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Research with Human Subjects:
Published in Lynne M. Bianchi, Research during Medical Residency, 2022
Lynne M. Bianchi, Joyce Babyak, Robert Maholic
Examples: (a) hair and nail clippings in a non-disfiguring manner; (b) deciduous teeth at time of exfoliation or if routine patient care indicates a need for extraction; (c) permanent teeth if routine patient care indicates a need for extraction; (d) excreta and external secretions (including sweat); (e) un-cannulated saliva collected either in an unstimulated fashion or stimulated by chewing gumbase or wax or by applying a dilute citric solution to the tongue; (f) placenta removed at delivery; (g) amniotic fluid obtained at the time of rupture of the membrane prior to or during labor; (h) supra- and subgingival dental plaque and calculus, provided the collection procedure is not more invasive than routine prophylactic scaling of the teeth and the process is accomplished in accordance with accepted prophylactic techniques; (i) mucosal and skin cells collected by buccal scraping or swab, skin swab, or mouth washings; (j) sputum collected after saline mist nebulization.
Medicines management
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Kirsty Andrews, Martina O’Brien
The most commonly used is the pressurised metered-dose inhaler (pMDI), which contains liquid medication under pressure. This is released in the form of a mist when the inhaler is used. Other examples you might have remembered include the diskhaler and the rotohaler. With a diskhaler, the inhaled particles are contained within a disc, and with a rotohaler, the particles are enclosed in a capsule. The disc or capsule is then inserted into the inhaler to deliver a metered amount and activated by inspiration. Individual preference regarding device is crucial, so a good assessment is very important. Autohalers and the Easi-breathe are alternative types, which are both breath-activated, removing the need for good coordination, but the range of drugs is restricted in these devices. Another device you have probably seen is a spacer (see Figure 10.8).
Inhalation Toxicity of Metal Particles and Vapors
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Long-term inhalation of Cr(III) compounds reveal no adverse health effects, but long-term inhalation exposure to insoluble Cr(VI) compounds is associated with lesions of the mucosa and submucosa of the respiratory tract and other toxic effects. Workers exposed to chromates and chromic acid mist may develop contact dermatitis, skin ulcers, nasal membrane inflammation and ulceration, nasal septum perforation, rhinitis, liver damage, and pulmonary congestion and edema. Chronic rhinitis, laryngitis, and pharyngitis are also common (Stokinger, 1981). Progressive pulmonary fibrosis in a small number of workers was reported in 1962, but no subsequent reports have appeared (Stokinger, 1981). Pneumoconiosis has also been reported. Bronchial asthma is common among chromate workers.
High inhaler resistance does not limit successful inspiratory maneuver among patients with asthma or COPD
Published in Expert Opinion on Drug Delivery, 2023
Ville A Vartiainen, Federico Lavorini, Anna C Murphy, Klaus F Rabe
The current inhaler types on the market have vastly different operating methods and inhalation technique. Correct use of inhaler devices is of paramount importance for successful therapy and ease of use has been associated with better treatment adherence [1,2]. Dry powder inhalers (DPIs) are passive devices which rely on patients’ inspiratory effort for drug dispersion and delivery. Propellant containing pMDIs use pressurized gas for dispersion but require coordination between inhaler actuation and inhalation. Soft mist inhalers (SMIs) disperse the formulation mechanically. Generally, pMDIs and SMIs require slow and deep inhalation against low device resistance while DPIs require fast and deep inhalation against higher resistance. Due to the propellant released into the atmosphere, pMDIs may have a significantly greater carbon footprint than the other devices [3].
Switching COPD patients from the disposable to the new reusable Respimat soft mist inhaler: a real-world study from Switzerland
Published in Current Medical Research and Opinion, 2021
Anne Tschacher, Cordula Cadus, Sebastian Schildge, Jens Peter Diedrich, Prashant N. Chhajed, Anne B. Leuppi-Taegtmeyer, Jörg Daniel Leuppi
The present survey assessed first experience of patients switching from the disposable to the reusable Respimat in Swiss clinical practice. Most of the patients were satisfied or very satisfied with the new reusable Respimat in comparison to the disposable device regarding inhaler preparation and handling resulting in a great overall satisfaction with the updated device version. In clinical studies, it was consistently shown that the disposable Respimat soft mist inhaler is well accepted by COPD patients2,6,22,23. This is mainly due to its user-friendly handling and comfortable inhalation, but despite all that, patients’ and physicians’ feedback indicated a preference for a reusable inhaler that is even easier to use6. Therefore, all approved features of the disposable Respimat have been retained in the updated version and have been supplemented with new features such as an improved dose counter or the ability for cartridge change to fulfil patients’ and physicians’ desires/wishes. Some studies recently demonstrated that patient satisfaction and acceptance of the new reusable Respimat is very good6,21. The present survey supports those findings since a great overall satisfaction concerning the updated Respimat device in Swiss COPD patients was observed.
Management of COPD patients during COVID: difficulties and experiences
Published in Expert Review of Respiratory Medicine, 2021
Mario Cazzola, Josuel Ora, Andrea Bianco, Paola Rogliani, Maria Gabriella Matera
Although inhaled bronchodilators and if indicated their combination with an ICS are critical to the optimal management of patients with COPD at all phases of the disease [38], there is hesitation on the part of patients to take inhaled drugs which are thought to be a possible source of viral transmission and immunosuppression [49]. The American Thoracic Society has advised patients to continue taking nebulizer medications when prescribed if they are already routinely using a nebulizer [50]. However, using a nebulizer by a patient with COVID-19 or other respiratory infection poses a real risk of infecting others through the expiring mist. For this reason, in symptomatic patients with COPD and COVID-19 it is preferable to administer bronchodilators and ICSs using pMDI and spacer rather than nebulizers [26]. Nebulizers can be used when it is impossible or difficult to utilize a pMDI with a spacer, such as in patients with severe and life-threatening disease or in those who are unable to properly use a pMDI [26]. However, it is essential that all patients always follow some practical advice before, during, and after nebulization regardless of being affected by COVID-19 [51].