Background Palliative oxygen therapy is widely used for dyspnea in individuals with life-limiting illness ineligible for long-term oxygen therapy. Methods This international double-blind randomized controlled trial evaluatedeffectiveness of oxygen vs. medical (room) air for relieving breathlessness in patients with life-limiting illness, refractory dyspnea, and PaO2>55 mm Hg. Participants were recruited from outpatient clinics at 9 sites (Australia, United States, England). Participants received oxygen or medical air via concentrator through nasal cannulae at 2 liters/minute for 7 days. The primary outcome measure was breathlessness (0-10 numerical rating scale [NRS]), measured twice daily. Findings Participants (N=239) were: mean age, 73 (standard deviation [SD] 10); 62% male; mean PaO2, 77 mm Hg (SD 12); mean morning dyspnea, 4.5 on NRS (SD 2.2); chronic obstructive pulmonary disease, 64%; cancer, 16%. Oxygen was not significantly superior to medical air for relief of breathlessness. Over the 7-day period, after provision of medical gas, mean morning and evening dyspnea decreased by -0.8 (95% confidence interval [CI]: -1.1, -0.5) and -0.4 (CI: -0.7, 0.1), respectively (p<0.001), regardless of intervention. Baseline dyspnea predicted improvement with medical gas; participants with moderate (4-6 NRS) and severe (7-10 NRS) baseline dyspnea had average decreases in morning dyspnea of -0.7 (CI: -1.1, -0.4) and -2.4 (CI: -3.0, -1.8), respectively. Interpretation There is no additional symptomatic benefit of oxygen over room air delivered by nasal cannulae for relieving refractory dyspnea related to life-limiting illness in patients with PaO2>55 mm Hg. Dyspnea intensity decreased in both study arms, temporally related to provision of medical gas.

Aims: To determine the accuracy of the forced expiratory volume ratio at one and six seconds (FEV1/FEV6) using a hand-held, expiratory flow meter (PiKo-6 ® , nSpire Health, Inc.) to screen for chronic obstructive pulmonary disease (COPD) in primary care settings. Conclusions: The PiKo-6 ® allows simple and reliable screening for COPD which could optimise early referral for spirometry and early, targeted interventions for COPD.

Domiciliary oxygen for chronic obstructive pulmonary disease.

A preliminary set of Australian predictive equations have been produced for the IOS. These have been compared with international equations. IOS has potential applications in a range of respiratory diseases and in population screening for occupational health assessment.

Given the progress in the symptomatic treatment of breathlessness, and the physical and psychological morbidity associated with chronic breathlessness, estimates of the size of the population that may benefit from better support become imperative. Prevalence estimates have varied widely (0.9% of clinical encounters to 32%) and have largely relied only on respondents who used clinical services. Whole-of-population approaches may be able to define better the "true" prevalence of chronic breathlessness and quantify exertion limited by breathlessness. The aim of this study was to estimate population levels of chronic breathlessness, severity of limits to exercise, and demographic predictors of the presence of breathlessness. A whole-of-population face-to-face survey method (n=8,396) in South Australia was used, directly standardized for age, gender, country of birth, and rurality. Respondents were asked about breathlessness and levels of exertion causing breathlessness for at least three of the last six months using a modified Medical Research Council dyspnea scale. Univariate and multivariate analyses identify the demographic characteristics of people more likely to experience chronic breathlessness. With a participation rate of 65.3%, 8.9% of respondents had breathlessness that chronically limited exertion. Significant associations with chronic breathlessness in multivariate analysis included female sex (P<0.001), not working full time (P<0.001), low income (P=0.007), and older age (P=0.031). There are significant levels of chronic breathlessness in the community. Given the prevalence, it is feasible to explore the onset of breathlessness, the underlying etiologies and subsequent health service utilization, and health consequences.

BackgroundBronchiectasis is predominantly an acquired disease process that represents the end stage of a variety of unrelated pulmonary insults. It is defined as persistent irreversible dilatation and distortion of medium-sized bronchi. It has been suggested that with widespread use of high-resolution computed tomography, more bronchiectasis diagnoses are being made. Patients diagnosed with bronchiectasis frequently have di iculty expectorating sputum. Sputum therefore is retained in the lungs and may become infected, leading to further lung damage. Mucolytic agents target hypersecretion or changed physiochemical properties of sputum to make it easier to clear. One drug, recombinant human DNase, breaks down the DNA that is released at the site of infection by neutrophils.Mucus clearance along with antimicrobial therapy remains an integral part of bronchiectasis management. Chest physiotherapy along with mucolytic agents is commonly used in practice without clear supportive evidence. ObjectivesTo determine whether ingested or inhaled mucolytics are e ective in the treatment of patients with bronchiectasis. Search methodsWe searched the Cochrane Airways Group Specialised Register and reference lists of relevant articles. We contacted experts in the field and drug companies. Searches were current as of June 2013. Selection criteriaRandomised trials of mucolytic treatment in people with bronchiectasis but not cystic fibrosis. Data collection and analysisData extraction was performed independently by two review authors. Study authors were contacted for confirmation. Main resultsFour trials (with a combined total of 528 adult participants) were included, but almost none of the data from these studies could be aggregated in a meta-analysis.One trial (with 88 participants) compared bromhexine versus placebo. Compared with placebo, high doses of bromhexine with antibiotics eased di iculty in expectoration (mean di erence (MD) -0.53, 95% confidence interval (CI) -0.81 to -0.25 at 16 days); the quality of the evidence was rated as low. A reduction in sputum production was noted with bromhexine (MD -21.5%, 95% CI -38.9 to -4.1 at day 16); again Mucolytics for bronchiectasis (Review)

Patients with chronic obstructive pulmonary disease and a stable daytime Pao2 of ≤ 55 mmHg (7.3kPa) live longer and have a better quality of life if provided with long‐term continuous oxygen therapy. It is reasonable to offer continuous oxygen therapy also to patients with other lung diseases that cause chronic hypoxaemia. Indications for supplemental oxygen therapy during exercise (ambulatory oxygen therapy) and sleep (nocturnal oxygen therapy) are less clear.

In routine practice, survival of unselected CAL patients with multiple comorbidities is less than that reported in the original RCT.