The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Randomized Controlled Trial
Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients.
Obstructive sleep apnoea (OSA) is associated with high cardiovascular morbidity and mortality. Several randomised controlled trials have shown that continuous positive airway pressure (CPAP) treatment of OSA reduces blood pressure (BP). This randomised, sham-placebo controlled crossover trial assesses whether CPAP produces a similar clinically significant fall in BP in hypertensive OSA patients, but without hypersomnolence. ⋯ There was no overall significant difference in mean 24-h BP: the change in mean 24-h BP on therapeutic CPAP was -2.1 mmHg (sd 8.1), and -1.1 mmHg (sd 8.1) on subtherapeutic CPAP, with a difference of 0.7 mmHg (95% confidence interval (CI) +2.9- -4.4). There was a small significant fall in Epworth Sleepiness Score, therapeutic (-1.4) versus sham (-0.3), and difference -1.2 (95% CI -2.0- -0.4), but no change in objective sleepiness. In nonhypersomnolent hypertensive patients with obstructive sleep apnoea, there is no significant fall in mean 24-h blood pressure with continuous positive airway pressure, in contrast to the fall seen in hypersomnolent patients with obstructive sleep apnoea.
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Randomized Controlled Trial Comparative Study
Physiological effects of vibration in subjects with cystic fibrosis.
The physiological mechanisms by which vibration and other physiotherapy interventions may clear secretions in subjects with cystic fibrosis are unknown. The main aim of this study was to compare the expiratory flow rates and frequencies of airflow oscillation of vibration to those of Acapella(R), Flutter(R), positive expiratory pressure and percussion. Respiratory flow rates were measured during interventions, the order of which was randomised. ⋯ Theoretically, the higher peak expiratory flow rate of vibration compared to the other physiotherapy interventions may promote secretion clearance. In addition, the frequency of oscillation of vibration was within the range demonstrated to increase mucus transport. This study has provided some evidence for the physiological rationale for the use of vibration to aid secretion clearance.
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Randomized Controlled Trial Comparative Study
Short-burst oxygen therapy for COPD patients: a 6-month randomised, controlled study.
Short-burst oxygen therapy (SBOT) remains widely advocated for patients with chronic obstructive pulmonary disease (COPD), despite a lack of supporting evidence. The aim of this randomised, double-blind, placebo-controlled, parallel group study was to determine whether SBOT improves health-related quality of life (HRQL) or reduces acute healthcare utilisation in patients discharged following an acute exacerbation of COPD. Consecutive patients were screened; 78 of 331 were eligible for randomisation to cylinder oxygen, cylinder air or usual care following discharge. ⋯ Cylinder use was high initially, but rapidly fell to very low levels within weeks in both cylinder oxygen and air groups. In conclusion, the availability of short-burst oxygen therapy for chronic obstructive pulmonary disease patients discharged from hospital following an acute exacerbation did not improve health-related quality of life or reduce acute healthcare utilisation. These results provide no support for the widespread use of short-burst oxygen therapy.
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Randomized Controlled Trial Multicenter Study
Determining asthma treatment by monitoring sputum cell counts: effect on exacerbations.
One important goal of asthma treatment is to reduce exacerbations. The current authors investigated if the use of sputum cell counts to guide treatment would achieve this goal. A total of 117 adults with asthma were entered into a multicentre, randomised, parallel group-effectiveness study for two treatment strategies over a 2-yr period. ⋯ The cumulative dose of corticosteroid during the trial was similar in both groups. Monitoring sputum cell counts was found to benefit patients with moderate-to-severe asthma by reducing the number of eosinophilic exacerbations and by reducing the severity of both eosinophilic and noneosinophilic exacerbations without increasing the total corticosteroid dose. It had no influence on the frequency of noneosinophilic exacerbations, which were the most common exacerbations.
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Randomized Controlled Trial Comparative Study
Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD.
To assess the clinical impact of noninvasive mechanical ventilation (NIMV) on stable hypercapnic chronic obstructive pulmonary disease, changes in exercise capacity, dyspnoea and simple physiological parameters were evaluated. The time course of these effects during treatment and recovery was also assessed. Patients were randomly allocated to NIMV (n=27) or sham-NIMV (n=15), applied 3 h.day-1, 5 days a week, for 3 weeks. ⋯ Dyspnoea improved with a mean TDI of three points. Changes in 6MWD were highly related to TDI and to a lesser extent to changes in FEV1 (r=0.60). The current authors conclude that noninvasive mechanical ventilation has significant and sustained clinical impact in stable hypercapnic chronic obstructive pulmonary disease.