Respirology : official journal of the Asian Pacific Society of Respirology
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Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. ACOS may be a special phenotype of a spectrum of chronic obstructive airway diseases, in which asthma and COPD are at the two opposite ends. The prevalence of ACOS varies considerably due to differing criteria being applied for diagnosis. ⋯ The approach to diagnosing ACOS depends on the population from which the patient originated. The management of ACOS should be individualized to ensure the most effective treatment with minimal side effects. In this paper, we review the diagnostic criteria of ACOS used in previous studies, propose practical approaches to diagnosing and managing ACOS and raise some research questions related to ACOS.
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Randomized Controlled Trial
Randomized controlled trial of the effect of regular paracetamol on influenza infection.
Anti-pyretic treatment is recommended in the management of influenza infection. In animal models anti-pyretic treatment increases mortality from influenza. We investigated the effects of paracetamol on viral and clinical outcomes in adults with influenza infection. ⋯ ACTRN12611000497909 at the Australian New Zealand Clinical Trials Registry.
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Review Meta Analysis
Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis.
This meta-analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English-language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. ⋯ Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.
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Delirium is an important predictor of negative clinical outcomes in intensive care unit (ICU), including prolonged mechanical ventilation (MV). However, delirium has not yet proven to be directly linked to weaning difficulties. The objective of this cohort study was to evaluate the association between delirium, as observed on the day of the weaning trial, and subsequent weaning outcomes in medical patients. ⋯ Delirium, as assessed by the CAM-ICU at the time of first weaning trial, was significantly associated with weaning difficulties in medical patients.
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Randomized Controlled Trial
Effects of low-dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study.
The management of chronic refractory breathlessness is one of the indications for regular low-dose (≤30 mg/24 h) oral sustained release morphine. Morphine may disrupt sleep in some conditions and improve sleep quality in others. This study aimed to determine any signal of regular, low-dose morphine on perceived sleep disruption due to breathlessness and perceived sleep quality. ⋯ Four days of low-dose morphine improved perceived sleep quality in elderly participants with refractory breathlessness. Regular low-dose morphine targeted to reduce refractory breathlessness may yield associated benefits by reducing sleep disruption and improving sleep quality.