Resp Care
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Randomized Controlled Trial Comparative Study
Nocturnal oxygenation using a pulsed-dose oxygen-conserving device compared to continuous flow.
The pulsed-dose oxygen-conserving device (PDOCD) has gained wide acceptance as a tool to reduce the cost and inconvenience of portable oxygen delivery. Despite the widespread use of PDOCDs in awake and ambulating patients, few studies report their use during sleep. This study was designed to compare heart rate and oxygen saturation (measured via pulse oximetry [S(pO2)]) of sleeping patients using one brand of PDOCD versus continuous-flow oxygen. ⋯ The PDOCD model we studied was able to deliver oxygen therapy (via nasal cannula) comparable to continuous-flow in 9 of 10 patients. The resting daytime S(pO2) on continuous-flow appears to be an appropriate target for setting the PDOCD to ensure adequate oxygenation, even during sleep, with the PDOCD we tested. We conclude that the PDOCD we tested is able to maintain adequate S(pO2) during sleep in selected patients. Because of differences in design, triggering-signal sensitivity, and oxygen-pulse volume, these results cannot be generalized to all patients or all oxygen-conserving devices. Further research is needed to determine the general performance of PDOCDs on larger populations of oxygen-dependent patients and patients with sleep-disordered breathing.
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The first clinical practice guidelines (CPGs) for the assessment and management of patients with chronic obstructive pulmonary disease (COPD) were published 30 years ago. These and subsequent CPGs issued by professional societies and other groups prior to 2000 were consensus recommendations based on expert opinion and available studies, and they have been criticized for being inconsistent and not explicitly evidence-based. The Global Initiative for Chronic Obstructive Lung Disease (GOLD), a joint project of the National Heart, Lung, and Blood Institute and the World Health Organization, released the first of a new generation of rigorous, evidence-based COPD guidelines in 2001. ⋯ While previous COPD guidelines had different severity-grading systems and differed in their therapy recommendations, the new CPGs are remarkably consistent and have very few areas of clinically relevant discrepancy. All are available free via the Internet, provide for regular revision and updating, and include materials for patients and the public, as well as for health-care providers. Although the GOLD and ATS-ERS guidelines both have international authorship and are intended for worldwide use, implementation of many of their recommendations (such as the requirement for spirometry in diagnosis and staging, an escalating management scheme that includes expensive inhaled medications and pulmonary rehabilitation, and consideration for lung-volume reduction surgery) remains beyond the reach of many patients and health care systems.
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Chronic obstructive pulmonary disease is characterized in part by a chronic inflammatory state in the airways (largely from chronic noxious stimuli such as tobacco smoke), punctuated with acute inflammatory exacerbations, which are often infectious. Although pathologically and biochemically different from the inflammation of asthma, the chronic inflammation of chronic obstructive pulmonary disease, especially in subgroups with asthma-like features and especially during exacerbations, might be expected to respond to corticosteroid therapy, as does asthma. Complications from long-term corticosteroid use are important, but they appear less when the corticosteroid is given via the inhaled route. Clinical evidence is particularly strong supporting the use of inhaled corticosteroids to prevent exacerbations and oral corticosteroids to reduce the duration and impact of exacerbations.
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Comparative Study
The presence of emphysema further impairs physiologic function in patients with idiopathic pulmonary fibrosis.
Emphysema, especially in the upper lobes, is frequently observed in association with idiopathic pulmonary fibrosis (IPF). However, the combination of emphysema plus IPF has received little attention. ⋯ In former smokers with IPF, the presence and the extent of emphysema have a profound influence on physiologic function in terms of both further impairment and confounding effects.