghar Kazemzadeh
- Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - MoosaalReza Tadayonfar
- Department of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Correspondence to: Tadayonfar MR, Address: Department of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran, Email address:
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14
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Liu B, Zan S, Luo W. Safety evaluation of revefenacin at the approved dose in patients with chronic obstructive pulmonary disease: A meta-analysis. Heart Lung 2021; 52:52-60. [PMID: 34875569 DOI: 10.1016/j.hrtlng.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Revefenacin is the first once-daily long-acting muscarinic antagonist (LAMA) for nebulization use in maintenance therapy for patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE To investigate the safety and tolerability profile of revefenacin at the approved dose (175 μg), compared with placebo and a lower dose (88 μg), for the treatment of COPD. METHODS Available randomized controlled trials (RCTs), both published and unpublished, were identified via databases. Risk differences (RDs) and risk ratios (RRs), with their corresponding 95% confidence intervals (CIs) were calculated as effect sizes. RESULTS One unpublished RCT and four articles containing 5 RCTs were included. Combined results showed that there were no significant differences between COPD patients receiving 175 μg revefenacin and those receiving a placebo, concerning the risk of discontinuation due to adverse events (AEs), any all-grade AE, or any serious AE. 175 μg revefenacin also did not significantly increase the risk of antimuscarinic-related AEs, cardiovascular AEs, or 12 commonly reported AEs. Plus, a lower dose of 88 μg was shown to share a comparable safety profile with the 175 μg revefenacin. A non-significant trend towards a decrease in risks of AEs for 175 μg revefenacin was observed. The most frequently reported AE for each group was COPD worsening/exacerbation. CONCLUSION Revefenacin at the approved dose is generally well-tolerated and safe with minimal AEs, which supports its use as a once-daily nebulized LAMA for the treatment of moderate to severe stable COPD. Additional studies are needed to complete the safety and tolerability profile.
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Affiliation(s)
- Baofeng Liu
- Tianjin Fourth Central Hospital, No.1 Zhongshan Road, Tianjin, Hebei 300140, China
| | - Shuangjiang Zan
- Tianjin Fourth Central Hospital, No.1 Zhongshan Road, Tianjin, Hebei 300140, China.
| | - Weishun Luo
- Tianjin Fourth Central Hospital, No.1 Zhongshan Road, Tianjin, Hebei 300140, China
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15
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Seif SM, Ma E, Rabea H, Saeed H, Abdelrahim MEA. Aerosol delivery of inhalation devices with different add-on connections to invasively ventilated COPD subjects: An in-vivo study. Eur J Pharm Sci 2021; 167:105988. [PMID: 34492291 DOI: 10.1016/j.ejps.2021.105988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022]
Abstract
Aerosol delivery to mechanically ventilated patients requires add-on connections to place the inhalation device within the ventilation circuit. The study aimed to evaluate the performance of Combihaler in dual limb invasive mechanical ventilation (IMV). A ventilator with a humidified dual limb circuit was adjusted to volume-controlled mode to imitate the adult breathing parameters. 24 (12 females) intubated chronic obstructive pulmonary disease (COPD) subjects had undergone the study. All patients were prescribed inhaled salbutamol dose delivered by either a metered-dose inhaler (pMDI) or vibrating mesh nebulizer (VMN). Each subject received salbutamol in four different inhalation device/connection conditions; pMDI+VMN+Combihaler, VMN+Combihaler, VMN+T-piece, and pMDI+T-piece. They were individually placed in the inspiratory limb at Y-piece. 5mg salbutamol was delivered by VMN with and without 2 pMDI puffs of salbutamol (100 µg), and 500µg was delivered by pMDI+T-piece. After aerosol delivery, two urine samples were collected from the patient; 30 min post-inhalation (USAL0.5) and cumulatively 24 h post-inhalation (USAL24) as indexes of lung deposition and systemic absorption, respectively. For the ex-vivo study, a collecting filter was placed before an endotracheal tube (ETT) to collect the delivered inhalable dose. In-vitro aerodynamic characteristics were also investigated. pMDI+VMN+Combihaler delivered more salbutamol to the lung and the ex-vivo filter than VMN+T-piece (p˂0.05, p≤0.01, respectively). VMN delivered a higher salbutamol amount to the lung, systemically, and the ex-vivo filter than pMDI+T-piece (p˂0.001). pMDI+VMN+Combihaler and VMN+Combihaler delivered aerosols with a less mass median aerodynamic diameter (MMAD) and higher fine particle fraction (FPF) compared to VMN+T-piece (p≤0.01 for MMAD, p˂0.01 for FPF) and pMDI+T-piece (p˂0.01 for both MMAD and FPF). Results of the study showed that pMDI+VMN+ Combihaler delivered more salbutamol than VMN+T-piece in IMV and demonstrate that 5 puffs (500-µg) of salbutamol with pMDI+T-piece has a lower aerosol delivering power at the level of USAL0.5, USAL24, and the ex-vivo inhalable dose than 5 mg nebulized salbutamol by VMNs in IMV.
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Affiliation(s)
- Salah M Seif
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Elnady Ma
- Chest Diseases Department, Kasr Al Einy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rabea
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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16
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Al Shamrani A, AlShammari A, AlAlkami H, AlShanwani J, Alharbi AS. When is asthma not guilty? Int J Pediatr Adolesc Med 2021; 8:203-211. [PMID: 34401444 PMCID: PMC8356124 DOI: 10.1016/j.ijpam.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/12/2020] [Accepted: 10/18/2020] [Indexed: 11/20/2022]
Abstract
Asthma is a common childhood condition. Its prevalence in Saudi Arabia is high, increasing, and could exceed 20% at the current trajectory. Asthma is a syndrome with different clinical presentations and phenotypes. Many conditions are often misdiagnosed as asthma because they share the same symptoms, particularly coughing and shortness of breath; physical findings, such as wheezing; radiological findings, such as hyperinflation on chest X-ray; or even responses to asthma therapies, as in some patients with bronchiolitis. When treating the younger age group (>5 years old), there should be a high degree of suspicion of alternative causes when evaluating patients presenting with clinical features suggestive of asthma or patients who do not respond well to asthma therapies. This study will highlight common conditions that may mimic asthma and, as a result of incorrect treatment, unnecessarily expose patients to steroids and other therapies for extended periods. Furthermore, we seek to alert healthcare providers to common symptoms and signs that suggest a cause other than asthma and suggest when to refer the patient to subspecialists.
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Affiliation(s)
| | - Ayshah AlShammari
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Halima AlAlkami
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Jawaher AlShanwani
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
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17
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Apter A, Carroll JK, Cardet JC, Cohen R, Colon-Moya AD, Ericson B, Forth VE, Gaefke C, Maher N, Morales-Cosme W, Rodriguez-Louis J, Tulchinsky A, Israel E. Nebulizer Use by Black and Latinx Adults with Moderate to Severe Asthma. J Allergy Clin Immunol Pract 2021; 10:517-524.e2. [PMID: 34673286 DOI: 10.1016/j.jaip.2021.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Generally, a short-acting beta-2 agonist (SABA) delivered via metered-dose inhaler (MDI) is recommended for quick relief of asthma symptoms. However, in the PeRson EmPowered Asthma RElief (PREPARE) pragmatic trial, 67% of patients reported having used a nebulizer for SABA administration. OBJECTIVE To understand preferences, experiences, and decision making regarding the use of nebulizers in Black and Latinx adults with uncontrolled asthma. METHODS We interviewed 40 of the 1,201 PREPARE patients employing a matrix analysis. Those interviewed were Black (n = 20) and Latinx (n = 20) adults with uncontrolled asthma seeking primary or specialty care in clinics throughout the United States. Data were analyzed used a Rapid Assessment Procedures qualitative methodology, informed by grounded theory. RESULTS Substudy participants, on average, reported using a nebulizer 3.5 times/wk. Daily use was common, and frequency ranged from less than daily to up to 6 times daily. Nearly all participants reported a longstanding history of nebulizer use. Participants tended to use their nebulizer at home, and some shared it with others in the home. Many reported preferring a nebulizer over an MDI for relief of severe symptoms and to avoid emergency room visits or hospitalizations. The extent to which cost affected nebulizer use varied among participants. CONCLUSIONS Despite asthma guideline recommendations that MDIs be used rather than nebulizers for SABA administration, nebulizer use was common among PREPARE study participants. Clinicians should explore patients' history and experiences with nebulizer use as part of evaluation of asthma control.
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Affiliation(s)
- Andrea Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pa.
| | - Jennifer K Carroll
- National Research Network, American Academy of Family Physicians, Leawood, Kan; Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Rubin Cohen
- Division of Pulmonary, Sleep, and Critical Care Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
| | | | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Victoria E Forth
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Claudia Gaefke
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Nancy Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Wilfredo Morales-Cosme
- Deanship of Student Affairs, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Abigail Tulchinsky
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass.
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18
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Abdelkreem E, Mahmoud SM, Aboelez MO, Abd El Aal M. Nebulized Magnesium Sulfate for Treatment of Persistent Pulmonary Hypertension of Newborn: A Pilot Randomized Controlled Trial. Indian J Pediatr 2021; 88:771-777. [PMID: 33415555 PMCID: PMC7790729 DOI: 10.1007/s12098-020-03643-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the effectiveness of nebulized magnesium sulfate in treating persistent pulmonary hypertension of newborn (PPHN). METHODS Twenty-eight mechanically ventilated term neonates with severe PPHN were randomized into two groups: NebMag group (n = 14), who receiving nebulized isotonic magnesium (1024 mg/h), and IVMag group (n = 14), who received intravenous magnesium (200 mg/kg over 30 min, followed by 50 mg/kg/h). The study time frame was 24 h. Outcome measures were the changes in oxygenation index (OI), mean arterial blood pressure (MABP), vasoactive inotropic score (VIS), and serum magnesium level. RESULTS Baseline demographic, ventilatory, and hemodynamic characteristics were comparable between the two groups. At the end of the study, the OI decreased by 44.3% in the NebMag group compared with 35.3% in the IVMag group (mean difference -3.14; 95%CI -5.08, -1.19; p 0.003). The NebMag group had a higher MABP (mean difference 2.29 mmHg; 95% CI 1.80, 2.77; p 0.000) and lower VIS (mean difference -14.64; 95% CI -16.52, -12.77; p 0.000) at the 24-h study time point. The increase in serum magnesium level, measured at 12-h study time point, was lower in the NebMag group (mean difference -2.26 mmol/L; 95% CI -2.58, -1.96; p 0.000). CONCLUSION Nebulized magnesium sulfate may be an effective therapeutic modality for neonates with severe PPHN on mechanical ventilation, but this should be confirmed by larger studies. Retrospectively registered at www.clinicaltrials.gov (identifier: NCT04328636).
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Affiliation(s)
- Elsayed Abdelkreem
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, 82524, Egypt.
| | - Shaimaa M Mahmoud
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, 82524, Egypt
| | - Moustafa O Aboelez
- Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Sohag University, Sohag, Egypt
| | - Mohamed Abd El Aal
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, 82524, Egypt
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19
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Park HM, Chang KH, Moon SH, Park BJ, Yoo SK, Nam KC. In vitro delivery efficiencies of nebulizers for different breathing patterns. Biomed Eng Online 2021; 20:59. [PMID: 34112170 PMCID: PMC8194228 DOI: 10.1186/s12938-021-00895-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Nebulizers are medical devices that deliver aerosolized medication directly to lungs to treat a variety of respiratory diseases. However, breathing patterns, respiration rates, airway diameters, and amounts of drugs delivered by nebulizers may be respiratory disease dependent. Method In this study, we developed a respiratory simulator consisting of an airway model, an artificial lung, a flow sensor, and an aerosol collecting filter. Various breathing patterns were generated using a linear actuator and an air cylinder. We tested six home nebulizers (jet (2), static (2), and vibrating mesh nebulizers (2)). Nebulizers were evaluated under two conditions, that is, for the duration of nebulization and at a constant output 1.3 mL using four breathing patterns, namely, the breathing pattern specified in ISO 27427:2013, normal adult, asthmatic, and COPD. Results One of the vibrating mesh nebulizers had the highest dose delivery efficiency. The drug delivery efficiencies of nebulizers were found to depend on breathing patterns. Conclusion We suggest a quantitative drug delivery efficiency evaluation method and calculation parameters that include considerations of constant outputs and residual volumes. The study shows output rates and breathing patterns should be considered when the drug delivery efficiencies of nebulizers are evaluated.
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Affiliation(s)
- Hyun Mok Park
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang, South Korea.,Graduate Program of Biomedical Engineering, Yonsei University, Seoul, South Korea
| | - Kyung Hwa Chang
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang, South Korea
| | - Sang-Hyub Moon
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang, South Korea.,Graduate Program of Biomedical Engineering, Yonsei University, Seoul, South Korea
| | - Bong Joo Park
- Department of Electrical & Biological Physics, Kwangwoon University, Seoul, South Korea.,Institute of Biomaterials, Kwangwoon University, Seoul, South Korea
| | - Sun Kook Yoo
- Graduate Program of Biomedical Engineering, Yonsei University, Seoul, South Korea. .,Department of Medical Engineering, Yonsei University College of Medicine, Seoul, South Korea.
| | - Ki Chang Nam
- Department of Medical Engineering, Dongguk University College of Medicine, Goyang, South Korea.
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20
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Motamed H, Verki MM, Nematollahi AV, Hesam S. Evaluation of efficacy of nebulized low molecular weight heparin as an adjunctive extra treatment for acute mild-moderate asthma attack; a randomized clinical trial study. Pulm Pharmacol Ther 2021; 68:102037. [PMID: 33989812 DOI: 10.1016/j.pupt.2021.102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 03/14/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is the most common chronic disorders of the respiratory tract. This study aimed to evaluate the effect of low-molecular-weight heparins (LMWHs) in the treatment of acute asthma. METHODS In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the intervention group received nebulized LMWH (1 mg/kg) with albuterol (2.5 mg) every 20 min for 10 min. The patients in the control group received nebulized albuterol with the same dose. Then peak expiratory flow rates (PEFR) and forced expiratory volume in 1 s (FEV1), and hemodynamic parameters in both groups were assessed for every 20 min. RESULTS In total 70 patients enrolled in this study. We found that the mean PEFR at 40 min was higher in the LMWH group than the control group (202.51 L/min and 180.2 L/min) (p = 0.001). Moreover, this difference remains significant in the 60th minute (p < 0.001). Further, FEV1 was significantly higher in the LMWH group after 60 min (1.82 L/min vs 1.48 L/min, p < 0.001). Moreover, we found that the hemodynamic parameters were sustainable in the intervention group. CONCLUSION The study suggests that LMWH in mild-moderate asthma attacks may be beneficial in the short term and could be prescribed in addition to standard albuterol therapy.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamadreza Maleki Verki
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ali Vefagh Nematollahi
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Epidemiology and Statistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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21
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Abstract
Aerosol delivery is a vital therapeutic strategy for both adult and pediatric patients presenting to the emergency department with respiratory distress. Aerosolized bronchodilators are frequently used as rescue medications for patients with diagnoses of asthma, chronic obstructive pulmonary disease (COPD), or pneumonia. Historically, emergency department providers utilized jet nebulizers (JNs) for medication delivery, but were challenged by a need for increasingly higher bronchodilator doses to elicit the desired response. Advancements in technology have led to the development of newer specialized aerosol delivery devices and treatment strategies which provide clinicians with improved options for aerosol delivery but may also cause some uncertainty regarding appropriate device selection. Initial investigations comparing these devices presented valuable evidence of in vitro benefit but were unable to demonstrate corresponding improvement in clinical results. More recently there has been an influx of clinical evidence that suggests improved clinical outcomes associated with more efficient aerosol delivery devices such as vibrating mesh nebulizers (VMN) compared to the standard JN device. VMN will likely become an increasingly important tool in emergency department treatment of patients with respiratory distress. Additional controlled studies are needed both to examine the effects of VMN on patient outcomes, as well as to analyze how performance differences between aerosol devices may affect dosing strategies. Future efforts should also focus on applying new evidence in the form of updated consensus guidelines and standardized treatment strategies.
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Affiliation(s)
- Patricia A Dailey
- Department of Medical Affairs, Senior Medical Science Liaison, Galway, Ireland
| | - Courtney M Shockley
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, UT Health San Antonio, San Antonio, TX, USA
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22
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Salimnia H, Meyer MP, Mitchell R, Fairfax MR, Gundel A, Guru N, Chopra T. A laboratory model demonstrating the protective effects of surgical masks, face shields, and a combination of both in a speaking simulation. Am J Infect Control 2021; 49:409-415. [PMID: 33485923 PMCID: PMC7826106 DOI: 10.1016/j.ajic.2021.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
Background The protection against aerosol transmission provided by masks vs face shields or in combination when speaking indoors is not well understood. Methods To simulate a human source, an aerosol generating system was made using a bacterial suspension in a nebulizer attached to an oxygen cylinder. A fan connected to the nebulizer created aerosols. Transmitted aerosols were detected using blood agar plates at 0.1524 and 1.8288 meters from source, simulating exposed person. The study was performed under controlled conditions at room temperature in a biohazard hood with high-efficiency particulate air (HEPA) filter and UV light. Results When face shields were used alone, significant numbers of bacterial colonies grew on blood agar plates. When a mask used alone for both the subjects (source and exposed), the blood agar yielded minimal colony forming units at both distances. When face shields were used in combination with masks, no significant improvement was observed as compared to masks alone. Discussion Our results were similar to what have been observed in related studies. Conclusions Surgical masks alone provided good protection, surpassing the protection provided by face shields alone. Both used together provided the best protection, although the combined protection was similar to surgical masks use alone.
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Affiliation(s)
- Hossein Salimnia
- Detroit Medical Center, Microbiology Laboratory, Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI
| | - Monica P Meyer
- Division of Infectious Diseases, Detroit Medical Center, Detroit, MI; Department of Internal Medicine, Wayne State University School of Medicine, MI
| | - Robert Mitchell
- Detroit Medical Center, Microbiology Laboratory, Detroit, MI
| | - Marilynn R Fairfax
- Detroit Medical Center, Microbiology Laboratory, Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI
| | - Angela Gundel
- Detroit Medical Center, Microbiology Laboratory, Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI
| | - Navneet Guru
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI
| | - Teena Chopra
- Division of Infectious Diseases, Detroit Medical Center, Detroit, MI; Department of Internal Medicine, Wayne State University School of Medicine, MI.
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23
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Kelly SJ, Martinsen P, Tatkov S. Rapid changes in mucociliary transport in the tracheal epithelium caused by unconditioned room air or nebulized hypertonic saline and mannitol are not determined by frequency of beating cilia. Intensive Care Med Exp 2021; 9:8. [PMID: 33728866 DOI: 10.1186/s40635-021-00374-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Inspired air is heated and humidified in the nose before it reaches lower airways. This mechanism is bypassed during tracheostomy, directly exposing the airways to colder and drier air from the environment, known to negatively affect mucociliary transport; however, little is known about how quickly mucociliary transport deteriorates. This study determines the short-term effect of flowing room air and nebulized hypertonic saline and mannitol on mucociliary transport in the trachea. In an ovine perfused in vitro tracheal model (N = 9) the epithelium was exposed to 25 L/min of flow, heated to lamb body temperature (38 °C) and fully saturated with water vapor as the control, followed by either room air (22 °C and 50% relative humidity) or nebulized solutions of NaCl 7% and mannitol 20% up to 1 min for a short duration, until mucociliary transport had visually changed. Mucus transport velocity (MTV) and cilia beat frequency (CBF) were continuously measured with video-microscopy. Results Exposing the tracheal epithelium to air heated to body temperature and fully humidified had stable MTV 9.5 ± 1.1 mm/min and CBF 13.4 ± 0.6 Hz. When exposed to flow of room air, MTV slowed down to 0.1 ± 0.1 mm/min in 2.0 ± 0.4 s followed by a decrease in CBF to 6.7 ± 1.9 Hz, after 2.3 ± 0.8 s. Both MTV and CBF recovered to their initial state when heated and humidified air-flow was re-introduced. Exposing the tracheal epithelium to nebulized hypertonic saline and nebulized mannitol for 1 min increased MTV without a subsequent increase in CBF. Conclusions This study demonstrates mucociliary transport can deteriorate within seconds of exposing the tracheal epithelium to flowing room air and increase rapidly when exposed to nebulized hypertonic solutions. The reduction in MTV precedes slowing of CBF with room air and MTV increases without a subsequent increase in CBF during the nebulization. Their relationship is non-linear and a minimum CBF of approximately 6 Hz is required for MTV > 0, while MTV can reach 10.9 mm/min without CBF increasing. Clinically these findings indicate a potential rapid detrimental effect of breathing with non-humidified air via bypassed upper airways and the short-term effects of nebulized osmotic agents that increase MTV.
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Le Guellec S, Ehrmann S, Vecellio L. In vitro - in vivo correlation of intranasal drug deposition. Adv Drug Deliv Rev 2021; 170:340-52. [PMID: 32918968 DOI: 10.1016/j.addr.2020.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022]
Abstract
In vitro - in vivo correlation (IVIVC) allows prediction of in vivo drug deposition from a nasally inhaled drug based on in vitro drug measurements. In vitro measurements include physical particle characterization and, more recently, deposition studies using anatomical models. Currently, there is a lack of IVIVC for deposition measurements in anatomical models, especially for deposition patterns in various nasal cavity regions. Therefore, improvement of in vitro and in vivo measurement methods and knowledge about nasal deposition mechanisms should help IVIVC in the future.
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Bianco F, Salomone F, Milesi I, Murgia X, Bonelli S, Pasini E, Dellacà R, Ventura ML, Pillow J. Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned. Respir Res 2021; 22:71. [PMID: 33637075 PMCID: PMC7908012 DOI: 10.1186/s12931-020-01585-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy. In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.
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Affiliation(s)
- Federico Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy.
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Ilaria Milesi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | | | - Sauro Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Elena Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.P.A., 43122, Parma, Italy
| | - Raffaele Dellacà
- TechRes Lab, Dipartimento Di Elettronica, Informazione E Bioingegneria (DEIB), Politecnico Di Milano University, Milano, Italy
| | | | - Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, Australia
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26
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McDermott K, Oakley JG. Droplet Size and Distribution of Nebulized 3% Sodium Chloride, Albuterol, and Epoprostenol by Phase Doppler Particle Analyzer. Curr Ther Res Clin Exp 2021; 94:100623. [PMID: 34306263 PMCID: PMC8296146 DOI: 10.1016/j.curtheres.2021.100623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Aerosolized drug therapy administered to mechanically ventilated patients is a standard part of pulmonary critical care medicine. Aerosol particle size and distribution are important factors in the optimal delivery of aerosolized drugs to ventilated patients. Objective The objective of this study was to characterize aerosol droplet size and distribution with laser diffraction for nebulized 3% sodium chloride, albuterol, and epoprostenol sodium (containing glycine) delivered via Aeroneb Solo Mesh Nebulizers (Aerogen, Mountain View, California). Methods A series of functional flow tests were run on each of 8 Solo mesh nebulizers before the study to verify accuracy of flow rates in milliliters per minute. Aerosolized droplets exiting the nebulizer heads were then measured using a phase Doppler particle analyzer. Data collected during delivery of 3% sodium chloride, albuterol, and epoprostenol sodium included aerosol droplet size distribution, mass median aerodynamic diameter (MMAD), and geometric standard deviation. For each Solo nebulizer, droplet size measurements were taken 2 cm away from the nebulizer head and 2 cm away from the wye of a heated, humidified adult ventilator circuit. For measurements taken at the wye, 4 distinct, continuous flow rates (2, 10, 20, and 40 L/min) were generated by an air pump to simulate inspiratory flows delivered with mechanical ventilation. The expiratory limb was capped, and the nebulizer head was inserted into the breathing circuit upstream of the humidifier. Results Each Solo nebulizer met Aerogen's recommended minimum flow rate of 0.2 mL/min, ranging from 0.23 to 0.31 mL/min. The MMAD of the 3 tested aerosols was several times smaller when measured at the wye outlet of the heated/humidified breathing circuit (0.82–2.73 µm) compared with droplets measured directly at the nebulizer outlet (MMAD, 4.6–7.3 µm). There was also significant variability across Solo heads with some ventilator flow rates. The mean MMAD at the wye for the 3% sodium chloride solution, albuterol, and epoprostenol test solutions was 1.62 µm, 1.09 µm, and 1.18 µm, respectively. The mean MMAD at the nebulizer for the 3% sodium chloride solution, albuterol, and epoprostenol test solutions was 5.37 µm, 5.73 µm, and 6.73 µm, respectively. Conclusions Results from this study suggest that particle size of aerosolized drugs administered via a commonly used setup for delivery of in-line aerosols to mechanically ventilated patients may be several times smaller than expected and may result in less drug being delivered to the patient than previously realized. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX) © 2021 Elsevier HS Journals, Inc.
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Affiliation(s)
- Kelly McDermott
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Jason G Oakley
- Department of Mechanical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin
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27
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Fennelly M, Keane J, Dolan L, Plant BJ, O'Connor DJ, Sodeau JR, Prentice MB. Containment of procedure-associated aerosols by an extractor tent: effect on nebulized drug particle dispersal. J Hosp Infect 2021; 110:108-113. [PMID: 33484782 PMCID: PMC7817412 DOI: 10.1016/j.jhin.2021.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Background Several medical procedures involving the respiratory tract are considered as ‘aerosol-generating procedures’. Aerosols from these procedures may be inhaled by bystanders, and there are consequent concerns regarding the transmission of infection or, specific to nebulized therapy, secondary drug exposure. Aim To assess the efficacy of a proprietary high-efficiency-particulate-air-filtering extractor tent on reducing the aerosol dispersal of nebulized bronchodilator drugs. Methods The study was conducted in an unoccupied outpatient room at St. James's Hospital, Dublin, Ireland. A novel real-time, fluorescent particle counter, the Wideband Integrated Bioaerosol Sensor (WIBS), monitored room air continuously for 3 h. Baseline airborne particle count and count during nebulization of bronchodilator drug solutions were recorded. Findings Nebulization within the tent prevented any increase over background level. Nebulization directly into room air resulted in mean fluorescent particle counts of 4.75 x 105/m3 and 4.21 x 105/m3 for Ventolin and Ipramol, respectively, representing more than 400-fold increases over mean background level. More than 99.3% of drug particles were <2 μm in diameter and therefore small enough to enter the lower respiratory tract. Conclusion The extractor tent was completely effective for the prevention of airborne spread of drug particles of respirable size from nebulized therapy. This suggests that extractor tents of this type would be efficacious for the prevention of airborne infection from aerosol-generating procedures during the COVID-19 pandemic.
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Affiliation(s)
- M Fennelly
- Environmental Research Institute, University College Cork, Cork, Ireland; Department of Pathology, University College Cork, Cork, Ireland.
| | - J Keane
- Respiratory Assessment Unit, St. James's Hospital, Dublin, Ireland
| | - L Dolan
- Respiratory Assessment Unit, St. James's Hospital, Dublin, Ireland
| | - B J Plant
- Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland
| | - D J O'Connor
- School of Chemical and Pharmaceutical Sciences, Technological University Dublin, Dublin, Ireland
| | - J R Sodeau
- Environmental Research Institute, University College Cork, Cork, Ireland
| | - M B Prentice
- Department of Pathology, University College Cork, Cork, Ireland; APC Microbiome Institute, University College Cork, Cork, Ireland.
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28
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Sood BG, Thomas R, Delaney-Black V, Xin Y, Sharma A, Chen X. Aerosolized Beractant in neonatal respiratory distress syndrome: A randomized fixed-dose parallel-arm phase II trial. Pulm Pharmacol Ther 2020; 66:101986. [PMID: 33338661 DOI: 10.1016/j.pupt.2020.101986] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/02/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE There is increasing research into novel techniques of administering surfactant to preterm infants (PTIs) with respiratory distress syndrome (RDS) receiving non-invasive respiratory support (NIRS). Although aerosolized surfactant (AS) is promising in PTIs receiving NIRS, the optimal surfactant dose and formulation, drug-device combination and patient profile is not known. The objective of this randomized clinical trial was to investigate the feasibility, safety, efficacy and impact of four dosing schedules of AS using two nebulizers in PTIs with RDS stratified by gestational age (GA). METHODS PTIs with RDS receiving pre-defined NIRS for ≤8 h were assigned to 4 A S dosing schedules and 2 nebulizers within three GA strata (I = 240/7-286/7, II = 290/7-326/7, III = 330/7-366/7 weeks). There was no contemporaneous control group; at the recommendation of the Data Monitoring Committee, data was collected retrospectively for control infants. RESULTS Of 149 subjects that received AS, the median age at initiation of the 1st dose and duration was 5.5 and 2.4 h respectively. There were 29 infants in stratum I, and 60 each in strata II and III. Of infants <32 weeks GA, 94% received caffeine prior to AS. Fifteen infants (10%) required intubation within 72 h; the rates were not significantly different between GA strata, dosing schedules and nebulizers for infants who received aerosolized surfactant. Compared to retrospective controls, infants who received AS were less likely to need intubation within 72 h in both the intention-to-treat (32% vs. 11%) and the per-protocol (22% vs. 10%) analyses (p < 0.05) with GA stratum specific differences. AS was well tolerated by infants and clinical caregivers. Commonest adverse events included surfactant reflux from nose and mouth (18%), desaturations (11%), and increased secretions (7%). CONCLUSIONS We have demonstrated the feasibility, absence of serious adverse events and short-term efficacy of four dosing schedules of AS in the largest Phase II clinical trial of PTIs 24-36 weeks' GA with RDS receiving NIRS (ClinicalTrials.gov NCT02294630). The commonest adverse events noted were surfactant reflux and desaturations; no serious adverse effects were observed. Infants who received AS were less likely to receive intubation within 72 h compared to historical controls. AS is a promising new therapy for PTIs with RDS.
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Affiliation(s)
- Beena G Sood
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Virginia Delaney-Black
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Yuemin Xin
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Amit Sharma
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Xinguang Chen
- Department of Epidemiology, University of Florida College of Medicine, 665 W 8th Street, Jacksonville, FL, 32209, USA
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Dubus JC, Becquemin MH, Vecellio L, Chaumuzeau JP, Reychler G. [Good practice for aerosol therapy by nebulization in 2020]. Rev Mal Respir 2020; 38:171-176. [PMID: 33288396 DOI: 10.1016/j.rmr.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
Nebulization is a drug delivery mode whose prescription and application remain uncertain. A guide to good practice has been proposed by the work group on aerosol therapy of the French Society for Respiratory Diseases, so-called GAT. The previous recommendations date from 2007. In addition to an update of data on nebulization, these expert recommendations aim to be of real help to the prescriber.
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Affiliation(s)
- J-C Dubus
- Pneumologie et allergologie pédiatrique, CHU Timone-Enfants, et Aix Marseille Université, IRD, MEPHI, IHU-Méditerranée Infection, Marseille, France.
| | - M-H Becquemin
- Hôpitaux universitaires Pitié-Salpétrière-Charles Foix, AP-HP, Paris, France
| | - L Vecellio
- Inserm, centre d'étude des pathologies respiratoires (CEPR), UMR 1100, université de Tours, Tours, France
| | | | - G Reychler
- Service de pneumologie, université catholique de Louvain, cliniques universitaires Saint-Luc, et institut de recherche expérimentale et clinique, Bruxelles, Belgique
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Ohar JA, Bauer A, Sharma S, Sanjar S. In Vitro Effect of Different Airflow Rates on the Aerosol Properties of Nebulized Glycopyrrolate in the eFlow® Closed System and Tiotropium Delivered in the HandiHaler®. Pulm Ther 2020; 6:289-301. [PMID: 32809156 PMCID: PMC7672140 DOI: 10.1007/s41030-020-00125-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Personalized therapy for patients with COPD requires appropriate choice of drug and delivery device. Inhalers and nebulizers vary in their drug delivery characteristics, particularly the need for passive or active patient inhalation for appropriate drug dispersal and delivery. In this in vitro analysis, we assessed the aerosol performance and drug delivery of two long-acting muscarinic antagonists, glycopyrrolate (GLY; 25 µg solution; 1 ml) and tiotropium (TIO; 18 µg powder) through their respective delivery systems: the eFlow® Closed System (CS) vibrating membrane nebulizer and the HandiHaler® dry-powder inhaler (DPI). METHODS The aerosol performances of the eFlow® CS nebulizer and the HandiHaler® were determined using the Next Generation cascade Impactor. The delivered dose of GLY and TIO was determined using different breathing patterns, which varied in tidal volume and peak inspiratory flow rate, respectively, to simulate breathing conditions ranging from normal to severe obstruction. RESULTS Aerodynamic particle analysis showed generally similar mass median aerodynamic diameter (MMAD, range, 3.6-4.6 µm) and fine particle fraction (FPF, range, 48.2%-63.7%) with GLY delivered using the eFlow® CS nebulizer under all breathing patterns tested. TIO, delivered via the HandiHaler®, showed variations in MMAD (range, 3.8-5.8 µm) and FPF (range, 16.1%-32.4%) under different inspiratory flow rates. The majority of GLY was deposited in stages 2-5 of the impactor, which corresponds with particle sizes in the respirable range (< 5 µm), whereas a large proportion of TIO was deposited in the throat/mouthpiece pre-separator, irrespective of test conditions. The median residual dose of GLY with eFlow® CS was notably lower compared to that of TIO with HandiHaler® (2.4%-4.4% vs. 40%-67%, respectively). CONCLUSIONS These simulation results highlight the different deposition patterns generated by a DPI device and a vibrating membrane nebulizer, which may help inform device selection and treatment decision in COPD management.
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Affiliation(s)
- Jill A Ohar
- Wake Forest University, Winston-Salem, NC, USA.
| | - Andrea Bauer
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Moghissi K, Dixon K, Gibbins S. Does PDT have potential in the treatment of COVID 19 patients? Photodiagnosis Photodyn Ther 2020; 31:101889. [PMID: 32592911 PMCID: PMC7313506 DOI: 10.1016/j.pdpdt.2020.101889] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Abstract
The corona virus pandemic has ignited a proliferation of research aimed at prevention of spread, early diagnosis and treatment. Coincidentally, in recent years the Yorkshire Laser Centre has been engaged in developing the methodology of applying PDT in chronic bronchiectasis. Our methodology is based on Methylene Blue (MB) mediated PDT used topically within the airway. The novelty of the method is the use of a nebulizer to deliver the photosensitizer. We suggest that our protocol and methodology could be modulated for use in respiratory infections of COVID -19.
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Affiliation(s)
- K Moghissi
- The Yorkshire Laser Centre, Goole & District Hospital, Goole, DN14 6RX, UK
| | - Kate Dixon
- The Yorkshire Laser Centre, Goole & District Hospital, Goole, DN14 6RX, UK.
| | - Sally Gibbins
- The Yorkshire Laser Centre, Goole & District Hospital, Goole, DN14 6RX, UK
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32
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Fieux M, Mélan JB, Hermann R, Truy E, Tringali S. The medical uses of manosonic nebulizers (AMSA®) in 2018. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:73-76. [PMID: 32674996 DOI: 10.1016/j.anorl.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of repeated application of manosonic nebulizers (AMSA®) is to ensure active Eustachian tube rehabilitation and optimal middle-ear drug diffusion. In response to recent changes in marketing authorizations issued by the French National Drug Safety Agency (ANSM), the present study investigated how AMSA® is used in the Auvergne-Rhône-Alpes Region of France. MATERIAL AND METHODS A prospective non-interventional regional 1-year survey was conducted in 701 general practitioners and community and hospital ENT physicians in the Auvergne-Rhône-Alpes Region, using a questionnaire sent by mail with a reminder at 2 months. Percentage responses were compared on Chi2 test with alpha risk of 5%. Non-respondents were excluded. ENDPOINTS The main endpoints were rate of AMSA® prescription, and prescription modalities in a specific geographical territory (Auvergne-Rhône-Alpes Region) in 2018. RESULTS 93% of the 114 respondents prescribed AMSA®, with 4,000 prescriptions in 1 year. 66.7% prescribed this treatment to avoid recourse to myringotomy. Mean treatment duration was 2 weeks (50.9% of respondents). The most frequent nebulized substance was saline serum (68.4% of respondents), sometimes associated to corticosteroids or mucolytics. CONCLUSION The majority of physicians in the Auvergne-Rhône-Alpes Region, and notably the ENT physicians, were AMSA® prescribers for the treatment of Eustachian tube dysfunction and its consequences. However, the duration and modalities of use of AMSA® were very heterogeneous, and further studies are needed to standardize prescription.
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Affiliation(s)
- M Fieux
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
| | - J-B Mélan
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - R Hermann
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - E Truy
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - S Tringali
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
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Savietto E, Marioni G, Maculan P, Pettorelli A, Scarpa B, Simoni E, Astolfi L, Marchese-Ragona R, Ottaviano G. Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study. Am J Otolaryngol 2020; 41:102502. [PMID: 32460989 DOI: 10.1016/j.amjoto.2020.102502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sodium hyaluronate has been proposed as a treatment for improving the symptoms of chronic rhinosinusitis. The present study evaluated the effect of the intranasal administration of hyaluronic acid in a group of patients affected by chronic rhinosinusitis without nasal polyps (CRSsNP). MATERIALS AND METHODS Thirty subjects aged 18-65 years affected by CRSsNP were enrolled. The subjects were randomly administered hyaluronic acid or isotonic saline solution by nasal nebulizer twice per day for 30 days. They were evaluated before (T0) and after the treatment (T1) with Sino-Nasal Outcome Test-22, visual analogue scale for rhinorrhea, nasal obstruction, facial pain and hyposmia/hypogeusia, nasal endoscopy, active anterior rhinomanometry, peak nasal inspiratory flow and nasal cytology. RESULTS Comparing the study and the control group, at T1 no significant differences were observed in both objective and subjective parameters. Being included in the study group rather than in the control group did not have a significant effect on the variation of the considered parameters between T0 and T1. Considering the effects of the micronized douches independently from the type of solution used (either hyaluronic acid or isotonic saline solution), although no difference emerged between study and control group for any of the objective parameters, there was an improvement of Sino-Nasal Outcome Test-22 scores (p = .0005), visual analogue scale for nasal obstruction (p = .0006) and for hyposmia/hypogeusia (p = .04). CONCLUSIONS The treatment with micronized nasal douches can improve the sino-nasal symptoms of CRSsNP, in particular nasal obstruction and olfactory ability. No advantage of the use of hyaluronic acid over isotonic saline solution emerged.
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Xu B, Gao H, Li D, Hu C, Yang J. Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial. PeerJ 2020; 8:e9247. [PMID: 32547872 PMCID: PMC7278887 DOI: 10.7717/peerj.9247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Dexmedetomidine (Dex), a selective a2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 µg/kg (Dex0.5 group), 1 µg/kg (Dex1 group) and 2 µg/kg (Dex2group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 µg/kg, 1 µg/kg and 2 µg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40–50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV15), after 30 and 60 min of OLV (OLV30and OLV60, respectively) and 15 min after reinstitution of TLV (ReTLV). Dynamic compliance was also calculated at TLV15, OLV30, OLV60 and ReTLV. Results Dex decreased the requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate (HR) and mean arterial pressure (MAP) displayed no significant difference among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex administered between 0.5 and 2 µg/kg increased partial pressure of oxygen (PaO2) significantly at OLV30 and OLV60(P = 0.000); however, Dex administered between 1 and 2 µg/kg decreased pulmonary shunt fraction (Qs/Qt) at OLV30 and OLV60(P = 0.000). Compared with the placebo group, there were significant increases with dynamic compliance (Cdyn) after OLV in Dex0.5, Dex1 and Dex2group(P = 0.000). Conclusions. Nebulized dexmedetomidine improved oxygenation not only by decreasing pulmonary shunt but also by improving lung compliance during OLV, which may be effective in managing OLV.
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Affiliation(s)
- Bo Xu
- The Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,The Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi, Jiangsu, China
| | - Hong Gao
- The Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi, Jiangsu, China
| | - Dan Li
- The Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi, Jiangsu, China
| | - Chunxiao Hu
- The Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi, Jiangsu, China
| | - Jianping Yang
- The Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Sorino C, Negri S, Spanevello A, Visca D, Scichilone N. Inhalation therapy devices for the treatment of obstructive lung diseases: the history of inhalers towards the ideal inhaler. Eur J Intern Med 2020; 75:15-18. [PMID: 32113944 DOI: 10.1016/j.ejim.2020.02.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 01/04/2023]
Abstract
Inhalation therapy allows conveying drugs directly into the airways. The devices used to administer inhaled drugs play a crucial role in the management of obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). To ensure high bronchial deposition of the drug, a device should deliver a high proportion of fine particles, be easy to use, and provide constant and accurate doses of the active substance. Nowadays, four different types of inhalers are widely used: nebulizers, dry powder inhalers (DPIs), pressurized metered-dose inhalers (pMDIs), and soft mist inhalers (SMIs). Nebulizers can be used by patients unable to use other inhalers. However, they require long times of administration and do not ensure precise dosages. The first pMDIs became popular since they were small, inexpensive, fast, and silent. Their performance was improved by spacers and then by new technologies which reduced the delivery speed. In DPIs, micronized drug particles are attached to larger lactose carrier particles. No coordination between actuation and inhalation is required. However, the patient is supposed to produce an adequate inspiratory flow to extract the drug and disaggregate it from the carrier. In SMIs, the medication is dissolved in an aqueous solution, without propellant, and it is dispensed as a slow aerosol cloud thanks to the energy of a spring. Smart inhalers, connected to smartphones, are promising tools that can provide information about patient's adherence and their inhaler technique. Inhalation has also been proposed as a route of administration for several systemic drugs.
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Affiliation(s)
- Claudio Sorino
- Division of Pulmonology, Sant'Anna Hospital, Como, Italy; University of Insubria, Faculty of Medicine and Surgery, Varese, Italy.
| | - Stefano Negri
- University of Insubria, Faculty of Medicine and Surgery, Varese, Italy
| | - Antonio Spanevello
- University of Insubria, Faculty of Medicine and Surgery, Varese, Italy; Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Dina Visca
- University of Insubria, Faculty of Medicine and Surgery, Varese, Italy; Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Nicola Scichilone
- Division of Respiratory Medicine, Department PROMISE, "Giaccone" University Hospital, University of Palermo, Italy
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Choe MSP, Lee MJ, Seo KS, Kam S, Kim KY, Je D, Kim SH, Nho WY, Park HI, Shin S, Ryoo HW. Application of calcium nebulization for mass exposure to an accidental hydrofluoric acid spill. Burns 2020; 46:1337-1346. [PMID: 32209280 DOI: 10.1016/j.burns.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF. METHODS This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals. RESULTS Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium-lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1-3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure. CONCLUSION Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.
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Affiliation(s)
- Michael Sung Pil Choe
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Kang Suk Seo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Sin Kam
- Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Keon Yeop Kim
- Department of Preventive Medicine and Public Health, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Dongwook Je
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Seong Hun Kim
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Woo Young Nho
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Hong In Park
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Sujeong Shin
- Department of Emergency Medicine, Gumi CHA Medical Center, CHA University, Gumi, Republic of Korea.
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Tabatabaii SA, Khanbabaee G, Sadr S, Farahbakhsh N, Aghdam MK, Lotfollahzadeh S, Hosseini A, Dara N, Nanbakhsh M, Gorji FA. Microbial contamination of home nebulizers in children with cystic fibrosis and clinical implication on the number of pulmonary exacerbations. BMC Pulm Med 2020; 20:33. [PMID: 32028925 PMCID: PMC7006379 DOI: 10.1186/s12890-020-1059-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early detection of pulmonary contamination in children with cystic fibrosis (CF) is essential since these children are vulnerable to Pseudomonas aeruginosa (P. aeruginosa) colonization. In Iran, home nebulization of antibiotics is a widespread practice in treatment for patients with CF and, to the best our knowledge, no bacteriological surveys have been conducted till date in this regard. METHOD This observational, cross sectional study was conducted on 61 children with CF at Mofid Children's Hospital, Tehran, from September 2017 to march 2018. The swab sampling was performed from 61 home nebulizers used by children diagnosed with CF. Contemporaneous sputum sample or deep nasopharyngeal swab was taken from each patient for bacterial and fungal testing. Medical records of the patients were reviewed and the number of exacerbations were recorded over the last 12 months prior to the study enrollment. RESULTS The results of study showed that, 43 (70.5%) nebulizers were contaminated; 31 (50.8%) mouthpieces, 21 (34.4%) reservoirs, and 11 (18%) connecting tubes. The most common organism to be isolated was P. aeruginosa and was recovered from 19 (31%) nebulizers, 16 of them belonged to patients chronically colonized with P. aeruginosa. The remaining three had at least one positive sputum culture for P. aeruginosa in the past 1 year before the study. There was a significant increase in the number of CF exacerbations with an average number of exacerbation being 1.5 ± 1(SD) over last 12 months in children who had pathogenic organisms recovered from their home nebulizers compared with 0.4 ± 0.7(SD) exacerbations per year in whom non-pathogenic organisms were isolated from their nebulizers (P < 0.001). CONCLUSION The majority of domiciliary nebulizers used by children with CF were contaminated with microorganisms indicating that the nebulizers may serve as potential reservoirs of pathogens for the patients' lung. Perpetuating colonization is a possible concern in the ones recently colonized with P. aeruginosa and, therefore, decontamination of nebulizer requires more attention to prevent ongoing infection. The negative impact of contamination of nebulizer on CF exacerbation requires serious attention and further investigations.
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Affiliation(s)
- Seyed Ahmad Tabatabaii
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghamartaj Khanbabaee
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Sadr
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Farahbakhsh
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Kazemi Aghdam
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saran Lotfollahzadeh
- Pediatric surgery Research Center, Research Institute for Children's Health, Shahid Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghi Dara
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nanbakhsh
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdollah Gorji
- Medical Research Development Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Leache L, Aquerreta I, Aldaz A, Monedero P, Idoate A, Ortega A. Effectiveness of adjunctive nebulized antibiotics in critically ill patients with respiratory tract infections. Eur J Clin Microbiol Infect Dis 2020; 39:361-8. [PMID: 31734797 DOI: 10.1007/s10096-019-03733-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/02/2019] [Indexed: 10/29/2022]
Abstract
The purpose of the study was to analyze the effectiveness of adding nebulized antibiotics to systemic antimicrobials in critically ill patients with respiratory tract infections (pneumonia or tracheobronchitis) and the effect on renal function. A retrospective observational cohort study including critically ill patients with respiratory tract infections during a 2-year period was conducted. Intervention group included patients that received nebulized and systemic antimicrobials. Patients in the control group received only systemic antimicrobials. Clinical resolution was the primary endpoint. Secondary outcomes included change in fever, inflammatory parameters, and creatinine clearance; length of hospital stay, systemic therapy, and mechanical ventilation; hospital readmission; and mortality. Regression models were performed to estimate the effect of nebulized antibiotics on outcome variables adjusted by potential confounders. A total of 136 patients were included (93 in control group and 43 in intervention group). The intervention group had higher odds of clinical resolution (adjusted odds ratio (OR): 7.1; 95% confidence interval (95% CI): 1.2, 43.3). Nebulized antibiotic therapy was independently associated with reduction in procalcitonin (adjusted OR: 12.4; 95% CI: 1.4, 109.7). There were no significant differences in the rest of the secondary outcomes or in creatinine clearance reduction. Adding nebulized antibiotics for the management of respiratory tract infections has a positive impact on clinical resolution without increasing the risk of renal toxicity.
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Plaza V, Giner J, Curto E, Alonso-Ortiz MB, Orue MI, Vega JM, Cosío BG. Assessing Adherence by Combining the Test of Adherence to Inhalers With Pharmacy Refill Records. J Investig Allergol Clin Immunol 2019; 31:58-64. [PMID: 31599726 DOI: 10.18176/jiaci.0461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Global Initiative for Asthma (GINA) recommends the concurrent use of self-report and pharmacy refill data to assess treatment adherence. However, clinical evidence to support this combined approach is limited. Objective: To determine nonadherence to inhaler medication based on a validated questionnaire (Test of Adherence to Inhalers; TAI) and prescription refill data in a community sample of patients with chronic obstructive pulmonary disease (COPD) or asthma. Secondarily, we sought to determine the degree of concordance between these two measures. METHODS Cross-sectional, observational multicenter study in patients with asthma or COPD. Sociodemographic and clinical data were obtained from clinical records. Refill data were retrieved from electronic pharmacy databases. Participants completed the 12-item TAI during a single visit as part of routine care. Nonadherence was defined as TAI <50 or <80% pharmacy refill rate (PRR) in the previous 6 months. RESULTS A total of 816 patients (mean age, 60) were included. Nonadherence rates were 58.1% (TAI) and 28.6% (PRR) compared with 64.6% for the combined data (P<.0001). Concordance between the 2 measures was weak (к=0.205). CONCLUSIONS These findings confirm the GINA recommendations, indicating that concomitant use of the TAI and pharmacy refill data identifies a higher percentage of nonadherent asthma or COPD patients than either instrument alone.
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Affiliation(s)
- V Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - J Giner
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - E Curto
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - M B Alonso-Ortiz
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - M I Orue
- Centro de Salud Javier Sáenz de Buruaga, Bilbao, Spain
| | - J M Vega
- Hospital Regional Universitario de Málaga, Malaga, Spain
| | - B G Cosío
- Hospital Universitario Espases-IdISBa and CIBERES, Mallorca, Spain
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Bianco F, Ricci F, Catozzi C, Murgia X, Schlun M, Bucholski A, Hetzer U, Bonelli S, Lombardini M, Pasini E, Nutini M, Pertile M, Minocchieri S, Simonato M, Rosa B, Pieraccini G, Moneti G, Lorenzini L, Catinella S, Villetti G, Civelli M, Pioselli B, Cogo P, Carnielli V, Dani C, Salomone F. From bench to bedside: in vitro and in vivo evaluation of a neonate-focused nebulized surfactant delivery strategy. Respir Res 2019; 20:134. [PMID: 31266508 PMCID: PMC6604359 DOI: 10.1186/s12931-019-1096-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/12/2019] [Indexed: 01/17/2023] Open
Abstract
Background Non-invasive delivery of nebulized surfactant has been a neonatology long-pursued goal. Nevertheless, the clinical efficacy of nebulized surfactant remains inconclusive, in part, due to the great technical challenges of depositing nebulized drugs in the lungs of preterm infants. The aim of this study was to investigate the feasibility of delivering nebulized surfactant (poractant alfa) in vitro and in vivo with an adapted, neonate-tailored aerosol delivery strategy. Methods Particle size distribution of undiluted poractant alfa aerosols generated by a customized eFlow-Neos nebulizer system was determined by laser diffraction. The theoretical nebulized surfactant lung dose was estimated in vitro in a clinical setting replica including a neonatal continuous positive airway pressure (CPAP) circuit, a cast of the upper airways of a preterm neonate, and a breath simulator programmed with the tidal breathing pattern of an infant with mild respiratory distress syndrome (RDS). A dose-response study with nebulized surfactant covering the 100–600 mg/kg nominal dose-range was conducted in RDS-modelling, lung-lavaged spontaneously-breathing rabbits managed with nasal CPAP. The effects of nebulized poractant alfa on arterial gas exchange and lung mechanics were assessed. Exogenous alveolar disaturated-phosphatidylcholine (DSPC) in the lungs was measured as a proxy of surfactant deposition efficacy. Results Laser diffraction studies demonstrated suitable aerosol characteristics for inhalation (mass median diameter, MMD = 3 μm). The mean surfactant lung dose determined in vitro was 13.7% ± 4.0 of the 200 mg/kg nominal dose. Nebulized surfactant delivered to spontaneously-breathing rabbits during nasal CPAP significantly improved arterial oxygenation compared to animals receiving CPAP only. Particularly, the groups of animals treated with 200 mg/kg and 400 mg/kg of nebulized poractant alfa achieved an equivalent pulmonary response in terms of oxygenation and lung mechanics as the group of animals treated with instilled surfactant (200 mg/kg). Conclusions The customized eFlow-Neos vibrating-membrane nebulizer system efficiently generated respirable aerosols of undiluted poractant alfa. Nebulized surfactant delivered at doses of 200 mg/kg and 400 mg/kg elicited a pulmonary response equivalent to that observed after treatment with an intratracheal surfactant bolus of 200 mg/kg. This bench-characterized nebulized surfactant delivery strategy is now under evaluation in Phase II clinical trial (EUDRACT No.:2016–004547-36). Electronic supplementary material The online version of this article (10.1186/s12931-019-1096-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - F Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - C Catozzi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - X Murgia
- Scientific Consultancy, Saarbrücken, Germany
| | - M Schlun
- PARI Pharma GmbH, Starnberg, Germany
| | | | - U Hetzer
- PARI Pharma GmbH, Starnberg, Germany
| | - S Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Lombardini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - E Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Nutini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Pertile
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - S Minocchieri
- Division of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M Simonato
- Pediatric Research Institute "Città della Speranza", Padova, Italy
| | - B Rosa
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Pieraccini
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - G Moneti
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - L Lorenzini
- Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy
| | - S Catinella
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Villetti
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Civelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - B Pioselli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - P Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - V Carnielli
- Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - C Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence School of Medicine, Careggi University Hospital of Florence, Viale Morgagni, 85, Florence, Italy.
| | - F Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
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Sood BG, Cortez J, Kolli M, Sharma A, Delaney-Black V, Chen X. Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study. Early Hum Dev 2019; 134:19-25. [PMID: 31121339 DOI: 10.1016/j.earlhumdev.2019.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Treating respiratory distress syndrome (RDS) with intratracheal surfactant requires endotracheal intubation and mechanical ventilation, (MV) with their attendant risks. Use of non-invasive respiratory support in the delivery room averts the need for MV but delays surfactant administration. OBJECTIVE We hypothesized that aerosolized surfactant is feasible and safe in infants 240/7-366/7 weeks gestational age (GA) with RDS, receiving non-invasive respiratory support. DESIGN/METHODS In an unblinded Phase I study, sequentially enrolled infants with RDS stratified by GA received increasing doses (100 or 200 mg/kg of phospholipid) and dilutions (12.5 or 8.3 mg/ml) of surfactant using a jet nebulizer. Infants were monitored clinically and with cerebral oximetry. RESULTS Seventeen infants were enrolled. Age at start of first dose and dose duration were 4.9 (3.4-10.1) and 2.1 (1.0-2.8) hours respectively. Two infants in the lowest GA stratum (240/7-286/7) required intubation within 2 h after the first dose. Fifteen infants completed the study; 13 received two doses. Infants tolerated the aerosol treatment well. No other significant adverse events were identified. Parental permission for cerebral oximetry was obtained in 16 infants. In the two infants who later exited the study, values prior to start of aerosolized surfactant were lower compared to 14 infants who completed the study (p = 0.0835), increased after start of study intervention (p = 0.0105) and decreased after intubation (p = 0.0003). CONCLUSIONS We have demonstrated the feasibility and safety of aerosolized surfactant in preterm infants receiving non-invasive respiratory support. The treatment was well tolerated by infants and clinical caregivers.
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Affiliation(s)
- Beena G Sood
- Children's Hospital of Michigan, 3901 Beaubien Blvd., Suite 3N027, Detroit, MI 48201, USA; Hutzel Women's Hospital, 3990 John R St, Detroit, MI 48201, USA; Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Josef Cortez
- Department of Pediatrics, University of Florida College of Medicine, 665 W 8th Street, Jacksonville, FL 32209, USA.
| | - Madhuri Kolli
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA
| | - Amit Sharma
- Children's Hospital of Michigan, 3901 Beaubien Blvd., Suite 3N027, Detroit, MI 48201, USA; Hutzel Women's Hospital, 3990 John R St, Detroit, MI 48201, USA; Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Virginia Delaney-Black
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Xinguang Chen
- University of Florida College of Medicine, College of Public Health, 2004 Mowray Road, Gainesville, FL 32610, USA.
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Leaker BR, Singh D, Nicholson GC, Hezelova B, Goodin T, Ozol-Godfrey A, Galluppi G, Barnes PJ. Evaluation of systemic absorption and bronchodilator effect of glycopyrronium bromide delivered by nebulizer or a dry powder inhaler in subjects with chronic obstructive pulmonary disease. Respir Res 2019; 20:132. [PMID: 31253162 DOI: 10.1186/s12931-019-1113-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023] Open
Abstract
Background Effective bronchodilator therapy depends upon adequate drug deposition in the lung. COPD patients who are unable to administer medications efficiently with conventional inhalers may benefit from the use of a nebulizer device. The aim of this study was to evaluate the systemic bioavailability and bronchodilator response of glycopyrronium bromide (GLY) administered by a novel nebulizer (eFlow® closed system [CS] vibrating membrane nebulizer) or dry powder inhaler (DPI) in subjects with moderate-to-severe chronic obstructive pulmonary disease (COPD). Methods In this randomized, open-label, single-dose, five-way crossover study, subjects received a sequence of either 50 μg GLY delivered by eFlow CS nebulizer (GLY/eFlow) or 63 μg GLY delivered by DPI (GLY/DPI), with and without activated charcoal, followed by intravenous infusion of 50 μg GLY with a washout period of 7 days between doses. Endpoints included plasma pharmacokinetics, safety and efficacy. Results The mean (± SD) baseline predicted forced expiratory volume in 1 s (FEV1) of the 30 subjects who completed the study was 51 ± 15%, with a FEV1/forced vital capacity ratio of 50 ± 11%. Without charcoal, the absolute systemic bioavailability of GLY/eFlow and GLY/DPI were approximately 15 and 22%, respectively. Changes from baseline in FEV1 at 60 min post-dose, without administration of charcoal, were 0.180 L and 0.220 L for GLY/eFlow and GLY/DPI, respectively; FEV1 improvements were similar when charcoal was administered (0.220 L for both GLY/eFlow and GLY/DPI). There were no significant differences in spirometry between the two devices. Fewer subjects administered GLY/eFlow reported adverse events (n = 15) than GLY/DPI (n = 18). Conclusions After single doses, GLY/DPI delivered numerically higher peak and steady state levels of drug than did GLY/eFlow. Nebulized GLY produced similar bronchodilation but lower systemic levels of drug than GLY/DPI. Slightly higher number of subjects reported adverse events with GLY/DPI than with GLY/eFlow. Nebulized GLY may offer an effective alternative to patients with COPD not adequately treated with other devices. Trial registration NCT02512302 (ClinicalTrials.gov). Registered 28 May 2015. Electronic supplementary material The online version of this article (10.1186/s12931-019-1113-z) contains supplementary material, which is available to authorized users.
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Frank E, Ishau S, Maier A, Reutman S, Reichard JF. An occupational exposure limit (OEL) approach to protect home healthcare workers exposed to common nebulized drugs. Regul Toxicol Pharmacol 2019; 106:251-261. [PMID: 31047944 DOI: 10.1016/j.yrtph.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022]
Abstract
Home healthcare is a growing area of employment. Assessment of occupational health risks to home health care workers (HHCWs) is important because in many cases the unique characteristics of the home environment do not facilitate the level of exposure control afforded to caregivers in hospitals and other fixed patient care sites. This assessment is focused on health risks to HHCWs from exposure to pharmaceutical drugs used to treat asthma and other respiratory diseases, which are commonly administered to patients in aerosolized form via nebulizers. We developed risk-based exposure limits for workers in the form of occupational exposure limits (OEL) values for exposure to nebulized forms of the three most common drugs administered by this method: albuterol, ipratropium, and budesonide. The derived OEL for albuterol was 2 μg/day, for ipratropium was 30 μg/day, and for budesonide was 11 μg/day. These OELs were derived based on human effect data and adjusted for pharmacokinetic variability and areas of uncertainty relevant to the underlying data (human and non-human) available for each drug. The resulting OEL values provide an input to the occupational risk assessment process to allow for comparisons to HHCW exposure that will guide risk management and exposure control decisions.
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Affiliation(s)
- Evan Frank
- University of Cincinnati, College of Medicine, Department of Environmental Health, USA
| | - Simileoluwa Ishau
- University of Cincinnati, College of Medicine, Department of Environmental Health, USA
| | - Andrew Maier
- University of Cincinnati, College of Medicine, Department of Environmental Health, and Cardno ChemRisk, USA
| | | | - John F Reichard
- University of Cincinnati, College of Medicine, Department of Environmental Health, USA.
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Sweeney L, McCloskey AP, Higgins G, Ramsey JM, Cryan SA, MacLoughlin R. Effective nebulization of interferon-γ using a novel vibrating mesh. Respir Res 2019; 20:66. [PMID: 30943978 PMCID: PMC6448243 DOI: 10.1186/s12931-019-1030-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interferon gamma (IFN-γ) is a clinically relevant immunomodulatory cytokine that has demonstrated significant potential in the treatment and management of respiratory diseases such as tuberculosis and pulmonary fibrosis. As with all large biomolecules, clinical translation is dependent on effective delivery to the disease site and delivery of IFN-γ as an aerosol offers a logical means of drug targeting. Effective localization is often hampered by instability and a lack of safe and efficient delivery systems. The present study sought to determine how effectively IFN-γ can be nebulized using two types of vibrating mesh nebulizer, each with differing mesh architectures, and to investigate the comparative efficiency of delivery of therapeutically active IFN-γ to the lungs. METHODS Nebulization of IFN-γ was carried out using two different Aerogen vibrating mesh technologies with differing mesh architectures. These technologies represent both a standard commercially available mesh type (Aerogen Solo®) and a new iteration mesh (Photo-defined aperture plate (PDAP®). Extensive aerosol studies (aerosol output and droplet analysis, non-invasive and invasive aerosol therapy) were conducted in line with regulatory requirements and characterization of the stability and bioactivity of the IFN-γ post-nebulization was confirmed using SDS-PAGE and stimulation of Human C-X-C motif chemokine 10 (CXCL 10) also known as IFN-γ-induced protein 10KDa (IP 10) expression from THP-1 derived macrophages (THP-1 cells). RESULTS Aerosol characterization studies indicated that a significant and reproducible dose of aerosolized IFN-γ can be delivered using both vibrating mesh technologies. Nebulization using both devices resulted in an emitted dose of at least 93% (100% dose minus residual volume) for IFN-γ. Characterization of aerosolized IFN-γ indicated that the PDAP was capable of generating droplets with a significantly lower mass median aerodynamic diameter (MMAD) with values of 2.79 ± 0.29 μm and 4.39 ± 0.25 μm for the PDAP and Solo respectively. The volume median diameters (VMD) of aerosolized IFN-γ corroborated this with VMDs of 2.33 ± 0.02 μm for the PDAP and 4.30 ± 0.02 μm for the Solo. SDS-PAGE gels indicated that IFN-γ remains stable after nebulization by both devices and this was confirmed by bioactivity studies using a THP-1 cell model in which an alveolar macrophage response to IFN-γ was determined. IFN-γ nebulized by the PDAP and Solo devices had no significant effect on the key inflammatory biomarker cytokine IP-10 release from this model in comparison to non-nebulized controls. Here we demonstrate that it is possible to combine IFN-γ with vibrating mesh nebulizer devices and facilitate effective aerosolisation with minimal impact on IFN-γ structure or bioactivity. CONCLUSIONS It is possible to nebulize IFN-γ effectively with vibrating mesh nebulizer devices without compromising its stability. The PDAP allows for generation of IFN-γ aerosols with improved aerodynamic properties thereby increasing its potential efficiency for lower respiratory tract deposition over current technology, whilst maintaining the integrity and bioactivity of IFN-γ. This delivery modality therefore offers a rational means of facilitating the clinical translation of inhaled IFN-γ.
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Affiliation(s)
- Louise Sweeney
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
- School of Pharmacy, RCSI, Dublin, Ireland
| | - Alice P. McCloskey
- School of Pharmacy, RCSI, Dublin, Ireland
- Tissue Engineering Research Group (TERG), RCSI, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM) NUIG & RCSI, Dublin, Ireland
| | - Gerard Higgins
- School of Pharmacy, RCSI, Dublin, Ireland
- Tissue Engineering Research Group (TERG), RCSI, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM) NUIG & RCSI, Dublin, Ireland
| | - Joanne M. Ramsey
- School of Pharmacy, RCSI, Dublin, Ireland
- Tissue Engineering Research Group (TERG), RCSI, Dublin, Ireland
| | - Sally-Ann Cryan
- School of Pharmacy, RCSI, Dublin, Ireland
- Tissue Engineering Research Group (TERG), RCSI, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), TCD, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM) NUIG & RCSI, Dublin, Ireland
| | - Ronan MacLoughlin
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
- School of Pharmacy, RCSI, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM) NUIG & RCSI, Dublin, Ireland
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Lee JH, Jung JY, Lee HJ, Kim DK, Kwak YH, Chang I, Kwon H, Choi YJ, Park JW, Paek SH, Cho JH. Efficacy of low-dose nebulized epinephrine as treatment for croup: A randomized, placebo-controlled, double-blind trial. Am J Emerg Med 2019; 37:2171-2176. [PMID: 30878411 DOI: 10.1016/j.ajem.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Croup treatment usually involves a single dose of systemic dexamethasone combined with nebulized epinephrine. However, the optimal dose of l-epinephrine remains unclear. We examined whether a low dose (0.1 mg/kg) was inferior to the conventional dose (0.5 mg/kg) of 1:1000 nebulized l-epinephrine in patients with moderate to severe croup. METHODS This randomized double-blind clinical non-inferiority trial was conducted in three pediatric emergency departments from May 2015 to October 2017. Children 6 months to 5 years old with moderate to severe croup (Westley scale scores 3-11) were eligible. Subjects were randomly assigned to the conventional dose (0.5 mg/kg: maximum 5 mg) or low dose (0.1 mg/kg; maximum 1 mg) group. All subjects received 0.6 mg/kg dexamethasone. Croup scores and other vital signs were measured before and at 30, 60, 90, and 120 min after nebulized l-epinephrine administration. The primary outcome was the change in croup score after 30 min. RESULTS The final analysis included 84 patients. The groups did not differ significantly in terms of demographic parameters. At 30 min after treatment with nebulized l-epinephrine, the croup scores in both groups were significantly reduced from the baseline values (p < 0.05) and did not differ between the two groups (p = 0.42). Neither blood pressure nor heart rate differed between the two groups. CONCLUSIONS Low-dose 1:1000 l-epinephrine was not inferior in croup score reduction to the conventional dose in patients with moderate to severe croup. Clinical trial No: NCT01664507, KCT0002318.
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Affiliation(s)
- Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea; School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, Soon Chun Hyang University Hospital, Cheonan, Republic of Korea.
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ikwan Chang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Jun Hwi Cho
- School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea; Department of Emergency Medicine, Institute of Medical Sciences, Kangwon National University Hospital, Chuncheon, Gangwon-do, Republic of Korea.
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Senthilkumaran S, Jena NN, Balamurugan N, Florence B, Thirumalaikolundusubramanian P. Anisocoria: Realities, Recognition, and Remedial Aspects. Indian J Crit Care Med 2019; 23:543. [PMID: 31911751 PMCID: PMC6900890 DOI: 10.5005/jp-journals-10071-23279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The realities, recognition, and remedial aspects of anisocoria at the bedside were highlighted by Adhikari et al.,1 which is almost similar to an earlier report from India.2 Since this condition involves patient safety and clinical assessment, we would like to touch upon 3 Ps (physiological, pathological, and pharmacological) of anisocoria. First and foremost is to elicit a thorough clinical history and then to assess the case in detail which not only rules out injuries, infections, instillation, or ingestion of medicines and instigating mechanisms but also helps rule out various other life-threatening conditions.
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Affiliation(s)
| | - Narendra N Jena
- Department of Emergency Medicine, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | | | - Benita Florence
- Department of Emergency Medicine, Dr Moopen's Wayanad Institute of Medical Sciences, Meppadi, Kerala, India
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Mohammadian M, Pourmehran O. CFPD simulation of magnetic drug delivery to a human lung using an SAW nebulizer. Biomech Model Mechanobiol 2018; 18:547-562. [PMID: 30506148 DOI: 10.1007/s10237-018-1101-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Targeted drug delivery is an impressive topic that attracted the attention of many scientists in various scientific communities. Magnetic drug targeting is one of the targeted drug delivery techniques, which uses the magnetic field to externally control the magnetic drug particles. In this study, we aim to assess the magnetic drug delivery to the human respiratory system using a new aerosolization technique driven by surface acoustic waves (SAWs) into a realistic lung model geometrically reconstructed using computed tomography scan images. To achieve this aim, a simulation study using computational fluid-particle dynamics considering the Lagrangian approach for particle tracking is carried out. An external magnetic field was applied to govern the Magnetit (Fe3O4) particles as the magnetic drug career. The drug particles were assumed to be spherical and inert. The effects of magnetic field intensity, magnetic source position, and SAW injection position were examined for a light breathing condition (Q = 15 L/min). Given the realistic geometry of the respiratory system and its complexity, the airflow patterns vary as it penetrates deeper into the lung and experiences many irregularities, and bending deflections exist in the airways model. High-inertia particles tend to deposit at locations where the geometry experiences a significant reduction in cross section. Our results show that the magnetic field highly affects the particle deposition efficiency for fourfold. However, the magnet and SAW injection positions have a low impact on the deposition efficiency of drug particles.
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Affiliation(s)
- M Mohammadian
- Department of Mechanical Engineering, Kordkuy Center, Gorgan Branch, Islamic Azad University, Kordkuy, Iran.
| | - O Pourmehran
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia.
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Lin Y, Chang RYK, Britton WJ, Morales S, Kutter E, Chan HK. Synergy of nebulized phage PEV20 and ciprofloxacin combination against Pseudomonas aeruginosa. Int J Pharm 2018; 551:158-65. [PMID: 30223075 DOI: 10.1016/j.ijpharm.2018.09.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 01/09/2023]
Abstract
Nebulization is currently used for delivery of antibiotics for respiratory infections. Bacteriophages (or phages) are effective predators of pathogens including Pseudomonas aeruginosa commonly found in the lungs of patients with cystic fibrosis (CF). It is known that phages and antibiotics can potentially show synergistic antimicrobial effect on bacterial killing. In the present study, we investigated synergistic antimicrobial effect of phage PEV20 with five different antibiotics against three P. aeruginosa strains isolated from sputum of CF patients. The antibiotics included ciprofloxacin, tobramycin, colistin, aztreonam and amikacin, which are approved by U.S Food and Drug Administration (FDA) for inhaled administration. Phage and antibiotic synergy was determined by assessing bacterial killing performing time-kill studies. Among the different phage-antibiotic combinations, PEV20 and ciprofloxacin exhibited the most synergistic effect. Two phage-ciprofloxacin combinations, containing 1/4 and 1/2 of the minimum inhibitory concentration (MIC) of ciprofloxacin against P. aeruginosa strains FADD1-PA001 (A) and JIP865, respectively were aerosolized using both air-jet and vibrating mesh nebulizers and the synergistic antibacterial activity was maintained after nebulization. Air-jet nebulizer generated droplets with smaller volume median diameters (3.6-3.7 µm) and slightly larger span (2.3-2.4) than vibrating mesh nebulizers (5.1-5.3 µm; 2.1-2.2), achieving a higher fine particle fraction (FPF) of 70%. In conclusion, nebulized phage PEV20 and ciprofloxacin combination shows promising antimicrobial and aerosol characteristics for potential treatment of respiratory tract infections caused by drug-resistant P. aeruginosa.
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Abstract
Pulmonary diseases frequently involve imbalances in immunity. The inability to control bacteria in tuberculosis is a failed response to a pathogen. Idiopathic pulmonary fibrosis (IPF), a progressive fibrotic lung disease, can lead to respiratory failure and death within 3 years of diagnosis. Chronic obstructive pulmonary disease (COPD) progresses until death and in recent years has been labeled an autoimmune disease. Proposed mechanistic pathways of pathophysiology involve uncontrolled healing governed by pro-fibrotic cytokines that are unresponsive to the standard anti-inflammatory agents (e.g., corticosteroids). Interferon-γ (IFN-γ), currently delivered as a subcutaneous injection for chronic granulomatous disease and osteopetrosis, is a cytokine that can stimulate macrophage function and inhibit fibrotic pathways. In recent studies, our group has repurposed IFN-γ as an inhaled aerosol, targeted directly to the lung to treat a host of diseases affected by dysregulated immunity. At present, we have studied its potential in treating tuberculosis and IPF. In a controlled clinical trial in tuberculosis, inhaled IFN-γ was effective while parenteral IFN-γ was not, indicating that macrophages can be effectively immune-stimulated by aerosol therapy. A similar approach has been taken in IPF. In a two-year safety study treating patients with IPF, the drug was safe and the pretreatment decline in pulmonary function was reversed. Furthermore, the same fibrotic pathways active in the lung parenchyma in IPF may be at fault in the airways of COPD patients. These experiences warrant the continued evaluation of inhaled IFN-γ in human clinical trials.
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Affiliation(s)
- Gerald C Smaldone
- Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, State University of New York at Stony Brook, 101 Nicolls Rd, HSC T-17-040, Stony Brook, NY 11794-8172, United States.
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Pizzulli A, Perna S, Bennewiz A, Roeblitz H, Tripodi S, Florack J, Wagner P, Hofmaier S, Matricardi PM. The impact of nasal aspiration with an automatic device on upper and lower respiratory symptoms in wheezing children: a pilot case-control study. Ital J Pediatr 2018; 44:68. [PMID: 29898751 PMCID: PMC6001015 DOI: 10.1186/s13052-018-0489-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background The impact of proper aspiration of nasal secretions during upper respiratory infection on the frequency and severity of symptoms of lower airways has never been investigated. The study was aimed at testing if cleaning the nasal cavities of children with recurrent wheezing using an automatic nasal aspirator improves the upper and lower respiratory symptoms during the cold season. Methods Parents of wheezing children (age 3-72 mo.) answered questionnaires and learned using a nebulizer equipped (cases) or not equipped (controls) with an automatic nasal aspirator (DuoBaby, OMRON, Japan). During a 90-days monitoring period parents filled an electronic diary (BreathMonitor, TPS, Rome, Italy) on their child’s symptoms of the upper and lower airways. Results Eighty-nine/91 patients (43 cases, 46 controls) completed the study. Less days with upper (25.0% vs 46.4%, p = 0.004) or lower (21.8% vs 32.8%, p = 0.022) airways symptoms and less days with salbutamol inhalation (12.2% vs 16.9%, p < 0.001) were reported by cases than by controls. The episodes of upper respiratory symptoms were shorter [4.3 days (95%CI:3.8–4.9) vs 5.7 days (95%CI:5.0–6.4), p = 0.007] but not less frequent [2.3 (95%CI: 1.8–2.8) vs 2.6 (95%CI:2.2–3.0), p = 0.122] among cases than among controls. Similarly, the episodes of lower respiratory symptoms tended to be shorter [3.8 days, (95%CI: 3.4–4.2) vs 4.4 days, (95%CI: 4.4–6.0), p = 0.067] but not less frequent [1.9 (95%CI:1.5–2.3) vs 2.1 (95%CI:1.7–2.4), p = 0.240] among the group using the nasal aspirator. Conclusions In our pilot study, the use of an automatic nasal aspirator in children with a history of recurrent wheezing was associated with an improved respiratory health during the cold season. Electronic supplementary material The online version of this article (10.1186/s13052-018-0489-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Serena Perna
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine Berlin, Augustenburger Platz, 1, 13353, Berlin, Germany
| | - Anja Bennewiz
- Practice for General Pediatrics and Pediatric Cardiology, Berlin, Germany
| | - Holger Roeblitz
- Practice for General Pediatrics and Pediatric Allergy, Berlin, Germany
| | - Salvatore Tripodi
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Jakob Florack
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine Berlin, Augustenburger Platz, 1, 13353, Berlin, Germany
| | - Petra Wagner
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine Berlin, Augustenburger Platz, 1, 13353, Berlin, Germany
| | - Stephanie Hofmaier
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine Berlin, Augustenburger Platz, 1, 13353, Berlin, Germany
| | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - University Medicine Berlin, Augustenburger Platz, 1, 13353, Berlin, Germany.
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