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Respiratory

Welcome to the respiratory category for physicians and pharmacists. This clinical category features links to resources such as thoracic guidelines, spirometry testing, medical journal articles and prescribing in respiratory diseases such as asthma, COPD (chronic obstructive pulmonary disease), pulmonary embolism and TB (tuberculosis).

British Thoracic Society Guidelines and Quality Standards

Source: brit-thoracic.org.uk
Clinical Resource: Guidelines and Quality Standards
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Last Checked: 11/05/15 Link Error: Report It

 

American Thoracic Society Official Documents: Statements, Guidelines & Reports

Source: thoracic.org
Clinical Resource: Statements, Guidelines and Reports
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Last Checked: 11/05/15 Link Error: Report It

 

American College of Chest Physicians Evidence-Based Clinical Practice Guidelines and Consensus Statements

Source: chestnet.org
Clinical Resource: Guidelines and Consensus Statements
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Last Checked: 29/04/13 Link Error: Report It

 

Canadian Thoracic Society
Canadian Respiratory Guidelines

Source: respiratoryguidelines.ca
Clinical Resource: Guidelines
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Last Checked: 29/04/13 Link Error: Report It

 

European Respiratory Society Guidelines

Source: ers-education.org
Clinical Resource: Guidelines
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Last Checked: 06/06/13 Link Error: Report It

 

International Union Against Tuberculosis and Lung Disease Technical Publications

Source: theunion.org
Clinical Resource: Technical Publications
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Last Checked: 16/12/13 Link Error: Report It

 

National Institute for Health and Care Excellence (NICE) Guidance > Respiratory conditions

Source: nice.org.uk
Clinical Resource: Guidance
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Last Checked: 18/05/15 Link Error: Report It

 

European Lung White Book

Published by the European Respiratory Society, the European Lung White Book draws on the latest data from the World Health Organization and European Centre for Disease Prevention and Control, and input from experts across the continent to present a rigorous examination of lung health and disease in Europe as it stands and an informed analysis of future trends. Covering risk factors, the major diseases, the development of the various fields of respiratory medicine and training and the growth of patient support organisations, the book lays out a series of policy recommendations to ensure a brighter, better future for respiratory health. It is a vital data source and advocacy tool for health professionals, policymakers, patient advocates and the media.

Source: erswhitebook.org
Clinical Resource: Book
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Last Checked: 05/05/15 Link Error: Report It

 

American Thoracic Society Clinical Cases

The American Thoracic Society features ATS Clinical Cases, a monthly series devoted to interactive clinical case presentations on all aspects of pulmonary, critical care and sleep medicine. It is designed to provide education to practitioners, faculty, fellows, residents, and medical students in the areas of pulmonary, critical care and sleep medicine.

Source: thoracic.org
Clinical Resource: Cases
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Last Checked: 11/05/15 Link Error: Report It

 

Respiratory - CLEAR: clinical enquiry and response service

The CLEAR service is delivered by a team of information professionals based at Healthcare Improvement Scotland and NHS Greater Glasgow and Clyde.

CLEAR aims to provide clinicians with summarised evidence relating to aetiology, diagnosis, prognosis and treatment queries about patient care.

Source: knowledge.scot.nhs.uk
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 22/04/13 Link Error: Report It

 

BestBETs
Respiratory

BETs were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is.

Source: bestbets.org
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 29/04/13 Link Error: Report It

 

The Cochrane Collaboration
Cochrane Reviews - Lungs & Airways

Cochrane is an international, non-profit, independent organisation, established to ensure that up-to-date, accurate information about the effects of healthcare interventions is readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions, and promotes the search for evidence in the form of clinical trials and other studies of the effects of interventions.

Source: cochrane.org
Clinical Resource: Systematic Reviews
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Last Checked: 13/07/15 Link Error: Report It

 

Bandolier Knowledge
Allergy, asthma, COPD and respiratory problems

In these pages are collected the stories from Bandolier relating to allergy, asthma and respiratory problems, including COPD.

Source: bandolier.org.uk
Clinical Resource: Evidence Based Abstracts
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Last Checked: 13/06/17 Link Error: Report It

 

Air index | European Lung Foundation

The potential problems associated with lung diseases and air travel are well recognised. Most people with lung conditions are now able to safely enjoy the benefits of air travel if they plan their provisions in advance.

In this database, airlines are listed alphabetically, detailing their individual oxygen policies for passengers. Contact details, including website address and Twitter usernames, are provided for you to give feedback directly to the airlines.

Source: europeanlung.org
Clinical Resource: Database
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Last Checked: 09/12/13 Link Error: Report It

 

Pneumotox On Line
The Drug-Induced Lung Disease Website

Pneumotox is an aid to the diagnosis of drug-induced & iatrogenic respiratory disease

The place to go for continuously updated information about DIRD

You may access it by generic drug names (alphabetical order) or patterns grouped by families

Source: pneumotox.com
Clinical Resource: Database
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Last Checked: 29/04/13 Link Error: Report It

 

Drug-Induced Pulmonary Toxicities

This article explores the relationship between pharmacotherapy and pulmonary adverse effects from frequently prescribed agents used to treat common chronic diseases.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Therapeutic Update on Drug-Induced Pulmonary Disorders

This review will provide an update regarding medications and their potential for pulmonary side effects. A summary of drugs known to cause pulmonary disorders, although not all inclusive, is provided in TABLE 1.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Drug-induced respiratory disease

Drug-induced lung disease is a relatively common condition caused by an adverse reaction to medication and it is often impossible to predict who will develop lung disease resulting from a drug.

Source: mcppnet.org
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Preoperative Evaluation of the Patient With Pulmonary Disease

This review will discuss current preoperative pulmonary evaluation strategies that are supported by the existing literature, focusing on new developments in the past 2 to 4 years.

Source: chestnet.org
Clinical Resource: Journal Article
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Last Checked: 12/07/13 Link Error: Report It

 

Risk of first-generation H1-antihistamines: a Global Allergy and Asthma European Network position paper

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 25/03/13 Link Error: Report It

 

Comparative pharmacology of the H1 antihistamines

Although the efficacy of the different H1 antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, they are very different in terms of chemical structure, pharmacology and toxic potential. Consequently, knowledge of their pharmacokinetic and pharmacodynamic characteristics is important for the correct usage of such drugs, particularly in patients belonging to extreme age groups, pregnant women, or subjects with concomitant diseases.

Source: jiaci.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

H1 Antihistamines in Allergic Disease

H1 antihistamines remain first-line medications for the treatment of allergic rhinoconjunctivitis and urticaria. Second-generation antihistamines are preferred to their predecessors because of better benefit- to-risk ratios. The newer antihistamines are not only more potent, but also have anti-allergic and anti-inflammatory properties. Although they are more expensive than the traditional antihistamines, the cost is substantially offset by their superior efficacy and safety profile when used in recommended dosages.

Source: allergysa.org
Clinical Resource: Journal Article
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Last Checked: 21/08/15 Link Error: Report It

 

Effect of H1 antihistamines upon the cardiovascular system

Histamine exerts a series of actions upon the cardiovascular system. Thus, through mediation of the H1 and H2 receptors, histamine increases vascular permeability and induces hypotension, with reflex tachycardia. In turn, at heart muscle level, histamine action upon the H1 receptors induces an increase in atrioventricular node conduction, while the H2 receptors mediate positive chronotropic and inotropic effects. The H1 antihistamines, as inverse agonists, exert the opposite effect, with partial countering of the aforementioned actions. However, the main concern in relation to the cardiovascular safety of the antihistamines refers to their cardiac arrhythmogenic potential. A review is provided below of the principles and clinical particulars of these worrisome adverse effects.

Source: jiaci.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Second generation antihistamines and pregnancy

The first generation antihistamines (i.e. chlorpheniramine which can be found in Chlor-Trimeton Allergy) are preferred for pregnancy because they have been around longer and better studied during pregnancy. However, second generation antihistamines may be preferred by women due to their lower rates of CNS side effects, such as sedation and performance impairment (Blaiss, 2003). Therefore, this Risk Newsletter will discuss pregnancy outcomes following use of the second generation antihistamines, cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin).

Source: fetal-exposure.org
Clinical Resource: Teratogen Information Service Newsletter
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Last Checked: 19/08/13 Link Error: Report It

 

Antihistamines and Breastfeeding

Source: breastfeedingnetwork.org.uk
Clinical Resource: Drug Information Factsheet
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Last Checked: 08/08/16 Link Error: Report It

 

Which oral antihistamines are available in lactose-free formulations?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

The table below gives details of lactose free formulations of oral antihistamine

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Position statement of the Society for Endocrinology on the endocrine effects of inhaled corticosteroids in respiratory disease

This position statement highlights the suppressive effects of inhaled corticosteroids on the endogenous hypothalamo-pituitary-adrenal axis.

Source: endocrinology.org
Clinical Resource: Position Statement
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Last Checked: 29/04/13 Link Error: Report It

 

Inhaled and nasal corticosteroids: safety aspects

Prepared by the Antiallergic Drugs Subcommittee of the European Academy of Allergology and Clinical Immunology (EAACI).

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 25/03/13 Link Error: Report It

 

Steroid Rage: Inhaled Corticosteroids

This article will review aerosolized corticosteroid agents available and their indication for use.

Steroid Rage: Hazards and Effects

This issue will focus on how corticosteroids work, how they help, and side effects by their use. The focus will be towards inhaled corticosteroids, however, systemic corticosteroids will be discussed pointing out major differences.

Steroid Rage: Using Aerolized Steroids for Asthma Treatment

This issue will focus on where and when corticosteroids can be used in clinical practice. The focus will be toward inhaled corticosteroids in the use of asthma and chronic obstructive pulmonary disease.

Source: foocus.com
Clinical Resource: Journal Articles
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Last Checked: 29/04/13 Link Error: Report It

 

Dose Equivalence and Back Titration for Commonly Used Inhaled Corticosteroids

Dose equivalence for commonly used inhaled corticosteroid inhalers

Source: pharmac.govt.nz
Clinical Resource: Brochure
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Last Checked: 28/11/16 Link Error: Report It

 

Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

As the debate continues about whether the EC formulation provides gastro-protection compared with the uncoated tablets, in addition to the cost differential of the two products (three-fold difference at time of writing based on Drug Tariff June 2013), a summary of the findings of the DTB and an update of the literature with a focus on the implications of switching formulations are presented

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Theophylline

Theophylline, usually administered orally, is an effective bronchodilator which may be used in the management of both asthma and chronic obstructive pulmonary disease(COPD).

Source: theipcrg.org
Clinical Resource: Opinion Sheet
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Last Checked: 29/04/13 Link Error: Report It

 

Theophylline toxicity

Theophylline is used as adjunctive treatment in severe persistent asthma and chronic obstructive airways disease. The use of theophylline is considered when the standard combination therapy of inhaled short and long acting bronchodilators and inhaled corticosteroids do not adequately control symptoms.

Source: auspharmlist.net.au
Clinical Resource: Pharmacy E-Bulletin
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Last Checked: 29/04/13 Link Error: Report It

 

How is an intravenous aminophylline dose converted to an oral aminophylline or theophylline dose?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

When changing a patient’s therapy from IV aminophylline to oral therapy with either theophylline or aminophylline, the bioavailability and the salt equivalence should be considered.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Using nebulisers safely

Nebulisers are used to deliver bronchodilators to people with asthma or COPD or antibiotics to those with bronchiectasis.

There is now substantial evidence that the use of a metered dose inhaler (MDI) with a spacer is just as effective as a nebuliser, even in acute asthma.

Source: bpac.org.nz
Clinical Resource: Article
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Last Checked: 29/04/13 Link Error: Report It

 

Nebulisation
Luton and Dunstable University Hospital

This section deals with nebulisers; compatibilities of commonly used nebulised solutions

Source: ldh.nhs.uk
Clinical Resource: Guideline
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Last Checked: 10/12/13 Link Error: Report It

 

Nebulized Medication Compatibility

Source: vhpharmsci.com
Clinical Resource: Table
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Last Checked: 29/04/13 Link Error: Report It

 

A Stepwise Approach to the Interpretation of Pulmonary Function Tests

Pulmonary function tests (PFTs) are useful for diagnosing the cause of unexplained respiratory symptoms and monitoring patients with known respiratory disease.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 05/05/15 Link Error: Report It

 

Global Initiative for Chronic Obstructive Lung Disease Spirometry Guide

A comprehensive guide to the use of spirometry in clinical practice, including an overview of information provided by spirometry, when to perform this test, interpretation of spirogram results, and troubleshooting.

Source: goldcopd.org
Clinical Resource: Guide
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Last Checked: 21/08/15 Link Error: Report It

 

Spirometry in Practice
A Practical Guide to Using Spirometry in Primary Care

Spirometry is fundamental to making a confident diagnosis of COPD, yet research has shown that it has been under-utilised.

Many doctors and nurses have been apprehensive about using spirometry in their day-to-day practice. They regarded it as time-consuming, and they lacked confidence about the interpretation of the results. The first edition of this booklet was produced by the British Thoracic Society (BTS) COPD Consortium to encourage use of spirometry by:

  • providing information on how to perform spirometry
  • explaining the interpretation of spirometry results
  • giving practical examples and case studies
  • explaining the importance of spirometry in the management of COPD
  • using quotes from nurses which reveal their personal experiences of spirometry.

This second edition has been revised to incorporate recommendations on the use of spirometry in the NICE guideline on COPD.

Keep this booklet handy so that you can refer to it at any time when you are considering spirometry and normal lung function. It is meant to be a working reference.

Source: brit-thoracic.org.uk
Clinical Resource: Booklet
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Last Checked: 11/05/15 Link Error: Report It

 

An Approach to Interpreting Spirometry

A great deal of information can be obtained from a spirometry test; however, the results must be correlated carefully with clinical and roentgenographic data for optimal clinical application. This article reviews the indications for use of spirometry, provides a stepwise approach to its interpretation, and indicates when additional tests are warranted.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 13/03/14 Link Error: Report It

 

Asthma versus COPD Calculator

Source: adelaide.edu.au
Clinical Resource: Calculator
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Last Checked: 10/12/13 Link Error: Report It

 

SpirXpert

The SpirXpert website aims at promoting understanding respiratory physiology and pathophysiology. The emphasis is on the measurement and interpretation of spirometric test results.

Source: spirxpert.com
Clinical Resource: Various
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Last Checked: 13/03/14 Link Error: Report It

 

Spirometry

Spirometry is the gold standard for the diagnosis, assessment and monitoring of COPD, and may assist the diagnosis of asthma. It can also contribute to the diagnosis of other causes of dyspnoea.

Source: theipcrg.org
Clinical Resource: Opinion Sheet
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Last Checked: 19/10/15 Link Error: Report It

 

Spirometry Reference Value Calculator

Enter Age, Height, Gender and Race. To see Percent Prediced, you must enter observed FVC, FEV1, and FEF25-75% values in the appropriate boxes.

Source: cdc.gov
Clinical Resource: Calculator
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Last Checked: 29/04/13 Link Error: Report It

 

Spirometry: The Measurement and Interpretation of Ventilatory Function in Clinical Practice
Rob Pierce and David P. Johns

This handbook was written as a guide for those involved in the performance and interpretation of spirometry in clinical practice, i.e. medical practitioners and assisting nursing staff, and as an introduction to the topic for scientists and technicians. It is not intended to be an exhaustive review but rather a guide aiming to help improve the knowledge and techniques of those already doing and interpreting spirometry, and to introduce spirometry to those learning how to do it for the first time. The important facts about types of spirometers, how the test is actually performed and interpreted, and some common pitfalls and problems are covered in the main text.

Source: nationalasthma.org.au
Clinical Resource: Handbook
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Last Checked: 15/05/15 Link Error: Report It

 

A Guide to Performing Quality Assured Diagnostic Spirometry

This step by step guide shows how high quality diagnostic spirometry can be delivered in primary care and elsewhere. It provides a clear outline covering operator competency, calibration and cleaning, preparation of the patient, operation of the equipment, interpretation of results and quality assurance.

Source: pcc-cic.org.uk
Clinical Resource: Guide
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Last Checked: 13/03/14 Link Error: Report It

 

Asthma & Lung Fuction Tests
An information paper for health professionals

This information paper provides an up-to-date summary of lung function testing for asthma, including practical advice on how to perform spirometry accurately and effectively, and when peak flow should be considered.

Source: nationalasthma.org.au
Clinical Resource: Information Paper
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Last Checked: 15/05/15 Link Error: Report It

 

British Guideline on the Management of Asthma
SIGN (Scottish Intercollegiate Guidelines Network) and the BTS (British Thoracic Society)

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 16/11/16 Link Error: Report It

 

American Academy of Allergy Asthma & Immunology Practice Parameters and Guidelines

Source: aaaai.org
Clinical Resource: Practice Parameters and Guidelines
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Last Checked: 08/05/15 Link Error: Report It

 

Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report

Asthma is the leading chronic disease among children in most industrialized countries. However, the evidence base on specific aspects of pediatric asthma, including therapeutic strategies, is limited and no recent international guidelines have focused exclusively on pediatric asthma. As a result, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams to find a consensus to serve as a guideline for clinical practice in Europe as well as in North America. This consensus report recommends strategies that include pharmacological treatment, allergen and trigger avoidance and asthma education. The report is part of the PRACTALL initiative**, which is endorsed by both academies.

Source: eaaci.org
Clinical Resource: Consensus Report
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Last Checked: 25/03/13 Link Error: Report It

 

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

The EPR 3 Guidelines on Asthma was developed by an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee (CC), coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Source: nih.gov
Clinical Resource: Guideline
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Last Checked: 29/04/13 Link Error: Report It

 

Global Initiative for Asthma
Global Strategy for Asthma Management and Prevention

Updated April 2015

This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

Source: ginasthma.org
Clinical Resource: Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

Global Initiative for Asthma
At-A-Glance Asthma Management Reference

A 4-page pocket-size booklet that puts key principles of evidence-based asthma treatment at the healthcare professional’s fingertips for quick reference in clinical decision-making situations. Based on the 2014 Global Strategy for Asthma Management and Prevention, the At-A-Glance Reference summarizes and reinforces the key messages of other GINA documents, enhancing the clinician’s understanding of effective therapies and their benefits. The booklet provides key reference information on topics including:

  • Diagnosing Asthma
  • Classification of asthma by level of control
  • Developing a doctor-patient partnership
  • Asthma management based on control
  • Asthma exacerbations—assessment and management
  • Equivalent daily dosages for certain medications
Source: ginasthma.org
Clinical Resource: Booklet
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Last Checked: 21/08/15 Link Error: Report It

 

Australian Asthma Handbook

The Australian Asthma Handbook is Australia's national guidelines for asthma management and National Asthma Council Australia's flagship publication, forming the foundation of all our health professional resources.

“The Australian Asthma Handbook was developed by primary care for primary care. It contains exactly what primary carers need — practical and useful information in plain English, underpinned by the latest evidence.”

Source: nationalasthma.org.au
Clinical Resource: Handbook
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Last Checked: 15/05/15 Link Error: Report It

 

American Academy of Allergy Asthma & Immunology
Ask the Expert

Ask the Expert serves the needs of licensed healthcare professionals who have questions about diagnosing and treating their patients' allergies and asthma

Source: aaaai.org
Clinical Resource: Questions and Answers
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Last Checked: 08/05/15 Link Error: Report It

 

Partners Asthma Center: Asthma Grand Rounds

A series of Grand Rounds presentations and group discussions regarding current issues in asthma management designed for physicians and other health care providers with a specialized interest in asthma and related diseases.

Source: asthma.partners.org
Clinical Resource: Grand Rounds
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Last Checked: 29/04/13 Link Error: Report It

 

Asthma & the Over 65s
An information paper for health professionals

This information paper outlines the importance of considering the possibility of adult-onset asthma in people aged 65 years and over with dyspnoea, wheeze or cough, even if they have no previous diagnosis of asthma.

Source: nationalasthma.org.au
Clinical Resource: Information Paper
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Last Checked: 15/05/15 Link Error: Report It

 

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008

The 2008 revision of the ARIA Report, published as a Supplement in the European Journal of Allergy and Clinical Immunology, reviews the latest scientific evidence on the definition and classification of rhinitis, risk factors, mechanisms, and diagnosis and treatment, with extensive citations from the scientific literature.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2010 Revision

In 2010, the ARIA expert panel completed an analysis of the key clinical questions in the ARIA Report according to the WHO GRADE methodology. This document gives additional perspective on the use of various treatments for allergic rhinitis using a careful, conflict-of-interest-free analysis.

Source: whiar.org
Clinical Resource: Report and Update
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Last Checked: 25/03/13 Link Error: Report It

 

Allergic Rhinitis and its Impact on Asthma Pharmacist's Guide
Management of Allergic Rhinitis Symptoms in the Pharmacy

This guide provides a practical, step-by-step approach to aid pharmacists in advising patients:

  • in recognising allergic rhinitis and assessing its severity,
  • in understanding the effect of treatment on rhinitis and co-morbidities,
  • in determining whether management in the pharmacy is appropriate,
  • in initiating an appropriate treatment and monitoring plan,
  • and in proposing appropriate preventive measures.
Source: whiar.org
Clinical Resource: Report
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Last Checked: 25/03/13 Link Error: Report It

 

Asthma & Allergy
An information paper for health professionals

This information paper looks at the relationship between asthma and allergy, focussing on allergy triggers and patterns, diagnosis and testing, allergy avoidance, and specific allergen immunotherapy.

Reference List

Source: nationalasthma.org.au
Clinical Resource: Information Paper and Reference
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Last Checked: 15/05/15 Link Error: Report It

 

Leukotriene Inhibitors in the Treatment of Allergy and Asthma

Leukotriene inhibitors are the first new class of medications for the treatment of persistent asthma that have been approved by the U.S. Food and Drug Administration in more than two decades. They also have been approved for the treatment of allergic rhinitis. Prescriptions of leukotriene inhibitors have outpaced the evidence supporting their use, perhaps because of perceived ease of use compared with other asthma medications.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

National Asthma Education and Prevention Program Working Group Report on Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment - Update 2004

This is the complete study and findings designed for clinicians and researchers who are seeking extensive information on the latest developments in asthma treatment and therapeutic approaches during pregnancy. It is a must-have for asthma specialists.

Source: nih.gov
Clinical Resource: Report
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Last Checked: 07/05/14 Link Error: Report It

 

Allergic Diseases and Asthma in Pregnancy

Allergic sensitization to common allergens can be detected in approximately 25% to 35% of the general population in industrialized countries. In the United States of America (USA) about 18-30% of woman in the childbearing age suffer from allergic diseases, especially rhinitis and asthma. Other allergic diseases which may complicate pregnancy include conjunctivitis, acute urticaria, anaphylaxis, food allergy and drug allergy. These disorders represent the most common group of medical conditions that complicate pregnancy. Optimal management of these disorders during pregnancy is vital to ensure the welfare of the mother and the baby.

Source: worldallergy.org
Clinical Resource: Summary
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Last Checked: 07/05/14 Link Error: Report It

 

Asthma & Complementary Therapies
An information paper for health professionals

This information paper provides an evidence-based summary of the effectiveness of various complementary therapies used by people with asthma.

Reference List

Source: nationalasthma.org.au
Clinical Resource: Information Paper and Reference
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Last Checked: 15/05/15 Link Error: Report It

 

Which Drugs Are Contraindicated for Asthma Patients?

One person in every five households in the UK is receiving treatment for asthma, according to latest figures. As well as treatment for asthma, many of these individuals also self-medicate for minor illnesses or require prescribed medication for other conditions. It is important that the drugs they take do not adversely affect their asthma control. In this article we review which drugs might cause problems in patients also taking treatment for asthma.

Source: bjpcn-respiratory.com
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Vaccines, allergy and asthma

Asthma and allergic disease rates have increased dramatically in the last few decades. The exact reasons for this increase remain unknown. Some media reports, anecdotal evidence and uncontrolled observational studies have suggested that this increase may be due to vaccines stimulating changes in the immune system which may affect the development of chronic allergic and autoimmune conditions.

Source: ncirs.edu.au
Clinical Resource: Factsheet
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Last Checked: 19/10/15 Link Error: Report It

 

Beta-blocker selectivity and airways obstruction

In this Drug Points article the author describes a case of unrecognised airways disease where prescribing timolol resulted in shortness of breath and comments on the issues it raises

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 22/04/13 Link Error: Report It

 

Beta-Blockers and Beta-Agonists: What Is the Risk?

Beta-agonists are commonly used in the treatment of asthma and chronic obstructive pulmonary disease(COPD). Beta-blocker use in asthma has been widely studied. In general, cardioselective beta-blockers (eg, acebutolol, atenolol, bisoprolol, celiprolol, metoprolol) appear to be effective for the treatment of thyrotoxicosis, tachyarrhythmias, hypertension, heart failure, and acute coronary syndrome without increased risk of asthma exacerbation.

Source: hanstenandhorn.com
Clinical Resource: Journal Article
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Last Checked: 12/06/17 Link Error: Report It

 

Beta-blockers for the treatment of elderly patients with coexisting heart failure and chronic obstructive pulmonary disease

In this review we will discuss common pathophysiological mechanisms involved in the development of COPD and HF and we will review the evidence derived from trials on beta-blocker use, safety and benefits among elderly patients.

Source: sigg.it
Clinical Resource: Journal Article
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Last Checked: 12/06/17 Link Error: Report It

 

Society for Endocrinology position statement on the use of synthetic ACTH (Synacthen) in patients with a history of asthma

This statement is issued to coincide with the publication of BNF62 that contains (in section 6.5.1) an amendment to cautions and contraindications in the use of Tetracosactide (Tetracosactrin).

Source: endocrinology.org
Clinical Resource: Position Statement
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Last Checked: 29/04/13 Link Error: Report It

 

 

Global Initiative for Chronic Obstructive Lung Disease
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

Updated January 2015. Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.

Source: goldcopd.org
Clinical Resource: Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

COPD

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

Anticholinergic bronchodilators

Inhaled atropine causes bronchodilatation, but systemic absorption via the lung results in unwanted adverse effects. Ipratropium bromide and tiotropium bromide are structural analogues of atropine which have minimal systemic absorption following inhalation because of their quaternary ammonium structure. These anticholinergic drugs are useful bronchodilators in chronic obstructive pulmonary disease.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

COPD - Special Considerations for Older Adults

This edition of Eldercare will review some of the interactions between treatments for COPD and treatments for two of the most chronic medical problems in older adults - heart disease and diabetes (Table 1). Please note that this review focuses on patients with stable COPD in outpatient settings, and does not apply to acutely ill or hospitalized patients.

Source: aging.arizona.edu
Clinical Resource: Factsheet
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Last Checked: 21/08/15 Link Error: Report It

 

Is it safe to use beta-blockers for cardiac disease in people with COPD?

Cardioselective beta-blockers such as metoprolol and atenolol are usually safe and effective in patients with well controlled COPD with or without a reversible obstructive component. Carvedilol (a combined non-selective beta-blocker and alpha-blocker) also appears to be safe to use in COPD patients without reversible airways obstruction.

Source: bpac.org.nz
Clinical Resource: Journal Article
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Last Checked: 22/04/13 Link Error: Report It

 

Early Diagnosis of COPD does help!

This opinion sheet will review the evidence for the benefits of early diagnosis and give you some tools that you can use to make changes in your practice to improve health outcomes for your patients.

Source: theipcrg.org
Clinical Resource: Opinion Sheet
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Last Checked: 19/10/15 Link Error: Report It

 

European Society of Hypertension Newsletter
Treatment of Hypertension in Patients With Chronic Obstructive Pulmonary Disease (COPD)

Source: eshonline.org
Clinical Resource: Newsletter
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Last Checked: 19/08/15 Link Error: Report It

 

Palliative care for people with COPD

Patients with advanced chronic obstructive pulmonary disease (COPD) have worse quality of life, greater limitation of activity, more anxiety and depression than patients with lung cancer, yet access to palliative care services is rare.

Source: theipcrg.org
Clinical Resource: Opinion Sheet
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Last Checked: 31/05/13 Link Error: Report It

 

Palliative Care of Dyspnea in Patients with Advanced COPD

The goal of palliative symptom management is to relieve the patient’s sense of breathlessness. Management can be pharmacologic and/or non-pharmacologic.

Source: aging.arizona.edu
Clinical Resource: Factsheet
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Last Checked: 26/10/15 Link Error: Report It

 

The management of croup

Croup is a common paediatric respiratory illness involving inflammation and narrowing of the subglottic region of the larynx, frequently precipitated by viral infections. Treatment is aimed at decreasing symptoms and reducing inflammation. Glucocorticoids are effective by oral, parenteral or nebulized routes, and continue to provide the mainstay of therapy. The common oral dexamethasone dose (0.6mg/kg) may exceed the dose required for good clinical efficacy.

Source: oxfordjournals.org
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Chronic cough
Three most common causes

This paper focuses on management of the most common causes of chronic cough in adults: postnasal drip syndrome (PNDS), asthma, and gastroesophageal reflux disease (GERD).

Source: cfp.ca
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Bronchiolitis in Children

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

Alberta Clinical Practice Guideline for the Management of Acute Bronchitis

Source: topalbertadoctors.org
Clinical Resource: Guideline
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Last Checked: 19/10/15 Link Error: Report It

 

Common Infections - Respiratory Tract

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Source: idsociety.org
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

Infectious Diseases Society of America Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

Source: idsociety.org
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

URTIs: recommended diagnosis and treatment in general practice

Upper respiratory tract infections collectively encompass a range of syndromes with various aetiologies. Our Drug review considers the common URTIs and their diagnosis and management, including when to prescribe antibiotics, followed by sources of further information in Resources.

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Rational Use of Antibiotics in Respiratory Tract Infections

This resource outlines the principles of rational antibiotic use in upper respiratory tract infections commonly encountered in general practice in New Zealand.

Source: bpac.org.nz
Clinical Resource: Publication
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Last Checked: 29/04/13 Link Error: Report It

 

Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America

Source: idsociety.org
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

Centers for Disease Control and Prevention
Tuberculosis

Topics

Basic TB Facts
Treatment
Testing & Diagnosis
TB & HIV Coinfection
Infection Control & Prevention
Vaccine & Immunizations
TB in Specific Populations
Laboratory Information
Drug-Resistant TB
Research

Source: cdc.gov
Clinical Resource: Various
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Last Checked: 29/04/13 Link Error: Report It

 

World Health Organization | Tuberculosis

Fact sheet on tuberculosis
Q&A: what is TB? How does it spread?
The Stop TB Strategy
Extensively drug-resistant tuberculosis (XDR-TB)
Tuberculosis and HIV

Source: who.int
Clinical Resource: Various
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Last Checked: 29/04/13 Link Error: Report It

 

New Jersey Medical School Global Tuberculosis Institute

The Institute Website houses an extensive collection of downloadable and adaptable resources and the training staff provides technical assistance to a variety of providers and TB programs to develop and integrate training into their own unique circumstances.

Source: umdnj.edu
Clinical Resource: Various
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Last Checked: 21/08/15 Link Error: Report It

 

Tuberculosis: Insidious But Treatable

Tuberculosis (TB) is a widespread disease found in both poorly developed and well-developed countries. TB can be a devastating and deadly disease despite advances in therapy. It primarily infects the lungs and is classified as either latent or active. Latent tuberculosis is treated in order to avoid progression to active tuberculosis disease. 

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 29/04/13 Link Error: Report It

 

Pulmonary tuberculosis: diagnosis and treatment

Tuberculosis remains a worldwide problem despite well documented, well publicised methods of prevention and cure. Poverty and HIV infection are major reasons for its persistence. We review the diagnosis, treatment, and prevention of tuberculosis.

Source: europepmc.org
Clinical Resource: Journal Article
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Last Checked: 07/04/14 Link Error: Report It

 

Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, 2nd edition

Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, Second Edition was created through a collaboration of the Francis J. Curry National Tuberculosis Center (CNTC) and the State of California Department of Public Health, Tuberculosis Control Branch (CDPH).

The Guide contains information and user-friendly tools and templates for use by any clinician who participates in the management of patients with drug-resistant TB. From physicians to pharmacists, infection control practitioners to public health nurses, the Guide arms all healthcare providers in the fight against drug-resistant TB.

The 10 chapters and 15 appendices cover major topics pertaining to epidemiology, diagnosis, treatment, medications, monitoring, special situations, adverse reactions, case management, legal issues, and treatment of contacts.

Source: currytbcenter.ucsf.edu
Clinical Resource: Guide
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Last Checked: 29/04/13 Link Error: Report It

 

Characteristics of Second-Line Drugs for MTB

One-page flow diagram for clinicians and health-care providers.

Source: heartlandntbc.org
Clinical Resource: Flow Diagram
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Last Checked: 19/08/15 Link Error: Report It

 

British HIV Association guidelines for the treatment of TB/HIV coinfection 2011

Source: bhiva.org
Clinical Resource: Guideline
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Last Checked: 29/04/13 Link Error: Report It

 

Queensland Tuberculosis Control Centre Guidelines for Management of Tuberculosis in Patients With HIV Co-Infection

Source: health.qld.gov.au
Clinical Resource: Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

Queensland Tuberculosis Control Centre Guidelines for Treatment of Tuberculosis in Pregnant Women and Newborn Infants

Source: health.qld.gov.au
Clinical Resource: Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

Queensland Tuberculosis Control Centre Guidelines for Treatment of Tuberculosis in Patients with Renal Disease

Source: health.qld.gov.au
Clinical Resource: Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

The Mantoux Test

Administration, reading and interpretation

Source: webarchive.org.uk
Clinical Resource: Factsheet
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Last Checked: 13/03/14 Link Error: Report It

 

Tuberculosis Adverse Drug Events

Source: heartlandntbc.org
Clinical Resource: Pocket Guide
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Last Checked: 19/08/15 Link Error: Report It

 

Guidelines for the Management of Adverse Drug Effects of Antimycobacterial Agents

Source: upenn.edu
Clinical Resource: Guideline
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Last Checked: 29/04/13 Link Error: Report It

 

Antituberculosis Drugs and Hepatotoxicity

The three key anti-tuberculosis drugs, viz isoniazid, pyrazinamide and rifampicin, are potentially hepatotoxic. Deaths due to fulminant liver necrosis have been reported, albeit rare in occurrence. With the changing demographics and clinical characteristics of tuberculosis patients in many parts of the world, hepatotoxicity is of increasing concern in the treatment of this disease.

Source: fmshk.org
Clinical Resource: Bulletin
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Last Checked: 29/04/13 Link Error: Report It

 

Assessing and Managing the Risk of Liver Disease in the Treatment of LTBI

Source: heartlandntbc.org
Clinical Resource: Flow Diagram
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Last Checked: 19/08/15 Link Error: Report It

 

Rifamycins and Anti-Diabetic Agents: Drug-Drug Interactions

A 2-sided diagram for clinicians and healthcare providers that describes drug-drug interactions of Rifamycins and Anti-Diabetic Agents.

Source: heartlandntbc.org
Clinical Resource: Diagram
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Last Checked: 19/08/15 Link Error: Report It

 

Tuberculosis Medication Drug and Food Interactions

Source: heartlandntbc.org
Clinical Resource: Pocket Guide
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Last Checked: 19/08/15 Link Error: Report It

 

European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism

Source: escardio.org
Clinical Resource: Guideline
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Last Checked: 28/04/15 Link Error: Report It

 

Pulmonary embolism

This article reviews the epidemiology, clinical features, diagnostic process, and treatment of pulmonary embolism.

Source: racgp.org.au
Clinical Resource: Journal Article
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Last Checked: 02/07/14 Link Error: Report It

 

Diagnosing pulmonary embolism

Objective testing for pulmonary embolism is necessary, because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. No single test has ideal properties (100% sensitivity and specificity, no risk, low cost).

Source: europepmc.org
Clinical Resource: Journal Article
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Last Checked: 07/04/14 Link Error: Report It

 

Royal College of Obstetricians and Gynaecologists Guideline on Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium

Source: rcog.org.uk
Clinical Resource: Guideline
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Last Checked: 19/08/15 Link Error: Report It

 

Royal College of Obstetricians and Gynaecologists Guideline on Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management

Source: rcog.org.uk
Clinical Resource: Guideline
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Last Checked: 19/08/15 Link Error: Report It

 

British Society for Haematology Guideline on Oral Anticoagulation With Warfarin - Fourth Edition

Source: b-s-h.org.uk
Clinical Resource: Guideline
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Last Checked: 16/11/16 Link Error: Report It

 

Clinical Practice Guide on Antithrombotic Drug Dosing and Management of Antithrombotic Drug Associated Bleeding Complications in Adults February 2014

Presented by the American Society of Hematology, adapted in part from the American College of Chest Physicians Evidence-Based Clinical Practice Guideline on Antithrombotic and Thrombolytic Therapy (9th Edition).

Source: hematology.org
Clinical Resource: Guide
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Last Checked: 20/08/15 Link Error: Report It

 

British Society for Haematology Guideline on the Management of Bleeding in Patients on Antithrombotic Agents

Source: b-s-h.org.uk
Clinical Resource: Guideline
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Last Checked: 16/11/16 Link Error: Report It

 

Can small volume intramuscular injections be given to patients taking oral anticoagulants?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

This Medicines Q&A focuses on the potential risks of adverse effects associated with the administration of small volume IM injections to patients taking oral anticoagulants.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

WarfarinDosing.org

Welcome to WarfarinDosing.org, a free Web site to help doctors and other clinicians begin warfarin therapy by estimating the therapeutic dose in patients new to warfarin. This site is supported by the Barnes-Jewish Hospital at Washington University Medical Center, the NIH, and donations. Estimates are based on clinical factors and (when available) genotypes of two genes: cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1).

Recommendations on this Web site are based on data from over 1000 patients.Once information is entered onto the next page, the initial estimate of therapeutic dose explains 53% of the variability in a warfarin dose. If you return to the Web site and enter an INR value after 3 and/or 4 warfarin doses, the dose refinement is even more accurate.

Source: warfarindosing.org
Clinical Resource: Calculator
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Last Checked: 17/02/14 Link Error: Report It

 

Anticoagulants and pregnancy: When are they safe?

While anticoagulants are useful in many circumstances, their use during pregnancy increases the risk of hemorrhage and other adverse effects on the mother and the fetus. Treatment with anticoagulants during pregnancy must therefore be carefully considered, with judicious selection of the agent, and with reflection on the physiologic changes of pregnancy to ensure appropriate dosing. In this article, we review these issues.

Source: mdedge.com
Clinical Resource: Journal Article
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Last Checked: 19/06/17 Link Error: Report It

 

Warfarin Drug Interactions

The drugs in this list are more usually associated with loss of INR control in patients already established on warfarin.

Source: derbyhospitals.nhs.uk
Clinical Resource: List
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Last Checked: 02/07/14 Link Error: Report It

 

Laboratory Monitoring of Warfarin Therapy

Crystalline warfarin sodium (Coumadin, Panwarfin, Sofarin, Coufarin, Athrombin-K) is the most widely used oral anticoagulant in the world. Warfarin interferes with the hepatic synthesis of the vitamin-K dependent coagulation factors by interfering with the vitamin K cycle. Laboratory monitoring of warfarin therapy is mandatory, since the agent has a relatively narrow therapeutic range.

Source: pathology.vcu.edu
Clinical Resource: Educational Resource
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Last Checked: 17/02/14 Link Error: Report It

 

Management of Warfarin Overdose and Supratherapeutic INR

Full reversal of warfarin-induced coagulopathy is indicated in patients who do not require warfarin therapy. However, special consideration must be given to patients who require therapeutic anticoagulation in the event of a warfarin overdose. The purpose of this discussion is to review treatment guidelines for these patents.

Source: utah.edu
Clinical Resource: Poison Control Centre Newsletter
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Last Checked: 02/07/14 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Patients with Lung Cancer

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

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