Exercise places a unique set of physiological demands on the airway tract. Historically, most work in this area has focused on the lower airway response, however it is now becoming increasingly apparent that the structural and functional behaviour of the upper airway and large central airways is equally important. Dysfunction in these sections of the airway tract can act to either hinder or modulate the exercise ventilatory response and as such lead to an increased work of breathing and the development of troublesome respiratory symptoms. This article provides an overview of the way in which the entire airway tract is challenged by the heightened ventilatory state mandated by physical activity, highlighting recent developments in our understanding of the physiology of laryngeal, large central and lower airway function during exercise.
The relative steady-state bioavailability of two oral digoxin dosage forms was studied in 17 subjects with malabsorption syndromes. Male subjects received the following treatments in randomized crossover fashion for 14 days: three 0.125-mg digoxin tablets or three 0.1-mg digoxin capsules once daily. Female subjects received digoxin on the same schedule but at two-thirds the dose. Serum and urine samples were collected and analyzed for digoxin by radioimmunoassay, and treatments were compared by evaluating pharmacokinetic parameters. The mean area under the serum concentration versus time curve for tablets (28.1 h.nmol/L [21.9 h.ng/mL]) was smaller (p less than 0.03) than that for capsules (31.1 h.nmol/L [24.3 h.ng/mL]), and the mean maximum serum digoxin concentration for tablets (2.9 nmol/L [2.3 ng/mL]) was lower (p less than 0.02) than that for capsules (4.0 nmol/L [3.1 ng/mL]). There was no difference in cumulative urinary excretion of digoxin between the two treatments. In contrast to previous reports, we observed that digoxin from Lanoxin Tablets appears to be well absorbed in subjects with malabsorption. Nevertheless, these subjects absorbed digoxin from capsules better than from tablets, with the greatest differences occurring in subjects without a colon and in those subjects with the lowest serum carotene concentrations.
Results There were 20 patients analysed (SAFS, n = 11) and (ABPA n = 9), M: F = 8:12, median age 65.5 yrs (range = 24-78). The median duration of therapy was 30 days (IQR,. Clinical benefit was observed in 2 (10%) in which mean ACQ score improved from 6 to 2, overall mean AQLQ score improved by 0.95 and mean FEV1 improved by 1.2 L ( 63.1%). Seven (35%) failed the challenge due to bronchospasm. 11 (55%) discontinued within 12 months of therapy due to delayed bronchospasm (n = 3, within 4 weeks), equipment problems (n = 4) and lack of clinical benefit (n = 4) (fig 1). There were no significant changes in immunological and radiological outcomes. Conclusion Our data suggests that the overall efficacy of nebulised amphotericin in this group of patients may be poor and is associated with high frequency of adverse events. However, the responses were excellent in 2 (10%) patients. It is not clear which patients are likely to respond. Further studies need to be conducted to establish the optimal dose range (dose, frequency), nebulizer type, pressures and identification of patients who may respond.Abstract S92 Figure 1. Reason for treatment failure in patients treated with non-liposomal, nebulised Amphotericin B (Fungisone). Na= Not applicable (ie no failure observed).
IntroductionSpecialist speech and language therapy (SLT) has an important role in the treatment of chronic refractory cough (CRC). Therapy is typically delivered to patients individually; however, this approach is resource-intensive and reduces service capacity. Moreover, the content of SLT for CRC is often similar across patients. The aim of this work was to describe the efficacy of a SLT-delivered cough therapy group (CTG).MethodologyEligible patients attended the CTG (2016–2017) after an initial 1:1 assessment to determine suitability. Individuals with an infectious cause of cough were excluded. All patients had undergone prior assessment and treatment optimisation at the RBH chronic cough clinic. Cough severity was rated using a visual analogue scale (VAS) at first attendance and on discharge from the group. Patients attended a maximum of four sessions with 4–8 patients per session, after which they were referred for individual review if they felt no improvement had been made. CTG sessions consisted of strategies to reduce cough frequency (through improved upper airway lubrication, reduction of laryngeal muscle strain and use of cough control strategies), sharing experiences, observing other patient-therapist interactions and time to talk individually with the SLT.ResultsNinety-one patients (n=26 males, 28.6%) aged between 30 and 83 years (M=61.4, SD 11.1) attended CTG. The majority of attendees (n=46, 50.5%) reported cough duration of greater than 15 years. There was a reduction in mean VAS following group attendance (p<0.05) (figure 1) with the greatest reduction noted after 3 attendances (p<0.05). The most common patient-reported benefits of group attendance were sharing advice (80.2%) and meeting other people with a cough (76.9%).Abstract P107 Figure 1Mean VAS scores of cough severity pre- and post-CTG attendance.ConclusionA group-delivered SLT treatment intervention was associated with reduction in cough severity in a cohort of patients with CRC. Service benefits included reduced waiting time and improved access to individual SLT sessions. Future work should focus on qualitative analysis of patient-reported benefits of group therapy and evaluation of efficacy in a prospective, randomised study.
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