Asthma Health Disparities

Pappalardo, Andrea A.; Martin, Molly A.

doi:10.1007/978-3-030-31222-0_7

Cited by 3 publications

(2 citation statements)

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“…This could be because smoking causes a severe inflammatory reaction followed by a massive shortage of blood supply to the lung. Destroying the matrix of the lung by smoking causes blood supply shortage, and epithelial cell death which results in a reduction in lung absorption and bioavailability of salbutamol 20‐23 . Additionally, this reduction in lung deposition could be because of the reduction of lung functions caused by cigarette smoking 24 .…”

Section: Discussionmentioning

confidence: 99%

Lung deposition and systemic bioavailability of dose delivered to smoker compared with non‐smoker COPD subjects

Mohamed

Eldin

et al. 2020

Int J Clin Pract

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Introduction Inhaled drugs are the most commonly used class of medications for COPD subjects. No studies have been performed to assess the influence of smoking on lung deposition of aerosolized medication, especially for the exacerbated COPD subject. The present study aimed to assess the influence of smoking on the lung deposition of the aerosol delivered to exacerbated COPD subjects. Methods Twenty‐four exacerbated COPD subjects using automatic continuous positive airway pressure (Auto‐CPAP), 12 smokers (six females) and 12 non‐smokers (six females) were recruited in the study. The subjects participated in the study received four salbutamol study doses; 1200 µg (12 puffs 100 µg/puff) of salbutamol emitted from pMDI canister connected to AeroChamber MV spacer; 1200 µg of salbutamol emitted from pMDI canister connected to Combihaler spacer; 1 mL of salbutamol respirable solution (5000 µg/mL) nebulized by Aerogen Solo connected to its T‐piece; and 1 mL of salbutamol respirable solution nebulized by Aerogen Solo connected to Combihaler spacer with 2 puffs salbutamol MDI (200 µg salbutamol) before nebulisation. The subjects were randomised to receive the four selected dose‐adaptor combination in a sealed envelope design on days 1, 3, 5 and 7. A washout period of 24 hours was provided between each salbutamol dosing. Auto‐CPAP was adjusted at non‐invasive ventilation mode with the integrated heated humidifier, as a source of humidity. Urine samples were provided by subjects, 30 minutes and cumulatively 24 hours post inhalation, as an index of the relative and systemic bioavailability, respectively, and aliquots were retained for salbutamol analysis using solid‐phase extraction and high‐performance liquid chromatography (HPLC). On day 2 of the study, a collecting filter was placed between the aerosol generator and the subject's mask so that the subjects would not inhale the salbutamol delivered. The same study doses and/or adapters were delivered to each subject, with filters changed with each dose‐adapter combination. Salbutamol entrained on the filter was desorbed to be analysed by the HPLC. Results Significantly higher lung deposition (30 minutes urinary salbutamol) was detected with the non‐smoker compared with smokers (P < .05). Significantly higher systemic bioavailability (pooled 24‐hour urinary salbutamol) for smokers compared with non‐smokers was found with Aerogen Solo connected to its T‐piece and CombiHaler spacer with pMDI (P < .05) only. Significantly higher amount desorbed from the ex‐vivo filter were found from pMDI with both spacers in non‐smokers (P < .05) compared with the smokers. Conclusion The study demonstrated that smoking reduced the lung deposition of inhaled salbutamol delivered by nebulizer or pMDI. However, the smoking effect on cytochrome p450 was observed to increase systemic absorption of the ingested portion of the inhaled dose. The lower lung deposition and possible higher systemic absorption should be taken into consideration while prescribing inhaled medication to COPD smokers...

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Section: Discussionmentioning

confidence: 99%

Lung deposition and systemic bioavailability of dose delivered to smoker compared with non‐smoker COPD subjects

Mohamed

Eldin

et al. 2020

Int J Clin Pract

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“…Despite significant pharmaceutical advances for asthma in the last decade, pediatric asthma health inequities persist and children from low-income and minority backgrounds continue to experience disproportionate morbidity from asthma, including learning loss, chronic school absenteeism, emergency department visits and hospitalizations [5,6]. Much of this morbidity and child health inequities are due to poor adherence and access to guideline-based asthma care [7,8].…”

Section: Introductionmentioning

confidence: 99%

Updates in school-based asthma management

Lowe

Onge

Trivedi

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewSchool-based asthma management is an important component of pediatric asthma care that has the potential to provide more universal evidence-based asthma care to children and mitigate asthma-related health inequities. The purpose of this review is to highlight relevant developments in school-based asthma management over the past 2 years.Recent findingsThere have been considerable recent scientific advances in school-based asthma management including robust clinical trials of environmental interventions in the classroom setting, school-nurse led interventions, stock albuterol policy changes, school-based telemedicine approaches and innovative methods to engage community stakeholders in research that have pushed the frontiers of school-based asthma care.SummaryRecent scientific work in school-based asthma management demonstrates the potential power of schools in providing access to guideline-based asthma care for all children with asthma and in improving their health outcomes. Future work should focus on the evaluation of methods to promote the adoption of school-based asthma management strategies in real-world practice and support evidence-based policy change and strategic partnerships to improve asthma health outcomes and produce meaningful public health impact for diverse children and families.

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