Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.989
Filtrar
2.
Ital J Pediatr ; 46(1): 143, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023602

RESUMO

The Veneto region is one of the most affected Italian regions by COVID-19. Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), may constitute a risk factor in COVID-19. Moreover, respiratory viruses were generally associated with severe pulmonary impairment in cystic fibrosis (CF). We would have therefore expected numerous cases of severe COVID-19 among the CF population. Surprisingly, we found that CF patients were significantly protected against infection by SARS-CoV-2. We discussed this aspect formulating some reasonable theories.


Assuntos
Infecções por Coronavirus/epidemiologia , Fibrose Cística/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Técnicas de Laboratório Clínico/métodos , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Fibrose Cística/diagnóstico , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Valores de Referência , Estudos Retrospectivos , Medição de Risco
3.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028570

RESUMO

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Assuntos
Infecções por Coronavirus , Falência Renal Crônica , Pandemias , Diálise Peritoneal/métodos , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Diálise Renal/métodos , Idoso , Antibacterianos/administração & dosagem , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Unidades Hospitalares de Hemodiálise , Humanos , Controle de Infecções/métodos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Exacerbação dos Sintomas
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4114-4117, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018903

RESUMO

Assessment of pulmonary function is vital for early detection of chronic diseases such as chronic obstructive pulmonary disease (COPD) in home healthcare. However, monitoring of pulmonary function is often omitted owing to the heavy burden that the use of specific medical devices places on the patients. In this study, we developed a non-contact spirometer using a time-of-flight sensor that measures very small displacements caused by chest wall motion during breathing. However, this sensor occasionally failed when estimating the values from breathing waveforms because their shape depends on the subject test experience. As a result, further measurements were required to address motion artifacts. To accomplish high accuracy estimation in the face of these factors, we developed methods to estimate parameters from a part of the waveform and remove outliers from multiple-region measurements. According to laboratory experiments, the proposed system achieved an absolute error of 5.26 % and a correlation coefficient of 0.88. This study also addressed the limitations of depth sensor measurements, thereby contributing to the implementation of high-accuracy COPD screening.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Respiração , Artefatos , Humanos , Movimento (Física) , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria
5.
Ther Adv Respir Dis ; 14: 1753466620951053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32873175

RESUMO

Infection with novel SARS-CoV-2 carries significant morbidity and mortality in patients with pulmonary compromise, such as lung cancer, autoimmune disease, and pneumonia. For early stages of mild to moderate disease, care is entirely supportive.Antiviral drugs such as remdesivir may be of some benefit but are reserved for severe cases given limited availability and potential toxicity. Repurposing of safer, established medications that may have antiviral activity is a possible approach for treatment of earlier-stage disease. Tetracycline and its derivatives (e.g. doxycycline and minocycline) are nontraditional antibiotics with a well-established safety profile, potential efficacy against viral pathogens such as dengue fever and chikungunya, and may regulate pathways important in initial infection, replication, and systemic response to SARS-CoV-2. We present a series of four high-risk, symptomatic, COVID-19+ patients, with known pulmonary disease, treated with doxycycline with subsequent rapid clinical improvement. No safety issues were noted with use of doxycycline.Doxycycline is an attractive candidate as a repurposed drug in the treatment of COVID-19 infection, with an established safety profile, strong preclinical rationale, and compelling initial clinical experience described here.The reviews of this paper are available via the supplemental material section.


Assuntos
Adenocarcinoma de Pulmão/complicações , Infecções por Coronavirus/tratamento farmacológico , Doxiciclina/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/complicações , Sarcoidose Pulmonar/complicações , Adenocarcinoma de Pulmão/diagnóstico , Adenocarcinoma de Pulmão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Medição de Risco , Amostragem , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/terapia , Resultado do Tratamento
6.
BMC Pulm Med ; 20(1): 237, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894108

RESUMO

BACKGROUND: This study aimed to evaluate whether the Homocysteine (Hcy) level was elevated in chronic obstructive pulmonary disease (COPD) patients and its correlation with the occurrence and acute progression of COPD. METHODS: From November 2014 to November 2015, COPD patients were enrolled from Beijing Chao-yang Hospital, and the the biological and clinical data were collected. These patients were tested in the non-acute exacerbation period and the acute exacerbation period, so they were defined as AECOPD group and Non-AECOPD group. Besides, 50 healthy subjects were recruited and defined as control group. Total plasma Hcy levels (antibodies-online, USA) were determined by enzyme-linked immunosorbent assay. Correlation analysis was used to analyze the correlation between serum Hcy level and ventilatory function. Using ROC curve, the diagnostic value of Hcy for the occurrence and acute progression of COPD was explored. RESULTS: In this study, we found that Hcy levels in the Non-AECOPD group or the AECOPD group were significantly higher than those in the control group (P < 0.001). Meanwhile, compared with the Non-AECOPD group, the Hcy level in the AECOPD group was significantly higher (P < 0.001). In addition, according to the classification of GOLD grade, there was significant difference in the Hcy level among different GOLD grade groups (P < 0.001). The correlation analysis showed that in the AECOPD group and the Non-AECOPD group, Hcy levels presented a negative correlation with FEV1(r < 0). Meanwhile, FEV1% was also negatively correlated with Hcy level (r < 0). ROC curve analysis showed that when the cutoff value was set to 10.8 µg/ml, the specificity, sensitivity and AUC were the best, which were 0.980, 0.800, and 0.945, respectively. Besides, our results showed that when the cutoff value was set to 14.0 µg / ml, the specificity, sensitivity and AUC were the best, which were 0.846, 0.680, and 0.802, respectively. In addition, compared with the prediction of acute progression of COPD, when Hcy level predicted the occurrence of COPD, its specificity (0.980 vs. 0.846, P < 0.001) and sensitivity (0.800 vs. 0.680, P < 0.001) were significantly higher. CONCLUSION: Hcy level is positively correlated with the severity of COPD patients, which has predictive value for the occurrence of COPD and acute progression.


Assuntos
Progressão da Doença , Homocisteína/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Aguda , Idoso , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1009-1013, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741162

RESUMO

Carrying out standardized diagnosis, treatment, intervention, management, surveillance and evaluation of COPD is an important part of the special action for the prevention and treatment of chronic respiratory diseases in the "Healthy China Initiative (2019-2030)" . The surveillance of COPD among Chinese residents provides basic data for assessing the level of standardized diagnosis, treatment, intervention and management of patients with COPD. Based the data of all COPD patients found in the surveillance of COPD (2014-2015), the key series articles report the awareness rate of COPD among patients aged ≥40 years in China, and analyze the spirometry examination rate, medicine treatment rate, inhalation therapy rate, respiratory rehabilitation rate, smoking cessation rate, successful smoking cessation rate, and pneumococcal vaccination rate in COPD patients aged ≥ 40 years and their associated factors, providing a scientific reference for China to carry out special action for the prevention and treatment of chronic respiratory diseases represented by COPD.


Assuntos
Vigilância da População , Doença Pulmonar Obstrutiva Crônica , Adulto , China/epidemiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Espirometria
9.
PLoS One ; 15(8): e0237080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764779

RESUMO

We previously demonstrated corticosteroid administration on the neonatal intensive care unit was associated with reduced lung function at 11 to 14 years of age in children born very prematurely. The objective of this observational study was to assess if lung function remained impaired at 16 to 19 years of age in those who had received postnatal corticosteroids and whether the trajectory of lung function with increasing age differed between those who had and had not received corticosteroids. One hundred and fifty-nine children born prior to 29 weeks of gestational age had comprehensive lung function measurements; 49 had received postnatal dexamethasone. Lung function outcomes were compared between those who had and had not received postnatal dexamethasone after adjustment for neonatal factors. Forced expiratory flow at 75%, 50%, 25% and 25-75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes (total lung capacity and residual volume) were assessed. The majority of results were significantly lower in those who received dexamethasone (between 0.61 to 0.78 standard deviations). Lung function reduced as the number of courses of dexamethasone increased. Between 11 and 14 years and 16 to 19 years, lung function improved in the unexposed group, but forced expiratory flow at 75% of the expired vital capacity and forced expiratory volume in one second deteriorated in those who had received postnatal corticosteroids (p = 0.0006). These results suggest that prematurely born young people who received postnatal corticosteroids may be at risk of premature onset of chronic obstructive pulmonary disease.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Dexametasona/efeitos adversos , Lactente Extremamente Prematuro/fisiologia , Nascimento Prematuro/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Displasia Broncopulmonar/etiologia , Criança , Dexametasona/administração & dosagem , Feminino , Seguimentos , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Humanos , Recém-Nascido , Masculino , Nascimento Prematuro/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Reino Unido/epidemiologia , Capacidade Vital/efeitos dos fármacos , Capacidade Vital/fisiologia
10.
J Allergy Clin Immunol ; 146(4): 808-812, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32735807
13.
Lancet Respir Med ; 8(7): 696-708, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32649918

RESUMO

BACKGROUND: Genetic factors influence chronic obstructive pulmonary disease (COPD) risk, but the individual variants that have been identified have small effects. We hypothesised that a polygenic risk score using additional variants would predict COPD and associated phenotypes. METHODS: We constructed a polygenic risk score using a genome-wide association study of lung function (FEV1 and FEV1/forced vital capacity [FVC]) from the UK Biobank and SpiroMeta. We tested this polygenic risk score in nine cohorts of multiple ethnicities for an association with moderate-to-severe COPD (defined as FEV1/FVC <0·7 and FEV1 <80% of predicted). Associations were tested using logistic regression models, adjusting for age, sex, height, smoking pack-years, and principal components of genetic ancestry. We assessed predictive performance of models by area under the curve. In a subset of studies, we also studied quantitative and qualitative CT imaging phenotypes that reflect parenchymal and airway pathology, and patterns of reduced lung growth. FINDINGS: The polygenic risk score was associated with COPD in European (odds ratio [OR] per SD 1·81 [95% CI 1·74-1·88] and non-European (1·42 [1·34-1·51]) populations. Compared with the first decile, the tenth decile of the polygenic risk score was associated with COPD, with an OR of 7·99 (6·56-9·72) in European ancestry and 4·83 (3·45-6·77) in non-European ancestry cohorts. The polygenic risk score was superior to previously described genetic risk scores and, when combined with clinical risk factors (ie, age, sex, and smoking pack-years), showed improved prediction for COPD compared with a model comprising clinical risk factors alone (AUC 0·80 [0·79-0·81] vs 0·76 [0·75-0·76]). The polygenic risk score was associated with CT imaging phenotypes, including wall area percent, quantitative and qualitative measures of emphysema, local histogram emphysema patterns, and destructive emphysema subtypes. The polygenic risk score was associated with a reduced lung growth pattern. INTERPRETATION: A risk score comprised of genetic variants can identify a small subset of individuals at markedly increased risk for moderate-to-severe COPD, emphysema subtypes associated with cigarette smoking, and patterns of reduced lung growth. FUNDING: US National Institutes of Health, Wellcome Trust.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/genética , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Volume Expiratório Forçado , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Fatores de Risco , Capacidade Vital
15.
PLoS One ; 15(7): e0236011, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32692772

RESUMO

Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004-2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783-0.809 and the calibration slopes between 0.911-1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator (https://skiddle.shinyapps.io/incidentcopdsurvival/).


Assuntos
Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Medição de Risco/métodos , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Inglaterra/epidemiologia , Feminino , Volume Expiratório Forçado , Humanos , Pessoa de Meia-Idade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Taxa de Sobrevida
17.
PLoS One ; 15(7): e0235152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634145

RESUMO

BACKGROUND: The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. METHODS: Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. RESULTS: A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e' and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. CONCLUSIONS: The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume Sistólico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Testes de Função Respiratória , Taxa de Sobrevida
19.
PLoS One ; 15(6): e0234606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569331

RESUMO

Skeletal muscle dysfunction is a common complication and an important prognostic factor in patients with chronic obstructive pulmonary disease (COPD). It is associated with intrinsic muscular abnormalities of the lower extremities, but it is not known whether there is an easy way to predict its presence. Using a mouse model of chronic cigarette smoke exposure, we tested the hypothesis that magnetic resonance spectroscopy allows us to detect muscle bioenergetic deficit in early stages of lung disease. We employed this technique to evaluate the synthesis rate of adenosine triphosphate (ATP) and characterize concomitant mitochondrial dynamics patterns in the gastrocnemius muscle of emphysematous mice. The fibers type composition and citrate synthase (CtS) and cytochrome c oxidase subunit IV (COX4) enzymatic activities were evaluated. We found that the rate of ATP synthesis was reduced in the distal skeletal muscle of mice exposed to cigarette smoke. Emphysematous mice showed a significant reduction in body weight gain, in the cross-sectional area of the total fiber and in the COX4 to CtS activity ratio, due to a significant increase in CtS activity of the gastrocnemius muscle. Taken together, these data support the hypothesis that in the early stage of lung disease, we can detect a decrease in ATP synthesis in skeletal muscle, partly caused by high oxidative mitochondrial enzyme activity. These findings may be relevant to predict the presence of skeletal bioenergetic deficit in the early stage of lung disease besides placing the mitochondria as a potential therapeutic target for the treatment of COPD comorbidities.


Assuntos
Metabolismo Energético , Músculo Esquelético/fisiopatologia , Fumaça/efeitos adversos , Trifosfato de Adenosina/biossíntese , Trifosfato de Adenosina/deficiência , Animais , Pneumopatias/diagnóstico , Espectroscopia de Ressonância Magnética/métodos , Camundongos , Mitocôndrias/metabolismo , Músculo Esquelético/metabolismo , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Tabaco/efeitos adversos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA