摘要:

Ten questions are posed to the indications for oral use of theophylline, some of them controversial. The role of theophylline has become more selective, but its indications are firmly rooted in the following useful properties: (a) additive action to other bronchodilators, both at peak and trough; (b) sustained action, tailored according to need; (c) systemic availability to sites of action; and (d) economy and convenience. Besides bronchodilation, it has some anti-inflammatory action, as yet undefined, and favorable action on respiratory muscle force production and respiratory drive, the latter useful in neonatal apnea. Mechanisms of action involve its nonspecific inhibition of cyclic-AMP phosphodiesterase isozymes (an area now under intense study), and antagonism of adenosine at the receptor level.Disadvantages are its variable metabolism and narrow therapeutic index, necessitating careful administration and monitoring of serum levels. Definite indications are: (a) severe chronic obstructive pulmonary disease (COPD); (b) severe asthma to minimize use of oral corticosteroids; and (c) nocturnal asthma. A strong case can be made for its use in: (a) impending respiratory failure caused by asthma or COPD; (b) mechanical ventilation, primarily for obstructed airways; and (c) sleep apnea or hypopnea in which continuous positive airway pressure or surgery either is rejected or not indicated. Optimal serum levels are near the midtherapeutic range (i.e., 12–15 μg/ml). More general use is dictated by cost, convenience, or preference, and lower levels may suffice. Theophylline's use may be further modified as new agents are introduced, especially the long-acting β2-agonists. However, it will remain a definite part of our armamentarium.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A variety of antibiotics is available to physicians caring for the pulmonary patient. New antimicrobial agents are continually being introduced, and an understanding of these new drugs is necessary if one hopes to make effective antibiotic choices. Our review focuses on two groups of agents that have been released recently: (a) those used primarily in hospitalized patients, and (b) those having a role in the outpatient setting. Drugs in the first group include imipenem-cilastatin, the parenteral fluoroquinolones, and the monobactams. Antibiotics in the second category include the new macrolides and azalides, the oral quinolones, the new oral cephalosporins, and the carbacephems. The pharmacokinetic properties, spectrum of activity, and safety profile of these agents serve as the basis for establishing their role in the therapy of pulmonary infections. This information should assist the clinician in deciding when these antibiotics offer advantages over older and frequently less expensive antimicrobial agents.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Sarcoidosis is a common-place multisystem disorder characterized by the presence of noncaseating granulomas. Although the clinical syndrome of the disease is recognized throughout the world, the pragmatic understanding of its diagnosis and management remains poorly understood and controversial. Much of the frustration experienced in elucidating its pathogenesis is directly related to our inability to find the cause of the disease. This article provides a brief and practical discussion of the diagnosis, pathogenesis, and concept of disease activity. It also recommends guidelines for management based on available clinical, immunologic, and radiological information enhanced by our experience at the University of Southern California during the past 30 years.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Chronic obstructive pulmonary disease (COPD) remains a leading cause of perioperative pulmonary morbidity and mortality. The anesthesiologist must identify these patients and attempt to optimize pulmonary function in the perioperative period. This requires an understanding of pulmonary pharmacology and the physiological changes associated with the administration of general anesthesia. The risk for postoperative complications also must be anticipated to improve outcome. This review discusses changes in lung function related to surgery, assessment of risk for postoperative pulmonary complications, preoperative pulmonary preparation, intraoperative anesthetic management, and optimization of postoperative pulmonary function.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

DNR (do not resuscitate) is an order not to perform cardiopulmonary resuscitation (CPR). CPR is defined as the measures used to restore ventilation and circulation in individuals in whom these functions have been compromised or have ceased. CPR has no place in the treatment of terminally ill or irreversibly ill persons.Admission to an intensive care unit (ICU) is consistent with a no CPR or DNR order in the event of a cardiopulmonary arrest. The ICU may be the only place in the hospital where appropriate therapy and monitoring of a patient can occur, even though they are DNR. Conversely, if the DNR order is part of an overall recognition of the hopelessness and/or terminal nature of the patient's disease, then the ICU probably is not the appropriate environment for the patient.The major problem with DNR orders for ICU patients is that the orders are not used enough, nor are they decided at an early-enough stage. Communication is the solution for most problems with DNR orders.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Patients receiving long-term mechanical ventilation are at great risk of developing psychological problems. Many factors known to precipitate psychological disturbances in the critically ill patient (i.e., severe illness, chronic disease, pharmacologic agents, etc.) are commonly present in the ventilator-dependent patient. In addition, dependence on a machine for life support that restricts mobility and complicates communication further compounds the problem.This review integrates information regarding psychological problems in patients with critical illnesses, chronic diseases, and pulmonary disorders with the limited data that currently exist relative to patients receiving mechanical ventilation. Furthermore, we use this information to develop a strategy for the evaluation and treatment of psychological disorders in the ventilator-dependent patient.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Lung transplantation has emerged as a therapeutic option for patients with end-stage lung disease. Primary care physicians must understand the surgical procedures available to their patients and the selection criteria for transplantation. This review covers these issues and discusses when to refer patients for transplantation based on the natural history of their underlying lung disease.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSynopsis: Patients with pneumonia are likely to have recurrences. Corticosteroid use, hypoalbuminemia, and gram-negative airway colonization are the most significant risk factors.Source: Hedlund J, et al. Factors of importance for the long term prognosis after hospital treated pneumonia. Thorax 1993;48:785–9.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSynopsis:Home oximetry using the pattern of repetitive desaturation rather than absolute thresholds improved the sensitivity and negative predictive value for sleep apnea hypopnea syndrome (SAHS).Source:Séries F, et al. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Int Med 1993;119(6):449–529.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSynopsis:Inhaled high-dose. corticosteroids led to modest improvements in pulmonary function and dyspnea in patients with nonasthmatic chronic obstructive pulmonary disease (COPD).Source:Weir DC, et al. Effects of high dose inhaled beclomethasone dipropionate, 750 μg and 1500 μg twice daily, and 40 mg per day oral prednisolone on lung function, symptoms, and bronchial hyperresponsiveness in patients with non-asthmatic chronic airflow obstruction. Thorax 1993;48:309–16.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID