Phrenic and diaphragm function after coronary artery bypass grafting

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Effects of antihistamines in adult asthma: a meta-analysis of clinical trials

A meta-analysis of clinical trials of antihistamines was performed to assess the risk-benefit ratio of this therapeutic class in asthma. Double-blind randomized placebo-controlled trials assessing lung function changes under repeated use of antihistamine in adult asthma were selected, and the quality of studies was scored, Morning peak expiratory now rate (PEER) was the primary outcome: an effect size was computed for each study, with a 95% confidence interval (95% CI), and a mean effect size was computed, combining all studies, Effect sizes were also determined for secondary outcomes: evening PEER, forced expiratory volume in one second (FEV1) and daily use of inhaled beta-agonists, Nineteen studies were included in the meta-analysis, Mean quality score of studies was 59.4%; asthma was generally uncontrolled at study inclusion. Altogether, 582 antihistamine-treated and 557 placebo-treated asthma patients were evaluable, Antihistamines had little effect on airway calibre (mean increase in morning PEER: 13 L.min(-1); 95 Cl: 8-18 L.min(-1)) and on use of inhaled beta-agonists (mean reduction in daily use: 0.4 doses; 95% CI: 0-0.8 doses), Sedation occurred more often with antihistamines than with placebo (p<0.001); additional side-effects were mentioned, including weight gain, altered taste, headache and dry mouth, Respiratory and systemic effects observed after repeated use of antihistamines do not support the use of these medications in the treatment of asthma; better designed studies could affect this appraisal

Management of COPD according to guidelines. A national survey among Belgian physicians

Current management of COPD by Belgian physicians was compared with the recommendations of the recently published GOLD guidelines. A random sample of 386 general practitioners and 86 pulmonologists filled in a questionnaire based on the GOLD guidelines and examining their attitudes towards COPD management. Several important deviations from the guidelines were noted. Only few GP's performed spirometry themselves and about 55% of the diagnoses were not based on spirometry. Both GP's and pulmonologists used inhaled corticosteroids considerably more often than prescribed by the guidelines, with 49% and 25% respectively, prescribing them to all COPD patients. Chronic systemic steroids were also overused in stable disease, with 55% of the GP's and 52% of the pulmonologists prescribing them in patients with repeated exacerbations. GP's did not use enough systemic corticosteroids and overused antibiotics in the treatment of exacerbations. Pulmonologists did not pay enough attention to pulmonary rehabilitation, as only 44% of them had a structured programme. Pulmonologists did not use non-invasive ventilation frequently enough in the treatment of exacerbations, as only 22% would use it in the correct indication. Both GP's and pulmonologists did not prescribe enough pharmacotherapy for smoking cessation, with 35% and 46%, respectively using it. Some interesting differences between Dutch and French speaking physicians were noted. These specific deviations from the guidelines will be addressed in a second phase implementation project