Respiratory medicine
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Respiratory medicine · Jul 2006
Titration of non-invasive positive pressure ventilation in chronic respiratory failure.
Non-invasive ventilation (NIV) is widely used for acute and chronic respiratory failure. If arterial blood gas tensions do not improve, the level of support can be increased. However, there may be a limit above which increasing ventilatory support leads only to greater interface leak with no improvement in ventilation. ⋯ There is debate about whether the therapeutic aim of NIV should be to reduce respiratory muscle effort, or to reverse nocturnal hypoventilation. We conclude that if the primary aim is to improve arterial blood gas tensions and this is not achieved, higher levels of ventilation can be obtained using greater pressure or volume, despite additional interface leak. If the aim is to abolish muscle effort completely, there is little to be gained by increasing the level of inspiratory pressure above 20 (CWD) or 25 (COPD) cm H(2)O.
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Respiratory medicine · Jul 2006
Review Meta AnalysisShort-burst oxygen therapy in chronic obstructive pulmonary disease.
Despite widespread prescription, the efficacy of short-burst oxygen therapy has not been established. ⋯ The studies in this review suggest that the widespread prescription of short-burst oxygen is not evidence-based. If prescription is to continue, the scientific rationale for short-burst oxygen therapy must be established.
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Respiratory medicine · Jul 2006
Randomized Controlled Trial Multicenter Study Comparative StudyEXCEL: A randomised trial comparing salmeterol/fluticasone propionate and formoterol/budesonide combinations in adults with persistent asthma.
This multicentre, parallel group, double-blind, double-dummy, randomised 24-week study was designed to compare the efficacy of salmeterol/fluticasone propionate combination (SFC) 50/250 microg one inhalation twice daily (bid) with formoterol/budesonide combination (FBC) 6/200 microg two inhalations bid in patients with persistent asthma, currently receiving 1000-2000 microg/day of inhaled corticosteroids. ⋯ Twice-daily treatment with SFC and FBC over 6 months significantly improved asthma symptoms and lung function in patients with persistent asthma. The rate of exacerbations was significantly reduced over time on both treatments but SFC was found to be significantly superior to FBC in reducing the rate of moderate/severe exacerbations with sustained treatment.
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Respiratory medicine · Jul 2006
Randomized Controlled TrialMontelukast improves pulmonary function measured by impulse oscillometry in children with asthma (Mio study).
Systemic drugs-like oral montelukast can reach lower airways, whose inflammation plays a crucial role in the evolution of asthma, while inhaled drugs hardly reach them. The impulse oscillometry (IOS) technique is useful to evaluate both central and peripheral airways function. ⋯ Montelukast improves central and especially peripheral airways function in the first month of treatment, as evaluated by IOS, a technique based on tidal breathing analysis which is more sensitive than conventional forced spirometry.
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Respiratory medicine · Jul 2006
Comparative StudyIncreased DNA damage in patients with chronic obstructive pulmonary disease who had once smoked or been exposed to biomass.
Chronic obstructive pulmonary disease (COPD) is a slowly progressive condition characterised by poorly reversible airflow limitation associated with an abnormal inflammatory response of the lung. The main causal factors of COPD are chronic oxidative stress as a result of long-term smoking, use of biomass fuels, and air pollution. In this study, basal levels of DNA strand breaks were investigated together with some additional oxidative markers implicating oxidative damage on the other biomolecules such as proteins and lipids in patients with COPD who were exposed to smoking and biomass. ⋯ Oxidative stress markers and DNA damage were strongly increased in both patient groups with smoking- and biomass-related COPD. However, DNA is more affected in smoking-related COPD patients than in biomass-related COPD. These data indicate that cigarette smoking is a more significant DNA damaging risk factor than biomass smoke.