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The management of asthma and chronic obstructive pulmonary disease (COPD) poses considerable challenges due to the intricate nature of these respiratory conditions. Fostair™ and Trimbow™, two pressurized metered dose inhalers, have emerged as noteworthy therapeutic options for treating both asthma and COPD. Fostair combines an inhaled corticosteroid, specifically beclometasone dipropionate, with a long-acting beta2-agonist, formoterol fumarate dihydrate, offering a dual-action approach to mitigate airway inflammation and bronchoconstriction. Conversely, Trimbow integrates a tri-particulate formulation consisting of beclometasone dipropionate, formoterol fumarate dihydrate, and glycopyrronium bromide, providing a comprehensive strategy to target the pathophysiology of COPD and asthma. Recent clinical trials have underscored Trimbow's superior efficacy compared with Fostair, particularly in terms of reducing exacerbation rates and enhancing lung function. However, despite their therapeutic promise, both inhalers encounter challenges, including limited generalizability of study findings and a disparity between in vitro and human trial results. This literature review offers an in-depth analysis of Fostair and Trimbow, delving into their mechanisms of action, clinical applications, and outcomes in human studies for asthma and COPD. Additionally, the review discusses the role of combination therapy in managing respiratory diseases and underscores the necessity for further research to address existing knowledge gaps and optimize therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of triple inhaled therapy, a combination of inhaled glucocorticoids, long-acting muscarinic antagonists, and long-acting β2 agonists in managing acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods: Medical data of 100 patients with acute exacerbation of COPD admitted to Shaoxing Second Hospital, Shaoxing, China between January 2020 to December 2022 was collected and retrospectively analyzed. The patients were randomized into control (n = 50) and study groups (n = 50). Control group received budesonide/formoterol inhalers while the study group received triple inhaled therapy (budesonide/glycopyrronium/formoterol inhalers). Arterial blood gas, pulmonary function, immune function, adverse effects, and efficacy were evaluated. Results: The study group exhibited significantly higher pH, partial pressure of arterial oxygen (PaO2), and lower partial pressure of carbon dioxide (PaCO2) compared to control group (p < 0.001). Furthermore, the study group showed significantly higher levels of pulmonary function and immune function indices compared to control group (p < 0.001). There was no significant difference in incidence of adverse reactions between the two groups (p > 0.05). The study group was associated with higher clinical efficacy compared to the control group (p < 0.05). Conclusion: Triple inhaled therapy significantly alleviates the clinical symptoms of patients with COPD and enhances pulmonary and immune functions. Future studies should cover a larger and more diverse group of participants for broader validity. [ABSTRACT FROM AUTHOR]

Glycopyrrolate is a competitive muscarinic receptor antagonist used in the treatment of sialorrhea, especially in pediatrics. Degradation research was conducted to better understand the stability of the active pharmaceutical ingredient (API). Using an HPLC-UV method, we evaluated the chemical stability of the oral solution of the galenic compound glycopyrrolate 0.5 mg/mL under different storage conditions. Method validation was performed according to the International Council for Harmonization (ICH) Q2(R2) guidelines. The results of the stability study of the galenic compound in different storage conditions, with the exception of those stored in glass containers at 45 °C for more than 3 months, were stable (100 ± 10% of the nominal concentration). The aim of this work was to study the stability of the galenic compound glycopyrrolate in two different types of containers and at three different storage temperatures. Glycopyrrolate showed degradation beyond the limits only in glass at 45 °C and after 2 months of storage. The results indicate that oral liquid dosage forms of glycopyrrolate are stable for at least 210 days when stored at room temperature or at 4 °C, in glass or PET, for at least 7 months, maintaining product quality according to the standards established by the European Pharmacopoeia, ensuring long-term coverage for pediatric patient therapies. [ABSTRACT FROM AUTHOR]

Despite the established efficacy of glycopyrronium bromide in reducing drooling among children with neurodevelopmental disabilities, evidence on its impact on the daily lives of children and parents and effectiveness in a real-world setting are scarce, especially among long-term users. This study explored timing and duration of glycopyrronium treatment, effect and impact on daily life, and occurrence of side effects to inform clinical practice. This was a retrospective cohort study at a national referral centre for drooling, including 61 children with nonprogressive neurodevelopmental disabilities, treated with glycopyrronium for anterior and/or posterior drooling between 2011 and 2021. Data were obtained from medical records and supplemented by structured telephone interviews with parents. Anterior drooling severity decreased in 82% of the included children. Changes in the impact of drooling on burden of care, social interaction, and self-esteem were reported in 55%, 31%, and 36%, respectively. Side effects were noted for 71% of cases, yet only 36% of parents deemed these as outweighing the positive impact of treatment. A substantial majority (77%) of the included children were long-term users (≥6 months). Among these, 38% of parents reported decreasing effectiveness and 27% noticed more prominent side effects over time. Glycopyrronium demonstrated potential in mitigating the impact of drooling on daily life, although variations were observed in the specific aspects and extent of improvement. The real-world context of our study provides important insights for refining clinical practices, emphasizing the need for balanced consideration of treatment benefits and potential side effects to facilitate shared decision-making. • Long-term glycopyrronium use, beyond 24 weeks, is prevalent among included children. • Glycopyrronium showed potential to mitigate the impact of drooling in daily life. • Changes in impact were contingent on drooling severity and varied across individuals. • Side effects were common yet expectable, emphasizing the need for close monitoring. [ABSTRACT FROM AUTHOR]

The article published in the Canadian Journal of Psychiatry discusses the occurrence of postprocedural urinary retention in patients undergoing electroconvulsive therapy (ECT) under general mask anesthesia. The study found that the incidence of post-ECT urinary retention was less than 1%, with an increased risk associated with advancing age and the administration of anticholinergic medications during the procedure. The use of anticholinergic agents was linked to a higher risk of post-ECT urinary retention, as these agents decrease bladder muscle tone, hindering urination. Anesthesia providers are advised to inform the psychiatric team when anticholinergic medications are used during ECT to monitor patients for signs of urinary retention, especially considering potential postictal cognitive changes in ECT patients. [Extracted from the article]

Abstract Background Glycopyrrolate-neostigmine (G/N) for reversing neuromuscular blockade (NMB) causes fewer changes in heart rate (HR) than atropine-neostigmine (A/N). This advantage may be especially beneficial for elderly patients. Therefore, this study aimed to compare the cardiovascular effects of G/N and A/N for the reversal of NMB in elderly patients. Methods Elderly patients aged 65–80 years who were scheduled for elective non-cardiac surgery under general anesthesia were randomly assigned to the glycopyrrolate group (group G) or the atropine group (group A). Following the last administration of muscle relaxants for more than 30 min, group G received 4 ug/kg glycopyrrolate and 20 ug/kg neostigmine, while group A received 10 ug/kg atropine and 20 ug/kg neostigmine. HR, mean arterial pressure (MAP), and ST segment in lead II (ST-II) were measured 1 min before administration and 1–15 min after administration. Results HR was significantly lower in group G compared to group A at 2–8 min after administration (P

Introduction: Glycopyrrolate is commonly researched as a preoperative medication or in conjunction with cholinesterase inhibitors to counteract the lingering muscarinic effects of non-depolarizing muscarinic agents. However, studies have yielded inconsistent results regarding the superiority of glycopyrrolate over other anti-cholinergic drugs, such as atropine, particularly its effect on heart rate, blood pressure (BP), and glandular secretions. This study aimed to evaluate the differences in perioperative oral secretions, hemodynamics, and recovery quality with glycopyrrolate versus those with atropine before anesthesia induction in children undergoing tonsillectomy and adenoidectomy. Methods: In this prospective, single-center, randomized, double-blind, controlled trial, a total of 103 children were randomly assigned to group A (n = 51, glycopyrrolate 0.005 mg/kg) or B (n = 52, atropine 0.01 mg/kg). The follow-up anesthetic induction and maintenance protocols were the same in both groups. Vital signs, duration of surgery, extubation time, degree of wetness around the vocal cords during tracheal intubation, weight of oral secretions, and perioperative complications were recorded. Results: No significant differences were observed in the degree of wetness around the vocal cords during tracheal intubation, as well as in the weight of oral secretions, duration of surgery, or extubation time, between the two groups. The intraoperative and postoperative heart rates were lower in group A than in group B (110.18 ± 10.58 vs. 114.94 ± 11.14, p = 0.028; 96.96 ± 10.81 vs. 103.38 ± 10.09, p = 0.002). The differences observed in the intraoperative and preoperative heart rates were lower in group A than in group B (23.84 ± 9.62 vs. 29.65 ± 8.75, p = 0.002). The differences observed in the postoperative and preoperative heart rates were lower in group A than in group B (10.63 ± 9.97 vs. 18.09 ± 9.39, p = 0.000). Conclusion: Glycopyrrolate showed a smoother change in heart rate than atropine during and after tonsillectomy and adenoidectomy, with no effect on BP or recovery quality, and did not increase oral secretions. The findings indicate that glycopyrrolate can serve as an alternative to atropine to prevent secretions in anesthesia induction for tonsillectomy and adenoidectomy in children. Trial registration: This study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200063578; Date of Registration: 12/09/2022). [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study was aimed at determining the effect of sugammadex versus a combination of glycopyrrolate and neostigmine (GN) for neuromuscular reversal blockage on transient postoperative urinary retention (TPOUR) in patients undergoing a laparoscopic and robot-assisted laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study in patients undergoing a laparoscopic or robotic hysterectomy between February 2017 and December 2021. Patients with and without concomitant procedures were included. Demographics and perioperative data were extracted from the patient's medical record. Before discharge, all patients were required to spontaneously void and have a post-void residual of less than 150 ml. Results: We identified 500 patients and 485 were included in the final analysis. We had 319 subjects who received sugammadex and 166 GN combination. Both groups had overall similar demographics and perioperative characteristics. Most patients had a conventional laparoscopy procedure (391 [82.5%]) compared with robotic (83 [17.5%]). Patients who received GN were significantly more likely to be discharged home with an indwelling catheter (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.09—3.05). After adjusting for perioperative medications and sling implantation during the surgery a logistic regression model continued to demonstrate that patients who received GN had significantly higher odds of being discharged with a catheter (OR, 1.79; 95% CI, 1.03–3.12). Conclusions: Our findings suggest that sugammadex decreases the odds of TPOUR after laparoscopic hysterectomies with and without slings compared with the combination of GN. Additional prospective trials are required to confirm this finding. [ABSTRACT FROM AUTHOR]

BACKGROUND Modified Electroconvulsive therapy has evolved as a safe, pleasant and effective non pharmacological therapy in schizophrenia and bipolar disorders due to anaesthetic management[1]. The goals of anaesthesia are sedation, amnesia, and muscle relaxation during seizures and cardiorespiratory monitoring. Cardiovascular responses to electro convulsive therapy included an initial parasympathetic surge causing bradycardia followed by sympathetic stimulation leading to tachycardia and hypertension[2]. AIMS AND OBJECTIVES: • To analyse pulse and blood pressure changes during MEC • To observe the effects of glycopyrrolate 0.2mg given along with induction agent on the sympathetic response to ECT. • To compare the hemodynamics with and without glycopyrrolate in MECT. • To offer suggestions in patients with cardiac comorbidities regarding use of peripheral anticholinergic drug. MATERIALS AND METHODS: Study Population ASA 1 and ASA 2 patients recommended for MECT by psychiatrists. Study Period January 2023 to December 2023 METHODS: Following a routine consent, pre anaesthetic check, starvation for 6 hours and withholding of anticonvulsants and benzodiazepines. Patients were counselled to preprocedural area. Intravenous line & Oxygenation were done. Pulse, blood pressure, oxygen saturation were recorded. First 25 cases [Group G1] were given inj. glycopyrrolate 0.2mg IV along with Thiopentone 200mg and succinylcholine 50mg for muscle relaxation. Airway was maintained and bitemporal short ECS applied to elicit seizure. Pulse, BP were noted at 2mins, 6 minutes and 10 minutes after ECT. The same procedure was repeated for next 25 patients without glycopyrrolate (Group. Go). The observations were tabulated and analysed. RESULTS The pulse rate increased to more than 0.5 percent [from 80 to 120-140] in group G1 patients especially at 2nd minute after MECT (p=0.5) and group Go patients the pulse and SBP rise was smaller. CONCLUSION: The primary aims of using an anticholinergic for drying of secretions and manage vagal bradycardia as a routine may be reconsidered due to significant sympathetic response (P=0.5) in the G1 group. This may play a significant role in patients with cardiac comorbidities as it increases myocardial oxygen demand. Kaplan and salock recommend Dr. Andrews D.Krystal's paper on CVS response to ECT. They recommend no peripheral anticholinergic drug if baseline heartrate is 90/min. [ABSTRACT FROM AUTHOR]