Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 8 Articles
The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment.\nDespite decades of availability and healthcare support and development of teaching aids and devices to promote better use,\npoor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC)\ndevice. Spacer/chamber features (size, shape, configuration, construction material, and hygiene considerations) can vie with\nclinical effectiveness (to deliver the same dose as a correctly used pMDI), user convenience, cost, and accessibility. Unsurprisingly,\nimprovised, low-cost alternatives (plastic drink bottles, paper cups, and paper towel rolls) have been pressed into seemingly effective\nservice. AUK law change permitting schools to hold emergency inhalers and spacers has prompted a development project to design\na low-cost, user-friendly, disposable, and recyclable spacer.This paper spacer requires neither pre use priming nor washing, and has\ndemonstrated reproducible lung delivery of salbutamol sulphate pMDI, comparable to an industry-standard VHC, an alternative\npaperboard VHC, and pMDI alone. This new device appears to perform better than these other VHC devices at the low flow rates\nthought achievable by paediatric patients. The data suggest that this disposable spacer may have a place in the single-use emergency\nsetting....
Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB)\npatients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002\nand 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of\nage, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment\nof treatment included male gender (OR = 2.05; 95% CI = 1.15ââ?¬â??3.65) and nonadherence to previous treatment (OR = 3.14; 95%\nCI = 1.96ââ?¬â??5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14ââ?¬â??0.76). The\nfollowing risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76ââ?¬â??3.85), coinfection with HIV\n(OR = 6.01, 95% CI = 3.78ââ?¬â??9.56), illiteracy (OR = 1.88, 95% CI = 1.27ââ?¬â??2.75), the presence of severe extrapulmonary TB (OR = 2.33,\n95% CI = 1.24ââ?¬â??4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01ââ?¬â??3.75). Conclusions.Male gender and retreatment after\nabandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with\nHIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we\nsuggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure\nand TB-associated mortality....
The aim of this study is to determine if COPD patients undergoing lung resection with perioperative...
Background. Management of individual triggers is suboptimal in practice. In this project, we investigated the impact of symptom\nperception interventions on asthma trigger identification and self-reported asthma quality of life. Methods. Children with asthma\n(...
Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health\nconsequences. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorders. We aimed to\nevaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA).\nMaterials and Methods. A total of 50 patients with a body mass index �30 and major OSA symptoms were included in this study.\nAnthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour\nurine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally\ninto 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI) <5 (...
Introduction.Awareness of the healthcare providers on chronic obstructive pulmonary disease (COPD),which is an important cause\nof mortality and morbidity in our country and all over the world, and on pulmonary rehabilitation (PR) which plays an important\nrole in its nonpharmacological treatment will provide effectiveness in diagnosis and treatment of COPD.The present study aimed at\ndetermining knowledge level of the healthcare providers about COPD and PR. Materials and Methods. In this cross-sectional study,\nfamily practitioners and staff of home-care in central county of Manisa City were applied a questionnaire in order to determine\ntheir knowledge level on COPD and pulmonary rehabilitation during the in-service training on ââ?¬Å?pulmonary rehabilitation, homecare\nservices for the pulmonary diseases, and respiratory exercises.ââ?¬Â Results. 65.5% of the healthcare providers responded to the\nsurvey. Rate of those correctly knowing at least one of four items was 97.2%. No responder knew all items correctly. Average value\nfor correct answers was 5.30 Ã?± 2.1 (range: 1ââ?¬â??10). The physicians,men, and those working in family health centers had higher level of\nknowledge on COPD compared to non physician healthcare providers (...
Background: Decreased physical capacity and increased systemic inflammatory response are frequently\nobserved in patients with chronic obstructive pulmonary disease (COPD). The relationship\nbetween the inflammatory response and disease severity and the immunological response to\nexercise were addressed in COPD. Objective: The first objective was to identify systemic biomarkers\nand their relationship with COPD severity. The second objective was to examine the effect of\nboth acute exercise and pulmonary rehabilitation on these biomarkers. Methods: Forty subjects\nparticipated in the study. Thirty-two patients with moderate or severe COPD and 8 healthy nonsmokers\ncompleted the study. Spirometry was preformed. Physical capacity was determined by a\nprogressive symptom-limited cycle ergo meter (incremental) test. Blood samples were analyzed\nfor C-reactive protein (CRP), pro-inflammatory cytokines (IL-6, TNF-), pro-fibrotic cytokines\n(TGF-) and oxidative burst in circulating leukocytes before and after exercise, and before and after\npulmonary rehabilitation. Results: IL-6, CRP, WCC and TGF-were higher in COPD (p < 0.05)\nthan eight healthy controls. WCC, IL-6, TNF-, CRP and TGF- were negatively related to forced expiratory\nvolume in 1 s (FEV1) (r = 0.4054, 0.3221, 0.1528, 0.1846 and 0.1187, respectively). Acute\nexercise increased circulating leucocytes and oxidative stress in both groups (p = 0.000, 0.0049\nrespectively), while IL-6 was increased in COPD group ((p = 0.0115) and circulating TNF- in\nhealthy control (p = 0.0369). Pulmonary rehabilitation didn�t modify the levels of inflammatory\nmediators. Conclusions: Reduced lung function is associated with increased levels of systemic in-flammatory markers and acute exercise can further increase this inflammatory response. However\npulmonary rehabilitation is unlikely to exacerbate systemic inflammation in COPD....
Objective: This prospective cohort study was designed to assess the rule of myocardial performance\n(Tei) index and NT-Pro BNP serum levels in prediction of weaning failure in mechanically\nventilated COPD patients. Methods: Forty patients with respiratory failure due to acute exacerbation\nof COPD were enrolled to this study. All patients underwent a comprehensive echocardiographic\nexamination including tissue doppler imaging within first 12 hours of admission. NT-pro\nBNP serum levels were measured on admission. Patients were followed up for outcome of weaning\nfailure. Results: Right ventricular Tei index was higher in patients with failed weaning in comparison\nto successfully weaned patients (mean 0.66 versus 0.36, P < 0.001), also left ventricular Tei\nindex was higher in patients who failed to be weaned (mean 0.45 versus 0.36, P = 0.007). There\nwas no difference in serum NT-Pro BNP between successfully weaned patients and patients with\nweaning failure. Right ventricular Tei index showed higher accuracy in predicting weaning failure\nthan the left ventricular Tei index (AUC 0.932 versus 0.754), while serum NT-Pro BNP showed no\ndiscrimination in predicting weaning failure (AUC 0.556). Conclusion: Tei index was superior to\nNT-ProBNP in prediction of weaning failure in COPD patients....
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