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Dubus JC, Becquemin MH, Vecellio L, Chaumuzeau JP, Reychler G. [Good practice for aerosol therapy by nebulization in 2020]. Rev Mal Respir 2020; 38:171-176. [PMID: 33288396 DOI: 10.1016/j.rmr.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
Nebulization is a drug delivery mode whose prescription and application remain uncertain. A guide to good practice has been proposed by the work group on aerosol therapy of the French Society for Respiratory Diseases, so-called GAT. The previous recommendations date from 2007. In addition to an update of data on nebulization, these expert recommendations aim to be of real help to the prescriber.
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Affiliation(s)
- J-C Dubus
- Pneumologie et allergologie pédiatrique, CHU Timone-Enfants, et Aix Marseille Université, IRD, MEPHI, IHU-Méditerranée Infection, Marseille, France.
| | - M-H Becquemin
- Hôpitaux universitaires Pitié-Salpétrière-Charles Foix, AP-HP, Paris, France
| | - L Vecellio
- Inserm, centre d'étude des pathologies respiratoires (CEPR), UMR 1100, université de Tours, Tours, France
| | | | - G Reychler
- Service de pneumologie, université catholique de Louvain, cliniques universitaires Saint-Luc, et institut de recherche expérimentale et clinique, Bruxelles, Belgique
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de Gabory L, Alharbi A, Kérimian M, Lafon ME. Le virus influenza, le SARS-CoV2 et les voies aériennes : mise au point pour l’otorhinolaryngologiste. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2020. [PMCID: PMC7274570 DOI: 10.1016/j.aforl.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Douafer H, Andrieu V, Wafo E, Brunel JM. Characterization of a new aerosol antibiotic/adjuvant combination for the treatment of P. aeruginosa lung infections. Int J Pharm 2020; 586:119548. [DOI: 10.1016/j.ijpharm.2020.119548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/27/2022]
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Fieux M, Mélan JB, Hermann R, Truy E, Tringali S. The medical uses of manosonic nebulizers (AMSA®) in 2018. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:73-76. [PMID: 32674996 DOI: 10.1016/j.anorl.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of repeated application of manosonic nebulizers (AMSA®) is to ensure active Eustachian tube rehabilitation and optimal middle-ear drug diffusion. In response to recent changes in marketing authorizations issued by the French National Drug Safety Agency (ANSM), the present study investigated how AMSA® is used in the Auvergne-Rhône-Alpes Region of France. MATERIAL AND METHODS A prospective non-interventional regional 1-year survey was conducted in 701 general practitioners and community and hospital ENT physicians in the Auvergne-Rhône-Alpes Region, using a questionnaire sent by mail with a reminder at 2 months. Percentage responses were compared on Chi2 test with alpha risk of 5%. Non-respondents were excluded. ENDPOINTS The main endpoints were rate of AMSA® prescription, and prescription modalities in a specific geographical territory (Auvergne-Rhône-Alpes Region) in 2018. RESULTS 93% of the 114 respondents prescribed AMSA®, with 4,000 prescriptions in 1 year. 66.7% prescribed this treatment to avoid recourse to myringotomy. Mean treatment duration was 2 weeks (50.9% of respondents). The most frequent nebulized substance was saline serum (68.4% of respondents), sometimes associated to corticosteroids or mucolytics. CONCLUSION The majority of physicians in the Auvergne-Rhône-Alpes Region, and notably the ENT physicians, were AMSA® prescribers for the treatment of Eustachian tube dysfunction and its consequences. However, the duration and modalities of use of AMSA® were very heterogeneous, and further studies are needed to standardize prescription.
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Affiliation(s)
- M Fieux
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
| | - J-B Mélan
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - R Hermann
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - E Truy
- Service ORL et Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon, Hôpital Edouard Herriot, Lyon, France
| | - S Tringali
- Service d'Otologie et Otoneurologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université de Lyon, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
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The influenza virus, SARS-CoV-2, and the airways: Clarification for the otorhinolaryngologist. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:291-296. [PMID: 32507410 PMCID: PMC7261469 DOI: 10.1016/j.anorl.2020.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The influenza virus and SARS-CoV-2 cause trivial upper and severe lower respiratory infections (Influenza virus 290,000 to 650,000 deaths/year). These viruses come into contact with the airways either by direct projection, by secondary inhalation of airborne droplets, or by handling (fomites). The objective of this article is to clarify the mechanisms of production and penetration of droplets of secretions emitted during all expiratory phenomena likely to transport these viruses and come into contact with the respiratory mucosa. The droplets>5μm follow the laws of ballistics, those<5μm follow Brownian motion and remain suspended in the air. The aerosols of droplets are very heterogeneous whether the subject is healthy or sick. During an infectious period, not all droplets contain viral RNA. If these RNAs are detectable around patients, on surfaces, and in the ambient air at variable distances according to the studies (from 0.5m to beyond the patient's room), this is without prejudice to the infectious nature (viability) of the virus and the minimum infectious dose. There is a time lag between the patient's infectious period and that of RNA detection for both viruses. Subsequently, the inhaled particles must meet the laws of fluid dynamics (filtration) to settle in the respiratory tree. All of this partly explains the contagiousness and the clinical expression of these two viruses from the olfactory cleft to the alveoli.
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Coste G. Aérosolthérapie par nébulisation, mise en pratique au comptoir. ACTUALITES PHARMACEUTIQUES 2019. [DOI: 10.1016/j.actpha.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Médicaments utilisés pour la nébulisation. ACTUALITES PHARMACEUTIQUES 2019. [DOI: 10.1016/j.actpha.2019.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Coste G. Les techniques d’aérosolthérapie par nébulisation. ACTUALITES PHARMACEUTIQUES 2019. [DOI: 10.1016/j.actpha.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Coste G. Aérosolthérapie par nébulisation : formes, indications et trajet du médicament. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eychenne N, Jaouadi A, Macquart de Terline D, Fratta A, Laribe-Caget S, Steichen O, Fernandez C, Antignac M. [Assessment of physicians' and nurses' knowledge and practices of aerosol therapy]. Rev Mal Respir 2016; 34:553-560. [PMID: 27863827 DOI: 10.1016/j.rmr.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Aerosol therapy is an efficient, but complex procedure. National and international practice guidelines are regularly updated. However, only a few studies have assessed the application of guidelines by users. The aim of this study is to assess the knowledge and practices of physicians and nurses regarding these guidelines. METHODS Two self-administered questionnaires were designed by a working team and presented to physicians and nurses of four university hospitals in Paris. A pharmacy resident collected and analyzed the data with the aid of an online survey website. RESULTS A total of 481 physicians and nurses completed the questionnaires (33 % of physicians and 67 % of nurses). Only 241/480 physicians and nurses (50 %) knew that several intravenous drugs cannot be nebulized. Ninety-four of 422 (22 %) of them always choose oxygen as the driving gas and 239/311 nurses (77 %) think that single use nebulizers can be re-used for the same patient. CONCLUSIONS This survey shows that many physicians and nurses lack knowledge and use inappropriate practices. Based on these results, a booklet has been designed by the working team. This booklet should help health professionals to harmonize practices across hospitals and to follow the guidelines correctly.
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Affiliation(s)
- N Eychenne
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Jaouadi
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - D Macquart de Terline
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Fratta
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Armand-Trousseau, 75012 Paris, France
| | - S Laribe-Caget
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Rothschild, 75012 Paris, France
| | - O Steichen
- Service de médecine interne, hôpitaux universitaires Est-Parisien, AP-HP, site Tenon, 75020 Paris, France; Faculté de médecine, UPMC, université Paris 6, Sorbonne universités, 75005 Paris, France
| | - C Fernandez
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Département de pharmacie clinique, faculté de pharmacie, université Paris Sud, 92290 Châtenay-Malabry, France
| | - M Antignac
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Orfanos S, Carsin A, Baravalle M, Dubus JC. [Health care providers' knowledge and abilities to use inhalation devices and spacers]. Rev Mal Respir 2016; 34:561-570. [PMID: 27863828 DOI: 10.1016/j.rmr.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Inhaled therapy is the mainstay of asthma treatment due to its local and rapid action. However, its efficiency relies on the teaching of a good inhalation technique by health care providers. We assessed health care providers' knowledge and practical skills in the use of inhalation devices. METHODS An observational multicenter study was conducted in the pulmonology and paediatric wards in Marseille. The departments' common practices, theoretical knowledge and practical skills were assessed through a questionnaire and a demonstration using a spacer device. RESULTS Forty health care providers were interviewed (9 attending physicians, 14 residents, 16 nurses and 1 physiotherapist), in 8 different pulmonology and paediatric wards. A total of 42.5% reported previous training in inhalation device technique. When evaluating theoretical knowledge, we found a mean of 54% correct answers. Attending physicians did significantly better than residents and nurses. With regard to practical skills, we found a mean of 1.12 failed steps out of 7. Here again attending physicians did significantly better than residents and nurses. CONCLUSION Based on the results of our study, we recommend that attending physicians provide training of inhalation technique to nurses and residents, as they did significantly better theoretically and practically.
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Affiliation(s)
- S Orfanos
- Faculté de médecine, Aix Marseille université, 13000 Marseille, France.
| | - A Carsin
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
| | - M Baravalle
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
| | - J-C Dubus
- Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France
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Aérosolstorming : la journée sur l’aérosolthérapie organisée par le GAT. Rev Mal Respir 2012; 29:114-5. [DOI: 10.1016/j.rmr.2011.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 12/27/2011] [Indexed: 11/19/2022]
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[Application of a hospital audit to the use of nebulizers: the Case of the Hôtel-Dieu de France-Lebanon]. Rev Mal Respir 2010; 27:1049-54. [PMID: 21111275 DOI: 10.1016/j.rmr.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 05/05/2010] [Indexed: 11/23/2022]
Abstract
PROBLEM The aim of the study was to reduce the unjustified prescriptions of nebulised therapy, in order to comply with the international guidelines and to reduce healthcare costs. METHODS DESIGN We performed a controlled, prospective study to evaluate the impact of local guidelines aimed at improving doctors' behaviour on appropriateness and costs of implementation. BACKGROUND AND SETTING All the departments of a university hospital: medical and surgical wards, intensive care units, emergency rooms and one-day admission units. KEY MEASURE FOR CHANGE: Reduction in the number of inappropriate prescriptions of nebulised therapy. STRATEGIES FOR CHANGE Implementation included two educational presentations, posters displayed in all departments, emails sent to all doctors and residents, and reassessment of the prescription one week after. RESULTS Prior to the intervention, the rate of inappropriate prescriptions was 11.9% (42/358 of patients treated with nebulizers did not have an indication for this treatment and 3/19 of patients had an indication for nebulisation but were not treated); in the postintervention, the rate of inappropriate prescriptions was 14.6% (15.7% of patients without indication for treatment, but no patient with an indication for treatment untreated), reflecting a lack of significant impact of the intervention. CONCLUSIONS Simple presentation of clinical guidelines did not lead to a change in medical practices. Another approach is needed to improve this outcome effectively.
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Salles M, de Monte M, Dubus JC, Diot P. [Nebulized corticosteroids and pediatricians: results of the NUAGES survey]. Arch Pediatr 2008; 15:1520-4. [PMID: 18804972 DOI: 10.1016/j.arcped.2008.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 04/25/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of the study was to analyze the data of the NUAGES survey (a survey on the practice of nebulization in France), concerning the prescriptions of nebulized steroids from 514 pediatricians. MATERIAL AND METHODS The reason why nebulization was chosen as a delivery route, the diseases motivating the prescription, the age of the patients, the kind of drug used, and the prescription and device modalities were studied. RESULTS Efficacy in treating various respiratory diseases was the main reason cited for using nebulization, in particular severe persistent asthma (76%). Pediatricians prescribed nebulization mainly to infants (60%). The most frequently used drug was budesonide suspension (89%), but the intravenous route for steroids (18%) and drug admixtures (62%) were also proposed by nebulization. A specific prescription for the nebulizer was given in 75% of the cases, with the type of interface to use specified in 66%. DISCUSSION Pediatricians consider that nebulization is well adapted to young children. Although the proper steroid is usually chosen, unfortunately, it is often prescribed with other drugs, with 1 prescription out of 4 not following the recommendations. Prescription of the device is not optimal and may compromise the efficacy of the treatment. CONCLUSION Nebulization is a potential mode of delivery for steroids that is difficult to prescribe and warrants improved pediatrician training.
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Affiliation(s)
- M Salles
- Unité de médecine infantile, URMITE 6236, CNRS, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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