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Chronic Obstructive Pulmonary Diseases... Jul 2019Metered dose inhalers (MDIs) are commonly prescribed for inhalation therapy, but correct use is critical to promoting effective medication delivery. This systematic... (Review)
Review
BACKGROUND
Metered dose inhalers (MDIs) are commonly prescribed for inhalation therapy, but correct use is critical to promoting effective medication delivery. This systematic literature review and meta-analysis evaluates the overall and step-by-step prevalence of errors among adults with obstructive lung diseases in the United States who used MDIs.
METHODS
Electronic and manual searches conducted between 1979-2018 using PubMed, EMBASE, PsycINFO, Cochrane, and Google identified 10 articles that met the following inclusion criteria: (a) English language, (b) U.S. adults diagnosed with chronic obstructive pulmonary disease, and (c) MDI use error rates. Meta-analytic techniques using random-effects models were applied to calculate effect sizes, weighted proportions, and 95% confidence intervals (CIs). Heterogeneity was assessed by the I statistic.
RESULTS
Aggregate findings revealed that 86.7% of patients (n=390, 95% CI 77.5-96.0) made at least 1 inhalation technique error, and 76.9% (n=885, 95% CI 65.8-87.9) incorrectly performed ≥ 20% of device use steps. The most prevalent step-by-step errors across the studies (n=1105) were failure to: (a) exhale fully and away from the inhaler before inhalation (65.5% [95% CI 52.0, 78.9]); (b) hold breath for 5-10 seconds (41.9% [95% CI 29.8, 53.9]); (c) inhale slowly and deeply (39.4% [95% CI 26.2, 52.5]); (d) exhale after inhalation (35.9% [95% CI 17.0, 54.8]); and (e) shake the inhaler before use (34.2% [95% CI 30.6, 37.7]).
CONCLUSIONS
Across the studies used in this meta-analysis more than three-fourths of U.S. adults with obstructive lung diseases used MDIs incorrectly. Our findings suggest the need for ongoing patient education and consideration of alternative devices to mitigate errors.
PubMed: 31342732
DOI: 10.15326/jcopdf.6.3.2018.0168 -
Advances in Respiratory Medicine 2019Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save...
Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
Topics: Attitude of Health Personnel; Clinical Competence; Humans; Medical Staff, Hospital; Noninvasive Ventilation; Pneumonia, Ventilator-Associated; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 30830962
DOI: 10.5603/ARM.a2019.0006 -
COPD Oct 2018Chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of type 2 diabetes (T2D). However, the mechanisms linking COPD and T2D is not... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of type 2 diabetes (T2D). However, the mechanisms linking COPD and T2D is not fully understood and contradicting results are reported in the literature.
AIM
The aim of this study is to investigate whether COPD is associated with an increased risk of T2D.
METHODS
A systematic review and meta-analysis of cohort and case-control studies were performed. Search for studies and data extraction was carried out by two authors independently. Study quality was assessed by NOS. Adjusted data were pooled using the random effects model to calculate summary odds ratios (ORs) with corresponding 95% confidence intervals (CIs).
RESULTS
We identified four cohort studies and three case-control studies with a total of 1,369,560 participants of whom 42,716 were COPD patients. The quality of the studies was acceptable, with an average on 7.7 indicating overall good study quality. The meta-analysis on adjusted data from all seven studies showed that the COPD group had a higher risk of T2D compared with the non-COPD group: random effect OR = 1.17 (1.01-1.35), p = 0.03. No heterogeneity was found I = 0%. When including only studies diagnosing both COPD and T2D according to recommended guidelines the association did not remain statistically significant, OR =1.17 (0.96-1.42), p = 0.12.
CONCLUSION
This systemic review and meta-analyses showed that the association between COPD and T2D might be influenced by the diagnostic method and should be further investigated in studies using diagnostic definition according to guidelines. Nevertheless, physicians should be aware of comorbidities in COPD patients.
Topics: Case-Control Studies; Cohort Studies; Comorbidity; Cytokines; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Guidelines as Topic; Humans; Inflammation; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Spirometry; Terminology as Topic
PubMed: 30822245
DOI: 10.1080/15412555.2018.1532495 -
ARYA Atherosclerosis May 2017Hyperlipidemia is one of the important diseases in pregnancy that causes fetal abnormalities during pregnancy and after the birth. Unfortunately, the usual anti-fat... (Review)
Review
BACKGROUND
Hyperlipidemia is one of the important diseases in pregnancy that causes fetal abnormalities during pregnancy and after the birth. Unfortunately, the usual anti-fat drugs are associated with high morbidity in fetus and due to people's inclination towards taking herbs, it is required to identify side effects of medicinal herbs in pregnancy. The aim of this study was to present hypolipidemic herbs that would not any complications for mother and fetus.
METHODS
In this review article, the major electronic databases such as EBSCO, Central Register of Controlled Trials (CENTRAL), China Network Knowledge Infrastructure (CNKI), Cochrane, Google scholar, MEDLINE, SciVerse, Scopus, and Web of Science were searched using the key words "herbal" and "hyperlipidemia", "herbal" and "pregnancy" matched by MeSH from their respective inceptions till September, 2016. Total of 1723 publications (145 review articles, 855 original research articles, and 723 abstracts) about the effect of herbals on hyperlipidemia and 682 publications (200 abstracts, 423 original research articles, and 59 review articles) about the effect of herbals in pregnancy were retrieved. At the end, a list of medicinal plants effective on hyperlipidemia alongside their effects on pregnancy was developed. Finally, the plants effective on hyperlipidemia and safe during pregnancy were determined and their dosage, complications, mechanism of action, and side effects were reported.
RESULTS
A total of 110 effective herbs on hyperlipidemia were identified and complications of 95 plants in pregnancy were studied. At last, among the 55 selected plants effective on hyperlipidemia and examined for pregnancy, we reported 12 herbs with their dosage and special considerations that can be used to treat hyperlipidemia during pregnancy.
CONCLUSION
Some medicinal plants can be used to treat hyperlipidemia during pregnancy without any significant side effects both on mother or fetus.
PubMed: 29147122
DOI: No ID Found -
Survey of Ophthalmology 2016Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of... (Meta-Analysis)
Meta-Analysis Review
Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes.
Topics: Anti-Inflammatory Agents; Antitubercular Agents; Disease Management; Humans; Prognosis; Tuberculosis, Ocular
PubMed: 26970263
DOI: 10.1016/j.survophthal.2016.03.001 -
Acta Bio-medica : Atenei Parmensis Sep 2015Because of reporting high side effects related to biosynthetic drugs, recent attention has been paid to the use of herbs instead of chemical drugs to balance serum... (Review)
Review
Because of reporting high side effects related to biosynthetic drugs, recent attention has been paid to the use of herbs instead of chemical drugs to balance serum lipids. The present systematic review aimed to evaluate the safety of herbal medicines and also to assess drug interaction in herbal therapy in treating hyperlipidemia. The international research databases including MEDLINE; Google scholar, Web of Science SciVerse Scopus (SCOPUS); EBSCO Academic Search; Cochrane Central Register of Controlled Trials (CENTRAL); and a Chinese database (China Network Knowledge Infrastructure [CNKI]) were searched from their respective inceptions up to September 2014 with the search terms of "hyperlipidemia", "herbal medicine", "medicine traditional", "extract plant", "Traditional Medicine" and "Chinese Herbal Medicine" without narrowing or limiting search elements. A total of 85 randomized clinical trials (RCTs) studies were finally assessed on human subjects. A notable number of herbal drugs that are commonly used as an anti-hyperlipidemia agent may be interacted with a variety of biosynthetic drugs. In this regard, the most common reported herb-drug reactions were related to anticoagulants, antidepressants, anti-epileptic, anti-inflammatory, and/or even antihypertension and anti-lipidemic drugs. Also, a considerable number of anti-lipidemic drugs of plants origin may be accompanied with metabolic disturbances and serious complications within pregnancy and breast feeding. The main fundamental principles for administration of these drugs include physicians' complete awareness of the effects and interactions of these drugs, educating people not taking these drugs arbitrarily, and closely monitoring the verification and distribution of the drugs in the society.
Topics: Drug Interactions; Humans; Hyperlipidemias; Internal Medicine; Phytotherapy; Plant Extracts; Practice Guidelines as Topic; Safety
PubMed: 26422426
DOI: No ID Found -
The Journal of Allergy and Clinical... 2014This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis... (Review)
Review
This article summarizes the findings of an expert panel of nationally recognized allergists and pulmonologists who met to discuss how to improve detection and diagnosis of exercise-induced bronchoconstriction (EIB), a transient airway narrowing that occurs during and most often after exercise in people with and without underlying asthma. EIB is both commonly underdiagnosed and overdiagnosed. EIB underdiagnosis may result in habitual avoidance of sports and physical activity, chronic deconditioning, weight gain, poor asthma control, low self-esteem, and reduced quality of life. Routine use of a reliable and valid self-administered EIB screening questionnaire by professionals best positioned to screen large numbers of people could substantially improve the detection of EIB. The authors conducted a systematic review of the literature that evaluated the accuracy of EIB screening questionnaires that might be adopted for widespread EIB screening in the general population. Results of this review indicated that no existing EIB screening questionnaire had adequate sensitivity and specificity for this purpose. The authors present a call to action to develop a new EIB screening questionnaire, and discuss the rigorous qualitative and quantitative research necessary to develop and validate such an instrument, including key methodological pitfalls that must be avoided.
Topics: Asthma, Exercise-Induced; Bronchial Diseases; Bronchoconstriction; Exercise; Humans; Reproducibility of Results; Sensitivity and Specificity; Surveys and Questionnaires
PubMed: 24811017
DOI: 10.1016/j.jaip.2013.11.001 -
Thorax Nov 2014Patients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of integrated disease management (IDM) is to... (Review)
Review
Patients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of integrated disease management (IDM) is to establish a programme of different components of care (ie, self-management, exercise, nutrition) in which several healthcare providers (ie, nurses, general practitioners, physiotherapists, pulmonologists) collaborate to provide efficient and good quality of care. The aim of this Cochrane systematic review was to evaluate the effectiveness of IDM on quality of life, exercise tolerance and exacerbation related outcomes. Searches for all available evidence were carried out in various databases. Included randomised controlled trials (RCTs) consisted of interventions with multidisciplinary (≥2 healthcare providers) and multitreatment (≥2 components) IDM interventions with duration of at least 3 months. Two reviewers independently searched, assessed and extracted data of all RCTs. A total of 26 RCTs were included, involving 2997 patients from 11 different countries with a follow-up varying from 3 to 24 months. In all 68% of the patients were men, with a mean age of 68 years and a mean forced expiratory volume in 1 s (FEV1) predicted value of 44.3%. Patients treated with an IDM programme improved significantly on quality of life scores and reported a clinically relevant improvement of 44 m on 6 min walking distance, compared to controls. Furthermore, the number of patients with ≥1 respiratory related hospital admission reduced from 27 to 20 per 100 patients. Duration of hospitalisation decreased significantly by nearly 4 days.
Topics: Disease Management; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 24415716
DOI: 10.1136/thoraxjnl-2013-204974 -
Journal of Bronchology & Interventional... Oct 2012Postintubation tracheal stenosis (PITS) is a common problem encountered by interventional pulmonologists. The aim of this study was to evaluate the utility of mitomycin... (Review)
Review
Utility of rigid bronchoscopic dilatation and mitomycin C application in the management of postintubation tracheal stenosis: case series and systematic review of literature.
BACKGROUND
Postintubation tracheal stenosis (PITS) is a common problem encountered by interventional pulmonologists. The aim of this study was to evaluate the utility of mitomycin C (MMC) as an adjunctive treatment to rigid bronchoscopic dilatation in patients with PITS.
METHODS
Prospective analysis of data from the interventional pulmonology unit of a large tertiary care teaching center in North India. Patients with a diagnosis of PITS undergoing rigid bronchoscopic dilatation and MMC (0.4 mg/mL) application were included. The primary outcome was the occurrence of restenosis.
RESULTS
Seven patients underwent rigid bronchoscopic dilatation, followed by the application of MMC at 4 quadrants of the stenosis. Controlled radial expansion balloon bronchoplasty was also performed, if necessary, in addition to mechanical dilatation using the barrel of the rigid bronchoscope. Restenosis occurred in all 7 patients (100%) and the mean duration to the detection of restenosis was 27 days. The restenosis was symptomatic in 6 out of 7 (85.7%) patients.
CONCLUSIONS
Rigid bronchoscopic dilatation and a single application of MMC is not an effective treatment in the management of PITS.
Topics: Adolescent; Adult; Airway Extubation; Bronchoscopy; Combined Modality Therapy; Dilatation; Female; Humans; Intubation, Intratracheal; Male; Mitomycin; Prospective Studies; Respiratory System Agents; Secondary Prevention; Tracheal Stenosis; Young Adult
PubMed: 23207530
DOI: 10.1097/LBR.0b013e3182721290