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  1. Article ; Online: Aerosol Plumes of Inhalers Used in COPD.

    Wachtel, Herbert / Emerson-Stadler, Rachel / Langguth, Peter / Hohlfeld, Jens M / Ohar, Jill

    Pulmonary therapy

    2024  Volume 10, Issue 1, Page(s) 109–122

    Abstract: Introduction: The selection of inhaler device is of critical importance in chronic obstructive pulmonary disease (COPD) as the interaction between a patient's inhalation profile and the aerosol characteristics of an inhaler can affect drug delivery and ... ...

    Abstract Introduction: The selection of inhaler device is of critical importance in chronic obstructive pulmonary disease (COPD) as the interaction between a patient's inhalation profile and the aerosol characteristics of an inhaler can affect drug delivery and lung deposition. This study assessed the in vitro aerosol characteristics of inhaler devices approved for the treatment of COPD, including a soft mist inhaler (SMI), pressurized metered-dose inhalers (pMDIs), and dry powder inhalers (DPIs).
    Methods: High-speed video recording was used to visualize and measure aerosol velocity and spray duration for nine different inhalers (one SMI, three pMDIs, and five DPIs), each containing dual or triple fixed-dose combinations of long-acting muscarinic receptor antagonists and long-acting β
    Results: The Respimat SMI had the slowest plume velocity (0.99 m/s) and longest spray duration (1447 ms) compared with pMDIs (velocity: 3.65-5.09 m/s; duration: 227-270 ms) and DPIs (velocity: 1.43-4.60 m/s; duration: 60-757 ms). With increasing flow rates, SMI aerosol duration was unaffected, but velocity increased (maximum 2.63 m/s), pMDI aerosol velocity and duration were unaffected, and DPI aerosol velocity tended to increase, with a more variable impact on duration.
    Conclusions: Aerosol characteristics (velocity and duration of aerosol plume) vary by inhaler type. Plume velocity was lower and spray duration longer for the SMI compared with pMDIs and DPIs. Increasing experimental flow rate was associated with faster plume velocity for DPIs and the SMI, with no or variable impact on plume duration, whereas pMDI aerosol velocity and duration were unaffected by increasing flow rate.
    Language English
    Publishing date 2024-01-09
    Publishing country United States
    Document type Journal Article
    ISSN 2364-1746
    ISSN (online) 2364-1746
    DOI 10.1007/s41030-023-00249-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical Implications of Peak Inspiratory Flow in COPD: Post Hoc Analyses of the TRONARTO Study.

    Mahler, Donald A / Watz, Henrik / Emerson-Stadler, Rachel / Ritz, John / Gardev, Asparuh / Shaikh, Asif / Drummond, M Bradley

    International journal of chronic obstructive pulmonary disease

    2023  Volume 18, Page(s) 1729–1740

    Abstract: Background: In patients with COPD, inhalation ability should be assessed when considering inhaler choice. To evaluate whether the soft mist inhaler (SMI) is suitable for COPD patients irrespective of inhalation ability, the TRONARTO study investigated ... ...

    Abstract Background: In patients with COPD, inhalation ability should be assessed when considering inhaler choice. To evaluate whether the soft mist inhaler (SMI) is suitable for COPD patients irrespective of inhalation ability, the TRONARTO study investigated the efficacy of dual long-acting bronchodilator therapy delivered via the Respimat
    Methods: This congress compilation summarizes post hoc analyses from the TRONARTO study presented at the annual American Thoracic Society 2022 and European Respiratory Society 2022 meetings. These analyses evaluated PIF in over 200 patients, with PIF measurements taken daily at home for 4 weeks, and in the clinic at baseline, Weeks 2 and 4.
    Results: Overall, 57.9% of patients had a PIF range (difference between lowest and highest PIF measurements) <20 L/min (12.4% of patients had PIF range <10 L/min). At-home PIF range decreased over the study period, suggesting that inhaler training/repeated PIF measurements may help to make patients' inspiratory effort more consistent. Some patient characteristics correlated with lower PIF (female gender, shorter stature, more severe disease, worse airflow obstruction) and lower PIF range (more severe disease). PIF measurements differed between medium-low and high-resistance settings, highlighting the importance of measuring PIF at the resistance of a patient's inhaler. PIF correlated poorly with spirometry measurements.
    Conclusion: As indicated in COPD management guidelines, choice of inhaler is essential to optimize pharmacologic therapies for COPD. Poor inspiratory ability should be viewed as a treatable trait that can help to inform inhaler choice. Inhaler training and consideration of PIF (if patients use a dry powder inhaler) can reduce patient-to-inhaler mismatch, with potential consequences for health status and exacerbation risk.
    MeSH term(s) Humans ; Female ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Dry Powder Inhalers ; Health Status ; Phenotype ; Respiratory Rate
    Language English
    Publishing date 2023-08-10
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2212419-6
    ISSN 1178-2005 ; 1176-9106
    ISSN (online) 1178-2005
    ISSN 1176-9106
    DOI 10.2147/COPD.S404243
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: EVELUT®: A Real-World, Observational Study Assessing Dyspnoea and Symptom Burden in COPD Patients Switched from LABA/ICS to LAMA/LABA or LAMA/LABA/ICS.

    Buhl, Roland / Dreher, Michael / Mattiucci-Guehlke, Muriel / Emerson-Stadler, Rachel / Eckhardt, Sebastian / Taube, Christian / Vogelmeier, Claus F

    Advances in therapy

    2023  Volume 40, Issue 7, Page(s) 3263–3278

    Abstract: Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023) no longer recommends a long-acting β: Methods: Patients with symptomatic COPD at low exacerbation risk (GOLD B) were switched, at their physicians' discretion, from ... ...

    Abstract Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023) no longer recommends a long-acting β
    Methods: Patients with symptomatic COPD at low exacerbation risk (GOLD B) were switched, at their physicians' discretion, from LABA/ICS to either fixed-dose LAMA/LABA (tiotropium/olodaterol, Respimat
    Results: The safety set contained 463 patients (Tio/Olo, n = 329; TT, n = 134). In a propensity score-matched set (Tio/Olo, n = 121; TT, n = 121), improvement in mMRC score was similar in patients on Tio/Olo (-0.23; 95% confidence interval [CI] -0.11, -0.36) and TT (-0.25; 95% CI -0.13, -0.38). Improvement in total CAT score was slightly larger in patients on Tio/Olo (-3.45; 95% CI -2.45, -4.45) versus TT (-2.51; 95% CI -1.62, -3.40). In both groups, Physician's Global Evaluation scores increased, with 69-89% of patients satisfied with their treatment overall. Marginally more patients on Tio/Olo responded to treatment versus TT (Δ mMRC score ≥ 1; 25% vs. 22%; Δ CAT score ≥ 2, 68% vs. 56%).
    Conclusion: In patients with symptomatic COPD at low exacerbation risk, treatment can be switched from LABA/ICS to LAMA/LABA without compromising clinical benefit, compared with escalating to LAMA/LABA/ICS. Switching from LABA/ICS to LAMA/LABA can provide symptom relief and improve health status without exposure to the risks associated with ICS.
    Clinical trial registration: ClinicalTrials.gov: NCT03954132.
    MeSH term(s) Humans ; Muscarinic Antagonists ; Administration, Inhalation ; Disease Progression ; Adrenergic beta-2 Receptor Agonists ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Drug Therapy, Combination ; Dyspnea/drug therapy ; Adrenal Cortex Hormones/therapeutic use ; Bronchodilator Agents/therapeutic use
    Chemical Substances Muscarinic Antagonists ; Adrenergic beta-2 Receptor Agonists ; Adrenal Cortex Hormones ; Bronchodilator Agents
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632651-1
    ISSN 1865-8652 ; 0741-238X
    ISSN (online) 1865-8652
    ISSN 0741-238X
    DOI 10.1007/s12325-023-02524-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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