Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients.
The Juan Fernández Ridge (JFRE) is a vulnerable marine ecosystem (VME) located off the coast of central Chile formed by the Juan Fernández Archipelago and a group of seamounts. This ecosystem has unique biological and oceanographic features, characterized by: small geographical units, high degree of endemism with a high degree of connectivity within the system. Two fleets have historically operated in this system: a long term coastal artisanal fishery associated with the Islands, focused mainly on lobster, and a mainland based industrial demersal finfish fishery operating on the seamounts which is currently considered overexploited. The management of these fisheries has been based on a classical single-species approach to determine output controls (industrial fleet) and a mixed management system with formal and informal components (artisanal fleet). There has been growing interest in increasing the exploitation of fisheries, and modernization of the fishing fleet already operating in the JFRE. Under this scenario of increased levels of fishing exploitation and the high level of interrelation of species it might be necessary to understand the impact of these fisheries from a holistic perspective based on a ecosystem-based modeling approach. To address these challenges we developed an Atlantis end-to-end model was configured for this ecosystem. The implemented model has a high degree of skill in representing the observed trends and fluctuations of the JFRE. The model shows that the industrial fishing has a localized impact and the artisanal fisheries have a relatively low impact on the ecosystem, mainly via the lobster fishery. The model indicates that the depletion of large sized lobster has leads to an increase in the population of sea urchins. Although this increase is not sufficient, as yet, to cause substantial flow-on effects to other groups, caution is advised in case extra pressure leads the ecosystem towards a regime shift.
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