Nebulized Medications for the Treatment of Dyspnea: A Literature Review.

J Aerosol Med Pulm Drug Deliv. 2014 Jun 10;

Authors: Boyden JY, Connor SR, Otolorin L, Nathan SD, Fine PG, Davis MS, Muir JC

Abstract
Abstract Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized. This article presents a review of the literature on the use of nebulized medications for the treatment of dyspnea related to cancer, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, or experimentally-induced dyspnea. Methods: A systematic review of peer-reviewed literature was conducted using Medline/PubMed, CINAHL, Cochrane, and Google Scholar. Results: Thirty-nine publications were included in this review, including 17 high-quality clinical research studies, as defined by the GRADE system. The evidence for nebulized morphine remains mixed, whereas a potential benefit was suggested for nebulized furosemide, hydromorphone, and fentanyl. No conclusions could be drawn as to which disease population derived greatest benefit from nebulized medications, or whether jet or ultrasonic nebulizers were more effective for the delivery of these medications. Conclusions: More research is needed to assess the characteristics of specific diseases and the combination of different nebulizers and medications that may yield the greatest benefit, and to assess the safety and efficacy of the chronic use of nebulized opioids and furosemide. Until larger, longer-term studies are completed, the use of nebulized medications to treat dyspnea should be assessed on a case-by-case basis and may be considered if the hoped-for benefits outweigh potential harm.

PMID: 24914770 [PubMed - as supplied by publisher]

Related Articles

Moving Towards Patient-Centered Medicine for COPD Management: Multidimensional Approaches versus Phenotype-Based Medicine-A Critical View.

COPD. 2014 Jun 10;

Authors: Lopez-Campos JL, Bustamante V, Muñoz X, Barreiro E

Abstract
Abstract For decades, chronic obstructive pulmonary disease (COPD) has been considered a relentlessly progressive disease in which the deterioration of lung function is associated with an increase in symptoms, interrupted only by periods of exacerbation. However, this paradigm of COPD severity based on FEV1 has been challenged by currently available evidence. So far, three main approaches, though with contradictory aspects, have been proposed in order to address the complexity of COPD as well as to develop appropriate diagnostic, prognostic and therapeutic strategies for the disease: 1) the use of independent, clinically relevant variables, 2) the use of multidimensional indices, and 3) disease approaches based on clinical phenotypes. Multivariable systems seem superior to FEV1 in predicting prognosis and defining disease severity. However, selection of variables available from current literature must be confronted with issues of medical practice. Future evidence will be needed to reveal their effective relationship with disease long-term prognosis and to demonstrate the most adequate cutoff values to be used in clinical settings. Multidimensional scores provide a good prognostic instrument for the identification of patients with a particular degree of disease severity. Clinical phenotyping can help clinicians identify the patients who respond to specific pharmacological interventions; however, there is some controversy about the phenotypes to select and their long-term implications. Although these approaches are not perfect, they represent the first step towards patient-centered medicine for COPD. In the near-future, these different approaches should converge towards one new field to focus on the better management of COPD patients.

PMID: 24914771 [PubMed - as supplied by publisher]

Related Articles

Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort.

COPD. 2014 Jun 10;

Authors: Takir HB, Karakurt Z, Salturk C, Kargin F, Balci M, Yalcinsoy M, Ozmen I, Yazicioglu OM, Gungor G, Burunsuzoğlu B, Adiguzel N

Abstract
Abstract Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.

PMID: 24915105 [PubMed - as supplied by publisher]

Related Articles

Combined sputum hypermethylation and eNose analysis for lung cancer diagnosis.

J Clin Pathol. 2014 Jun 10;

Authors: Hubers AJ, Brinkman P, Boksem RJ, Rhodius RJ, Witte BI, Zwinderman AH, Heideman DA, Duin S, Koning R, Steenbergen RD, Snijders PJ, Smit EF, Sterk PJ, Thunnissen E

Abstract
AIMS: The aim of this study is to explore DNA hypermethylation analysis in sputum and exhaled breath analysis for their complementary, non-invasive diagnostic capacity in lung cancer.
METHODS: Sputum samples and exhaled breath were prospectively collected from 20 lung cancer patients and 31 COPD controls (Set 1). An additional 18 lung cancer patients and 8 controls only collected exhaled breath as validation set (Set 2). DNA hypermethylation of biomarkers RASSF1A, cytoglobin, APC, FAM19A4, PHACTR3, 3OST2 and PRDM14 was considered, and breathprints from exhaled breath samples were created using an electronic nose (eNose).
RESULTS: Both DNA hypermethylation markers in sputum and eNose were independently able to distinguish lung cancer patients from controls. The combination of RASSF1A and 3OST2 hypermethylation had a sensitivity of 85% with a specificity of 74%. eNose had a sensitivity of 80% with a specificity of 48%. Sensitivity for lung cancer diagnosis increased to 100%, when RASSF1A hypermethylation was combined with eNose, with specificity of 42%. Both methods showed to be complementary to each other (p≤0.011). eNose results were reproducible in Set 2.
CONCLUSIONS: When used in concert, RASSF1A hypermethylation in sputum and exhaled breath analysis are complementary for lung cancer diagnosis, with 100% sensitivity in this series. This finding should be further validated.

PMID: 24915850 [PubMed - as supplied by publisher]