Nebulized perflubron and carbon dioxide rapidly dilate constricted airways in an ovine model of allergic asthma.

BACKGROUND: The low toxicity of perfluorocarbons (PFCs), their high affinity for respiratory gases and their compatibility with lung surfactant have made them useful candidates for treating respiratory diseases such as adult respiratory distress syndrome. We report results for treating acute allergic and non-allergic bronchoconstriction in sheep using S-1226 (a gas mixture containing carbon dioxide and small volumes of nebulized perflubron). The carbon dioxide, which is highly soluble in perflubron, was used to relax airway smooth muscle. METHODS: Sheep previously sensitized to house dust mite (HDM) were challenged with HDM aerosols to induce early asthmatic responses. At the maximal responses (characterised by an increase in lung resistance), the sheep were either not treated or treated with one of the following; nebulized S-1226 (perflubron + 12% CO2), nebulized perflubron + medical air, 12% CO2, salbutamol or medical air. Lung resistance was monitored for up to 20 minutes after cessation of treatment. RESULTS: Treatment with S-1226 for 2 minutes following HDM challenge resulted in a more rapid, more profound and more prolonged decline in lung resistance compared with the other treatment interventions. Video bronchoscopy showed an immediate and complete (within 5 seconds) re-opening of MCh-constricted airways following treatment with S-1226. CONCLUSIONS: S-1226 is a potent and rapid formulation for re-opening constricted airways. Its mechanism(s) of action are unknown. The formulation has potential as a rescue treatment for acute severe asthma.

A phase IIa proof-of-concept, placebo-controlled, randomized, double-blind, crossover, single-dose clinical trial of a new class of bronchodilator for acute asthma.

BACKGROUND: This study evaluates a novel bronchodilator, S1226, for its efficacy in reversing allergen-induced bronchoconstriction in subjects with mild, allergic asthma. S1226 is a new class of bronchodilator that is an aerosol/vapor/gas mixture combining pharmacological and biophysical principles for a novel mode of action. It contains a potent bronchodilator gas (carbon dioxide or CO2) and nebulized perflubron (a synthetic surfactant possessing mucolytic properties). It has demonstrated rapid reversal of allergen-induced bronchoconstriction in an ovine study model. METHODS: This was a phase IIa proof-of-concept, placebo-controlled, randomized, double-blind, crossover single-dose clinical trial to evaluate the safety, tolerability, and efficacy of S1226 (8% CO2) administered by nebulization following an allergen-induced early asthmatic response in 12 subjects with mild, allergic asthma. Primary safety endpoints were adverse events, vital signs, pulse oximetry, and spirometry. Efficacy endpoints included bronchodilator response (measured as the forced expiratory volume in 1 s or FEV1) over time, the area under the curve of FEV1 for the early asthmatic response over time, and achievement of responder status, defined as a 12% improvement after the allergen challenge. RESULTS: No significant safety issues were observed. All adverse events were non-serious, mild, and transient. There was a statistically significant decrease in peripheral blood oxygenation levels over time in the placebo group following allergen inhalation, whereas blood oxygenation was maintained at normal levels in the S1226-treated subjects (P = 0.028). This effect was greatest 5 min after start of treatment (P < 0.001). The recovery rate was faster but not significantly so (P = 0.272) for S1226 compared to the placebo at earlier time points (5, 10, and 15 min), as assessed by ≥12% reversal of FEV1. The recovery of FEV1 over time was significantly greater (P = 0.04) with S1226 compared to the placebo. CONCLUSIONS: S1226 was safe, tolerated well, and provided bronchodilation and improved blood oxygenation in subjects with mild atopic asthma following allergen-induced bronchoconstriction. Additional studies to optimize the therapeutic response are indicated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02334553 . Registered on 12 November 2014.

A phase I, placebo-controlled, randomized, double-blind, single ascending dose-ranging study to evaluate the safety and tolerability of a novel biophysical bronchodilator (S-1226) administered by nebulization in healthy volunteers.

BACKGROUND: A major challenge in treating acute asthma exacerbations is the need to open constricted airways rapidly enough to reestablish ventilation and allow delivery of conventional medication to diseased airways. The solution requires a new approach that considers both biophysical and pharmacological aspects of treatments used in acute asthma. The result of testing several formulations was S-1226: carbon dioxide-enriched air delivered in nebulized perflubron, a synthetic surfactant. These agents act synergistically to rapidly reopen closed airways within seconds. The bronchodilator effect is independent of ß-adrenergic and cholinergic mediated-signaling pathways, offering a unique mechanism of action. S-1226 has a low toxicity profile and was effective in treating bronchoconstriction in animal models of asthma. The goal of the present study was to evaluate the safety and tolerability of S-1226 in healthy human subjects. METHODS: The phase I study was a single-center, randomized, double-blind, placebo-controlled, sequential, single-ascending-dose study conducted in Canada. Thirty-six subjects were distributed into three cohorts. Within each cohort, subjects were randomized to receive a single dose of S-1226 or a matching placebo administered over a 2-minute nebulization period. S-1226 was formulated with perflubron and 4 %, 8 %, or 12 % CO2. The dose of CO2 was sequentially escalated by cohort. The safety and tolerability of S-1226 were evaluated through assessment of adverse events, vital signs, 12-lead electrocardiograms, clinical laboratory parameters, and physical examinations. RESULTS: S-1226 was safe and well tolerated at all three CO2 levels (4 %, 8 %, and 12 %). A total of 28 adverse events were reported, and all were judged mild in severity. Twenty-four adverse events occurred in the S-1226 cohort, of which five were considered remotely related and six possibly related to S-1226. CONCLUSIONS: S-1226 is a novel drug being developed for the treatment of acute asthma exacerbations. It consists of CO2-enriched air and perflubron and has potential to offer rapid and potent bronchodilation. The results of the study indicate that S-1226 is safe and well tolerated. All adverse events were mild, reversible, and likely due to known side effects of CO2 inhalation. TRIAL REGISTRATION: ClinicalTrials.gov NCT02616770 . Registered on 25 November 2015.

Standardization issues: in vitro assessment of nebulizer performance.

The delivery of nebulized drugs is poorly controlled and the choice of the most appropriate delivery device is poorly understood, particularly because of off-license prescriptions and a lack of evidence-based medicine. Standardized in vitro methods for measuring nebulizer performance have been adopted in Europe, by the 2001 publication of a European Standard, prEN13544-1. These standardized methods were subsequently incorporated within the European Respiratory Society nebulizer guidelines, which will provide clinicians with useful information to improve nebulizer therapies. Standards for measuring nebulizer performance should be considered in North America and elsewhere. Careful consideration should be given to either adopting the methods embodied in the European Standard or developing the basis for developing that standard further through the International Standards Organization. Either way, confusion among clinicians would be reduced and nebulizer safety and aerosol delivery efficiency increased by standardizing in vitro methods of nebulizer performance assessment.

The accuracy of self-reported high noise exposure level and hearing loss in a working population in Eastern Saudi Arabia.

OBJECTIVE: To determine the accuracy of questions in identifying subjects occupationally exposed to high noise level and those with hearing loss using noise dosimeter and pure-tone air conduction audiometry as the gold standards. DESIGN: A cross-sectional study involving 259 noise-exposed workers selected randomly from two factories in Eastern Saudi Arabia. Personal noise exposure was determined using a noise dosimeter. The hearing impairment for each subject was assessed using otoscopic examination and audiometry. Each subject completed a comprehensive questionnaire including questions about noise exposure and hearing loss. RESULTS: Eighty five percent of the total workers reported exposure to high noise level, compared to 76% found to be exposed to a high noise level defined as more than 85 dB (A) as determined by noise dosimeter. The prevalence of audiometric hearing loss (threshold average of 25 dB HL or more in any ear) was 32.4% for the low frequency average (0.5, 1 and 2 kHz), 47.9% for the all frequency average (0.5, 1, 2. 4 and 8 kHz) and 65.6% for the high frequency average (4 and 8 kHz). However, the percentage of the subjects who reported hearing loss ranged between 3.9% and 85.3% depending on the question used as indicator of hearing loss. The question "Do you consider the noise level where you are working now high?" was the most sensitive in correctly identifying subjects exposed to a noise level of more than 85 dB (A) (sensitivity = 93.4%) and subjects with hearing loss (sensitivity > 86%) compared with other questions evaluated. However, it overestimated the prevalence rate determined by audiometry. CONCLUSION: We conclude that in industries where facilities for an objective assessment of noise exposure and hearing loss are not available, questions addressing noise exposure and hearing loss might be a useful alternative means for screening subjects exposed to high noise level and those with hearing loss for the purpose of designing and implementing hearing conservation program.

Control of exposure to hexavalent chromium and ozone in gas metal arc welding of stainless steels by use of a secondary shield gas.

Previous work has demonstrated that the shield gas composition in gas metal arc welding can have a considerable effect on hexavalent chromium [Cr(VI)] concentration in the fume and on ozone concentrations near the arc. Normally a single shield gas is used. This paper describes a double shroud torch that allows used of concentric shield gases of different compositions. A solid stainless steel wire was used for welding. The double shroud torch used secondary shield gases containing small amounts of the reducing agents NO and C2H4. The Cr(VI) concentration in the fume and ozone concentration at a fixed point relative to the arc were measured and compared with results when using a single shield gas. Use of the reducing agents in secondary shielding using the double shroud torch was found to offer advantages for ozone concentration reduction compared with use in a conventional torch, but this was not found to be an advantage for reducing Cr(VI) concentrations.

Control of occupational exposure to hexavalent chromium and ozone in tubular wire arc-welding processes by replacement of potassium by lithium or by addition of zinc.

Hexavalent chromium [Cr(VI)] and ozone are produced in many arc-welding processes. Cr(VI) is formed when welding with chromium-containing alloys and is a suspected carcinogen. Ozone is formed by the action of ultraviolet light from the arc on oxygen and can cause severe irritation to the eyes and mucous membranes. Previous work has demonstrated that reduction of sodium and potassium in manual metal arc-welding electrodes leads to substantial reductions in Cr(VI) concentrations in the fume as well as a reduction in the fume formation rate. In this paper replacement of potassium by lithium in a tubular wire welding electrode (self-shielding flux-cored) is shown to give reductions in Cr(VI) concentrations and fume formation rates. Previous work has also demonstrated that use of a tubular wire (metal cored) containing 1% zinc can, under certain conditions, result in a reduction in Cr(VI) formation rate and in ozone concentration near the arc but with a rise in the total fume formation rate. The effects of different shield gases and different levels of zinc are examined. An experimental chromium-containing tubular wire with 1% zinc was used with the following shield gases: argon, Argoshield 5, Argoshield 20, Helishield 101, Ar + 2% CO2, Ar + 5% CO2, Ar + 1% O2 and Ar + 2% O2. The wire gave > 98% reduction in Cr(VI) formation rate compared to the control wire provided the shield gas contained no oxygen. When the shield gas did contain oxygen, 1% zinc enhanced Cr(VI) formation rate, resulting in more than double the rates measured when welding with the control wire. Experiments with zinc concentrations, from 0.018 to 0.9% using Helishield 101, gave results indicating that there is an optimum zinc concentration from the point of view of Cr(VI) reduction. Implications of the use of lithium or zinc on the overall exposure risk are discussed.