Aerosol Treatment

A range of devices, including scrubbing and scavenging devices, are used for atmospheric cleaning and atmospheric aerosol particle and/or droplet collection. These are described in Sections 8.5 and 2.8, respectively. 

Holmes, A. (1965) Principles of Physical Geology, 2nd edn, Thomas Nelson, London. 

and Cross, H. (1979) Geochemistry of Colloid Systems for Earth Scientists, Springer-Verlag, Berlin. 

Beckett, R. (ed.) (1990) Surface and Colloid Chemistry in Natural Waters and Water Treatment, Plenum Press, New York. 

Sparks, D.L. (ed.) (1999) Soil Physical Chemistry, 2nd edn, CRC Press, Boca Raton, PL. 

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Topical aerosol treatment of fenvalerate plus Deet (N-N-diethyl-m-toluamide) to control fleas and ticks... 

Aerosol - Several serious adverse events occurred in severely ill infants with life-threatening underlying diseases, many of whom required assisted ventilation. Additional reports of worsening of respiratory status, bronchospasm, pulmonary edema, hypoventilation, cyanosis, dyspnea, bacterial pneumonia, pneumothorax, apnea, atelectasis, and ventilator dependence have occurred. Sudden deterioration of respiratory function has been associated with initiation of aerosolized ribavirin use in infants. If ribavirin aerosol treatment produces sudden deterioration of respiratory function, stop treatment and reinstitute only with extreme caution, continuous monitoring, and consideration of coadministration of bronchodilators. 

Twenty-five children selected at random received aerosol treatment with RP 6000 vitamin A units per 2 weeks over 3 months being provided. Twenty-five further children served as controls receiving a placebo also aerosol delivered. The aerosol was administered through the mouth during breath inhalation with an adapter. No adverse effects or reactions were observed during inhalation and the children complied well with the treatment. Trained field workers performed the inhalation trials and blood sampling. In the study and control group. Heparin blood samples were collected before and at completion of the study for measurements of vitamin A, RBP, and TTR concentrations. 

Topical aerosol treatment of Kitten, 3 months old, died in 6 h following hypersalivation,... 

Aerosol treatment is the most effective way to avoid the systemic adverse effects of corticosteroid therapy. The introduction of corticosteroids such as beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, and triamcinolone... 

Atrophic changes and fungal and other infections can alter the nasal mucosa after aerosol treatment (39), and since most systematic published documentation on these intranasal products is limited to 1-2 years of experience (although they have been in use for a far longer period), some reserve is warranted with respect to their long-term safety and the wisdom of continual use. 

Adverse effects Side effects reported for oral or parenteral use of ribavirin have included dose-dependent transient anemia in Lassa fever victims. Elevated bilirubin has been reported. The aerosol may be safer, although respiratory function in infants can deteriorate quickly after initiation of aerosol treatment and therefore, monitoring is essential. Because of teratogenic effects in experimental animals, ribavirin is contraindicated in pregnancy. 

Garcia-Contreras, L., and Hickey, A. J. (2003), Aerosol treatment of cystic fibrosis, Crit. 

Fire and EMS services became the community lifeline making well care checks for families who had been stranded, providing aerosol treatments for respiratory patients, while attempting to meet their communities ... 

Hall, C.B. Aerosolized treatment of acute pulmonary infections. Journal of Aerosol Medicine 1989, 2. 

In one patient with AIDS with severe but reversible thrombocytopenia after intravenous pentamidine, the serum during the acute phase contained antiplatelet antibodies that reacted with glycoprotein Ilb/IIIa, similar to the reactions observed with quinine-induced thrombocytopenia (SEDA-18, 292). This suggests that even aerosol treatment or environmental exposure will need to be avoided in such patients. 

In a randomized comparison of nebulized tobramycin and nebulized colistin in patients with cystic fibrosis, 26 of 53 patients treated with tobramycin had at least one respiratory adverse event, most commonly pharyngitis (3). In 520 patients, inhaled tobramycin (300 mg bd for three 28-day cycles, each cycle being separated by a 28-day period of no treatment) was compared with placebo. Respiratory function was significantly improved as early as the second week and remained so for the rest of the study, even dnring periods withont aerosol treatment. There was also a parallel rednetion in the relative risk of hospitalization, the number of days of hospitalization, and the number of days of intravenous antibiotic treatment (4). 

Unlabeled u.ses of ribavirin include aerosol treatment of influenza types A and B and oral treatment of hepatitis, genital herpes, and Lassa fever. Ribavirin does not protect cells again.st the cytotoxic effects of the AIDS virus. 

Secondary Pulmonary Hypertension. Secondary pulmonary hypertension is seen in some heart transplant candidates, and documenting the potential for reversibility when the primary defect is corrected is important in selecting appropriate heart transplant candidates and liver transplant patients as well. Aerosolized prostacyclin has been shown at least as effective as inhaled NO 40 ppm for this purpose in heart transplant candidates [170], while aerosolized epoprostenol has been shown similarly useful in liver transplant candidates. Delivery of iloprost was faster with an ultrasonic nebulizer but equally efficacious as compared to a jet nebulizer [171]. The role of aerosolized prostacyclin and related medications for pulmonary hypertension and for diagnostic evaluation of transplant candidates remains to be proven. Certainly, a successful aerosol treatment for pulmonary hypertension would be well received because of the inconvenience of the current method of constant infusion via an indwelling catheter. From an economic viewpoint, the market is small, so the chance of recovery of investment in new treatment would be limited. 

Ribavirin seems to be effective, but the lengthy administration that has been used is a disadvantage. There is now evidence that shorter courses (two hours three times per day) of ribavirin are as useful as standard therapy (18 hours per day) [207]. Aerosolized ribavirin has been used with variable success for children ventilated for bronchiolitis caused by RSV [208-210]. The more recent evidence casts some doubt on the efficacy of this aerosol treatment. Ribavirin aerosol has also been used for treatment or prophylaxis following bone marrow transplantation [211,212], but controlled trials are needed to better clarify efficacy. Considering the magnitude of this problem, definitive trials to clearly define efficacy would be welcome. 

These questions of efficacy are especially important as new aerosol therapies are evaluated. Of special importance is the need for careful evaluation of aerosol treatments for acute lung injury, i.e., for patients in respiratory failure who are on a mechanical ventilator in an intensive care unit (ICU). Application of new therapies such as aerosol surfactant, various vasodilators, and others should not be adopted until clear proof of improved outcome is documented. 

Mandelberg A, Chen E, Noviski N, Priel IE. Nebulized wet aerosol treatment in emergency department Is it essential Comparison with large spacer device for metered-dose inhaler. Chest 1997 112 1501-1505. 

For treatment of HIV-associated PCP, pentamidine isethionate is administered intravenously usually in doses of 4 mg/kg per day, although a pilot study has reported successful treatment with 3 mg/kg per day. Aerosolized pentamidine should not be used for treatment of PCP because comparative studies with intravenous pentamidine indicate that aerosolized treatment is associated with a slower clinical response and higher rates of therapeutic failure and PCP relapse. The efficacy of trimethoprim-sulfamethoxazole or pentamidine for treatment of an initial episode of PCP in HIV-infected individuals is similar, with published response rates between 60% to 80%. While comparative studies between the two regimens are few, one prospective, randomized trial found that oxygenation improved more quickly and survival was better in those who received trimethoprim-sulfamethoxazole. ... 

The technology today prefers electron-beam over y-ray facilities because the former allow to deliver high dose rates such as appear at present not practicable with the latter. A drawback of the former is a moderate penetration depth of the electron beam this requires sheet-flow or aerosol treatment which imposes narrower limits on throughput. 

The actual amount of drug remaining in a patient after an aerosol treatment... 

Figure 23 Sputum aminoglycoside level ( Xg/mL) sampled from patients maintained on mechanical ventilation. The patients were receiving gentamicin (80 mg every 8 h) and clinically were in a steady state. The trough level was from sputum sampled just prior to an aerosol treatment. Following aerosol therapy, average values of gentamicin exceeded 1200 jig. (From Ref. 34.)...

In summary, the mechanical actuation of a DPI into a spacer provides a new option for aerosol treatment. In addition to the general advantages offered by a spacer, this device provides the advantage of a dmg aerosol delivered without use of potentially harmfnl additives and propellants. The mechanical actuation ensures a high repeatability of drug delivery. Finally, the tower-shaped spacer and its nonelectrostatic properties ensure a stable aerosol, which remains airborne for a prolonged period. This makes coordination and forced inspiration unnecessary and should permit effective inhalation, even by children who have previously been nnable to use spacer devices effectively. 

Spacers rednce the need for coordination, improve the therapentic index of aerosol treatment, and reduce the cost of treatment. In children, pMDIs should not be nsed withont spacers, but pMDIs with spacers are the devices of choice... 

Pedersen S. Aerosol treatment of bronchoconstriction in children with or without a tube spacer. N Engl J Med 1983 308 1328-1330. 

Device development and documentation are driven by many different needs. For patients, important factors include device size, simplicity, irritants, taste and odors, and interactive features. Such factors impact on compliance, which is the main hindrance for effectiveness of aerosol treatment. The needs of the patient change significantly with age. On the other hand, clinicians require... 

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