Resp Care
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In long-term management of stable chronic obstructive pulmonary disease (COPD), a number of medications improve pulmonary function test results. The long-term clinical benefits of those drugs would seem intuitive, but there is very little strong evidence that long-term outcomes in COPD are substantially affected by those drugs. Nevertheless, symptom improvement such as dyspnea reduction is certainly strong reason to use those agents. ⋯ In acute exacerbations, the rationale for therapy comes in part from the large body of literature regarding acute asthma therapy. Bronchodilator therapy and corticosteroids both seem to reduce the severity and the duration of exacerbations. Moreover, routine antibiotic use seems beneficial, and the role of noninvasive positive-pressure ventilation with patients suffering impending respiratory failure from acute COPD exacerbations is well supported by the literature.
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Many acute and chronic respiratory diseases are associated with increased respiratory secretions in the airways. Narrative reviews and a few systematic reviews of secretion clearance techniques have been published. These reviews raise concerns regarding the lack of evidence to support the various secretion clearance techniques. ⋯ Most of the studies were small, most used crossover designs, and few used sham therapy. Many studies were limited to short-term outcomes such as sputum clearance with a single treatment session. Despite the clinical observation that retained secretions are detrimental to respiratory function and despite anecdotal associations between secretion clearance and improvements in respiratory function, there is a dearth of high-level evidence to support any secretion clearance technique.
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Outcomes research seeks to understand the end results of particular health care interventions. End results include effects that people experience and care about, such as change in ability to function. The modern outcomes movement in the United States had its beginnings in the early 1980s, with an official start when Congress created the Agency for Health Care Policy and Research in 1989. ⋯ For example, outcomes research is population-centered rather than disease-centered, deals more with processes of care than drugs and devices, and relies less on the "hard sciences" such as physics and biochemistry and more on the social sciences such as economics, behavioral sciences, and epidemiology. Appropriate outcomes measures may be classified as (A) clinical, such as physiologic measures and mortality; (B) economic, such as direct and indirect costs of care; or (C) humanistic, such as quality of life and patient satisfaction with care. Respiratory therapists need to be familiar with outcomes research issues in order to be educated consumers of (and to participate in) future studies.