Factores determinantes de la calidad de los inhaladores presurizados de dosis medida / Factors that determine the quality of metered-dose inhaler

Los inhaladores presurizados de dosis medida (IPDMs) son una de las herramientas terapéuticas de elección en el tratamiento del asma y EPOC. Los IPDMs son un producto farmacéutico complejo ya que la calidad del principio activo, su formulación, los propelentes, la válvula dispensadora y el envase, entre otros, son factores determinantes de su eficacia y seguridad. Con la aparición de distintas formulaciones de IPDMs, una tentación razonable es optar por el producto de menor precio. No obstante, para que esta decisión sea acertada, es indispensable que la calidad de las formulaciones esté asegurada. Este aspecto le compete a la autoridad sanitaria, pese a limitaciones presupuestarias, de infraestructura y de equipamiento disponibles. En este artículo se discuten aspectos que determinan la calidad de los IPDMs, los controles de calidad requeridos y la evidencia que avala la intercambiabilidad entre innovadores y genéricos.

Availability and consumption status of CFC and non-CFC inhalers for asthma and chronic obstructive pulmonary diseases in Thailand.

In response to the Montreal Protocol and the calls for global early-bird CFC phase-out before 2010, the demand and supply status of both CFC and non-CFC inhalers for prevention and treatment of asthma and COPD in Thailand were evaluated to determine how soon the country would be able to discontinue CFC MDIs with least impacts to both consumers and importers. Availability and supply of the inhalers were collected from registration and importation database of the Thai FDA. Demand and product cost were obtained from the local importers and from IMS, Thailand. Available inhaled products comprise of 39% CFC MDIs, 28% DPIs, 20% solutions for nebulizers and 13% HFA MDls, respectively. All 31 brands of portable hand-held inhalers, comprising 16 CFC MDIs, 6 HFA MDIs and 9 DPIs, are imported, only solutions for nebulization are locally manufactured. Salbutamol is mostly prescribed MDI, its consumption is over 50% of all. The transition to non-CFC alternatives (HFA MDIs and DPIs) has become evidence since 2000. After being informed about the demand and supply of the inhalers, in 2005, Thai FDA has announced its CFC phase-out policy and encouraged importation of HFA alternatives by facilitating the registration and approval process. When the most prescribing CFC MDls, salbutamol, is completely replaced with non-CFC form in 2006, Thailand would be able to reduce considerable amount of CFCs into our atmosphere.

The Effect of Spacer on the Bronchodilator Response in the First Medical Examination of Old Age

BACKGROUNDS: When measuring lung function and response to bronchodilator, MDI(metered-dose inhaler) is commonly used but unfamiliarity of its use and cold sensation by the puffed gas decrease reliability of the result. Spacer can reduce the cold freon effect and undesired oropharyngeal deposition caused by the rapid evaporation of the propellant and there are many studies which showed more effectiveness of spacer on the treatment of children with asthma but no study whether it is effective on the bronchodilator response test in the first medical examination of old age. Therefore, we tested whether the use of spacer can reduce the cold freon effect and improve the bronchodilator response in the first medical examination of old age. METHODS: Two hundred of elderly patients( 65years) who had never used MDI were measured the bronchodilator response. Subjects were randomised to either spacer-user or spacer-nonuser. Twenty minutes after 400 g fenoterol was administered, FEV1 (forced expiratory volume in one second) was measured. Bronchoconstriction was defined as a decrease in FEV1 by 10% or greater after bronchodilator inhalation. We further devided each group into normal or obstructive group, obstructive group was defined as FEV10.05) but brochoconstriction(n=1) occured only in spacer-nonuser. CONCLUSION: Spacer improved bronchodilator response and prevented bronchoconstriction, in the first medical examination of old age.

Asphyxia Due to Oxygen Deficiency: The Report of Two Autopsy Cases / 대한법의학회지

Two autopsy cases of asphyxia due to oxygen deficiency are reported. The first case is that a 38-year-old man died in a storehouse. Many pears were stored in a storehouse and the its atmosphere was strictly controlled. The second case is that a 42-year-old man died in the boiler room of a fishing ship. Much amount of Freon gas escaped due to a defect of the refrigerator in the boiler room. The victim entered the boiler room because he repaired the refrigerator. But, the victim died when he entered the boiler room immediately. In this article, the autopsy findings and the contents of the investigation of scene of two cases are described.

Green house effect

This paper describes the Green House effect [GHE], one important factor of global warming. It presents the causes [Carbondioxide, Nitrous Oxides, Methane, CFCs and Ozone] and effects [Rising sea level, rising temperature, weather, agriculture, famine, wildlife, mass migrations and world security] of GHE. To control it both at local and global level, some realistic recommendations are given at the end of the paper

Metered dose inhaler(MDI)-induced bronchocostriction in asthmatic patients: the effects of the incert ingredients and propellants / 천식및알레르기

BACKGROUND: Bronchoconstriction associated with aerosolized agents delivered by a metered dose inhaler (MDI) is relatively uncommon, but has been of particular interest. MATERIAL AND METHOD: In this study, we investigated to what extent the inert ingredients and propellants (freons) influence pulmonary function in 25 asthmatic patients. Forced expiratory volume in one second(FEV,) was measured by spirometry, Autospira HI 498(Chest, Japan) before and 1, 3, 5 and 10 minutes after the inhalation of saline control and MDI-placebo containing freons and inert ingredients. RESULT: Twenty four % (6/25) of asthmatics experienced a decrease in FEV20 by 10% or greater when compared to saline control. Number of positive cases in steroid dependent asthmatics is significantly higher compared to non-steroid dependent asthmatics. (p<0.05) Bronchoconstriction associated with the use of MDI-placebo appeared within 3 to 5 minutes and resolved spontaneouly at 10 minutes after the inhalation. CONCLUSION: The bronchoconstrictive response induced by MDI might be caused by the pro-pellants and/or the other inert ingredients contained in MDIs.