Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background: Despite advances in asthma treatment, severe asthma (SA) still results in high morbidity and use of\nhealth resources. Our hypothesis was that SA patients would achieve adequate control with a systematic protocol,\nincluding oral corticosteroids, budesonide/formoterol maintenance and reliever therapy and a multidisciplinary\napproach to improve adherence.\nMethods: Non-controlled (NC) SA patients were enrolled to receive 2 weeks of oral corticosteroids and 12 weeks of\nformoterol + budesonide. Assessments included asthma control questionnaire (ACQ), asthma control test (ACT),\ndaily symptom diary, lung function and health-related quality of life (HRQoL) questionnaires.\nResults: Of 51 patients, 13 (25.5%) achieved control. NC patients had higher utilization of health resources and\nhigher exacerbation rates. Both controlled (C) and NC patients had significantly reduced ACQ scores after oral\ncorticosteroid treatment. After 12 weeks, C patients continued improving. NC patients did not have significant\nchanges. A similar pattern was found regarding lung function, use of rescue medication, and days free of\nsymptoms. After 2 weeks of oral corticosteroids, an increase occurred in those who achieved the ACQ cut off;\nhowever, 53.8% of C patients had an ACQ < 1.57 versus 21.1% of NC patients (p = 0.03). Both groups had low\nHRQoL at baseline with improvement after intervention.\nConclusions: Despite rigorous, optimized follow-up treatment, 75% of SA patients did not achieve adequate\nsymptom control and presented with impaired quality of life. Conversely, application of a low-cost, easy to\nimplement systematic protocol can prevent up to 25% of SA patients from up-titrating to new and complex\ntherapies, thus reducing costs and morbidity....
Background: Hypoxemia is a major complication of COPD and is a strong predictor of mortality. We previously\nidentified independent risk factors for the presence of resting hypoxemia in the COPDGene cohort. However, little\nis known about characteristics that predict onset of resting hypoxemia in patients who are normoxic at baseline.\nWe hypothesized that a combination of clinical, physiologic, and radiographic characteristics would predict\ndevelopment of resting hypoxemia after 5-years of follow-up in participants with moderate to severe COPD\nMethods: We analyzed 678 participants with moderate-to-severe COPD recruited into the COPDGene cohort who\ncompleted baseline and 5-year follow-up visits and who were normoxic by pulse oximetry at baseline.\nDevelopment of resting hypoxemia was defined as an oxygen saturation ââ?°Â¤88% on ambient air at rest during\nfollow-up. Demographic and clinical characteristics, lung function, and radiographic indices were analyzed with\nlogistic regression models to identify predictors of the development of hypoxemia.\nResults: Forty-six participants (7%) developed resting hypoxemia at follow-up. Enrollment at Denver (OR 8.30,\n95%CI 3.05ââ?¬â??22.6), lower baseline oxygen saturation (OR 0.70, 95%CI 0.58ââ?¬â??0.85), self-reported heart failure (OR 6.92,\n95%CI 1.56ââ?¬â??30.6), pulmonary artery (PA) enlargement on computed tomography (OR 2.81, 95%CI 1.17ââ?¬â??6.74), and\nprior severe COPD exacerbation (OR 3.31, 95%CI 1.38ââ?¬â??7.90) were independently associated with development of\nresting hypoxemia. Participants who developed hypoxemia had greater decline in 6-min walk distance and greater\n5-year decline in quality of life compared to those who remained normoxic at follow-up.\nConclusions: Development of clinically significant hypoxemia over a 5-year span is associated with comorbid heart\nfailure, PA enlargement and severe COPD exacerbation. Further studies are needed to determine if treatments\ntargeting these factors can prevent new onset hypoxemia....
Background. Conventional flexible bronchoscopy has limited sensitivity in the diagnosis of peripheral lung lesions and is dependent\non lesion size. However, advancement of CT imaging offers multiplanar reconstruction facilitating enhanced preprocedure\nplanning. This study aims to report efficacy and safety while considering the impact of patient selection and multiplanar CT\nplanning. Method. Prospective case series of patients with peripheral lung lesions suspected of having lung cancer who underwent\nflexible bronchoscopy (forceps biopsy and lavage). Endobronchial lesions were excluded. Patients with negative results underwent\nCT-guided transthoracic needle aspiration, surgical biopsy, or clinical-radiological surveillance to establish the final diagnosis.\nResults. 226 patients were analysed. The diagnostic yield of bronchoscopy was 80.1% (181/226) with a sensitivity of 84.2% and\nspecificity of 100%. In patients with a positive CT-Bronchus sign, the diagnostic yield was 82.4% compared to 72.8% with negative\nCT-Bronchus sign (...
Background. This study investigated respiratory gas exchanges and heart rate (HR) kinetics during early-phase recovery after a\nmaximal cardiopulmonary exercise test (CPET) in patients with chronic obstructive pulmonary disease (COPD) grouped according\nto airflow limitation. Methods. Thirty control individuals (control group: CG) and 81 COPD patients (45 with ââ?¬Å?mildââ?¬Â or ââ?¬Å?moderateââ?¬Â\nairflow limitation, COPDI-II, versus 36 with ââ?¬Å?severeââ?¬Â or ââ?¬Å?very severeââ?¬Â COPD, COPDIII-IV) performed a maximal CPET. The first\n3 min of recovery kinetics was investigated for oxygen uptake (VÃ?â?¡ O2),minute ventilation (VÃ?â?¡ E), respiratory equivalence, andHR.The\ntime for VÃ?â?¡ O2 to reach 25% (T1/4\nVÃ?â?¡ O2) of peak value was also determined and compared. Results.The VÃ?â?¡ O2, VÃ?â?¡ E, and HR recovery\nkinetics were significantly slower in both COPD groups than CG (...
Background: Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory\nsupport with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the\nstudy is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care.\nMethods: In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering\nfrom acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were\ntreated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015. Adherence to treatment was evaluated by\nnumber of adverse events and discontinuation of treatment. Intensive care admissions and mortality were reported in\nthis cohort. Effectiveness was evaluated by changes in peripheral oxygen saturation (SpO2) and respiratory rate during\ntransport and compared to a historical control (non-CPAP) group treated with standard care only. Values were\ncompared by hypothesis testing and linear modelling of SpO2 on arrival at scene and Ã?â?SpO2 stratified according to\ntreatment group.\nResults: In fourteen months, 171 patients were treated with CPAP (mean treatment time 35 Ã?± 18 min). Adverse events\nwere reported in 15 patients (9 %), hereof six discontinued CPAP due to hypotension, nausea or worsening dyspnoea.\nOne serious adverse event was reported, a suspected pneumothorax treated adequately by an anaesthesiologist called\nfrom a mobile emergency care unit. Among CPAP patients, 45 (27 %) were admitted to an intensive care unit and 24\n(14 %) died before hospital discharge. The non-CPAP group consisted of 739 patients. From arrival at scene to arrival at\nhospital, CPAP patients had a larger increase in SpO2 than non-CPAP patients (87 to 96 % versus 92 to 96 %, p < 0.01)\nand a larger decrease in respiratory rate (32 to 25 versus 28 to 24 breaths/min, p < 0.01). In a linear model, CPAP was\nsuperior to non-CPAP in patients with initial SpO2 ââ?°Â¤90 % (p < 0.05). One CPAP patient (0.6 %) and eight non-CPAP\npatients (1.1 %) were intubated in the prehospital setting.\nDiscussion: The study design reflects the daily prehospital working environment including long transport timesand\nparamedics educated in treating symptoms of acute respiratory failure, rather than treating one specific diagnosis. The\nstudy population was included consecutively and few patients were lost to follow-up. However, the study was too\nsmall to allow assessment of any effect of prehospital CPAP on mortality, nor could the effectiveness in specific disease\nconditions be examined....
Introduction: Lung protective ventilation therapy with low tidal volume-high\nPEEP is the standard treatment for the patients with acute respiratory distress\nsyndrome (ARDS). Oscillators are occasionally used for salvage ventilation in\ncases where poor compliance restricts the use of traditional ventilation with\nARDS. In addition to ventilator therapy, prone positioning has been used to\nimprove oxygenation. We presented a challenging case of ARDS, which failed\nmedical management extracorporeal membrane oxygenation (ECMO) support\nand oscillatory ventilation. Prone positioning was initiated which improved\noxygenation, respiratory compliance and posterior atelectasis. Case presentation:\nA 41-year-old morbid obese female developed ARDS due to influenza\npneumonia. The patient remained hypoxic despite optimum medical and\nventilator management and required veno-venous extracorporeal membrane\noxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior\nconsolidation. Despite ARDSnet ventilation support, antiviral therapy and\nECMO support, there was no clinical improvement. High frequency oscillatory\nventilation was initiated on ECMO day #13, which resulted in no respiratory\nimprovement over the next 5 days. On ECMO day #18, the patient was\nplaced on a Rotaprone�® bed Therapy, utilizing a proning strategy of 16 hours a\nday. The clinical improvements observed were resolving of the consolidation\non CXR, improvements in ventilatory parameters and decreased oxygen requirements.\nThe patient was successfully weaned off ECMO on POD#25 (8\ndays post prone bed). Conclusions: Prone position improved oxygen saturation\nand pulmonary compliance in severe ARDS requiring ECMO and it might\nfacilitate early weaning....
Background: Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD).\nCardiac troponin (cTn) elevation, indicating myocardial injury, is frequent during acute COPD exacerbations\nand associated with increased mortality. The prognostic value of circulating cTnT among COPD patients in\nthe stable state of the disease is still unknown.\nThe purpose of the present study was to assess the association between circulating cTnT measured by a high\nsensitive assay (hs-cTnT) and all-cause mortality among patients with stable COPD without overt CVD.\nMethods: In a prospective cohort study we included 275 patients from the Akershus University Hospitalââ?¬â?¢s outpatient\nclinic and from Glittre, a pulmonary rehabilitation clinic. COPD-severity and cardiovascular risk factors were assessed,\nand time to all-cause death was recorded during a mean follow-up time of 2.8 years.\nResults: One hundred-eighty patients (65%) had hs-cTnT concentrations ââ?°Â¥ the level of detection (5.0 ng/L) and\n66 patients (24%) had hs-cTnT above the normal range (ââ?°Â¥14.0 ng/L). In total, 47 patients (17%) died. hs-cTnT\nconcentrations in the ranges <5.0, 5.0ââ?¬â??13.9 and ââ?°Â¥14 ng/L were associated with crude mortality rates of 2.8, 4.4\nand 11.0 per 100 patient-years, respectively. In adjusted analyses the hazard ratios (95% confidence intervals) for death\nwere 1.7 (0.8ââ?¬â??3.9) and 2.9 (1.2ââ?¬â??7.2) among patients with hs-cTnT concentrations 5.0ââ?¬â??13.9 and ââ?°Â¥14 ng/L, respectively,\ncompared to patients with hs-cTnT <5.0 ng/L.\nConclusions: hs-cTnT elevation is frequently present in patients with stable COPD without overt CVD, and\nassociated with increased mortality, independently of COPD-severity and other cardiovascular risk factors....
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