Chest
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Comparative Study
Diagnostics of spontaneous cough in childhood asthma: results of continuous tracheal sound recording in the homes of children.
Spontaneous cough is a symptom with diffuse diagnostic significance for childhood asthma. Information on the interrelations between presence/frequency of cough and other symptoms of asthma are not available to the physician. Tracheal sounds were continuously recorded in the homes of 60 children with and 30 without asthma, at 72 and 24 h, respectively. ⋯ Three children did not cough during exacerbations. Persistent, isolated cough was observed in two children. It was concluded that spontaneous cough is modestly predictive of asthmatic exacerbations, but not of a diagnosis of asthma or severity of asthma.
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To investigate the ability of patients with COPD to reproduce an exercise intensity accurately on the treadmill using dyspnea ratings obtained during incremental exercise on the cycle ergometer (cross-modal exercise prescription). ⋯ Patients with COPD can use dyspnea ratings from an incremental cycle ergometry test to regulate exercise on the treadmill without systematic bias at an intensity of 80% of peak VO2, but exceed the desired VO2 when using the dyspnea rating at an intensity of 50% of peak VO2.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group.
To evaluate the costs, consequences, effectiveness, and safety of ciprofloxacin vs standard antibiotic care in patients with an initial acute exacerbation of chronic bronchitis (AECB) as well as recurrent AECBs over a 1-year period. ⋯ Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care; however, the difference was not statistically significant. Further, usual care was found to be more reflective of best available care rather than usual first-line agents such as amoxicillin, tetracycline, or trimethoprim-sulfamethoxazole as originally expected. Despite the similar antimicrobial activities and broad-spectrum coverage of both ciprofloxacin and usual care, the trends in clinical outcomes and all quality of life measurements favor ciprofloxacin. In patients suffering from an AECB with a history of moderate to severe chronic bronchitis and at least four AECBs in the previous year, ciprofloxacin treatment offered substantial clinical and economic benefits. In these patients, ciprofloxacin may be the preferred first antimicrobial choice.
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Lung cancer, which is the leading cause of cancer mortality, remains a significant health-care problem among men and women in the United States, despite an overall 20-year decline in the incidence of cigarette smoking. Non-small cell lung cancer (NSCLC) comprises 75 to 80% of all lung cancer cases. The metastatic nature of this disease has been responsible for the poor survival statistics reported to date and emphasizes the need for effective systemic treatment. ⋯ Recently, however, several new compounds and classes of compounds have offered some hope for at least small improvements in response and survival while being relatively well tolerated in patients with this disease. This article presents current findings for some of these agents, including the taxanes paclitaxel and docetaxel, the topoisomerase inhibitors irinotecan and topotecan, and the novel pyrimidine analogue gemcitabine. In addition, the University of Southern California/Norris Cancer Center experience with the combination of carboplatin and paclitaxel is presented.
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The disappointing results obtained with currently available chemotherapy for lung cancer has led to the development of several new agents over the past 5 years. These include paclitaxel, docetaxel, vinorelbine, gemcitabine, and the camptothecins, irinotecan and topotecan. To date, phase I and II clinical trials with paclitaxel, docetaxel, gemcitabine, and combinations containing these drugs have been performed in patients with non-small cell lung cancer in Australia. ⋯ In general, the agents have been well tolerated. However, these studies cannot be compared with previous studies employing conventional chemotherapeutic agents, primarily because the results of the former studies may have been skewed due to enrollment of younger, healthier patients and a variable proportion of patients with locally advanced rather than metastatic disease. Randomized controlled trials will be needed to determine whether use of these newer agents is associated with improvements in survival, palliation, and/or toxic reactions when compared with currently used regimens.