Respiratory medicine
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Respiratory medicine · Mar 2010
Multicenter StudyGenetic variability in the severity and outcome of community-acquired pneumonia.
Several studies have investigated single nucleotide polymorphisms (SNP) in candidate genes associated with susceptibility, severity or outcome in patients with community-acquired pneumonia (CAP) with conflicting results. ⋯ Our study does not support a role for the controversial studied polymorphisms of the TNF, LTA, IL6 and IL1RN genes in the susceptibility or outcome of CAP. A protective role of heterozygosity for the functionally relevant TNFRSF1B+676 polymorphism in the outcome of CAP was observed.
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Respiratory medicine · Mar 2010
Review Meta AnalysisFrequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis.
To clarify issues regarding the frequency, prevention, outcome, and treatment of patients with ventilator-associated tracheobronchitis (VAT), which is a lower respiratory tract infection involving the tracheobronchial tree, while sparing the lung parenchyma. ⋯ Approximately one tenth of mechanically ventilated patients suffer from VAT. Antimicrobial treatment of patients with VAT may protect against the development of subsequent ventilator-associated pneumonia and improve weaning outcome.
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Respiratory medicine · Mar 2010
Randomized Controlled TrialCombining triple therapy and pulmonary rehabilitation in patients with advanced COPD: a pilot study.
The synergistic interactions between pharmacotherapy and pulmonary rehabilitation has been provided, but it remains to be established whether this may also apply to more severe patients. ⋯ Our study clearly indicates that there is an advantage in combining pulmonary rehabilitation with an aggressive drug therapy in more severe patients.
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Respiratory medicine · Mar 2010
Breath-by-breath quantification of progressive airflow limitation during exercise in COPD: a new method.
During heavy exercise in chronic obstructive pulmonary disease (COPD), dynamic airways compression leads to a progressive fall in intrabreath flow. This is manifested by concavity in the spontaneous expiratory flow-volume (SEFV) curve. We developed a method to quantify the SEFV curve configuration breath-by-breath during incremental exercise utilizing a computerized analysis. ⋯ SEFV in healthy individuals manifested progressively more convex SEFV curves throughout exercise (RAR=0.56+/-0.08 at rest and 0.61+/-0.05 at peak exercise), but became progressively more concave in COPD patients (RAR=0.52+/-0.08 at rest and 0.46+/-0.06 at peak exercise). In conclusion, breath-by-breath quantification of SEFV curve concavity describes progressive shape changes denoting expiratory flow limitation during incremental exercise in COPD patients. Further studies are warranted to establish whether this novel method can be a reliable indicator of expiratory flow limitation during exercise and to examine the relationship of RAR time course to the development of dynamic hyperinflation.
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Respiratory medicine · Mar 2010
Effect of mannitol and repetitive coughing on the sputum properties in bronchiectasis.
Mucociliary clearance increases with increasing doses of mannitol and clearance is enhanced when mannitol inhalation is followed by repetitive voluntary coughing. The aim of the study was to investigate: 1) the effect of increasing doses of mannitol and repetitive coughing on the sputum physical properties; 2) if the changes in sputum properties can predict the efficacy of mucus clearance measured by radioaerosol technique in bronchiectasis patients. Sputum was collected from 14 patients, age: 63+/-6yr, who participated on the mucociliary and cough clearance studies at baseline, with mannitol (160, 320 and 480mg) and control (Daviskas et al. ERJ 2008; 31:765-772). Sputum was collected: 1) on the screening visit before and after mannitol challenge (635mg); 2) at the start and end of each clearance study after 100 repetitive voluntary coughs except on the control study (no mannitol or repetitive coughing). The sputum solids content, surface tension, contact angle and rheology were measured. Mannitol in association with coughing and coughing alone reduced the solids content, surface tension, contact angle and viscoelastic sputum properties (p<0.0001) and this effect, unlike mucociliary clearance, was not dose dependent. The control produced no effect. Total mucus clearance correlated only with the percentage reduction in surface tension on 480mg mannitol and with the reduction in solids content at baseline. ⋯ Inhaled mannitol and voluntary repetitive coughing improved the sputum physical properties in bronchiectasis patients and this effect was not dose dependent. Changes in sputum properties do not predict efficacy of mucociliary and cough clearance.