Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 8 Articles
Background: Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary\ndisease (COPD). The aim of the study is to determine, in people with COPD who desaturate during exercise,\nwhether supplemental oxygen during an eight-week exercise training program is more effective than medical air\n(sham intervention) in improving exercise capacity and health-related quality of life both at the completion of\ntraining and at six-month follow up.\nMethods/Design: This is a multi-centre randomised controlled trial with concealed allocation, blinding of\nparticipants, exercise trainers and assessors, and intention-to-treat analysis. 110 people with chronic obstructive\npulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be\nrecruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia. People with chronic\nobstructive pulmonary disease on long term oxygen therapy will be excluded. After confirmation of eligibility and\nbaseline assessment, participants will be randomised to receive either supplemental oxygen or medical air during\nan eight-week supervised treadmill and cycle exercise training program, three times per week for eight weeks, in\nhospital outpatient settings. Primary outcome measures will be endurance walking capacity assessed by the\nendurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease\nQuestionnaire. Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk\ntest, dyspnoea via the Dyspnoea-12 questionnaire and physical activity levels measured over seven days using an\nactivity monitor. All outcomes will be measured at baseline, completion of training and at six-month follow up. Discussion: Exercise training is an essential component of pulmonary rehabilitation for people with COPD. This\nstudy will determine whether supplemental oxygen during exercise training is more effective than medical air in\nimproving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise....
Background: Acute stroke patients suffering from aspiration may present with acute respiratory distress syndrome\n(ARDS). There is still a lack of convincing data about the efficacy of corticosteroids in the treatment of aspirationrelated\nARDS. Therefore, we evaluated the clinical impact of corticosteroids on aspiration-related ARDS.\nMethods: Between 2012 and 2014, we conducted a retrospective study among acute stroke patients diagnosed\nwith aspiration-related ARDS. The data analyzed included demographic characteristics, clinical manifestations,\nlaboratory examinations, chest imaging, and hospital discharge status.\nResults: Seventy-three acute stroke patients were diagnosed with aspiration-related ARDS. The hospital mortality\nrate was 39.7 %. Corticosteroids were administered in 47 patients (64.4 %). The mean dosage was 1.14 (standard\ndeviation [SD] 0.47) mg/kg daily of methylprednisolone (or an equivalent) by intravenous infusion for a period of\n7.3 (SD 3.8) days. Ground glass opacities in chest computed tomography images were resolved when\ncorticosteroids were administered. The admission National Institute of Health Stroke Scale score (odds ratio [OR]\n5.17, 95 % confidence interval [CI] 1.27ââ?¬â??10.64) and Acute Physiology and Chronic Health Evaluation II score (OR 2.00,\n95 % CI 1.12ââ?¬â??3.56) were associated with an increased risk of hospital mortality, while albumin (OR 0.81, 95 % CI\n0.64ââ?¬â??0.92) and corticosteroids therapy (OR 0.50, 95 % CI 0.35ââ?¬â??0.70) were associated with a decreased risk.\nConclusions: Low-dose and short-term corticosteroid therapy may have an impact on survival in aspiration-related\nARDS. The presence of ground glass opacities on the chest computed tomography, performed to rule out\naspiration-related ARDS, could be translated into an increased possibility of positive response to corticosteroid\ntherapy....
Background: Many patients with bronchiectasis have recurrent hospitalisations for infective exacerbations. Acute\nkidney injury (AKI) is known to be associated with increased in-hospital mortality. This study examined the frequency of\nAKI, associated risk-factors, and the association of AKI with in-hospital mortality among patients with bronchiectasis.\nMethods: Anonymised data of patients with non-cystic fibrosis bronchiectasis from the UK Clinical Practice Research\nDatalink, linked to Hospital Episode Statistics, were used to identify hospitalisations with a primary diagnosis of lower\nrespiratory tract infection (LRTI), from 2004 to 2013. After estimating the proportion of AKI diagnoses, a multivariable\nlogistic regression model was constructed to investigate which background factors were associated with AKI.\nIn-hospital mortality was compared between hospitalisations with and without an AKI diagnosis, with\nsubsequent logistic regression analyses carried out for the association between AKI and in-hospital mortality.\nResults: Of 7804 hospitalisations due to LRTI observed in 3477 patients with bronchiectasis, 230 hospitalisations\ninvolved an AKI diagnosis, an average of 2.9 %. However, the percentage increased from less than 2 % in\n2004 to nearly 5 % in 2013. After taking this temporal change into account, AKI was independently associated\nwith older age, male sex, decreased baseline kidney function, previous history of AKI, and a diagnosis of sepsis. In-hospital\nmortality was 33.0 % (76/230) and 6.8 % (516/7574), in hospitalisations with and without AKI, respectively (P < 0.001). After\nadjustment for confounding factors, diagnosis of AKI remained associated with in-hospital mortality (Odds ratio\n5.52, 95 % confidence interval: 3.62-8.42).\nConclusions: Among people with bronchiectasis hospitalised for infective exacerbations, there is an important\nsubgroup of patients who develop AKI. These patients have substantially increased in-hospital mortality and therefore\ngreater awareness is needed....
Background: The knowledge of the mediastinal lymph node positions from an intrabronchial view was important\nfor conventional transbronchial needle aspiration (TBNA). The introduction of endobronchial ultrasound guided\ntransbronchial needle aspiration (EBUS-TBNA) changed the focus from the intrabronchial landmarks to the real life\nultrasound images. However when all EBUS reachable lymph nodes are evaluated (mapping), the knowledge of the\nintrabronchial positions is crucial. The objective of this study was to present a new expert opinion map from an\nintrabronchial perspective validated by an interobserver variation analysis.\nMethods: Physicians who had performed more than 30 EBUS-TBNA were included. They marked areas for optimal\nTBNA sampling on standardized pictures from an intrabronchial perspective. Areas marked by more than 3 of the\n14 experts who had performed more than 1000 EBUS provided the data for the map. The map was validated\namong the experts and the agreement was compared to the agreement among less experienced physicians.\nResults: There was high agreement (>80 %) among the experts in lymph node positions 4 L, 7, 10 L, 11R and 11 L.\nThe agreement for 4R and 10R was low (<70 %). The agreement among the most experienced physicians was\nsignificantly higher than the less experienced physicians in station 10 L (92 % vs. 50 %, p:0.01).\nConclusions: It was possible to present a new map of expert opinion for optimal sampling positions in lymph\nnode stations 4 L, 4R, 7, 10 L, 11R and 11 L. All positions except 4R had high agreement. No area was covered by\nmore than 3 of the 14 experts in station 10R...
Background: Increasing evidence suggests pharmacological treatments may impact on overall survival in Chronic\nObstructive Pulmonary Disease (COPD) patients. Individual clinical trials are rarely powered to detect mortality\ndifferences between treatments and may not include all treatment options relevant to healthcare decision makers.\nMethods: A systematic review was conducted to identify RCTs of COPD treatments reporting mortality; evidence\nwas synthesised using network meta-analysis (NMA). The analysis included 40 RCTs; a quantitative indirect comparison\nbetween 14 treatments using data from 55,220 patients was conducted.\nResults: The analysis reported two treatments reducing all-cause mortality; salmeterol/fluticasone propionate\ncombination (SFC) was associated with a reduction in mortality versus placebo in the fixed effects (HR 0.79;\n95 % Crl 0.67, 0.94) but not the random effects model (0.79; 0.56, 1.09). Indacaterol was associated with a\nreduction in mortality versus placebo in fixed (0.28; 0.08 to 0.85) and random effects (0.29; 0.08, 0.89) models.\nMean estimates and credible intervals for hazard ratios for indacaterol versus placebo are based on a small\nnumber of events; estimates may change when the results of future studies are included. These results were\nmaintained across a variety of assumptions and provide evidence that SFC and indacaterol may lead to\nimproved survival in COPD patients.\nConclusion: Results of an NMA of COPD treatments suggest that SFC and indacaterol may reduce mortality.\nFurther research is warranted to strengthen this conclusion....
Objective. This study aimed to examine the nutritional status and nutrient intake of patients with MAC lung disease with a focus on\nvisceral fat area. Patients and Methods.Among 116 patients of our hospital with nontuberculous mycobacterios is who were registered\nbetween May 2010 and August 2011, 103 patients with MAC lung disease were included in this study. In all patients, nutritional status\nand nutrient intake were prospectively examined. Results. Patients were 23 men and 80 women (mean age, 72.3 �± 10.9 years). BMI\n(kg/m2) at the time of registration was 20.4 �± 2.7 in men and 19.2 �± 2.9 in women. Visceral fat area (cm2) was significantly lower in\nwomen (35.7 �± 26.6) than inmen (57.5 �± 47.4) (...
Background and Objective. The concentration of exhaled nitric oxide (eNO), reflecting the activity of inducible NO synthase in\nairway epithelium, has been found to increase in patients with obstructive sleep apnea (OSA). This study aimed to measure\neNO concentration in patients with suspected OSA and to correlate different eNO parameters with clinical and sleep apnea\ncharacteristics. Methods. In this cross-sectional study, all patients underwent in-lab overnight polysomnography (PSG) and eNO\nmeasurement using a method of multiple flow rates before and after PSG (pre- and post-PSG). Results. According to the result of\nPSG, 82 persons were divided into two groups: control subjects (...
Physicians have noted dyspnea in severely ill asthmatic patients to be associatedwith fright or panic; in more stable patients dyspnea\nmay reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea\nin 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed,\ndyspnea quantified (Borg scale), and panic assessed with a specialized measure of acute panic (the acute panic inventory (API)) in\nthe 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were\nalso administered.When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC) correlated with dyspnea.Multiple\nlinear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41%\nof dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who\ndescribed themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that\ninterpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients....
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