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1.
Zhonghua Yi Xue Za Zhi ; 101(15): 1071-1076, 2021 Apr 20.
Artículo en Chino | MEDLINE | ID: mdl-33878834

RESUMEN

Objective: To investigate the clinical efficacy and safety analysis of bronchial thermoplasty (BT) in the treatment of severe asthma and asthma-chronic obstructive pulmonary disease overlap. Methods: The clinical data of 49 patients with asthma-COPD overlap who received BT in the University of Chinese Academy of Sciences Shenzhen Hospital from January 2016 to December 2018 and 50 patients with severe asthma who received BT in the same period were retrospectively analyzed. Patients were divided into overlap group and asthma group, and the baseline data of two groups were recorded. The pulmonary function before and after treatment (including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1 as a percentage of predicted value (FEV1% pred)), hormone consumption, asthma control test (ACT) score, asthma quality of life questionnaire (AQLQ) score, asthma control questionnaire (ACQ) score, the overlap group before and after treatment COPD assessment test (CAT) score, modified British Medical Research Council (mMRC) score and postoperative respiratory adverse events in the next 3 weeks were comparatively analyzed. Results: The general baseline characteristics of the two groups are compared. The patients in the overlap group were older than those in the asthma group, and the course of disease and smoking history were longer than those in the asthma group. The inhaled hormone dosage in asthma group was greater than those in the overlap group ((64±11) years vs (48±11) years; 10.00 (10.00, 25.00) years vs 9.00 (1.75, 20.00) years; 20.00(2.00, 40.00) years vs 0 (0, 10.00) years; 320 (320, 640) µg/d vs 960 (320, 960) µg/d) (all P<0.05). The predicted values of lung function indexes FVC, FEV1, FEV1% pred in the overlap group before treatment were all lower than those in the asthma group (1.98 (1.43, 2.43) L vs 2.54 (2.02, 3.15) L; 0.92 (0.61, 1.26) L vs 1.69(1.17, 2.16) L; (50±16) L vs (65±14) L) (all P<0.05). There were no significant differences in ACT, ACQ, and AQLQ scores between the two groups before treatment (all P>0.05). Within 3 months after treatment, except for no significant improvement in FEV1% predicted value and inhaled hormone dosage in the overlap group (all P>0.05), other indexes in both groups were improved compared with those before treatment (all P<0.05). After 1 year of treatment, all indexes of the two groups were significantly improved than those before treatment, and all indexes of the asthma group were better than those of the overlap group (all P<0.05). In terms of respiratory adverse events occurring within 3 weeks after the operation, the incidence of cough and bloody sputum in the overlap group was higher than that in the asthma group, while the incidence of sputum and short-term wheezing was lower than that in the asthma group (all P<0.05). There were no statistically significant differences in the incidence of chest tightness, chest pain, segmental atelectasis and pneumonia between the two groups (all P>0.05), and the postoperative adverse reactions could be effectively controlled in a short period of time. Conclusion: BT treatment could not only improve the lung function, clinical symptoms and quality of life of asthmatic patients, but was also effective for asthma-COPD overlap patients. However, BT treatment had more benefits for asthmatic patients without serious adverse events occurred.


Asunto(s)
Asma , Termoplastia Bronquial , Enfermedad Pulmonar Obstructiva Crónica , Volumen Espiratorio Forzado , Humanos , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
2.
Sr Care Pharm ; 36(5): 248-257, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33879286

RESUMEN

OBJECTIVE AND DESIGN: To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD). PATIENTS AND SETTING: Residents 60 years of age and older with a COPD diagnosis and≥ 6 months' nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities. OUTCOME MEASURES: Data, extracted from residents' charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. At enrollment, residents completed the modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT™). Spirometry and PIFR were also assessed. RESULTS: Residents' (N = 179) mean age was 78.0 ± 10.6 years, 63.7% were female, and 57.0% had low PIFR. Most prevalent comorbidities were hypertension (79.9%), depression (49.2%), and heart failure (41.9%). The average forced expiratory volume in 1 second (FEV11) % predicted was 45.9% ± 20.9%. On the CAT, 78.2% scored≥ 10 and on the mMRC Dyspnea Scale, 74.1% scored≥ 2, indicating most residents had high COPD symptom burden. Only 49.2% were receiving a scheduled long-acting bronchodilator (LABD). Among those with low PIFR prescribed a LABD, > 80% used dry powder inhalers for medication delivery. CONCLUSION: This study highlights underutilization of scheduled LABD therapy in nursing facility residents with COPD. Low PIFR was prevalent in residents while the majority used suboptimal medication delivery devices. The findings highlight opportunities for improving management and outcomes for nursing facility residents with COPD.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Broncodilatadores/uso terapéutico , Inhaladores de Polvo Seco , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Espirometría , Estados Unidos
3.
Clinics (Sao Paulo) ; 76: e2420, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33886788

RESUMEN

The risk factors of bronchiectasis in patients with chronic obstructive pulmonary disease have not yet been established. This systematic review and meta-analysis aimed to investigate and identify potential risk factors for patients with chronic obstructive pulmonary disease accompanied by bronchiectasis. We reviewed eight electronic journal databases from their inception to November 2019 for observational studies with no language restrictions. The Newcastle-Ottawa Scale was applied to evaluate the quality of the literature. Binary variables were pooled using odds ratios and continuous variables using the standardized mean difference with 95% confidence intervals. The confidence of evidence was assessed according to the grading of the recommendations assessment, development, and evaluation method. Eight case-control studies met the inclusion criteria. Tuberculosis history, smoking history, hospitalization stays, admissions in the past year, and duration of symptoms were considered risk factors. In addition, the ratio between the forced expiratory volume in 1s and forced vital capacity, the percentage of forced expiratory volume in 1s, the forced expiratory volume in 1s as a percentage of the predicted value, purulent sputum, purulent mucus sputum, positive sputum culture, Pseudomonas aeruginosa infection, arterial oxygen pressure, daily dyspnea, C-reactive protein, leukocytes, and the percentage of neutrophils were found to be closely related to bronchiectasis. However, these were not considered risk factors. The evidence of all outcomes was judged as "low" or "very low." Additional prospective studies are required to elucidate the underlying risk factors and identify effective preventive interventions.


Asunto(s)
Bronquiectasia , Enfermedad Pulmonar Obstructiva Crónica , Bronquiectasia/complicaciones , Volumen Espiratorio Forzado , Humanos , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Factores de Riesgo
4.
Mymensingh Med J ; 30(2): 509-513, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830136

RESUMEN

Smoking has extensive effects on respiratory function. The rate of cigarette smoking among young people has continued to increase steadily. Exposure to cigarette smoking is usually measured in terms of 'Pack-Year'. The aim of the study was to observe the effect of pack years on pulmonary functions in apparently healthy asymptomatic smokers by measuring FVC, FEV1, FEV1/FVC ratio and PEFR value by digital spirometer. This cross-sectional observational study was conducted in the department of Physiology, Sylhet MAG Osmani Medical College in collaboration with department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2016 to June 2017. A total number of 100 male smokers, age ranging from 18-60 years and BMI within normal limit (18.5-24.9kg/m²) were included in this study. Their pulmonary functions were studied by measuring FVC, FEV1, FEV1/FVC ratio and PEFR. Relationship between pack-year and pulmonary function test parameters was established by one way ANOVA test. In this study we found that lung function parameters shared an inverse relationship with pack year of smoking. The percentage of predicted values of FEV1, FEV1/FVC ratio and PEFR were significantly lower (p<0.001) in heavy smokers who smoked more than 30 pack years. Therefore, by this study we inferred that those who smoked more than 10 pack years are associated with accelerated decline in lung function.


Asunto(s)
Pulmón , Fumadores , Adolescente , Adulto , Bangladesh/epidemiología , Estudios Transversales , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Capacidad Vital , Adulto Joven
5.
Wiad Lek ; 74(2): 288-290, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813488

RESUMEN

OBJECTIVE: The aim: To study the regulation of acid-base balance and blood acid - renal excretory function in patients with COPD. PATIENTS AND METHODS: Materials and methods: We examined 82 people, suggests that even during the most severe stages of COPD. Group 1 included 56 patients with COPD, group C. The average age was 60.54 + 2.04 years old, including 24 men and 32 women. The second group included 16 patients with COPD, group B, whose average age was 55.37 + 3.21 years old, including 7 men and 9 women. The third group included 10 healthy individuals, with an average age of 34.30 + 2.21 years, including 6 men and 4 women. Respiration function was evaluated on the basis of the forced expiratory curve recorded on a Spirolab II MIR S / N computer spirograph. The following indicators were evaluated: forced vital capacity (FVC), forced expiratory volume (FEV1) and FEV1 / FVC ratio. RESULTS: Results: For all patients with COPD there is a characteristic presence of acidosis (pH in patients with COPD group B - 7,34 ± 0,01, in patients with COPD group C - 7,31 ± 0,07). For patients with COPD group C there are pronounced respiratory disorders (pCO2 - 48,25 + 1,14 mm Hg, p02 - 28.07 +1.37 mm Hg). For patients with COPD group B characteristic metabolic disorders (BE--3,71 + 0,57), which increase as the disease progresses. For patients with COPD group C this figure is equal to 7.62 + 0.49. Thus, the analysis of indicators indicates the presence for all patients of mixed (respiratory and metabolic) acidosis, which increases as the chronic obstructive pulmonary disease progresses. CONCLUSION: Conclusions: There is activation of acid - renal excretory function and the inclusion of renal mechanisms in the regulation of acid-base balance.


Asunto(s)
Equilibrio Ácido-Base , Enfermedad Pulmonar Obstructiva Crónica , Adulto , Femenino , Volumen Espiratorio Forzado , Humanos , Riñón , Masculino , Persona de Mediana Edad , Capacidad Vital
6.
BMC Pulm Med ; 21(1): 136, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902513

RESUMEN

BACKGROUND: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.


Asunto(s)
/fisiopatología , Pulmón/fisiopatología , Calidad de Vida , Anciano , Convalecencia , Femenino , Volumen Espiratorio Forzado , Estado de Salud , Humanos , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Suiza , Tomografía Computarizada por Rayos X , Capacidad Vital , Prueba de Paso
7.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648488

RESUMEN

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Asunto(s)
Enfermedades Bronquiales/cirugía , Broncoscopía/métodos , Cicatriz/cirugía , Laringoestenosis/cirugía , Stents , Estenosis Traqueal/cirugía , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Enfermedades Bronquiales/patología , Enfermedades Bronquiales/fisiopatología , Cicatriz/fisiopatología , Constricción Patológica , Tos/fisiopatología , Criocirugia/métodos , Dilatación/métodos , Combinación de Medicamentos , Disnea/fisiopatología , Femenino , Volumen Espiratorio Forzado , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Laringoestenosis/fisiopatología , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio , Complicaciones Posoperatorias/epidemiología , Pronóstico , Recurrencia , Estudios Retrospectivos , Fumar , Estenosis Traqueal/fisiopatología , Capacidad Vital , Adulto Joven
8.
Artículo en Inglés | MEDLINE | ID: mdl-33673619

RESUMEN

Previous studies have reported an association between the impairment of cognitive performance and lung diseases. However, whether obstructive or restrictive lung diseases have an impact on cognitive function is still inconclusive. We aimed to investigate the association between cognitive function and obstructive or restrictive lung diseases in Taiwanese adults using the Mini-Mental State Examination (MMSE). In this study, we used data from the Taiwan Biobank. Cognitive function was evaluated using the MMSE. Spirometry measurements of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained to assess lung function. Participants were classified into three groups according to lung function, namely, normal, restrictive, and obstructive lung function. In total, 683 patients enrolled, of whom 357 participants had normal lung function (52.3%), 95 had restrictive lung function (13.9%), and 231 had obstructive lung function (33.8%). Compared to the normal lung function group, the obstructive lung function group was associated with a higher percentage of cognitive impairment (MMSE < 24). In multivariable analysis, a low MMSE score was significantly associated with low FVC, low FEV1, and low FEV1/FVC. Furthermore, a low MMSE score was significantly associated with low FEV1 in the participants with FEV1/FVC < 70%, whereas MMSE was not significantly associated with FVC in the participants with FEV1/FVC ≥ 70%. Our results showed that a low MMSE score was associated with low FEV1, low FVC and low FEV1/FVC. Furthermore, a low MMSE score was associated with obstructive lung diseases but not with restrictive lung diseases.


Asunto(s)
Enfermedades Pulmonares Obstructivas , Enfermedades Pulmonares , Adulto , Cognición , Volumen Espiratorio Forzado , Humanos , Pulmón , Enfermedades Pulmonares Obstructivas/epidemiología , Espirometría , Taiwán/epidemiología , Capacidad Vital
9.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33647535

RESUMEN

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.


Asunto(s)
/complicaciones , Disnea/fisiopatología , Tolerancia al Ejercicio , Fatiga/fisiopatología , Intercambio Gaseoso Pulmonar , Espirometría , Adulto , Anciano , Enfermedad Crónica , Disnea/sangre , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Sobrevivientes , Capacidad Vital , Prueba de Paso
10.
Cochrane Database Syst Rev ; 3: CD007923, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33686652

RESUMEN

BACKGROUND: Inhalation of the enzyme dornase alfa reduces sputum viscosity and improves clinical outcomes of people with cystic fibrosis. This is an update of a previously published Cochrane Review. OBJECTIVES: To determine whether the timing of dornase alfa inhalation (in relation to airway clearance techniques or morning versus evening inhalation) has an impact on objective and subjective measures of clinical efficacy in people with cystic fibrosis. SEARCH METHODS: Relevant randomised and quasi-randomised controlled trials were identified from the Cochrane Cystic Fibrosis Trials Register, the Physiotherapy Evidence Database (PEDro), clinical trial registries and international cystic fibrosis conference proceedings. Date of the most recent search: 12 October 2020. SELECTION CRITERIA: Any trial of dornase alfa in people with cystic fibrosis where timing of inhalation was the randomised element in the trial with either: inhalation before compared to after airway clearance techniques; or morning compared to evening inhalation.  DATA COLLECTION AND ANALYSIS: Both authors independently selected trials, assessed risk of bias and extracted data with disagreements resolved by discussion. Relevant data were extracted and, where possible, meta-analysed. We assessed the quality of the evidence using GRADE. MAIN RESULTS: We identified 115 trial reports representing 55 trials, of which five trials (providing data on 122 participants) met our inclusion criteria. All five trials used a cross-over design. Intervention periods ranged from two to eight weeks. Four trials (98 participants) compared dornase alfa inhalation before versus after airway clearance techniques. Inhalation after instead of before airway clearance did not significantly change forced expiratory volume at one second (very-low quality evidence). Similarly, forced vital capacity (low-quality evidence) and quality of life (very-low quality evidence) were not significantly affected; forced expiratory flow at 25% was significantly worse with dornase alfa inhalation after airway clearance, mean difference -0.17 litres (95% confidence interval -0.28 to -0.05), based on the pooled data from two small trials in children (7 to 19 years) with well-preserved lung function. All other secondary outcomes were statistically non-significant. In one trial (25 participants), morning versus evening inhalation had no impact on lung function or symptoms (low-quality evidence). AUTHORS' CONCLUSIONS: The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and trials with variable follow-up. In the absence of strong evidence to indicate that one timing regimen is better than another, the timing of dornase alfa inhalation can be largely based on pragmatic reasons or individual preference with respect to the time of airway clearance and time of day. Further research is warranted.


Asunto(s)
Fibrosis Quística/terapia , Desoxirribonucleasa I/administración & dosificación , Terapia Respiratoria/métodos , Administración por Inhalación , Adolescente , Niño , Terapia Combinada/métodos , Esquema de Medicación , Volumen Espiratorio Forzado , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes/administración & dosificación , Factores de Tiempo , Capacidad Vital , Adulto Joven
11.
Cochrane Database Syst Rev ; 3: CD001127, 2021 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-33735508

RESUMEN

BACKGROUND: Dornase alfa is currently used as a mucolytic to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. It reduces mucus viscosity in the lungs, promoting improved clearance of secretions. This is an update of a previously published review. OBJECTIVES: To determine whether the use of dornase alfa in cystic fibrosis is associated with improved mortality and morbidity compared to placebo or other medications that improve airway clearance, and to identify any adverse events associated with its use. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstracts from conferences. Date of the most recent search of the Group's Cystic Fibrosis Register: 12 October 2020. Clinicaltrials.gov and the International Clinical Trials Registry Platform were also searched to identify unpublished or ongoing trials. Date of most recent search: 08 February 2021. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing dornase alfa to placebo, standard therapy or other medications that improve airway clearance. DATA COLLECTION AND ANALYSIS: Authors independently assessed trials against the inclusion criteria; two authors carried out analysis of methodological quality and data extraction. GRADE was used to assess the level of evidence. MAIN RESULTS: The searches identified 74 trials, of which 19 (2565 participants) met our inclusion criteria. 15 trials compared dornase alfa to placebo or no dornase alfa (2447 participants); two compared daily dornase to hypertonic saline (32 participants); one compared daily dornase alfa to hypertonic saline and alternate day dornase alfa (48 participants); one compared dornase alfa to mannitol and the combination of both drugs (38 participants). Trial duration varied from six days to three years. Dornase alfa compared to placebo or no treatment Dornase alfa probably improved forced expiratory volume at one second (FEV1) at one month (four trials, 248 participants), three months (one trial, 320 participants; moderate-quality evidence), six months (one trial, 647 participants; high-quality evidence) and two years (one trial, 410 participants). Limited low-quality evidence showed treatment may make little or no difference  in quality of life. Dornase alfa probably reduced the number of pulmonary exacerbations in trials of up to two years (moderate-quality evidence). One trial that examined the cost of care, including the cost of dornase alfa, found that the cost savings from dornase alfa offset 18% to 38% of the medication costs. Dornase alfa: daily versus alternate day One cross-over trial (43 children) found little or no difference between treatment regimens for lung function, quality of life or pulmonary exacerbations (low-quality evidence). Dornase alfa compared to other medications that improve airway clearance Results for these comparisons were mixed. One trial (43 children) showed dornase alfa may lead to a greater improvement in FEV1 compared to hypertonic saline (low-quality evidence), and one trial (23 participants) reported little or no differences in lung function between dornase alfa and mannitol or dornase alfa and dornase alfa plus mannitol (low-quality evidence). One trial (23 participants) found dornase alfa may improve quality of life compared to dornase alfa plus mannitol (low-quality evidence); other comparisons found little or no difference in this outcome (low-quality evidence). No trials in any comparison reported any difference between groups in the number of pulmonary exacerbations (low-quality evidence). When all comparisons are assessed, dornase alfa did not cause significantly more adverse effects than other treatments, except voice alteration and rash. AUTHORS' CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa may improve lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer, probably due to treatment. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function.


Asunto(s)
Fibrosis Quística/tratamiento farmacológico , Desoxirribonucleasa I/uso terapéutico , Expectorantes/uso terapéutico , Adolescente , Adulto , Niño , Preescolar , Desoxirribonucleasa I/efectos adversos , Progresión de la Enfermedad , Expectorantes/efectos adversos , Volumen Espiratorio Forzado , Humanos , Lactante , Manitol/uso terapéutico , Placebos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Solución Salina Hipertónica/uso terapéutico , Capacidad Vital
12.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 265-270, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33691920

RESUMEN

OBJECTIVE: To study the correlation between the bronchial dilation test (BDT) and asthma control level in children with asthma. METHODS: A total of 153 children with asthma, aged 5-14 years, who attended the outpatient service from March 2016 to March 2018 were enrolled. According to the presence or absence of atopic constitution, they were divided into an allergic group with 79 children and a non-allergic group with 74 children. The correlation between BDT and Childhood Asthma Control Test (C-ACT) scores was analyzed for both groups. RESULTS: All basic pulmonary function parameters were positively correlated with C-ACT scores in the non-allergic group (P < 0.05). Except the forced vital capacity, peak expiratory flow and maximal expiratory flow at 25% vital capacity in percent predicted values, the other pulmonary function parameters were positively correlated with C-ACT scores in the allergic group (P < 0.05). The improvement rates of all BDT parameters (except maximal expiratory flow at 25% vital capacity in the allergic group and maximal expiratory flow at 50% vital capacity in the non-allergic group) were negatively correlated with C-ACT scores in the two groups (P < 0.05). CONCLUSIONS: The improvement rate of BDT is well correlated with C-ACT scores in children with asthma, suggesting that BDT can be used as an index for predicting asthma control level.


Asunto(s)
Asma , Adolescente , Niño , Preescolar , Dilatación , Volumen Espiratorio Forzado , Humanos , Pulmón , Capacidad Vital
13.
Nutrients ; 13(2)2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33578669

RESUMEN

Diet is a health-related factor that can modify lung function. This study hypothesized that the change in age-related dietary intake affects lung function. The subjects who undertook a dietary assessment and spirometry in 2012 and 2017, were retrospectively collected in a health screening center. Dietary intakes were directly evaluated using food frequency questionnaires (FFQ) administered by trained dietitians and were compared at the baseline (2012) and 5-year follow-up (2017). A forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) value below 0.70 was defined as airflow limitation. Logistic regression models were used to estimate the odds ratio (ORs) adjusted for potential confounders. A total of 1439 subjects with normal spirometry were enrolled. New airflow limitations were detected in 48 subjects (3.3%) at the 5-year follow-up, including 41 (85.4%) men and 11 (22.9%) current smokers. After adjusting for age, sex, smoking history, and baseline FEV1/FVC, the odd ratios (OR) for new airflow limitation in fiber, vitamin C, and folic acid per 10% decrease in daily recommended requirement were 2.714 (95% confidence interval (CI), 1.538-4.807; p = 0.001), 1.083 (95% CI: 1.020-1.149; p = 0.007), and 1.495 (95% CI: 1.172-1.913; p = 0.001), respectively. A decreased intake of dietary fiber, vitamin C, and folic acid is associated with a newly developed airflow limitation.


Asunto(s)
Antioxidantes/administración & dosificación , Dieta/métodos , Fibras de la Dieta/administración & dosificación , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Anciano , Ácido Ascórbico/administración & dosificación , Encuestas sobre Dietas , Femenino , Ácido Fólico/administración & dosificación , Volumen Espiratorio Forzado , Humanos , Modelos Logísticos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fumar/epidemiología , Espirometría/métodos , Capacidad Vital , Vitaminas/administración & dosificación
14.
Environ Res ; 195: 110850, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33577771

RESUMEN

Patients with chronic obstructive pulmonary disease (COPD) are frequently colonised or sensitised by Aspergillus, but clinical significance remains unclear. Furthermore, little is known on the impact of indoor mould exposure during COPD. In this study, we assessed the relationship between domestic mould exposure, Aspergillus biomarkers and COPD severity during acute exacerbation and at stable state. Aspergillus section Fumigati culture in sputum and anti-Aspergillus antibodies detection (IgG and precipitins) were followed up in COPD patients that were prospectively recruited during exacerbation (n = 62), and underwent a visit at stable state after 18 months (n = 33). Clinical characteristics were collected at inclusion. Electrostatic dust collectors (EDCs) were used to measure domestic mould contamination. Aspergillus section Fumigati was more frequently detected during exacerbation (16.9%) than at stable state (4.0%), but the frequency of patients presenting with anti-Aspergillus antibodies was similar (32.2% and 33.3%, respectively). Aspergillus section Fumigati detection was associated with a higher body-mass index (BMI) during exacerbation, whereas patients with anti-Aspergillus antibodies presented a lower BMI and forced expiratory volume in 1 s, as well as a higher frequency of inhaled corticoids and higher total mould and Penicillium exposure at final visit (P < 0.05). The frequency of patients with anti-Aspergillus antibodies was higher for total mould counts >30 CFU/cm2 (P = 0.03). Aspergillosis was diagnosed in 2 patients (6.1%) who presented increased levels of antibodies. Our data suggest that anti-Aspergillus antibodies are associated with chronic lung function alteration and/or domestic mould exposure, thereby supporting the consideration of indoor mould contamination and anti-Aspergillus antibodies kinetics in COPD management.


Asunto(s)
Aspergilosis , Enfermedad Pulmonar Obstructiva Crónica , Aspergillus , Biomarcadores , Volumen Espiratorio Forzado , Humanos , Pulmón
15.
Medicine (Baltimore) ; 100(7): e24675, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607805

RESUMEN

BACKGROUND: In the present study, we aimed to evaluate the effects of pulmonary rehabilitation on respiratory functions after the surgery on the basis of early radiological findings, pain degree, function, and satisfaction scores in operated patients with adolescent idiopathic scoliosis (AIS). METHODS: Thirty patients with AIS were included in the present study, who were divided into 2 groups. Scoliosis surgery and diaphragmatic breathing and pursed lip exercises were applied in Group 1 (n = 15), whereas merely scoliosis surgery was applied in Group 2 (n = 15). Pulmonary functions, arterial blood gas analysis, Cobb and kyphosis angles, apical vertebral rotation, and apical vertebral translation were measured before and 1st and 6th months after the surgery. Using the SRS-30 test, the psychosocial statuses of the patients and their satisfaction degrees with surgery applied were measured before and after the surgery. RESULTS: Six months after the surgery, the values of Cobb and kyphosis angles and apical vertebral rotations, and apical vertebral translation of the patients were determined to be significantly ameliorated, which is consistent with the literature. Forced vital capacity (l) and forced expiratory volume in the first second (l/s) were observed to be significantly improved in both groups after the surgery (respectively, P = .001, P = .014, P = .001, P = .005). In addition, the partial pressure of oxygen (pO2) value was found to be significantly increased 6 months after the surgery compared with that before the surgery in Group 2 (P = .022). SRS-30 showed that most of the scores in Group 1 were dramatically increased; a significant difference between the groups was not recorded. CONCLUSION: Patients with AIS have been found to be satisfied with the surgery. Conversely, pulmonary rehabilitation has been shown to slightly improve the respiratory functions in the patients with AIS, 1 and 6 months after the surgery.


Asunto(s)
Pulmón/fisiopatología , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Fusión Vertebral/instrumentación , Adolescente , Análisis de los Gases de la Sangre/métodos , Estudios de Casos y Controles , Niño , Diafragma , Femenino , Volumen Espiratorio Forzado , Humanos , Cifosis/diagnóstico por imagen , Masculino , Radiografía/métodos , Respiración , Pruebas de Función Respiratoria/estadística & datos numéricos , Escoliosis/fisiopatología , Fusión Vertebral/métodos , Resultado del Tratamiento , Capacidad Vital , Adulto Joven
16.
Can Respir J ; 2021: 6692409, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33628349

RESUMEN

We aimed to investigate changes in pulmonary function and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the recovery period. COVID-19 patients underwent symptom assessment, pulmonary function tests, and high-resolution chest CT 6 months after discharge from the hospital. Of the 54 patients enrolled, 31 and 23 were in the moderate and severe group, respectively. The main symptoms 6 months after discharge were fatigue and exertional dyspnea, experienced by 24.1% and 18.5% of patients, respectively, followed by smell and taste dysfunction (9.3%) and cough (5.6%). One patient dropped out of the pulmonary function tests. Of the remaining 54 patients, 41.5% had pulmonary dysfunction. Specifically, 7.5% presented with restrictive ventilatory dysfunction (forced vital capacity <80% of the predicted value), 18.9% presented with small airway dysfunction, and 32.1% presented with pulmonary diffusion impairment (diffusing capacity for carbon monoxide <80% of the predicted value). Of the 54 patients enrolled, six patients dropped out of the chest CT tests. Eleven of the remaining 48 patients presented with abnormal lung CT findings 6 months after discharge. Patients with residual lung lesions were more common in the severe group (52.6%) than in the moderate group (3.4%); a higher proportion of patients had involvement of both lungs (42.1% vs. 3.4%) in the severe group. The residual lung lesions were mainly ground-glass opacities (20.8%) and linear opacities (14.6%). Semiquantitative visual scoring of the CT findings revealed significantly higher scores in the left, right, and both lungs in the severe group than in the moderate group. COVID-19 patients 6 months after discharge mostly presented with fatigue and exertional dyspnea, and their pulmonary dysfunction was mostly characterized by pulmonary diffusion impairment. As revealed by chest CT, the severe group had a higher prevalence of residual lesions than the moderate group, and the residual lesions mostly manifested as ground-glass opacities and linear opacities.


Asunto(s)
/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Pulmón/fisiopatología , Adulto , Anciano , Tos/fisiopatología , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Trastornos del Olfato/fisiopatología , Ápice del Flujo Espiratorio , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Trastornos del Gusto/fisiopatología , Tomografía Computarizada por Rayos X , Capacidad Vital
17.
BMC Pulm Med ; 21(1): 59, 2021 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-33593334

RESUMEN

BACKGROUND: Asthma and osteoarthritis (OA) are medical conditions that inhibit physical activity and adversely affect quality of life. Despite the high prevalence, there are limited studies focusing on the comorbid condition and association between asthma and OA. The aim of this study was to assess the prevalence of OA co-occurring with asthma and to identify the relevant clinical considerations. METHODS: Adult participants aged over 40 years who completed questionnaire assessments and spirometry tests were enrolled from the Korean National Health and Nutrition Examination Survey. Asthma and OA were defined based on the medical history of a diagnosis made by a doctor. Radiographic severities of OA were measured using the Kellgren-Lawrence grading system. Chronic obstructive pulmonary disease (COPD), as a comparative respiratory disease, was diagnosed based on the spirometric results. RESULTS: A total of 9344 subjects were enrolled, and the prevalence of asthma and COPD were 4.6% ± 0.3% and 12.0% ± 0.5%, respectively. The prevalence of OA in the asthma group was 31.9% ± 2.8%, which was significantly higher than that in the COPD (17.8% ± 1.5%) or control (16.2% ± 0.6%) groups. OA was more prevalent in patients with asthma after adjusting for age, sex, body mass index, and smoking status (OR 1.65; 95% CI 1.27-2.13). Furthermore, after adjustment of this model for the prescription of OA medication, OA remained independently associated with asthma (OR 1.56; 95% CI 1.10-2.20). Conversely, the relationship of OA medication with asthma was not significant (P = 0.64). This relationship was evident in patients with asthma without airflow limitation measured by spirometry (OR 1.97; 95% CI 1.32-2.93). Moreover, the radiographic severity of knee OA correlated with asthma (OR 1.10; 95% CI 1.0-||1.21). CONCLUSIONS: OA shows a high prevalence in patients with asthma, higher than in patients with COPD or the controls. The comorbid characteristics of these two conditions need to be considered in clinical practice.


Asunto(s)
Asma/epidemiología , Osteoartritis/epidemiología , Adulto , Anciano , Asma/fisiopatología , Estudios de Casos y Controles , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Rodilla/epidemiología , Osteoartritis de la Columna Vertebral/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , República de Corea/epidemiología , Fumar/epidemiología , Espirometría , Capacidad Vital
18.
Medicine (Baltimore) ; 100(4): e23858, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530179

RESUMEN

BACKGROUND: This meta-analysis aimed to systematically estimate the prevalence of comorbid bronchiectasis in patients with asthma and to summarize its clinical impact. METHODS: Embase, PubMed, and Cochrane Library electronic databases were searched to identify relevant studies published from inception until March 2020. STUDY SELECTION: Studies were included if bronchiectasis was identified by high-resolution computed tomography. Outcomes included the prevalence of bronchiectasis and its association with demographic characteristics and indicators of asthma severity, including results of lung function tests and the number of exacerbations. RESULTS: Five observational studies with 839 patients were included. Overall, the mean prevalence of bronchiectasis in patients with asthma was 36.6% (307/839). Patients with comorbid bronchiectasis had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (MD: -2.71; 95% CI: -3.72 to -1.69) and more frequent exacerbations (MD: 0.68; 95% CI: 0.03 to 1.33) than those with asthma alone, and there was no significant difference of sex, duration of asthma and serum levels of immunoglobulin(Ig)Es between asthmatic patients with or without bronchiectasis. CONCLUSION: The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.


Asunto(s)
Asma/complicaciones , Bronquiectasia/complicaciones , Asma/epidemiología , Asma/fisiopatología , Biomarcadores/sangre , Bronquiectasia/epidemiología , Bronquiectasia/fisiopatología , Comorbilidad , Eosinófilos/metabolismo , Volumen Espiratorio Forzado , Humanos , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Capacidad Vital
19.
Respir Res ; 22(1): 15, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33441106

RESUMEN

BACKGROUND: Elderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients. METHODS: We conducted a retrospective analysis on a series of 758 asthmatics subdivided in three groups: lower than 40, between 40 and 70 and older than 70. All the patients who had a successful sputum induction were included in the study. RESULTS: Older patients had a higher Body Mass Index, had less active smokers and were more often treated with Long Acting anti-Muscarinic Agents. We found a significant increase in sputum neutrophil counts with ageing. There was no significant difference in blood inflammatory cell counts whatever the age group. Forced expiratory volume in one second (FEV1) and FEV1/FVC values were significantly lower in elderly who had lower bronchial hyperresponsiveness and signs of air trapping. We found a lower occurrence of the allergic component in advanced ages. Asthmatics older than 70 years old had later onset of the disease and a significant longer disease duration. CONCLUSION: Our study highlights that asthmatics older than 70 years old have higher bronchial neutrophilic inflammation, a poorer lung function, signs of air trapping and lower airway variability. The role of immunosenescence inducing chronic low-grade inflammation in this asthma subtype remains to be elucidated.


Asunto(s)
Asma/metabolismo , Volumen Espiratorio Forzado/fisiología , Mediadores de Inflamación/metabolismo , Neutrófilos/metabolismo , Pruebas de Función Respiratoria/métodos , Esputo/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Asma/diagnóstico , Asma/inmunología , Femenino , Humanos , Mediadores de Inflamación/inmunología , Masculino , Persona de Mediana Edad , Neutrófilos/inmunología , Estudios Retrospectivos , Esputo/inmunología
20.
Respir Res ; 22(1): 18, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33451329

RESUMEN

BACKGROUND: Physical inactivity due to cachexia and muscle wasting is well recognized as a sign of poor prognosis in chronic obstructive pulmonary disease (COPD). However, there have been no reports on the relationship between trunk muscle measurements and energy expenditure parameters, such as the total energy expenditure (TEE) and physical activity level (PAL), in COPD. In this study, we investigated the associations of computed tomography (CT)-derived muscle area and density measurements with clinical parameters, including TEE and PAL, in patients with or at risk for COPD, and examined whether these muscle measurements serve as an indicator of TEE and PAL. METHODS: The study population consisted of 36 male patients with (n = 28, stage 1-4) and at risk for (n = 8) COPD aged over 50 years. TEE was measured by the doubly labeled water method, and PAL was calculated as the TEE/basal metabolic rate estimated by the indirect method. The cross-sectional areas and densities of the pectoralis muscles, rectus abdominis muscles, and erector spinae muscles were measured. We evaluated the relationship between these muscle measurements and clinical outcomes, including body composition, lung function, muscle strength, TEE, and PAL. RESULTS: All the muscle areas were significantly associated with TEE, severity of emphysema, and body composition indices such as body mass index, fat-free mass, and trunk muscle mass. All trunk muscle densities were correlated with PAL. The product of the rectus abdominis muscle area and density showed the highest association with TEE (r = 0.732) and PAL (r = 0.578). Several trunk muscle measurements showed significant correlations with maximal inspiratory and expiratory pressures, indicating their roles in respiration. CONCLUSIONS: CT-derived measurements for trunk muscles are helpful in evaluating physical status and function in patients with or at risk for COPD. Particularly, trunk muscle evaluation may be a useful marker reflecting TEE and PAL.


Asunto(s)
Metabolismo Energético/fisiología , Fuerza Muscular/fisiología , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Ejercicio Físico/fisiología , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de Riesgo
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