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How can you protect yourself from respiratory infections?

Flu and cold viruses are spread by means of droplet infection: when someone who is infected coughs or sneezes, droplets containing the viruses are released into the air. One of the most effective things you can do to protect yourself and others is stop the viruses from spreading.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 18, 2013

Respiratory function monitoring to reduce mortality and morbidity in newborn infants receiving resuscitation

When resuscitating a newborn baby, the team attending to the baby uses clinical judgement to determine how much assisted breathing is required during resuscitation. However, this approach is frequently inadequate. A respiratory function monitor measures the amount of air going into the babies lung. The clinical team can use this information to deliver better care to a newborn baby when assisted breathing alone is required. We were unable to identify any studies that compared the clinical judgement of assisted breathing with clinical judgement of assisted breathing plus the additional use of a respiratory function monitor to reduce mortality and morbidity in newborn infants receiving resuscitation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antithrombin for respiratory distress syndrome in preterm infants

Antithrombin (AT) is a substance that is produced by the liver and that plays an important role in the control of blood clotting and the subsequent breakdown of the clot. Critically ill infants, such as those born prematurely with immature lungs leading to respiratory distress (Respiratory Distress Syndrome; RDS) have low concentrations of AT in the blood. Studies have been conducted to examine whether preterm infants with RDS benefit from the administration of AT. In our systematic review, we found that preterm infants with RDS do not benefit from therapy with AT and may be harmed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Digoxin for preventing or treating neonatal respiratory distress syndrome

There is no evidence that the administration of digoxin helps babies with neonatal respiratory distress syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome

There is no current evidence from clinical trials to guide the use of pharyngeal instillation of surfactant before the first breath in preterm infants at risk of respiratory distress syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Antibiotics to treat respiratory infections caused by the bacteria Mycoplasma pneumoniae in children

This review sought to answer the question of whether antibiotics are effective in the treatment of LRTIs caused by the bacteria Mycoplasma pneumoniae (M. pneumoniae) in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease

Mechanical ventilation of newborn infants with severe lung disease results in reduced mortality. Mechanical ventilation with intermittent positive or negative pressure was introduced in the 1960s. It was compared with standard treatment in five trials for infants with very severe lung disease and resulted in a reduction in mortality. This effect was observed principally in infants with birth weights over two kilograms. Mechanical ventilation has become standard therapy for severe respiratory failure. There have been no trials in modern neonatal intensive care units so the magnitude of the benefits and harms in current practice are not known.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Diuretics for respiratory distress syndrome in preterm infants

There is not enough data to support the routine use of diuretics for respiratory distress syndrome in newborn babies. Diuretics are drugs that increase the production of urine by encouraging salt and water to be released from the kidneys. When newborn babies have respiratory distress syndrome (RDS), their lungs may also contain excess fluid that can cause breathing problems. Babies with RDS sometimes may also have a reduced urine output. Using diuretics in these babies may improve lung or kidney function transiently, but may also increase cardiovascular complications. The review of trials did not find enough evidence supporting the routine use of diuretics in these infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Inhaled nitric oxide for respiratory failure in preterm infants

The use of inhaled nitric oxide (iNO) may help reduce breathing failure in preterm babies. Breathing failure in premature newborn babies may be complicated by raised pressure within the vessels that carry blood to the lung (pulmonary hypertension). Medications that cause sedation or muscle relaxation and mechanically assisted breathing (mechanical or assisted ventilation) are used to treat pulmonary hypertension. Nitric oxide is believed to help regulate muscle tone in the arteries of the lungs and, thereby lessen pulmonary hypertension; however, iNO may also cause excessive bleeding (hemorrhage). This review of studies found that nitric oxide therapy does not appear to improve the chances of the baby having an improved outcome. When given to babies who were very ill, iNO did not seem to help, and may have contributed to an increase in intracranial hemorrhage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Chinese herbs combined with Western medicine for treating severe acute respiratory syndrome (SARS)

Severe acute respiratory syndrome (SARS) is an acute respiratory disease, characterised by influenza‐like (flu‐like) symptoms, which first appeared in 2002. SARS is a rapidly progressive, acute, community‐acquired respiratory illness, which spreads to all contacts. Integrated Chinese and Western medicines played an important role in the treatment of SARS and this review assessed the effectiveness and safety of this integrated treatment approach. Among 5327 confirmed cases, 3104 patients received traditional Chinese medicine. We explored the role of Chinese herbs in treating SARS to offer an effective method for SARS treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Advising patients to increase fluid intake for treating acute respiratory infections

Doctors commonly recommend that people with acute respiratory infections drink extra fluids. Acute infections include colds, acute sinusitis, tonsillitis, laryngitis, bronchitis, pneumonia and influenza. This review intended to find out the benefit or harm from this recommendation. Potential benefits of fluids are replacing fluid lost because of fever or rapid breathing, treating dehydration and reducing the viscosity of mucus. In infections of the lower part of the respiratory tract, possible harmful effects of fluids might be a dilution of the blood sodium concentration, leading to headache, confusion and seizures. This review found no evidence for or against the use of increased fluids in acute respiratory infections. No randomised controlled trials have been conducted to determine the benefit or harm from extra fluids. It is important that further studies be done in order to determine the true effect of this very common medical advice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Common colds: Can Umckaloabo or Kaloba relieve the symptoms of acute respiratory tract infections?

There is weak evidence that an extract from the root of the plant Pelargonium sidoides could shorten the length of respiratory tract infections and relieve symptoms. But these extracts can have side effects like stomach and bowel problems.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 23, 2014

Non‐invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease

Non‐invasive positive pressure ventilation (NPPV) used in patients with acute exacerbations of COPD substantially improves recovery. Invasive mechanical ventilation is undoubtedly a lifesaving procedure for patients with severe life threatening (respiratory failure) exacerbation of their COPD. However, this procedure is also associated with numerous adverse effects. NPPV that requires wearing a nasal or facial mask connected to a mechanical ventilator has been shown to be beneficial for such patients in reducing hospital deaths and also the number of patients going on to require tracheal intubation. NPPV has also been shown to reduce complications associated with treatment and length of hospital stay.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants

Premature babies often lack the substance, surfactant, a detergent like substance produced by the lung. This causes their lungs to fail to expand properly at birth, and breathing in requires a big effort. If left untreated, breathing difficulty progressively worsens and it may cause damage to the lung. Continuous distending pressure (CDP) improves the expansion of the lung making it easier for the premature baby to breath. It is applied through a face mask, or into the nostrils or by a partial vacuum outside the chest. When applied early, it may also reduce the lung damage that causes chronic lung disease. Different ways of using CDP were assessed in six controlled trials (four randomized), and it was found that fewer infants who received early CDP had to go on to be treated with intermittent positive pressure ventilation. No adverse effect of early use of CDP was found in these trials. However, there were several limitations to information from the studies, as the number of infants was small and the mean age ranged from seven to eighteen hours old when CDP was applied. Practice has changed from when these studies were done. CDP interventions are applied earlier, and surfactants are commonly given as well. Corticosteroids are given to the fetus before birth (antenatally) to prepare their lungs for birth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Postnatal thyroid hormones for respiratory distress syndrome in preterm infants

In preterm infants with breathing problems after birth, there is no evidence that thyroid hormone treatment given immediately after delivery reduces the severity of breathing difficulties or improves outcomes. Infants born prematurely are at risk of breathing problems due to lack of surfactant production by the lungs in the first days after birth. In animal research, thyroid hormones given before birth stimulate surfactant production and reduce the incidence and severity of breathing problems. This review found two small trials that compared the use of thyroid hormones to no treatment in infants with breathing problems in the first hours after birth. No benefit was found from use of these hormones on severity of breathing problems or complications that occurred as a result of these breathing problems. The effect on longer term development was not reported.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Recruitment manoeuvres compared to standard care for treatment of acute lung injury or acute respiratory distress syndrome.

A ventilated patient with acute lung injury or acute respiratory distress syndrome may be given a recruitment manoeuvre to open lung units that are collapsed. This is done by using a pressure that is higher than a normal breath for a longer period of time than is required for a normal breath. The effects of recruitment manoeuvres have not, however, been well established. We included seven trials in this review, totalling 1170 participants with acute lung injury or acute respiratory distress syndrome. We found that there was no significant difference in survival between groups given an 'open‐lung' ventilatory strategy that included recruitment manoeuvres and groups given standard ventilatory care. Recruitment manoeuvres briefly increased arterial oxygen partial pressure compared to standard care. Recruitment manoeuvres did not affect blood pressure, heart rate, or risk of air leak from the lungs. The main limitation of the review was the design of included trials that either did not isolate recruitment manoeuvres from other variables or assessed only short‐term outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antivirals for recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a condition in which wart‐like growths occur in the upper airway of children or adults. This can cause difficulty in breathing or a change in voice. This condition is usually treated by repeated surgery to remove these 'warts', but it has been proposed that additionally using antiviral medications may help this condition. This review found one good quality study of cidofovir (an antiviral agent) injected into the warts at the time of surgical removal. After one year of treatment, however, this study found no benefit of the injected cidofovir when compared to injected salt water solution (placebo). There is still a need for a larger randomised study which includes more patients, and higher doses of cidofovir.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support

There is not enough evidence to determine whether active chest physiotherapy is of benefit to neonates on mechanical ventilation. Babies who require mechanical ventilation are at risk of lung collapse from increased secretions. Chest physiotherapy (patting or vibrating the chest) is used to improve clearance of secretions from the airway to try to prevent lung collapse. This review found no clear overall benefit or harm from chest physiotherapy. Some individual chest physiotherapy techniques were more beneficial than others in resolving atelectasis and maintaining oxygenation. These results do not support one technique over another. Due to the limited number, poor quality and age of trials in this review, there is not enough evidence to determine whether or not chest physiotherapy is beneficial or harmful in the treatment of infants being ventilated in today's intensive care units. Further good quality trials are needed to address this issue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Acetylcysteine and carbocysteine to treat acute upper and lower respiratory tract infections in children without chronic broncho‐pulmonary disease

Acetylcysteine and carbocysteine are the most commonly prescribed drugs which aim to change the structure of bronchial secretions. This systematic review assessed their efficacy and safety for treating acute upper and lower respiratory tract infections in children without chronic broncho‐pulmonary disease. We also looked in particular at patients younger than two years of age.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Use of inhaled nitric oxide in acute respiratory failure patients with low blood oxygen does not improve survival

There is a lack of knowledge from previous research to support the use of inhaled nitric oxide (INO) to improve the survival of patients with acute respiratory failure and low blood oxygen levels. In the present systematic review we set out to assess the benefits and harms of its use in patients with acute respiratory failure. We identified 14 randomized trials comparing INO with placebo or no intervention. We could not identify any beneficial effect of INO on our predefined outcomes or in any subgroups of patients. Despite signs of initial improvement, INO does not appear to improve survival and might be hazardous since it may cause kidney function impairment. Our analysis does not indicate reduced cost or decreased length of stay in either an intensive care unit or hospital.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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