Respiratory medicine
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Respiratory medicine · Nov 2008
ReviewImmunomodulatory and biologic therapies for severe refractory asthma.
Despite undoubted efficacy of the combination of inhaled corticosteroids and beta(2)-agonists for most asthmatic patients with moderate-to-severe disease, there remains approximately 10% of the asthmatic population with serious unremitting symptoms, resulting in considerable impact on quality of life, disproportionate use of health care resources, and adverse effects from regular systemic steroid use. In an ideal world, optimal treatment of severe refractory asthma should achieve the best possible asthma control and quality of life with the least dose of systemic corticosteroids. ⋯ Unfortunately, current asthma guidelines offer little contribution to the management of the challenging patient with severe refractory asthma and none of them have addressed therapeutic alternatives to oral corticosteroids. This article reviews the current evidence for immunomodulating and biologic approaches in severe refractory asthma.
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Respiratory medicine · Nov 2008
Randomized Controlled TrialRandomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation.
Long-term home mechanical ventilation (HMV) is usually initiated in hospital. Admission to hospital has resource implications and may not be reimbursable in some healthcare systems. ⋯ Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.
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Respiratory medicine · Nov 2008
Comparative StudyAdaptation and follow-up to noninvasive home mechanical ventilation: ambulatory versus hospital.
Noninvasive home mechanical ventilation (HMV) has been shown to be beneficial for certain forms of respiratory failure, improving symptoms and quality of life. Adaptation and follow-up are usually conducted within the hospital framework. Our objective was to verify whether the same results could be obtained in the patient's home by the Home Hospitalization Unit. ⋯ HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.
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Respiratory medicine · Nov 2008
Case ReportsBronchogenic cyst: an uncommon cause of congenital lobar emphysema.
We report a case of a 1-month-old boy who has developed respiratory distress. Chest X-ray and CT scan showed over distension of the left upper lobe and a mediastinal shift in favour of congenital lobar emphysema (CLE) of the left upper lobe. One month after uneventful lobectomy, he was readmitted at hospital for another episode of respiratory distress. ⋯ Surgical examination found a subcarinal bronchogenic cyst which compressed the main left bronchus, causing the CLE of both upper and lower left lobes. Histological examination of removed cyst confirmed these data. Authors discuss causes of diagnostic delay.
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Respiratory medicine · Nov 2008
EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients.
The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. ⋯ In COPD patients receiving rehabilitation, responsiveness of EQ-5D utility was poor. One explanation might be a "ceiling effect" of this instrument.