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Abstract
INTRODUCTION The demand for Hospital in the Home has increased, especially as an avenue for treatment of respiratory exacerbations. However, a limiting factor of Hospital in the Home efficiency is excess travel. Telehealth can potentially increase in-home access to specialist care such as physiotherapy. This study examined clinical outcomes achieved with a hybrid telehealth model and assessed safety and efficiency. METHOD This study was an observational benchmarking study of Hospital in the Home physiotherapy episodes of care during respiratory exacerbations between January 2017-June 2019. The participants were young people aged 8-18 years, with cystic fibrosis receiving intravenous antibiotics and bi-daily physiotherapy. The intervention was physiotherapy via either a hybrid model (1× telehealth, 1× face-to-face session) or standard care (2× face-to-face sessions). The outcomes were frequency of return to at least 95% of baseline percentage predicted forced expiratory volume in the first second (ppFEV1), ppFEV1 change, adverse events, travel time and distance saved. RESULTS There were 82 episodes of Hospital in the Home; 41 hybrid and 41 standard care. Return to at least 95% of baseline was achieved in 49% of the hybrid group and 32% of standard care. Median ppFEV1 change was +6% for the hybrid group and +2% standard care. There were no adverse events. Estimated travel time and distance saved was 16,520 min and 12,301.2 km. CONCLUSION Preliminary information supports a hybrid telehealth physiotherapy model as an alternative to standard care for young people with cystic fibrosis during an exacerbation. Safety of telehealth in conjunction with home visits favoured its use to improve efficiency and capacity without added risk.
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Affiliation(s)
- Cloe Benz
- Physiotherapy, Children's Hospital Westmead, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | | | | | - Adrienne Harvey
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Australia
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Fainardi V, Caffarelli C, Bergamini BM, Biserna L, Bottau P, Corinaldesi E, Dondi A, Fornaro M, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Venturelli C, Ricci G, Esposito S; Emilia-Romagna Asthma (ERA) Study Group. Management of Children with Acute Asthma Attack: A RAND/UCLA Appropriateness Approach. Int J Environ Res Public Health 2021; 18:12775. [PMID: 34886505 DOI: 10.3390/ijerph182312775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/22/2022]
Abstract
Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease.
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Renner S, Nachbaur E, Jaksch P, Dehlink E. Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation. J Fungi (Basel) 2020; 6:jof6040381. [PMID: 33371198 PMCID: PMC7766476 DOI: 10.3390/jof6040381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022] Open
Abstract
Cystic fibrosis is the most common autosomal-recessive metabolic disease in the Western world. Impaired trans-membrane chloride transport via the cystic fibrosis transmembrane conductance regulator (CFTR) protein causes thickened body fluids. In the respiratory system, this leads to chronic suppurative cough and recurrent pulmonary infective exacerbations, resulting in progressive lung damage and respiratory failure. Whilst the impact of bacterial infections on CF lung disease has long been recognized, our understanding of pulmonary mycosis is less clear. The range and detection rates of fungal taxa isolated from CF airway samples are expanding, however, in the absence of consensus criteria and univocal treatment protocols for most respiratory fungal conditions, interpretation of laboratory reports and the decision to treat remain challenging. In this review, we give an overview on fungal airway infections in CF and CF-lung transplant recipients and focus on the most common fungal taxa detected in CF, Aspergillus fumigatus, Candida spp., Scedosporium apiospermum complex, Lomentospora species, and Exophiala dermatitidis, their clinical presentations, common treatments and prophylactic strategies, and clinical challenges from a physician’s point of view.
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Affiliation(s)
- Sabine Renner
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Associated National Center in the European Reference Network on Rare Respiratory Diseases ERN-LUNG and the European Reference Network on Transplantation in Children, ERN TRANSPLANT-CHILD, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (E.N.)
| | - Edith Nachbaur
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Associated National Center in the European Reference Network on Rare Respiratory Diseases ERN-LUNG and the European Reference Network on Transplantation in Children, ERN TRANSPLANT-CHILD, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (E.N.)
| | - Peter Jaksch
- Division of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Eleonora Dehlink
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Associated National Center in the European Reference Network on Rare Respiratory Diseases ERN-LUNG and the European Reference Network on Transplantation in Children, ERN TRANSPLANT-CHILD, Medical University of Vienna, 1090 Vienna, Austria; (S.R.); (E.N.)
- Correspondence:
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Hayama H, Ishikane M, Sato R, Kanda K, Kinoshita N, Izumi S, Ohmagari N, Hiroi Y. Association of plain computed tomography-determined pulmonary artery-to-aorta ratio with clinical severity of coronavirus disease 2019. Pulm Circ 2020; 10:2045894020969492. [PMID: 33282198 PMCID: PMC7686624 DOI: 10.1177/2045894020969492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease (COVID-19) is associated with pulmonary hypertension due to pulmonary
embolism, which affects subsequent outcomes. However, definitive diagnosis of pulmonary
hypertension is difficult because of the risk of spreading the infection. Here, we assess
the utility of plane computed tomography in noninvasively predicting the clinical severity
of COVID-19.
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Affiliation(s)
- Hiromasa Hayama
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Rubuna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kohei Kanda
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Kinoshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
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Annunziata A, Valente T, Cauteruccio R, Fiorentino G. Silent dysphagia in two patients with Steinert disease and recurrent respiratory exacerbations. Acta Myol 2020; 39:141-143. [PMID: 33305171 PMCID: PMC7711324 DOI: 10.36185/2532-1900-019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
We describe two cases of patients with Steinert’s dystrophy or myotonic dystrophy type 1 (DM1) who presented with frequent respiratory exacerbations and pneumonia. They did not report any risk factors for asthma, allergy, bronchopathy or dysphagia in their history. The Videofluoroscopic swallow study test allowed to highlight post-swallowing aspiration phenomena responsible for respiratory exacerbations.
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Affiliation(s)
- Anna Annunziata
- UOC Pathophysiology and Respiratory Rehabilitation, Intensive Care Department, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Tullio Valente
- UOC Radiology, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Rosa Cauteruccio
- UOC Pathophysiology and Respiratory Rehabilitation, Intensive Care Department, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Fiorentino
- UOC Pathophysiology and Respiratory Rehabilitation, Intensive Care Department, Azienda Ospedaliera dei Colli, Naples, Italy
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Rong Y, Bentley JP, McGwin G, Yang Y, Banahan BF, Noble SL, Kirby T, Ramachandran S. Association Between Transient Opioid Use and Short-Term Respiratory Exacerbation Among Adults With Chronic Obstructive Pulmonary Disease: A Case-Crossover Study. Am J Epidemiol 2019; 188:1970-1976. [PMID: 31361012 DOI: 10.1093/aje/kwz169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/14/2022] Open
Abstract
The association of historical opioid use with health care use and death among patients with chronic obstructive pulmonary disease (COPD) has been tested. Using Mississippi Medicaid data, we examined the association of transient or short-term opioid use and acute respiratory exacerbations among adults with COPD. We used a case-crossover design and 2013-2017 Mississippi Medicaid administrative claims data. A total of 1,972 qualifying exacerbation events occurred in 1,354 beneficiaries. The frequency and dose of opioid exposure in the 7 days before the exacerbation were examined and compared with the opioid exposure in 10 control windows, each 7 days long, before the exacerbation. Adjusted odds ratios were estimated using conditional logistic regression models to estimate the risk of opioid use on exacerbations after accounting for use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Overall, opioid exposure in the 7 days before an exacerbation was significantly associated with acute respiratory exacerbation (odds ratio = 1.81; 95% confidence interval: 1.60, 2.05). Each 25-mg increase in morphine equivalent daily dose was associated with an 11.2% increase in the odds of an acute respiratory exacerbation (odds ratio = 1.11; 95% confidence interval: 1.04, 1.20). Transient use of opioids was significantly associated with acute respiratory exacerbation of COPD.
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Milito C, Pulvirenti F, Cinetto F, Lougaris V, Soresina A, Pecoraro A, Vultaggio A, Carrabba M, Lassandro G, Plebani A, Spadaro G, Matucci A, Fabio G, Dellepiane RM, Martire B, Agostini C, Abeni D, Tabolli S, Quinti I. Double-blind, placebo-controlled, randomized trial on low-dose azithromycin prophylaxis in patients with primary antibody deficiencies. J Allergy Clin Immunol 2019; 144:584-593.e7. [PMID: 30910492 DOI: 10.1016/j.jaci.2019.01.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lacking protective antibodies, patients with primary antibody deficiencies (PADs) experience frequent respiratory tract infections, leading to chronic pulmonary damage. Macrolide prophylaxis has proved effective in patients with chronic respiratory diseases. OBJECTIVE We aimed to test the efficacy and safety of orally administered low-dose azithromycin prophylaxis in patients with PADs. METHODS We designed a 3-year, double-blind, placebo-controlled, randomized clinical trial to test whether oral azithromycin (250 mg administered once daily 3 times a week for 2 years) would reduce respiratory exacerbations in patients with PADs and chronic infection-related pulmonary diseases. The primary end point was the number of annual respiratory exacerbations. Secondary end points included time to first exacerbation, additional antibiotic courses, number of hospitalizations, and safety. RESULTS Eighty-nine patients received azithromycin (n = 44) or placebo (n = 45). The number of exacerbations was 3.6 (95% CI, 2.5-4.7) per patient-year in the azithromycin arm and 5.2 (95% CI, 4.1-6.4) per patient-year in the placebo arm (P = .02). In the azithromycin group the hazard risk for having an acute exacerbation was 0.5 (95% CI, 0.3-0.9; P = .03), and the hazard risk for hospitalization was 0.5 (95% CI, 0.2-1.1; P = .04). The rate of additional antibiotic treatment per patient-year was 2.3 (95% CI, 2.1-3.4) in the intervention group and 3.6 (95% CI, 2.9-4.3) in the placebo group (P = .004). Haemophilus influenzae and Streptococcus pneumoniae were the prevalent isolates, and they were not susceptible to macrolides in 25% of patients of both arms. Azithromycin's safety profile was comparable with that of placebo. CONCLUSION The study reached the main outcome centered on the reduction of exacerbation episodes per patient-year, with a consequent reduction in additional courses of antibiotics and risk of hospitalization.
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Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, University of Brescia, and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Annarosa Soresina
- Department of Pediatrics, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Maria Carrabba
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Lassandro
- Department of Biomedicine and Evolutive Age, University of Bari, Bari, Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, University of Brescia, and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Baldassarre Martire
- Department of Biomedicine and Evolutive Age, University of Bari, Bari, Italy
| | - Carlo Agostini
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Damiano Abeni
- Health Services Research Unit IDI, IRCCS, Rome, Italy
| | | | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
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Vianello A, Carraro E, Pipitone E, Marchese-Ragona R, Arcaro G, Ferraro M, Paladini L, Martinuzzi A. Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy. Respir Care 2015; 60:1431-7. [PMID: 25922546 PMCID: PMC9993764 DOI: 10.4187/respcare.04024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient. METHODS Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight SpO2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, ≥ 2 exacerbations) and infrequent exacerbators (ie, < 2 exacerbations). RESULTS The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P = .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P = .02) and higher PaCO2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in PaCO2 , P = .05). Subjects with PaCO2 ≥ 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5-152.5, P = .01). CONCLUSIONS Gastroesophageal reflux and increased PaCO2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP.
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Affiliation(s)
- Andrea Vianello
- Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy.
| | - Elena Carraro
- Neuropediatric Rehabilitation Unit, E Medea Scientific Institute, Conegliano, Italy
| | - Emanuela Pipitone
- Department of Formative Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giovanna Arcaro
- Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy
| | - Marco Ferraro
- Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy
| | - Luciana Paladini
- Respiratory Pathophysiology Division, City Hospital of Padova, Padova, Italy
| | - Andrea Martinuzzi
- Neuropediatric Rehabilitation Unit, E Medea Scientific Institute, Conegliano, Italy
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