Respiratory medicine
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Respiratory medicine · Jul 2006
Randomized Controlled Trial Multicenter Study Comparative StudyEXCEL: A randomised trial comparing salmeterol/fluticasone propionate and formoterol/budesonide combinations in adults with persistent asthma.
This multicentre, parallel group, double-blind, double-dummy, randomised 24-week study was designed to compare the efficacy of salmeterol/fluticasone propionate combination (SFC) 50/250 microg one inhalation twice daily (bid) with formoterol/budesonide combination (FBC) 6/200 microg two inhalations bid in patients with persistent asthma, currently receiving 1000-2000 microg/day of inhaled corticosteroids. ⋯ Twice-daily treatment with SFC and FBC over 6 months significantly improved asthma symptoms and lung function in patients with persistent asthma. The rate of exacerbations was significantly reduced over time on both treatments but SFC was found to be significantly superior to FBC in reducing the rate of moderate/severe exacerbations with sustained treatment.
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Respiratory medicine · Jul 2006
Randomized Controlled TrialMontelukast improves pulmonary function measured by impulse oscillometry in children with asthma (Mio study).
Systemic drugs-like oral montelukast can reach lower airways, whose inflammation plays a crucial role in the evolution of asthma, while inhaled drugs hardly reach them. The impulse oscillometry (IOS) technique is useful to evaluate both central and peripheral airways function. ⋯ Montelukast improves central and especially peripheral airways function in the first month of treatment, as evaluated by IOS, a technique based on tidal breathing analysis which is more sensitive than conventional forced spirometry.
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Respiratory medicine · Jun 2006
Randomized Controlled TrialNoninvasive proportional assist ventilation and pressure support ventilation during arm elevation in patients with chronic respiratory failure. A preliminary, physiologic study.
It has been shown that upper limbs activity increases the respiratory workload in patients with chronic respiratory failure (CRF). The object of the present study was to investigate whether, in these patients: (i) noninvasive positive pressure ventilation (NPPV) could sustain the inspiratory muscles to meet the greater ventilatory demand during upper limbs activity with the arm elevation test (AE); (ii) proportional assist ventilation (PAV) might be superior to pressure support ventilation (PSV) during AE, because of its potential more adaptable response to sudden changes in the ventilatory pattern. ⋯ PAV and PSV unloads the diaphragm in patients with CRF due to COPD both during SB and AE; PAV can be more efficient than PSV in assisting the diaphragm during AE in producing a greater level of minute ventilation for a similar rise in PTP(di) compared to PSV. Noninvasive ventilatory support should be considered in rehabilitation programs for training of upper limbs activity.
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Respiratory medicine · Mar 2006
Randomized Controlled Trial Multicenter StudyA new BAL fluid instillation and aspiration technique: a multicenter randomized study.
Bronchoalveolar lavage (BAL) is a widely used clinical and research tool even though certain steps in the procedure have not been standarized. One step that is subject to variation is the technique used to instill and recover BAL fluid. Our aim was to assess whether attaching a plastic tube between the syringe and the working channel of the flexible bronchoscope allowed recovery of more fluid in comparison with recovery using only a syringe, and whether tubing had a favorable impact on diagnostic yield and complications. ⋯ In the group with tubing, 8% more fluid was recovered. The difference was both statistically significant and clinically relevant given that 17.4% more diagnoses, 6.9% fewer complications, and 8.8% fewer technical failures were recorded. Based on these results, we recommend performing BAL using plastic tubing between the 50 mL syringe and the working channel of the flexible bronchoscope when carrying out manual instillation and suction.
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Respiratory medicine · Feb 2006
Randomized Controlled TrialEffect of formoterol/budesonide combination on arterial blood gases in patients with acute exacerbation of COPD.
Patients with severe chronic airway obstruction might suffer dangerous hypoxemia after administration of a beta-agonist despite bronchodilation. ⋯ These results suggest that when treating patients suffering from acute exacerbation of COPD with formoterol, it is prudent to check their arterial blood gases. In any case, combined administration of formoterol and budesonide reduces the potential for acute effects of formoterol on blood-gas tensions.