Practice and exploration of physician-pharmacist joint outpatient service mode of chronic obstructive pulmonary disease (COPD) and asthma / 药学实践杂志

Objective To explore the physician-pharmacist joint outpatient service mode of chronic obstructive pulmonary disease ( COPD) and asthma. Methods Cases of COPD or asthma patients who visited the joint outpatient department from June 2021 to December 2021 were collected in our hospital, the inhaler usage score，compliance ( MMAS-8) score，clinical control efficacy，incidence of adverse reactions and patient satisfaction were evaluated before and after pharmaceutical care intervention and statistically analyzed．Results The inhaler usage score，MMAS-8 score，and the Asthma Control Test（ACT）/COPD Assessment Test（CAT） score had been changed significantly after the intervention (P<0.05). Patient satisfaction with pharmaceutical care was basically above 94.75%．Conclusion Pharmaceutical care provided by joint outpatient department in our hospital could help COPD and asthma patients to use inhaler device correctly，resulting in improving compliance of inhaler usage, better disease control，and reducing the occurrence of adverse drug reactions, which could be a positive attempt and exploration of standardized pharmaceutical care model for patients with COPD and asthma．

The use of metered-dose inhaler versus nebulization for the delivery of salbutamol in pediatric severe asthma exacerbations: A systematic review

BACKGROUND@#Recent guidelines for the management of asthma have advocated the use of a pressurized metered-dose inhaler (MDI) and spacer in the delivery of salbutamol. However, there is a dearth of research in children with severe exacerbation.@*OBJECTIVES@#To compare the effectiveness of MDI with spacers versus nebulizers in drug delivery of salbutamol for the management of pediatric severe asthma exacerbations. @*METHODOLOGY@#A systematic search of the Pubmed, Cochrane library, Herdin, WPRIM, ClinicalTrials and reference review databases was conducted for studies containing “severe asthma” using MDI and spacer as an intervention with nebulization as a comparator.@*RESULTS@#Of 220 articles, 4 met the criteria. In the subgroup analysis, children who received salbutamol through MDI showed no significant difference in hospital admission, pulmonary score, heart and respiratory rate, oxygen saturation, and lung function.@*CONCLUSION@#In severe asthma exacerbations, there is evidence to support that MDI compared with nebulizer is statistically equal in terms of hospital admission, pulmonary scores, clinical improvement, and side effects@*RECOMMENDATIONS@#Further randomized controlled trials are suggested to explore the intricacies of drug delivery in management of severe asthma. A meta-analysis may be made possible in the future with more evidence.

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La crisis climática es una enorme amenaza para la salud humana. La evidencia que el cambio climático está ocurriendo es abrumadora, impulsado por actividades humanas que aumentan los gases de efecto invernadero en la atmósfera. Los inhaladores de dosis medidas presurizados utilizaban propulsores de clorofluorocarbonos. Los propulsores de clorofluorocarbonos fueron prohibidos debido a su gran impacto en el agotamiento de la capa de ozono. El protocolo de Montreal, introducido para proteger la capa de ozono, estableció una eliminación planificada de los clorofluorocarbonos, reemplazándolos con los hidrofluorocarbonos que ahora se utilizan en los inhaladores de dosis medidas presurizados. Si bien los hidrofluorocarbonos no agotan la capa de ozono, son potentes gases de efecto invernadero tienen un potencial de calentamiento global muchas veces mayor que el del dióxido de carbono. El sector de la salud es un contribuyente significativo a las emisiones de gases de efecto invernadero a nivel mundial. Los aumentos de la temperatura global ya están teniendo un impacto significativo en nuestro clima. La lucha contra el cambio climático se ha descrito como la mayor oportunidad de salud pública del siglo XXI. Para reducir el impacto de los inhaladores en el cambio climático, hay varias opciones disponibles, incluidas el reciclaje de los inhaladores, el uso de dispositivos alternativos, reducir la cantidad del propulsor por dosis o usar un propulsor con un potencial de calentamiento global menor. Los profesionales sanitarios tenemos el deber de proteger y promover la salud de los pacientes y emprender acciones para disminuir los peores efectos del cambio climático. Se deben hacer todos los esfuerzos posibles para minimizar la emisión de gases de efecto invernadero si queremos proteger a las generaciones actuales y futuras.

The climate crisis is a massive threat to human health. The evidence that climate change is happening, driven by human activities which increase atmospheric greenhouse gases, is overwhelming. Pressurized metered-dose inhalers used chlorofluorocarbons propellants. Chlorofluorocarbons propellants were banned because of their big impact on the ozone layer depletion. The Montreal Protocol, introduced to protect the ozone layer, saw a planned phase-out of chlorofluorocarbons, replacing them with the hydrofluorocarbons now used in metered-dose inhalers used. While hydrofluorocarbons are not ozone depleting, they are potent greenhouse gases and have global warming potential many times that of carbon dioxide. The healthcare sector is a significant contributor to greenhouse gases emissions globally. Increases in global temperature are already having a significant impact on our climate. Combating climate change has been described as 'the greatest public health opportunity of the 21st century. To reduce the climate change impact of inhalers, several options are available including inhaler recycling, the use of alternatives devices, reduce the propellant quantity per dose or use a different propellant with a lower global warming potential. Healthcare professionals have a duty to protect and promote the health of patients and take actions to minimize the worst effects of climate change. Every effort must be made to minimize greenhouse gases release if we are to protect current and future generations

Preparation and in vitro Release Property Study of Curcumin Dry Powder Inhalation Loaded by Nanoporous Flower-shaped Lactose / 中国药房

OBJECTIVE：To preparea novel Curcumin （Cur）dry powder inhalation （DPI）loaded by nanoporous flower-shaped lactose（FL），and to provide a safe and effective intrapulmonary drug delivery method for the therapy of chronic obstructive pulmonary disease with insoluble drugs. METHODS ：FL-loaded Cur （Cur-FL） compound powder was prepared by solution adsorption method. Using drug-loading amount and adsorption rate as indicators ，single-factor experiment was used to optimize Cur concentration，Cur-FL ratio （m/m）and adsorption time so as to determine the optimal preparation technology for Cur-FL compound powder. Fourier transform infrared spectroscopy ，scanning electron microscope and differential scanning calorimetry were used to characterize the physical and chemical properties of Cur-FL compound powder prepared with optimal technology. The water content and aerodynamic properties were determined ；in vitro drug release behavior was investigated by simulating the environment of artificial lung fluid. RESULTS ：The optimal preparation technology of Cur-FL compound powder was Cur concentration of 5 mg/mL，Cur-FL ratio of 1 ∶ 4，adsorption time of 1 h. The drug-loading amount of compound powder was （23.37±0.43）％，the encapsulation rate was （91.64±0.44）％，and the adsorption rate was （30.50±0.72）％. Cur-FL particles were flower shaped ；Cur was physically adsorbed in the pores of FL without chemical changes. The bulk density of Cur-FL compound was （0.21±0.02） g/cm3，tap density was （0.33±0.01）g/cm3，angle of repose was（24.07±0.31）°，average particle size was （3.96±0.80） μm，aerodynamic particle size was （3.33±0.99）μm，water content was （5.63 ±0.24）％，emptying rate was （92.53± 0.87）％，and deposition rate of effective parts in vitro was son- （45.93 ± 1.77）％ . Its 24 h solubility in artificial lung gwen.tan@csu.edu.cn fluid [（358.93±1.67）μg/mL] were 3.28 times of Cur ，48 h cumulative release ratesin in vitro （90.21％）were 1.63 times of Cur ，but Cur+FL physical mixture could not improve the solubility and release of Cur in artificial lung fluid. CONCLUSIONS ：Cur-FL compound powder has good in vitro release property ，and its powder properties ，solubility，water content ，fluidity and aerodynamic properties meet the requirements of DPI in Chinese Pharmacopoeia.

Assessment of Errors during Inhaler Usage among Asthma and COPD Patients.

BACKGROUND The cornerstone therapy for respiratory diseases is drugs for inhalation. Effectiveness of inhalers can be influenced by factors such as gender, age, educational status, and type of inhaler used and correct inhalation technique. The aim of this study is to provide information about common errors in technique that occur during inhalation.METHODSMale and female patients who met the inclusion criteria (age 18 - 80) years, using inhalers particularly MDI and DPI were included in the study. The study patients were asked to perform inhalation technique and the errors in technique that occur during inhalation were recorded. The sample size was 150 and duration of study was 6 months.RESULTSThe common errors during the use of inhalers included, no exhalation before inhalation, no breath hold, and absence of proper washing of mouth after inhalation. Among the 86 MDI users, no exhalation before inhalation (n=50), no breath hold (n=35) and absence of proper washing of mouth after inhalation (n=21). For the 64 patients using DPI, no exhalation before inhalation (n=68), no breath hold (n=51) and absence of proper washing of mouth after inhalation (n=35).

TEST DE ADHESIÓN A INHALADORES EN PACIENTES CON ASMA DE NUESTRA POBLACION EN ARGENTINA

RESUMEN Introducción: el asma es una enfermedad infamatoria crónica de la vía aérea, requiere un adecuado tratamiento y control. El Test de Adhesión a los Inhaladores (TAI) identifica al paciente con pobre adherencia al tratamiento, establece el nivel de adhesión y tipo de incumplimiento terapéutico por su técnica y conocimiento sobre el inhalador. Objetivos: evaluar el grado de adhesión al tratamiento del asma en nuestra población e identificar el tipo de incumplimiento que se presenta con mayor prevalencia. Materiales y métodos: se realizó un estudio observacional, prospectivo, transversal y multicéntrico en Argentina, donde se realizó el cuestionario TAI a pacientes entre 18 a 80 años con diagnóstico de asma en tratamiento con inhaladores durante febrero 2017 a mayo 2018. Resultados: se evaluaron 134 pacientes con una edad promedio de 45 años, 59% de sexo femenino y 41% de sexo masculino, en el que el 56% fue del ámbito privado y 44% del público. El 81.5% (101) fueron incumplidores, de tipo errático el 89.1% (110), deliberado el 87% (107) e inconsciente el 18.5% (22). Solo el 18.5% (23) presento buena adhesión. Conclusión: en este estudio se detectó una alta tasa de incumplimiento (81.5%) a los tratamientos inhalados en los pacientes con asma, siendo el errático y deliberado los de mayor frecuencia.

SUMMARY Introduction: asthma is a chronic infammatory disease of the airway, it requires adequate treatment and control. The Test of Adhesion to Inhalers (TAI) identifies the patient with poor adherence to treatment, establishes the level of adherence and type of therapeutic non-compliance due to their technique and knowledge about the inhaler. Objectives: to evaluate the degree of adherence to asthma treatment in our population and to identify the type of non-compliance with the highest prevalence. Materials and methods: An observational, prospective, cross-sectional and multicenter study was carried out in Argentina, where the TAI questionnaire was performed on patients between 18 and 80 years of age with a diagnosis of asthma being treated with inhalers during February 2017 to May 2018. Results: 134 patients with an average age of 45 years, 59% female and 41% male, were evaluated, in which 56% were from the private sphere and 44% from the public. 81.5% (101) were non-compliant, 89.1% (110) erratic, 87% (107) deliberate and 18.5%(22) unconscious. Only 18.5% (23) presented good adhesion. Conclusion: in this study, a high non-compliance rate (81.5%) was detected for inhaled treatments in patients with asthma, the most frequent being erratic and deliberate

Acute exacerbations of asthma occurring frequently time to check your techniques

Background: Asthmatics form a predominant section of patients in OPD. If poorly controlled the frequency of attacks requiring an emergency department visit adds to the burden. It was noticed that the patients who were on inhalational therapy had poor control despite the absence of other factors which could lead to exacerbations. Hence author evaluated the inhalational techniques.Methods: A prospective study undertaken in the department of medicine in tertiary care hospital in Dakshina Kannada District, Karnataka enlisting 25 patients admitted with acute exacerbation of bronchial asthma. The patients were assessed for their symptoms, signs and recurrent attacks along with their cough severity index and inhaler scores and the observations were tabulated.Results: Of the twenty-five, 15 were on inhalation therapy with various modes of deliveries. There were 15 males and 10 females from ages 20 to 50years. The number of attacks of asthma was higher in those not on inhalation therapies than those using inhalation therapies. Also, the level/severity of cough, measured as Cough Severity Index, was assessed among the two groups. Those on inhalation therapy had a lower grade of cough than those not on therapy . Mean AEC was 94 among those on inhalation therapy and 209 among those not on therapy. Inhalational score was calculated for each patient. There is a strong negative correlation of -0.709 between inhalation score and recurrent attacks, which is statistically significant (p=0.003). Lower inhalation scores were associated with recurrent attacks.Conclusions: Recurrent exacerbations in an asthmatic patient on inhalation therapy are due to improper inhalational technique. It was suggested that it is wise to spend time with the patients in authors OPD set up and teach them the correct techniques of using inhalational therapy hence reducing frequency of attacks and cost of health care in such patients.

Evaluation of oral health of 6 to 10-year-old asthmatic children receiving bronchodilator through inhaler

Aim: The aim of this study was to evaluate the oral health status in 6 to 10-year-old asthmatic children receiving bronchodilator (salbutamol, salmeterol, etc.) through inhaler and compare them with nonasthmatic healthy children. Settings and Design: The present study was carried out at pediatric and pedodontic department and neighboring government school. It was an observational and case–control study. Statistical Analysis: All data were analyzed using SPSS 20.0 software program and presented as mean ± standard error of mean. Chi-square test was used for the categorical data between groups. Numerical data were analyzed by Mann–Whitney U-test and t-test. Kruskal–Wallis test was performed for comparisons of median value of decayed, missing, filled surface and Decayed, Missing, Filled Surface (dmfs and DMFS) for different variables within asthmatic group. Mann–Whitney U-test for multiple comparisons and P value was adjusted according to Bonferroni correction. Negative binomial analysis was used to calculate adjusted dmfs and DMFS, and univariate analysis of variance was used for adjusted mean plaque and gingival index. Materials and Methods: The study group composed of 70 asthmatic and 70 nonasthmatic children with the same age and social background aged between 6 and 10 years old. Oral health status was assessed using caries, plaque, and gingival index. Dental caries examination was done using the WHO criteria (1997), plaque index by Silness and Loe in 1964 and gingival health by Loe and Silness in 1963. Results: The children in the asthmatic group had significantly higher caries prevalence, severity of dental plaque, and gingivitis compared with the nonasthmatic group. Plaque accumulation and gingivitis increased significantly as severity and duration of asthma increased. Conclusions: Bronchial asthma had an overall deleterious effect on caries prevalence and severity, plaque, and gingivitis on primary and permanent teeth.

Introduction of a teaching module on intravenous drug administration and communication skills in pharmacology

Background: Pharmacology practicals mainly focus on increasing the knowledge component but teaching on psychomotor and soft skills is largely lacking. Teaching correct method of intravenous drug administration and the communication skills about drug therapy in Pharmacology practical classes can help in minimizing the errors in drug administration and improving the patient compliance and adherence to the therapy. Objectives of this study were teaching module on intravenous drug administration and communication skills to undergraduate students in Pharmacology and to evaluate the perceptions of students and teachers towards the new teaching module.Methods: Correct methods of intravenous drug administration were demonstrated in practical classes. Role play was done to teach about communication skills regarding right method of using an inhaler and also about prescribing the correct dosage regimens. Perceptions of students and teaching staff members were collected on the teaching module.Results: Almost all of the students (>96 %) were of the opinion that learning correct drug administration methods and communication skills was relevant to the future practice and 95% students felt that after the role play sessions, they were better equipped in communicating with the patients about the medication use and were in favour of teaching these to all the medical students.Conclusions: Our study concludes that the teaching module on intravenous drug administration and communication skills was well accepted by both the teaching staff and the students and was found feasible and relevant to be introduced in the curriculum by both of them.

An evaluation of proper inhaler technique and adherence to treatment in asthma patients

Background: Medications used to manage Asthma is delivered via inhaler devices. Proper usage of these devices are required for effective medication delivery. Aim of this study is assess the degree of proper inhaler technique and adherence to treatment among adult asthma patients.Methods: Patients using inhalers were identified and interviewed regarding inhaler use. Checklists were used to document the adherence to manufacturers’ directions for each respective inhaler, and data were then tabulated and assessed for the types of inhalers used, incorrectly performed steps in using the inhalers, as well as demographic information of patients.Results: Out of 120 patients that taken as subjects, twenty-four percent of inhalers (29/120) used incorrectly, with the most common errors being improper priming, lack of proper exhalation prior to inhaling the medication, and absence of rinsing mouth following the use of inhaled corticosteroid. Furthermore, only 60% of the patients are adherent to asthma medications.Conclusions: Inhaler technique among adult patients is substandard and is considered a key area for physicians to more proactive in educating patients. For obtaining most accurate therapeutic advantage among patients with inhalers, proper instruction and demonstration regarding inhaler use need to be given to all patients, particularly elderly patients.

Role of educational intervention with practical demonstration in improving inhaler technique

Background: Chronic respiratory diseases are among the leading causes of morbidity and mortality worldwide with chronic obstructive pulmonary disease (COPD) and asthma being the most common. There is under-utilization of the basic tools of inhalation therapy technique(s) in their management. Implementation of a personalized educational and demonstrational intervention by the attending physician during regular follow-up visits of these patients will substantially improve the treatment outcome.Methods: This prospective interventional study was conducted on 239 diagnosed cases of asthma and COPD. Inhaler technique was assessed in accordance to standard checklist and errors were corrected by a practical demonstration. A follow-up assessment was conducted for the same after 2 weeks. Data thus collected was evaluated.Results: Out of 239 patients, 47.6% (n=114) reported for follow-up assessment. Average reporting time for follow-up assessment was 27.4 days. Amongst them, an improvement of at least one step was found in 86.8% (n= 99) and about 28% (n=32) patients performed all steps correctly. Average number of steps improved was 2.1.Conclusions: Majority of the patients showed an improvement in the inhaler technique during follow-up assessment after an educational intervention and practical demonstration. Near perfection was achieved by about more than quarter of the patients. Regular practical demonstration of the inhalation technique during subsequent follow-up sessions unequivocally improves results.

Factors influencing bronchial asthma exacerbations with special emphasis on inhaler usage

Background: Study of risk factors help make patients aware about them and they can be taught to take proper precautions to prevent the exacerbation of asthma. Objective was to study factors influencing bronchial asthma exacerbations with special emphasis on inhaler usage.Methods: A hospital based cross sectional study was carried out over a period of three months among 218 eligible patients with asthma who could give written informed consent and willing to participate in the present study and the data was recorded in a pre tested, semi structured study questionnaire. The data was recorded in the Microsoft Excel Worksheet and analyzed using proportions and mean+2SD.Results: We found that advanced age, exposure to dust, fumes and allergens, lower social class, presence of other co-morbidities, irregular use of inhalers, and not demonstrated the technique of proper inhaler use were significantly associated with exacerbation of bronchial asthma. Other factors like mean duration of illness, mean duration of use of inhalers, gender, presence of allergic rhinitis, type of device used for inhalation and taking consultation from pulmonologist were not significantly associated with exacerbations of asthma.Conclusions: Demonstrating and teaching the patient on how to use the device of inhaler plays a significant role in reducing the risk of exacerbation of bronchial asthma.

Progress in inhaler devices of asthmatic children using inhaled corticosteroids / 国际儿科学杂志

Asthma is a common,chronic respiratory disease in childhood.Inhaled corticosteroids are the key anti-inflammatory treatment of asthma.Delivery of respiratory medications by inhalation achieves a higher concentration in the airways,more rapid onset of action,and fewer systemic adverse effects.Inhaler devices include pressurized metered-dose inhaler,dry powder inhaler and nebulizer.Effective use of inhalers requires proper inhaler techniques,which is an important part of education and self-management of asthmatic children.However,the majority of children cannot master proper inhaler techniques,which leads to poor asthma control and increased risk of exacerbations and hospital visits,and seriously affects their quality of life.Therefore,health care professionals should choose the most appropriate inhaler device for children,show how to use the device correctly with a physical demonstration,and inform them of the do's and don'ts and recheck and correct their inhaler technique at every follow-up.

Effect of carrier size and surface morphology on the aerosolization of formulation in a capsule-based dry powder inhaler / 药学学报

The size and surface morphology of carrier lactose had influence on the aerosolization performance of dry powder inhalers. In this article, chlorpheniramine maleate was blended with two types of commercial carrier lactose, which were Lactohale 100® and Respitose SV003® (SV003), as formulation model. In vitro experiments were conducted using fast screening impactor at 30 L·min-1 and 60 L·min-1 respectively. Meanwhile, computational fluid dynamics (CFD) coupling with discrete element modelling (DEM) was applied to discuss the movements of those two carrier particles in Handihaler® at the flow rate mentioned above. The dispersion characteristics of two formulations and the dispersion mechanism of Handihaler® were analyzed by establishing the relationship between in vitro experiments and numerical simulation. The results of in vitro experiments and CFD-DEM demonstrated that the aerosolization performance of formulation with SV003 was better. The linear correlation (R2 = 0.940 1) between fine particle dose and total energy loss by carrier collision within the wall of device was found by comparing the in vitro experimental results with CFD-DEM results. It revealed that particle-wall collision in Handihaler® had direct impact on the dispersion results of formulation.

Liposomal melatonin dry powder inhalers for the treatment of primary lung cancer / 药学学报

Melatonin (MLT) is an endogenous chemical that has antitumor effects at high doses. However, it shows low oral bioavailability and short in vivo half-life, leading to drug resistance. Here, liposomal melatonin dry powder inhalers (LMD) were prepared, and were used for treatment of primary rat lung cancer by pulmonary delivery. Liposomal melatonin (LM) was prepared by the ethanol injection method to achieve an entrapment efficiency of 98.89%. LMD was obtained by freeze-drying after LM was mixed with mannitol. LMD appeared as spherical particles under a scanning electron microscope. The rehydrated liposomes had a small size of 65.15 nm and the zeta potential of -14.2 mV without change inentrapment efficiency. LMD had an aerodynamic particle size of 6.73 ± 0.012 μm and a fine particle fraction (FPF<8.06 μm) of 22.2%, suitable for pulmonary delivery. When administered with the same dose, LMD showed much higher inhibition on A549 lung cancer cells than MLT and gemcitabine. LMD of a large dose had no effect on the growth of normal lung epithelial cells (BEAS-2B). Rat lung cancer models were established after 45 days by instilling 3-methylcholanthrene (MCA) and N,N-dimethylnitrosamine (DEN) into the rat lungs once (the experiments had been approved by the ethics committee and carried out in accordance with relevant guidelines and regulations). Decreases of tumor nodules and inflammatory cells in the tumor-bearing rat lungs were observed after treatment of MLT, gemcitabine and LMD by pulmonary delivery compared with the models, wherein LMD was most effective. The efficiencies of inhibition of NF-κB p65, increase of Tunel detection (indicating enhancement of apoptosis), and decrease of malondialdehyde corresponded to LMD being most effective. Therefore, given the fact that LMD can deliver the drug into the tumor tissues of lungs, and it presents as a promising pulmonary inhalable regiment for treatment of lung cancer.

Drug Release in vitro and Acute Toxicity in vivo of Curcumin Solid Lipid Nanoparticles Dry Powder Inhaler and Its Effects on Inflammatory Response in Asthmatic Model Mice / 中国药房

OBJECTIVE： To study in vitro drug release and acute toxicity in vivo of Curcumin （Cur） solid lipid nanoparticles （SLN） dry powder inhaler （DPI） and its effects of inflammatory response in asthmatic model mice. METHODS： Cur-SLN-DPI was obtained with spray-drying method by micronizing the Cur-SLN suspension prepared by the microemulsion method and thoroughly mixing with lactose （200 mesh） etc. The drug release in vitro was investigated by dynamic membrane dialysis. Accumulative release rates （Q） of Cur raw material， Cur-SLN and Cur-SLN-DPI in 3 kinds of release mediums [phosphate buffer solution （PBS， pH 7.4） containing 1.0％ sodium dodecyl sulfate （SDS）， PBS （pH 7.4） containing 0.2％ tween 80， normal saline-20％ ethanol solution] were compared 5， 15， 30 min and 1， 1.5， 3， 6， 8， 12， 18， 24， 36， 48 h after releasing. Drug release model was fitted. The effects of intravenous injection of maximal dose 2 000 mg/kg Cur-SLN-DPI via tail vein on KM mice were investigated by acute toxicity test. KM mice were randomly divided into normal control group， model group， positive drug group （budesonide 3 mg）， Cur-SLN-DPI high-dose and low-dose groups （100， 50 mg/kg）， with 7 mice in each group. The ovalbumin （OVA） was used as sensitizer to induce asthma model； the model mice were given relevant medicine with aerosol administration 30 min before aerosol administration of OVA inducing asthma on Monday， Wednesday and Friday per week， for consecutive 3 weeks. Within 24 h after last induction， total number of leukocyte， the number of lymphocyte， neutrophil and eosinophil were counted in broncho alveolar lavage fluid （BALF）； the pathological changes of bronchus and lung tissue were observed. RESULTS： Compared with Cur raw material， Cur-SLN and Cur-SLN-DPI showed good sustained-release effect， and Cur-SLN-DPI had more stable sustained release in 3 kinds of release mediums. The characteristics of drug release conformed to the Weibull model. Intravenous injection of 2 000 mg/kg Cur-SLN-DPI via tail vein had no significant acute toxicity in mice. Compared with normal control group， total number of leukocyte， the number of lymphocyte， neutrophil and eosinophil were increased significantly （P＜0.01）； bronchial mucosal epithelium was covered with pseudostratified ciliated columnar cells， with severe infiltration of inflammatory cells， pulmonary congestion and moderate interstitial pneumonia. Compared with model group， the number of above cells in BALF of mice were decreased significantly in administration group （P＜0.01）； tracheal lesions of mice were improved in Cur-SLN-DPI low-dose and high-dose groups； pulmonary congestion of them were alleviated， and that of high-dose group was alleviated more significantly. CONCLUSIONS： Cur-SLN-DPI shows sustained-release effect in vitro and has no obvious acute toxicity to mice. Cur-SLN-DPI can improve the inflammatory response of the airway and the degree of pulmonary congestion in asthmatic model mice.

Comparação de duas técnicas inalatórias para administrar broncodilatador em crianças e adolescentes com crise aguda de asma: metanálise / Comparison of two inhalational techniques for bronchodilator administration in children and adolescents with acute asthma crisis: a meta-analysis

RESUMO Objetivo: Comparar a eficácia no tratamento da asma pediátrica por nebulizador e inalador dosimetrado com uso de espaçador (MDI-espaçador), no emprego das técnicas de resgate de pacientes asmáticos atendidos em emergências pediátricas. Fontes de dados: Realizou-se uma revisão sistemática para identificar os principais estudos randomizados controlados que comparam a administração de broncodilatador (β-2 agonista) por meio das técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. Foram pesquisadas as bases de dados PubMed, Scientific Electronic Library Online (SciELO) e ScienceDirect. Dois pesquisadores, de forma independente, aplicaram os critérios de elegibilidade, sendo incluídos na pesquisa apenas estudos randomizados controlados com o objetivo de comparar as técnicas inalatórias nebulização e MDI-espaçador no tratamento da asma em unidades de emergência pediátrica. Síntese dos dados: Foram pré-selecionados 212 artigos, dos quais apenas nove seguiram os critérios de elegibilidade e foram incluídos na metanálise. Os resultados apontam não existir diferenças nas técnicas inalatórias em nenhum dos quatro desfechos analisados: frequência cardíaca (diferença -Df: 1,99 [intervalo de confiança de 95% - IC95% -2,01-6,00]); frequência respiratória (Df: 0,11 [IC95% -1,35-1,56]); saturação de O2 (Df: -0,01 [IC95% -0,50-0,48]); e escore clínico de asma (Df: 0,06 [IC95% -0,26-0,38]). Conclusões: Os achados demonstram não haver diferenças na frequência cardiorrespiratória, na saturação de O2 nem nos escores de asma, na administração de β-2 agonista entre as técnicas inalatórias (nebulizador e MDI-espaçador) em pacientes asmáticos atendidos em emergências pediátricas.

ABSTRACT Objective: To compare the efficacy of pediatric asthma treatment by nebulizer and metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue techniques for asthmatic patients assisted at pediatric emergency units. Data sources: A systematic review was conducted to identify the most relevant randomized controlled trials comparing the administration of a bronchodilator (β-2 agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat asthma in children at pediatric emergency units. The following databases were searched: PubMed, Scientific Electronic Library Online (SciELO), and ScienceDirect. Two researchers independently applied the eligibility criteria, and only randomized controlled trials that compared both inhalation techniques (nebulization and MDI-spacer) for asthma treatment at pediatric emergency units were included. Data synthesis: 212 articles were pre-selected, of which only nine met the eligibility criteria and were included in meta-analysis. Results show no differences between inhalation techniques for any of the four outcomes analyzed: heart rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]); respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation (Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI -0,26-0.38]). Conclusions: The findings demonstrate no differences in cardiorespiratory frequency, O2 saturation, and asthma scores upon administration of β-2 agonist by both inhalation techniques (nebulization and MDI-spacer) to asthmatic patients assisted at pediatric emergency units.

Prescription pattern among patients having mild to moderate bronchial asthma using metered dose inhaler and dry powder inhaler in tertiary hospital in western india

Background: Bronchial asthma is a syndrome characterized by airflow obstruction that manifests as shortness of breath, wheezing and cough. The treatment is tailored according to the severity of the disease. The drugs used for treatment of bronchial asthma include inhaled corticosteroids, beta-2 agonists, methylxanthines, leukotriene antagonists and mast cell stabilizers. Despite the availability of all these drugs, which are recommended for the treatment, not every patient achieves complete control of the disease. The reason behind this could be irrational prescribing of drugs for the treatment and errors in the technique of using inhaler devices. Though rational prescribing of drugs and correct technique for the use of inhaler can be improved by proper training of target population, but there is paucity of such data in our country.Methods: This study was planned to monitor prescription pattern and errors in use of inhalation devices, in patients diagnosed as cases of mild to moderate bronchial asthma, attending Out Patient Department (OPD) of respiratory medicine of a tertiary hospital. A total of 207 patients were recruited and their prescription pattern and inhalation technique were assessed.Results: The study showed that inhaled short acting ?2-agonists and inhaled corticosteroids were the most commonly used drug groups, which were prescribed to all the patients in the study, followed by long acting ?2-agonists, leukotriene antagonists and methylxanthines in decreasing order.Conclusions: As a conclusion, the treating physicians were prescribing according to the laid down guidelines. It is concluded that such studies should be periodically done to ensure the adherence to the treatment guidelines.

Continued Innovation in Respiratory Care: The Importance of Inhaler Devices / 결핵및호흡기질환

When it comes to the use in inhalers in the management of chronic obstructive pulmonary diseases, there are many options, considerations and challenges, which health care professionals need to address. Considerations for prescribing and dispensing, administering and following up, education, and adherence; all of these factors impact on treatment success and all are intrinsically linked to the device selected. This review brings together relevant evidence, real-life data and practice tools to assist health care professionals in making decisions about the use of inhalers in the management of chronic obstructive pulmonary diseases. It covers some of the key technical device issues to be considered, the evidence behind the role of inhalers in disease control, population studies which link behaviors and adherence to inhaler devices as well as practice advice on inhaler technique education and the advantages and disadvantages in selecting different inhaler devices. Finally, a list of key considerations to aid health care providers in successfully managing the use of inhaler devices are summarized.

Inhalation treatment of primary lung cancer using liposomal curcumin dry powder inhalers

Lung cancer is the leading cause of cancer-related deaths. Traditional chemotherapy causes serious toxicity due to the wide bodily distribution of these drugs. Curcumin is a potential anticancer agent but its low water solubility, poor bioavailability and rapid metabolism significantly limits clinical applications. Here we developed a liposomal curcumin dry powder inhaler (LCD) for inhalation treatment of primary lung cancer. LCDs were obtained from curcumin liposomes after freeze-drying. The LCDs had a mass mean aerodynamic diameter of 5.81 μm and a fine particle fraction of 46.71%, suitable for pulmonary delivery. The uptake of curcumin liposomes by human lung cancer A549 cells was markedly greater and faster than that of free curcumin. The high cytotoxicity on A549 cells and the low cytotoxicity of curcumin liposomes on normal human bronchial BEAS-2B epithelial cells yielded a high selection index partly due to increased cell apoptosis. Curcumin powders, LCDs and gemcitabine were directly sprayed into the lungs of rats with lung cancer through the trachea. LCDs showed higher anticancer effects than the other two medications with regard to pathology and the expression of many cancer-related markers including VEGF, malondialdehyde, TNF-, caspase-3 and BCL-2. LCDs are a promising medication for inhalation treatment of lung cancer with high therapeutic efficiency.