Choosing a route of administration for quadrivalent meningococcal polysaccharide vaccine: intramuscular versus subcutaneous.

A clinical trial was conducted to compare intramuscular (im) with subcutaneous (sc) routes for administration of quadrivalent meningococcal polysaccharide vaccine in 141 adults. Safety assessment showed the im route had reduced erythema (P<.01) and reduced headache on days 1 and 2 (P<.05). Serological testing for serum bactericidal antibody titers against capsular groups A and C did not detect significant differences.

RinoFlow nasal wash and sinus system as a mechanism to deliver medications to the paranasal sinuses: results of a radiolabeled pilot study.

Direct delivery of medication to the sinuses with standard nebulizers is difficult to achieve. The nasal inhalation of aerosolized medications is dependent on the size of the particles and the pressure with which they are delivered; when the particles are too small or the pressure is too low, the drug cannot reach the sinuses. The ability of topical medications to treat sinus disorders can be improved if the medication could be delivered directly to the sinuses. We tested the ability of the RinoFlow nasal aerosol delivery device to deposit aerosol directly to the paranasal sinuses. Five normal, healthy subjects used the device to administer technetium Tc 99m nasally. Nuclear scanning was used to detect deposition in the frontal and maxillary sinuses. Three subjects underwent additional testing after administration of a nasal decongestant. Three of the five subjects showed some evidence of direct delivery to the sinuses, although deposition was not uniform or complete. Pretreatment with a decongestant had no apparent effect on subsequent technetium delivery. We conclude that the results of this study are promising and that further study is warranted.

Is an anticholinergic agent superior to a beta 2-agonist in improving dyspnea and exercise limitation in COPD?

STUDY OBJECTIVE: To evaluate the impact of a week-long course of inhaled albuterol compared with ipratropium on expiratory peak flow, exercise performance, and dyspnea in patients with stable COPD. DESIGN AND INTERVENTIONS: A double-blind, two-period, crossover evaluation, wherein the subjects inhaled albuterol, two puffs four times a day (qid) for 7 days, or ipratropium, two puffs quid for 7 days, in random sequence. SETTING: Outpatients of the Pennsylvania State University Hospital, Lebanon VA Medical Center, and local private office practices. PARTICIPANTS: A sample of 15 subjects with stable COPD with FEV1 < 55% predicted. MEASUREMENTS AND RESULTS: Variables measured at baseline (no inhaled bronchodilator) and/or on day 7 of each arm included FEV1 (liters), 12-min walk test distance (meters), "rescue" puffs of metaproterenol needed each week, and dyspnea scoring after walking, on the Borg Category Scale (0 to 10 = maximal). There was no significant difference in distance walked in 12 min (mean of 751.0 +/- 55.5 [+/- SE]) vs 755.7 +/- 61.3 m) or perceived dyspnea (mean 2.7 +/- 0.4 vs 3.3 +/- 0.4) during albuterol or ipratropium use. Seven patients preferred ipratropium, seven preferred albuterol, and one had no preference. CONCLUSION: We conclude that the effects of 1 week of albuterol or ipratropium have similar effects on exercise performance and subjective dyspnea in patients with stable COPD.

Continuous versus bilevel positive airway pressure for obstructive sleep apnea.

Recent objective studies demonstrate relatively low hours of nightly use during nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). Patients frequently complain of dyspnea or discomfort during CPAP use, especially during expiration (against the continuous pressure), which may be a reason for the low hours of use. We hypothesized that with decreased expiratory pressure, hours of nightly use would increase. Therefore, we randomized 83 OSA patients to receive either continuous or bilevel positive airway pressure when expiratory pressure is lower. To document objectively the effective use of either therapy, we built and installed elapsed-time and mask pressure sensors in the patients' positive airway pressure units. A total of 62 patients were evaluable and followed for 1 yr. Of these, 26 received bilevel and 36 CPAP pressures. The machine timers measured accumulated "machine-on" time, and the mask pressure sensor recorded the total time in which the mask pressure was within 2 cm H2O of the effective pressure (pressure shown to eliminate 95% of the obstructive apneas during a full night of polysomnography). The mean machine timer hours of CPAP were 5.0 +/- 0.19 SEM and 4.9 +/- 0.23 SEM during bilevel therapy (p NS) over a 12-mo period. The pressures required during CPAP or bilevel therapy were not different between high and low hourly users. Effective use, the percentage of time that the machine was running and the prescribed pressure was being delivered, was 80% in CPAP and 82% in the bilevel users (p NS). Both groups had equal complaints with regard to mask discomfort, machine noise, and nasal stuffiness.(ABSTRACT TRUNCATED AT 250 WORDS)

Nasal CPAP: an objective evaluation of patient compliance.

Nasal continuous positive airway pressure (NCPAP) improves sleepiness and prognosis in obstructive sleep apnea (OSA). Our objective was to document NCPAP compliance and the percentage of time that the effective pressure shown to eliminate 95% of the obstructive apneas and hypopneas was maintained. We built and covertly installed an elapsed timer and mask pressure transducer recorder in NCPAP units of 47 OSA patients. Subjects were seen at 2- to 8-wk intervals over 6 months. Group mean age was 51 yr; 38 males, with mean body mass index of 42; all complained of daytime sleepiness. Initial full night polysomnography demonstrated a mean apnea-hypopnea index (AHI) of 58 +/- 2.6 SEM (range, 10 to 115). Nine subjects discontinued therapy within 3 months for various reasons. In the remaining subjects (n = 38) the actual mean nightly hours of use was 4.7 which represents 68% of the stated total sleep time (compliance). However, effective mean hours of use was 4.3 which represents 91% of the time that prescribed effective pressure was maintained at the mask. The AHI did not correlate with compliance, but did correlate with effective use (R = 0.27048, p = 0.0006). Subjective initial complaints of daytime sleepiness correlated with compliance only during the first visit (R = 0.38590, p = 0.05). No predictors for compliance were found.