Effects of Dronabinol on Dyspnea and Quality of Life in Patients With COPD.

Background: Dyspnea is frequently a debilitating symptom of chronic obstructive pulmonary disease (COPD). Cannabinoid receptor agonists have the potential to alter dyspnea in these patients. Objective: Our objective was to determine if dronabinol, a pure cannabinoid, improves dyspnea and exercise tolerance in COPD. Methods: In this double-blind randomized, crossover pilot study, COPD patients received up to 20mg of oral dronabinol or placebo daily for 6 weeks with an intervening washout period. Dyspnea and fatigue were assessed using the Borg scale at rest and after an incremental shuttle walk. Functional status, mood, and depression were measured using the St George's Respiratory Questionnaire (SGRQ), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and the Geriatric Depression Scale (GDS). Results: A total of 11 participants (with mean forced expiratory volume in 1 second 50.8 ± 24.8%) completed the study with no improvement in dyspnea at rest or postexercise taking dronabinol versus placebo (Borg scale 0.27, 95% confidence interval [CI] -0.59 to 1.14 versus 0.23 points, 95% CI -0.71 to 1.07 at rest and 0.82, 95% CI -0.59 to 2.22 versus 0.36 points, 95% CI 0.13 to 2.78 post exercise; p=0.94 and p=0.69 respectively). Dronabinol compared with placebo showed no significant change in PFSDQ dyspnea scores (0.64, 95% CI -3.92 to 5.20 versus 5.0, 95% CI -6.29 to 16.29; p=0.43) or shuttle walk distances (20.7m, 95% CI -21.5 to 62.8 versus 13.7m, 95% CI -24.8 to 52.2; p=0.69). There were no significant differences in fatigue at rest and postexercise, SGRQ scores, or GDS scores. Conclusion: In this pilot study, dronabinol did not significantly improve dyspnea or exercise capacity compared with placebo.

A survey of physicians to identify their expectations of respiratory therapists in patient assessment.

INTRODUCTION: The exact role of respiratory therapists (RTs) in patient assessment is not well defined. The purpose of this study was to identify local physician expectations of RTs for the application and interpretation of various assessment procedures. METHODS: A survey was developed that called for physicians to indicate on a scale of 1 to 5 (1 = never, 2 = rarely, 3 = occasionally, 4 = often, and 5 = always) how important they perceive it is for RTs to be able to interpret or perform 20 commonly used patient assessment tests or procedures. The survey was mailed to 25 physicians who care for patients in the medical and surgical intensive care units at Loma Linda University Medical Center and the Jerry L Pettis Veterans Administration Memorial Medical Center. RESULTS: Twenty (80%) of the surveys were returned. The assessment procedures rated highest were: to assess lung sounds (4.8), to interpret arterial blood gas values (4.5), to interpret pulmonary function tests (4.4), to assess and interpret vital signs (4.4), and to interview patient to clarify symptoms (4.3). The procedures consistently rated low were: to interpret echocardiography (2.5), to assess abdomen (2.3), to interpret sleep studies (2.2), and to interpret electroencephalogram (1.7). A total expectation score for each completed survey was determined by adding the scores from each of the 20 assessment procedures. The average +/- SD total score was 66.8 +/- 10.4 on a scale of 20 to 100. The total expectation score did not vary by years of experience in patient care or type of medical specialty. CONCLUSIONS: The results indicate that the physicians completing our survey generally have high expectations of RTs for the application of patient assessment techniques that involve direct evaluation of lung performance or condition.