Respiratory medicine
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Respiratory medicine · Aug 2002
ReviewGuidelines for the management of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a respiratory condition characterized by progressive decline in lung function. It imposes a considerable burden on patients, healthcare services and society that is likely to increase in the future. It is, therefore, important to ensure that this disease is managed as effectively as possible. ⋯ In all COPD guidelines, however, lung function measures feature prominently with limited reference to outcome measures of interest to patients and healthcare payers (e.g. frequency of exacerbations requiring hospitalization). Low expectations among physicians and patients may also impair implementation. In conclusion, guidelines may improve the management of COPD, but the main challenge is to ensure implementation.
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Respiratory medicine · Aug 2002
ReviewGuidelines for the management of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a respiratory condition characterized by progressive decline in lung function. It imposes a considerable burden on patients, healthcare services and society that is likely to increase in the future. It is, therefore, important to ensure that this disease is managed as effectively as possible. ⋯ In all COPD guidelines, however, lung function measures feature prominently with limited reference to outcome measures of interest to patients and healthcare payers (e.g. frequency of exacerbations requiring hospitalization). Low expectations among physicians and patients may also impair implementation. In conclusion, guidelines may improve the management of COPD, but the main challenge is to ensure implementation.
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Respiratory medicine · Apr 2002
ReviewThe association between respiratory syncytial virus infection and reactive airway disease.
Evidence has been accumulating that respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in infants may be linked to subsequent development of reactive airway disease (RAD) in childhood, and therefore research into the prevention of RSV LRTI may have important implications for the prevention of RAD. This article reviews the epidemiological evidence linking RSVand RAD and some ofthe theories concerning cellular and molecular mechanisms of post-viral airway inflammation in order to understand how RSV prophylaxis may assist in reducing the occurrence of RSV LRTI and RAD.
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Lymphangioleiomyomatosis (LAM), characterized by alveolar smooth muscle proliferation and cystic destruction of lung parenchyma, can occur as a rare sporadic disease or as a complication of tuberous sclerosis (TSC). It is a cystic lung disease, usually generalized and progressive, may be extremely difficult to treat and has been considered to have a poor prognosis. It has almost exclusively been reported to present in women of childbearing age, most commonly with dyspnoea and pneumothorax. ⋯ The natural course of LAM remains unclear and effect of treatment variable. Although symptomatic LAM is uncommon it causes a significant amount of morbidity and mortality both in the TSC and general population, but asymptomatic LAM is not uncommon in TSC. Further research is required to determine the natural history of this condition and to evaluate current treatment regimes.
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Respiratory medicine · May 2001
ReviewAnalysis of montelukast in mild persistent asthmatic patients with near-normal lung function.
Few studies have specifically evaluated controller therapy in patients with mild persistent asthma. We used a subgroup analysis to investigate the effects of montelukast, a potent cysteinyl leukotriene receptor antagonist, on adult patients on the milder end of the asthma severity spectrum. We have identified seven double-blind, randomized, placebo-controlled studies of adult patients with mild-to-moderate chronic asthma in which montelukast was investigated. ⋯ There was a significant improvement in FEV1 in montelukast-treated patients (7-8% over baseline) compared with placebo (1-4% over baseline, between-group difference P < or = 0.02) for all cohorts. Similarly, the percentage of rescue-free days increased substantially more with montelukast (22-30%) than with placebo (8-13%). This subgroup analysis indicates that montelukast produced improvements in parameters of asthma control in patients with milder persistent asthma that should be confirmed in additional prospective trials.