Respiratory medicine
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Respiratory medicine · Apr 2009
ReviewImproving mucociliary clearance in chronic obstructive pulmonary disease.
Patients with COPD usually experience mucus hypersecretion as a result of airway inflammation and response to noxious stimuli. These in turn lead to worsening airway resistance, impaired airflow, increased work of breathing, dyspnoea and exercise intolerance. ⋯ This review examines the current evidence base and best clinical practice in the area of airway clearance. Mechanical devices such as the flutter valves, positive end expiratory pressure and high frequency chest wall oscillation (HFCWO) may be able to provide the benefits of improved airway clearance in the patient's home potentially with reduced demands on healthcare resources.
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Respiratory medicine · Dec 2008
Review Meta AnalysisInspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review.
The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. ⋯ Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI(max), PI(max) % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve(max), Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.
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We report a series of patients with postextubation pulmonary edema who had no obvious risk factors for the development of this syndrome. ⋯ It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains uncertain in many cases.
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Respiratory medicine · Nov 2008
ReviewImmunomodulatory and biologic therapies for severe refractory asthma.
Despite undoubted efficacy of the combination of inhaled corticosteroids and beta(2)-agonists for most asthmatic patients with moderate-to-severe disease, there remains approximately 10% of the asthmatic population with serious unremitting symptoms, resulting in considerable impact on quality of life, disproportionate use of health care resources, and adverse effects from regular systemic steroid use. In an ideal world, optimal treatment of severe refractory asthma should achieve the best possible asthma control and quality of life with the least dose of systemic corticosteroids. ⋯ Unfortunately, current asthma guidelines offer little contribution to the management of the challenging patient with severe refractory asthma and none of them have addressed therapeutic alternatives to oral corticosteroids. This article reviews the current evidence for immunomodulating and biologic approaches in severe refractory asthma.
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Respiratory medicine · Oct 2008
ReviewOutcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit.
Idiopathic pulmonary fibrosis (IPF) is the commonest cause of interstitial lung disease. Till date there is no proven successful treatment. The prognosis is poor with a median survival of 3 years. ⋯ Available data showed that outcome of these patients is very poor and mechanical ventilation is mostly futile. Patients and their families should be informed about the prognosis, outcome and overall outlook before making decision about ventilation and organ support. Available outcome data should be used to develop institutional and professional guidelines to help in making these difficult decisions.