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1.
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
2.
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
3.
Artigo em Chinês | MEDLINE | ID: mdl-31594118

RESUMO

Objective: To investigate the incidence and rank of chronic obstructive pulmonary disease and pneumoconiosis to the workers in different occupational positions in Jinchang Cohort. Methods: In January 2014, a cohort of follow-up population in jinchang city was taken as the research object, 17843 individuals among follow-up populations in Jinchang Cohort Study, removed the individuals with chronic obstructive pulmonary disease and pneumoconiosis before 2013, and counted the new incidence individuals diagnosed by the A-Class hospital in Grade III in Jinchang City, Gansu Province, as the investigation objects to investigate the incidence rate & rank of chronic obstructive pulmonary disease and pneumoconiosis. The statistical significance was tested by chi-square test. Results: The 2-year incidence rate of Chronic Obstructive Pulmonary Disease and Pneumoconiosis in the population of Jinchang Cohort Study were 11.60‰, 13.51‰ for male and 8.46‰ for female. the ranks of 2-year incidence rates of chronic bronchitis, emphysema, pneumoconiosis and other phenotypes of chronic obstructive pulmonary disease were 7.06‰ã€3.42‰ã€0.84‰ã€0.34‰, respectively. Incidence rate of chronic bronchitis among administrators and executive staffs were 10.45‰; incidence rate of chronic bronchitis among service staffs were 10.45‰; incidence rate of pneumoconiosis among mining staffs were 3.44‰. Conclusion: The first incidence rank of chronic obstructive pulmonary disease and pneumoconiosis in Jinchang cohort is chronic bronchitis, and the risk factors are smoking and occupational exposure.


Assuntos
Ocupações/estatística & dados numéricos , Pneumoconiose/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Bronquite/epidemiologia , China , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Exposição Ocupacional/efeitos adversos , Enfisema Pulmonar/epidemiologia , Fatores de Risco , Fumar/efeitos adversos
4.
BMC Infect Dis ; 19(1): 764, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477038

RESUMO

BACKGROUND: Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. METHODS: Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. RESULTS: Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis, 22 (1.5%) were M. bovis, and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. CONCLUSION: This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/epidemiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , China/epidemiologia , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/classificação , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Adulto Jovem
5.
Medicine (Baltimore) ; 98(37): e17162, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517866

RESUMO

Vertebral compression fracture (VCF) is a common comorbidity of chronic obstructive pulmonary disease (COPD), and the coexistence of COPD and temporomandibular disorder (TMD) has been clinically noted. The present study aimed to investigate whether VCF increases the risk of TMD in patients with COPD.With a follow-up period of 15 years, this retrospective, population-based longitudinal cohort study enrolled sex- and age-matched COPD patients with and without VCF (1:3) who were identified from Taiwan's National Health Insurance Research Database from 2000 to 2015. Multivariate Cox regression analysis was performed to determine the risk of TMD in COPD patients with and without VCF. The cumulative risk of TMD between groups was estimated using Kaplan-Meier analysis.The risk factors for TMD in patients with COPD were VCF, osteoporosis, and winter season. The COPD with VCF group was more likely to develop TMD (adjusted hazard ratio = 3.011, P < .001) than the COPD without VCF group after adjustment for sex, age, variables, and comorbidities. In the subgroup analysis, the COPD with VCF group had a higher risk of TMD than the COPD without VCF group in almost all stratifications.COPD patients with VCF are at a higher risk of developing TMD. Clinicians taking care of patients with COPD should be aware of the occurrence of TMD as a comorbidity.


Assuntos
Fraturas por Compressão/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Fraturas da Coluna Vertebral/complicações , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas por Compressão/epidemiologia , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Transtornos da Articulação Temporomandibular/complicações
7.
Pneumologie ; 73(11): 651-669, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31499562

RESUMO

When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Comorbidade , Dispneia/epidemiologia , Alemanha/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia
8.
Int J Med Inform ; 129: 107-113, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445244

RESUMO

OBJECTIVE: Use symptoms to stratify temporal disease trajectories. MATERIALS AND METHODS: We use data from the Danish National Patient Registry to stratify temporal disease pairs by the symptom distributions they associate to. The underlying data comprise of 6.6 million patients collectively assigned with 7.5 million symptoms from chapter XVIII in the WHO International Classification of Disease version 10 terminology. RESULTS: We stratify 33 disease pairs into 67 temporal disease-symptom-disease trajectories from three main diagnoses (two diabetes subtypes and COPD), where the symptom significantly changes the risk of developing the subsequent diseases. We combine these trajectories into three temporal disease networks, one for each main diagnosis. We confirm apparent relations between diseases and symptoms and discovered that multiple symptoms decrease the risk for diabetes progression. CONCLUSION: Symptoms can be used to stratify disease trajectories, and we suggest that this approach can be applied to temporal disease trajectories systematically using structured claims data. The method can be extended to also use text-mined symptoms from unstructured data in health records.


Assuntos
Diabetes Mellitus/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto Jovem
9.
MMWR Morb Mortal Wkly Rep ; 68(24): 533-538, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220055

RESUMO

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) in the United States; however, an estimated one fourth of adults with COPD have never smoked (1). CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD. The age-adjusted prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. Higher prevalences of COPD were observed in southeastern and Appalachian states, regardless of smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who had never smoked suggests secondhand smoke exposure as a potential risk factor for COPD. Continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
10.
Kardiologiia ; 59(6): 48-55, 2019 Jun 25.
Artigo em Russo | MEDLINE | ID: mdl-31242841

RESUMO

Chronic obstructive pulmonary disease (COPD) is the fourth largest cause of worldwide mortality.  Presence of comorbidities is registered in 96% of COPD patients. The most important of these are cardiovascular diseases (coronary artery disease, arterial hypertension, chronic heart failure), which contribute to COPD patients' mortality in every third case. COPD and cardiovascular diseases have common risk factors and pathogenesis mechanisms. Cardioselective beta-blockers reduce morbidity risk and frequency of COPD exacerbation, are effective and safe in treatment of COPD patients.


Assuntos
Doenças Cardiovasculares , Insuficiência Cardíaca , Doença Pulmonar Obstrutiva Crônica , Antagonistas Adrenérgicos beta , Doenças Cardiovasculares/epidemiologia , Comorbidade , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia
11.
J Glob Health ; 9(1): 010434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31217961

RESUMO

Background: The global burden of chronic obstructive pulmonary disease (COPD) disproportionately affects resource-limited settings such as sub-Saharan Africa (SSA), but population-based prevalence estimates in SSA are rare. We aimed to estimate the population prevalence of COPD and chronic respiratory symptoms in rural southwestern Uganda. Methods: Adults at least 18 years of age who participated in a population-wide census in rural southwestern Uganda completed respiratory questionnaires and lung function testing with bronchodilator challenge at health screening events in June 2015. We defined COPD as post-bronchodilator forced expiratory volume in one second to forced vital capacity ratio less than the lower limit of normal. We fit multivariable linear and log binomial regression models to estimate correlates of abnormal lung function and respiratory symptoms, respectively. We included inverse probability of sampling weights in models to facilitate population-level estimates. Results: Forty-six percent of census participants (843/1814) completed respiratory questionnaires and spirometry, of which 565 (67%) met acceptability standards. COPD and respiratory symptom population prevalence were 2% (95% confidence interval (CI) = 1%-3%) and 30% (95% CI = 25%-36%), respectively. Respiratory symptoms were more prevalent and lung function was lower among women and ever-smokers (P < 0.05). HIV serostatus was associated with neither respiratory symptoms nor lung function. Conclusions: COPD population prevalence was low despite prevalent respiratory symptoms. This work adds to the growing body of literature depicting lower-than-expected COPD prevalence estimates in SSA and raises questions about whether the high respiratory symptom burden in rural southwestern Uganda represents underlying structural lung disease not identified by screening spirometry.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Transtornos Respiratórios/epidemiologia , Saúde da População Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espirometria , Inquéritos e Questionários , Uganda/epidemiologia , Capacidade Vital , Adulto Jovem
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 686-691, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238620

RESUMO

Objective: To explore the short-term effects of ambient PM(2.5) on the outpatient visits of chronic obstructive pulmonary disease (COPD) in Ningbo city. Methods: Through the regional health information platform, number of daily COPD outpatients from the four general hospitals in Ningbo was gathered. Related data on meteorological and air pollution from 2014 to 2016 was also collected. Generalized additive model (GAM) of Possion regression was used to estimate the impact of PM(2.5) pollution on COPD outpatients and the lagging effects. Results: In cold (November- April) or warm seasons (May-October), an 10 µg/m(3) increase of PM(2.5) would result in the excessive number of COPD outpatients as 1.87% (95%CI: 0.98%-2.76%), 2.09% (95%CI: 1.11%-3.08%) and 2.56% (95%CI: 0.56%-4.59%), respectively. In terms of the short-term effects of PM(2.5) the strongest was seen in the days of warm season but without delay (P<0.05). The strongest effect appeared at day 4 in cold season and the effect was particularly significant seen in the over 65 year-old group or in the female population. After the introduction of PM(10), SO(2) and NO(2), the concentration of PM(2.5), did not show significant effect on the number of hospital visits due to COPD on the same day (P>0.05). The effect of COPD on the fourth day showed a slight change after the lagging, and the effect was statistically significant (P<0.05). Conclusion: The increase of PM(2.5) concentration in Ningbo was related to the increase of COPD outpatient numbers. Effective prevention measures should be taken to protect the vulnerable population and to reduce the risk of COPD.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Ambulatório Hospitalar/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Material Particulado/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/etiologia , Idoso , Poluição do Ar/estatística & dados numéricos , Assistência Ambulatorial , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/epidemiologia , População Urbana
13.
Orv Hetil ; 160(23): 908-913, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31155879

RESUMO

Introduction: The increased metabolism of nutrients and the low energy intake may lead to malnutrition among chronic obstructive pulmonary disease (COPD) patients. Aim: The goal of our study was to examine the nutritional status of our population aged over 40, and its relationship with the severity of the disease. Method: We conducted a retrospective study at the National Korányi Institute of Pulmonology in 2017. Pulmonary function and anthropometric data were obtained from the electronic health record system. Inclusion criteria were age over 40 and the diagnosis of COPD. Severity of disease was assessed by forced expiration volume and categorized according to GOLD stages. We used SPSS Statistics V22.0 for data analysis. Results: The mean age of participants was 66; 49.3% were men, 50.7% were women. Average BMI was 27.14 kg/m², with values comprising cachexia and severe obesity. According to the FEV1%pred results of the 3236 patients, 30% fell in the GOLD I, 40% in the GOLD II, 23% in the GOLD III, and 7% in the GOLD IV categories. Pearson coefficient found positive correlation between FEV1 and nutritional status (H = 0.2297, r = 0.1401), specifically between severity of cachexia and severity of disease. The analysis of variance showed significant correlation between severity of disease and nutritional status; patients with higher BMI had better pulmonary function. Conclusion: Malnutrition had an adverse effect on pulmonary functions and performance of respiratory muscles, whereas higher BMI had a positive effect on FEV1. Our results suggest that BMI could be used as a lung function prognostic indicator for COPD patients. Orv Hetil. 2019; 160(23): 908-913.


Assuntos
Desnutrição/epidemiologia , Estado Nutricional , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Desnutrição/diagnóstico , Avaliação Nutricional , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
Environ Sci Pollut Res Int ; 26(24): 25326-25340, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254199

RESUMO

Exposure to PM10 generated by biomass burning may reduce lung function and induce cytogenetic effects, especially in chronic obstructive pulmonary disease patients. This study investigated the frequency of DNA-damaged cells, cells with cytokinetic defect, and different types of cell death using a buccal micronucleus cytome assay. The correlations between each biomarker and lung function were investigated. The changes in these biomarkers associated with high pollutant levels (PM10 > 50 µg/m3) and low pollutant levels (PM10 < 50 µg/m3) were evaluated to explore whether PM10 exposure induced genotoxic damages and cytokinetic defects in COPD patients when the daily average PM10 concentration reached above 50 µg/m3. Fifty-eight COPD patients and 26 healthy subjects living in Chiang Dao district, Chiang Mai, Thailand, were recruited in this study. The results revealed that buccal cells with micronuclei (high vs low 1.09 ± 1.95 vs 0.29 ± 0.64 in COPD patients) and binucleated cells (high vs low 11.43 ± 18.68 vs 1.60 ± 1.31 and 7.77 ± 12.76 vs 1.00 ± 1.17 in COPD and healthy subjects, respectively) observed during the high pollutant period were more frequent than in the low pollutant period. Moreover, exposure to PM10 increased the risk of micronucleus induction in COPD patients 295.23-fold.


Assuntos
Dano ao DNA , Material Particulado/toxicidade , Doença Pulmonar Obstrutiva Crônica/patologia , Idoso , Biomarcadores , Biomassa , Morte Celular , Citocinese , Feminino , Humanos , Masculino , Testes para Micronúcleos , Pessoa de Meia-Idade , Mucosa Bucal , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Tailândia/epidemiologia
15.
Environ Monit Assess ; 191(Suppl 2): 366, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254075

RESUMO

The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.


Assuntos
Asma/epidemiologia , Geografia Médica/métodos , Modelos Estatísticos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Monitoramento Ambiental/estatística & dados numéricos , Humanos , Análise dos Mínimos Quadrados , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Regressão Espacial , Sri Lanka/epidemiologia
16.
BMC Infect Dis ; 19(1): 555, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238916

RESUMO

BACKGROUND: Among people living with HIV (PLWH), the prevalence of non-HIV related co-morbidities is increasing. Aim of the present study is to describe co-morbidity and multi-morbidity, their clustering mode and the potential disease-disease interactions in a cohort of Italian HIV patients. METHODS: Cross-sectional analysis conducted by the Coordinamento Italiano per lo Studio di Allergia e Infezioni da HIV (CISAI) on adult subjects attending HIV-outpatient facilities. Non-HIV co-morbidities included: cardiovascular disease, diabetes mellitus, hypertension, oncologic diseases, osteoporosis, probable case of chronic obstructive pulmonary disease (COPD), hepatitis C virus (HCV) infection, psychiatric illness, kidney disease. Multi-morbidity was defined as the presence of two or more co-morbidities. RESULTS: One thousand and eighty-seven patients were enrolled in the study (mean age 47.9 ± 10.8). One hundred-ninety patients (17.5%) had no co-morbidity, whereas 285 (26.2%) had one condition and 612 (56.3%) were multi-morbid. The most recurrent associations were: 1) dyslipidemia + hypertension (237, 21.8%); 2) dyslipidemia + COPD (188, 17.3%); 3) COPD + HCV-Ab+ (141, 12.9%). Multi-morbidity was associated with older age, higher body mass index, current and former smoking, CDC stage C and longer ART duration. CONCLUSIONS: More than 50% of PLHW were multi-morbid and about 30% had three or more concurrent comorbidities. The identification of common patterns of comorbidities address the combined risks of multiple drug and disease-disease interactions.


Assuntos
Infecções por HIV/epidemiologia , Multimorbidade , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Análise por Conglomerados , Estudos de Coortes , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , HIV , Infecções por HIV/complicações , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia
17.
Drugs Aging ; 36(8): 733-745, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31172422

RESUMO

Chronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the lungs has significant challenges. Long-acting bronchodilators, inhaled corticosteroids, and roflumilast decrease the risk of exacerbations, although inhaled corticosteroids should be used judiciously in this population because of the risk of pneumonia and oropharyngeal side effects. Treatment of COPD exacerbations should occur early and consideration should be made to the benefits and risks of systemic corticosteroids and antibiotics. Clinical research in the COPD population in nursing homes is clearly lacking, and ripe for discovery of effective management strategies.


Assuntos
Corticosteroides/uso terapêutico , Aminopiridinas/uso terapêutico , Benzamidas/uso terapêutico , Broncodilatadores/uso terapêutico , Casas de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/administração & dosagem , Idoso , Aminopiridinas/administração & dosagem , Benzamidas/administração & dosagem , Broncodilatadores/administração & dosagem , Ciclopropanos/administração & dosagem , Ciclopropanos/uso terapêutico , Feminino , Humanos , Casas de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estados Unidos/epidemiologia
18.
Lancet ; 394(10204): 1145-1158, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31248666

RESUMO

BACKGROUND: Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. METHODS: We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). FINDINGS: Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). INTERPRETATION: China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. FUNDING: China National Key Research and Development Program and Bill & Melinda Gates Foundation.


Assuntos
Carga Global da Doença , Morbidade , Mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/estatística & dados numéricos , Causas de Morte , Criança , Pré-Escolar , China/epidemiologia , Dieta/estatística & dados numéricos , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/mortalidade , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Material Particulado , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Adulto Jovem
20.
Ter Arkh ; 91(1): 44-47, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31090370

RESUMO

AIM: the study of comorbid status and characteristics of clinical course of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: We conducted a retrospective analysis of case histories of 958 IHD patients aged 32 to 93 years (mean age of 60.8±10.2 years), including men - 525 (54.8%), women - 433 (45.2%) who were treated in the cardiology Department of city clinical hospital №5 of Nizhny Novgorod. Related COPD was diagnosed in 251 patients (26.3%). We compared two groups patients: with IHD and COPD, and the second - persons suffering from only IHD (without COPD). RESULTS: Myocardial infarction was transferred by 62.2% of patients in Group 1, which is 16.3% more than in Group 2 (p<0.05). Arterial hypertension in patients with COPD was 13.6% more frequent than in patients without COPD (p<0.05), and 6.4% more often (p<0.05), with comorbid pathology there was a chronic and paroxysmal forms of atrial fibrillation. In patients with IHD in combination with COPD it is 21.5% more often (p<0.05) than in IHD without COPD, there was shortness of breath and 32.1% more often (p<0.05) of the heartbeat. In patients with IHD with COPD, a higher level of was C-reactive protein detected (p<0.05) and more pronounced violations of the lipid profile (p<0.05). CONCLUSION: COPD makes a significant contribution to the development of the cardiovascular continuum, modifying its course. A modern patient with COPD is a high-risk patient with severe cardiovascular comorbidity and various polymorbidity.


Assuntos
Doenças Cardiovasculares/epidemiologia , Isquemia Miocárdica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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