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Michele Vitacca, Luca Barbano, Daniele Colombo, Olivia Leoni, Enrico Guffanti
Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared...
January 29, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Yves Lacasse, Ai-Yui M Tan, François Maltais, Jerry A Krishnan
Two landmark trials conducted more than 35 years ago provided scientific evidence that, under very specific circumstances, long-term oxygen therapy (LTOT) may prolong life. These two trials enrolled 290 patients with chronic obstructive pulmonary disease (COPD) and severe daytime hypoxemia documented by direct arterial blood gas measurement. From this moment, LTOT became a standard of care and the indications for oxygen therapy have expanded to include nocturnal oxygen therapy for isolated nocturnal oxygen desaturation, ambulatory oxygen to correct exercise-induced desaturation, and short-burst oxygen to relieve dyspnea...
March 16, 2018: American Journal of Respiratory and Critical Care Medicine
Wei Xiong, Yunfeng Zhao, Sugang Gong, Qinhua Zhao, Jinming Liu
No abstract text is available yet for this article.
January 1, 2018: Pulmonary Circulation
Magnus Ekström, Thomas Ringbaek
Long-term oxygen therapy (LTOT) improves prognosis in patients with COPD and chronic severe hypoxemia. The efficacy in moderate hypoxemia (tension of arterial oxygen; on air, 7.4-8.0 kPa) was questioned by a recent large trial. We reviewed the evidence to date (five randomized trials; 1,191 participants, all with COPD). Based on the current evidence, the survival time may be improved in patients with moderate hypoxemia with secondary polycythemia or right-sided heart failure, but not in the absence of these signs...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Richard Casaburi
No abstract text is available yet for this article.
January 31, 2018: Annals of the American Thoracic Society
Magnus Ekström, Zainab Ahmadi, Josefin Sundh
No abstract text is available yet for this article.
January 31, 2018: Annals of the American Thoracic Society
Kovi Levin, Brigitte Borg, Belinda Miller, Kirk Kee, Eli Dabscheck
BACKGROUND AND OBJECTIVE: Patients with persistent hypoxia following an acute hospital admission may be discharged with "bridging" domiciliary oxygen as per criteria defined by the Thoracic Society of Australia and New Zealand. The need for continuous Long-Term Oxygen Therapy (LTOT) is then reassessed at a clinic review 1-2 months later. The aim of this study is to describe the characteristics of patients discharged from an acute hospital admission with continuous Short Term Oxygen Therapy (STOT), and subsequently to investigate for differences between subjects who proceeded to qualify for continuous LTOT versus those who were able to cease STOT at review...
January 18, 2018: Internal Medicine Journal
Kazuma Nagata, Takashi Kikuchi, Takeo Horie, Akira Shiraki, Takamasa Kitajima, Toru Kadowaki, Fumiaki Tokioka, Naohiko Chohnabayashi, Akira Watanabe, Susumu Sato, Keisuke Tomii
RATIONALE: A growing evidence base suggests a benefit of using high-flow nasal cannula oxygen therapy (HFNC) in the acute setting. However, the clinical benefit of domiciliary use of HFNC in patients with chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) remains unclear. OBJECTIVES: To evaluate the efficacy and safety of HFNC use in stable COPD patients. METHODS: This was a multicenter, randomized crossover trial comparing HFNC plus long-term oxygen therapy (HFNC/LTOT) with LTOT-only in 32 adults with stable hypercapnic COPD...
December 28, 2017: Annals of the American Thoracic Society
Hilary Mosher, Shoshana J Herzig, Itai Danovitch, Christina Boutsicaris, Sameer Hassamal, Karl Wittnebel, Azadeh Dashti, Teryl Nuckols
Individuals who are on long-term opioid therapy (LTOT) for chronic noncancer pain are frequently admitted to the hospital with acute pain, exacerbations of chronic pain, or comorbidities. Consequently, hospitalists find themselves faced with complex treatment decisions in the context of uncertainty about the effectiveness of LTOT as well as concerns about risks of overdose, opioid use disorders, and adverse events. Our multidisciplinary team sought to synthesize guideline recommendations and primary literature relevant to assessing medical inpatients on LTOT, with the objective of assisting practitioners in balancing effective pain treatment and opioid risk reduction...
December 6, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Jessica S Merlin, Sarah R Young, Joanna L Starrels, Soraya Azari, E Jennifer Edelman, Jamie Pomeranz, Payel Roy, Shalini Saini, William C Becker, Jane M Liebschutz
BACKGROUND: Current guideline-recommended monitoring of patients prescribed long-term opioid therapy (LTOT) for chronic pain will likely result in increased identification of behaviors of concern for misuse and addiction, but there is a dearth of empiric evidence about how these behaviors should be managed. OBJECTIVE: To establish expert consensus about treatment approaches for common and challenging concerning behaviors that arise among patients on LTOT. DESIGN: We used a Delphi approach, which allows for generation of consensus...
February 2018: Journal of General Internal Medicine
Magnus Ekström, Hanan Tanash
Background: Individuals with severe alpha-1 antitrypsin deficiency (AATD) have an increased risk of developing COPD. However, outcomes during long-term oxygen therapy (LTOT) in patients with severe AATD and hypoxemia are unknown. Patients and methods: This was a prospective, population-based, consecutive cohort study of patients on LTOT due to COPD in the period from January 1, 1987, to June 30, 2015, in the Swedish National Registry for Respiratory Failure (Swedevox)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Shannon M Nugent, Bobbi Jo Yarborough, Ning X Smith, Steven K Dobscha, Richard A Deyo, Carla A Green, Benjamin J Morasco
OBJECTIVE: Little is known about co-occurring long-term opioid therapy (LTOT) and medical cannabis use. We compared characteristics of patients prescribed LTOT who endorsed using medical cannabis for pain to patients who did not report cannabis use. METHOD: Participants (n=371) prescribed LTOT completed self-report measures about pain, substance use, and mental health. RESULTS: Eighteen percent of participants endorsed using medical cannabis for pain...
January 2018: General Hospital Psychiatry
Helene Vogelsinger, Michael Halank, Silke Braun, Heinrike Wilkens, Thomas Geiser, Sebastian Ott, Armin Stucki, Christian M Kaehler
BACKGROUND: Nasal high-flow oxygen therapy (HFOT) is a novel treatment option for patients suffering from acute or chronic respiratory failure. Aim of our study was to compare safety and efficacy of HFOT with those of conventional oxygen treatment (COT) in normo- and hypercapnic COPD patients. METHODS: A single cohort of 77 clinically stable hypoxemic patients with an indication for long-term oxygen treatment (LTOT) with or without hypercapnia successively received COT and HFOT for 60 min each, including oxygen adaption and separated by a 30 min washout phase...
November 17, 2017: BMC Pulmonary Medicine
Thaís Sant'Anna, Leila Donária, Nidia A Hernandes, Karina C Furlanetto, Décio S Barbosa, Rik Gosselink, Fabio Pitta
PURPOSE: To analyze the relationship between oxygen desaturation episodes during a laboratory-based ADL protocol and in real-life routine in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Twenty patients with stable COPD (12 men, 70 ± 7 years, FEV1% 54 ± 15 predicted) with no indication for long-term oxygen therapy (LTOT) were submitted to assessments including ADL performance by the Londrina ADL Protocol (LAP) and level of physical activity in daily life, both while submitted to simultaneous activity and pulse oximeter monitoring...
November 13, 2017: Lung
Magnus Ekström, Zainab Ahmadi, Hillevi Larsson, Tove Nilsson, Josefin Wahlberg, Kerstin E Ström, Bengt Midgren
Background: Long-term oxygen therapy (LTOT) improves prognosis in COPD with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden. Methods: The study was a prospective, population-based study of 23,909 patients on LTOT from 1987 to 2015 in the Swedish National Register of Respiratory Failure (Swedevox)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Constance C Mussa, Laura Tonyan, Yi-Fan Chen, David Vines
BACKGROUND: Although routine physical activity for individuals with COPD is recommended, there are inherent limitations of available oxygen delivery devices that may result in hypoxemia during activity. Changes in Medicare laws have resulted in an increased use of oxygen cylinders and a reduction in the use of liquid oxygen devices. The aim of this survey was to assess the impact of perceived satisfaction with various oxygen delivery devices on perceived mobility and quality of life (QOL) of oxygen-dependent subjects with COPD...
January 2018: Respiratory Care
Winfried Häuser, Tino Schubert, Norbert Scherbaum, Thomas Tölle
Recent evidence-based guidelines for long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) have defined daily morphine equivalent doses (MEQ/d) that require particular caution. The recommendation for a threshold MEQ/d is based on North American studies that have demonstrated negative health outcomes associated with high-dose LTOT for CNCP. We have conducted a retrospective cross-sectional study using an anonymized German health claims database, including 4,028,618 persons insured by 69 German statutory health insurances, representative of age and sex for the German population in 2014...
October 31, 2017: Pain
Michele Vitacca, Dicle Kaymaz, Barbara Lanini, Guido Vagheggini, Pınar Ergün, Francesco Gigliotti, Nicolino Ambrosino, Mara Paneroni
BACKGROUND AND OBJECTIVE: The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. METHODS: All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone...
September 22, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
Ajay Manhapra, Albert J Arias, Jane C Ballantyne
BACKGROUND: In response to the opioid epidemic and new guidelines, many patients on high-dose long-term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: although many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies, and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking...
September 20, 2017: Substance Abuse
Michael I Demidenko, Steven K Dobscha, Benjamin J Morasco, Thomas H A Meath, Mark A Ilgen, Travis I Lovejoy
OBJECTIVE: Little is known about patient outcomes following discontinuation of opioid therapy, which may include suicidal ideation (SI) and suicidal self-directed violence (SSV). The purpose of this study was to examine correlates of SI and non-fatal SSV in a sample of patients discontinued from long-term opioid therapy (LTOT). METHOD: Five hundred-nine Veterans Health Administration (VHA) patients whose clinicians discontinued them from LTOT were selected from a national cohort of VHA patients who discontinued opioids in 2012...
July 2017: General Hospital Psychiatry
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