Brain natriuretic peptide measurement in pulmonary medicine.
Respir Med. 2011 Aug 5;
Authors: Salerno D, Marik PE
Serum levels of natriuretic peptides are well established as important biomarkers in patients with cardi…

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Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD.
Respir Med. 2011 Jul 30;
Authors: Yu AP, Guérin A, de Leon DP, Ramakrishnan K, Wu EQ, Mocarski M, Blum SI, Setyawan J
OBJECTIVE: T…

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The health, activity, dyspnea, obstruction, age, and hospitalization: Prognostic score for stable COPD patients.
Respir Med. 2011 Jun 22;
Authors: Esteban C, Quintana JM, Aburto M, Moraza J, Arostegui I, España PP, Aizpiri S,…

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Pulmonary-renal syndromes: An update for respiratory physicians.
Respir Med. 2011 Jun 17;
Authors: McCabe C, Jones Q, Nikolopoulou A, Wathen C, Luqmani R
Pulmonary-renal syndromes are a group of disorders characterised…

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Costs of COPD exacerbations in the emergency department and inpatient setting.
Respir Med. 2011 Mar;105(3):454-60
Authors: Dalal AA, Shah M, D’Souza AO, Rane P
Exacerbations of COPD contribute to lung function decline …

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Detection of antisynthetase syndrome in patients with idiopathic interstitial pneumonias.
Respir Med. 2011 Apr 21;
Authors: Watanabe K, Handa T, Tanizawa K, Hosono Y, Taguchi Y, Noma S, Kobashi Y, Kubo T, Aihara K, Chin K, Nag…

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Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD(®) Gen-probe testing.
Respir Med. 2011 Mar 19;
Authors: Iyer VN, Joshi AY, Boyce TG, Brutinel MW, Scalcini MC, Wilson JW, McCoy K, Aksamit TR
…

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Pulmonary involvement in pleural tuberculosis: How often does it mean disease activity?
Respir Med. 2011 Mar 8;
Authors: Seiscento M, Vargas FS, Bombarda S, Sales RK, Terra RM, Uezumi K, Teixeira LR, Antonangelo L
OBJE…

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COPD severity score as a predictor of failure in exacerbations of COPD. The ESFERA study.

Respir Med. 2011 Jan 10;

Authors: Miravitlles M, Izquierdo I, Herrejón A, Torres JV, Baró E, Borja J,

BACKGROUND: Exacerbations are a frequent cause of morbidity and mortality in COPD. It is crucial to identify risk factors for failure after treatment of exacerbations of COPD. This study evaluates the COPD severity score (COPDSS) as a predictor of clinical failure, together with other severity, activity and quality of life measurements, in patients with exacerbated COPD. METHOD: Multicenter, prospective, observational study in ambulatory patients with exacerbation of COPD. The patients completed the COPDSS, the London Chest Activities of Daily Living (LCADL) and the EuroQol 5D (EQ-5D). A follow-up visit was scheduled one month after presentation with the exacerbation to assess the clinical evolution. RESULTS: A total of 346 patients were included (mean age 68.5 years (SD = 9.5 years and 90.7% male) and mean FEV(1)(% predicted) 46.9% (SD = 17)). After one month, 28.2% of episodes were classified as failures, with half of them requiring hospital admission. Patients who failed were more frequently active smokers, with more severe dyspnoea at presentation and worse lung function. They had significantly worse scores of COPDSS, LCADL, EQ-5D index and EQ-5D visual analogue score (VAS) and shorter mean time walking per day. ROC analysis of relationship between COPDSS and failure gave AUC 0.72, which improved only to 0.77 when the other significant variables in univariate analysis were considered. CONCLUSIONS: Clinical failure after ambulatory treatment of exacerbation of COPD is frequent. Usual markers of severity (impaired lung function, active smoking and severe dyspnoea) are associated with failure; however, a short severity questionnaire (COPDSS) provides better predictive value than the usual variables.

PMID: 21227672 [PubMed - as supplied by publisher]

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Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia.

Respir Med. 2008 Sep;102(9):1257-63

Authors: Guessous I, Cornuz J, Stoianov R, Burnand B, Fitting JW, Yersin B, Lamy O

BACKGROUND: Although there is no strong evidence of benefit, chest physiotherapy (CP) seems to be commonly used in simple pneumonia. CP requires equipment and frequently involves the assistance of a respiratory therapist, engendering a significant medical workload and cost. AIM: To measure and compare the efficacy of two modalities of chest physiotherapy (CP) guideline implementation on the appropriateness of CP prescription among patients hospitalised for community-acquired pneumonia (CAP). PATIENTS AND METHODS: We measured the CP prescription rate and duration in all consecutive CAP inpatients admitted in a division of general internal medicine at an urban teaching community hospital during three consecutive one-year time periods: (1) before any guideline implementation; (2) after a passive implementation by medical grand rounds and guideline diffusion through mailing; (3) after adding a one-page reminder in the CAP patient's medical chart highlighting our recommendations. Death and recurrent hospitalisation rates within one year after hospitalisation were recorded to assess whether CP prescription reduction, if any, impaired patient outcomes. RESULTS: During the three successive phases, 127, 157, and 147 patients with similar characteristics were included. Among all CAP inpatients, the CP prescription rate decreased from 68% (86/127) to 51% (80/157), and to 48% (71/147), respectively (P for trend <0.01 for trend). A significant reduction in CP duration was observed after the active guideline implementation (12.0, 11.0, 7.0days, respectively) and persisted after adjustment for length of stay. Reductions in CP prescription rate and duration were also observed among CAP patients with COPD CP prescription rate: 97% (30/31), 67% (24/36), 75% (35/47), respectively (P<0.01 for trend). The mean cost of CP per patient was reduced by 56%, from $709 to $481, and to $309, respectively. Neither the in-hospital deaths, the one-year overall recurrent hospitalisation nor the one-year CAP-specific recurrent hospitalisation significantly differed between the three phases. CONCLUSION: Both passive and active implementation of guidelines appear to improve the appropriateness of CP prescription among inpatients with CAP without impairing their outcomes. Restricting CP use to patients who benefit from this treatment might be an opportunity to decrease CAP medical cost and workload.

PMID: 18619824 [PubMed - indexed for MEDLINE]

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A real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma.

Respir Med. 2008 Oct;102(10):1360-70

Authors: Ställberg B, Ekström T, Neij F, Olsson P, Skoogh BE, Wennergren G, Löfdahl CG,

OBJECTIVE: To evaluate direct asthma-related costs in Swedish primary care in a real-life setting. DESIGN: 12-month open-label study. SETTING: Swedish primary care in a real-life setting. PARTICIPANTS: 1776 patients with persistent asthma. INTERVENTIONS: Patients with persistent asthma were randomised to one of three treatments: a free adjustable combination of budesonide (100-400 microg/inhalation) and formoterol (4.5 or 9 microg/inhalation) via separate inhalers plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, two inhalations twice daily) plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, one inhalation twice daily or two inhalations once daily), for maintenance plus additional inhalations as needed. Doses depended on previous inhaled corticosteroid dose. Patients attended the clinic at 0, 1.5, and 12 months. Telephone interviews were conducted at 4, 6, 8, and 10 months. MAIN OUTCOME MEASURES: The primary endpoint was direct asthma-related healthcare costs. RESULTS: Statistically significant reductions in annual direct costs per patient were observed with budesonide/formoterol maintenance and reliever therapy compared with the free adjustable combination of budesonide and formoterol (-13%, P<0.001) and fixed-dose budesonide/formoterol plus terbutaline (-20%, P<0.001). Time to first severe exacerbation did not differ significantly across treatment groups, with a mean reduction of 28% versus the free adjustable combination of budesonide and formoterol (P=0.076). Patients receiving budesonide/formoterol maintenance and reliever therapy used a significantly lower daily dose of budesonide compared with the conventional (P<0.001). CONCLUSIONS: This study reports direct cost savings with budesonide/formoterol maintenance and reliever therapy compared with conventional treatment regimens with at least equivalent efficacy.

PMID: 18723335 [PubMed - indexed for MEDLINE]

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Postextubation pulmonary edema: a case series and review.

Respir Med. 2008 Nov;102(11):1659-62

Authors: Mulkey Z, Yarbrough S, Guerra D, Roongsritong C, Nugent K, Phy MP

We report a series of patients with postextubation pulmonary edema who had no obvious risk factors for the development of this syndrome. METHODS: Patients identified by the pulmonary consultation service at an academic medical center were reviewed. RESULTS: Fourteen cases were collected and analyzed. The average age was 34.5 years; 12 patients were male. The average BMI was 25.5. None had documented previous lung disease. Most operations were scheduled as outpatient procedures, and the type of surgery ranged from an incision and drainage of a bite wound to an open reduction-internal fixation of the radius. None of the patients had upper airway surgery. The length of surgeries ranged from 27 to 335 min. Laryngospasm was the most commonly identified obstructing event postextubation. Treatment involved airway support when needed, supplemental oxygen, and diuretics. CONCLUSIONS: It would appear that all patients, especially young men, are at risk for the development of this syndrome and that the pathogenesis remains uncertain in many cases.

PMID: 18804361 [PubMed - indexed for MEDLINE]

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Recombinant tissue plasminogen activator in the treatment of pleural infections in adults.

Respir Med. 2008 Dec;102(12):1694-700

Authors: Froudarakis ME, Kouliatsis G, Steiropoulos P, Anevlavis S, Pataka A, Popidou M, Mikroulis D, Pneumatikos I, Bouros D

BACKGROUND: Intrapleural recombinant tissue plasminogen activator (r-TPA) has been successfully evaluated in pediatric patients with complicated parapneumonic pleural effusion (CPE) and pleural empyema (PE). Yet, there is no data concerning r-TPA in adults with CPE/PE. The aim of our study was to investigate the efficacy and complications of r-TPA in adult patients with CPE/PE. METHODS: Twenty consecutive patients (mean age 50+/-18.9 years) with pleural infection (14 CPE and 6 PE) were included. Chest tube was inserted under guidance of chest ultrasound and/or computed tomography. After failure of pleural fluid drainage, 25mg of r-TPA was administered intrapleurally in a single daily dose. The evaluation was made according to imaging and clinical status. RESULTS: The mean volume of fluid increased significantly after r-TPA administration (p<0.0001). White blood cells count (WBC) and C-reactive protein (CRP) were significantly improved after r-TPA instillations (both p<0.0001). Significant clinical and imaging improvement was noted in all but one patient after r-TPA administration (overall p<0.0001). Complications observed were mild: pain in 4 (25%) and local bleeding in 3 (15%) patients. The median number of r-TPA instillations was 3 (range 2-5). CONCLUSION: Intrapleural instillation of r-TPA at a dose of 25 mg is a well-tolerated and effective treatment in 95% of our adult patients with CPE/PE.

PMID: 18824340 [PubMed - indexed for MEDLINE]

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Rational timing of combination therapy with tiotropium and formoterol in moderate and severe COPD.

Respir Med. 2008 Dec;102(12):1701-7

Authors: Terzano C, Petroianni A, Conti V, Ceccarelli D, Graziani E, Sanduzzi A, D’Avelli S

AIM: To determine which timing of therapy with formoterol (FOR) and/or tiotropium (TIO) shows the greater and more continuous functional improvement during 24 h in patients with moderate to severe COPD. METHODS: In this randomised, blind, crossover study 80 patients with stable COPD (40 moderate and 40 severe) received 5 different bronchodilator 30-day treatments in a random order. Treatments (Tr) were: Tr1: TIO 18 microg once-daily (8 am); Tr2: TIO 18 microg (8 am) + FOR 12 microg (8 pm); Tr3: FOR 12 microg twice-daily (8 am and 8 pm); Tr4: TIO 18 microg (8 am) + FOR 12 microg twice-daily (8 am and 8 pm); Tr5: FOR 12 microg twice-daily (8 am and 8 pm) + TIO 18 microg (8 pm). Spirometries were performed during 24 h (13 steps) on Day1 and Day30. End-points were: gain of FEV(1) (DeltaFEV(1)) from baseline of the Day1 and Day30, AUC (Area Under Curve), Dyspnoea Index, and as-needed use of salbutamol. RESULTS: Sixty-eight patients completed all treatments. The greater and continuous daily functional improvement was showed during Tr4 and Tr5 (Day1 +135.8 mL and +119.1 mL; Day30 +160.2 mL, and +160.5 mL, respectively). Daily means of DeltaFEV(1) were significantly different between single-drug treatments and combination therapy. Dyspnoea was greater in single-drug treatments. Less use of rescue salbutamol was reported in Tr4 (0.80 puffs/die) and Tr5 (0.71 puffs/die). CONCLUSIONS: In patients with moderate to severe COPD, combination therapy with tiotropium administered in the morning (Tr4) was the most effective; in patients with prevailing night-symptoms, treatment with tiotropium in the evening (Tr5) reduced symptoms and use of salbutamol. Tr5 showed less variability of FEV(1) during the 24 h (CV=0.256). These results are relevant for opening new ways in clinical practice.

PMID: 18760583 [PubMed - indexed for MEDLINE]

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Targeting the COPD exacerbation.

Respir Med. 2008 Jun;102 Suppl 1:S3-15

Authors: Decramer M, Nici L, Nardini S, Reardon J, Rochester CL, Sanguinetti CM, Troosters T

Exacerbations of COPD have a profound detrimental effect on the patient and impose a significant burden on healthcare resource utilization. Prevention and treatment of exacerbations are major objectives of the clinical management of COPD. For this approach to be successful, clinicians must combine both pharmacologic approaches and non-pharmacologic strategies aimed at improving the patient’s disease management. Non-pharmacologic approaches include those that can be incorporated into the office setting as well as intervention strategies that are integrated into the lifelong management of COPD. These strategies include developing a partnership with the patient and their social supports, encouraging and facilitating smoking cessation, immunizations, proper use of supplemental oxygen, and most importantly, giving the patient the tools to manage their illness appropriately. Moreover there is clear evidence of an irrevocable decline in pulmonary function after each exacerbation, usually resulting in reduced physical activity and impaired skeletal muscle function. Not surprisingly, pulmonary rehabilitation after such events has been shown to prevent relapse, improve survival and enhance patients’ overall function after acute exacerbations.

PMID: 18582795 [PubMed - indexed for MEDLINE]

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