Journal of Clinical Respiratory Diseases & Care: Open Access

Objective: Ambulation and early mobility is used in concert with oxygen therapy, as exercise is linked to improved patient outcomes. Past studies with ambulatory oxygen have evaluated patients with a need for oxygenation and ventilatory support during daily activity. The goal of this study is to establish the feasibility of a low risk model, using High Velocity Nasal Insufflation (HVNI; a form of non-invasive ventilation that augments breathing) providing oxygenation and ventilation support to facilitate ambulation of patients experiencing Dyspnea, and assess the impact of HVNI on outcomes compared to treatment as usual (TAU) in both inpatients and outpatients.

Methods: The study was performed as a prospective, crossover trial of patients across three sites. Patients prescribed ambulation (in the conduct of normal clinical care) were studied on oxygen therapy, and then crossed to HVNI therapy for the subsequent ambulation attempt. Ambulation distance and duration time were primary outcomes, with recovery time, vital signs, patient perception and clinician perception were secondary measurements. Patients with Dyspnea were recruited from both inpatient and outpatient settings.

Results: 32 patients were enrolled, 28 completed both study arms and 25 were analysed after post hoc exclusion. HVNI improved inpatient distance, duration and recovery outcomes: 8.5% increase in walk duration, 12.4% increase in distance walked, 32.5% decrease in recovery time, and the speed was 7.1% faster in HVNI than in TAU. Comparable improvement was not seen among outpatient ambulation.

Conclusion: The study suggests that HVNI during ambulation is feasible and may have more effective improvement in the inpatient acute care population of the study subjects. Enhanced duration and distance whilst reducing recovery time may provide clinical advantage to inpatient ambulation. A larger, randomised controlled study is required to further explore the role of HVNI in rehabilitation and allow for deeper review of outcomes.

Bronchiectasis is an abnormal, irreversible condition of bronchus, which caused recurrent inflammation and infection, and characterized by chronic cough, and sputum. Its management aims to clear airways. The active cycle of breathing is considering as the utmost standard treatment for bronchiectasis patients as it can reduce the dependency on the drug. The study aimed to explore the effectiveness of the Active cycle breathing technique by review of the article. Review of 5 articles was done to fulfil this purpose. Randomized controlled trial study with PEDro score between 4 to 6 was taken. Studies compare the ACBT with other techniques like conventional therapy, Flutter device, Acapella device, ACBT with postural drainage, Test incremental respiratory endurance (TIRE) technique. From the review, it is found that ACBT causes a decrease in the amount of cough and sputum, increase lung function and quality of life of bronchiectasis patients. Although Flutter and Acapella show more preference to the patient for easy administration and cost-effectiveness, in terms of symptoms improvement ACBT shows a better outcome than these devices. Two article shows the use of ACBT with postural drainage has a more beneficial effect than the use of ACBT alone. One article shows TIRE technique is not effective by comparing with ACBT. So, from the overall review, it is shown that not superior to other technique but it can use as a most effective treatment technique for bronchiectasis patients. 

Background: Antihistamine medicines are used in variety of allergic disorders including rhinitis of infectious as well as non-infectious origin. There lacks an extensive study suggesting the increased incidence of Bronchitis on exposure to antihistamine medication. From our experience we noticed increased incidence of Bronchitis in patients using anti allergic medication for rhinitis and this motivated us to undertake a retrospective study on the previous patients’ management data.

Method: We collected and documented the clinical data during last 10 years of approximately 7650 patients treated in our clinic out of which we took 3101 patients for study. Antihistamine medicines Cetrizine and Fexofenadin were used in 2009 patients and these antihistamine medicines were not received by 1092 patients, which were termed as control.

Results: There was significant increase in the incidence of Bronchitis in the patients who were given antihistamine medicines in regular doses in the initial stage of disease.

Conclusion: The patients treated with antihistamines were more prone to develop bronchitis than the control group. There is compelling evidence that antihistamines have this side effect. Additionally, albumin bound structure of Cetrizine that is present in Protein Data Bank suggests that Cetrizine could be circulated in the blood stream to its target through albumin and so it might be possible for it to have distributed to other tissues and so its side reactions. Detailed molecular structural analysis and Ingenuity Pathway Analysis further suggest that cetirizine can bind proteins involved in infectious diseases (such as Bronchitis).