β-Adrenergic agonists are banned as growth promoters in the European Union, and clenbuterol and salbutamol are routinely screened in poultry under national residue-control programs; characterizing their residue behavior in edible tissues therefore supports the detection of illicit use. This study examined the residue depletion and tissue distribution of salbutamol, clenbuterol, and terbutaline in 168 Ross 308 broiler chickens. Each compound was administered in drinking water at 2.5 or 5 mg/L for seven consecutive days, chosen to model a covert exposure route rather than an authorized feed protocol, followed by a withdrawal period. Concentrations in breast muscle, liver, and kidney were quantified using a validated LC-MS/MS method compliant with Commission Implementing Regulation (EU) 2021/808. Residue values are group mean concentrations of three birds per group per sampling point (n = 3); because the individual per-bird results were not retained, no measures of dispersion are reported for the residue data. Quantifiable residues were detected in all three tissues at the first post-treatment sampling point, with the highest concentrations in kidney and liver and the lowest in breast muscle. Residues declined over the withdrawal period; terbutaline depleted most rapidly and clenbuterol persisted longest, and apparent depletion half-lives derived by log-linear regression were 1.1-1.5 days in liver and 0.7-1.2 days in kidney. By Day 46, all residues were below their respective matrix-specific decision limits (CCα), and no growth-promoting effect was observed for any compound at either concentration. Under this short drinking-water exposure, the three β-agonists showed distinct, tissue-dependent residue-depletion profiles but no measurable growth-promoting response in broilers. The comparative dataset, referenced to validated CCα values, supports residue surveillance and food-safety risk assessment of β-agonist residues in poultry.

The goal of this American Rhinologic Society expert practice statement (EPS) is to provide an evidence-based evaluation of the current literature on posterior nasal nerve ablation. Subtopics reviewed include the evidence for specific indications such as nonallergic rhinitis, allergic rhinitis, and postnasal drip and chronic cough; the durability of response; the safety profile of posterior nasal nerve ablation; the ability of ipratropium bromide response to predict procedural success; and recommendations regarding surgical technique. This EPS was developed following the previously published methodology and approval process. Following a modified Delphi approach, eight statements were developed, five of which reached consensus and three of which did not reach consensus. These statements and accompanying evidence are summarized along with an assessment of future needs.

While short-acting beta-agonists have been a mainstay of therapy during acute asthma exacerbations and for patients with intermittent asthma, there is increasing evidence that the use of combination inhalers, containing both an inhaled corticosteroid and a fast-acting bronchodilator, lead to improvement in symptom control, reduction in severe asthma exacerbations, and increased adherence to medications. These combination inhalers may be used in the form of stand-alone anti-inflammatory reliever therapy or as single maintenance and reliever therapy.

Exacerbations of chronic obstructive pulmonary disease (COPD) are a leading cause of morbidity, mortality, and healthcare burden. While standard bronchodilator therapy alleviates airway obstruction, its efficacy is often limited. This study evaluated nebulized furosemide, which has bronchodilatory and anti-inflammatory effects, as an adjunct to salbutamol-ipratropium in hospitalized COPD patients. Ninety‑two patients with exacerbated COPD were randomly assigned to two equal groups (46 each). The intervention group received nebulized salbutamol-ipratropium plus furosemide (20 mg), and the control group received salbutamol-ipratropium, both every 8 hours for 10 minutes over 5 consecutive days. Demographic and clinical variables, pulmonary function indices (FEV1, FVC, FEV1/FVC), clinical outcomes (COPD Assessment Test (CAT), Modified Medical Research Council (mMRC)scores, and quality of life by St. George's Respiratory Questionnaire (SGRQ)), arterial blood gases, and inflammatory biomarkers (TNF-α, IL-6, IL-8, CRP, ESR, neutrophil %, WBC) were measured before and after treatment. Demographic characteristics and baseline indices did not differ significantly between the groups. Dyspnea and respiratory symptoms (mMRC and CAT scores) decreased significantly, while quality of life, improved markedly in the intervention group compared to the control group. Pulmonary function also showed significant enhancement, with the FEV1/FVC ratio increasing. Arterial blood gas analysis showed higher PaO2 and lower PaCO2 in the intervention group. IL-6 and IL-8 decreased significantly, and no adverse events were reported. Nebulized furosemide enhances standard therapy in COPD exacerbations, improving lung function, relieving symptoms, and reducing systemic inflammation. Its safety, accessibility, and low cost make it a promising adjunct treatment.

Transient tachypnea of the newborn (TTN) commonly affects near- and full-term infants and often requires respiratory support. The use of nebulized salbutamol to improve respiratory outcomes has been of interest, though its clinical efficacy remains controversial. This systematic review and meta-analysis aimed to evaluate whether nebulized salbutamol improves clinical outcomes in affected infants. We searched PubMed, Scopus, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating the efficacy of nebulized salbutamol in infants with TTN. We used a random-effects model to calculate mean differences (MDs) with 95% confidence intervals (CIs). Twenty-five studies were included in the systematic review, comprising seventeen RCTs for meta-analysis involving 1,317 infants. The analysis showed that salbutamol significantly decreased the duration of respiratory support (MD: -14.85 hours; 95% CI [-25.05, -4.65]; p = 0.004), duration of continuous positive airway pressure (MD: -18.19 hours; 95% CI [-30.03, -6.35]; p = 0.003), duration of oxygen requirement (MD: -24.57 hours; 95% CI [-35.03, -14.10]; p < 0.001), and length of hospitalization (MD: -1.17 days; 95% CI [-1.69, -0.65]; p < 0.001). However, there was no significant decrease in duration of tachypnea (MD: -9.93 hours; 95% CI [-25.42, 5.56]; p = 0.21) or duration of neonatal intensive care unit stay (MD: -0.84 days; 95% CI [-2.62, 0.94]; p = 0.36). Subgroup analysis for respiratory support duration showed no significant effect in infants with clinical score of TTN < 5 (MD: -10.88 hours; 95% CI [-24.48, 2.73]; p = 0.12), while the certainty of evidence for all outcomes was low to very low. Nebulized salbutamol may improve clinical outcomes relevant to the evolution of the disease in TTN infants, with potential benefits in certain subgroups such as those with greater disease severity, though the available evidence is of low to very low certainty. Therefore, our confidence in its efficacy in treating TTN remains limited.

ObjectiveAt the end of life, changing healthcare needs may lead to decreased use of preventive therapies and increased use of medications for symptom management. This study compared polypharmacy, hyperpolypharmacy, and medication-dispensing patterns among community-dwelling older adults with dementia, community-dwelling older adults without dementia, and older adults with dementia in long-term care.MethodsWe completed a retrospective, matched case-control study using linked administrative health data from Nova Scotia, Canada. We compared polypharmacy, hyperpolypharmacy, and medications dispensed among three groups (community-dwelling older adults with dementia, community-dwelling older adults without dementia, and older adults with dementia in long-term care). We chose community-dwelling older adults with dementia with dates of death between 1 January 2019 and 1 January 2021, and then matched with replacement to community-dwelling older adults without dementia and older adults with dementia in long-term care based on age, administrative sex, and date of death ±30 days. Descriptive comparisons of polypharmacy, hyperpolypharmacy, and medications used during each of three equal periods of the last year of life (early, mid, and late) were made. Logistic regression was used to estimate the probability of polypharmacy and hyperpolypharmacy, adjusting for demographic and clinical factors.ResultsEach group included 1274 individuals. The mean age was 84.8 years. Overall, 50.9% (1944/3822) experienced polypharmacy and 8.7% (332/3822) hyperpolypharmacy, with community-dwelling older adults with dementia consistently having the highest rates. The most common medications dispensed in the last year of life were furosemide, levothyroxine sodium, salbutamol, and vitamin B12.ConclusionsCommunity-dwelling older adults with dementia had the highest rates of polypharmacy and hyperpolypharmacy across all time periods assessed. Medications most frequently dispensed in the last year of life did not change in ways that would be expected if deprescribing recommendations were being followed. This suggests that prescribing and deprescribing at the end of life are potential areas for pharmacist support and involvement.

Background/Objectives: Transdermal delivery of hydrophilic drugs remains limited by poor partitioning into the lipid-rich stratum corneum (SC). This study systematically investigated how ternary nanoemulsion composition and surfactant architecture jointly influence the transdermal delivery of salbutamol and whether the resulting composition-performance relationships are preserved across different skin models. Methods: Salbutamol-loaded nanoemulsions were prepared by the phase inversion temperature (PIT) method across a predefined ternary design space using two non-ionic surfactant systems: polyoxyl castor oil and polyoxyl hydroxystearate. Physicochemical characterization, ternary compositional mapping, in vitro permeation testing, generalized additive modeling (GAM), and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy were combined to evaluate formulation-dependent transport across pig and mouse skin models, complemented by exploratory human-skin experiments. Results: Among the nanoemulsion formulations, pig skin showed the highest salbutamol permeation, with flux values reaching approximately 390 µg/cm[2]·h. Within the PHS-based system, mouse skin showed lower permeation and a stronger dependence on formulation composition than pig skin, while the simple aqueous vehicle also produced comparatively low permeation in the murine model. The aqueous-vehicle control produced substantially higher permeation than the nanoemulsions in pig skin but lower permeation in mouse skin, while receptor-phase salbutamol concentrations remained below the limit of quantification in human skin. Across both surfactant systems, the most favorable nanoemulsion-mediated permeation was generally associated with water-rich formulations containing comparatively low surfactant levels, whereas highly surfactant-rich regions showed reduced flux despite marked lipid- or protein-associated spectral changes in the descriptive ATR-FTIR analysis. Regression analyses suggested that droplet size and viscosity alone could not consistently explain permeation behavior, whereas compositional modeling revealed pronounced non-linear effects of the water-surfactant-oil balance. Conclusions: Overall, this study demonstrates that nanoemulsion-mediated delivery of hydrophilic drugs is governed primarily by ternary composition, with formulation effects varying across skin models. These findings highlight the importance of composition-based formulation design and appropriate skin-model selection during the development of transdermal systems for hydrophilic drugs.

Background/Objectives: Packing, flow, and aerosolization properties of a series of binary adhesive mixtures containing micronized or spray-dried drugs were investigated, and the relationships between these blend properties and the blend structure were studied. Methods: Micronized or spray-dried terbutaline sulfate and salbutamol sulfate were used as model drugs, and an α-lactose powder was used as the carrier. Binary mixtures with drug loads ranging from 2 to 20% were prepared. The bulk density, compressibility, permeability, and shearing properties of the carrier powder and mixtures were determined, along with the in vitro aerosolization propensity of the mixtures using two types of inhalers. Imaging of the mixtures was used to assess the blend structure. Conclusions: The particle engineering method gave differences in particle crystallinity and morphology. The development of the adhesive layer with drug load was broadly consistent with the blend state concept. Spray-dried particles, however, exhibited a higher propensity to localize within surface cavities on the carrier and produced a more voluminous enveloped adhesive layer. The spray-dried particles gave a higher bulk density, a lower Hausner ratio, comparable shear strength, and a lower angle of internal friction. Aerosolization performance, including metrics such as fine particle fraction (FPF), depended on inhaler design; nevertheless, for both inhalers, aerosolization behavior was influenced by blend state and physicochemical properties of the drug. At low drug loads, spray-dried particles dispersed to a lower degree, while at high drug loads, the dispersion performance of the two particle types converged. For example, at an intermediate drug load of 7.4%, the FPF was about 20% for the spray-dried drugs and about 30% for the micronized drugs using the Screenhaler device, while the corresponding FPF:s were about 25% and 50% for spray-dried drugs and 40% and 55% for crystalline drugs using the Monodose inhaler. Overall, the physical characteristics of the drug particles were found to influence the structural evolution of the blends, as well as their mechanical and aerosolization properties.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the most prevalent chronic respiratory diseases in Switzerland, but their diagnosis remains challenging. Recent updates in international management guidelines have led to revisions in diagnosis, classification, and therapeutic management. In asthma, diagnostic criteria and exams are better defined and hierarchized, biologic therapies currently play a central role in severe asthma management, and salbutamol reliever monotherapy is no longer recommended. In COPD, GOLD guidelines have simplified their patient stratification into 3 categories (A, B, and E) and a single moderate exacerbation is now sufficient for inclusion in the high exacerbation risk group (E). Exacerbation severity is now graded according to the Rome proposal framework.