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Inhaled medications are commonplace for administering bronchodilators, anticholinergics, and corticosteroids. While they have a defined legitimate use, they are also used in sporting events as performance-enhancing drugs. These performance enhancers can be acquired via both legal (i.e., at a pharmacy through over-the-counter medications or through a prescription) and illicit (i.e., black market and foreign pharmacies) means, thus making monitoring procurement impossible. While urine tests can detect these pharmacological agents hours after they have been inhaled, there is a significant lag time before they are observed in urine. Direct detection of these inhaled agents is complicated and requires a multiplexed approach due to the sheer number of inhaled pharmacological agents. Therefore, detection of propellants, which carry the drug into the lungs, provides a simpler path forward toward detection of broad pharmacological agents. In this paper, we demonstrate the first use of terahertz spectroscopy (THz) to detect inhaled medications in human subjects. Notably, we were able to detect and quantitate the propellant, HFA-134a, in breath up to 30 min after using an asthma inhaler, enabling the use of a point-of-care device to monitor exhaled breath for the presence of propellants. We also demonstrate via simulations that the same approach can be leveraged to detect and identify next-generation propellants, specifically HFA-152a. As a result, we provide evidence that a single point-of-care THz sensor can detect when individuals have used pressure-mediated dose inhalers (pMDIs) without further modification of the hardware.

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region., Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management., Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives., Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care., Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care., Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.