Biomedical subjects

Felix S F Ram

Publications and source records attributed to Felix S F Ram.

5 recordsLinked to original sources

PubMed2006

Use of theophylline in chronic obstructive pulmonary disease: examining the evidence.

PURPOSE OF REVIEW: The role of theophylline in the management of chronic obstructive pulmonary disease remains controversial. This review was undertaken to determine the efficacy of theophylline in patients with stable disease. RECENT FINDINGS: Twenty-two good quality randomized controlled trials were included in this systematic review. The review showed that theophylline significantly improved forced expiratory volume in 1 s and forced vital capacity (weighted mean difference 0.10 L; 95% confidence interval 0.04-0.16 and weighted mean difference 0.21 L; 95% confidence interval 0.10-0.31, respectively). V also improved with theophylline (weighted mean difference 195.27 mL/min; 95% confidence interval 112.71-277.83), as did Pa and Pa (weighted mean difference 1.45 mmHg; 95% confidence interval 0.26-2.65 and weighted mean difference -1.09 mmHg; 95% confidence interval -1.83 to -0.35, respectively). Patients preferred theophylline over placebo (relative risk 2.27; 95% confidence interval 1.26-4.11). Theophylline increased the risk of nausea, however, compared with placebo (relative risk 7.67; 95% confidence interval 1.47-39.94). SUMMARY: This review has shown that oral theophylline plays an important role in the management of patients with stable chronic obstructive pulmonary disease by improving lung function, arterial blood gas tensions and ventilatory capacity. Patients also preferred treatment with theophylline when compared with placebo. The benefits of theophylline in stable chronic obstructive pulmonary disease, however, have to be weighed against the risk of adverse effects, particularly nausea.

Bronchodilator Agents↗

PubMed2004

Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence.

OBJECTIVES: To evaluate the efficacy of hospital at home schemes compared with inpatient care in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN: A systematic review of randomised controlled trials. MAIN OUTCOME MEASURE: Mortality and readmission to hospital. RESULTS: Seven trials with 754 patients were included in the review. Hospital readmission and mortality were not significantly different when hospital at home schemes were compared with inpatient care (relative risk 0.89, 95% confidence interval 0.72 to 1.12, and 0.61, 0.36 to 1.05, respectively). However, compared with inpatient care, hospital at home schemes were associated with substantial cost savings as well as freeing up hospital inpatient beds. CONCLUSIONS: Hospital at home schemes can be safely used to care for patients with acute exacerbations of COPD who would otherwise be admitted to hospital. Clinicians should consider this form of management, especially as there is increasing pressure for inpatient beds in the United Kingdom.

Acute Disease↗

PubMed2003

Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of non-invasive positive pressure ventilation (NPPV) in the management of respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Systematic review of randomised controlled trials that compared NPPV and usual medical care with usual medical care alone in patients admitted to hospital with respiratory failure resulting from an exacerbation of chronic obstructive pulmonary disease and with PaCO2 >6 kPa. RESULTS: The eight studies included in the review showed that, compared with usual care alone, NPPV as an adjunct to usual care was associated with a lower mortality (relative risk 0.41 (95% confidence interval 0.26 to 0.64)), a lower need for intubation (relative risk 0.42 (0.31 to 0.59)), lower likelihood of treatment failure (relative risk 0.51 (0.38 to 0.67)), and greater improvements at 1 hour in pH (weighted mean difference 0.03 (0.02 to 0.04)), PaCO2 (weighted mean difference -0.40 kPa (-0.78 to -0.03)), and respiratory rate (weighted mean difference -3.08 breaths per minute (-4.26 to -1.89)). NPPV resulted in fewer complications associated with treatment (relative risk 0.32 (0.18 to 0.56)) and shorter duration of stay in hospital (weighted mean difference -3.24 days (-4.42 to -2.06)). CONCLUSIONS: NPPV should be the first line intervention in addition to usual medical care to manage respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease in all suitable patients. NPPV should be tried early in the course of respiratory failure and before severe acidosis, to reduce mortality, avoid endotracheal intubation, and decrease treatment failure.

Humans↗

PubMed2003

Clinical efficacy of inhaler devices containing beta(2)-agonist bronchodilators in the treatment of asthma: cochrane systematic review and meta-analysis of more than 100 randomized, controlled trials.

BACKGROUND: A number of different inhaler devices are available to deliver beta(2)-adrenoceptor agonist (beta(2)-agonist) bronchodilators in asthma. These include hydrofluoroalkane or chlorofluorocarbon (CFC)-free propelled pressurized metered-dose inhalers (pMDIs), many dry powder inhalers and breath-actuated inhalers. OBJECTIVE: To determine the clinical efficacy of all available hand-held inhaler devices compared with the standard CFC-containing pMDI for the delivery of short-acting beta(2)-agonist bronchodilators in nonacute asthma in both children and adults. METHODOLOGY: A systematic review and meta-analysis was carried out of all available randomized, controlled trials (RCTs) using the standard pMDI compared with any other hand-held inhaler device, delivering short-acting beta(2)-agonist bronchodilators in patients with stable asthma. RESULTS: One hundred and eighteen RCTs were included in this review. No clinical differences were found between the standard CFC-containing pMDI and 12 other hand-held inhaler devices for most outcome measures. We found no evidence of clinical differences between studies using either a 1 : 1 (pMDI: another inhaler) or a 2 : 1 dosing ratio. CONCLUSIONS: In patients with stable asthma, short-acting beta(2)-agonist bronchodilators in standard CFC-pMDIs are as effective as any other hand-held inhaler device; therefore the cheapest available device that the patient is able to use should always be considered. Pharmaceutical companies should in future submit to regulatory authorities clinical outcome data (as opposed to in vitro data) in support of any dosing schedules greater than 1 : 1 when compared with the standard pMDI. Clinical effectiveness studies that use an intention-to-treat analysis and report more patient-centered outcomes are required.

Administration, Inhalation↗

PubMed2003

Asthma education.

Education about asthma and self-management of asthma are now key recommendations of asthma management guidelines. A Cochrane systematic review of 12 RCTs found that limited education programmes that offer information about asthma but not self-management skills did not reduce hospitalisation rates or visits to the doctor for asthma. The positive outcomes from limited asthma education were a reduction in symptoms. Asthma self-management education which consists of information, self-monitoring, regular medical review, and a written action plan is effective and leads to a reduction in hospitalisation and ER visits for asthma, unscheduled doctors visits, days lost from work, episodes of nocturnal asthma, indirect costs and an improvement in quality of life. The effects were large enough to be of both clinical and statistical significance. While a structured asthma self-management programme is effective in a hospital setting, attempts to deliver these programmes in primary care have met with varying success.

Asthma↗