Aust Prescr
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Long-term home oxygen therapy improves survival in patients with chronic obstructive pulmonary disease and persistent, severe hypoxaemia. It is uncertain that this benefit extends to patients with other chronic lung diseases. Oxygen is a treatment for hypoxaemia, not breathlessness. ⋯ Laboratory studies show improvements in exercise capacity and dyspnoea, but these do not translate into significant benefits in the home setting. Patients should be educated regarding the expected benefits, risks and burdens of home oxygen therapy. It is particularly important that the patient does not smoke.
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Chronic non-cancer pain is a common problem among older people and has a significant impact on their quality of life. Medical comorbidities and polypharmacy are often additional challenges in managing these patients Appropriate assessment of chronic non-cancer pain is important for the development of a patient-centred, goal-directed management plan. ⋯ Caution is generally advised when introducing drugs and escalating the doses Drugs that are not effective should be stopped. A shared decision-making approach is advised for deprescribing analgesics used for chronic non-cancer pain.
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Cluster headache is characterised by attacks of very severe, unilateral headache lasting 15-180 minutes, up to eight times per day. The attacks are associated with cranial autonomic symptoms on the same side and a sense of agitation or restlessness First-line acute abortive treatments include intranasal or subcutaneous sumatriptan or high-flow oxygen. ⋯ Close monitoring is required for the adverse effect of arrhythmia There are several emerging therapies that have either proven efficacy, or possible benefit for cluster headache. They include drugs aimed at the calcitonin gene-related peptide.
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The most effective intervention for stopping smoking is a combination of professional counselling and pharmacotherapy. Medicines are recommended for all smokers who are motivated to quit and are nicotine dependent. Combination nicotine replacement therapy with a patch and an oral product is more effective than the patch alone. ⋯ Varenicline is the most effective oral drug. It is safe in people with stable mental illness. Vaping nicotine is a second-line treatment which can be considered for smokers who are unable to quit with other methods.