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The lungs can be affected by a number of diseases, including pneumonia and lung cancer.

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Hydralazine for pulmonary hypertension in low birth weight infants with chronic lung disease

In premature infants, pulmonary arterial hypertension (PAH) associated with chronic lung disease (CLD) is associated with high mortality rate. With the exception of oxygen supplementation, no specific interventions have been established as an effective treatment for PAH in premature infants with CLD. Vasodilators could be effective treatments to reduce pulmonary arterial pressure, but little has been proven regarding their clinical effectiveness and concern remains regarding adverse effects. This review found no trials of the use of hydralazine for low birth weight infant with PAH related to CLD. However, since hydralazine is inexpensive and potentially beneficial, randomised controlled trials are recommended.

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

Version: 2013

Restriction of oral intake of water for aspiration lung disease in children

Primary aspiration of food and fluid can cause serious lung consequences in infants and children. Treatment recommendations for children who have primary aspiration of thin fluids includes restriction of thin fluids and provision of thickened fluids. Children often refuse to drink thickened fluids presenting a challenge for families to ensure that the child takes sufficient fluid. Allowing children who have thin fluid aspiration to drink water may assist in providing enough fluid without endangering the lung . This review found no evidence about drinking water in children with primary aspiration of thin fluids.

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

Version: 2012

Compounds which can break down the structure of mucus for lung disease in cystic fibrosis

Cystic fibrosis is a genetic disorder which mainly affects the lungs. Chest infections recur in people with cystic fibrosis due to a build up of thick sputum (phlegm) in the air passages. Several treatments, including thiol derivatives, aim to loosen this sputum and so improve lung function and reduce the frequency of chest infections. Thiol derivatives may be either nebulized (breathed in) or oral (by mouth). They have been shown to help in other lung conditions, such as chronic obstructive pulmonary disease. This review aims to find out if there is enough evidence to recommend the use of nebulized or oral thiol derivatives for people with cystic fibrosis. We included nine trials; three assessed the effect of nebulized thiol derivatives. Of the nebulized trials, one compared 20% N‐acetylcysteine to 2% N‐acetylcysteine; another compared sodium‐2‐mercaptoethane sulphonate to 7% hypertonic saline; and the other compared glutathione to 4% hypertonic saline. Nebulized thiol derivatives were generally well‐tolerated with no major adverse effects. However they showed no significant improvements in any of our outcome measures.

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

Version: 2015

Domiciliary oxygen for interstitial lung disease

Oxygen therapy is used to treat patients with interstitial lung disease (ILD) with low arterial blood oxygen levels. This review evaluated the effect of domiciliary long‐term oxygen therapy on survival and quality of life in patients with ILD. Only one randomized controlled trial was identified. This unpublished study reported that long‐term oxygen therapy did not improve survival compared with no oxygen therapy in patients with ILD. No data on quality of life was available.

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

Version: 2011

Nebulised morphine for severe interstitial lung disease

Nebulized morphine has been reported to have some beneficial effect on breathlessness and exercise limitation in terminally ill patients with chronic lung disease. Patients with end‐stage interstitial lung disease might also benefit from treatment of breathlessness with nebulized morphine. This review evaluates the effectiveness of using nebulized morphine for breathlessness reduction in patients with interstitial lung disease. Only one small randomised controlled trial was identified. This study concluded that low‐dose nebulized morphine is of no benefit in the management of exercise‐induced dyspnoea and exercise limitations in patients with interstitial lung disease. However, the patients included in this study were relatively mild, and definitive conclusions on the effect of nebulized morphine in the reduction of dyspnoea in end‐stage interstitial lung disease requires further work.

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

Version: 2011

Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease

There is no strong evidence of benefit from routine use of distal diuretics in preterm infants with chronic lung disease. Lung disease in infants born early (preterm) is often complicated with excess of water. Medications that reduce body water (diuretics) might help the infant recover from lung disease. The review of trials analysed the effects of diuretics working on the end of the small kidney tubes (distal diuretics). It found that diuretic treatment for four weeks improved lung function. Only one study showed long term benefit (decreased rates of death and artificial ventilation). However, the infants in these trials did not receive all the medications that are currently available.

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

Version: 2011

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease

There is no evidence of benefit from routine use of inhaled diuretics in preterm babies at risk of chronic lung disease. Lung disease in babies born early (preterm) is often complicated with excess accumulation of water in the lungs. Medications that reduce body water (diuretics) might help the baby recover from lung disease. In theory, giving the diuretic as an inhaled mist (aerosol) could drain water from the lung more than from the rest of the body, which could reduce adverse effects. The review found several small trials of a single type of diuretic (furosemide). A single dose improved lung function, but only temporarily. No information was available about long term outcome.

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

Version: 2010

Erythromycin for the prevention of chronic lung disease in intubated preterm infants at risk for, or colonized or infected with Ureaplasma urealyticum

More evidence needed on using antibiotics to try and prevent chronic lung disease in preterm babies testing positive for U urealyticum. Chronic lung disease (CLD) is a major health risk often faced by preterm babies on ventilation (machine‐assisted breathing). Ureaplasma urealyticum is a common type of infection that may be one of the causes of CLD, although this has not been proven. Erythromycin is an antibiotic used for other infections caused by U urealyticum. When a baby tests positive for U urealyticum, erythromycin has been tried as a preventive measure. The review found that there is not enough evidence from trials to show whether or not testing preterm babies for U urealyticum and using erythromycin can prevent CLD or mortality.

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

Version: 2009

Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease

There is no strong evidence of benefit from routine use of loop diuretics in preterm babies at risk of, or with, chronic lung disease. Lung disease in babies born early (preterm) is often complicated with excess of water. Medications that reduce body water (diuretics) might help the baby recover from lung disease. The review analysed the effects of diuretics working on the deep part of the small kidney tubes (loop diuretics). The review of trials found that diuretics, given from a single dose to one week's treatment, inconsistently improved lung function and oxygen levels in the blood. There was not enough evidence to show any improvement in long‐term outcome.

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

Version: 2011

Observation alone versus drain tube or needle insertion (interventional) for primary spontaneous pneumothorax in adults without previous lung disease.

Review question: A primary spontaneous pneumothorax (PSP) is a collection of air in the lining of the lung that occurs on its own or without a traumatic event. When this occurs, people can have chest pain and shortness of breath. Most of the time, the air in the lung is absorbed by the body and slowly decreases with time. Most of the guidelines in managing this condition recommend draining the air by sucking it out with a small needle, or placing a larger tube into the chest that drains the air over a period of time (both called 'interventional' management'). We aimed to examine the evidence for the recommendation.

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

Version: 2015

Alpha‐1 proteinase inhibitor (a1PI) for preventing chronic lung disease in preterm infants

There is not enough evidence to show the long term effect of using Alpha‐1 proteinase inhibitor for chronic lung disease in premature babies. Inflammation of the lungs is one of the causes of chronic lung disease (CLD) in babies born before 37 weeks. Babies with CLD need extra oxygen and the disease can also cause serious long‐term problems. Lung damage is caused by the release of enzymes and other anti‐oxidants because babies with CLD have a low level of Alpha‐1 proteinase inhibitor (a1P1), a substance that stops lung tissue being destroyed. A medication version of AlP1 is sometimes given to protect their lungs. The review of the trials found that there is not enough evidence to show long term beneficial effects of a1P1. More research is needed.

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

Version: 2011

Superoxide dismutase for preventing chronic lung disease in mechanically ventilated preterm infants

Not enough evidence to show the effectiveness of superoxide dismutase in preventing chronic lung disease in premature babies. Chronic lung disease (CLD) is a common problem in preterm babies who are mechanically ventilated (machine assisted breathing). Free oxygen radicals are believed to cause CLD. Superoxide dismutase is an enzyme normally present in the body to provide a defence against free radicals but preterm infants do not have a sufficient supply to provide natural resistance. Giving superoxide dismutase to preterm infants may therefore prevent CLD. The review of trials found there is not enough evidence yet to show if this is effective. More research is needed.

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

Version: 2009

Increased energy intake for preterm infants with (or developing) bronchopulmonary dysplasia/ chronic lung disease

Chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD) is a disease of premature babies who required prolonged support with their breathing and supplemental oxygen. These babies are at high risk of many short and long‐term problems with their breathing, growth and development, including death in infancy or childhood. Studies have shown that these babies have higher energy expenditure and lower energy intake compared with babies without CLD/BPD. Increasing energy intake for these babies beyond standard levels may therefore seem beneficial. However, setting high targets for energy intake for these babies may not be achievable. Furthermore, methods of increasing energy intake such as increasing the milk volume or concentration or giving intravenous nutrition may lead to complications of their own. We planned to examine whether increasing energy intake for these babies improves their breathing status, their growth and development, and reduces their risk of death without producing significant complications. Having found no suitable study to date that answers these questions, we are currently unable to provide any evidence on whether increasing the energy intake for babies with (or developing) CLD/BPD is overall beneficial.

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

Version: 2013

Simple aspiration versus leaving a drainage tube in (intercostal tube drainage) for primary spontaneous pneumothorax in adults without obvious underlying lung disease

When air collects between the lung and the chest wall (the pleural space) this is described as a pneumothorax. This may be caused by trauma or lung disease, but sometimes it happens spontaneously without any obvious cause. When this happens the lungs cannot expand properly, which makes it difficult to breathe effectively. The person becomes breathless and has chest pain. It is important to treat the pneumothorax by removing the collection of air and allowing healing of the pleura, a thin membrane that covers the lungs to make a lining for them in the chest. For initial management where medical intervention is needed, the air can be removed either by simple aspiration, drawing the air out through a thin tube, or by insertion of a much larger chest tube in the space between the ribs (intercostal tube drainage). Both are done using local anaesthesia. Simple aspiration is technically easier to do. The review authors searched the medical literature and identified one randomized controlled study eligible for inclusion. The included study comprised a total of 60 patients with primary spontaneous pneumothorax; 27 of these underwent simple aspiration and 33 underwent intercostal tube drainage. The review found that simple aspiration is immediately as effective as intercostal tube drainage for primary spontaneous pneumothorax. However, simple aspiration is associated with less likelihood of being hospitalized. There was no significant difference between the two treatments with regard to the following: duration of hospitalization, early failure rate and one year success rate. The inclusion of only one small study in this review may have led to important differences between these two treatments being undetected.

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

Version: 2013

Moderately early (7‐14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants

Moderately early use of steroids helps to get preterm babies off ventilators, reduces chronic lung disease, and may also improve survival to 28 days, but there are important short term adverse effects. Chronic lung disease (CLD) is usually caused by a persistent inflammation in the lung. Steroid drugs have been effective in improving lung function but early use is associated with an increase in adverse effects (see Early Review). The review of trials found that moderately early use of corticosteroids (started at 7‐14 days) reduces the risk of developing CLD. There is limited evidence about possible long term harmful effects. Short term adverse effects include high blood pressure, infection and an excess of glucose in the blood of these preterm babies. More research is needed. Steroid use should be limited until more information is available.

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

Version: 2011

Inhaled versus systemic corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates

Preterm babies who require breathing support often develop chronic lung disease. It is thought that inflammation in the lungs may be part of the cause. Corticosteroid drugs when given orally or through a vein reduces this inflammation, but the use of corticosteroids is associated with serious side effects. Corticosteroids use has been associated with cerebral palsy (motor problem) and developmental delay. It is possible that inhaling steroids, so that the drug directly reaches the lung, may reduce the adverse effects. The review looked at trials that compared preterm babies who received steroids by inhalation to those who received steroids systemically (through a vein or orally) while they were receiving breathing support. There was no evidence that inhaling steroids prevented chronic lung disease or the number of days the baby needed breathing support and additional oxygen.

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

Version: 2012

Early (up to seven days) postnatal corticosteroids for preventing chronic lung disease in preterm infants

Corticosteroids can reduce lung inflammation in newborns with chronic lung disease, but there are major adverse effects of the drugs. Chronic lung disease is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to either prevent or treat chronic lung disease because of their strong anti‐inflammatory effects. This review of trials found that the benefits of giving corticosteroids to infants up to seven days of age may not outweigh the known adverse effects. The beneficial effects were a shorter time on the ventilator and less chronic lung disease, but the adverse effects included high blood pressure, bleeding from the stomach or bowel, perforation of the bowel, an excess of glucose in the bloodstream and an increased risk of cerebral palsy at follow‐up. Use of early corticosteroids, especially dexamethasone, to treat or prevent chronic lung disease should be curtailed until more research has been performed.

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

Version: 2014

Inhaled versus systemic corticosteroids for the treatment of chronic lung disease in ventilated very low birth weight preterm infants

Preterm babies (babies who are born before term, 40 weeks pregnancy) often need breathing support (ventilator support) for breathing difficulties. Babies who need breathing support for a prolonged period of time often develop chronic lung disease (CLD). It is thought that inflammation in the lungs may be part of the cause. Corticosteroid drugs when given orally or through a vein reduces this inflammation (swelling) in the lungs and are used to treat such conditions. However, the use of corticosteroids is associated with serious side effects. Its use has been associated with cerebral palsy (motor problem) and developmental delay. Inhaling steroids, so that the drug directly reaches the lung, has been tried as a way to limit adverse effects. This review of trials found that inhaled steroids do not offer any advantages. More research is needed to show whether any form of routine use of steroids results in overall health improvements for babies at risk of CLD.

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

Version: 2012

Pulmonary rehabilitation for interstitial lung disease (ILD)

Review question: We reviewed available evidence on the effects of pulmonary rehabilitation on exercise capacity, shortness of breath and quality of life in people with interstitial lung disease (ILD).

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

Version: 2014

Intravenous alpha‐1 antitrypsin augmentation therapy for treating patients with alpha‐1 antitrypsin deficiency and lung disease

Alpha‐1 antitrypsin deficiency is an inherited disorder that can cause lung disease (chronic obstructive pulmonary disease or COPD, which is a chronic lung condition that prevents the air supply from getting to the lungs). It affects about 1 in 1600 to 1 in 5000 people. Patients with lung disease suffer from shortness of breath, reduced ability to exercise and wheezing. People who smoke are more seriously affected and have a greater risk of dying from the disease.

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

Version: 2016

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