Respiratory medicine
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Respiratory medicine · Sep 2006
Randomized Controlled Trial Multicenter StudyTiotropium in COPD patients not previously receiving maintenance respiratory medications.
Use of maintenance bronchodilator therapy is currently recommended in symptomatic patients with Chronic obstructive pulmonary disease (COPD) and in those with Stage II or greater COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Because no prospective data describe when rescue therapy alone is insufficient or the optimal time to start maintenance therapy, it is unclear whether maintenance therapy has benefits in milder disease. To explore potential benefits we asked: Does once-daily tiotropium improve lung function, health status, and/or symptoms in "undertreated" COPD patients (i.e., those who are not receiving maintenance bronchodilator therapy) or patients considered by their health care providers as having milder disease? ⋯ Once-daily tiotropium provides significant improvement in lung function, health status, and dyspnea when used as maintenance therapy in undertreated COPD patients who were not previously receiving maintenance bronchodilator therapy.
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Respiratory medicine · Sep 2006
Randomized Controlled Trial Comparative StudyInspired oxygen fraction achieved with a portable ventilator: determinant factors.
Non-invasive positive pressure ventilation (NIPPV) is an effective treatment in respiratory failure. Continuous positive pressure (CPAP) may also be useful in acute hypoxaemic patients. Supplementary oxygen is usually necessary in both systems. However, the inspired oxygen fraction (FiO2) delivered by a NIV portable ventilator is unknown. The main objectives of this study were to establish the maximal FiO2 that could be achieved by these devices and to analyse the FiO2 determinant factors. ⋯ FiO2 obtained while using a NIPPV portable ventilator depends on the ventilatory assistant mode, the oxygen connection point and the MV reached.
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Respiratory medicine · Sep 2006
Asthma-related healthcare services utilization by African-Americans enrolled in West Virginia Medicaid.
Over the past 25 years, African-Americans have experienced higher rates of emergency department (ED) visits, hospitalizations, and death due to asthma compared to other ethnic groups in the US. African-Americans of lower socioeconomic groups are particularly vulnerable to asthma morbidity and mortality. Few studies have investigated asthma-related healthcare services use by different age and gender groups within this sub-population. ⋯ Asthma prevalence and asthma-related medical services utilization rates among African-American recipients of Medicaid varied by age and gender groups. These recipients appeared to be underutilizing controller pharmacotherapy for asthma.
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Respiratory medicine · Sep 2006
Multicenter StudyDeficient alpha-1-antitrypsin phenotypes and persistent airflow limitation in severe asthma.
Persistent airflow limitation is common among patients with severe asthma, but its pathogenesis has not been fully clarified. Severe alpha-1-antitrypsin (AAT) deficiency is a risk factor of chronic airflow limitation and emphysema, and partially deficient phenotypes have been associated with an accelerated decline in lung function. We hypothesized that partial deficiency of AAT (non-PiM AAT phenotype) is a risk factor of persistent airflow limitation in asthma. ⋯ AAT heterozygoty does not seem to be an important risk factor of persistent airflow limitation in patients with asthma. Although confirmation by longitudinal follow-up studies with larger sample sizes is needed, these results suggest that routine assessment of the AAT phenotype is not indicated in asthmatic patients even if they exhibit fixed airflow limitation.
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Respiratory medicine · Sep 2006
Randomized Controlled TrialPhysiological response to intrapulmonary percussive ventilation in stable COPD patients.
Intrapulmonary percussive ventilation (IPV) is a ventilatory technique that delivers bursts of high-flow respiratory gas into the lung at high rates, intended for treating acute respiratory failure and for mobilization of secretions. We performed a study, aimed at assessing the physiological response to IPV, on patients' breathing pattern, inspiratory effort, lung mechanics and tolerance to ventilation. Ten COPD patients underwent randomized trials of IPV through a face mask at different pressure/frequency combinations (1.2 bar/250 cycles/min; 1.8/250; 1.2/350; 1.8/350), separated by return to baseline (SB), using the IMP2 ventilator. ⋯ Tolerance to ventilation and oxygen saturation were satisfactory and did not change during the different trials. In 5 normal subjects a prolonged apnea trial lasting > 2 min was also performed, without any significant decrease in SaO2 or subjective discomfort. In conclusion, IPV was able to guarantee an adequate ventilation, while inducing a significant unloading of the diaphragm during the "low-frequency" trials.