Home Noninvasive Ventilation to Reduce Readmissions for Chronic Obstructive Pulmonary Disease

Hill, Nicholas S.; Uğurlu, Aylin Özsancak

doi:10.1001/jama.2017.5226

Cited by 9 publications

(6 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Published studies are conflicting showing variable benefit and a 2013 Cochrane review concluded that there was no evidence of significant benefit in any of the measured parameters. 1 Other studies suggest a reduction in re-admission and death at 1 year between regular nocturnal NIV use and standard care. We have used oral modafinil 200 mg/day as a respiratory stimulant for chronic HRF in COPD without NIV.…”

mentioning

confidence: 98%

P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure

Varney

Quirke

Kearon

et al. 2017

Sleep and Breathing

View full text Add to dashboard Cite

Hypercapnic respiratory failure (HRF) is common in advanced COPD. The standard treatment is usually nasal ventilation (NIV) to reduce the blood carbon dioxide level acutely or regular nocturnal use in chronic cases. Not all patients tolerate such treatment and failures occur. Published studies are conflicting showing variable benefit and a 2013 Cochrane review concluded that there was no evidence of significant benefit in any of the measured parameters.1 Other studies suggest a reduction in re-admission and death at 1 year between regular nocturnal NIV use and standard care.We have used oral modafinil 200 mg/day as a respiratory stimulant for chronic HRF in COPD without NIV. We present the data from the first 11 cases (6 out of study and 7 in our current open randomised crossover study). The study patients had documented HRF for 6–12 months with PaC02 ≥6.5 before entry but refused NIV. We present the data at baseline and day 10 and 40 of modafinil, including mean arterial oxygen and carbon dioxide, Daytime and overnight oxygen saturations along with spirometry. We compare these Results with 2 published studies of NIV reported, one after 4 weeks2 and the other 12 months.3 The study showed a mean improvement by day 40 of +1.8 kPa in Pa02 and a reduction in PaCO2 by 2.7 kPa. Daytime saturations, improved by +15% and overnight saturations by +11%. FEV-1 and FVC improved by +4%–5% which may reflect reduced acidosis on ventilatory muscles. Compared with studies of nocturnal nasal ventilation, modafinil equalled the effects of NIV and tolerance was excellent. It could provide a cheaper and more effective alternative for patient unable to use long term NIV in HRF.Abstract P219 Table 1Study Datan=11BaselinePre-modafinil Day 10 modafinil200 mg/dayDay 40Modafinil200 mg/dayImprovementAt 40 days4 week NIV2ImprovementAfter 4 weeksOf NIV1 year study ofNIV 3ImprovementAt 1 year Mean ArterialPa02 kPaOn air (range)5.8(4.3–7.3)6.7(4.1–8.1)7.67(5.5–9.3)+1.87 kPa7.5 +1.7 7.0+2.4Mean ArterialPaC02 kPaOn air(range)8.6(6.5–13.4)6.7(5.2–8.0)5.9(5.0–6.3)−2.7 kPa7.5 −0.7 7.2−1.35Mean daytime saturations on air (range)75%(58–89)85%(65–92)90%(79–95)15%No dataNo dataNo dataNo dataMean overnight saturations on air(range)72%(58–86)79%(67–89)83%(68–91)+11%79%0%No dataNo dataMeanFEV-1 (%)28%30%32%+4%31%+6%25%−1%MeanFVC (%)48%45%53%+5%No dataNo data54%No dataReferencesN S Hill. JAMA on line21may, 2017.P Sivasothy. ERJ 1998;11:34–40.RD McEvoy. Thorax2009;64:561–566.

show abstract

mentioning

confidence: 98%

P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure

Varney

Quirke

Kearon

et al. 2017

Sleep and Breathing

View full text Add to dashboard Cite

show abstract

“…Introduction and objectives An association between silicosis and mycobacterium disease is well reported globally particularly amongst gold miners. 1 The rate of mycobacterium infection in silicosis cases in the last 15 years in the UK is unclear. The aim of this study was to establish the frequency of either Conclusion This study indicates that rates of TB and NTM in silicosis are relatively high, supporting previously published international data.…”

mentioning

confidence: 99%

“…The lifetime cost of a diagnosis is estimated to be £100 million and is largely borne by the patientwho may need to change their job with subsequent loss of earningsand the State. 1 We sought to understand changes in symptoms over time and the impact of a diagnosis of OA or occupational rhinitis (OR) on patients attending our clinic.…”

mentioning

confidence: 99%

“…The current evidence-based guidance on the prevention and management of OA was commissioned by the British Occupational Health Foundation (BOHRF) in 2010. 1 Our aim was to update these guidelines to help stakeholders reducing the incidence of OA by improved prevention, and the severity of individual cases of disease by earlier identification and better management. Methods We conducted a literature systematic review according to state-of-the-art methods via search of two electronic database (Embase and Medline), using the Ovid interface, from January 2009 to November 2016.…”

mentioning

confidence: 99%

See 1 more Smart Citation

P221 Silicosis and mycobacterium disease: is it a problem in the uk?

Hayton

Hoyle

2017

Danger at Work: Occupational Lung Disease and Asthma

View full text Add to dashboard Cite

Introduction and objectivesAn association between silicosis and mycobacterium disease is well reported globally particularly amongst gold miners.1 The rate of mycobacterium infection in silicosis cases in the last 15 years in the UK is unclear. The aim of this study was to establish the frequency of either tuberculosis (TB) or non-tuberculous mycobacterium (NTM) disease in a UK cohort.MethodsAn occupational lung disease database (2004–2017) identified those with an MDT diagnosis of silicosis. Case notes were examined.Results22 patients were identified. 100% men, mean age 59.1 years (24–83) and mean length of silica exposure of 23.0 years (2–51). 63.6% were current or ex-smokers with a mean pack year history of 27.1 pack years (5–40). Figure 1 shows the relevant occupational history. 5 (22.7%) had an obstructive pattern of spirometry, 5 (22.7%) restrictive, 5 (22.7%) mixed and 7 (31.9%) normal spirometry. Mean FEV1 was 79% predicted (29%–106%) at presentation and FVC 90% predicted (48%–116%). 36.4% of patients had evidence of progressive massive fibrosis on chest radiology at presentation. 18.2% of patients were classified as accelerated silicosis (onset within 10 years of exposure). 19 of 22 (86.4%) silicosis cases identified had actively been screened for TB. 6 of 22 (27.3%) received anti-mycobacterium treatment. 5 of 6 received empirical treatment for TB prior to a diagnosis of silicosis being confirmed, of these 2 later relapsed and had NTM confirmed and treated. The other patient received empirical treatment for TB while awaiting lung transplantation and subsequently died of pulmonary TB. 3 of 6 had NTM grown on at least one occasion.Abstract P221 Figure 1Occupations. n=22.ConclusionThis study indicates that rates of TB and NTM in silicosis are relatively high, supporting previously published international data. In addition, this study also highlights the difficulty in diagnosis of TB/NTM in silicosis due to similar clinical and radiological features, frequently leading to patients being treated empirically for TB and high relapse rates. The need for lung transplantation in accelerated disease may also necessitate careful screening for TB/NTM.ReferenceCowie RL. The epidemiology of tuberculosis in gold miners with silicosis. Am J Respir Crit Care Med 1994;150(5 pt 1):1460–1462.

show abstract

mentioning

confidence: 99%

P220 Profiling of occupations and exposures of patients diagnosed with occupational respiratory diseases at a uk regional referral unit

Sadhra

Kurmi

Walters

2017

Danger at Work: Occupational Lung Disease and Asthma

View full text Add to dashboard Cite

IntroductionPatients with suspected work-related respiratory symptoms are referred to tertiary NHS clinics in the UK for diagnosis of an occupational lung disease. Analysis of diagnosis data provides an opportunity to understand the profile of occupations and workplace exposures.MethodsThe study population comprised 500 patients who were referred to a tertiary occupational respiratory unit (Heart of England NHS Foundation Trust, UK) and diagnosed with an occupational respiratory disease. The 500 cases were randomly selected from a database of 2400 patients diagnosed over the period 2010–2015. Information on patients included: occupation (current), industry type, gender, diagnosis and date of diagnosis. The occupation titles were first reviewed and then coded (using CASCOT) at the four-digit level using SOC 2000. The automated assigned codes were accepted where percentage match was ≥50%, the remainder of jobs coded manually using information on industry type. A UK general population JEM (ACEJEM) was then linked to the assigned SOC codes. The job coding was conducted independently of knowledge of diagnosed lung diseases.ResultsJob titles and diagnosis were available for 497 patients. 73% of the job titles were coded automatically. The most common diagnosis was asthma 141 (28%), pleural plaques 119 (24%) and pneumoconiosis 81 (16%). 402 (81%) of the patient jobs were allocated to three of nine main SOC occupational groups; ‘skilled trade occupation’, ‘process, and machine operators’ and ‘elementary occupations’. Over 89% of asthma and pneumoconiosis cases were exposed to vapours, gases, dust or fumes (VGDF). Of the asthma cases the highest proportion were exposed to dusts (81%, 114/141) and mineral dusts (66%, 93/141), and assigned as exposed to moderate or high level of dust exposure. Only 29% of the asbestosis cases were assigned as exposed to fibres. The most common 4 digit code for asthma was 5241 (Electricians and electrical fitters), followed by 5315 (carpenters and joiners).ConclusionThe use of a general population JEM and coding of patient jobs enables a standardised approach to understanding the nature of occupations and workplace exposures for different lung disease. The approach overcomes the reliance on patient recall of workplace exposures.

show abstract

Home Noninvasive Ventilation to Reduce Readmissions for Chronic Obstructive Pulmonary Disease

Cited by 9 publications

References 16 publications

P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure

P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure

P221 Silicosis and mycobacterium disease: is it a problem in the uk?

P220 Profiling of occupations and exposures of patients diagnosed with occupational respiratory diseases at a uk regional referral unit

Contact Info

Product

Resources

About