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IoT Is Watching You
Published in Salvatore Volpe, Health Informatics, 2022
Salvatore G. Volpe, Paul Quigley
Now that we have introduced you to the IoT and have shown you actual examples of IoT devices, we will narrow the rest of this discussion to IoT in healthcare. We will begin with the first “smart” medical devices brought into healthcare: the smart inhaler.12 Inhalers are used to deliver medications to treat asthma, chronic obstructive pulmonary disease (COPD), and other respiratory conditions. The device was a plastic container that replaced standard inhaler canisters. The smart inhaler recorded dose actuations and could be connected to a computer to graph them against time on a regular basis. Though the technology was not wireless, devices like the smart inhaler led to the development and widespread use of other smart medication adherence devices, such as smart pill bottles, smart pill organizers, smart injectable devices, and “true” smart inhalers.13 The groundwork has already been laid for IoT across the healthcare industry, but now we finally have a label we can use to define this whole category of innovations: healthcare or medical IoT (MIoT).
Statistical Methods for Assessment of Complex Generic Drugs
Published in Wei Zhang, Fangrong Yan, Feng Chen, Shein-Chung Chow, Advanced Statistics in Regulatory Critical Clinical Initiatives, 2022
Metered-Dose Inhalers (MDIs), Dry Powder Inhalers (DPIs), and nasal sprays are classical representatives of drug-device combination products. For BE assessment of these products, in vitro studies for evaluation of drug delivery characteristics should be conducted prior to in vivo PK BE study and PD BE study (or clinical endpoint BE study). In the case of albuterol sulfate aerosol, which is delivered through a metered-dose inhaler, equivalence in device characteristics including: (i) Single Actuation Content (SAC); (ii) Aerodynamic Particle Size Distribution (APSD); (iii) spray pattern; (iv) plume geometry; and (v) priming and repriming are required to be demonstrated. After that, an in vivo PK BE study should be conducted (Saluja et al., 2014). However, one in vivo PK BE study may not be adequate, as albuterol sulfate aerosol is locally acting and systemic exposure doesn't reflect therapeutic effect. Therefore, a PD study, in which PD endpoint is obtained through a bronchoprovocation test, is required to establish BE. For products that have no suitable PD endpoints, such as triamcinolone acetonide nasal spray for the treatment of allergic rhinitis, a comparative clinical endpoint BE study is generally needed (US FDA, 2020c).
Medicines management
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Kirsty Andrews, Martina O’Brien
You have probably seen inhalers used by both children and adults. Asthma is probably the commonest reason for inhaler use. Inhalers are used in chronic obstructive pulmonary disease (COPD). Inhalers may be used as maintenance therapy (called preventers), as well as in emergency situations where acute breathlessness occurs (called relievers) (Asthma UK 2019; NICE 2019b). Malcolm’s inhaler is therefore a reliever. Inhalers can be used as prophylactic (preventative) treatment, for example, before coming into contact with animal fur, grass, pollen, etc., which may be allergens to people with asthma, or before taking strenuous activity where extra oxygen is needed. If steroid inhalers are being used, they need to be taken after bronchodilators.
Impact of choice of inhalers for asthma care on global carbon footprint and societal costs: a long-term economic evaluation
Published in Journal of Medical Economics, 2022
Kalé Kponee-Shovein, Jessica Marvel, Ryotaro Ishikawa, Abhay Choubey, Harneet Kaur, Khadidja Ngom, Iman Fakih, Natalia Swartz, Todd Schatzki, James Signorovitch
Inhalation therapy is the cornerstone of asthma management. Globally, pressurized metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) are the most common types of inhaler devices used for asthma5. However, MDI use has a disproportionately large carbon footprint compared to DPI use. Specifically, currently available MDIs have a carbon footprint 20–30 times higher than DPIs per equivalent dose6. This difference in carbon footprint is due to MDIs’ reliance on certain propellants (hydrofluoroalkanes, HFAs; 7) whereas DPIs are propellant-free. HFAs have high global warming potentials (GWPs), a measure of how much heat a GHG traps in the atmosphere over a specified time relative to carbon dioxide (CO2). Notably, HFAs used in currently available MDIs have GWPs 1,300–3,350 times higher than that of CO27–9. Annually, 630 million MDIs are used globally for treatment of all respiratory conditions, resulting in an estimated burden of 13 million tonnes of CO2 equivalent emissions (tCO2e), which is comparable to the carbon footprint of 2 million European Union (EU) citizens10.
The use of puzzles in inhaler technique training
Published in Journal of Asthma, 2022
Inhaled drugs are essential for the treatment of many chronic respiratory diseases (1). They affect the lungs locally; therefore, their systemic effects are minimal. There is a wide variety of inhaler devices available for children (e.g. metered-dose inhalers (MDIs), Diskus, Turbuhalers, etc.). Each type of inhaler requires various steps for its correct use (1). Further, the appropriate inhaler technique varies according to the patient’s age and skills. For example, MDIs require a high degree of hand-breath coordination during therapy; therefore, it is essential to use them with spacers in children (2). Also, children need to know multiple steps in the inhaler technique to effectively use MDIs (2). Similarly, patients need to carry out multiple steps for using most inhaler devices efficiently, and many of them encounter problems while performing the correct inhaler technique (2). In Turkey, it is common among physicians to prescribe drugs to patients without describing their usage. In general, the responsibility of explaining the usage of the prescribed drugs is placed on the pharmacies (3). In a study, which included 140 asthmatic children aged 1–18 years who were followed up for at least three months, it was found that 89 patients (63.6%) used MDIs, out of which 85 (95.5%) used the correct spacers. This study shows that MDIs and spacers are frequently prescribed for children in our country (4).
Recommendations for COPD management in Central and Eastern Europe
Published in Expert Review of Respiratory Medicine, 2022
Arschang Valipour, Zaurbek Aisanov, Sergey Avdeev, Vladimir Koblizek, Ivan Kocan, Ivan Kopitovic, Gergely Lupkovics, Milena Man, Maris Bukovskis, Neven Tudoric, Marija Vukoja, Wojciech Naumnik, Nikolay Yanev
Following initiation of therapy, patients should be followed up for achievement of treatment goals, and adjustments made where necessary [1]. Here, we recommend a rather short-term follow-up of about 6 weeks after the initial assessment, which is believed to be the average interval between two physician visits in the CEE region after initiation of treatment. At follow-up, changes in physical activity, side effects of and adherence to inhaler therapy, and inhalation technique should be checked. If response to initial pharmacologic treatment is not sufficient, it is important to consider whether symptoms or exacerbations are the main characteristic according to the GOLD 2022 strategy report. For symptoms such as dyspnea, a long-acting bronchodilator should be added for those on LAMA or LABA monotherapy (Figure 2); for exacerbations, please see the section on patients with frequent exacerbations below.