Respiratory care
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Sialorrhea or drooling represents quite a common problem in patients with amyotrophic lateral sclerosis (ALS). In this review, we describe the possible treatments for this issue. ⋯ In this review, we also explore the possible surgical options for treatment of sialorrhea. Although no specific studies have been conducted on patients with ALS, surgical therapies might represent a valid option for treatment of sialorrhea since there is no tachyphylaxis or need for repeated therapeutic sessions.
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Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means to improve adherence. ⋯ Interventions to improve adherence show varying results, with most studies reporting an increase in adherence but unfortunately not necessarily an improvement in outcome. Even following successful interventions, adherence remains low. Further research is needed to explore barriers to adherence and interventions for improvement.
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Multicenter Study
Single-Breath Diffusing Capacity for Carbon Monoxide Instrument Accuracy Across 3 Health Systems.
Measuring diffusing capacity of the lung for carbon monoxide (DLCO) is complex and associated with wide intra- and inter-laboratory variability. Increased D(LCO) variability may have important clinical consequences. The objective of the study was to assess instrument performance across hospital pulmonary function testing laboratories using a D(LCO) simulator that produces precise and repeatable D(LCO) values. ⋯ D(LCO) instrument accuracy was unacceptable in 43% of devices. Instrument inaccuracy can be primarily attributed to errors in inspired volume measurement and not gas analyzer performance. D(LCO) instrument performance may be improved by regular testing with a simulator. Caution should be used when comparing D(LCO) results reported from different laboratories.
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There has not been a detailed description of expiratory reserve volume (ERV) during slow expiration with glottis open in infralateral decubitus position (ELTGOL, for Expiration Lente Totale Glotte Ouverte en infraLatéral) and its reproducibility. The aim of this study was to determine ERV during ELTGOL and to evaluate ERV intra-observer and inter-observer reliability. ⋯ ELTGOL mobilized more than 80% of ERV in subjects with moderate airway obstruction; there is no difference in ERV exhaled during the technique applied by a physiotherapist or by the subject. ELTGOL is a reproducible technique, determined by inter- and intra-observer testing.
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Observational Study
Limitation of Activities of Daily Living and Quality of Life Based on COPD Combined Classification.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 update recommends that the management and treatment of COPD be made to combine the impact of disease and future risk of exacerbation. These patients have worsening quality of life and limitation of activities of daily living (ADLs), which can be manifested as a decrease in S(pO2) and progressive dyspnea. The aim of this study was to determine whether the COPD combined classification proposed by GOLD 2011 is able to differentiate patients with ADL limitation, such as oxygen desaturation or dyspnea, and impaired quality of life. ⋯ The COPD combined classification was not efficient in determining oxygen desaturation and dyspnea while subjects were performing ADLs. The subjects in the symptomatic groups with increased risk of exacerbation showed poorer quality of life and higher dyspnea levels. (ClinicalTrials.gov registration NCT01977469).