Faculty Bibliography

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) affect over 400 million people and are incurable. The pressurized metered dose inhaler (pMDI) has been the most popular inhaler device in inhaled therapy in recent times. However the pMDIs require good coordination between inhaling and actuating the inhaler to deliver the aerosolized drug most effectively. Poor coordination can greatly reduce the amount of drug delivered to a patient and therefore reducing the control of respiratory disease symptoms. Acoustic methods have been recently employed to monitor inhaler technique quite effectively. This study employs a noninvasive acoustic method to detect actuation sounds in a portable monitoring device. A total of 158 actuation sounds were obtained from a group of healthy subjects (n=5) and subjects suffering from respiratory diseases (n=15). The developed algorithm generated an overall accuracy of 99.7% demonstrating that this method may have clinical potential to monitor pMDI actuation coordination. The informative feedback from this method may also be employed in clinical training to highlight patient actuation technique.

BACKGROUND:The implementation of workplace smoking bans has contributed to a significant reduction in the incidence of acute coronary syndrome admissions, but their influence on adult acute pulmonary disease admissions is unclear. We sought to assess the impact of a national smoking ban on nationwide admissions of individuals of working age with acute pulmonary illness. METHODS:Data relating to emergency hospital admissions of subjects aged 20 to 70 years preceding and succeeding the implementation of the Irish smoking ban were obtained from a central registry. Population, weather, pollution, and influenza data were obtained from the relevant authorities. Poisson regression analysis was used to assess adjusted risk of emergency hospital admission following implementation of the smoking ban. RESULTS:Overall admissions with pulmonary illness decreased from 439 per 100,000 population per annum to 396 per 100,000 population per annum following the ban (unadjusted relative risk [RR], 0.91; 95% CI, 0.83-0.99; P = .048). This persisted following adjustment for confounding factors (adjusted RR, 0.85; 95% CI, 0.72-0.99; P = .04) and was most marked among younger age groups and in admissions due to asthma (adjusted RR, 0.60; 95% CI, 0.39-0.91; P = .016). Admissions with acute coronary syndromes (adjusted RR, 0.82; 95% CI, 0.70-0.97; P = .02), but not stroke (adjusted RR, 0.93; 95% CI, 0.73-1.20; P = .60), were also reduced. CONCLUSIONS:The implementation of a nationwide workplace smoking ban is associated with a decline in admissions with acute pulmonary disease among specific age groups and an overall reduction in asthma admissions. This may result from reduced exposure of vulnerable individuals to environmental tobacco smoke, emphasizing the potential benefit of legislation reducing second-hand smoke exposure.