Thorax
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Randomized Controlled Trial Comparative Study Clinical Trial
Dose response study of ipratropium bromide aerosol on maximum exercise performance in stable patients with chronic obstructive pulmonary disease.
Although the bronchodilating effect of inhaled anticholinergics has been established in patients with chronic obstructive pulmonary disease (COPD), their effects on exercise capacity are still controversial. Previous studies have suggested that the standard dosage hardly affects exercise tolerance, whereas higher doses might elicit an improvement. The aim of the present study was to determine the dose of ipratropium bromide aerosol that improves exercise performance using progressive cycle ergometry in patients with stable COPD. ⋯ A dose of at least four times the standard dose of ipratropium bromide from an MDI with a spacer device was necessary to improve maximal cycle exercise capacity in patients with stable COPD. Although the data from cycle ergometry cannot be directly applied to exercise performed during day to day activities, it is conceivable that the recommended doses of ipratropium bromide do not elicit the optimal clinical benefits.
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Direct information on the health effects of air pollution in humans relies mainly on chamber studies and epidemiological studies. Although chamber studies have limitations they allow the acute effects of individual pollutants to be studied in well characterised subjects under controlled conditions. Most chamber studies have shown relatively small falls in lung function and relatively small increases in bronchial reactivity at the concentrations of ozone, SO2, and NO2 that occur even during high pollution episodes in the UK. ⋯ But did the smog episodes in Manchester in the 1950s or subsequent vehicle related pollution play a part and did they interact with the bronchial challenges he underwent over the years (estimated at 3000)? Air pollution is a product of the way that society chooses to live. Obtaining an accurate picture of the extent to which current levels of air pollution cause acute and chronic effects on health is important if sensible choices are to be made by individuals and society about the processes contributing to air pollution. It is also important for patients with or at risk of developing cardiorespiratory disease.
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A study was carried out to evaluate the potential place of spiral volumetric computed tomography (SVCT) in the diagnostic strategy for pulmonary embolism. ⋯ SVCT is a relatively noninvasive test for pulmonary embolism which is both sensitive and specific and which may serve as an alternative to ventilation scintigraphy and possibly to pulmonary angiography in the diagnostic strategy for pulmonary embolism.
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Peritoneal ventilation has been shown to be effective in achieving extrapulmonary oxygenation and carbon dioxide elimination in an animal model of severe adult respiratory distress syndrome (ARDS). Cisapride is a "prokinetic" agent (increases gastric emptying), that may increase the splanchnic circulation and thus favourably affect gas exchange in peritoneal ventilation. ⋯ Cisapride increases arterial oxygenation in rabbits with severe ARDS treated with peritoneal ventilation, probably due to its ability to increase splanchnic circulation. It should be considered as an adjuvant medication to peritoneal ventilation.