RESUMEN
Use of proton-pump inhibitors (PPIs) is common among people with cystic fibrosis (pwCF) both for the management of suspected GERD, as well as pancreatic enzyme replacement therapy augmentation. Despite their use, limited data exist to demonstrate a clinically significant impact of PPIs on key endpoints in pwCF. Furthermore, the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy may modify the need for use. These notions, coupled with the potential for adverse outcomes associated with long-term PPI use in pwCF, should facilitate re-evaluation of long-term PPI use in pwCF and promote potential deprescribing. Despite limited data on PPI deprescribing in pwCF, it intuitively mirrors the existing guidance in adults in the general population, but with added consideration given to tapering strategy, and monitoring for CF-specific outcomes such as nutritional and respiratory status. The development of a monitoring and re-initiation plan is key to reducing deprescribing inertia. This review aims to summarize the evidence that details the concern for long-term use of PPIs and provide CF clinicians with rationale and guidance on how to approach deprescribing in their practice.
RESUMEN
Based on experiments conducted in low wind speed and calm air environments, the current International Organization for Standardization (ISO) and European Committee for Standardization (CEN) convention modeling human aerosol inhalability (i.e. aspiration efficiency) may not be valid when wind speeds are less than 0.5 ms-1. Additionally, the convention is based primarily on mouth breathing data and aerosols with aerodynamic diameters smaller than 100 µm. Since the convention's development, experimental inhalation data at wind speeds lower than 0.5 ms-1 for nose, mouth, and oronasal breathing have been generated for aerosols in a wider range of sizes (1.5-135 µm). These data were gathered and modeled with the intention of providing a simple convention recommendation for inhalability in low wind speed (>0 to <0.5 ms-1) and calm air (~0 ms-1) conditions to the ISO Technical Committee (TC) 146, Subcommittee 2, Working Group (WG) 1 ('Particle Size-Selective Sampling and Analysis'), as it relates to standard ISO 7708, and to CEN TC 137/WG 3, as it relates to standard EN 481. This paper presents several equations as possibilities, all relating aspiration efficiency to aerodynamic diameter. The equation AE=1+0.000019dae2-0.009788dae stands out as a possible new convention. This polynomial model balances simplicity and fit while addressing the weakness of the current convention.