Respiratory medicine
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Respiratory medicine · Nov 2013
Randomized Controlled Trial Multicenter StudyCost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries.
Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). ⋯ BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).
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Respiratory medicine · Nov 2013
Randomized Controlled Trial Comparative StudyPhysiologic response to various levels of pressure support and NAVA in prolonged weaning.
Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation wherein the delivered assistance is proportional to diaphragm electrical activity (EAdi) throughout inspiration. We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV) in 13 tracheostomised patients with prolonged weaning. Each patient randomly underwent 8 trials, at four levels of assistance either in PSV and NAVA. i - high (no dyspnoea and/or distress); iv - low (associated with dyspnoea and/or distress; ii and iii - at ∼75% and ∼25% of the difference between high and low support respectively. ⋯ VT variability significantly increased when reducing ventilatory assistance in PSV only, while remained unchanged varying the NAVA level. The ineffective triggering index was not significantly different between the two modes. In patients with prolonged weaning, with the specific settings adopted, compared to PSV, NAVA reduced the risk of over-assistance and overall improved patient-ventilator interaction, while not significantly affecting patient-ventilator synchrony.
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Respiratory medicine · Nov 2013
Multicenter Study Observational StudyAssessment of asthma control: the SERENA study.
Several studies suggest that many asthmatic subjects have uncontrolled asthma. The control of asthma is now considered the major goal of therapy. ⋯ This study highlights the importance in clinical practice of a periodic assessment by a validated asthma control instrument and exacerbations/health care contacts during previous year. Clinicians should be aware that a significant proportion of patients can have uncontrolled asthma, despite regular pharmacological treatment.
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Patients with Chronic Obstructive Pulmonary Disease (COPD) have been shown to experience significant pain that interferes with their daily activities and quality of life. The purpose of this study was to examine if pain is associated with functional exercise capacity (assessed with the six-minute walk test, 6MWT), physical activity (assessed by accelerometry), and muscle performance (maximal knee extensor torque) in people with COPD. ⋯ Pain in patients with COPD is associated with low functional exercise capacity, reduced physical activity, and high BMI. Pain can adversely affect physical activity and quality of life in patients with COPD. Early evaluation of pain needs to be considered in the assessment and treatment plan for people with COPD.
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Respiratory medicine · Nov 2013
Case ReportsSevere adenovirus pneumonia requiring extracorporeal membrane oxygenation support--Serotype 7 revisited.
Adenovirus causing severe fatal pneumonia has been well described in infants, children, and patients with immunocompromised function, but reports in previously healthy adults are rare. We report 3 cases of severe adenovirus pneumonia in whom conventional mechanical ventilation failed and required extracorporeal membrane oxygenation support. ⋯ The mainstay of treatment for patients with severe adenovirus pneumonia is still supportive, with the use of antivirals not apparently effective. Whilst ECMO support for rescue ventilation may be considered, the outcomes do not appear as promising as other viral pneumonias, mirroring that previously described in the paediatric population.