American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2013
Randomized Controlled Trial Multicenter StudyLoss of salmeterol bronchoprotection against exercise in relation to ADRB2 Arg16Gly polymorphism and FeNO.
β2-Agonists are the treatment of choice for exercise-induced bronchoconstriction (EIB) and act through specific receptors (ADRB2). Arg16Gly polymorphisms have been shown to affect responses to regular use of β2-agonists. ⋯ The LOB that occurs with chronic long-acting β2-agonists use is not affected by ADRB2 Arg16Gly polymorphisms. High FE(NO) was associated with marked LOB. Use of long-acting β2-agonists before achieving a reduction in FeNO may need to be avoided. Clinical trial registered with www.clinicaltrials.gov (NCT 00595361).
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Am. J. Respir. Crit. Care Med. · Dec 2013
Club Cell Protein 16 and Disease Progression in Chronic Obstructive Pulmonary Disease (COPD).
Club (Clara) cell protein 16 (CC-16) is a protein that is synthesized predominantly in the lungs and is detectable in serum. Its expression decreases with lung injury and smoking, and is thus a marker of bronchial cell dysfunction. ⋯ Serum CC-16 is associated with disease progression, and may assist in the identification of "rapid progressors." However, the absence of CC-16 does not appear to modify the risk of cigarette-related COPD in mice.
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Am. J. Respir. Crit. Care Med. · Dec 2013
Clinical TrialBeneficial Hemodynamic Effects of Prone Positioning in Patients with Acute Respiratory Distress Syndrome.
The effects of prone positioning during acute respiratory distress syndrome on all the components of cardiac function have not been investigated under protective ventilation and maximal alveolar recruitment. ⋯ In patients with acute respiratory distress syndrome under protective ventilation and maximal alveolar recruitment, prone positioning increased the cardiac index only in patients with preload reserve, emphasizing the important role of preload in the hemodynamic effects of prone positioning.
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Am. J. Respir. Crit. Care Med. · Dec 2013
Spontaneous Effort Causes Occult Pendelluft during Mechanical Ventilation.
In normal lungs, local changes in pleural pressure (P(pl)) are generalized over the whole pleural surface. However, in a patient with injured lungs, we observed (using electrical impedance tomography) a pendelluft phenomenon (movement of air within the lung from nondependent to dependent regions without change in tidal volume) that was caused by spontaneous breathing during mechanical ventilation. ⋯ Spontaneous breathing effort during mechanical ventilation causes unsuspected overstretch of dependent lung during early inflation (associated with reciprocal deflation of nondependent lung). Even when not increasing tidal volume, strong spontaneous effort may potentially enhance lung damage.