Respiratory medicine
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The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the endoscopist's view beyond the mucosal surface of the large airways to peri-bronchial structures and peripheral lung lesions. Guided biopsies and real-time transbronchial needle aspirations (TBNA) have been shown to increase the diagnostic yield over conventional bronchoscopic techniques. ⋯ Complications are rare with either EBUS modality and are usually related to the underlying biopsy procedure rather than the use of ultrasound. Procedure duration is short enough to be incorporated into an outpatient setting and can performed under moderate sedation. Clear training standards are emerging to facilitate credentialing as EBUS is rapidly evolving to become a part of standard diagnostic bronchoscopy.
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Respiratory medicine · Oct 2009
Review Meta AnalysisTiotropium and risk for fatal and nonfatal cardiovascular events in patients with chronic obstructive pulmonary disease: systematic review with meta-analysis.
There are safety concerns regarding the use of anticholinergics in the COPD patient population. The purpose of this review was to evaluate the cardiovascular risk of regular use of inhaled tiotropium bromide in patients with COPD of any severity. ⋯ Compared with control (placebo or salmeterol), tiotropium did not significantly increase the risk of adverse major cardiovascular events among COPD patients. Subgroup analysis suggested that smoking history can modify the risk of cardiovascular adverse events.
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Respiratory medicine · Oct 2009
Randomized Controlled Trial Multicenter StudyEvaluation of withdrawal of maintenance tiotropium in COPD.
In chronic diseases such as chronic obstructive pulmonary disease (COPD), patients may not perceive all of the benefits of drug therapy until withdrawal. Thus, we evaluated the effect of tiotropium withdrawal on clinical variables. ⋯ The withdrawal of tiotropium results in worsening of COPD over a three-week interval. There was no evidence of a rebound effect in response to tiotropium withdrawal.
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Recently, heater/humidifier devices that use novel methods to condition breathing gases from an external source have been introduced. The addition of sufficient warmth and high levels of humidification to breathing gas has allowed for higher flow rates from nasal cannula devices to be applied to patients (i.e., high flow therapy). This article provides a review of the proposed mechanisms behind the efficacy of high flow therapy via nasal cannula, which include washout of nasopharyngeal dead space, attenuation of the inspiratory resistance associated with the nasopharynx, improvement in conductance and pulmonary compliance, mild distending pressure and reduction in energy expenditure for gas conditioning.
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Respiratory medicine · Oct 2009
Depression and its relationship with poor exercise capacity, BODE index and muscle wasting in COPD.
The prevalence of depression in stable COPD patients varies markedly, possibly because of use of different scales. We aimed to assess depression using 2 different depression scales and to examine the association between depression and poor exercise performance, BODE index and muscle wasting in clinically stable COPD patients. ⋯ The administration of different depression scales may affect some of the characteristics of depressed patients rather than the prevalence rate of depression. Depression was associated with poor exercise performance and BODE index in COPD.