Chronic respiratory disease
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Chronic cough is a common and disabling symptom. Recent guidelines have attempted to provide direction in the clinical management of cough in both primary and secondary care. They have also provided a critical review of the available literature and identified gaps in current knowledge. ⋯ In this review, we summarize the current consensus on the clinical management of chronic cough and attempt to rationalize this based on recent evidence. We have also provided an overview of the likely pathophysiological mechanisms responsible for cough and highlighted areas, where knowledge deficits exist and suggest directions for future research. Such progress will be critical in the search for new and effective treatments for cough.
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Randomized Controlled Trial Comparative Study
Acapella versus 'usual airway clearance' during acute exacerbation in bronchiectasis: a randomized crossover trial.
Devices such as the Acapella may facilitate independent airway clearance, however, few clinical trials have investigated the efficacy of Acapella. The aim of this study was to compare the effectiveness of Acapella to 'usual airway clearance' in adults during an acute exacerbation of bronchiectasis requiring oral antibiotic therapy. Twenty patients with bronchiectasis and an acute exacerbation requiring oral antibiotic therapy were recruited into a randomized crossover trial. ⋯ Mean duration of Acapella sessions was greater than usual airway clearance sessions and approached significance. There were no significant between group differences in changes in lung function. This study demonstrates that the Acapella device may offer an acceptable, user-friendly method of airway clearance in patients with bronchiectasis.
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Clinical Trial
Four weeks' intensive rehabilitation generates significant health effects in COPD patients.
Changes in health according to World Health Organization's International Classification of Functioning, Disability and Health (ICF) after four weeks of pulmonary rehabilitation (PR) were investigated. Gender differences in the response to PR, and the correlation between improvements in the two components of ICF (Body functions and Activities and Participation) were examined. Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV attended in-patient, multidisciplinary PR consisting of endurance training four to five times/week at 70% of peak work rate (WRpeak), resistance training three to four times/week at 72% of 15 repetitions maximum, educational sessions and individual counselling. ⋯ Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes. Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies.
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It is considered that Kartagener's syndrome is caused by ciliary dysfunction. This syndrome is characterized by the clinical triad of bronchiectasis, sinusitis, and dextrocardia. We describe an elderly patient with Kartagener's syndrome who reached advanced age. We suppose that it may be possible for patients with Kartagener's syndrome to live a full span with optimal therapy for respiratory tract infection and control progression of this disease.