ABSTRACT
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) carry significant morbidity and mortality. AECOPD treatment remains limited. High molecular weight hyaluronan (HMW-HA) is a glycosaminoglycan sugar, which is a physiological constituent of the lung extracellular matrix and has notable anti-inflammatory and hydrating properties. RESEARCH QUESTION: We hypothesized that inhaled HMW-HA will improve outcomes in AECOPD. METHODS: We conducted a single center, randomized, placebo-controlled, double-blind study to investigate the effect of inhaled HMW-HA in patients with severe AECOPD necessitating non-invasive positive-pressure ventilation (NIPPV). Primary endpoint was time until liberation from NIPPV. RESULTS: Out of 44 screened patients, 41 were included in the study (21 for placebo and 20 for HMW-HA). Patients treated with HMW-HA had significantly shorter duration of NIPPV. HMW-HA treated patients also had lower measured peak airway pressures on the ventilator and lower systemic inflammation markers after liberation from NIPPV. In vitro testing showed that HMW-HA significantly improved mucociliary transport in air-liquid interface cultures of primary bronchial cells from COPD patients and healthy primary cells exposed to cigarette smoke extract. INTERPRETATION: Inhaled HMW-HA shortens the duration of respiratory failure and need for non-invasive ventilation in patients with AECOPD. Beneficial effects of HMW-HA on mucociliary clearance and inflammation may account for some of the effects (NCT02674880, www.clinicaltrials.gov ).
Subject(s)
Hyaluronic Acid/administration & dosage , Inflammation Mediators/metabolism , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/metabolism , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/metabolism , Adjuvants, Immunologic/administration & dosage , Administration, Inhalation , Aged , Aged, 80 and over , Cells, Cultured , Double-Blind Method , Female , Humans , Inflammation Mediators/antagonists & inhibitors , Length of Stay/trends , Male , Middle Aged , Molecular Weight , Pilot Projects , Tobacco Smoke Pollution/adverse effectsABSTRACT
There is a paucity of data on the impact of mobile technology on physician-led education in the pediatric population. We performed a prospective pilot study in a pediatric diabetes clinic to evaluate the impact of tablet-based patient education. A total of 106 patients and caregivers completed postclinic surveys, 64 (60%) in the intervention group and 42 (40%) in the control group. The majority of the intervention group patients (86%) liked tablet use and felt it was better or similar (99%) to baseline. Moreover, a majority receiving tablet-based education perceived an increase in diabetes knowledge (57%) compared with baseline (39%), though the difference did not reach statistical significance ( P = .059). Those who received tablet-based education felt they were educated on more diabetes-related topics. As the use of mobile technology in medicine grows, additional research is needed to compare mobile technology with traditional methods in providing education to the pediatric population.
