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NIHR Signal Using both nicotine patches and gum together improves the chances of quitting smoking
Using a nicotine patch together with a fast-acting type of nicotine replacement therapy (NRT) such as gum or lozenges improves smoking cessation rates compared to using only a single type of NRT. Higher-dose nicotine patches are also more effective than lower dose ones, this NIHR-funded review suggests. A previous Cochrane systematic review found that NRT boosts people’s chances of successfully quitting smoking compared to none, but it was unclear which types, doses and schedules were mos...
NIHR Signal Providing pressurised air through a mask may improve outcomes for people with deteriorating heart failure
Non-invasive positive pressure ventilation may help people with rapidly deteriorating heart failure who become short of breath due to fluid build-up in the lungs. For people not requiring immediate mechanical ventilation using an endotracheal tube, this approach may reduce the risk of death in hospital and the need for intubation. This review evaluated 24 trials of 2,664 adults comparing a group who received air under pressure through a mask, to a group receiving standard medical care. These ty...
NIHR Signal Smartphones instead of direct supervision can improve adherence rates for TB treatment
People who need supervision take their medication for tuberculosis (TB) more reliably when using a smartphone to send video evidence instead of direct observations;for example, by attending a clinic appointment. Almost double the number of observations was completed in the video-supervised arm at six months than when people were directly observed. Ensuring the effectiveness of treatment is central to worldwide TB control. Directly-observed treatment, in which a healthcare professional supervise...
NIHR Signal Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions
A 12% reduction in GP antibiotic prescriptions for respiratory conditions was achieved through the use of electronic decision and training tools. This reduction did not increase the risk of serious infections compared to usual care. The low-cost intervention in this large NIHR-funded trial included a short training webinar for GPs and feedback on their practice’s prescribing rates. The decision support tool gave prompt access to NICE prescribing guidelines and printable patient informatio...
NIHR Signal Treating vitamin D deficiency may reduce exacerbations of COPD
Vitamin D supplements halve the number of exacerbations of chronic obstructive pulmonary disease (COPD) in people with low levels of the vitamin, from two per year to one per year. The supplements do not affect exacerbations of COPD in people who are not deficient. This NIHR-funded review is the first to pool individual-level data from randomly controlled trials to see whether taking vitamin D can help reduce exacerbations. People with moderate to severe COPD may be at risk of low vitamin D le...
NIHR Signal London’s Low Emission Zone has not been shown to improve children’s respiratory health
The Low Emission Zone covering much of Greater London was introduced between 2008 and 2012 to improve air quality. Some measures of air pollution have slightly reduced over that time, but measures of children’s respiratory health and lung development have not significantly improved. This NIHR funded study assessed over 2,000 primary school children during the first five years of the Low Emission Zone, during which charges were phased in for several categories of commercial diesel vehicles...
NIHR Signal Reviewing inhaler technique for older people with COPD can improve disease control
Educating older adults with chronic obstructive pulmonary disease or asthma about the correct way to use their inhalers, as part of disease management, can reduce their risk of exacerbations. Either a demonstration using a placebo inhaler or written information appears effective for this. This review pooled the results of four trials, with a total of 1,225 participants. It found that a pharmacist or nurse intervention to improve inhaler technique for older adults can reduce exacerbations. Peopl...
NIHR Signal Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations
Taking low-dose theophylline tablets in addition to inhaled corticosteroids did not significantly reduce chronic obstructive pulmonary disease flare-ups (exacerbations). This NIHR funded study found that people taking the combination and those taking an inhaled steroid had the same number of exacerbations - just over two per year. People who experience frequent exacerbations are often prescribed steroid inhalers to reduce inflammation of the airways. Theophylline also helps open up the airways,...
NIHR Signal People with COPD exacerbations prefer early discharge then treatment at home
People with flare-ups of COPD (chronic obstructive pulmonary disease) prefer to be managed at home rather than in hospital. Hospital stay was on average four days shorter when people were discharged early to the hospital at home scheme, and there was no noticeable increase in readmissions in this group. This NIHR-funded trial aimed to establish the costs and outcomes of hospital at home compared with staying in hospital for treatment. The findings support current guidance that hospital at home...
NIHR Signal New airway device as good as tracheal tube insertion for out-of-hospital resuscitation
A supraglottic airway device works as well as a tracheal tube for paramedics resuscitating patients in cardiac arrest and is simpler to use. People who have stopped breathing need to get air into their lungs urgently. Usually, a tube is placed through the vocal cords into their trachea to secure a reliable airway, but correct placement needs skill and practice and can interrupt chest compressions during resuscitation. More recently, paramedics have used a supraglottic airway device, placed in t...
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