Respiratory care
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Oxygen therapy is usually combined with a humidification device, to prevent mucosal dryness. Depending on the cannula design, oxygen can be administered pre- or intra-nasally (administration of oxygen in front of the nasal ostia vs cannula system inside the nasal vestibulum). The impact of cannula design on intra-nasal humidity, however, has not been investigated to date. ⋯ Pre-nasal administration of dry oxygen achieves levels of intranasal humidity similar to those achieved by intranasal administration in combination with a bubble through humidifier. Pre-nasal oxygen simplifies application and may reduce therapy cost.
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Distance walked during the 6-min walk test (6MWT) predicts mortality in COPD. The body weight of the patient affects the work required to walk. Calculated work during the 6MWT (6MWT work) may account for differences in walk distance resulting from change in body weight. Thus, 6MWT work might be a better predictor of mortality than distance walked. This study was designed to test this hypothesis and to assess if other variables measured during the 6MWT, like continuous oximetry recording, offered additional prognostic information. ⋯ 6MWT work was not more useful than 6MWT distance to predict mortality. The study confirms that 6MWT distance and dyspnea on exertion are key elements in prognostic evaluation in COPD, while the value of exercise oxygen desaturation is less clear.
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Comparative Study
Respiratory therapists' smoking cessation counseling practices: a comparison between 2005 and 2010.
We assessed whether smoking cessation counseling practices and related psychosocial characteristics among respiratory therapists (RTs) improved between 2005 and 2010. ⋯ Although the proportion of RTs trained in smoking cessation counseling during and after studies increased between 2005 and 2010 (from 3% to 14%, and from 17% to 29%, respectively), sustained efforts are needed to increase the number of trained RTs, so that this translates into positive observable changes in counseling practices.
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Comparative Study
Airway dimensions in asthma and COPD in high resolution computed tomography: can we see the difference?
Airway remodeling in asthma and COPD results in bronchial wall thickening. The thickness of the bronchial wall can be measured in high-resolution computed tomography. The objectives of the study were to assess the bronchial lumen and wall dimensions in asthma and COPD patients, in relation to disease severity, and to compare the airway dimensions in patients with asthma and COPD. ⋯ Our results indicate that bronchial walls are thicker in asthmatics than in patients with COPD. It seems that airway wall thickness and the lumen diameter in patients with asthma are related to disease severity. There is no such a relationship in COPD patients. High-resolution computed tomography may be a useful tool in the assessment of airway structure in obstructive lung disease.
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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. ⋯ The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!