Evolving to a single inhaler extrafine LABA/LAMA/ICS - Inhalation technique and adherence at the heart of COPD patient care (TRIVOLVE).

OBJECTIVE: Incorrect inhaler use and poor treatment adherence have a negative impact on COPD outcomes. This multi-centre, single arm, non-interventional, phase IV study investigated whether inhalation technique, treatment adherence and patient outcomes change in patients who evolve from dual therapy or multiple inhaler triple therapy to single inhaler extrafine triple therapy (beclomethasone dipropionate (BDP, 87 µg), formoterol fumarate (FF, 5 µg) and glycopyrronium (G, 9 µg)) in combination with inhalation technique training. METHODS: A total of 126 COPD patients were included in the per protocol set. Inhalation technique and treatment adherence were assessed at baseline and at two visits at approximately 3 and 6 months of treatment with extrafine BDP/FF/G. In addition, lung function, symptom score, patient satisfaction and exacerbations (exploratory) were followed up. RESULTS: Before switching to single inhaler extrafine BDP/FF/G (baseline), any device errors and critical errors were detected for 28.8% and 9.6% of patients, respectively. After switching to BDP/FF/G, the percentage of patients with any device errors decreased to 14.0% (visit 2) and 16.3% (visit 3), without critical errors at the two follow-up visits. Treatment adherence increased from 67.5% at baseline to 75.8% (visit 2) and 80% (visit 3). In addition, lung function, symptom and patient satisfaction scores improved, whilst exacerbation rates substantially decreased. CONCLUSIONS: This observational study demonstrates that in eligible COPD patients in a real-life setting, the switch from dual therapy or multiple inhaler triple therapy to single inhaler extrafine BDP/FF/G in combination with inhalation technique training is associated with improved inhalation technique and adherence.

Compensatory Lung Growth after Pneumonectomy: Case Report.

Lung expansion after pneumonectomy is well documented in animal models like dogs or mice. We present a lung expansion case after left pneumonectomy for an advanced carcinoid tumor in a 16-year-old patient with hemoptysis and acute dyspnea. This tumor was localized in the left upper lobe (LUL) invading the left main bronchus. During the follow-up we noticed a real growth of the remaining lung.

Fatal Capnocytophaga canimorsus septicemia in a previously healthy woman.

A previously healthy 47-year-old woman presented to the emergency department with septic shock five days after a small dog bite on the dorsum of her hand. Capnocytophaga canimorsus was isolated from blood cultures. Despite intensive therapy, multiple organ failure developed, and the patient died 27 days after admission. Characteristics of Capnocytophaga (formerly CDC group Dysgonic Fermenter-2) infection are briefly discussed. This unusual outcome in a previously healthy patient and the need for careful management of dog bite wounds, even if initially very small, is emphasized.

Intensive care management of Guillain-Barré syndrome during pregnancy.

A particularly severe case of Guillain-Barré syndrome occurring during pregnancy is reported. The therapeutic approach including plasmapheresis, ventilation, analgesia, sedation, metabolic requirements and heparin therapy is discussed with the consequences on foetal development and the early days of life.