Current opinion in pulmonary medicine
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To review the basis for spirometry, its benefits in diagnosing and managing both acute and chronic pulmonary disorders with emphasis on chronic obstructive pulmonary disease, and to critically examine the barriers to its widespread use. ⋯ Spirometry is an important office diagnostic device that should be used by all primary care and most specialist physicians. Spirometry is to dyspnea as the electrocardiogram is to chest pain.
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This article reviews findings from recently published randomized controlled clinical trials to address the question whether a long-acting inhaled bronchodilator should be the initial choice for maintenance therapy in patients with stable, symptomatic chronic obstructive pulmonary disease (COPD). ⋯ Current evidence supports the recommendation of the Global Initiative for Chronic Obstructive Lung Disease guidelines of at least one of the two classes of long-acting inhaled bronchodilators as initial maintenance therapy for symptomatic COPD. In patients who do not respond satisfactorily to tiotropium or a long-acting inhaled beta-agonist as the initially prescribed single maintenance agent, the Global Initiative for Chronic Obstructive Lung Disease guidelines recommend the addition of the alternate class of long-acting inhaled bronchodilator as the next step. Further clinical trials are required to investigate whether this recommendation is preferable to that of adding an inhaled corticosteroid, which has been shown to have additive benefits to those of a long-acting beta-agonist with respect to bronchodilation and, variably, dyspnea, rescue bronchodilator use, and quality of life. The choice of agents will depend ultimately on how well the patient responds to a trial of the drug in terms of both efficacy and side effects, and patient preference and cost.
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The catastrophic collapse of the World Trade Center (WTC) towers on September 11, 2001 created a large-scale disaster site in a densely populated urban environment. Over the ensuing months, tens of thousands of rescue, recovery and cleanup workers, volunteers, and residents of the adjacent community were exposed to a complex mixture of airborne pollutants. This review focuses on currently described respiratory syndromes, symptoms, and physiologic derangements in WTC rescue, recovery, and cleanup workers, discusses potential long-term effects on respiratory health, and draws parallels to community findings. ⋯ While it is too early to ascertain long-term effects of WTC dust exposure, current studies already demonstrate a definite link between exposure to WTC-derived airborne pollutants and respiratory disease, both in the occupational and the community setting. A better understanding of causes and effects of this exposure will help in developing appropriate preventative tools for rescue workers in future disasters.
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Most patients with significant chronic obstructive pulmonary disease (COPD) have inspiratory and expiratory muscle weakness. In addition, hyperinflation induces functional weakening of the inspiratory muscles, increased elastic load to breathing, and intrinsic positive end expiratory pressure (PEEPi). Therefore, it was rational to expect that patients with COPD would benefit from specific inspiratory or expiratory muscle training (SIMT, SEMT respectively). However, the functional benefits of SIMT have remained equivocal. In recent years, a number of studies have demonstrated that, when training loads are controlled, SIMT results in important functional benefits. The role of SEMT is still unclear. ⋯ Inspiratory and expiratory muscles can be specifically trained yielding improvements in both strength and endurance. The improvement in inspiratory muscle performance is associated with an improvement in the sensation of dyspnea, exercise tolerance, and quality of life. When the expiratory muscles are specifically trained, a significant increase in exercise performance has also been shown. However, there is probably no additional benefit in combining SEMT with SIMT.