Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care
Introduction:We developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California.Methods:We performed a review of the evidence in the prehospital treatment of adult patients with respiratory distress. The quality of evidence was rated and used to form guidelines. We then compared the respiratory distress protocols of each of the 33 LEMSAs for consistency with these recommendations.Results:PICO (population/problem, intervention,...
Source: Western Journal of Emergency Medicine - June 26, 2020 Category: Emergency Medicine Source Type: research

Emergency Medication Access and Administration in Schools: A Focus on Epinephrine, Albuterol Inhalers, and Glucagon.
Abstract Access to emergency medications is a growing concern, particularly regarding the availability, safety, and use of these medications in schools. The purpose of this article is to report results not previously published from a national survey, specifically regarding the emergency use of epinephrine, albuterol inhalers, and glucagon. A nonexperimental, cross-sectional design was utilized for this descriptive study. An online survey was distributed to school nurses in 2015, and data from 6,298 school nurse respondents are presented in the analysis. Findings related to stock and student-specific emergency medi...
Source: The Journal of School Nursing - June 26, 2020 Category: Nursing Authors: McCaughey RA, McCarthy AM, Maughan E, Hein M, Perkhounkova Y, Kelly MW Tags: J Sch Nurs Source Type: research

Commercial valved spacers versus home-made spacers for delivering bronchodilator therapy in pediatric acute asthma: a cost-effectiveness analysis.
Conclusions. The present study shows that in Colombia, an MIC, compared with commercial valved spacers, the use of home-made spacers for administering bronchodilator therapy is more cost-effective because it yields a similar probability of hospital admission at lower overall treatment costs. PMID: 32546110 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - June 19, 2020 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Inhaled Isotonic Saline for Bronchiolitis
To the Editor I read with interest the meta-analysis by House et al showing that inhaled isotonic saline may have a beneficial therapeutic effect in bronchiolitis. While I am glad that they included our study in their analysis, I wish to point out that a novel element of our study was the use of a physiologic outcome measure to assess response to inhaled albuterol and isotonic saline, namely, respiratory inductance plethysmography (RIP). We observed no significant changes in the variables assessed by House et al (respiratory rate, oxygen saturation, and respiratory distress assessment index). However, 30% of albuterol-trea...
Source: JAMA Pediatrics - June 8, 2020 Category: Pediatrics Source Type: research

Child tobacco smoke exposure and healthcare resource utilization patterns.
CONCLUSION: Tobacco smoke-exposed children are more likely to have higher resource utilization patterns, highlighting the importance of screening and providing TSE prevention and remediation interventions. IMPACT: Tobacco smoke exposure may affect the healthcare resource utilization patterns of children.Evidence is lacking concerning these associations among the highly vulnerable pediatric emergency department patient population.This study examined the association between tobacco smoke exposure and healthcare resource utilization patterns among pediatric emergency department patients.Tobacco smoke exposure increased t...
Source: Pediatric Research - June 6, 2020 Category: Pediatrics Authors: Merianos AL, Jandarov RA, Gordon JS, Lyons MS, Melinda Mahabee-Gittens E Tags: Pediatr Res Source Type: research

P319 Effect of shake-fire delay on the amount of delivered dose from a pMDI albuterol HFA and valved holding chamber
(Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - June 1, 2020 Category: Respiratory Medicine Authors: A. Berlinski, R. Qaqish Tags: Posters Source Type: research

Sterilization plan of the used metered dose inhalers (MDI) to avoid wastage amid COVID-19 pandemic drug shortage
AbstractBackgroundCoronavirus is causing a shortage of critical inhalers needed by patients with Asthma and respiratory illness. Patients with Asthma are at higher risk if they tract the novel Coronavirus. As the coronavirus continues to spread, hospitals are turning to use more salbutamol MDI. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with Corona Virus Disease 2019 (COVID-19) and have respiratory distress .[Hui et al 2020 ,and Center for Drug Evaluation and Research 2020]During the COVID pandemic, there has been a drastic increase in the use of MDI inhaler...
Source: Journal of Pharmaceutical Policy and Practice - May 20, 2020 Category: Pharmaceuticals Source Type: research

Generic Albuterol Inhaler Approved
The FDA has approved the first generic version of Proventil HFA Metered Dose Inhaler, 90 μg per inhalation, to treat or prevent bronchospasm in patients aged 4 years or older who have reversible obstructive airway disease. The generic albuterol sulfate inhaler also is indicated for exercise-induced bronchospasm prevention in the same age group. (Source: JAMA)
Source: JAMA - May 19, 2020 Category: General Medicine Source Type: research

Standardized Protocol Is Associated With a Decrease in Continuous Albuterol Use and Length of Stay in Critical Status Asthmaticus*
Conclusions: Implementation of a quality improvement protocol in critically ill patients with status asthmaticus was associated with a decrease in continuous albuterol duration and hospital length of stay. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2020 Category: Pediatrics Tags: Quality and Safety Source Type: research

Subcutaneous terbutaline as an alternative to aerosolized albuterol
Publication date: Available online 20 April 2020Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Ronald A. Strauss (Source: The Journal of Allergy and Clinical Immunology: In Practice)
Source: The Journal of Allergy and Clinical Immunology: In Practice - April 21, 2020 Category: Allergy & Immunology Source Type: research

Asthma rescue treatments, time to reboot
Short-acting β2-agonists (SABAs) are inseparable from asthma. The word "Ventolin" has not only entered common language, but it profoundly symbolises relief from breathing distress, quite similar to how "nitroglycerin" supposedly rescues the heart. After the Second World War, synthetic corticosteroids revolutionised asthma management and gained nobility once an inhaled formulation was available [1]. Intriguingly, despite the fact that chronic airway inflammation is inherent to the definition of asthma, as needed SABA was kept in guidelines as the preferred option for the mildest patients, and this u...
Source: European Respiratory Journal - April 16, 2020 Category: Respiratory Medicine Authors: Charriot, J., Gaga, M., Suehs, C., Bourdin, A. Tags: Editorials Source Type: research

Predictors for the prescription of albuterol in infants hospitalized for viral bronchiolitis.
Martinez CE Abstract INTRODUCTION AND OBJECTIVES: Despite the recommendation against routine use of inhaled bronchodilators in infants with viral bronchiolitis given in the main clinical practice guidelines (CPGs) on viral bronchiolitis, albuterol is widely prescribed to patients with this disease. The aim of this study was to identify predictors of prescription of albuterol in a population of infants hospitalized for viral bronchiolitis. MATERIAL AND METHODS: An analytical cross-sectional study performed during the period from March 2014 to August 2015, in a random sample of patients
Source: Allergologia et Immunopathologia - April 8, 2020 Category: Allergy & Immunology Authors: Piña-Hincapie SM, Sossa-Briceño MP, Rodriguez-Martinez CE Tags: Allergol Immunopathol (Madr) Source Type: research

Analysis of Unregulated Sale of Lifesaving Prescription Drugs Online in the United States
This cross-sectional analysis examines the prevalence of unregulated resale of insulin, albuterol, and epipenephrin online in the United States. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 1, 2020 Category: Internal Medicine Source Type: research

CVS to Prevent Stockpiling of Malaria Drug Amid COVID-19
March 25 (Reuters)—CVS Health said on Wednesday its pharmacy benefit management (PBM) unit was laying out measures to prevent the stockpiling of malaria drug, hydroxychloroquine, which is being tested as a potential treatment for the coronavirus. The company said it was also setting up limits on the use of azithromycin, a protease inhibitor and albuterol... [Read More] (Source: The Rheumatologist)
Source: The Rheumatologist - March 25, 2020 Category: Rheumatology Authors: Reuters Staff Tags: Drug Updates Drug shortage HCQ Hydroxychloroquine (HCQ) Source Type: research

Comparative pharmacokinetics of salbutamol inhaled from a pressurized metered dose inhaler either alone or connected to a newly enhanced spacer design.
CONCLUSIONS: Compared with VC, AS doubled the inhaled salbutamol lung dose and minimised its precipitation in the oral cavity. The results suggest this inhalation aid can add therapeutic and safety benefits particularly in patients with continued pMDI technique issues despite repeated VC. PMID: 32165316 [PubMed - as supplied by publisher] (Source: European Journal of Pharmaceutical Sciences)
Source: European Journal of Pharmaceutical Sciences - March 9, 2020 Category: Drugs & Pharmacology Authors: Ammari WG, Oriquat GA, Sanders M Tags: Eur J Pharm Sci Source Type: research

Analysis of Unregulated Sale of Life-Saving Prescription Drugs Online in the United States
This cross-sectional analysis examines the prevalence of unregulated resale of insulin, albuterol, and epipenephrin online in the United States. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 17, 2020 Category: Internal Medicine Source Type: research

Air Trapping Correlates with Increased Frequency of Albuterol Use and Severity of Wheeze in Persistent Asthma.
CONCLUSIONS: Frequent albuterol use and wheezing may be a sign of unrelieved air trapping. Chest pain is a unique symptom in persistent asthma, and the pathogenesis requires further studies. Lung volume measurement added to routine spirometry can help identify patients with asthma and with air trapping. PMID: 32019852 [PubMed - as supplied by publisher] (Source: Respiratory Care)
Source: Respiratory Care - February 4, 2020 Category: Respiratory Medicine Authors: Vempilly JJ, Abejie BA, Rashidian A, Jain VV, Bhakta N Tags: Respir Care Source Type: research

Inhalation Parameters In Patients With Asthma Using Albuterol Electronic Multi-dose Dry Powder Inhaler
Inhalation therapy is the mainstay of asthma treatment and reliant upon proper technique to allow optimal deposition of medication. Despite face-to-face demonstration of inhaler technique, patients do not maintain correct technique at home and errors are common. ProAir Digihaler (albuterol 90 μg/dose) is an electronic multi-dose dry powder inhaler designed with an integrated electronic module, which records objective information on inhaler usage and inhalation parameters, and thereby technique. (Source: Journal of Allergy and Clinical Immunology)
Source: Journal of Allergy and Clinical Immunology - February 1, 2020 Category: Allergy & Immunology Authors: Nabeel Farooqui, Guilherme Safioti, Lena Granovsky, Michael Reich, Thomas Li, Tanisha Hill, Roy Pleasants, Michael Depietro Source Type: research

Parent Perceptions on Enhanced Monitoring with Pediatric Asthma Sensor Technology
An asthma medication monitoring study involving inhaler sensors allowed parents and clinics to track albuterol and inhaled corticosteroid (ICS) use. Clinic staff were alerted to non-adherence to ICS or increase in albuterol use and called parents. We explored a subset of parent ’s experiences with enhanced monitoring from the intervention group (n=125). (Source: Journal of Allergy and Clinical Immunology)
Source: Journal of Allergy and Clinical Immunology - February 1, 2020 Category: Allergy & Immunology Authors: Madeleine Kanaley, Kristin Kan, Sara Shaunfield, Avneet Chadha, Kathy Boon, Deneen Vojta, Ruchi Gupta Source Type: research

An Updated Model For Prediction Of Asthma Exacerbations Using Albuterol Electronic Multi-dose Dry Powder Inhaler
Early detection of an impending clinical asthma exacerbation (CAE) would provide opportunities for pre-emptive treatment and improve asthma action plans. A predictive model for impending CAEs was successfully developed using data from ProAir Digihaler (albuterol 90 μg), an electronic multi-dose dry powder inhaler with integrated sensors. Refinement with additional patient data could improve the predictive accuracy of the model. (Source: Journal of Allergy and Clinical Immunology)
Source: Journal of Allergy and Clinical Immunology - February 1, 2020 Category: Allergy & Immunology Authors: Rajan Merchant, Guilherme Safioti, Lena Granovsky, Michael Reich, Thomas Li, Tanisha Hill, Roy Pleasants, Giselle Mosnaim, Michael Depietro Source Type: research

A Standard Guideline for Albuterol Weaning in Pediatric Patients Admitted with an Asthma Exacerbation
The average length of stay for a pediatric asthma exacerbation in the United States is about 2.2 days; as nearly 1 in 50 children with asthma is hospitalized with an exacerbation each year, this creates a substantial burden for patients and their families. A critical determinant of length of stay is the patient ’s albuterol wean; however, providers' approaches to weaning patients vary widely. The purpose of this quality improvement project was to reduce patients’ lengths of stay by implementing a guideline for weaning albuterol. (Source: Journal of Allergy and Clinical Immunology)
Source: Journal of Allergy and Clinical Immunology - February 1, 2020 Category: Allergy & Immunology Authors: Max Collard, Leslie Bernal Charondo, Eric Kim, Mabel Chan Source Type: research

Association of Various Weight Based Doses of Continuous Albuterol on Hospital Length of Stay.
CONCLUSION: No optimal weight based dose of continuous albuterol was found. Further investigation is needed to see if lower amounts of continuous albuterol may be as efficacious as higher doses. This could improve cost of status asthmaticus management and limit the number of adverse events associated with high exposure to continuous albuterol. PMID: 31994959 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - January 31, 2020 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Indoor air pollution and respiratory health effects in inner city children with moderate to severe asthma
AbstractIndoor air pollution is increasingly recognized as a significant risk for respiratory illness, particularly in vulnerable populations. Thirty-six children aged 6 –14 years with moderate/severe asthma from inner city areas in New York City were studied for 2-week periods (summer and winter) using diaries and spirometry. Seven-day integrated indoor samples of PM10, PM2.5, trace elements, elemental/organic carbon, black carbon, and criteria gases (NO2, SO2, and O3) were collected in the subjects ’ residences. Asthma outcomes included cough and wheeze severity, albuterol use, and pulmonary function. Mi...
Source: Air Quality, Atmosphere and Health - January 13, 2020 Category: Environmental Health Source Type: research

Mysterious Cause of Respiratory Failure and Multilobar Atelectasis in a 17-Month-Old Male.
Authors: Davis GW, Lockett CJ, Charny G Abstract A 17-month-old male presented to a community hospital emergency department in respiratory distress suggestive of reactive airway exacerbation or pneumonia. He rapidly deteriorated into fulminant respiratory failure with multilobar atelectasis. He was managed with continuous albuterol, intravenous antibiotics, corticosteroids, intubation, and vasopressors. He was then transported to a tertiary Children's Hospital. The patient was extubated 20 hours after presentation and again developed respiratory failure while in the pediatric intensive care unit. During prepar...
Source: Military Medicine - January 11, 2020 Category: International Medicine & Public Health Tags: Mil Med Source Type: research

Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children.
Conclusions: SVT is rare during hospital-based treatment for acute asthma using inhaled SABAs and has low morbidity and mortality. PMID: 31902263 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - January 8, 2020 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Improved muscle function in a phase I/II clinical trial of albuterol in Pompe disease
Publication date: Available online 10 December 2019Source: Molecular Genetics and MetabolismAuthor(s): Dwight D. Koeberl, Laura E. Case, Ankit Desai, Edward C. Smith, Crista Walters, Sang-oh Han, Beth L. Thurberg, Sarah Young, Deeksha Bali, Priya S. KishnaniAbstractThis 24-week, Phase I/II, double-blind, randomized, placebo-controlled study investigated the safety and efficacy of extended-release albuterol in late-onset Pompe disease stably treated with enzyme replacement therapy at the standard dose for 4.9 (1.0–9.4) years and with no contraindications to intake of albuterol. Twelve of 13 participants completed the ...
Source: Molecular Genetics and Metabolism - December 11, 2019 Category: Genetics & Stem Cells Source Type: research

Characteristics of Asthma Visits to Physician Offices in the United States: 2012-2015 National Ambulatory Medical Care Survey.
Conclusions-Asthma physician office visit rates declined from 2001 through 2016. During 2012-2015, primary care providers saw nearly two-thirds of asthma visits. Physician adherence to documenting asthma severity or control and providing patient education appeared low. Quick-acting relief medication was the most frequently prescribed medication. PMID: 31751210 [PubMed - in process] (Source: National health statistics reports)
Source: National health statistics reports - November 23, 2019 Category: American Health Tags: Natl Health Stat Report Source Type: research

A randomized trial to determine the effect of glycopyrrolate/formoterol on exercise tolerance in COPD: influence of dynamic hyperinflation and dead space ventilation
Purpose: We investigated whether dual bronchodilator therapy (glycopyrrolate/formoterol fumarate (GFF, Bevespi Aerosphere®)) would increase exercise tolerance during high intensity constant work rate (CWR) cycle ergometry. We also determined its separate contributions to altering ventilatory requirement (dead space ventilation (VD/VT)) and ventilatory capacity (dynamic hyperinflation (change in inspiratory capacity)).Methods: 48 COPD patients (62.9±7.8y; 33 male; GOLD spirometry 1/2/3, n=2/35/11) performed a randomized, double blind, placebo (PL) controlled, two-week crossover, single center trial. Gas exchange ...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Stringer, W., Porszasz, J., Von Plato, M., Khosrovi-Eghbal, A., Zopey, M., Cao, M., Soriano, A., Calmelat, R., Rossiter, H., Leyva, A., Siddiqui, S., Rennard, S., Casaburi, R. Tags: Airway pharmacology and treatment Source Type: research

Increase of FeNO after acute bronchodilation test in asthmatic patients: a clue for small airways disease?
Exhaled nitric oxide (FeNO) is known to be a marker of TH2 airway inflammation, but several studies have shown that its value is affected by acute changes in airways caliber. Most of FeNO production occurs in the small conductive airways, but studies have investigated the relationship between FeNO and small airways caliber changes in asthma. Impulse oscillometry (IOS) unlike spirometry can assess the obstruction of small peripheral airwaysThe aim of this study was to evaluate whether changes in FeNO after acute bronchodilation test are associated with specific features of asthmatic patients.This observational retrospective...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Imeri, G., Ribolla, F., Berti, A., Di Marco, F., Licini, A., Lombardi, C., Cottini, M. Tags: Monitoring airway disease Source Type: research

Aerosol delivery through an endotracheal tube in a model of a spontaneously breathing child
Background: Spontaneously breathing pediatric patients who are intubated often receive inhaled medications while disconnected from the ventilator circuit. Several medication delivery devices are available. Increased knowledge of drug delivery under this circumstance would allow for optimization of inhaled therapies in that population.Methods: A breathing simulator (VT 200 ml, iT 0.8s, and RR 20/min) was connected to a collection filter, followed by a 5 mm ID cuffed endotracheal tube. Albuterol was delivered via jet nebulizer/t-piece/50 ml tubing extension (6 L/min, 2500 µg/3ml) for 15 minutes. The pMDI (90 µg/p...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Berlinski, A., Tucker, M. Tags: Neonatology and paediatric intensive care Source Type: research

In vitro evaluation of spacers in comparison with T-adapters in mechanical ventilation with pressurized metered dose inhalers (pMDI) and vibrating mesh nebulizer
Introduction: Lung deposition in mechanical ventilation depends on multiple factors including the aerosol generators and their various interfaces. The aim of this study is to compare the in vitro perfromances of spacers in adult mechanical ventilation in comparison with T-adapters with both a pMDI and a vibrating mesh nebulizer.Methods: A ventilator (Evita 2 Duta, Dräger) was used in volume-controlled mode with adults settings (tidal volume 450mL, 15 breaths/min, ratio between inspiratory and expiratory 40/60 and Positive End-Expiratory Pressure (PEEP) 5 cmH2O). A filter was placed between the endotracheal tube and a tes...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Eckes, M., Poree, T. Tags: Acute critical care Source Type: research

Late Breaking Abstract - Comparison of mesh and jet nebulizers with different interfaces in acute moderate to severe paediatric asthma
Background: Mesh nebulizers (MN) combined with valved masks or mouthpieces have been shown to be more efficient and deliver higher concentrations of medication compared to jet nebulizers (JN) used with aerosol masks and mouthpieces. However, the clinical efficacy of delivering higher doses has not been established. The purpose of this study was to compare clinical outcomes related to using a MN versus JN in the treatment of pediatric patients with acute moderate to severe asthma exacerbations.Methods: We conducted a single-blinded RCT of 217 children (2-18 years old) with a known history of asthma who presented to the emer...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Moody, G. Tags: Paediatric asthma and allergy Source Type: research

Impact of inhalation delay on medication delivery from a salbutamol HFA pressurized metered dose inhaler used with and without a new prototype portable valved holding chamber
Conclusions: The prototype VHC may provide a potential option for patients previously unwilling to carry more conventional VHCs with them, in order to give delivery assurance of their reliever medication. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Suggett, J., Ellery, A., Doyle, C., Ali, R., Nagel, M. Tags: Airway pharmacology and treatment Source Type: research

Real-life inhaler technique in asthma patients using the electronic ProAir Digihaler
Introduction: A challenge when managing asthma patients is the lack of reliable information about inhaler technique. ProAir Digihaler (Teva Pharmaceuticals, Israel), with integrated sensors, can accurately measure inhalation parameters, thereby recording objective information on inhaler use and technique. This analysis aimed to identify and characterize issues related to inhaler technique by using data from the integrated electronic Digihaler.Methods: A 12-week, open-label study was conducted with ProAir Digihaler (salbutamol 90 mcg 1–2 inhalations every 4 hours as needed) among patients (≥18 years) with exacerbat...
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Chrystyn, H., Safioti, G., Buck, D., Granovsky, L., Calderon, E., Li, T., Reich, M., Hill, T., Depietro, M., Pleasants, R. Tags: Airway pharmacology and treatment Source Type: research

Combining Inhalation by A Breath Actuated Nebuliser (BAN) With Exhalation Through An Oscillating Positive Expiratory Pressure Device (OPEP) Offers The Potential For Optimal Combined Therapy
Conclusions: The delivery of medication from the AEROECLIPSE* II BAN to the lungs was not significantly affected by the incorporation of the Aerobika* OPEP device. This therapy could offer the clinician the opportunity for combined aerosol/OPEP therapy (ie in cystic fibrosis patients) thereby reducing the time needed for the patient to take nebuliser and OPEP treatment separately. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 21, 2019 Category: Respiratory Medicine Authors: Nagel, M., Suggett, J., Kushnarev, V., Coppolo, D., Wesolowski, A., Corcoran, T. Tags: Cystic fibrosis Source Type: research

High Frequency Percussive Ventilation as a Rescue Mode for Refractory Status Asthmaticus - a Case Study.
Conclusion: This case describes the successful use of HFPV for a status asthmaticus patient failing conventional mechanical ventilation. We have anecdotal evidence of other medical centers using HFPV for these patients but larger studies are needed to verify its efficacy. PMID: 31668108 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - November 3, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Antistatic treatment and salbutamol dosing have variable effect on drug delivery of valved holding chambers
ConclusionVHCs marketed as antistatic are significantly affected by antistatic treatment. To ensure optimal drug delivery, salbutamol should be actuated to VHCs one puff at a time. Each VHC brand has its unique characteristic that affects drug delivery in a way that cannot be generalised to another VHC. There is a need for universal standardisation of VHCs.Key notesValved holding chambers (VHCs) that are marketed as antistatic are significantly affected by antistatic treatment. Multiple actuations before inhalation tend to decrease the drug delivery efficacy of VHCs. Each VHC brand has its unique characteristic that affect...
Source: Pulmonary Pharmacology and Therapeutics - November 1, 2019 Category: Respiratory Medicine Source Type: research

Improving Bronchiolitis Care in Outpatient Settings Across a Health Care System
Conclusion A system-wide quality improvement project involving multiple outpatient care settings reduced the use of ineffective therapies and interventions in patients with bronchiolitis and resulted in significant cost savings. Improvements in care were sustained for 3 bronchiolitis seasons. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - November 1, 2019 Category: Emergency Medicine Tags: Original Research-QI Source Type: research

D202 rescue medication use and inhalation patterns during asthma exacerbations recorded by digihaler
Inhalation parameters, such as peak inspiratory flow (PIF) and inhalation volume, are correlated to inhaler technique for dry powder inhalers (DPIs) and could be markers of worsening disease. Digihaler, a multi-dose DPI with an integrated electronic module, delivers 90mcg albuterol/dose, records date/time stamps and inhalation profile parameters when used. This paper summarizes albuterol use patterns and inhalation parameters during ±14-day window around clinical asthma exacerbations (CAEs). (Source: Annals of Allergy, Asthma and Immunology)
Source: Annals of Allergy, Asthma and Immunology - November 1, 2019 Category: Allergy & Immunology Authors: R. Pleasants, G. Safioti, M. Reich, L. Granovsky, O. Itzahary, Y. Hadar, T. Li, T. Hill, M. DePietro, H. Chrystyn Source Type: research

Bronchodilator dose responsiveness in children and adolescents: Clinical features and association with future asthma exacerbations
ConclusionsBronchodilator dose responsiveness may be useful for phenotyping and may be of utility in practice and future studies focused on asthma outcomes or quantification of treatment responses. In children and adolescents, this phenotype of poor bronchodilator responsiveness may be associated with periods of relatively stable disease yet marked airway constriction in response to triggers, including tobacco smoke, respiratory infections/pneumonia, and aeroallergens. (Source: The Journal of Allergy and Clinical Immunology: In Practice)
Source: The Journal of Allergy and Clinical Immunology: In Practice - October 13, 2019 Category: Allergy & Immunology Source Type: research

No Loeffing Matter: The Dilemma of Loeffler's Endocarditis
A 69 year-old woman presented to the emergency department with one week of progressively worsening shortness of breath. The dyspnea worsened with exertion and was alleviated with rest. Associated symptoms included orthopnea, lower extremity edema, and weight gain. Her medical history consisted of emphysema and hypothyroidism with no prior cardiac history. Her home medications were levothyroxine, an albuterol rescue inhaler, and tiotropium. She had no past surgeries and no family history of cardiac disease. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 10, 2019 Category: General Medicine Authors: Amir Farid, Bradley Stauber, Solomon Khamishon, Douglas Fedder, Dali Fan Tags: Diagnostic Dilemma Source Type: research

Patiromer for Treatment of Hyperkalemia in the Emergency Department: A Pilot Study.
CONCLUSION: In this open label pilot study of severe hyperkalemia, a single dose of 25.2g of oral patiromer reduced serum potassium within 2 hours but did not show a difference at 6 hours. This is the first study showing patiromer may have a role in the acute management of hyperkalemia; however more rigorous studies are needed. PMID: 31599043 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 10, 2019 Category: Emergency Medicine Authors: Rafique Z, Liu M, Staggers KA, Minard CG, Peacock WF Tags: Acad Emerg Med Source Type: research

As-needed ICS-LABA in Mild Asthma: What Does the Evidence Say?
AbstractFor the last three decades, the guidelines for asthma management have supported a stepwise therapeutic approach, based on the administration of controller medications (especially inhaled corticosteroids) complemented by on-demand use of rescue medication. Classically, the rescue medication recommended comprised short-acting β agonists (SABA). Some years ago, the use of Symbicort Maintenance and Reliever Therapy (SMART) demonstrated the benefits of a combination of budesonide-formoterol, an inhaled corticosteroid, and a long-acting β agonist (ICS-LABA) as rescue medication in moderate and severe asthma. Th...
Source: Drugs - October 4, 2019 Category: Drugs & Pharmacology Source Type: research

Case report: Paradoxical responses to short acting beta-agonists in a pediatric patient.
Conclusion: This case highlights the need to include paradoxical response to SABAs in the differential of a patient with poorly controlled asthma. It also provides an example of successful treatment of a pediatric patient with a class of medications previously reserved for adults with chronic obstructive pulmonary disease. PMID: 31573361 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - October 3, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Aerosol Delivery During Continuous High Frequency Oscillation for Simulated Adults During Quiet and Distressed Spontaneous Breathing.
Abstract BACKGROUND: Continuous high-frequency oscillation (CHFO) is a therapeutic mode for the mobilization of secretions. The Metaneb CHFO device (Hill-Rom) also incorporates aerosol administration using an integrated jet nebulizer. However, the effectiveness of aerosol delivery and influential factors remain largely unreported. METHODS: A collecting filter was placed between an adult manikin with a representative upper airway and a breath simulator, set to simulate quiet and distressed patterns of spontaneous adult breathing. The Metaneb CHFO device was attached to the manikin via a mask. Two jet nebulizer...
Source: Respiratory Care - October 1, 2019 Category: Respiratory Medicine Authors: Li J, Elshafei AA, Gong L, Fink JB Tags: Respir Care Source Type: research

Albuterol and Pediatric Perioperative Respiratory Complications —Reply
In Reply We thank our colleagues for their interest in our study. We agree that many respiratory adverse events are common and minor and may have little effect on the patient ’s immediate clinical care. However, bronchospasm and laryngospasm are known to be a major cause of perioperative cardiac arrests, unplanned intensive care unit admissions, and neurological damage following anesthesia. The composite of these respiratory adverse events allows a standardized approac h to clinical trials and minimizes the potential for operator bias across treatment arms. We do acknowledge that different approaches to these composi...
Source: JAMA Pediatrics - September 16, 2019 Category: Pediatrics Source Type: research

Albuterol and Pediatric Perioperative Respiratory Complications
To the Editor Perturbations of the respiratory system are common in children during general anesthesia, especially following tonsillectomy. Many complications (mild desaturations and airway obstruction) are relatively benign and easily remedied, although some, such as laryngospasm and bronchospasm, are severe and lead to rapid escalation of care in the perioperative environment. Fortunately, severe complications during pediatric anesthesia are uncommon. This rarity makes them hard to study owing to the prohibitive sample size needed to power such studies. Consequently (and to improve statistical efficiency), investigators ...
Source: JAMA Pediatrics - September 16, 2019 Category: Pediatrics Source Type: research

Albuterol-Induced Lactic Acidosis
No abstract available (Source: American Journal of Therapeutics)
Source: American Journal of Therapeutics - September 1, 2019 Category: Drugs & Pharmacology Tags: Letters to the Editor Source Type: research

Is This the End of Albuterol?
Synopsis: In patients with mild asthma, a strategy of budesonide-formoterol as needed was superior to albuterol as needed to prevent asthma exacerbations. Source: Beasley R, Holiday M, Reddel HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020–2030. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research

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As-needed budesonide-formoterol has been shown to prevent severe exacerbations in patients with mild asthma compared with as-needed use of a short-acting b2-agonist, such as albuterol, in tightly controlled clinical trials. Beasley et al (N Engl J Med 2019;380:2020-30; https://doi.org/10.1056/NEJMoa1901963) reproduced this finding in an open-label randomized trial (START) that better mimicked clinical practice. Use of as-needed budesonide-formoterol decreased the annualized rate of all exacerbations, as well as that of severe exacerbations specifically, compared with as-needed albuterol and was also superior to maintenance...
Source: Journal of Allergy and Clinical Immunology - September 1, 2019 Category: Allergy & Immunology Authors: Marc E. Rothenberg, Jean Bousquet Tags: News beyond our pages Source Type: research