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Academic literature on the topic 'Inhalers'

Author: Grafiati
Published: 4 June 2021
Last updated: 28 July 2024

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Journal articles on the topic "Inhalers"

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Chaudhary, K., and A. Kumar. "An analysis of inhalation technique errors in metered-dose inhaler and dry powder inhaler users." International Journal of Science Annals 6, no. 1 (June 30, 2023): 47–52. http://dx.doi.org/10.26697/ijsa.2023.1.5.

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Background and Aim of Study: Decreased efficacy of metered dose inhaler and dry powder inhalers are associated with errors in inhalational techniques. The aim of the study: to study the association of errors in the technique for using two types of inhalers with demographic and other variables. Material and Methods: Five hundred adult patients with respiratory diseases who were currently using an inhaler device were enrolled in this study. Patient’s demographics and duration of inhaler therapy and assessment of inhaler technique were recorded by interview and direct observation. Results: Out of 500 enrolled patients, 465 patients were using the device with wrong technique. Among 465 patients, 188 patients were using metered dose inhaler and 277 patients were using dry powder inhalers. Technical errors were common in both the devices but more common with metered dose inhaler device. Failure to exhale before the inhale through device was most common error with metered dose inhaler (68.6%) and dry powder inhalers (71.4%). Association of errors with female gender is seen in both metered dose inhaler and dry powder inhalers users. Reduction in the numbers of errors is seen with increase in the duration of therapy and regular training on follow-up visits. Conclusions: Dry powder inhalers and metered dose inhalers are commonly used in management of respiratory patients. Therefore, the errors in using these devices, technique and handling errors are common in both dry powder inhalers and metered dose inhaler users. More error was found in old age, female and short-term users. However regular training on follows up visits can solve this current problem.
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Padmini, Anaswara K., and Shabna Basheer. "Evaluating metered dose inhaler and dry powder inhaler use technique among bronchial asthma and COPD patients attending tertiary health care centre in South India." International Journal Of Community Medicine And Public Health 8, no. 9 (August 27, 2021): 4545. http://dx.doi.org/10.18203/2394-6040.ijcmph20213567.

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Background: Inhaler is a device used by patients who have chronic respiratory illness. Inhaled medication is directly deposited in the lungs, which is its site of action. Improper use of inhalers can lead to worsening of disease, over medication and side effects including oral candidiasis. This study aims to evaluate the inhaler use technique.Methods: A hospital based cross sectional study was conducted among patients who were using inhalers for one year or more attending respiratory medicine OPD using pretested semi-structured questionnaire.Results: The majority of 81 patients were MDI users. Only 8.64% of them performed all the steps according to NIH guidelines regarding proper technique of inhaler use properly. Among the 39 patients who used dry powder Inhaler, 33% correctly performed all the steps according to the guidelines.Conclusions: Only a low proportion of patients properly performed the steps in the technique of using inhalers. Improper use of inhalers leads to poor efficacy of the treatment. So health care providers should take measures to ensure that the patients on inhalers are aware of the proper technique and are following the steps in using inhalers correctly.
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P., Abdul Hashim K., and Muhammed Anas Ayoob. "An evaluation of proper inhaler technique and adherence to treatment in asthma patients." International Journal of Research in Medical Sciences 7, no. 6 (May 29, 2019): 2382. http://dx.doi.org/10.18203/2320-6012.ijrms20192533.

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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.
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Hamzavi, Mohammad. "Combination Therapy with Budesonide and Formoterol in Single Inhaler of Asthma." Clinical Medicine Insights: Therapeutics 2 (January 2010): 1179559X1000200. http://dx.doi.org/10.1177/1179559x1000200002.

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Inhaled corticosteroids are the mainstay of asthma therapy, but there is now compelling evidence that addition of a long-acting inhaled β2-agonist, such as formoterol, gives better control in terms of reduced symptoms, improved lung function and reduced exacerbations in patients with mild to severe persistent asthma than increasing the dose of corticosteroids in patients not fully in control by low dose. This has led to development of fixed dose combination inhalers such as budesonide/formoterol. Budesonide/formoterol combination in a single inhaler represents a safe, effective and convenient treatment option for management of patients with unstable asthma than inhaled steroid alone. This combination has shown effectiveness for both maintenance and rescue therapy. Clinical results show that the budesonide/formoterol by SMART approach prolongs the time to first severe asthma exacerbation, reduces frequency of exacerbation and maintains day to day asthma control at a reduced corticosteroid load and cost when compared with higher fixed maintenance dose of combination inhalers. With regular maintenance therapy by this approach it is more likely to improve patient compliance. Budesonide/formoterol combination inhaler has shown to have a faster bronchodialatory effect compared with other combination inhalers, a quality highly in demand during exacerbation episodes. Due to this rapid onset of action, budsonide/formoterol in a single inhaler lends itself to be used as a rescue medication, as well.
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Wilkinson, Alexander J. K., Rory Braggins, Ingeborg Steinbach, and James Smith. "Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England." BMJ Open 9, no. 10 (October 2019): e028763. http://dx.doi.org/10.1136/bmjopen-2018-028763.

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ObjectivesMetered-dose inhalers (MDIs) contain propellants which are potent greenhouse gases. Many agencies propose a switch to alternative, low global warming potential (GWP) inhalers, such as dry powder inhalers (DPIs). We aimed to analyse the impact on greenhouse gas emissions and drug costs of making this switch.SettingWe studied National Health Service prescription data from England in 2017 and collated carbon footprint data on inhalers commonly used in England.DesignInhalers were separated into different categories according to their mechanisms of action (eg, short-acting beta-agonist). Within each category we identified low and high GWP inhalers and calculated the cost and carbon impact of changing to low GWP inhalers. We modelled scenarios for swapping proportionally according to the current market share of each equivalent DPI (model 1) and switching to the lowest cost pharmaceutically equivalent DPI (model 2). We also reviewed available data on the carbon footprint of inhalers from scientific publications, independently certified reports and patents to provide more accurate carbon footprint information on different types of inhalers.ResultsIf MDIs using HFA propellant are replaced with the cheapest equivalent DPI, then for every 10% of MDIs changed to DPIs, drug costs decrease by £8.2M annually. However if the brands of DPIs stay the same as 2017 prescribing patterns, for every 10% of MDIs changed to DPIs, drug costs increase by £12.7M annually. Most potential savings are due to less expensive long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) inhalers. Some reliever inhalers (eg, Ventolin) have a carbon footprint over 25 kg CO2e per inhaler, while others use far less 1,1,1,2-tetrafluoroethane (HFA134a) (eg, Salamol) with a carbon footprint of <10 kg CO2e per inhaler. 1,1,1,2,3,3,3-Heptafluoropropane (HFA227ea) LABA/ICS inhalers (eg, Flutiform) have a carbon footprint over 36 kg CO2e, compared with an equivalent HFA134a combination inhaler (eg, Fostair) at <20 kg CO2e. For every 10% of MDIs changed to DPIs, 58 kt CO2e could be saved annually in England.ConclusionsSwitching to DPIs would result in large carbon savings and can be achieved alongside reduced drug costs by using less expensive brands. Substantial carbon savings can be made by using small volume HFA134a MDIs, in preference to large volume HFA134a MDIs, or those containing HFA227ea as a propellant.
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Lavorini, Federico, Christer Janson, Fulvio Braido, Georgios Stratelis, and Anders Løkke. "What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape." Therapeutic Advances in Respiratory Disease 13 (January 2019): 175346661988453. http://dx.doi.org/10.1177/1753466619884532.

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Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.
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Bhattacharyya, Neil, and Lynn Kepnes. "Bacterial Colonization of Nasal Steroid Inhalers in Chronic Rhinosinusitis." American Journal of Rhinology 16, no. 6 (November 2002): 319–21. http://dx.doi.org/10.1177/194589240201600607.

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Background The aim of this study was to determine if nasal steroid inhalers harbor bacteria. Methods Nasal steroid inhalers were randomly selected from an adult patient population with chronic rhinosinusitis. Swab cultures of the tip of the nasal inhaler were obtained and submitted for microbiological analysis. Contemporaneous control cultures were obtained from freshly opened nasal steroid inhalers. Comparisons were conducted between bacterial recovery rates and types of organisms recovered from the patient and control groups. Results Among 31 nasal inhalers in use, 14 inhalers (45%) were found to harbor bacteria. The most common organisms were coagulase negative Staphylococci (11 inhalers) followed by oral flora (2 inhalers) and bacillus species (1 inhaler). None of the 10 control cultures were found to harbor bacteria. Nasal steroid inhalers in use were more likely to have bacterial colonization than new inhalers (p = 0.008, chi-square). Conclusions Nasal steroid inhalers may harbor pathogenic bacteria. Therefore, they may serve as a vehicle for subsequent reinfection.
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Vieira-Marques, Pedro, Rute Almeida, João F. Teixeira, José Valente, Cristina Jácome, Afonso Cachim, Rui Guedes, Ana Pereira, Tiago Jacinto, and João A. Fonseca. "InspirerMundi—Remote Monitoring of Inhaled Medication Adherence through Objective Verification Based on Combined Image Processing Techniques." Methods of Information in Medicine 60, S 01 (April 27, 2021): e9-e19. http://dx.doi.org/10.1055/s-0041-1726277.

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Abstract Background The adherence to inhaled controller medications is of critical importance for achieving good clinical results in patients with chronic respiratory diseases. Self-management strategies can result in improved health outcomes and reduce unscheduled care and improve disease control. However, adherence assessment suffers from difficulties on attaining a high grade of trustworthiness given that patient self-reports of high-adherence rates are known to be unreliable. Objective Aiming to increase patient adherence to medication and allow for remote monitoring by health professionals, a mobile gamified application was developed where a therapeutic plan provides insight for creating a patient-oriented self-management system. To allow a reliable adherence measurement, the application includes a novel approach for objective verification of inhaler usage based on real-time video capture of the inhaler's dosage counters. Methods This approach uses template matching image processing techniques, an off-the-shelf machine learning framework, and was developed to be reusable within other applications. The proposed approach was validated by 24 participants with a set of 12 inhalers models. Results Performed tests resulted in the correct value identification for the dosage counter in 79% of the registration events with all inhalers and over 90% for the three most widely used inhalers in Portugal. These results show the potential of exploring mobile-embedded capabilities for acquiring additional evidence regarding inhaler adherence. Conclusion This system helps to bridge the gap between the patient and the health professional. By empowering the first with a tool for disease self-management and medication adherence and providing the later with additional relevant data, it paves the way to a better-informed disease management decision.
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Mitta, Sandeep Goud, Sannidhi Tanvi, Uppu Bhargavi, and Vemunoori Ruchitha. "An Overview on Pulmonary Insulin." Global Academic Journal of Pharmacy and Drug Research 6, no. 02 (June 6, 2024): 12–19. http://dx.doi.org/10.36348/gajpdr.2024.v06i02.001.

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Pulmonary insulin as an alternative to intravascular, intramuscular, and subcutaneous insulin administration, non-invasive insulin administration was created and implemented. It enters the lungs' alveoli through an as-yet-unidentified paracellular process, traverses the alveolar wall, and then circulates throughout the bloodstream. Inhaled insulin was divided into two categories based on its mechanism of action: 1. Rapid acting pulmonary insulin, which quickly disintegrates in the alveoli and circulates throughout the bloodstream as fine powder particles; and 2. slow acting pulmonary insulin. Recently, two technologies were developed: pulmosol powder technology, which employs a rapid drying procedure to make insulin particles of the right size and chemical stability, and AIR technology, which is a porous dry particle aerosol technology. Dry powders, liquid aerosols in cartridge-shaped inhalers, passive inhalers, Microprocessor-controlled inhalers, and liquid nebulizers were the various ways that inhaled insulin was delivered. Many studies have been conducted to examine various intrapulmonary delivery methods, and in January 2006, the US Food and Drug Administration authorized exubera, a dry powder passive inhaler, as the first pulmonary inhaled insulin. The pharmacokinetics of inhaled insulin, dosage guidelines, administration tools, benefits and drawbacks, and candidates for inhaled insulin administration are all discussed in this article.
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Sahay, Sandeep, Royanne Holy, Shirley Lyons, Edwin Parsley, Mari Maurer, and Jeffry Weers. "Impact of human behavior on inspiratory flow profiles in patients with pulmonary arterial hypertension using AOS™ dry powder inhaler device." Pulmonary Circulation 11, no. 1 (January 2021): 204589402098534. http://dx.doi.org/10.1177/2045894020985345.

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Relative to healthy subjects, patients with pulmonary arterial hypertension often present with decreased respiratory muscle strength, resulting in decreased maximum inspiratory pressure. Little is known about the impact of reduced respiratory muscle strength on the ability to achieve the peak inspiratory pressures needed for effective drug delivery when using portable dry powder inhalers (≥1.0 kPa). The objective of this study was to assess the impact of inhaler resistance and patient instruction on the inspiratory flow profiles of pulmonary arterial hypertension patients when using breath-actuated dry powder inhalers. The inspiratory flow profiles of 35 patients with pulmonary arterial hypertension were measured with variants of the RS01 dry powder inhaler. Profiles were determined with a custom inspiratory flow profile recorder. Results showed that going from the low resistance RS01 dry powder inhaler to the high resistance AOS® dry powder inhaler led to increases in mean peak inspiratory pressures for pulmonary arterial hypertension subjects from 3.7 kPa to 6.5 kPa. Instructions that ask pulmonary arterial hypertension subjects to inhale with maximal effort until their lungs are full led to a mean peak inspiratory pressures of 6.0 kPa versus 2.1 kPa when the same subjects are asked to inhale comfortably. Significant decreases in mean peak inspiratory pressures are also observed with decreases in lung function, with a mean peak inspiratory pressures of 7.2 kPa for subjects with FEV1 > 60% predicted, versus 3.3 kPa for those subjects with FEV1 < 50% predicted. In conclusion, despite having reduced respiratory muscle strength, subjects with pulmonary arterial hypertension can effectively use a breath-actuated dry powder inhaler. The probability of achieving effective dose delivery may be increased by using dry powder inhalers with increased device resistance, particularly when subjects do not follow the prescribed instructions and inhale comfortably.
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Dissertations / Theses on the topic "Inhalers"

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Azouz, Wahida Ahmed Abugrara. "Novel methodology to characterise how asthma and chronic obstructive pulmonary disease patients use their inhalers and methods to improve their inhaler technique : objective assessment of how patients use inhalers." Thesis, University of Huddersfield, 2012. http://eprints.hud.ac.uk/id/eprint/17484/.

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Inhaled administration is the mainstay of asthma and chronic obstructive pulmonary disease (COPD) management using either a pressurised metered dose inhaler (pMDI) or a dry powder inhaler (DPI). Poor disease control and increased hospitalisations is linked to poor inhaler technique. Previous studies to assess inhaler technique have used subjective measures and there is very limited data about the inhalation characteristics used by patients when they use their inhalers. Inhalation flow profiles when patients use their pMDI and inhalation pressure profiles when they use DPIs have been measured using 659 subjects (106 children with asthma [CHILD], 361 adults with asthma [ADULT], 142 COPD [COPD] and 50 healthy volunteers [HEALTHY]) in 5 separate studies. All patient studies used their real life inhaler technique. One of the studies also evaluated the value of using a pMDI co-ordination aid and training these patients to prolong their inhalation whilst a different one investigated the impact of using enhanced training when using a DPI. The first study, 20 CHILD, 57 ADULT and 32 COPD subjects, revealed that the mean (SD) inhalation flows through a pMDI were 108.9 (40.4), 146.0 (58.8) and 107 (50.6) L/min, respectively and only 7, 10 and 10 used a slow flow. In the second pMDI study involving, 20 CHILD, 130 ADULTS, 31 COPD patients, their flows were 70.5 (36.4), 131.4 (60.8) and 70.9 (28.1) L/min and 5, 53 and 10 used their pMDI with good co-ordination. However only 3, 6 and 9 patients had good co-ordination and slow flow. In the third study, 71 ADULT patients, the mean (SD) pMDI inhalation flow was 155.6 (61.5) L/min which decreased (p<0.001) to 112.3 (48.4) when the pMDI was fitted with a co-ordination aid. This was due to the increased resistance to airflow from the aid. Inhalation flow further reduced (p<0.001) to 73.9 (34.9) L/min when patients were trained to prolong their inhalations. Their inhaled volumes did not change whereas mean (SD) inhalation times were 1.60 (0.21), 1.92 (0.80) and 2.66 (1.03) seconds (p< 0.001) respectively. There was a good correlation between their inhaled volume and forced vital capacity with a ratio of 0.7 suggesting that the patient used a full inhalation. A DPI study, involving 16 CHILD, 53 ADULT and 29 COPD patients, measured inhalation characteristics through different DPIs (low to high resistance) when patients used their real life DPI inhalation manoeuvres. The inhalation characteristics were lower in CHILD and highest in ADULT. Overall flows were higher when using low resistance DPIs but the pressure changes and the acceleration of the inhalation flow were significantly higher with high resistance DPIs which suggest more efficient de-aggregation of the formulation. There was a tendency for more problems with low resistance DPIs than high resistance DPIs. The last study involved CHILD, ADULT, COPD and HEALTHY subjects (50 of each) when they inhaled through a Spiromax and a Turbuhaler (similar resistance) after standard verbal inhalation technique training and when using enhanced training with an IN-Check Dial. The order of inhalation characteristics was HEALTHY > ADULT > COPD > CHILD. Significant (p<0.001) improvements in the inhalation flows, pressure changes and acceleration of the flow were achieved in all groups after the enhanced training. The studies provide an insight into the inhalation characteristics of patients when they use different inhalers. The main problem with pMDI use was short inhalation times and when patients were trained to prolong their inhalation then flows reduced. Enhanced training when using a DPI significantly improved the technique of all patients.
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Lord, John David. "Particle interactions in dry powder inhalations." Thesis, University of Bath, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336708.

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Kjellberg, Karolina Charlotte. "Microparticle adhesion in model metered dose inhalers." Thesis, University College London (University of London), 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.515063.

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Jones, Stuart Allen. "The formation of novel hydrofluoroalkane metered dose inhalers." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417774.

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Kopsch, Thomas. "Computational modelling and optimization of dry powder inhalers." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/275902.

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Dry powder inhalers (DPIs) are a common therapeutic modality for lung diseases such as asthma, but they are also used to treat systemic diseases such as diabetes. Advantages of DPIs include their portable design and low manufacturing costs. Another advantage of DPIs is their breath activation, which makes them popular among patients. In a passive DPI drug is only released when the patient inhales. When the patient inhales, air flows through the device. The flow of air entrains a dry powder formulation inside the device and carries it to the lung. Currently, no DPI exists which can deliver drug independent of the patient to the desired target site in the lung. This is because drug release depends on the patient’s inhalation manoeuvre. To maximize the effect of the treatment it is necessary to optimize DPIs to achieve drug delivery that (A) is independent of the inhalation manoeuvre and (B) is targeted to the correct site in the lung. Therefore, this thesis aims to apply numerical and experimental methods to optimize DPIs systematically. First, two clinically justifiable cost functions have been developed corresponding to the DPI design objectives (A) and (B). An Eulerian-Eulerian (EE) computational fluid dynamics (CFD) approach has then been used to optimize a DPI entrainment geometry. Three different optimized entrainment geometries have been found corresponding to three different therapeutic applications. Second, the CFD approach has been validated experimentally. This is the first experimental study to validate an EE CFD approach for DPI modelling. Third, a personalized medicine approach to DPI design has been proposed. The development of this approach makes it possible to achieve the design objectives for patients with highly different lung functions. Finally, an adaptive DPI with a variable bypass element has been developed. This DPI achieves design objectives (A) and (B) for patients with highly different lung functions with a single device. In contrast to the personalized medicine approach, there is no need to select the optimal amount of bypass, since the device adapts automatically.
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Parisini, Irene. "Improved aerosol deposition profiles from dry powder inhalers." Thesis, University of Hertfordshire, 2015. http://hdl.handle.net/2299/15931.

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Lung diseases such as asthma and chronic obstructive pulmonary disease (COPD) are major health burdens on the global population. To treat diseases of the lung, topical therapies using dry powder inhalers (DPIs) have been employed. However, a relatively small amount of dose (5.5 - 28 %) reaches the lung during DPI therapy leading to high inter-patient variability in therapy response and oropharyngeal deposition. Strategies were assessed to take patient variability in inhalation performance into account when developing devices to reduce throat deposition and to mitigate flow rate dependency of the emitted aerosol. A cyclone-spacer was manufactured and evaluated with marketed and in-house manufactured formulations. An in vivo study showed that a high resistance inhaler would produce longer inhalation times in lung disease patients and that a spacer with high resistance may prove a suitable approach to address inter-patient variability. Two spacer prototypes were evaluated with cohesively- and adhesively-balanced particle blends. The data suggested that the throat deposition dramatically decreased for the emitted particles when the spacers were used with the inhalers (e.g. 18.44 ± 2.79% for salbutamol sulphate, SS 4 kPa) due to high retention of the formulation within the spacer (87.61 ± 2.96%). Moreover, variation in fine particle fraction and dose was mitigated when increasing the flow rate (82.75 ± 7.34 %, 92.2 ± 7.7 % % and 77.0 ± 10.1 % at 30, 45 and 60 Lmin-1, respectively). The latter was an improvement over previous proposed DPI spacers, where variability in emitted dose due to airflow rate was a major issue. Due to the different physicochemical properties of the active pharmaceutical ingredients used in the formulation, throat deposition and respirable fraction for adhesively-balanced particles (e.g. SS) were double that of the cohesively- balanced particles (salmeterol xinafoate, SX) (e.g. 65.83 ± 8.99 % vs. 45.83 ± 5.04 % for SS:Coarse Lactose (CL) and SX:CL, respectively). Scanning electron microscopy revealed that surface-bound agglomerates were more freely removed from the carrier, but subject to decreased impaction-type deagglomeration forces in the spacer than for carrier-bound drug. An ex vivo study using breath profiles from healthy volunteers identified the minimization of differences between adhesively- and cohesively-balanced blends when full breath profiles were studied compared to square-wave airflow. Therefore the use of constant flow for in vitro testing should not be the sole flow regime to study aerosolization when developing new inhalation devices and formulations.
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Grimes, Matthew, Paul Myrdal, and Poonam Sheth. "Cosolvent Effect on Droplet Evaporation Time, Aerodynamic Particle Size Distribution, and Differential Throat Deposition for Pressurized Metered Dose Inhalers." The University of Arizona, 2015. http://hdl.handle.net/10150/614123.

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Class of 2015 Abstract
Objectives: To evaluate the in vitro performance of various pressurized metered dose inhaler (pMDI) formulations by cascade impaction primarily focusing on throat deposition, fine particle fraction (FPF), and mass-median aerodynamic diameter (MMADR) measurements Methods: Ten solution pMDIs were prepared with varying cosolvent species in either low (8% w/w) or high (20% w/w) concentration. The chosen cosolvents were either alcohol (ethanol, n-propanol) or acetate (methyl-, ethyl-, and butyl acetate) in chemical nature. All formulations used HFA-134a propellant and 0.3% drug. The pMDIs were tested by cascade impaction with three different inlets to determine the aerodynamic particle size distribution (APSD), throat deposition, and FPF of each formulation. Theoretical droplet evaporation time (DET), a measure of volatility, for each formulation was calculated using the MMADR. Results: Highly volatile formulations with short DET showed consistently lower throat deposition and higher FPF than their lower volatility counterparts when using volume-constrained inlets. However, FPF values were not significantly different for pMDI testing with a non-constrained inlet. The MMADR values generated with volume-constrained inlets did not show any discernible trends, but MMADR values from the non-constrained inlet correlated with DET. Conclusions: Formulations with shorter DET exhibit lower throat deposition and higher FPF, indicating potentially better inhalational performance over formulations with longer DET. There appear to be predictable trends relating both throat deposition and FPF to DET. The shift in MMADR values for volume-constrained inlets suggests that large diameter drug particles are preferentially collected in these inlets.
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Yang, Jiecheng. "DEM-CFD analysis of micromechanics for dry powder inhalers." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6019/.

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Dry powder inhalers (DPIs) are widely used for the therapy of respiratory and pulmonary diseases. In this study, a coupled discrete element method and computational fluid dynamics (DEM-CFD) is employed to investigate the micromechanics of carrier-based DPIs. The effects of van der Waals forces and electrostatic forces on the mixing process, and the influences of air flow and particle-wall impact on the dispersion process are examined. For the mixing of carrier and active pharmaceutical ingredient (API) particles in a vibrating container, it is found that vibration conditions affect the mixing performance. While there is an optimal mixing condition to maximise the number of API particles attaching to the carrier (i.e. contact number) for van der Waals cases, the contact number decreases with increasing vibration velocity amplitude and frequency for electrostatic force cases. It is also revealed that van der Waals forces (short range) and electrostatic forces (long range) result in different mixing behaviours. For the air flow induced and impact induced dispersion, it is found that the dispersion performance improves with increasing air velocity, impact velocity and impact angle, and reduces with increasing work of adhesion. The dispersion performance can be approximated using the cumulative Weibull distribution function governed by the ratio of air drag force to adhesive force or the ratio of impact energy to adhesion energy.
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Harang, Marie. "Characterisation of aerosols generated by pressurised metered dose inhalers." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/characterisation-of-aerosols-generated-by-pressurised-metered-dose-inhalers(57ce7267-ffbe-4aad-8654-c7822e89b7a0).html.

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For over half a century, pressurised metered dose inhalers (pMDIs) have been the most sold inhaler devices for the treatment of lung diseases. However, they suffer from significant drug deposition in the mouth and throat, mainly due to the aerosolisation of large and fast-moving droplets. This causes a high occurrence of side effects and is wasteful of drug. They are also affected by a low consistency of dosing and as a result users might not benefit from maximal device efficiencies. The hypothesis of this work was that the performance of pMDIs is dependent on numerous factors which might alter the characteristics of their particles and their deposition location within the respiratory tract. For example, it was thought that the variations in actuation forces of pMDIs and temperatures at which they are used might contribute to their low consistency. A one-dimensional Matlab computational model was developed in order to calculate spray properties at the exit of the device where experimental measurements are difficult to conduct. The model simulated the discharge of pure HFA134a formulations and HFA134a-based suspension formulations containing uticasone propionate, the latter representing a commercially available formulation. The results showed that the actuation force of a 'healthy' adult led to a higher valve opening rate and to the aerosolisation of smaller droplets than the actuation force provided by a 'weak' adult. The model also showed that an increase of temperature led to the aerosolisation of smaller droplets. The model was validated using impaction measurements and laser techniques. The next generation impactor (NGI) experiments revealed the importance of actuation forces on the throat deposition. Automated actuation forces with high valve opening rates led to a lower throat deposition than a manual actuation force with low valve opening rate.
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Traini, Daniela. "Physical properties and interactions in pressurised metered dose inhalers." Thesis, University of Bath, 2005. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415764.

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Books on the topic "Inhalers"

1

McKeown, Marie Teresa Grainne. Technological change in portable inhalers for asthma. S. l.[: The Author], 1997.

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Anne, Rannard, and University of Liverpool. Department of Primary Care., eds. Managing the transition from CFC to CFC-free inhalers. Liverpool: Department of Primary Care, University of Liverpool, 1998.

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C, Allport Dennis, Gilbert D. S, and Outterside S. M, eds. MDI and TDI: Safety, health and the environment : a source book and practical guide. Chichester: Wiley, 2003.

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C, Allport Dennis, Gilbert D. S, and Outterside S. M, eds. MDI and TDI: A safety, health and the environment : a source book and practical guide. New York: J. Wiley, 2003.

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United States. Congress. Senate. Committee on Labor and Human Resources. Chlorofluorocarbon propellants in the atmosphere, inhalers, and regulation: Hearing before the Committee on Labor and Human Resources, United States Senate, One Hundred Fifth Congress, second session, on examining the federal role in the implementation of Title VI of the Clean Air Act as it relates to the use of chlorofluorocarbons (CFC) in metered-dose inhalers (MDI), and an advance notice of proposed rulemaking to phase out essential-use exemptions for CFC-based MDI's, April 2, 1998. Washington: U.S. G.P.O., 1998.

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United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Energy and Power. H.R.------, the "U.S. Agricultural Sector Relief Act of 2012," and H.R.------, the "Asthma Inhalers Relief Act of 2012": Hearing before the Subcommittee on Energy and Power of the Committee on Energy and Commerce, House of Representatives, One Hundred Twelfth Congress, second session, July 18, 2012. Washington: U.S. Government Printing Office, 2013.

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Store, Multiple, ed. Inhaler. London: The Multiple Store, 1998.

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S, Purewal Tol, and Grant, David J. W. 1937-, eds. Metered dose inhaler technology. Buffalo Grove, Ill: Interpharm Press, 1998.

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United Nations Environment Programme. Medical Technical Options Committee. 2006 report of the Medical Technical Options Committee: 2006 assessment. Nairobi: United Nations Environment Programme, Ozone Secretariat, 2007.

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Chiu-sen, Wang, ed. Inhaled particles. Boston, Mass: Elsevier B.V., 2005.

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Book chapters on the topic "Inhalers"

1

Haettig, Elena, and Marc Schneider. "Oral Inhalers." In Essentials of Industrial Pharmacy, 123–49. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-84977-1_9.

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Hickey, Anthony J., and Zhen Xu. "Dry Powder Inhalers." In Particulate Products, 295–322. Cham: Springer International Publishing, 2013. http://dx.doi.org/10.1007/978-3-319-00714-4_10.

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Leiner, Stefan, David Cipolla, Joachim Eicher, Wilbur de Kruijf, and Herbert Wachtel. "Soft Mist Inhalers." In Pharmaceutical Inhalation Aerosol Technology, 493–507. Third edition. | Boca Raton, Florida : CRC Press, [2019] |: CRC Press, 2019. http://dx.doi.org/10.1201/9780429055201-21.

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Richard Dekhuijzen, P. N., Matteo Bonini, and Federico Lavorini. "Slow Mist Inhalers." In Inhaled Delivery Systems for the Treatment of Asthma and COPD, 48–55. Boca Raton: CRC Press, 2023. http://dx.doi.org/10.1201/9781003269014-5.

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Mahler, Donald A., and Roy A. Pleasants. "Dry Powder Inhalers." In Inhaled Delivery Systems for the Treatment of Asthma and COPD, 56–68. Boca Raton: CRC Press, 2023. http://dx.doi.org/10.1201/9781003269014-6.

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Cazzola, Mario, and Maria Gabriella Matera. "Fixed-Dose Combination Inhalers." In Handbook of Experimental Pharmacology, 117–29. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/164_2016_66.

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Rocha, Sandro R. P. da, Balaji Bharatwaj, Rodrigo S. Heyder, and Lin Yang. "Pressurized Metered-Dose Inhalers." In Pharmaceutical Inhalation Aerosol Technology, 427–53. Third edition. | Boca Raton, Florida : CRC Press, [2019] |: CRC Press, 2019. http://dx.doi.org/10.1201/9780429055201-18.

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Gardner, Donna D., and Sandra G. Adams. "Pressurized Metered-Dose Inhalers (pMDI)." In Inhaled Delivery Systems for the Treatment of Asthma and COPD, 20–29. Boca Raton: CRC Press, 2023. http://dx.doi.org/10.1201/9781003269014-3.

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Horiguchi, Takahiko, and Rieko Kondo. "How to Improve Adherence Technique for Inhaler Use and Selection of Inhalers." In Advances in Asthma, 133–44. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-13-2790-2_12.

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Crowder, Timothy M., and Martin J. Donovan. "Science and Technology of Dry Powder Inhalers." In Controlled Pulmonary Drug Delivery, 203–22. New York, NY: Springer New York, 2011. http://dx.doi.org/10.1007/978-1-4419-9745-6_9.

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Conference papers on the topic "Inhalers"

1

Beukes, Giancarlo, Gokul Nair, Mike Levin, and Sudesh Sivarasu. "Design of a Novel Dosage Counter for a Low-Cost Sleeve Attachment for Enhanced Usability of Any Standard Pressurised Metered Dosage Inhaler." In 2019 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2019. http://dx.doi.org/10.1115/dmd2019-3277.

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The study focuses on developing a novel dosage counter system for a low-cost sleeve attachment device for enhancing the usability and functionality of any standard pressurised metered dosage inhaler (MDI). The paediatric metered dosage inhaler sleeve attachment’s (pMDI’s) primary function is to allow patients 5 years and older to safely use their inhalers, particularly in emergencies. Currently patients don’t know how many dosages are remaining in the MDIs, cant activate the devices and refuse to use their inhalers because of stigma, The dosage counter was a critical feature as it was discovered that patients are using empty inhalers, which leads to hospitalizations and increased mortality rates. A dosage counter was found to be a critical feature for the sleeve attachment, as all MDIs should have one.
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Weaver, Leslie, and Brent Utter. "Shape Memory Alloy Actuation of a Metered-Dose Inhaler." In ASME 2017 Conference on Smart Materials, Adaptive Structures and Intelligent Systems. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/smasis2017-3853.

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Respiratory diseases such as asthma or chronic obstructive pulmonary disorder (COPD) affect millions of people around the world. The most common treatment approach is to take an inhaled corticosteroid as needed with a dry-powder inhaler or a metered-dose inhaler. Unfortunately, rates of inhaler mishandling and misuse are staggeringly high and as a result, the majority of those suffering from asthma and COPD are not receiving proper treatment. There are a myriad of ways inhalers are mishandled and misused, but one significant challenge results from the timing miscoordination of the medicine dispersion and inhalation breath. To address this, the current study successfully demonstrates the feasibility of automating the timing of the medicine dispersion by the addition of a Shape Memory Alloy (SMA) actuator and a differential pressure sensor into the casing of a traditional metered-dose inhaler. To meet actuation requirements and reliably depress the inhaler cartridge, the SMA wire was routed around a set of miniature bearings within the casing of the inhaler. By demonstrating that a metered-dose inhaler may be actuated by SMA without a significant increase of its weight or size, this study provides a practical technological approach to reducing the improper treatment of asthma and COPD due to inhaler misuse.
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Nusrat, R., M. McInroy, T. Georgia, A. Sherman, M. Roots, L. Hinojosa, and Quality Improvement Group. "Improving Use of Medication Inhalers: Factors Linked to Suboptimal Inhaler Use." In American Thoracic Society 2024 International Conference, May 17-22, 2024 - San Diego, CA. American Thoracic Society, 2024. http://dx.doi.org/10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a4718.

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Varunkiv, Oleksandr, Kseniia Ostrovska, Mykola Ostrovskyy, Iryna Savelikhina, and Nadiia Korzh. "Side effects of inhaled budesonide through different types of inhalers." In ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.pa4226.

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Hyun, Sinjae, Sun Jin Moon, and Chong S. Kim. "Computational Modeling of Aerosol Deposition Characteristics in Cyclic Bifurcating Tube Flow." In ASME 2010 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2010. http://dx.doi.org/10.1115/sbc2010-19169.

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An accurate model of the human respiratory system allows health scientists to gain insight into the interactions between particulate matter (PM) and the exposed surfaces of the lung airways. Respiratory dose simulations and modeling are frequently used for evaluating health effects of inhaled toxic substances [1–4] and for analyzing the risk potentials of inhaled toxic or harmful PM such as vehicle emissions [4,5]. Pharmaceutical companies and pulmonologists find it useful in evaluating efficacy of inhaled medicinal aerosols and devising new patient treatment regimen [6–8], especially in vulnerable population groups such as children, industrial workers, and the elderly [10]. Recently, the respiratory system has seen increased attention as a possible venue for drug delivery to fight diseases such as AIDS, diabetes, and various cancers, among others. Computational fluid dynamics modeling and simulation continues to be an important tool for understanding of delivery of pharmaceutical aerosols to the lung airways and thereby improving treatment of airway disease, particularly, asthma with bronchodilators and corticosteroids inhalers [11,12].
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Silva, Lui´s F., Senhorinha Teixeira, Jose´ Carlos Teixeira, Rita Rebelo, Ricardo Oliveira, and Henedina Antunes. "Study and Development of Spacers for Pressurized Inhaler Devices: A Project Review." In ASME 2009 International Mechanical Engineering Congress and Exposition. ASMEDC, 2009. http://dx.doi.org/10.1115/imece2009-13171.

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In recent years, allergic diseases, particularly asthma, have been acquiring an increasing importance in the developed countries, due to the rising of its prevalence and morbidity and the economic burden associated, becoming a serious public health problem. Recent therapeutic approaches in asthma patients may help to prevent most of the crisis and remain free of symptoms. Several inhalation devices are available for drug delivery to the lungs, including metered-dose inhalers (MDIs), dry powder inhalers (PDIs) and nebulizers. Although this variety of devices used for drug delivery to the bronchial tree have shown encouraging results, a great amount of the drug does not reach the goal and remains in the mouth (less than 20% of the drug can reach the lungs) and higher airways. This causes not only a loss of drug but also increases costs and produces undesirable side effects. For better efficiency of the process, spacers, such as the Volumatic® used in the study herein reported, are used. This paper will describe and summarize part of the developments being carried out so far at the University of Minho in this domain, as well as the latest developments in order to understand the characteristics of the used spacer and the parameters affecting its performance. By using computational fluid Dynamics (CFD) techniques, the behavior of the drug flow inside the spacer, combined with a pressurized metered-dose inhaler (pMDI), the discrete phase model (DPM) flow inside the Volumatic® is also reported. The results obtained are also analyzed and discussed, using two different 3D grid types (Cooper and T-Grid). The insight provided by the detailed data of the flow patterns inside the Volumatic® provides possible options for new geometry possibilities for the spacer devices.
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Silva Duarte De Araújo, António Manuel, Pedro Teixeira, Maria Figueiredo, Venceslau Hespanhol, and Jaime Correia-de-Sousa. "Misuse of inhalers devices in clinical practice." In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa671.

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Ruzycki, C. A., W. H. Finlay, and A. R. Martin. "Predicting Pharmacokinetics from Three Marketed Dry Powder Inhalers." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a1331.

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Benazzouz, Redouene Sid Ahmed, Safia Benazzouz, Azeddine Mekideche, Massinissa Benyagoub, Halima Chati, Aicha Djadj, Hassiba Benferhat, Fethi Boulekbache, Imad Damou, and Mounir Ould Setti. "An Algerian study on patient’s attitude towards inhalers." In ERS International Congress 2023 abstracts. European Respiratory Society, 2023. http://dx.doi.org/10.1183/13993003.congress-2023.pa2387.

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Fawbush, J., J. Haas, B. A. Stewart, and J. C. Benson. "From Inhalers to Insights: When Wheezing Isn't Asthma." In American Thoracic Society 2024 International Conference, May 17-22, 2024 - San Diego, CA. American Thoracic Society, 2024. http://dx.doi.org/10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a6140.

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Reports on the topic "Inhalers"

1

Kesavan, Jana, Deborah R. Schepers, Jerold R. Bottiger, Maria D. King, and Andrew R. McFarland. Use of Medical Metered Dose Inhalers for Functionality Testing of Bioaerosol Detection and Identification Systems. Fort Belvoir, VA: Defense Technical Information Center, May 2012. http://dx.doi.org/10.21236/ada563525.

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E, Flemyng, and Mitchell D. Increased versus stable doses of inhaled steroids for exacerbations of chronic asthma in adults and children: Protocol. Epistemonikos Interactive Evidence Synthesis, January 2022. http://dx.doi.org/10.30846/ies.b984bf9656.v3.

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Abstract Rationale Early treatment of asthma exacerbations with inhaled corticosteroids is the best strategy for management, although use of an increased or stable dose is questioned. Objectives To compare the clinical effectiveness and safety of increased versus stable doses of inhaled corticosteroids as part of a patient-initiated action plan for the home management of exacerbations in children and adults with persistent asthma. Search methods We searched the Cochrane Airways Group Specialised Register (part of CENTRAL), MEDLINE, Embase, CINAHL, major trials registries and handsearched abstracts up to 20 December 2021. Eligibility criteria Parallel and cross-over blinded randomised controlled trials (RCTs) Outcomes Treatment failure (the need for rescue oral steroids) in the randomised population and in the subset who initiated the study inhaler, unscheduled physician visits, unscheduled acute care, emergency department or hospital visits, serious and non-serious adverse events, and duration of exacerbation. Risk of bias We used Risk of Bias 2 (RoB 2)and the tool's extension for cross-over trials. Synthesis methods We conducted meta-analyses using fixed-effect models to calculate odds ratios (OR) and 95% confidence intervals (CI) for all but one outcome, which used random-effects models due to heterogeneity (treatment failure in the subset who initiated the study inhaler). We summarised certainty of evidence according to GRADE methods. Included studies We included nine RCTs (seven parallel and two cross‐over) with a total of 1923 participants. The studies were conducted in Europe, North America, and Australasia and were published between 1998 and 2018. Five studies evaluated adult populations (1247 participants; ≥ 15 years), and four studies evaluated child or adolescent populations (676 participants; < 15 years). Approximately 50% of randomised participants initiated the study inhaler (range 23% to 100%). The studies reported treatment failure in various ways, so we made assumptions to allow us to combine data. Synthesis of results People randomised to increase their inhaled corticosteroids dose at the first signs of an exacerbation probably had similar odds of needing rescue oral corticosteroids to those randomised to a placebo inhaler (OR 0.97, 95% CI 0.76 to 1.25; 8 studies, 1774 participants; moderate-certainty evidence). Results for the same outcome in the subset of participants who initiated the study inhaler (approximately 50%) gives a different point estimate with very low certainty due to heterogeneity, imprecision and risk of bias (OR 0.84, 95% CI 0.54 to 1.30; 7 studies, 766 participants; random-effects model used). For adverse effects, imprecision and risk of bias from missing data, outcome measurement and reporting meant we were very uncertain about the effect estimate (serious adverse events OR 1.69, 95% CI 0.77 to 3.71; 2 studies, 394 participants; non-serious adverse events OR 2.15, 95% CI 0.68 to 6.73; 2 studies, 142 participants). We had very low confidence in the effect estimates for unscheduled physician visits, unscheduled acute care, emergency department or hospital visits and duration of exacerbation due to risk of bias. Authors' conclusions Evidence suggests that adults and children with mild to moderate asthma are unlikely to have an important reduction in the need for oral steroids from increasing a patient's inhaled corticosteroid dose at the first sign of an exacerbation. Other clinically important benefits and potential harms cannot be ruled out due to wide confidence intervals, risk of bias in the studies, and assumptions made for synthesis when combining data. Included studies reflect evolving clinical practice and study methods, and the data do not support thorough investigation of effect modifiers such as baseline dose, fold increase, asthma severity and timing. The review does not include recent evidence from pragmatic, unblinded studies showing benefits of larger dose increases in those with poorly controlled asthma. Differences between the blinded and unblinded studies should be investigated. Funding This Cochrane Review had no dedicated funding. Registration Protocol (2009): doi.org/10.1002/14651858.CD007524 Original review (2010): doi.org/10.1002/14651858.CD007524.pub3 Review update (2014): doi.org/10.1002/14651858.CD007524.pub4
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E, Flemyng, and Mitchell D. Increased versus stable doses of inhaled steroids for exacerbations of chronic asthma in adults and children: Protocol. Epistemonikos Interactive Evidence Synthesis, January 2022. http://dx.doi.org/10.30846/ies.b984bf9699.v2.

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Abstract Rationale Early treatment of asthma exacerbations with inhaled corticosteroids is the best strategy for management, although use of an increased or stable dose is questioned. Objectives To compare the clinical effectiveness and safety of increased versus stable doses of inhaled corticosteroids as part of a patient-initiated action plan for the home management of exacerbations in children and adults with persistent asthma. Search methods We searched the Cochrane Airways Group Specialised Register (part of CENTRAL), MEDLINE, Embase, CINAHL, major trials registries and handsearched abstracts up to 20 December 2021. Eligibility criteria Parallel and cross-over blinded randomised controlled trials (RCTs) Outcomes Treatment failure (the need for rescue oral steroids) in the randomised population and in the subset who initiated the study inhaler, unscheduled physician visits, unscheduled acute care, emergency department or hospital visits, serious and non-serious adverse events, and duration of exacerbation. Risk of bias We used Risk of Bias 2 (RoB 2)and the tool's extension for cross-over trials. Synthesis methods We conducted meta-analyses using fixed-effect models to calculate odds ratios (OR) and 95% confidence intervals (CI) for all but one outcome, which used random-effects models due to heterogeneity (treatment failure in the subset who initiated the study inhaler). We summarised certainty of evidence according to GRADE methods. Included studies We included nine RCTs (seven parallel and two cross‐over) with a total of 1923 participants. The studies were conducted in Europe, North America, and Australasia and were published between 1998 and 2018. Five studies evaluated adult populations (1247 participants; ≥ 15 years), and four studies evaluated child or adolescent populations (676 participants; < 15 years). Approximately 50% of randomised participants initiated the study inhaler (range 23% to 100%). The studies reported treatment failure in various ways, so we made assumptions to allow us to combine data. Synthesis of results People randomised to increase their inhaled corticosteroids dose at the first signs of an exacerbation probably had similar odds of needing rescue oral corticosteroids to those randomised to a placebo inhaler (OR 0.97, 95% CI 0.76 to 1.25; 8 studies, 1774 participants; moderate-certainty evidence). Results for the same outcome in the subset of participants who initiated the study inhaler (approximately 50%) gives a different point estimate with very low certainty due to heterogeneity, imprecision and risk of bias (OR 0.84, 95% CI 0.54 to 1.30; 7 studies, 766 participants; random-effects model used). For adverse effects, imprecision and risk of bias from missing data, outcome measurement and reporting meant we were very uncertain about the effect estimate (serious adverse events OR 1.69, 95% CI 0.77 to 3.71; 2 studies, 394 participants; non-serious adverse events OR 2.15, 95% CI 0.68 to 6.73; 2 studies, 142 participants). We had very low confidence in the effect estimates for unscheduled physician visits, unscheduled acute care, emergency department or hospital visits and duration of exacerbation due to risk of bias. Authors' conclusions Evidence suggests that adults and children with mild to moderate asthma are unlikely to have an important reduction in the need for oral steroids from increasing a patient's inhaled corticosteroid dose at the first sign of an exacerbation. Other clinically important benefits and potential harms cannot be ruled out due to wide confidence intervals, risk of bias in the studies, and assumptions made for synthesis when combining data. Included studies reflect evolving clinical practice and study methods, and the data do not support thorough investigation of effect modifiers such as baseline dose, fold increase, asthma severity and timing. The review does not include recent evidence from pragmatic, unblinded studies showing benefits of larger dose increases in those with poorly controlled asthma. Differences between the blinded and unblinded studies should be investigated. Funding This Cochrane Review had no dedicated funding. Registration Protocol (2009): doi.org/10.1002/14651858.CD007524 Original review (2010): doi.org/10.1002/14651858.CD007524.pub3 Review update (2014): doi.org/10.1002/14651858.CD007524.pub4
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E, Flemyng, and Mitchell D. Increased versus stable doses of inhaled steroids for exacerbations of chronic asthma in adults and children: Update. Epistemonikos Interactive Evidence Synthesis, January 2022. http://dx.doi.org/10.30846/ies.b984bf9639.v2.

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Abstract Rationale Early treatment of asthma exacerbations with inhaled corticosteroids is the best strategy for management, although use of an increased or stable dose is questioned. Objectives To compare the clinical effectiveness and safety of increased versus stable doses of inhaled corticosteroids as part of a patient-initiated action plan for the home management of exacerbations in children and adults with persistent asthma. Search methods We searched the Cochrane Airways Group Specialised Register (part of CENTRAL), MEDLINE, Embase, CINAHL, major trials registries and handsearched abstracts up to 20 December 2021. Eligibility criteria Parallel and cross-over blinded randomised controlled trials (RCTs) Outcomes Treatment failure (the need for rescue oral steroids) in the randomised population and in the subset who initiated the study inhaler, unscheduled physician visits, unscheduled acute care, emergency department or hospital visits, serious and non-serious adverse events, and duration of exacerbation. Risk of bias We used Risk of Bias 2 (RoB 2)and the tool's extension for cross-over trials. Synthesis methods We conducted meta-analyses using fixed-effect models to calculate odds ratios (OR) and 95% confidence intervals (CI) for all but one outcome, which used random-effects models due to heterogeneity (treatment failure in the subset who initiated the study inhaler). We summarised certainty of evidence according to GRADE methods. Included studies We included nine RCTs (seven parallel and two cross‐over) with a total of 1923 participants. The studies were conducted in Europe, North America, and Australasia and were published between 1998 and 2018. Five studies evaluated adult populations (1247 participants; ≥ 15 years), and four studies evaluated child or adolescent populations (676 participants; < 15 years). Approximately 50% of randomised participants initiated the study inhaler (range 23% to 100%). The studies reported treatment failure in various ways, so we made assumptions to allow us to combine data. Synthesis of results People randomised to increase their inhaled corticosteroids dose at the first signs of an exacerbation probably had similar odds of needing rescue oral corticosteroids to those randomised to a placebo inhaler (OR 0.97, 95% CI 0.76 to 1.25; 8 studies, 1774 participants; moderate-certainty evidence). Results for the same outcome in the subset of participants who initiated the study inhaler (approximately 50%) gives a different point estimate with very low certainty due to heterogeneity, imprecision and risk of bias (OR 0.84, 95% CI 0.54 to 1.30; 7 studies, 766 participants; random-effects model used). For adverse effects, imprecision and risk of bias from missing data, outcome measurement and reporting meant we were very uncertain about the effect estimate (serious adverse events OR 1.69, 95% CI 0.77 to 3.71; 2 studies, 394 participants; non-serious adverse events OR 2.15, 95% CI 0.68 to 6.73; 2 studies, 142 participants). We had very low confidence in the effect estimates for unscheduled physician visits, unscheduled acute care, emergency department or hospital visits and duration of exacerbation due to risk of bias. Authors' conclusions Evidence suggests that adults and children with mild to moderate asthma are unlikely to have an important reduction in the need for oral steroids from increasing a patient's inhaled corticosteroid dose at the first sign of an exacerbation. Other clinically important benefits and potential harms cannot be ruled out due to wide confidence intervals, risk of bias in the studies, and assumptions made for synthesis when combining data. Included studies reflect evolving clinical practice and study methods, and the data do not support thorough investigation of effect modifiers such as baseline dose, fold increase, asthma severity and timing. The review does not include recent evidence from pragmatic, unblinded studies showing benefits of larger dose increases in those with poorly controlled asthma. Differences between the blinded and unblinded studies should be investigated. Funding This Cochrane Review had no dedicated funding. Registration Protocol (2009): doi.org/10.1002/14651858.CD007524 Original review (2010): doi.org/10.1002/14651858.CD007524.pub3 Review update (2014): doi.org/10.1002/14651858.CD007524.pub4
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5

E, Flemyng, and Mitchell D. Increased versus stable doses of inhaled steroids for exacerbations of chronic asthma in adults and children: Protocol. Epistemonikos Interactive Evidence Synthesis, January 2022. http://dx.doi.org/10.30846/ies.b984bf9656.v2.

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Abstract Rationale Early treatment of asthma exacerbations with inhaled corticosteroids is the best strategy for management, although use of an increased or stable dose is questioned. Objectives To compare the clinical effectiveness and safety of increased versus stable doses of inhaled corticosteroids as part of a patient-initiated action plan for the home management of exacerbations in children and adults with persistent asthma. Search methods We searched the Cochrane Airways Group Specialised Register (part of CENTRAL), MEDLINE, Embase, CINAHL, major trials registries and handsearched abstracts up to 20 December 2021. Eligibility criteria Parallel and cross-over blinded randomised controlled trials (RCTs) Outcomes Treatment failure (the need for rescue oral steroids) in the randomised population and in the subset who initiated the study inhaler, unscheduled physician visits, unscheduled acute care, emergency department or hospital visits, serious and non-serious adverse events, and duration of exacerbation. Risk of bias We used Risk of Bias 2 (RoB 2)and the tool's extension for cross-over trials. Synthesis methods We conducted meta-analyses using fixed-effect models to calculate odds ratios (OR) and 95% confidence intervals (CI) for all but one outcome, which used random-effects models due to heterogeneity (treatment failure in the subset who initiated the study inhaler). We summarised certainty of evidence according to GRADE methods. Included studies We included nine RCTs (seven parallel and two cross‐over) with a total of 1923 participants. The studies were conducted in Europe, North America, and Australasia and were published between 1998 and 2018. Five studies evaluated adult populations (1247 participants; ≥ 15 years), and four studies evaluated child or adolescent populations (676 participants; < 15 years). Approximately 50% of randomised participants initiated the study inhaler (range 23% to 100%). The studies reported treatment failure in various ways, so we made assumptions to allow us to combine data. Synthesis of results People randomised to increase their inhaled corticosteroids dose at the first signs of an exacerbation probably had similar odds of needing rescue oral corticosteroids to those randomised to a placebo inhaler (OR 0.97, 95% CI 0.76 to 1.25; 8 studies, 1774 participants; moderate-certainty evidence). Results for the same outcome in the subset of participants who initiated the study inhaler (approximately 50%) gives a different point estimate with very low certainty due to heterogeneity, imprecision and risk of bias (OR 0.84, 95% CI 0.54 to 1.30; 7 studies, 766 participants; random-effects model used). For adverse effects, imprecision and risk of bias from missing data, outcome measurement and reporting meant we were very uncertain about the effect estimate (serious adverse events OR 1.69, 95% CI 0.77 to 3.71; 2 studies, 394 participants; non-serious adverse events OR 2.15, 95% CI 0.68 to 6.73; 2 studies, 142 participants). We had very low confidence in the effect estimates for unscheduled physician visits, unscheduled acute care, emergency department or hospital visits and duration of exacerbation due to risk of bias. Authors' conclusions Evidence suggests that adults and children with mild to moderate asthma are unlikely to have an important reduction in the need for oral steroids from increasing a patient's inhaled corticosteroid dose at the first sign of an exacerbation. Other clinically important benefits and potential harms cannot be ruled out due to wide confidence intervals, risk of bias in the studies, and assumptions made for synthesis when combining data. Included studies reflect evolving clinical practice and study methods, and the data do not support thorough investigation of effect modifiers such as baseline dose, fold increase, asthma severity and timing. The review does not include recent evidence from pragmatic, unblinded studies showing benefits of larger dose increases in those with poorly controlled asthma. Differences between the blinded and unblinded studies should be investigated. Funding This Cochrane Review had no dedicated funding. Registration Protocol (2009): doi.org/10.1002/14651858.CD007524 Original review (2010): doi.org/10.1002/14651858.CD007524.pub3 Review update (2014): doi.org/10.1002/14651858.CD007524.pub4
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Kobzik, Lester. Scavenger Receptors and Resistance to Inhaled Allergens. Fort Belvoir, VA: Defense Technical Information Center, February 2008. http://dx.doi.org/10.21236/ada485554.

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James, A. C. Dosimetry of inhaled radon and thoron progeny. Office of Scientific and Technical Information (OSTI), June 1994. http://dx.doi.org/10.2172/10166789.

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Kobzik, Lester. Scavenger Receptors and Resistance to Inhaled Allergens. Fort Belvoir, VA: Defense Technical Information Center, February 2007. http://dx.doi.org/10.21236/ada467837.

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Griffith, W. C., B. A. Muggenburg, and F. F. Hahn. Comparison of bone cancer risks in beagle dogs for inhaled plutonium-238 dioxide, inhaled strontium-90 chloride, and injected strontium-90. Office of Scientific and Technical Information (OSTI), December 1995. http://dx.doi.org/10.2172/381397.

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Sobieraj, Diana M., William L. Baker, Erin R. Weeda, Elaine Nguyen, Craig I. Coleman, C. Michael White, Stephen C. Lazarus, Kathryn V. Blake, and Jason E. Lang. Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Asthma. Agency for Healthcare Research and Quality, 2017. http://dx.doi.org/10.23970/ahrqepccer194.

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