American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · May 1996
Randomized Controlled Trial Clinical TrialDoes oxygen help dyspnea in patients with cancer?
Dyspnea in patients with advanced cancer is a common symptom that is difficult to treat. This study investigated whether oxygen helps to relieve rest dyspnea in patients with advanced cancer. In a single-blind controlled trial, oxygen and air were administered in random order to hospice patients reporting dyspnea at rest. ⋯ The improvement in dyspnea with oxygen could not be predicted from a subject's initial level of hypoxia. Results suggested that benzodiazepines may potentiate the effect of oxygen. The overall conclusion is that oxygen and air can have a significant effect in reducing dyspnea at rest in patients with advanced cancer.
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Am. J. Respir. Crit. Care Med. · May 1996
Pulmonary fibrosis deaths in the United States, 1979-1991. An analysis of multiple-cause mortality data.
We sought to describe pulmonary fibrosis mortality in the United States from 1979 through 1991 by analyzing death certificate reports compiled by the National Center for Health Statistics. Of the 26,866,600 people who died during the study period, 107,292 had a diagnosis of pulmonary fibrosis listed on their death certificates. Among men, age-adjusted mortality rates increased from 48.6 per 1,000,000 in 1979 to 50.9 per 1,000,000 in 1991 and, among women, these rates increased from 21.4 per 1,000,000 in 1979 to 27.2 per 1,000,000 in 1991. ⋯ Age-adjusted mortality rates varied by state, with lowest rates in the Midwest and Northeast, and the highest rates in the West and Southeast. We conclude that the age-adjusted rate of pulmonary fibrosis among decedents in the United States increased, and pulmonary fibrosis was listed as the underlying cause of death with increasing frequency, over the study period. We cannot determine whether the differences we detected between regions, sexes, and races are related to characteristics of the disease or problems in death certification and coding.
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Am. J. Respir. Crit. Care Med. · May 1996
Comparative StudyEffect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis.
In patients with cystic fibrosis (CF), dehydration of airway secretions leads to a decrease in mucociliary clearance (MCC). We examined the acute effect of MCC of a single administration by aerosolization of hypertonic saline (7%) (HS), amiloride (0.3% in 0.12% NaCl) (AML) and a combination of AML and HS (AML + HS) in 12 patients with CF using a radioaerosol technique. Isotonic saline [0.9%] (IS) was used as a control solution. ⋯ Comparison of the amount of radioaerosol cleared from the right lung was made at 60 min (%C60) and 90 min (%C90) using repeated measures ANOVA. The percent cleared at 60 and 90 min was significantly increased with HS (%C60 = 26.5%, %C90 = 29.4%) and the combination of AML + HS (%C60 = 23.1%, %C90 = 27.4%) compared with both IS (%C60 = 14.7%, %C90 = 17.5%) and COUGH (%C60 = 18.0%, %C90 = 19.5%), p < 0.01. Inhalation of hypertonic saline is a potentially useful treatment in patients with cystic fibrosis.
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Am. J. Respir. Crit. Care Med. · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialHome versus intensive care pressure support devices. Experimental and clinical comparison.
A bench study using an artificial lung model and a clinical study in patients were performed to evaluate six commercially available home pressure support devices. Six devices were tested in the in vitro study, including five designed for home use and one designed for use in intensive care units. Minimal positive end-expiratory pressure (PEEP) varied across home devices, from 0.5 cm H2O to 4.3 cm H2O. ⋯ However, the esophageal pressure-time product was 30% higher with the home device (165 +/- 93 versus 119 +/- 80 cm H2O/min, p < 0.05). In conclusion, differences exist between devices in terms of occurrence of rebreathing, speed of attainment of stable pressure support level, and expiratory resistance. These differences characterizing the delivery of pressure support may have clinical impact on the inspiratory effort of patients.
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Am. J. Respir. Crit. Care Med. · May 1996
Comparative StudyLung mechanics and dyspnea after lung transplantation for chronic airflow obstruction.
Single lung transplantation (SLT) is widely used to treat chronic airflow obstruction (CAO). During exercise the native lung should increase end-expiratory lung volume (EELV) and result in a different respiratory sensation compared with double lung transplantation (DLT). Eight SLT recipients and 12 DLT recipients demonstrated a similar maximal work load and achieved VO2. ⋯ Tidal flow volume loop analysis demonstrated encroachment of the expiratory limb in four of seven SLT patients but in only one of 12 DLT recipients. A lesser peak breathlessness in DLT recipients approached statistical significance (p = 0.051), although the relation of respiratory sensation versus VE or VO2% predicted did not differ between the two groups. EELV increases in SLT recipients at peak exercise, although overall aerobic response is preserved and respiratory sensation is similar.