Respiratory medicine
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Corticosteroids (oral or inhaled) are commonly used to treat pulmonary sarcoidosis; however, there is no consensus about when to start treatment, what dose of steroids to give and for how long. Immunosuppressive and cytotoxic agents (used in immunosuppressive doses) are used in addition to oral corticosteroids to treat multisystem and chronic sarcoidosis, or as steroid-sparing agents. We summarize the findings from two Cochrane systematic reviews that have examined the efficacy of corticosteroids and immunosuppressive and cytotoxic drugs in the treatment of pulmonary sarcoidosis. ⋯ Methotrexate had a steroid-sparing effect in one small study. Significant adverse events were associated with cyclosporine A, chloroquine and pentoxifylline. Evidence from randomized-controlled trials (RCTs) supporting the use of immunosuppressive and cytotoxic agents is limited.
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Respiratory medicine · Jan 2008
Randomized Controlled Trial Comparative StudyA randomized study of tiotropium Respimat Soft Mist inhaler vs. ipratropium pMDI in COPD.
The aim of these studies was to compare the efficacy and the safety of tiotropium, delivered via Respimat Soft Mist Inhaler (SMI), a novel multi-dose, propellant-free inhaler, with ipratropium pressurized metered-dose inhaler (pMDI) in chronic obstructive pulmonary disease (COPD) patients. Two identical, 12-week, multi-national, randomized, double-blind, double-dummy, parallel-group, active- and placebo-controlled studies were performed. COPD patients were randomized to treatment with either inhaled tiotropium (5 or 10 microg) via Respimat SMI administered once daily, ipratropium (36 microg) pMDI QID or placebo. ⋯ All active treatments significantly reduced the rescue medication use compared with placebo, but only tiotropium 10 microg was statistically superior to ipratropium (P=0.04). The incidence of adverse events was comparable across groups. In conclusion, tiotropium 5 and 10 microg daily, delivered via Respimat SMI, significantly improved lung function compared with ipratropium pMDI and placebo.
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Respiratory medicine · Jan 2008
Randomized Controlled Trial Comparative StudyEarly administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma.
Evaluate the efficacy of adding two intravenous bolus of aminophylline to the standard treatment of acute asthma episode in children admitted to the pediatric emergency room (PER). ⋯ In children aged 2-5 years admitted to a PER with asthma, two intravenous doses of 5mg/kg of aminophylline given 6h apart did not change the length of stay in hospital, the number of nebulizations given or the duration of oxygen therapy required. We are unable to tell whether there would be benefit with higher doses of aminophylline designed to give levels in the usual therapeutic range.
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Air hunger at end-of-life poses challenges to providers who attempt to comfort while not diminishing mental capacities. We examined the presence, methods of assessment, and treatment of air hunger. This observational study prospectively screened 198 consecutive medicine admissions for increased risk of near-term death. ⋯ Borg or VAS scales appear useful in assessing terminal dyspnea and can be employed in assessing terminal air hunger. No individual treatment or combination of treatments significantly improved patients' dyspnea. However, air hunger significantly improved with hospitalization.
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Respiratory medicine · Jan 2008
The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has introduced a four-stage classification of chronic obstructive pulmonary disease (COPD) severity. The present study investigated the discriminatory capacity of the GOLD classification for health status outcomes in patients with COPD. An additional analysis was performed to investigate the discriminatory capacity of a multidimensional staging system, i.e. the Body-Mass Index, Degree of Airflow Obstruction and Dyspnea, and Exercise Capacity Index (BODE index) for the outcome of quality of life. ⋯ Scatterplots revealed marked inter-individual variation within each GOLD stage or BODE index quartile, and considerable overlap between stages for all health status outcomes. These findings show that the GOLD classification indeed can be used to discern groups of COPD patients, but due to large inter-individual variability it does not seem adequate as a basis for individual management plans in rehabilitation. The BODE index appeared to discriminate slightly better for quality of life, however, it still leaves a significant part of the variance unexplained.