Current clinical management of smoke inhalation injuries: a reality check

Smoke inhalation injury is a complex clinical condition and respiratory clinicians need to have a good understanding of its current clinical management. However, evidence derives mostly from retrospective cohorts and case series. Is this enough

Non-pharmacological techniques for the extremes of the cough spectrum

Cough can be viewed as a continuum where extremes represent disease phenotypes. Under this unified concept, non-pharmacological treatment for the extremes of the cough spectrum includes both cough augmentation and cough control techniques. Supporting the cough motor output and exercising the cognitive control on coughing are the main directions of these techniques. Cough augmentation can be provided to patients who present low ability to generate adequate peak cough flows, with the aim to develop the sheering forces that are essential for effective airway clearance. On the other hand, individuals with high cough sensitivity or frequency can practice techniques for cough control, which incorporates a combination of education, retraining and psychological support. These techniques aim to empower patients to increase their supramedulary control on cough. Although hypotheses that are generated by the physiology of cough can support most non-pharmacological techniques, their exact mechanisms of effectiveness remain unclear

Physiotherapy in cystic fibrosis Α comprehensive clinical overview

Physiotherapy remains the cornerstone of cystic fibrosis (CF) management alongside medical treatment. Traditionally, physiotherapy intervention focussed on airway clearance during the clinically stable stage and chest infections. Research evidence consistently supports greater mucus clearance with chest physiotherapy compared to cough alone or no treatment. Various methods and techniques of airway clearance have been developed and investigated, and data suggest that most of them are of similar effectiveness. Nowadays physiotherapy management also extends to other areas, supported by studies and clinical practice. The physiotherapists plan, supervise and follow-up systematic exercise or personalised rehabilitation programs, which, similarly to airway clearance, are recommended in all patients with CF. Furthermore, based on a comprehensive assessment, physiotherapists incorporate the management of accompanying musculoskeletal problems such as back pain and postural disorders, as well as urine incontinence issues. In the era that aims to improve quality of life, it is essential that physiotherapists are aware of specific conditions that might affect the management of CF. Their role is to work alongside and within the CF multi-disciplinary team throughout patient’s treatment and consistently support the patient and carers, in particular whilst on clinical pathways of the lung transplantation and palliative care

Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST)

BACKGROUND: Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and to an increased mortality. Improved detection of exacerbations has been accomplished in chronic obstructive pulmonary disease through the use of patient completed diaries. These tools may enhance exacerbation reporting and identification. The aim of this study was to develop a novel symptom diary for bronchiectasis symptom burden and detection of exacerbations, named the BEST diary. METHODS: Prospective observational study of patients with bronchiectasis conducted at Ninewells Hospital, Dundee. We included patients with confirmed bronchiectasis by computed tomography, who were symptomatic and had at least 1 documented exacerbation of bronchiectasis in the previous 12\u2009months to participate. Symptoms were recorded daily in a diary incorporating cough, sputum volume, sputum colour, dyspnoea, fatigue and systemic disturbance scored from 0 to 26. RESULTS: Twenty-one patients were included in the study. We identified 29 reported (treated exacerbations) and 23 unreported (untreated) exacerbations over 6-month follow-up. The BEST diary score showed a good correlation with the established and validated questionnaires and measures of health status (COPD Assessment Test, r =\u20090.61, p =\u20090.0037, Leicester Cough Questionnaire, r =\u2009-\u20090.52,p =\u20090.0015, St Georges Respiratory Questionnaire, r =\u20090.61,p <\u20090.0001 and 6\u2009min walk test, r =\u2009-\u20090.46,p =\u20090.037). The mean BEST score at baseline was 7.1 points (SD 2.2). The peak symptom score during exacerbation was a mean of 16.4 (3.1), and the change from baseline to exacerbation was a mean of 9.1 points (SD 2.5). Mean duration of exacerbations based on time for a return to baseline symptoms was 15.3\u2009days (SD 5.7). A minimum clinically important difference of 4 points is proposed. CONCLUSIONS: The BEST symptom diary has shown concurrent validity with current health questionnaires and is responsive at onset and recovery from exacerbation. The BEST diary may be useful to detect and characterise exacerbations in bronchiectasis clinical trials

Prescribing preferences and availability of nebulisers and inhalers for inhaled medications in bronchiectasis:results of a specialist survey

Specialists caring for people with bronchiectasis recommend specialised nebulisers for inhaled antibiotics, but are often limited by availability and cost of nebulisation devices https://bit.ly/40FvFdZ.</p

Older Adults with Osteoarthritis: Higher Mental Toughness Associated with Greater Improvement in Knee Pain/Functionality

Older adults (the least physically active of all age groups) have a high prevalence of knee pathologies, such as osteoarthritis (OA). Physical activity (PA) is essential for managing OA through its anabolic, lipolytic, and anti-inflammatory effects. Pain and functional limitations can present challenges when performing PA. Mental toughness (MT) is associated with higher success when pursuing exercise/PA goals, but little is known about its role in rehabilitation settings. MT has been primarily researched cross sectionally. MT can be developed. PURPOSE: To examine the relationship between MT and knee pain/functionality via a longitudinal design in older adults with OA who underwent knee surgery. METHODS: The sample (n = 52; Mage = 71.5, SD = 8.5; females = 39) consisted of active patients who had a diagnosis of OA and underwent surgery. The Oxford Knee Score (OKS) was administered to assess knee function/pain and the Mental Toughness Index (MTI) to assess MT levels. We chose a multilevel growth model to examine the change in the OKS one day before surgery (T1) and one month (T2) and six months (T3) after surgery. We also used MTI scores as a time-varying covariate. First, we examined the proportion of variability in the three sets of variables due to between-individual differences via the intraclass correlation coefficient. Next, we estimated the growth model for the OKS. RESULTS: On average, the OKS increased from 11.3 (T1) to 23.1 (T2) to 37.0 (T3). The MTI scores did not change across time: the average scores were 39.0, 40.1, and 39.6, respectively. The growth model indicated that about 64% of the variability in OKS was due to between-patient differences. Of the variability that was attributable to differences within patient across time, MT accounted for about 39% of the variability. That is, there was a significant interaction between time and mental toughness: those with higher mental toughness scores had greater improvement in OKS (βO×MT = 0.18, SE = 0.04, p \u3c .001). CONCLUSION: Overwhelming evidence exists that supports the benefits of PA in older adults. The disability burden of arthritis is rapidly escalating globally. Our results indicate that MT interventions might help fight the barriers of knee pain and functionality. Therefore, our findings may possibly inform rehabilitation psychology practices in that age group

Psychometrics of HRQoL questionnaires in bronchiectasis: A systematic review and meta-analysis

INTRODUCTION: Understanding the psychometric properties of health related quality of life (HRQoL) questionnaires can help inform selection in clinical trials. OBJECTIVE: To assess the psychometric properties of HRQoL questionnaires in bronchiectasis. METHODS: A literature search was conducted. HRQoL questionnaires were assessed for psychometric properties (reliability, validity, minimal clinically important difference (MCID), floor/ceiling effects). Meta-analyses assessed the associations of HRQoL with clinical measures and responsiveness of HRQoL in clinical trials. RESULTS: 166 studies and 12 HRQoL questionnaires were included. The BHQ, LCQ, CAT and SF-36 had good internal consistency in all domains reported (Cronbach's α≥0.7) across all studies and the QoL-B, SGRQ, CRDQ and SOLQ had good internal consistency in all domains in the majority of (but not all) studies. The BHQ, SGRQ, LCQ and CAT had good test-retest reliability in all domains reported ((intraclass correlation coefficient) ICC ≥0.7) across all studies and the QoL-B, CRDQ and SOLQ had good test-retest reliability in all domains in the majority of (but not all) studies. HRQoL questionnaires were able to discriminate between demographics, important markers of clinical status, disease severity, exacerbations and bacteriology. For HRQoL responsiveness, there was a difference between the treatment and placebo effect. CONCLUSION: SGRQ was the most widely used HRQoL questionnaire in bronchiectasis studies and it had good psychometric properties, however good psychometric data are growing on bronchiectasis specific HRQoL questionnaires, QoL-B and BHQ. Future studies should focus on the medium-long term test-retest reliability, responsiveness and MCID in these HRQoL questionnaires which show potential in bronchiectasis

The Objective Assessment of Cough Frequency in Bronchiectasis.

INTRODUCTION: Cough in bronchiectasis is associated with significant impairment in health status. This study aimed to quantify cough frequency objectively with a cough monitor and investigate its relationship with health status. A secondary aim was to identify clinical predictors of cough frequency. METHODS: Fifty-four patients with bronchiectasis were compared with thirty-five healthy controls. Objective 24-h cough, health status (cough-specific: Leicester Cough Questionnaire LCQ and bronchiectasis specific: Bronchiectasis Health Questionnaire BHQ), cough severity and lung function were measured. The clinical predictors of cough frequency in bronchiectasis were determined in a multivariate analysis. RESULTS: Objective cough frequency was significantly raised in patients with bronchiectasis compared to healthy controls [geometric mean (standard deviation)] 184.5 (4.0) vs. 20.6 (3.2) coughs/24-h; mean fold-difference (95% confidence interval) 8.9 (5.2, 15.2); p < 0.001 and they had impaired health status. There was a significant correlation between objective cough frequency and subjective measures; LCQ r = -0.52 and BHQ r = -0.62, both p < 0.001. Sputum production, exacerbations (between past 2 weeks to 12 months) and age were significantly associated with objective cough frequency in multivariate analysis, explaining 52% of the variance (p < 0.001). There was no statistically significant association between cough frequency and lung function. CONCLUSIONS: Cough is a common and significant symptom in patients with bronchiectasis. Sputum production, exacerbations and age, but not lung function, were independent predictors of cough frequency. Ambulatory objective cough monitoring provides novel insights and should be further investigated as an outcome measure in bronchiectasis