Browsing by Author "Saeed, Haitham"

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Effect of Human Error, Inhalation Flow, and Inhalation Volume on Dose Delivery from Ellipta (R) Dry-Powder Inhaler
(Springer, 2019-09) Saeed, Haitham; Salem, Heba F; Rabea, Hoda; Abdelrahim, Mohamed E. A
Purpose Ellipta® is a new dry-powder inhaler (DPI), with mediumflow resistance. The present study aimed to evaluate Ellipta® dose preparation and inhalation technique and determine the effect of human factor, inhalation flow, and inhalation volume on total emitted dose (TED). Methods Two-hundred obstructive lung disease patients were asked to load Ellipta® dose and inhale from placebo Ellipta®, without receiving counseling (first attempt). They were divided into patients who previously used DPI (100 patients) and others who never used DPI before (100 patients). Secondly, TED of single-loaded dose from Relvar-Ellipta® was determined at different inhalation flows (20, 40, and 60 L/min) and inhalation volumes (2 and 4 L). TED was also determined after loading the dose twice at inhalation flows of 40 and 60 L/min and inhalation Q1 volume of 4 L. Doses were prepared while Ellipta® is in upright and horizontal positions. Results The number of handling errors performed by patients who previously used DPI was lower compared to others who never used DPI before. No significant difference was found between TEDs of 40 and 60 L/min inhalation flow at 2 or 4 L inhalation volume when loading Ellipta®, once or twice, in an upright or horizontal position. TED at inhalation flow of 20 L/min was significantly lower than at 40 and 60 L/min (p < 0.001). A 4-L inhalation volume significantly increased TED than 2 L/min only at inhalation flow of 20 L/min (p = 0.001). Conclusions Ellipta® is a consistent DPI. It can be used to deliver inhaled medication at a flow of ≥ 40 L/min without fear of not receiving the needed dose. It does not allow delivering double dosing.
Effects of Fill Volume and Humidification on Aerosol Delivery During Single-Limb Noninvasive Ventilation
(DAEDALUS ENTERPRISES INC., 2018) Saeed, Haitham; Mohsen, Marwa; Eldin, Abeer Salah; Elberry, Ahmed A.; Hussein, Raghda R. S.; Rabea, Hoda; Abdelrahim, Mohamed E. A.; https://t.ly/2rA2d
BACKGROUND: The aim of this work was to determine the effect of nil volume and humidification change on aerosol delivery during single-limb noninvasive ventilation (NIV). METHODS: Four groups were recruited, each consisting of 12 subjects (6 females) with COPD receiving NIV. Groups 1 and 3 received inhaled salbutamol with a vibrating mesh nebulizer, and Groups 2 and 4 received inhaled salbutamol with a jet nebulizer. The in vivo study was carried out on days 1 and 3. In groups 1 and 2, 2 fill-volumes were delivered to each subject; 1 mL 5,000 mu g/mL salbutamol respirable solution used as it is or diluted to a total of 2 mL using normal saline. In groups 3 and 4, 1 mL 5,000 mu g/mL salbutamol respirable solution diluted to 2 mL total volume using normal saline was delivered to each subject with and without humidification. Unchanged salbutamol in urine at 30 min (USAL0.5) and in pooled urine at 24 h (USAL24) was determined. On day 2, the ex vivo study was carried out on subjects using the same experimental setting with a filter placed proximal to their face mask for collection of total inhaled dose of salbutamol (aerosol emitted). RESULTS: The vibrating mesh nebulizer delivered higher USAL0.5, USAL24, and aerosol emitted compared to the jet nebulizer at all fill volumes and humidification conditions (P < .001). Increasing till volume from 1 mL to 2 mL resulted in a significant increase in USAL0.5, USAL24, and aerosol emitted from the jet nebulizer (P < .05) with an insignificant effect on the vibrating mesh nebulizer. A 2-mL fill volume with the jet nebulizer delivered USAL24 and aerosol emitted comparable to those of 1 mL with the vibrating mesh nebulizer with significantly longer nebulization times (P < .001). Humidification had an insignificant effect on aerosol delivery. CONCLUSIONS: Increasing the fill volume of a jet nebulizer is essential to increase the amount of inhaled medication reaching a subject. In contrast, there is no need to increase rill volumes when using a vibrating mesh nebulizer. There is no need to switch off the humidifier while delivering aerosol through a single-limb NIV circuit.
The Impact of Adding a Training Device to Familiar Counselling on Inhalation Technique and Pulmonary Function of Asthmatics
(SPRINGER, 233 SPRING ST, NEW YORK, NY 10013 USA, 2018-07) Nicola, Mina; Elberry, Ahmed; Sayed, Ossama; Hussein, Raghda; Saeed, Haitham; Abdelrahim, Mohamed
We have investigated the effect of adding a pressurized metered dose inhaler (pMDI) training device to verbal counselling on pulmonary function and inhalation technique. A total of 304 adult asthmatic subjects (> 18 years old) were enrolled in a 3-month study of assessment and education. They were divided into an investigation group (Trainhaler plus Flo-Tone and verbal counselling, n = 261, mean age 49.2 years) and a control group (verbal counselling only, n = 43, mean age 48.7 years). Pulmonary function and inhalation technique were evaluated, mistakes noted, and the correct technique advised at three consecutive monthly visits. Visits also included verbal pMDI counselling (both groups) and training device coaching (investigation group). By visit 2, the mean number of technique errors decreased significantly (p < 0.05) in both groups (investigation group p < 0.001). The investigation group demonstrated a marked decrease in the frequency of the critical error of maintaining a slow inhalation rate until the lungs are full-a technique difficult to learn via verbal counselling alone. The improvement in pulmonary function was significant from the second clinic visit in the investigation group (p < 0.05) and from the third visit in both groups (p < 0.001). Use of a training device combined with verbal counselling improved inhalation technique. An earlier, significant improvement was also noted in pulmonary function.
Modeling and optimization of nebulizers' performance in non-invasive ventilation using different fill volumes: Comparative study between vibrating mesh and jet nebulizers
(ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD, 24-28 OVAL RD, LONDON NW1 7DX, ENGLAND, 2018-06) Saeed, Haitham; Ali, Ahmed M. A.; Elberry, Ahmed A.; Eldin, Abeer Salah; Rabea, Hoda; Abdelrahim, Mohamed E. A.
Backgrounds: Substituting nebulisers by another, especially in non-invasive ventilation (NIV), involves many process-variables, e.g. nebulizer-type and fill-volume of respirable-dose, which might affect patient optimum therapy. The aim of the present work was to use neural-networks and genetic-algorithms to develop performance-models for two different nebulizers. Methods: In-vitro, ex-vivo and in-vivo models were developed using input-variables including nebulizer-type [jet nebulizer (JN) and vibrating mesh nebulizer (VMN)] fill-volumes of respirable dose placed in the nebulization chamber with an output-variable e.g. average amount reaching NIV patient. Produced models were tested and validated to ensure effective predictivity and validity in further optimization of nebulization process. Results: Data-mining produced models showed excellent training, testing and validation correlation-coefficients. VMN showed high nebulization efficacy than JN. JN was affected more by increasing the fill-volume. The optimization process and contour-lines obtained for in-vivo model showed increase in pulmonary-bioavailability and systemic-absorption with VMN and 2 mL fill-volumes. Conclusions: Modeling of aerosol-delivery by JN and VMN using different fill-volumes in NIV circuit was successful in demonstrating the effect of different variable on dose-delivery to NIV patient. Artificial neural networks model showed that VMN increased pulmonary-bioavailability and systemic-absorption compared to JN. VMN was less affected by fill-volume change compared to JN which should be diluted to increase delivery.