Assuntos
Anormalidades Múltiplas/diagnóstico , Aorta Torácica/anormalidades , Asma/diagnóstico , Erros de Diagnóstico , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Tomografia Computadorizada por Raios X , Estenose Traqueal/etiologia , Veia Cava Superior/anormalidades , Adolescente , Antiasmáticos/uso terapêutico , Aortografia , Asma/tratamento farmacológico , Bronquite/etiologia , Broncoscopia , Transtornos de Deglutição/etiologia , Diagnóstico Tardio , Resistência a Medicamentos , Dispneia/etiologia , Feminino , Humanos , Imageamento Tridimensional , Recidiva , Rinite Alérgica Sazonal/complicações , Rinite Alérgica Sazonal/diagnóstico , Traqueomalácia/etiologiaRESUMO
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is underdiagnosed because of limited disease awareness with trivialization of the symptoms in the general population. METHODS: A survey was conducted in a representative sample (n=2758) of individuals older than 40 years of age in the general population of France. Respiratory symptoms and knowledge about COPD were assessed in individuals with or at risk for COPD (n=860, 31% of the sample). RESULTS: In the overall sample, 40% of individuals had a Medical Research Council dyspnea grade of 1 or more but only 9% spontaneously reported shortness of breath. Of these 9%, 72% reported limitations to their daily activities but only 14% believed they had severe lung disease. In the overall sample, only 220 (8%) individuals knew the term COPD and only 66% associated the term COPD with respiratory disease. CONCLUSIONS: Despite a large proportion of individuals at risk for COPD or having COPD and a high prevalence of breathlessness, awareness of respiratory symptoms and knowledge of COPD were limited. These findings indicate a need for educating the general population about COPD.
Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Dispneia/epidemiologia , Feminino , França/epidemiologia , Comportamentos Relacionados com a Saúde , Educação em Saúde , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Conhecimento , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/psicologia , Risco , Estudos de Amostragem , Fumar/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Populações VulneráveisRESUMO
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
Assuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Adulto , Bronquiectasia/tratamento farmacológico , Gerenciamento Clínico , Medicina Baseada em Evidências , Humanos , Pneumonia/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológicoRESUMO
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
Assuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Adulto , Bronquiectasia/tratamento farmacológico , Gerenciamento Clínico , Medicina Baseada em Evidências , Humanos , Pneumonia/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológicoRESUMO
Exacerbations of COPD are common and cause a considerable burden to the patient and the healthcare system. To optimize the hospital care of patients with exacerbations of COPD, clinicians should be aware of some key points: management of exacerbations is broadly based on clinical features and severity. Initial clinical evaluation is crucial to define those patients requiring hospital admission and those who could be managed as outpatients. In hospitalized patients, the appropriate level of care should be determined by the initial severity and response to initial medical treatment. Medical treatment should follow recent recommendations, including rest, titrated oxygen therapy, inhaled or nebulized short-acting bronchodilators (Beta2-agonists and anticholinergic agents), DVT prevention with LMWH, steroids in most severely ill patients, unless there are contraindications and antibiotics in the case of a clear bacterial infectious aetiology. Severe exacerbations may lead to acute hypercapnic respiratory failure. Unless contraindicated, non-invasive ventilation (NIV) should be the first line ventilatory support for these patients. NIV should be commenced early, before severe acidosis ensues, to avoid the need for endotracheal intubation and to reduce mortality and treatment failures. Several randomised controlled clinical trials support the use of NIV in the management of acute exacerbations of COPD, demonstrating a decreased need for mechanical ventilation and an improved survival. In most severe cases, NIV should be provided in ICU. Although it has been shown that for less severe patients (with pH values>7.30), NIV can be administered safely and effectively on general medical wards, a lead respiratory consultant and trained nurses are mandatory. Mechanical ventilation through an endotracheal tube should be considered when patients have contraindications to the use of NIV or fail to improve on NIV. The duration of mechanical ventilation should be shortened as much as possible by an early weaning process, including preventive post-extubation NIV in hypercapnic patients. hospital stay could be shortened by non-invasive treatments. Future exacerbations should be avoided by respiratory specialist management of the patients, including education, optimization of long-term medical treatment, vaccinations, nutritional support, and pulmonary rehabilitation.
Assuntos
Administração dos Cuidados ao Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Aguda , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Broncodilatadores/uso terapêutico , Terapia Combinada , Diuréticos/uso terapêutico , Hospitalização , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Apoio Nutricional , Oxigenoterapia , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Radiografia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração ArtificialRESUMO
Tobacco smoking is the leading cause of COPD worldwide but other risk factors have been recognized. Air pollution is one of them, but its exact role in the development of COPD is hard to demonstrate. Its physiological effects on lung function have only been studied since the nineties by long and tedious cohort studies. Difficulties arise from the heterogeneity of air pollution (gas and particles); thus, its respiratory effects have to be examined for every component separately, and in different populations. It is also necessary to analyse the effects of atmospheric pollution in the short and the long term, considering both its physiological, clinical and toxicological effects, from childhood to adulthood. These factors make it difficult to obtain statistically significant results. Nevertheless, most studies seem to point to a role of air pollution in the development of COPD via oxydative stress but further studies are needed to confirm the exact effect of each component of air pollution on the respiratory tract. These studies could lead to improved public health policies and results are awaited that would identify at-risk populations, decide appropriate preventive measures and propose documented thresholds in pollution exposure... thereby limiting the spread of COPD.
Assuntos
Poluição do Ar/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/etiologia , Poluentes Atmosféricos/efeitos adversos , Estudos de Coortes , Exposição Ambiental , Estudos Epidemiológicos , Gases/efeitos adversos , Humanos , Estudos Longitudinais , Compostos Orgânicos/efeitos adversos , Estresse Oxidativo/fisiologia , Material Particulado/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de RiscoRESUMO
We report the case of a 61-year old man in whom a deep venous thrombosis was the presenting feature of disseminated lung carcinoma. A few days later, an arterial thrombosis occurred necessitating amputation. Within a few weeks, the lung cancer progressed dramatically and the patient died. While the association between venous thrombosis and cancer is well known, the relationship between cancer and arterial thrombosis has been less explored. This observation allows discussion of the pathophysiological and clinical aspects of this association, as well as the implications for patient care.
Assuntos
Carcinoma de Células Grandes/complicações , Artéria Femoral , Veia Femoral , Artéria Ilíaca , Neoplasias Pulmonares/complicações , Trombofilia/complicações , Trombose/etiologia , Trombose Venosa/etiologia , Amputação Cirúrgica , Angiografia , Biópsia , Carcinoma de Células Grandes/diagnóstico por imagem , Carcinoma de Células Grandes/patologia , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia , Radiografia Torácica , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A 60 year old male patient was admitted to hospital with pulmonary and cerebral abscesses. A percutaneous lung biopsy under CT scanning showed actinomycosis. After 4 weeks antibiotic therapy with ceftriaxone and metronidazole there was an improvement in the pulmonary lesion but new cerebral lesions appeared. A neurosurgical cerebral biopsy showed evidence of metastatic squamous carcinoma, probably of pulmonary origin. The diagnosis had been delayed by the presence of the actinomycosis. His general condition did not permit anti-tumour treatment and the patient soon afterwards. In the presence of pulmonary actinomycosis an associated malignancy should be excluded.
Assuntos
Actinomicose/complicações , Abscesso Encefálico/complicações , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/secundário , Abscesso Pulmonar/complicações , Neoplasias Pulmonares/complicações , Actinomicose/patologia , Biópsia , Encéfalo/patologia , Abscesso Encefálico/patologia , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Humanos , Pulmão/patologia , Abscesso Pulmonar/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is markedly under-diagnosed, which may relate to under-reporting of symptoms and poor awareness of the disease. METHODS: A survey was conducted in a sample of the French general population aged 40-75 years (n=2758) to assess respiratory symptoms and level of knowledge of the disease in subjects with or at-risk of COPD (n=860, 31%). RESULTS: The high frequency of dyspnoea (MRC dyspnoea grade > or =1: 40%) contrasted with that of subjects spontaneously reporting respiratory problems (9%). Among these, 72% reported limitations in daily-life activities but only 14% considered that they were severely affected by their respiratory status. A very low proportion of subjects knew the term COPD (8%) and only 66% of these associated COPD with a respiratory disease. CONCLUSIONS: There is a wide gap between the high number of subjects at risk of COPD in the general population and the frequency of breathlessness in these subjects on one hand, and the poor knowledge of the disease, poor perception of symptoms, and under-diagnosis and under-use of spirometry on the other. Increasing awareness of COPD in the population is needed.
Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Idoso , Tosse/etiologia , Dispneia/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Fumar/efeitos adversos , Espirometria , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Lung deposition is crucial for asthma treatment. However, there is no study comparing the potential role of lung co-deposition of combination therapy (inhaled corticosteroid and long-acting beta2 agonist) in the same inhaler. In moderate to severe asthmatics, an extra-fine hydrofluoroalkane combination of beclomethasone dipropionate and formoterol given via a single pressurised metered-dose inhaler (pMDI) was compared with beclomethasone dipropionate chlorofluorocarbon (CFC) pMDI and formoterol dry powder inhaler (DPI) given via separate inhalers. METHODS: In a double-blind, double-dummy, 24-week randomised clinical trial, 645 patients with moderate to severe asthma uncontrolled by regular treatment with inhaled corticosteroids received regular treatment with extra-fine fixed combination beclomethasone dipropionate 200 microg/formoterol 12 microg bid, or beclomethasone dipropionate (500 microg bid) via CFC pMDI and formoterol (12 microg bid) via DPI, or beclomethasone dipropionate (500 microg bid) via CFC pMDI. The primary outcome was morning peak expiratory flow (PEF). Secondary outcomes included lung function measured at clinic, asthma symptoms and control, exacerbations. RESULTS: Beclomethasone dipropionate/formoterol combination via single inhaler or via separate inhalers improved morning PEF. However, the combination via single inhaler was more effective than given via separate inhalers for asthma control. Both combination treatments were superior to beclomethasone dipropionate alone in improving lung function and asthma control. All treatments were well tolerated. INTERPRETATION: In patients with moderate to severe asthma, beclomethasone dipropionate/formoterol in a single inhaler was as effective as beclomethasone dipropionate plus formoterol and superior to beclomethasone dipropionate alone in improving lung function. For the first time with a single inhaler, beclomethasone dipropionate/formoterol was significantly superior to separate components for asthma control.
Assuntos
Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Beclometasona/administração & dosagem , Etanolaminas/administração & dosagem , Administração por Inalação , Adulto , Albuterol/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/sangue , Asma/fisiopatologia , Beclometasona/uso terapêutico , Broncodilatadores/uso terapêutico , Método Duplo-Cego , Esquema de Medicação , Combinação de Medicamentos , Etanolaminas/uso terapêutico , Feminino , Fumarato de Formoterol , Humanos , Hidrocortisona/sangue , Masculino , Inaladores Dosimetrados , Pessoa de Meia-Idade , Pico do Fluxo Expiratório/efeitos dos fármacos , Resultado do TratamentoAssuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Estudos de Coortes , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Fumar/efeitos adversos , Abandono do Hábito de Fumar , EspirometriaRESUMO
In patients with hematological malignancy (HM) developing acute respiratory failure (ARF) bronchoalveolar lavage (BAL) is considered as a major diagnostic tool. However, the benefit/risk ratio of this invasive procedure is probably lower in the subset of patients with acute myeloid leukemia (AML). The study was to analyze the yield of BAL performed in HM patients (n=175) with AML or lymphoid malignancies (LM) admitted in intensive care unit (ICU) for ARF and pulmonary infiltrates. BAL was performed in 121 patients (53/73 AML patients (73%) and 68/102 LM patients (67%)) without a definite diagnosis at admission or contraindication for fiberoptic bronchoscopy. Life-threatening complications were noticed in 12/121 patients (10%). The overall diagnostic yield of BAL was 47% (25/53) in AML patients and 50% (34/68) in LM patients. A microorganism was recovered from BAL in 23% (12/53) of AML patients and 41% (28/68) of LM patients (P<0.005). BAL results induced significant therapeutic changes in 17% (9/53) of AML patients vs 35% (24/68) of LM patients (P=0.039). This study underlines the rather low diagnostic yield of BAL for infectious diagnosis and the low rate of therapeutic changes induced by its results in AML patients with ARF admitted in ICU.
Assuntos
Lavagem Broncoalveolar/métodos , Unidades de Terapia Intensiva , Leucemia Mieloide Aguda/complicações , Pneumonia/diagnóstico , Insuficiência Respiratória/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lavagem Broncoalveolar/efeitos adversos , Broncoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Respiratória/mortalidadeRESUMO
Data on the individual and collective impact of chronic airflow obstruction at a population level are scarce. In a nationwide survey, dyspnoea, quality of life and missed working days were compared between subjects with and without spirometrically diagnosed chronic airflow obstruction. Subjects aged > or =45 yrs were recruited in French health prevention centres (n = 5,008). Results of pre-bronchodilator spirometry and questionnaires (European Community Respiratory Health Survey-derived questionnaire and European quality of life five-dimension questionnaire) were collected. Adequate datasets were available for 4,764 subjects aged 60+/-10 yrs (only 2% were aged > or =80 yrs). The prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity of <0.70) was 7.5%. The vast majority (93.9%) of cases had not been diagnosed previously. Health status was significantly influenced by dyspnoea. Both were associated with the number of missed working days. Despite mild-to-moderate severity, subjects with chronic airflow obstruction exhibited more dyspnoea, poorer quality of life and higher numbers of missed working days (mean 6.71 versus 1.45 days.patient(-1).yr(-1) in patients without airflow obstruction, for the population with no known heart or lung disease). In conclusion, even mild-to-moderate airflow obstruction is associated with an impaired health status, which represents an additional argument in favour of early detection in chronic obstructive pulmonary disease.
Assuntos
Dispneia/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Qualidade de Vida , Licença Médica , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dispneia/epidemiologia , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , EspirometriaRESUMO
BACKGROUND: Whether sputum microbiological examination should be performed systematically in hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations remains unclear. OBJECTIVES: To assess the yield of sputum microbiological examination in COPD patients hospitalized in a medical ward for an acute exacerbation with purulent sputum. METHODS: Two hundred consecutive exacerbations in 118 patients were studied. Patients underwent sputum microbiological examination on admission and baseline lung function tests and CT scans were recorded. Factors associated with positive culture were analyzed. RESULTS: Sputum culture was positive (>or=10(7) CFU/ml) in 59% of samples, Haemophilus influenzae and Streptococcus pneumoniae being the most frequent pathogens. Factors associated with positive culture were bronchiectasis, long-term oxygen therapy and low FEV1. Pseudomonas spp. were found in 8.5% of all patients, who all had a FEV1<50% of predicted and were older. Only 25% of sputum samples satisfied all quality criteria. Sputum culture was positive in a high proportion of these samples (80.5%), but also in one half of samples with >25 leukocytes but >10 epithelial cells per field. Microbiological results induced a change in antibiotic therapy in 43.9% of cases with both quality criteria but also in 25.2% of cases with only one quality criterion. Finally, a predominant aspect after Gram stain was found in all positive samples. CONCLUSIONS: These data suggest that sputum microbiological examination with direct examination and leukocyte count should be performed routinely in patients hospitalized for COPD exacerbations with purulent sputum, especially when FEV1 is less than 50% predicted and in patients with bronchiectasis.
Assuntos
Infecções por Haemophilus/complicações , Haemophilus influenzae/isolamento & purificação , Pacientes Internados , Infecções Pneumocócicas/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Escarro/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Idoso , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Infecções por Haemophilus/microbiologia , Humanos , Contagem de Leucócitos , Masculino , Infecções Pneumocócicas/microbiologia , Prognóstico , Estudos Prospectivos , Pseudomonas/isolamento & purificação , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Supuração/complicações , Supuração/microbiologia , Supuração/patologiaRESUMO
The follow-up of Community Acquired Pneumonias (CAP) and Acute Exacerbations of Chronic Obstructive Pulmonary Diseases (AECOPD) differs with the setting of care, but overall calls upon the same investigations as the initial evaluations. In the event of initial ambulatory care, the evaluation is carried out primarily on clinical data, at the 2 or 3rd day for the CAP, at the 2nd to 5th day for the AECOPD. In the event of unfavourable evolution, or from the start in the most severe cases, the follow-up is carried out in hospital; clinical evaluation is readily daily, and all the more frequent that the clinical condition is worrying because of the severity or risk factors. The investigations will be limited to those initially abnormal in the event of favourable evolution; on the contrary, unfavourable evolution can justify new investigations which depend on clinical characteristics. Remotely, i.e. 4 to 8 weeks later, must be checked the return at the baseline clinical state, a chest X-ray (CAP), spirometry and arterial blood gas (AECOPD), even bronchoscopy and thoracic CT-scan.
Assuntos
Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/terapia , Pneumonia/complicações , Pneumonia/terapia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Aguda , Infecções Comunitárias Adquiridas/fisiopatologia , Seguimentos , Humanos , Pneumonia/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Resultado do TratamentoAssuntos
Doença Pulmonar Obstrutiva Crônica , Educação Médica , Estudos Epidemiológicos , França/epidemiologia , Educação em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Participação do Paciente , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade da Assistência à Saúde , Projetos de Pesquisa , Fatores de Risco , Prevenção do Hábito de FumarRESUMO
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, which results in the progressive development of dyspnea and exercise limitation. OBJECTIVE AND METHODS: To compare the effect of tiotropium with placebo on forced vital capacity (FVC) in patients with moderate-to-severe COPD and lung hyperinflation, using exercise endurance, dyspnea and health-related quality of life (HRQoL) as secondary endpoints. One hundred patients were randomized to receive either tiotropium 18 mug once daily or placebo for 12 weeks. RESULTS: Trough (predose) FVC was significantly improved with tiotropium compared to placebo on day 42 (0.27 +/- 0.08 liters) and 84 (0.20 +/- 0.08 liters; p < 0.05 for both). Trough inspiratory capacity (IC) was also significantly improved with tiotropium compared to placebo on day 42 (0.16 +/- 0.07 liters) and 84 (0.15 +/- 0.07 liters; p < 0.05 for both). Tiotropium increased the mean distance walked during the shuttle walking test by 33 +/- 12 (day 42) and 36 +/- 14 m (day 84) compared to placebo (p < 0.05 for both). On day 84, 59% of the patients in the tiotropium group and 35% of the patients in the placebo group had significant and clinically meaningful improvements in the St. George's Respiratory Questionnaire total score (p < 0.05). Numerical decreases in the focal score in the Transition Dyspnea Index in patients receiving tiotropium versus placebo suggest that tiotropium also improved dyspnea during activities of daily living. CONCLUSION: Tiotropium 18 mug once daily reduced hyperinflation with consequent improvements in walking distance and HRQoL in patients with COPD and lung hyperinflation.
Assuntos
Broncodilatadores/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Derivados da Escopolamina/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , França , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Placebos , Pletismografia , Brometo de TiotrópioAssuntos
Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Adulto , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Quimioterapia Combinada , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Inflamação/complicações , Doença Pulmonar Obstrutiva Crônica/etiologia , Infecções Respiratórias/complicações , Prevenção Secundária , Administração por Inalação , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Broncodilatadores/uso terapêutico , Expectorantes/uso terapêutico , Humanos , Hidroxicorticosteroides/administração & dosagem , Fatores Imunológicos/uso terapêutico , Inflamação/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Infecções Respiratórias/tratamento farmacológicoRESUMO
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major health problem. Few data about COPD economic burden are available. METHODS: SCOPE was an observational economical retrospective and prospective study conducted in France in 2001, by 114 general practitioners (GPs) and 57 lung specialists. The aim was to describe the burden of COPD patients and to estimate the annual cost according to severity stages. Health resource utilization was collected by questionnaires over a 12-month period for 285 patients. RESULTS: It was a cost-of-illness analysis. COPD patients followed by a lung specialist were more severe than patients followed by a GP and had a higher level of medical resource consumption. The COPD disease and its complications explained 66% of the total cost. The main cost drivers were inpatient care (35%, or 1509,9 euros/year/patient) and prescription medications (31%, or 1340,6 euros/year/patient). The direct total cost varied according to COPD severity on account of inpatient care and respiratory assistance. DISCUSSION: This study confirmed the economic burden of COPD in France. Actions allowed to slow down the disease's evolution and to anticipate the exacerbation could reduce the cost.