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Illegal Passive Smoking at Work

This study's aim is to estimate the prevalence of passive smoking at work (PSW), the characteristics of illegal passive smoking and to identify eventual respiratory effects.

Methods. Occupational practitioners (OPs) of a French county of 320,000 wage earners were contacted by mail. Then OP answered questions from a standardized questionnaire. These questions concerned the practised job, exposure features linked to PSW and health effects in relationship with second-hand smoke in workplace, and the focus on nonsmoker encountered by OP during the most recent occupational medical examination.

Results. Ninety-five percent of a total group of 172 OP of Champagne county filled the postal questionnaire. More than 80% of OP's replies identified illegal PSW. The average prevalence of PSW exp...

An overview of extracorporeal membrane oxygenation (ECMO)

Extracorporeal membrane oxygenation is used for unresponsive cardiorespiratory failure in neonates, children and adults. There is good evidence of its efficacy in neonates and adults and as such it is reasonable that children are referred for ECMO when faced with severe cardiorespiratory failure.Whilst the average length of stay for survivors on ECMO is about one week patients who are in single organ failure i.e. respiratory failure have been looked after for many weeks on ECMO with successful outcomes.

Patient selection is crucial to the success of any ECMO programme and the underlying functionality of the patient as well as the potential reversibility of the disease are good selection criteria for putting patients on ECMO.Overall ECMO results are very encouraging across the age...

PaCO(2) Six months after the Initiation of Long-term Noninvasive Ventilation in Patients with COPD.

The appropriate target level for PaCO(2) after the introduction of long-term noninvasive positive pressure ventilation (NPPV) in patients with COPD remains uncertain, and therefore must be tested.

Methods : Data on 54 patients with COPD receiving long-term domiciliary NPPV were examined retrospectively. PaCO(2) a few months after NPPV and potential confounders were analyzed with discontinuation of long-term NPPV as the primary outcome. The differences in annual hospitalization rates due to respiratory deterioration between those from 1 year before to 2 years after initiation of NPPV were compared according to the PaCO(2) measured at 6 months after NPPV (6-mo PaCO(2)).

Results : 6-mo PaCO(2) seemed to be most related to continuation of NPPV (p=0.019). Patients with 6-mo PaCO(2) of less than 60 mmHg had maintained a significantly lower PaCO(2) value 6 to 24 months after NPPV (p=0.04) and had a significantly higher continuation rate of NPPV (p=0.03) than those with a 6-mo PaCO(2) of 60 mmHg or more. Annual hospitalization rates due to respiratory deterioration were not associated with the 6-mo PaCO(2) level, but fatal hospitalization rates during the first year of NPPV were significantly correlated with relatively high 6-mo PaCO(2) (p=0.008).

Conclusion : A relatively low 6-mo PaCO(2) value was predictive of long-term use of NPPV. The target values of 6-mo PaCO(2) may, therefore, be less than 60 mmHg in COPD patients with extremely severe hypercapnia, although more prospective studies are needed.

Tiotropium versus salmeterol for the prevention of exacerbations of COPD.

Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-to-very-severe chronic obstructive pulmonary disease (COPD) but do not specify whether a long-acting anticholinergic drug or a β(2)-agonist is the preferred agent.

We investigated whether the anticholinergic drug tiotropium is superior to the β(2)-agonist salmeterol in preventing exacerbations of COPD.

Impact of Inhaled corticosteroid use on outcome in COPD patients admitted with pneumonia.

The aim of this study was to investigate if inhaled corticosteroid(ICS) use impacts on outcome in patients with chronic obstructive pulmonary disease(COPD) admitted with community-acquired pneumonia(CAP).

A prospective observational study of patients with spirometry-confirmed COPD presenting with a primary diagnosis of CAP in Lothian,UK. Outcome measures were compared between ICS users and non-users. Of 490 patients included in the study, 76.7% were classified as ICS users. ICS users had higher GOLD stage compared with non-users (mean(SD) 3.2(0.8) vs 2.6(0.9); p<0.0001).

There were no significant differences in pneumonia severity (mean(SD) pneumonia severity index(PSI) 4.2(0.8) vs 4.3(0.8), p=0.3; mean(SD) CURB65 score 2.1(1.3) vs 2.3(1.3), p=0.07) or markers of systemic inflammation (median CRP 148(58-268) vs 183(85-302) mg·L(-1); p=0.08 ) between ICS users and non-users. On multivariable analysis, after adjustment for COPD severity and PSI, ICS use was not independently associated with 30-day mortality (OR 1.71 [95% CI 0.75-3.90], p=0.2), 6-month mortality (OR 1.62 [95% CI 0.82-3.16], p=0.2), requirement for mechanical ventilation and/or inotropic support (OR 0.73 [95% CI 0.33-1.62], p=0.4) or development of complicated pneumonia (OR 0.71 [95% CI 0.25-1.99], p=0.5).

Prior ICS use has no impact on outcome in patients with COPD admitted with CAP.

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