Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.762
Filtrar
1.
JAMA ; 323(22): 2268-2280, 2020 06 09.
Artículo en Inglés | MEDLINE | ID: mdl-32515814

RESUMEN

Importance: Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), yet much of COPD risk remains unexplained. Objective: To determine whether dysanapsis, a mismatch of airway tree caliber to lung size, assessed by computed tomography (CT), is associated with incident COPD among older adults and lung function decline in COPD. Design, Setting, and Participants: A retrospective cohort study of 2 community-based samples: the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which involved 2531 participants (6 US sites, 2010-2018) and the Canadian Cohort of Obstructive Lung Disease (CanCOLD), which involved 1272 participants (9 Canadian sites, 2010-2018), and a case-control study of COPD: the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), which involved 2726 participants (12 US sites, 2011-2016). Exposures: Dysanapsis was quantified on CT as the geometric mean of airway lumen diameters measured at 19 standard anatomic locations divided by the cube root of lung volume (airway to lung ratio). Main Outcomes and Measures: Primary outcome was COPD defined by postbronchodilator ratio of forced expired volume in the first second to vital capacity (FEV1:FVC) less than 0.70 with respiratory symptoms. Secondary outcome was longitudinal lung function. All analyses were adjusted for demographics and standard COPD risk factors (primary and secondhand tobacco smoke exposures, occupational and environmental pollutants, and asthma). Results: In the MESA Lung sample (mean [SD] age, 69 years [9 years]; 1334 women [52.7%]), 237 of 2531 participants (9.4%) had prevalent COPD, the mean (SD) airway to lung ratio was 0.033 (0.004), and the mean (SD) FEV1 decline was -33 mL/y (31 mL/y). Of 2294 MESA Lung participants without prevalent COPD, 98 (4.3%) had incident COPD at a median of 6.2 years. Compared with participants in the highest quartile of airway to lung ratio, those in the lowest had a significantly higher COPD incidence (9.8 vs 1.2 cases per 1000 person-years; rate ratio [RR], 8.12; 95% CI, 3.81 to 17.27; rate difference, 8.6 cases per 1000 person-years; 95% CI, 7.1 to 9.2; P < .001) but no significant difference in FEV1 decline (-31 vs -33 mL/y; difference, 2 mL/y; 95% CI, -2 to 5; P = .30). Among CanCOLD participants (mean [SD] age, 67 years [10 years]; 564 women [44.3%]), 113 of 752 (15.0%) had incident COPD at a median of 3.1 years and the mean (SD) FEV1 decline was -36 mL/y (75 mL/y). The COPD incidence in the lowest airway to lung quartile was significantly higher than in the highest quartile (80.6 vs 24.2 cases per 1000 person-years; RR, 3.33; 95% CI, 1.89 to 5.85; rate difference, 56.4 cases per 1000 person-years; 95% CI, 38.0 to 66.8; P<.001), but the FEV1 decline did not differ significantly (-34 vs -36 mL/y; difference, 1 mL/y; 95% CI, -15 to 16; P=.97). Among 1206 SPIROMICS participants (mean [SD] age, 65 years [8 years]; 542 women [44.9%]) with COPD who were followed up for a median 2.1 years, those in the lowest airway to lung ratio quartile had a mean FEV1 decline of -37 mL/y (15 mL/y), which did not differ significantly from the decline in MESA Lung participants (P = .98), whereas those in highest quartile had significantly faster decline than participants in MESA Lung (-55 mL/y [16 mL/y ]; difference, -17 mL/y; 95% CI, -32 to -3; P = .004). Conclusions and Relevance: Among older adults, dysanapsis was significantly associated with COPD, with lower airway tree caliber relative to lung size associated with greater COPD risk. Dysanapsis appears to be a risk factor associated with COPD.


Asunto(s)
Volumen Espiratorio Forzado , Pulmón/patología , Enfermedad Pulmonar Obstructiva Crónica/patología , Capacidad Vital , Anciano , Femenino , Humanos , Pulmón/anatomía & histología , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Espirometría , Tomografía Computarizada por Rayos X
2.
Medicine (Baltimore) ; 99(18): e20035, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358383

RESUMEN

INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) involves a severe inflammatory response. Systemic glucocorticoids are very important for the treatment of the acute exacerbation period; however, their use causes serious adverse effects. There is still no evidence on whether traditional Chinese medicine (TCM) can be used to reduce the dosage of systemic glucocorticoids in the treatment of patients with AECOPD. METHODS: In this trial, we plan to enroll 204 eligible patients with AECOPD who will be randomly assigned to receive TCM or a placebo. The effect of TCM in the treatment of patients with AECOPD will be measured by the dosage of systemic glucocorticoids (at which COPD assessment test [CAT] scores improve by 50%). Safety will also be assessed. TRIAL REGISTRATION: ChiCTR2000029568.


Asunto(s)
Glucocorticoides/uso terapéutico , Medicina China Tradicional/métodos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Adulto , Anciano , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Glucocorticoides/administración & dosificación , Humanos , Mediadores de Inflamación/metabolismo , Masculino , Medicina China Tradicional/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Proyectos de Investigación , Pruebas de Función Respiratoria
3.
Health Qual Life Outcomes ; 18(1): 138, 2020 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-32404113

RESUMEN

BACKGROUND: Cultural differences affect the administration and results of health status questionnaires. "Cross cultural adaptation" ensures retention of psychometric properties such as validity and reliability at an item and/or scale level. OBJECTIVE: To develop a Malaysian version of St George's respiratory COPD specific questionnaire (SGRQ-CM), to evaluate the full spectrum of psychometric properties (reliability, validity and responsiveness), to test the factor structure and to assess minimum clinically important difference for the SGRQ-CM, to be used in population of Malaysia. METHODOLOGY: SGRQ-C was translated to Bahasa Malaysia using a standard protocol. 240 COPD patients were included in the study. All patients were followed-up for six months. Construct validity, internal consistency, item convergent validity, test-retest ability, responsiveness, factor analysis and MCID of the Malaysian version of SGRQ-C to be used in population of Malaysia were evaluated. RESULTS: The Cronbach alpha coefficient and intraclass correlation coefficients (ICC) for SGRQ-CM were reported as 0.87, and 0.88 respectively. Correlation of SGRQ-CM with CAT, EQ-5D-5 L, mMRC dyspnea scales and FEV1%predicted were reported as 0.86, - 0.82, 0.72 and - 0.42 respectively. Correlation coefficient between the subscales and other clinical and health status measures ranged from r = - 0.35 to r = - 0.87. The MCID was reported as 5.07 (- 2.54-12.67). CONCLUSION: The Malaysian version of SGRQ-C has a good psychometric property comparable to those of the original version and has a strong evidence of validity, reliability and responsiveness towards disease severity in Malaysian COPD patients. It can be recommended as a reliable quality of life measure for future research.


Asunto(s)
Psicometría , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Encuestas y Cuestionarios , Traducciones , Anciano , Estudios de Cohortes , Disnea/clasificación , Análisis Factorial , Volumen Espiratorio Forzado , Estado de Salud , Humanos , Malasia , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Reproducibilidad de los Resultados , Capacidad Vital
4.
Medicine (Baltimore) ; 99(18): e19826, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358353

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by cough, sputum production, and dyspnea, and has a high prevalence and mortality. Pulmonary rehabilitation (PR) is a management that improves the quality of life for COPD patients; however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed without any limitations. LCE consists of breathing, stretching, and tapping to relieve dyspnea in COPD patients. METHODS/DESIGN: This randomized, assessor-blind, multicenter trial aims to recruit 54 patients with moderate and severe COPD. Subjects will be randomly allocated to a control group (only medication), an LCE group (medication + LCE, 5 times a week), or a PR group (medication + PR, 5 times a week). The 6-minute walk distance, pulmonary function tests (forced expiratory volume at 1 second, forced vital capacity, and forced expiratory volume at 1 second/forced vital capacity), modified Borg scale, modified medical research council dyspnea scale, COPD assessment test, and St. George respiratory questionnaire will be measured before starting the trial and after the 4th and 8th weeks to determine motor performance, lung function, and dyspnea. CONCLUSION: We aim to demonstrate that LCE is effective in improving symptoms and psychosomatic stability in COPD patients. Therefore, this trial will play an important role in fortifying the foundation of clinical application.


Asunto(s)
Ejercicios Respiratorios/métodos , Terapia por Ejercicio/métodos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Terapia Respiratoria/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Pruebas de Función Respiratoria , Método Simple Ciego , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(20): e20241, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443359

RESUMEN

BACKGROUND: This study aims to investigate the efficacy and safety of benralizumab for the treatment of patients with chronic obstructive pulmonary disease (COPD). METHODS: This study will systematically and comprehensively search relevant literatures in electronic databases (MEDLINE, EMBASE, Cochrane Library, Global health, PsycINFO, Scopus, WANGFANG, and CNKI) from inception to the present without language and publication time restrictions. Two reviewers will independently carry out literature identification, data collection, and study quality assessment. Any disagreement will be settled down by a third reviewer through discussion and a consensus will be reached. RevMan 5.3 software will be used for statistical analysis performance. RESULTS: This study will summarize up-to-date evidence to assess the efficacy and safety of benralizumab for the treatment of COPD. CONCLUSION: The findings of this study will provide helpful evidence to determine whether benralizumab is effective or not for the treatment of COPD. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040039.


Asunto(s)
Antiasmáticos/normas , Anticuerpos Monoclonales Humanizados/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Antiasmáticos/uso terapéutico , Protocolos Clínicos , Humanos , Metaanálisis como Asunto , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Resultado del Tratamiento
6.
Life Sci ; 252: 117649, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32275936

RESUMEN

Chronic obstructive pulmonary disease (COPD) with cardiovascular complications is very common. Due to fear of exacerbating airway spasm, ß-blockers are rarely used in such patients. Many observational studies suggest that ß-blockers can reduce the disease progression and the risk of mortality in patients with COPD, but lack of confirmation from randomized controlled trials. This article reviews the application of ß-blockers in patients with COPD based on the results of the latest published randomized controlled trials.


Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Enfermedades Cardiovasculares/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Antagonistas Adrenérgicos beta/efectos adversos , Progresión de la Enfermedad , Humanos , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
Anesth Analg ; 130(5): 1407-1414, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32167976

RESUMEN

BACKGROUND: The ventilation/perfusion mismatch in chronic obstructive pulmonary disease (COPD) patients can exacerbate cardiac function as well as pulmonary oxygenation. We hypothesized that inhaled iloprost can ameliorate pulmonary oxygenation with lung mechanics and myocardial function during one-lung ventilation (OLV) in COPD patients combined with poor lung oxygenation. METHODS: A total of 40 patients with moderate to severe COPD, who exhibited the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FIO2) <150 mm Hg 30 minutes after initiating OLV, were enrolled in this study. Patients were randomly allocated into either ILO group (n = 20) or Control group (n = 20), in which iloprost (20 µg) and saline were inhaled, respectively. The PaO2/FIO2 ratio, dead space, dynamic compliance, and tissue Doppler imaging with myocardial performance index (MPI) were assessed 30 minutes after initiating OLV (pre-Tx) and 30 minutes after completion of drug inhalation (post-Tx). Repeated variables were analyzed using a linear mixed-model between the groups. RESULTS: At pre-Tx, no differences were observed in measured parameters between the groups. At post-Tx, PaO2/FIO2 ratio (P < .001) and dynamic compliance (P = .023) were significantly higher and dead space ventilation was significantly lower (P = .001) in iloprost group (ILO group) compared to Control group. Left (P = .003) and right ventricular MPIs (P < .001) significantly decreased in ILO group compared to Control group. CONCLUSIONS: Inhaled iloprost improved pulmonary oxygenation, lung mechanics, and cardiac function simultaneously during OLV in COPD patients with poor lung oxygenation.


Asunto(s)
Iloprost/administración & dosificación , Pulmón/efectos de los fármacos , Ventilación Unipulmonar/métodos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Mecánica Respiratoria/efectos de los fármacos , Vasodilatadores/administración & dosificación , Administración por Inhalación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón/fisiología , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ventilación Pulmonar/efectos de los fármacos , Ventilación Pulmonar/fisiología , Mecánica Respiratoria/fisiología , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 99(10): e19390, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150084

RESUMEN

INTRODUCTION: Patients with chronic pulmonary obstructive disease (COPD) are at risk of acute exacerbation. Diaphragm muscle is classically highly solicited in COPD exacerbation. PATIENT CONCERNS: A COPD patient was admitted because of acute dyspnea with wheezing. DIAGNOSIS: acute COPD exacerbation. INTERVENTIONS: A diaphragm ultrasound and a Doppler echocardiography were performed at bedside. OUTCOMES: We measured diaphragm thickening at the apposition zone and diaphragm inspiratory motion from the subcostal view, in addition with classical echocardiographic parameters. CONCLUSION: Despite a normal diaphragm thickening, diaphragm motion during inspiration is reduced in acute COPD exacerbation. These apparently discrepant findings may be explained by the alterations of the respiratory mechanics during COPD exacerbations, which should be considered when evaluating the diaphragmatic function by imaging.


Asunto(s)
Diafragma/anomalías , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anciano de 80 o más Años , Diafragma/fisiopatología , Progresión de la Enfermedad , Trastornos Disociativos , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ultrasonografía/métodos
9.
PLoS One ; 15(2): e0229257, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32106226

RESUMEN

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. METHODS: We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. RESULTS: 253 patients were included, aged 68.9±9.8years, FEV1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission. CONCLUSIONS: The patients' limitation to perform BADLs and their history of admissions for AECOPD were the best predictive variables for the likelihood of readmission when adjusted for many other social and clinical variables, regardless of the time period considered for such prediction.


Asunto(s)
Actividades Cotidianas , Readmisión del Paciente/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Calidad de Vida , Índice de Severidad de la Enfermedad , Medio Social , Anciano , Comorbilidad , Femenino , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Pruebas de Función Respiratoria , Factores de Riesgo , Factores Socioeconómicos , España/epidemiología
10.
Braz J Med Biol Res ; 53(3): e9391, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32077467

RESUMEN

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.


Asunto(s)
Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Ventilación Voluntaria Máxima/fisiología , Consumo de Oxígeno/fisiología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Recuperación de la Función/fisiología , Anciano , Humanos , Cinética , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología
11.
PLoS One ; 15(2): e0228940, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32040531

RESUMEN

In chronic obstructive pulmonary disease (COPD), acute exacerbation of COPD requiring hospital admission is associated with mortality and healthcare costs. The ERICA study assessed multiple clinical measures in people with COPD, including the short physical performance battery (SPPB), a simple test of physical function with 3 components (gait speed, balance and sit-to-stand). We tested the hypothesis that SPPB score would relate to risk of hospital admissions and length of hospital stay. Data were analysed from 714 of the total 729 participants (434 men and 280 women) with COPD. Data from this prospective observational longitudinal study were obtained from 4 secondary and 1 tertiary centres from England, Scotland, and Wales. The main outcome measures were to estimate the risk of hospitalisation with acute exacerbation of COPD (AECOPD and length of hospital stay derived from hospital episode statistics (HES). In total, 291 of 714 individuals experienced 762 hospitalised AECOPD during five-year follow up. Poorer performance of SPPB was associated with both higher rate (IRR 1.08 per 1 point decrease, 95% CI 1.01 to 1.14) and increased length of stay (IRR 1.18 per 1 point decrease, 95% CI 1.10 to 1.27) for hospitalised AECOPD. For the individual sit-to-stand component of the SPPB, the association was even stronger (IRR 1.14, 95% CI 1.02 to 1.26 for rate and IRR 1.32, 95% CI 1.16 to 1.49 for length of stay for hospitalised AECOPD). The SPPB, and in particular the sit-to-stand component can both evaluate the risk of H-AECOPD and length of hospital stay in COPD. The SPPB can aid in clinical decision making and when prioritising healthcare resources.


Asunto(s)
Hospitalización/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Admisión del Paciente/estadística & datos numéricos , Rendimiento Físico Funcional , Estudios Prospectivos , Medición de Riesgo , Reino Unido
12.
PLoS One ; 15(1): e0227737, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32004333

RESUMEN

RATIONALE: Ineffective peak inspiratory flow rate (PIFR) generation in patients using inhalers results in insufficient drug delivery to the lungs and poor clinical outcomes. Low inspiratory muscle strength is associated with suboptimal PIFR. OBJECTIVE: To examine in a prospective study the relationship between PIFR and skeletal muscle strength using hand grip strength (HGS) as a surrogate. METHODS: Adult patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled. PIFR was measured within 48 hours before discharge. PIFR below 60L/min was considered suboptimal. HGS was measured using a handheld dynamometer. Any readmissions and emergency department visit data were collected. The associations between PIFR, HGS, 30 and 90-day COPD and all-cause readmissions were examined, without and with adjustment for age, race and gender. RESULTS: Of the 75 enrolled patients, 56% had suboptimal PIFR; they were older (63.9±9.7 vs. 58.2±7.7 years) and had significantly lower HGS (24.2±11.1 vs. 30.9±10.9 Kg) compared to those with optimal PIFR. There were no significant differences between the two PIFR groups by gender, race, history of coronary artery disease, congestive heart failure, hypertension or functional scores. Each kilogram increase in HGS was associated with 0.50 (95%CI 0.18-0.89, p = 0.003) L/min increase in PIFR. We did not observe an association between PIFR and 30 or 90-day readmission rates. CONCLUSION: We found a significant association between HGS and PIFR in hospitalized patients with acute exacerbations of COPD. Whether interventions aimed at increasing skeletal muscle strength also result in improvement in PIFR remains unclear and need further study.


Asunto(s)
Broncodilatadores/administración & dosificación , Fuerza de la Mano/fisiología , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Ventilación Pulmonar/fisiología , Administración por Inhalación , Anciano , Inhaladores de Polvo Seco , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Dinamómetro de Fuerza Muscular , Oligopéptidos , Readmisión del Paciente/estadística & datos numéricos , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Espirometría , Brote de los Síntomas
13.
PLoS One ; 15(2): e0228279, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027677

RESUMEN

Smoke exposure is known to decrease total pulmonary surfactant and alter its composition, but the role of surfactant in chronic obstructive pulmonary disease (COPD) remains unknown. We aimed to analyze the compositional changes in the surfactant lipidome in COPD and identify specific lipids associated with pulmonary function decline. Bronchoalveolar lavage (BAL) fluid was obtained from 12 former smokers with COPD and 5 non-smoking, non-asthmatic healthy control volunteers. Lipids were extracted and analyzed by liquid chromatography and mass spectrometry. Pulmonary function data were obtained by spirometry, and correlations of lung function with lipid species were determined. Wild-type C57BL/6 mice were exposed to 6 months of second-hand smoke in a full-body chamber. Surfactant lipids were decreased by 60% in subjects with COPD. All phospholipid classes were dramatically decreased, including ether phospholipids, which have not been studied in pulmonary surfactant. Availability of phospholipid, cholesterol, and sphingomyelin in BAL strongly correlated with pulmonary function and this was attributable to specific lipid species of phosphatidylcholine with surface tension reducing properties, and of phosphatidylglycerol with antimicrobial roles, as well as to other less studied lipid species. Mice exposed to smoke for six months recapitulated surfactant lipidomic changes observed in human subjects with COPD. In summary, we show that the surfactant lipidome is substantially altered in subjects with COPD, and decreased availability of phospholipids correlated with decreased pulmonary function. Further investigation of surfactant alterations in COPD would improve our understanding of its physiopathology and reveal new potential therapeutic targets.


Asunto(s)
Lípidos/análisis , Pulmón/metabolismo , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Surfactantes Pulmonares/metabolismo , Anciano , Animales , Líquido del Lavado Bronquioalveolar/química , Estudios de Casos y Controles , Cromatografía Líquida de Alta Presión , Modelos Animales de Enfermedad , Humanos , Espectrometría de Masas , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Fosfatidilcolinas/química , Fosfatidilcolinas/metabolismo , Fosfolípidos/química , Fosfolípidos/metabolismo , Fumadores , Contaminación por Humo de Tabaco
14.
Medicine (Baltimore) ; 99(7): e19118, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049827

RESUMEN

Cigarette smoking is considered the main risk factor for chronic obstructive pulmonary disease (COPD), although the mechanism remains unknown. surfactant protein A (SP-A) is thought to protect the lung from smoking-induced damage, but related studies performed in China are scarce. The aim of the study is to assess alterations of SP-A expression and distribution in lung samples from Chinese smokers with or without COPD.This cross-sectional study assessed 45 men in Wuhan Tongji Hospital after lobectomy for lung cancer in June 2010 to September 2010. Peripheral lung specimens were collected from control nonsmokers without airflow obstruction (nonsmoking group, n = 15), smokers without airflow obstruction (smoking group, n = 15), and patients with COPD (COPD group, n = 15). SP-A expression levels in lung tissue samples and its distribution in lung cells, type II pneumocytes (PNII), and alveolar macrophages (MACR) were determined by immunoblotting and immunohistochemistry.SP-A levels were significantly decreased in the COPD group (1.00 ±â€Š0.25) compared with the smoking (2.31 ±â€Š0.64) and nonsmoking (8.03 ±â€Š2.80) groups; the smoking group also showed significantly reduced levels compared with the nonsmoking group (P < .05). PNII expressing SP-A were less abundant in the COPD group (39.3% ±â€Š7.1%) compared with the smoking group (76.2% ±â€Š29.8%), whereas SP-A MACR were more abundant (92.4% ±â€Š7.1% vs 68.5% ±â€Š20.2%) (all P < .05). Among the 30 smokers, forced expiratory volume in one second (% predicted) was positively correlated with SP-A levels (r = 0.739) and the rate of SP-A+ PNII (r = 0.811), and negatively correlated with the rate of SP-A+ MACR (r = -0.758) (all P < .05).Changes in SP-A expression and distribution in lung tissues may be involved in COPD pathogenesis in smokers.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/genética , Proteína A Asociada a Surfactante Pulmonar/metabolismo , Fumar/efectos adversos , Anciano , Estudios de Casos y Controles , China , Estudios Transversales , Volumen Espiratorio Forzado , Humanos , Pulmón/patología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/etiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Fumadores/estadística & datos numéricos
15.
Postgrad Med ; 132(2): 198-205, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31900019

RESUMEN

Long-acting inhaled bronchodilator medications are recommended as initial maintenance therapy for many patients with COPD. These medications include long-acting muscarinic antagonists (LAMA) and long-acting ß2-agonists (LABA). Combinations of long-acting bronchodilator agents (LAMA/LABA) and inhaled corticosteroids combined with LABA (ICS/LABA) are also used as initial or follow-up therapy in patients with more severe symptoms or at risk of COPD exacerbations. This review summarizes the position of LAMA/LABA combinations in treatment recommendations, and the evidence supporting their placement relative to LAMA monotherapy and ICS/LABA combination therapy, as well as differences within the LAMA/LABA class. Most studies show that LAMA/LABA treatment leads to greater improvements in lung function and symptoms than LAMA monotherapy or ICS/LABA treatment. There are fewer studies comparing the impact of different medication classes on patients' risk of exacerbations; however, the available evidence suggests that LAMA/LABA treatment and LAMA monotherapy lead to a similar reduction in exacerbation risk, while the effect of LAMA/LABA compared with ICS/LABA remains unclear. The incidence of adverse events is similar with LAMA/LABA and LAMA alone. There is a lower risk of pneumonia with LAMA/LABA compared with ICS/LABA. This evidence supports the use of LAMA/LABA combinations as an initial maintenance therapy option for symptomatic patients with low exacerbation risk and severe breathlessness or patients with severe symptoms who are at risk of exacerbations, and as follow-up treatment in patients with uncontrolled symptoms or exacerbations on bronchodilator monotherapy.


Asunto(s)
Corticoesteroides/uso terapéutico , Broncodilatadores/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Administración por Inhalación , Corticoesteroides/administración & dosificación , Agonistas de Receptores Adrenérgicos beta 2/farmacología , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Broncodilatadores/administración & dosificación , Broncodilatadores/farmacología , Preparaciones de Acción Retardada , Combinación de Medicamentos , Quimioterapia Combinada , Humanos , Antagonistas Muscarínicos/farmacología , Antagonistas Muscarínicos/uso terapéutico , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad
16.
PLoS One ; 15(1): e0227730, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945115

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with poor quality of life, hospitalization and mortality. COPD phenotype includes using pulmonary function tests to determine airflow obstruction from the forced expiratory volume in one second (FEV1):forced vital capacity. FEV1 is a commonly used value for severity but is difficult to identify in structured electronic health record (EHR) data. DATA SOURCE AND METHODS: Using the Microsoft SQL Server's full-text search feature and string functions supporting regular-expression-like operations, we developed an automated tool to extract FEV1 values from progress notes to improve ascertainment of FEV1 in EHR in the Veterans Aging Cohort Study (VACS). RESULTS: The automated tool increased quantifiable FEV1 values from 12,425 to 16,274 (24% increase in numeric FEV1). Using chart review as the reference, positive predictive value of the tool was 99% (95% Confidence interval: 98.2-100.0%) for identifying quantifiable FEV1 values and a recall value of 100%, yielding an F-measure of 0.99. The tool correctly identified FEV1 measurements in 95% of cases. CONCLUSION: A SQL-based full text search of clinical notes for quantifiable FEV1 is efficient and improves the number of values available in VA data. Future work will examine how these methods can improve phenotyping of patients with COPD in the VA.


Asunto(s)
Minería de Datos/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Volumen Espiratorio Forzado/fisiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Capacidad Vital/fisiología , Estudios de Cohortes , Sistemas de Información en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Pulmón/fisiopatología , Procesamiento de Lenguaje Natural , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Índice de Severidad de la Enfermedad , Programas Informáticos , Estados Unidos , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/estadística & datos numéricos
17.
Fisioter. Pesqui. (Online) ; 27(1): 64-70, jan.-mar. 2020. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1090404

RESUMEN

RESUMO O objetivo do estudo foi correlacionar a diferença entre capacidade vital lenta (CVL) e capacidade vital forçada (CVF) (CVL-CVF) com a atividade física na vida diária (AFVD) em pacientes com doença pulmonar obstrutiva crônica (DPOC); e verificar as diferenças na AFVD entre indivíduos com CVL maior ou menor do que a CVF. Vinte e oito indivíduos com DPOC (18 homens; 67±8 anos; VEF1: 40±13% previsto) tiveram a função pulmonar avaliada pela espirometria e foram divididos em dois grupos: CVL>CVF (n=17) e CVL≤CVF (n=11). Ademais, tiveram a AFVD avaliada objetivamente pelo monitor de atividade física DynaPort®, que quantifica na vida diária, dentre outros, o tempo gasto por dia andando, em pé, sentado e deitado. Não foram encontradas correlações significativas entre CVL-CVF e as variáveis da AFVD no grupo geral. No grupo CVL>CVF foi encontrada significância estatística na correlação entre a CVL-CVF e o tempo gasto por dia em pé (r=−0,56) e sentado (r=0,75). Já no grupo CVL≤CVF, houve correlação significativa somente com o tempo gasto por dia em pé (r=0,57) e deitado (r=−0,62). Ao comparar ambos os grupos, não houve diferença estatisticamente significante para nenhuma das variáveis da AFVD (p>0,05 para todas). No grupo com CVL maior que a CVF houve correlação alta com o tempo gasto sentado, mas não com o tempo andando. Portanto, indivíduos com maior obstrução ao fluxo aéreo segundo a diferença CVL-CVF tendem a gastar mais tempo em atividades de menor gasto energético, que não envolvam caminhar.


RESUMEN El presente estudio tuvo el objetivo de correlacionar la diferencia entre la capacidad vital lenta (CVL) y la capacidad vital forzada (CVF) (CVL-CVF) con la actividad física en la vida diaria (AFVD) de pacientes con enfermedad pulmonar obstructiva crónica (EPOC); y verificar las diferencias de la AFVD entre individuos con CVL mayor o menor que la CVF. Se evaluaron la función pulmonar de veintiocho personas con EPOC (18 hombres; 67±8 años; VEF1: 40±13% esperado) mediante espirometría, y los dividieron en dos grupos: CVL>CVF (n=17) y CVL≤CVF (n=11). La AFVD también se evaluó objetivamente por el monitor de actividad física DynaPort®, el cual cuantifica el tiempo que se gasta en la vida diaria caminando, de pie, sentado y acostado. No se encontraron correlaciones significativas entre CVL-CVF y las variables de la AFVD en el grupo general. En el grupo CVL>CVF, se encontró una significación estadística en la correlación entre CVL-CVF y el tiempo que se gasta diariamente en pie (r=−0,56) y sentado (r=0,75). El grupo CVL≤CVF presentó una correlación significativa solo con el tiempo que se gasta diariamente en pie (r=0,57) y acostado (r=−0,62). La comparación entre ambos grupos no resultó en diferencias estadísticamente significativas en ninguna de las variables de AFVD (p>0,05 para todas). En el grupo con CVL mayor que la CVF, hubo una alta correlación con el tiempo que se gasta sentado, pero con el tiempo que se gasta caminando no se encontró este resultado. Se concluye que las personas con una mayor obstrucción del flujo de aire de acuerdo con la diferencia CVL-CVF tienden a gastar más tiempo en actividades con menos gasto de energía, las que no implican caminar.


ABSTRACT The aim of this study was to correlate the difference of vital capacity (VC) and forced vital capacity (FVC) (VC-FVC) with physical activity in daily life (PADL) in patients with chronic obstructive pulmonary disease (COPD); and investigate the differences in PADL in individuals with VC smaller or greater than FVC. Twenty-eight patients with COPD (18 men, 67±8 years; FEV1: 40±13% predicted) had their lung function assessed by spirometry and were divided into two groups: VC>FVC (n=17) and VC≤CVF (n=11). Furthermore, they had their PADL evaluated by a validated activity monitor which measures, among other variables, time spent/day walking, standing, sitting and lying. There were no correlations between VC-FVC and the variables of PADL in the general group. In the group VC>FVC there was statistically significant correlation between VC-FVC and the time spent/day standing (r=−0.56) and sitting (r=0.75). In the group VC≤CVF , VC-FVC was significantly correlated with time spent/day standing (r=0.57) and lying (r=−0.62). When comparing the groups, there was no statistically significant difference for any variable of PADL (p>0.05 for all). In conclusion, in patients with VC greater than FVC there was high correlation with time spent/day sitting, but not with time spent/day walking. Therefore, individuals with greater airflow obstruction according to the VC-FVC difference tend to spend more time in activities of lower energy expenditure, which do not involve walking.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Ejercicio Físico/fisiología , Capacidad Vital/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria , Espirometría/métodos , Estudios Transversales , Monitoreo , Disnea/fisiopatología , Prueba de Esfuerzo/métodos , Conducta Sedentaria
18.
Expert Rev Clin Pharmacol ; 13(2): 103-113, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31951778

RESUMEN

Introduction: Treatment options for COPD have evolved rapidly in the last decade and inhaled bronchodilators have largely supplanted the use of oral bronchodilators because of their increased efficacy and excellent safety with topical delivery to the lung. Recently added to the therapeutic armamentarium are fixed-dose combinations (FDC) of two long acting bronchodilators. LAMAs (long acting muscarinic antagonists) and LABAs (long acting beta agonists) are the main classes available and use different pathways to effectively produce bronchial smooth muscle relaxation.Areas covered: The most recent inhaled FDC LAMA/LABA to come to market is Aclidinium Bromide and Formoterol Fumarate. We searched databases of PubMed, Cochrane Library, and manufacturers' websites and retrieved all the randomized-controlled trials (RCTs) conducted with these drugs up to September 2019.Expert opinion: It is likely that FDCs will become the core of our COPD pharmacotherapy for all but the mildest COPD patients. These individual drugs have excellent efficacy and safety records for the maintenance treatment of COPD. Studies have demonstrated that twice daily treatment with aclidinium/formoterol resulted in significant improvement in lung function and an improved exercise tolerance when compared to placebo. Adverse effects are within the range of what is seen with other LAMA/LABA combinations.


Asunto(s)
Fumarato de Formoterol/administración & dosificación , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Tropanos/administración & dosificación , Administración por Inhalación , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Agonistas de Receptores Adrenérgicos beta 2/efectos adversos , Agonistas de Receptores Adrenérgicos beta 2/farmacología , Broncodilatadores/administración & dosificación , Broncodilatadores/efectos adversos , Broncodilatadores/farmacología , Combinación de Medicamentos , Fumarato de Formoterol/efectos adversos , Fumarato de Formoterol/farmacología , Humanos , Antagonistas Muscarínicos/administración & dosificación , Antagonistas Muscarínicos/efectos adversos , Antagonistas Muscarínicos/farmacología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tropanos/efectos adversos , Tropanos/farmacología
19.
J Acquir Immune Defic Syndr ; 83(2): 189-196, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31929407

RESUMEN

BACKGROUND: Persons living with HIV (PLWH) are at risk of developing different phenotypes of chronic lung disease, including chronic obstructive pulmonary disease. Mechanisms underlying these phenotypes are unclear. OBJECTIVE: To identify clusters of peripheral inflammatory mediators associated with pulmonary function to determine inflammatory pathways and phenotypes of chronic obstructive pulmonary disease in PLWH and HIV-uninfected individuals. METHODS: Study participants were PLWH and HIV-uninfected individuals enrolled in the Pittsburgh HIV Lung Cohort. Pulmonary function tests were performed for all participants. Chest computed tomographic scans were performed in a subset of PLWH. Plasma levels of 19 inflammatory mediators were measured by Luminex or ELISA. Clusters were identified based on the expression pattern of inflammatory mediators in PLWH and HIV-uninfected individuals, and the relationships among clinical parameters were evaluated within clusters by using cluster and network analyses. RESULTS: In PLWH, we identified a distinct cluster with higher levels of Th1, Th2, and Th17 inflammatory mediators with increased complexity of these mediators and inferred presence of pathogenic Th17 cell types. Individuals in this cluster had worse airway obstruction and more radiographic emphysema. In HIV-uninfected individuals, a cluster with high-grade systemic inflammation also had worse diffusing capacity for carbon monoxide. CONCLUSIONS: Inflammatory pathways associated with pulmonary dysfunction in PLWH suggest multifaceted immune dysregulation involved in different phenotypes of pulmonary dysfunction with a potential specific contribution of the Th17 pathway to airway obstruction in PLWH. Identification of these associations may help in development of treatments that could alter the course of the disease.


Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/fisiopatología , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/fisiopatología , Fenotipo , Adulto , Recuento de Linfocito CD4 , Monóxido de Carbono , Análisis por Conglomerados , Estudios de Cohortes , Femenino , Infecciones por VIH/inmunología , Humanos , Pulmón/fisiopatología , Enfermedades Pulmonares/inmunología , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfisema Pulmonar , Pruebas de Función Respiratoria , Factores de Riesgo , Células TH1 , Células Th17 , Células Th2 , Estados Unidos
20.
Braz J Phys Ther ; 24(1): 54-60, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30497829

RESUMEN

OBJECTIVE: To determine Glittre-ADL test minimal important difference in patients with chronic obstructive pulmonary disease. METHODS: This is quasi-experimental study. Sixty patients with moderate to very severe chronic obstructive pulmonary disease (age 64.1, SD=9.09 years; forced expiratory volume in the first second 37.9, SD=13.0% predicted participated in a pulmonary rehabilitation program based on physical training, conducted over 24 sessions supervised, three times a week, including aerobic training in treadmill and resistance training for upper limbs and lower limbs. The main outcomes were the Glittre-ADL test and six-minute walk test, before and after 24 sessions of pulmonary rehabilitation. The minimal important difference was established using the distribution and anchor-based methods. RESULTS: Patients improved their functional capacity after the pulmonary rehabilitation. The effect sizes of Glittre-ADL test and six-minute walk test improvement were similar (0.45 vs 0.44, respectively). The established minimal important differences ranged from -0.38 to -1.05. The reduction of 0.38min (23s) corresponded to a sensitivity of 64% and a specificity of 69% with an area under the curve of 0.66 (95%CI 0.51-0.81; p=0.04). Subjects who achieved the minimal important difference of -0.38min for the Glittre-ADL test had a superior improvement of approximately 42m in the six-minute walk test when compared to patients who did not. CONCLUSIONS: The present findings suggest -0.38min as the minimal important difference in the time spent in the Glittre-ADL test after 24 sessions of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. TRIAL REGISTRATION: NCT03251781 (https://clinicaltrials.gov/ct2/show/NCT03251781).


Asunto(s)
Extremidad Inferior/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Prueba de Paso/instrumentación , Actividades Cotidianas , Volumen Espiratorio Forzado , Humanos , Extremidad Inferior/fisiopatología , Pruebas de Función Respiratoria , Prueba de Paso/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA