Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 137
Filter
Add more filters

Country/Region as subject
Publication year range
1.
Paediatr Respir Rev ; 2024 Mar 28.
Article in English | MEDLINE | ID: mdl-38637185

ABSTRACT

Dyspnea on exertion in otherwise healthy adolescents and young adults is often brought to the attention of a pediatric pulmonologist when it interferes with an athletic activity. Assessment of the cause and management has been controversial. Skilled pediatric pulmonologists may suspect the cause from a careful history, but a more definite diagnosis is needed to provide the most appropriate management. Suspecting that laryngeal obstruction is the major cause, continuous laryngoscopy during exercise has been proposed. However, that method tends to over diagnose laryngeal obstruction and does not consider that the larynx is not the major cause of dyspnea on exertion (DOE). The cause of DOE can generally be best identified by a treadmill test using cardiopulmonary monitoring to determine the physiology associated with reproduced symptoms. Management of DOE requires a specific diagnosis and may involve medication, surgery, or education and training.

2.
N Engl J Med ; 387(22): 2102, 2022 12 01.
Article in English | MEDLINE | ID: mdl-36449440
4.
5.
J Allergy Clin Immunol ; 152(6): 1687-1688, 2023 12.
Article in English | MEDLINE | ID: mdl-37737750
6.
N Engl J Med ; 382(6): 579, 2020 02 06.
Article in English | MEDLINE | ID: mdl-32023385
7.
Ann Allergy Asthma Immunol ; 131(2): 275, 2023 08.
Article in English | MEDLINE | ID: mdl-37536874
11.
Paediatr Respir Rev ; 25: 85-87, 2018 Jan.
Article in English | MEDLINE | ID: mdl-27091766

ABSTRACT

Asthma is the leading cause of hospitalization among children. Recognition of inadequate control of asthma stimulated the development of Guidelines by an Expert Panel convened by the National Asthma and Prevention Program of the National Institute of Health. Those Guidelines with several revisions spanning 24 years were well-intentioned but ineffective at altering the continued high prevalence of urgent care and hospitalization among children with asthma. Meanwhile, there is strong evidence that specialists, with their greater clinical experience and knowledge have demonstrated excellent outcome compared with non-specialist care. It is time to recognize that there is strong evidence-based data that asthma specialty programs and not Guidelines disseminated to generalists alter the outcome of asthma.


Subject(s)
Asthma/therapy , Delivery of Health Care/methods , Patient Care Management/standards , Child , Evidence-Based Practice/methods , Evidence-Based Practice/standards , Humans , Practice Guidelines as Topic , Quality Improvement , United States
13.
Allergy Asthma Proc ; 39(3): 169-176, 2018 May 01.
Article in English | MEDLINE | ID: mdl-29669663

ABSTRACT

BACKGROUND: There are many nonprescription (over-the-counter [OTC]) medications available on pharmacy shelves marketed for relief of respiratory symptoms. The number of such medications has been increasing. OBJECTIVE: This review provides an evidence-based examination of OTC products used for respiratory symptoms. METHODS: Antihistamines, decongestants, mucolytics, antitussives, and intranasal steroids were selected as the most common OTC medications taken by adults and children for various respiratory symptoms. Controlled clinical trials of efficacy were identified by searching a medical literature data base. Those trials and key publications related to the pharmacokinetics and pharmacodynamics of the products were reviewed. RESULTS: Comparisons of the various OTC antihistamines' ability to suppress the effects of histamine were related to their clinical benefit. Intranasal corticosteroids are the preferred agents for maintenance therapy of persistent nasal congestion and are highly effective for symptoms of inhalant allergy other than allergic conjunctivitis. The disconnect between marketing claims and evidence was demonstrated for antihistamines and oral alpha-1 adrenergic agonist decongestants. Data for OTC mucolytics and antitussives were insufficient to justify their use based on the evidence. CONCLUSION: There was little relationship between marketing claims and evidence regarding OTC medications used for respiratory symptoms. Analysis of data supported cetirizine, levocetirizine, and fexofenadine as the most effective of the OTC antihistamines. There were no data that supported the use of oral phenylephrine as a decongestant. Neither OTC mucolytics or antitussives provided sufficient evidence to justify their use.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Conjunctivitis, Allergic/drug therapy , Histamine Antagonists/therapeutic use , Nonprescription Drugs/therapeutic use , Respiratory Insufficiency/drug therapy , Adult , Cetirizine , Child , Conjunctivitis, Allergic/epidemiology , Drug Utilization , Evidence-Based Medicine , Expectorants/therapeutic use , Guaifenesin , Humans , Marketing , Nasal Decongestants/therapeutic use , Patient Education as Topic , Phenylephrine , Respiratory Insufficiency/epidemiology , United States/epidemiology
14.
J Allergy Clin Immunol ; 149(6): 2177, 2022 06.
Article in English | MEDLINE | ID: mdl-35393094

Subject(s)
Algorithms , Gait , Humans
17.
Am J Respir Crit Care Med ; 194(3): 356-73, 2016 08 01.
Article in English | MEDLINE | ID: mdl-27479061

ABSTRACT

BACKGROUND: Infantile wheezing is a common problem, but there are no guidelines for the evaluation of infants with recurrent or persistent wheezing that is not relieved or prevented by standard therapies. METHODS: An American Thoracic Society-sanctioned guideline development committee selected clinical questions related to uncertainties or controversies in the diagnostic evaluation of wheezing infants. Members of the committee conducted pragmatic evidence syntheses, which followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The evidence syntheses were used to inform the formulation and grading of recommendations. RESULTS: The pragmatic evidence syntheses identified few studies that addressed the clinical questions. The studies that were identified constituted very low-quality evidence, consisting almost exclusively of case series with risk of selection bias, indirect patient populations, and imprecise estimates. The committee made conditional recommendations to perform bronchoscopic airway survey, bronchoalveolar lavage, esophageal pH monitoring, and a swallowing study. It also made conditional recommendations against empiric food avoidance, upper gastrointestinal radiography, and gastrointestinal scintigraphy. Finally, the committee recommended additional research about the roles of infant pulmonary function testing and food avoidance or dietary changes, based on allergy testing. CONCLUSIONS: Although infantile wheezing is common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing. Our committee made several conditional recommendations to guide clinicians; however, additional research that measures clinical outcomes is needed to improve our confidence in the effects of various diagnostic interventions and to allow advice to be provided with greater confidence.


Subject(s)
Respiratory Sounds/diagnosis , Humans , Infant , Infant, Newborn , Recurrence , Respiratory Function Tests , Societies , United States
SELECTION OF CITATIONS
SEARCH DETAIL