Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Aug 2015
ReviewSupplemental Oxygen Therapy for Patients with Chronic Obstructive Pulmonary Disease.
Oxygen is necessary for aerobic metabolism. Since the human body cannot produce or store oxygen, a continuous and adequate delivery of oxygen needs to be secured by oxygen uptake from inhaled air via the respiratory system and oxygen delivery to body tissues via the circulation. ⋯ In this article, we review the physiological effects and discuss the clinical benefits of oxygen therapy. We also evaluate the evidence supporting and arguing against its use in the published literature, discuss its risks and benefits, define criteria for prescribing oxygen therapy, and review methods of oxygen delivery in home settings.
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Delivery of medication to sites of action through airways has been used for centuries but has gained momentum in recent decades. Currently available modes of aerosol delivery offer advantages but still there are shortcomings. Delivery of active agents to sites of action is affected by many factors beyond the characteristics of the delivery devices, including the coordination between inhalation and actuation and dependence on the patient's inspiratory flow and breathing pattern. ⋯ Further, smart devices can provide feedback to patients. Novel inhaler technologies, separately or in combination with new therapeutic agents, are in development not only for respiratory diseases but also for diseases of other systems. This article reviews some of the recent clinically relevant advances in aerosol delivery devices.
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Semin Respir Crit Care Med · Aug 2015
ReviewEpidemiology of Chronic Obstructive Pulmonary Disease: Prevalence, Morbidity, Mortality, and Risk Factors.
Chronic obstructive pulmonary disease (COPD) remains a common and important cause of morbidity and mortality both in the United States and globally. The increasing trends of COPD prevalence, morbidity, and mortality seen in the later part of last century have not continued in the United States. ⋯ Future trends in COPD will probably be driven by factors in addition to tobacco use, such as longer survival in the population, other occupational and environmental exposures, and the increasing prevalence of asthma. Globally, factors such as air pollution and chronic respiratory infections, such as tuberculosis, will remain important predictors of future trends.
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In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. ⋯ To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance.
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Semin Respir Crit Care Med · Aug 2015
ReviewNew Pharmacotherapeutic Approaches for Chronic Obstructive Pulmonary Disease.
The last 5 years have seen a proliferation of data about the best way to treat chronic obstructive pulmonary disease (COPD). New long-acting inhaled β-agonist and antimuscarinic drugs have been developed as a once-daily inhaled corticosteroid. ⋯ New data are beginning to define which patients benefit from which treatments and this will help us develop more appropriate treatment regimes. These topics are considered in this review which provides an overview of the latest data and some direction as to how these findings can be applied in practice.