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1.
Rev Med Suisse ; 15(671): 2082-2086, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742938

RESUMO

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


Assuntos
Fenótipo , Doença Pulmonar Obstrutiva Crônica , Biomarcadores/análise , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
2.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(10): 764-767, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31726508

RESUMO

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


Assuntos
Poeira , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Madeira , Humanos , Fatores de Risco
3.
Zhonghua Nei Ke Za Zhi ; 58(10): 770-776, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594176

RESUMO

Objective: To observe the levels of serum reactive oxygen species (ROS) and hydrogen sulfide(H(2)S) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and nicotinamide adenine dinucleotide phosphate-reduced (NADPH) oxidase 4 (NOX4) and cystathionine-γ-lyase (CSE) in lung tissue of patients with stable chronic obstructive pulmonary disease (COPD). Methods: (1) A total of 60 patients with AECOPD admitted to the Department of Respiratory Medicine at Ningxia Hui People's Hospital from November 2015 to December 2016 were recruited. According to the results of pulmonary function and echocardiography, the participants were divided into AECOPD-related pulmonary hypertension (PH) group(A) and AECOPD non-PH group (B).Other 30 healthy subjects were selected as the control group (C).Serum ROS and H(2)S of group A, B and C were detected by enzyme-linked immunosorbent assay (ELISA).(2)The lung tissues of patients undergoing lobectomy for lung cancer from November 2012 to April 2017 were collected, who were divided into COPD-related PH group (D), COPD non-PH group (E) and negative control (F). The expression of NOX4 and CSE protein in lung tissue was detected by immunohistochemistry and the thickness of pulmonary arteriole wall was measured. Results: (1)The serum ROS level in group A was higher than group B and C which were (613.52±69.66)IU/ml,(565.76±71.33)IU/ml, (294.63±60.39)IU/ml, respectively with that in group B higher than that in group C (P<0.05). Serum H(2)S level in group A was lower than group B and C, with that in group B lower than group C [(18.59±5.50) nmol/ml, (20.49±4.97) nmol/ml, (38.03±4.43) nmol/ml, respectively P<0.05]. ROS level was positively correlated with pulmonary systolic pressure (PASP) (r=0.59, P<0.05), H(2)S level was negatively correlated with PASP(r=-0.62, P<0.05).(2)The lung tissue expression of NOX4 in group D was higher than group E and F (P<0.05), which were 0.08±0.01,0.06±0.01,0.03±0.01, respectively,while the level of NOX4 in group E was higher than group F (P<0.05). The expression of CSE between group D, E and F were all significantly different (P<0.05),which were 0.03±0.01, 0.07±0.02,0.12±0.02, respectively.(3)Smooth muscle thickness of pulmonary arterioles as a percentage of vascular diameter (WT%) between group D, E and F was all different(P<0.05), which were (40.58±6.63)%,(36.87±5.60)%,(31.27±6.24)%, respectively; so was smooth muscle area of pulmonary arterioles as a percentage of total vascular area(WA%) with (32.33±6.27)%, (30.20±5.28)%, (25.20±4.31)%, respectively (P<0.05). (4)The expression of NOX4 was positively correlated with WT% and WA%, r was 0.81 and 0.66, respectively (P<0.05). The expression of CSE was negatively correlated with WT% and WA%, r was -0.55 and -0.39 respectively (P<0.05). Conclusions: NOX4/ROS and CSE/H(2)S signaling pathways may play an important role in the pathogenesis of COPD related PH.


Assuntos
Cistationina gama-Liase/metabolismo , Cistationina/metabolismo , Sulfeto de Hidrogênio/sangue , Hipertensão Pulmonar/metabolismo , Hipertensão Pulmonar/fisiopatologia , NADPH Oxidase 4/metabolismo , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Espécies Reativas de Oxigênio/sangue , Estudos de Casos e Controles , Humanos , Hipertensão Pulmonar/sangue , Oxirredutases , Doença Pulmonar Obstrutiva Crônica/sangue
4.
Med. clín (Ed. impr.) ; 153(5): 191-195, sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183994

RESUMO

Introducción: La enfermedad pulmonar obstructiva crónica y la insuficiencia cardíaca (IC) son 2 enfermedades con una elevada morbimortalidad. La coexistencia de estas 2 enfermedades se estima que es frecuente, pero ha sido escasamente estudiada. Objetivo: Estudiar la prevalencia de limitación al flujo aéreo en una muestra de pacientes diagnosticados de IC en seguimiento en una unidad de IC y valorar las características y comorbilidades de estos pacientes. Métodos: Se trata de un estudio prospectivo observacional. Se incluyeron de forma consecutiva los pacientes visitados en la Unidad de Insuficiencia Cardíaca del Hospital Universitari Germans Trias i Pujol entre enero del 2014 y junio del 2015. Se realizaron pruebas funcionales respiratorias y se obtuvieron datos clínicos. Resultados: Se incluyeron 118 pacientes en el estudio (edad 67,2 años; DE 12,1; el 77,1% hombres). La prevalencia de limitación al flujo aéreo fue del 36,4%, con un porcentaje de infradiagnóstico del 67,4%. Los pacientes con limitación al flujo aéreo presentaban un aumento de las comorbilidades y de la mortalidad. Conclusión: La prevalencia de limitación al flujo aéreo en pacientes con IC es elevada, con un importante grado de infradiagnóstico. Sería recomendable la realización de una espirometría de cribado en estos pacientes


Background: Chronic obstructive pulmonary disease and heart failure (HF) are 2 diseases with high morbidity and mortality. The coexistence of these two diseases is estimated to be frequent, but has been poorly studied. Aim: To study the prevalence of airflow limitation in a sample of patients diagnosed with HF in follow-up in an HF unit and to assess their characteristics and comorbidities. Methods: This is a prospective observational study. The patients who visited the HF Unit of the Hospital Universitari Germans Trias i Pujol between January 2014 and June 2015 were included consecutively. Respiratory functional tests were performed and clinical data were obtained. Results: 118 patients were included in the study (age 67.2 years, 77.1% men). The prevalence of non-reversible airflow obstruction was 36.4%, with an underdiagnosis percentage of 67.4%. Patients with airflow limitation had an increase in comorbidities, but no worse prognosis. Conclusion: The prevalence of airflow limitation in patients with HF is high, with a significant degree of underdiagnosis. It seems reasonable to recommend performing a screening spirometry in these patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/complicações , Obstrução das Vias Respiratórias/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Prospectivos , Testes Respiratórios , Obstrução das Vias Respiratórias/fisiopatologia , Espirometria
5.
Pol Merkur Lekarski ; 47(279): 95-98, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31557137

RESUMO

The pathogenesis of both chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is closely related to oxidative stress, which is characterized by an imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense. AIM: The aim of the study was to assess the parameters of free-radical oxidation and to establish their correlation to spirogram findings in patients with COPD without comorbidity and in patients with COPD and AH. MATERIALS AND METHODS: Detection of intracellular ROS levels was performed by EPICS XL cytometer (Beckman Coulter, USA) with DCFH-DA and DHE. Serum levels of 8-isoprostane were assayed with ELISA, Cayman Chemicals (USA). RESULTS: Intracellular ROS levels suggest a probable increase in production of O2•- in patients with COPD and in patients with COPD+AH vs control. The direction of changes in production of H2O2 in the assessed patients was also identical. Serum levels of 8-isoprostane were found to be significantly increased in patients with COPD and in patients with COPD+AH. High levels of H2O2, O2•- and 8-isoprostane were significantly associated with low values of spirometry parameters in patients of both test groups, which suggested bronchial obstruction. In this respect, oxidative stress parameters were significantly negatively correlated with the values characteristic of impaired patency of largeand medium-sized bronchi. CONCLUSIONS: Oxidative stress is playing an important role in the mechanisms of COPD/AH comorbidity, since intracellular ROS levels were found to increase, leading to destruction of cell membrane. In the meantime, the degree of oxidative stress correlates with the severity of bronchial obstruction.


Assuntos
Hipertensão , Estresse Oxidativo , Doença Pulmonar Obstrutiva Crônica , Humanos , Peróxido de Hidrogênio , Hipertensão/complicações , Hipertensão/fisiopatologia , Oxirredução , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
6.
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
7.
Tuberk Toraks ; 67(2): 116-123, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414642

RESUMO

Introduction: Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. Materials and Methods: A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. Result: The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p<0.001), improved by 26%. Significant improvements were found in dyspnea, quality of life and i-BODE index in more symptomatic patients (group B and D). Conclusions: This study highlights that changes in i-BODE scores after PR significantly correlated with improvements in dyspnea, exercise capacity and quality of life. i-BODE score could be a better predictor of efficacy of PR than some individual variables such as BMI or FEV1. Significant improvements in dyspnea sensation, quality of life and i-BODE index could be seen symptomatic patients in after PR.


Assuntos
Doença Pulmonar Obstrutiva Crônica/reabilitação , Índice de Gravidade de Doença , Fatores Etários , Idoso , Composição Corporal , Índice de Massa Corporal , Dispneia/fisiopatologia , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários
8.
Tuberk Toraks ; 67(2): 124-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414643

RESUMO

Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) are often caused by respiratory tract infections. The aim of this study was to investigate the clinical, laboratory and computed tomography features of patients with hospitalized COPD exacerbations in which respiratory viruses were detected using a real-time polymerase chain reaction (PCR) technique. Materials and Methods: This retrospectively planned study included patients hospitalized in the chest diseases clinic due to exacerbation of COPD between November 2018-February 2019. The study included patients who had virus-specific real-time PCR, and computed tomography scans of the chest. Result: A total of 110 patients were included in the study. Respiratory viruses were identified in the nasopharyngeal swabs of 50 patients (45.5%) using the real-time PCR method, with rhinovirus (25%), influenza A (13.1%) and coronavirus (11.8%) being the most commonly isolated agents. The mean age of the patients was 68.28 ± 9.59 years in the virus-positive group and 68.20 ± 8.27 years in the virus-negative group (p= 0.963). Gender distribution, rate of smokers, exposure to biofuels, blood leukocyte count, neutrophil percentage, C-reactive protein (CRP) level, FEV1/FVC ratio did not significantly differ between the two groups (p> 0.05). Procalcitonin (PCT) and FEV1 values were significantly lower (p= 0.001 and p= 0.028, respectively) and the number of exacerbations was significantly higher in the virus-positive group (p= 0.001). The length of hospital stay was longer in the virus-positive group than in the virus-negative group (p= 0.012). Among the findings of computed tomography (CT) of the chest, bronchial wall thickening, cystic bronchiectasis, and emphysema did not differ significantly (p> 0.05). The rate of infiltrative lesions (tree-in-bud opacity, ground-glass opacity, atypical pneumonia) was significantly higher in the virus-positive group (p= 0.020). Conclusions: Viral respiratory tract infections should be considered in hospitalized patients with an exacerbation of COPD who have a history of frequent exacerbations, normal PCT value, and the absence of consolidation in CT scan of the chest. The use of broadspectrum antibiotic therapy should be avoided in patients with these features.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Infecções Respiratórias/complicações , Viroses/complicações , Idoso , Bronquiectasia , Coronavirus/isolamento & purificação , Feminino , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/virologia , Reação em Cadeia da Polimerase em Tempo Real , Testes de Função Respiratória , Infecções Respiratórias/virologia , Estudos Retrospectivos , Rhinovirus/isolamento & purificação , Tomografia Computadorizada por Raios X , Viroses/virologia
9.
Tuberk Toraks ; 67(2): 131-135, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414644

RESUMO

Chronic obstructive pulmonary disease (COPD) has many systemic effects influencing morbidity and mortality of the disease. Thyroid diseases which are more common in COPD patients than who do not have COPD are underestimated despite important clinical consequences. Similar to general population, thyroid dysfunctions are more common in females than males among COPD patients. Both hypothyroidism and hyperthyroidism may be associated to COPD. As well as systemic inflammation hypoxia, age, glucocorticoid use and smoking are some of the effective factors on developing thyroid dysfunction in COPD patients. In this article thyroid dysfunctions that are underrecognized comorbidities of COPD patients, their mechanisms of action and clinical outcomes were reviewed.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Comorbidade , Feminino , Humanos , Hipertireoidismo/epidemiologia , Hipertireoidismo/fisiopatologia , Hipotireoidismo/epidemiologia , Hipotireoidismo/fisiopatologia , Inflamação , Masculino , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar , Doenças da Glândula Tireoide/fisiopatologia
10.
Arq Bras Cir Dig ; 32(2): e1439, 2019 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460599

RESUMO

BACKGROUND: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. AIM: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. METHOD: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . RESULTS: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. CONCLUSIONS: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.


Assuntos
Exercícios Respiratórios/métodos , Procedimentos Cirúrgicos do Sistema Digestório , Cuidados Pré-Operatórios/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/reabilitação , Testes de Função Respiratória , Estudos Retrospectivos , Software , Espirometria
11.
Ther Adv Respir Dis ; 13: 1753466619860058, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291820

RESUMO

BACKGROUND: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. METHODS: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC

Assuntos
Obstrução das Vias Respiratórias/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Ansiedade/epidemiologia , Doenças Cardiovasculares/mortalidade , Depressão/epidemiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Fatores Sexuais , Capacidade Vital
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 709-713, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315728

RESUMO

OBJECTIVE: To evaluate the effect of transcutaneous neuromuscular electrical stimulation on prevention of intensive care unit-acquired weakness (ICU-AW) in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation. METHODS: A prospective randomized controlled study was conducted. Sixty COPD patients aged 18-85 years old who were accepted mechanical ventilation therapy admitted to general intensive care unit (ICU) of the First Affiliated Hospital of Hunan University of Medicine from October 2017 to October 2018 were enrolled. Patients were divided into control group (n = 30) and intervention group (n = 30) by random number table method. All patients were accepted routine treatment, and on this basis, the intervention group was applied transcutaneous neuromuscular electrical stimulation on the extremities (twice a day, 30 minutes each time) after 24 hours of admission until ICU discharge. The Medical Research Council muscle strength score (MRC-Score), grip strength, incidence of ICU-AW on the 7th day after admission and on the day of ICU discharge; modified Barthel index score on the day of ICU discharge; and duration of mechanical ventilation, the length of ICU stay, and the length of hospital stay were compared between the two groups. RESULTS: Twenty-nine and 27 patients in the control group and the intervention group respectively finally completed the study in dividually. There was no significant difference in gender, age, Barthel index score before 2 weeks of ICU admission, body mass index or acute physiology and chronic health evaluation (APACHE) in ICU between the two groups. There was no significant difference in the MRC-Score, grip strength or incidence of ICU-AW on the 7th day after ICU admission between the two groups. Compared to the control group, the MRC-Score, grip strength and Barthel index score in the intervention group were significantly increased [MRC-Score: 55.97±8.43 vs. 46.32±7.36, grip strength (kg): 33.46±11.62 vs. 27.42±9.64, Barthel index score: 46.04±5.46 vs. 42.13±3.32, all P < 0.05], the incidence rate of ICU-AW was significantly decreased [7.4% (2/27) vs. 31.0% (9/29), P < 0.05], and duration of mechanical ventilation, the length of ICU stay, the length of hospital stay were significantly shortened [duration of mechanical ventilation (days): 5.12±2.01 vs. 7.24±4.35, the length of ICU stay (days): 8.34±2.36 vs. 10.45±2.62, the length of hospital stay (days): 13.21±2.21 vs. 15.38±3.67, all P < 0.05]. CONCLUSIONS: Transcutaneous neuromuscular electrical stimulation can effectively improve the muscle strength of COPD patients with mechanical ventilation and reduce the incidence of ICU-AW.


Assuntos
Debilidade Muscular/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial , Estimulação Elétrica Nervosa Transcutânea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Resultado do Tratamento , Adulto Jovem
14.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(6): 444-450, 2019 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-31189231

RESUMO

Objective: To describe the development of the Chronic Obstructive Pulmonary Disease Morning Symptom Diary (COPD-MSD) Chinese version and to test its reliability and validity. Methods: The COPD-MSD Chinese version was developed by the standard cross-cultural translation principle. A hundred and eight patients with COPD in stable condition from the Second Xiangya Hospital were assessed by interview with COPD-MSD Chinese version, and underwent mMRC, CAT scores and pulmonary function test.The reliability and validity were evaluated by performing correlation analysis.The stages of COPD determined by lung function were compared to observe the value of COPD-MSD Chinese version in determining disease severity. Results: The Cronbach's alpha and retest reliability of the total scale were 0.908 and 0.927, respectively.The explanatory factor analysis was conducted using orthogonal rotation through the maximum variation principle components extraction which revealed the presence of 5 components with eigen values exceeding 1, explaining totally 74.257% of the variance, and the total score of the COPD-MSD Chinese version was significantly correlated with the mMRC and CAT scores (r=0.44 and 0.56,P<0.01), indicating that the scale of the convergence validity was good. The COPD-MSD Chinese version scores varied significantly in patients with different severity of COPD(χ(2)=9.808, P<0.05). Conclusion: The COPD-MSD Chinese version showed good reliability and validity and could be used in clinical assessment of morning symptoms in Chinese COPD patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários/normas , Humanos , Psicometria , Doença Pulmonar Obstrutiva Crônica/psicologia , Reprodutibilidade dos Testes , Testes de Função Respiratória , Índice de Gravidade de Doença
15.
Life Sci ; 232: 116608, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31254583

RESUMO

Preventing vascular damage is considered an effective strategy in patients who suffer from chronic obstructive pulmonary disease (COPD) with hypertension. Here, we investigated vascular damage in COPD-like and hypertensive rats, which demonstrated the presence of the three related factors of COPD with hypertension. These include elevated systolic blood pressure (SBP), serum malondialdehyde (MDA) and serum lactate dehydrogenase (LDH), which are positively correlated with vascular damage in patients. In addition to increases in these three related factors, COPD-like and hypertensive rats exhibited increased levels of pro-inflammatory mediators, such as tumor necrosis factor-α, interleukin-6, and matrix metallopeptidase-9 in bronchoalveolar lavage fluid, and enlargement of alveolar airspaces, recapitulating clinical findings in previous studies of patients. Moreover, the appearance of these related factors was prevented by linalyl acetate. Our results provide novel insight into the potential of LA to prevent vascular damage and elevated SBP, serum MDA and serum LDH in COPD with hypertension, and could lead to an alternative strategy for preventing vascular damage for patients who suffered from COPD with hypertension in a clinical setting.


Assuntos
Hipertensão/tratamento farmacológico , Monoterpenos/farmacologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Animais , Pressão Sanguínea/fisiologia , Líquido da Lavagem Broncoalveolar , Modelos Animais de Doenças , Hipertensão/patologia , Hipertensão/fisiopatologia , L-Lactato Desidrogenase/análise , L-Lactato Desidrogenase/sangue , Pulmão/patologia , Masculino , Malondialdeído/análise , Malondialdeído/sangue , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ratos , Ratos Sprague-Dawley
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 551-555, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198138

RESUMO

OBJECTIVE: To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: The patients with mild to moderate AECOPD (clinical classification I-II) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluation II (APACHE II) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. RESULTS: Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPD II grade or APACHE II score between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times×min-1×mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. CONCLUSIONS: HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.


Assuntos
Cânula , Diafragma/fisiologia , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Resultado do Tratamento
17.
BMC Public Health ; 19(1): 690, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164109

RESUMO

BACKGROUND: Lung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution's associations with lung function. METHODS: Data are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV1) and standardised to the percentage of expected FEV1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV1%). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution's associations with FEV1%. RESULTS: SEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution. CONCLUSION: The findings suggest that disadvantaged SEP in childhood may make people's lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation.


Assuntos
Envelhecimento/fisiologia , Pulmão/fisiopatologia , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/fisiopatologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
18.
Ther Adv Respir Dis ; 13: 1753466619853500, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31240995

RESUMO

BACKGROUND: Patients diagnosed with chronic obstructive pulmonary disease (COPD) in China are commonly prescribed ipratropium plus theophylline (I+T) therapy. Studies have shown that an inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) combination is also efficacious in reducing symptoms and exacerbations. This study evaluated the efficacy and tolerability of adding budesonide/formoterol (BUD/FORM) to I+T in Chinese patients with severe COPD. METHODS: A randomized, parallel-group, open-label, multicenter phase IV study (Clinical Trials.gov identifier: NCT01415518) was conducted in China. Patients received either BUD/FORM (160/4.5 µg; two inhalations twice daily [bid] via Turbuhaler®) + I (20 µg per inhalation, two inhalations four times daily) + T (100 mg bid) or I+T alone for 12 weeks. The primary efficacy variable was change from baseline in predose forced expiratory volume in 1 s (FEV1). RESULTS: A total of 584 patients were randomized equally between treatment groups. At the end of the study, the BUD/FORM plus I+T group displayed significant improvements in predose FEV1 versus the I+T group (between-group difference 6.9%; 95% confidence interval [CI]: 4.3, 9.6; p < 0.0001). Forced vital capacity, inspiratory capacity, peak expiratory flow and health-related quality of life (HRQoL) scores were significantly improved (all p < 0.0001) and exacerbation frequency was reduced (43.5% reduction; rate ratio 0.565, 95% CI 0.325, 0.981; p = 0.0425) with BUD/FORM plus I+T versus I+T alone. CONCLUSION: Patients with severe COPD in China treated with BUD/FORM plus I+T showed significant improvements in lung function and HRQoL and a reduction in exacerbations compared with I+T alone. Both treatments were well tolerated and no safety concerns were noted. The reviews of this paper are available via the supplemental material section.


Assuntos
Combinação Budesonida e Fumarato de Formoterol/administração & dosagem , Ipratrópio/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Teofilina/administração & dosagem , Idoso , Broncodilatadores/administração & dosagem , China , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Ter Arkh ; 91(3): 22-26, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31094454

RESUMO

AIM: The aim of this study was to evaluate the state of the vascular wall in patients with chronic obstructive pulmonary disease (COPD) combined with chronic coronary artery disease (CAD). MATERIALS AND METHODS: The study included 108 patients: 37 patients with COPD and CAD and 71 patients with COPD without CAD. Endothelial function was studied in tests with reactive hyperemia and nitroglycerin. The number of blood plasma desquamated endotheliocytes were determined by the Hladovec method. In patients with COPD identified are signs of vascular wall remodeling: thickening wall of the brachial artery, reduction of the flow-mediated vasodilation. Patients with COPD in combination with CHD demonstrated higher impairments of the vasoregulatory dysfunction of endothelial of the vascular wall. CONCLUSION: In patients with COPD combined with chronic coronary heart disease more pronounced endothelial dysfunction with disturbance of endothelium-dependent vasomotor reactions.


Assuntos
Doença da Artéria Coronariana , Endotélio Vascular , Doença Pulmonar Obstrutiva Crônica , Artéria Braquial , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Vasodilatação
20.
Ter Arkh ; 91(3): 93-100, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-31094466

RESUMO

This review presents an analysis of the literature on the topic of respiratory muscle (RM) dysfunction in various forms of respiratory pathology: chronic obstructive pulmonary disease (COPD), asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis (IPF), sarcoidosis and interstitial lung diseases (ILD), associated with systemic connective tissue diseases (polymyositis, dermatomyositis and systemic lupus erythematosus - SLE). Various clinical and pathophysiological aspects of RM dysfunction and general patterns of its pathogenesis were examined. It was proved that the role of RM in the development of respiratory failure depends on the form and stage of the pulmonary pathology and the severity of systemic manifestations of these diseases: excessive proteolysis, oxidative stress, hypoxia, chronic systemic inflammation. These factors modify the morphofunctional status of RM, worsens their contractile function, which is contributed to the development of respiratory failure. In some cases, the primary weakness of RM precedes the clinical manifestation of pulmonary pathology, which is distinctive for some variants of myositis-associated ILD and SLE. Endogenous intoxication syndrome plays a significant role in the development of RM dysfunction during community-acquired pneumonia. It is noted that sarcoid pulmonary ventilation disorders associate with the RM weakness, but not with the degree of lung damage. In most cases, secondary RM dysfunction predominates that contributes to respiratory failure progression, which is especially noticeable in case of COPD, asthma and IPF.


Assuntos
Pulmão/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Músculos Respiratórios/fisiopatologia , Asma/fisiopatologia , Doenças do Tecido Conjuntivo/fisiopatologia , Humanos , Fibrose Pulmonar Idiopática/fisiopatologia , Pneumopatias Obstrutivas/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
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