Respiratory Tract Diseases Commons^™

Survey Of Certified Asthma Educator (Ae-C) Pharmacists – Who Are They And How Is This Credential Being Used?, Timothy R. Hudd, Susan G. Bollmeier, Enrique Seoane-Vazquez

Pharmacy Faculty Articles and Research

Objective: A survey was developed and distributed to pharmacists who have earned the certified asthma educator credential (AE-C) to assess asthma education services provided and their perceived value of the AE-C.

Design: A 28 item survey was developed, pretested and distributed electronically.

Participants: 224 AE-C certified pharmacists practicing within the United States were invited to participate.

Main Outcome Measures: Information pertaining to the level of education, professional affiliations, and practice setting was collected along with other demographic attributes.We also inquired about the types of asthma education services provided, related clinical activities, and whether AE-C pharmacists or …

Lung Cancer Survival Disparities In Nevada, Chima Osuoha

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lung cancer is the leading cause of cancer death in both men and women in the United States. Nevada shows moderate incidence rates of lung cancer for men but high rates for women. Little is known about the lung cancer experience and survival characteristics of the nearly 2000 new cases occurring every year in the State. The purpose of this study was to measure the extent to which geographic area of residency, gender, race, health insurance, social economic status (SES) and stage at diagnosis were associated with survival in patients diagnosed with lung cancer in Nevada. This was a retrospective …

The Omega-3 Fatty Acid Docosahexaenoic Acid Attenuates Organic Dust-Induced Airway Inflammation., Tara M. Nordgren, Taylor D. Friemel, Art J. Heires, Jill A. Poole, Todd A. Wyatt, Debra J. Romberger

Journal Articles: Pulmonary & Critical Care Med

Workers exposed to organic dusts from concentrated animal feeding operations (CAFOs) are at risk for developing airway inflammatory diseases. Available preventative and therapeutic measures for alleviating dust-induced lung disease are inadequate. Because omega-3 fatty acids can mitigate inflammatory processes, we aimed to determine whether nutritional supplementation with the omega-3 fatty acid docosahexaenoic acid (DHA) could reduce the airway inflammatory consequences of exposures to organic dust. Aqueous extracts of organic dusts from swine CAFOs (ODE) were utilized. In DHA-pretreated human bronchial epithelial cells, lung fibroblasts, monocyte cell cultures, and precision-cut murine lung slices, we found that DHA pretreatment dose-dependently decreased ODE-induced …

Integration Of Non-Communicable Diseases Into Primary Health Care: A Snapshot From Eastern Mediterranean Region, Shehla Zaidi, Abdul Latif Khan, Aftab Ali Mukhi, Yousuf Memon, Slim Slama, Samer Jabbour

Community Health Sciences

No abstract provided.

Acute Respiratory Distress Syndrome, Brian Flowers

Nursing Student Class Projects (Formerly MSN)

In healthcare, there are many interesting and intriguing conditions that are vital to understand from both a clinical and a pathophysiological standpoint. Comprehending and knowing how to treat these conditions effectively, ultimately leads to the best care and patient outcomes. As a current critical care nurse and future advanced practice nurse, it was important to select a research topic of interest to explore that would benefit a high risk group of patients. Based on this precedent, acute respiratory distress syndrome (ARDS) was chosen. As a critical care nurse, exposure to respiratory conditions and mechanical ventilation management is something nurses are …

Acute Respiratory Distress Syndrome, Jaqueline Yunker

Nursing Student Class Projects (Formerly MSN)

Acute Respiratory Distress Syndrome is an inflammatory response resulting from injury to the alveolar-­‐capillary membrane. This injury is caused by a systemic inflammatory response that involves either direct trauma to the lung cells, such as a pneumonia, or indirect, such as sepsis. The inflammatory response that is triggered results in leaky alveolar-­‐capillary beds and infiltration of the lungs (Villar, 2011). This is very common with approximately 150,000 cases annually in the United States and a very high mortality rate of 60,000 deaths per year (Pipeling & Fan, 2010). Despite the high mortality rate, 15-­‐35%, there is no set of guidelines …

Global Burden Of Tuberculosis, Diana Moses

Nursing Student Class Projects (Formerly MSN)

Tuberculosis (TB) is a major health concern not only in the United States, but in the entire world. TB is an airborne communicable infection which has affected human beings from immemorial times, evidenced by TB being found in the skeletal remains of ancient mummies (Gough & Kaufman, 2011). There are many patho physiological events in TB that concern the entire body, especially the respiratory and immunological systems. According to Knechel, TB prevalence is rising due to the increased number of patients infected with HIV, bacterial resistance to medications, increased international travel and immigration from countries with high prevalence of TB, …

Enterovirus: What Everyone Should Know, Debra Mccorkle

Nursing Student Class Projects (Formerly MSN)

Enterovirus is capturing the attention of everyone; but what is it, who is affected by it, and can it be treated and/or prevented? Like any virus the enterovirus has many different strains. The strain capturing everyone’s attention lately is human enterovirus 68 (HEV68). This strain was first detected in California in 1962 (Oberste et al., 2004). Most cases of HEV68 are mild and do not require medical attention, however some can become severe and may cause serious heart or brain infections according to the Center for Disease Control and Prevention (CDC) website (Updated September 8, 2014). HEV68 is a respiratory …

Idiopathic Pulmonary Fibrosis, Stacey Rosselot

Nursing Student Class Projects (Formerly MSN)

Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible lung disease, characterized by chronic inflammation and fibroproliferation of the parenchymal cells of the lung that lead to chronic respiratory failure and ultimately death (Kotsianidis et al., 2009). IPF is more prevalent in men than in women and risk for disease increases after age 60. IPF is the most common form of idiopathic interstitial pneumonia and it affects over 100,000 persons in the United States alone (Ding et al., 2011). Most of IPF cases are considered to be unpredictable and sporadic in nature, however approximately 15-20% of cases have a family history …

Review Of The Effectiveness Of Tissue Plasminogen Activator For The Treatment Of Plastic Bronchitis In Patients With Fontan Physiology, Ruth Ferroni

Nursing Student Class Projects (Formerly MSN)

Plastic bronchitis is a condition characterized by the formation of bronchial casts ranging from small to large obstructions of the pulmonary airways. Cast formation is intricate and resembles a plastic, rubbery model of the airway it obstructs. Its form was first described by Galen (A.D. 131-200). One of the patient populations at risk for developing this rare complication are those with single ventricle disease who are surgically corrected to Fontan physiology. It is a very abnormal type of circulation that is suspect in the development of plastic bronchitis. The cellular composition of plastic bronchitis differs from the casts seen in …

Evaluation Of The Effectiveness Of A Newly Implemented, Proactive Approach To Legionellosis Investigations Conducted By The Southern Nevada Health District, Devin Charlotte Raman

UNLV Theses, Dissertations, Professional Papers, and Capstones

This project is an evaluation of a new, more proactive approach to legionellosis investigations conducted by the Southern Nevada Health District. The new protocol was conceived, written and adopted in April of 2012 with the goal of preventing outbreaks of Legionnaires' disease that can have a significant impact on public health and the resort industry of Las Vegas. The objectives of this project were to determine if the remediation methods were successful at eliminating the target organism from water systems and maintaining a negative status throughout the monitoring period, to conduct a cost/benefit analysis, and to compare this protocol with …

Investigating The Viability Of Two Stenotrophomonas Maltophilia Isolates After Air-Drying, Samantha Lane, Joanna Brooke

DePaul Discoveries

Abstract

Stenotrophomonas maltophilia is a water-borne infectious bacterium that is found in both clinical (hospitals) and non-clinical environments. This human pathogen is commonly recovered from respiratory tract infections. A recent study at a hospital in Taiwan suggested that dry patient charts can serve as a vehicle of transmission of this bacterium⁷. As S. maltophilia is not commonly isolated from dry surfaces, this current study tested the hypothesis that this pathogen can remain viable for some time on a dry surface. This study was designed to determine how long S. maltophilia could remain viable after air-drying by observing …

Pediatric Asthma Telemonitoring: Literature, Theory, And Application To Practice, Erin Christine Shankel

DNP Projects

Asthma is one of the most prevalent and costly chronic diseases faced by Americans today. It is marked by inflammation and hyperresponsiveness of the airways which fluctuates, often unpredictably, in response to triggers. As such, it causes particular challenges symptom management, especially on the part of the patient who is tasked with dealing with these frequent fluctuations for months at a time between regularly scheduled health care appointments. This is further complicated when the patient is a child, and symptoms must be interpreted and managed second-hand by a caregiver. Uncertainty about how to manage symptoms, as well as minimization of …

Palivizumab Administration Decreases Recurrent Wheeze, Shelly Daniels

Physician Assistant Scholarly Project Posters

Children who have been infected with Respiratory Syncytial Virus have a higher incidence of wheeze-associated clinic visits and hospitalizations compared to children without previous RSV exposure. The purpose of this study is to determine if palivizumab, an immunoglobulin injection used to prevent RSV infections, can decrease the incidence of recurrent wheezing in children. The review of literature will follow male and female children from infancy to age 13 who were treated with palivizumab and compare these children to patients with similar demographics that were not treated with palivizumab to determine if there is any difference in incidence of wheezing. The …

Non-Emphysematous Chronic Obstructive Pulmonary Disease Is Associated With Diabetes Mellitus, Craig P. Hersh, Barry J. Make, David A. Lynch, R. Graham Barr, Russell P. Bowler, Peter M.A. Calverley, Peter J. Castaldi, Michael H. Cho, Harvey O. Coxson, Dawn L. Demeo, Marilyn G. Foreman, Meilan K. Han, Benjamin J. Harshfield, John E. Hokanson, Sharon Lutz, Joe W. Ramsdell, Elizabeth A. Regan, Stephen I. Rennard, Joyce D. Schroeder, Frank C. Sciurba, Robert M. Steiner, Ruth Tal-Singer, Edwin Van Beek, Edwin K. Silverman, James D. Crapo, Copdgene And Eclipse Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has been classically divided into blue bloaters and pink puffers. The utility of these clinical subtypes is unclear. However, the broader distinction between airway-predominant and emphysema-predominant COPD may be clinically relevant. The objective was to define clinical features of emphysema-predominant and non-emphysematous COPD patients.

METHODS: Current and former smokers from the Genetic Epidemiology of COPD Study (COPDGene) had chest computed tomography (CT) scans with quantitative image analysis. Emphysema-predominant COPD was defined by low attenuation area at -950 Hounsfield Units (LAA-950) ≥10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA-950 …

Sexually-Dimorphic Targeting Of Functionally-Related Genes In Copd, Kimberly Glass, John Quackenbush, Edwin K. Silverman, Bartolome Celli, Stephen I. Rennard, Guo-Cheng Yuan, Dawn L. Demeo

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: There is growing evidence that many diseases develop, progress, and respond to therapy differently in men and women. This variability may manifest as a result of sex-specific structures in gene regulatory networks that influence how those networks operate. However, there are few methods to identify and characterize differences in network structure, slowing progress in understanding mechanisms driving sexual dimorphism.

RESULTS: Here we apply an integrative network inference method, PANDA (Passing Attributes between Networks for Data Assimilation), to model sex-specific networks in blood and sputum samples from subjects with Chronic Obstructive Pulmonary Disease (COPD). We used a jack-knifing approach to …

The Search For Novel Inhibitors Of The Mycobacterial Enoyl Reductase Inha, Esther Saul

The Science Journal of the Lander College of Arts and Sciences

Isoniazid (INH), one of two first-line drugs used to treat tuberculosis (TB), has been shown to be a potent inhibitor of InhA, the mycobacterial enoyl reductase. However, the increasing resistance to INH makes it imperative to find alternative drugs that are as effective as the first-line drugs, yet active against INH-resistant strains. Since InhA has been validated as an excellent target of TB, there have been attempts to find novel inhibitors of InhA. Through rational drug design, a variety of high affinity InhA inhibitors were synthesized. Triclosan itself was observed to be a suboptimal inhibitor of InhA with a K …

The Association Of Plasma Biomarkers With Computed Tomography-Assessed Emphysema Phenotypes, Brendan J. Carolan, Grant Hughes, Jarrett Morrow, Craig P. Hersh, Wanda K. O'Neal, Stephen I. Rennard, Sreekumar G. Pillai, Paula Belloni, Debra A. Cockayne, Alejandro P. Comellas, Meilan Han, Rachel L. Zemans, Katerina Kechris, Russell P. Bowler

Journal Articles: Pulmonary & Critical Care Med

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a phenotypically heterogeneous disease. In COPD, the presence of emphysema is associated with increased mortality and risk of lung cancer. High resolution computed tomography (HRCT) scans are useful in quantifying emphysema but are associated with radiation exposure and high incidence of false positive findings (i.e., nodules). Using a comprehensive biomarker panel, we sought to determine if there was a peripheral blood biomarker signature of emphysema.

METHODS: 114 plasma biomarkers were measured using a custom assay in 588 individuals enrolled in the COPDGene study. Quantitative emphysema measurements included percent low lung attenuation (%LAA) ≤ …

Randomized Study Of The Safety, Pharmacokinetics, And Bronchodilatory Efficacy Of A Proprietary Glycopyrronium Metered-Dose Inhaler In Study Patients With Chronic Obstructive Pulmonary Disease, Stephen I. Rennard, Charles Fogarty, Colin Reisner, Carlos Fernandez, Tracy Fischer, Michael Golden, Earl St Rose, Patrick Darken, Gregory Tardie, Chadwick Orevillo

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Bronchodilator medications are central to the symptomatic management of chronic obstructive pulmonary disease (COPD). Metered-dose inhalers (MDIs) are the most commonly used devices to deliver treatment to patients with COPD and asthma, comprising approximately 70% of bronchodilator prescriptions. Proprietary porous-particle technology permits the formulation of long-acting muscarinic antagonists, long-acting β2-agonists, and a combination of both in hydrofluoroalkane (HFA) MDIs, providing a solution to formulation challenges inherent to the development of HFA MDIs, which have contributed to the development of dry-powder inhalers.

METHODS: In this randomized, double-blind, 4-period, 6-treatment, placebo- and active-controlled, multicenter, crossover study, 4 ascending single doses of …

Analyzing Networks Of Phenotypes In Complex Diseases: Methodology And Applications In Copd, Jen-Hwa Chu, Craig P. Hersh, Peter J. Castaldi, Michael H. Cho, Benjamin A. Raby, Nan Laird, Russell Bowler, Stephen I. Rennard, Joseph Loscalzo, John Quackenbush, Edwin K. Silverman

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: The investigation of complex disease heterogeneity has been challenging. Here, we introduce a network-based approach, using partial correlations, that analyzes the relationships among multiple disease-related phenotypes.

RESULTS: We applied this method to two large, well-characterized studies of chronic obstructive pulmonary disease (COPD). We also examined the associations between these COPD phenotypic networks and other factors, including case-control status, disease severity, and genetic variants. Using these phenotypic networks, we have detected novel relationships between phenotypes that would not have been observed using traditional epidemiological approaches.

CONCLUSION: Phenotypic network analysis of complex diseases could provide novel insights into disease susceptibility, disease …

Clinical And Computed Tomographic Predictors Of Chronic Bronchitis In Copd: A Cross Sectional Analysis Of The Copdgene Study, Victor Kim, Adam Davey, Alejandro P. Comellas, Meilan K. Han, George Washko, Carlos H. Martinez, David Lynch, Jin Hwa Lee, Edwin K. Silverman, James D. Crapo, Barry J. Make, Gerard J. Criner, The Copdgene® Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Chronic bronchitis (CB) has been related to poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). From a clinical standpoint, we have shown that subjects with CB in a group with moderate to severe airflow obstruction were younger, more likely to be current smokers, male, Caucasian, had worse health related quality of life, more dyspnea, and increased exacerbation history compared to those without CB. We sought to further refine our clinical characterization of chronic bronchitics in a larger cohort and analyze the CT correlates of CB in COPD subjects. We hypothesized that COPD patients with CB would have thicker airways …

Comparison Of Serum, Edta Plasma And P100 Plasma For Luminex-Based Biomarker Multiplex Assays In Patients With Chronic Obstructive Pulmonary Disease In The Spiromics Study, Wanda K. O'Neal, Wayne Anderson, Patricia V. Basta, Elizabeth E. Carretta, Claire M. Doerschuk, R. Graham Barr, Eugene R. Bleecker, Stephanie A. Christenson, Jeffrey L. Curtis, Meilan K. Han, Nadia N. Hansel, Richard E. Kanner, Eric C. Kleerup, Fernando J. Martinez, Bruce E. Miller, Stephen P. Peters, Stephen I. Rennard, Mary Beth Scholand, Ruth Tal-Singer, Prescott G. Woodruff, David J. Couper, Sonia M. Davis, Spiromics Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: As a part of the longitudinal Chronic Obstructive Pulmonary Disease (COPD) study, Subpopulations and Intermediate Outcome Measures in COPD study (SPIROMICS), blood samples are being collected from 3200 subjects with the goal of identifying blood biomarkers for sub-phenotyping patients and predicting disease progression. To determine the most reliable sample type for measuring specific blood analytes in the cohort, a pilot study was performed from a subset of 24 subjects comparing serum, Ethylenediaminetetraacetic acid (EDTA) plasma, and EDTA plasma with proteinase inhibitors (P100).

METHODS: 105 analytes, chosen for potential relevance to COPD, arranged in 12 multiplex and one simplex platform …

Dnah5 Is Associated With Total Lung Capacity In Chronic Obstructive Pulmonary Disease, Jin Hwa Lee, Merry-Lynn N Mcdonald, Michael H. Cho, Emily S. Wan, Peter J. Castaldi, Gary M. Hunninghake, Nathaniel Marchetti, David A. Lynch, James D. Crapo, David A. Lomas, Harvey O. Coxson, Per S. Bakke, Edwin K. Silverman, Craig P. Hersh, The Copdgene And Eclipse Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by expiratory flow limitation, causing air trapping and lung hyperinflation. Hyperinflation leads to reduced exercise tolerance and poor quality of life in COPD patients. Total lung capacity (TLC) is an indicator of hyperinflation particularly in subjects with moderate-to-severe airflow obstruction. The aim of our study was to identify genetic variants associated with TLC in COPD.

METHODS: We performed genome-wide association studies (GWASs) in white subjects from three cohorts: the COPDGene Study; the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE); and GenKOLS (Bergen, Norway). All subjects were current or ex-smokers …

Influence Of Diet And Obesity On Copd Development And Outcomes, Corrine K. Hanson, Erica P. Rutten, Emiel F.M. Wouters, Stephen I. Rennard

Journal Articles: Pulmonary & Critical Care Med

The global increase in the prevalence and incidence of obesity has called serious attention to this issue as a major public health concern. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Independently of obesity, diet also plays a role as a risk factor for many chronic diseases, and evidence is accumulating to support a role for diet in the prevention and management of several lung diseases. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and …

Roflumilast And Dyspnea In Patients With Moderate To Very Severe Chronic Obstructive Pulmonary Disease: A Pooled Analysis Of Four Clinical Trials, Stephen I. Rennard, Shawn X. Sun, Stavros Tourkodimitris, Paul Rowe, Udo M. Goehring, Dirk Bredenbröker, Peter M.A. Calverley

Journal Articles: Pulmonary & Critical Care Med

PURPOSE: Breathlessness is a predominant symptom of chronic obstructive pulmonary disease (COPD), making it a valuable outcome in addition to lung function to assess treatment benefit. The phosphodiesterase-4 inhibitor roflumilast has been shown to provide small but significant improvements in dyspnea, as measured by the transition dyspnea index (TDI), in two 1-year studies in patients with severe to very severe COPD.

PATIENTS AND METHODS: To provide a more comprehensive assessment of the impact of roflumilast on dyspnea, post hoc analyses of four 1-year roflumilast studies (M2-111, M2-112, M2-124, and M2-125) in patients with moderate to very severe COPD were conducted. …

Efficacy And Safety Of Fixed-Dose Combinations Of Aclidinium Bromide/Formoterol Fumarate: The 24-Week, Randomized, Placebo-Controlled Augment Copd Study, Anthony D. D'Urzo, Stephen I. Rennard, Edward M. Kerwin, Victor Mergel, Anne R. Leselbaum, Cynthia F. Caracta, Augment Copd Study Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Combining two long-acting bronchodilators with complementary mechanisms of action may provide treatment benefits to patients with chronic obstructive pulmonary disease (COPD) that are greater than those derived from either treatment alone. The efficacy and safety of a fixed-dose combination (FDC) of aclidinium bromide, a long-acting muscarinic antagonist, and formoterol fumarate, a long-acting β2-agonist, in patients with moderate to severe COPD are presented.

METHODS: In this 24-week double-blind study, 1692 patients with stable COPD were equally randomized to twice-daily treatment with FDC aclidinium 400 μg/formoterol 12 μg (ACL400/FOR12 FDC), FDC aclidinium 400 μg/formoterol 6 μg (ACL400/FOR6 FDC), aclidinium 400 μg, …

Increased Incidence Of Asthma After Previous Infantile Rsv Bronchiolitis Infection, Ellen Adelia Doebler

Physician Assistant Scholarly Project Posters

• Respiratory Syncytial Virus (RSV) is a very common infection in children less than two years of age.

• Asthma is a common respiratory disease in childhood, which may cause frequent hospitalizations.

• The purpose of this study is to determine if infants previously diagnosed with RSV bronchiolitis have an increased incidence of asthma diagnosis compared to infants not diagnosed with RSV.

• The literature review examines correlation studies of both disease processes and explores incidence of asthma in patients previously diagnosed with Respiratory Syncytial Virus bronchiolitis.

• Individuals previously diagnosed with Respiratory Syncytial Virus bronchiolitis have a higher risk …

The Addition Of Tiotropium In Uncontrolled Asthma, Kathryn Gray

Physician Assistant Scholarly Project Posters

• Many patients with asthma have poorly controlled disease despite the use of both an inhaled corticosteroid (ICS) and a long acting beta agonist (LABA).

• The review explored several studies that compared the addition of tiotropium to patients with uncontrolled asthma currently using both a ICA and a LABA to determine if further symptom reduction is obtained along with reduction of exacerbations

• It was found that patients with poorly controlled asthma will benefit from the addition of tiotropium to the current medication regimen of an ICS and a LABA. Tiotropium offers providers an additional disease controlling option in …

Treatment Of Acute Bronchitis In Children With Pelargonium Sidoides, Amber Houge

Physician Assistant Scholarly Project Posters

Bronchitis is one of the most common acute infections affecting pediatric patients. Most cases are caused by viral infections, do not respond to antibiotic therapy, and can take up to 14 days to resolve with supportive therapy. The purpose of this study is to determine if the use of Pelargonium Sidoides (Umcka™, EPs 7630) extract will decrease the duration and severity of symptoms from acute bronchitis in the pediatric population. Pelargonium Sidoides abstract is an extract of an African Geranium that has been used in traditional medicine for centuries. The review of the literature will evaluate multiple randomized controlled trials …

Hypertonic Saline Therapy In Cystic Fibrosis, Idil Mohamed

Physician Assistant Scholarly Project Posters

Cystic fibrosis is an autosomal recessive genetic disorder that severely affects the lungs as well as other organs in the body. The pathophysiology of cystic fibrosis lung disease involves the production of thick and sticky mucus that accumulates leading to obstruction and inflammation of the airways. This disease is characterized by abnormal transport of sodium and chloride across an epithelium by defective genes, resulting in thick mucus secretions.

Nebulized hypertonic saline (3% NaCl) improves mucociliary clearance through rehydration of the airway surface liquid of the lungs. The purpose of this study is to evaluate the effects of nebulized hypertonic saline …