Resp Care
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Randomized Controlled Trial Comparative Study Clinical Trial
Counseling about turbuhaler technique: needs assessment and effective strategies for community pharmacists.
Optimal effects of asthma medications are dependent on correct inhaler technique. In a telephone survey, 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional. In a subsequent pilot study, 26 patients were randomized to receive one of 3 Turbuhaler counseling techniques, administered in the community pharmacy. ⋯ After 2 weeks, optimal technique was achieved by 0/7 patients receiving standard verbal counseling (A), 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming (B), and 7/9 receiving augmented verbal counseling plus physical demonstration (C) (Fisher's exact test for A vs C, p = 0.006). Satisfactory technique (4 essential steps correct) also improved (A: 3/8 to 4/7; B: 2/9 to 5/8; and C: 1/9 to 9/9 patients) (A vs C, p = 0.1). Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management, but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique.
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Randomized Controlled Trial Comparative Study Clinical Trial
Noninvasive positive-pressure ventilation in patients with milder chronic obstructive pulmonary disease exacerbations: a randomized controlled trial.
To determine the effect of the addition of noninvasive positive-pressure ventilation (NPPV) to standard medical therapy on length of hospital stay among patients presenting with mild exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospitalization. ⋯ The effectiveness and cost-effectiveness of the addition of NPPV to standard therapy in milder COPD exacerbations remains unclear. P(aCO(2)) related to this increased WOB that requires intervention with some form of assisted ventilation. All patients developing an exacerbation of COPD that requires hospitalization have an increased WOB and, we hypothesize, potentially develop some degree of associated respiratory muscle fatigue. We further hypothesize that adding intermittent NPPV during the initial days of hospital stay would afford respiratory muscle rest for patients with milder COPD exacerbations and that this rest would allow these patients to recover more quickly and to be discharged home earlier. The objective of this trial was to determine whether the addition of NPPV to standard therapy during the first 3 days of admission in milder COPD exacerbations could decrease length of hospital stay.
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Randomized Controlled Trial Comparative Study Clinical Trial
Acute physiologic effects of nasal and full-face masks during noninvasive positive-pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease.
To assess the efficacy of and patient tolerance for nasal and full-face masks during noninvasive positive-pressure ventilation (NPPV) with patients suffering acute exacerbations of chronic obstructive pulmonary disease. ⋯ In patients suffering acute exacerbations of chronic obstructive pulmonary disease NPPV improves arterial blood gases and respiratory effort indices regardless of the type of mask used.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of intrapulmonary percussive ventilation on mucus clearance in duchenne muscular dystrophy patients: a preliminary report.
To determine the effects of intrapulmonary percussive ventilation (IPV) on mucus clearance in tracheostomized Duchenne muscular dystrophy patients. ⋯ IPV is a safe airway clearance method for tracheostomized Duchenne muscular dystrophy patients, and this preliminary study suggests that IPV increases the effectiveness of assisted mucus clearance techniques.
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Randomized Controlled Trial Clinical Trial
A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients.
Cystic fibrosis (CF) patients have abnormally viscid bronchial secretions that cause airway obstruction, inflammation, and infection that leads to lung damage. To enhance airway clearance and reduce airway obstruction, daily bronchopulmonary hygiene therapy is considered essential. ⋯ HFCWC and IPV are at least as effective as vigorous, professionally administered PD&P for hospitalized CF patients, and the 3 modalities were equally acceptable to them. A hospitalized CF patient should try each therapy and choose his or her preferred modality.