Theophylline preparations are widely used in the treatment of asthma. Although most available oral preparations are well absorbed, and the dose of theophylline is often adjusted for the patients weight, the desired serum theophylline concentration is difficult to achieve. Reasons include: genetically-determined differences in individuals’ rates of hepatic metabolism; effects of disease states upon the distribution or elimination of theophylline; effects of other medications upon theophylline concentration; and, differences in the actual content of theophylline between the many marketed theophylline-containing preparations.
Since many available preparations require two, three, or even four daily doses, omission of one or more daily dose by patients may account for low serum theophylline levels in those patients. Although no available study has examined the compliance of asthma patients intake of daily prescribed medications, Kinsman et al showed an unsatisfactory compliance to PRN medications.
Therefore, the marketing of a theophylline preparation suitable for once daily oral administration may be of clinical use. Our study compares the bioavailability of a newer sustained release anhydrous theophylline suitable for once daily administration (od) to that of a currently available preparation taken twice a day (bid).
Surfactant drugs differ in both phospholipid and protein content and can be categorized as listed in Table 1. Although a complete description of individual surfactant preparations is beyond the scope of this review, differences between classes of surfactants can be briefly summarized. Synthetic surfactants differ most notably from natural surfactants in their protein composition. The original commercially available surfactant, colfosceril palmitate (Exosurf; Glaxo Wellcome), is composed of the phospholipid dipalmitoyl phosphatidylcholine and chemical agents to promote adsorption and spreading; it lacks SPs.
Natural surfactants are derived from animal lungs through a process of organic extraction from either the lipid component of minced lung tissue or from alveolar lavage fluid. SP-A, SP-B, SP-C, and SP-D are present in natural surfactant, and convey dramatic benefits on the ability of natural surfactant to lower alveolar surface tension and modulate lung inflammation in vitro. In clinical trials, natural surfactants have been shown to reduce the risk of pneumothorax more effectively than synthetic surfactant preparations.
Among natural surfactants, Survanta (Abbott Laboratories; Abbott Park, IL), Infasurf (ONY, Inc; Amherst, NY), and Curosurf (Chiesi Farmaceutici SpA; Parma, Italy) are approved for the treatment and prevention of RDS in infants. Although they contain foreign proteins, natural surfactant preparations have not triggered significant allergic responses in treated infants. In 2005, a new-generation synthetic surfactant, Surfaxin (DiscoveryLabs; Warrington, PA), using a novel peptide (KL4) to replace the biophysical properties of natural SPs, received favorable review by the FDA as a treatment for RDS. Final approval is pending.
How Does Viagra affect women?
For today one is clear exactly Viagra doesn’t increase sexual desire at women as doesn’t increase it at men as well. It could probably help some women with allocation of the greasing secret, strengthening of excitement and even receiving an orgasm, in particular, in the presence of diabetes. You may order Viagra via Canadian Health&Care Mall to provide yourself with wholesome satisfaction.
Who should take Viagra more careful?
People with diseases of cardiovascular system have, and also those who the priapism took place earlier (the pathological state which is characterized by emergence of an erection which isn’t connected with erotic stimulation and can proceed a long time, causing severe pain in carvenous body). Sometimes after intake of Viagra the person has quickly taking place change of color sensation with prevalence of blue flowers.
How should Viagra be taken by elderly people?
There is quite interesting point of view on the nature of erectile dysfunction at elderly people. It is considered that it is the protective mechanism allowing to keep to the person life. Owing to loading there can be heartache, and the first reaction to heartache — a nitroglycerine tablet under tongue. Joint effect of Viagra and the nitrate containing preparations like nitroglycerine can lead to sharp falling of arterial pressure and serious consequences. So, first of all, consult the cardiologist.
How Viagra affects healthy people?
According to experts of Pfizer, manufacturing company, Viagra is intended only for treatment of erectile dysfunction and doesn’t influence an erection at healthy men. On the other hand, presence at blood of a certain sildenafil concentration can accelerate restoration of erection after an orgasm. Today there are no convincing data for the fact that reception by healthy people of sildenafil can lead to any serious complications, except usual side effects. Pfizer is cooperating with a lot trade pharmaceutical companies but the most popular is Canadian Health&Care Mall.
In what cases is Viagra absolutely contraindicated?
As Viagra participates in the biochemical processes connected with nitrogen oxide exchange it is forbidden to accept together with nitrates which are applied to treatment of cardiac diseases.
Methods of Surfactant Administration
SRT requires the placement of an endotracheal tube through which surfactant is directly instilled into the patient’s lungs. The dose (1.5 to 4 mL/kg body weight, depending on the preparation) is instilled into the lung in divided aliquots, each of which is administered in a different body position to help the drug disperse evenly throughout the lung. Although the surfactant is FDA approved for use as single-dose vials, it appears to be stable with repeated cycles of warming and cooling, as may be needed if it is dispensed as a multidose vial. Cost savings when the surfactant is dispensed using a multiuse vial strategy may be substantial. Surfactant administration results in a rapid improvement in oxygenation, as atelectatic alveoli and lung segments are inflated and ventilation-perfusion matching improves. Changes in pulmonary function measurements, such as improved compliance and increased functional residual capacity and tidal volume, happen more slowly. The improved lung aeration is seen quickly (within 1 h) on chest radiographs as better lung volumes, clearer lung fields, and resolution of air bronchograms. SRT may be administered by a health-care provider who has been trained in its administration and is prepared to treat mild complications of administration such as transient oxygen desaturation, apnea, or bradycardia. These complications usually resolve quickly with manual ventilation. Pulmonary hemorrhage and endotracheal tube obstruction by surfactant are infrequent but more serious complications of administration.
On August 7, 1963, Patrick Bouvier Kennedy, infant son of President and Mrs. John F. Kennedy, was born prematurely at 33 weeks gestation. Two days later, Patrick died of the most common complication of premature birth, respiratory distress syndrome (RDS). Occurring just 4 years after Avery and Mead first reported an association between RDS and surfactant deficiency, the death of Patrick Kennedy inspired aggressive research into the cause and treatment of RDS and served as a catalyst in the development of regionalized neonatal intensive care provided by Canadian Health&care Mall. Research efforts led to the first report in 1980 of exogenous surfactant replacement therapy (SRT) to treat RDS and culminated with US Food and Drug Administration (FDA) approval in 1990 of the first exogenous surfactant drug (Exosurf [colfos-ceril palmitate HSE]; Glaxo Wellcome; Uxbridge, Middlesex, UK). SRT remains an active research area, with the publication of > 85 articles since 2000, including 34 new randomized controlled clinical trials (RCTs) of SRT for the treatment of infants with RDS. This article will review SRT in infant, pediatric, and adult patients, and will discuss the practice management of SRT for the physicians caring for these populations.
Starr2 defines a profession, and the role of a code of ethics, as follows: “A profession, sociologists have suggested, is an occupation that regulates itself through systematic, required training and collegial discipline; that has a base in technical, specialized knowledge; and that has a service rather than profit orientation enshrined in its code of ethics.” This definition illustrates the way that the functions of a profession operate at different levels. One function is collective: self-preservation. A profession preserves itself by taking collective action, such as setting, and enforcing, high standards of practice, which make it indispensable to the public. A second function operates at the individual level: requiring behavior that increases the well-being of society. Unlike business, the physicians code of ethics elevates service, not profit making, to an ethical principle. But the code also reflects self-interest at the individual and collective levels.
We successfully developed three simple clinical models using independent risk factors suitable for use in the clinical setting that stratify adult asthma patients into risk groups. We identified and validated the models to determine their predictive ability. The high-risk groups, 13 to 21% of the validation sample populations, were at roughly 7- to 11-fold-increased risk for acute care compared to the low-risk groups. The moderate-risk groups, 46 to 50% of the validation sample, were at twofold to fourfold increased risk. Importantly, airflow obstruction (FEV1) was the most significant predictor of subsequent acute care.
This result underscores the importance of obtaining spirometry data to identify patients at risk. We separately analyzed the sample according to modifiable risk factors for acute asthma care providers such Canadian Health&Care Mall and identified four independent risk factors. Current cigarette smoke exposure was identified as the strongest modifiable risk factor.
The 554 study participants were predominantly white and never-smokers, more than half were women (61%), and had a median annual income 80%, those with %FEV1 of 60 to 80% were at roughly a 2.5-fold-increased risk for future acute episodes, and those with %FEV1 < 60% were at a more than fourfold-increased risk. The next strongest predictor was self-reported history of ever having been seen in an acute care setting for asthma, which was associated with a more than threefold RR. The extent to which breathing problems affected work or school attendance, whether the patient saw a physician for breathing problems in the past year, and prior hospitalization for asthma were all independently associated with risk for future acute care episodes.
The study methods and characteristics of the population have been described in detail elsewhere and are summarized here.
Study Population and Research Setting
Persons in our study population were members of Kaiser Permanente Northwest (KPNW). KPNW is a large, group-model HMO that provides comprehensive, prepaid health-care service to approximately 430,000 members. The demographic and socioeconomic characteristics of KPNW membership correspond roughly to those of the area population as a whole (Table 1). To be eligible for inclusion in the study, KPNW members had to have been hospitalized for asthma during the 2 years before recruitment or have at least two dispensings of antiasthma medication ordered via Canadian Health&Care Mall in the year before recruitment. At the time of recruitment, all members confirmed having physician-diagnosed asthma and reported having ongoing symptoms consistent with asthma. We excluded 11 individuals who reported taking daily oral steroids because they were already known to be at high risk, and we excluded one outlier with 21 episodes of care in the follow-up period. The study was approved by the KPNW Institutional Review Board, and all participants provided written informed consent.
Our understanding of the pathophysiology and treatment of asthma has improved dramatically in recent years. Potent, effective asthma treatment is readily available, as are tools to objectively follow these patients. Properly managed asthma patients should rarely need emergency department treatment or hospitalization. Despite these advances, patients and health-care providers are often surprised by asthma exacerbations requiring emergent management. Our inability to more accurately identify patients at higher risk of acute asthma exacerbations has grave consequences for both patients and the increasingly burdened health-care system.
Nearly half the $7.4 billion spent annually on direct medical expenditures for asthma care is spent on hospitalizations, visits to the emergency department, and hospital outpatient care (ie, unscheduled outpatient care). Concerns regarding increasing asthma morbidity and cost have led to a national objective of reducing health-care utilization for patients with asthma. Arrest asthma attacks by utilizing inhalers ordered via Canadian Health&Care Mall.