Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

Laryngeal and respiratory patterns in patients with paradoxical vocal fold motion

The purposes of this study were to determine the differences in spirometric measures obtained from patients with endoscopically-documented paradoxical vocal fold motion (PVFM) and to compare them to a group of normal subjects without endoscopically-documented paradoxical vocal fold motion during non-provocative breathing and following speech.

Thirty eight subjects with documented paradoxical vocal fold motion using transnasal flexible laryngoscopy (TFL) and no history of asthma and 21 normal subjects with documented normal breathing patterns and normal findings on endoscopy underwent flow-volume loop studies. Endoscopic judgments of vocal fold motion from three breathing conditions were made by two observers.

The results of the endoscopic judgments indicate that paradoxical motion occurs whether breathing through the nose or mouth in the PVFM subjects, mainly after speaking and inhalation. In addition, the spirometry results indicated that the inspiratory measure of FIVC%, FVC% and FIV0.5/FIVC were significantly lower in the PVFM group compared to the normal subjects.

The data supports the hypothesis that in patients with PVFM, inspiratory spirometric values play a role in identifying patients with PVFM. The finding of vocal fold closure following a speech utterance in the majority of the PVFM subjects but not in the normal control group warrants further investigation.

Effect of adjunct fluticasone propionate on airway physiology during rest and exercise in COPD

Combination therapy with corticosteroid and long-acting β2-agonists (LABA) in a single inhaler is associated with superior effects on airway function and exercise performance in COPD compared with LABA monotherapy. The physiological effects of adding inhaled corticosteroid monotherapy to maintenance bronchodilator therapy (long-acting anticholinergics and LABA singly or in combination) in COPD are unknown.

Methods : This was a randomized, double-blind, placebo-controlled, crossover study (NCT00387036) to compare the effects of inhaled fluticasone propionate 500 μg (FP500) twice-daily and placebo (PLA) on airway function during rest and exercise, measured during constant work rate cycle exercise at 75% of maximum incremental cycle work rate, in 17 patients with COPD (FEV1 ≤ 70% predicted).

Results : After treatment with FP500 compared to PLA, there were significant increases in post-dose measurements of FEV1(+115 mL,P = 0.006) and the FEV1/FVC ratio (+2.5%,P = 0.017), along with decreases in plethysmographic residual volume (−0.32L;P = 0.031), functional residual capacity (−0.30L,P = 0.033), and total lung capacity (−0.30L,P = 0.027) but no changes in vital capacity or inspiratory capacity (IC). Post-treatment comparisons demonstrated a significant improvement in endurance time by 188 ± 362 s with FP500 (P = 0.047) with no concomitant increase in dyspnea intensity. End-inspiratory and end-expiratory lung volumes were reduced at rest and throughout exercise with FP500 compared with PLA (P < 0.05).

Conclusion : Inhaled FP500 monotherapy was associated with consistent and clinically important improvements in FEV1, static lung volumes, dynamic operating lung volumes, and exercise endurance when added to established maintenance long-acting bronchodilator therapy in patients with moderate to severe COPD.

Does the presence of connective tissue disease modify survival in patients with pulmonary fibrosis?

Previous studies into the survival differences between individuals with idiopathic pulmonary fibrosis and those with connective tissue disease associated pulmonary fibrosis (CTD-PF) have yielded mixed results. The aim of this study is to compare the survival of individuals with CTD-PF to those with idiopathic pulmonary fibrosis clinical syndrome (IPF-CS) using data derived from The Health Improvement network, a large primary care database in the UK.

Methods : Incident cases of CTD-PF and IPF-CS between the years 2000–2009 were identified. Survival analysis was performed using Kaplan–Meier methods, stratified by type of connective tissue disease. Cox regression was then used to compare mortality rates between the groups, adjusting for age, gender and year of diagnosis.

Results : A total of 324 cases of CTD-PF and 2209 cases of IPF-CS were followed up over a mean period of 2.3 years. During this period, 113 (34.9%) cases of CTD-PF and 1073 (48.6%) cases of IPF-CS died. The mortality rates for cases with CTD-PF and IPF-CS were 123.6 per 1000 person years (95%CI: 102.8–148.9) and 229.8 per 1000 person years (95% CI: 216.4–244.0) respectively. After adjusting for age, sex and year of diagnosis, cases with CTD-PF had a better prognosis compared to those with IPF-CS (HR 0.76,95%CI: 0.62–0.92).

Conclusion : The prognosis of individuals with CTD-PF appears to be significantly better than those with IPF-CS, but remains an important cause of death in patients with connective tissue disease, and requires more effective treatment options.

Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia

In order to evaluate the use of an algorithm based on a procalcitonin (PCT) cut-off value as a means of guiding antibiotic therapy, 319 hospitalised children with uncomplicated community-acquired pneumonia (CAP) were randomised 1:1 to be treated on the basis of the algorithm or in accordance with standard guidelines.

The children in the PCT group did not receive antibiotics if their PCT level upon admission was <0.25 ng/mL, and those receiving antibiotics from the time of admission were treated until their PCT level was ≥0.25 ng/mL.

The final analysis was based on 155 patients in the PCT group and 155 in the control group. In comparison with the controls, the PCT group received significantly fewer antibiotic prescriptions (85.8%vs100%;p < 0.05), were exposed to antibiotics for a shorter time (5.37vs10.96 days;p < 0.05), and experienced fewer antibiotic-related adverse events (3.9%vs25.2%;p < 0.05), regardless of CAP severity. There was no significant between-group difference in recurrence of respiratory symptoms and new antibiotic prescription in the month following enrollment. The results of this first prospective study using a PCT cut-off value to guide antibiotic therapy for pediatric CAP showed that this approach can significantly reduce antibiotic use and antibiotic-related adverse events in children with uncomplicated disease.

However, because the study included mainly children with mild to moderate CAP and the risk of the use of the algorithm-based approach was not validated in a relevant number of severe cases, further studies are needed before it can be used in routine clinical practice.

Lung changes independently linked to COPD exacerbation frequency

Increased airway wall thickness and a greater degree of emphysema are associated with an increased frequency of chronic obstructive pulmonary disease exacerbations, independent of airflow obstruction severity, show study results.

Search

Search