Thorax
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Respiratory muscle weakness is an important clinical problem. Tests of varying complexity and invasiveness are available to assess respiratory muscle strength. The relative precision of different tests in the detection of weakness is less clear, as is the value of multiple tests. ⋯ The use of single tests such as Pimax, Pemax and other available individual tests of inspiratory, diaphragm and expiratory muscle strength tends to overdiagnose weakness. Combinations of tests increase diagnostic precision and, in the population studied, they reduced the diagnosis of inspiratory, specific diaphragm and expiratory muscle weakness by 19-56%. Measuring both Pimax and Sniff Pnasal resulted in a relative reduction of 19.2% of patients falsely diagnosed with inspiratory muscle weakness. The addition of Twitch Pdi to Sniff Pdi increased diagnostic precision by a smaller amount (18.9%). Having multiple tests of respiratory muscle function available both increases diagnostic precision and makes assessment possible in a range of clinical circumstances.
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Editorial Comment
Nicotine replacement therapy for smoking cessation in the "real world".
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There is increasing evidence for a possible association between chronic obstructive pulmonary disease (COPD) and the use of biomass fuels for cooking and heating in developing countries. Data on the prevalence of COPD and objective measurements of indoor pollution from biomass fuel have not been widely available from China. A study was undertaken to investigate the prevalence of COPD in two study communities in Guangdong province in China and to measure the association between COPD and indoor biomass fuel air pollution. ⋯ Indoor pollutants from biomass fuels may be an important risk factor for COPD in rural South China.
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Randomized Controlled Trial Multicenter Study
Weekly versus basic smoking cessation support in primary care: a randomised controlled trial.
There is insufficient and conflicting evidence about whether more intensive behavioural support is more effective than basic behavioural support for smoking cessation and whether primary care nurses can deliver effective behavioural support. ⋯ The absolute quit rates achieved are those expected from nicotine replacement alone, implying that neither basic nor weekly support were effective. Primary care smoking cessation treatment should provide pharmacotherapy with sufficient support only to ensure it is used appropriately, and those in need of support should be referred to specialists.
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Multicenter Study
Improved outcomes from acute severe asthma in Australian intensive care units (1996 2003).
There is limited information on changes in the epidemiology and outcome of patients with asthma admitted to intensive care units (ICUs) in the last decade. A database sampling intensive care activity in hospitals throughout Australia offers the opportunity to examine these changes. ⋯ There has been a significant decline in the incidence of asthma requiring ICU admission between 1996 and 2003 among units sampled by the Australian and New Zealand Intensive Care Society Adult Patient Database. The mortality of these patients has also decreased over time and is lower than reported in other studies.