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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Case Reports
Successful Colchicine Therapy in a Patient With Follicular Bronchiolitis Presumed to Be Asthma.
Follicular bronchiolitis (FB) is a rare small-airway pathology that is associated mainly with connective tissue diseases. This case report presents a new, diagnosed, different airway disease in a non-smoker with rheumatoid arthritis in remission who was treated for presumed asthma, but was not controlled. ⋯ The clinical findings of FB were controlled successfully by colchicine after she did not respond to systemic steroid therapy. This is the first case report of FB associated with rheumatoid arthritis that responded to colchicine.
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The incidence of pneumothoraces with automated cardiopulmonary resuscitation (CPR) is unknown. Herein, we present 4 cases of pneumothoraces occurring in the setting of automated mechanical CPR (AM-CPR) in a 2-month period since incorporating mechanical devices into our resuscitation program. Two of the cases were in-hospital cardiac arrests, whereas the other 2 were out-of-hospital cardiac arrests. ⋯ Two of the cases presented with obstructive lung disease, whereas the other 2 had underlying malignancy. Suboptimal positioning and failure to secure the included shoulder straps could have led to migration of the piston over the ribs. Further study is needed to determine the incidence of complications for all FDA-approved AM-CPR devices compared with manual chest compressions.
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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.).