Thorax
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Some patients started on nasal intermittent positive pressure ventilation (NIPPV) with the Monnal D ventilator deteriorate after a period. The effects of changing them to the Nippy ventilator were investigated. ⋯ Support with NIPPV using the Monnal D ventilator may fail after an interval and changing to the Nippy ventilator can reverse this deterioration, probably because of its superior responsiveness to leaks and patient effort. The regular follow up of patients on long term NIPPV is necessary if secondary treatment failure is to be identified and effectively treated.
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Clinical Trial Controlled Clinical Trial
Effect of allergen challenge on airway responsiveness to histamine and sodium metabisulphite in mild asthma.
Airway responsiveness to histamine and methacholine, direct smooth muscle spasmogens, is increased following inhalation of allergen. Although the aetiology of this phenomenon is unclear, increased cellular or neural activity may be involved since allergen also induces increases in airway responsiveness to the mast cell stimulus adenosine-5'-monophosphate (AMP) and the neural stimulus bradykinin. ⋯ These data suggest that activation of airway sensory nerves is unlikely to contribute to the increase in airway responsiveness following inhalation of allergen. The previously observed allergen induced increase in airway responsiveness to bradykinin and AMP may involve non-neural pathways.
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Accurate assessment of diaphragm strength can be difficult. Transdiaphragmatic pressure (PDI) measurements during volitional manoeuvres are useful but it may be difficult to ensure maximum patient effort. Magnetic stimulation of the phrenic nerves is easy to perform and the results are reproducible in normal subjects. The purpose of the present study was to evaluate the usefulness of magnetic stimulation of the phrenic nerves in the assessment of diaphragm weakness in patients. ⋯ TwPDI following magnetic stimulation of the phrenic nerves is a clinically useful measurement when assessing diaphragm weakness.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care.
Oral corticosteroids used in short courses for acute asthma are regarded as safe, although the frequent use of these drugs may result in patients suffering from systemic side effects. It has become common practice for patients to increase their own inhaled corticosteroid intake when their asthma goes out of control, but it has never been established whether a high dose of inhaled corticosteroid can be as effective as a short course of oral corticosteroid in the treatment of acute exacerbations. ⋯ There is no evidence of a significant difference in efficacy between a reducing dose course of oral prednisolone and high dose inhaled fluticasone propionate in mild exacerbations of asthma which do not require admission to hospital.