Canadian respiratory journal : journal of the Canadian Thoracic Society
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The aim of this study was to evaluate the outcome of intensive care unit (ICU) admission in patients with idiopathic pulmonary fibrosis (IPF) who develop acute respiratory failure of unknown etiology. ⋯ In the absence of a reversible cause, patients with IPF who develop acute exacerbation of IPF may not benefit from ICU admission and mechanical ventilation. However, it is imperative that a diagnostic workup be performed to rule out an infectious or other reversible cause of respiratory failure before admission to the ICU is denied.
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Evidence supporting antibiotic treatment guidelines and respiratory quinolones (RQs) in community-acquired pneumonia (CAP) is limited. ⋯ Findings support empirical treatment guidelines for CAP and their recommendations regarding RQs. The association between mortality and anaerobic coverage or combination therapy may reflect prognostic information available at presentation but not captured by the PSI.
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Overdiagnosis of asthma may be an emerging problem after years of attention to the rising prevalence and reported underdiagnosis of the disease. ⋯ Overdiagnosis of asthma is a potential problem, which may result in unnecessary or inappropriate medication use, increased health care costs and mislabelling of patients. The authors recommend greater use of objective diagnostic tests such as spirometry, peak flow diaries and bronchial provocation to establish a clinical diagnosis of asthma.
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McArdle's disease is a rare, inherited deficiency of myophosphorylase, an enzyme required for the utilization of glycogen. Patients with myophosphorylase deficiency classically present with exercise intolerance, leg pain and muscle fatigue. The case of a young woman with exertional dyspnea and leg cramps is described. ⋯ Evaluation of lung mechanics with esophageal pressure measurements demonstrated the presence of respiratory muscle weakness and early fatiguability, suggesting that the patient's dyspnea might have been attributable to an increased respiratory effort. Dyspnea is not a classic symptom associated with myophosphorylase deficiency, although subclinical respiratory muscle impairment may be present. No previous studies have evaluated respiratory muscle function during exercise in patients with myophosphorylase deficiency.