Resp Care
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Cystic fibrosis is a genetic disease that typically produces malnutrition and chronic respiratory infections. Prolonged bronchial obstruction, infection, and inflammation result in bronchiectstasis and permanent lung damage. Most cystic fibrosis patients die because of this progressive respiratory disease. ⋯ Aerosol therapy, airway clearance techniques, and noninvasive ventilation can all improve quality of life and possibly extend survival. Close patient monitoring with pulmonary function testing, chest radiography, and induced sputum can result in earlier treatment, potentially reducing permanent lung damage. Earlier diagnosis has prevented serious complications through early initiation of preventive therapies such as improved nutrition.
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Though asthma cannot be cured, it can be effectively controlled with existing treatments. Management strategies for acute and chronic asthma often vary substantially within and among medical facilities and practices, often driven by physician preference and familiarity rather than by data. The use of carefully designed care paths can improve quality of care and decrease management costs of acute asthma in both the emergency department and in-patient setting. ⋯ Assessment-driven care paths can be safely and effectively administered by respiratory therapists and nurses. The major controversies in the management of chronic asthma center on what to do for the patient who fails to respond to low or moderate doses of inhaled corticosteroids. The addition of a long-acting beta agonist or a leukotriene receptor antagonist may be beneficial.
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Comparative Study
Assessing need for long-term oxygen therapy: a comparison of conventional evaluation and measures of ambulatory oximetry monitoring.
Appropriate identification of hypoxic patients with chronic obstructive pulmonary disease (COPD) is important because of the demonstrated survival benefit of long-term oxygen therapy (LTOT) and its associated cost. Resting oxygen saturation (measured via pulse oximetry [S(pO2)]) and lowest exercise S(pO2) (during a 6-min walk test) is the standard method of determining LTOT requirements, but that method does not measure the patient's oxygenation during sleep or activities of daily living. We hypothesized that values obtained via the standard method would correlate poorly with values obtained via ambulatory oximetry monitoring. ⋯ There was a poor relationship between the conventional oxygenation assessment method and continuous ambulatory oximetry during LTOT screening with COPD patients.
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Comparative Study
A comparison of the OxyArm oxygen delivery device and standard nasal cannulae in chronic obstructive pulmonary disease patients.
Compare the performance of the OxyArm to that of nasal cannulae in the delivery of supplemental oxygen to patients with chronic obstructive pulmonary disease. ⋯ The OxyArm maintained stable S(pO2) over the range of oxygen flows studied and at levels equivalent to those maintained by nasal cannulae in 9 of the 10 subjects. The OxyArm does not contact the face and may be ideal for patients on long-term home oxygen therapy.
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Comparative Study
Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter.
Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. ⋯ Acapella and Flutter have similar performance characteristics. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.