For patients with chronic non-malignant lung disease, severe chronic breathlessness can significantly impact quality of life, causing significant disability, distress, social isolation, and recurrent hospital admissions. Caregivers for people with challenging symptoms, such as severe breathlessness, are also profoundly impacted. Despite increasing research focused on breathlessness over recent years, this symptom remains extremely difficult to manage, with no effective treatment that completely relieves breathlessness. A new potential treatment for relieving breathlessness in patients at home is nasal high flow (NHF) therapy. NHF therapy is a respiratory support system that delivers heated, humidified air (together with oxygen if required) with flows of up to 60 L/min. This case describes a patient with very severe chronic obstructive pulmonary disease who received domiciliary NHF therapy (approximately 8 hours/day, flow rate of 20 L/min) over twelve months with good effect for the relief of severe chronic breathlessness. We discuss the management principles for severe chronic breathlessness, the physiological effects of NHF therapy and the evidence for long-term use in the community setting. With the support of respiratory and palliative care clinicians together, domiciliary NHF therapy has great potential for improving current symptom management approaches in people with life-limiting illnesses.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.09.016 | DOI Listing |
Am J Respir Crit Care Med
December 2024
APHP, Groupe Hospitalier Pitie Salpêtrière, Medecine intensive Reanimation, Paris, France.
Rationale: High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated.
Objectives: To compare dyspnea, airway occlusion pressure (P) and inspiratory work with and without nasal high flow (NHF, FiO 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT).
Methods: Dyspnea (numerical rating scale, NRS and Mechanical Ventilation - Respiratory Distress Observational Scale, MV-RDOS), P, esophageal pressure, respiratory muscles EMG, arterial blood gas were compared in intubated patients on pressure support ventilation presenting a dyspnea-NRS > 3 during two sequences: 1) pressure support ventilation with NHF at 0 L/min followed by 30, 50 and 60 L/min (the last three were randomized) and 2) a SBT with NHF at 0 and 50 L/min (randomized).
BMC Pulm Med
November 2024
Department of Respiratory Medicine, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Introduction: Nasal high flow (NHF) is a popular technique to provide support in respiratory failure in different conditions. Recently published bench studies have hypothesized that airway pressure can be increased by using different cannula sizes and corresponding prongs resulting in a range of prong-nare ratios. We conducted this study to verify these experimental findings in clinical practice.
View Article and Find Full Text PDFPLoS Negl Trop Dis
September 2024
Institute for Global Health (IGH) and Department of Risk and Disaster Reduction, University College London (UCL), London, United Kingdom.
Mikrochim Acta
September 2024
Department of Chemistry, Center of Nanotechnology and Tissue Engineering, Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
A nanoemulsion containing CdTe quantum dots (NE-CdTe-QD) was developed to shield cells from cadmium toxicity and shown to be a promising candidate for brain tumor diagnosis. CdTe-QD was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and Raman spectroscopy. CdTe-QD exhibited high luminescence emission at 700 nm, and their stability was maintained when encapsulated in lipidic/polymeric nanoemulsions (198 ± 2.
View Article and Find Full Text PDFInt J Biol Macromol
November 2024
Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand; Research and Innovation Center for Advanced Therapy Medicinal Products, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, 73000, Thailand. Electronic address:
Untreated or poorly managed chronic wounds can progress to skin cancer. Topically applied 5-fluorouracil (5-FU), a nonspecific cytostatic agent, can cause various side effects. Its high polarity also results in low cell membrane affinity and bioavailability.
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