The utility of aromatic oil inhalation for the reduction of pain after tonsillectomy was examined. Tea tree and peppermint oils were inhaled twice a day using a jet-type nebulizer. The degree of pain two days after the operation was significantly lower in the group that had inhaled the aromatic oils, compared with the control group that had not received inhalation therapy. The total use of analgesics was also significantly lower in the inhalation group than in the control group. The inhalation of aromatic oils appears to effectively reduce pain after a tonsillectomy.

View full abstract

To test whether the kampo herbal medicine, Saiboku-to (Cha-Po-Tang : CPT) prevents asthma exacebation during reducted medium-dose corticosteroid beclomethasone dipropionate (BDI), inhalation, we conducted a well-controlled randomized comparative study in 94 asthma patients requiring doses (800 μg/day) of inhaled BDI for clinical control. After BDI doses were halved, patients were assigned to inhale either CPT at 500μg/capsule, 1 capsule/1 time×4 times/days (CPT group) or sodium cromoglycate (DSCG) 20 mg/capsule, 1 capusle/1 time×4 times/day (DSCG group) for 12 months. In the CPT group, FEV_1.0 increased after 12 months and morning and evening PEF increased. In contrast, these variables decreased to below the baseline in the DSCG group (p <0.01 vs CPT group). The number of daytime and nighttime asthma symptoms and the use of β₂-agonist decreased in the CPT group, whereas they incredsed in the DSCG group (p<0.01 vs DSCG group). In the CPT group, concentrations of leukotriens and other chemical mediators decreased, as did exhaled nitric oxide, the number of eosinophils, and other asthmatic releated substances, compared to a significant low in the DSCG group (p<0.01). In the CPT group, endothelin-1, TXA₂, IL-3, IL-5 and IL-8 decreased during the 12 months, but not in the DSCG group (endotheline-1, IL-3, IL-5, IL-8 : p<0.01 vs CPT group, TAX₂ : p<0.05 vs CPT group). CPT thus prevents the asthma deterioration provoked by a 12-month halving of inhaled BDI administration.

View full abstract

Nebulization therapy as a topical treatment for sinusitis is one of the most widely used therapies because of its safety and convenience and due to its advantages as a painless therapy and its ability to simultaneously spread an agent to plural paranasal sinuses. We conducted a randomized controlled study on the efficacy of cefmenoxime (CMX) nebulization therapy vs oral resolutional enzyme therapy, and report interesting results on efficacy. Subjects were 18 CMX nebulization patients and 15 oral resolutional enzyme therapy patients was examined for therapeutic efficacy. Clinical efficacy was 77.8% in CMX nebulization and 26.7% in oral resolutional enzyme therapy. We concluded that CMX nebulization has at least a statistical advantage over oral resolutional enzyme therapy.

View full abstract

We conducted out a prospective controlled study to evaluate effects of nebulizer therapy on chronic rhinosinusitis. Coronal computed tomography (CT) was assessed before and after treatment in all cases, and disease extent in each sinus was evaluated based on staging proposed by Lund and Mackay. After treatment, overall CT scores significantly decreased from the baseline in the nebulizer group (median : 7-5), but remained unchanged in the control group (8-7.5). The degree of improvement was most prominent in anterior ethmoidal cells. These objective findings substantiate the efficacy of nebulizer therapy in chronic rhinosinusitis treatment and support the basic concept that healing osteomeatal complex diseases leads to the improvement of other adverse sinus conditions.

View full abstract

We studied the effect of cleaning and widening the middle nasal meatus in 220 patients with rhinosinusitis using nebulizer treatment. Patients were assigned to 2 groups : in the first, 98 applied cotton wool soaked with epinephrine to the middle nasal meatus for 10 minutes after cleaning the meatus ; in the second, 122 patients cleaned the meatus only. Results were analyzjed using X-ray and subjective complaints using a questionnaire. Nasal symptoms and X-ray scores were significantly better in the first group than in the second. Cleaning and widening the middle nasal meatus can thus be considered clinically useful in rhinosinusitis

View full abstract

Antibiotics and steroid are used for aerosol therapy in chronic sinusitis. We evaluated aerosol depositions in maxillary and ethomoidal sinuses in 6 patients undergoing endoscopic sinus surgery with 1% cefmenoxime hydrochloride administered by nebulization. More aerosolized particles were deposited in the anterior tip of inferior turbinates, the maxillary sinus, and the posterior ethmoidal cells, in this order. We cultured epithelial nasal polyp cells from a chronic sinusitis patient to dentermine whether dexamethasone alters mucin gene expression induced by lipopolysaccharide. RT-PCR analysis showed that MUC 8 mRNA expression induced by lipopolysaccharide was significantly inhibited by dexamethasone administration.

View full abstract

Subjects were 16 cases (28 sides) undergoing nebulizer therapy (cefmenoxime hemihydrochloride and dexamethasone sodium phosphate) taking an enzyme drug of 10 mg and 15 cases (23 sites) without nebulizer therapy taking an enzyme drug of 10 mg after endoscopic sinus surgery. Improvement in pathological sinus mucosa were compared in both groups.
Significant improvement was seen in ethmoid sinus mucosa in both groups under endoscopy, and the usefulness of nebulizer therapy was indicated. In maxillary sinus mucosa, no significance was seen either group apparently due to a difference in the cure period between ethmoid sinus mucosa and maxillary sinus mucosa. No significant difference was seen in improvement of nasal symptoms postoperativly in both groups. In the nebulizer group, the wet sensation of the nasal cavity was significantly sensed, according to a questionnaire on nasal cavity dryness, apparently demonstrating the effect with the nebulizer chemicals action in cures.

View full abstract

We clinically studied nebulizer therapy as a topical nasal antimicrobial therapy with cefmenoxime hydrochloride for acute rhinosinusitis in children. We evaluated results with the standard for the new antibiotics of the Japanese Society of Chemotherapy. Subjects were 54 children with acute rhinosinusitis. Bacteriological effectiveness was significantly higher in 12 of 25 children (48%) in the group with nebulizer therapy than in 3 of 12 children (25%) in the group without nebulizer therapy. By the standard of total evaluation, consisting of clinical and bacteriological study, the cure rate was very high in 17 of 25 children (68%) given poor cure rate of acute rhinosinusitis in children. We thus found nebulizer therapy with cefmenoxime hydrochloriide to be effective in pediatric acute rhinosinusitis.

View full abstract

Systemic drug delivery via the nasal route is a useful and convenient alternative to oral or intravenous administration. However, the duration of drug retention within the nasal cavity is limited because of mucociliary clearance and other factors. To achieve effective nasal drug delivery with sufficient absorption, the permeability of drugs into nasal tissues must be improved.
Some liquid formulations, containing enhancers and mucoadhesive polymers, and powder formulations have been reported to enhance either drug absorption or permeability. However, the influence of these enhancers and polymers on the nasal mucosa must be considered before clinical use.
We have found that nasal suspensions with lower osmolality greatly improve drug permeability, providing an effective delivery system without the addition of any enhancers or novel ingredients.
Suspension formulations containing fluorescein as a model compound were adjusted to different osmolalities by sorbitol, and then administered intranasally to rabits. The blood concentration of fluorescein increased dramatically as the osmolality of the suspension was lowered.
In addition, a preliminary 28-day toxicological study in rabbits on the intranasal administration of low osmolality suspensions produced no significant mucosal injuries. Thus, the enhanced permeability of the fluorescein in this system may not be derived from mucosal injuries.
In conclusion, low osmolality suspensions is useful as a novel nasal drug delivery system to enhance drug permeability without the addition of enhancers. The system appears to be safe and can be used for systemic drug delivery as well as topical drug delivery via the nasal route.

View full abstract

A qualitative analysis of the distribution of aerosol mist sprayed by a nebulizer into the nasal cavity and paranasal sinuses was made by measuring changes in temperature using a thermograph. When aerosol mist at a certain temperature was sprayed using various types of nebulizers, changes in the temperature within the nasal cavity and paranasal sinus areas were confirmed. When a naphasoline chloride solution was sprayed, the temperature of the nasal cavity and paranasal sinuses decreased. These experiments imply that the aerosol mist reached the nasal cavity and the paranasal sinuses.

View full abstract

Ultrasonic nebulization is wildey used in inhalation therapy. Teicoplanin, a glycopeptide antibiotic marketed in European countries, was recently marketed in Japan. The antibacterial spectrum of teicoplanin is equivalent or superior to that of vancomycin, and vancomycin inhalation therapy has been reported useful in temporarily eliminating MRSA. With vancomycin resistance increasingly observed among S. aureus strains, we must consider application of new antimicrobials. Since almost no information is available on teicoplanin use via nebulizers, we evaluated this using a new ultrasonic nebulizer (NE-U 14 Ultrasonic Nebulizer; Omron Co., Tokyo, Japan) marketed recently in Japan. Conventional ultrasonic nebulizers cannot nebulize teicoplanin. We found that teicoplanin lowers interfacial tension adversely affecting nebulization at clinical doses. Teicoplanin was successfully delivered (96%) via the ultrasonic nebulizer and confirmed to be highly stable in the aerosolized solution. We concluded that the ultrasonic nebulizer is effective in teicoplanin inhalation therapy, and teicoplanin delivered to the respiratory tract temporarily eliminated MRSA.

View full abstract

Ultrasonic nebulization, although widely used in inhalant therapy, poses problems in drug stability in inhalant solutions during ultrasonic nebulization. We studied the effectiveness of a ultrasonic nebulizer (NE-U 22) developed by Omron, focusing on cefmenoxime hydrochloride stability. Stability tests showed drug ratios exceeding 95% after ultrasonic nebulization using the new ultrasonic nebulizer, indicating, the drug is highly stable when the new ultrasonic nebulizer is used. The nebulizer generates an aerosol that delivers particles smaller than a commpressor nebulizer and occupies less dead volume in the medicine container. We concluded that use of the new ultrasonic nebulizier offers advantages in cefmenoxime hydrochloride inhalant therapy.

View full abstract

We studied the clinical efficiency of nasal inhalation of heated aerosol and reactions of the nasal mucosa to humidified aerosol stimulation. Sneezing occurred in 42.8%, nasal discharge in 20.8%, improved nasal obstruction in 52.2% after 10 min. of local hyperthermia twice a day for 1 week in 27 perennial nasal allergy patients. After only 1 humidified aerosol stimulation at 43°C for 10 min. to nasal mucosa, no significant changes were seen in nasal resistance in healthy subjects, but resistance increased significantly 15 min. after stimulation in allergic rhinitis patients. The reaction of nasal mucosa to heated aerosol stimulation in allergic patients may therefore differ from that in healthy subjects.

View full abstract

To determine possible nasal inhalation mechanisms in heated aerosol in treating allergic rhinitis, we measured nasal resistance before and after antigen or histamine challenge to nasal mucosa in nasal allergy patients treated and untreated by local hyperthermia. In antigen stimulation, mean nasal resistance in the group treated with local heated aerosol was significantly lower than that in the untreated group at early and late allergic reaction phases. In histamine stimulation, mean nasal resistance in the treated group was significantly lower and mean sneezing time was shorter than in the untreated group. We consider suppressed chemical mediator release from mast cells and decreased nonspecific hypersensitivity in allergic nasal mucosa to be possible mechanisms behind the effectiveness of heated local aerosol therapy.

View full abstract