American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Aug 2020
Randomized Controlled TrialSingle-Session Bronchial Thermoplasty Guided by 129Xe Magnetic Resonance Imaging: A Pilot Randomized Clinical Trial.
Rationale: Adverse events have limited the use of bronchial thermoplasty (BT) in severe asthma. Objectives: We sought to evaluate the effectiveness and safety of using 129Xe magnetic resonance imaging (129Xe MRI) to prioritize the most involved airways for guided BT. Methods: Thirty subjects with severe asthma were imaged with volumetric computed tomography and 129Xe MRI to quantitate segmental ventilation defects. ⋯ After one BT, the guided group had a greater reduction in the percentage of poorly and nonventilated lung from baseline when compared with unguided (-17.2%; P = 0.009). Thirty-three percent experienced asthma exacerbations after one guided BT compared with 73% after three unguided BTs (P = 0.028). Conclusions: Results of this pilot study suggest that similar short-term improvements can be achieved with one BT treatment guided by 129Xe MRI when compared with standard three-treatment-session BT with fewer periprocedure adverse events.
-
Am. J. Respir. Crit. Care Med. · Aug 2020
Randomized Controlled Trial Multicenter StudyTargeted Retreatment of Incompletely Recovered COPD Exacerbations With Ciprofloxacin: A Double-blind, Randomised, Placebo-controlled, Multicentre Phase III Trial.
Rationale: Chronic obstructive pulmonary disease (COPD) exacerbations are prone to nonrecovery, but there are no data about the effectiveness of retreatment for these prolonged events. We examined whether further therapy with ciprofloxacin for incompletely resolved COPD exacerbations prolonged the time until the next event. Objectives: To assess whether incompletely recovered COPD exacerbations benefit from additional treatment with ciprofloxacin, at Day 14. ⋯ Conclusions: In patients with persistent symptoms and/or raised C-reactive protein 14 days after a COPD exacerbation, an additional course of ciprofloxacin resulted in no additional benefit compared with placebo. This suggests that nonrecovered exacerbations are not driven by ongoing bacterial infection and may potentially be targeted with antiinflammatory therapy. Clinical trial registered with www.clinicaltrials.gov (NCT02300220).
-
Am. J. Respir. Crit. Care Med. · Aug 2020
Randomized Controlled TrialHome Monitoring in Patients with Idiopathic Pulmonary Fibrosis: A Randomized Controlled Trial.
Rationale: Idiopathic pulmonary fibrosis (IPF) is a deadly disease with increasingly impaired health-related quality of life (HRQOL). eHealth technologies facilitate collection of physiological outcomes and patient-reported outcomes at home, but randomized controlled trials (RCTs) on the effects of eHealth are scarce. Objectives: To investigate whether a home monitoring program improves HRQOL and medication use for patients with IPF. Methods: We performed a multicenter RCT in newly treated patients with IPF. ⋯ Conclusions: The results of this first-ever eHealth RCT in IPF showed that a comprehensive home monitoring program did not improve overall HRQOL measured with K-BILD but tended to improve psychological well-being. Home monitoring was greatly appreciated by patients and allowed for individually tailored medication adjustments. Clinical trial registered with www.clinicaltrials.gov (NCT03420235).