RESUMEN
PURPOSE: Acute exacerbations (AE) in patients with COPD are associated with a decline in lung function, increased risk of hospitalization, and mortality. In this cross-sectional study we tested whether the level of objectively measured daily physical activity and exercise capacity are associated with the number of COPD exacerbations. METHODS: In 210 patients with COPD (67 % men; mean (SD) age: 63 (8) years) enrolled in The Obstructive Pulmonary Disease Outcomes Cohort of Switzerland (TOPDOCS) physical activity (PA) (steps per day, physical activity level, (PAL)), exercise capacity (6-min walking distance, (6MWD)), comorbidities, lung function, and medication were assessed. Differences between COPD patients with frequent (≥2 year) and infrequent (0-1 year) exacerbations were assessed. Univariate and multivariate analyses were performed to investigate whether the level of objectively measured daily physical activity and exercise capacity are associated with the number of COPD exacerbations. RESULTS: Patients with frequent AE had a significantly lower FEV1 and 6MWD compared to patients with infrequent AE. In univariate analysis, the number of exacerbations was inversely associated with FEV1, 6MWD, BMI, and smoking status while there was a positive association with RV/TLC and combined inhaled medication. However, there was no significant association with PAL and steps per day. In multivariate analysis, FEV1 and the use of combined inhaled medication were independently associated with the number of AE, after correction for covariates. CONCLUSIONS: The findings of this study imply that FEV1, independent of inhaled medication, is significantly associated with COPD exacerbations. Neither physical activity nor exercise capacity was independently associated with COPD exacerbations.
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Tolerancia al Ejercicio , Pulmón/fisiopatología , Actividad Motora , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Anciano , Distribución de Chi-Cuadrado , Comorbilidad , Estudios Transversales , Progresión de la Enfermedad , Prueba de Esfuerzo , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/efectos de los fármacos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Suiza/epidemiología , Factores de Tiempo , Capacidad Pulmonar TotalRESUMEN
Malignant airway-oesophageal fistulas (AEF) are a serious complication of advance oesophageal or lung cancer. The aim of this study was to assess the quality of life before and after stent insertion, and to examine the role of treatment and location of AEF as factors influencing survival in AEF patients managed with airway and/or oesophageal stent insertion. 112 patients with AEF were included prospectively. 83 (74%) patients had advanced lung cancer and 29 (26%) patients had oesophageal cancers. Airway stents were inserted in 65 (58%) patients, oesophageal stents in 37 (33%) patients, and both airway and oesophageal stents in 10 (9%) patients. Seven (6%) patients developed respiratory failure and required transient ventilator support in the intensive care unit (four patients with airway stenting, two patients with double stents and one patient in the oesophageal stenting group). None of the patients developed stent migration or needed stent repositioning. Overall, mean survival was 236.6 days (airway stent 219.1 days, oesophageal stent 262.8 days and combined airway-oesophageal stent 252.9 days). Backward, stepwise regression revealed the site of stent placement (airway and/or oesophagus; p < 0.028), exact location of the fistula in airway (p = 0.011) and additional treatment with chemotherapy and/or radiation (p < 0.001) as independent risk factors predicting increased survival. The mean quality of life score (QoL) was 81 prior to stent insertion and 72 post-stent insertion (p < 0.001). Airway and/or oesophageal stent insertion provides an effective approach to improve the QoL in patients with malignant AEF.
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Fístula Bronquial/cirugía , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Neoplasias Esofágicas/complicaciones , Neoplasias Pulmonares/complicaciones , Carcinoma Pulmonar de Células Pequeñas/complicaciones , Stents , Fístula Traqueoesofágica/cirugía , Adulto , Anciano , Fístula Bronquial/etiología , Fístula Bronquial/mortalidad , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Estudios Prospectivos , Calidad de Vida , Radioterapia Adyuvante , Insuficiencia Respiratoria/etiología , Tasa de Supervivencia , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/mortalidad , Resultado del TratamientoRESUMEN
BACKGROUND: Respiratory diseases such as asthma may affect individuals' fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms at conscription, objective and reliable tests are needed. OBJECTIVE: To prospectively determine the diagnostic value of the mannitol and methacholine bronchial provocation test (BPT) as well as exhaled nitric oxide in assessing physician-diagnosed asthma in a group of Swiss Armed Forces conscripts. METHODS: Questionnaire, spirometry, BPT with methacholine and mannitol, exhaled nitric oxide (FeNO) and skin prick testing were conducted in 18-20-year-old male conscripts. Asthma was diagnosed by a military physician not involved in this study according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication. RESULTS: Two hundred and eighty four subjects participated in the study. Complete data for the BPT with methacholine, mannitol and measurement of FeNO were available on 235 subjects. Forty-two conscripts (17.9%) had physician-diagnosed asthma. The sensitivity/specificity of mannitol to identify physician-diagnosed asthma was 41%/93% and for methacholine it was 43%/92%. Using a cut-off point of 36.5 p.p.b., FeNO had a similar negative predictive value to rule out physician-diagnosed asthma as BPT with mannitol or methacholine. CONCLUSION: BPT with mannitol has a sensitivity and specificity similar to methacholine for the diagnosis of physician-diagnosed asthma in military conscripts but is less costly to perform without the need to use and maintain a nebulizer.
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Asma/diagnóstico , Pruebas de Provocación Bronquial , Personal Militar , Adolescente , Adulto , Humanos , Masculino , Manitol/administración & dosificación , Cloruro de Metacolina/administración & dosificación , Óxido Nítrico/administración & dosificación , Óxido Nítrico/análisis , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Pruebas Cutáneas , Encuestas y Cuestionarios , Suiza , Adulto JovenRESUMEN
BACKGROUND: Diagnosis of chronic obstructive pulmonary disease (COPD) and its severity determination is based on spirometry. The quality of spirometry is crucial. OBJECTIVES: Our aim was to assess the quality of spirometry performed using a spirometer with automated feedback and quality control in a general practice setting in Switzerland and to determine the prevalence of airflow limitation in smokers aged > or =40 years. METHOD: Current smokers > or =40 years of age were consecutively recruited for spirometry testing by general practitioners. General practitioners received spirometry training and were provided with an EasyOne spirometer. Spirometry tests were assigned a quality grade from A to D and F, based on the criteria of the National Lung Health Education Program. Only spirometry tests graded A-C (reproducible measurements) were included in the analysis of airflow limitation. RESULTS: A total of 29,817 spirometries were analyzed. Quality grades A-D and F were assigned to 33.9, 7.1, 19.4, 27.8 and 11.8% of spirometries, respectively. 95% required < or =5 trials to achieve spirometries assigned grade A. The prevalence of mild, moderate, severe and very severe airway obstruction in individuals with spirometries graded A-C was 6, 15, 5 and 1%, respectively. CONCLUSION: Spirometries in general practice are of acceptable quality with reproducible spirometry in 60% of measurements. Airway obstruction was found in 27% of current smokers aged > or =40 years. Office spirometry provides a simple and quick means of detecting airflow limitation, allowing earlier diagnosis and intervention in many patients with early COPD.
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Obstrucción de las Vías Aéreas/diagnóstico , Fumar/efectos adversos , Espirometría , Adulto , Obstrucción de las Vías Aéreas/etiología , Medicina Familiar y Comunitaria , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/etiología , Espirometría/instrumentación , Capacidad VitalRESUMEN
Asthma and allergic rhinitis are chronic inflammatory airway diseases which often occur concomitantly. The objective of the LARA program was to identify the comorbidities and characteristics of asthma (A), intermittent or persistent rhinitis (IPR) and physician defined atopic dermatitis (AD) in 6- to 16-year old asthmatic Swiss children and adolescents. Overall, 126 general practitioners and paediatricians collected the data of 670 asthmatics. Approximately one third of the asthmatic children in Switzerland had well-controlled asthma. Almost two thirds of these asthmatics suffered from concomitant IPR. The latter presented with significantly less symptoms while the treatment rates with inhaled corticosteroids (approximately 90%) and leukotriene-receptorantagonists (approximately 50%) were comparable. However, there were almost twice as many passive smokers in the less well-controlled group. The prevalence of AD was similar in both groups. IPR and AD may play an important role as risk factors in the future development of asthma.
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Asma/diagnóstico , Asma/epidemiología , Rinitis Alérgica Perenne/diagnóstico , Rinitis Alérgica Perenne/epidemiología , Administración por Inhalación , Adolescente , Corticoesteroides/administración & dosificación , Asma/tratamiento farmacológico , Causalidad , Niño , Estudios Transversales , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/epidemiología , Diagnóstico Diferencial , Femenino , Encuestas Epidemiológicas , Humanos , Antagonistas de Leucotrieno/administración & dosificación , Masculino , Rinitis Alérgica Perenne/tratamiento farmacológico , Factores de Riesgo , Contaminación por Humo de Tabaco/efectos adversosRESUMEN
Smoking is a major health risk in young adults. We undertook a study in young Swiss military recruits to determine the impact of intensive training and of help offered on smoking cessation during Basic Military Training (BMT). A questionnaire including questions according to their smoking status, sporting activities and, alcohol use was administered to 999 conscripts at beginning and at the end of the BMT. The results were compared to a control group of BMT schools where no such intervention took place. The study shows that the prevalence of smokers in the intervention group decreased (start BMT 31.9%, end BMT 25.5%; p = 0.021), while the prevalence of smokers increased in the control group (start BMT 26.4%, end BMT 32.6%; p = 0.038). A motivation to serve in the armed forces, as well as the willingness to stop smoking in the next month were the factors associated with a subsequent cessation of smoking during BMT. A smoke stop intervention during BMT is viable and can lead to a decrease in the prevalence of smoking at the end of BMT.
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Personal Militar/educación , Cese del Hábito de Fumar , Estudios Transversales , Estudios de Seguimiento , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Fumar/epidemiología , Suiza , Adulto JovenRESUMEN
BACKGROUND: The GINA guidelines have redefined the primary goal of asthma treatment as achieving optimum control. OBJECTIVES: To document the level of asthma control in Switzerland, the correlations between the international guidelines by GINA and the ACT's rating of asthma control, current treatment in adolescent and adult Swiss asthma patients and factors associated with asthma control. METHODS: General practitioners and specialists (pulmonologists, allergologists and paediatricians) were invited to participate in the cross-sectional survey. Asthma control was assessed in 1093 asthma patients using both the ACT and the GINA classification for asthma control. RESULTS: According to the GINA guidelines controlled asthma was found in 290 (27%) patients, when measured with the ACT 124 (11.5%) patients showed sufficient asthma control. Of the test results 65% were in accordance with each other, whereas in 85% of the non-matching results the ACT underestimated control according to GINA classification. An ACT cut-off score of ≤17 best identified uncontrolled asthma according to GINA guidelines. A total of 956 (87.7%) patients received controller medication and 849 (77.9%) patients received reliever medication. The following parameters were consistently identified to be significantly associated with insufficient asthma control in both GINA and ACT measurements: presence of exacerbation, use of reliever medication, switch of therapy and smoking. STUDY LIMITATION: For this study only the ACT version for adults was used. CONCLUSION: Asthma control remains insufficient in the majority of patients, despite prescription of regular controller medication. This survey confirms the validated ACT to be useful and important in everyday practice as an objective measure for asthma control according to GINA guidelines in order to monitor control and adjust treatment.
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Asma/terapia , Recolección de Datos , Adhesión a Directriz , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Guías de Práctica Clínica como Asunto , SuizaRESUMEN
Smoking is one of the leading preventable risk factors for the development of lung-, cardio-vascular diseases and cancer. We report results of a prospective survey regarding smoking behaviour and willingness to stop smoking in patients of an internal medicine clinic. Twenty percent of participants admitted smoking cigarettes in the previous 7 days. Smokers were more often males and were younger than non- or ex-smokers. Every second smoker reported being told to stop smoking by a physician before but only about a third was offered active support in doing so. About half of the smoking participants were interested to quit smoking and to participate in a hospital-based smoking cessation program. In patients admitted to the hospital, smoking behaviour and willingness to quit smoking should be recorded and help in quitting smoking should be offered actively. Beside recording smoking behaviour and willingness to quit, patients who are admitted in the hospital should be offered help to quit smoking or to join a proactive structured smoking cessation program.
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Aceptación de la Atención de Salud/psicología , Admisión del Paciente/estadística & datos numéricos , Cese del Hábito de Fumar/psicología , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Medicina Interna/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Motivación , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Suiza , Adulto JovenRESUMEN
PRINCIPLES: Chronic obstructive pulmonary disease (COPD) is a major burden on patients and healthcare systems. Diagnosis and the management of COPD are often administered by general practitioners (GPs). This analysis investigated the adherence of GPs in Switzerland to the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guidelines. METHODS: As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD. RESULTS: Of the 615 patients recruited, 44% did not fulfil GOLD criteria for COPD. Pulmonary rehabilitation was prescribed to 5% of all patients and less than one-third of patients exercised regularly. Less than half the patients in all groups used short-acting bronchodilators. Prescribing long-acting bronchodilators or inhaled corticosteroids conformed to GOLD guidelines in two-thirds of patients with GOLD stage III or IV disease, and approximately half of the less severe patients. Systemic steroids were inappropriately prescribed during stable disease in 6% of patients. CONCLUSIONS: Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.
RESUMEN
BACKGROUND: Asthma is not adequately controlled in many patients. A new approach in asthma treatment, known as Budesonide/Formoterol Maintenance and Reliever Therapy has shown improvement in asthma control compared to conventional therapy regimens. As Switzerland was the first European country to formally approve budesonide/formoterol maintenance and reliever therapy, a patient follow-up programme was commenced in January 2006 to investigate its efficacy and safety in a "real-life" environment. METHODS: A non randomized uncontrolled post-marketing survey involving 420 physicians in all language regions in Switzerland was carried out. 2035 patients with asthma were enrolled. Data on current asthma treatment, asthma control and unscheduled visits due to worsening asthma were recorded. Asthma control was assessed subjectively by both the patients and the physicians as well as by means of the validated 5-item Asthma Control Questionnaire (ACQ5). An ACQ score of 0.75 or less indicates well-controlled asthma. RESULTS: Data from 2006 out of 2035 patients were analysed (mean age 44.9 +/- 19.6 years, 50.5% female). With budesonide/formoterol maintenance and reliever therapy the mean ACQ5 score improved by more than 3-fold the defined minimal important difference (MID). The percentage of patients with an ACQ score < or =0.75 increased from 4.8% at baseline to 58.0% at the end of the follow-up programme. Patient satisfaction with budesonide/formoterol for both maintenance and relief was high. CONCLUSIONS: Budesonide/formoterol maintenance and reliever therapy improves asthma control in a non randomised real-life setting.
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Corticoesteroides/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/prevención & control , Budesonida/uso terapéutico , Etanolaminas/uso terapéutico , Administración por Inhalación , Adolescente , Corticoesteroides/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Asma/tratamiento farmacológico , Budesonida/administración & dosificación , Combinación Budesonida y Fumarato de Formoterol , Niño , Combinación de Medicamentos , Etanolaminas/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios , Suiza , Factores de TiempoRESUMEN
The aim of the present study was to assess respiratory health in professional firefighters. A total of 101 male professional firefighters from Basel, Switzerland, were included in the study. A control group consisting of 735 male subjects of the general population was composed of the Basel sample of the Swiss Study on Air Pollution and Lung Diseases in Adults. All subjects were administered a standardised questionnaire, spirometry, skin-prick tests and bronchial challenge testing to methacholine. Respiratory symptoms at work were more frequent in firefighters compared with the control group, including burning eyes (21 versus 3%), running nose (19 versus 2%), itchy throat (26 versus 3%), cough (28 versus 3%), dyspnoea (7 versus 2%) and headache (25 versus 3%), respectively. Atopy was present in 51% of firefighters compared with 32% in the control group. The odds ratio for hyperreactivity to methacholine was 2.24 (95% confidence interval 1.12-4.48) for firefighters compared with the control group. Firefighters reported more respiratory symptoms at work and suffered more often from atopy compared with the control group. Bronchial hyperreactivity was more pronounced in firefighters, but it was not related to acute exposure or duration of employment. It remains unclear whether these findings were present at recruitment or developed after joining the workforce.
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Hiperreactividad Bronquial/diagnóstico , Incendios , Enfermedades Profesionales/diagnóstico , Trastornos Respiratorios/diagnóstico , Hipersensibilidad Respiratoria/diagnóstico , Hiperreactividad Bronquial/epidemiología , Pruebas de Provocación Bronquial , Estudios Transversales , Volumen Espiratorio Forzado , Encuestas Epidemiológicas , Humanos , Incidencia , Pruebas Intradérmicas , Masculino , Cloruro de Metacolina , Enfermedades Profesionales/epidemiología , Oportunidad Relativa , Trastornos Respiratorios/epidemiología , Hipersensibilidad Respiratoria/epidemiología , Fumar/efectos adversos , Fumar/epidemiología , SuizaRESUMEN
HISTORY AND CLINICAL FINDINGS: An 80-year old female patient, hospitalised with pneumonia and myocardial infarction, suddenly developed fever, dyspnoea, malaise, arthralgia and crampy abdominal pain. On the following day, she developed a petechial rash and on the 6 (th) day, macroscopic haematuria. On physical examination, the patient presented with a temperature of 40 degrees C, tachypnoea, tachycardia, and on auscultation coarse crepitations at the left lower base. The abdomen was tender upon deep palpation but bowel sounds were normal. Initially the petechial rash was located at the trunk, later progressing towards the extremities. INVESTIGATIONS: Chest X-ray and laboratory tests were consistent with left lower lobe pneumonia. The clinical picture was not consistent with any haematological causes, coagulopathy or any medication the patient was taking. Rheumatological blood tests (involving ANA, ANCA, rheumatoid factors) were basically negative. A skin biopsy revealed microvessel necrosis and IgA deposits, verifying Henoch-Schoenlein Purpura. An immune electrophoresis revealed a selective IgG-deficiency, which may explain the cause for the patient's recurrent pneumonias. COURSE: The patient recovered well under antibiotic treatment and skin lesions healed without sequelae. CONCLUSION: We present an unusual case of Henoch Schoenlein purpura associated with strictly petechial rash in an 80 year old female.
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Vasculitis por IgA/diagnóstico , Infarto del Miocardio/complicaciones , Neumonía/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vasculitis por IgA/tratamiento farmacológico , Vasculitis por IgA/etiologíaRESUMEN
The current authors present the case of a 68-yr-old female patient who developed severe respiratory failure after medication with ciprofloxacin for acute urinary tract infection. A chronic subdural haematoma was surgical evacuated. Postoperatively, an acute urinary tract infection was treated with ciprofloxacin. Six days later, C-reactive protein was rising and the patient was suffering from intermittent high fever, dyspnoea and severe hypoxaemia. The high-resolution-computed tomography (HRCT) showed an interstitial lung disease in the anterior upper lobe on the left side as well as in the lingula. Assuming a bacterial infection amoxyl/clavulanic acid was started which did not improve the clinical symptoms. Bronchoalveolar lavage revealed a marked lymphocytosis (87%). Analysis for typical bacterial infections, Tuberculosis, Mycoplasma, Chlamydia and Legionella spp. were all negative. Another HRCT scan was made because of worsening of symptoms and this showed rapidly progressive infiltrates in most lobes. An open lingular biopsy showed an interstitial lymphoplasmocytotic infiltrate with some eosinophilic granulocytes and a few scattered giant cell granulomas, consistent with hypersensitivity pneumonitis. The patient's symptoms rapidly improved with systemic corticosteroid therapy and another HRCT scan revealed complete remission of pulmonary infiltrates. Ciprofloxacin can induce interstitial pneumonitis with acute respiratory failure. This is an important fact considering that ciprofloxacin is a widely used antibiotic agent in treatment of urinary tract infection.
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Antiinfecciosos/efectos adversos , Ciprofloxacina/efectos adversos , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedad Aguda , Anciano , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
BACKGROUND: Current British Thoracic Society guidelines do not recommend routinely the combined use of a benzodiazepine and opiate during flexible bronchoscopy (FB). A randomised, placebo controlled, double blind study was undertaken to determine whether hydrocodone in combination with midazolan improves cough suppression during FB without increasing the risk of desaturation. METHODS: 120 patients were randomised to receive midazolam and 5 mg i.v. hydrocodone or midazolam and placebo with topical anaesthesia. Pulse oximetry was recorded continuously during FB. Bronchoscopists and nurses charted their perception of cough and the patients rated their discomfort during the procedure on a 10 cm visual analogue scale (VAS). RESULTS: There was no significant difference between the two groups with regard to the indication for FB, duration of procedure (21 (11) min v 22 (10) min, p = 0.570), doses of supplemental lignocaine (171 (60) mg v 173 (66) mg, p = 0.766) and midazolam (4.5 (2.3) mg v 4.9 (2.7) mg, p = 0.309), lowest oxygen saturation (94.8 (2.7) v 94.9 (2.7), p = 0.433), and desaturations < or =90%. Perception of cough by both the bronchoscopist and the nurse was significantly lower in the hydrocodone group (3 (0-10) and 3 (0-10)) than in the placebo group (6 (0-10) and 6 (0-10)), respectively (p = 0.001). According to the VAS scale, patients' tolerance was also significantly better with hydrocodone than with placebo (2 (0-8) v 3 (0-9), p = 0.043). CONCLUSION: The combination of midazolam and hydrocodone markedly reduces cough during FB without causing significant desaturation, especially when invasive diagnostic procedures are performed.
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Antitusígenos/administración & dosificación , Broncoscopía/métodos , Tos/prevención & control , Hidrocodona/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Líquido del Lavado Bronquioalveolar , Broncoscopía/efectos adversos , Tos/etiología , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: The Swiss Drug Monitoring Center (SANZ) uses a systematic approach to the collection of spontaneously reported individual cases on suspected adverse drug reactions (ADRs). Spontaneous reporting schemes are designed to detect new, rare and unexpected ADRs and to act as an early warning system but there is a tendency to overreport severe reactions. OBJECTIVES: The aim of the study was to determine drug-induced episodes of bronchospasm, their seriousness and predisposing risk factors. An ADR is classified as serious if the reaction results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity. RESULTS: From 1986 to 1995 SANZ received 8,191 case reports of suspected ADRs. In 187 cases (2%) bronchospasm was reported. In 55% of these cases the reaction was regarded as serious. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) were reported most frequently and were involved in 24% of the cases of which 64.5% were classified as serious. In three cases a lethal outcome was reported after intravenous administration of metamizol. Anti-infectious agents were implicated in 18% (52% serious), cardiovascular drugs in 11% (50% serious), drug formulation agents in 9% (41% serious), vaccines and immunoglobulins in 5.5% (50% serious), and plasma volume expanders in 5.5% (80% serious). Other drug groups were involved in 27% of the cases. About 50% of patients experiencing bronchospasm after NSAIDs, pharmaceutical formulation agents, vaccines and immunoglobulins had predisposing risk factors such as asthma, atopy or drug allergy. In other drug groups a predisposing factor was identified in 27% or less. CONCLUSION: Drug-induced bronchospasm is frequently reported with NSAIDs, anti-infective agents, cardiovascular drugs and excipients with a high proportion of serious reactions.
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Espasmo Bronquial/inducido químicamente , Antiinfecciosos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Fármacos Cardiovasculares/efectos adversos , Humanos , Sistema de Registros , Factores de Riesgo , Suiza/epidemiologíaRESUMEN
BACKGROUND: The perception of airway narrowing is reduced in subjects with severe asthma and may be related to the severity of airway inflammation. A study was undertaken to determine if the perception of airway narrowing changes during the reduction of inhaled corticosteroid (ICS) dose or during an asthma exacerbation. METHODS: Forty two asthmatic subjects with well controlled asthma had their daily ICS dose halved every 2 months until they were weaned off ICS or they developed an exacerbation. Perception was measured at baseline and at monthly intervals during bronchial challenge with mannitol as the slope and intercept of the regression of the Borg score and percentage fall in forced expiratory volume in 1 second (FEV(1)), and as the Borg score at 20% fall in FEV(1) (PS(20)FEV(1)). Sputum was collected for measurement of inflammatory cell numbers. RESULTS: In 33 subjects who successfully halved their ICS dose without exacerbation there were significant reductions in slope (p = 0.01), intercept (p = 0.01), and PS(20)FEV(1) (p = 0.003). Sputum eosinophils and airway hyperresponsiveness increased significantly but, in 14 subjects from whom sputum was obtained, changes in eosinophils were not correlated with changes in perception. Change in airway hyperresponsiveness correlated with change in PS(20)FEV(1) (r = -0.40, p = 0.025). In 27 subjects who developed an exacerbation, slope decreased (p = 0.02) and intercept increased (p = 0.01) compared with the visit before the exacerbation. Changes in intercept correlated with changes in resting FEV(1) (r = -0.57, p = 0.002). CONCLUSIONS: Perception of airway narrowing decreases during ICS dose reduction and decreases further during a mild asthma exacerbation. These changes are related to concurrent changes in airway hyperresponsiveness and resting lung function. The effect of changes in airway inflammation on perception is unclear.
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Corticoesteroides/administración & dosificación , Asma/tratamiento farmacológico , Administración por Inhalación , Adulto , Asma/fisiopatología , Bronquios/efectos de los fármacos , Hiperreactividad Bronquial/fisiopatología , Pruebas de Provocación Bronquial , Bronquitis/etiología , Bronquitis/fisiopatología , Disnea/etiología , Disnea/psicología , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Óxido Nítrico/análisis , Percepción , Esputo/citologíaRESUMEN
BACKGROUND AND OBJECTIVE: Patients with COPD often have exertional dyspnoea. They are incapacitated less by impairment of pulmonary function than by deconditioning of the cardiovascular and muscular systems. Pulmonary rehabilitation through the currently customary "low intensity" training programme can at best achieve limited improvement of aerobic capacity. The aim of this study was to clarify whether in the course of in-patient rehabilitation with a medical "high intensity" training regimen patients with COPD can better their endurance capacity (e.c.). PATIENTS AND METHODS: Eleven patients with mild to moderate COPD (ten men, one woman; average age 59 [54-76] years) participated. In addition to optimal drug treatment they undertook "high intensity" training (to 85-95% of maximally achievable heart rate). RESULTS: The patients achieved significant (P < 0.05) improvement in maximal oxygen uptake, maximal performance and walking distance in the 6-minute walking test. CONCLUSION: Medically supervised "high intensity" training can produce a significant rise in endurance capacity even in patients with COPD.
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Terapia por Ejercicio , Enfermedades Pulmonares Obstructivas/rehabilitación , Resistencia Física , Adulto , Anciano , Análisis de Varianza , Análisis de los Gases de la Sangre , Prueba de Esfuerzo , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Educación y Entrenamiento Físico , Estudios Prospectivos , Pruebas de Función RespiratoriaRESUMEN
The prevalence of asthma was studied in a ice hockey team compared with both a floor ball team and the Swiss population. Lung function, bronchial hyperresponsiveness to methacholine, asthma symptoms and exercise-induced asthma were measured in a cross-sectional prospective study. A positive response to the methacholine bronchial provocation test was found in 34.6% of the ice hockey players and 20.8% of the floor ball players (Swiss population 16.4%). The provocative dose causing a 20% fall in the forced expiratory volume in one second (PD20) was significantly lower in ice hockey players than in floor ball players, but there was no significant difference in the dose-response slopes between the two groups. Asthma was diagnosed in 19.2% of the ice hockey players and in 4.2% of the floor ball players (Swiss population 6.8%), whereas exercise-induced asthma was found in 11.5% of the ice hockey players and in 4.2% of the floor ball players. In conclusion, asthma and bronchial hyperresponsiveness seemed to be more common in ice hockey players than in floor ball players and in the Swiss population. Strenuous exercise at lower temperatures may be a risk factor for the higher prevalence of asthma and bronchial hyperresponsiveness, as well as the increased severity of bronchial hyperresponsiveness, particularly in ice hockey players.
Asunto(s)
Asma/epidemiología , Hiperreactividad Bronquial/epidemiología , Hockey/estadística & datos numéricos , Adolescente , Adulto , Asma/etiología , Hiperreactividad Bronquial/etiología , Pruebas de Provocación Bronquial , Estudios Transversales , Relación Dosis-Respuesta a Droga , Volumen Espiratorio Forzado , Humanos , Incidencia , Masculino , Cloruro de Metacolina , Riesgo , SuizaRESUMEN
Elderly people have an increased risk of suffering from thrombo-embolic events. Lung embolism is often found as a cause of death in autopsies in elderly people. However, it is unknown whether the increased age is a risk factor per se or whether elderly people suffer more often from co-morbidities associated with a higher thrombo-embolic risk. Immobility is the most important risk factor for thrombo-embolic events. Other risk factors include trauma, surgery, venous stase, genetic factors (thrombophilia) and a history of past thrombo-embolic events. Although the probability of suffering from a thrombo-embolic event increases with age, it can be difficult to find the correct diagnosis in elderly people: symptoms like dyspnoe or chest pain might be explained by other cardio-pulmonary diseases. In this review, we would like to give an overview about the diagnostic and therapeutic steps in elderly people.
Asunto(s)
Embolia Pulmonar/etiología , Anciano , Anticoagulantes/uso terapéutico , Causas de Muerte , Diagnóstico Diferencial , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/mortalidad , Factores de Riesgo , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/mortalidadRESUMEN
Between 1991 and 1995 about 3% of the unwanted drug-induced side effects reported to the Swiss Drug Monitoring Center (SANZ) concerned pulmonary disturbances (144 out of a total of 4824 reports). The most frequent reports were those about cough and taste disorders caused by ACE-inhibitors, smell disorders caused by antimicotics, and asthma attacks caused by nonsteroidal antirheumatics or betablocking eye drops. 33% of these unwanted side effects have been classified as severe. By spontaneous reporting a correct calculation of incidence is not possible. The reports, however, have signal function. Precise case analysis, temporary correlations (reaction and exposure time and onset of reaction), exclusion of other causes for the disease, comparisons between similar cases and critical study of literature concerning drug-related side effects are still the most important foundations for diagnosis.