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Non-invasive ventilation in COPD: Impact of inspiratory pressure levels on sleep quality: A randomized cross-over trial.

Although high-intensity non-invasive positive pressure ventilation (NPPV) has been shown to be superior to low-intensity NPPV in controlling nocturnal hypoventilation in stable hypercapnic COPD-patients, it produces higher amounts of air leakage, which, in turn, could impair sleep quality. Therefore, the present study assessed the difference in sleep quality during high- and low-intensity NPPV.

METHODS: A randomized controlled cross-over trial comparing sleep quality during high-intensity NPPV (mean inspiratory positive airway pressure 29±4 mbar) and low-intensity NPPV (mean inspiratory positive airway pressure 14 mbar) was performed in 17 stable hypercapnic COPD-patients who were already familiar with high-intensity NPPV.

RESULTS: Thirteen patients (mean FEV(1) 27±11 %predicted) completed the trial, four patients refused to sleep under low-intensity NPPV. There was no significant difference in sleep quality between the treatment groups (all p>0.05), with a mean difference of -3.0% (95%CI -10.0 to 3.9) (p=0.36) in the primary outcome, namely non-rapid eye movement sleep stage 3&4. However, nocturnal PaCO(2) was lower during high-intensity NPPV compared to low-intensity NPPV, with a mean difference of -6.4 mmHg (95%CI -10.9 to -1.8) (p=0.01).

CONCLUSIONS: In COPD-patients, high inspiratory pressures used with long-term high-intensity NPPV produce acceptable sleep quality that is no worse than that produced by lower inspiratory pressures, which are more traditionally applied in conjunction with low-intensity NPPV. In addition, higher pressures are more successful in maintaining sufficient alveolar ventilation compared to low pressures. Thus, high-intensity NPPV is a very promising new approach, but still requires large, longer term trials to determine the impact on outcomes such as exacerbation rates and longevity.

Safety of chronic obstructive pulmonary disease medications: a primary care perspective.

Chronic obstructive pulmonary disease (COPD), which affects > 210 million individuals worldwide, places primary care practitioners at the forefront of diagnosing and managing COPD, and preventing adverse drug reactions (ADRs) associated with COPD medications. Therefore, it is essential that practitioners understand the safety profiles of these medications. They should also be aware of the host factors and any preexisting comorbidities in their patients that may impact the safety and efficacy of the prescribed therapy.

Drug safety information obtained from randomized controlled trials, observational studies, and meta-analyses should be analyzed to assess the risk-benefit to a patient, since the majority of ADRs associated with COPD medications are predictable, and are avoidable with judicious use of these drugs. This article discusses the different medications available for COPD management and the factors affecting their safety based on current evidence.

Efficacy of tiotropium in COPD patients from Asia: a subgroup analysis from the UPLIFT trial

Conclusions : In COPD patients from Asia, tiotropium improves lung function, improves health‐related quality of life and reduces exacerbations over 4 years of treatment.

Pleural Controversy: Pleurodesis versus Indwelling Pleural Catheters for Malignant Effusions

Malignant pleural effusions (MPE) are a common complication of advanced malignancy. The treatment of MPE should be focused on palliation of associated symptoms. The traditional approach to MPE has been to attempt pleurodesis by introducing a sclerosant into the pleural space.

A more recent development in the treatment of MPE has been the use of indwelling pleural catheters (IPCs) for ongoing drainage of the pleural space. Controversy exists as to which approach is superior.Pleurodesis approaches will have the advantage of a time‐limited course of treatment and high pleurodesis rate at the cost of a more invasive procedure requiring a general anaesthetic or conscious sedation (for thoracoscopic approaches) and an inpatient hospital stay. Use of IPCs will allow the patient to be tr...

Respiratory Disorders in the Middle‐East: A Review

The spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East.

We shed light on the diverse conditions commonly encountered in the region, from the centuries‐old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare.

We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, eg climate factors in the desert region, cultural habits, eg water‐pipe smoking and disorders unique to the region, such as Behçet's disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social and health issues, r...

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