No description available.

Class of 2008 Abstract / Objectives: Inhaled insulin is indicated for the treatment of type 1 and type 2 diabetes mellitus. This project was designed to evaluate the level of pharmacist knowledge concerning inhaled insulin therapy. Methods: An invitation to complete a questionnaire concerning inhaled insulin was sent via email to pharmacists registered in Arizona and preceptors for the University of Arizona College of Pharmacy. Respondents completed a 36 item questionnaire, including 25 knowledge questions. To determine overall pharmacist knowledge of inhaled insulin, the questionnaire results were aggregated into a total correct score. Independent t-tests were used to compare mean scores based on status as a preceptor, completion of a residency, attendance of an inhaled insulin training session, and pharmacist-reported level of confidence in counseling on inhaled insulin use. Results: The mean total correct score for 60 pharmacists who completed the questionnaire was 13.6 (SD = 6.7) out of 25. The mean scores for preceptor pharmacists and non-preceptor pharmacists were not statistically different. Only pharmacist-reported level of confidence in counseling patients on the use of inhaled insulin was significantly related to total score. Pharmacists who reported they were either “very confident” or “confident” in counseling patients about inhaled insulin achieved a higher total correct score compared to pharmacists reporting lower levels of confidence ( p = 0.009). Conclusions: This study identified an overall lack of knowledge regarding therapy with inhaled insulin among participating pharmacists. Pharmacists who self-reported that they were confident in providing counseling regarding inhaled insulin were significantly more knowledgeable.

No description available.

No description available.

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone.

Corticosteroids are the most potent and reliable of the available agents among the anti-inflammatory drugs, and have assumed a major role in the management of asthma. This has subsequently resulted in the global widespread use of inhaled corticosteroids (ICS). A variety of studies have been undertaken to examine the effects of ICS on voice production among people with asthma. Most research suggests that the long-term use of ICS has a negative effect on voice production. However, the results of these studies are limited because of the reliance upon examining an asthmatic population and not consistently recording the dose prescribed. As a result, one cannot exclude that some of the voice problems may have been previously caused by asthma and thus, the contributing effects of ICS are obscured. Therefore, an ideal approach to examine the influence of ICS on voice is to test its short-term effects on healthy individuals, using a specific ICS (Fluticasone Propionate) at a fixed dose (1000 µg/Day). Thirty healthy adults (15 females & 15 males) aged between 18 to 30 years participated in this study. All participants were non-smokers with no history of speech, language or voice disorder. No participants had a history of asthma, respiratory illness hospital admission or inhaler use within the past 3 months. All participants followed the treatment regime often prescribed by physicians (in Canterbury region) for treating asthma (500 µg in morning & 500 µg in evening). Each participant self administered (inhaled) two puffs of ICS in the morning and again in the evening over a six day period. Voice samples were audio-recorded prior to undergoing the ICS regime, at various points during the ICS regime, and at the conclusion of ICS regime. Each participant’s audio-recorded samples were submitted for acoustic analysis using a commercially available speech analysis system (CSL 4300B, Kay Elemetrics, 1994). Three measures were performed, (1) vocal fundamental frequency (F0), (2) long-time spectral analysis (LTAS) and (3) formant frequency and formant frequency bandwidth. The results of this study indicate that ICS does have an effect on acoustic properties of voice. These effects were more evident in connected speech compared to isolated vowel productions. In particular, the spectral tilt and first spectral peak of continuous speech samples were found to change from baseline. The current results are discussed in regard to the phonatory deterioration associated with ICS use. The present study provides a framework for developing ICS treatment for respiratory disease in the phase of minimizing adverse effects on voice.

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone.

Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94 – 1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Severe influenza, recognized as a clinical syndrome characterized by hyper-induction of pro-inflammatory cytokine production, results in approximately 250–500 thousand deaths annually worldwide. Current influenza research is focused on therapeutics to target the influenza virus or modulate influenza virus-induced inflammation as potential treatment options to improve clinical outcome in experimental influenza A (H1N1) virus infection. The goals of this work were: (1) to evaluate the utility of inhaled nitric oxide (iNO) for decreasing influenza virus production in the lungs, and (2) investigate the use of mesenchymal stromal (stem) cells (MSCs) for mitigating deleterious host responses to influenza infection. Here, we report that MSCs and iNO, administered alone either prophylactically or post-influenza virus infection, fail to modulate host inflammation, fail to improve acute lung injury, fail to dampen lung viral load, and fail to improve survival of infected mice.

Severe influenza, recognized as a clinical syndrome characterized by hyper-induction of pro-inflammatory cytokine production, results in approximately 250–500 thousand deaths annually worldwide. Current influenza research is focused on therapeutics to target the influenza virus or modulate influenza virus-induced inflammation as potential treatment options to improve clinical outcome in experimental influenza A (H1N1) virus infection. The goals of this work were: (1) to evaluate the utility of inhaled nitric oxide (iNO) for decreasing influenza virus production in the lungs, and (2) investigate the use of mesenchymal stromal (stem) cells (MSCs) for mitigating deleterious host responses to influenza infection. Here, we report that MSCs and iNO, administered alone either prophylactically or post-influenza virus infection, fail to modulate host inflammation, fail to improve acute lung injury, fail to dampen lung viral load, and fail to improve survival of infected mice.