1,721,217 research outputs found
Is cough important in acute exacerbations of COPD?
No full textChronic obstructive pulmonary disease is predicted to become the 4th leading cause of death worldwide by 2030. The natural history of the disease includes progressive symptoms punctuated by acute exacerbations during which symptoms rapidly deteriorate. The resulting disability places significant burden on health and social care systems. Cough is the second most common symptom reported by COPD patients, is a source of significant distress and is associated with adverse outcomes. We discuss the importance of cough in COPD, its mechanism and the relationship between cough and COPD exacerbations. We review the literature and present original data relating to the investigation of cough during COPD exacerbation, its associations and potential benefits of cough monitoring
Anti Reflux Surgery
No full textSurgery may be necessary to control gross reflux disease, particularly when anatomical abnormalities underlie the pathophysiology. Treatment is generally less successful when directed at isolated airway reflux and aspiration since the refluxate consists mainly of a gaseous mist which even the tightest ‘wrap’ will not be able to control. When successful however, repeated admissions for recurrent aspiration can be abruptly terminated
Inhaled beclomethasone/formoterol in idiopathic pulmonary fibrosis: a randomised controlled exploratory study
Full text linkTextural analysis demonstrates heterogeneous [18F]-fluorodeoxyglucose uptake in radiologically normal lung in patients with idiopathic pulmonary fibrosis
Full text linkPositron Emission Tomography (PET) scanning in idiopathic pulmonary fibrosis (IPF) has revealed increased [18F]-fluorodeoxyglucose ([18F]-FDG) uptake in areas of the lungs that appear normal on high resolution computed tomography (HRCT). We hypothesised that “microscopic” disease identified using PET would be heterogeneous because IPF is characterised histologically by patchy fibrosis. We applied textural analysis to PET scans to evaluate heterogeneity of [18F]-FDG uptake in lung regions that appeared normal on HRCT. We identified six textural features that demonstrated significantly more heterogeneous [18F]-FDG uptake in radiologically normal lung in IPF patients compared with controls. Textural analysis of lung PET-CT imaging is a novel approach to study early changes in IPF before HRCT abnormalities are apparent
The Assessment and Validation of Pulmonary Drug Delivery Systems Using Fluorine-18 Radiolabelling and Positron Emission Tomography
No full textAn investigation into the mechanism of inhalational cough challenge
Full text linkChronic cough is a common problem. Historically treatments have focussed on treating underlying physiological causes. More recently an overarching theory of cough hypersensitivity syndrome has developed. In-vitro models of cough have not successfully translated into human studies. Testing the cough reflex in humans via inhalational cough challenge has been utilised since the 1950s. The mechanisms of cough challenge are poorly understood. This thesis sets out to investigate these mechanisms further in three different experiments. By altering pH in a citric acid challenge and measuring cough response, I show that cough hypersensitivity is not due purely to a shift in the dose response curve to pH, but also an alteration in the pattern of response to a given stimulus. Designing a cough challenge with a novel agent (ATP) revealed that the cough response to ATP is clearly delineated from that of AMP. The response to ATP in chronic cough is heightened, but not to such a degree as to implicate the acute response to inhalation of ATP in the pathophysiology of cough hypersensitivity syndrome. Comparing four cough challenges – the commonly used citric acid and capsaicin; the slightly less utilised distilled water fog challenge; and the new ATP challenge – proved that all challenges show less intra-patient reproducibility in chronic cough patients. Inhaled ATP cough challenge responses correlated with citric acid and capsaicin challenge suggesting overlap in mode of action. All experiments explore the cough challenge further in a group who have had little previous cough challenge investigation: the patient with chronic cough. They reveal that patients with cough hypersensitivity syndrome have not only a heightened but an unpredictable cough reflex, and that this is not due solely to upregulation of the cough receptors at peripheral nerve endings. Inhalational cough challenge plays an important role in further elucidating the mechanisms of chronic cough
The differential in vitro effects of clinically used vasoactive drugs on small human pulmonary vessels
Full text linkIntroduction:Pulmonary hypertension (PH) is an important prognostic factor in cardiac surgery and is associated with increased morbidity and mortality. The mechanism of the underlying pathophysiology is complex and PH may exist prior to surgery or might develop during or after surgery. Different models are used to explore the underlying cellular and molecular mechanism of lung disease especially pulmonary vascular disease. Isolation of human pulmonary artery and measurement of pulmonary vascular tension are vital to understand the pathophysiology of human pulmonary vessels. The aim of this study was to characterize the effects of clinically used pharmacological agents on the human pulmonary vasculature.Methods:Patients undergoing lung resection were consulted and consented for their resected lung tissue to be included in the study. Pulmonary arteries (PA) dissected from disease free areas of lung resection and PA rings of internal diameter 2-4 mm and 2 mm long were prepared. Integrity of the endothelium was confirmed with 1μM acetylcholine (ACh) and 37.6 μM (EC₈₀) potassium chloride (KCl) was used to check the contractility of PA rings. Multiwire myograph system was used to mount the PA rings under physiological conditions in modified Krebs solution. Concentration response curves were constructed to pharmacological agents by cumulative addition to the myograph chambers.Results:Both the multi-wire myograph and organ bath system have demonstrated identical conclusions and confirmed that the most efficient resting tension for human PA rings of internal diameter 2-4 mm is 1.61 gf Vasopressin had no vasoconstrictive effect on the small human pulmonary arteries and hence may be safe to use for systemic vasoconstriction in patients with pulmonary hypertension. The prostacyclin analogues were the most potent and efficacious vasodilators in the isolated human pulmonary arteries.Conclusions:The current study is the only in vitro study that demonstrated the efficacy and potency of clinically used vasopressors, prostacyclin analogues, sodium nitroprusside and phosphodiesterase inhibitors on human pulmonary vascular reactivity. These effects may inform the use of these drugs in the clinical setting as prostacyclin analogues provide better results. Fully blinded randomized control trials are needed to show the potential bench to bed effect of this study
- …
