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1.
Chron Respir Dis ; 17: 1479973120962800, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33000648

RESUMO

INTRODUCTION: The COVID pandemic has had a high psychological impact on healthy populations. Increased levels of perceived stress, depression, and insomnia are expected, especially in people with pre-existing medical conditions, such as asthma and chronic obstructive pulmonary disease (COPD), who seem to be particularly vulnerable. However, the difference in psychological distress frequency between asthma and COPD patients is unknown. OBJECTIVE: To compare the prevalence of depression, perceived stress related to COVID, post-traumatic stress, and insomnia in asthma and COPD patients at a pulmonology clinic in Santa Marta, Colombia. METHODS: A cross-sectional study was designed. The patients were contacted by telephone. An electronic link was sent to those who accepted. The questionnaire asked for perceived stress related to COVID-19, post-traumatic stress symptoms, depressive symptoms, and insomnia risk. RESULTS: 148 asthma patients and 144 COPD patients participated in, between 18 and 96 years. The prevalence of high COVID-19 perceived stress was 10.6% (n = 31); post-traumatic stress risk, 11.3% (n = 33); depression risk, 31.5% (n = 92); and insomnia risk, 57.7% (n = 169). No significant differences were found between asthma and COPD in indicators of psychological distress. CONCLUSIONS: Asthma and COPD patients present similar frequencies of depression risk, COVID-19 perceived stress, post-traumatic stress risk, and insomnia risk during the Colombian lockdown. It is essential to evaluate and manage psychological distress among asthma and COPD patients. It can reduce the risk of exacerbation and improve the quality of life.


Assuntos
Asma , Infecções por Coronavirus , Depressão , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Asma/epidemiologia , Asma/psicologia , Betacoronavirus , Colômbia/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Autoavaliação Diagnóstica , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Angústia Psicológica , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Pesquisa Qualitativa , Autoimagem , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
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.
Ann Ist Super Sanita ; 56(3): 373-377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32959804

RESUMO

We aimed to compare COVID-19-specific and all-cause mortality rates among natives and migrants in Italy and to investigate the clinical characteristics of individuals dying with COVID-19 by native/migrant status. The mortality rates and detailed clinical characteristics of natives and migrants dying with COVID-19 were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2,687) between February 21st and April 29th, 2020. The migrant or native status was assigned based on the individual's country of birth. The expected all-cause mortality among natives and migrants living in Italy was derived by the last available (2018) dataset provided by the Italian National Institute of Statistics. Overall, 68 individuals with a migration background were identified. The proportions of natives and migrants among the COVID-19-related deaths (97.5% and 2.5%, respectively) were similar to the relative all-cause mortality rates estimated in Italy in 2018 (97.4% and 2.6%, respectively). The clinical phenotype of migrants dying with COVID-19 was similar to that of natives except for the younger age at death. International migrants living in Italy do not have a mortality advantage for COVID-19 and are exposed to the risk of poor outcomes as their native counterparts.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Migrantes/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Albânia/etnologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , França/etnologia , Efeito do Trabalhador Sadio , Registros Hospitalares , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Neoplasias/epidemiologia , Obesidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia
4.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883943

RESUMO

BACKGROUND The rapid worldwide spread of the coronavirus disease 2019 (COVID-19) epidemic has placed patients with pre-existing conditions at risk of severe morbidity and mortality. The present study investigated the clinical characteristics and outcomes of patients with severe COVID-19 and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS This study enrolled 336 consecutive patients with confirmed severe COVID-19, including 28 diagnosed with COPD, from January 20, 2020, to April 1, 2020. Demographic data, symptoms, laboratory values, comorbidities, and clinical results were measured and compared in survivors and non-survivors. RESULTS Patients with severe COVID-19 and COPD were older than those without COPD. The proportions of men, of patients admitted to the intensive care unit (ICU) and of those requiring invasive ventilation were significantly higher in patients with than without COPD. Leukocyte and neutrophil counts, as well as the concentrations of NT-proBNP, hemoglobin, D-dimer, hsCRP, ferritin, IL-2R, TNF-alpha and procalcitonin were higher, whereas lymphocyte and monocyte counts were lower, in patients with than without COPD. Of the 28 patients with COPD, 22 (78.6%) died, a rate significantly higher than in patients without COPD (36.0%). A comparison of surviving and non-surviving patients with severe COVID-19 and COPD showed that those who died had a longer history of COPD, more fatigue, and a higher ICU occupancy rate, but a shorter average hospital stay, than those who survived. CONCLUSIONS COPD increases the risks of death and negative outcomes in patients with severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
5.
BMJ Open ; 10(9): e038976, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32948572

RESUMO

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Assuntos
Doença das Coronárias/epidemiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Bronquite Crônica/epidemiologia , Estudos de Casos e Controles , Infarto Cerebral/epidemiologia , China/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal/epidemiologia , Adulto Jovem
6.
BMC Fam Pract ; 21(1): 203, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988371

RESUMO

BACKGROUND: Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees' and trainers' perspectives towards the blended learning approach. METHODS: We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. RESULTS: Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. CONCLUSIONS: Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Educação a Distância/métodos , Educação Médica Continuada , Clínicos Gerais/educação , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Ensino , Atitude do Pessoal de Saúde , Bangladesh/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Instrução por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/organização & administração , Educação Médica Continuada/tendências , Estudos de Viabilidade , Humanos , Modelos Educacionais , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Ensino/normas , Ensino/tendências
7.
N Z Med J ; 133(1522): 30-41, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994614

RESUMO

AIM: Chronic respiratory diseases, such as chronic obstructive pulmonary disease, are a worldwide public health problem. Pulmonary rehabilitation is a gold-standard intervention for these diseases, yet attendance and completion rates are poor. Counties Manukau Health, in Auckland, New Zealand, has a high prevalence of chronic respiratory disease and a culturally diverse population, comprising large numbers of Maori and Pacific Island people, who are known to be disproportionately affected by chronic respiratory disease. The aim of this study was to investigate patient characteristics affecting engagement with the Counties Manukau Health pulmonary rehabilitation programme and identify factors predicting completion of the programme. METHODS: Investigators performed a retrospective analysis using routinely collected data of 2,756 patients invited to attend the pulmonary rehabilitation programme at Counties Manukau Health. Data were analysed to compare demographic and clinical outcomes of patients who completed, did not complete or did not attend the programme, and identified factors predicting completion. RESULTS: Significant differences were found between groups in demographic and clinical characteristics. Increasing age, higher six-minute walk test distance at programme commencement and European ethnicity were significant predictors of completion of the PR programme. CONCLUSIONS: Compared to European people, Maori were 52% less likely and Pacific Island people were 40% less likely to complete the programme. These findings are significant for the Counties Manukau Health population. Further work needs to focus on determining how to make programmes more engaging to different cultures and how we can aim to reduce health inequities in these populations.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia Respiratória/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
8.
PLoS Med ; 17(9): e1003321, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32911500

RESUMO

BACKGROUND: At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19. METHODS AND FINDINGS: A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18-90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50-69 years, or 70-90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35-63) and 54.5% (n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06-1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55-1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31-1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64-2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21-1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07-1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08-1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00-1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53-4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84-2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19-2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured. CONCLUSIONS: Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Diabetes Mellitus/epidemiologia , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores Etários , Doença Crônica/classificação , Doença Crônica/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores Sexuais , Estados Unidos/epidemiologia
9.
Respir Med ; 171: 106085, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32917356

RESUMO

BACKGROUND: Chronic respiratory diseases are risk factors for severe disease in coronavirus disease 2019 (COVID-19). Respiratory tract infection is one of the commonest causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There has not been evidence suggesting the link between COVID-19 and AECOPD, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing. METHODS: This is a retrospective study to assess the number of admissions of AECOPD in the first three months of 2020 in Queen Mary Hospital with reference to the admissions in past five years. Log-linear model was used for statistical inference of covariates, including percentage of masking, air quality health index and air temperature. RESULTS: The number of admissions for AECOPD significantly decreased by 44.0% (95% CI 36.4%-52.8%, p < 0.001) in the first three months of 2020 compared with the monthly average admission in 2015-2019. Compare to same period of previous years, AECOPD decreased by 1.0% with each percent of increased masking (p < 0.001) and decreased by 3.0% with increase in 1 °C in temperature (p = 0.045). The numbers of admissions for control diagnoses (heart failure, intestinal obstruction and iron deficiency anaemia) in the same period in 2020 were not reduced. CONCLUSIONS: The number of admissions for AECOPD decreased in first three months of 2020, compared with previous years. This was observed with increased masking percentage and social distancing in Hong Kong. We postulated universal masking and social distancing during COVID-19 pandemics both contributed in preventing respiratory tract infections hence AECOPD.


Assuntos
Infecções por Coronavirus , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Infecções Respiratórias , Poluição do Ar/análise , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Distância Social , Exacerbação dos Sintomas
10.
BMC Pulm Med ; 20(1): 241, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32912168

RESUMO

BACKGROUND: Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD. METHODS: We identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC < 70% and FEV1 < 80%) using standardised criteria in multiple countries, to re-estimate the prevalence of COPD. Hospitalised COPD patients develop IA in 1.3-3.9%, based on positive cultures of Aspergillus spp. and radiological findings. Given limited data on per-patient annual hospitalisation rates, we assumed a conservative 10.5% estimate. Annual IA mortality in COPD was estimated using the literature rates of 43-72%. A separate literature search assessed the impact of Aspergillus sensitisation on severity of COPD (by FEV1). RESULTS: We re-estimated the global prevalence of COPD GOLD stages II-IV at 552,300,599 people (7.39% of the population) with 339,206,893 (8.58%) in Asia, 85,278,783 (8.52%) in the Americas, 64,298,051 (5.37%) in Africa, 59,484,329 (7.77%) in Europe and 4,032,543 (10.86%) in Oceania. An estimated 57,991,563 (10.5%) people with COPD are admitted to hospital annually and of these 753,073 (1.3%) - 2,272,322 (3.9%) develop IA and 540,451-977,082 deaths are predicted annually. Aspergillus sensitisation prevalence in COPD was 13.6% (7.0-18.3%) and not related to lower predicted FEV1% (P > 0.05). CONCLUSIONS: The prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality.


Assuntos
Aspergilose/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Saúde Global , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia
11.
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
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1014-1020, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741163

RESUMO

Objective: To understand the situation of respiratory rehabilitation and oxygen inhalation therapy in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China, and provide basic information for the development of pulmonary rehabilitation. Methods: The data were from 2014-2015 COPD surveillance in China. Chinese residents aged 40 years or older were recruited through a complex multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities). Standardized face to face electronic questionnaires were used to collect information about respiratory rehabilitation and oxygen inhalation therapy of the patients. Spirometry was performed on all participants, and patients with post- bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. The number of defined COPD patients was 9 134. Based on the complex sampling design, the respiratory rehabilitation treatment rate and oxygen inhalation therapy rate of COPD patients aged 40 years old or older in China were estimated, and the influencing factors were analyzed. Results: A total of 9 118 COPD patients aged 40 years or older were included in the analysis. The rate of respiratory rehabilitation was 0.8% (95CI: 0.6%-1.0%), and the rate of oxygen inhalation therapy was 2.5% (95%CI: 2.0%-2.9%). Among patients with severe symptoms or high risk of acute exacerbation (combined COPD assessment groups B, C, D), the rate of respiratory rehabilitation was 1.4% (95%CI: 0.9%-1.9%), and the rate of oxygen inhalation therapy was 5.4% (95%CI: 4.4%-6.4%). Multivariate logistic regression analysis showed that urban or rural residences, geographic area, awareness of COPD, history of acute exacerbation and severity of airflow restriction had influences on the respiratory rehabilitation rate in the COPD patients. Gender, geographic area, awareness of COPD, history of acute exacerbation, mMRC scores and severity of airflow restriction had influences on the patients' oxygen inhalation therapy rate. Conclusions: The rate of respiratory rehabilitation and oxygen inhalation therapy in COPD patients aged 40 years or older was relatively low in China. It is necessary to explore an effective model of pulmonary rehabilitation and COPD management, so that more COPD patients may have access to scientific pulmonary rehabilitation treatment.


Assuntos
Oxigenoterapia/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Adulto , China/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1028-1033, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741165

RESUMO

Objective: To understand the pneumococcal vaccination rate in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention. Methods: COPD patients with post-bronchodilator FEV(1)/FVC<70% in COPD surveillance (2014-2015) of China were used as study subjects, in which 9 067 patients with definite pneumococcal vaccination status were included. The pneumococcal vaccination rate and its 95%CI in COPD patients were estimated using data adjusted by complicated sampling method. The factors in association with the vaccination rate were also identified. Results: The pneumococcal vaccination rate was 0.8% in the past five years in COPD patients aged 40 years or older in China (95%CI: 0.3%-1.4%). The vaccination rate was 0.3% in the patients aged 40 to 59 years (95%CI: 0.2%-0.5%) and 1.2% in the patients aged 60 years or older (95%CI: 0.3%-2.1%) (P<0.05). The rate was higher in the patients living in urban area (1.5%) than in those living in rural area (0.4%) (P<0.05). The vaccination rate increased with the severity of airflow limitation (P<0.05). The patients with comorbidities of other chronic lung diseases or diabetes had higher vaccination rate (1.7% and 2.1%) compared with those without comorbidities (P<0.05). The vaccination rate was 1.4% in former smokers and 0.6% in current smokers. The pneumococcal vaccination rate in COPD patients was associated with age, education level, occupation, the severity of airflow limitation and the history of influenza vaccination. Conclusions: The pneumococcal vaccination rate was extremely low in COPD patients aged 40 years or older in China. It is necessary to strengthen the health education and recommendation for pneumococcal vaccination in COPD patients through different measures.


Assuntos
Vacinas Pneumocócicas/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/terapia , Vacinação/estatística & dados numéricos , Adulto , China/epidemiologia , Humanos , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1034-1040, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741166

RESUMO

Objective: To understand the awareness of chronic obstructive pulmonary disease (COPD) status and awareness of COPD-related knowledge and its influencing factors in COPD patients aged ≥40 years in China in 2014-2015. Methods: The study subjects were selected through multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities) in China. The number of the subjects was 75 107. The relevant variables about COPD diagnosis and COPD-related knowledge awareness were collected by electronic questionnaire in face to face interviews. A total of 9 134 participates with post-bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. Based on the complex sampling design, the awareness rate of COPD status and related knowledge were estimated, and the influencing factors were analyzed. Results: A total of 9 132 COPD patients were included in the analysis. Among COPD patients aged ≥40 years in China, 0.9% were aware of their COPD status (95%CI: 0.6%-1.1%), and 5.7% were aware of COPD related knowledge (95%CI: 4.8%-6.6%), and 3.4% were aware of pulmonary function test (95%CI: 2.8%-4.0%). The COPD status awareness rate was 3.9% in the patients with history of chronic respiratory disease (95%CI: 2.9%-4.8%), 2.4% in the patients with respiratory symptoms (95%CI: 1.7%-3.1%), and 7.1% in the patients with COPD related knowledge awareness (95%CI: 4.5%-9.8%) respectively. The results of multivariate logistic regression analysis showed that chronic respiratory disease history, respiratory symptoms, occupational dust and/or harmful gas exposure and COPD related knowledge awareness had influences on the awareness rate of COPD status. Educational level and chronic respiratory disease history had influences on the awareness rate of COPD related knowledge. And ethnic groups, educational level and history of chronic respiratory diseases had influences on the awareness rate of pulmonary function test. Conclusions: The awareness rates of COPD status, COPD-related knowledge and pulmonary function test in COPD patients in China were low. The comprehensive intervention of COPD should be carried out to improve the level of diagnosis and the awareness COPD status of COPD patients.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , China/epidemiologia , Humanos , Testes de Função Respiratória , Inquéritos e Questionários
15.
Medicine (Baltimore) ; 99(30): e21302, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791715

RESUMO

INTRODUCTION: By detecting the metabolic difference of the Heart and Lung meridians, the present study aims to investigate the specificity of different meridians and verify whether functional near infrared spectroscopy is validated as an add-on technique to assist diagnosis of chronic obstructive pulmonary disease (COPD). METHODS AND ANALYSIS: The Lung and Heart meridians are chosen as the target for comparison; accordingly, 120 eligible participants will be included and divided into the COPD group, healthy control group, and healthy intervention group. Functional near infrared spectroscopy will be adopted to measure the metabolic characteristics of the Heart and Lung meridians. On one hand, the specificity of the meridian-visceral association will be investigated by comparing the metabolic difference in the Heart and Lung meridians between the healthy control group and COPD group. On the other hand, the specificity of site-to-site association will be determined by comparing the metabolic change between the 2 meridians that induced by moxibustion in the Heart meridian and Lung meridian, respectively, in the healthy control group. The primary outcome will be regional oxygen saturation of corresponding regions along the Heart and Lung meridians. TRIAL REGISTRATION: ClinicalTrials.gov NCT04046666.


Assuntos
Coração/fisiologia , Pulmão/metabolismo , Moxibustão/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Espectrofotometria Infravermelho/métodos , Pontos de Acupuntura , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , Masculino , Meridianos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Oxigênio/metabolismo , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Sensibilidade e Especificidade
16.
BMC Infect Dis ; 20(1): 610, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811432

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases worldwide. Episodes of acute exacerbations of COPD (AECOPD) are associated with disease severity and progression. Although substantial progress has been made in understanding the dynamics of AECOPD, little is known about the sputum microbiome of AECOPD in the Chinese population. METHODS: In this study, we characterized the sputum microbiomes from sputum specimens collected from healthy controls (n = 10), stable (n = 4), AECOPD (n = 36), and recovery (n = 18) stages by sequencing the V3-V4 region of the 16S rRNA gene with a HiSeq sequencer. RESULTS: Streptococcus was the most dominant genus among all the different types of sputum. A random forest model was developed to identify bacterial taxa that differentiate AECOPD samples from others. Most of the top predictors, except Pseudomonas, were less abundant in AECOPD samples. We also developed random forest models to differentiate subtypes of AECOPD based on blood eosinophil counts, the frequency of AECOPD, and sputum eosinophils. Bacterial taxa associated with Pasteurellaceae, Fusobacterium, Solobacterium, Haemophilus, Atopobium, Corynebacterium and Streptococcus, were enriched in the sputum microbiomes of eosinophilic AECOPD. Random forest models also demonstrate that a total of 2 bacterial OTUs were needed to differentiate frequent from non-frequent AECOPDs, and 23 OTUs were enough to accurately predict sputum-eosinophilic (sputum eosinophilic concentration ≥ 3%) AECOPD. CONCLUSION: This study expanded our understanding of the sputum microbiome associated with different subtypes and clinical status of patients with AECOPD in a Chinese cohort, which provides insights into novel and more targeted management of the different subtypes of AECOPD.


Assuntos
Microbiota/genética , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Escarro/microbiologia , Streptococcus/genética , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , China/epidemiologia , Estudos de Coortes , Progressão da Doença , Eosinófilos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Prevalência , RNA Ribossômico 16S/genética
17.
Respir Med ; 171: 106096, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763754

RESUMO

BACKGROUND: An outbreak of Corona Virus Disease 2019 (COVID-19) has spread rapidly reaching over 3 million of confirmed cases worldwide. The association of respiratory diseases and smoking, both highly prevalent globally, with COVID-19 severity has not been elucidated. Given the gap in the evidence and the growing prevalence of COVID-19, the objective of this study was to explore the association of underlying respiratory diseases and smoking with severe outcomes in patients with COVID-19 infection. METHODS: A systematic search was performed to identify studies reporting prevalence of respiratory diseases and/or smoking in relation with disease severity in patients with confirm COVID-19, published between January 1 to April 15, 2020 in English language. Pooled odds-ratio (OR) and 95% confidence intervals (95% CI) were calculated. FINDINGS: Twenty two studies met the inclusion criteria. All the studies presented data of 13,184 COVID-19 patients (55% males). Patients with severe outcomes were older and a larger percentage were males compared with the non-severe. Pooled analysis showed that prevalence of respiratory diseases (OR 4.21; 95% CI, 2.9-6.0) and smoking (current smoking OR 1.98; 95% CI, 1.16-3.39 and former smoking OR 3.46; 95% CI, 2.46-4.85) were significantly associated with severe COVID-19 outcomes. INTERPRETATION: Results suggested that underlying respiratory diseases, specifically COPD, and smoking were associated with severe COVID-19 outcomes. These findings may support the planning of preventive interventions and could contribute to improvements in the assessment and management of patient risk factors in clinical practice, leading to the mitigation of severe outcomes in patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prevalência , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Fatores de Risco , Índice de Gravidade de Doença , Prevenção do Hábito de Fumar
18.
Respiration ; 99(8): 649-657, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841948

RESUMO

BACKGROUND: A new virus broke out in Wuhan, Hubei, China, that was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical characteristics of severe pneumonia caused by SARS-CoV-2 are still not clear. OBJECTIVES: The aim of this study was to explore the clinical characteristics and risk factors of severe pneumonia caused by the SARS-CoV-2 in Wuhan, China. METHODS: The study included patients hospitalized at the Central Hospital of Wuhan who were diagnosed with COVID-19. Clinical features, chronic comorbidities, demographic data, laboratory examinations, and chest computed tomography (CT) scans were reviewed through electronic medical records. SPSS was used for data analysis to explore the clinical characteristics and risk factors of patients with severe pneumonia caused by SARS-CoV-2. RESULTS: A total of 110 patients diagnosed with COVID-19 were included in the study, including 38 with severe pneumonia and 72 with nonsevere pneumonia. Statistical analysis showed that advanced age, increased D-Dimer, and decreased lymphocytes were characteristics of the patients with severe pneumonia. Moreover, in the early stage of the disease, chest CT scans of patients with severe pneumonia showed that the illness can progress rapidly. CONCLUSIONS: Advanced age, decreased lymphocytes, and D-Dimer elevation are important characteristics of patients with severe COVID-19. Clinicians should focus on these characteristics to identify high-risk patients at an early stage.


Assuntos
Infecções por Coronavirus/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pulmão/diagnóstico por imagem , Contagem de Linfócitos , Pneumonia Viral/sangue , APACHE , Adulto , Fatores Etários , Betacoronavirus , Proteína C-Reativa/metabolismo , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tosse/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Escores de Disfunção Orgânica , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pró-Calcitonina/sangue , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Medição de Risco , Albumina Sérica/metabolismo , Índice de Gravidade de Doença , Fatores Sexuais , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 99(34): e21908, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846856

RESUMO

BACKGROUND: A meta-analysis was performed to evaluate the relationship between chronic obstructive pulmonary disease (COPD) and occupational dust exposure, and to provide a scientific basis for the prevention and treatment of COPD caused by occupational factors. METHODS: PubMed and Embase databases were used to search for original epidemiological literature related to theme. Both random and fixed effects models were used to calculate pooled odds ratios and their corresponding 95% confidence intervals. Review Manager was used to perform data analysis. RESULTS: Nine studies were included in the meta-analysis in accordance with the inclusion criteria. There was a significantly obvious correlation between occupational dust exposure and COPD of the population-based studies assessed in this article. The risk of developing COPD for workers exposed to dust was 1.51 times higher than for controls (I = 40%, 95% confidence interval: 1.27-1.79). The presence of publication bias was not found. CONCLUSION: The study provided evidence supporting the association between occupational dust exposure and the risk of developing COPD.


Assuntos
Poeira , Exposição por Inalação/efeitos adversos , Doenças Profissionais/complicações , Doença Pulmonar Obstrutiva Crônica/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Medição de Risco
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