Cargando…
Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial
Long‐lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad‐spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic feve...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067626/ https://www.ncbi.nlm.nih.gov/pubmed/26661344 http://dx.doi.org/10.1002/ajh.24262 |
_version_ | 1782460678349520896 |
---|---|
author | Møller, Tom Moser, Claus Adamsen, Lis Rugaard, Grith Jarden, Mary Bøtcher, Tina S. Wiedenbein, Liza Kjeldsen, Lars |
author_facet | Møller, Tom Moser, Claus Adamsen, Lis Rugaard, Grith Jarden, Mary Bøtcher, Tina S. Wiedenbein, Liza Kjeldsen, Lars |
author_sort | Møller, Tom |
collection | PubMed |
description | Long‐lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad‐spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient‐performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty‐five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80‐76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy. Am. J. Hematol. 91:271–276, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc. |
format | Online Article Text |
id | pubmed-5067626 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-50676262016-11-01 Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial Møller, Tom Moser, Claus Adamsen, Lis Rugaard, Grith Jarden, Mary Bøtcher, Tina S. Wiedenbein, Liza Kjeldsen, Lars Am J Hematol Original Articles Long‐lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad‐spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient‐performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty‐five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80‐76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy. Am. J. Hematol. 91:271–276, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc. John Wiley and Sons Inc. 2016-03 2016-02-09 /pmc/articles/PMC5067626/ /pubmed/26661344 http://dx.doi.org/10.1002/ajh.24262 Text en © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Møller, Tom Moser, Claus Adamsen, Lis Rugaard, Grith Jarden, Mary Bøtcher, Tina S. Wiedenbein, Liza Kjeldsen, Lars Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title | Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title_full | Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title_fullStr | Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title_full_unstemmed | Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title_short | Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial |
title_sort | early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: a randomized controlled trial |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067626/ https://www.ncbi.nlm.nih.gov/pubmed/26661344 http://dx.doi.org/10.1002/ajh.24262 |
work_keys_str_mv | AT møllertom earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT moserclaus earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT adamsenlis earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT rugaardgrith earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT jardenmary earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT bøtchertinas earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT wiedenbeinliza earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial AT kjeldsenlars earlywarningandpreventionofpneumoniainacuteleukemiabypatienteducationspirometryandpositiveexpiratorypressurearandomizedcontrolledtrial |