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

News beyond our pages
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

Identification and Follow up of Prescribed Medications that Potentially Exacerbate Heart Failure: A Quality Improvement Project
ConclusionsMedication regimes are complex yet careful review of non- HF medications and frequency of use is critical to ensuring HF success. Strategies to promote medication review with early identification of potential medications that can exacerbate HF and facilitate communication with prescribing providers are necessary. Since implementation of this intervention we have expanded education among the nursing staff to promote awareness and have included pharmacy and nursing students into the medication review process to identify medications associated with HF exacerbation.ResultsA total of 86 HF patients’ records wer...
Source: Heart and Lung: The Journal of Acute and Critical Care - August 30, 2019 Category: Respiratory Medicine Source Type: research

Weighing in on asthma: Insights on BMI, magnesium, and hospitalizations from the Ohio Pediatric Asthma Repository.
Conclusions: Ov/Ob children had similar PRD to nOv/nOb children and were prone to repeat magnesium dosing. Previous hospitalization for exacerbation was positively associated with increasing BMI percentile. Additional research should investigate differential magnesium use by weight status, quantifying risks and benefits. PMID: 31411907 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - August 16, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

98. improving bronchiolitis management with a care path
Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Ripal Patel, Melissa Schafer, Heidi Ochs, John Andrake, John Pires Ervoes, Eric GershonBackgroundBronchiolitis is the number one cause of hospitalization in children under 2 years of age. AAP guidelines emphasize that only supportive care is needed for bronchiolitis. Data obtained from our institution showed poor adherence to AAP guidelines. This project was undertaken with the goal of improving compliance with these guidelines.Aim StatementOur aim was to reduce length of stay (LOS) for admitted low risk patients with bronchiolitis, age ...
Source: Academic Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma
Publication date: Available online 30 July 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Kaharu Sumino, Leonard B. Bacharier, Juanita Taylor, Kelley Chadwick-Mansker, Vanessa Curtis, Alison Nash, Shawni Jackson-Triggs, Joseph Moen, Kenneth B. Schechtman, Jane Garbutt, Mario CastroBackgroundSymptom-based adjustment (SBA) of inhaled corticosteroids may be an alternative patient-centered approach in which day-to-day inhaled corticosteroid use is adjusted by symptoms and short-acting β-agonist need.ObjectiveTo evaluate the effectiveness of SBA in the primary care setting.MethodsWe condu...
Source: The Journal of Allergy and Clinical Immunology: In Practice - July 30, 2019 Category: Allergy & Immunology Source Type: research

Medication ‐Induced Hyperlactatemia and Lactic Acidosis: A Systematic Review of the Literature
This article is protected by copyright. All rights reserved. (Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy)
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - July 30, 2019 Category: Drugs & Pharmacology Authors: Zachary R. Smith, Michelle Horng, Megan A. Rech Tags: Review of Therapeutics Source Type: research

Comprehensive Real-World Assessment of Marketed Medications to Guide Parkinson ’s Drug Discovery
ConclusionsArmodafinil, modafinil, and methylphenidate were associated with a decreased risk of parkinsonism, as were β-agonists. Of the β-blockers, only propranolol was associated with increased risk. Healthcare database analyses that incorporate scientific rigor provide insight and direction for drug discovery efforts. These findings show association not causality; however, they offer considerable support to th e association between β-adrenergic receptor modulation and risk of Parkinson’s disease. (Source: Clinical Drug Investigation)
Source: Clinical Drug Investigation - July 20, 2019 Category: Drugs & Pharmacology Source Type: research

Comparison of Two Continuous Nebulized Albuterol Doses in Critically Ill Children with Status Asthmaticus.
Conclusions: In our PICU cohort of children with status asthmaticus, use of 10 mg/hr continuous albuterol was associated with lower fluid bolus resuscitation without more adjunctive therapies. These findings support the safety of lower doses in this population. Prospective studies evaluating the efficacy and toxicity of specific continuous albuterol dosages in critically ill children with status asthmaticus are warranted. PMID: 31119958 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - May 25, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Emergency Department Management of Bronchiolitis in the United States
Conclusions The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - May 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

An occupational exposure limit (OEL) approach to protect home healthcare workers exposed to common nebulized drugs
Publication date: Available online 29 April 2019Source: Regulatory Toxicology and PharmacologyAuthor(s): Evan Frank, Simileoluwa Ishau, Andrew Maier, Susan Reutman, John F. ReichardAbstractHome healthcare is a growing area of employment. Assessment of occupational health risks to home health care workers (HHCWs) is important because in many cases the unique characteristics of the home environment do not facilitate the level of exposure control afforded to caregivers in hospitals and other fixed patient care sites. This assessment is focused on health risks to HHCWs from exposure to pharmaceutical drugs used to treat asthma...
Source: Regulatory Toxicology and Pharmacology - April 29, 2019 Category: Toxicology Source Type: research

An occupational exposure limit (OEL) approach to protect home healthcare workers exposed to common nebulized drugs.
Abstract Home healthcare is a growing area of employment. Assessment of occupational health risks to home health care workers (HHCWs) is important because in many cases the unique characteristics of the home environment do not facilitate the level of exposure control afforded to caregivers in hospitals and other fixed patient care sites. This assessment is focused on health risks to HHCWs from exposure to pharmaceutical drugs used to treat asthma and other respiratory diseases, which are commonly administered to patients in aerosolized form via nebulizers. We developed risk-based exposure limits for workers in the...
Source: Regulatory Toxicology and Pharmacology : RTP - April 29, 2019 Category: Toxicology Authors: Frank E, Ishau S, Maier A, Reutman S, Reichard JF Tags: Regul Toxicol Pharmacol Source Type: research

Effects of bronchial provocation test and bronchial dilation test for the diagnosis of lung diseases.
Authors: Feng M, Yang X, He Y Abstract AIM: Present study was performed to explore the effects of bronchial provocation test (BPT) and bronchial dilation test (BDT) for the diagnosis of lung diseases. METHODS: BPT and BDT results were respectively detected by methacholine and albuterol in patients with different lung diseases and non-lung diseases. BPT and BDT indexes including exhaled nitric oxide (ENO), forced expiratory volume of first minute (FEV1), forced vital capacity (FVC), diffusion of carbon monoxide in the lungs (DLCO) and eosinophilia (EOS) were compared by t-test between different groups. RESUL...
Source: Artificial Cells, Nanomedicine and Biotechnology - April 24, 2019 Category: Biotechnology Tags: Artif Cells Nanomed Biotechnol Source Type: research

Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) With Albuterol
This randomized clinical trial evaluates the effect of preoperative administration of albuterol vs placebo on the rates of perioperative respiratory adverse events in young children undergoing tonsillectomy. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - April 22, 2019 Category: Pediatrics Source Type: research

Real-world use of rescue inhaler sensors, electronic symptom questionnaires and physical activity monitors in COPD.
Discussion: The study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials. PMID: 30956796 [PubMed] (Source: Respiratory Care)
Source: Respiratory Care - April 10, 2019 Category: Respiratory Medicine Authors: Bowler R, Allinder M, Jacobson S, Miller A, Miller B, Tal-Singer R, Locantore N Tags: BMJ Open Respir Res Source Type: research

Rheumatoid arthritis-associated interstitial lung disease
A 34-year-old undocumented woman from Mexico, past medical history of asthma and rheumatoid arthritis (RA) presents to the ED with fever, myalgia, fatigue, cough, and difficulty taking deep breaths for the past 3 days requiring albuterol inhaler three to four times a day. Her symptoms worsened 1 h prior to arrival. (Source: QJM)
Source: QJM - April 1, 2019 Category: Internal Medicine Source Type: research

Omega-3 and Omega-6 Intake Modifies Asthma Severity and Response to Indoor Air Pollution in Children.
Abstract RATIONALE: Higher indoor particulate matter (PM) concentrations are linked with increased asthma morbidity. Dietary intake of fatty acids, also linked with asthma outcomes, may influence this relationship. OBJECTIVES: Determine (1) the relationship between omega-3 and omega-6 fatty acid intake and pediatric asthma morbidity, and (2) the association between fatty acid intake and strength of indoor, PM-related asthma symptoms, albuterol use, and systemic inflammation. METHODS: Analyses included 135 children with asthma enrolled in the AsthmaDIET Study. At baseline, 3, and 6 months, data included: ...
Source: American Journal of Respiratory and Critical Care Medicine - March 29, 2019 Category: Respiratory Medicine Authors: Brigham EP, Woo H, McCormack M, Rice J, Koehler K, Vulcain T, Wu T, Koch A, Sharma S, Kolahdooz F, Bose S, Hanson C, Romero K, Diette G, Hansel NN Tags: Am J Respir Crit Care Med Source Type: research

Pharmacologic anisocoria due to nebulized ipratropium bromide: A diagnostic challenge
Anisocoria may be physiological or seen in fatal conditions, such as intracranial hemorrhage. Newly developing anisocoria may cause confusion and diagnostic difficulty in the emergency department (ED). A 35-year-old female was admitted to the ED with an asthma attack and dyspnea. On examination, the patient was observed to have bilateral rhonchi and was treated with nebulized albuterol (salbutamol) and ipratropium bromide. After the treatment, the dyspnea improved, and mydriasis developed in the left eye (left pupil diameter 9  mm, right 4 mm). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - March 27, 2019 Category: Emergency Medicine Authors: Kamil Kokulu, Haldun Öner, Can Özen, Serkan E. Eroğlu, İbrahim Altunok, H. Şeyma Akça Source Type: research

Right Care for Children: Top Five Do's and Don'ts.
Abstract Underuse and overuse of medical interventions, failure to use interventions known to be effective, and provision of tests or interventions in which benefits do not exceed harms are types of low-value care. The Lown Institute's Right Care Alliance Children's Health Council identified five "do" recommendations that highlight underuse and five "don't" recommendations that highlight overuse in children's health care. The five "do" recommendations include: do provide access to long-acting reversible contraception for adolescents, do use nonpharmacologic interventions first for tre...
Source: American Family Physician - March 15, 2019 Category: Primary Care Authors: Schefft M, Schroeder AR, Liu D, Nicklas D, Moher J, Quinonez R Tags: Am Fam Physician Source Type: research

Racial/Ethnic Variation in Emergency Department Care for Children With Asthma
Conclusions In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - March 1, 2019 Category: Emergency Medicine Tags: Original Articles Source Type: research

Exercise-Induced Dyspnea in Children and Adolescents: Differential Diagnosis.
Abstract Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, chest wall restrictive abnormalities, cardiac causes, and normal physiologic limitation. When exercise-induced dyspnea is not from asthma, cardiopulmonary exercise testing with repr...
Source: Pediatric Annals - March 1, 2019 Category: Pediatrics Authors: Bhatia R, Abu-Hasan M, Weinberger M Tags: Pediatr Ann Source Type: research

Differentiating non-responders from responders in children with moderate and severe asthma exacerbations.
Authors: Sneller H, Carroll CL, Welch K, Sturm J Abstract OBJECTIVE: Our goal was to assess factors associated with non-response to treatment in children presenting to the Emergency Department (ED) with moderate and severe asthma exacerbations. METHODS: A retrospective chart review was completed from 9/2014 to 2/2017 for patients with a discharge diagnosis of asthma exacerbation. The Modified Pulmonary Index Score (MPIS) was used to quantify illness acuity. The rate of change of MPIS per hour was calculated, and differentiated responders from non-responders. After examining a histogram of ΔMPIS/h, a thres...
Source: Journal of Asthma - February 24, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

Author response
Dr Weinberger disagrees with my assertion that large studies1 –5 demonstrating the safety of combination inhaled glucocorticoid (IGC) and long-acting–agonist (LABA) therapy are compelling because they did not include patients with life-threatening asthma. Dr Weinberger describes a case report he published in 2006 of 2 children with poorly controlled asthma despite high-dose IGC and LABA combination therapy who developed life-threatening episodes of bronchospasm after exercise that were not prevented by albuterol pretreatment. (Source: Annals of Allergy, Asthma and Immunology)
Source: Annals of Allergy, Asthma and Immunology - February 21, 2019 Category: Allergy & Immunology Authors: Joseph D. Spahn Tags: Correspondence Source Type: research

An Unusual Hypoxia Patient
​BY GORDON MURPHY, PA-C, MPHThe patient was blue, her primary care physician noted. Quite literally, in fact.The 38-year-old woman had sought care for a recurrent urinary tract infection, and that's when her primary care physician found her pulse oximetry to be 74%. He was concerned about hypoxia and asked us to evaluate her.The patient reported taking an SSRI for anxiety and having a hormone-eluting IUD. She had previously had a Roux-en-Y gastric bypass. She said she had a headache, but had been instructed not to take NSAIDs. She said she had just finished a course of Cipro for her UTI, but continued to be symptomatic w...
Source: The Case Files - February 20, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

65-Year-Old Woman With a Wheeze
A 65-year-old woman sought care from her primary care physician for a 5-month history of a gradually progressive cough, shortness of breath, and wheezing. Her medical history was notable for hypertension and asthma. Her medications included an albuterol rescue inhaler and lisinopril. With the exception of one hospital admission for pneumonia 5 years previously, she was in excellent health. Before the onset of symptoms, she was able to exercise 5 times a week with no limitations on activity. During the 5 months before the current presentation, however, her clinical status had deteriorated such that she was only able to walk...
Source: Mayo Clinic Proceedings - January 31, 2019 Category: Internal Medicine Authors: Divya Padmanabhan Menon, Neal M. Patel Tags: Residents ’ clinic Source Type: research

Two versus four puffs of albuterol: does dose change bronchodilator response?
(Source: Journal of Asthma and Allergy)
Source: Journal of Asthma and Allergy - January 30, 2019 Category: Allergy & Immunology Tags: Journal of Asthma and Allergy Source Type: research

Effects of flow pattern, device and formulation on particle size distribution of nebulized aerosol
In this study, the aerosol concentration and particle size distribution (PSD) were measured under a realistic breathing pattern and constant flow. Two types of nebulizer (i.e., breath-enhanced nebulizer and vibrating-mesh nebulizer) and two formulations (i.e., budesonide suspension and albuterol solution) were chosen for comparison. The aerosol concentration under the realistic pattern was not constant, which was different from the result at constant flow. The changing trend of aerosol concentration varied with the operation process of each device. The aerosol concentration profile was similar between budesonide suspension...
Source: International Journal of Pharmaceutics - January 20, 2019 Category: Drugs & Pharmacology Source Type: research

Burkholderia cepacia complex outbreaks among non-cystic fibrosis patients in the intensive care units: A review of adult and pediatric literature.
Authors: Abdallah M, Abdallah HA, Memish ZA Abstract Burkholderia cepacia complex (Bcc) is a Gram-negative bacterium commonly found in moist environments and soil. Bcc species are associated with many outbreaks in intensive care units (ICUs). In this review, we describe the sources of Bcc outbreaks among non-cystic fibrosis (CF) patients in various ICUs that include neonatal intensive care units, pediatric intensive care units and adult ICUs. Also we summarize the risk factors and outcome predictors of Bcc infection or colonization in non-CF critically ill patients. Finally, we describe the infection control measur...
Source: Infezioni in Medicina - December 19, 2018 Category: Infectious Diseases Tags: Infez Med Source Type: research

[Drug Output and Aerosol Characteristics of Different Jet Nebulisers for Adults While Simulating the Nebulisation of Salbutamol].
CONCLUSION:  The results of the in vitro simulation studies can be utilised to select an appropriate nebuliser for the individual patient. In order to enhance therapeutic efficacy and patient compliance, a nebuliser with a high RDDR should be selected. PMID: 30453377 [PubMed - as supplied by publisher] (Source: Pneumologie)
Source: Pneumologie - November 21, 2018 Category: Respiratory Medicine Tags: Pneumologie Source Type: research

Allergic Sensitization Is Associated with Decreased Risk of ED Visits and Hospitalizations for Pain in Sickle Cell Disease
Conclusions: In a population of children with SCD, allergic sensitization was associated with decreased risk of ED visits (total, for pain, and for fever). The mechanism for an association between atopy and a less severe phenotype of SCD is unclear. These findings point to potential differences in immunologic endotype/phenotype and add support to the hypothesis that lower airway disease in children with SCD has a different mechanism than typical childhood atopic asthma. Further investigation into the immunologic phenotypes and mechanisms of lower airway disease in children with SCD is warranted.1All IRR presented are per a...
Source: Blood - November 21, 2018 Category: Hematology Authors: Sadreameli, C., Kopp, B., Creary, S. E., Jacobs, E., Strouse, J. J., McGrath-Morrow, S. A., Casella, J. F., Matsui, E. C. Tags: 114. Hemoglobinopathies, Excluding Thalassemia-Clinical: Poster III Source Type: research

Hypofibrinogenemia in Patient with Extended Exposure to Argatroban Therapy
A 42 year old female with past medical history of asthma and recent admission for Alprazolam overdose presented to our hospital with dyspnea and generalized weakness.. She was noted by paramedics to be hypoxic, hypotensive and bradycardic, and she was intubated in the field prior to arrival.. Medication prior to admission, Albuterol HFA. Patient had no known drug allergies. On presentation to the emergency department, patient appeared critically ill, hypotensive to 74/50 , hypoxic with oxygen saturation of 60%, heart rate of 137 BPM, respiratory rate 15/min, temp 99 F, and unresponsive to verbal stimuli. Endotrachial tube ...
Source: Blood - November 21, 2018 Category: Hematology Authors: Saudi, M. Tags: 322. Disorders of Coagulation or Fibrinolysis Source Type: research

Valved holding chambers vary considerably in drug delivery efficacy
Conclusion: The evident difference in drug delivery with VHCs has potentially great consequences regarding successful treatment of children with bronchoconstriction. There is a need for comprehensive and financially independent testing and standardisation of VHCs. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Csonka, P., Lehtimaki, L. Tags: Paediatric asthma and allergy Source Type: research

Late Breaking Abstract - Explore the effective dose of bronchodilator nebulization via high flow nasal cannula in adult COPD and asthma patients
Conclusion: Bronchodilator delivery via HFNC is similarly effective as MDI with spacer. Standard label dose (2.5mg) of albuterol via HFNC is sufficient to cause bronchodilation for asthma and COPD patients. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Li, J., Hadeer, M., Zhao, M., Fink, J. Tags: Airway pharmacology and treatment Source Type: research

Short-acting bronchodilators for in-hospital management of acute exacerbation of COPD: Systematic Review
Introduction: No specific guidelines exist for administration of short-acting bronchodilator (SABD) for people hospitalised with acute exacerbation of chronic obstructive pulmonary disease (AECOPD); despite routine use in practice and risk of cardiac adverse events.Aim: To review evidence underpinning use and optimal dose, in terms of risk versus benefit, of SABD for inpatient management of AECOPD.Methods: A systematic search of Medline, Embase, CENTRAL and grey literature was conducted (up to December 2017) to identify relevant randomised controlled trials (RCT) or controlled clinical trials (CCT). Review methods were in ...
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Kopsaftis, Z., Sulaiman, N., Carson, K., Mountain, O., Phillips, P., Smith, B. Tags: Clinical Problems Source Type: research

Comparing Lung Geometrical Areas of interest in Gamma Scintigraphy as Assessment Tool for Inhaled Drug Deposition
Background: Planar gamma scintigraphy is a powerful tool in therapeutic aerosol studies to evaluate inhaled drug delivery to the lungs. Alas, different laboratories use different approaches for analysing and quantifying aerosol lung deposition and its airway distribution, making it difficult to compare data.Aim: To compare the most common analysis approaches, assess total and regional deposition of inhaled aerosol and highlight similarities and differences. The eventually aim is to draw nearer to a consensus on standardized methodology for defining lung regions of interest so that data from different laboratories may be co...
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Ghazwani, A., Biddiscombe, M., Usmani, O. Tags: Airway pharmacology and treatment Source Type: research

Nebulizer Location and spontaneous breathing on Aerosol Delivery during Airway Pressure Release Ventilation in Adult Lung Model
Conclusion: The position at gas inlet of a heated humidifier is to the benefet to the albuterol deposition. APRV with spontaneous breath increase the deposition. Minutes volume of the cohorts was significantly correlated with the delivery drug dose. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Ge, H., Wang, J. Tags: Acute Critical Care Source Type: research

Noninvasive ventilation compared to Albuterol in respiratory mechanics and lung function of asthmatics after bronchoprovocation. Randomized cross-over trial.
Conclusion: the NIV has bronchodilator effect and may recovery the IC besides to retrieve the baseline minute volume faster although the effects on lung function are more modest. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Gomes, E., David, M., Santos, A., Magalhaes, A., Alves, V., Costa, D. Tags: Noninvasive Ventilatory Support Source Type: research

Comparison of aerosol delivery from two inhaler technique-guidance devices.
Conclusions: FTCR reduced throat (IP) deposition; CT did not. FTCR is providing mini-spacer functionality which has regulatory implications. CT, which locates ahead of the point of aerosol generation, does not change delivery and is therefore potentially regulatable with in vitro data. Control+FTCRControl+CTFPF (%
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Sanders, M., Bruin, R., Tran, C. Tags: Monitoring Airway Disease Source Type: research

Albuterol delivery by soft mist and pressurized metered dose inhalers during noninvasive ventilation in a model of a spontaneously breathing child
Conclusion: Albuterol delivery during NIV with a single-limb ventilator circuit in a model of a spontaneously breathing child using pMDI/SMI is inefficient and is not a cost-efficient when compared to nebulization. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Berlinski, A., Velasco, J. Tags: Neonatology and paediatric intensive care Source Type: research

A Machine-Learning Approach to Predicting Need for Hospitalization for Pediatric Asthma Exacerbation at the Time of Emergency Department Triage.
CONCLUSIONS: The gradient boosting machines model was the most successful at predicting need for hospitalization at the time of triage in pediatric patients presenting with asthma exacerbation. The addition of weather data significantly improved the performance of this model. This article is protected by copyright. All rights reserved. PMID: 30382605 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - November 1, 2018 Category: Emergency Medicine Authors: Patel SJ, Chamberlain DB, Chamberlain JM Tags: Acad Emerg Med Source Type: research

Cell-based assays and molecular dynamics analysis of a boron-containing agonist with different profiles of binding to human and guinea pig beta2 adrenoceptors.
taño JA, Trujillo-Ferrara JG Abstract The design of beta2 adrenoceptor (β2AR) agonists is attractive because of their wide-ranging applications in medicine, and the details of agonist interactions with β2AR are interesting because it is considered a prototype for G-protein coupled receptors. Preclinical studies for agonist development have involved biological assays with guinea pigs due to a similar physiology to humans. Boron-containing Albuterol derivatives (BCADs) designed as bronchodilators have improved potency and efficacy compared with their boron-free precursor on guinea pig β2ARs (gp...
Source: European Biophysics Journal : EBJ - November 1, 2018 Category: Physics Authors: Soriano-Ursúa MA, Bello M, Hernández-Martínez CF, Santillán-Torres I, Guerrero-Ramírez R, Correa-Basurto J, Arias-Montaño JA, Trujillo-Ferrara JG Tags: Eur Biophys J Source Type: research