The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea.

Study Objectives: The impact of direct mail order sales of positive airway pressure (PAP) devices, accentuated by the coronavirus disease 2019 (COVID-19) pandemic, on PAP adherence in patients with obstructive sleep apnea remains unclear. In this study we compared the impact of different modes of continuous positive airway pressure delivery on adherence and daytime symptoms. We hypothesized that adherence would not be affected by remote PAP setup, aided by telehealth technology.

Clinical Use of Loop Gain Measures to Determine Continuous Positive Airway Pressure Efficacy in Patients with Complex Sleep Apnea. A Pilot Study.

Rationale: Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy.

Objectives: In this pilot study, we aimed to determine if this measure could also be applied to patients with complex sleep apnea (predominant obstructive sleep apnea, with worsening or emergent central apneas on CPAP). We hypothesized that loop gain was higher in patients whose central events persisted 1 month later despite CPAP treatment versus those whose events resolved over time.

Impact of CPAP use and age on mortality in patients with combined COPD and obstructive sleep apnea: the overlap syndrome.

Background: The overlap syndrome, defined by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to define better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome.

Methods: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identified 3,396 patients which were classified in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA.

Chronic persistent cough: diagnosis and treatment update.

The approach to patients with chronic cough has been well defined and evaluated in the literature through a number of prospective studies. Meticulous attention to detail of the afferent loop of the cough reflex has helped identify the cause of cough in most patients. The most common causes appear to be similar in both children and adults and include asthma, postnasal drip syndromes, gastroesophageal reflux diseases, and aspiration.

Pulmonary complications from alveolar accumulation of carbonaceous material in a cocaine smoker.

A 27-year-old woman presented with cough, fever, and pulmonary infiltrates after heavy cocaine smoking. Large amounts of carbonaceous material and pigment-laden macrophages were recovered by bronchoalveolar lavage. Alveolar deposition of particulate matter from heavy cocaine smoking has not been previously reported and may have been the cause of this patient's symptoms and abnormal findings on chest radiograph.

Integration of clinical and administrative strategies to reduce expenditures for antimicrobial agents.

A comprehensive program of clinical and administrative strategies to reduce expenditures for antimicrobial agents is described. Clinical intervention strategies include the use of antimicrobial order sheets, standardized dosage regimens, restriction policies for certain antimicrobial agents, and position statements on the use of restricted agents. A cornerstone of the program is the support for cost-reduction interventions offered by the pharmacy and therapeutics committee and its subcommittee on therapeutics; that support is demonstrated through endorsement and enforcement of pharmacy programs.

Methacholine challenge in the evaluation of chronic cough.

Inhalation challenge with methacholine is helpful in establishing the diagnosis of hyperreactive airways disease and its association with cough. It remains a valuable, safe, diagnostic tool. It appears that cough resulting from hyperreactive airways disease is a common clinical disorder that can be treated successfully in nearly all patients.

Bronchoprovocation testing.

Bronchial hyperresponsiveness is a constant feature of asthma even when airflow obstruction is absent. Detecting nonspecific bronchial hyperresponsiveness is useful when the diagnosis of asthma has not been confirmed or when a patient describes symptoms of cough, chest tightness, and dyspnea that cannot be ascribed to other causes. Also, because wheezing is a symptom of other disorders, inhalation challenge tests can be useful in defining its cause when reversible airflow obstruction has not been documented.

Cough: differential diagnosis and treatment.

Cough is a complex physiologic event that protects the lungs from mechanical, chemical, and thermal injury. It is a normal reflex and therefore helps humans to adapt to an ever-changing environment. Cough can also be a pathologic reflex in that it may be an important and often the only sign of serious disease, may significantly contribute to the spread of airborne infection, and in some instances, may result in severe functional or structural damage to the organism.

Airway hyperresponsiveness in allergic rhinitis. A risk factor for asthma.

In order to study whether the methacholine inhalation challenge could predict which patients with allergic rhinitis were at risk to develop asthma, we prospectively studied a group of ragweed-sensitive patients over a four to five year period. On the initial study, 16 of 40 patients (40 percent) were found to be hyperresponsive to methacholine. On the follow-up study, three of these 16 patients (19 percent) were found to have developed asthma from one and one-half to five years after the initial testing.

Chronic cough: an approach to management.

Management of chronic cough is complex and warrants careful evaluation. Some patients cough for years without help because of the indiscriminate use of antitussive medications. All patients should be evaluated in a specific manner.

Chronic cough. Diagnosis and treatment.

Cough is a common symptom in the smoking and non-smoking patient seeking medical attention from the office-based physician. Often, a comprehensive history and physical examination suggest the correct diagnosis, and specific therapy can be directed to the underlying disease. A chest roentgenogram is an essential part of the workup; it may suggest tuberculosis, chronic fungal infection, bronchiectasis, or lung abscess.

Lateral position improves wedge-left atrial pressure correlation during positive-pressure ventilation.

Because lateral position can be used to locate a pulmonary artery catheter tip in lung regions where venous pressure exceeds alveolar pressure, we studied the effect of lateral position on the correlation between pulmonary artery occlusion pressure (Pw) and left atrial pressure (Pla) at various increments of positive-end expiratory pressure (PEEP). In ten normal anesthetized pigs, catheters were placed in the left atrium and right and left pulmonary arteries; simultaneous measurements of Pla and Pw from both catheters were obtained in the supine, right lateral, and left lateral positions. Pw obtained in the lateral position when the catheter tip was vertically located below the left atrium ("lower") more accurately reflected Pla changes than Pw obtained from catheters above the left atrium, at PEEP levels less than 20 cm H2O.

Effect of catheter position on thermodilution cardiac output during continuous positive-pressure ventilation.

PEEP may decrease regional perfusion to nondependent lung regions, thereby creating different zones of thermal dissipation in dependent and nondependent zones of the lung. Under these conditions, the measurement of cardiac output by thermodilution may, thus, be influenced by the vertical position of the pulmonary artery catheter in the lung. We investigated this hypothesis in 7 healthy, anesthetized pigs by comparing cardiac output measurements from thermistors located in dependent and nondependent lung regions at varying levels of PEEP.

Factitious asthma. Physiological approach to diagnosis.

Three patients with recurrent emergency room visits and hospitalizations for bronchial asthma are described. Although each patient had respiratory distress associated with wheezing and an apparent response to conventional therapy, other features were inconsistent with the pathophysiology of asthma. These included absence of a significantly elevated alveolar-arterial oxygen tension difference, lack of roentgenographic hyperinflation, and normal small airway function soon after clinical response.

Chronic cough: a manifestation of bronchial asthma.

Current theories of cough have been reviewed and related to the pathophysiology of bronchial asthma. The cough reflex arc and its association with the phenomenon of bronchial hyperreactivity have been stressed. A review of the recent literature suggests that bronchodilator therapy will modify this reflex and eliminate cough in most patients.

Prediction of tracheobronchial colonization in current cigarette smokers with chronic obstructive bronchitis.

To help in clarifying the conflicting data on the role of tracheobronchial microflora in chronic bronchitis, the tracheobronchial microflora of a homogeneous group of clinically stable patients with chronic obstructive bronchitis was characterized by transtracheal aspiration. Their mean percentage ratio of forced expiratory volume in 1 sec to the forced vital capacity was 45%. The results were that (1) a bacterial tracheobronchial microflora was present in only 50% of the patients, (2) viridans streptococci were the bacteria most frequently isolated, and (3) the presence or absence of a tracheobronchial microflora was significantly associated with the amount of present cigarette smoking.

Clinical applicability of a methacholine inhalational challenge.

Cough, dyspnea, and chest pain are symptoms common to many cardiopulmonary diseases. A comprehensive evaluation, including a history, physical examination, ECG, chest roentgenogram, and pulmonary function studies, will often yield a specific diagnosis. However, when these symptoms are intermittent, as they often are in patients with bronchial asthma, the diagnosis may not be apparent.

Sampling lower respiratory tract secretions in primary lung abscess: a comparison of the accuracy of four methods.

To determine the relative cultural accuracy of transtracheal aspiration (TTA), wire-brushing under direct vision through a flexible fiberoptic bronchoscope (WBB), and expectorated sputum (ES) in localized pulmonary infections, we compared each method with percutaneous needle lung aspiration (PLA) cultures in patients with peripheral lung abscesses. Of the 27 organisms that PLA cultures isolated from ten lung abscesses (eight aerobic, two anaerobic), TTA identified 81 percent plus an additional five, and WBB 68 percent plus 16. Of the 14 organisms that PLA cultures isolated from eight aerobic abscesses, TTA identified 93 percent plus an additional two, WBB 83 percent plus 12, and ES 71 percent plus 19.

Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy.

Using a diagnostic protocol based on the anatomy and distribution of cough receptors and afferent nerves, we sought to determine the causes and outcome of specific therapy of chronic persistent cough in 49 consecutive and unselected patients. A specific diagnosis was made in all. Cough was due to chronic postnasal dip from a variety of conditions in 29%, asthma in 25%, postnasal drip plus asthma in 18%, chronic bronchitis in 12%, gastroesophageal reflux in 10%, and miscellaneous disorders in 6%.