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The Swedish National Airway Register (SNAR): development, design and utility to date. 瑞典国家航道登记册(SNAR):迄今为止的开发、设计和实用性。
IF 1.8 Q3 RESPIRATORY SYSTEM Pub Date : 2020-10-23 DOI: 10.1080/20018525.2020.1833412
C Stridsman, J R Konradsen, L Vanfleteren, C Pedroletti, J Binnmyr, P Edfelt, K Fjällman Schärberg, Y Sjöö, F Nyberg, A Lindberg, A Tunsäter, A Ekberg-Jansson

Background: The Swedish National Airway Register (SNAR) was initiated in 2013 to ensure and improve the quality of care for patients with asthma and COPD.

Aim: To describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care.

Methods: SNAR includes data from patients with asthma (both children and adults) and COPD from primary, secondary and tertiary care, and also, for COPD inpatient care. Data on diagnostic investigations (e.g. spirometry, blood sample, skin prick test), symptom-scores, comorbidities and prescribed treatments are registered. The registrations are entered manually by healthcare professionals, or directly transferred from electronic medical records to a web-based platform.

Results: In 2019, 1000 clinics participated and data were directly transferred by about 88% of them. The register included data on 205,833 patients with asthma and 80,372 with COPD (of these, 5% had both diagnoses). Registrations of new patients and follow-up visits from primary and secondary/tertiary care in 2019 were completed for 75,707 patients with asthma (11,818 children <12 yr, 6545 adolescents 12-17 yr, and 57,344 adults >17 yr) and 38,117 with COPD. Depending on age and disease group, 43-77% had performed spirometry, 36-65% Asthma Control Test, and 60% COPD Assessment Test. The prevalence of current smoking was about 2% in adolescents, 10% in adults with asthma, and 34% in COPD. For these, smoking cessation support was offered to 27%, 38% and 51%, respectively. Overall, limited data were available on investigation of allergy, 6-min walk test, patient education and written treatment plans. Regarding asthma, sex-differences in disease management were evident.

Conclusion: SNAR has cumulatively registered data from over 270,000 individuals, and the register is important for patients, caregivers, authorities, politicians and researchers to evaluate the effect of treatment and to ensure high and equal quality of care nationwide.

背景:瑞典国家气道登记(SNAR)于 2013 年启动,旨在确保和提高哮喘和慢性阻塞性肺疾病患者的护理质量。目的:介绍 SNAR 的开发和设计,并研究 2019 年的数据,以评估其在提高护理质量方面的潜在作用:SNAR包括来自初级、二级和三级医疗机构的哮喘(儿童和成人)和慢性阻塞性肺病患者的数据,以及慢性阻塞性肺病住院患者的数据。有关诊断检查(如肺活量测定、血液样本、皮肤点刺试验)、症状评分、合并症和处方治疗的数据均被登记在册。登记数据由医护人员手动输入,或直接从电子病历转入网络平台:2019 年,共有 1000 家诊所参与,其中约 88% 的诊所直接传输了数据。登记册包括 205833 名哮喘患者和 80372 名慢性阻塞性肺病患者的数据(其中 5%的患者同时患有这两种疾病)。2019 年完成了 75707 名哮喘患者(11818 名 17 岁儿童)和 38117 名慢性阻塞性肺病患者的新患者登记和初级和二级/三级医疗机构的随访登记。根据年龄和疾病组别,43%-77%的患者进行过肺活量测定,36%-65%进行过哮喘控制测试,60%进行过慢性阻塞性肺疾病评估测试。当前吸烟率在青少年中约为 2%,在成人哮喘患者中约为 10%,在慢性阻塞性肺病患者中约为 34%。对于这些人,分别为 27%、38% 和 51% 的人提供了戒烟支持。总体而言,关于过敏调查、6 分钟步行测试、患者教育和书面治疗计划的数据有限。在哮喘方面,疾病管理的性别差异明显:SNAR已累计登记了超过27万人的数据,该登记册对于患者、护理人员、当局、政治家和研究人员评估治疗效果以及确保全国范围内优质、平等的医疗质量非常重要。
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引用次数: 0
Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD. 评估哮喘和慢性阻塞性肺病患者吸入错误、训练时间和患者对DuoResp®Spiromax®和Symbicort®Turbuhaler®的偏好
IF 1.9 Q3 Medicine Pub Date : 2020-10-18 DOI: 10.1080/20018525.2020.1833411
Jordi Giner, Marta Villarnovo Cerrillo, Jaime Aboín Sierra, Laura Casas Herrero, Oliver Patino, Vicente Plaza

While poor inhaler technique in asthma and chronic obstructive pulmonary disease (COPD) can compromise the effectiveness of inhaled medications, identifying and quantifying these errors may suggest ways to improve inhalation technique and patient outcomes. The objective of this international, multicentre care improvement programme was to investigate errors in inhaler use (handling errors and inhalation errors) made by patients in handling two dry powder inhalers; DuoResp® Spiromax® and Symbicort® Turbuhaler®. Patients with asthma or COPD aged between 18 and 80 years attending the allergology/pneumology departments of 14 hospitals in Spain and Portugal were included. All assessments were performed during one regular scheduled visit to the study clinic. Among 161 eligible patients (138 with asthma; 23 with COPD), inhalation errors were the most common type of error, with no significant difference between devices in overall total error rate, handling error rate or inhalation error rate. Significantly fewer total errors per patient (1.4 vs. 1.9; p < 0.001) and handling errors per patient (0.5 vs. 0.8; p < 0.001) were observed with DuoResp® Spiromax® compared with Symbicort® Turbuhaler®. The mean number of attempts for patients using DuoResp® Spiromax® to perform two correct procedures was 1.9 (0.6) compared with 2.1 (0.9) attempts for patients using Symbicort® Turbuhaler® (p = 0.016). Compared with Symbicort® Turbuhaler®, DuoResp® Spiromax® was found to be easy to learn how to use (p < 0.001), easy to prepare (p < 0.001), easy to use (p < 0.001), comfortable in terms of weight and size (p = 0.001), and patients felt that they were using the device correctly (p < 0.001). Overall, 79.5% of patients stated that they preferred DuoResp® Spiromax® as their first option over Symbicort® Turbuhaler®. The findings of this study may be useful in developing effective inhaler training programmes and thus improve outcomes in asthma and COPD.

虽然在哮喘和慢性阻塞性肺疾病(COPD)中,不良的吸入器技术可能会影响吸入药物的有效性,但识别和量化这些错误可能会为改善吸入技术和患者预后提供方法。这项国际、多中心护理改进计划的目的是调查患者在处理两个干粉吸入器时发生的吸入器使用错误(处理错误和吸入错误);DuoResp®Spiromax®和Symbicort®Turbuhaler®。在西班牙和葡萄牙的14家医院的过敏症/肺炎科就诊的年龄在18至80岁之间的哮喘或COPD患者被纳入研究。所有的评估都是在一次定期访问研究诊所期间进行的。在161例符合条件的患者中(138例哮喘患者;23例COPD患者),吸入错误是最常见的错误类型,不同设备在总体总错误率、处理错误率或吸入错误率方面无显著差异。每位患者的总错误显著减少(1.4 vs 1.9;P P P = 0.016)。与Symbicort®Turbuhaler®相比,DuoResp®Spiromax®易于学习如何使用(p p p p = 0.001),患者认为他们正确使用了该设备(p
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引用次数: 6
Automatic oxygen titration with O2matic® to patients admitted with COVID-19 and hypoxemic respiratory failure. O2matic®自动氧滴定治疗新冠肺炎合并低氧性呼吸衰竭患者
IF 1.9 Q3 Medicine Pub Date : 2020-10-14 DOI: 10.1080/20018525.2020.1833695
Ejvind Frausing Hansen, Charlotte Sandau Bech, Jørgen Vestbo, Ove Andersen, Linette Marie Kofod

Introduction: Patients with coronavirus disease (COVID-19) and pneumonitis often have hypoxemic respiratory failure and a need of supplementary oxygen. Guidelines recommend controlled oxygen, for most patients with a recommended interval of SpO2 between 92 and 96%. We aimed to determine if closed-loop control of oxygen was feasible in patients with COVID-19 and could maintain SpO2 in the specified interval.

Methods: Patients were prospectively enrolled in an observational study on a medical ward dedicated to patients with COVID-19. Closed-loop controlled oxygen was delivered by O2matic® which can deliver 0-15 liters/min and adjusts flow every second based on 15 seconds averaging of SpO2 measured by pulse oximetry. Lung function parameters were measured at admission.

Results: Fifteen patients (six women, nine men) participated in the study. Average age was 72 years. Lung function was severely impaired with FEV1, FVC and PEF reduced to approximately 50%. The average stay on the ward was 3.2 days and O2matic was used on average for 66 hours, providing 987 hours of observation. O2matic maintained SpO2 in the desired interval for 82.9% of the time. Time with SpO2 > 2% below interval was 5.1% and time with SpO2 > 2% above interval was 0.6%.

Conclusion: Closed-loop control of oxygen to patients with COVID-19 is feasible and can maintain SpO2 in the specified interval in the majority of time. Closed-loop automated control could be of particular benefit for patients in isolation with decreased visibility, surveillance and monitoring. Further studies must examine the clinical benefits.

简介:冠状病毒病(COVID-19)和肺炎患者经常出现低氧性呼吸衰竭,需要补充氧气。指南建议控制氧气,对于大多数患者,建议SpO2间隔在92 - 96%之间。我们的目的是确定在COVID-19患者中闭环控制氧是否可行,并能维持SpO2在规定的时间间隔内。方法:前瞻性地将患者纳入一项针对COVID-19患者的医学病房的观察性研究。闭环控制氧气由O2matic®提供,可提供0-15升/分钟,并根据脉搏血氧仪测量的15秒SpO2平均值每秒调节流量。入院时测量肺功能参数。结果:15例患者(6名女性,9名男性)参与了研究。平均年龄为72岁。肺功能严重受损,FEV1、FVC和PEF降低至约50%。平均住院时间3.2天,平均使用O2matic 66小时,观察时间987小时。O2matic在82.9%的时间内将SpO2维持在所需的时间间隔内。SpO2 < 2%的时间为5.1%,高于SpO2 > 2%的时间为0.6%。结论:对COVID-19患者进行闭环控氧是可行的,在大多数时间内可将SpO2维持在规定的时间间隔内。闭环自动控制对于能见度、监测和监测下降的隔离患者可能特别有益。进一步的研究必须检验临床效益。
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引用次数: 8
Improved bioavailability of cromolyn sodium using inhaled PA101 delivered via eFlow® nebulizer. 通过eFlow®喷雾器吸入PA101提高了色胺酸钠的生物利用度。
IF 1.9 Q3 Medicine Pub Date : 2020-08-20 DOI: 10.1080/20018525.2020.1809083
Khalid Abd-Elaziz, Hanneke Oude Elberink, Zuzana Diamant

In 1960s, cromolyn sodium (CS) has been introduced as the first non-steroidal anti-inflammatory drug for the treatment of allergic and mast-cell driven diseases. Its applicability has been limited due to a poor bioavailability. Here we present pharmacokinetic data of a novel high concentration formulation of CS (PA101) delivered via a high-efficiency nebulizer (eFlow®) in healthy volunteers (HVs), allergic asthmatics and patients with indolent systemic mastocytosis (ISM). In HVs, PA101 40 mg and 80 mg (30 L) and PA101 40 mg (40 L), IntalTM (via LC® Plus) 20 mg and Nalcrom® (oral suspension) 200 mg showed maximum measured plasma concentration (Cmax) of 156, 236, 88.6, 17.8 and 5.23 ng/mL, respectively, with respective areas under the plasma time-concentration curve (AUC) of 338, 526, 212, 40.6 and 33.3 h·ng/mL. Systemic exposure (AUC) to CS with PA101 40 mg was approximately 8-fold and 11-fold higher compared to IntalTM and Nalcrom® in HVs, respectively. PA101 via eFlow® yielded comparable PK profiles in HVs and patients. Systemic bioavailability of PA101 was approximately 25% compared to approximately 1% for Nalcrom® and approximately 10% for IntalTM, respectively. These data warrant further research on the therapeutic potential of PA101 (via eFlow®) in allergic and mast-cell driven diseases.

在20世纪60年代,色molyn钠(CS)作为第一种非甾体抗炎药被引入治疗过敏性和肥大细胞驱动的疾病。由于生物利用度差,其适用性受到限制。在这里,我们展示了一种新型高浓度CS (PA101)制剂通过高效雾化器(eFlow®)在健康志愿者(HVs)、过敏性哮喘患者和惰性全身性肥大细胞增多症(ISM)患者中的药代动力学数据。在HVs中,PA101 40 mg、80 mg (30 L)和PA101 40 mg (40 L)、IntalTM (via LC®Plus) 20 mg和Nalcrom®(口服混悬液)200 mg的最大血药浓度(Cmax)分别为156、236、88.6、17.8和5.23 ng/mL,血药时间-浓度曲线下面积(AUC)分别为338、526、212、40.6和33.3 h·ng/mL。与IntalTM和Nalcrom®相比,在HVs中,PA101 40mg的CS系统暴露(AUC)分别高出约8倍和11倍。PA101通过eFlow®在hiv患者和患者中获得了相似的PK谱。PA101的系统生物利用度约为25%,而Nalcrom®约为1%,IntalTM约为10%。这些数据为进一步研究PA101(通过eFlow®)在过敏性和肥大细胞驱动疾病中的治疗潜力提供了依据。
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引用次数: 0
Changes in management of idiopathic pulmonary fibrosis: impact on disease severity and mortality. 特发性肺纤维化治疗的改变:对疾病严重程度和死亡率的影响
IF 1.9 Q3 Medicine Pub Date : 2020-08-12 DOI: 10.1080/20018525.2020.1807682
Charlotte Hyldgaard, Janne Møller, Elisabeth Bendstrup

Background: Idiopathic pulmonary fibrosis (IPF) is a serious interstitial lung disease (ILD) with a median survival of 3-5 years. The aim of the present study was to evaluate disease severity and survival in patients diagnosed with IPF in the era of antifibrotic therapies compared with an earlier IPF cohort.

Methods: We identified all patients with fibrotic ILD in the hospital electronic case record system between 2011 and 2016, and reviewed each case in order to identify incident patients with IPF. We used the GAP-index to compare disease severity and mortality to previous findings in patients with IPF diagnosed at our center between 2003 and 2009.

Results: 260 patients were diagnosed with IPF between 2011 and 2016. Mean age was 72.6 years, 79% were male, mean forced vital capacity (FVC) was 80%, and mean diffusing capacity for carbon monoxide (DLco) was 44%. Age, FVC and DLco were significant predictors of mortality, but the presence of a typical usual interstitial pneumonia pattern on HRCT was not. Eighty percent of patients in GAP stage I received antifibrotic therapy, 73% in GAP stage II, and 29% in GAP stage III.The median survival was four years in the 2011-2016 cohort compared with three years in the 2003-2009 cohort. The distribution of patients between GAP stages was unchanged in 2011-2016 compared with 2003-2009, (stage I 34% vs. 32%, stage II 49% vs. 48% and stage III 20% vs. 16%). One-year mortality was 13% in 2011-2016 and 26% in 2003-2009. In severe disease (GAP stage III), one-year mortality was 26% and 54%, respectively, (p=0.019).

Conclusion: Short-term mortality was significantly lower in the 2011-2016 cohort compared with 2003-2009. This improvement may be linked to changes in treatment strategies towards limited use of corticosteroids. Although early diagnosis of IPF still needs increased focus, the improvement is encouraging.

背景:特发性肺纤维化(IPF)是一种严重的间质性肺疾病(ILD),中位生存期为3-5年。本研究的目的是评估抗纤维化治疗时代诊断为IPF的患者的疾病严重程度和生存率,并与早期IPF队列进行比较。方法:我们在2011年至2016年的医院电子病例记录系统中对所有纤维化ILD患者进行分析,并对每个病例进行回顾,以确定IPF事件患者。我们使用gap指数来比较2003年至2009年间在本中心诊断的IPF患者的疾病严重程度和死亡率。结果:2011 - 2016年共诊断IPF 260例。平均年龄72.6岁,男性79%,平均用力肺活量(FVC) 80%,平均一氧化碳弥散量(DLco) 44%。年龄、FVC和DLco是死亡率的重要预测因子,但HRCT上是否存在典型的间质性肺炎则不是。80%的GAP I期患者接受抗纤维化治疗,73%的GAP II期患者接受抗纤维化治疗,29%的GAP III期患者接受抗纤维化治疗。2011-2016年队列的中位生存期为4年,而2003-2009年队列的中位生存期为3年。与2003-2009年相比,2011-2016年GAP分期之间的患者分布没有变化(I期34%对32%,II期49%对48%,III期20%对16%)。2011-2016年一年死亡率为13%,2003-2009年为26%。重症(GAP III期)患者一年死亡率分别为26%和54% (p=0.019)。结论:与2003-2009年相比,2011-2016年队列的短期死亡率显著降低。这种改善可能与有限使用皮质类固醇治疗策略的改变有关。虽然IPF的早期诊断仍然需要更多的关注,但改善是令人鼓舞的。
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引用次数: 5
Acute exacerbations of COPD and risk of lung cancer in COPD patients with and without a history of asthma. 有或无哮喘史的COPD患者的COPD急性加重和肺癌风险
IF 1.9 Q3 Medicine Pub Date : 2020-08-07 DOI: 10.1080/20018525.2020.1799540
Ane Aamli Gagnat, Miriam Gjerdevik, Stein Atle Lie, Amund Gulsvik, Per Bakke, Rune Nielsen

Rationale: There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma.

Methods: In the GenKOLS study of 2003-2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function.

Measurements and results: During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39-5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer.

Conclusions: AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.

理由:关于慢性阻塞性肺疾病(AECOPD)急性加重对有或无哮喘病史的COPD患者肺癌风险的影响的知识有限。本研究旨在研究AECOPD是否与肺癌风险相关,以及这种影响是否取决于哮喘史。方法:在2003-2005年的GenKOLS研究中,852例COPD患者进行肺活量测定,并填写吸烟习惯、症状和病史问卷。这些数据与2013年挪威癌症登记处的肺癌数据相关联。基线AECOPD是主要预测指标。为了量化肺癌风险的差异,我们进行了Cox-proportional hazards regression。我们调整了性别、年龄、吸烟变量、体重指数和肺功能。测量和结果:随访期间,8.8%有加重的受试者和5.9%无加重的受试者被诊断为肺癌。Cox回归分析显示,无哮喘病史的COPD患者伴一次或多次急性发作的肺癌风险显著增加,HRR = 2.77 (95% CI 1.39-5.52)。我们发现哮喘病史和AECOPD对肺癌有显著的相互作用。结论:无哮喘病史的COPD患者AECOPD与肺癌风险增加相关。
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引用次数: 2
Evaluating the effect on asthma quality of life of added reflexology or homeopathy to conventional asthma management - an investigator-blinded, randomised, controlled parallel group study. 评估在传统哮喘治疗基础上增加反射疗法或顺势疗法对哮喘患者生活质量的影响--一项由研究者盲法随机对照的平行小组研究。
IF 1.9 Q3 Medicine Pub Date : 2020-07-14 DOI: 10.1080/20018525.2020.1793526
Ayfer Topcu, Anders Løkke, Leila Eriksen, Lars Peter Nielsen, Ronald Dahl

Background: Asthma is a common chronic disease worldwide without any known cure. Despite remarkable improvement in asthma treatment, better education and guideline implementation strategies, there is growing interest in using complementary and alternative medicine, like reflexology and homeopathy. However, evidence supporting the effectiveness of homeopathy and reflexology in asthma treatment is not available.

Objective: The aim of this study was to evaluate the effect of reflexology and homeopathy as adjunctive therapies in asthma.

Methods: In a single centre, randomised, investigator blinded, controlled study 86 asthma patients were enrolled. They were assigned to one of three study groups (conventional treatment alone or conventional treatment with addition of either homeopathy or reflexology). All patients received their asthma treatment during the study and were followed as usual by their general practitioner. The study assignment group of individual patients were blinded to the investigators, who made the clinical evaluation of asthma control. The primary outcome was the change in the asthma quality of life questionnaire (AQLQ) scores after 26 weeks. Secondary outcomes included asthma control questionnaire, EuroQol, forced expiratory volume in 1 sec, morning and evening peak expiratory flow, asthma symptoms, rescue medication use, and total medication score.

Results: Minor improvements in the AQLQ score were observed in all three groups. However, no statistically significant changes in AQLQ scores were seen within or between groups. Likewise, secondary outcomes did not differ between groups.

Conclusions: In this study, the addition of homeopathy or reflexology to conventional treatment did not result in improved quality of life in asthma.

背景:哮喘是一种全球常见的慢性疾病,目前尚无根治方法。尽管哮喘治疗有了明显改善,教育和指南实施策略也得到了改善,但人们对使用反射疗法和顺势疗法等补充和替代医学的兴趣却与日俱增。然而,支持顺势疗法和反射疗法在哮喘治疗中的有效性的证据并不存在:本研究旨在评估反射疗法和顺势疗法作为哮喘辅助疗法的效果:在一项单中心、随机、研究者盲法对照研究中,86 名哮喘患者参与了研究。他们被分配到三个研究组中的一组(单纯常规治疗组或在常规治疗基础上加用顺势疗法或反射疗法组)。所有患者都在研究期间接受了哮喘治疗,并由其全科医生照常随访。研究人员对每个患者的研究分配组进行盲测,由研究人员对哮喘控制情况进行临床评估。研究的主要结果是 26 周后哮喘生活质量问卷 (AQLQ) 分数的变化。次要结果包括哮喘控制问卷、EuroQol、1秒用力呼气量、早晚高峰呼气流量、哮喘症状、抢救用药和用药总分:所有三组患者的 AQLQ 评分都略有提高。然而,在组内或组间,AQLQ 评分均未出现统计学意义上的显著变化。同样,各组之间的次要结果也没有差异:在这项研究中,在常规治疗的基础上增加顺势疗法或反射疗法并不能改善哮喘患者的生活质量。
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引用次数: 0
Disease self-management in patients with moderate COPD: a thematic analysis. 中度慢性阻塞性肺病患者的疾病自我管理:专题分析。
IF 1.9 Q3 Medicine Pub Date : 2020-05-31 DOI: 10.1080/20018525.2020.1762376
Katrine Rutkær Molin, Henning Langberg, Peter Lange, Ingrid Egerod

Background: Treatment of patients with moderate chronic obstructive pulmonary disease (COPD) is challenged by the low priority of the disease by patients and general practitioners (GPs) affecting the extent of self-management. The aim of this study was to explore (i) attitudes to COPD self-management in patients with moderate COPD, (ii) perceptions of GP commitment to pulmonary rehabilitation in patients with moderate COPD, and (iii) COPD knowledge in patients with moderate COPD.

Methods: The study had a qualitative design using semi-structured interviews to explore the views of 14 patients diagnosed with moderate COPD. We applied strategic sampling to obtain maximum variation and conducted a thematic analysis of the data.

Results: Our main findings were that the degree of COPD self-management was linked to the resources of the informants. Further, the patients experienced that GPs only availed themselves of selected parts of the recommendations for COPD treatment by focusing on medical treatment and smoking cessation rather than physical activity and diet. Many patients lacked knowledge regarding the tolerated level of physical activity and therefore avoided activity increasing their heart rate. Finally, many patients were reluctant to accept the diagnosis because the disease is known to be self-inflicted.

Conclusion: Our study suggests that patients with moderate COPD need more information, especially regarding the positive effects of physical activity. GPs might need to devote more time to the three main elements of COPD treatment, smoking cessation, medical treatment, and physical activity, to promote self-management and a healthier lifestyle in patients with COPD.

背景:中度慢性阻塞性肺疾病(COPD)患者的治疗面临挑战,因为患者和全科医生(GPs)对该疾病的重视程度较低,影响了患者自我管理的程度。本研究旨在探讨:(i) 中度慢性阻塞性肺病患者对慢性阻塞性肺病自我管理的态度;(ii) 中度慢性阻塞性肺病患者对全科医生肺康复承诺的看法;(iii) 中度慢性阻塞性肺病患者对慢性阻塞性肺病知识的了解:研究采用半结构式访谈的定性设计,探讨了 14 名中度慢性阻塞性肺病患者的观点。我们采用策略性抽样以获得最大程度的差异,并对数据进行了主题分析:我们的主要发现是,慢性阻塞性肺病自我管理的程度与信息提供者的资源有关。此外,患者认为全科医生只利用了慢性阻塞性肺病治疗建议中的部分内容,重点放在了药物治疗和戒烟上,而不是体育锻炼和饮食上。许多患者不了解可耐受的体育锻炼水平,因此避免进行增加心率的活动。最后,许多患者不愿接受诊断,因为众所周知这种疾病是自己造成的:我们的研究表明,中度慢性阻塞性肺病患者需要更多的信息,尤其是关于体育锻炼积极作用的信息。全科医生可能需要在慢性阻塞性肺病治疗的三大要素--戒烟、药物治疗和体育锻炼上投入更多时间,以促进慢性阻塞性肺病患者的自我管理和更健康的生活方式。
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引用次数: 0
Guideline for the management of COVID-19 patients during hospital admission in a non-intensive care setting. 非重症监护环境中 COVID-19 患者入院管理指南。
IF 1.8 Q3 RESPIRATORY SYSTEM Pub Date : 2020-05-28 DOI: 10.1080/20018525.2020.1761677
Klaus Nielsen Jeschke, Barbara Bonnesen, Ejvind Frausing Hansen, Jens-Ulrik Stæhr Jensen, Therese Sophie Lapperre, Ulla Møller Weinreich, Ole Hilberg

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has presented health-care systems worldwide with novel challenges and experiences and evidence is emerging during the pandemic. Patients requiring hospitalization frequently suffer from respiratory failure of different severities.

Aim: The aim of this guideline is the treatment of patients with SARS CoV-2 (COVID-19) in hospital; in particular, it addresses the treatment of respiratory failure treated in general Internal Medical- and Pulmonary Medical wards.

Results: Elderly patients and patients with chronic disease are particularly vulnerable to COVID-19. Target oxygen saturation should be between 92% and 96% in patients without chronic lung diseases. Treatment with >5 L oxygen/min should be in close collaboration with intensive care colleagues and >15 l/min preferably in intensive care units. High-flow nasal canula (HFNC) and long-term Continuous Positive Airway Pressure (CPAP) are recommended for patients not responding to conventional oxygen therapy. Non-invasive ventilation (NIV) is only recommended for selected patients, such as those with a ceiling of treatment or patients presenting with hypercapnic failure. With the use of humidification protective equipment as FFP2-3 masks should be used. Nebulized medication should be avoided, and spacers should be used instead.

Conclusion: Respiratory failure is frequently the cause of hospitalization in patients with COVID-19 and should be monitored closely.

导言:严重急性呼吸系统综合症冠状病毒 2(SARS-CoV-2)给全世界的医疗保健系统带来了新的挑战和经验,而且在这一流行病的过程中也出现了新的证据。目的:本指南的目的是治疗住院的 SARS CoV-2 (COVID-19) 患者,尤其是在普通内科和肺科病房治疗呼吸衰竭的患者:结果:老年患者和慢性病患者特别容易感染 COVID-19。无慢性肺病患者的目标血氧饱和度应在 92% 至 96% 之间。应与重症监护室的同事密切合作,使用大于 5 升/分钟的氧气进行治疗,最好在重症监护室使用大于 15 升/分钟的氧气。对于常规氧疗无效的患者,建议使用高流量鼻导管(HFNC)和长期持续气道正压(CPAP)。无创通气 (NIV) 只推荐用于特定患者,如治疗达到上限或出现高碳酸血症衰竭的患者。在使用加湿保护设备时,应使用 FFP2-3 面罩。应避免雾化吸入药物,而应使用喷雾器:结论:呼吸衰竭是 COVID-19 患者住院的常见原因,应密切监测。
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引用次数: 0
Clinical and daily respiratory care and clinical trials within the COVID-19 era. 新冠肺炎时代的临床和日常呼吸护理及临床试验。
IF 1.9 Q3 Medicine Pub Date : 2020-05-25 DOI: 10.1080/20018525.2020.1766817
Zuzana Diamant, Vibeke Backer, Leif Bjermer
Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
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引用次数: 1
期刊
European Clinical Respiratory Journal
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