Asthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory diseases affecting millions of people worldwide, resulting in high morbidity and mortality. Inadequate use of inhalation devices (IDs) is a critical factor that compromises treatment effectiveness, leading to increased hospitalizations and worsening symptoms. This study aimed to analyze the prevalence of inadequate techniques in the administration of IDs among patients with asthma and COPD, identify critical errors and associated risk factors, and propose pharmaceutical interventions to improve the use of these devices. An observational, cross-sectional study was conducted with 575 patients attended at a pulmonary outpatient clinic in a university hospital and a specialized unit, both in Natal, Brazil. Participants, aged 18 and older with a diagnosis of asthma and/or COPD, completed questionnaires on sociodemographic characteristics and performed inhalation techniques for evaluation. Treatment adherence was assessed using the Morisky-Green-Levine test, while inhalation technique was analyzed using specific checklists for each ID, considering as critical errors those with the highest potential to affect drug effectiveness, such as poor expiration, inadequate sealing around the mouthpiece, improper inspiration, and failure to pause during inhalation. Results showed a high prevalence of inadequate inhalation technique (55.2%), with the most frequent errors being improper inspiration (61.2%) and incorrect inhalation pause (56.6%). Multivariate analysis indicated that factors such as older age (OR: 1.016), lower household income (OR: 2.450), worsening symptoms with exertion (OR: 1.935), and asthma diagnosis (OR: 3.596) are significantly associated with inadequate technique. These findings highlight the complexity involved in using IDs and the need for ongoing educational interventions, especially targeted at vulnerable populations. Implementing training and guidance programs, as well as using checklists during consultations, are suggested strategies to enhance adherence and treatment effectiveness. In conclusion, this study highlights the high prevalence of inadequate techniques in the administration of IDs among patients with asthma and COPD. The identified critical errors and associated risk factors underscore the importance of targeted educational interventions to optimize the use of IDs and, consequently, improve the management of respiratory diseases.

Objective: To assess the impact of severe drug-drug interactions (DDIs) on clinical parameters and maternal-fetal outcomes in high-risk hospitalized pregnant women. Methodology: Prospective cohort study involving 571 hospitalized pregnant women from September 2019 to June 2022, with a mean age of 30.6 years, mostly diagnosed with hypertensive syndromes (69.7%) and gestational diabetes mellitus (57.1%). DDIs were characterized daily using the Lexicomp® database, and clinical parameters related to their mechanisms of action were monitored. Multivariate logistic regression models adjusted for major risk factors for DDI occurrence were used to evaluate the potential influence of severe DDIs on clinical parameters and maternal-fetal outcomes. Results: We identified 203 pregnant women with one or more severe DDIs (35.6%). Risk factors for their occurrence were gestational age (AOR: 0.958; 95% CI: 0.932-0.984), hypertension diagnosis (AOR: 3.997; 95% CI: 2.493-6.409), number of medications (AOR: 1.088; 95% CI: 1.031-1.148), and duration of treatment (AOR:1.184; 95% CI: 1.116-1.257). Concomitant use of dipyrone and acetylsalicylic acid led to increased systolic blood pressure (AOR: 2.124; 95% CI: 1.008-4.474), while patients using scopolamine and levomepromazine simultaneously experienced increased drowsiness (AOR: 5.375; 95% CI: 1.660-17.398) and slight temperature elevation (AOR: 5.956; 95% CI: 1.226-28.982). Conclusion: Hospitalized pregnant women, especially those with lower gestational age and diagnosed with hypertensive syndromes, are exposed to severe drug-drug interactions. However, these interactions do not significantly impact maternal-fetal clinical outcomes.

BACKGROUND: Necrotizing enterocolitis (NEC) is the leading cause of mortality among preterm neonates with inflammatory bowel disease. While the prior use of antimicrobials is recognized as a risk factor for NEC, there is limited understanding of which specific antimicrobials pose a higher risk. This study aims to identify antimicrobials associated with an increased risk of NEC in neonates undergoing intensive therapy. METHODS: A retrospective cohort study assessed 594 neonates (mean gestational age: 33.2 ± 4.4 weeks; mean birth weight: 1978.3 ± 1010.2 g) receiving intensive care and antimicrobial treatment at a Brazilian Teaching Maternity Hospital. Multivariate logistic regression identified factors associated with NEC, serving as adjustment variables in examining the relationship between prior antimicrobial use and NEC occurrence (p < 0.05). RESULTS: Risk factors for NEC included gestational age (OR 1.250, 95% CI 1.134 - 1.377), birth weight (OR 0.998, 95% CI 0.997 - 0.999), congenital heart disease (OR 4.777, 95% CI 2.217 - 10.293), methicillinresistant Staphylococcus aureus (MRSA) marker (OR 2.748, 95% CI 2.067 - 7.705), and prolonged hospitalization (OR 1.004, 95% CI 1.000 - 1.008). Meropenem, administered around the 17th day of hospitalization, preceded NEC diagnosis around the 34th day (17.5, 95% CI 10.6 - 24.4 vs. 34.5, 95% CI 20.3 - 42.7 days; p = 0.03). CONCLUSION: The prior administration of meropenem was associated with a higher incidence of NEC in neonates under intensive care.