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1.
J Anim Sci ; 1012023 Jan 03.
Article in English | MEDLINE | ID: mdl-36592754

ABSTRACT

The objective of this study was to determine impacts on immune parameters, anti-oxidant capacity, and growth of finishing steers fed a Saccharomyces cerevisiae fermentation product (SCFP; NaturSafe; Diamond V, Cedar Rapids, IA) and ractopamine hydrochloride (RAC; Optaflexx; Elanco Animal Health, Greenfield, IN). Angus-crossbred steers (N = 288) from two sources were utilized in this 90-d study. Steers were blocked by source, stratified by initial body weight to pens of six steers, and pens randomly assigned to treatments (16 pens per treatment). Three treatments compared feeding no supplemental SCFP (control; CON) and supplemental SCFP for 57 d (SCFP57), and 29 d (SCFP29) before harvest. Supplementation of SCFP was 12 g per steer per d, and all steers were fed RAC at 300 mg per steer per d for 29 d before harvest. Blood samples were collected from3 steers per pen, and muscle samples were collected from 1 steer per pen at 57, 29 (start of RAC), and 13 (midRAC) days before harvest. Blood was analyzed from 2 steers per pen for ferric reducing anti-oxidant power (FRAP). Muscle gene expression of myokines, markers of anti-oxidant and growth signaling were assessed. Individual animal BW were also collected on 57, 29, 13, and 1 d before being harvested at a commercial facility (National Beef, Tama, IA). Data were analyzed using the Mixed procedure of SAS 9.4 (Cary, NC) with pen as the experimental unit. The model included fixed effects of treatment and group. Increased BW compared to CON was observed days -29, -13, and -1 in SCFP57 steers (P ≤ 0.05), with SCFP29 being intermediate days -13 and -1. Overall G:F was improved in SCFP29 and SCFP57 (P = 0.01). On day -29, FRAP was greater in SCFP57 than CON (P = 0.02). The percent of gamma delta T cells and natural killer cells in both SCFP29 and SCFP57 was greater than CON on day -13 (P = 0.02). There were no treatment × day effects for muscle gene expression measured (P ≥ 0.25). Interleukin 6 tended to decrease in SCFP29 and SCFP57 on day -13 (P = 0.10). No other treatment effects were observed for muscle gene expression. Muscle gene expression of interleukin 15 was increased (P = 0.01), and expression of interleukin 8 was decreased (P = 0.03) due to RAC feeding. Increased growth in SCFP-fed cattle may be related to changes in anti-oxidant capacity and the immune system.


Saccharomyces cerevisiae fermentation products (SCFP) can provide additional support for improved growth performance. This study investigated the effects of supplementing a SCFP (NaturSafe; Diamond V, Cedar Rapids, IA; 12 g per steer per d) for 29 (SCFP29) or 57 (SCFP57) d before harvest when also feeding ractopamine hydrochloride (RAC; 300 mg per steer per d; Optaflexx, Elanco Animal Health, Greenfield, IN) for 29 d before harvest. Compared to steers not fed SCFP (CON), SCFP29 and SCFP57 had improved gain:feed for the entire feeding period. Steers supplemented with SCFP had increased percentages of gamma delta T cells and natural killer cells 13 d before harvest compared to CON. Gene expression of cytokine and anti-oxidant signaling in muscle were changed in all treatments during RAC compared to before RAC. Improvements in growth during RAC with SCFP supplementation may be due to the changes in anti-oxidant and cytokine signaling in muscle.


Subject(s)
Diet , Dietary Supplements , Cattle , Animals , Diet/veterinary , Antioxidants , Saccharomyces cerevisiae , Fermentation , Animal Feed/analysis , Muscles , Immune System , Gene Expression
2.
Forensic Sci Int ; 342: 111539, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36529085

ABSTRACT

Members of the genus Aconitum have been used for millennia, both as poisons and medicines, in Eastern culture. Higenamine has non-selective beta-agonist effects, activating both ß1 and ß2 adrenoreceptors, and is present in a variety of plants. The World Anti-Doping Agency has banned Higenamine both in competition and out of competition. Due to the common uses of higenamine in Brazilian culture, both as medicine and food, we studied the urinary concentrations of higenamine after the consumption of fruits of the Annona genus. We evaluated whether the ingestion of these fruits has the potential to cause anti-doping code violations. We measured higenamine concentrations for a 72 h period in the urine of ten healthy, physically active males (age 20-30; weight 70-80 kg; not consuming supplements or medications) after eating a unique meal containing fruits. Fruit consumption ranges were: Carica papaya (control) 348 ± 98 g; A. muricata 450 ± 282 g; and A. squamosa 314 ± 60 g. (all mean± SD). Higenamine was measured using ultra-performance liquid chromatography coupled with electrospray-tandem mass spectrometry. The appearance of urinary higenamine occurred within the first 12 h after eating A. muricata (n = 3), and the maximum concentration found was 1.9 ng/mL. The ingestion of A. squamosa has also been shown to cause higenamine urinary excretion. The elimination kinetics of the subjects who ingested A. squamosa (n = 4) were different from each other. After ingestion of the control fruit, C. papaya, we detected no higenamine in the urine of any participants (n = 3). Although the kinetics varied by individuals and fruits, A. muricata ingestion produced higher higenamine excretion; however, the A. squamosa portion weighed ∼66 % of the A. muricata portion. We conclude that eating Annonaceae family fruits cause detectable higenamine excretion. Conversely, single ingestion did not reach the WADA's threshold to cause adverse analytical findings.


Subject(s)
Annonaceae , Fruit , Male , Humans , Young Adult , Adult , Tandem Mass Spectrometry/methods , Diet , Chromatography, Liquid
3.
Transl Behav Med ; 11(3): 863-869, 2021 04 07.
Article in English | MEDLINE | ID: mdl-33449120

ABSTRACT

Use of digital communication technologies (DCT) shows promise for enhancing outcomes and efficiencies in asthma care management. However, little is known about the impact of DCT interventions on healthcare personnel requirements and costs, thus making it difficult for providers and health systems to understand the value of these interventions. This study evaluated the differences in healthcare personnel requirements and costs between usual asthma care (UC) and a DCT intervention (Breathewell) aimed at maintaining guidelines-based asthma care while reducing health care staffing requirements. We used data from a pragmatic, randomized controlled trial conducted in a large integrated health system involving 14,978 patients diagnosed with asthma. To evaluate differences in staffing requirements and cost between Breathewell and UC needed to deliver guideline-based care we used electronic health record (EHR) events, provider time tracking surveys, and invoicing. Differences in cost were reported at the patient and health system level. The Breathewell intervention significantly reduced personnel requirements with a larger percentage of participants requiring no personnel time (45% vs. 5%, p < .001) and smaller percentage of participants requiring follow-up outreach (44% vs. 68%, p < .001). Extrapolated to the total health system, cost for the Breathewell intervention was $16,278 less than usual care. The intervention became cost savings at a sample size of at least 957 patients diagnosed with asthma. At the population level, using DCT to compliment current asthma care practice presents an opportunity to reduce healthcare personnel requirements while maintaining population-based asthma control measures.


Subject(s)
Asthma/therapy , Cell Phone , Communication , Electronic Mail , Health Personnel/economics , Personnel Management/economics , Personnel Management/methods , Humans , Surveys and Questionnaires , Time Factors
4.
J Anim Sci ; 98(6)2020 Jun 01.
Article in English | MEDLINE | ID: mdl-32428228

ABSTRACT

Heat stress hinders growth and well-being in livestock, an effect that is perhaps exacerbated by the ß1 agonist ractopamine. Heat stress deficits are mediated in part by reduced feed intake, but other mechanisms involved are less understood. Our objective was to determine the direct impact of heat stress on growth and well-being in ractopamine-supplemented feedlot lambs. Commercial wethers were fed under heat stress (40 °C) for 30 d, and controls (18 °C) were pair-fed. In a 2 × 2 factorial, lambs were also given a daily gavage of 0 or 60 mg ractopamine. Growth, metabolic, cardiovascular, and stress indicators were assessed throughout the study. At necropsy, 9th to 12th rib sections (four-rib), internal organs, and feet were assessed, and sartorius muscles were collected for ex vivo glucose metabolic studies. Heat stress increased (P < 0.05) rectal temperatures and respiration rates throughout the study and reduced (P < 0.05) weight gain and feed efficiency over the first week, ultrasonic loin-eye area and loin depth near the end of the study, and four-rib weight at necropsy. Fat content of the four-rib and loin were also reduced (P < 0.05) by heat stress. Ractopamine increased (P < 0.05) loin weight and fat content and partially moderated the impact of heat stress on rectal temperature and four-rib weight. Heat stress reduced (P < 0.05) spleen weight, increased (P < 0.05) adrenal and lung weights, and was associated with hoof wall overgrowth but not organ lesions. Ractopamine did not affect any measured indicators of well-being. Heat stress reduced (P < 0.05) blood urea nitrogen and increased (P < 0.05) circulating monocytes, granulocytes, and total white blood cells as well as epinephrine, TNFα, cholesterol, and triglycerides. Cortisol and insulin were not affected. Heat stress reduced (P < 0.05) blood pressure and heart rates in all lambs and increased (P < 0.05) left ventricular wall thickness in unsupplemented but not ractopamine-supplemented lambs. No cardiac arrhythmias were observed. Muscle glucose uptake did not differ among groups, but insulin-stimulated glucose oxidation was reduced (P < 0.05) in muscle from heat-stressed lambs. These findings demonstrate that heat stress impairs growth, metabolism, and well-being even when the impact of feed intake is eliminated by pair-feeding and that systemic inflammation and hypercatecholaminemia likely contribute to these deficits. Moreover, ractopamine improved muscle growth indicators without worsening the effects of heat stress.


Subject(s)
Heat Stress Disorders/veterinary , Phenethylamines/administration & dosage , Sheep Diseases/etiology , Adrenergic beta-Agonists/administration & dosage , Adrenergic beta-Agonists/adverse effects , Adrenergic beta-Agonists/pharmacology , Animal Feed/analysis , Animals , Body Composition/drug effects , Dietary Supplements , Glucose/metabolism , Heat-Shock Response , Inflammation/metabolism , Inflammation/veterinary , Insulin/metabolism , Male , Muscle, Skeletal/metabolism , Phenethylamines/adverse effects , Phenethylamines/pharmacology , Sheep , Triglycerides/metabolism , Weight Gain/drug effects
5.
Expert Rev Clin Pharmacol ; 13(2): 103-113, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31951778

ABSTRACT

Introduction: Treatment options for COPD have evolved rapidly in the last decade and inhaled bronchodilators have largely supplanted the use of oral bronchodilators because of their increased efficacy and excellent safety with topical delivery to the lung. Recently added to the therapeutic armamentarium are fixed-dose combinations (FDC) of two long acting bronchodilators. LAMAs (long acting muscarinic antagonists) and LABAs (long acting beta agonists) are the main classes available and use different pathways to effectively produce bronchial smooth muscle relaxation.Areas covered: The most recent inhaled FDC LAMA/LABA to come to market is Aclidinium Bromide and Formoterol Fumarate. We searched databases of PubMed, Cochrane Library, and manufacturers' websites and retrieved all the randomized-controlled trials (RCTs) conducted with these drugs up to September 2019.Expert opinion: It is likely that FDCs will become the core of our COPD pharmacotherapy for all but the mildest COPD patients. These individual drugs have excellent efficacy and safety records for the maintenance treatment of COPD. Studies have demonstrated that twice daily treatment with aclidinium/formoterol resulted in significant improvement in lung function and an improved exercise tolerance when compared to placebo. Adverse effects are within the range of what is seen with other LAMA/LABA combinations.


Subject(s)
Formoterol Fumarate/administration & dosage , Pulmonary Disease, Chronic Obstructive/drug therapy , Tropanes/administration & dosage , Administration, Inhalation , Adrenergic beta-2 Receptor Agonists/administration & dosage , Adrenergic beta-2 Receptor Agonists/adverse effects , Adrenergic beta-2 Receptor Agonists/pharmacology , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/adverse effects , Bronchodilator Agents/pharmacology , Drug Combinations , Formoterol Fumarate/adverse effects , Formoterol Fumarate/pharmacology , Humans , Muscarinic Antagonists/administration & dosage , Muscarinic Antagonists/adverse effects , Muscarinic Antagonists/pharmacology , Pulmonary Disease, Chronic Obstructive/physiopathology , Randomized Controlled Trials as Topic , Tropanes/adverse effects , Tropanes/pharmacology
6.
HCA Healthc J Med ; 1(4): 201-204, 2020.
Article in English | MEDLINE | ID: mdl-37425664

ABSTRACT

Description Clenbuterol is a long-acting ß-agonist used in oral and inhaled form for asthma treatment outside the U.S. and in veterinary medicine within the U.S. It is also used off-label for anabolic effects worldwide. Toxicity with clenbuterol is increasingly seen in U.S. hospitals, primarily in younger individuals using the drug for competitive athletics or bodybuilding. We present a case of a young patient who presented after an intentional overdose and discuss the relevant literature. Presentations do not correlate with the dosage ingested. Signs and symptoms can range from simple nausea to myocardial ischemia, rhabdomyolysis and cardiogenic shock. Treatment of overdose is simple and should be promptly started using intravenous fluid hydration and potassium supplementation. Benzodiazepines may be utilized for agitation or delirium. ß-blockers or phenylephrine may be used to give hemodynamic support. More research is needed to gain an understanding of the optimal treatment of clenbuterol toxicity, especially if it becomes a more frequent reason for medical encounters in the U.S.

7.
J Anim Sci ; 97(10): 4101-4113, 2019 Oct 03.
Article in English | MEDLINE | ID: mdl-31410479

ABSTRACT

Feedlot performance is reduced by heat stress and improved by ß adrenergic agonists (ßAA). However, the physiological mechanisms underlying these outcomes are not well characterized, and anecdotal reports suggest that ßAA may confound the effects of heat stress on wellbeing. Thus, we sought to determine how heat stress and ßAA affect growth, metabolic efficiency, and health indicators in lambs on a feedlot diet. Wethers (38.6 ± 1.9 kg) were housed under thermoneutral (controls; n = 25) or heat stress (n = 24) conditions for 21 d. In a 2 × 3 factorial, their diets contained no supplement (unsupplemented), ractopamine (ß1AA), or zilpaterol (ß2AA). Blood was collected on days -3, 3, 9, and 21. On day 22, lambs were harvested and ex vivo skeletal muscle glucose oxidation was determined to gauge metabolic efficiency. Feet and organ tissue damage was assessed by veterinary pathologists. Heat stress reduced (P < 0.05) feed intake by 21%, final bodyweight (BW) by 2.6 kg, and flexor digitorum superficialis (FDS) muscle mass by 5%. ß2AA increased (P < 0.05) FDS mass/BW by 9% and average muscle fiber area by 13% compared with unsupplemented lambs. Blood lymphocytes and monocytes were greater (P < 0.05) in heat-stressed lambs, consistent with systemic inflammation. Plasma insulin was 22% greater (P < 0.05) and glucose/insulin was 16% less (P < 0.05) in heat-stressed lambs than controls. Blood plasma urea nitrogen was increased (P < 0.05) by heat stress on day 3 but reduced (P < 0.05) on days 9 and 21. Plasma lipase and lactate dehydrogenase were reduced (P < 0.05) by heat stress. Glucose oxidation was 17% less (P < 0.05) in muscle from heat-stressed lambs compared with controls and 15% greater (P < 0.05) for ß2AA-supplemented compared with unsupplemented lambs. Environment and supplement interacted (P < 0.05) for rectal temperature, which was increased (P < 0.05) by heat stress on all days but more so (P < 0.05) in ß2AA-supplemented lambs on days 4, 9, and 16. Heat stress increased (P < 0.05) the frequency of hoof wall overgrowth, but ßAA did not produce any pathologies. We conclude that reduced performance in heat-stressed lambs was mediated by reduced feed intake, muscle growth, and metabolic efficiency. ß2AA increased muscle growth and improved metabolic efficiency by increasing muscle glucose oxidation, but no such effects were observed with ractopamine. Finally, ßAA supplementation was not detrimental to health indicators in this study, nor did it worsen the effects of heat stress.


Subject(s)
Adrenergic beta-Agonists/administration & dosage , Heat Stress Disorders/veterinary , Hypertrophy/veterinary , Muscular Diseases/veterinary , Phenethylamines/administration & dosage , Sheep Diseases/drug therapy , Trimethylsilyl Compounds/administration & dosage , Animal Feed/analysis , Animals , Blood Urea Nitrogen , Body Weight , Diet/veterinary , Dietary Supplements , Heat Stress Disorders/metabolism , Heat-Shock Response/drug effects , Hot Temperature , Humidity , Hypertrophy/drug therapy , Hypertrophy/physiopathology , Immunohistochemistry , Male , Muscular Diseases/drug therapy , Muscular Diseases/physiopathology , Myosin Heavy Chains/analysis , Random Allocation , Sheep , Sheep Diseases/physiopathology , Sheep, Domestic
8.
Respir Med Case Rep ; 28: 100899, 2019.
Article in English | MEDLINE | ID: mdl-31341763

ABSTRACT

We described three severe asthmatics whose asthma symptoms were rapidly improved by benralizumab following favorable response to mepolizumab. Benralizumab-induced eosinophil depletion contributed to clinical improvement of severe asthma after mepolizumab-induced eosinophil reduction; thus, prior favorable responses to mepolizumab may predict benralizumab efficacy.

9.
Bioorg Med Chem Lett ; 29(8): 995-1000, 2019 04 15.
Article in English | MEDLINE | ID: mdl-30792038

ABSTRACT

Oxadiazole replacement of an amide linkage in an RARα agonist template 1, followed by lead optimisation, has produced a highly potent and selective RARß agonist 4-(5-(4,7-dimethylbenzofuran-2-yl)-1,2,4-oxadiazol-3-yl)benzoic acid (10) with good oral bioavailability in the rat and dog. This molecule increases neurite outgrowth in vitro and induces sensory axon regrowth in vivo in a rodent model of avulsion and crush injury, and thus has the potential for the treatment of nerve injury.


Subject(s)
Oxadiazoles/chemistry , Receptors, Retinoic Acid/agonists , Administration, Oral , Animals , Dogs , Drug Evaluation, Preclinical , Half-Life , Locomotion/drug effects , Madin Darby Canine Kidney Cells , Neuronal Outgrowth/drug effects , Optic Nerve Injuries/drug therapy , Oxadiazoles/pharmacokinetics , Oxadiazoles/pharmacology , Rats , Receptors, Retinoic Acid/metabolism , Structure-Activity Relationship
10.
Int J Chron Obstruct Pulmon Dis ; 13: 3003-3009, 2018.
Article in English | MEDLINE | ID: mdl-30319248

ABSTRACT

A single inhaler containing inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA) is a more convenient way of delivering triple therapy in patients with COPD. Single triple therapy has been shown to be superior at reducing exacerbations and improving quality of life compared to LABA/LAMA, especially in patients with a prior history of frequent exacerbations and blood eosinophilia, who have ICS responsive disease. The corollary is that patients with infrequent exacerbations who are noneosinophilic may be safely de-escalated from triple therapy to LABA/LAMA without loss of control. Pointedly, there is a substantially increased risk of pneumonia associated with the triple therapy containing fluticasone furoate but not beclometasone dipropionate or budesonide. Since triple therapy is also better than ICS/LABA at reducing exacerbations and improving lung function, symptoms, and quality of life, this brings into question the rationale for using ICS/LABA. Hence, we propose a simplified pragmatic decision process based on symptoms, prior to exacerbation history, and blood eosinophils to select which patients should be given a single triple inhaler or LABA/LAMA. Differences in patient preference of inhaler device, formulations and drugs will also determine which triple inhaler prescribers elect to use.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Muscarinic Antagonists/administration & dosage , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Adult , Aged , Bronchodilator Agents/administration & dosage , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Randomized Controlled Trials as Topic , Risk Assessment , Severity of Illness Index , Treatment Outcome
11.
Int J Chron Obstruct Pulmon Dis ; 12: 2307-2312, 2017.
Article in English | MEDLINE | ID: mdl-28814858

ABSTRACT

Long-acting bronchodilators are the mainstay of the treatment of COPD. With the advent of several combination inhalers with long-acting antimuscarinic agents (LAMAs) and long-acting beta agonists (LABAs), the choice of therapy in the treatment of COPD has been ever expanding. With the focus of COPD management shifting from FEV1-based treatment escalation to symptoms and risk-based treatment, we are seeing a paradigm shift in COPD treatment with early introduction of LAMA-LABA combination as a single inhaler. Glycopyrronium/formoterol fumarate fixed-dose combination formulated in a familiar metered-dose inhaler format using proprietary co-suspension technology is a new option on the market. We purport to discuss the evidence behind the approval of the drug combination and its place in therapy.


Subject(s)
Adrenergic beta-2 Receptor Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Formoterol Fumarate/administration & dosage , Glycopyrrolate/administration & dosage , Lung/drug effects , Muscarinic Antagonists/administration & dosage , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Adrenergic beta-2 Receptor Agonists/adverse effects , Bronchodilator Agents/adverse effects , Disease Progression , Drug Combinations , Forced Expiratory Volume , Formoterol Fumarate/adverse effects , Glycopyrrolate/adverse effects , Humans , Lung/physiopathology , Metered Dose Inhalers , Muscarinic Antagonists/adverse effects , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Time Factors , Treatment Outcome
12.
Int J Chron Obstruct Pulmon Dis ; 12: 1877-1882, 2017.
Article in English | MEDLINE | ID: mdl-28694698

ABSTRACT

Long-term maintenance therapy for COPD is evolving rapidly. Dual bronchodilation with new long-acting muscarinic antagonist and long-acting beta-agonist (LAMA/LABA) fixed dose combination inhalers were introduced over the past 2 years. In clinical trials, these inhalers significantly improved lung function (trough forced expiratory volume in 1 second), patient-reported outcomes, and quality of life measures compared with placebo, their respective monocomponents, and tiotropium. The recorded adverse events of these new inhalers were also similar to those of their monocomponents or placebo. There are concerns regarding long-term complications (weight gain, osteoporosis, cataract) and increased risk of community-acquired pneumonia with the use of inhaled corticosteroids (ICS). The new LAMA/LABA inhalers could potentially reduce the use of ICS as part and parcel of maintenance therapy in COPD. Recent studies compared these LAMA/LABA inhalers with ICS/LABA combination inhalers in moderate-to-severe COPD. The results are promising and favor the LAMA/LABA inhalers, especially in the longer duration trials. Furthermore, there is a clearer picture emerging as to the subgroup of COPD patients who may be able to successfully switch from their current ICS/LABA therapy to these new LAMA/LABA inhalers.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Lung/drug effects , Muscarinic Antagonists/administration & dosage , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Adrenal Cortex Hormones/adverse effects , Adrenergic beta-2 Receptor Agonists/adverse effects , Bronchodilator Agents/adverse effects , Disease Progression , Drug Combinations , Forced Expiratory Volume , Humans , Lung/physiopathology , Maintenance Chemotherapy , Muscarinic Antagonists/adverse effects , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Time Factors , Treatment Outcome
13.
Gen Thorac Cardiovasc Surg ; 65(7): 388-391, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28281043

ABSTRACT

OBJECTIVE: This study aimed to investigate whether perioperative inhalations of long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) might decrease the incidence of postoperative complications in lung cancer patients with chronic obstructive pulmonary disease (COPD). METHODS: We retrospectively analyzed 108 patients with COPD who underwent pulmonary resections for primary lung cancer at our hospital between January 2013 and January 2016 to determine the association between the incidence of postoperative complications (e.g., prolonged air leakage and pneumonia) and the use of LABAs or LAMAs. RESULTS: Thirty patients with COPD experienced postoperative complications (27.8%): Fourteen patients had prolonged air leakages (more than 7 days), ten patients developed pneumonia. The frequency of these postoperative pulmonary complications was significantly higher among the patients with COPD (24/108 cases, 22.2%), compared with the frequency among non-COPD patients (15/224 cases, 6.7%). Inhaled bronchodilators, such as LAMA or LABA, were prescribed for 34 of the 108 patients with COPD; the remaining 74 patients were not treated with bronchodilators. Pulmonary complications were significant lower among the LAMA or LABA users (3/34 cases, 8.8%) than among the untreated COPD patients (21/74 cases, 28.4%). CONCLUSION: For lung cancer patients with COPD, preoperative management using LABA or LAMA bronchodilators and smoking cessation can reduce the frequency of postoperative pulmonary complications after surgical lung resection. LAMA or LABA inhalation might be useful for not only perioperative care, but also for the long-term survival of COPD patients after surgery.


Subject(s)
Adrenergic beta-2 Receptor Agonists/administration & dosage , Lung Neoplasms/surgery , Muscarinic Antagonists/administration & dosage , Pneumonectomy/adverse effects , Preoperative Care/methods , Pulmonary Disease, Chronic Obstructive/drug therapy , Respiratory Therapy/methods , Administration, Inhalation , Aged , Aged, 80 and over , Delayed-Action Preparations , Female , Humans , Lung Neoplasms/complications , Male , Middle Aged , Postoperative Complications , Pulmonary Disease, Chronic Obstructive/complications , Retrospective Studies
14.
Article in English | MEDLINE | ID: mdl-28293106

ABSTRACT

BACKGROUND: Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy (2015) provides guidance for the treatment of chronic obstructive pulmonary disease (COPD) with different first-choice options per GOLD category without specification. OBJECTIVES: To evaluate the level of medical experts' consensus on their preferred first-choice treatment within different COPD categories. METHODS: A two-round Delphi Panel consisting of 15 questions was completed by Belgian pulmonologists (n=31) and European (n=10) COPD experts. RESULTS: Good consensus was reached by both expert groups for long-acting bronchodilators instead of short-acting bronchodilators as first-choice treatment in GOLD A. Single bronchodilation with long-acting muscarinic antagonist (LAMA) was preferred over long-acting ß2-agonist (LABA) and LABA/LAMA as first-choice treatment in GOLD B and GOLD C. For GOLD D patients based on the forced expiratory volume in 1 second (FEV1)<50%, a very good consensus was reached for LAMA/LABA as first-choice treatment. For GOLD D patients based on frequent or severe exacerbations, there was a good consensus for LABA/LAMA/inhaled corticosteroids (ICS) as first choice in the Belgian group. According to the European experts, both LABA/LAMA and LABA/LAMA/ICS could be the first choice for these patients. CONCLUSION: Belgian and European experts recommend long-acting bronchodilators as first-choice treatment. Treatment containing ICS was found only appropriate in patients with FEV1<50% and ≥2 moderate exacerbations or 1 severe exacerbation/year.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Delphi Technique , Lung/drug effects , Muscarinic Antagonists/administration & dosage , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Adrenal Cortex Hormones/adverse effects , Adrenergic beta-2 Receptor Agonists/adverse effects , Belgium , Bronchodilator Agents/adverse effects , Consensus , Disease Progression , Drug Combinations , Evidence-Based Medicine , Forced Expiratory Volume , Humans , Lung/physiopathology , Muscarinic Antagonists/adverse effects , Patient Selection , Predictive Value of Tests , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Risk Factors , Time Factors , Treatment Outcome
15.
Expert Rev Respir Med ; 10(2): 113-25, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26677916

ABSTRACT

Fixed dose combinations (FDC) of inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) are well established in asthma treatment. The budesonide/salmeterol (B/S) FDC is now about to reach the market. It is provided as powder in hard capsules of two strengths: 120/20µg and 240/20µg when expressed as delivered doses, equivalent to 150/25µg and 300/25µg when expressed as nominal doses. Its development involved 9 pharmacokinetic (320 subjects), 3 phase II (123 subjects) and 4 phase III (1206 patients with different asthma severity) studies. Delivery is effectuated via low resistance inhaler device, Axahaler®, generating also fine particles targeting the small airways. B/S safety, assessed in 1401 subjects, did not outline novel concerns specific for this FDC. In conclusion, the B/S dry powder FDC can be used for asthma treatment in adults not adequately controlled on ICS alone, or to maintain control of ICS/LABA treated patients, in whom switching to alternative FDC is indicated.


Subject(s)
Adrenergic beta-2 Receptor Agonists/administration & dosage , Asthma/drug therapy , Budesonide/administration & dosage , Glucocorticoids/administration & dosage , Salmeterol Xinafoate/administration & dosage , Adrenergic beta-2 Receptor Agonists/pharmacokinetics , Budesonide/pharmacokinetics , Clinical Trials as Topic , Drug Combinations , Drug Evaluation, Preclinical , Glucocorticoids/pharmacokinetics , Humans , Nebulizers and Vaporizers , Salmeterol Xinafoate/pharmacokinetics
16.
J Anim Sci ; 93(1): 185-96, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25568367

ABSTRACT

Two experiments were conducted to determine the effects of increasing the dietary Zn content on growth performance, carcass characteristics, plasma Zn, and ileal mucosal inflammation mRNA expression of finishing pigs fed diets containing ractopamine HCl (RAC; Elanco Animal Health, Greenfield, IN). In Exp. 1, 312 pigs (327 × 1050; PIC, Hendersonville, TN; 94 kg BW) were used in a 27-d study. There were 2 pigs per pen and 26 pens per treatment. Treatments included a corn-soybean meal diet (control; 0.66% standardized ileal digestible [SID] Lys); a diet (0.92% SID Lys) with 10 mg/kg RAC; and the RAC diet plus 50, 100, or 150 mg Zn/kg from ZnO or 50 mg Zn/kg from a Zn AA complex (ZnAA; Availa-Zn; Zinpro, Eden Prairie, MN). All diets also contained 83 mg Zn/kg from ZnSO4 in the trace mineral premix. Pigs fed the RAC diet without added Zn had increased (P < 0.05) ADG, G:F, HCW, carcass yield, and loin weight compared with pigs fed the control diet. Increasing Zn from ZnO in diets containing RAC tended to increase (linear, P = 0.067) G:F and loin weight (quadratic, P = 0.064). Pigs fed diets with 50 mg Zn/kg from ZnAA tended to have increased (P = 0.057) ADG compared with pigs fed the RAC diet. In Exp. 2, 320 pigs (327 × 1050; PIC; 98 kg BW) were used in a 35-d study. There were 2 pigs per pen and 20 pens per treatment. Treatments included a control diet (0.66% SID Lys); a diet (0.92% SID Lys) with 10 mg/kg RAC; or the RAC diet plus 75, 150, and 225 mg Zn/kg from ZnO or ZnAA. All diets also contained 55 mg Zn/kg from ZnSO4 from the trace mineral premix. Pigs fed the RAC diet had increased (P < 0.05) ADG, G:F, HCW, loin depth, percentage lean, and liver weight compared with pigs fed the control diet. No Zn level or source effects or level × source interactions were observed for growth performance. A Zn level × source interaction (quadratic, P = 0.007) was observed in liver Zn concentrations. This resulted from liver Zn concentrations plateauing at 150 mg Zn/kg when ZnO was supplemented, while there was a linear increase when using ZnAA. Increasing Zn in diets containing RAC increased (linear, P < 0.05) plasma Zn on d 18 and 32. The expression of IL-1ß was increased (P = 0.014) in mucosa of pigs fed the RAC diet compared with those fed the control diet. Expression of IL-1ß decreased (linear, P = 0.026) in the mucosa of pigs fed increasing added Zn. In conclusion, adding Zn to diets containing RAC resulted in a trend for improved growth performance of pigs in 1 of 2 experiments. Also, additional Zn increased plasma Zn and reduced IL-1ß.


Subject(s)
Body Composition/drug effects , Body Weight/drug effects , Dietary Supplements , Ileitis/metabolism , Phenethylamines/pharmacology , RNA, Messenger/metabolism , Swine/growth & development , Zinc/pharmacology , Animal Feed , Animal Nutritional Physiological Phenomena , Animals , Diet/veterinary , Ileum/metabolism , Interleukin-1beta/genetics , Interleukin-1beta/metabolism , Intestinal Mucosa/metabolism , Liver/metabolism , RNA, Messenger/genetics , Swine/metabolism , Zinc/administration & dosage , Zinc/metabolism
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