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H Giffordalex - One of the best experts on this subject based on the ideXlab platform.

Donald A Mahler - One of the best experts on this subject based on the ideXlab platform.

  • nebulized versus dry powder long acting muscarinic antagonist bronchodilators in patients with copd and suboptimal Peak Inspiratory Flow rate
    Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2019
    Co-Authors: Donald A Mahler, Edmund Moran, Srikanth Pendyala, Chris N Barnes, Jill A Ohar, Glenn Crater
    Abstract:

    Background: Patients with chronic obstructive pulmonary disease (COPD) and suboptimal Peak Inspiratory Flow rate (sPIFR) may not benefit optimally from dry powder inhalers (DPI) because of inadequate Inspiratory Flow. Nebulized bronchodilators may provide a better alternative. We compared bronchodilation with the long-acting muscarinic antagonist (LAMA) revefenacin for nebulization versus the DPI LAMA tiotropium, in patients with COPD and sPIFR (< 60 L/min against the resistance of Diskus®). Methods: This was a randomized, double-blind, double-dummy, 28-day Phase 3b study in patients with COPD enrolled based on sPIFR. The primary endpoint was trough forced expiratory volume in 1 second (FEV1) on Day 29 for revefenacin for nebulization versus tiotropium HandiHaler® DPI. Results: We enrolled 206 patients with mean (standard deviation) age, 65 (8) years; percent predicted FEV1, 37 (16)%; PIFR, 45 (12) L/min. In the intent-to-treat (ITT) population, revefenacin improved trough FEV1 from baseline; however, the difference versus tiotropium was not significant (least squares [LS] mean difference [standard error], 17.0 [22.4] mL, P=0.4461). In a prespecified analysis of patients with FEV1 100 mL increase in FEV1 in 41.6% versus 34.4% of patients with tiotropium in ITT and 41.4% versus 25.7% of patients in FEV1 < 50% predicted populations. Conclusions: Revefenacin did not produce significant improvements in FEV1 versus tiotropium in the ITT population, but increased trough FEV1 in patients with FEV1 < 50% predicted and sPIFR. Clinical Trial Registration (www.Clinicaltrials.gov): Study 0149 ({"type":"clinical-trial","attrs":{"text":"NCT03095456","term_id":"NCT03095456"}}NCT03095456)

  • Prevalence of Low Peak Inspiratory Flow Rate at Discharge in Patients Hospitalized for COPD Exacerbation.
    Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2017
    Co-Authors: Gulshan Sharma, Mayorga Vm, Deering Kl, Harshaw O, Donald A Mahler, Ganapathy
    Abstract:

    Background: Low Peak Inspiratory Flow rate (PIFR) (

  • prevalence of low Peak Inspiratory Flow rate at discharge in patients hospitalized for copd exacerbation
    Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2017
    Co-Authors: Gulshan Sharma, V M Mayorga, K L Deering, Donald A Mahler, O Harshaw
    Abstract:

    Background: Low Peak Inspiratory Flow rate (PIFR) (<60 L/min) among patients with chronic obstructive pulmonary disease (COPD) may result in ineffective medication inhalation, leading to poor bronchodilation. Objective: The objectives of this analysis were to evaluate the prevalence of low PIFR at the time of discharge from a COPD-related hospitalization and to examine the real-world treatment patterns and rehospitalizations by PIFR. Methods: Patients at 7 sites in the United States were screened for enrollment at hospital discharge. PIFR was measured using the InCheckTM DIAL to simulate resistance of the DISKUS® dry powder inhaler (DPI). An equal number of patients were enrolled into low PIFR (<60 L/min) or normal PIFR (≥60 L/min) cohorts. Demographics, COPD-related clinical characteristics, health status, treatment and rehospitalization data were collected. Results: Mean PIFR was 71±22.12 L/min among 268 screened patients; 31.7% (n=85) of patients had low PIFR. Among all enrolled patients (n=170), the low PIFR cohort was older (66.2±10.04 years versus 62.1±9.41 years, p=0.006) and more likely to be female (61.2% versus 42.4%, p=0.014). There was an increase in DPI use at discharge, compared with admission, in the low PIFR cohort (62.4% versus 70.6%, p=0.020). The incidences of all-cause rehospitalization up to 180 days were similar between the low and normal PIFR cohorts. Conclusions: At discharge following hospitalization for an exacerbation of COPD, approximately one-third of patients had a PIFR <60 L/min. More patients with a low PIFR were discharged with a DPI medication compared with use at admission. There was no difference in the rehospitalization rates by PIFR.

  • Peak Inspiratory Flow rate as a criterion for dry powder inhaler use in chronic obstructive pulmonary disease
    Annals of the American Thoracic Society, 2017
    Co-Authors: Donald A Mahler
    Abstract:

    Dry powder bronchodilator devices have an internal resistance. Effective use depends on the patient generating an adequate Inspiratory Flow to break up the powder packets into particles less than 5-μm in diameter that can be inhaled into the lower respiratory tract. This disaggregation takes place inside the device before the dose leaves the inhaler; this process is increased if the acceleration is fast at the start of inhalation. Peak Inspiratory Flow depends on an individual’s effort along with the strength of the respiratory muscles, which may be compromised in those with chronic obstructive pulmonary disease as a result of lung hyperinflation, hypoxemia, and muscle wasting. A handheld Inspiratory Flow meter can be used with an adjustable dial to simulate internal resistances of dry powder devices to assess whether a patient can achieve an optimal Peak Inspiratory Flow rate of at least 60 L/min. Observational studies demonstrate that 19 to 78% of stable outpatients with chronic obstructive pulmonary di...

  • prevalence and copd phenotype for a suboptimal Peak Inspiratory Flow rate against the simulated resistance of the diskus dry powder inhaler
    Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2013
    Co-Authors: Donald A Mahler, Laurie A. Waterman, Alex H. Gifford
    Abstract:

    Abstract Background: Patients who exhibit a suboptimal Peak Inspiratory Flow rate (PIFR) against the resistance (resist) of a dry powder inhaler (DPI) may not be able to effectively inhale the medication into their lower respiratory tract. PIFRresist was measured using the In-Check DIAL® to simulate the resistance of the Diskus® DPI in patients with chronic obstructive pulmonary disease (COPD) who were ≥60 years of age and had forced expiratory volume in 1 sec (FEV1) of ≤50% predicted. Our objectives were to: establish the prevalence of a suboptimal PIFRresist (<60 L/min) in this population; identify a phenotype of patients with COPD who exhibit a suboptimal PIFRresist; and assess test–retest reliability of PIFRresist. Methods: PIFRresist and Inspiratory capacity (IC) were measured after spirometry was performed in patients with advanced COPD. Repeat measurement of PIFRresist was performed in a subset of patients who returned for scheduled follow-up appointments. Results: The prevalence of a PIFRresist of...

Sophie Périé - One of the best experts on this subject based on the ideXlab platform.

  • upper airway obstruction assessment Peak Inspiratory Flow and clinical copd questionnaire
    Clinical Otolaryngology, 2018
    Co-Authors: J Sanchezguerrero, Joanne Guerlain, S Samaha, A. Burgess, Lacau J St Guily, Sophie Périé
    Abstract:

    OBJECTIVES: Spirometric evaluation of upper airway obstruction (UAO) is not commonly performed by Otolaryngologists. In addition, functional evaluation of UAO by Flow-volume loops (FVL) is not available in all clinical settings. More recently, Peak Inspiratory Flow (PIF) has proven to be a useful tool to monitor UAO at the patient's bedside. The aim of this work is to assess the role of PIF measured with a simple Flow metre (In-Check method) as a standardised, simple, non-invasive tool in quantifying chronic and subacute UAO in a routine clinical practice. In addition, a Clinical COPD Questionnaire (CCQ), previously validated to assess the psychophysical status in patients with laryngotracheal stenosis, was utilised to evaluate respiratory function in UAO. DESIGN: Prospective cohort study. SETTINGS: University teaching hospital. PARTICIPANTS: Seventy 2 subjects, an UAO group of 26 patients and a control group of 46 healthy subjects. MAIN OUTCOME MEASURES: The ability of PIF values to discriminate between the UAO group and the control group was assessed using a ROC curve. A Spearman rank correlation was used to test the relationship between PIF measurements and the global CCQ score. Additionally, an analysis of CCQ at domain and items levels was performed. RESULTS: Peak Inspiratory Flow values were accurate, with an area under the ROC curve (AUC) of 0.98 (P < .05) for differentiating the control group from the UAO group. A threshold PIF value of 170 L/min was found for diagnosing UAO. An inconclusive negative trend was found (r = -.19; P = .35) between PIF values and CCQ global score. Concerning CCQ, the symptoms domain was the most affected by UAO, higher than mental domains (P < .001) as well as functional domains (P < .01). Exertional dyspnoea and cough were the items that obtained the highest disturbed scores. CONCLUSIONS: Peak Inspiratory Flow is a non-invasive, quantitative parameter to evaluate the severity of UAO. Testing can be easily performed in a routine clinical setting, with a non-expensive hand-held device, and could help medical follow-up programmes and prevent emergency situations. However, FVL may be necessary for further assessment of UAO diseases. The CCQ confirms that exertional dyspnoea is the main symptom of UAO, but cough remains a common symptom.

  • Peak Inspiratory Flow as predictor for tracheotomy
    European Annals of Otorhinolaryngology Head and Neck Diseases, 2017
    Co-Authors: Maja Lešnik, J Sanchezguerrero, Joanne Guerlain, O. De Crouy Chanel, C. Herve, Sophie Périé
    Abstract:

    European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 135 - N° 1 - p. 3-6

  • Peak Inspiratory Flow is a simple means of predicting decannulation success following head and neck cancer surgery a prospective study of fifty six patients
    Laryngoscope, 2015
    Co-Authors: Joanne Guerlain, Jose A. S. Guerrero, Bertrand Baujat, Jean Lacau St Guily, Sophie Périé
    Abstract:

    Objectives/Hypothesis Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum Peak Inspiratory Flow (PIF) as a standardized simple tool for successful decannulation after surgery. Study Design Prospective review between January 2011 and June 2013 in a university teaching hospital. Methods Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation. Results A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to be the threshold with the best sensitivity (90%) and specificity (95%) for predicting decannulation success. There was a significant difference (P < .001) between mean PIF in the positive (86 L/min) and negative (20 L/min) decannulation groups and between mean PIF values with (77 L/min) and without cannula (100 L/min). Conclusions PIF ≥40 L/min with cannula (>60 L/min without) using the In-Check Dial oral method is a threshold associated with decannulation success. PIF is a simple quantitative parameter for evaluating the upper airway, aiding the decision to decannulate safely. Level of Evidence 4. Laryngoscope, 125:365–370, 2015

  • Peak Inspiratory Flow is a simple means of predicting decannulation success following head and neck cancer surgery: a prospective study of fifty-six patients.
    Laryngoscope, 2014
    Co-Authors: Joanne Guerlain, Jose A. S. Guerrero, Bertrand Baujat, Jean Lacau St Guily, Sophie Périé
    Abstract:

    Objectives/Hypothesis Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum Peak Inspiratory Flow (PIF) as a standardized simple tool for successful decannulation after surgery. Study Design Prospective review between January 2011 and June 2013 in a university teaching hospital. Methods Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation. Results A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to be the threshold with the best sensitivity (90%) and specificity (95%) for predicting decannulation success. There was a significant difference (P 60 L/min without) using the In-Check Dial oral method is a threshold associated with decannulation success. PIF is a simple quantitative parameter for evaluating the upper airway, aiding the decision to decannulate safely. Level of Evidence 4. Laryngoscope, 125:365–370, 2015

  • Peak Inspiratory Flow is a simple means of predicting decannulation success following head and neck cancer surgery: a prospective study of fifty-six patients.
    Laryngoscope, 2014
    Co-Authors: Joanne Guerlain, Jose A. S. Guerrero, Bertrand Baujat, Jean Lacau St Guily, Sophie Périé
    Abstract:

    Objectives/Hypothesis Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum Peak Inspiratory Flow (PIF) as a standardized simple tool for successful decannulation after surgery. Study Design Prospective review between January 2011 and June 2013 in a university teaching hospital. Methods Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation. Results A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to be the threshold with the best sensitivity (90%) and specificity (95%) for predicting decannulation success. There was a significant difference (P 60 L/min without) using the In-Check Dial oral method is a threshold associated with decannulation success. PIF is a simple quantitative parameter for evaluating the upper airway, aiding the decision to decannulate safely. Level of Evidence 4. Laryngoscope, 125:365–370, 2015

A Mahlerdonald - One of the best experts on this subject based on the ideXlab platform.

Masaji Nishimura - One of the best experts on this subject based on the ideXlab platform.

  • High Peak Inspiratory Flow can aggravate ventilator-induced lung injury in rabbits.
    Medical Science Monitor, 2007
    Co-Authors: Yasuki Fujita, Akinori Uchiyama, Yuji Fujino, Takashi Mashimo, Masaji Nishimura
    Abstract:

    Background: The study investigated the effect of Peak Inspiratory Flow in a rabbit acute lung injury model. Material/Methods: Twenty-five male rabbits were anesthetized and mechanically ventilated with high tidal volume (V T ) until PaO 2 dropped below 300 mmHg. Then the animals were randomly assigned to two groups: group V (n=10) receiving volume-control ventilation and group P (n=10) receiving pressure-regulated volume-control ventilation. Each animal was ventilated for 8 h at the following settings: V T 20 ml/kg, positive end-expiratory pressure 5 cmH 9 O, and respiratory rate 20 breaths/min with Inspiratory-to-expiratory ratio of 1:4. Whether eleven hours of pressure-regulated volume-control ventilation at a V T of 20 ml/kg was harmful in rabbits with healthy lungs (control group, n=5) was also investigated. Results: Group P's Peak Inspiratory Flow was significantly (p

  • high Peak Inspiratory Flow can aggravate ventilator induced lung injury in rabbits
    Medical Science Monitor, 2007
    Co-Authors: Yasuki Fujita, Akinori Uchiyama, Yuji Fujino, Takashi Mashimo, Masaji Nishimura
    Abstract:

    Background: The study investigated the effect of Peak Inspiratory Flow in a rabbit acute lung injury model. Material/Methods: Twenty-five male rabbits were anesthetized and mechanically ventilated with high tidal volume (V T ) until PaO 2 dropped below 300 mmHg. Then the animals were randomly assigned to two groups: group V (n=10) receiving volume-control ventilation and group P (n=10) receiving pressure-regulated volume-control ventilation. Each animal was ventilated for 8 h at the following settings: V T 20 ml/kg, positive end-expiratory pressure 5 cmH 9 O, and respiratory rate 20 breaths/min with Inspiratory-to-expiratory ratio of 1:4. Whether eleven hours of pressure-regulated volume-control ventilation at a V T of 20 ml/kg was harmful in rabbits with healthy lungs (control group, n=5) was also investigated. Results: Group P's Peak Inspiratory Flow was significantly (p<0.05) higher than group V's. From 4 h after the establishment of acute lung injury to the end of the experiment, group V's PaO 2 values were significantly higher than group P's. Wet-to-dry ratio and upper lobe tissue injury scores were higher in group P than in group V. Control animals showed neither apparent lung injury after 11 h of mechanical ventilation nor deterioration in gas exchange during the protocol. Conclusions: Compared with volume-control ventilation with V T (20 ml/kg), pressure-regulated volume-control ventilation with the same V T worsened oxygenation, histological injury score in upper lobes, and wet-to-dry ratio in rabbits with injured lungs. The evidence suggests that greater deterioration in gas exchange and lung injury is associated with high Inspiratory Flow.

  • effect of Peak Inspiratory Flow on gas exchange pulmonary mechanics and lung histology in rabbits with injured lungs
    Journal of Anesthesia, 2006
    Co-Authors: Yasuki Fujita, Akinori Uchiyama, Yoshiko Maeda, Yuji Fujino, Takashi Mashimo, Masaji Nishimura
    Abstract:

    Purpose The aim of this study was to evaluate, using a rabbit model, the little-known effect of different levels of Peak Inspiratory Flow on acutely injured lungs.

  • effects of Peak Inspiratory Flow on development of ventilator induced lung injury in rabbits
    Anesthesiology, 2004
    Co-Authors: Yoshiko Maeda, Akinori Uchiyama, Nariaki Matsuura, Yuji Fujino, Takashi Mashimo, Masaji Nishimura
    Abstract:

    Background:A lung-protecting strategy is essential when ventilating acute lung injury/acute respiratory distress syndrome patients. Current emphasis is on limiting Inspiratory pressure and volume. This study was designed to investigate the effect of Peak Inspiratory Flow on lung injury.Methods:Twent

  • effects of Peak Inspiratory Flow on development of ventilator induced lung injury in rabbits
    International Conference of the American Thoracic Society, 2004
    Co-Authors: Yoshiko Maeda, Akinori Uchiyama, Nariaki Matsuura, Yuji Fujino, Takashi Mashimo, Masaji Nishimura
    Abstract:

    Background: A lung-protecting strategy is essential when ventilating acute lung injury/acute respiratory distress syndrome patients. Current emphasis is on limiting Inspiratory pressure and volume. This study was designed to investigate the effect of Peak Inspiratory Flow on lung injury. Methods: Twenty-four rabbits were anesthetized, tracheostomized, ventilated with a Siemens Servo 300, and randomly assigned to three groups as follows: 1) the pressure regulated volume control group received pressure-regulated volume control mode with Inspiratory time set at 20% of total cycle time, 2) the volume control with 20% Inspiratory time group received volume-control mode with Inspiratory time of 20% of total cycle time, and 3) the volume control with 50% Inspiratory time group received volume-control mode with Inspiratory time of 50% of total cycle time. Tidal volume was 30 ml/kg, respiratory rate was 20 breaths/min, and positive end-expiratory pressure was 0 cm H 2 O. After 6 h mechanical ventilation, the lungs were removed for histologic examination. Results: When mechanical ventilation started, Peak Inspiratory Flow was 28.8 ± 1.4 l/min in the pressure regulated volume control group, 7.5 ± 0.5 l/min in the volume control with 20% Inspiratory time group, and 2.6 ± 0.3 l/min in the volume control with 50% Inspiratory time group. Plateau pressure did not differ significantly among the groups. Gradually during 6 h, Pao 2 in the pressure regulated volume control group decreased from 688 ± 39 to a significantly lower 304 ± 199 mm Hg (P < 0.05) (mean ± SD). The static compliance of the respiratory system for the pressure regulated volume control group also ended significantly lower after 6 h (P < 0.05). Wet to dry ratio for the pressure regulated volume control group was larger than for other groups (P < 0.05). Macroscopically and histologically, the lungs of the pressure regulated volume control group showed more injury than the other groups. Conclusion: When an injurious tidal volume is delivered, the deterioration in gas exchange and respiratory mechanics, and lung injury appear to be marked at a high Peak Inspiratory Flow.