ABSTRACT
The quality of asthma care is the second topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group recommended an asthma continuous quality improvement model as an appropriate framework for examining the quality of asthma care. This model can be implemented by various organizations and providers of care in a variety of settings. The framework consists of four steps: (1) define the opportunity for improvement, (2) set the asthma quality improvement goals (outcomes), (3) characterize the process of care, and (4) begin the improvement cycle. Several case studies are presented to illustrate the use of this model in various settings, including managed care facilities, emergency departments, teaching hospitals, physician's offices, schools, workplaces, and communities. In addition, the appendix provides an overview of asthma outcome measures in the framework of patient-centered versus organizationally based perspectives.
Subject(s)
Asthma/therapy , Quality Assurance, Health Care , Child , Health Facilities , Health Maintenance Organizations , Humans , Outcome Assessment, Health Care , United StatesSubject(s)
Health Care Reform , Societies, Medical , State Health Plans , Colorado , Humans , Insurance Benefits , United StatesSubject(s)
Lung/pathology , Neurosecretory Systems/pathology , Respiratory Tract Diseases/pathology , Adult , Aged , Bronchi/pathology , Carcinoid Tumor/pathology , Dyspnea/pathology , Female , Fibrosis/pathology , Humans , Hyperplasia , Lung Diseases/pathology , Lung Neoplasms/pathology , Male , Middle AgedABSTRACT
The treatment of nocturnal asthma remains a challenge. We investigated the use of a pulsed-released albuterol in ten patients with nocturnal symptoms of asthma. In a randomized, double-blind, placebo-controlled, crossover designed study, we tested the use of 8 mg of pulsed-release albuterol sulfate (Proventil Repetabs) vs placebo. The pulsed-release albuterol significantly blunted the overnight drop in FEV1, improved peak flow readings in the morning, and decreased subjective awakenings from sleep. We conclude that pulsed-released albuterol is an effective therapeutic option in patients with nocturnal asthma.
Subject(s)
Albuterol/administration & dosage , Asthma/drug therapy , Circadian Rhythm/drug effects , Adolescent , Adult , Aged , Asthma/physiopathology , Circadian Rhythm/physiology , Delayed-Action Preparations , Double-Blind Method , Drug Evaluation , Humans , Middle Aged , Sleep/drug effects , Sleep/physiology , SpirometryABSTRACT
We assessed the bronchodilator response to a recently available ultrasonic nebulizer (USN) in a population of 17 stable asthmatic patients. These patients were also evaluated for bronchodilator response to two other aerosol delivery systems routinely used in standard clinical practice, the metered-dose inhaler (MDI) and the jet nebulizer (JN). Albuterol was administered from each of the delivery systems in the following manner: MDI, two actuations (180 micrograms); JN, 0.5 ml of 0.5 percent solution (2.5 mg) in 1.0 ml saline solution diluent; and USN, 0.5 ml of 0.5 percent solution (2.5 mg) in 2.5 ml saline solution diluent. Patients demonstrated significant bronchodilator responses to all three delivery systems (p less than 0.0001). The USN produced a greater percentage of increase in FEV1 15 minutes after treatment with albuterol (35.8 +/- 2.3 percent) than either the MDI (18.2 +/- 3.4 percent) or JN (20.8 +/- 3.1 percent) (p less than 0.005). The mean percentage of increase in FE1 observed over a 4-h period after treatment was also greater for the USN (26.5 +/- 2.5 percent) than either the MDI (18.8 +/- 1.8 percent) or JN (15.0 +/- 1.6 percent) (p less than 0.001). We conclude that the USN yields effective bronchodilation in a population of stable asthmatics.
Subject(s)
Albuterol/administration & dosage , Asthma/drug therapy , Bronchi/drug effects , Nebulizers and Vaporizers , Ultrasonic Therapy/instrumentation , Adult , Aerosols , Albuterol/pharmacology , Analysis of Variance , Asthma/physiopathology , Blood Pressure/drug effects , Equipment Design , Female , Forced Expiratory Volume/drug effects , Humans , Male , Middle Aged , Peak Expiratory Flow Rate/drug effects , Pulse/drug effects , Spirometry , Time Factors , Vital Capacity/drug effectsABSTRACT
In the case reported herein a patient developed bilateral pneumonia and septic shock and subsequently developed bilateral effusions. Chest roentgenograms, computed tomograms, and findings from analysis of the fluid within the chest were consistent with typical empyemas. When surgical decortication was attempted, the effusions were found to be anatomically extrapleural. Symptomatic improvement was noted following débridement.
Subject(s)
Pleural Effusion/etiology , Pneumonia/complications , Diaphragm/pathology , Female , Humans , Lung/diagnostic imaging , Middle Aged , Pleura/pathology , Pleural Effusion/pathology , Pneumonia/diagnostic imaging , Shock, Septic/complications , Tomography, X-Ray ComputedABSTRACT
This case report describes two episodes of pneumonia caused by Bordetella bronchiseptica in a patient with chronic lymphocytic leukemia. There was discrepancy between the in vitro sensitivity testing of the organism and subsequent clinical response to several antimicrobial agents. Human infection with B bronchiseptica is almost always associated with severe underlying disease and contact with an appropriate animal reservoir.
Subject(s)
Bordetella Infections/etiology , Leukemia, Lymphoid/complications , Pneumonia/etiology , Aged , Animals , Bordetella/pathogenicity , Cattle , Disease Reservoirs/veterinary , Humans , Immune Tolerance , Male , SwineABSTRACT
Hangover following consumption of alcohol includes many disagreeable signs and symptoms that are suggestive of sympathetic overactivity. We performed a randomized, double-blind, crossover controlled study to assess the effect of beta blockade in preventing the symptoms of hangover. Ten subjects were randomized to receive 160 mg of a long-acting preparation of propranolol or a placebo and then participated in a controlled drinking situation. Patients were then evaluated for symptoms and signs of hangover. The results showed that although beta blockade was achieved, there was no clinically important reduction in symptoms of hangover. We conclude that propranolol does not prevent the symptoms of hangover.
Subject(s)
Alcoholic Intoxication/drug therapy , Propranolol/therapeutic use , Adult , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Placebos , Random AllocationABSTRACT
Hangover following consumption of alcohol includes many disagreeable signs and symptoms that are suggestive of sympathetic overactivity. We performed a randomized, double-blind, crossover controlled study to assess the effect of beta blockade in preventing the symptoms of hangover. Ten subjects were randomized to receive 160 mg of a long-acting preparation of propranolol or a placebo and then participated in a controlled drinking situation. Patients were then evaluated for symptoms and signs of hangover. The results showed that although beta blockade was achieved, there was no clinically important reduction in symptoms of hangover. We conclude that propranolol does not prevent the symptoms of hangover.
