OBJECTIVE: The study aimed to evaluate efficacy of tiotropium as add-on therapy on top of standard regimens for uncontrolled asthma, specifically in terms of FEV1, morning and evening PEF, reduction in exacerbations, rescue medication use, and quality of life improvement.
METHODS: A search was done for eligible trials after which validity screen and data extraction was performed. Results were presented as mean differences, standard errors, and 95% confidence intervals, and graphically as forest plots. Estimates were pooled using the random effects model with I2 and Chi2 tests used to assess heterogeneity. Adverse events were reported as dichotomous variables.
RESULTS: Four studies were included totaling 1617 participants. The tiotropium group had statistically significant improvement in FEV1 (95% Cl, 0.14 [0.09, 0.19], p<0.00001), morning (95% Cl, 20.03 [11.71, 28.35], p<0.00001) with trend towards benefit in reduction of rescue medications (95% Cl, 0.12 [-0.17,0.4],p=0.42) and quality of life improvements (95% Cl, 0.1 [-0.05,0.25], p=0.20). Homogeneity (I2= 0%, Chi2= 0.47-3.22) was found across studies.
CONCLUSION: Tiotropium is associated with significant improvement in pulmonary function among patients with uncontrolled asthma, with possible benefit in reduction of rescue medications and quality of life improvement.

Human ; Male ; Female ; Adult ; Asthma ; Bronchodilator Agents ; Confidence Intervals ; Quality Of Life ; Respiratory Physiological Phenomena ; Scopolamine Derivatives ; Tiotropium Bromide ; Meta-analysis

INTRODUCTION: The eosinophilic phenotype of chronic obstructive pulmonary disease (COPD) has been demonstrated to respond better to corticosteroids and associated with better outcomes. This review aims to clarify the correlation of blood eosinophilia and outcomes patients with COPD exacerbations.

METHODS: This is a review of cohorts and case-control studies that looked into eosinophilia and outcomes in exacerbations using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The primary study outcome was length of hospitalization; other outcomes include readmission and mortality rate within one year, in-patient mortality, and need for mechanical ventilation.

RESULTS: Six studies were included in the review. Patients with blood eosinophilia had significantly shorter hospital stay compared to non-eosinophilic patients (mean difference 0.68 days [95% CI 1.09,0.27]). Eosinophilic patients had significantly less frequent readmissions (OR 0.69 [95% CI 0.55,0.87]) but there was no statistically significant difference in the one-year mortality rate (OR 0.88 [95% CI 0.73, .06]). Analysis showed a trend toward lower in-patient mortality among eosinophilic patients (OR 0.53 [95% CI 0.27,1.05]). Furthermore, COPD patients with eosinophilia had significantly less need for mechanical ventilation during an exacerbation (OR 0.56 [95% CI 0.35,0.89]).

CONCLUSION: COPD patients with blood eosinophilia had significantly shorter hospital stay, less frequent readmissions, and are less likely to require mechanical ventilation compared to the non-eosinophilic phenotype. 

Human ; Length Of Stay ; Patient Readmission ; Respiration, Artificial ; Hospital Mortality ; Hospitalization ; Pulmonary Disease, Chronic Obstructive ; Eosinophilia ; Adrenal Cortex Hormones ; Phenotype

Background and Significance: Sleep is a vital facet of human existence that is vital to learning and memory; lack of sleep is associated with significant impairment in learning. Medical students are a special population because of the demands of medical school. They are very prone to sleep deprivation and poor quality of sleep, hence academic performance might be affected. Objectives: We determined the different sleeping habits of medical students using a descriptive tool, with variables chosen specifically for this study. The level of sleepiness was then correlated with the academic performance (using the general weighted average) among students in a state university run-medical school in the Philippines. Methods: The study is a prospective cross-sectional survey among medical students in a state university-run medical school enrolled for the academic year 2016-2017. The questionnaires used were the Epworth Sleepiness Score and specific questions about sleeping habits. The General Weighted Average (GWA) of those who participated were obtained from the student records section of the college. Descriptive statistics were used to describe the results on different sleeping habits, while the chi-squared test was used to determine any significant differences in the GWA versus level of sleepiness across all year levels. Results: A total of 426 medical students (or 60% of the total student population of the college) participated. However, of the 426, only 326 had complete GWAs and were therefore included in the final analysis for correlation. The average medical student is “sleep-deprived”, sleeping two hours less (six hours) than the recommended daily minimum duration of sleep (eight to 10 hours). For the correlation of sleepiness and academic performance, we found out that there is no significant difference in academic performance among those who are excessively sleepy (ESS greater than 10) versus those who are not, p-value = 0.892. Conclusion Increased level of sleepiness does not correlate with poorer academic performance among these medical students, despite them sleeping less than the general recommendation for adults. The study is limited however by the use of the GWA as the sole tool to measure academic performance, which is affected by many other factors. We recommend the performance of this study in a broader population and use more validated tools to measure sleepiness and academic performance.
Sleep ; Sleepiness ; Academic Performance ; Students, Medical