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Evaluation of the asthmas
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
The mean differences (SD) in the SGRQ from studies including severe asthma patients have been found to be −6.3 (1.18) for the total domain, −11.4 (1.77) for symptoms, −3.5 (1.59) for activities and −6.57 (1.21) for impact. Most of these values are above the standard MID value of −4 units. calculated in patients with chronic airflow limitation, regardless of assessment methods.
Fluid Bed Processing
Published in Dilip M. Parikh, Handbook of Pharmaceutical Granulation Technology, 2021
Standard air velocities are based on the application. Airflow velocities are normally 1.0–2.0 m/sec. For agglomeration, the air velocity required is normally five to six times the minimum fluidization velocity. Low air velocities, such as 0.8–1.4 m/sec are required for drying. The higher velocity is required during the early stages of drying because of the wet mass present in the bowl but is normally reduced when the product loses its moisture. The objective is to have good particle movement but to keep the material out of filters. Particle movement and quick-drying are important during the agglomeration process. An indication of good fluidization is a free downward flow of the granulation at the sight glass of the product container. However, improper fluidization can also be detected by monitoring the outlet air temperature. Every product has a unique constant rate of drying in which the bed temperature remains relatively constant for a significant length of time. Therefore, if the outlet temperature rises more rapidly than anticipated, it will indicate improper fluidization and the process may have to be stopped and manual or mechanical intervention may be required to assist the fluidization.
Supplemental oxygen and heliox
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Paolo Palange, Richard Casaburi
In COPD, airflow obstruction may be the result of either airway narrowing (e.g. chronic bronchitis) and/or loss of lung elastic recoil (e.g. pulmonary emphysema). During exercise, the demand for increased rate and depth of breathing results in the inability to complete the desired exhaled volume in the time available for expiration. Breathing is then shifted to a higher lung volume to prevent the central airways from collapsing downstream from the flow-limiting segments, and to permit adequate ventilation without necessarily failing to satisfy the ventilatory demand imposed by the neural respiratory drive. Lung hyperinflation results from a well-refined action of various neural and mechanical mechanisms, presumably converging to achieve the best compromise to yield the minimum amount of expiratory flow limitation and the least load for the inspiratory muscles (6).
Angle β combined with FeNO and FEV1/FVC% for the detection of asthma in school-aged children
Published in Journal of Asthma, 2022
Yanli Zhang,, Hongke Shi,, Aifang Su,, Fuli Dai,, Xiufang Wang,, Yan Zhang,, Yuehong Zheng,, Chunling Cai,, Xiao Wang,
Asthma diagnosis is based on typical respiratory symptoms and variable expiratory airflow limitations (1). Pulmonary function testing is thus required to reflect expiratory airflow limitations in the diagnosis of asthma (4). Current guidelines note that a forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) ratio below the lower limit of normal at least once during the diagnostic process is suggestive of airflow limitations (5). However, the sensitivity and specificity of FEV1/FVC% are not ideal. A recent study reported that angle β of the ascending limb of the maximum expiratory flow-volume (MEFV) curve may be used to assess expiratory efforts and the quality of the MEFV curve outset (6). The tangent of the MEFV curve is drawn through the coordinate origin, and angle β between the tangent line and the x-axis is obtained. In the flow–volume curve, the tangent of each point in an MEFV curve reflects the variation of the forced expiratory flow (FEF) (6). Therefore, we speculate that angle β may reflect diversification of the FEF to some extent. Currently, angle β has not been applied to study the diagnosis of asthma. Therefore, the diagnostic value of angle β in school-aged children with asthma is unknown.
Pan-Canadian standards for severe asthma in electronic medical records
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
M. Diane Lougheed, Alison Morra, Emma Bullock, Noah Tregobov, Dave Barber, Louis-Philippe Boulet, Sharon Dell, Francine M. Ducharme, Madonna Ferrone, J. Mark FitzGerald, Samir Gupta, Christopher Licskai, Delanya Podgers, Parameswaran Nair, Dhenuka Radhakrishnan, Mohsen Sadatsafavi, Itamar E. Tamari, Teresa To, Brandie Walker, Connie L. Yang, Catherine Lemiere
Uncontrolled asthma is further defined by the CTS as at least 1 of the following:Poor symptom control: as per Canadian Thoracic Society asthma control criteria or other standardized questionnaires: Asthma Control Questionnaire (ACQ) consistently > 1.5, Asthma Control Test (ACT) < 20, or Childhood Asthma Control Test (cACT) < 20Frequent severe exacerbations: two or more courses of systemic corticosteroids (3 days each) in the previous year.Serious exacerbations: at least one hospitalization, intensive care unit (ICU) stay or mechanical ventilation in the previous year.Airflow limitation: forced expiratory volume in one second (FEV1) < 80% of personal best (or < the lower limit of normal (LLN)), and a reduced FEV1/forced vital capacity (FVC) defined as less than the LLN (after appropriate bronchodilator withhold).2
Status of inhalable antimicrobial agents for lung infection: progress and prospects
Published in Expert Review of Respiratory Medicine, 2021
Sujit Kumar Debnath, Rohit Srivastava, Monalisha Debnath, Abdelwahab Omri
Multiple delivery systems, such as pressurized metered-dose inhalers, dry powder inhalers, nebulizers, and slow-mist inhalers are available for delivering drugs to the lungs. Clinical benefits achieved by patients rely on effective delivery of the inhaled medication to the airways. Among several factors, inspiratory flow (IF) is one of the most important parameter that influences significantly in drug deposition. The inspiratory flow impacts drug delivery and subsequent clinical efficacy. It is necessary to train patients to ensure correct inhaler use. Peak inspiratory flow is the maximal airflow generated during a forced inspiratory maneuver. Health-care professionals need to select the appropriate delivery system after carefully considering patient characteristics, including lung function, optimal inspiratory flow, manual dexterity, and cognitive function.