Respiratory medicine
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Respiratory medicine · May 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialImproved delivery of ipratropium bromide/fenoterol from Respimat Soft Mist Inhaler in patients with COPD.
We performed a multicentre, randomised, double-blind (within-device), placebo- and active-controlled, parallel-group study to compare the efficacy and safety of ipratropium bromide plus fenoterol hydrobromide (IB/FEN; Berodual) delivered via the novel, propellant-free Respimat Soft Mist Inhaler (SMI) and from a chlorofluorocarbon (CFC)-metered-dose inhaler (MDI) in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. After 2-weeks' run-in (CFC-MDI [IB 20 microg/FEN 50 microg per actuation] two actuations q.i.d. [MDI 40/100]), 892 patients were randomised to Respimat SMI containing IB 10 microg/FEN 25 microg (Respimat SMI 10/25), IB 20 microg/FEN 50 microg (Respimat SMI 20/50) or placebo (one actuation q.i.d.), or a CFC-MDI containing IB 20 microg/FEN 50 microg (MDI 40/100) or placebo (two actuations q.i.d.) for 12 weeks. ⋯ Switching from MDI 40/100 to Respimat SMI was well tolerated. Respimat SMI enables a 50% reduction of the nominal inhaled dose of IB/FEN in COPD patients while offering similar therapeutic efficacy and safety to the CFC-MDI.
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Respiratory medicine · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial of auto-titrating CPAP and fixed CPAP in the treatment of obstructive sleep apnea-hypopnea.
Continuous positive airway pressure (CPAP) remains the treatment of choice for obstructive sleep apnea hypopnea (OSAH). Auto-titrating CPAP (APAP) devices automatically adjust pressure and may improve treatment compliance compared to fixed CPAP (F-CPAP). ⋯ A-PAP was as effective as F-CPAP in the treatment of OSAH but was not associated with fewer side effects, better compliance, better satisfaction or increased patient preference.
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Respiratory medicine · Apr 2004
Risk factors of emergency care and admissions in COPD patients with high consumption of health resources.
This study is a case-control study looking to identify factors associated with frequent use of hospital services (emergency care and admissions) in COPD patients. Data from 64 patients with moderate-severe COPD (FEV1/FVC < or = 70, FEV1 < or = 50%) were prospectively collected, 32 cases with high consumption of health resources (COPD-HC) and 32 controls. COPD-HC was defined as a patient diagnosed of COPD requiring during one year: (1) two or more hospitalizations; (2) three or more emergency visits; or (3) one admission and two emergency visits. ⋯ For each point of worsened quality of life, the risk of hospital care increased 1.06-fold (95%CI: 1.01-1.10). Although a severity bias related to the presence of long-acting beta2-agonists in the final regression equation cannot be ruled out, the variables associated in our sample to an increased utilization of hospital services are the regular use of inhaled salmeterol, the presence of cardiac arrhythmias, and an impaired health-related quality of life. The use of specific strategies aimed at modulating these aspects could, at least in theory, reduce the number of exacerbations requiring hospital care, with the resultant individual and collective benefits derived.
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Respiratory medicine · Apr 2004
Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese.
To evaluate the relationship between cephalometric parameters, upper airway morphological factors and obstructive sleep apnea (OSA) in Chinese subjects. ⋯ Craniofacial factors and upper airway morphology contributed to severity of OSA in Chinese subjects. Having controlled for obesity, more retropositioned mandible was associated with more severe OSA.
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Studies over the past few decades have showed a clear association between cigarette smoking and the development of chronic airway obstruction. Yet, only a minority of smokers is affected so that in many, even heavy, smokers, pulmonary function remains within normal limits. While carcinogens have been well characterized, there is only limited information about the constituents of cigarette smoke responsible for inducing chronic airway obstruction. ⋯ The role of classical inflammatory cells such as neutrophils and alveolar macrophages is reviewed, but emphasis is put on recent evidence indicating the involvement of CD8 + T-lymphocytes and possibly eosinophils in the genesis of the structural changes leading to airways obstruction. The mechanisms by which airway inflammation and remodelling cause airway narrowing and airflow limitation are discussed, along with the associated loss of lung elasticity secondary to destructive emphysema. Other biological, epidemiological, physiopathological, and clinical aspects are analyzed, stressing such fundamental aspects as the defence mechanisms, the morpho-functional correlations, the identification of susceptible smokers, and the early detection of airway obstruction, both in specialized laboratories and in primary care.