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Latest & greatest articles for copd
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(or erythromycin 500mg qid if allergic) and oral ciprofloxacin 500mg bd as second line treatment. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients with a discharge diagnosis of infective exacerbation of chronicobstructiveairwaysdisease (COAD). The patients in the two groups were around 60 years old. Setting The clinical and economic studies were set in a regional respiratory unit at a hospital in Dundee, UK. Dates to which data relate (...) Evaluation of an antibiotic prescribing protocol for treatment of acute exacerbations of chronicobstructiveairwaysdisease in a hospital respiratory unit Evaluation of an antibiotic prescribing protocol for treatment of acute exacerbations of chronicobstructiveairwaysdisease in a hospital respiratory unit Evaluation of an antibiotic prescribing protocol for treatment of acute exacerbations of chronicobstructiveairwaysdisease in a hospital respiratory unit Boyter A C, Davey P G, Hudson S
Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronicobstructiveairwaysdisease. Acute exacerbations of chronicobstructiveairwaysdisease (COAD) are a common cause of admission to hospital, and have a high mortality. Nasal intermittent positive pressure ventilation (NIPPV) has been used successfully in patients with respiratory failure due to neuromuscular and skeletal disorders, but the outcome of treatment in patients with COAD is less well known. We (...) carried out a prospective randomised controlled trial of conventional treatment versus conventional treatment plus NIPPV, in 60 patients with acute ventilatory failure due to exacerbations of COAD. For the NIPPV group there was a rise in pH, compared with a fall in the controls (mean difference of change between the groups 0.046 [95% CI 0.06-0.02, p < 0.001]), and a larger fall in PaCO2 (mean difference in change between the groups 1.2 kPa [95% CI 0.45 to 2.03, p < 0.01]). Median visual analogue
1993LancetControlled trial quality: predicted high
Economic benefits of teaching patients with chronicobstructivepulmonarydisease about their illness. The PASTMA Group. By instructing patients in how to deal with their disease financial demands on health services may be reduced. 100 consecutive patients (aged 48 to 89) admitted to a general medical ward in Denmark with chronicobstructivepulmonarydisease (COPD) were allocated randomly to receive either "personalized hospital practice" (PHP), which includes training in aspects (...) , Wilcoxon test). Consumption of general practitioner services was significantly increased in the control group compared with the PHP group (mean [95% Cl] Kr1346 [549 to 2143] vs -89 [-423 to 245] per patient per year; p = 0.001, Wilcoxon test). These differences could not be explained by changes in smoking habits. PHP reduces the consumption of health services by patients with COPD, probably by increasing patients' knowledge of disease and hence their ability to manage themselves.
Effect of negative pressure ventilation in severe chronicobstructivepulmonarydisease. The hypothesis that patients with chronicobstructivepulmonarydisease (COPD) have chronic inspiratory muscle fatigue was tested in an effectiveness trial in which negative pressure ventilation (NPV) was used to produce inspiratory muscle rest. In a double-blind study 184 patients with severe COPD were randomly allocated active or sham NPV treatment for a 12-week period of home use. The distance walked (...) or statistically significant difference in any outcome measure between active and sham groups. No dose-response relation was observed. Moreover, the intervention was poorly accepted despite substantial clinical support. We conclude that NPV as used in this study is difficult to apply and ineffective when used with the aim of resting the respiratory muscles in patients with stable COPD.
1992LancetControlled trial quality: predicted high
. The respiratory-muscle performance of the patients taking theophylline improved by approximately 29 percent (P less than 0.0001), as indicated by a decline in the ratio of inspiratory pleural pressure during quiet breathing to maximal pleural pressure. We conclude that theophylline improves respiratory function and dyspnea in patients with severe chronicobstructivepulmonarydisease and that these improvements are probably due to better respiratory-muscle performance. (...) A randomized, controlled trial of theophylline in patients with severe chronicobstructivepulmonarydisease. To assess the effects of theophylline in chronicobstructivepulmonarydisease, we conducted a randomized, placebo-controlled, double-blind, crossover trial in 60 patients with severe but stable disease. The patients (mean age, 61 years) were studied before and after two months of placebo and two months of treatment with a sustained-release preparation of theophylline (10 mg per
Dose response relation to oral theophylline in severe chronicobstructiveairwaysdisease. To evaluate measurement of the trapped gas volume as a measure of respiratory function in patients with chronicobstructiveairwaysdisease and their response to treatment with theophylline.Patients able to produce consistent results on testing of respiratory function spent two weeks having dosage of theophylline adjusted to give individual pharmacokinetic data. This was followed by random assignment (...) to 55.6 m (20%). There was a modest improvement in dyspnoea as the dose of theophylline was increased. Side effects were mostly minor but they became more frequent as the dose was increased.The fall in trapped gas volume may reflect an improvement in peripheral ventilation (associated with treatment with theophylline) which is less apparent in the more common tests of lung function used in patients with chronicobstructiveairwaysdisease.
Antibiotics or placebo for chronicobstructivepulmonarydisease. 3592433 1987 07 20 2004 11 17 0003-4819 107 1 1987 Jul Annals of internal medicine Ann. Intern. Med. Antibiotics or placebo for chronicobstructivepulmonarydisease. 117-8 Dudek J J JJ Heaney R M RM eng Clinical Trial Letter Randomized Controlled Trial United States Ann Intern Med 0372351 0003-4819 0 Anti-Bacterial Agents 0 Placebos AIM IM Anti-Bacterial Agents therapeutic use Humans LungDiseases, Obstructive complications
Oral immunisation with killed Haemophilus influenzae for protection against acute bronchitis in chronicobstructivelungdisease. Fifty patients with chronicobstructivelungdisease were randomly allocated to three groups, to assess whether an oral vaccine containing non-typable Haemophilus influenzae protected against acute bronchitis. The double-blind prospective study over a three-month winter period included two placebo groups and one test group. Oral immunisation with H influenzae induced
Effects of prednisolone in chronicairflowlimitation. A double-blind, randomised, placebo-controlled, crossover trial of prednisolone (40 mg daily for 14 days) was carried out in 43 patients with chronicairflowlimitation (mean age 60 years, mean FEV1 1.02 litres, FEV1/FVC ratio 43.7%). Several subjective and objective variables for response were measured. Significant improvements occurred with prednisolone in most variables measured, but improvements also occurred with placebo in some (...) variables. The improvements with prednisolone in general wellbeing, 12 min walk distance, peak expiratory flow, FEV1, and relaxed vital capacity were significantly greater than those with placebo. Clinical assessment and assessment of atopic status did not reveal any feature of major predictive value for steroid responsiveness. A proportion of patients with chronicairflowlimitation do improve on oral corticosteroids and the continued use of such trials in clinical practice is justified, though
Assessment of steroid responsiveness in patients with chronicairflowobstruction. A simple steroid trial was conducted to assess whether 31 patients with chronicairflowobstruction would benefit from oral steroid therapy. Peak expiratory flow (PEF), forced expired volume in 1 s (FEV1), and ratio of FEV1, to forced vital capacity (FVC) were monitored during a 6-month period (when patients were on maximum bronchodilator therapy), after 2 weeks on placebo and after 2 weeks on prednisolone 30 mg (...) daily. Patients also measured that PEF at home thrice daily. None had a significant degree of steroid reversible airflowobstruction. The preliminary observation period (of at least 3 months) is important to prevent an improvement being attributed to steroids, when it has in fact occurred spontaneously or is the result of bronchodilator therapy or cessation of smoking.
Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. A controlled trial of long term domiciliary oxygen therapy has been carried out in three centres in the U.K. The 87 patients, all under 70 years of age, who took part had chronic bronchitis or emphysema with irreversibleairwaysobstruction, severe arterial hypoxaemia, carbon dioxide retention, and a history of congestive (...) heart failure. The patients were randomised to oxygen therapy (treated) or no oxygen (controls). Oxygen was given by nasal prongs for at least 15 h daily, usually at 2 1/min. The two groups were well matched, both clinically and in terms of lung function and other laboratory findings. 19 of the 42 oxygen treated patients died in the five years of survival follow-up compared with 30 out of 45 controls: in the 66 men in this trial the survival advantage of oxygen did not emerge until 500 days had
Treatment of chronicobstructivepulmonarydisease with orally administered theophylline. A double-blind, controlled study. Theophylline is commonly prescribed for chronicobstructivepulmonarydisease (COPD), although controlled studies do not exist to support this use. We administered theophylline and placebo orally to 40 ambulatory COPD patients in a double-blind, crossover manner. Pulmonary function tests were conducted before and after isoproterenol nebulization on the final day of each (...) to most COPD patients, and potential responders should be given carefully monitored therapeutic trials rather than arbitrarily being given maintenance therapy.