Comparison of the acute effects on gas exchange of nasal ventilation and doxapram in exacerbations of chronic obstructive pulmonary disease.

Angus, Robert; Ahmed, Abdulla; Fenwick, L. J.; Peacock, AJ

doi:10.1136/thx.51.10.1048

Cited by 106 publications

(46 citation statements)

References 5 publications

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“…The infusion may be continued for several days with gradual reduction of the infusion rate over time. However its use, at least in the U.K., has declined probably due to the greater efficacy of other techniques such as nasal intermittent positive pressure ventilation as a temporizing measure in respiratory failure (2).…”

Section: Use As a Stimulant In Respiratory Failurementioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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A number of life-threatening clinical disorders may be amenable to treatment with a drug that can stimulate respiratory drive. These include acute respiratory failure secondary to chronic obstructive pulmonary disease, post-anesthetic respiratory depression, and apnea of prematurity. Doxapram has been available for over forty years for the treatment of these conditions and it has a low side effect profile compared to other available agents. Generally though, the use of doxapram has been limited to these clinical niches involving patients in the intensive care, post-anesthesia care and neonatal intensive care units. Recent basic science studies have made considerable progress in understanding the molecular mechanism of doxapram's respiratory stimulant action. Although it is unlikely that doxapram will undergo a clinical renaissance based on this new understanding, it represents a significant advance in our knowledge of the control of breathing.

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Section: Use As a Stimulant In Respiratory Failurementioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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“…This drug is a potent stimulus to breathing in healthy individuals [33] but appears inferior to noninvasive positive pressure ventilation in COPD patients [34].…”

Section: Maintaining Gas Exchangementioning

confidence: 99%

Respiratory failure in chronic obstructive pulmonary disease

Calverley¹

2003

Eur Respir J

107

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Respiratory failure in chronic obstructive pulmonary disease. P.M.A. Calverley. #ERS Journals Ltd 2003. ABSTRACT: Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality.The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation/perfusion mismatching with a relative increase in the physiological dead space leads to hypercapnia and hence acidosis. This is largely the result of a shift to a rapid shallow breathing pattern and a rise in the dead space/tidal volume ratio of each breath. This breathing pattern results from adaptive physiological responses which lessen the risk of respiratory muscle fatigue and minimise breathlessness.Treatment is directed at reducing the mechanical load applied to each breath, correcting specific precipitating factors, e.g. bacterial infection, and maintaining gas exchange. Both bronchodilators and oral corticosteroids can improve spirometric results in exacerbations of COPD and should be routinely offered to patients with respiratory failure. Controlled oxygen is still not always prescribed appropriately and high inspired oxygen concentrations can lead to severe acidosis by either worsening ventilation/perfusion mismatching and/or inducing a degree of hypoventilation. Ventilatory support using noninvasive ventilation has revolutionised the approach to these patients.Acute respiratory failure due to chronic obstructive pulmonary disease remains a common medical emergency that can be effectively managed. More attention should be focused on the prevention of these episodes and identifying the factors which cause early relapse. Eur Respir J 2003; 22: Suppl. 47, 26s-30s.

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“…Respiratory failure can be managed by giving parental respiratory stimulants with doxapram hydrochloride being the favourite drug. Reports over 30 years ago suggest that this might improve blood gas tensions, but more recent studies have found it inferior to noninvasive positive pressure ventilation in the management of significant hypercapnic exacerbations of COPD [41].…”

Section: Other Medicationsmentioning

confidence: 99%

Modern treatment of chronic obstructive pulmonary disease

Calverley¹

2001

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a major cause of ill health and medical expenditure worldwide. Despite recent increases in the knowledge about the nature of the disease process and recognition of cytokine-mediated pathways of inflammation, current management is focussed on patient outcomes that relate to physiological measures of dysfunction.The new Global initiative in Obstructive Lung Disease (GOLD) management guidelines are evidence-based and stress both pharmacological and nonpharmacological therapy. Effective drug therapy can help smoking cessation in motivated patients (nicotine replacement, bupropion). Bronchodilator therapy is best given by inhaler, can use either beta-agonists or anticholinergics and is more effective if long acting. Health status and exercise performance can improve without parallel changes in forced expiratory volume in one second. Inhaled corticosteroids are indicated if there is a significant bronchodilator response or the patient has more severe disease with frequent exacerbations.Antioxidant therapy remains controversial but may reduce exacerbation number. Acute exacerbations require higher doses of bronchodilators and short courses of oral corticosteroids. New drug treatment is a major priority for chronic obstructive pulmonary disease research.

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Comparison of the acute effects on gas exchange of nasal ventilation and doxapram in exacerbations of chronic obstructive pulmonary disease.

Cited by 106 publications

References 5 publications

A New Look at the Respiratory Stimulant Doxapram

A New Look at the Respiratory Stimulant Doxapram

Respiratory failure in chronic obstructive pulmonary disease

Modern treatment of chronic obstructive pulmonary disease

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