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Journal of Applied Physiology... Jun 2022Specific ventilation imaging (SVI) measures the spatial distribution of specific ventilation (SV) in the lung with MRI by using inhaled oxygen as a contrast agent....
Specific ventilation imaging (SVI) measures the spatial distribution of specific ventilation (SV) in the lung with MRI by using inhaled oxygen as a contrast agent. Because of the inherently low signal-to-noise ratio in the technique, multiple switches between inspiring air and O are utilized, and the high spatial resolution SV distribution is determined as an average over the entire imaging period (∼20 min). We hypothesized that a trade-off between spatial and temporal resolution could allow imaging at a higher temporal resolution, at the cost of a coarser, yet acceptable, spatial resolution. The appropriate window length and spatial resolution compromise were determined by generating synthetic data with signal- and contrast-to-noise characteristics reflective of that in previously published experimental data, with a known and unchanging distribution of SV, and showed that acceptable results could be obtained in an imaging period of ∼7 min (80 breaths), with a spatial resolution of ∼1 cm. Previously published data were then reanalyzed. The average heterogeneity of the temporally resolved maps of SV was not different from the previous overall analysis, however, the temporally resolved maps were less effective at detecting the amount of bronchoconstriction resulting from methacholine administration. The results further indicated that the initial response to inhaled methacholine and subsequent inhalation of albuterol were largely complete within ∼22 min and ∼9 min, respectively, although there was a tendency for an ongoing developing effect in both cases. These results suggest that it is feasible to use a shortened SVI protocol, with a modest sacrifice in spatial resolution, to measure temporally dynamic processes. Dynamic imaging providing maps of specific ventilation with a temporal resolution of ∼7 min with a spatial resolution of ∼1 cm using MRI was shown to be practical. The technique provides an ionizing radiation free means of temporally following the spatial pattern of specific ventilation. Reanalysis of previously published data showed that the effects of inhaled methacholine and albuterol were largely complete at ∼22 min and ∼9 min, respectively after administration.
Topics: Albuterol; Bronchoconstriction; Lung; Magnetic Resonance Imaging; Methacholine Chloride; Oxygen
PubMed: 35482322
DOI: 10.1152/japplphysiol.00652.2021 -
Journal of Perinatology : Official... Jul 2021Bronchodilator responses among preterm infants are heterogeneous. Bedside measurements may identify responders.
BACKGROUND
Bronchodilator responses among preterm infants are heterogeneous. Bedside measurements may identify responders.
STUDY DESIGN
Respiratory measurements (Resistance, Compliance, FiO) and pulse oximetry (SpO) patterns were downloaded from infants <30 weeks gestational age during the first 2 months of life. Mechanically ventilated infants who received albuterol were included (n = 33). Measurements were compared before and after first albuterol. Secondary analyses assessed subsequent doses.
RESULTS
Median gestation and birthweight were 25 3/7 weeks and 730 g, respectively. Mean Resistance decreased post-albuterol (p = 0.007). Sixty-eight percent of infants were responders based on decreased Resistance. Compliance and FiO did not significantly differ. Percent time in hypoxemia (SpO< 85%) decreased post albuterol (p < 0.02). In responders, Resistance changes diminished with subsequent administration (all p = 0.01).
CONCLUSIONS
Ventilator resistance decreased in two-thirds of preterm infants, consistent with studies that utilized formal pulmonary function testing. Albuterol had a variable effect on delivered FiO; however, hypoxemia may be useful in evaluating albuterol response.
Topics: Albuterol; Bronchodilator Agents; Humans; Infant; Infant, Newborn; Infant, Premature; Oximetry; Respiration, Artificial
PubMed: 34035457
DOI: 10.1038/s41372-021-01071-0 -
The Journal of Asthma : Official... Feb 2023Medication maintenance is critical in the management of asthma. We investigated the differences in electronic health record (EHR) documentation of medication refills for...
OBJECTIVE
Medication maintenance is critical in the management of asthma. We investigated the differences in electronic health record (EHR) documentation of medication refills for Spanish- and English-speaking Latino children and non-Hispanic white children by examining rates of albuterol rescue inhaler refills from 2005 to 2017, and and inhaled corticosteroid refills from 2015 to 2017 in a multi-state network of community health centers (CHCs).
METHODS
We used data from the ADVANCE network of CHCs. Our sample consisted of children aged 3-17, with a diagnosis of asthma and either albuterol or inhaled corticosteroid prescriptions ( = 39,162; = 4,738 children, respectively). Negative binomial regression was used to calculate rates of refills per prescription adjusted for relevant patient-level covariates. Analyses stratified by asthma severity were also conducted.
RESULTS
English-speaking Latino children had lower rates of albuterol refills compared with non-Hispanic white children (rate ratio [RR] = 0.88, 95% confidence interval [CI]: 0.80-0.98), a trend that persisted among children with moderate/severe persistent asthma severity (RR = 0.85, 95% CI: 0.76-0.95). Spanish-speaking Latino and non-Hispanic white children had similar albuterol refills. Inhaled corticosteroid refill rates were comparable between all groups.
CONCLUSIONS
In a multi-state network, these findings suggest that CHCs deliver equitable asthma care related to prescription refills between their Latino and white patients, but there is still opportunity for providers to ensure that their English-speaking Latino patients have access to necessary emergency asthma medication.
Topics: Humans; Asthma; Ethnicity; Albuterol; Language; Adrenal Cortex Hormones; Prescriptions
PubMed: 35259312
DOI: 10.1080/02770903.2022.2051545 -
The Lancet. Global Health Jan 2023Small airways obstruction is a common feature of obstructive lung diseases. Research is scarce on small airways obstruction, its global prevalence, and risk factors. We... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Small airways obstruction is a common feature of obstructive lung diseases. Research is scarce on small airways obstruction, its global prevalence, and risk factors. We aimed to estimate the prevalence of small airways obstruction, examine the associated risk factors, and compare the findings for two different spirometry parameters.
METHODS
The Burden of Obstructive Lung Disease study is a multinational cross-sectional study of 41 municipalities in 34 countries across all WHO regions. Adults aged 40 years or older who were not living in an institution were eligible to participate. To ensure a representative sample, participants were selected from a random sample of the population according to a predefined site-specific sampling strategy. We included participants' data in this study if they completed the core study questionnaire and had acceptable spirometry according to predefined quality criteria. We excluded participants with a contraindication for lung function testing. We defined small airways obstruction as either mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF) less than the lower limit of normal or forced expiratory volume in 3 s to forced vital capacity ratio (FEV/FVC ratio) less than the lower limit of normal. We estimated the prevalence of pre-bronchodilator (ie, before administration of 200 μg salbutamol) and post-bronchodilator (ie, after administration of 200 μg salbutamol) small airways obstruction for each site. To identify risk factors for small airways obstruction, we performed multivariable regression analyses within each site and pooled estimates using random-effects meta-analysis.
FINDINGS
36 618 participants were recruited between Jan 2, 2003, and Dec 26, 2016. Data were collected from participants at recruitment. Of the recruited participants, 28 604 participants had acceptable spirometry and completed the core study questionnaire. Data were available for 26 443 participants for FEV/FVC ratio and 25 961 participants for FEF. Of the 26 443 participants included, 12 490 were men and 13 953 were women. Prevalence of pre-bronchodilator small airways obstruction ranged from 5% (34 of 624 participants) in Tartu, Estonia, to 34% (189 of 555 participants) in Mysore, India, for FEF, and for FEV/FVC ratio it ranged from 5% (31 of 684) in Riyadh, Saudi Arabia, to 31% (287 of 924) in Salzburg, Austria. Prevalence of post-bronchodilator small airways obstruction was universally lower. Risk factors significantly associated with FEV/FVC ratio less than the lower limit of normal included increasing age, low BMI, active and passive smoking, low level of education, working in a dusty job for more than 10 years, previous tuberculosis, and family history of chronic obstructive pulmonary disease. Results were similar for FEF, except for increasing age, which was associated with reduced odds of small airways obstruction.
INTERPRETATION
Despite the wide geographical variation, small airways obstruction is common and more prevalent than chronic airflow obstruction worldwide. Small airways obstruction shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether small airways obstruction is also associated with respiratory symptoms and lung function decline.
FUNDING
National Heart and Lung Institute and Wellcome Trust.
TRANSLATIONS
For the Dutch, Estonian, French, Icelandic, Malay, Marathi, Norwegian, Portuguese, Swedish and Urdu translations of the abstract see Supplementary Materials section.
Topics: Adult; Male; Female; Humans; Child; Cross-Sectional Studies; Bronchodilator Agents; Vital Capacity; Forced Expiratory Volume; Spirometry; Lung; Pulmonary Disease, Chronic Obstructive; Risk Factors; Albuterol; Prevalence
PubMed: 36521955
DOI: 10.1016/S2214-109X(22)00456-9 -
Pediatric Pulmonology Dec 2022In children, obesity typically reduces functional residual capacity (FRC), which reduces airway caliber and increases airway resistance. Whether these obesity-related...
BACKGROUND
In children, obesity typically reduces functional residual capacity (FRC), which reduces airway caliber and increases airway resistance. Whether these obesity-related changes in respiratory function can alter bronchodilator responsiveness is unknown.
OBJECTIVE
To investigate bronchodilator responsiveness in nonasthmatic children with and without obesity.
METHODS
Seventy nonasthmatic children, 8-12 years old, without (n = 19) and with (n = 51) obesity, completed spirometry, impulse oscillometry, and airway resistance measurements through plethysmography pre/post 360 µg of inhaled albuterol. FRC was assessed pre albuterol. A two-way analysis of variance determined the effects of obesity (group) and inhaled albuterol (pre-post) on outcome measures.
RESULTS
FRC (%total lung capacity) was 16% lower in children with obesity compared with those without obesity. There was no significant group by pre-post albuterol interaction on any outcome variables. Albuterol inhalation reduced total, central and peripheral airway resistance and increased airway reactance (i.e., less negative) to a similar degree in children with and without obesity. In children with obesity, airway resistance was increased whether measured by impulse oscillometry or plethysmography. However, once airway resistance was adjusted for lung volumes (i.e., specific airway resistance or sR ), there were no differences between children with and without obesity. In addition, significant but moderate associations were detected between chest mass and FRC (r = -0.566; p < 0.001), FRC and total airway resistance (i.e., R ; r = -0.445; p < 0.001).
CONCLUSIONS
In nonasthmatic early pubescent children, obesity increases total, central, and peripheral respiratory system resistance. However, the added respiratory system resistance and low lung volume breathing with obesity are not sufficient to reduce bronchodilator responsiveness.
Topics: Child; Humans; Airway Resistance; Bronchodilator Agents; Albuterol; Lung; Obesity
PubMed: 35949183
DOI: 10.1002/ppul.26111 -
Critical Care (London, England) Nov 2023Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies...
BACKGROUND
Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII.
METHODS
A 15-person multidisciplinary panel comprised anaesthetists, intensivists and plastic surgeons involved in the clinical management of major burn patients adopted a modified Delphi approach using the RAM method. They rated the appropriateness of statements describing diagnostic and management options for BII on a Likert scale. A modified final survey comprising 140 statements was completed, subdivided into history and physical examination (20), investigations (39), airway management (5), systemic toxicity (23), invasive mechanical ventilation (29) and pharmacotherapy (24). Median appropriateness ratings and the disagreement index (DI) were calculated to classify statements as appropriate, uncertain, or inappropriate.
RESULTS
Of 140 statements, 74 were rated as appropriate, 40 as uncertain and 26 as inappropriate. Initial intubation with ≥ 8.0 mm endotracheal tubes, lung protective ventilatory strategies, initial bronchoscopic lavage, serial bronchoscopic lavage for severe BII, nebulised heparin and salbutamol administration for moderate-severe BII and N-acetylcysteine for moderate BII were rated appropriate. Non-protective ventilatory strategies, high-frequency oscillatory ventilation, high-frequency percussive ventilation, prophylactic systemic antibiotics and corticosteroids were rated inappropriate. Experts disagreed (DI ≥ 1) on six statements, classified uncertain: the use of flexible fiberoptic bronchoscopy to guide fluid requirements (DI = 1.52), intubation with endotracheal tubes of internal diameter < 8.0 mm (DI = 1.19), use of airway pressure release ventilation modality (DI = 1.19) and nebulised 5000IU heparin, N-acetylcysteine and salbutamol for mild BII (DI = 1.52, 1.70, 1.36, respectively).
CONCLUSIONS
Burns experts mostly agreed on appropriate and inappropriate diagnostic and management criteria of BII as in published guidance. Uncertainty exists as to the optimal diagnosis and management of differing grades of severity of BII. Future research should investigate the accuracy of bronchoscopic grading of BII, the value of bronchial lavage in differing severity groups and the effectiveness of nebulised therapies in different severities of BII.
Topics: Humans; Acetylcysteine; Burns; Respiration, Artificial; Heparin; Lung Injury; Albuterol
PubMed: 38012797
DOI: 10.1186/s13054-023-04718-w -
The Ulster Medical Journal Jan 2017
Topics: Adrenergic beta-2 Receptor Agonists; Albuterol; Asthma; Drug Utilization Review; Humans; Nebulizers and Vaporizers; Prescription Drug Overuse; United Kingdom
PubMed: 28298715
DOI: No ID Found -
American Journal of Respiratory and... Sep 2021For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at...
For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access. To provide policy recommendations and outline steps for passing and implementing stock albuterol laws. We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups-legislation and implementation-on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders. We offer several recommendations for crafting state legislation and facilitating program implementation. ) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. ) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. ) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature's health or education committee. ) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments. Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclusions can lay the groundwork for success. Future work should focus on passing legislation in all states, implementing policy in schools, and evaluating the impact of such programs on academic and health outcomes.
Topics: Adolescent; Albuterol; Asthma; Bronchodilator Agents; Child; Female; Guidelines as Topic; Health Policy; Health Services Accessibility; Humans; Male; School Health Services; United States
PubMed: 34499024
DOI: 10.1164/rccm.202106-1550ST -
The Journal of Allergy and Clinical... Feb 2024Digital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence, and short-acting β-agonist overuse.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Digital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence, and short-acting β-agonist overuse. The maintenance and reliever Digihaler System (DS) comprises 2 Digihaler inhalers (fluticasone propionate/salmeterol and albuterol) with an associated patient App and web-based Dashboard. Clinicians can review patients' inhaler use and Digihaler inhalation parameter data to support clinical decision-making.
OBJECTIVE
CONNECT2 evaluated asthma control in participants using the DS versus standard-of-care (SoC) maintenance and reliever inhalers.
METHODS
Participants (13 years or older) with uncontrolled asthma (Asthma Control Test [ACT] score <19) were randomized 4:3 (open-label) to the DS (n = 210) or SoC (n = 181) for 24 weeks. The primary endpoint was the proportion of patients achieving well-controlled asthma (ie, an ACT score ≥20 or increase from baseline of ≥3 units at week 24).
RESULTS
There was an 88.7% probability that participants using the DS would have greater odds of achieving improvement in asthma control compared with SoC after 24 weeks. The mean odds ratio (95% credible interval) for DS versus SoC was 1.35 (0.846-2.038), indicating a 35% higher odds of improved asthma control with the DS. The DS group had more clinician-participant interactions versus SoC, mainly addressing a poor inhaler technique. DS participants' maintenance treatment adherence was good (month 1: 79.2%; month 6: 68.6%); reliever use decreased by 38.2% versus baseline. App and Dashboard usability was rated "good."
CONCLUSION
The positive results in asthma control in this study after 24 weeks demonstrate the effectiveness of the DS in asthma management.
Topics: Humans; Budesonide; Formoterol Fumarate; Ethanolamines; Anti-Asthmatic Agents; Drug Combinations; Asthma; Albuterol; Administration, Inhalation; Bronchodilator Agents
PubMed: 38040117
DOI: 10.1016/j.jaip.2023.11.037 -
Journal of Medical Economics 2022For hospitalized patients with chronic obstructive pulmonary disease (COPD), albuterol and levalbuterol can both be used as relievers to alleviate bronchoconstriction....
OBJECTIVES
For hospitalized patients with chronic obstructive pulmonary disease (COPD), albuterol and levalbuterol can both be used as relievers to alleviate bronchoconstriction. This study aimed to evaluate levalbuterol and albuterol's cost-utility and budget impact in hospitalized patients with COPD.
INTERVENTIONS
A cost-utility analysis was used to evaluate the impact on the costs of nebulized levalbuterol verse albuterol in hospitalized patients with COPD. The decision tree model was employed to estimate the incremental cost per quality-adjusted life year in the admission setting. A budget impact model was used to examine the impact of budget on levalbuterol's entry into the Chinese market from the healthcare system's perspective. One-way sensitivity and probabilistic sensitivity analyses were performed to test the uncertainty of the parameters.
RESULTS
The cost-utility results showed that levalbuterol saved ¥495.7 ($105.1) per hospitalization, while the budget impact analysis revealed a potential saving of ¥22.3 ($6.8) million in 3 years. The sensitivity analysis indicated that the results were robust to the changes in input parameter values.
CONCLUSION
Levalbuterol is a cost-saving option for treating hospitalized patients with COPD in China.
Topics: Albuterol; Asthma; Bronchodilator Agents; Humans; Levalbuterol; Pulmonary Disease, Chronic Obstructive
PubMed: 35786135
DOI: 10.1080/13696998.2022.2096892