Clinical efficacy of Kuanxiong aerosol for patients with prehospital chest pain: A randomized controlled trial.

BACKGROUND: Kuanxiong Aerosol (KXA)(CardioVent®), consisting of Asarum sieboldii Miq. oil, Santalum album L. oil, Alpinia officinarum Hance oil, Piper longum L. oil and borneol, seems to relieve the symptoms of chest pain and serve as a supplementary treatment for prehospital chest pain in emergency department. STYLE OF THE STUDY: This randomized controlled trial aimed to determine the clinical effect and safety of KXA for patients with prehospital chest pain. METHODS: A total of 200 patients were recruited from Guangdong Provincial Hospital of Chinese Medicine and randomly divided into KXA group (n = 100) and Nitroglycerin Aerosol (NA) group (n = 100) by SAS 9.2 software. All patients were treated with standardized Western medicine according to the pre-hospital procedure. The experimental group and NA group was additionally treated with KXA and NA respectively. The primary outcome was the relieving time of prehospital chest pain (presented as relief rate) after first-time treatment. The secondary outcomes included the evaluation of chest pain (NRS scores, degree of chest pain, frequency of chest pain after first-time treatment), efficacy in follow-up time (the frequency of average aerosol use, emergency department visits, 120 calls, medical observations and hospitalization at 4 weeks, 8 weeks, 12 weeks), alleviation of chest pain (Seattle angina questionnaire, chest pain occurrence, and degree of chest pain at 12-weeks treatment) and the change of TCM symptoms before and after 12-weeks treatment. In addition, the safety of KXA was also assessed by the occurrence of adverse events. The database was created using Epidata software, and statistical analysis was conducted by SPSS 23.0 software. RESULTS: A total of 194 participants finally completed the trial, the results showed that after first-time treatment, KXA had a higher relief rate (72.2%) of chest pain within 30 min than that of NA group (59.4%, p = 0.038), KXA group had a lower degree of chest pain (p = 0.005), lower NRS score (p = 0.011) and higher reduction of NRS score (p = 0.005) than the NA. In the follow-up period, KXA group decreased the frequency of 120 call better than that of NA group at 4 weeks (p = 0.040), but KXA had a similar efficacy as NA in the improvement on the of frequency of chest pain, aerosol use, emergency department visits, 120 call, medical observation and hospitalization at 4 weeks, 8 weeks and 12 weeks (p>0.05). There also had no difference between the two groups on the occurrence of chest pain, degree of chest pain, physical limitation, angina stability, treatment satisfaction, and disease perception between the two groups at 12 weeks (p>0.05). In addition, KXA and NA both improved the patient's chest pain, but not the TCM symptoms. In terms of safety, KXA showed similar safety as NA in this study. CONCLUSIONS: KXA relieved prehospital chest pain faster than NA and had a better remission effect on the prehospital chest pain than that of the NA group in short-period. In long-period, KXA showed similar efficacy on the improvement of prehospital chest pain as NA. KXA may be a safe and reliable therapy for prehospital chest pain.

INDIVIDUAL ARTICLE: Vehicles Matter: Calcipotriene and Betamethasone Dipropionate Foam as a Topical Psoriasis Therapy.

Topical medications are commonly used to manage mild-to-moderate psoriasis and serve as adjunct therapies used in combination with phototherapy and systemic treatments. Fixed-dose calcipotriene (Cal) 0.005%/betamethasone dipropionate (BD) 0.064% aerosol foam is a safe, efficacious topical therapy approved for the treatment of psoriasis vulgaris in the United States and European Union. Several investigator-initiated studies (IISs) have been conducted to provide real-world evidence related to the safety, effectiveness, and therapeutic indications of Cal/BD foam and are relevant to clinicians' every-day practice. This paper summarizes the findings of the IISs around the globe published to date and presents the real-world data related to the effectiveness and clinical considerations of Cal/BD foam as a treatment for psoriasis.

Intraperitoneal chemotherapy in the management of pancreatic adenocarcinoma: A systematic review and meta-analysis.

BACKGROUND: Pancreatic cancer represents one of the leading causes of cancer-related death worldwide. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal chemotherapy (NIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proven with curative intent mainly for other tumors and there is a lack of consensus regarding possible benefits also in pancreatic cancer. The present systematic review and meta-analysis aim to provide an up-to-date overview of the effectiveness and safety of intraperitoneal treatments in the management of pancreatic cancer. METHODS: A systematic review of articles was conducted according to PRISMA and AMSTAR-2 guidelines. 11 studies were included in the analysis. RESULTS: We included in our analysis 212 patients subdivided in three groups: 64 in the HIPEC group (57 with prophylactic intent and 7 with curative intent), 55 in the PIPAC group and 93 in the NIPEC group. Primary outcomes were represented by survival rates; we evidenced at an observation time of three years a survival of 24% in the HIPEC group (25.5% in the prophylactic arm and 6.2% in the curative arm), 5.3% in the PIPAC group and 7.9% in the NIPEC group. CONCLUSIONS: HIPEC could be considered as a promising technique for prophylaxis and treatment of peritoneal metastasis (PM) in case of borderline resectable and locally advanced disease. Increased survival rates emerged without additional morbidity when surgical resection and CRS are possible. In addition, our data about PIPAC and NIPEC as palliative treatment in unresectable disease seems to identify more favorable survival rates compared to literature.

Study on the Effects of Kuanxiong Aerosol on the Isolated Artery and Rabbits Acute Myocardial Ischemia Model.

BACKGROUND: Kuan Xiong aerosol (KXA) is a Chinese herbal compound used to regulate qi-flowing to relieve pain and improve angina. However, only a few pharmacological studies on this traditional Chinese medicine preparation have been reported to confirm these activities. OBJECTIVES: This article aims to observe the effect of resisting acute myocardial ischemia (AMI) in vivo and dilating vessel in vitro of KXA. METHODS: The AMI model involves intravenously injecting the pituitary (2 U.kg-1) into the ear of rabbits. Electrocardiograph (ECG) T waves were then recorded after administration, and the falling range was calculated. Following this, the level of serum Cardiac troponin T (cTn-T) and the histopathology of the cardiac muscle tissue were evaluated. In vitro, the effect of KXA on vasodilation of isolated aortic rings that had been pre-contracted with KCl (30 mM) was observed. RESULTS: It was found that KXA reduced ECG ST-T waves and serum cTn-T in the rabbit AMI model, protecting myocardial tissue from fracturing and loss of myocardial fibers and inhibiting inflammatory cell infiltration, cavitation degeneration, and karyopyknosis of the myocardial matrix. Furthermore, the administration of 0.215, 1.075, and 2.150 mg.mL-1 of KXA resulted in significant relaxation of the aortic rings at a rate of 69.63 %, 90.14 %, and 118.72 % (p < 0.01) in the untreated ones, and a second shrinkage ratio of 20.17 %, 4.29 %, and 4.54 % (p < 0.01) in the untreated ones, respectively. CONCLUSION: These results suggest that KXA protects against AMI, contributes to the dilation of blood vessels, and has long-acting effectiveness.

Kuanxiong aerosol inhibits apoptosis and attenuates isoproterenol-induced myocardial injury through the mitogen-activated protein kinase pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: Kuanxiong aerosol (KXA) is a common clinical drug based on Fangxiang Wentong (FXWT) therapy in the treatment of angina pectoris. However, the pharmacological mechanism of KXA in the prevention and treatment of myocardial injury (MI) is not clear. AIM OF THE STUDY: The purpose of this study was to explore the protective effect of KXA on isoproterenol (ISO)-induced MI in rats. MATERIALS AND METHODS: The study included male Wistar Kyoto rats (age: 6 weeks). The rats were randomly divided into the following 5 groups (n = 6 per group): control group, ISO group, isosorbide mononitrate (ISMN) group (5 mg/kg), KXA-L group (0.1 mL/kg), and KXA-H group (0.3 mL/kg). The rats in the last three groups were given intragastric administration for 14 days, and rats in control group and ISO group were given the same amount of normal saline daily. ISO (120 mg/kg) was used to induce MI on the 13th and 14th days. We assessed electrocardiograms (ECGs), myocardial specific enzymes, histopathological changes, and apoptosis. RESULTS: We found that KXA reduced the increase in the ST-segment amplitude (elevation or depression) and the levels of myocardial marker enzymes induced by ISO in MI rats, improved the pathological changes in myocardial tissue, and reduced cardiomyocyte apoptosis. At the same time, KXA significantly inhibited the up-regulation of caspase-3 and Bax expression and down-regulation of Bcl-2 expression induced by ISO. RNA sequencing showed that 90 up-regulated genes induced by ISO were down-regulated after KXA treatment, whereas 27 down-regulated genes induced by ISO were up-regulated after KXA treatment. In addition, KEGG pathway enrichment analysis showed that the mitogen-activated protein kinase (MAPK) signaling pathway may be an important target of KXA in the treatment of ISO-induced MI in rats. The results of RNA sequencing verified by Western blot analysis showed that KXA significantly inhibited the activation of the ISO-induced MAPK pathway. CONCLUSIONS: KXA improves cardiac function in MI rats by inhibiting apoptosis mediated by the MAPK signaling pathway.

Effect of Kuanxiong Aerosol () on Patients with Angina Pectoris: A Non-inferiority Multi-center Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect and safety of Kuanxiong Aerosol (, KA) on patients with angina pectoris. METHODS: Block randomization was performed to randomly allocate 750 patients into KA (376 cases) and control groups (374 cases). During an angina attack, the KA group received 3 consecutive sublingual sprays of KA (0.6 mL per spray). The control group received 1 sublingual nitroglycerin tablet (NT, 0.5 mg/tablet). Log-rank tests and Kaplan-Meier estimations were used to estimate the angina remission rates at 6 time-points after treatment (1, 2, 3, 4, 5, and >5 min). Logistic regression analysis was performed to observe the factors inflfluencing the rate of effective angina remission, and the remission rates and incidences of adverse reactions were compared for different Canadian Cardiovascular Society (CCS) classes of angina. RESULTS: The 5-min remission rates in the KA and control groups were not signifificantly different (94.41% vs. 90.64%, P>0.05). The angina CCS class signifificantly inflfluenced the rate of remission (95% confidence interval = 0.483-0.740, P<0.01). In the CCS subgroup analysis, the 3-and 5-min remission rates for KA and NT were similar in the CCSII and III subgroups (P>0.05), while they were signifificantly better for KA in the CCSI and II subgroups (P<0.05 or P<0.01). Furthermore, the incidence of adverse reactions was signifificantly lower in the KA group than in the control group for the CCSII and III subgroups (9.29% vs. 26.22%, 10.13% vs. 20.88%, P<0.05 or P<0.01). CONCLUSIONS: KA is not inferior to NT in the remission of angina. Furthermore, in CCSII and III patients, KA is superior to NT, with a lower incidence of adverse reactions. (Registration No. ChiCTRIPR-15007204).

Tratamiento complementario de la fibrosis quística con terapia acuática. A propósito de un caso / Supplementary treatment of cystic fibrosis with hydrotherapy. A case report

Antecedentes y objetivo: La fibrosis quística (FQ) produce una afectación multisistémica, por lo que la hidroterapia puede aportar numerosos beneficios en su tratamiento. El objetivo de este estudio es la presentación de la efectividad de un programa de hidroterapia en una paciente pediátrica con FQ. Descripción del caso: Niña de 23 meses de edad con FQ que presenta dificultad respiratoria. Intervención: El programa de tratamiento consiste en la realización de 5 sesiones de hidroterapia de 30 min de duración cada una. Resultados: Se muestran mejoras en los signos vitales y las capacidades de la paciente (movilización de secreciones y expectoración), generando efectos positivos sobre su calidad de vida. Discusión: Otros autores han relacionado este tipo de tratamiento con trastornos respiratorios en edades pediátricas y en edad adulta, confirmando igualmente los beneficios que se han obtenido en el caso clínico planteado

Background and objective: Cystic Fibrosis (CF) leads to a multisystemic involvement. Hydrotherapy shows many positive effects. The aim of this study is to show the effectiveness of a hydrotherapy program in a patient with CF. Case description: The patient is a 23 month-old girl with CF and respiratory distress. Intervention: The treatment program consisted of the fulfilment of five 30-minute hydrotherapy sessions. Results: There was an improvement in in patient vital signs and capacities (mainly in terms of mobilisation of secretions and expectoration), generating positive effects on her quality of life. Discussion: Other authors have associated this type of treatment with respiratory disorders, and have confirmed its benefits in paediatric and adult patients, including those obtained in the case presented

Is there a role for aerosol nasal sprays in the treatment of allergic rhinitis: a white paper.

This White Paper presents the Consensus Statements derived from a Special Issues Board (SIB) held in Chicago, IL, in October 2010. The SIB was convened to address the question of whether there is a need for both aerosol and aqueous intranasal steroids (INSs) in the treatment of allergic rhinitis (AR). The faculty reviewed the published record of efficacy and safety of aerosol and aqueous INSs, as well as patient and physician satisfaction and preferences for currently available INSs, and burden of disease. Agreement on unmet needs also included the practice experience of the faculty and their colleagues. The body of evidence indicates that INSs are equally effective and well tolerated for most patients. However, differences exist among current aqueous formulations as well as between these products and their aerosol antecedents, based on the properties of the nasal spray. Aerosol formulations, although no longer available, may be preferred for some patients with specific pathophysiology and may be preferred by some patients based on sensory perception. There are good reasons to expand the currently available options of INSs by having both aerosol and aqueous formulations.

Pre-clinical evaluation of a next-generation spray adhesion barrier for multiple site adhesion protection.

Intra-abdominal adhesions represent a major cause of postoperative morbidity, including chronic or recurrent pelvic pain and infertility in a significant percent of patients. The SprayShield™ Adhesion Barrier System (Covidien, Waltham, MA) is a next-generation sprayable adhesion barrier to prevent postoperative adhesions. Initially sprayed as a liquid, SprayShield™ solidifies within 2 seconds of contact with tissue through a polyethylene glycol (PEG) ester-Trilysine reaction to form an adherent, internal tissue barrier that protects the underlying tissues for several days after surgery. After tissue begins to heal, the adhesion barrier liquefies via hydrolysis and completely absorbs within 7 days. Safety testing has shown the product to be nongenotoxic, noncytotoxic, nonsensitizing, and nonirritating. SprayShield™ has been shown to adhere well to tissue, with the mechanism of adherence believed to be mainly due to tissue surface mechanical interlocking. In studies that compared SprayShield™ to good surgical technique, virgin hogs were randomized to receive SprayShield™ or good surgical technique (Control). Compared to Controls, SprayShield™ demonstrated a statistically significant reduction in the number of adhesions (46%, p=0.04) and in the area of adhesions (83%, p=0.012) to injured sites. With its ease of application, biocompatibility and adhesion prevention efficacy, SprayShield™ may be an effective next-generation adhesion prevention product for open and laparoscopic abdominopelvic procedures as an adjunct to good surgical technique.

Morbilidad y mortalidad por neumonía nosocomial en pacientes tratados con aerosoles de eucalipto durante la ventilación artificia / Morbidity and mortality for nosocomial pneumonia in patients treated with eucalyptus aerosols during the artificial ventilation

Se efectuó un estudio longitudinal y prospectivo sobre 26 pacientes tratados con ventilación mecánica artificial en el Servicio de Terapia Intensiva del Hospital Provincial Docente “Dr. Joaquín Castillo Duany” de Santiago de Cuba, en los meses de septiembre a diciembre del 2006. El empleo de aerosoles con eucalipto persiguió disminuir la incidencia de neumonía asociada a ventilación, la colonización del árbol bronquial por gérmenes intrahospitalarios, los efectos de la infección y la letalidad, la cual resultó ser de 37,5 % en la casuística, causada fundamentalmente por microorganismos gramnegativos como Acinetobacter y Pseudomonas. La utilización de dichos aerosoles en los pacientes con ventilación mecánica artificial puede constituir un tratamiento eficaz para aminorar la incidencia, gravedad y letalidad de la neumonía en estos casos.

A longitudinal and prospective study was carried on 26 patients treated with artificial mechanical ventilation in the Service of Intensive Therapy of "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital in Santiago de Cuba, in the months of September to December, 2006. The use of aerosols with eucalyptus was aimed at diminishing the pneumonia incidence associated with ventilation, the colonization of the bronchial tree by nosocomial pathogens and the effects of infection and lethality, which turned out to be of 37,5% in the case material, mainly caused by gram-negative microorganisms such as Acinetobacter and Pseudomonas. The use of these aerosols in the patients with artificial mechanical ventilation can constitute an effective treatment to reduce the incidence, severity and lethality of pneumonia in these cases.

Morbilidad y mortalidad por neumonía nosocomial en pacientes tratados con aerosoles de eucalipto durante la ventilación artificia / Morbidity and mortality for nosocomial pneumonia in patients treated with eucalyptus aerosols during the artificial ventilation

Se efectuó un estudio longitudinal y prospectivo sobre 26 pacientes tratados con ventilación mecánica artificial en el Servicio de Terapia Intensiva del Hospital Provincial Docente “Dr. Joaquín Castillo Duany” de Santiago de Cuba, en los meses de septiembre a diciembre del 2006. El empleo de aerosoles con eucalipto persiguió disminuir la incidencia de neumonía asociada a ventilación, la colonización del árbol bronquial por gérmenes intrahospitalarios, los efectos de la infección y la letalidad, la cual resultó ser de 37,5 % en la casuística, causada fundamentalmente por microorganismos gramnegativos como Acinetobacter y Pseudomonas. La utilización de dichos aerosoles en los pacientes con ventilación mecánica artificial puede constituir un tratamiento eficaz para aminorar la incidencia, gravedad y letalidad de la neumonía en estos casos(AU)

A longitudinal and prospective study was carried on 26 patients treated with artificial mechanical ventilation in the Service of Intensive Therapy of "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital in Santiago de Cuba, in the months of September to December, 2006. The use of aerosols with eucalyptus was aimed at diminishing the pneumonia incidence associated with ventilation, the colonization of the bronchial tree by nosocomial pathogens and the effects of infection and lethality, which turned out to be of 37,5% in the case material, mainly caused by gram-negative microorganisms such as Acinetobacter and Pseudomonas. The use of these aerosols in the patients with artificial mechanical ventilation can constitute an effective treatment to reduce the incidence, severity and lethality of pneumonia in these cases.

[Prescriptions of aerosol therapy. A survey of practices at the Besançon University Hospital]. / Les conditions de prescription de l'aérosolthérapie. Une enquête de pratique réalisée au CHU de Besançon.

OBJECTIVE: Prescriptions of aerosol sprays concomitantly with other drugs can raise problems of incompatibility. METHODS: Medical practices in the clinical units of the Besançon University Hospital were analyzed to assess the therapeutic indications, the most frequently prescribed drugs, possible admixtures, the nature and volume of solvents used, drug protocols and type of aerosol therapy and nebulizer used. Sixty questionnaires were sent to all the units of the University Teaching Hospital of Besançon. RESULTS: Analysis of 48 questionnaires completed by head nurses showed that 28 different drugs and 26 different admixtures were prescribed. Only 2 of the admixtures had undergone prior validation. Only 7 (26%) of the drug formulations prescribed had received marketing approval. Recognized clinical practices for the administration of aerosol therapy were not applied and the aerosol sessions were not standardized. CONCLUSION: Many prescriptions are carried out without knowledge of the chemical compatibility of co-administered medicines.

[New ways in aerosol therapy. Development of FCKW-free gases-- powder inhalation systems]. / Neue Wege in der Aerosoltherapie. Entwicklung FCKW-freier Treibgase--Pulverinhalationssysteme.

New approaches in the field of aerosol therapy are pointing into two directions. In one, chlorofluorocarbons are now beginning to make place for the hydrofluoroalkanes--which are non-destructive of the ozone layer--as propellants for use in metered-dose inhalers. On the other hand, the use and new development of dry powder inhalation devices are on the increase. In the future, systemic pharmacotherapy applied via aerosols will provide an important option for use not only in the field of pneumology, but also, for example, in the treatment of diabetes mellitus and for anticoagulation.

Verificaçao da dispersao de respingos durante o trabalho do cirurgiao-dentista / Confirmation of spatter dispersion during dental work

Todas as pessoas envolvidas em um atendimento odontológico estao sujeitas a contaminaçao por bactérias, vírus e fungos que podem causar diversas enfermidades, dentre as quais se destacam a hepatite, a tuberculose, o herpes e a AIDS. Sabe-se, que durante um atendimento, há possibilidade de ocorrer dispersao de respingos e aerossóis contendo microrganismos patogênicos. No entanto, algumas clínicas odontológicas sao projetadas com vários consultórios no mesmo ambiente, sem divisórias entre eles. O objetivo deste trabalho foi verificar qual o alcance dos respingos provenientes da utilizaçao de seringa tríplice e turbina de alta rotaçao em cinco atendimentos clínicos simulados em uma clínica de atendimento coletivo, considerando que estes respingos podem conter saliva e sangue do paciente. Para isso, anilina de diferentes cores (rosa, azul, amarela, verde e marrom) foi adicionada a agua do reservatório de cada um dos cinco equipamentos. Todo o ambiente físico, assim como a roupa do operador e do paciente, foram cobertos com papel crepom branco. Constatou-se grande concentraçao de respingos sobre as cadeiras, osbre o operador, sobre o piso, cadeiras vizinhas e bandejas clínicas das unidades vizinhas. A distancia máxima atingida pelos respingos foi de 1,82 m, medindo-se a partir do ponto correspondente a boca do paciente. Durante um atendimento real, coletivo e simultaneo nesta clínica, as cadeiras vizinhas e seus respectivos pacientes e operadores, bem como a bandejas clínicas contendo instrumental esterilizado situam-se dentro da área de abrangência dos respingos. Portanto, existe uma possibilidade real de ocorrer contaminaçao cruzada, havendo necessidade de colocaçao de barreiras físicas entre os equipamentos. O estudo evidenciou também a necessidade de proteçao de toda a face, o corpo, o cabelo e os braços do operador, uma vez que estas foram regioes muito atingidas pelos respingos

The professionals and patients involved in dental examinations are at risk for infection by various disease-causing bacteria, viruses, and fungi, such as those responsible for hepatitis, tuberculosis, herpes, and AIDS. It is known that aerosols and spatter containing pathogenic microorganisms can spread during an examination. Nevertheless, some dental clinics are designed to have multiple examination areas in the same room, with no physical barriers between them. The objective of this study was to verify the reach of spatter resulting from the use of a triple syringe and high-rotation turbine during five simulated exams in a collective clinic, bearing in mind that spatter can contain the patient's saliva and blood. To facilitate tracking of the spatter, aniline dye (pink, blue, yellow, green, and brown) was added to the water in the appropriate receptacle in each of the five units. The room, the equipment, and the patient's and operator's clothing were covered with white paper. A high concentration of spatter was observed on the chair, the operator, and the floor of each unit, and it also appeared on the chairs and trays of the surrounding units. The maximum distance reached by spatter was 1.82 m from a point on the chair corresponding to the position of the patient's mouth. During real simultaneous examinations, the surrounding chairs and their patients and operators, as well as the trays containing sterilized instruments, are within spatter range. Therefore, there is a real possibility of crossinfection, and physical barriers should be placed between the units. This study also confirmed the need for protection of the operator's face, body, hair, and arms, since these regions were heavily affected by spatter.

Inhibition of wound contraction by topical antimicrobials.

Spontaneous wound healing occurs partly by wound contraction, a process that requires intact functioning fibroblasts, and collagen production. Disruption of fibroblasts by the topical antimicrobials, silver sulfadiazine and mafenide acetate has been demonstrated in vitro. An acute rat wound model was used to show that wound contraction in vivo is significantly impeded by silver sulfadiazine and mafenide acetate.

Clinical aerosols II. Therapeutic aerosols.

The current uses of clinical aerosols such as water, saline, mucolytics, bronchodilators, cromolyn sodium, corticosteroids, and antimicrobials have been reviewed. The benefits of water, saline, and detergent aerosols continue to be surrounded by uncertainty and controversy. Aerosolized mucolytic and proteolytic agents have not been conclusively shown to be of substantial value in the improvement of respiratory disorders. Favorable bronchodilator therapy is achieved with aerosols of certain sympathomimetic and anticholinergic agents. However, successful therapy depends on the dose administered and the site of aerosol deposition in the lung. The prophylactic use of cromolyn sodium in patients with asthma is another useful application of aerosols. Topically active corticosteroid aerosols are increasingly being used since they may reduce risks of systemic effects from corticosteroids. Research on uncommonly aerosolized agents has widened the spectrum of therapeutic applications of aerosols.