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[PMID]:29384621
[Au] Autor:Jasim R; Schneider EK; Han M; Azad MAK; Hussein M; Nowell C; Baker MA; Wang J; Li J; Velkov T
[Ti] Título:A Fresh Shine onCystic Fibrosis Inhalation Therapy: Antimicrobial Synergy of Polymyxin B in Combination with Silver Nanoparticles.
[So] Source:J Biomed Nanotechnol;13(4):447-57, 2017 Apr.
[Is] ISSN:1550-7033
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This in vitro study aimed to investigate the synergistic antibacterial activity of polymyxin B in combination with 2 nm silver nanoparticles (NPs) against Gram-negative pathogens commonly isolated from the cystic fibrosis (CF) lung. The in vitro synergistic activity of polymyxin B with silver NPs was assessed using the checkerboard assay against polymyxinsusceptible and polymyxin-resistant Pseudomonas aeruginosa isolates from the lungs of CF patients. The combination was also examined against the Gram-negative species Haemophilus influenzae, Burkholderia cepacia, Burkholderia pseudomallei, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii that are less common in the CF lung. The killing kinetics of the polymyxin B-silver NPs combinations was assessed against P. aeruginosa by static time-kill assays over 24 h. Polymyxin B and silver NPs alone were not active against polymyxin-resistant (MIC ≥4 mg/L) P. aeruginosa. Whereas, the combination of a clinically-relevant concentration of polymyxin B (2 mg/L) with silver NPs (4 mg/L) successfully inhibited the growth of polymyxin-resistant P. aeruginosa isolates from CF patients as demonstrated by ≥2 log10 decrease in bacterial count (CFU/mL) after 24 h. Treatment of P. aeruginosa cells with the combination induced cytosolic GFP release and an increase of cellular reactive oxygen species. In the nitrocefin assay, the combination displayed a membrane permeabilizing activity superior to each of the drugs alone. The combination of polymyxin B and silver NPs displays excellent synergistic activity against highly polymyxin-resistant P. aeruginosa and is potentially of considerable clinical utility for the treatment of problematic CF lung infections.
[Mh] Termos MeSH primário: Fenômenos Fisiológicos Bacterianos/efeitos dos fármacos
Fibrose Cística/tratamento farmacológico
Fibrose Cística/microbiologia
Nanopartículas Metálicas/administração & dosagem
Pneumonia Bacteriana/diagnóstico por imagem
Polimixina B/administração & dosagem
Prata/administração & dosagem
[Mh] Termos MeSH secundário: Administração por Inalação
Anti-Infecciosos/administração & dosagem
Anti-Infecciosos/química
Sobrevivência Celular/efeitos dos fármacos
Fibrose Cística/patologia
Difusão
Relação Dose-Resposta a Droga
Combinação de Medicamentos
Sinergismo Farmacológico
Seres Humanos
Nanopartículas Metálicas/química
Pneumonia Bacteriana/microbiologia
Polimixina B/química
Terapia Respiratória/métodos
Prata/química
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Infective Agents); 0 (Drug Combinations); 1404-26-8 (Polymyxin B); 3M4G523W1G (Silver)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE


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[PMID]:29226712
[Au] Autor:Vágvölgyi A; Rozgonyi Z; Vadász P; Varga JT
[Ad] Endereço:Mellkassebészeti Osztály, Országos Korányi Pulmonológiai Intézet Budapest.
[Ti] Título:[Risk stratification before thoracic surgery, perioperative pulmonary rehabilitation].
[Ti] Título:A mellkassebészeti mutéti teherbíró képesség megítélése, perioperatív légzésrehabilitáció..
[So] Source:Orv Hetil;158(50):1989-1997, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:INTRODUCTION: Besides the oncology and operative surgical technics, functional aspects influence the operability of lung cancer. Preoperative risk stratification, evaluation of postoperative complications needs to be considered. AIM: To review international literature and experiences of our institute. METHOD: We focused the literature of risk stratification of thoracic surgery. Lung function, lung mechanics, chest kinematics, exercise physiology were considered. Effectiveness of pulmonary rehabilitation for cardiovascular system, lung mechanics, muscles, exercise capacity and quality of life were evaluated. Laboratory parameters, comorbidities, obesity, cachexia, smoking cessation were considered. RESULTS: Elevated blood sugar, kidney function, reduced albumin level increased the risk. COPD, sleep apnoea, heart failure, obesity and cachexia influences the outcome. Smoking cessation may reduce postoperative complications. Controlled breathing technics, chest wall mobilization, training have favourable effects. Psychosocial support and dietetics are important. CONCLUSIONS: Risk stratification is supported by laboratory parameters, lung function, oxygen uptake and comorbidities. Pulmonary rehabilitation can improve functionality and quality of life. Orv Hetil. 2017; 158(50): 1989-1997.
[Mh] Termos MeSH primário: Assistência Perioperatória/métodos
Complicações Pós-Operatórias/prevenção & controle
Procedimentos Cirúrgicos Torácicos
[Mh] Termos MeSH secundário: Seres Humanos
Neoplasias Pulmonares/cirurgia
Terapia Respiratória/métodos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30862


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[PMID]:28849871
[Au] Autor:Singh M; Singh M; Jaiswal N; Chauhan A
[Ad] Endereço:Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India, 160012.
[Ti] Título:Heated, humidified air for the common cold.
[So] Source:Cochrane Database Syst Rev;8:CD001728, 2017 08 29.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Heated, humidified air has long been used by people with the common cold. The theoretical basis is that steam may help congested mucus drain better and that heat may destroy the cold virus as it does in vitro. This is an update of a review last published in 2013. OBJECTIVES: To assess the effects of inhaling heated water vapour (steam) in the treatment of the common cold by comparing symptoms, viral shedding, and nasal resistance. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (to February 2017), MEDLINE (1966 to 24 February 2017), Embase (1990 to 24 February 2017), and Current Contents (1998 to 24 February 2017). We also searched World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (8 March 2017) and ClinicalTrials.gov (8 March 2017) as well as reference lists of included studies. SELECTION CRITERIA: Randomised controlled trials using heated water vapour in participants with the common cold or experimentally induced common cold were eligible for inclusion. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Three review authors independently screened titles and abstracts for inclusion of potential studies identified from the search. We recorded the selection process in sufficient detail to complete a PRISMA flow diagram. We used a data collection form for study characteristics and outcome data that was developed and used for previous versions of this review. Two review authors independently extracted data, and a third review author resolved any disagreements. We used Review Manager 5 software to analyse data. MAIN RESULTS: We included six trials from five publications involving a total of 387 participants. We included no new studies in this 2017 update. The 'Risk of bias' assessment suggested an unclear risk of bias in the domain of randomisation and a low risk of bias in performance, detection, attrition, and reporting.It was uncertain whether heated, humidified air provides symptomatic relief for the common cold, as the fixed-effect analysis showed evidence of an effect (odds ratio (OR) 0.30, 95% confidence interval (CI) 0.16 to 0.56; 2 studies, 149 participants), but the random-effects analysis showed no significant difference in the results (OR 0.22, 95% CI 0.03 to 1.95). There is an argument for using either form of analysis. No studies demonstrated an exacerbation of clinical symptom scores. One study conducted in the USA demonstrated worsened nasal resistance, but an earlier Israeli study showed improvement. One study examined viral shedding in nasal washings, finding no significant difference between treatment and placebo groups (OR 0.47, 95% CI 0.04 to 5.19). As judged by the subjective response to therapy (i.e. therapy did not help), the number of participants reporting resolution of symptoms was not significantly higher in the heated humidified group (OR 0.58, 95% CI 0.28 to 1.18; 2 studies, 124 participants). There was significant heterogeneity in the effects of heated, humidified air on different outcomes, therefore we graded the quality of the evidence as low. Some studies reported minor adverse events (including discomfort or irritation of the nose). AUTHORS' CONCLUSIONS: The current evidence does not show any benefits or harms from the use of heated, humidified air delivered via the RhinoTherm device for the treatment of the common cold. There is a need for more double-blind, randomised trials that include standardised treatment modalities.
[Mh] Termos MeSH primário: Ar
Resfriado Comum/terapia
Terapia Respiratória/métodos
Vapor
[Mh] Termos MeSH secundário: Resfriado Comum/virologia
Calefação
Seres Humanos
Umidade
Infecções por Picornaviridae/terapia
Ensaios Clínicos Controlados Aleatórios como Assunto
Rhinovirus/fisiologia
Vapor/efeitos adversos
Eliminação de Partículas Virais
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Steam)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD001728.pub6


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[PMID]:28549673
[Au] Autor:Santana-Rodríguez N; Llontop P; Clavo B; Fiuza-Pérez MD; Zerecero K; Ayub A; Alshehri K; Yordi NA; Re L; Raad W; Fernández-Pérez L; García-Herrera R; Huang CJ; Bhora FY
[Ad] Endereço:Department of Thoracic Surgery, Mount Sinai Health System, New York, New York; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS)-BioPharm Group, ULPGC, Spain. Electronic address: norbesanrod@gmail.com.
[Ti] Título:Ozone Therapy Protects Against Rejection in a Lung Transplantation Model: A New Treatment?
[So] Source:Ann Thorac Surg;104(2):458-464, 2017 Aug.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: No satisfactory treatment exists for chronic rejection (CR) after lung transplantation (LT). Our objective was to assess whether ozone (O ) treatment could ameliorate CR. METHODS: Male Sprague-Dawley inbred rats (n = 36) were randomly assigned into four groups: (1) control (n = 6), (2) sham (n = 6), (3) LT (n = 12), and (4) O -LT (n = 12). Animals underwent left LT. O was rectally administered daily for 2 weeks before LT (from 20 to 50 µg) and 3 times/wk (50 µg/dose) up to 3 months. CR; acute rejection; and Hspb27, Prdx, Epas1, Gpx3, Vegfa, Sftpa1, Sftpb, Plvap, Klf2, Cldn5, Thbd, Dsip, Fmo2, and Sepp1 mRNA gene expression were determined. RESULTS: Severe CR was observed in all animals of LT group, but none of the O -LT animals showed signs of CR, just a mild acute rejection was observed in 1 animal. A significant decrease of Hspb27, Prdx, Epas1, Gpx3, Vegfa, Sftpa1, Sftpb, Plvap, Klf2, Cldn5, Thbd, Dsip, and Fmo2 gene expression in the O -LT group was observed CONCLUSIONS: O therapy significantly delayed the onset of CR regulating the expression of genes involved in its pathogenesis. No known immunosuppressive therapy has been capable of achieving similar results. From a translational point of view, O therapy could become a new adjuvant treatment for CR in patients undergoing LT.
[Mh] Termos MeSH primário: Rejeição de Enxerto/prevenção & controle
Transplante de Pulmão/efeitos adversos
Ozônio/administração & dosagem
Terapia Respiratória/métodos
[Mh] Termos MeSH secundário: Administração por Inalação
Animais
Modelos Animais de Doenças
Relação Dose-Resposta a Droga
Masculino
Oxidantes Fotoquímicos/administração & dosagem
Ratos
Ratos Sprague-Dawley
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Oxidants, Photochemical); 66H7ZZK23N (Ozone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170528
[St] Status:MEDLINE


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[PMID]:28442594
[Au] Autor:Auger C; Hernando V; Galmiche H
[Ad] Endereço:Medical Device Department French National Authority for Health Saint-Denis La Plaine, France.
[Ti] Título:Evidence-Based Medicine Analysis of Mechanical Insufflation-Exsufflation Devices-Reply.
[So] Source:Respir Care;62(5):643-644, 2017 05.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Medicina Baseada em Evidências
Insuflação
[Mh] Termos MeSH secundário: Tosse
Doenças Neuromusculares
Terapia Respiratória
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170427
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.05642


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[PMID]:28442593
[Au] Autor:Bach JR; Chiou M; Saporito LR; Esquinas AM
[Ad] Endereço:Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical School Newark, New Jersey.
[Ti] Título:Evidence-Based Medicine Analysis of Mechanical Insufflation-Exsufflation Devices.
[So] Source:Respir Care;62(5):643, 2017 05.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Medicina Baseada em Evidências
Insuflação
[Mh] Termos MeSH secundário: Tosse
Doenças Neuromusculares
Terapia Respiratória
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170427
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.05535


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[PMID]:28442590
[Au] Autor:Jones TD
[Ad] Endereço:Associate Chair and Program Director Cardio-Respiratory Care Program College of Health Professions University of Arkansas for Medical Sciences Little Rock, Arkansas tjones@4uams.edu.
[Ti] Título:From Here to There: Vision, Value, and the Advancement of Respiratory Care.
[So] Source:Respir Care;62(5):636-638, 2017 05.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Terapia Respiratória
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170427
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.05576


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[PMID]:28434554
[Au] Autor:Fehr JJ; McBride ME; Boulet JR; Murray DJ
[Ad] Endereço:Anesthesiology & Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: fehrj@wustl.edu.
[Ti] Título:The Simulation-Based Assessment of Pediatric Rapid Response Teams.
[So] Source:J Pediatr;188:258-262.e1, 2017 Sep.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To create scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners. STUDY DESIGN: A set of 10 simulated scenarios was designed for the training and assessment of pediatric RRTs. Pediatric RRTs, comprising a pediatric intensive care unit (PICU) registered nurse and respiratory therapist, led by a PICU intensivist-in-training or a pediatric nurse practitioner, managed 7 simulated acutely decompensating patients. Two raters evaluated the scenario performances and psychometric analyses of the scenarios were performed. RESULTS: The teams readily managed scenarios such as supraventricular tachycardia and opioid overdose but had difficulty with more complicated scenarios such as aortic coarctation or head injury. The management of any particular scenario was reasonably predictive of overall team performance. The teams led by the PICU intensivists-in-training outperformed the teams led by the pediatric nurse practitioners. CONCLUSIONS: Simulation provides a method for RRTs to develop decision-making skills in managing decompensating pediatric patients. The multiple scenario assessment provided a moderately reliable team score. The greater scores achieved by PICU intensivist-in-training-led teams provides some evidence to support the validity of the assessment.
[Mh] Termos MeSH primário: Competência Clínica
Equipe de Respostas Rápidas de Hospitais
[Mh] Termos MeSH secundário: Adulto
Cuidados Críticos
Docentes de Medicina
Feminino
Seres Humanos
Masculino
Meia-Idade
Missouri
Profissionais de Enfermagem
Recursos Humanos de Enfermagem no Hospital
Pediatria
Terapia Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170425
[St] Status:MEDLINE


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[PMID]:28427362
[Au] Autor:Jenkins CR; Eriksson G; Bateman ED; Reddel HK; Sears MR; Lindberg M; O'Byrne PM
[Ad] Endereço:Department of Thoracic Medicine, Concord Hospital and The George Institute for Global Health, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia. christine.jenkins@sydney.edu.au.
[Ti] Título:Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment.
[So] Source:BMC Pulm Med;17(1):65, 2017 Apr 20.
[Is] ISSN:1471-2466
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Asthma management may involve a step up in treatment when symptoms are not well controlled. We examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher, fixed-dose budesonide plus as-needed terbutaline in patients requiring step-up from Step 2 treatment (low-dose inhaled corticosteroids), stratified by baseline reliever use. METHODS: A post-hoc analysis utilized data from three clinical trials of 6-12 months' duration. Patients aged ≥12 years with symptomatic asthma uncontrolled despite Step 2 treatment were included. Severe exacerbation rate, lung function and reliever use were analysed, stratified by baseline reliever use (<1, 1-2 and >2 occasions/day). RESULTS: Overall, 1239 patients were included. Reductions in severe exacerbation rate with budesonide/formoterol MRT versus fixed-dose budesonide were similar across baseline reliever use levels, and were statistically significant in patients using 1-2 (42%, p = 0.01) and >2 (39%, p = 0.02) reliever occasions/day, but not <1 reliever occasion/day (35%, p = 0.11). Both treatments significantly increased mean FEV from baseline; improvements were significantly greater for budesonide/formoterol MRT in all reliever use groups. Reductions in reliever use from baseline were significantly greater with budesonide/formoterol MRT versus fixed-dose budesonide in patients using 1-2 and >2 reliever occasions/day (-0.33 and -0.74 occasions/day, respectively). CONCLUSIONS: Treatment benefit with budesonide/formoterol MRT versus higher, fixed-dose budesonide plus short-acting ß -agonist was found in Step 2 patients with relatively low reliever use, supporting the proposal that budesonide/formoterol MRT may be useful when asthma is uncontrolled with low-dose inhaled corticosteroid.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Asma/tratamento farmacológico
Budesonida/administração & dosagem
Fumarato de Formoterol/administração & dosagem
Terbutalina/administração & dosagem
[Mh] Termos MeSH secundário: Administração por Inalação
Adolescente
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem
Adulto
Idoso
Idoso de 80 Anos ou mais
Antiasmáticos/administração & dosagem
Austrália
Criança
Pré-Escolar
Método Duplo-Cego
Combinação de Medicamentos
Quimioterapia Combinada
Feminino
Seres Humanos
Pulmão/fisiopatologia
Masculino
Meia-Idade
Análise de Regressão
Terapia Respiratória/métodos
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Adrenergic beta-2 Receptor Agonists); 0 (Anti-Asthmatic Agents); 0 (Drug Combinations); 51333-22-3 (Budesonide); N8ONU3L3PG (Terbutaline); W34SHF8J2K (Formoterol Fumarate)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE
[do] DOI:10.1186/s12890-017-0401-y


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[PMID]:28325181
[Au] Autor:Cha ML; Costa LR
[Ad] Endereço:Kulshan Veterinary Hospital, 8880 Benson Rd, Lynden, WA 98264, USA.
[Ti] Título:Inhalation Therapy in Horses.
[So] Source:Vet Clin North Am Equine Pract;33(1):29-46, 2017 Apr.
[Is] ISSN:1558-4224
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article discusses the benefits and limitations of inhalation therapy in horses. Inhalation drug therapy delivers the drug directly to the airways, thereby achieving maximal drug concentrations at the target site. Inhalation therapy has the additional advantage of decreasing systemic side effects. Inhalation therapy in horses is delivered by the use of nebulizers or pressured metered dose inhalers. It also requires the use of a muzzle or nasal mask in horses. Drugs most commonly delivered through inhalation drug therapy in horses include bronchodilators, antiinflammatories, and antimicrobials.
[Mh] Termos MeSH primário: Doenças dos Cavalos/tratamento farmacológico
Terapia Respiratória/veterinária
[Mh] Termos MeSH secundário: Administração por Inalação
Aerossóis/administração & dosagem
Animais
Broncodilatadores/administração & dosagem
Cavalos
Nebulizadores e Vaporizadores/veterinária
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Aerosols); 0 (Bronchodilator Agents)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170602
[Lr] Data última revisão:
170602
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE



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