Pulmonary pharmacology & therapeutics
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Pulm Pharmacol Ther · Oct 2017
Comparative Study Controlled Clinical TrialVideo instruction is more effective than written instruction in improving inhaler technique.
Many patients with asthma use inhalers incorrectly. Better inhaler technique is associated with better asthma control. We tested the effectiveness of a computer-based video training solution versus traditional written instructions, both which may be used in a resource-limited setting, for teaching inhaler technique. We hypothesized that computer based training will provide a higher quality of instruction which will improve technique more effectively than written training. ⋯ We conclude that written instruction appears to be inadequate to achieve safe and effective administration of inhaled medicine. In contrast, video-based education can effectively create adequate inhaler technique without additional provider time. REGISTRATION NUMBER (CLINICALTRIALS.GOV IDENTIFIER): NCT02660879.
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Pulm Pharmacol Ther · Oct 2017
Comparative StudyUse of nebulized milrinone in cardiac surgery; Comparison of vibrating mesh and simple jet nebulizers.
Cardiopulmonary bypass triggers an ischemia-reperfusion injury with endothelial dysfunction in the pulmonary circulation which can result in pulmonary hypertension. Inhaled milrinone reduces this reperfusion phenomenon and two methods commonly available for administering it are simple jet and vibrating mesh nebulizations. However, neither their generated milrinone particle size profiles, nor their ability to aid endothelial relaxation have been compared. ⋯ In vitro studies showed lower emitted and inhaled doses from the simple jet nebulizer and its particle size distribution indicated upper and middle airway targeting. During in vivo studies, milrinone pre-treated, unlike saline groups maintained baseline pulmonary pressures up to 30 min post-CPB. Ex vivo studies showed better endothelial relaxation of arteries from the two milrinone groups over those from the control group in an administration/pathway-dependent manner, favoring simple jet administration.
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Pulm Pharmacol Ther · Aug 2017
Meta AnalysisWithdrawal of inhaled corticosteroids in COPD: A meta-analysis.
Conflicting findings exist on the benefit of withdrawal of inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD). We performed a quantitative synthesis in order to assess real impact of ICS discontinuation in COPD patients. ⋯ The discrepancy between statistical analysis and clinical interpretation of this meta-analytic evaluation demonstrates the strong clinical need in understanding what is the real impact of ICS withdrawal in COPD. ICS discontinuation is a complex procedure that requires a well planned and tailored strategy. Further well designed studies on withdrawal of ICS should be performed by clustering COPD patients with regard to the phenotype characteristics, rate of exacerbations/year, decline of lung function, and quality of life.
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Pulm Pharmacol Ther · Aug 2017
Aerosolized tobramycin for Pseudomonas aeruginosa ventilator-associated pneumonia in patients with acute respiratory distress syndrome.
Ventilator-associated pneumonia (VAP) due to Pseudomonas aeruginosa has a high mortality and recurrence rate, especially in patients with acute respiratory distress syndrome (ARDS). Therefore, new therapeutic strategies against severe pneumonia are needed. This study evaluated the efficacy of aerosolized tobramycin for P. aeruginosa VAP in ARDS patients. ⋯ Aerosolized tobramycin was an effective therapeutic strategy for P. aeruginosa VAP patients with ARDS.
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Pulm Pharmacol Ther · Jun 2017
Randomized Controlled Trial Multicenter StudyEffects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial.
Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO2-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. This study evaluated the effects of ACTZ on the duration of MV in patients with MA and COPD or obesity hypoventilation syndrome (OHS) intubated with acute respiratory failure. ⋯ Among patients with MA and COPD or OHS, early treatment with ACTZ did not shorten significantly the duration of MV compared with placebo.