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NPJ Primary Care Respiratory Medicine Mar 2023Poor adherence to asthma preventer medication is associated with life-threatening asthma attacks. The quality and outcomes framework mandated primary care annual asthma... (Review)
Review
Poor adherence to asthma preventer medication is associated with life-threatening asthma attacks. The quality and outcomes framework mandated primary care annual asthma review does not include adherence monitoring and the effect of poor adherence on lung function in paediatric primary care patients is unknown. The aim was to investigate the link between inhaled corticosteroid (ICS) adherence and spirometry, fraction of exhaled nitric oxide (FeNO) and asthma control in asthmatic school-age children in this cross-sectional observational study involving three Leicestershire general practices. Children 5-16 years on the practice's asthma registers, were invited for a routine annual asthma review between August 2018 and August 2019. Prescription and clinical data were extracted from practice databases. Spirometry, bronchodilator reversibility (BDR) and FeNO testing were performed as part of the review. 130 of 205 eligible children (63.4%) attended their review. Mean adherence to ICS was 36.2% (SEM 2.1%) and only 14.6% of children had good adherence (≥75% prescriptions issued). We found no differences in asthma exacerbations in the preceding 12 months between the adherence quartiles. 28.6% of children in the lowest and 5.6% in the highest adherence quartile had BDR ≥ 12% but this was not statistically significant (p = 0.55). A single high FeNO value did not predict adherence to ICS. Adherence to ICS in children with asthma in primary care is poor. The link between adherence to ICS and asthma exacerbations, spirometry and FeNO is complex but knowledge of adherence to ICS is critical in the management of children with asthma.
Topics: Humans; Child; Cross-Sectional Studies; Asthma; Bronchodilator Agents; Adrenal Cortex Hormones; Medication Adherence; Lung; Primary Health Care; Anti-Asthmatic Agents; Observational Studies as Topic
PubMed: 36966170
DOI: 10.1038/s41533-022-00323-6 -
Journal of the American Association of... Aug 2021New lung cancer cases and annual deaths caused by lung cancers are significantly associated with tobacco smoking. Continued, routine smoking cessation prevention...
BACKGROUND
New lung cancer cases and annual deaths caused by lung cancers are significantly associated with tobacco smoking. Continued, routine smoking cessation prevention education has been linked with a decrease in lung cancer prevalence, resulting in a decline in new lung cancer diagnoses annually and ultimately less lung cancer-associated deaths in the United States.
LOCAL PROBLEM
An independent review of core measures revealed inadequate smoking cessation education documentation and no established system-based monitoring protocols, including formal education of health care providers. The lack of education and understanding contributed to a low compliance rate of 25% in core measure documentation.
METHODS
An educational program was designed to increase smoking cessation documentation core measures adherence. A preimplementation and postimplementation design was used to compare smoking cessation documentation compliance rates.
INTERVENTION
The program included education in the form of guided handouts, practical demonstrations, and one-on-one teaching sessions. Compliance, under guidance set forth by the Quality Oncology Practice Initiative, was calculated over a quarterly period including all practice providers.
RESULTS
Results revealed a smoking cessation documentation compliance rate of 25% preimplementation and 77% postimplementation, reflecting a 52% increase in rate of smoking cessation documentation adherence over a 6-month project period.
CONCLUSION
Z-test analysis showed statistical significance determining the interventions are a successful method to help increase smoking cessation core measure compliance. The smoking cessation education program led to better understanding of core measures, improved documentation, increased revenue, and increased level of patient smoking cessation.
Topics: Documentation; Health Personnel; Humans; Patient Compliance; Prevalence; Smoking Cessation; United States
PubMed: 34469361
DOI: 10.1097/JXX.0000000000000630 -
Rehabilitacion 2021Currently, several studies have identified low adherence to pulmonary rehabilitation in patients with COPD, despite the positive effects of the treatment. Patient... (Review)
Review
Currently, several studies have identified low adherence to pulmonary rehabilitation in patients with COPD, despite the positive effects of the treatment. Patient adherence to pulmonary rehabilitation is affected by factors such as the absence of family support, and the presence of multiple comorbidities, respiratory distress, anxiety and depression. Given that there is no conclusive evidence about which of these factors are most influential in determining adherence to pulmonary rehabilitation in patients with COPD, we conducted this scoping review to analyse the available evidence on the factors influencing the adherence of patients with COPD to pulmonary rehabilitation programs (PRP). A wide literature search was carried out in Medline, Ovid, Science Direct, EMBASE, EBSCO and ISI-web of science, with prior definition of the selection criteria that included the factors associated with healthcare and adherence in patients with COPD in PRP. We used the adherence model proposed by the WHO as a conceptual framework. As a significant result, we found that factors in the dimension of illness (40%) and patient (30%) were the most frequently found dimensions in the studies, revealing that the design of pulmonary rehabilitation programs must take into account the specific needs of the patient. Further studies are needed to establish barriers and facilitators of adherence among COPD patients to PRP in the Colombian setting.
Topics: Anxiety; Comorbidity; Dyspnea; Humans; Patient Compliance; Pulmonary Disease, Chronic Obstructive
PubMed: 33641937
DOI: 10.1016/j.rh.2020.09.007 -
European Respiratory Review : An... Sep 2019Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7-9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and... (Review)
Review
Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7-9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk.
Topics: Acute Coronary Syndrome; Continuous Positive Airway Pressure; Female; Hemodynamics; Humans; Lung; Male; Patient Compliance; Prevalence; Respiration; Risk Factors; Sleep; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 31366458
DOI: 10.1183/16000617.0114-2018 -
Journal of Controlled Release :... Feb 2024In the past decade RNA-based therapies such as small interfering RNA (siRNA) and messenger RNA (mRNA) have emerged as new and ground-breaking therapeutic agents for the... (Review)
Review
In the past decade RNA-based therapies such as small interfering RNA (siRNA) and messenger RNA (mRNA) have emerged as new and ground-breaking therapeutic agents for the treatment and prevention of many conditions from viral infection to cancer. Most clinically approved RNA therapies are parenterally administered which impacts patient compliance and adds to healthcare costs. Pulmonary administration via inhalation is a non-invasive means to deliver RNA and offers an attractive alternative to injection. Nebulisation is a particularly appealing method due to the capacity to deliver large RNA doses during tidal breathing. In this review, we discuss the unique physiological barriers presented by the lung to efficient nebulised RNA delivery and approaches adopted to circumvent this problem. Additionally, the different types of nebulisers are evaluated from the perspective of their suitability for RNA delivery. Furthermore, we discuss recent preclinical studies involving nebulisation of RNA and analysis in in vitro and in vivo settings. Several studies have also demonstrated the importance of an effective delivery vector in RNA nebulisation therefore we assess the variety of lipid, polymeric and hybrid-based delivery systems utilised to date. We also consider the outlook for nebulised RNA medicinal products and the hurdles which must be overcome for successful clinical translation. In summary, nebulised RNA delivery has demonstrated promising potential for the treatment of several lung-related conditions such as asthma, COPD and cystic fibrosis, to which the mode of delivery is of crucial importance for clinical success.
Topics: Humans; Cytosol; Respiratory Aerosols and Droplets; RNA, Small Interfering; Asthma; Lung
PubMed: 38101753
DOI: 10.1016/j.jconrel.2023.12.012 -
PloS One 2023Postoperative pulmonary complications (PPCs) are a major cause of morbidity and mortality after open abdominal surgery. Optimized perioperative lung expansion may...
BACKGROUND
Postoperative pulmonary complications (PPCs) are a major cause of morbidity and mortality after open abdominal surgery. Optimized perioperative lung expansion may minimize the synergistic factors responsible for the multiple-hit perioperative pulmonary dysfunction. This ongoing study will assess whether an anesthesia-centered bundle focused on perioperative lung expansion results in decreased incidence and severity of PPCs after open abdominal surgery.
METHODS
Prospective multicenter randomized controlled pragmatic trial in 750 adult patients with at least moderate risk for PPCs undergoing prolonged (≥2 hour) open abdominal surgery. Participants are randomized to receive either a bundle intervention focused on perioperative lung expansion or usual care. The bundle intervention includes preoperative patient education, intraoperative protective ventilation with individualized positive end-expiratory pressure to maximize respiratory system compliance, optimized neuromuscular blockade and reversal management, and postoperative incentive spirometry and early mobilization. Primary outcome is the distribution of the highest PPC severity by postoperative day 7. Secondary outcomes include the proportion of participants with: PPC grades 1-2 through POD 7; PPC grades 3-4 through POD 7, 30 and 90; intraoperative hypoxemia, rescue recruitment maneuvers, or cardiovascular events; and any major extrapulmonary postoperative complications. Additional secondary and exploratory outcomes include individual PPCs by POD 7, length of postoperative oxygen therapy or other respiratory support, hospital resource use parameters, Patient-Reported Outcomes Measurements (PROMIS®) questionnaires for dyspnea and fatigue collected before and at days 7, 30 and 90 after surgery, and plasma concentrations of lung injury biomarkers (IL6, IL-8, RAGE, CC16, Ang-2) analyzed from samples obtained before, end of, and 24 hours after surgery.
DISCUSSION
Participant recruitment for this study started January 2020; results are expected in 2024. At the conclusion of this trial, we will determine if this anesthesia-centered strategy focused on perioperative lung expansion reduces lung morbidity and healthcare utilization after open abdominal surgery.
TRIAL REGISTRATION
ClinicalTrial.gov NCT04108130.
Topics: Adult; Humans; Anesthesia; Lung; Lung Diseases; Multicenter Studies as Topic; Positive-Pressure Respiration; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; Pragmatic Clinical Trials as Topic
PubMed: 37023031
DOI: 10.1371/journal.pone.0283748 -
AAPS PharmSciTech Dec 2023Tuberculosis (TB) is among the top 10 infectious diseases worldwide. It is categorized among the leading killer diseases that are the reason for the death of millions of... (Review)
Review
Tuberculosis (TB) is among the top 10 infectious diseases worldwide. It is categorized among the leading killer diseases that are the reason for the death of millions of people globally. Although a standardized treatment regimen is available, non-adherence to treatment has increased multi-drug resistance (MDR) and extensive drug-resistant (XDR) TB development. Another challenge is targeting the death of TB reservoirs in the alveoli via conventional treatment. TB Drug resistance may emerge as a futuristic restraint of TB with the scarcity of effective Anti-tubercular drugs. The paradigm change towards nano-targeted drug delivery systems is mostly due to the absence of effective therapy and increased TB infection recurrent episodes with MDR. The emerging field of nanotechnology gave an admirable opportunity to combat MDR and XDR via accurate diagnosis with effective treatment. The new strategies targeting the lung via the pulmonary route may overcome the new incidence of MDR and enhance patient compliance. Therefore, this review highlights the importance and recent research on pulmonary drug delivery with nanotechnology along with prevalence, the need for the development of nanotechnology, beneficial aspects of nanomedicine, safety concerns of nanocarriers, and clinical studies.
Topics: Humans; Antitubercular Agents; Tuberculosis, Multidrug-Resistant; Extensively Drug-Resistant Tuberculosis; Drug Delivery Systems; Lung; Mycobacterium tuberculosis
PubMed: 38049695
DOI: 10.1208/s12249-023-02708-3 -
International Journal of Pharmaceutics Aug 2023Pulmonary delivery is an alternative route of administration with numerous advantages over conventional routes of administration. It provides low enzymatic exposure,... (Review)
Review
Pulmonary delivery is an alternative route of administration with numerous advantages over conventional routes of administration. It provides low enzymatic exposure, fewer systemic side effects, no first-pass metabolism, and concentrated drug amounts at the site of the disease, making it an ideal route for the treatment of pulmonary diseases. Owing to the thin alveolar-capillary barrier, and large surface area that facilitates rapid absorption to the bloodstream in the lung, systemic delivery can be achieved as well. Administration of multiple drugs at one time became urgent to control chronic pulmonary diseases such as asthma and COPD, thus, development of drug combinations was proposed. Administration of medications with variable dosages from different inhalers leads to overburdening the patient and may cause low therapeutic intervention. Therefore, products that contain combined drugs to be delivered via a single inhaler have been developed to improve patient compliance, reduce different dose regimens, achieve higher disease control, and boost therapeutic effectiveness in some cases. This comprehensive review aimed to highlight the growth of drug combinations by inhalation over time, obstacles and challenges, and the possible progress to broaden the current options or to cover new indications in the future. Moreover, various pharmaceutical technologies in terms of formulation and device in correlation with inhaled combinations were discussed in this review. Hence, inhaled combination therapy is driven by the need to maintain and improve the quality of life for patients with chronic respiratory diseases; promoting drug combinations by inhalation to a higher level is a necessity.
Topics: Humans; Quality of Life; Respiratory Aerosols and Droplets; Administration, Inhalation; Asthma; Nebulizers and Vaporizers; Drug Combinations; Pharmaceutical Preparations; Patient Compliance; Pulmonary Disease, Chronic Obstructive
PubMed: 37230369
DOI: 10.1016/j.ijpharm.2023.123070 -
International Journal of Molecular... Jun 2021Lung fibrosis results from the synergic interplay between regenerative deficits of the alveolar epithelium and dysregulated mechanisms of repair in response to alveolar... (Review)
Review
Lung fibrosis results from the synergic interplay between regenerative deficits of the alveolar epithelium and dysregulated mechanisms of repair in response to alveolar and vascular damage, which is followed by progressive fibroblast and myofibroblast proliferation and excessive deposition of the extracellular matrix. The increased parenchymal stiffness of fibrotic lungs significantly affects respiratory mechanics, making the lung more fragile and prone to non-physiological stress during spontaneous breathing and mechanical ventilation. Given their parenchymal inhomogeneity, fibrotic lungs may display an anisotropic response to mechanical stresses with different regional deformations (micro-strain). This behavior is not described by the standard stress-strain curve but follows the mechano-elastic models of "squishy balls", where the elastic limit can be reached due to the excessive deformation of parenchymal areas with normal elasticity that are surrounded by inelastic fibrous tissue or collapsed induration areas, which tend to protrude outside the fibrous ring. Increasing evidence has shown that non-physiological mechanical forces applied to fibrotic lungs with associated abnormal mechanotransduction could favor the progression of pulmonary fibrosis. With this review, we aim to summarize the state of the art on the relation between mechanical forces acting on the lung and biological response in pulmonary fibrosis, with a focus on the progression of damage in the fibrotic lung during spontaneous breathing and assisted ventilatory support.
Topics: Algorithms; Alveolar Epithelial Cells; Animals; Disease Progression; Disease Susceptibility; Elasticity; Extracellular Matrix; Humans; Idiopathic Pulmonary Fibrosis; Lung; Mechanical Phenomena; Mechanotransduction, Cellular; Models, Biological; Pulmonary Fibrosis
PubMed: 34208586
DOI: 10.3390/ijms22126443 -
Journal of Medical Virology Jan 2021Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a significant hypoxemia. The exactly mechanism of such hypoxemia in patients with... (Observational Study)
Observational Study
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a significant hypoxemia. The exactly mechanism of such hypoxemia in patients with coronavirus disease 2019 (COVID-19) is not well described. It has been suggested that microthrombosis contributes to this mechanism, increasing pulmonary dead space. However, dead spaces would not be sensible to oxygen supplementation, and also, enlargement of pulmonary vessels it has been evidenced. Shunt mechanism by vasodilatation, instead, could explain decubitus dependence in oxygenation by blood redistribution as observed in these patients, and moreover, would be more sensible to oxygen supplementation than dead spaces. We hypothesized that SARS-CoV-2 causes an intrapulmonary vascular dilatation (IPVD), determining a shunt mechanism by vasodilatation. We performed contrast-enhanced transthoracic echocardiography to search IPVD shunt in patients with confirmed COVID-19, hospitalized in an intensive care unit. Ten patients were recruited; one patient was excluded due to low quality of echocardiographic image, and nine patients were included. IPVD was found in seven (78%) patients, with different grades, including patient with normal compliance and the one without invasive ventilation. We demonstrated that shunt by IPVD is present among patients with COVID-19, and this mechanism is probably implicated in significant hypoxemia observed.
Topics: Adult; Aged; COVID-19; Female; Humans; Lung; Male; Middle Aged; SARS-CoV-2; Vasodilation
PubMed: 32706407
DOI: 10.1002/jmv.26342