Respiratory care
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Clinicians responsible for treating pulmonary disease often encounter challenges in the management of patients with COPD. This is due in part to the number of drugs now available to ameliorate COPD symptoms and the complexity of adhering to good disease management programs. Each aspect of treatment is a critical component in improving outcomes for these patients. The purpose of this article is to review some of the most significant findings regarding the treatment of COPD, with emphasis on disease management and pharmacotherapy.
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Comparative Study
Reliability of Apnea-Hypopnea Index Measured by a Home Bi-Level Pressure Support Ventilator Versus a Polysomnographic Assessment.
Ventilators designed for home care provide clinicians with built-in software that records items such as compliance, leaks, average tidal volume, total ventilation, and indices of residual apnea and hypopnea. Recent studies have showed, however, an important variability between devices regarding reliability of data provided. In this study, we aimed to compare apnea-hypopnea indices (AHI) provided by home ventilators (AHINIV) versus data scored manually during polysomnography (AHIPSG) in subjects on noninvasive ventilation (NIV) for obesity-hypoventilation syndrome. ⋯ In stable subjects with obesity-hypoventilation syndrome, the home ventilator software tested was appropriate for determining if control of respiratory events was satisfactory on NIV or if further testing or adjustment of ventilator settings was required. (ClinicalTrials.gov registration NCT01130090.).
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Nasal CPAP is the most common respiratory support for neonates. Several factors are considered important for effective treatment, including leaks at the patient interface and the delivery of pressure-stable CPAP. Investigations of pressure stability during leaks should include both the change in the mean delivered CPAP and the pressure variation during each breath. The aim of this study was to examine the response of ventilators delivering nasal CPAP when challenged with leaks at the patient interface. ⋯ There was no simple relationship between maintaining delivered CPAP during leaks and providing CPAP with low pressure swing amplitude. Maintaining the delivered CPAP and providing this without pressure swings are 2 separate aspects of pressure stability, and investigations concerning the clinical importance of pressure stability should address both aspects. This study also shows that compensation for leaks does not necessarily provide pressure-stable CPAP.
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Only a few cases of sarcoidosis-like reaction to a pharmacologic compound have been reported in patients with melanoma in the literature. Long-term treatment with interferon alpha may be assumed. ⋯ He had a history of malignant melanoma with 18 months of interferon alpha-2 therapy. Histological analysis of a transbronchial biopsy revealed sarcoidosis-like reactions.
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Editorial Comment
Mechanical Insufflation-Exsufflation: The Good, the Bad, and the Ugly.