Respiratory medicine
-
Respiratory medicine · Mar 2008
Comparative StudyPhysiological responses to high intensity, constant-load arm exercise in COPD.
The aim of the study was to compare the metabolic, ventilatory and dyspnoea responses of a single bout of high intensity, constant-load arm exercise to peak arm exercise in people with chronic obstructive pulmonary disease (COPD). Thirty people with COPD (mean age+/-SD=65+/-8 years; FEV1% predicted=56+/-12%) were included. All subjects performed an incremental arm exercise test to peak work capacity on an arm ergometer and, on a separate day, a constant-load arm exercise test at 80% of the peak work rate achieved on the incremental test. ⋯ At end exercise, VE, dyspnoea and RPE for the constant-load test was significantly higher compared to the incremental test (VE: 41.3+/-14.4 L/min and 38.3+/-11.8 L/min; dyspnoea: 5.6+/-2.7 and 4.6+/-2.1; RPE: 7.1+/-2.3 and 6.0+/-2.0; all p<0.05). Constant-load arm exercise at 80% peak work rate elicits higher ventilatory, dyspnoea and RPE responses at end exercise compared to incremental arm exercise in people with COPD. This finding suggests that an intensity of 80% peak work rate may be too high as an initial training intensity for supported arm exercise in people with COPD.
-
Exhaled breath condensate (EBC) is being used increasingly to sample airway fluid. EBC pH may be a biomarker of airway inflammation in asthma. In this study, we assessed the long-term reproducibility of EBC pH in asthma. ⋯ EBC pH in asthmatics tended to fluctuate more than in healthy subjects. However, EBC pH variability in asthma was not influenced by changes in clinical status. Rather, we suggest that cigarette smoke may be implicated in EBC pH variability.
-
Respiratory medicine · Mar 2008
Comparative StudyEvaluation of bronchoalveolar lavage fluid from ARDS patients with regard to apoptosis.
Apoptosis is thought to play an important role in the development of acute respiratory distress syndrome (ARDS). We evaluated the bronchoalveolar lavage (BAL) fluid from ARDS patients focusing on apoptosis. ⋯ Among the mediators in BAL fluid from ARDS patients, G-CSF had the most significant prognostic implications, and the sFas and TRAIL levels were correlated with clinical severity.
-
Respiratory medicine · Mar 2008
Aerosolized colistin as adjunctive treatment of ventilator-associated pneumonia due to multidrug-resistant Gram-negative bacteria: a prospective study.
Ventilator-associated pneumonia (VAP) remains the leading cause of death in patients with intensive care unit (ICU) acquired infections associated with an attributable mortality around 30%. Increasing antimicrobial resistance in patients with VAP challenges intensivists to search for alternative therapeutic options. There is scarcity of data in the literature concerning the administration of aerosolized colistin in critically ill patients with VAP due to multidrug-resistant (MDR) Gram-negative pathogens. ⋯ Aerosolized colistin may be considered as adjunctive to intravenous treatment in patients with VAP due to MDR Gram-negative bacteria susceptible to colistin in critically ill patients. Although colistin is safe and effective, the best route of administration remains unclear. In addition, controlled comparative studies are needed to establish its effectiveness and safety.
-
Respiratory medicine · Feb 2008
Randomized Controlled Trial Multicenter StudyEfficacy and safety of formoterol fumarate delivered by nebulization to COPD patients.
Nebulized solutions of long-acting bronchodilators provide an alternative to DPI and MDI delivery, particularly for COPD patients unable to use hand-held devices easily or correctly. The long-acting beta2-agonist, formoterol fumarate, is differentiated by its onset of significant bronchodilation within 5 min of administration. In a randomized, double-blind, double-dummy trial, COPD subjects (n=351, mean forced expiratory volume FEV1=1.3 L, 44% predicted) received nebulized formoterol fumarate (Perforomist inhalation solution; FFIS 20 microg) or DPI (Foradil Aerolizer; FA 12 microg), or placebo twice daily for 12 weeks. ⋯ Drug related AEs in the FFIS arm with a frequency > or = 1% and exceeding placebo were dry mouth, nausea, and insomnia. Nebulized FFIS provided significant improvement in respiratory status and quality of life in subjects with COPD relative to placebo and was well tolerated. The efficacy and safety profile of FFIS was comparable to FA DPI.