human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The delivery of bronchodilators with a metered-dose inhaler ( MDI ) and a spacer in mechanically ventilated patients has become widespread practice . However , the various ventilator setting s that influence the efficacy of MDI are not well established . Application of an end-inspiratory pause ( EIP ) during drug delivery has been suggested as one of the factors that might increase the effectiveness of this therapy . To test this , the effect of EIP on the bronchodilation induced by beta2-agonists administered with MDI and a spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) was examined . Twelve patients with COPD , mechanically ventilated on volume-controlled mode , were prospect ively r and omized to receive six puffs of salbutamol ( 100 microg x puff(-1 ) ) either with or without EIP of 5 s duration . Salbutamol was administered with an MDI adapted to the inspiratory limb of the ventilator circuit using an aerosol cloud-enhancer spacer . After a 6 h wash-out , patients were crossed over to receive salbutamol by the alternative mode of administration . Static and dynamic airway pressures , minimum ( Rmin ) and maximum ( Rmax ) airflow resistance , the difference between Rmax and Rmin ( deltaR ) , static end-inspiratory respiratory system compliance ( Cst , rs ) and cardiac frequency ( fc ) were measured before and at 15 , 30 and 60 min after salbutamol administration . Salbutamol caused a significant decrease in dynamic and static airway pressures , Rmin and Rmax . These changes were not influenced by application of EIP and were evident at 15 , 30 and 60 min after salbutamol . With and without EIP , Cst , rs , deltaR and fc did not change after salbutamol . In conclusion , salbutamol delivered with a metered-dose inhaler and a spacer device induced significant bronchodilation in mechanically ventilated patients with chronic obstructive pulmonary disease , the magnitude of which was not affected by an end-expiratory pause of 5 s. These results do not support the use of end-inspiratory pause when bronchodilators are administered in adequate doses during controlled mechanical ventilation Patients with chronic obstructive pulmonary disease ( COPD ) often subjectively benefit from inhaled R2-agonists in spite of little or no demonstrable effect in forced expiratory volume in 1 second ( FEV1.0 ) . A comparison between the effects of terbutaline administered via a dry powder inhaler ( Turbuhaler ® ) and via a chlorofluorocarbon ( CFC ) inhaler in conjunction with a spacer device ( Nebuhaler ® ) was performed in patients with regard to FEV1.0 , forced expiratory capacity ( FVC ) , residual volume ( RV ) , and specific conductance ( s-Gaw ) . Fifteen hospitalised patients ( 11 male ) with COPD were studied , each of whom had a diurnal variation in peak expiratory flow ( PEF ) not exceeding 15 % and with a demonstrated volume response to inhaled β2-agonists in FVC and /or RV of at least 15 % . Patients were administered each of the following five treatments on a single occasion in a r and omized order ( latin square ) in intervals of at least 2 days : placebo , terbutaline via Turbuhaler ( 1.0 and 2.5 mg ) and terbutaline via a CFC inhaler ( 1.0 mg without and 2.5 mg with Nebuhaler ) . Inhalation of terbutaline in different doses and from different devices induced a decrease in RV , an increase in FVC , and s-Gaw and a less pronounced increase in FEV1.0 . No statistically significant differences between the four terbutaline treatments were seen , but all were significantly different from the placebo . These findings indicate that while patients with COPD may benefit from inhaled terbutaline through decreased hyperinflation , the choice of inhalation device seems to be of little importance for its efficacy Respiratory infections , viral or bacterial , are a common cause of acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) . A rapid , point-of-care , and easy-to-use tool distinguishing viral and bacterial from other causes would be valuable in routine clinical care . An electronic nose ( e-nose ) could fit this profile but has never been tested in this setting before . In a single-center registered trial ( NTR 4601 ) patients admitted with AE COPD were tested with the Aeonose ( ® ) electronic nose , and a diagnosis of viral or bacterial infection was obtained by bacterial culture on sputa and viral PCR on nose swabs . A neural network with leave-10%-out cross-validation was used to assess the e-nose data . Forty three patients were included . In the bacterial infection model , 22 positive cases were tested versus the negatives ; and similarly 18 positive cases were tested in the viral infection model . The Aeonose was able to distinguish between COPD -subjects suffering from a viral infection and COPD patients without infection , showing an area under the curve ( AUC ) of 0.74 . Similarly , for bacterial infections , an AUC of 0.72 was obtained . The Aeonose e-nose yields promising results in ' smelling ' the presence or absence of a viral or bacterial respiratory infection during an acute exacerbation of COPD . Validation of these results using a new and large cohort is required before introduction into clinical practice The present study aims to determine whether treating chronic obstructive pulmonary disease ( COPD ) exacerbations with intravenous steroids and aerosol bronchodilators ( group I ) is superior to oral steroids and multiple dose inhaler ( MDI ) bronchodilators with a spacer ( group II ) . Group I received 40 mg methylprednisolone·day−1 intravenously with a decrease to 20 mg after 10 days and a further decrease of 4 mg·4 days−1 . Aerosol therapy consisted of 10 mg salbutamol and 1 mg ipratropiumbromide·day−1 . Group II received 32 mg methylprednisolone orally for 1 week followed by 24 mg·day−1 for 4 days and a subsequent decrease of 4 mg·week−1 . Duovent ® MDI with a spacer was given at a dose of 1.6 mg fenoterol and 640 µg ipratropiumbromide·day−1 . In group I ( n=19 ) forced expiratory volume in one second ( FEV1 ) rose from 0.82±0.46 to 0.91±0.47 L and average dyspnoea decreased from 6.0±1.9 to 4.1±2.6 within 10 days . The Chronic Respiratory Disease Index Question naire ( CRQ ) score increased from 78±24 to 90±24 points after 4 weeks . In group II (  n=18 ) FEV1 increased from 0.70±0.27 to 0.90±0.29 L , dyspnoea regressed from 6.2±2.4 to 2.7±2.6 and CRQ from 67±17 to 86±20 . Both groups showed similar results in dropout rate , length of hospital stay and patient satisfaction . In conclusion , the two treatment strategies appear equally effective in treating chronic obstructive pulmonary disease exacerbations , although oral steroids and metered dose inhaler bronchodilators appear associated with a higher risk of hospital re-admission BACKGROUND It is unknown whether the bronchodilation and anti-inflammatory effects of inhaled salmeterol and fluticasone ( SF ) are better than those of traditionally inhaled ipratropium , terbutaline and budesonide ( ITB ) in mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Nineteen stable COPD patients with respiratory failure were r and omly enrolled into two groups . Patients were treated with inhaled SF delivered by a metered-dose inhaler with a spacer or with inhaled nebulized ITB . Respiratory parameters were measured for 7 days and plasma cytokine levels were measured on days 1 and 7 . RESULTS The kinetic curve of the rapid shallow index ( RSI ) from day 1 to day 7 was significant lower in the SF group than that in the ITB group . There were no significant differences in minute ventilation , intrinsic positive end expiratory pressure , and airway resistance between the ITB and SF groups from day 1 to day 7 . There were no differences in plasma interleukin (IL)-6 , IL-10 , IL- 12 , and transforming growth factor-beta1 levels between day 1 and day 7 in the ITB or SF group . CONCLUSIONS Patients with inhaled SF treatment had a lower RSI . The effects of bronchodilators and anti-inflammation were similar between inhaled SF and ITB in COPD patients with ventilator support Thirty-six acutely III , hospitalized patients with acute exacerbations of obstructive airway disease and a greater than 10 % increase in forced expiratory volume in 1 s after administration of aerosolized bronchodilator were r and omized to receive either metaproterenol sulfate delivered by updraft-compressor nebulization ( UDN ) or terbutaline sulfate delivered by metered-dose inhaler ( MDI ) with a spacer . Serial analyses of pulmonary function measurements were performed with the use of 95 % confidence intervals for the percentage response ratios of MDI to UDN . The response to MDI was at least equivalent to that of UDN , and MDI use was associated with no prolongation of hospital stay . Equivalent bronchodilation was achieved with MDI therapy with a lower daily charge for therapy for each patient and less respiratory therapist time . In hospitalized bronchodilator-responsive patients with acute exacerbations of obstructive airway disease , the MDI/spacer combination is the preferred approach when the status of the patient allows its use BACKGROUND Acute exacerbations of asthma and chronic obstructive pulmonary disease ( COPD ) are associated with increased airflow Limitation , hyperinflation and respiratory muscle fatigue . It is unclear , whether patients are able to perform adequate inhalations through various inhalation devices with different orfices during an exacerbation . The aim of this study was to examine the evolution of inhalation profiles of patients inhaling through Diskus , Turbuhaler , pressurized metered dose inhaler ( pMDI ) and Volumatic and consequently the appropriateness of using the various devices during an exacerbation . MEASUREMENTS 15 hospitalized patients participated in this r and omized comparison of inhalation profiles through the four placebo-devices . For each device , triplicate inhalation profiles were recorded during day 1 - 9 of admission and in stable phase ( day 50 ) . RESULTS The mean percentage of patients performing optimum inhalation profiles was 100 % for Diskus , 60 % for Turbuhaler , 14 % for pMDI and 87 % for Volumatic over the interval of day 1 - 9 and day 50 . Patients with an inspiratory muscle strength ( MIP ) of less than 6kPa were generally unable to generate the optimum flow through the Turbuhaler ( > 60 l/min ) . CONCLUSION The Diskus and Volumatic can be used effectively in the acute phase of an exacerbation of asthma or COPD . The Turbuhaler could be optimally used after the fifth day of convalescence . The pMDI is rather unsuitable during an exacerbation OBJECTIVE Four-hour comparison of the bronchodilator response of albuterol administered via metered-dose inhaler ( MDI ) with spacer versus small-volume nebulizer ( SVN ) to mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve r and omized clinical trial . SETTING Medical intensive care unit in a university hospital . PATIENTS Thirteen mechanically ventilated COPD patients . INTERVENTION Albuterol administration of 4 puffs ( 0.4 mg ) or 10 puffs ( 1.0 mg ) via MDI with spacer or 2.5 mg via SVN to mechanically ventilated patients in order to assess the bronchodilator response over 4 hours . MEASUREMENTS AND RESULTS Mechanically ventilated patients were enrolled in a r and omized crossover study wherein one group received 4 puffs ( 0.4 mg ) or 2.5 mg of albuterol and another group received 10 puffs ( 1.0 mg ) or 2.5 mg of albuterol on separate days . Respiratory mechanics measurements were obtained over 4 hours . Total airway resistance declined by 14.4 + /- 3.8 % after 4 MDI puffs , 18.3 + /- 1.8 % after 10 MDI puffs , or 13.7 + /- 2.6 % after 2.5 mg via SVN , compared to baseline ( p < 0.01 ) . After albuterol delivery , airway resistance remained improved for 90 - 120 minutes ( p < 0.05 ) and returned to baseline by 4 hours with all treatments . CONCLUSION The airway response to albuterol administration via MDI and SVN to mechanically ventilated patients was similar in magnitude and duration , returning to baseline by 240 minutes . In stable , mechanically ventilated COPD patients , albuterol may be administered via MDI with spacer or via SVN every 4 hours BACKGROUND Formoterol fumarate ( FF ) is a well-est 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The delivery of bronchodilators with a metered-dose inhaler ( MDI ) and a spacer in mechanically ventilated patients has become widespread practice . However , the various ventilator setting s that influence the efficacy of MDI are not well established . Application of an end-inspiratory pause ( EIP ) during drug delivery has been suggested as one of the factors that might increase the effectiveness of this therapy . To test this , the effect of EIP on the bronchodilation induced by beta2-agonists administered with MDI and a spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) was examined . Twelve patients with COPD , mechanically ventilated on volume-controlled mode , were prospect ively r and omized to receive six puffs of salbutamol ( 100 microg x puff(-1 ) ) either with or without EIP of 5 s duration . Salbutamol was administered with an MDI adapted to the inspiratory limb of the ventilator circuit using an aerosol cloud-enhancer spacer . After a 6 h wash-out , patients were crossed over to receive salbutamol by the alternative mode of administration . Static and dynamic airway pressures , minimum ( Rmin ) and maximum ( Rmax ) airflow resistance , the difference between Rmax and Rmin ( deltaR ) , static end-inspiratory respiratory system compliance ( Cst , rs ) and cardiac frequency ( fc ) were measured before and at 15 , 30 and 60 min after salbutamol administration . Salbutamol caused a significant decrease in dynamic and static airway pressures , Rmin and Rmax . These changes were not influenced by application of EIP and were evident at 15 , 30 and 60 min after salbutamol . With and without EIP , Cst , rs , deltaR and fc did not change after salbutamol . In conclusion , salbutamol delivered with a metered-dose inhaler and a spacer device induced significant bronchodilation in mechanically ventilated patients with chronic obstructive pulmonary disease , the magnitude of which was not affected by an end-expiratory pause of 5 s. These results do not support the use of end-inspiratory pause when bronchodilators are administered in adequate doses during controlled mechanical ventilation Patients with chronic obstructive pulmonary disease ( COPD ) often subjectively benefit from inhaled R2-agonists in spite of little or no demonstrable effect in forced expiratory volume in 1 second ( FEV1.0 ) . A comparison between the effects of terbutaline administered via a dry powder inhaler ( Turbuhaler ® ) and via a chlorofluorocarbon ( CFC ) inhaler in conjunction with a spacer device ( Nebuhaler ® ) was performed in patients with regard to FEV1.0 , forced expiratory capacity ( FVC ) , residual volume ( RV ) , and specific conductance ( s-Gaw ) . Fifteen hospitalised patients ( 11 male ) with COPD were studied , each of whom had a diurnal variation in peak expiratory flow ( PEF ) not exceeding 15 % and with a demonstrated volume response to inhaled β2-agonists in FVC and /or RV of at least 15 % . Patients were administered each of the following five treatments on a single occasion in a r and omized order ( latin square ) in intervals of at least 2 days : placebo , terbutaline via Turbuhaler ( 1.0 and 2.5 mg ) and terbutaline via a CFC inhaler ( 1.0 mg without and 2.5 mg with Nebuhaler ) . Inhalation of terbutaline in different doses and from different devices induced a decrease in RV , an increase in FVC , and s-Gaw and a less pronounced increase in FEV1.0 . No statistically significant differences between the four terbutaline treatments were seen , but all were significantly different from the placebo . These findings indicate that while patients with COPD may benefit from inhaled terbutaline through decreased hyperinflation , the choice of inhalation device seems to be of little importance for its efficacy Respiratory infections , viral or bacterial , are a common cause of acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) . A rapid , point-of-care , and easy-to-use tool distinguishing viral and bacterial from other causes would be valuable in routine clinical care . An electronic nose ( e-nose ) could fit this profile but has never been tested in this setting before . In a single-center registered trial ( NTR 4601 ) patients admitted with AE COPD were tested with the Aeonose ( ® ) electronic nose , and a diagnosis of viral or bacterial infection was obtained by bacterial culture on sputa and viral PCR on nose swabs . A neural network with leave-10%-out cross-validation was used to assess the e-nose data . Forty three patients were included . In the bacterial infection model , 22 positive cases were tested versus the negatives ; and similarly 18 positive cases were tested in the viral infection model . The Aeonose was able to distinguish between COPD -subjects suffering from a viral infection and COPD patients without infection , showing an area under the curve ( AUC ) of 0.74 . Similarly , for bacterial infections , an AUC of 0.72 was obtained . The Aeonose e-nose yields promising results in ' smelling ' the presence or absence of a viral or bacterial respiratory infection during an acute exacerbation of COPD . Validation of these results using a new and large cohort is required before introduction into clinical practice The present study aims to determine whether treating chronic obstructive pulmonary disease ( COPD ) exacerbations with intravenous steroids and aerosol bronchodilators ( group I ) is superior to oral steroids and multiple dose inhaler ( MDI ) bronchodilators with a spacer ( group II ) . Group I received 40 mg methylprednisolone·day−1 intravenously with a decrease to 20 mg after 10 days and a further decrease of 4 mg·4 days−1 . Aerosol therapy consisted of 10 mg salbutamol and 1 mg ipratropiumbromide·day−1 . Group II received 32 mg methylprednisolone orally for 1 week followed by 24 mg·day−1 for 4 days and a subsequent decrease of 4 mg·week−1 . Duovent ® MDI with a spacer was given at a dose of 1.6 mg fenoterol and 640 µg ipratropiumbromide·day−1 . In group I ( n=19 ) forced expiratory volume in one second ( FEV1 ) rose from 0.82±0.46 to 0.91±0.47 L and average dyspnoea decreased from 6.0±1.9 to 4.1±2.6 within 10 days . The Chronic Respiratory Disease Index Question naire ( CRQ ) score increased from 78±24 to 90±24 points after 4 weeks . In group II (  n=18 ) FEV1 increased from 0.70±0.27 to 0.90±0.29 L , dyspnoea regressed from 6.2±2.4 to 2.7±2.6 and CRQ from 67±17 to 86±20 . Both groups showed similar results in dropout rate , length of hospital stay and patient satisfaction . In conclusion , the two treatment strategies appear equally effective in treating chronic obstructive pulmonary disease exacerbations , although oral steroids and metered dose inhaler bronchodilators appear associated with a higher risk of hospital re-admission BACKGROUND It is unknown whether the bronchodilation and anti-inflammatory effects of inhaled salmeterol and fluticasone ( SF ) are better than those of traditionally inhaled ipratropium , terbutaline and budesonide ( ITB ) in mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Nineteen stable COPD patients with respiratory failure were r and omly enrolled into two groups . Patients were treated with inhaled SF delivered by a metered-dose inhaler with a spacer or with inhaled nebulized ITB . Respiratory parameters were measured for 7 days and plasma cytokine levels were measured on days 1 and 7 . RESULTS The kinetic curve of the rapid shallow index ( RSI ) from day 1 to day 7 was significant lower in the SF group than that in the ITB group . There were no significant differences in minute ventilation , intrinsic positive end expiratory pressure , and airway resistance between the ITB and SF groups from day 1 to day 7 . There were no differences in plasma interleukin (IL)-6 , IL-10 , IL- 12 , and transforming growth factor-beta1 levels between day 1 and day 7 in the ITB or SF group . CONCLUSIONS Patients with inhaled SF treatment had a lower RSI . The effects of bronchodilators and anti-inflammation were similar between inhaled SF and ITB in COPD patients with ventilator support Thirty-six acutely III , hospitalized patients with acute exacerbations of obstructive airway disease and a greater than 10 % increase in forced expiratory volume in 1 s after administration of aerosolized bronchodilator were r and omized to receive either metaproterenol sulfate delivered by updraft-compressor nebulization ( UDN ) or terbutaline sulfate delivered by metered-dose inhaler ( MDI ) with a spacer . Serial analyses of pulmonary function measurements were performed with the use of 95 % confidence intervals for the percentage response ratios of MDI to UDN . The response to MDI was at least equivalent to that of UDN , and MDI use was associated with no prolongation of hospital stay . Equivalent bronchodilation was achieved with MDI therapy with a lower daily charge for therapy for each patient and less respiratory therapist time . In hospitalized bronchodilator-responsive patients with acute exacerbations of obstructive airway disease , the MDI/spacer combination is the preferred approach when the status of the patient allows its use BACKGROUND Acute exacerbations of asthma and chronic obstructive pulmonary disease ( COPD ) are associated with increased airflow Limitation , hyperinflation and respiratory muscle fatigue . It is unclear , whether patients are able to perform adequate inhalations through various inhalation devices with different orfices during an exacerbation . The aim of this study was to examine the evolution of inhalation profiles of patients inhaling through Diskus , Turbuhaler , pressurized metered dose inhaler ( pMDI ) and Volumatic and consequently the appropriateness of using the various devices during an exacerbation . MEASUREMENTS 15 hospitalized patients participated in this r and omized comparison of inhalation profiles through the four placebo-devices . For each device , triplicate inhalation profiles were recorded during day 1 - 9 of admission and in stable phase ( day 50 ) . RESULTS The mean percentage of patients performing optimum inhalation profiles was 100 % for Diskus , 60 % for Turbuhaler , 14 % for pMDI and 87 % for Volumatic over the interval of day 1 - 9 and day 50 . Patients with an inspiratory muscle strength ( MIP ) of less than 6kPa were generally unable to generate the optimum flow through the Turbuhaler ( > 60 l/min ) . CONCLUSION The Diskus and Volumatic can be used effectively in the acute phase of an exacerbation of asthma or COPD . The Turbuhaler could be optimally used after the fifth day of convalescence . The pMDI is rather unsuitable during an exacerbation OBJECTIVE Four-hour comparison of the bronchodilator response of albuterol administered via metered-dose inhaler ( MDI ) with spacer versus small-volume nebulizer ( SVN ) to mechanically ventilated patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve r and omized clinical trial . SETTING Medical intensive care unit in a university hospital . PATIENTS Thirteen mechanically ventilated COPD patients . INTERVENTION Albuterol administration of 4 puffs ( 0.4 mg ) or 10 puffs ( 1.0 mg ) via MDI with spacer or 2.5 mg via SVN to mechanically ventilated patients in order to assess the bronchodilator response over 4 hours . MEASUREMENTS AND RESULTS Mechanically ventilated patients were enrolled in a r and omized crossover study wherein one group received 4 puffs ( 0.4 mg ) or 2.5 mg of albuterol and another group received 10 puffs ( 1.0 mg ) or 2.5 mg of albuterol on separate days . Respiratory mechanics measurements were obtained over 4 hours . Total airway resistance declined by 14.4 + /- 3.8 % after 4 MDI puffs , 18.3 + /- 1.8 % after 10 MDI puffs , or 13.7 + /- 2.6 % after 2.5 mg via SVN , compared to baseline ( p < 0.01 ) . After albuterol delivery , airway resistance remained improved for 90 - 120 minutes ( p < 0.05 ) and returned to baseline by 4 hours with all treatments . CONCLUSION The airway response to albuterol administration via MDI and SVN to mechanically ventilated patients was similar in magnitude and duration , returning to baseline by 240 minutes . In stable , mechanically ventilated COPD patients , albuterol may be administered via MDI with spacer or via SVN every 4 hours BACKGROUND Formoterol fumarate ( FF ) is a well-est 
    Output:
    