H2 inhalation therapy in patients with moderate COVID-19 (H2COVID): a prospective ascending-dose phase I clinical trial.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has triggered a serious global health crisis, resulting in millions of reported deaths since its initial identification in China in November 2019. The global disparities in immunization access emphasize the urgent need for ongoing research into therapeutic interventions. This study focuses on the potential use of molecular dihydrogen (H2) inhalation as an adjunctive treatment for COVID-19. H2 therapy shows promise in inhibiting intracellular signaling pathways associated with inflammation, particularly when administered early in conjunction with nasal oxygen therapy. This phase I study, characterized by an open-label, prospective, monocentric, and single ascending-dose design, seeks to assess the safety and tolerability of the procedure in individuals with confirmed SARS-CoV-2 infection. Employing a 3 + 3 design, the study includes three exposure durations (target durations): 1 day (D1), 3 days (D2), and 6 days (D3). We concluded that the maximum tolerated duration is at least 3 days. Every patient showed clinical improvement and excellent tolerance to H2 therapy. To the best of our knowledge, this phase I clinical trial is the first to establish the safety of inhaling a mixture of H2 (3.6%) and N2 (96.4%) in hospitalized COVID-19 patients. The original device and method employed ensure the absence of explosion risk. The encouraging outcomes observed in the 12 patients included in the study justify further exploration through larger, controlled clinical trials. CLINICAL TRIALS: This study is registered with ClinicalTrials.gov as NCT04633980.

Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices, and tracheostomies.

BACKGROUND: Perioperative respiratory adverse events account for a third of all perioperative cardiac arrests, with bronchospasm and laryngospasm being most common. Standard treatment for bronchospasm is administration of inhaled salbutamol, via pressurized metered dose inhaler. There is little evidence on the best method of attaching the pressurized metered dose inhaler to the artificial airway during general anesthesia. AIM: The aim of this study is to investigate the best method to deliver aerosolized salbutamol via pressurized metered dose inhaler to the lungs of an anesthetized child. METHODS: We measured salbutamol delivered by pressurized metered dose inhaler through different sized tracheal tubes, supraglottic airway devices, and tracheostomies in vitro for methods commonly employed for connecting the pressurized metered dose inhaler to the artificial airway. Breathing was simulated for patients weighing 3, 16, 50, and 75 kg. Pressurized metered dose inhaler actuation coincided with inspiration. RESULTS: A pressurized metered dose inhaler combined with an in-line non-valved or valved spacer, or the direct method, when delivered via tracheal tube, was linked with improved delivered dose of salbutamol, compared to all other methods for 3 or 50 kg simulated patients weights. The delivered dose when using a non-valved spacer was greater than all methods for 16 and 75 kg patient weights. A spacer improved delivery for the flexible supraglottic airway device type, and there was no difference with or without a spacer for remaining types. CONCLUSION: Via tracheal tube and non-valved spacer, the following doses should be delivered after single actuation of a 100 µg labeled-claim salbutamol dose: ~2 µg kg-1 per actuation to a 3 kg neonate, ~1 µg kg-1 per actuation to a 16 kg child, and ~ 0.5 µg kg-1 per actuation for a 50-75 kg child. The least effective methods were the syringe, and the uni- and bidirectional adaptor methods, which require replacement by the direct method if a spacer is unavailable.

Application of electronic inhaler monitoring for adherence of inhalational drug administration in patients with chronic respiratory diseases / 中华全科医师杂志

The adherence of inhalational drug administration is closely related the treatment effectiveness for patients with chronic respiratory diseases; on the other hand, poor adherence may increase healthcare costs or even lead to the death of patients. Electronic inhaler monitoring, currently considered the gold standard for assessing adherence, can provide clinicians with objectively accurate medication data, thereby assisting in clinical decision-making. This article provides a review of the significance of inhalation administration, the newly concept of medication adherence, the challenges faced in chronic respiratory diseases, and the current status of the application and value of electronic inhaler monitoring in improving adherence of inhalational drug administration for respiratory disease patients.

Effects of acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation on quality of life in patients with stable chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the effects of acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation on quality of life in patients with stable chronic obstructive pulmonary disease (COPD).Methods:A total of 109 patients with stable COPD admitted to People's Hospital of Gaomi from March 2019 to May 2020 were included in this study. They were randomly divided into a control group ( n = 54) and an observation group ( n = 55). Both groups were given tiotropium bromide powder inhalation and acupoint application therapy ( Dazhui, Shenque, Feishu, Pishu, Shenshu and Zusanli). Chinese medicine ointment was applied in the observation group, but not in the control group. All patients were treated for 6 consecutive months. Before and after treatment, pulmonary function indicators [forced expiratory volume in the first second (FEV 1), the percentage of expiratory volume in the first second (FEV 1%), forced vital capacity (FVC), FEV 1/FVC], modified Medical Research Council (mMRC) dyspnea scale score, and the Saint George's Respiratory Questionnaire (SGRQ) score were compared between the two groups before and after treatment to evaluate therapeutic efficacy and quality of life. Results:Before and after treatment, there were no significant differences in FEV 1, FEV 1% and FEV 1/FVC between the two groups (all P > 0.05). After treatment, mMRC score and SGRQ total score in the observation group were (1.91 ± 0.27) points and (38.54 ± 8.18) points, respectively, which were significantly lower than (2.43 ± 0.33) points and (43.12 ± 7.86) points in the control group ( t = 4.93, 4.47, both P < 0.05). The number of exacerbations and the number of hospitalizations were (0.42 ± 0.09) times/6 months and (0.27 ± 0.05) times/6 months in the observation group and they were (0.69 ± 0.17) times/6 months and (0.47 ± 0.13) times/6 months in the control group. There were significant differences in these indices between the two groups ( t = 3.90, 3.85, P < 0.05). Conclusion:Acupoint application therapy with Chinese medicine combined with tiotropium bromide inhalation has a good therapeutic effect on stable COPD. The combined therapy can reduce the number of acute attacks and improve patient's quality of life. This study is scientific and innovative.

Pulmonary protective effect of nebulized inhalation of lidocaine on elderly patients undergoing hip fracture surgery / 中国医师杂志

Objective:To explore the lung protective effect of nebulized inhalation of lidocaine (NL) on elderly patients undergoing hip fracture surgery.Methods:A prospective study was conducted on 80 elderly patients who underwent hip fracture surgery at the Huizhou Sixth People′s Hospital from September 2020 to December 2021. They were randomly divided into an NL group and a control group with 40 patients in each group. Within 30 minutes before the start of anesthesia, the NL group was given 2% lidocaine 10 ml oxygen driven nebulization inhalation, while the control group was given equal volume sterile injection water nebulization inhalation. All patients underwent general anesthesia with laryngeal mask intubation and iliac fascia space block. A randomized, double-blind, and controlled clinical study was conducted. The average values of intraoperative peak airway pressure (P peak), plateau airway pressure (P plat), and lung dynamic compliance (C dyn) were compared between two groups of patients; We compared the changes in arterial partial pressure of CO 2 (PaCO 2), alveolar arterial oxygen differential pressure (A-aDO 2), respiratory index (RI), and oxygen index (OI) between the two groups of patients and before and after surgery; The clinical pulmonary infection score (CPIS) and lung ultrasound score (LUS) were also compared between two groups of patients on the first day before surgery, the second day after surgery, and the seventh day after surgery. Resultsl:There was no statistically significant difference in the average values of P peak, P plat, and C dyn between the two groups during surgery (all P>0.05). After surgery, A-aDO 2 and RI in both groups increased compared to before surgery, while OI decreased compared to before surgery (all P<0.05); After surgery, A-aDO 2 and RI in the NL group decreased compared to the control group, while OI increased compared to the control group (all P<0.05); There was no statistically significant difference in PaCO 2 between the two groups before and after skin incision (all P>0.05). Compared with the 1st day before surgery, the CPIS and LUS in both groups were significantly increased on the 2nd and 7th day after surgery (all P<0.05); Compared with the second day after surgery, the CPIS and LUS of both groups of patients were significantly reduced on the seventh day after surgery (all P<0.05); On the second day after surgery, the CPIS and LUS in the NL group were significantly lower than those in the control group (all P<0.05); On the 7th day after surgery, the LUS of the NL group was significantly lower than that of the control group ( P<0.05); There was no statistically significant difference in CPIS scores between the two groups ( P>0.05). Conclusions:Nebulized inhalation of lidocaine can reduce lung function damage in elderly patients undergoing hip fracture surgery, and has a certain lung protective effect.

Symptom scores of patients with chronic obstructive pulmonary disease and their response to different inhalation drug treatments / 中国医师杂志

Objective:To analyze the response of patients with chronic obstructive pulmonary disease (COPD) with multiple and few symptoms to different inhalation drugs, including acute exacerbation and symptom changes.Methods:This study was a multi center, retrospective Cohort study. The subjects of this study were patients with chronic obstructive pulmonary disease in stable stage in 12 hospitals in Hunan and Guangxi from December 2016 to February 2022. Demographics data, lung function, Chronic Obstructive Pulmonary Disease Assessment test questionnaire (CAT) score, modified British Medical Research Council dyspnea questionnaire (mMRC) score and inhalation drug scheme of patients were collected. According to the CAT and mMRC scores, patients were divided into a multi symptom group (CAT≥10 points or mMRC≥2 points) or a few symptom group (CAT<10 points and mMRC<1 point); Subsequently, they were divided into four subgroups based on the inhalation drug regimen: long-acting anticholinergic drugs (LAMA) group, long-acting β2-receptor agonists (LABA)+ inhaled corticosteroids (ICS) group, LABA+ LAMA group, and LABA+ LAMA+ ICS group. All patients were followed up for 1 year, with minimum clinical improvement (MCID) defined as a decrease of ≥2 points in the patient′s CAT score at 6 months, and clinical symptom deterioration (CSD) defined as an increase of ≥2 points in the patient′s CAT score at 6 months.Results:A total of 929 patients with chronic obstructive pulmonary disease were included, including 719(77.4%) with multiple symptoms and 210(22.6%) with few symptoms. There was no statistically significant difference in MCID, CSD, acute exacerbation, hospitalization frequency, and mortality rate among subgroups of asymptomatic COPD patients treated with different inhalation drug regimens (all P>0.05). Among patients with multiple symptoms of chronic obstructive pulmonary disease, compared to those who use LAMA or LABA+ ICS, those who used LABA+ LAMA or LABA+ LAMA+ ICS were more likely to obtain MCID and had a more significant improvement in CAT scores, and the risk of acute exacerbation is lower (all P<0.05). Conclusions:Lesser symptomatic COPD patients should receive single drug LAMA as the initial inhalation treatment drug, while multi symptomatic COPD patients should receive LABA+ LAMA as the initial inhalation treatment drug.

Efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children / 中国基层医药

Objective:To investigate the efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children.Methods:Seventy-two children with bronchopneumonia admitted to Huaiyuan Jingtu Hospital from July 2021 to June 2022 were retrospectively included in this study. These children were divided into BS and BSY groups according to different treatment methods. Based on conventional treatment, the BS group was given atomization treatment with budesonide and salbutamol, and the BSY group was given atomization treatment with budesonide, salbutamol, and acetylcysteine. After two courses of treatment, clinical efficacy, duration to improvements in symptoms and signs, adverse drug reactions, and changes in serum C-reactive protein and procalcitonin levels after treatment relative to those before treatment were compared between the two groups. The optimal medication plan was investigated.Results:The total response rate in the BSY group was 91.67% (33 cases/36 cases), which was significantly higher than 72.22% (26/36) in the BS group ( χ2 = 4.59, P = 0.032). The incidence of adverse drug reactions in the BSY group was 11.11% (4/36), which was significantly lower than 19.44% (7/36) in the BS group ( χ2 = 0.96, P = 0.326). After treatment, the levels of C-reactive protein and procalcitonin in the BSY group were (5.86 ± 5.66) mg/L and (2.59 ± 0.74) μg/L, respectively, which were lower than (15.64 ± 5.85) mg/L and (4.71 ± 0.93) μg/L in the BS group ( t = 7.20, 10.70, both P < 0.001). The durations to the disappearance of symptoms and signs including fever, cough, lung rales, and X-ray lung shadow in the BSY group were significantly shorter compared with the BS group ( t = 11.85, 4.19, 2.72, 2.39, all P < 0.05). Conclusion:Atomization with budesonide, salbutamol, and acetylcysteine in combination for the adjuvant treatment of bronchopneumonia in children can quickly relieve the clinical symptoms of children, improve the lung signs, reduce the degree of inflammation, and has a remarkable therapeutic effect on bronchopneumonia in children.

Effects of nebulization with high-dose budesonide combined with ipratropium bromide on airway remodeling and mucus secretion in patients with AECOPD / 中国基层医药

Objective:To investigate the effects of nebulization with high-dose budesonide (BUD) combined with ipratropium bromide (IB) on airway remodeling and mucus secretion in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).Methods:Ninety patients with AECOPD who received treatment in Wenling Hospital of Traditional Chinese Medicine between January 2020 and June 2021 were included in this study. They were assigned to the conventional-dose group ( n = 45, odd number) and high-dose group ( n = 45, even number) according to the number of admission. In the conventional-dose group, nebulization with IB (0.5 mg administered within 20 minutes, three times daily) and BUD (2 mg administered within 20 minutes, twice daily) was performed. In the high-dose group, nebulization with IB (0.5 mg administered within 20 minutes, three times daily) and BUD (4 mg administered within 20 minutes, twice daily) was performed. After nebulization, a mouthwash was required in each group. After 7 days of treatment, clinical efficacy was compared between the two groups. Before and 7 days after treatment, airway remodeling level (matrix metalloproteinase-9 and interleukin-8), airway mucus secretion (mucin-5ac and neutrophil elastase) and the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the high-dose group was significantly higher than that in the conventional-dose group [95.56% (43/45) vs. 82.22% (37/45), χ2 = 4.05, P < 0.05]. After 7 days of treatment, serum matrix metalloproteinase-9 and interleukin-8 levels in the high-dose group were (416.96 ± 30.96) μg/L and (6.33 ± 1.03) μg/L, respectively, which were significantly lower than those in the conventional-dose group [(452.25 ± 32.16) μg/L, (7.85 ± 1.24) μg/L, t = 5.30, 6.32, both P < 0.001)]. After 7 days of treatment, serum mucin-5ac and neutrophil elastase levels in the high-dose group were (1.33 ± 0.21) μg/L and (4.06 ± 1.03) μg/L, respectively, which were significantly lower than those in the conventional-dose group [(1.58 ± 0.23) μg/L, (5.11 ± 1.14) μg/L, t = 5.38, 4.58, both P < 0.001]. There was no significant difference in incidence of adverse reactions between high-dose and conventional-dose groups [8.89% (4/45) vs. 4.44% (2/45), χ2 = 0.71, P > 0.05). Conclusion:Nebulization with high-dose BUD combined with IB for treatment of AECOPD can improve airway remodeling, reduce airway mucus hypersecretion and has definite therapeutic effects. Findings from this study are of great innovation and science.

Status and compliance with the guideline of inhaled corticosteroids use in patients with chronic obstructive pulmonary disease / 中国医师杂志

Objective:To understand the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) in the real world and analyze its compliance with the guidelines.Methods:This study is a multicenter, cross-sectional study. 1 051 COPD patients who were treated in the Second Xiangya Hospital of Central South University, the First Affiliated Hospital of Shaoyang College and Zhuzhou Central Hospital from January 2020 to March 2022 were collected. The general information, drug use, types of exposure risk factors, acute exacerbation (AE) in the past year, the scores of the modified British Medical Research Council Dyspnea Questionnaire (mMRC), COPD Assessment Test (CAT), pulmonary function, blood routine of patients were collected. The status of ICS use in COPD patients, the clinical characteristics and guideline compliance of non-ICS users and ICS users were analyzed.Results:Among 1 051 patients with COPD, ICS was used in 490 cases (46.6%) and was not used in 561 cases (53.4%). ICS use was associated with relapse, frequent AE, severe AE, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grade 2 or above, GOLD D group, mMRC score, bronchial asthma, and blood eosinophils (EOS) (all P<0.05). Among 1 051 patients, 583(55.5%) were newly treated, 222(38.1%) were newly treated with ICS, and 361(61.9%) were not treated with ICS. ICS use in newly treated patients was associated with frequent AE, severe AE in the past year, GOLD grade 2 to 3, GOLD B and D group, mMRC score, bronchial asthma, and blood EOS (all P<0.05). Conclusions:Nearly half of patients with COPD are treated with ICS, and patients with ICS use had a higher risk of AE, more severe symptoms, higher blood EOS, and higher rates of asthma. However, there still exists the phenomenon of overuse of ICS.

Clinical characteristics and guideline compliance analysis of chronic obstructive pulmonary disease patients with initial triple therapy in real-life world / 中国医师杂志

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Research progress of triple therapy in chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a chronic airway disease, which is mainly characterized by persistent respiratory symptoms and irreversible airflow limitation, with high prevalence and high mortality. Exacerbations of COPD will lead to deterioration of lung function and disease progression, which is the focus of COPD management. Pharmacological therapy for COPD is used to improve symptoms, lung function and health status, prevent and treat exacerbation. Triple inhaled therapy for COPD includes long-acting muscarinic antagonist (LAMA), long-acting β 2-agonist (LABA) and inhaled corticosteroid (ICS). This article will review the research progress of triple inhaled therapy for COPD, and provide a reference for the clinical management of COPD.

Clinical study of Guben-Tiaoping Decoction in improving the success rate of inhaled corticosteroid stepwise treatment in asthma / 国际中医中药杂志

Objective:To evaluate the effect of combined use of Guben-Tiaoping Decoction on the success rate of stepwise treatment and life quality of asthma patients. Methods:A total of 76 patients with asthma in remission stage who were using ICS were divided into treatment group (38 cases) and control group(38 cases) according to random number table. Both groups were treated with ICS reduction based on the 2017 Gina Protocol. The treatment group was treated with Guben-Tiaoping Decoction for 12 weeks. The number of patients who were able to successfully complete the stepwise treatment after the end of the trial was calculated, the relevant indexes of Asthma Control Test (ACT), TCM Syndrome score, St. George’s respiratory questionnaire (SGRQ) and lung function were collected before and after treatment. Result:After 12 weeks’ treatment, the success rate of stepwise was 89.5% (34/38) in the treatment group and 78.9% (30/38) in the control group ( χ2=14.862, P=0.001). Meanwhile, the ACT score of the treatment group were better than those in the control group (Daytime symptoms t=-3.860, P=0.001, Dyspnea t=-2.007, P=0.40, Night waking t=-2.732, P=0.009, Reliever needed for symptoms t=-2.262, P=0.031, Control situation t=-6.994, P=0.001, Total Score t=-9.562, P=0.001). The score of TCM Syndrome in the treatment group was significantly lower than that of the control group ( P=0.001); PEF in treatment group [(6.92 ± 1.71) L vs. (5.84 ± 1.22) L; t=-2.880, P=0.005] was significantly better than that of the control group. Conclusion:Guben-Tiaoping Decoction is helpful to improve the success rate of ICS stepwise treatment and the life quality of patients.

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

PURPOSE: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. METHODS: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. RESULTS: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients. CONCLUSIONS: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

O uso do brinquedo terapêutico na administração por inalação em pré-escolares / Using therapeutic toy for administering by inhalation in pre-schools / El uso de juguete terapéutico para administración por inhalación en preescolares

Objetivo: comparar o comportamento de pré-escolares durante o uso de administração por inalação, antes e após sessão de Brinquedo Terapêutico. Método: estudo quase-experimental de abordagem quantitativa, com a técnica de observação antes e após a intervenção, realizado por meio de amostra intencional, recrutadas em uma Unidade de Pronto Atendimento no interior de Minas Gerais. Os dados foram analisados por estatística descritiva e inferencial, coletados entre os meses de novembro de 2017 a abril de 2018. Resultados: foram avaliados 25 comportamentos de 99 pré-escolares durante a administração por inalação. Após a sessão, 73,7% estavam com a postura e expressão facial relaxada, 76,8% estavam à vontade, 19,2% interromperam o procedimento e 38,4 % solicitaram a presença da mãe ou acompanhante. Conclusão: o uso do brinquedo, favoreceu maior aceitação e adaptação de pré-escolares submetidos à administração por inalação, evidenciado a importância em implementar essa estratégia em serviços de pronto atendimento pediátrico.

Objective: to compare the behavior of preschoolers during inhalation therapy, before and after a Therapeutic Play session. Method: quasi-experimental, quantitative study using pre- and post-intervention observation with an intentional sample recruited at an Emergency Care Unit in Minas Gerais. Data were collected from November 2017 to April 2018 and analyzed by descriptive and inferential statistics. Results: twenty-five behaviors of 99 preschoolers were evaluated during inhalation administration. After the session, 73.7% were relaxed in posture and facial expression, 76.8% were comfortable, 19.2% interrupted the procedure, and 38.4% requested the mother or companion to be present. Conclusion: the use of toys favored greater acceptance and adaptation by preschoolers undergoing inhalation therapy, evidencing the importance of implementing this strategy in pediatric emergency services.

Objetivo: comparar el comportamiento de los preescolares durante la terapia de inhalación, antes y después de una sesión de Juego Terapéutico. Método: estudio cuantitativo cuasi-experimental utilizando observación previa y posterior a la intervención con una muestra intencional reclutada en una Unidad de Atención de Emergencia en Minas Gerais. Los datos se recopilaron de noviembre de 2017 a abril de 2018 y se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: se evaluaron veinticinco comportamientos de 99 niños en edad preescolar durante la administración por inhalación. Después de la sesión, el 73.7% se relajó en la postura y la expresión facial, el 76.8% se sintió cómodo, el 19.2% interrumpió el procedimiento y el 38.4% solicitó que la madre o la acompañante estuvieran presentes. Conclusión: el uso de juguetes favoreció una mayor aceptación y adaptación por parte de los preescolares sometidos a terapia de inhalación, lo que evidencia la importancia de implementar esta estrategia en los servicios de emergencia pediátricos.

The percentage of inspired oxygen at different flow rates during nebulisation.

The aim of this study was to determine the mean value for the fraction of inspired oxygen (FiO2) in normal subjects at oxygen flow rates of 2L/min, 4L/min and 6L/min during mouthpiece nebulisation. The FiO2 was defined as the fractional extraction of oxygen at the mouth. The variation in the FiO2 during normal and deep breathing was also studied in order to assess whether a significant difference in the FiO2 occurred. Breathing at a normal tidal volume, the values of the FiO2 were 27.5 per cent, 30.8 per cent and 34.9 per cent respectively. The values during deep breathing were 24.4 per cent, 27.9 per cent and 31.3 per cent respectively. It was clearly evident that the FiO2 during deep breathing was approximately 3 per cent less than that during normal tidal breathing.

Efficacy and safety of the single-capsule combination of fluticasone/formoterol in patients with persistent asthma: a non-inferiority trial.

OBJECTIVE: Fluticasone and formoterol are effective in the treatment of asthma. When a corticosteroid alone fails to control asthma, combination therapy is the treatment of choice. The objective of this study was to compare the efficacy and safety of formulations containing budesonide/formoterol (BUD/FOR), fluticasone alone (FLU), and the single-capsule combination of fluticasone/formoterol (FLU/FOR) on lung function in patients with mild-to-moderate persistent asthma. METHODS: This was a randomized, multicenter, open phase III trial conducted in Brazil. The primary efficacy analysis was the assessment of non-inferiority between FLU/FOR and BUD/FOR combinations regarding FEV1 (in L) at the final visit. The secondary analyses were PEF, level of asthma control, serum cortisol levels, frequency of adverse events, adherence to treatment, and appropriate inhaler use. RESULTS: We randomized 243 patients to three groups: FLU/FOR (n = 79), BUD/FOR (n = 83), and FLU (n = 81). In terms of the mean FEV1 after 12 weeks of treatment, the difference between the FLU/FOR and BUD/FOR groups was 0.22 L (95% CI: -0.06 to 0.49), whereas the difference between the FLU/FOR and FLU groups was 0.26 L (95% CI: -0.002 to 0.52). Non-inferiority was demonstrated by the difference between the lower limits of the two 95% CIs (-0.06 vs. -0.002). The level of asthma control and PEF were significantly greater in the FLU/FOR and BUD/FOR groups than in the FLU group. There were no significant differences among the groups regarding patient adherence, patient inhaler use, or safety profile of the formulations. CONCLUSIONS: The single-capsule combination of FLU/FOR showed non-inferiority to the BUD/FOR and FLU formulations regarding efficacy and safety, making it a new treatment option for persistent asthma.

OBJETIVO: A fluticasona e o formoterol são efetivos no tratamento da asma. A terapia combinada é o tratamento de escolha quando o corticosteroide isolado não controla a asma. O objetivo deste estudo foi comparar a eficácia e segurança de formulações contendo budesonida/formoterol (BUD/FOR), fluticasona (FLU) e fluticasona/formoterol (FLU/FOR) em cápsula única sobre a função pulmonar em pacientes com asma persistente leve e moderada. MÉTODOS: Estudo de fase III multicêntrico brasileiro, aleatorizado e aberto. A análise primária de eficácia foi a avaliação de não inferioridade da combinação FLU/FOR perante a combinação BUD/FOR em relação ao VEF1 (em L) na visita final. As análises secundárias foram PFE, nível de controle da asma, nível de cortisol sérico, frequência de eventos adversos, aderência ao tratamento e uso adequado do inalador. RESULTADOS: Foram randomizados 243 pacientes nos grupos FLU/FOR (n = 79), BUD/FOR (n = 83) e FLU (n = 81). Após 12 semanas de tratamento, a média da diferença do VEF1 foi de 0,22 L (IC95%: −0,06 a 0,49) entre os grupos FLU/FOR e BUD/FOR e de 0,26 L (IC95%: −0,002 a 0,52) entre os grupos FLU/FOR e FLU. A não inferioridade ficou demonstrada pela diferença de limite inferior do IC95% (−0,06 vs. −0,002). O nível de controle da asma e o PFE foram significativamente maiores nos grupos FLU/FOR e BUD/FOR em comparação com o grupo FLU. Não houve diferenças significativas em relação a adesão, uso do inalador e perfil de segurança entre os grupos. CONCLUSÕES: A combinação FLU/FOR em cápsula única apresentou eficácia e segurança não inferior às formulações BUD/FOR e FLU e representa uma nova opção de tratamento para asma persistente.

Ventilator-integrated jet nebulization systems: tidal volume control and efficiency of synchronization.

BACKGROUND: Jet nebulizers constitute the aerosolization devices most frequently used during mechanical ventilation. Continuous nebulization can influence the delivered tidal volume (V(T)) and lead to significant medication loss during expiration. Ventilators thus provide integrated jet nebulization systems that are synchronized during inspiration and ostensibly keep VT constant. METHODS: This was a bench study of systems integrated in the Evita XL, Avea, Galileo, and G5 ventilators. The VT delivered with and without nebulization, the inspiratory synchronization of nebulization, and the aerosol deposition were measured with 2 locations of the nebulizer. RESULTS: Changes in V(T) with the nebulizer were below 20 mL and below 10% of set V(T) for all ventilators. Synchronization was good at the beginning of insufflation, but prolonged nebulization was observed with all ventilators at the end of insufflation, until up to 1 s during expiration: 5-80% of nebulization occurred during expiration with significant aerosol loss in the expiratory limb. Synchrony could be improved by (1) reducing gas compression/decompression phenomena proximal to the jet nebulizer and (2) increasing inspiratory time, which reduced the amount of nebulization occurring during expiration. Placing the nebulizer upstream in the inspiratory limb did not affect inspiratory synchrony but allowed reduction of the amount of aerosol lost in the expiratory limb. CONCLUSIONS: Jet nebulizer systems integrated in the tested ventilators are reliable in terms of V(T) control. Gas compression in tubing driving gas to the nebulizer delays synchronization and reduces nebulization yield if the nebulizer is placed close to the Y-piece. Increasing inspiratory time with no end-inspiratory pause reduces the expiratory loss of medication if placement of the nebulizer upstream in the inspiratory limb is not feasible.

Therapeutic effect of salmeterol-fluticasone aerosol on mild to moderate chronic obstructive pulmonary disease / 中国基层医药

Objective@#To analyze the clinical efficacy of salmeterol-fluticasone aerosol in the treatment of mild to moderate chronic obstructive pulmonary disease (COPD).@*Methods@#From February 2017 to February 2018, 68 patients with mild to moderate COPD treated in the General Hospital of Shanxi Tongmei Group were selected in the study.The patients were divided into control group (34 cases) and observation group (34 cases) by random number table method.The control group was treated with salbutamol aerosol inhalation, while the observation group was treated with salmeterol and fluticasone aerosol inhalation.Both two groups were treated for 12 weeks.The clinical efficacy, improvement of pulmonary function, 6-minute walking distance, oxygen saturation and heart rate were compared between the two groups.@*Results@#The total effective rate of the observation group was 97.06% (33/34), which was significantly higher than that of the control group [73.53%(25/34)] (χ2=7.503, P<0.05). Before treatment, FEV1%, FEV1/FVC (percentage of forced expiratory volume in 1 second forced vital capacity), FEV1 (1 second hard breathing volume), blood oxygen saturation, heart rate and 6 min walking distance had no statistically significant differences between the two groups (all P>0.05). After treatment, the FEV1, FEV1/FVC, FEV1% in the observation group were (65.48±4.06)%, (74.66±8.12)%, (1.99±0.55) L, respectively, which were significantly higher than those in the control group [(63.55±6.14)%, (70.85±7.56)%, (1.71±0.52)L] (t=2.321, 2.002, 2.157, all P<0.05). The oxygen saturation, heart rate and 6-minute walking distance in the observation group were (92.27±1.83)%, (80.55±4.08)times/min and (263.35±28.73)m, respectively, which in the control group were (88.52±2.06)%, (91.43±5.16)times/min and (231.95±22.69)m, respectively, and there were statistically significant differences between the two groups (t=7.936, 9.644, 5.001, all P<0.05).@*Conclusion@#Salmeterol and fluticasone aerosol inhalation has good clinical efficacy in the treatment of mild to moderate COPD, and can significantly improve the lung function of patients.

Analysis of the effect of oxygen driven aerosol inhalation in the treatment of acute exacerbation of bronchial asthma / 中国基层医药

Objective To analyze the effect of oxygen driven aerosol inhalation in the treatment of acute exacerbation of bronchial asthma .Methods 96 patients with acute exacerbation of bronchial asthmawere selected as the subjects .They were divided into observation group and control group by the random number table ,48 cases in each group.All patients were treated with salbutamol and budesonide inhalation therapy ,the control group was treated with ultrasonic atomization inhalation ,the observation group was treated with oxygen driven aerosol inhalation .The changes of blood oxygen saturation ( SpO2 ) ,maximum expiratory peak flow ( PEF) ,forced expiratory volume in the first second ( FEV1 ) and respiratory index ( RI) were observed before and after treatment in the two groups .The time of disappear-ance of major clinical symptoms was compared ,and the clinical treatment effect was analyzed .Results After treat-ment,the total effective rate of the observation group was 91.67％,which of the control group was 72.92％,the differ-ence between the two groups was statistically significant (χ2 =7.19,P<0.05).Compared with the control group ,the fever,cough,asthma,wheezing,shortness of breath,pulmonary rales and main clinical symptoms disappear time of the observation group were significantly shortened [observation group:(3.05 ±1.23)d,(4.43 ±1.16)d,(3.12 ± 1.11)d,(4.26 ±1.37)d,(4.98 ±1.75)d,(3.51 ±1.37)d;control group:(4.14 ±1.03)d,(7.75 ±1.98)d, (5.75 ±1.86)d,(6.53 ±1.46)d,(8.42 ±1.55)d,(6.53 ±1.46)d,t=4.71,10.02,8.41,7.86,10.20,10.45, all P<0.01].After treatment,the SpO2,PEF and FEV1 of the two groups were significantly increased [observation group:( 98.70 ±1.44 )％, ( 126.33 ±9.87 ) mL/min, ( 2.06 ±0.52 ) L;control group:( 83.15 ±1.39 )％,(108.32 ±7.26)mL/min,(1.42 ±0.38)L],while RI decreased significantly[observation group:(0.17 ±0.08), control group:(0.27 ±0.06),the differences were significant (to =36.18,16.77,12.04,10.69,tc =11.03,8.15, 5.34,2.69,all P<0.01),and the improvement of SpO2,PEF,FEV1 and RI of the observation group were significantly better than those of the control group (t=53.8310.18,6.88,6.74,all P<0.01).Conclusion In the treatment of acute exacerbation of bronchial asthma ,the clinical efficacy of oxygen driven aerosol inhalation is significant .The way can better alleviate patients'major clinical symptoms,such as fever,cough,improve lung ventilation function,and is worthy of further clinical application .

Avaliação de vídeos sobre a técnica inalatória na asma infantil: educativos ou midiáticos? / Assessment of videos about the inhalation technique for childhood asthma: educational or mediatic?

Vídeos relacionados à técnica inalatória na asma são populares no YouTube, mas sua qualidade é questão de preocupação. Neste estudo objetivou-se avaliar vídeos que demonstram a técnica inalatória do inalador pressurizado acoplado ao espaçador, para crianças e adolescentes com asma, quanto a conformidade das diretrizes da Global Initiative for Asthma. Estudo exploratório, realizado em 11 de julho de 2017 usando os termos inalador pressurizado e aerossol dosimetrado. Os vídeos foram avaliados por três enfermeiras, independentes e experientes na área, quanto aos critérios de conteúdo, produção e usuários. Dentre os 492 vídeos encontrados, seis preencheram os critérios de elegibilidade. Ponto de destaque foi a demonstração incorreta da técnica inalatória em todos os vídeos e a pontuação inadequada na avaliação técnica e de conteúdo. As descobertas deste estudo mostram que os vídeos não são confiáveis e nem compatíveis com as diretrizes de asma e, portanto, não podem ser recomendados para fins educacionais.

Videos related to asthma inhaling technique are popular on YouTube, but their quality is concerning. In this study, we aimed to assess videos demonstrating the inhaling technique of the pressurized metered dose inhaler, attached to the spacer, for children and adolescents with asthma, according to the guidelines of the Global Initiative for Asthma. We conducted an exploratory study, on 11 July 2017 using the terms "inalador pressurizado" and "aerossol dosimetrado". Three independent nurses experienced in the field assessed the videos regarding content inclusion, production, and users. Within the 492 videos found, six met the eligibility criteria. The highlight point was the incorrect demonstration of the inhalation technique in all videos and the inadequate scoring for technique and content assessments. Our study findings show that videos are not reliable neither compatible with asthma guidelines and, therefore, they should not be recommended for educational purposes.