Inhaled mannitol for the treatment of cystic fibrosis
Inhaled dry powder mannitol is well established for use in bronchial provocation testing. Inhaled mannitol also increases mucociliary clearance, and therefore could have a role in treating chronic suppurative lung disease. There have been a number of studies in cystic fibrosis and bronchiectasis. An international Phase III trial has just been published that suggests the use of regular inhaled mannitol increases lung function and reduces exacerbation frequency in cystic fibrosis.
Inhaled mannitol exerts its effects in a number of ways, most importantly like hypertonic saline, setting up an osmotic gradient so water flows into the airway lumen, increasing mucus hydration and mucociliary clearance. Its formulation as a dry powder makes it quick and convenient to take.
Ergonomics in bronchoscopy: is there a need for better design or a change in the work environment? (Free)
The field of conventional bronchoscopy has undergone a paradigm shift over the last decade. The ability to visualize peribronchial structures in real time has increased the diagnostic and therapeutic scope of flexible bronchoscopy.
Ultrasound engineering and the development of a probe with an interface capable of sound wave transmission, has led to the development of a new procedure, endobronchial ultrasound, which has been widely adapted, both throughout the USA and worldwide..
Similarly, techniques such as electromagnetic navigation bronchoscopy, autofluorescence bronchoscopy, optical coherence tomography and other interventional procedures, including bronchial thermoplasty, cryotherapy, brachytherapy, balloon dilatation and stent are increasingly being adopted at large academic centers. ...
Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma (Free)
Asthma and chronic obstructive pulmonary disease are both common conditions with an increasing prevalence worldwide. Inhaled therapy for these conditions has a number of advantages over systemic therapy, including reduced side effects and quicker onset of action. The effective use of inhaled therapy is critically dependent upon the nature of the drug-delivery system and the ability of the patient to use the system correctly.
There are a wide number of inhaler devices on the market, each with positive and negative aspects. A crucial part of patient care is to ensure that the choice of inhaler device for the individual is an effective therapy. There are a number of interventions that can help with the choice of inhaler device and also improve the ability of the patient to use inhaled therapy.
Inhaler technique training needs to be a cornerstone of the care of patients with asthma or chronic obstructive pulmonary disease to ensure optimal therapy.
Lung volume reduction for advanced emphysema: surgical and bronchoscopic approaches.
Chronic obstructive pulmonary disease is the third leading cause of death in the United States, affecting more than 24 million people. Inhaled bronchodilators are the mainstay of therapy; they improve symptoms and quality of life and reduce exacerbations. These and smoking cessation and long-term oxygen therapy for hypoxemic patients are the only medical treatments definitively demonstrated to reduce mortality.
Surgical approaches include lung transplantation and lung volume reduction and the latter has been shown to improve exercise tolerance, quality of life, and survival in highly selected patients with advanced emphysema. Lung volume reduction surgery results in clinical benefits. The procedure is associated with a short-term risk of mortality and a more significant risk of cardiac and pulmonary perioperative complications. Interest has been growing in the use of noninvasive, bronchoscopic methods to address the pathological hyperinflation that drives the dyspnea and exercise intolerance that is characteristic of emphysema.
In this review, the mechanism by which lung volume reduction improves pulmonary function is outlined, along with the risks and benefits of the traditional surgical approach. In addition, the emerging bronchoscopic techniques for lung volume reduction are introduced and recent clinical trials examining their efficacy are summarized.
The impact of asthma medication guidelines on asthma controller use and on asthma exacerbation rates comparing 1997-1998 and 2004-2005.
OBJECTIVE: To estimate the change in asthma controller medication use between 2 time periods as measured by the controller-to-total asthma medication ratio and its association with changes in asthma exacerbation rates between 1997-1998 and 2004-2005.
METHODS: The study design was a cross-sectional population-level comparison between individuals from 1997-1998 and 2004-2005. Study participants were individuals aged 5 to 56 years identified as having asthma in the Medical Expenditure Panel Survey (MEPS). The main outcome measures were a controller-to-total asthma medication ratio greater than 0.5 and asthma exacerbation rates (dispensing of systemic corticosteroid or emergency department visit/hospitalization for asthma) in 1997-1998 compared with 2004-2005.
RESULTS: The proportion of individuals with a controller-to-total asthma medication ratio greater than 0.5, when adjusted for other demographic factors, has improved by 16.1% (95% CI: 10.8%, 21.3%) for all individuals from 1997-1998 to 2004-2005. Annual asthma exacerbation rates did not change significantly in any group from 1997-1998 to 2004-2005 (0.27/year to 0.23/year). African American and Hispanic individuals with asthma had higher asthma exacerbation rates and a lower proportion with a controller-to-total asthma medication ratio greater than 0.5 than whites in both 1997-1998 and 2004-2005; however, these differences were not statistically significant.
CONCLUSIONS: An increase in asthma controller-to-total medication ratio in a sample reflective of the US population was not associated with a decreased asthma exacerbation rate comparing 1997-1998 and 2004-2005.