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Adetona AM, Adetona O, Chartier RT, Paulsen MH, Simpson CD, Rathbun SL, Naeher LP. Differences in Fine Particle Exposure and Estimated Pulmonary Ventilation Rate with Respect to Work Tasks of Wildland Firefighters at Prescribed Burns: A Repeated Measures Study. Ann Work Expo Health 2022; 66:985-997. [PMID: 35652799 PMCID: PMC9551324 DOI: 10.1093/annweh/wxac037] [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: 05/22/2021] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Wildland firefighters (WLFFs) are exposed to a mixture of chemicals found in wildland fire smoke and emissions from nonwildland-fuel smoke sources such as diesel. We investigated compositional differences in exposure to particulate matter and explored differences in ventilation rate and potential inhaled dose relative to the work tasks of WLFFs. Repeated measures on ten professional and two volunteer firefighters were collected on prescribed burn and nonburn days. Personal monitoring consisted of real-time and gravimetric fine particulate matter (PM2.5), carbon monoxide (CO), and accelerometer measurements to estimate ventilation rate and potential dose of PM2.5. The fine particulate matter was analyzed for levoglucosan (LG) and light absorbing carbon as a surrogate for black carbon (BC). Breathing zone personal exposure concentrations of PM2.5, LG, BC, and CO were higher on burn days (P < 0.05). Differences in exposure concentrations were observed between burn day tasks (P < 0.05) with firefighters managing fire boundaries (holders) being exposed to higher CO and LG concentrations and less BC concentrations than those conducting lighting (lighters). While no statistical difference in PM2.5 exposure measures was observed between the two tasks, holders in the study tended to be exposed to higher PM2.5 concentrations (~1.4×), while lighters tended to have more inhaled amounts of PM2.5 (~1.3×). Our findings demonstrate possible diversity in the sources of particulate matter exposure at the fireline and suggest the potential importance of using dose as a metric of inhalation exposure in occupational or other settings.
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Affiliation(s)
- Anna M Adetona
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
| | - Olorunfemi Adetona
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - Michael H Paulsen
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christopher D Simpson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Stephen L Rathbun
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA, USA
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Perry MR, Neal M, Hawks R, Pressburger D, Satola J, Triplett C, Reed B, Andrews M, Harvilchuck JA, Nealy MS, Platoff GE, Yeung DT. A novel sulfur mustard (HD) vapor inhalation exposure model of pulmonary toxicity for the efficacy evaluation of candidate medical countermeasures. Inhal Toxicol 2021; 33:221-233. [PMID: 34396872 DOI: 10.1080/08958378.2021.1951401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/20/2022]
Abstract
OBJECTIVE To develop a novel inhalation exposure system capable of delivering a controlled inhaled HD dose through an endotracheal tube to anesthetized rats to investigate the lung pathophysiology and evaluate potential medical countermeasures. MATERIALS AND METHODS Target HD vapor exposures were generated by a temperature-controlled vapor generator, while concentration was monitored near real-time by gas chromatography. Animal breathing parameters were monitored real-time by in-line EMKA/SciReq pulmonary analysis system. Individual exposures were halted when the target inhaled doses were achieved. Animals were observed daily for clinical observations and lethality with scheduled termination at 28 days post-exposure. Upon scheduled or unscheduled death, animals underwent a gross necropsy and lung and trachea were collected for histopathology. RESULTS Controlled HD concentrations ranged from 60 to 320 mg/m3. Delivered inhaled doses range from 0.3 to 3.20 mg/kg with administered doses within 3% of the target. The 28-day inhaled LD50 is 0.80 mg/kg (95% CI = 0.42-1.18 mg/kg). Post exposure respiratory abnormalities were observed across all dose levels though the higher dose levels had earlier onset and higher frequency of occurrence. Histopathologic alterations were not qualitatively altered in accordance with dose but instead showed a relationship to an animals' time of death, with early deaths demonstrating acute damage and later deaths displaying signs of repair. DISCUSSION/CONCLUSION This novel exposure system administers targeted HD inhaled doses to generate a small animal model that can be used to evaluate physiological toxicities of inhaled HD on the lungs and for evaluation of potential medical countermeasure treatments.
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Affiliation(s)
| | - Matthew Neal
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Roger Hawks
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | | | - Jan Satola
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Cheryl Triplett
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | - Beth Reed
- Biomedical Research Center, Battelle, West Jefferson, OH, USA
| | | | | | - Michael S Nealy
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Gennady E Platoff
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - David T Yeung
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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Hussein T, Löndahl J, Thuresson S, Alsved M, Al-Hunaiti A, Saksela K, Aqel H, Junninen H, Mahura A, Kulmala M. Indoor Model Simulation for COVID-19 Transport and Exposure. Int J Environ Res Public Health 2021; 18:2927. [PMID: 33809366 PMCID: PMC7999367 DOI: 10.3390/ijerph18062927] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
Transmission of respiratory viruses is a complex process involving emission, deposition in the airways, and infection. Inhalation is often the most relevant transmission mode in indoor environments. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the risk of inhalation transmission is not yet fully understood. Here, we used an indoor aerosol model combined with a regional inhaled deposited dose model to examine the indoor transport of aerosols from an infected person with novel coronavirus disease (COVID-19) to a susceptible person and assess the potential inhaled dose rate of particles. Two scenarios with different ventilation rates were compared, as well as adult female versus male recipients. Assuming a source strength of 10 viruses/s, in a tightly closed room with poor ventilation (0.5 h-1), the respiratory tract deposited dose rate was 140-350 and 100-260 inhaled viruses/hour for males and females; respectively. With ventilation at 3 h-1 the dose rate was only 30-90 viruses/hour. Correcting for the half-life of SARS-CoV-2 in air, these numbers are reduced by a factor of 1.2-2.2 for poorly ventilated rooms and 1.1-1.4 for well-ventilated rooms. Combined with future determinations of virus emission rates, the size distribution of aerosols containing the virus, and the infectious dose, these results could play an important role in understanding the full picture of potential inhalation transmission in indoor environments.
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Affiliation(s)
- Tareq Hussein
- Department of Physics, The University of Jordan, Amman 11942, Jordan
- Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, FI-00014 Helsinki, Finland; (A.M.); (M.K.)
| | - Jakob Löndahl
- Department of Design Sciences, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden; (J.L.); (S.T.); (M.A.)
| | - Sara Thuresson
- Department of Design Sciences, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden; (J.L.); (S.T.); (M.A.)
| | - Malin Alsved
- Department of Design Sciences, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden; (J.L.); (S.T.); (M.A.)
| | - Afnan Al-Hunaiti
- Department of Chemistry, School of Science, University of Jordan, Amman 11942, Jordan;
| | - Kalle Saksela
- Department of Virology, Helsinki University Hospital, University of Helsinki, FI-00014 Helsinki, Finland;
| | - Hazem Aqel
- Department of Clinical Laboratory Sciences, Collage of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia;
| | - Heikki Junninen
- Institute of Physics, Faculty of Science and Technology, University of Tartu, 51005 Tartu, Estonia;
| | - Alexander Mahura
- Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, FI-00014 Helsinki, Finland; (A.M.); (M.K.)
| | - Markku Kulmala
- Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, FI-00014 Helsinki, Finland; (A.M.); (M.K.)
- Joint International Research Laboratory of Atmospheric and Earth System Sciences, School of Atmospheric Sciences, Nanjing University, Nanjing 210023, China
- Aerosol and Haze Laboratory, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
- Faculty of Geography, Lomonosov Moscow State University, 119991 Moscow, Russia
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Lin HL, Chen CS, Fink JB, Lee GH, Huang CW, Chen JC, Chiang ZY. In Vitro Evaluation of a Vibrating-Mesh Nebulizer Repeatedly Use over 28 Days. Pharmaceutics 2020; 12:pharmaceutics12100971. [PMID: 33076232 PMCID: PMC7602390 DOI: 10.3390/pharmaceutics12100971] [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: 09/07/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
This in vitro study evaluates the performance of a disposable vibrating-mesh nebulizer when used for 28 days. A lung model was used to simulate the breathing pattern of an adult with chronic obstructive pulmonary disease. The vibrating-mesh nebulizer was used for three treatments/day over 28 days without cleaning after each test. Results showed that the inhaled drug dose was similar during four weeks of use (p = 0.157), with 16.73 ± 4.46% at baseline and 15.29 ± 2.45%, 16.21 ± 2.21%, 17.56 ± 1.98%, and 17.13 ± 1.81%, after the first, second, third, and fourth weeks, respectively. The particle size distribution, residual drug volume, and nebulization time remained similar across four weeks of use (p = 0.110, p = 0.763, and p = 0.573, respectively). Mesh was inspected using optical microscopy and showed that approximately 50% of mesh pores were obscured after 84 runs, and light penetration through the aperture plate was significantly reduced after the 21st use (p < 0.001) with no correlation to nebulizer performance. We conclude that the vibrating-mesh nebulizer delivered doses of salbutamol solution effectively over four weeks without cleaning after each use even though the patency and clarity of the aperture plate were reduced by the first week of use.
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Affiliation(s)
- Hui-Ling Lin
- Department of Respiratory Therapy, Collage of Medicine, Chang Gung University, Taoyuan 33301, Taiwan; (G.-H.L.); (C.-W.H.); (J.-C.C.); (Z.Y.C.)
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chiayi 61301, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61301, Taiwan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 30013, Taiwan;
- Correspondence:
| | - Chi-Shuo Chen
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 30013, Taiwan;
| | - James B. Fink
- Aerogen Pharma Corp., San Mateo, CA 94043, USA;
- Department of Respiratory Care, University of Texas, Round Rock, TX 78665, USA
| | - Guo-Hao Lee
- Department of Respiratory Therapy, Collage of Medicine, Chang Gung University, Taoyuan 33301, Taiwan; (G.-H.L.); (C.-W.H.); (J.-C.C.); (Z.Y.C.)
| | - Chun-Wei Huang
- Department of Respiratory Therapy, Collage of Medicine, Chang Gung University, Taoyuan 33301, Taiwan; (G.-H.L.); (C.-W.H.); (J.-C.C.); (Z.Y.C.)
| | - Jui-Chi Chen
- Department of Respiratory Therapy, Collage of Medicine, Chang Gung University, Taoyuan 33301, Taiwan; (G.-H.L.); (C.-W.H.); (J.-C.C.); (Z.Y.C.)
| | - Zi Yi Chiang
- Department of Respiratory Therapy, Collage of Medicine, Chang Gung University, Taoyuan 33301, Taiwan; (G.-H.L.); (C.-W.H.); (J.-C.C.); (Z.Y.C.)
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Borghi F, Spinazzè A, Fanti G, Campagnolo D, Rovelli S, Keller M, Cattaneo A, Cavallo DM. Commuters' Personal Exposure Assessment and Evaluation of Inhaled Dose to Different Atmospheric Pollutants. Int J Environ Res Public Health 2020; 17:E3357. [PMID: 32408600 DOI: 10.3390/ijerph17103357] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
Abstract
Several studies evaluating exposure to pollutants in microenvironments (MEs) are available in the scientific literature, but studies that evaluate the inhaled doses of pollutants are few in number. Therefore, this study aimed to evaluate the exposure of commuters to different pollutants (i.e., nitrogen dioxide [NO2] and fractionated particulate matter [PM], including ultrafine particles [UFPs]) using miniaturized and portable real-time monitoring instruments in selected MEs; the inhaled doses of these pollutants were estimated for each of these MEs. Measurements were performed along a typical commute, considering different traffic and nontraffic MEs. Experimental data were collected over four working weeks in two different seasons (winter and summer). Different portable and miniaturized instruments were used to evaluate PM and NO2 exposure. Furthermore, physiological parameters were evaluated using a heart rate monitor. The principal results show that higher exposure levels were measured in Underground (for all PM fractions and NO2) and in Car (UFP), while lower levels were measured in Car (PM and NO2) and in Train (UFP). In contrast, higher values of the inhaled cumulative dose were estimated in environments defined as Other, followed by Walking (ht), while lower values were observed in Walking (lt) and in Car.
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Fang TP, Chen YJ, Yang TM, Wang SH, Hung MS, Chiu SH, Li HH, Fink JB, Lin HL. Optimal Connection for Tiotropium SMI Delivery through Mechanical Ventilation: An In Vitro Study. Pharmaceutics 2020; 12:E291. [PMID: 32213833 DOI: 10.3390/pharmaceutics12030291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/01/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/26/2023] Open
Abstract
We aimed to quantify Soft Mist Inhalers (SMI) delivery to spontaneous breathing model and compare with different adapters via endotracheal tube during mechanical ventilation or by manual resuscitation. A tiotropium SMI was used with a commercial in-line adapter and a T-adapter placed between the Y-adapter and the inspiratory limb of the ventilator circuit during mechanical ventilation. The SMI was actuated at the beginning of inspiration and expiration. In separate experiments, a manual resuscitator with T-adapter was attached to endotracheal tube, collecting filter, and a passive test lung. Drug was eluted from collecting filters with salt-based solvent and analyzed using high-performance liquid chromatography. Results showed the percent of SMI label dose inhaled was 3-fold higher with the commercial in-line adapter with actuation during expiration than when synchronized with inspiration. SMI with T-adapter delivery via ventilator was similar to inhalation (1.20%) or exhalation (1.02%), and both had lower delivery dose than with manual resuscitator (2.80%; p = 0.01). The inhaled dose via endotracheal tube was much lower than inhaled dose with spontaneous breathing (22.08%). In conclusion, the inhaled dose with the commercial adapter was higher with SMI actuated during expiration, but still far less than reported spontaneous inhaled dose.
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Ke WR, Wang WJ, Lin TH, Wu CL, Huang SH, Wu HD, Chen CC. In Vitro Evaluation of Aerosol Performance and Delivery Efficiency During Mechanical Ventilation Between Soft Mist Inhaler and Pressurized Metered-Dose Inhaler. Respir Care 2020; 65:1001-1010. [PMID: 32071134 DOI: 10.4187/respcare.06993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/05/2022]
Abstract
BACKGROUND Soft mist inhalers (SMIs) generate aerosols with a smaller particle size than pressurized metered-dose inhalers (pMDIs). However, the whole-span particle size distribution (PSD) of SMIs and the optimal delivery method of SMIs during mechanical ventilation have not been fully investigated. This study aimed to measure the PSD of the SMI alone and the SMI coupled to an inhalation aid (eg, a spacer, a valved holding chamber), as well as the delivery efficiency of SMI in different actuation timings and circuit positions during mechanical ventilation. As a suitable comparison, the pMDI was chosen for the same measurement. METHODS SMIs (2.5 μg/actuation of tiotropium) were compared with pMDIs (100 μg/actuation of salbutamol). A microorifice uniform deposit impactor was utilized for the particle sizing of drug aerosols generated by inhalers alone, inhalers with a spacer, and inhalers with a valved holding chamber. To optimize the delivery efficiency of both inhalers during mechanical ventilation, the operating parameters included the circuit positions and actuation timings in the ventilator circuit. Particle sizes and inhaled doses were measured with an optical particle sizer and filters used to collect and quantify the drug, respectively. RESULTS The SMI generated a smaller mass medium aerodynamic diameter (MMAD) than that from the pMDI. The extrafine-particle fraction (EFPF, < 1 μm) of the SMI was significantly higher than that of the pMDI. With the use of either inhalation aid, the MMAD of both inhalers decreased, and both inhalers with inhalation aid showed significant increases in EFPF. During mechanical ventilation, the optimum way to deliver the SMI and pMDI was at 15 cm from the Y-piece and actuated at the end of expiration and the onset of inspiration, respectively. CONCLUSIONS The SMI with an inhalation aid showed marginal improvement on the PSD. The inhaler type, actuation timing, and position within the circuit also played important roles in delivery efficiency during mechanical ventilation.
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Affiliation(s)
- Wei-Ren Ke
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Wei-Jhen Wang
- Department of Respiratory Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hsuan Lin
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Ling Wu
- Department of Respiratory Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Hsiu Huang
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Huey-Dong Wu
- Department of Respiratory Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chieh Chen
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
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Brągoszewska E. The Dose of Fungal Aerosol Inhaled by Workers in a Waste-Sorting Plant in Poland: A Case Study. Int J Environ Res Public Health 2019; 17:E177. [PMID: 31881797 DOI: 10.3390/ijerph17010177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 12/13/2022]
Abstract
Bioaerosol monitoring is a rapidly emerging area in the context of work environments because microbial pollution is a key element of indoor air pollution and plays an important role in certain infectious diseases and allergies. However, as yet, relatively little is known about inhaled doses of microorganisms in workplaces. Today, the important issue of social concern is due to waste management, transport, sorting, and processing of wastes and their environmental impact and effects on public health. In fact, waste management activities can have numerous adverse effects on human wellbeing. Health effects are generally linked to exposure (EX), defined as the concentration of a contaminant and the length of time a person is exposed to this concentration. Dose is an effective tool for evaluating the quantity of a contaminant that actually crosses the body’s boundaries and influences the goal tissue. This document presents an analysis of the fungal waste-sorting plant EX dose (FWSPED) inhaled by workers in a waste-sorting plant (WSP) in Poland in March 2019. The main purpose of this research was to assess FWSPED inhaled by workers in two cabins at the WSP: the preliminary manual sorting cabin (PSP) and the purification manual sorting cabin (quality control; QSP). It was found that the FWSPED inhaled by workers was 193 CFU/kg in the PSP and 185 CFU/kg in the QSP. Fungal particles were quantitatively evaluated and qualitatively identified by the GEN III Biolog system. During the research, it was found that isolates belonging to the Aspergilus flavus and Penicillum chrysogenum strains were detected most frequently in the WSP. The total elimination of many anthropogenic sources is not possible, but the important findings of this research can be used to develop realistic management policies and methods to improve the biological air quality of WSPs for effective protection of WSP workers.
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Li J, Elshafei AA, Gong L, Fink JB. Aerosol Delivery During Continuous High Frequency Oscillation for Simulated Adults During Quiet and Distressed Spontaneous Breathing. Respir Care 2019; 65:227-232. [PMID: 31575710 PMCID: PMC10044211 DOI: 10.4187/respcare.07050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Continuous high-frequency oscillation (CHFO) is a therapeutic mode for the mobilization of secretions. The Metaneb CHFO device also incorporates aerosol administration using an integrated jet nebulizer. However, the effectiveness of aerosol delivery and influential factors remain largely unreported. METHODS A collecting filter was placed between an adult manikin with a representative upper airway and a breath simulator, set to simulate quiet and distressed patterns of spontaneous adult breathing. The Metaneb CHFO device was attached to the manikin via a mask. Two jet nebulizers were tested in 2 different positions: placement in the manifold and placement between manifold and mask. A vibrating mesh nebulizer was placed between the manifold and mask with and without extension tubing. Aerosol administration was compared during CHFO and during nebulization mode alone. Albuterol (2.5 mg in 3 mL) was nebulized for each condition. The drug was eluted from the filter and assayed with ultraviolet spectrophotometry (276 nm). RESULTS During CHFO, inhaled doses with jet nebulizers were low (∼ 2%), regardless of nebulizer placement. Inhaled dose was improved with the vibrating mesh nebulizer placed between the manifold and mask (12.48 ± 2.24% vs 2.58 ± 0.48%, P = .004). Inhaled doses with the jet nebulizer in the manifold with nebulization mode alone was lower than with the jet nebulizer with an aerosol mask (4.03 ± 1.82% vs 10.39 ± 2.79%, P = .004). Inhaled dose was greater with distressed breathing than quiet breathing. The use of a vibrating mesh nebulizer (P < .001) and distressed breathing (P = .001) were identified as predictors of increased inhaled dose. CONCLUSIONS Inhaled dose with a jet nebulizer via the Metaneb CHFO device was lower than with a jet nebulizer alone. Placement of a vibrating mesh nebulizer at the airway and distressed breathing increased inhaled dose.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois.
| | - Ahmad A Elshafei
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois
| | - Lingyue Gong
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois
| | - James B Fink
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois.,Aerogen Pharma, San Mateo, California
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Breen M, Seppanen C, Isakov V, Arunachalam S, Breen M, Samet J, Tong H. Development of TracMyAir Smartphone Application for Modeling Exposures to Ambient PM 2.5 and Ozone. Int J Environ Res Public Health 2019; 16:E3468. [PMID: 31540404 DOI: 10.3390/ijerph16183468] [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] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 01/20/2023]
Abstract
Air pollution epidemiology studies of ambient fine particulate matter (PM2.5) and ozone (O3) often use outdoor concentrations as exposure surrogates. Failure to account for the variability of the indoor infiltration of ambient PM2.5 and O3, and time indoors, can induce exposure errors. We developed an exposure model called TracMyAir, which is an iPhone application ("app") that determines seven tiers of individual-level exposure metrics in real-time for ambient PM2.5 and O3 using outdoor concentrations, weather, home building characteristics, time-locations, and time-activities. We linked a mechanistic air exchange rate (AER) model, a mass-balance PM2.5 and O3 building infiltration model, and an inhaled ventilation model to determine outdoor concentrations (Tier 1), residential AER (Tier 2), infiltration factors (Tier 3), indoor concentrations (Tier 4), personal exposure factors (Tier 5), personal exposures (Tier 6), and inhaled doses (Tier 7). Using the application in central North Carolina, we demonstrated its ability to automatically obtain real-time input data from the nearest air monitors and weather stations, and predict the exposure metrics. A sensitivity analysis showed that the modeled exposure metrics can vary substantially with changes in seasonal indoor-outdoor temperature differences, daily home operating conditions (i.e., opening windows and operating air cleaners), and time spent outdoors. The capability of TracMyAir could help reduce uncertainty of ambient PM2.5 and O3 exposure metrics used in epidemiology studies.
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Ari A, Dang T, Al Enazi FH, Alqahtani MM, Alkhathami A, Qoutah R, Almamary AS, Fink JB. Effect of Heat Moisture Exchanger on Aerosol Drug Delivery and Airway Resistance in Simulated Ventilator-Dependent Adults Using Jet and Mesh Nebulizers. J Aerosol Med Pulm Drug Deliv 2017; 31:42-48. [PMID: 28829202 DOI: 10.1089/jamp.2016.1347] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Placement of a heat moisture exchanger (HME) between aerosol generator and patient has been associated with greatly reduced drug delivery. The purpose of this study was to evaluate the effect of filtered and nonfiltered HMEs placed between nebulizer and patient on aerosol deposition and airway resistance (Raw) in simulated ventilator-dependent adults. METHODS An in vitro lung model was developed to simulate a mechanically ventilated adult (Vt 500 mL, RR 15/min, and PEEP 5 cmH2O, using two inspiratory flow rates 40 and 50 L/min) using an intubated adult manikin with an endotracheal tube (8 mmID). The bronchi of the manikin were connected to a Y-adapter through a collecting filter (Respirgard II) attached to a test lung through a heated humidifier (37°C producing 100% relative humidity) to simulate exhaled humidity. For treatment conditions, a nonfiltered HME (ThermoFlo™ 6070; ARC Medical) and filtered HMEs (ThermoFlo™ Filter; ARC Medical and PALL Ultipor; Pall Medical) were placed between the ventilator circuit at the endotracheal tube and allowed to acclimate to the exhaled heat and humidity for 30 minutes before aerosol administration. Airway resistance (cmH2O/L/s) was taken at 0, 10, 20, and 30 minutes after HME placement and after each of four aerosol treatments. Albuterol sulfate (2.5 mg/3 mL) was administered with jet (Misty Max 10; Airlife) and mesh (Aerogen Solo; Aerogen) nebulizers positioned in the inspiratory limb proximal to the Y-adapter. Control consisted of nebulization with no HME. Drug was eluted from filter at the end of the trachea and measured using spectrophotometry (276 nm). RESULTS Greater than 60% of the control dose was delivered through the ThermoFlo. No significant difference was found between the first four treatments given by the jet (p = 0.825) and the mesh (p = 0.753) nebulizers. There is a small increase in Raw between pre- and post-four treatments with the jet (p = 0.001) and mesh (p = 0.015) nebulizers. Aerosol delivery through filtered HMEs was similar (<0.5%) across the four treatments. Airway resistance was similar using the ThermoFlo Filter. With the PALL Ultipor, changes in Raw increased with mesh nebulizer after treatment (p = 0.005). Changes in resistance pre- and post-treatment were similar with both filtered HMEs. CONCLUSION The ThermoFlo™ nonfilter HME allowed the majority of the control dose to be delivered to the airway. Increases in Raw would likely not be outside of a tolerable range in ventilated patients. In contrast, filtered HMEs should not be placed between nebulizers and patient airways. Further research with other HMEs and materials is warranted.
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Affiliation(s)
- Arzu Ari
- 1 Department of Respiratory Care, Texas State University , San Marcos, TX
| | | | - Fahad H Al Enazi
- 3 King Saud bin Abdulaziz University for Health Sciences , Saudi Arabia
| | | | | | - Rowaida Qoutah
- 4 King Faisal Medical City for Southern Regions, Saudi Arabia
| | - Ahmad S Almamary
- 3 King Saud bin Abdulaziz University for Health Sciences , Saudi Arabia
| | - James B Fink
- 1 Department of Respiratory Care, Texas State University , San Marcos, TX
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12
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Michotte JB, Staderini E, Le Pennec D, Dugernier J, Rusu R, Roeseler J, Vecellio L, Liistro G, Reychler G. In Vitro Comparison of a Vibrating Mesh Nebulizer Operating in Inspiratory Synchronized and Continuous Nebulization Modes During Noninvasive Ventilation. J Aerosol Med Pulm Drug Deliv 2016; 29:328-36. [PMID: 27310926 DOI: 10.1089/jamp.2015.1243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/13/2022] Open
Abstract
UNLABELLED Backround: Coupling nebulization with noninvasive ventilation (NIV) has been shown to be effective in patients with respiratory diseases. However, a breath-synchronized nebulization option that could potentially improve drug delivery by limiting drug loss during exhalation is currently not available on bilevel ventilators. The aim of this in vitro study was to compare aerosol delivery of amikacin with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes. METHODS Using an adult lung bench model of NIV, we tested a vibrating mesh device coupled with a bilevel ventilator in both nebulization modes. Inspi-Neb delivered aerosol only during the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. The nebulizer was charged with amikacin solution (250 mg/3 mL) and placed at two different positions: between the lung and exhalation port and between the ventilator and exhalation port. Inhaled, expiratory wasted and circuit lost doses were assessed by residual gravimetric method. Particle size distribution of aerosol delivered at the outlet of the ventilator circuit during both nebulization modes was measured by laser diffraction method. RESULTS Regardless of the nebulizer position, Inspi-Neb produced higher inhaled dose (p < 0.01; +6.3% to +16.8% of the nominal dose), lower expiratory wasted dose (p < 0.05; -2.7% to -42.6% of the nominal dose), and greater respirable dose (p < 0.01; +8.4% to +15.2% of the nominal dose) than Conti-Neb. The highest respirable dose was found with the nebulizer placed between the lung and exhalation port (48.7% ± 0.3% of the nominal dose). CONCLUSIONS During simulated NIV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization improves respirable dose and reduces drug loss of amikacin compared with continuous vibrating mesh nebulization.
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Affiliation(s)
- Jean-Bernard Michotte
- 1 Western Switzerland University of Applied Sciences-Haute Ecole de Santé Vaud , Filière Physiothérapie, Switzerland .,6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium
| | - Enrico Staderini
- 2 Western Switzerland University of Applied Sciences-Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud , Switzerland
| | - Deborah Le Pennec
- 3 Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Equipe "aérosolthérapie et biomédicaments à visée respiratoire," Université de Tours , Faculté de Médecine, France
| | - Jonathan Dugernier
- 4 Cliniques Universitaires Saint-Luc , Service des soins intensifs, Belgium
| | - Rares Rusu
- 2 Western Switzerland University of Applied Sciences-Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud , Switzerland
| | - Jean Roeseler
- 4 Cliniques Universitaires Saint-Luc , Service des soins intensifs, Belgium
| | - Laurent Vecellio
- 3 Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Equipe "aérosolthérapie et biomédicaments à visée respiratoire," Université de Tours , Faculté de Médecine, France .,5 Aerodrug, DTF, Faculty of Medicine, Tours University , France
| | - Giuseppe Liistro
- 6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium
| | - Grégory Reychler
- 6 Cliniques Universitaires Saint-Luc, Service de Pneumologie; Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC) , Pôle de Pneumologie, ORL & Dermatologie, Belgium
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13
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Pasalic E, Hayat MJ, Greenwald R. Air pollution, physical activity, and markers of acute airway oxidative stress and inflammation in adolescents. J Ga Public Health Assoc 2016; 6:314-330. [PMID: 30662974 PMCID: PMC6338427 DOI: 10.21633/jgpha.6.2s19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The airway inflammatory response is likely the mechanism for adverse health effects related to exposure to air pollution. Increased ventilation rates during physical activity in the presence of air pollution increases the inhaled dose of pollutants. However, physical activity may moderate the relationship between air pollution and the inflammatory response. The present study aimed to characterize, among healthy adolescents, the relationship between dose of inhaled air pollution, physical activity, and markers of lung function, oxidative stress, and airway inflammation. METHODS With a non-probability sample of adolescents, this observational study estimated the association between air pollution dose and outcome measures by use of general linear mixed models with an unstructured covariance structure and a random intercept for subjects to account for repeated measures within subjects. RESULTS A one interquartile range (IQR) (i.e., 345.64 μg) increase in ozone (O3) inhaled dose was associated with a 29.16% average decrease in the percentage of total oxidized compounds (%Oxidized). A one IQR (i.e., 2.368E+10 particle) increase in total particle number count in the inhaled dose (PNT) was associated with an average decrease in forced expiratory flow (FEF25-75) of 0.168 L/second. Increasing activity levels attenuated the relationship between PNT inhaled dose and exhaled nitric oxide (eNO). The relationship between O3 inhaled dose and percent oxidized exhaled breath condensate cystine (%CYSS) was attenuated by activity level, with increasing activity levels corresponding to smaller changes from baseline for a constant O3 inhaled dose. CONCLUSIONS The moderating effects of activity level suggest that peaks of high concentration doses of air pollution may overwhelm the endogenous redox balance of cells, resulting in increased airway inflammation. Further research that examines the relationships between dose peaks over time and inflammation could help to determine whether a high concentration dose over a short period of time has a different effect than a lower concentration dose over a longer period of time.
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Affiliation(s)
- Emilia Pasalic
- Master of Public Health Program, Georgia State University School of Public Health, Atlanta, GA
| | - Matthew J. Hayat
- Graduate Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta, GA
| | - Roby Greenwald
- Graduate Division of Environmental Health, Georgia State University School of Public Health, Atlanta, GA
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14
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MacLoughlin RJ, van Amerongen G, Fink JB, Janssens HM, Duprex WP, de Swart RL. Optimization and Dose Estimation of Aerosol Delivery to Non-Human Primates. J Aerosol Med Pulm Drug Deliv 2015; 29:281-7. [PMID: 26646908 DOI: 10.1089/jamp.2015.1250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In pre-clinical animal studies, the uniformity of dosing across subjects and routes of administration is a crucial requirement. In preparation for a study in which aerosolized live-attenuated measles virus vaccine was administered to cynomolgus monkeys (Macaca fascicularis) by inhalation, we assessed the percentage of a nebulized dose inhaled under varying conditions. METHODS Drug delivery varies with breathing parameters. Therefore we determined macaque breathing patterns (tidal volume, breathing frequency, and inspiratory to expiratory (I:E) ratio) across a range of 3.3-6.5 kg body weight, using a pediatric pneumotachometer interfaced either with an endotracheal tube or a facemask. Subsequently, these breathing patterns were reproduced using a breathing simulator attached to a filter to collect the inhaled dose. Albuterol was nebulized using a vibrating mesh nebulizer and the percentage inhaled dose was determined by extraction of drug from the filter and subsequent quantification. RESULTS Tidal volumes ranged from 24 to 46 mL, breathing frequencies from 19 to 31 breaths per minute and I:E ratios from 0.7 to 1.6. A small pediatric resuscitation mask was identified as the best fitting interface between animal and pneumotachometer. The average efficiency of inhaled dose delivery was 32.1% (standard deviation 7.5, range 24%-48%), with variation in tidal volumes as the most important determinant. CONCLUSIONS Studies in non-human primates aimed at comparing aerosol delivery with other routes of administration should take both the inter-subject variation and relatively low efficiency of delivery to these low body weight mammals into account.
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Affiliation(s)
| | | | - James B Fink
- 3 Division of Respiratory Therapy, Georgia State University , Atlanta, Georgia
| | - Hettie M Janssens
- 4 Department of Pediatric Pulmonology, Erasmus MC-Sophia Children's Hospital , Rotterdam, Netherlands
| | - W Paul Duprex
- 5 Department of Microbiology, Boston University School of Medicine , Boston, Massachusetts
| | - Rik L de Swart
- 2 Department of Viroscience, Erasmus MC , Rotterdam, Netherlands
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15
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Abstract
Experimental animal models of tuberculosis (TB) have convincingly demonstrated that inhaled dose predicts immunopathology and survival. In contrast, the importance of inhaled dose has generally not been appreciated in TB epidemiology, clinical science, or the practice of TB control. Infectiousness of TB patients has traditionally been assessed using microscopy for acid-fast bacilli in the sputum, which should be considered only a risk factor. We have recently demonstrated that cough aerosol cultures from index cases with pulmonary TB are the best predictors of new infection among household contacts. We suggest that cough aerosols of M. tuberculosis are the best surrogates of inhaled dose, and we hypothesize that the quantity of cough aerosols is associated with TB infection versus disease. Although several factors affect the quality of infectious aerosols, we propose that the particle size distribution of cough aerosols is an important predictor of primary upper airway disease and cervical lymphadenitis and of immune responses in exposed hosts. We hypothesize that large droplet aerosols (>5 μ) containing M. tuberculosis deposit in the upper airway and can induce immune responses without establishing infection. We suggest that this may partially explain the large proportion of humans who never develop TB disease in spite of having immunological evidence of M. tuberculosis infection (e.g., positive tuberculin skin test or interferon gamma release assay). If these hypotheses are proven true, they would alter the current paradigm of latent TB infection and reactivation, further demonstrating the need for better biomarkers or methods of assessing TB infection and the risk of developing disease.
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Affiliation(s)
- Kevin P Fennelly
- Department of Medicine, Emerging Pathogens Institute, University of Florida , Gainesville, FL , USA
| | - Edward C Jones-López
- Section of Infectious Diseases, Boston Medical Center, Boston University School of Medicine , Boston, MA , USA
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16
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Amirav I, Borojeni AAT, Halamish A, Newhouse MT, Golshahi L. Nasal versus oral aerosol delivery to the "lungs" in infants and toddlers. Pediatr Pulmonol 2015; 50:276-283. [PMID: 24482309 DOI: 10.1002/ppul.22999] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 08/31/2013] [Accepted: 01/05/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The oral route has been considered superior to the nasal route for aerosol delivery to the lower respiratory tract (LRT) in adults and children. However, there are no data comparing aerosol delivery via the oral and nasal routes in infants. The aim of this study was to compare nasal and oral delivery of aerosol in anatomically correct replicas of infants' faces containing both nasal and oral upper airways. METHODS Three CT-derived upper respiratory tract ("URT") replicas representing infants/toddlers aged 5, 14 and 20 months were studied and aerosol delivery to the "lower respiratory tract" (LRT) by either the oral or nasal route for each of the replicas was measured at the "tracheal" opening. A radio-labeled (99mDTPA) normal saline solution aerosol was generated by a soft-mist inhaler (SMIRespimat® Boehringer Ingelheim, Germany) and aerosol was delivered via a valved holding chamber (Respichamber® TMI, London, Canada) and an air-tight mask (Unomedical, Inc., McAllen, TX). A breath simulator was connected to the replicas and an absolute filter at the "tracheal" opening captured the aerosol representing "LRT" dose. Age-appropriate mask dimensions and breathing patterns were employed for each of the airway replicas. Two different tidal volumes (Vt ) were used for comparing the nasal versus oral routes. RESULTS Nasal delivery to the LRT exceeded that of oral delivery in the 5- and 14-month models and was equivalent in the 20-month model. Differences between nasal and oral delivery diminished with "age"/size. Similar findings were observed with lower and higher tidal volumes (Vt ). CONCLUSION Nasal breathing for aerosol delivery to the "LRT" is similar to, or more efficient than, mouth breathing in infant/toddler models, contrary to what is observed in older children and adults. Pediatr Pulmonol. 2015; 50:276-283. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Israel Amirav
- Pediatric Department, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Michael T Newhouse
- Firestone Institute for Respiratory Health, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
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