Respiratory care
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Although tobacco use is the leading cause of numerous preventable diseases, including respiratory illnesses, respiratory therapy students historically have received inadequate education for treating tobacco use and dependence. To address this gap, a respiratory-specific tobacco cessation training program was created and disseminated via a train-the-trainer approach for faculty in respiratory therapy and respiratory care programs across the United States. The purpose of this study was to estimate the impact of the live, web-based, train-the-trainer programs on participating faculty, and to assess changes in the extent of adoption of tobacco cessation content in respiratory therapy curricula across institutions in the United States. ⋯ Training respiratory therapy faculty using a train-the-trainer approach had a positive impact on faculty's perceived confidence and ability to teach tobacco cessation at their institutions.
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Observational Study
Reliability of Smartphone Pulse Oximetry in Subjects at Risk for Hypoxemia.
Pulse oximeters are used to measure [Formula: see text] and pulse rate. These devices are either standalone machines or integrated into physiologic monitoring systems. Some smartphones now have pulse oximetry capabilities. Because it is possible that some patients might utilize this technology, we sought to assess the accuracy and usability of smartphone pulse oximeters. ⋯ Smartphone pulse oximeters were unreliable compared to a hospital pulse oximeter. Further research is needed with evolving technology to better understand smartphone pulse oximetry. (ClinicalTrials.gov registration NCT03534271.).
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Noninvasive ventilation (NIV) is routinely used to treat patients with cystic fibrosis and respiratory failure. However, evidence on its use is limited, with no data on its role in disease progression and outcomes. The aim of this study was to assess the indications of NIV use and to describe the outcomes associated with NIV in adults with cystic fibrosis in a large adult tertiary center. ⋯ NIV is being used in cystic fibrosis as adjunct therapy for the management of advanced lung disease in a similar fashion to other chronic respiratory conditions. Adherence to NIV treatment can stabilize lung function but does not reduce pulmonary exacerbations or intravenous antibiotic requirement.
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A 20% reduction in the FEV1 is routinely used as an end point for methacholine challenge testing (MCT). Measurement of FEV1 is effort dependent, and some patients are not able to perform acceptable and repeatable forced expiration maneuvers. The goal of the present study was to investigate the diagnostic value of airway resistance measurement by forced oscillation technique (FOT), body plethysmography, and interrupter technique compared with the traditionally accepted standard FEV1 measurement in evaluating the responsiveness to methacholine during MCT. ⋯ Measurements of airway resistance could possibly be used as an alternative method to spirometry in airway challenge. Significant changes in airway mechanics during MCT are detectable by airway resistance measurement in FEV1 non-responders with methacholine-induced asthma-like symptoms. (ClinicalTrials.gov registration NCT02343419.).
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Although FEV1 and FEV1/FVC are accepted as standard parameters in treatment follow-up, these parameters have a limited ability to predict clinical outcomes in patients with COPD. However, small airways dysfunction, which is determined by maximum mid-expiratory flow, is variable in the same stage of patients with COPD, even if their FEV1 and FEV1/FVC are similar. The aim of this study was to compare pulmonary function, the severity of perceived dyspnea, the severity of fatigue, physical activity level, and health-related quality of life based on the severity of small airways dysfunction in male subjects with moderate COPD. ⋯ Increased small airways dysfunction led to increased perception of dyspnea and fatigue, as well as poor exercise capacity and health-related quality of life in male subjects with COPD. We suggest that it may be useful to consider the maximum mid-expiratory flow in addition to FEV1 and FEV1/FVC in the treatment and follow-up of male patients with moderate COPD.