scholarly journals VENTILATION AND DIFFUSIONAL DISORDERS IN PERSONS AFTER COMMUNITYACQUIRED PNEUMONIA, ASSOCIATED WITH CORONAVIRUS DISEASE (COVID-19). POSSIBILITIES OF INHALATION THERAPY

2021 ◽  
Vol 2021 (4) ◽  
pp. 27-42
Author(s):  
T. O. Pertseva ◽  
L. I. Konopkina ◽  
K. O. Bielosludtseva ◽  
O. O. Shchudro ◽  
K. V. Fuhol
Keyword(s):  
Lung Tissue ◽  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Bronchial Tree ◽  
Pathological Process ◽  
Community Acquired Pneumonia ◽  
Inhalation Therapy ◽  
Long Acting ◽  
Medical University

VENTILATION AND DIFFUSIONAL DISORDERS IN PERSONS AFTER COMMUNITYACQUIRED PNEUMONIA, ASSOCIATED WITH CORONAVIRUS DISEASE (COVID-19). POSSIBILITIES OF INHALATION THERAPY T. O. Pertseva, L. I. Konopkina, K. O. Bielosludtseva, O. O. Shchudro, K. V. Fuhol Dnipro State Medical University, Dnipro, Ukraine Abstract. The aim of the study was to evaluate the results of our own observations of persons after communityacquired pneumonia associated with coronavirus disease (COVID-19), to determine options of functional disorders that may be observed in the post COVID-19 period, and to justify the possibility of inhalation therapy in patients with certain clinical symptoms in the post COVID-19 period, and demonstrate its effectiveness. Materials and methods. The results of our own observations are presented in the form of descriptions of ten clinical cases of functional state of the respiratory system in persons after community-acquired pneumonia associated with COVID-19. Conclusions. At the end of the acute period of COVID-19, the ventilatory function of the lungs in patients may be different: normal, with restrictive disorders (varying degrees of severity), with obstructive disorders (usually mild), with mixed disorders (without prevalence of certain types of changes, or with prevalence, most often, restrictive disorders). In this case, impaired diffusion capacity of the lungs is an extremely common phenomenon. Most likely, in COVID-19 in a certain category of patients, not only interstitial lung tissue but also bronchial tree tissue (mucous membrane, submucosal layer, muscles, vessels) may be involved in the pathological process. It is possible that this process may be of autoimmune origin. If there are bronchoobstructive disorders in the post COVID-19 period, patients should be prescribed bronchodilator therapy; long-acting β2 -agonists, in particular formoterol, may be the drugs of choice. If there is a long-term recovery of lung tissue structure, given that coronavirus disease is an autoimmune disease, the use of inhaled corticosteroids should be considered individually. The combined drug Bufomix Easyhailer® , prescribed according to the indications, has shown good efficacy and safety in the management of the patient in the post COVID-19 period. Key words: coronavirus disease; COVID-19; pneumonia, associated with COVID-19; post COVID-19 period; spirometry; diffusion lung capacity of carbon monoxide; DLCO.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

2009 ◽  
Vol 24 (5) ◽  
pp. 287-296 ◽  
Author(s):  
J.M. Olivares ◽  
A. Rodriguez-Morales ◽  
J. Diels ◽  
M. Povey ◽  
A. Jacobs ◽  
...  
Keyword(s):  
Observational Study ◽  
Treatment Adherence ◽  
Prospective Observational Study ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Treatment Retention ◽  
Severity Scores ◽  
Long Term Treatment ◽  
Long Acting

AbstractBackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (−1.14 for RLAI versus −0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

scholarly journals Evaluation of the pharmacoeconomics of drugs used for the treatment of long-term complications of sulfur mustard

2016 ◽  
Vol 10 ◽  
Author(s):  
Yunes Panahi ◽  
Mostafa Ghanei ◽  
Milad Vakili Zarch ◽  
Zohreh Poursaleh ◽  
Shahram Parvin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Inhaled Corticosteroids ◽  
Sulfur Mustard ◽  
Cost Effective ◽  
Chemical Warfare Agent ◽  
Pulmonary Complications ◽  
High Dose ◽  
Chemical Injuries ◽  
Long Acting

Sulfur mustard (SM), a cytotoxic vesicant chemical warfare agent, has powerful irritant and blistering effects on the skin, eyes and respiratory tract. Since during the Iraq-Iran war, many Iranian soldiers and civilians were exposed to SM, there are several victims still suffering from long-term cutaneous, ocular and pulmonary complications. Currently, there is no definite treatment for long-term complications of SM, and only supportive medical care is being taken to minimize the symptoms. In this study, we compared the cost-effectiveness of common drugs that are used against long-term SM-induced complications in Iranian patients. In this review article, electronic databases were checked using the following key words: sulfur mustard, lung, skin, eye, cost-effectiveness, pharmacoeconomics and treatment. Abstracts of non-English papers and proceedings of congresses on SM were also assessed. Among the studied drugs, high-dose oral N-acetyl cysteine and long-acting inhaled corticosteroids against respiratory complications, topical corticosteroids and oral antihistamines against cutaneous complications and NSAIDS and corticosteroids ophthalmic drops against ocular complications were found to be cost-effective. Usage of different drugs in the treatment of SM injuries in Iran, have imposed a significant economic burden to patients and their families because many drugs that are effective against chemical injuries are not covered by insurance. In addition, development of more effective drugs in this field is considered as an urgent demand that should be noticed by the pharmaceutical industry.

scholarly journals Individual trajectory-based care for COPD: getting closer, but not there yet

2021 ◽  
pp. 00451-2021
Author(s):  
Nicolas Roche ◽  
Philippe Devillier ◽  
Patrick Berger ◽  
Arnaud Bourdin ◽  
Daniel Dusser ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Pharmacological Therapy ◽  
Response To Therapy ◽  
Treatment Preference ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Chronic obstructive pulmonary disease (COPD) is a main cause of death due to interplaying factors, including comorbidities that interfere with symptoms and response to therapy. It is now admitted that COPD management should be based on clinical symptoms and health status, and should consider the heterogeneity of patients’ phenotypes and treatable traits. This precision medicine approach involves a regular assessment of the patient's status and of expected benefits and risks of therapy. The cornerstone of COPD pharmacological therapy is inhaled long-acting bronchodilation. In patients with persistent or worsened symptoms, factors likely to interfere with treatment efficacy include the patient's non-adherence to therapy, treatment preference, inhaler misuse and/or comorbidities, which should be systematically sought before escalation is considered. Several comorbidities are known to impact symptoms, activity and lung function in vicious circles. The possible long-term risks of inhaled corticosteroids contrasting with their over-prescription in COPD patients justify the regular assessment of their benefits and risks, and de-escalation under close monitoring after a sufficient period of stability is to be considered. While commonly used in clinical trials, the relevance of routine blood eosinophil counts to guide therapy adjustment is not fully clarified. Patients’ characteristics, which define phenotypes and treatable traits and thus guide therapy, often change during life, forming the basis of the concept of clinical trajectory. The application of individual trajectory-based management of COPD in clinical practice therefore implies that the benefit:risk ratio is regularly reviewed according to the evolution of the patient's traits over time to allow optimized therapy adjustments.

scholarly journals Tiotropium bromide: additional options for the treatment of bronchial asthma

2019 ◽  
Vol 16 (3) ◽  
pp. 67-74
Author(s):  
O M Kurbacheva ◽  
M E Dyneva
Keyword(s):  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Biological Properties ◽  
Additional Treatment ◽  
Tiotropium Bromide ◽  
Inhalation Therapy ◽  
Global Initiative For Asthma ◽  
Successful Control ◽  
Global Initiative ◽  
Long Acting

Bronchial asthma (BA) is one of the most common chronic diseases, characterized by airway inflammation and bronchospasm. Symptoms of BA are wheezing, shortness of breath, a feeling of constriction in the chest and cough, the frequency and severity of which vary greatly over time. Today studies of BA phenotypes allow selecting treatment depending on the particular pathogenesis of each phenotype individually, thereby helping to achieve control, which is the main goal of BA therapy. However, it is necessary to take into account the peculiarities of airway innervation, since an increased parasympathetic tone is characteristics of all BA phenotypes and plays an important role in the development of bronchoconstriction and inflammation. Therefore, tiotropium bromide, which is a long-acting blocker of muscarinic cholinergic receptors, is one of the main bronchodilators in the treatment of BA. It blocks bronchoconstriction, hypersecretion and swelling of the mucous membrane of the airway, which in turn prevents the progression of inflammation, and the prolonged action of tiotropium bromide, which allows it to be used once a day helps to achieve control of asthma in addition to basic inhalation therapy - inhaled corticosteroids (ICS) long-acting P2-agonists (LABA). According to GINA (Global Initiative for Asthma), tiotropium bromide is recommended as an additional treatment, starting from step 4, and in accordance with the Russian Federal Clinical Guidelines for Bronchial Asthma - from step 3. Currently, according to clinical studies, much is known about the mechanisms of action and biological properties of tiotropium bromide, which made it possible to substantiate the needs for its administration to patients with BA regardless of its phenotype. This strategy will contribute to a more successful control of BA considering risk factors and comorbidity, thereby reducing needs of increasing ICS dose.

scholarly journals Pro/Con: A unified conclusion-Inhaled corticosteroids for chronic obstructive pulmonary disease

2019 ◽  
Vol 2 (1) ◽  
pp. 46-47
Author(s):  
Margaret F. Ragland ◽  
Donald A. Mahler ◽  
Barry J. Make
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Con A ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
The Right

ICS are like any other drug: they have benefits and they have risks.6,7 In the right patient, often the patient with frequent exacerbations and severe uncontrolled symptoms, an inhaler regimen, including dual long-acting bronchodilators and an ICS may be the right choice. For the patient with infrequent exacerbations, low symptom burden, and recent pneumonia that caused hospitalization, an inhaler regimen that contains an ICS may bring more risk than benefit. In addition, analysis of recent data, including the WISDOM8 trial, has provided evidence that ICS may be most beneficial in the immediate postexacerbation period. Further, ICS may be safely discontinued in patients with few exacerbations and stable symptoms.9 As with any long-term medication, a nuanced risk-benefit calculation by the prescribing physician and informed discussion with the patient are ultimately the best ways to balance the use of ICS that have benefits in some patients and risks in others.

Posterior laryngeal clefts

2021 ◽  
Vol 20 (3) ◽  
pp. 70-76
Author(s):  
P. V. Pavlov ◽  
◽  
M. L. Zakharova ◽  
M. R. Abubakarova ◽  
A. P. Ivanov ◽  
...  
Keyword(s):  
Congenital Malformation ◽  
Clinical Symptoms ◽  
Pathological Process ◽  
Type I ◽  
Results Of Treatment ◽  
Type Iiia ◽  
Laryngeal Cleft ◽  
Medical University ◽  
Neurological Pathology ◽  
Positive Results

The posterior laryngeal cleft is a rare congenital malformation of the larynx, with an estimated incidence of 1 in 10,000–20,000 children born alive. Despite the apparent obviousness of the pathology, the diagnosis of the posterior cleft of the larynx often causes difficulties, which is associated with a variety of clinical symptoms, primarily due to the varying prevalence of the pathological process. Objective: To analyze the results of treatment of patients with congenital laryngeal cleft. Materials and methods: A retrospective analysis of case histories of children in the department of otolaryngology of the clinic of the St. Petersburg State Pediatric Medical University, from 2003 to 2018, diagnosed with congenital malformation of the larynx, posterior laryngeal cleft, was performed. Results: Normal respiration and nutrition through the natural pathways was achieved in 13 children with type I cleft and in 2 with type IIIa. Three patients with IIIa and IIIb types of clefts could not be rehabilitated due to severe concomitant somatic and neurological pathology, for which they continue treatment with relevant specialists at the present time. Conclusions: Rehabilitation of patients with laryngeal cleft of type IIIa and IIIb, especially in the presence of severe concomitant somatic and neurological pathology, does not always give positive results.

scholarly journals Differential treatment strategy in patients with different clinical phenotypes of chronic obstructive pulmonary disease

2013 ◽  
Vol 94 (5) ◽  
pp. 610-614
Author(s):  
E A Lapteva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Treatment Strategy ◽  
Inhaled Corticosteroids ◽  
Control Treatment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinical Phenotypes ◽  
Long Acting

Aim. To optimize the treatment in patients with chronic obstructive pulmonary disease in primary care. Methods. The effectiveness of different strategies of long-term control treatment in 245 patients with chronic obstructive pulmonary disease depending on clinical phenotypes of the disease was evaluated. Three groups of patients were formed: patients from the 1 st group (70 patients, 33 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) were using long-acting anticholinergics, patients from the 2 nd group (110 patients, 52 - with predominant emphysema phenotype, 58 - with predominant bronchitis phenotype) - long-acting anticholinergics and inhaled corticosteroids, and patients from the 3 rd group (65 patients, 28 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) - long-acting anticholinergics together with inhaled corticosteroids and long-acting beta 2-agonists. The respiratory function, diffusing lung capacity and gas exchange parameters were assessed after 12 months of long-term control treatment. Results. The 2nd treatment strategy was more effective in patients with bronchitis phenotype, confirmed by the increase of forced expiratory volume at 1st second (FEV 1) value from 1.12±1.04 to 1.90±1.05 (р 0.05), and partial oxygen pressure (р аО 2) increase from 53.72±6.28 to 69.56±6.83 mmHg, as well as partial carbon dioxide pressure (р аCО 2) decrease from 55.71±8.34 to 52.34±8.16 mmHg. No significant changes in patients with emphysema phenotype were observed. The treatment strategy 3 was the most effective in patients with emphysema phenotype which was demonstrated by the increase of FEV 1 from 1.18±0.03 to 1.47±0.03, р аО 2 from 66.43±3.79 to 78.48±5.78 mmHg (р 0.05), diffusion capacity of carbon monoxide to alveolar volume ratio (DLCO/Va) increase from 35.32±11.34 to 44.12±12.2 (р 0.05) and decrease of р аО 2 from 50.21±3.68 to 43.43±5.47 mmHg. No significant improvement of gas exchange parameters in patients with bronchitis phenotype was registered. The treatment strategy 1 had no significant effect on respiratory function parameters. Conclusion. The differential strategies of long-term control treatment should be used depending on clinical phenotypes to optimize the treatment of chronic obstructive pulmonary disease.

scholarly journals Uncontrolled asthma: what is behind it?

2018 ◽  
Vol 96 (6) ◽  
pp. 485-490
Author(s):  
Y. G. Belotserkovskaya ◽  
A. G. Romanovskikh ◽  
I. P. Smirnov ◽  
E. A. Sturt
Keyword(s):  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Atopic Asthma ◽  
Uncontrolled Asthma ◽  
Trigger Factors ◽  
Eosinophilic Asthma ◽  
Systemic Corticosteroids ◽  
Long Acting ◽  
Inhalation Techniques

Authors describe the clinical features and causes of severe uncontrolled asthma. Algorithm of evaluation of the patient with persisting clinical symptoms receiving treatment with the highest doses of inhaled corticosteroids in combination with long-acting β­-agonists and/or systemic corticosteroids, should include: a preliminary exclusion of an alternative diagnosis, eliminating the influence of concomitant diseases, preventing exposure to trigger factors, achieving high adherence to prescribed treatment, improving the inhalation techniques. Further steps on the path of regaining control should be aimed at determining phenotype of asthma. Difficulties in achieving control can be expected in patients with severe atopic asthma, late-onset persistent eosinophilic asthma, obesity-related severe nonatopic asthma, neutrophilic asthma.

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