-
Pneumologie (Stuttgart, Germany) Aug 2023Chronic cough (i.e., cough lasting >8 weeks) has a global prevalence of approximately 10%. The individual burden can be long-lasting, with some patients experiencing...
Chronic cough (i.e., cough lasting >8 weeks) has a global prevalence of approximately 10%. The individual burden can be long-lasting, with some patients experiencing cough for many years. Although chronic cough is often a symptom of respiratory diseases (e.g., lung cancer, tuberculosis, chronic obstructive pulmonary disease) or associated with triggers (e.g., asthma, gastroesophageal reflux disease, rhinosinusitis) and may resolve after targeted treatment of these conditions, some patients continue to cough despite optimal treatment (refractory chronic cough, RCC) or have no identifiable conditions presumed to be contributing to the cough (unexplained chronic cough, UCC). In patients with chronic cough, it is critical to perform a thorough initial patient assessment with adherence to a diagnostic algorithm (e.g., of the German Respiratory Society Cough Guidelines) to identify the cause of the symptom cough and provide appropriate treatment; or diagnose RCC and UCC. Primary care physicians should provide the initial diagnostic workup of patients with chronic cough (history, physical exam, chest X-ray and spirometry). If no cause of the cough can be identified, referral to specialists (e.g., pulmonologists, gastroenterologists, otolaryngologists) may be appropriate. Increased appreciation of chronic cough as a distinct condition, rather than as only a symptom of other diseases, may help overcome current challenges in diagnosing and managing chronic cough.
Topics: Humans; Cough; Carcinoma, Renal Cell; Pulmonary Disease, Chronic Obstructive; Asthma; Kidney Neoplasms
PubMed: 37619576
DOI: 10.1055/a-1849-4345 -
The Lancet. Respiratory Medicine Feb 2024In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is... (Randomized Controlled Trial)
Randomized Controlled Trial
Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial.
BACKGROUND
In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction.
METHODS
We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete.
FINDINGS
The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep [SD 20·9]) or standard care plus ASV (n=356; 43·3 events per h of sleep [20·5]). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio [HR] 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified.
INTERPRETATION
In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely.
FUNDING
Canadian Institutes of Health Research and Philips RS North America.
Topics: Humans; Stroke Volume; Sleepiness; Ventricular Function, Left; Canada; Sleep Apnea Syndromes; Heart Failure; Sleep Apnea, Central; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 38142697
DOI: 10.1016/S2213-2600(23)00374-0 -
British Journal of Nursing (Mark Allen... Jul 2023Respiratory disease is ubiquitous in hospitals and community healthcare settings in the UK. Nurses, therefore, must be able to understand the physiology and...
Respiratory disease is ubiquitous in hospitals and community healthcare settings in the UK. Nurses, therefore, must be able to understand the physiology and pathophysiology that underpins the care they provide for people living with a respiratory disorder. This article summarises the fundamental anatomy and physiology of the respiratory system and respiration. It also explores the pathophysiological changes that occur in the four most common respiratory conditions, namely pneumonia, lung cancer, asthma and chronic obstructive pulmonary disease. Key elements of a comprehensive respiratory assessment and how nurses can determine acute deterioration are explored. The case study and reflective questions aim to enhance the reader's understanding of respiratory assessment and nursing care.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Lung; Respiration; Asthma; Pneumonia
PubMed: 37410687
DOI: 10.12968/bjon.2023.32.13.613 -
Therapeutische Umschau. Revue... Aug 2023Often dyspnea is caused by cardiac disease which has a dismal prognosis if left untreated. This article is focused on primary care and provides an overview of the most...
Often dyspnea is caused by cardiac disease which has a dismal prognosis if left untreated. This article is focused on primary care and provides an overview of the most important etiologies, evaluation algorithms and therapies.
Topics: Humans; Dyspnea; Prognosis; Algorithms; Diagnosis, Differential
PubMed: 37855529
DOI: No ID Found -
Ugeskrift For Laeger Oct 2023
Topics: Humans; Heart Failure; Muscular Diseases; Respiration Disorders; Soft Tissue Injuries
PubMed: 37921112
DOI: No ID Found -
International Journal of Molecular... Jul 2023Aprotinin (APR) was discovered in 1930. APR is an effective pan-protease inhibitor, a typical "magic shotgun". Until 2007, APR was widely used as an antithrombotic and... (Review)
Review
Aprotinin (APR) was discovered in 1930. APR is an effective pan-protease inhibitor, a typical "magic shotgun". Until 2007, APR was widely used as an antithrombotic and anti-inflammatory drug in cardiac and noncardiac surgeries for reduction of bleeding and thus limiting the need for blood transfusion. The ability of APR to inhibit proteolytic activation of some viruses leads to its use as an antiviral drug for the prevention and treatment of acute respiratory virus infections. However, due to incompetent interpretation of several clinical trials followed by incredible controversy in the literature, the usage of APR was nearly stopped for a decade worldwide. In 2015-2020, after re-analysis of these clinical trials' data the restrictions in APR usage were lifted worldwide. This review discusses antiviral mechanisms of APR action and summarizes current knowledge and prospective regarding the use of APR treatment for diseases caused by RNA-containing viruses, including influenza and SARS-CoV-2 viruses, or as a part of combination antiviral treatment.
Topics: Humans; Aprotinin; SARS-CoV-2; Prospective Studies; COVID-19; Antiviral Agents; Respiration Disorders
PubMed: 37446350
DOI: 10.3390/ijms241311173 -
Ugeskrift For Laeger Nov 2023Hydrofluorocarbons, the propellants used in metered dose inhalers, are powerful greenhouse gases. However, this review investigates the use of metered dose inhalers... (Review)
Review
Hydrofluorocarbons, the propellants used in metered dose inhalers, are powerful greenhouse gases. However, this review investigates the use of metered dose inhalers which continue to be on the rise in Denmark despite evidence that most patients are treated equally well with dry powder inhalers. If the use of metered dose inhalers in Denmark were reduced to approximately the level seen in Sweden it would lead to a reduction in CO2e comparable with the emissions from the electricity used in 16,500 typical Danish households.
Topics: Humans; Asthma; Nebulizers and Vaporizers; Metered Dose Inhalers; Dry Powder Inhalers; Respiration Disorders; Respiratory Tract Diseases; Administration, Inhalation
PubMed: 37987432
DOI: No ID Found -
Chest Dec 2023Respiratory failure is a common and potentially life-threatening complication of neuromuscular diseases. Prompt recognition and accurate diagnosis of new or worsening... (Review)
Review
Respiratory failure is a common and potentially life-threatening complication of neuromuscular diseases. Prompt recognition and accurate diagnosis of new or worsening chronic neuromuscular disease have important clinical management and prognostic implications. In this article, we present an approach to the acute presentation of undifferentiated neuromuscular respiratory failure in the ICU and guidance for determination and respiratory management of the underlying disorder.
Topics: Humans; Neuromuscular Diseases; Respiratory Insufficiency; Prognosis; Intensive Care Units
PubMed: 38070961
DOI: 10.1016/j.chest.2023.09.009 -
The International Journal of... Nov 2023Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual...
Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual susceptibility and other co-factors and comorbidities. Asthma and other respiratory pathologies can be worsened by climate change and exposure to other agents in occupational environments. PubMed and Scopus, and several websites on public and occupational health were queried to find publications and documents on work-related respiratory diseases, asthma, rhinitis, chronic obstructive pulmonary disease (COPD), pneumoconiosis and allergic alveolitis in association with climate change. Most of the retrieved articles concerned asthma (75 in Scopus), while the other topics were less frequently covered in the scientific literature, with a maximum of 29 papers for rhinitis and 23 for COPD. The most important terms highlighted by the word clouds were 'health', 'air', 'pollution', and, only for asthma and rhinitis, 'pollen' and 'allergic/allergy'. Website data on public and occupational health, and climate change were reported. Assessment and management of respiratory diseases that recognise occupational exposures should be improved, and more research into integrated approaches should be favoured. Health surveillance practices for workers exposed to agents that cause respiratory diseases should be implemented. The development of biomarkers of exposure, effect and susceptibility needs further study.
Topics: Humans; Rhinitis; Climate Change; Asthma; Hypersensitivity; Respiration Disorders; Occupational Diseases; Occupational Exposure; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Diseases
PubMed: 37880894
DOI: 10.5588/ijtld.23.0131 -
Journal of Cardiothoracic and Vascular... Oct 2023
Topics: Humans; Prostheses and Implants; Respiration Disorders; Hypoxia; Bronchoscopy
PubMed: 37188585
DOI: 10.1053/j.jvca.2023.04.022