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,...
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...
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...
Steroids rapidly reduce children’s croup symptoms and shorten hospital stays
Corticosteroids reduce symptoms of croup in children within two hours and continue to do so for at least 24 hours. They also cut the amount of time children spend in hospital by 15 hours and reduce return visits or readmissions from about 20% to 10%.
This Cochrane review assessed the effectiveness of corticosteroids such as dexamethasone and budesonide compared with placebo. It updates a previous review which concluded that corticosteroids reduce symptoms of croup at six hours.
The review also...
Tools for GPs can help reduce unnecessary antibiotic prescribing
Interventions to reduce inappropriate antibiotic prescribing for upper respiratory tract infections are most effective when they provide a negotiation tool to support patient interaction. These interventions are more likely to be rejected if they are perceived as interfering with individual clinical judgment or damaging patient relationships.
Upper respiratory tract infections often resolve themselves within a few days, without the need for antibiotics, yet antibiotics are often prescribed. Thi...
High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy.
Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital.
A reminder that too much oxygen increases mortality in acutely ill adults
In acutely ill adults, liberal use of oxygen supplementation is found to increase the risk of death compared with more conservative oxygen strategies. More liberal oxygen therapy increases patient mortality in hospital by about 11 deaths amongst every 1,000 people exposed. Deaths also increase after 30 days follow-up, without improving other important health outcomes, such as disability, infection or length of hospital stay.
Oxygen is routinely used for acutely ill patients and is widely consid...
Ultrasound shows potential for confirming the diagnosis of pneumonia in children
Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances.
A review of the published evidence found that lung ultrasound was more sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation.
Ultrasound also spares the child...
Increasing inhaled steroids for short periods reduces asthma exacerbations
Taking four times the usual dose of inhaled corticosteroids for up to two weeks can modestly reduce the chance of asthma worsening.
This NIHR-funded trial assessed increasing the inhaled corticosteroid dose compared with staying on the usual dose, as part of a self-management plan. Participants were adults and adolescents with uncontrolled asthma and had at least one exacerbation needing additional medical attention in the year before the trial.
Quadrupling the inhaled corticosteroid dose when...
One week of steroids may be as effective as two weeks in managing severe COPD
A shorter course of steroids lasting 3 to 7 days appears as effective as the recommended 7 to 14-day standard treatment for managing a flare-up of severe chronic obstructive pulmonary disease.
This update to an earlier Cochrane review looked at randomised clinical trials comparing a short course (7 days or fewer) with a longer course (7 to 14 days) of steroids given by mouth or injection. All participants had been admitted to hospital, but none required mechanical ventilation.
The evidence sug...