Holistic services in advanced lung disease can help people cope better with breathlessness
Services providing holistic health care can improve the psychological well-being of people who are living with breathlessness associated with chronic or advanced lung disease, such as lung cancer or chronic obstructive pulmonary disease. Breathlessness is a distressing symptom in which feelings of fear and helplessness, social isolation, high levels of anxiety and significant carer burden are common experiences.
Drugs can have limited effectiveness in advanced disease and do not address the und...
‘As-needed’ combination asthma inhalers can be more effective than regular inhaled steroids
In adults with mild to moderate asthma, budesonide-formoterol used as needed for symptom relief was more effective at preventing severe exacerbations than maintenance low-dose budesonide plus as-needed terbutaline. In this trial involving 885 adults, those using the combination inhaler as required had fewer severe asthma attacks, with similar levels of general symptom control, and overall used a lower dose of corticosteroid.
The results of this trial suggest that for people with mild asthma, ex...
Long-term macrolide antibiotics reduce risk of exacerbations of bronchiectasis
People with bronchiectasis (not caused by cystic fibrosis) who take long-term macrolide antibiotics are around 50% less likely to experience acute worsening of symptoms like cough and sputum production (an exacerbation) than people taking a placebo.
Bronchiectasis guidelines only recommend preventative macrolide antibiotics in people with frequent exacerbations who do not carry a bacterium (Pseudomonas aeruginosa). This review pooled data from three trials in 341 patients where erythromycin or ...
High-flow nasal oxygen reduces reintubation after major surgery compared with conventional oxygen therapy
In adults after major surgery, high-flow nasal oxygen decreases by about two-thirds the need for reintubation compared with conventional oxygen therapy. In this study, only about four in every 100 patients needed reintubation with high-flow nasal oxygen, compared with about 11 in every 100 patients receiving conventional oxygen therapy.
This review evaluated seven randomised and three non-randomised studies in 1,327 adult patients recovering from surgery under a general anaesthetic. Most of the...
C-reactive protein testing in general practice safely reduces antibiotic use for COPD flare-ups
Use of a rapid C-reactive protein (CRP) blood test in general practice for people with a flare-up of COPD reduces the proportion who take antibiotics over the next month by about 20 percentage points compared with usual care alone. The reduction in antibiotic use does not lead to worse health, more visits to the doctor or greater need for antibiotics later on.
Flare-ups of COPD can be caused by infections of the airways or environmental triggers, and cause about 115,000 admissions to hospital e...
A temporary clot-catching filter inserted after major trauma does not prevent lung clots
In adults after major trauma who cannot safely be given anti-clotting drugs, placing a removable metal filter in a major vein to the heart (the inferior vena cava) within 3 days of admission does not reduce their chances of having a clot in their lungs (pulmonary embolus) within 90 days, compared with having no filter. The filters do not affect the risk of bleeding.
The filter aims to catch clots that might develop in the legs and travel to the lungs, until anti-clotting drugs can be safely sta...
Exercise training improves physical capacity after lung cancer surgery
People who receive exercise training following surgery for lung cancer can walk about 57 metres further in six minutes than controls who did not exercise. After surgery like thisto remove all or part of a lung, people typically manage about 500 metres in six minutes on the test, and anything above 20 metres is considered a worthwhile improvement. Exercise also increases leg strength and quality of life.
A decline in physical fitness is a common and debilitating effect of lung resection. Exerci...
Packages of care interventions ‘not effective’ to reduce repeat admissions for COPD
Care bundles for COPD are difficult to implement, and their introduction in NHS hospitals does not reduce repeat admissions, deaths or use of resources when used on or after admission.
Care bundles are packages of interventions which, in other situations, can improve care. COPD care bundles include:
checking inhaler technique and medication use
providing a written plan for COPD management and supply of emergency medicines
assessing willingness to stop smoking
assessing suitability for pul...
Mucus-thinning drugs slightly reduce COPD symptom flare-ups
People with chronic obstructive pulmonary disease (COPD) have a slightly reduced risk of having a flare-up of symptoms if they take mucolytic drugs. The number of days on which they are too ill to perform their normal activities is also slightly reduced, from 1.57 days to 1.14 days per month.
A review of placebo-controlled trials, including 10,377 people taking a variety of mucolytic drugs, for between two months to three years, found improvements in exacerbations, days of disability, and hospi...