Environmental impact of inhaler devices on respiratory care: a narrative review / Impacto ambiental dos dispositivos inalatórios nos cuidados respiratórios: uma revisão narrativa

ABSTRACT Climate change is a huge and present threat to human health. This article aims to deepen the knowledge about the environmental impact of inhaler devices on their carbon footprint for patients and health professionals, providing information that allows a better choice of the type of device to be prescribed for the treatment of asthma and COPD. This narrative and nonsystematic review was carried out by searching databases (PubMed, Google Scholar, SciELO, and EMBASE) for articles published between 2017 and 2022, written in Portuguese or in English, using the search words "inhalation device" OR "environmental." The review showed that global warming cannot be addressed by focusing only on inhaler devices. However, the devices that we use to treat respiratory diseases such as asthma and COPD, which are diseases that are aggravated by climate change, are also causing that change. Therefore, health professionals, patient organizations, and industries should take a lead in health policies to offer affordable alternatives to inhalers containing hydrofluoroalkane.

RESUMO As mudanças climáticas são uma ameaça enorme e presente para a saúde humana. Este artigo visa aprofundar o conhecimento sobre o impacto ambiental dos dispositivos inalatórios na pegada de carbono para pacientes e profissionais de saúde, fornecendo informações que permitem uma melhor escolha do tipo de dispositivo a ser prescrito para o tratamento da asma e da DPOC. Esta revisão narrativa e não sistemática foi realizada por meio de busca nas bases de dados PubMed, Google Acadêmico, SciELO e EMBASE de artigos publicados entre 2017 e 2022, escritos em português ou inglês, utilizando as palavras de busca "inhalation device" OR "environmental". A revisão mostrou que o aquecimento global não pode ser abordado com foco em dispositivos inalatórios apenas. No entanto, os dispositivos que utilizamos para tratar doenças respiratórias como asma e DPOC, que são doenças agravadas pelas mudanças climáticas, também estão causando essa mudança. Portanto, profissionais de saúde, organizações de pacientes e indústrias devem assumir a liderança nas políticas de saúde para oferecer alternativas acessíveis aos inaladores contendo hidrofluoralcano.

Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma

ABSTRACT Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010

Nivel de adhesión y prevalencia a inhaladores en pacientes ambulatorios con Asma y Enfermedad Pulmonar Obstructiva Crónica / Level of inhaler adhesion and prevalence in outpatients with Asthma and Chronic Obstructive Pulmonary Disease

INTRODUCCIÓN. Para el tratamiento farmacoterapéutico de enfermedades respi-ratorias, el uso de herramientas para abordar la vía inhalatoria es de elección por su mayor eficacia y menos efectos secundarios; registrar su adhesión y prevalencia es importante. OBJETIVO. Determinar el nivel y la prevalencia de adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Cróni-ca. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 215 y muestra de 121 Historias Clínicas. Se aplicó el Test de Adhesión a Inhaladores, que consistió en dos cuestionarios complementarios: el de 10 ítems, que valoró el nivel de adhesión, y el de 12 que identificó el tipo de incumplimiento en pacientes de Consulta Externa de la Unidad Técnica de Neumología del Hospital de Especialidades Carlos Andrade Marín, periodo julio 2018 - enero 2019. La tabulación y análisis de datos se realizó con el programa Excel. RESULTADOS. La prevalencia de mala adhesión en asmáticos fue de 83,33% y en Enfermedad Pulmonar Obstructiva Crónica 13,33%. En cuanto al sexo, la prevalencia de mala adhesión fue de 15,28% en hombres y de 40,82% en mujeres, con una p<0,05. No se encontró diferencia significativa respecto a los niveles de instrucción. CONCLUSIÓN. La prevalencia de mala adhesión al uso de inhaladores en pacientes con Asma y Enfermedad Pulmonar Obstructiva Crónica fue alta sobre todo en los asmáticos.

INTRODUCTION. For respiratory diseases and their pharmacotherapeutic treatment, the use of tools to address the inhalation route is chosen due to its greater efficacy and fewer secondary effects; then record the adherence and prevalence is important. OBJECTIVE. To determine both level and prevalence of adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease. MATE-RIALS AND METHODS. Cross-sectional analytical study. Population of 215 and sam-ple of 121 patients. The Inhaler Adherence Test was applied, which consisted of two complementary questionnaires: a 10-item questionnaire, which assessed the level of adherence, and a 12-item questionnaire that identified the type of non-compliance in patients of the Pneumology Technical Unit of the Hospital de Especialidades Carlos Andrade Marín, period July 2018 - January 2019. The tabulation and data analysis was performed with Microsoft Excel program. RESULTS. The prevalence of poor ad-herence in asthmatics was 83.33% and in Chronic Obstructive Pulmonary Disease was 13.3%. Regarding gender, the prevalence of poor adherence was 15.28% in men and 40.82% in women, with a p <0.05. No significant differences were found regarding the levels of instruction. CONCLUSION. The prevalence of poor adherence to the use of inhalers in patients with Asthma and Chronic Obstructive Pulmonary Disease was high, especially in asthmatics

Effectiveness of administration of bronchodilator by spacers, home-made spacers and nebulizers in patients with chronic obstructive pulmonary disease

Background: In chronic obstructive pulmonary disease (COPD), bronchodilator therapy using dry powder inhaler (DPI) or a measured dose inhaler (MDI) is more convenient at a lower cost than nebulizer therapy. Mistakes in the use of MDI often occur due to lack of coordination but with the addition of spacers, drawbacks in the use of this MDI can be overcome so that it does not require coordination. Commercial spacers are relatively expensive and not available anywhere while home-made spacers made from bottles of mineral water are very cheap and can be made alone. Study aimed to evaluate the effectiveness of each device, namely a spacer, a home-made spacer and nebulizer.Methods: This study is an experimental study of 62 COPD patients who received bronchodilators using spacers, home-made spacers, and nebulizers. Spirometry is performed for each sample before and after bronchodilator administration to assess FEV1, KVP and changes in VAS dyspnea. The difference in the effectiveness of bronchodilators for various devices in COPD patients was statistically analyzed using the ANOVA test.Results: There were significant differences in the values of VEP1, KVP and VAS dyspnoea after bronchodilator administration through the spacer, home-made spacer and nebulizer (p<0.001), (p=0.002), (p<0.001). The increase in% VEP1 with a nebulizer device was higher than that of a spacer (p=0.001) and the increase in% VEP1 with the nebulizer device was also significantly significant compared to home-made spacer (p<0.001). The increase in% KVP with the nebulizer device was higher than that of home-made spacer (p<0.001), as well as between spacers and home-made spacers and this was significant (p=0.038). The decrease in VAS dyspnoea in patients using nebulizer device than the spacer (p<0.001). Decreasing VAS dyspnoea with nebulizer devices is higher compared to home-made spacers, also gives significant results (p<0.001). There were no differences in the decrease in VAS dyspnoea between spacers and home-made spacers.Conclusions: The administration of bronchodilators by use of three devices (spacers, home-made spacers and nebulizers) can significantly increase the values of FEV1, KVP and VAS dyspnoea. On the use of spacers and home-made spacers, the increase of pulmonary physiological values is not significantly different.

Asma: uso adecuado de dispositivos para inhalación / Asthma: correct use of inhalation drug-delivery devices

Resumen La terapia inhalada se considera la piedra angular del manejo del asma. Sin embargo, a pesar de ser la forma ideal de administración de estos medicamentos, solamente el 70% de los pacientes cumple el tratamiento adecuadamente y sólo del 39 al 67% de los médicos conocen y pueden explicar de forma adecuada las distintas técnicas de inhalación. La terapia inhalada tiene características muy particulares. El depósito pulmonar de un medicamento inhalado a través del tracto respiratorio es más complejo que cuando se administra por vía oral, y varía dependiendo de varios factores, tanto inherentes al medicamento como a la forma de administrarlo. Para que la terapia inhalada sea exitosa, se requiere que se generen partículas del medicamento de un tamaño apropiado que penetren más allá de la orofaringe y la laringe, y que puedan depositarse en los pulmones. Existen múltiples dispositivos para la administración de medicamentos en la vía respiratoria baja. Cada uno ha probado tener una eficacia similar, siempre y cuando se utilicen con la técnica correcta. La decisión para su uso se realiza con base en la edad del paciente, la capacidad de coordinar entre la inhalación y la activación del dispositivo y la presencia de síntomas agudos. La elección del dispositivo a utilizar siempre deberá hacerse de forma conjunta, evaluando pros y contras de cada uno de los dispositivos y siempre de forma individualizada.

Abstract Inhaled therapy is considered the cornerstone of asthma treatment. However, despite being the ideal form of drug delivery, it is recognized that only 70% of patients have an adequate attachment to their treatment and only 39-67% of physicians can explain the optimal inhaler technique. Inhaled therapy has very specific characteristics. Pulmonary deposit of an inhaled medication through the respiratory tract is more complex than when administered orally and depends on several factors inherent to both the medication and the administration. For successful inhaled therapy, the drug needs to be converted into particles of an appropriate size, which can enter beyond the oropharynx and larynx, and be deposited in the lungs. There are multiple devices for the administration of drugs in the lower respiratory tract, each one with a similar efficacy as long as it is used with the correct technique. The decision of which device should be used is made based on the age of the patient, the ability to coordinate between the inhalation and activation of the device, and the presence of acute symptoms. The choice of the device must be evaluated individually.

Analysis of curative effect of atomization inhalation combined with montelukast in the treatment of cough after infantile infection / 中国基层医药

Objective To investigate the clinical efficacy of atomization inhalation combined with montelukast in the treatment of children with post infectious cough.Methods From January 2016 to January 2018,100 children with post-infection cough were selected and randomly divided into two groups according to the digital table,with 50 cases in each group.The observation group was treated with oral budesonide atomization inhalation.The control group was not given drugs.The clinical efficacy,symptom score,pulmonary function index,inflammatory factor index and adverse reaction were compared between the two groups.Results The total effective rate in the observation group was higher than that in the control group [96％ (48/50) vs.80％ (40/50),P ＜ 0.05].After treatment,the scores of daytime cough,nocturnal cough and expectoration in both two groups were lower than those before treatment (all P ＜0.05),which in the observation group were lower than those in the control group(all P ＜ 0.05).After treatment,the two pulmonary function indicators of FEV1,FEV1/FVC in the observation group were higher than those in the control group(all P ＜ 0.05),and the inflammatory cytokines such as CRPIL-6,TNF-α in the observation group were lower than those in the control group(all P ＜ 0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups [6％ (3/50) 比 4％ (2/50),P ＞ 0.05].Conclusion The combination of oral montelukast and budesonide atomization inhalation can effectively treat children with cough after infection,relieve their symptoms,improve the lung function,suppress the inflammatory reaction of respiratory tract,and it is safe and reliable.

Analysis of curative effect of atomization inhalation combined with montelukast in the treatment of cough after infantile infection / 中国基层医药

Objective@#To investigate the clinical efficacy of atomization inhalation combined with montelukast in the treatment of children with post infectious cough.@*Methods@#From January 2016 to January 2018, 100 children with post-infection cough were selected and randomly divided into two groups according to the digital table, with 50 cases in each group.The observation group was treated with oral budesonide atomization inhalation.The control group was not given drugs.The clinical efficacy, symptom score, pulmonary function index, inflammatory factor index and adverse reaction were compared between the two groups.@*Results@#The total effective rate in the observation group was higher than that in the control group[96%(48/50) vs.80%(40/50), P<0.05]. After treatment, the scores of daytime cough, nocturnal cough and expectoration in both two groups were lower than those before treatment(all P<0.05), which in the observation group were lower than those in the control group(all P<0.05). After treatment, the two pulmonary function indicators of FEV1, FEV1/FVC in the observation group were higher than those in the control group(all P<0.05), and the inflammatory cytokines such as CRPIL-6, TNF-α in the observation group were lower than those in the control group(all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups[6%(3/50)比4%(2/50), P>0.05].@*Conclusion@#The combination of oral montelukast and budesonide atomization inhalation can effectively treat children with cough after infection, relieve their symptoms, improve the lung function, suppress the inflammatory reaction of respiratory tract, and it is safe and reliable.

Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem / Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

ABSTRACT Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

RESUMO Objetivo: Nebulizadores caseiros são usados rotineiramente no tratamento de pacientes com fibrose cística (FC). Este estudo objetiva avaliar a contaminação de nebulizadores utilizados por pacientes de FC que estão cronicamente colonizados por Pseudomonas aeruginosa e a associação da contaminação do nebulizador com a higienização, esterilização e método de secagem. Métodos: Um estudo transversal, observacional, multicêntrico foi conduzido em sete centros de referência de FC no Brasil para obter dados de registros médicos; foram feitas entrevistas estruturadas com os pacientes/cuidadores e partes de nebulizadores (máscara e copo) foram coletados para cultura microbiológica. Resultados: No geral, 77 pacientes com FC foram incluídos. A frequência da contaminação do nebulizador foi de 71,6%. Candida spp. (52,9%), Stenotrophomonas maltophilia (11,9%), P. aeruginosa não mucoide (4,8%), Staphylococcus aureus (4,8%) e complexo Burkholderia cepacia (2.4%) foram os patógenos isolados mais comuns. A frequência de higienização dos nebulizadores foi de 97,4%, e 70,3% dos pacientes relata higienização, esterilização e secagem dos aparelhos. A lavagem com água da torneira e secagem das partes no tempo, em espaço aberto, aumentou significativamente (9 a 10 vezes) a chance de contaminação dos nebulizadores. Conclusões: Apesar dos relatos de frequente higienização dos nebulizadores, os métodos de limpeza e esterilização usados eram inadequados. Uma proporção significativa de nebulizadores foi contaminada com microrganismos potencialmente patogênicos para pacientes com FC. Estes resultados apoiam a necessidade de inclusão dos pacientes/cuidadores em programas educacionais e/ou novas estratégias para fornecimento de antibióticos inalatórios.

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital / Erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário

ABSTRACT Objective: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. Methods: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. Results: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. Conclusion: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

RESUMO Objetivo: Demonstrar os erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário. Métodos: Estudo transversal, com amostra de conveniência de pacientes com asma, com 18 anos ou mais, em tratamento em ambulatório de pneumologia de um hospital terciário. A avaliação da técnica inalatória dos usuários dos dispositivos de pó seco Aerolizer ®, Aerocaps® ou Diskus®, ou de aerossóis dosimetrados teve como base as orientações da bula do fabricante de cada dispositivo inalatório. Os pacientes demonstraram a técnica inalatória com dispositivos inalatórios vazios, e ela foi considerada correta quando todas as etapas foram realizadas de forma apropriada, ou quando os equívocos provavelmente não interferiam no resultado do tratamento. Resultados: Entre os 71 participantes, 43 (60,5%) realizaram a técnica inalatória de forma incorreta. Dentre os usuários de aerossóis dosimetrados e dispositivos de pó seco, ocorreram erros de técnica inalatória em 84,2% e 51,9%, respectivamente (p=0,013). Os erros foram mais frequentes na etapa da expiração (67,4%), seguidos da aspiração (58,1%) e da apneia (51,2%). No grupo que usava dispositivos de pó seco, os erros mais comuns aconteceram na expiração e, nos que utilizavam aerossóis dosimetrados, a etapa mais comprometida foi a aspiração. Conclusão: Os erros foram mais frequentes entre os que usavam aerossóis dosimetrados em comparação com dispositivos de pó seco. Os equívocos foram mais comuns na etapa da expiração entre os usuários de dispositivos de pó seco e na aspiração entre os que usavam aerossóis dosimetrados.

Hipersensibilidad a corticoides y manejo en asma severa. A propósito de un caso / Hipersensitivity to corticosteroids and management of severe bronchial asthma. Case study

Resumen Las reacciones de hipersensibilidad a corticoides son raras en la población general, se dividen en dos categorías: Inmediatas, típicamente mediadas por Inmunoglobulina E (IgE), donde se incluye la anafilaxia luego de la administración de un fármaco en un corto período. Su prevalencia descrita es de 0,3-0,5%. Otra reacción es la 'no inmediata', que se manifiesta en un tiempo mayor de una hora después de la administración del fármaco. Se revisó la literatura con el objetivo de mejorar y aclarar el tratamiento en pacientes asmáticos que poseen esta condición. Se encontró que las vías posibles para generar estas reacciones son intranasal, aerosol por inhalador, oral y parenteral. Frente a esta condición se requiere una evaluación estrecha y detallada de la historia clínica, síntomas y reacciones secundarias al fármaco sospechoso. Finalmente, al momento de elegir tipo de corticoide a usar es primordial la seguridad del paciente logrando, además, el control de la enfermedad.

Hypersensitivity reactions to corticosteroids are rare in the general population, they fall into two categories: 'immediate', typically mediated by immunoglobulin E (IgE), which includes anaphylaxis after administration of a drug in a short period of time. Its reported prevalence is 0.3-0.5%. Another reaction is 'not immediate', which manifests itself in a time longer than one hour after the administration of the drug. We reviewed the literature with the aim of improving and clarifying the treatment in asthmatic patients with this condition. It was found that the possible routes to generate these reactions are intranasal, aerosol by inhaler, oral and parenteral. Facing this condition requires a close and detailed evaluation of the clinical history, symptoms and side reactions to the suspected drug. Finally, when choosing which corticosteroid to use, the patient's safety is paramount, and control of the disease is also essential.

Comparison between lignocaine nebulization and airway nerve block for awake fiberoptic bronchoscopy-guided nasotracheal intubation: a single-blind randomized prospective study / 대한마취과학회지

BACKGROUND: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation. METHODS: Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups. Group N received jet nebulization (10 ml of 4% lignocaine) and Group B received bilateral superior laryngeal and transtracheal recurrent laryngeal nerve blocks (each with 2 ml of 2% lignocaine) followed by fiberoptic bronchoscopy-guided nasotracheal intubation. All patients received procedural sedation with dexmedetomidine. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t test was used to analyze parametric data, while the Mann-Whitney U test was applied to non-parametric data and Fisher’s test to categorical data. P values < 0.05 were considered statistically significant. RESULTS: The time taken for intubation was significantly shorter in Group B [115.2 (14.7) s compared with Group N [214.0 (22.2) s] (P = 0.029). The intubating conditions and degree of patient comfort were better in Group B compared with Group N. Although all patients were successfully intubated, patient satisfaction was higher in Group B. CONCLUSIONS: Airway nerve blocks are preferable to lignocaine nebulization as they provide superior-quality airway anesthesia. However, nebulization may be a suitable alternative when a nerve block is not feasible.

Performance evaluation of nebulizers based on aerodynamic droplet diameter characterization using the Direct Laminar Incidence (DLI)

Abstract Introduction Optical microscope images can be useful to evaluate nebulizers considering the size of droplets produced by these devices. From this perspective, the proposed method was compared to the classic concept of Mass Median Aerodynamic Diameter (MMAD) for the ideal droplet size between 0.5-5.5 µm. Methods We tested a sample of five home nebulizers sold on the Brazilian market. A high-speed camera coupled to a microscope obtained images of the droplets during the nebulization process, which allowed us to characterize the diameter of the aero-dispersed droplets. The Count Median Aerodynamic Diameter (CMAD) was used as measurement parameter. Results The images obtained during the nebulization process with the five different nebulizers provided data to determine the frequency distribution of the aero-dispersed droplet population. Successive images were obtained in the range of 2.0s to evaluate the dynamic behavior of the droplets. The generated data also allowed the elaboration of histograms emphasizing the ideal diameter range of droplets between 0.5 and 5.5 μm. Conclusion The Direct Laminar Incidence (DLI) model using digital image processing technique allowed the characterization of respirable particles. This model proposes the creation of a range of optimum absorption of the droplets by the respiratory tract. Although there is a technical limitation in the direct acquisition of images due to the depth of focus, presenting an error of 9.3%, the described method provides consistent results when compared to other droplets characterization techniques. Thus, the authors believe that Direct Laminar Incidence (DLI) is a viable method to assess the performance of nebulizers despite the requirement of adjustments and possible improvements required to minimize measurement errors.

Clinical effect of massage therapy on infants and young children with asthmatic disease / 中国基层医药

Objective To study the clinical effect of massage therapy on infants and young children with asthmatic disease.Methods 100 infants and young children with asthmatic disease were selected.The children and parents who agreed to cooperate with massage therapy were enrolled as treatment group.The children and parents who were unwilling to cooperate with massage therapy,but willing to cooperate with home aerosol therapy were enrolled as control group,50 cases in each group.The two groups of children took comprehensive treatment measures,the treatment group was given massage therapy,the control group was given home aerosol therapy.The therapeutic effects of the two groups were compared and analyzed.Results The respite time,recurrent frequency of wheezing within 1 year,respiratory infection occurred within 1 year,number of re-hospitalization within 1 year of the control group were (5.6 ± 1.36) d,(2.35 ± 1.13) times,(2.96 ± 1.22) times,(0.85 ± 0.58) times,which of the treatment group were (5.82 ± 1.44) d,(2.31 ± 1.09) times,(2.89 ± 1.19) times,(0.86 ± 0.51) times,the differences were not statistically significant between the two groups (t=0.573,0.417,0.523,0.872,all P ＞0.05).The peak time before treatment,1 month after treatment and 6 months after treatment,and the peak volume ratio before treatment,1 month after treatment and 6 months after treatment between the two groups had no statistically significant differences(all P ＞ 0.05).Conclusion Massage therapy can achieve the same effect with the home aerosol therapy,the method is simple,easy,without any adverse reactions,it is worthy of clinical promotion.

Efficacy of domestic electronic vaporizer when used for sevoflurane anesthesia in rabbits / 中华麻醉学杂志

Objective To evaluate the efficacy of domestic electronic vaporizer when used for sevoflurane anesthesia in rabbits.Methods Ninety healthy pathogen-free New Zealand rabbits of both sexes,aged 4-5 months,weighing 2.5-3.5 kg,were divided into 3 groups (n=30 each) using a random number table:mechanical vaporizer group (group M),domestic electronic vaporizer group (group E) and Zeus electronic vaporizer group (group Z).In group M,the mechanical vaporizer was used,the sevoflurane vaporizer dial was adjusted to 2％,with the fresh air flow set at 2 L/min.In E and Z groups,BR850 domestic electronic vaporizer and Zeus electronic vaporizer were used,respectively,and the concentration of sevoflurane inhaled was 2％.Sevoflurane was inhaled for 2 h in each group.The formula method and weighing method were used to calculate the consumption of sevoflurane in group M.The electronic calculation method and weighing method were used to calculate the consumption of sevoflurane in Z and E groups.The stable value of end-tidal sevoflurane concentration (ETCsev) and time for ETCsev reaching the stable value were recorded.ETCsev was recorded every 10 min after reaching the stable value (T1T12).Results Compared with group M,the consumption of sevoflurane (weighing method) was significantly reduced,and the time for ETCsev reaching the stable value was shortened in Z and E groups (P＜ 0.05).Compared with group Z,the consumption of sevoflurane (weighing method) was significantly increased (P＜0.05),and no significant change was found in the time for ETCsev reaching the stable value in group E (P＞0.05).Compared with the consumption of sevoflurane (weighing method),no significant change was found in the consumption of sevoflurane (electronic method) in group Z (P＞0.05),and the consumption of sevoflurane (electronic method) was significantly increased in group E (P＜0.05).There was no significant difference in the stable value of ETCsev between the three groups (P＜0.05).There was no significant difference in ETCsev between and within groups (P＞0.05).Conclusion The domestic electronic vaporizer achieves automatic and precise control of volatile concentrations of inhalation anesthetics and can be effectively used for sevoflurane anesthesia in rabbits.When compared with Zeus electronic vaporizer,the precision of the domestic electronic vaporizer needs further improvement,but the cost is obviously low,the compatibility is strong,and it has clinical application value.

Cigarrillos eléctrónicos: ¿Podemos recomendar su uso? / Electronic cigarettes: can we recommend its use?

Los cigarrillos electrónicos (Cig-e) son dispositivos que contienen un líquido compuesto por un solvente, saborizantes y, en la mayoría de los casos, nicotina. Este liquido, al ser calentado en el dispositivo, se vaporiza, siendo aspirado por el usuario. En los últimos años, el uso de los Cig-e ha aumentado rápidamente, especialmente entre escolares y gente joven, sin existir hasta el día de hoy evidencias ciertas sobre su seguridad y efectos a largo plazo. En este artículo revisamos la evidencia existente en cuanto a los efectos y seguridad de cada uno de los componentes de los Cig-e y analizamos sus potenciales indicaciones en distintos escenarios clínicos.

Electronic cigarettes (Cig-e) are devices that contain a liquid composed of a solvent, flavors and, in most cases, nicotine. This liquid, when heated in the device, vaporizes, being aspirated by the user. In recent years, the use of Cig-e has increased rapidly, especially among schoolchildren and young people, with no clear evidence of safety and long-term effects to date. In this article we review the existing evidence regarding the effects and safety of each of the components of Cig-e and analyze their potential indications in different clinical scenarios.

Educational interventions to improve inhaler techniques and their impact on asthma and COPD control: a pilot effectiveness-implementation trial / Educação para a melhora da técnica inalatória e seu impacto no controle da asma e DPOC: um estudo piloto de efetividade-intervenção

ABSTRACT To assess the impact that educational interventions to improve inhaler techniques have on the clinical and functional control of asthma and COPD, we evaluated 44 participants before and after such an intervention. There was a significant decrease in the number of errors, and 20 patients (46%) significantly improved their technique regarding prior exhalation and breath hold. In the asthma group, there were significant improvements in the mean FEV1, FVC, and PEF (of 6.4%, 8.6%, and 8.3% respectively). Those improvements were accompanied by improvements in Control of Allergic Rhinitis and Asthma Test scores but not in Asthma Control Test scores. In the COPD group, there were no significant variations. In asthma patients, educational interventions appear to improve inhaler technique, clinical control, and functional control.

RESUMO Para avaliar o impacto do ensino da técnica inalatória no controle clínico e funcional de pacientes com asma ou DPOC, incluíram-se 44 participantes antes e após essa intervenção. Houve uma diminuição significativa no número de erros cometidos, sendo que 20 pacientes (46%) melhoraram significativamente sua técnica na expiração prévia e apneia final. No grupo asma, houve significativa melhora nas médias de FEV1 (6,4%), CVF (8,6%) e PFE (8,3%), e essa melhora correlacionou-se com os resultados no Control of Allergic Rhinitis and Asthma Test, mas não com os do Asthma Control Test. No grupo DPOC, não houve variações significativas. O ensino da técnica inalatória parece melhorar seu desempenho e os controles clínico e funcional em pacientes com asma.

The investigation of oxygen nebulizer use in an upper first-class hosipital / 重庆医学

Objective To investigate oxygen nebulizer usage among inpatients in an upper first‐class hospital so that this de‐vice can be used by medical personnel and patients properly .Methods Totally 409 patients were investigated about the usage of the device from May 12th to 30th 2014 ,whose outcomes were analyzed by Excel2007 software .Results The total liquid volume of in‐halation on prescription was much larger than the favorable one ,ranging from 4 to 6 mL .And the Oxygen flow ,ranging from 2 .5 to 3 .5 L/min ,was much lower than the normal flow (ranging from 6 to 8 L/min) .In addition ,all patients failed to breathe normally with occasional deep breaths and failed to gargle timely after corticosteroid inhalation .Only 3% patients cleaned their faces after corticosteroid inhalation ,43 .5% patients sit in an upright position ,44 .0% patients kept the nebulizer vertical during treatment .The accuracy rates of mouthpiece position ,the right time to stop nebulizer therapy ,rinsing the nebulizer with sterile or distilled water and allowing to air dry were 95 .1% ,99 .2% ,and 99 .3% ,respectively .Conclusion There are many common patient use nebulizer incorrectlly in the upper first‐class hospital ,and education and guidance by medical personnel should be strengthened .

Effect that an educational program for cystic fibrosis patients and caregivers has on the contamination of home nebulizers / Efeito de um programa de educação para cuidadores e pacientes com fibrose cística na contaminação de nebulizadores de uso domiciliar

OBJECTIVE: To describe the pathogens found in home nebulizers and in respiratory samples of cystic fibrosis (CF) patients, and to evaluate the effect that a standardized instruction regarding cleaning and disinfection of nebulizers has on the frequency of nebulizer contamination. METHODS: We included 40 CF patients (22 males), all of whom used the same model of nebulizer. The median patient age was 11.2 ± 3.74 years. We collected samples from the nebulizer mouthpiece and cup, using a sterile swab moistened with sterile saline. Respiratory samples were collected by asking patients to expectorate into a sterile container or with oropharyngeal swabs after cough stimulation. Cultures were performed on selective media, and bacteria were identified by classical biochemical tests. Patients received oral and written instructions regarding the cleaning and disinfection of nebulizers. All determinations were repeated an average of two months later. RESULTS: Contamination of the nebulizer (any part) was detected in 23 cases (57.5%). The nebulizer mouthpiece and cup were found to be contaminated in 16 (40.0%) and 19 (47.5%), respectively. After the standardized instruction had been given, there was a significant decrease in the proportion of contaminated nebulizers (43.5%). CONCLUSIONS: In our sample of CF patients, nebulizer contamination was common, indicating the need for improvement in patient practices regarding the cleaning and disinfection of their nebulizers. A one-time educational intervention could have a significant positive impact. .

OBJETIVO: Descrever os patógenos encontrados nos nebulizadores de uso domiciliar e nas amostras de trato respiratório de pacientes com fibrose cística (FC) e verificar o efeito de uma instrução padronizada de higiene e desinfecção de nebulizadores na contaminação dos mesmos. MÉTODOS: Foram incluídos no estudo 40 pacientes com FC (22 do sexo masculino) que utilizavam um mesmo modelo de nebulizador. A mediana de idade foi de 11,2 ± 3,74 anos. Amostras dos nebulizadores foram coletadas do bocal e do copo reservatório utilizando-se um swab estéril umedecido em solução salina estéril. As amostras de trato respiratório dos pacientes foram colhidas por expectoração em coletor estéril ou com swab de orofaringe após estímulo de tosse. As culturas foram realizadas em meios seletivos, e a identificação bacteriana foi feita através de provas bioquímicas clássicas. Instruções verbais e escritas sobre higiene e desinfecção dos nebulizadores foram ministradas. Todas as determinações foram repetidas dois meses após, em média. RESULTADOS: A contaminação de alguma parte dos nebulizadores foi observada em 23 casos (57,5%). A contaminação do bocal e do copo foi similar, em 16 (40.0%) e 19 casos (47.5%), respectivamente. Houve uma redução significativa da proporção de nebulizadores contaminados (43,5%) após a instrução padronizada. CONCLUSÕES: Nesta amostra de pacientes com FC, a contaminação dos nebulizadores foi alta, o que indica a necessidade de melhoria nas práticas de higiene e desinfecção dos nebulizadores de pacientes com FC. Uma única intervenção educacional pode ter um impacto positivo significativo. .

Recent advance in inhaler medications for chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) is one of the highest ranking diseases with regard to prevalence and mortality in Korea and also worldwide. In the past decade, effective inhaler medications for COPD treatment have been developed or approved. These inhaler medications have been proven to have beneficial effects on symptoms, lung function, quality of life, exercise capacity, and exacerbation. The inhalers used widely are long-acting anticholinergics, long-acting beta2-agonists, and combined inhalers of a corticosteroid and long-acting beta2-agonist. These inhaler medications are more effective than oral medications and less likely to produce adverse events. However, the inhaler medications should be used appropriately to achieve the desired effect. For COPD patients with a forced expiratory volume in 1 second (FEV1) less than 80% of the predicted value, a long-acting anticholinergic or long-acting beta2-agonist is usually the medication of first choice. If a COPD patient with a FEV1 less than 60% of the predicted value suffers frequent exacerbations, a combined inhaler of corticosteroid and long-acting beta2-agonist is a good choice. To prescribe an inhaler medication for COPD patients, spirometry should be performed, not only to confirm the diagnosis but also to define severity. These effective inhaler medications should be used widely for COPD patients in Korea.

Aerossolterapia / Aerossoltherapy

As doenças do trato respiratório têm uma elevada prevalência emnosso meio. A via inalatória é a preferida para a administração da terapia. Vários dispositivos, com diferentes características, estão disponíveis no mercado. Esta revisão teve o objetivo de descrever os tipos de dispositivos, suas vantagens e desvantagens, e indicações de uso conforme cada faixa etária, além de abordar alguns aspectos técnicos relevantes para a obtenção de melhores resultados com a terapia inalatória. Evidências científicas enfatizam novas formas de administração de medicação inalatória. Nebulizadores convencionais apresentam numerosos inconvenientes. Aerossóis com espaçadores/aerocâmaras permitem melhora na deposição pulmonar, resultando, principalmente em pacientes sem coordenação adequada, em uma melhor relação custo-benefício do que outros métodos tradicionalmente utilizados. Naqueles que conseguem gerar altos fluxos inspiratórios, os inaladores de pó seco podem ser utilizados.

The prevalence of respiratory diseases is high in Brazil. Inhalation isthe preferred route of delivery for therapy. Various inhalation devices, with different characteristics, are available. The objective of this review was to describe those devices, their advantages, disadvantages, and indications for each age group, as well as to address certain relevant technical aspects of obtaining optimal results with inhalation therapy. New means of delivering inhaled therapy have been described. Conventional nebulizers have a number of disadvantages. Aerosol inhalation via spacers or holding chambers seems to be another method, resulting, specifically in patients without adequate coordination, in a relative superior cost-benefit relationship in comparison with traditional methods. In patients who can generate high inspiratory flow rates, dry power inhalers can be used.