Respirology : official journal of the Asian Pacific Society of Respirology
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Clinical Trial
Treatment of severe exacerbation of chronic obstructive pulmonary disease with mask-applied continuous positive airway pressure.
The efficacy of mask-applied continuous positive airway pressure (CPAP) in the treatment of patients with acute severe exacerbations of chronic obstructive pulmonary disease (COPD) was examined. Ten patients with severe exacerbation of COPD who had deteriorated during conventional therapy were treated with face-mask delivered CPAP (+5 cmH2O; Downs Vital signs Inc., New Jersey, USA) instead of tracheal intubation and mechanical ventilation. The patients that were selected required mental alertness, intact upper airway reflexes, the clinical signs of dynamic hyperinflation and a positive end-expiratory pressure auto-(PEEP) manifested as expiratory wheeze and grunting. ⋯ One patient deteriorated on mask-CPAP and required intubation and mechanical ventilation. Three patients died (none of these patients died during the acute period of exacerbation). It was concluded that Mask-CPAP may be an alternative to mechanical ventilation in the treatment of selected patients with severe hypercapnic exacerbations of COPD.
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Airway inflammation may cause alteration of airway responses in chronic airway diseases, such as bronchial asthma. The objective of this study was to examine whether interleukin-1beta (IL-1beta) [corrected], one of the pro-inflammatory cytokines, has a direct effect on airway functions. The effects of IL-1beta on carbachol, KCl and isoproterenol (ISO) responses of isolated guinea-pig tracheal strips were examined by measuring isometric tension in tissue bath. ⋯ Epithelial denudation abolished the effects of IL-1beta on KCl and ISO responses. Indomethacin (2 micromol/L) [corrected] reversed the effects of IL-1beta both on KCl and on ISO. These results suggest that IL-1 beta decreases the sensitivity of airway strips to KCl and ISO, possibly by stimulating prostaglandin production from the airway epithelium [corrected].
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This review will attempt to put together the voluminous studies and concepts that have been published during the past 25 years following the description of the acute respiratory distress syndrome (ARDS) regarding diagnosis and management. The initial discussion will focus on how to clinically diagnose ARDS based recommendations. ⋯ The radiographic and hemodynamic characteristics are discussed including oxygenation parameters. The management outlines the conventional as well as new therapies intended to improve survival of this devastating disease.
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Tobacco use, particularly cigarette smoking, is widely recognized by the medical community and the general public as a major public health problem. Physicians and medical organizations share a public health duty to address this problem. ⋯ The issues involved are complex and affect medical practice in a number of ways. The following statement developed by six international organizations--the American College of Chest Physicians, the American Thoracic Society, the European Respiratory Society, the Asian Pacific Society of Respirology, the Canadian Thoracic Society, and the International Union Against Tuberculosis and Lung Disease--is intended to state the physician's responsibilities both to patients and to the community with regard to these general issues.