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Nebulizers
Published in Anthony J. Hickey, Sandro R.P. da Rocha, Pharmaceutical Inhalation Aerosol Technology, 2019
John N. Pritchard, Dirk von Hollen, Ross H.M. Hatley
Nebulizers represent the original medical means of delivering liquid aerosolized medication to the lungs, but were supplanted by pMDI and DPI inhalers in the mid to late twentieth century. There has been a recent resurgence in nebulized therapy due to the arrival of mesh nebulizers that offer patient convenience akin to that of inhalers along with the ability to deliver larger doses of drug, and the ability of patients to use nebulizers successfully without the need to perform the specific breathing maneuvers that are required for the correct use of inhalers. These advantages coupled with both the popularity of the nebulizer in the Far East and the opportunities for incorporation of advanced nebulizer features such as adherence and physiological parameter monitoring as well as improvements in the speed of nebulization imply an increasing role for nebulized therapy in inhaled medication delivery in the future.
Overview of the delivery technologies for inhalation aerosols
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Daniel F. Moraga-Espinoza, Ashlee D. Brunaugh, Silvia Ferrati, Lara A. Heersema, Matthew J. Herpin, Patricia P. Martins, Hairui Zhang, Hugh D.C. Smyth
The design of this type of nebulizer allows devices to sense the respiratory pattern of patients and deliver aerosol only during the inhalation process. For example, AeroEclipse II® has a breath-actuated valve that can move up and down to trigger the delivery of drug aerosol. When patients exhale, the valve is closed, resulting in no generation or delivery of drug aerosol, which significantly decreases the loss of drug to the environment. In addition, both the breath-enhanced and breath-actuated nebulizers enhance efficiency of delivery of aerosol and reduce nebulization time compared with other jet nebulizers (97).
Recognition and Management of the Difficult Airway
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Valerie Cunningham, Alistair McNarry
Topical anaesthesia with lignocaine may be provided by: nebulizationtranslaryngeal administrationspecific nerve blockstransendoscopic administration. Nebulization sounds attractive but use of the technology that provides particles for alveolar deposition of drug (e.g. salbutamol nebulizer) may lead to disappointing results, partly because the particles are too small but also because a large amount of the drug escapes to the atmosphere. High drug concentrations may be effective and nebulized lignocaine 10% in a dose of 6 mg /kg has been described as effective.
Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis
Published in Journal of Asthma, 2022
Wytse B. van den Bosch,, Sanne F. Kloosterman,, Eleni-Rosalina Andrinopoulou,, Rients Greidanus,, Mariëlle W. H. Pijnenburg,, Harm A. W. M. Tiddens,, Hettie M. Janssens,
Patients started with nebulization of budesonide 1 mg twice daily or fluticasone propionate 2 mg twice daily depending on physician’s choice and availability of the drug formulation. Before nebulization of the selected ICS, patients nebulized salbutamol 2.5 mg and/or ipratropium bromide 0.5 mg. The emitted dose is approximately 40% of the nominal or loading dose. Of the emitted dose, 60% is deposited in the lung and 40% extrathoracic (19). At initiation of treatment all maintenance asthma medication was continued. ICS administered with pMDI or DPI were tapered down or stopped when sufficient asthma control was achieved, according to the patient and treating physician. ICS dose administered with the Akita® was decreased once ICS administered through pMDI or DPI was stopped. Nominal daily average pMDI or DPI ICS dose for every patient was calculated and converted to budesonide pMDI/DPI equivalent dose (250 μg fluticasone propionate = 400 μg budesonide, 500 μg beclomethasone standard particle size = 400 μg budesonide, 200 μg beclomethasone extra‐fine = 400 μg budesonide and 160 μg ciclesonide= 400 μg budesonide) (27).
Aerosol inhalation of Mycobacterium vaccae ameliorates airway structural remodeling in chronic asthma mouse model
Published in Experimental Lung Research, 2022
Qian-Nan Zhang, Huan Xiao, Li-Ting Fang, Qi-Xiang Sun, Lao-Dong Li, Si-Yue Xu, Chao-Qian Li
Respiratory drug delivery of pharmaceutical aerosols is commonplace in the treatment of a variety of pulmonary diseases, local delivery of drug to the lungs reduces required doses and side effects as compared to other routes of delivery.33 Furthermore, this nebulization treatment is simple and easy to administer with few side effects, any associated discomfort can be treated immediately, and patients can administer the treatment at home. Therefore, in our research, we treated asthmatic mice with M. vaccae nebulization. We found that M. vaccae can improve airway remodeling, and the specific mechanism may be via Wnt/β-catenin signaling pathway plays a role. However, questions remain about whether there are dose dependent effects and time-dependent effects of M. vaccae or not, and further studies are needed to confirm the dosage and duration of treatment.
Interferon-α2b induced anemia in severe coronavirus disease 2019 patients: a single centered, retrospective study
Published in Immunopharmacology and Immunotoxicology, 2021
Xina Li, Tong Liu, Xin Hai, Le Li
The mechanisms of IFN inducing different types of cytokine signaling and transcription factor expression will help to clarify the effects on Hb reduction. Due to direct drug medullary toxicity or autoimmunity induction, IFN-α2b may contribute to hemolytic anemia [37–39]. Meanwhile, IFN could suppress progenitor cell proliferation and increase the destruction of erythroid precursor cells [40]. Previous studies have shown that IFN-γ enhances the expressions of SOCS1 and SOCS3 in hematopoietic progenitor cells which induces the dysfunction of TPO or G-CSF-related response and restrains the proliferation and differentiation of the progenitors [41,42]. In addition, IFN-γ may negatively decrease hematopoietic lineages through inhibiting SOCS or STAT (STAT1, STST3, and STAT5) activation, the erythropoiesis is suppressed [43,44]. Furthermore, IFN-γ may affect PU.1 and IRF family expressions which drive the impairment of eosinophil differentiation and eosinophil progenitors [45,46]. Other possible mechanisms include the increased apoptosis in erythroid cells lines and the reduced renal function [47–50]. Besides, IFN-α2b may blunt or attenuate the bone marrow reticulocyte response to ribavirin-induced hemolysis, which exacerbates the severity of anemia. Subcutaneous injection of interferon-α has been widely used for the treatment of Middle East respiratory syndrome and SARS, and Hb reduction has not been reported [51–54]. Taken together, nebulization may induce rapid action and mild systemic adverse reactions. The mechanism of Hb reduction induced by nebulized IFN-α2b in severe COVID-19 patients still needs to be further studied.