James Fink - Academia.edu (original) (raw)

Papers by James Fink

Research paper thumbnail of The Effect of Aerosol Device and Administration Technique on Drug Delivery in a Simulated Spontaneously Breathing Pediatric Model with Tracheostomy

Journal of Aerosol Medicine and Pulmonary Drug Delivery

Research paper thumbnail of Breath-Actuated Nebulizer Versus Small-Volume Nebulizer: Efficacy, Safety, and Satisfaction

Research paper thumbnail of Aerosol Drug Therapy

Research paper thumbnail of Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

Respiratory care, Jan 7, 2015

The primary focus of previous aerosol research during mechanical ventilation was the endotracheal... more The primary focus of previous aerosol research during mechanical ventilation was the endotracheal tube (ETT). Consequently, there are limited data in the literature on the delivery of inhaled medications administered with different aerosol devices in mechanically ventilated patients with a tracheostomy tube (TT). The purpose of this study was to quantify and compare the efficiency of aerosol devices in a lung model of an intubated and mechanically ventilated adult with a TT. An in vitro lung model was constructed to simulate a ventilator-dependent adult with a Portex TT and a Mallinckrodt ETT (8-mm inner diameter). Aerosol was collected distal to the bronchi of an adult mannikin on a filter attached to a passive test lung. A ventilator delivered adult breathing parameters (tidal volume 450 mL, breathing frequency 20 breaths/min, peak expiratory flow 40 L/min, and inspiratory-expiratory ratio 1:3) to the airway. A jet nebulizer and pressurized metered-dose inhaler (pMDI) were placed ...

Research paper thumbnail of Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

Respiratory care, Jan 23, 2015

In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are sca... more In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are scarce in the literature. The aim of this study was to compare radioaerosol pulmonary index and radioaerosol mass balance in the different compartments (pulmonary and extrapulmonary) of radio-tagged aerosol administered using vibrating mesh nebulizers and conventional jet nebulizers during NIV. This was a crossover clinical trial involving 10 healthy subjects (mean age of 33.7 ± 10.0 y) randomly assigned to both treatment arms of this study: group 1 (NIV + vibrating mesh nebulizer, n = 10) and group 2 (NIV + jet nebulizer, n = 10). All subjects inhaled 3 mL of technetium-99m diethylenetriaminepentaacetic acid (25 mCi) and 0.9% saline solution via vibrating mesh and jet nebulizers during NIV through a face mask secured with straps while receiving positive inspiratory and expiratory pressures of 12 and 5 cm H2O, respectively. Scintigraphy was performed to count radioaerosol particles deposite...

Research paper thumbnail of Comparison of Aerosol Delivery by Face Mask and Tracheostomy Collar

Respiratory Care, 2015

BACKGROUND: The purpose of this study was to compare the performance of a tracheostomy collar, Wr... more BACKGROUND: The purpose of this study was to compare the performance of a tracheostomy collar, Wright mask, and aerosol mask attached to a jet nebulizer in facilitating aerosolized medication delivery to the lungs. We also compared albuterol delivery with open versus closed fenestration and determined the effect of inspiratory-expiratory ratio (I:E) on aerosol delivery. METHODS: Albuterol (2.5 mg/3 mL) was administered to an in vitro model consisting of an adult teaching mannequin extrathoracic and upper airway with stoma intubated with an 8-mm fenestrated tracheostomy tube. The cuff was deflated. A collecting filter at the level of the bronchi was connected to a breathing simulator at a tidal volume of 400 mL, breathing frequency of 20 breaths/ min, and I:E of 2:1 and 1:2. A jet nebulizer was operated with O 2 at 8 L/min. Each interface was tested in triplicate. The flow was discontinued at the end of nebulization. For each test, the nebulizer was attached to a tracheostomy collar with the fenestration open or closed, a Wright mask, or an aerosol mask. Drug was analyzed by spectrophotometry (276 nm). A paired t test and analysis of variance were performed (P < .05). RESULTS: The mean ؎ SD percent albuterol dose delivered distal to the bronchi was greater with the tracheostomy collar with a closed fenestration (9.4 ؎ 1.5%) compared with an open fenestration (7.0 ؎ 0.8%). The doses delivered with the Wright mask (4.1 ؎ 0.6%) and aerosol mask (3.5 ؎ 0.04%) were both less than with the tracheostomy collar under either condition (P < .05). Increasing the I:E from 1:2 to 2:1 increased aerosol delivery by 2.5-4%, with significance for the tracheostomy collar with an open fenestration (11.6 ؎ 1.4%), Wright mask (7.2 ؎ 0.6%), and aerosol mask (6.1 ؎ 0.5%). CONCLUSIONS: In an adult tracheostomy model, the tracheostomy collar delivered more aerosol to the bronchi than the Wright or aerosol mask. An I:E of 2:1 caused greater aerosol deposition compared with an I:E of 1:2. During aerosol administration via a tracheostomy collar, closing the fenestration improved aerosol delivery.

Research paper thumbnail of In vitro evaluation of aerosol delivery by different nebulization modes in pediatric and adult mechanical ventilators

Respiratory care, 2014

Aerosol delivery through mechanical ventilation is influenced by the type of aerosol generator, p... more Aerosol delivery through mechanical ventilation is influenced by the type of aerosol generator, pattern of nebulization, and a patient's breathing pattern. This study compares the efficiency of pneumatic nebulization modes provided by a ventilator with adult and pediatric in vitro lung models. Three pneumatic nebulization modes (inspiratory intermittent [IIM], continuous [CM], and expiratory intermittent [EIM]) provided by the Galileo Gold ventilator delivered medical aerosol to collection filters distal to an endotracheal tube with adult and pediatric test lungs. A unit dose of 5 mg/2.5 mL albuterol was diluted into 4 mL with distilled water and added to a jet nebulizer. The nebulizer was placed proximal to the ventilator, 15 cm from the inlet of the heated humidifier chamber with a T-piece and corrugated aerosol tubing and powered by gas from the ventilator in each of the 3 modes. Time for nebulization was recorded in minutes. Albuterol samples collected in the inhalation filt...

Research paper thumbnail of Effect of Aerosol Devices and Administration Techniques on Drug Delivery in a Simulated Spontaneously Breathing Pediatric Tracheostomy Model

Respiratory Care, 2015

BACKGROUND: This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh ... more BACKGROUND: This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh nebulizers, and pressurized metered-dose inhalers (pMDI) during assisted and unassisted administration techniques using a simulated spontaneously breathing pediatric model with a tracheostomy tube (TT). METHODS: An in vitro breathing model consisting of an uncuffed TT (4.5-mm inner diameter) was attached to a collecting filter (Respirgard) connected to a dualchamber test lung and a ventilator (Hamilton Medical) to simulate breathing parameters of a 2-y-old child (breathing frequency, 25 breaths/min; tidal volume, 150 mL; inspiratory time, 0.8 s; peak inspiratory flow, 20 L/min). Albuterol sulfate was administered using a jet nebulizer (Micro-Mist, 2.5 mg/3 mL), vibrating mesh nebulizer (Aeroneb Solo, 2.5 mg/3 mL), and pMDI (ProAir HFA, 432 g). Each device was tested 5 times with an unassisted technique (direct administration of aerosols with simulated spontaneous breathing) and with an assisted technique (using a manual resuscitation bag in conjunction with an aerosol device and synchronized with inspiration). Drug collected on the filter was analyzed by spectrophotometry. RESULTS: With the unassisted technique, the pMDI had the highest inhaled mass percent (IM%, 47.15 ؎ 7.82%), followed by the vibrating mesh nebulizer (19.77 ؎ 2.99%) and the jet nebulizer (5.88 ؎ 0.77%, P ‫؍‬ .002). IM was greater with the vibrating mesh nebulizer (0.49 ؎ .07 mg) than with the pMDI (0.20 ؎ 0.03 mg) and the jet nebulizer (0.15 ؎ 0.01 mg, P ‫؍‬ .007). The trend of lower deposition with the assisted versus unassisted technique was not significant for the jet nebulizer (P ‫؍‬ .46), vibrating mesh nebulizer (P ‫؍‬ .19), and pMDI (P ‫؍‬ .64). CONCLUSIONS: In this in vitro pediatric breathing model with a TT, the pMDI delivered the highest IM%, whereas the vibrating mesh nebulizer delivered the highest IM. The jet nebulizer was the least efficient device. Delivery efficiency was similar with unassisted and assisted administration techniques.

Research paper thumbnail of Gene expression analysis of human induced pluripotent stem cell-derived neurons carrying copy number variants of chromosome 15q11-q13.1

Research paper thumbnail of Performance Comparisons of Jet and Mesh Nebulizers With Mouthpiece, Aerosol Mask, and Valved Mask in Simulated Spontaneously Breathing Adults

CHEST Journal, 2014

Background: Different types of nebulizers and interfaces are used for the treatment of adults and... more Background: Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer ( JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study.

Research paper thumbnail of Bronchodilator Therapy in Mechanically Ventilated Patients

Research paper thumbnail of Metered-dose inhalers, dry powder inhalers, and transitions

Respiratory care, 2000

Since 1956, the pMDI has become the most commonly prescribed and used aerosol device in the world... more Since 1956, the pMDI has become the most commonly prescribed and used aerosol device in the world. While concerns about global warming have led to a worldwide ban of CFCs, new HFA-propelled pMDIs are in development, requiring an evolutionary transition in the technology. The phase-out of CFC-propelled pMDIs has stimulated the development of more efficient DPIs, but issues such as cost of device production, inspiratory flow requirement, and the effects of ambient humidity on drug delivery may limit DPI acceptance, and industry projections suggest that the DPI will not completely replace the pMDI. Holding chambers may perform differently with HFA-propelled pMDIs, but HFA-propelled pMDIs generally appear to cause less oropharyngeal deposition and to improve lung delivery while continuing to provide protection from poor hand-breath coordination. The initial offerings of the emerging HFA-propelled pMDI technology appear to be resulting in an improved pMDI.

Research paper thumbnail of Problems with inhaler use: a call for improved clinician and patient education

Respiratory care, 2005

Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers rep... more Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. Between 28% and 68% of patients do not use metered-dose inhalers or powder inhalers well enough to benefit from the prescribed medication, and 39-67% of nurses, doctors, and respiratory therapists are unable to adequately describe or perform critical steps for using inhalers. Of an estimated 25 billion dollars spent for inhalers annually, 5-7 billion dollars is wasted because of inhaler misuse. Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.

Research paper thumbnail of Use of Positive Airway Pressure Adjuncts to Bronchial Hygiene Therapy

International Anesthesiology Clinics, 1996

Advertisement. International Anesthesiology Clinics. Wolters Kluwer Health Logo. All Issues. ...

Research paper thumbnail of Aerosol Deposition in Neonatal Ventilation

Research paper thumbnail of Directed Cough

International Anesthesiology Clinics, 1996

Research paper thumbnail of Incentive Spirometry

International Anesthesiology Clinics, 1996

Research paper thumbnail of An Inhaled Matrix Metalloprotease Inhibitor Prevents Cigarette Smoke-Induced Emphysema in the Mouse

COPD: Journal of Chronic Obstructive Pulmonary Disease, 2005

Inadequately regulated proteolytic activity is responsible for the chronic lung tissue degenerati... more Inadequately regulated proteolytic activity is responsible for the chronic lung tissue degeneration and irreversible loss of pulmonary function that define emphysema. In this study, we show that an inhaled broad-spectrum matrix metalloprotease inhibitor, ilomastat, can provide protection against the development of emphysema in cigarette smoke-treated mice. Control animals were exposed to daily cigarette smoke for 6 months. As has been reported previously, cigarette smoke was seen to increase significantly the recruitment of macrophages into the lungs of these animals, leading to concomitant alveolar airspace enlargement and emphysema. In animals treated daily with nebulized ilomastat for 6 months, lung macrophage levels were greatly reduced, and neutrophil accumulation was also inhibited. Corresponding reductions in airspace enlargement of up to 96% were observed. These striking observations suggest that delivery of ilomastat directly into the lungs of smoke-treated mice can not only inhibit lung tissue damage mediated by metalloproteases, but may also reduce that component of tissue degeneration mediated by excess neutrophil-derived products. Our data also suggest that the matrix metalloprotease inhibitors may represent a class of drugs that, when delivered by inhalation, could be used practically to treat cigarette smoking-related chronic obstructive pulmonary disease by modifying the course of the disease.

Research paper thumbnail of Selection of Aerosol Delivery Device

International Anesthesiology Clinics, 1996

ABSTRACT

Research paper thumbnail of Intermittent Positive Pressure Breathing

International Anesthesiology Clinics, 1996

Research paper thumbnail of The Effect of Aerosol Device and Administration Technique on Drug Delivery in a Simulated Spontaneously Breathing Pediatric Model with Tracheostomy

Journal of Aerosol Medicine and Pulmonary Drug Delivery

Research paper thumbnail of Breath-Actuated Nebulizer Versus Small-Volume Nebulizer: Efficacy, Safety, and Satisfaction

Research paper thumbnail of Aerosol Drug Therapy

Research paper thumbnail of Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study

Respiratory care, Jan 7, 2015

The primary focus of previous aerosol research during mechanical ventilation was the endotracheal... more The primary focus of previous aerosol research during mechanical ventilation was the endotracheal tube (ETT). Consequently, there are limited data in the literature on the delivery of inhaled medications administered with different aerosol devices in mechanically ventilated patients with a tracheostomy tube (TT). The purpose of this study was to quantify and compare the efficiency of aerosol devices in a lung model of an intubated and mechanically ventilated adult with a TT. An in vitro lung model was constructed to simulate a ventilator-dependent adult with a Portex TT and a Mallinckrodt ETT (8-mm inner diameter). Aerosol was collected distal to the bronchi of an adult mannikin on a filter attached to a passive test lung. A ventilator delivered adult breathing parameters (tidal volume 450 mL, breathing frequency 20 breaths/min, peak expiratory flow 40 L/min, and inspiratory-expiratory ratio 1:3) to the airway. A jet nebulizer and pressurized metered-dose inhaler (pMDI) were placed ...

Research paper thumbnail of Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

Respiratory care, Jan 23, 2015

In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are sca... more In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are scarce in the literature. The aim of this study was to compare radioaerosol pulmonary index and radioaerosol mass balance in the different compartments (pulmonary and extrapulmonary) of radio-tagged aerosol administered using vibrating mesh nebulizers and conventional jet nebulizers during NIV. This was a crossover clinical trial involving 10 healthy subjects (mean age of 33.7 ± 10.0 y) randomly assigned to both treatment arms of this study: group 1 (NIV + vibrating mesh nebulizer, n = 10) and group 2 (NIV + jet nebulizer, n = 10). All subjects inhaled 3 mL of technetium-99m diethylenetriaminepentaacetic acid (25 mCi) and 0.9% saline solution via vibrating mesh and jet nebulizers during NIV through a face mask secured with straps while receiving positive inspiratory and expiratory pressures of 12 and 5 cm H2O, respectively. Scintigraphy was performed to count radioaerosol particles deposite...

Research paper thumbnail of Comparison of Aerosol Delivery by Face Mask and Tracheostomy Collar

Respiratory Care, 2015

BACKGROUND: The purpose of this study was to compare the performance of a tracheostomy collar, Wr... more BACKGROUND: The purpose of this study was to compare the performance of a tracheostomy collar, Wright mask, and aerosol mask attached to a jet nebulizer in facilitating aerosolized medication delivery to the lungs. We also compared albuterol delivery with open versus closed fenestration and determined the effect of inspiratory-expiratory ratio (I:E) on aerosol delivery. METHODS: Albuterol (2.5 mg/3 mL) was administered to an in vitro model consisting of an adult teaching mannequin extrathoracic and upper airway with stoma intubated with an 8-mm fenestrated tracheostomy tube. The cuff was deflated. A collecting filter at the level of the bronchi was connected to a breathing simulator at a tidal volume of 400 mL, breathing frequency of 20 breaths/ min, and I:E of 2:1 and 1:2. A jet nebulizer was operated with O 2 at 8 L/min. Each interface was tested in triplicate. The flow was discontinued at the end of nebulization. For each test, the nebulizer was attached to a tracheostomy collar with the fenestration open or closed, a Wright mask, or an aerosol mask. Drug was analyzed by spectrophotometry (276 nm). A paired t test and analysis of variance were performed (P < .05). RESULTS: The mean ؎ SD percent albuterol dose delivered distal to the bronchi was greater with the tracheostomy collar with a closed fenestration (9.4 ؎ 1.5%) compared with an open fenestration (7.0 ؎ 0.8%). The doses delivered with the Wright mask (4.1 ؎ 0.6%) and aerosol mask (3.5 ؎ 0.04%) were both less than with the tracheostomy collar under either condition (P < .05). Increasing the I:E from 1:2 to 2:1 increased aerosol delivery by 2.5-4%, with significance for the tracheostomy collar with an open fenestration (11.6 ؎ 1.4%), Wright mask (7.2 ؎ 0.6%), and aerosol mask (6.1 ؎ 0.5%). CONCLUSIONS: In an adult tracheostomy model, the tracheostomy collar delivered more aerosol to the bronchi than the Wright or aerosol mask. An I:E of 2:1 caused greater aerosol deposition compared with an I:E of 1:2. During aerosol administration via a tracheostomy collar, closing the fenestration improved aerosol delivery.

Research paper thumbnail of In vitro evaluation of aerosol delivery by different nebulization modes in pediatric and adult mechanical ventilators

Respiratory care, 2014

Aerosol delivery through mechanical ventilation is influenced by the type of aerosol generator, p... more Aerosol delivery through mechanical ventilation is influenced by the type of aerosol generator, pattern of nebulization, and a patient's breathing pattern. This study compares the efficiency of pneumatic nebulization modes provided by a ventilator with adult and pediatric in vitro lung models. Three pneumatic nebulization modes (inspiratory intermittent [IIM], continuous [CM], and expiratory intermittent [EIM]) provided by the Galileo Gold ventilator delivered medical aerosol to collection filters distal to an endotracheal tube with adult and pediatric test lungs. A unit dose of 5 mg/2.5 mL albuterol was diluted into 4 mL with distilled water and added to a jet nebulizer. The nebulizer was placed proximal to the ventilator, 15 cm from the inlet of the heated humidifier chamber with a T-piece and corrugated aerosol tubing and powered by gas from the ventilator in each of the 3 modes. Time for nebulization was recorded in minutes. Albuterol samples collected in the inhalation filt...

Research paper thumbnail of Effect of Aerosol Devices and Administration Techniques on Drug Delivery in a Simulated Spontaneously Breathing Pediatric Tracheostomy Model

Respiratory Care, 2015

BACKGROUND: This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh ... more BACKGROUND: This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh nebulizers, and pressurized metered-dose inhalers (pMDI) during assisted and unassisted administration techniques using a simulated spontaneously breathing pediatric model with a tracheostomy tube (TT). METHODS: An in vitro breathing model consisting of an uncuffed TT (4.5-mm inner diameter) was attached to a collecting filter (Respirgard) connected to a dualchamber test lung and a ventilator (Hamilton Medical) to simulate breathing parameters of a 2-y-old child (breathing frequency, 25 breaths/min; tidal volume, 150 mL; inspiratory time, 0.8 s; peak inspiratory flow, 20 L/min). Albuterol sulfate was administered using a jet nebulizer (Micro-Mist, 2.5 mg/3 mL), vibrating mesh nebulizer (Aeroneb Solo, 2.5 mg/3 mL), and pMDI (ProAir HFA, 432 g). Each device was tested 5 times with an unassisted technique (direct administration of aerosols with simulated spontaneous breathing) and with an assisted technique (using a manual resuscitation bag in conjunction with an aerosol device and synchronized with inspiration). Drug collected on the filter was analyzed by spectrophotometry. RESULTS: With the unassisted technique, the pMDI had the highest inhaled mass percent (IM%, 47.15 ؎ 7.82%), followed by the vibrating mesh nebulizer (19.77 ؎ 2.99%) and the jet nebulizer (5.88 ؎ 0.77%, P ‫؍‬ .002). IM was greater with the vibrating mesh nebulizer (0.49 ؎ .07 mg) than with the pMDI (0.20 ؎ 0.03 mg) and the jet nebulizer (0.15 ؎ 0.01 mg, P ‫؍‬ .007). The trend of lower deposition with the assisted versus unassisted technique was not significant for the jet nebulizer (P ‫؍‬ .46), vibrating mesh nebulizer (P ‫؍‬ .19), and pMDI (P ‫؍‬ .64). CONCLUSIONS: In this in vitro pediatric breathing model with a TT, the pMDI delivered the highest IM%, whereas the vibrating mesh nebulizer delivered the highest IM. The jet nebulizer was the least efficient device. Delivery efficiency was similar with unassisted and assisted administration techniques.

Research paper thumbnail of Gene expression analysis of human induced pluripotent stem cell-derived neurons carrying copy number variants of chromosome 15q11-q13.1

Research paper thumbnail of Performance Comparisons of Jet and Mesh Nebulizers With Mouthpiece, Aerosol Mask, and Valved Mask in Simulated Spontaneously Breathing Adults

CHEST Journal, 2014

Background: Different types of nebulizers and interfaces are used for the treatment of adults and... more Background: Different types of nebulizers and interfaces are used for the treatment of adults and children with pulmonary diseases. The purpose of this study was to determine the efficiency of a mesh nebulizer (MN) with a proprietary adapter and a jet nebulizer ( JN) under different configurations in adult and pediatric models of spontaneous breathing. We hypothesize that delivery efficiency of JN and MN will differ depending on the interface used during aerosol therapy in simulated spontaneously breathing adult and pediatric models. While we expect that aerosol delivery with JN will be less efficient than MN, we also hypothesize that lung deposition obtained with the adult lung model will be more than that with the pediatric lung model in all conditions tested in this study.

Research paper thumbnail of Bronchodilator Therapy in Mechanically Ventilated Patients

Research paper thumbnail of Metered-dose inhalers, dry powder inhalers, and transitions

Respiratory care, 2000

Since 1956, the pMDI has become the most commonly prescribed and used aerosol device in the world... more Since 1956, the pMDI has become the most commonly prescribed and used aerosol device in the world. While concerns about global warming have led to a worldwide ban of CFCs, new HFA-propelled pMDIs are in development, requiring an evolutionary transition in the technology. The phase-out of CFC-propelled pMDIs has stimulated the development of more efficient DPIs, but issues such as cost of device production, inspiratory flow requirement, and the effects of ambient humidity on drug delivery may limit DPI acceptance, and industry projections suggest that the DPI will not completely replace the pMDI. Holding chambers may perform differently with HFA-propelled pMDIs, but HFA-propelled pMDIs generally appear to cause less oropharyngeal deposition and to improve lung delivery while continuing to provide protection from poor hand-breath coordination. The initial offerings of the emerging HFA-propelled pMDI technology appear to be resulting in an improved pMDI.

Research paper thumbnail of Problems with inhaler use: a call for improved clinician and patient education

Respiratory care, 2005

Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers rep... more Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. Between 28% and 68% of patients do not use metered-dose inhalers or powder inhalers well enough to benefit from the prescribed medication, and 39-67% of nurses, doctors, and respiratory therapists are unable to adequately describe or perform critical steps for using inhalers. Of an estimated 25 billion dollars spent for inhalers annually, 5-7 billion dollars is wasted because of inhaler misuse. Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.

Research paper thumbnail of Use of Positive Airway Pressure Adjuncts to Bronchial Hygiene Therapy

International Anesthesiology Clinics, 1996

Advertisement. International Anesthesiology Clinics. Wolters Kluwer Health Logo. All Issues. ...

Research paper thumbnail of Aerosol Deposition in Neonatal Ventilation

Research paper thumbnail of Directed Cough

International Anesthesiology Clinics, 1996

Research paper thumbnail of Incentive Spirometry

International Anesthesiology Clinics, 1996

Research paper thumbnail of An Inhaled Matrix Metalloprotease Inhibitor Prevents Cigarette Smoke-Induced Emphysema in the Mouse

COPD: Journal of Chronic Obstructive Pulmonary Disease, 2005

Inadequately regulated proteolytic activity is responsible for the chronic lung tissue degenerati... more Inadequately regulated proteolytic activity is responsible for the chronic lung tissue degeneration and irreversible loss of pulmonary function that define emphysema. In this study, we show that an inhaled broad-spectrum matrix metalloprotease inhibitor, ilomastat, can provide protection against the development of emphysema in cigarette smoke-treated mice. Control animals were exposed to daily cigarette smoke for 6 months. As has been reported previously, cigarette smoke was seen to increase significantly the recruitment of macrophages into the lungs of these animals, leading to concomitant alveolar airspace enlargement and emphysema. In animals treated daily with nebulized ilomastat for 6 months, lung macrophage levels were greatly reduced, and neutrophil accumulation was also inhibited. Corresponding reductions in airspace enlargement of up to 96% were observed. These striking observations suggest that delivery of ilomastat directly into the lungs of smoke-treated mice can not only inhibit lung tissue damage mediated by metalloproteases, but may also reduce that component of tissue degeneration mediated by excess neutrophil-derived products. Our data also suggest that the matrix metalloprotease inhibitors may represent a class of drugs that, when delivered by inhalation, could be used practically to treat cigarette smoking-related chronic obstructive pulmonary disease by modifying the course of the disease.

Research paper thumbnail of Selection of Aerosol Delivery Device

International Anesthesiology Clinics, 1996

ABSTRACT

Research paper thumbnail of Intermittent Positive Pressure Breathing

International Anesthesiology Clinics, 1996