Respiratory medicine
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Respiratory medicine · Aug 2007
Investigation of an outbreak of Legionnaires' disease: Hereford, UK 2003.
This report describes the investigation and control of a community outbreak of Legionnaires' disease in Hereford, UK, in November 2003. Outbreak investigation consisted of epidemiological survey, identification and environmental investigation of potential sources, microbiological analysis of clinical and environmental samples and mapping the location of potential sources and the movement and residence of cases. Each identified source was allocated a 'composite score' based on different zones of exposure and wind direction. ⋯ Environmental samples from one of the cooling towers in the cluster and clinical samples from two patients were positive for Legionella pneumophilia serogroup 1 and were indistinguishable by molecular sub-typing. In this outbreak, the use of microbiological, environmental and epidemiological techniques facilitated the rapid identification of a cooling tower as the source of this outbreak. This study illustrates the continuing importance of cooling towers as a source of Legionnaires' disease and the utility of obtaining and comparing both clinical and environmental samples.
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Previous data from the literature reported blunted perception of airway obstruction in severe asthmatics with near fatal asthma. Approximately 25% of patients with asthma are current smokers. ⋯ Mild asthmatics who smoke display reduced dyspnea perception during a non-specific provocative challenge with methacholine. This altered perception of airway obstruction does not relate to airway inflammation.
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Respiratory medicine · Jul 2007
Multicenter Study Comparative StudyEnhanced persistence with tiotropium compared with other respiratory drugs in COPD.
Tiotropium is a once-daily inhaled anticholinergic maintenance treatment with demonstrated effectiveness in chronic obstructive pulmonary disease (COPD). ⋯ Persistence with tiotropium was higher compared to other inhaled respiratory drugs in COPD in clinical practice.
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Respiratory medicine · Jul 2007
Multicenter StudySurvival and future need of long-term oxygen therapy for chronic obstructive pulmonary disease--gender differences.
We aimed to study trends in gender-related differences in incidence, and prevalence for long-term oxygen therapy due to chronic obstructive pulmonary disease. Another aim was to study survival after onset of oxygen therapy. Prospectively followed were 5689 Swedish patients, who were prescribed oxygen therapy because of chronic obstructive pulmonary disease from 1987 to 2000. ⋯ In conclusion, the incidence and prevalence for long-term oxygen therapy increases more rapidly among women than in men. This is probably due to the increased frequency of smoking in women compared with men and a higher susceptibility to develop severe hypoxaemia in women. The survival is better in women with long-term oxygen therapy than in men.
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Respiratory medicine · Jul 2007
Randomized Controlled TrialProphylactic use of noninvasive ventilation in patients undergoing lung resectional surgery.
We studied whether prophylactic use of noninvasive pressure support ventilation (NIPSV) administered pre- and postoperatively may reduce the postoperative pulmonary function impairment. ⋯ Two hours after surgery, PaO(2), FVC and FEV(1) values were significantly better in the NIPSV group. On day 1, 2 and 3, PaO(2) was significantly improved in the NIPSV group. Also on day 1, FVC and FEV(1) improved significantly in the NIPSV group. The hospital stay was significantly longer in the control group than in the study group (p=0.04). The incidence of major atelectasis was 14.2% in the NIPSV group and 38.9% in the no-NIPSV group (p=0.15). ANSWER TO THE QUESTION: Prophylactic use of NIPSV in a pre- and postoperative manner significantly reduces pulmonary dysfunction after lung resection. As a result, recovery of preoperative respiratory function is accelerated.