J Cyst Fibros
The Adult Cystic Fibrosis Unit, The Prince Charles Hospital, Brisbane, Qld, Australia.
Published: December 2002
Background: Dornase alpha improves sputum clearance and pulmonary function in patients with moderate bronchiectasis and cystic fibrosis (CF). Several studies have demonstrated variable adherence to treatment regimens in patients with CF. We aimed to compare self-reported adherence with computer based dispensing records of dornase alpha.
Method: Direct interview of adherence to dornase alpha was compared with pharmacy-dispensing records during a 12-month period. The reasons for dornase alpha usage, and change in lung function in three groups of patients were compared (group 1 (n=42): positive trial, continuing therapy; group 2 (n=13): positive trial, ceased therapy; group 3 (n=22): negative trial). Ninety patients with CF were surveyed. Patients who had ceased dornase alpha provided reasons for drug cessation. Lung function and anthropometric data were collected prior to dornase alpha treatment and at 3 years. Health care professionals rated adherence to therapy.
Results: Of the 42 patients on dornase alpha, the average utilisation was 197 days (54%). From dispensing records, 24% of patients were classified as good adherence, 46% as moderate adherence and 30% as poor adherence. Eighty-two percent claimed to use dornase alpha therapy more than 20 days/month, whereas dispensing records showed that only 24% of collected sufficient drug supplies. Health professionals' assessment of adherence of therapy was often incorrect and an overestimation was more common than underestimation. The change in FEV(1) 3 years after trial was not significantly different between groups. There was a negative correlation between initial response to dornase alpha and baseline FEV(1) (r=-0.44, P=0.001), however, initial response was not related to the change in FEV(1) over 3 years (r=0.20, P=0.16).
Conclusion: There is variability in adherence to dornase alpha in adults with CF and patient self-reporting is likely to over-estimate drug collection from the pharmacy. Further study of the long-term effects of dornase alpha is required. To date, proven interventions to enhance adherence are limited and require investigation in CF.
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http://dx.doi.org/10.1016/s1569-1993(02)00095-4 | DOI Listing |
Ann Acad Med Singap
December 2024
Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.
Introduction: Pleural infections are a significant cause of mortality. Intrapleural fibrinolytic therapy (IPFT) utilising alteplase and dornase is a treatment option for patients unsuitable for surgery. The optimal dose of alteplase is unknown, and factors affecting treatment success in an Asian population are unclear.
View Article and Find Full Text PDFPediatr Crit Care Med
December 2024
Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, UT.
Objectives: Describe β2-agonists, steroids, hypertonic saline (HTS), n-acetylcysteine (NAC), and dornase alfa (DA) use to treat bronchiolitis, factors associated with use, and associations between use and PICU length of stay (LOS).
Design: Retrospective, multicenter cohort study.
Setting: PICUs in the Pediatric Health Information System database.
Cureus
October 2024
Internal Medicine, Norton Community Hospital, Norton, USA.
This case report explores the intricate challenges of diagnosing and managing empyema caused by , particularly in patients with predisposing factors such as alcohol abuse and underlying respiratory conditions. We present a 34-year-old male patient with a medical history of hypertension, peripheral neuropathy, and alcohol abuse who developed empyema. Despite an initial presentation at another facility with symptoms mimicking a myocardial infarction and unremarkable chest X-ray results, his condition worsened, leading to a subsequent emergency department visit.
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November 2024
Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA. Electronic address:
Front Cell Infect Microbiol
November 2024
National Institutes of Health, National Cancer Institute, Thoracic Surgery Branch, Bethesda, MD, United States.
We present a patient with a post-pneumonectomy empyema refractory to surgical debridement and systemic antibiotics. The patient initially presented with a bronchopleural fistula and pneumothorax secondary to tuberculosis (TB) destroyed lung, which required a pneumonectomy with Eloesser flap. Ongoing pleural infection delayed the closure of the Eloesser flap, and thoracoscopic inspection of his chest cavity revealed a green, mucous biofilm-like structure lining the postpneumonectomy pleural cavity.
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