Resp Care
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Comprehensive management of chronic obstructive pulmonary disease (COPD) includes proper assessment, monitoring of disease, reduction of risk factors, the management of stable COPD, and the prevention and management of exacerbations. The 2007 COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease address each of these aspects of COPD management in detail and provide evidence-based recommendations for patients and health-care professionals. Reduction of risk factors emphasizes the importance of smoking cessation and control of environmental indoor and outdoor pollutants. ⋯ Since exacerbations influence lung function and clinical decline in patients with COPD and contribute to the cost of caring for this disease, efforts must be directed at prevention and management of exacerbations. In addition to controlled oxygen therapy, antimicrobials, brief courses of systemic corticosteroids and, on occasion, noninvasive or invasive mechanical ventilation may play a role. The role of respiratory therapists in the prevention, diagnosis, and management of stable COPD and exacerbations is absolutely essential if the goals of the 2007 Global Initiative for Chronic Obstructive Lung Disease guidelines are to be attained.
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Although existing evidence confirms that no pharmacologic agent ameliorates the decline in the lung function or changes the prognosis of chronic obstructive pulmonary disease (COPD), inhaled pharmacotherapy is a critical component of the management for patients suffering with COPD. Inhaled agents are directed to provide immediate relief of symptoms and to restore functional capacity in treatment of stable COPD. ⋯ Respiratory therapists play an important role in the implementation of these guidelines, since they are often responsible for educating patients on the correct use of the inhalers. This paper reviews current evidence regarding the use of inhaled pharmacotherapy in the treatment of COPD and provides a guided approach to the use of different agents in stable COPD.
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Ventriculopleural shunts are uncommonly used for the treatment of normal pressure hydrocephalus in adults. Pleural effusion has been reported to complicate the course of these ventriculopleural shunts in children. The pleural effusion should typically resemble the cerebrospinal fluid unless frankly infected. ⋯ We discuss the possible mechanisms in the development of the effusion. It is important to be aware of this unlikely complication of an uncommon procedure. Recognizing the origin of the pleural effusion can help in instituting close follow-up and early referral for revision of the ventriculopleural shunt.
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Spirometric testing is one of the oldest clinical tests still in use today. It is a straightforward test that has the patient maximally exhale from total lung capacity. The key measurements are the forced expiratory volume in the first second (FEV(1)) and the maximum exhaled volume (vital capacity [VC]). ⋯ Using this measurement can diagnose the presence and severity of airway obstruction. This can be used to guide therapies and predict outcomes. Using spirometry to screen for obstructive lung disease, however, can be problematic, and the effect of screening on outcomes has yet to be demonstrated.
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Review
Pulmonary rehabilitation and chronic lung disease: opportunities for the respiratory therapist.
Pulmonary rehabilitation is a core component of the management of a patient with chronic lung disease. The respiratory therapist plays a vital role in pulmonary rehabilitation. Identifying patients who are eligible for pulmonary rehabilitation, assessing the individual patient prior to entry into the program, providing education regarding the patient's disease, and actively participating in the exercise and training programs are just a few of the ways that the respiratory therapist can participate in this very important activity for patients with chronic lung disease.