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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
2.
Medicine (Baltimore) ; 98(47): e18035, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764822

RESUMO

Chronic obstructive pulmonary disease (COPD) patients are at a higher risk of development of lung cancer. Frequent exacerbations of COPD trigger the disease course to chronic inflammation which likely plays a role in the pathogenesis of lung cancer. Previous studies showed influenza virus infection is one of important causes for exacerbations of COPD. Therefore, the aim of this study was to know whether influenza vaccination could reduce the incidence of lung cancer in patients with COPD.This cohort study enrolled patients (≥55 years old) with a recorded diagnosis of COPD between January 1, 2000 and December 31, 2012 by using the Taiwan Health Insurance Database. A propensity score was calculated to reduce vaccine therapy selection bias. Cox proportional hazard regressions were used to investigate the association between the influenza vaccination and lung cancer incidence after adjusting for known confounding factors. Besides, we categorized the patients into 4 groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2-3, ≥4) to evaluate the dose-dependent effect on reducing lung cancer occurrence of lung cancer in COPD patients.Our study comprised of 28,752 eligible individuals from the COPD cohort database. Among them, 51% (14,630) received influenza vaccination; the rest (49%) of the COPD patients did not receive influenza vaccination. We observed that COPD patients receiving influenza vaccination had a lower risk of lung cancer (adjusted HR = 0.40, 95% CI (0.35-0.45), P < .001). We also founded comparable protective effect in both sexes and all age groups (55-64, 65-74, ≥75) regardless of influenza seasonality. Furthermore, dose-dependent protective effect could be seen after stratifying patients according to the total number vaccinations, the adjusted HRs for lung cancer risk were 0.48 (0.40-0.54) and 0.24 (0.20-0.29) for patients who received 2 to 3 and ≥4 vaccinations during the follow-up period.This population-based cohort study demonstrated that annual influenza vaccination administration could reduce incidence of lung cancer in COPD patients.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/complicações , Influenza Humana/prevenção & controle , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Esquemas de Imunização , Incidência , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade
3.
Cas Lek Cesk ; 158(5): 175-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703528

RESUMO

Non-invasive ventilation represents one of the milestones in respiratory and sleep medicine. In this article is presented brief history of non-invasive ventilation and overview of different regimes of non-invasive ventilation used in the treatment of patients with obstructive sleep apnoea and chronic obstructive pulmonary disease.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Pneumologia , Humanos
4.
Rev Med Liege ; 74(11): 566-571, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31729844

RESUMO

Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive pulmonary disease (COPD) patients. The main objective of the study was to reduce the number of hospitalizations for COPD exacerbation. The patients included in the study had been at least hospitalized once in 12 months before the beginning of the telemonitoring. A close collaboration with the general practitioner was required. Patients were educated in the manipulation of the application and connected objects. The numerous technical difficulties encountered limited the number of patients studied within the short time allowed by INAMI. However, some interesting observations could be made and a first experience in the field acquired. A project on a large scale seems necessary.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Telemedicina , Hospitalização , Humanos , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/diagnóstico
5.
Ther Umsch ; 76(6): 301-310, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762413

RESUMO

Development of inhaled therapies for COPD and asthma Abstract. Inhaled therapies still represent one of the most important pillars of the COPD and asthma treatments. In recent years, the importance of inhaled corticosteroids in the treatment of COPD changed again and again and currently it seems that they are gaining more importance again. In the future, inhaled therapies will increasingly focus on biomarkers. New to the market are the "triple therapies as a fixed combination", whose success will be evident in the next few years. Despite the great variety of new agents, new combinations and new inhalation systems, it is important to keep a good overview and to focus on the individual benefit of the patients. The goal is to find the products that are suitable for the individual patient in a dosage form that is ideal for him. A correct inhalation technique and a good medication adherence to the prescribed treatment plan is crucial for the success of an inhaled therapy.


Assuntos
Asma , Broncodilatadores/administração & dosagem , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Feminino , Humanos , Masculino , Adesão à Medicação , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
6.
Ther Umsch ; 76(6): 311-316, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762414

RESUMO

The data situation for the use of ICS in asthma is clear. In the case of COPD, on the other hand, where in recent years the pendulum has moved away from ICS towards a dual therapy based on LABA / LAMA, the discussion is open again thanks to new work. However, it would certainly be wrong to recommend ICS as a meaningful therapy for all COPD patients at this point in time, since therapy with ICS is associated with side effects, in particular an increase in the risk of developing pneumonia or osteoporosis. However, there is no doubt that patients with asthma COPD overlap require ICS therapy.


Assuntos
Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2 , Asma , Broncodilatadores/uso terapêutico , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Asma/tratamento farmacológico , Quimioterapia Combinada , Humanos , Antagonistas Muscarínicos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
7.
Ther Umsch ; 76(6): 323-327, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762415

RESUMO

Pulmonary Rehabilitation Abstract. Pulmonary rehabilitation is a comprehensive therapeutic approach for patients with advanced chronic lung diseases which leads to a decline of dyspnea, an increase of exercise capacity and an increase of quality of life. Further effects are a reduction of frequency of hospitalisations and an increase of physical activity, if a self management education program is integrated. Pulmonary rehabilitation incorporates an individualised training program with focus on endurance, strength and mobility, further a disease specific education with the goal to improve self efficacy and self management of the patients, specially with the goal to improve their daily physical activity. Due to the good evidence of pulmonary rehabilitation, the accredited programs are accepted and paid by the swiss insurances.


Assuntos
Terapia por Exercício , Pneumopatias , Doença Pulmonar Obstrutiva Crônica , Dispneia/etiologia , Dispneia/prevenção & controle , Exercício , Humanos , Pneumopatias/reabilitação , Resistência Física , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Resultado do Tratamento
8.
Ther Umsch ; 76(6): 287-292, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762419

RESUMO

Asthma, COPD or overlap? Symptoms and diagnostic procedures Abstract. Medical history combined with spirometry before and after bronchodilation provides important information, and allows distinguishing between asthma and Chronic obstructive pulmonary disease (COPD) in most of the cases. COPD and asthma are sometimes difficult to discriminate, mainly in older patients with a smoking history and /or history of atopia. Symptoms and the results of diagnostic tests are the basis on which therapeutic decisions are made. Differentiation between asthma and COPD is of great importance because management approaches and goals for these conditions differ. Asthma-COPD-overlap has to be considered if a significant interleave of clinical features of both conditions is identified. If it is not possible to differentiate between the two conditions, ways of additional diagnostic testing are described in this article.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Idoso , Asma/diagnóstico , Diagnóstico Diferencial , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria
9.
Ther Umsch ; 76(6): 328-336, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762420

RESUMO

Advanced emphysema and asthma constitute major health burden worldwide and are associated with significant morbidity and mortality. Pharmacological options are limited. Researches are being carried out aiming to modify the natural course of both the diseases. Lung volume reduction surgeries are performed in advanced emphysema but are associated with significant morbidity and prolonged hospital stay. Various minimally invasive bronchoscopic methods have been developed with the goal of achieving clinical benefits of volume reduction surgery but lower complications. Bronchial thermoplasty is a bronchoscopic method of delivering controlled heat in the airways to reduce airway smooth muscle mass, thereby reducing bronchoconstriction in patients with severe asthma who remain uncontrolled despite optimal medical therapy. Various randomised controlled trials have been performed to evaluate the safety and efficacy of various endoscopic treatments like valves, coils, use of sclerosants and targeted lung denervation for severe emphysema and bronchial thermoplasty in severe asthma. The current review summaries the clinical trial evidence available for lung volume reduction in emphysema and thermoplasty in asthma and provide guidance for optimal patient selection for various therapies available.


Assuntos
Asma , Broncoscopia/métodos , Doença Pulmonar Obstrutiva Crônica , Asma/cirurgia , Brônquios/cirurgia , Humanos , Músculo Liso , Doença Pulmonar Obstrutiva Crônica/cirurgia
10.
J Surg Oncol ; 120(8): 1371-1378, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31696512

RESUMO

BACKGROUND: Postoperative complications after gastric cancer resection vary in different series and they might have a significant impact in long-term outcomes. Our aim was to build a prediction rule on gastric cancer patients' overall and major morbidity risks. METHODS: This retrospective study included 1223 patients from a single center who were resected between 1992 and 2016. Overall and major morbidity predictors were identified through multiple logistic regression. Models' performances were assessed through discrimination, calibration, and cross-validation, and nomograms were constructed. RESULTS: The mean age was 61.3-year old and the male gender was more frequent (60%). The most common comorbidities were hypertension (HTN), diabetes, and chronic obstructive pulmonary disease (COPD). A D2-distal gastrectomy was the most frequent procedure and 87% of all lesions were located in the middle or distal third. Age, COPD, coronary heart disease, chronic liver disease, pancreatic resection, and operative time were independent predictors of overall and major morbidity. The extent of resection and splenectomy was associated with overall events and HTN with major ones. Both models were very effective in predicting events among patients at higher risk. CONCLUSIONS: The overall and major morbidity models and nomograms included clinical- and surgical-related data that were very effective in predicting events, especially for high-risk patients.


Assuntos
Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Doença das Coronárias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pâncreas/cirurgia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Esplenectomia , Neoplasias Gástricas/epidemiologia
11.
FP Essent ; 486: 26-32, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710455

RESUMO

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease characterized by cough, dyspnea, and sputum production caused by inhalation of harmful chemicals, such as tobacco smoke. COPD should be suspected in patients with a significant smoking history, shortness of breath, and sputum production. The diagnosis is made by spirometry. A forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) ratio of less than 0.7 after bronchodilator administration confirms the diagnosis. Therapy for patients with stable COPD should include a bronchodilator, either a long-acting beta2-agonist (LABA) or a long-acting muscarinic antagonist (LAMA). For patients who continue to experience dyspnea with a single bronchodilator, dual therapy with a LABA and LAMA is appropriate. For patients with continued exacerbations, inhaled corticosteroids can be added to LABA-LAMA therapy. Acute exacerbations are characterized by a worsening of symptoms that requires additional therapy. Short-acting beta2-agonists with or without short-acting muscarinic antagonists are the basic therapy for acute exacerbations of COPD. Systemic glucocorticoids have been shown to shorten exacerbations and improve lung function. Antibiotics have been shown to reduce rates of treatment failure and sputum purulence. Noninvasive mechanical ventilation is preferred for patients with respiratory failure.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2 , Broncodilatadores , Antagonistas Muscarínicos , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Broncodilatadores/uso terapêutico , Volume Expiratório Forçado , Humanos , Antagonistas Muscarínicos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
14.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 35(4): 293-296, 2019 Jul 28.
Artigo em Chinês | MEDLINE | ID: mdl-31701708

RESUMO

OBJECTIVE: To investigate the effects of vitamin E on the respiratory function impairment in rats with chronic obstructive pulmonary disease (COPD) after exposed to high temperature and PM2.5. METHODS: Fifty-four 7-week-old SPF male Wistar rats were randomly divided into 9 experimental groups (n=6). The rat COPD model was established by lipopolysaccharide (LPS) and smoke exposure. After modeled, the rats were tracheal instilled with PM2.5 (0 mg/ml, 3.2 mg/ml) and intraperitoneally injected with vitamin E at the dose of 40 mg/kg (20 mg/ml). Part of rats (high temperature groups) were then exposed to high temperature (40℃), once (8 h) a day for three consecutive days. After the last exposure, the lung function of rats was detected. The expression levels of inducible nitric oxide synthase (iNOS), tumor necrosis factor-α (TNF-α) and monocyte chemotactic protein-1 (MCP-1) were detected by corresponding ELISA kits. RESULTS: Compared with the control group, exposure of high temperature and PM2.5 could inhibit the lung function of COPD rats significantly (P<0.05); the level of MCP-1 was increased significantly in PM2.5-exposure groups (P<0.05); iNOS was increased significantly in the groups of high temperature (P<0.05). Compared with the single-PM2.5 exposure groups, TNF-α in lung was decreased in the normal temperature health group and high temperature COPD group (P<0.05) after treated with vitamin E; MCP-1 was decreased in all vitamin E-treated groups (P<0.05); the decreased iNOS only appeared in the group of high temperature with vitamin E treatment. CONCLUSION: High temperature and PM2.5 could aggravate the inflammation of COPD rats. As an antioxidant, vitamin E may protect the lung from the damage effects.


Assuntos
Temperatura Alta/efeitos adversos , Material Particulado/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Vitamina E/farmacologia , Animais , Quimiocina CCL2/metabolismo , Pulmão/fisiopatologia , Masculino , Óxido Nítrico Sintase Tipo II/metabolismo , Distribuição Aleatória , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/metabolismo
15.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 826-831, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694092

RESUMO

Objectives: Long-term use of inhaled corticosteroids (ICS) was reported as a risk factor for patients with chronic obstructive pulmonary disease (COPD) complicated with nontuberculous mycobacterial lung disease (NTM-LD). But it was not reported often in China. Methods: We conducted a retrospective analysis of patients who were diagnosed with COPD and NTM-LD in our department from January 1(st) 2017 to December 31(th) 2018. Results: This study consisted of 10 male and 5 female patients with a mean age of (66±7) years. The detailed clinical data and radiological images were reviewed systemically. There were 4 current smokers (26.7%) and 6 past smokers (40%). All cases were current ICS users, with a mean duration of (27.3±9.7) months, ranging from 3 months to 61 months. Among them, 8 cases (53.3%) used inhaled fluticasone and 7 cases (46.7%) used inhaled budesonide. Aggravated coughing (15 cases, 100%), expectoration (15 cases, 100%) and dyspnea (10 cases, 66.7%) were the common clinical manifestations, although fever was only reported in 4 cases (26.7%). All cases showed normal white blood cell count and lymphocyte count, and some of them (7 cases, 46.7%) showed elevated erythrocyte sedimentation rate and C-reactive protein. Most of them (14 cases, 93.3%) had normal TB-SPOT results. Multiple focal bronchiectasis (9 cases, 60%) and significant emphysema (12 cases, 80%) were the common manifestations of basic high-resolution CT (HRCT) prior NTM infection. The occurrence of bronchiectasis (15 cases, 100%), "tree in bud" sign (12 cases, 80%) and tiny cavities (8 cases, 53.3%) were the common HRCT abnormalities for the NTM-LD cases. According to the 2007's NTM-LD diagnosis criteria, most of them (13 cases, 86.7%) were diagnosed with positive sputum samples at least twice, and 2 cases were diagnosed with positive CT-directed bronchial alveolar lavage fluid. NTM-PCR analysis was performed routinely for the isolated NTM samples to identify the NTM species. Mycobacterium avium complex (MAC) was the most common NTM species (8 cases, 53.3%). After treatment with proposed anti-NTM strategies, most cases improved (9 cases, 60%), and some of them (4 cases, 26.7%) were cured and a few cases (2 cases, 13.3%) relapsed. Conclusions: When COPD patients treated with ICS showed aggravated cough, expectation and/or dyspnea, and new occurrence of bronchiectasis and/or "tree in bud" sign in the recent HRCT, the differential diagnosis of NTM-LD should be considered. Respiratory samples should be arranged for NTM cultures and PCR analysis as soon as possible. Earlier antimicrobial strategies according to the identified NTM species would improve the clinical outcomes.


Assuntos
Glucocorticoides/administração & dosagem , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Fármacos do Sistema Respiratório/administração & dosagem , Administração por Inalação , Idoso , China/epidemiologia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Sistema Respiratório/microbiologia , Sistema Respiratório/fisiopatologia , Fármacos do Sistema Respiratório/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
16.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 832-837, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694093

RESUMO

Objective: To compare clinical characteristics between patients with chronic obstructive pulmonary disease (COPD) and COPD -OSA overlap, and to analyze the risk factors for OSA in patients with COPD. Methods: A total of 431 patients with COPD were divided into a COPD-OSA group with AHI>15 events/h or a COPD group with AHI ≤ 15 events/h according to the results of polysomnography, and their clinical characteristics were summarized. Risk factors for OSA overlap in COPD patients were identified by univariate and multivariate logistic regression analyses. Results: There were no significant differences in gender composition, dyspnea scale (mMRC) score, the numbers of acute exacerbations and hospitalizations in the last year, prevalence of coronary heart disease, or cor pulmonale or diabetes mellitus in the two groups (all P>0.05). Age, BMI, neck circumference, smoking index, COPD assessment test (CAT) score, the values of FEV(1) or FEV(1)%, FEV(1)/FVC ratios, and the prevalence of hypertension in the COPD-OSA group with AHI>15 events/h were significantly higher than in the COPD group with AHI ≤15 events/h, while the duration of COPD and the proportion of severe COPD were lower than the COPD group with AHI≤ 15 (P<0.05). The scores of Charlson Comorbidity Index, Epworth Sleepiness Scale (ESS) and Sleep Apnea Clinical Score (SACS) in the COPD-OSA group were significantly higher than in the COPD group with AHI≤ 15, with all P values<0.05. Risk factors for AHI>15 OSA coinciding in patients with COPD included BMI, neck circumference, ESS, SACS and CAT (P<0.05). Furthermore, BMI, ESS and CAT were independent risk factors for OSA in COPD patients (P<0.05). Compared with mild or moderate COPD cases, patients with severe COPD (FEV(1)%<50%) had a lower risk of having OSA (ß=-0.459, OR=0.632, 95% CI 0.401-0.997, P=0.048). Conclusions: Compared to COPD patients with AHI ≤ 15 events/h, OSA-COPD overlap patients (AHI>15 events/h) had a worse quality of life, more daytime sleepiness and higher prevalence of hypertension. BMI, ESS and CAT were independent risk factors for AHI>15 OSA in patients with COPD. The risk of having OSA in severe COPD patients was lower than cases with mild or moderate COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Apneia Obstrutiva do Sono/epidemiologia , Comorbidade , Humanos , Hipertensão/epidemiologia , Polissonografia , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/psicologia , Sonolência
17.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 838-844, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694094

RESUMO

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 µg, and 127 received tiotropium 5 µg and 95 received olodaterol 5 µg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 µg, tiotropium 5 µg and olodaterol 5 µg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 µg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 µg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.


Assuntos
Benzoxazinas/administração & dosagem , Broncodilatadores/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Qualidade de Vida , Brometo de Tiotrópio/administração & dosagem , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Benzoxazinas/uso terapêutico , Broncodilatadores/uso terapêutico , China/epidemiologia , Método Duplo-Cego , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/etnologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Brometo de Tiotrópio/uso terapêutico , Resultado do Tratamento
18.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(10): 764-767, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31726508

RESUMO

Objective: To clarify the association between occupational exposure to wood dust and chronic obstructive pulmonary disease risk by a meta-analysis. Methods: A systematic search of the studies was conducted using 3 English databases (Pubmed, Embase, and Cochrane library) and 3 Chinese databases (CNKI, WanFang, and VIP) before March 2019. The following key words was used: 1) wood, 2) hardwood, 3) softwood, 4) saw, 5) dust, 6) chronic obstructive pulmonary disease, 7) chronic obstructive airway disease, 8) lung function. A quality score was evaluated by Newcastle-Ottawa Scale, NOS (Wells, 2012). Pooled effect value with 95% confidence interval (CI) was calculated using fixed-effect model (Heterogeneity test I(2)<25%) or random-effect model (Heterogeneity test I(2)≥25%). Meta-regression was used to explore heterogeneous source. Sensitivity analysis was used to verify the stability of the results. Publication bias was assessed by Egger's test. Fill and trim method was used to correct the pool effect value with 95%CI for studies which wit publication bias. The TSA threshold was calculated by the O'Brien-Fleming loss function in the TSA data. The studies were evaluated based on the accrued information size (AIS) . Results: A total of 9 studies were included in the analysis. The occupational exposure to wood dust was not significantly associated with increased chronic obstructive pulmonary disease risk (ES=1.01, 95%CI: 0.856-1.194). TSA showed that the cumulative Z-value curve neither gone beyond the traditional (Z=1.96) threshold line, nor exceed the TSA threshold, but has reached the expected amount of information. This result was consistent with the meta-analysis. Conclusion: This study does not yet consider that COPD is associated with occupational wood dust exposure.


Assuntos
Poeira , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Madeira , Humanos , Fatores de Risco
19.
Rev Med Suisse ; 15(671): 2082-2086, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742938

RESUMO

Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of chronic respiratory diseases which phenotyping is less codified as for asthma yet as essential. The phenotype helps to better understand the evolution of the disease, punctuated by exacerbations and favors a better targeting for treatments and clinical work-up. The latest studies, mostly based on the ECLIPSE and SPIROMICS cohorts, highlight the importance of the search for eosinophilia and the complete assessment of cardiovascular comorbidities. This article will discuss the role of lung function, exacerbations, biomarkers, and comorbidities in COPD phenotyping.


Assuntos
Fenótipo , Doença Pulmonar Obstrutiva Crônica , Biomarcadores/análise , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
20.
Rev Med Suisse ; 15(671): 2087-2089, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742939

RESUMO

Overlap syndrome (OVS) is defined by the co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a same patient. This condition is associated with increased mortality and a higher risk of respiratory exacerbation, compared to patients with COPD or OSA alone. Nocturnal positive PAP treatment is effective to mitigate the additional risk related to OSA. Identification of OVS is a major challenge for clinicians because of the many phenotypes of OVS patients, with atypical OSA presentation, whose sleep quality is already impacted by COPD itself. Dedicated prospective studies are mandatory to improve our understanding of OVS patients and to optimize their medical care.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Apneia Obstrutiva do Sono/complicações , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Apneia Obstrutiva do Sono/terapia
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