Nebulized Ipratropium bromide protects against tracheal and bronchial secretion during bronchoscopy: A randomized controlled trial

The effects of the atomization inhalation of budesonide, salbutamol, and ipratropium bromide on the T-lymphocyte subset and inflammatory cytokine levels in children with asthmatic pneumonia

OBJECTIVE

This study aimed to explore the effects of the atomization inhalation of budesonide (BUD), salbutamol (SAL), and ipratropium bromide (IB) on the T-lymphocyte subset and inflammatory cytokine levels in children with asthmatic pneumonia (AP).

METHODS

A total of 118 children with AP admitted to our hospital were selected as the study cohort and randomly divided into two groups. The study group, included 67 patients who were treated with the atomization inhalation of BUD, SAL, and IB. The control group, included 51 patients who were treated with the atomization inhalation of BUD. The two groups were compared in terms of their symptom disappearance times, the therapeutic effects, inflammatory cytokine changes, their pulmonary function indices [C-reactive protein (CRP), respiratory frequency, forced vital capacity (FVC), one-second forced expiratory volume (FEV1), blood oxygen saturation (SpO2)], and their T-lymphocyte subset levels before and after the treatment, and the incidences of adverse reactions after the treatment.

RESULTS

The symptom disappearance times in the study group were shorter than they were in the control group (P<0.05), and the overall response rate (ORR) was significantly higher in the study group (P<0.05). The IL-5, IL-6, and IL-10 levels were all lower in the study group (P<0.05), but the interferon-γ levels were higher in this group (P<0.05). The CRP level was lower in the study group (P<0.05), but the FVC, FEV1, and SpO2 levels were higher in this group (P<0.05). After the treatment, the CD3⁺, CD4⁺ and CD4⁺/CD8⁺ levels were all higher in the study group (P<0.05), but the CD8⁺ level was lower in this group (P<0.05). The incidence of adverse reactions in the study group was lower than it was in the control group (P=0.014).

CONCLUSION

The atomization inhalation of BUD, SAL, and IB is markedly effective in treating children with AP, and it can improve their immune function and reduce their inflammatory cytokines levels.

Effects of ipratropium bromide on the occurrence of postoperative respiratory complications in craniectomy patients with COPD: A nationwide multicenter retrospective study

INTRODUCTION

Postoperative pulmonary complications (PPCs) are common and associated with increased morbidity, mortality, and medical cost. They are gaining increasing concerns among patients receiving neurological surgery. Chronic obstructive pulmonary disease (COPD) affect a large section of whole population and is also one of the risk factors of PPCs in the perioperative setting. Ipratropium bromide is the inhalation solution for the treatment of COPD. Studies showed the perioperative nebulization of ipratropium bromide could increase the lung function and decrease the incidence of postoperative pneumonia in COPD patients underwent thoracic surgery. The purpose of this study is to investigate the effect of perioperative nebulization of ipratropium bromide on PPCs in COPD patients underwent neurosurgical surgery.

METHODS AND ANALYSIS

This study is a multicenter retrospective study in China. Patients who meet the inclusion/exclusion criteria are selected from 7 neurosurgical centers in China. According to whether ipratropium bromide is used in perioperative period, the patients are divided into exposure group and control group. The primary outcome is the incidence of postoperative pneumonia. Secondary outcomes are unplanned intubation, postoperative mechanical ventilation ≥ 48 hours, respiratory failure, atelectasis, death, and length of stay.

ETHICS AND DISSEMINATION

This study was approved by the ethics committee (EC) of the School of Public Health, Fudan University, Shanghai, China. Waived by the ethics committee, no written consent form was obtained since we used the registry data. The study results will be communicated via publication.

TRIAL REGISTRATION NUMBER

ChiCTR1900022552.

Organic Cation Transporters (OCTs) in EpiAirway™, A Cellular Model of Normal Human Bronchial Epithelium

Organic cation transporters (OCTs) and novel organic cation transporters (OCTNs) are responsible for drug delivery in the intestine and kidney; in the lung, OCTs mediate inhaled drugs’ transport, although their physiological role in airways remains poorly understood. The studies addressing OCTs/OCTNs in human airways were mostly performed in immortal or transformed cell lines; here, we studied OCTs in EpiAirway™, a recently developed in vitro model of normal bronchial epithelium. Calu-3 monolayers were used for comparison. The activity of OCTs was evaluated by measuring the uptake of 1-methyl-4-phenylpyridinium (MPP⁺) at the apical and basolateral side of monolayers and protein expression through Western Blot analysis. OCTs and OCTNs expression, along with that of Amino acid Transporter B^0,+ (ATB^0,+)transporter, was determined by measuring the number of mRNA molecules through quantitative Polymerase Chain Reaction (qPCR). The interaction of the transporters with bronchodilators was also assessed. Results highlight significant differences between Calu-3 cells and EpiAirway™, since, in the latter, OCTs are active only on the basolateral membrane where they interact with the bronchodilator ipratropium. No activity of OCTs is detectable at the apical side; there, the most abundant carrier is, instead, SLC6A14/ATB^0,+, that can thus be potentially listed among organic cation transporters responsible for drug delivery in the lung.

Future Trends in Nebulized Therapies for Pulmonary Disease

Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.