Inhaled mannitol is a new treatment approved for adults with cystic fibrosis to help clear mucus from the lungs. Two phase 3 clinical trials showed inhaled mannitol was well tolerated and led to clinically meaningful benefits over a 6 month period. Mannitol works by hydrating mucus to make it easier to cough up. While mannitol was generally well tolerated, withdrawal rates were higher in the treatment group compared to controls, indicating the importance of education and training on proper inhaler use. A mannitol tolerance test can help identify patients at risk for bronchospasm and provides an opportunity for education prior to use.
Antihistamine drugs
Introduction
Antihistamines are drugs that treat allergy symptoms by blocking the effects of histamines.
Histamine is chemical released by your body during an allergic reaction and acts on a specific histamine receptor.
There are four types of histamine receptor: H1, H2, H3 and H4 receptors.
The term antihistamine only refers to H1 receptor antagonists.
allergy symptoms:
Congestion, runny nose, sneezing, or itching
Swelling of the nasal passages
Hives and other skin rashes
Itchy, runny eye
Mechanism Of Action
Block action of histamine at H1 receptors.
Compete with histamine for binding at unoccupied receptors.
Cannot push histamine off the receptors if already bound.
Types of Antihistamine
1: first-generation drugs
sedating antihistamine drugs block peripheral H1 receptors, but also cross the blood – brain barrier and block central H1 and cholinergic receptors as well.
Ex. diphenhydramine (Benadryl) - Dimetindene (fenistil)
2: second-generation drugs
Non-sedating antihistamine drugs block peripheral H1 receptors, but do not cross the blood – brain barrier.
Ex. Cetirizine (Zyrtec) - Loratadine (Alavert, Claritin)
Diphenhydramine
Diphenhydramine is in a class of medications called antihistamines
1st generation antihistamine
Has a peripheral and central H1-antagonist action
Sedating antihistamine
Uses
allergic symptoms - insomnia - common cold - Motion sickness
Adverse side effects
Side effects are due to CNS depression :
Sedation - Dizziness - Euphoria - Blurred vision - Tinnitus
Anticholinergic effects
Contraindication
hypersensitivity to diphenhydramine
this drug should not be used in new-born or premature infants
interaction
Alcohol and other CNS depressants
MAO inhibitors
nitrates mechanism of action,overview of nitroglycerin[short acting], iso sorbide dinitrates, iso sorbide mononitrates, amyl nitrates and nitroprusside,
An overview of muscarinic receptor agonists and antagonists. This presentation was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology class and accompanies Goodman & Gilman's (12e) chapter 9.
Antihistamine drugs
Introduction
Antihistamines are drugs that treat allergy symptoms by blocking the effects of histamines.
Histamine is chemical released by your body during an allergic reaction and acts on a specific histamine receptor.
There are four types of histamine receptor: H1, H2, H3 and H4 receptors.
The term antihistamine only refers to H1 receptor antagonists.
allergy symptoms:
Congestion, runny nose, sneezing, or itching
Swelling of the nasal passages
Hives and other skin rashes
Itchy, runny eye
Mechanism Of Action
Block action of histamine at H1 receptors.
Compete with histamine for binding at unoccupied receptors.
Cannot push histamine off the receptors if already bound.
Types of Antihistamine
1: first-generation drugs
sedating antihistamine drugs block peripheral H1 receptors, but also cross the blood – brain barrier and block central H1 and cholinergic receptors as well.
Ex. diphenhydramine (Benadryl) - Dimetindene (fenistil)
2: second-generation drugs
Non-sedating antihistamine drugs block peripheral H1 receptors, but do not cross the blood – brain barrier.
Ex. Cetirizine (Zyrtec) - Loratadine (Alavert, Claritin)
Diphenhydramine
Diphenhydramine is in a class of medications called antihistamines
1st generation antihistamine
Has a peripheral and central H1-antagonist action
Sedating antihistamine
Uses
allergic symptoms - insomnia - common cold - Motion sickness
Adverse side effects
Side effects are due to CNS depression :
Sedation - Dizziness - Euphoria - Blurred vision - Tinnitus
Anticholinergic effects
Contraindication
hypersensitivity to diphenhydramine
this drug should not be used in new-born or premature infants
interaction
Alcohol and other CNS depressants
MAO inhibitors
nitrates mechanism of action,overview of nitroglycerin[short acting], iso sorbide dinitrates, iso sorbide mononitrates, amyl nitrates and nitroprusside,
An overview of muscarinic receptor agonists and antagonists. This presentation was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology class and accompanies Goodman & Gilman's (12e) chapter 9.
A PowerPoint presentation on Anti Muscarinic drugs it has a broad information on different drugs like Anti-Muscarinic drugs Anti-Nicotinic drugs and some information on Ganglionic blocking drugs with their general information including different brands, different generics, their pictures, dosage, side effort and treatment measures etc.
May this information may be helpful to you.
Regards.
SYED MASOOD AHMED QUADRI
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
Dexamethasone Sodium Phosphate Injections (Dexona Injections) is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, Cerebral oedema(raised intracranial pressure),auto-immune, endocrine, pulmonary, blood disorders or breathing disorders.
chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice
A PowerPoint presentation on Anti Muscarinic drugs it has a broad information on different drugs like Anti-Muscarinic drugs Anti-Nicotinic drugs and some information on Ganglionic blocking drugs with their general information including different brands, different generics, their pictures, dosage, side effort and treatment measures etc.
May this information may be helpful to you.
Regards.
SYED MASOOD AHMED QUADRI
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
Dexamethasone Sodium Phosphate Injections (Dexona Injections) is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, Cerebral oedema(raised intracranial pressure),auto-immune, endocrine, pulmonary, blood disorders or breathing disorders.
chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice
TIVA is a technique of anesthesia involving the induction and maintenance of anesthetic state with IV drugs alone. Shorter context sensitivity half time anesthetic agents like propofol is the universally accepted induction agent of choice widely used as a component of TIVA.
This presentation give detail overview of pharmacoepidemiology, epidemiological study design, case report, case series, analysis of secular trends, case control studies, cohort studies, statistical interpretation, randomised clinical trials, field trials, community trials, drug utilisation studies.
For all five YouTube Live video lecture series of this topic click:
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This poster was presented at the 45th Union World Conference on Lung Health in 2014. It outlines the interim findings of a study that tests behaviour change interventions aimed at lung health patients in Nepal
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr Lee Chew Kiok, Consultant Intensivist, Hospital Sungai Buloh, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/g8q7y5-critical-care-of-covid-19
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
4. • CF chronic airway infection and
inflammation.
• Airway clearance therapies (ACTs) is a
primary therapy for CF patients.
– Inhaled hypertonic saline
– Recombinant human DNAase
5. • Naturally occurring sugar alcohol
• Dry powder formulated.
• Mechanism of Action:
– Change the viscoelastic properties of airway phlegm
– Increase the hydration of the airway surface liquid
increased clearance of the retained secretions
through mucociliary activity and productive cough.
6.
7. • phase 3 studies (CF301 and CF302):
– Investigate the safety and efficacy of inhaled mannitol
in subjects with CF over a period of 6 months.
– These studies demonstrated clinically relevant
benefits of inhaled mannitol.
– Inhaled mannitol was recently approved for use in
adults in Europe.
8. – To discuss the importance of airway clearance
treatments in the management of cystic fibrosis.
– To describe the clinical data that supports the use of
mannitol in adult patients with cystic fibrosis.
– To highlight the role of mannitol tolerance testing in
screening for hyperresponsiveness.
– To provide practical considerations for patient
education in use of mannitol inhaler
9. • Multicentre, randomised, controlled, parallel-arm,
double-blind
• phase III clinical trial to determine the efficacy and
safety of inhaled dry powder
• Pooled Data from CF301, CF302.
– Adults > 18 years
– Sample size: 390
– Subjects:
• diagnosed patient with CF
• FEV1 range 30-90% (CF301); 40-90% (CF302)
10. • Continuation of all approved CF therapies.
• Mannitol Tolerance Test (MTT):
• subjects were randomised 3:2
• 2phases:
– Phase I: 26 weeks (control 50 mg BID, study group
400mg BID)
– Phase II: 26 weeks optional , open-Labeled , all
subjects received 400mg BID mannitol.
16. • Withdrawals, education and compliance:
– CF301: withdrawal rate 35.3 %
– CF302: withdrawal rate 20.5%
• Mannitol was well tolerated by adult subjects
with CF, although there was a higher drop-out
rate overall in the mannitol group compared
with the control group
42% reduction in
withdrawal rate
17.
18. • Factors that may influence adherence to
mannitol inhaler:
• Simple
• Portable
• disposable.
• requires no special care
• not require sterilisation
Positive factors:
•Excessive coughing on inhalation
•No perceived short-term benefit
Negative factors:
19. • Inhaled mannitol is a safe, effective treatment for adult
patients with CF, and it can be used in addition to best
standard care.
• The differences in the withdrawal rates between studies
CF301 and CF302
– Indicates the importance of education and training.
• MTT is an effective screening procedure to identify those
patients at risk for bronchospasm.
• MTT provides opportunity to educate patients about the
proper use of the inhaler.
20. • Only remove capsules immediately before use.
• Pierce capsules once only.
• Tilt inhaler so mouth-piece faces slightly downward
• Breathe out completely away from the inhaler.
• With the head tilted upwards, the patient should inhale deeply
“rattling” sound
– The inhalation rate may be slowed down if coughing occurs
• After the dose from each capsule is inhaled, breath hold for 5 s
• Exhale and cough AWAY from the inhaler to prevent humidity build-
up within the device.
• The 10 capsules should be taken closely together over a 3–5 min.
• A sip of water may be taken throughout the challenge to relieve
cough and/or dry throat.
21. • Inhaled mannitol is now available for adult
patients with CF as an adjunctive therapy to
augment airway clearance.
• autosomal recessive, CFTR gene found on chromosome 7 (ΔF508 mutation in 70%, over 800
different mutations identified)
• 1 in 3,000 live births, mostly Caucasians
• mutation in transmembrane conductance regulator of chloride – causes cells to be impermeable
to Cl which increases the reabsorption of Na
• leads to relative dehydration of airway secretions, resulting in impaired mucociliary transport
and airway obstruction
Chronic airways infection and inflammation is associated with considerable morbidity and early mortality in patients with cystic fibrosis (CF) [3]. In CF, the lung airway surface liquid is depleted, resulting in a defective mucociliary clearance. This contributes to retained airways phlegm, which promotes infection and inflammation within the airway lumen and wall, leading to airway remodelling. Initial reversible injury eventually results in refractory bronchiectasis and progressive loss of lung function [4].
Recombinant human DNAase
These agents alter the rheological properties of airway phlegm, thereby easing its clearance from the airways [5]. Inhaled rh DNase improves lung function by digesting high molecular weight DNA that is typically released in the CF airways by dead neutrophils and which contributes to the secretion viscosity
Inhaled hypertonic saline
increase airway surface liquid volume in vitro and modestly improve lung function in patients with CF [9–12]. Although recommended in guidelines, hypertonic saline is not a regulatory approved treatment and there are widely recognised tolerability issues in some patients [13, 14]. In addition, the administration of nebulised saline is time consuming and is associated with poor adherence
Mannitol is a sugar alcohol that is
currently used in medicine as an osmotic agent [11].
When inhaled, it creates an osmotic gradient that
is thought to facilitate movement of water into
the lumen of the airways, thereby increasing the
volume of airway surface liquid and improving
clearance of mucus
Two recent, near identical, randomised, multicentre, double-blind, controlled, parallel-group
open-label trial or open trial is a type of clinical trial in which both the researchers and participants know which treatment is being administered.[1][2] This contrasts with single blind and double blind experimental designs, where participants are not aware of what treatment they are receiving (researchers are also unaware in a double blind trial).
-all subjects were screened for significant airway hyperresponsiveness to mannitol
Unlike the first phase II efficacy study, where a nonrespirable dose of mannitol was given, this study used a subtherapeutic (50 mg) dose of mannitol as the control
Steps:
MTT
Randomisations in ratio of 2:3
Subjects took a dose of the short-acting bronchodilator salbutamo (400 mg) 5–15 min before each dose of study medication.
400mg Mannitol BID for 26 weeks
Inhaled mannitol was supplied as 10 capsules (40 mg each) together with an inhaler device (RS01 Monodose Inhaler Model 7; Plastiape, Milan, Italy). Capsules were loaded into the inhaler device, punctured, then mannitol inhaled in a deep, controlled manner, followed by a 5-s breath hold. The process was repeated until the contents of 10 capsules were inhaled. The time taken to inhale from 10 capsules was usually 2–5 min. The inhaler device was replaced after 1 week
Assessment of Effecacy of mannitol:
change in FEV1 over 26 weeks was the primary end-point selected for this trial.
they did not mention about f/u
The OL phase included patient follow-up visits at 38 and 52 weeks to assess lung function, sputum microbiology, and review PEs and safety. Safety was assessed by tracking the number and percentage of adverse events (AEs) as well as monitoring for changes in haematology, liver and renal function, and sputum pathogens.
there were more male subjects in the mannitol group (61.4 versus 53.0% in the control group), and more subjects receiving rhDNase treatment in the control group (63.4 versus 58.9% in the mannitol group).
Effects of mannitol on lung function:
In general population: Study CF301 and study CF302 both demonstrated a statistically significant improvement in lung function (FEV1 P <0.001 and FVC P <o.o35)
In the pooled data:317 subjects
Over 26 weeks, mannitol improved lung function as demonstrated by a mean absolute change in FEV1 from baseline compared with control of +99.5 mL (95% CI 49.1–149.9; p=0.001) and a relative change in % predicted for normal compared with control of +4.72% (95% CI 1.86–7.59; p=0.001).
Statistically significant improvements in FEV1 were sustained over the duration of the double-blind phase (fig. 3).
Improvements in lung function were maintained for an additional 26 weeks in mannitol- treated subjects who consented to enter the open-label phase, indicating that the beneficial effects of mannitol on lung function can be sustained with prolonged treatment (fig. 4).
The individual subject response at week 6 was highly predictive of longer-term FEV1 changes as shown in figure 5.
In subjects who had received control medication (mannitol 50 mg twice daily) in the double-blind phase, the mean FEV1 increased upon switching treatment to mannitol 400 mg twice daily in the open-label phase. At week 52, the mean FEV1 had increased by 74.7 mL in these subjects.
The individual subject response at week 6 was highly predictive of longer-term FEV1 changes as shown in figure 5.
Effects of mannitol on the frequency of pulmonary exacerbations:
This appeared to be driven by mannitol-treated subjects who had improved FEV1 between baseline and week 26. These subjects had a significantly reduced frequency of pulmonary exacerbations relative to those whose lung function did not respond (relative risk 0.4; p=0.03).
الاشخاص الذين وجد عندهم تحسن في FEV1 من بعد استخدام ال مانيتول قلت نسبة ال exacerbations
Lung function in other subgroups of adult subjects:
To assess the efficacy of inhaled mannitol when used in conjunction with best standard care, lung function scores were compared in various treatment groups.
Improvements were seen irrespective of rhDNase, tobramycin or colistin use, as shown in figure 7
Withdrawal rate:
Additional instruction of study coordinators to teach subjects proper inhaler technique with reinforcement and additional training provided during study CF302.
Compliance:
Median treatment compliance as measured by capsule returns in adult subjects who stayed on medication for the duration of the study was over 88% and 91% in the mannitol and control groups, respectively
Adverse events were generally mild or moderate, and consistent with CF and its standard therapies
There was a greater incidence of adverse events leading to discontinuation in mannitol-treated subjects compared with those on control.
The most frequently reported adverse event in both treatment groups was “condition aggravated” (pulmonary exacerbation)
The most commonly reported respiratory adverse events occurring more frequently in mannitol- treated subjects were cough, haemoptysis and pharyngeal pain.
The incidence of exacerbation-related haemoptysis episodes in mannitol treated subjects was lower than the incidence in the control group (mannitol 4.8% versus control 9.7%).
The total incidence of haemoptysis, including all events reported as a haemoptysis adverse event or those occurring as part of an exacerbation was marginally lower in the mannitol arm (15.5% and 17.9%, for mannitol and control, respectively).
There was no change in growth of CF organisms with mannitol and no difference in growth between mannitol and control over 26 weeks
For the management of hacking, dry and irritated cough:
patients were advised to slow down the speed of inhalation
take sips of water between capsules and take time to settle the cough.
Productive cough was managed by:
patients taking a moment between capsules to get control of their coughing and by practicing controlled huffing and coughing to clear secretions between inhalations.
Patients tend to accommodate cough well, provided expectations are set, and the positive implication of a productive cough is understood.
These data suggest that demonstration and reinforcement of proper inhaler technique and setting clear expectations with respect to treatment effects may increase the proportion of patients who could benefit from this novel medication.
The differences in the withdrawal rates between studies CF301 and CF302 however, seem to highlight the importance of education and training in achieving good treatment adherence.
MTT provides opportunity to educate patients about the proper use of the inhaler including loading capsules, inhaler technique and the appropriate inspiratory flow rate.
Only remove capsules immediately before use.
Pierce capsules once only.
Tilt inhaler so mouth-piece faces slightly downward which allows capsule to drop forward into spinning chamber.
Keep inhaler tilted in this way and breathe out completely away from the inhaler.
With the head tilted upwards, the patient should inhale deeply at an even, steady rate that is fast enough to make the capsule spin - the capsule will make a “rattling” sound in the inhaler when inspiratory flow is sufficient.
The inhalation rate may be slowed down if coughing occurs – controlled coughing should be encouraged where possible
After the dose from each capsule is inhaled, the patient must breath hold for 5 s – exhale and cough AWAY from the inhaler to prevent humidity build-up within the device.
The 10 capsules should be taken closely together over a 3–5 min.
A sip of water may be taken throughout the challenge to relieve cough and/or dry throat.