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1.
Medicine (Baltimore) ; 100(35): e27126, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477156

RESUMO

ABSTRACT: Currently no research is available on muscle and functional performance of chronic obstructive pulmonary disease (COPD) patients with type 2 diabetes (T2DM) in China, even though both diseases have been reported to damage motor function.This single-center prospective study involves 55 males with COPD and T2DM and 46 males with COPD. Lung function, muscle strength and endurance of the upper limbs, and quadriceps strength of both legs were assessed using instruments. The 6-min walk (6MW) test was performed to evaluate physical performance.Between the two groups, respiratory function of COPD patients with T2DM was worse than in those without (P < .05). Mean handgrip strength and muscle endurance of upper limbs and mean quadriceps strength at both 60°/s and 120°/s in COPD males with T2DM was also significantly less (P < .05). Mean 6MW distances of COPD patients with T2DM were significantly worse (P < .05), and mean pulse rate (PR) increments of COPD patients with T2DM in 6MW test were significantly higher (P < .05).The combination of COPD and T2DM not only brings one more chronic disease to elderly patients but also significantly affects muscle strength and endurance as well as physical performance. Accordingly, in the management of chronic diseases, we recommend that clinicians as well as patients themselves actively control blood sugar and review them regularly with a view to reducing adverse effects on physical performance.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Desempenho Físico Funcional , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Músculo Quadríceps/fisiopatologia
2.
Nutrients ; 13(8)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34444947

RESUMO

Chronic obstructive pulmonary disease (COPD) is a respiratory disease associated with airways inflammation and lung parenchyma fibrosis. The primary goals of COPD treatment are to reduce symptoms and risk of exacerbations, therefore pulmonary rehabilitation is considered the key component of managing COPD patients. Oxidative airway damage, inflammation and reduction of endogenous antioxidant enzymes are known to play a crucial role in the pathogenesis of COPD. Recently, also natural antioxidants have been considered as they play an important role in metabolism, DNA repair and fighting the effects of oxidative stress. In this paper we evaluated the response of 105 elderly COPD patients to pulmonary rehabilitation (PR), based on high or low vegetable consumption, by analyzing clinical parameters and biological measurements at baseline and after completion of the three weeks PR. We found that daily vegetable intake in normal diet, without any specific intervention, can increase the probability to successfully respond to rehabilitation (65.4% of responders ate vegetables daily vs. 40.0% of non-responders, p = 0.033). The association was especially evident in subjects ≥ 80 year of age (OR = 17.0; p < 0.019). Three weeks of pulmonary rehabilitation are probably too short to reveal a reduction of the oxidative stress and DNA damage, but are enough to show an improvement in the patient's inflammatory state.


Assuntos
Dieta Saudável/métodos , Ingestão de Alimentos/fisiologia , Fenômenos Fisiológicos da Nutrição do Idoso/fisiologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Verduras , Administração por Inalação , Corticosteroides/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Broncodilatadores/administração & dosagem , Dano ao DNA/fisiologia , Inquéritos sobre Dietas , Feminino , Humanos , Inflamação , Pulmão/metabolismo , Masculino , Estresse Oxidativo/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Resultado do Tratamento
3.
Chron Respir Dis ; 18: 14799731211035822, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34382888

RESUMO

In people with advanced respiratory disease, we examined (i) the impact of COVID-19-related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton-Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3-8]-month period, often leading to lower levels of physical activity at home (n = 94, 47%), and outside home (n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = -0.28, p < 0.001) and instrumental (r = -0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03-1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.


Assuntos
Atividades Cotidianas , COVID-19/prevenção & controle , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Exercício Físico , Doenças Pulmonares Intersticiais/fisiopatologia , Neoplasias Pulmonares/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Controle de Doenças Transmissíveis , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Distanciamento Físico , SARS-CoV-2 , Isolamento Social
4.
Medicine (Baltimore) ; 100(33): e26976, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414971

RESUMO

BACKGROUND: We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs. METHODS: Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331). RESULTS: Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75). CONCLUSION: Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.


Assuntos
Dispneia/etiologia , Tolerância ao Exercício , Exercício Físico , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/terapia , Dispneia/fisiopatologia , Dispneia/reabilitação , Dispneia/terapia , Exercício Físico/fisiologia , Tolerância ao Exercício/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Água
5.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205308

RESUMO

Increasing epidemiological evidence suggests that optimal diet quality helps to improve preservation of lung function and to reduce chronic obstructive pulmonary disease (COPD) risk, but no study has investigated the association of food insecurity (FI) and lung health in the general population. Using data from a representative sample of US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2012 cycles, we investigated the association between FI with lung function and spirometrically defined COPD in 12,469 individuals aged ≥ 18 years of age. FI (high vs. low) was defined using the US Department of Agriculture's Food Security Scale). Population-weighted adjusted regression models were used to investigate associations between FI, and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), their ratio, and spirometrically defined restriction (FVC below the lower limit of normal) and airflow obstruction (COPD). The prevalence of household FI was 13.2%. High household FI was associated with lower FVC (adjusted ß-coefficient -70.9 mL, 95% CI -116.6, -25.3), and with higher odds (OR) of spirometric restriction (1.02, 95% CI 1.00, 1.03). Stratified analyses showed similar effect sizes within specific ethnic groups. High FI was associated with worse lung health in a nationally representative sample of adults in the US.


Assuntos
Insegurança Alimentar , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Índice de Massa Corporal , Dieta Saudável , Grupos Étnicos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Fumar/epidemiologia , Espirometria , Estados Unidos/epidemiologia , Capacidade Vital
6.
Int J Mol Sci ; 22(12)2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34198546

RESUMO

Chronic obstructive pulmonary disease (COPD) is a debilitating heterogeneous disease characterised by unregulated proteolytic destruction of lung tissue mediated via a protease-antiprotease imbalance. In COPD, the relationship between the neutrophil serine protease, neutrophil elastase, and its endogenous inhibitor, alpha-1-antitrypsin (AAT) is the best characterised. AAT belongs to a superfamily of serine protease inhibitors known as serpins. Advances in screening technologies have, however, resulted in many members of the serpin superfamily being identified as having differential expression across a multitude of chronic lung diseases compared to healthy individuals. Serpins exhibit a unique suicide-substrate mechanism of inhibition during which they undergo a dramatic conformational change to a more stable form. A limitation is that this also renders them susceptible to disease-causing mutations. Identification of the extent of their physiological/pathological role in the airways would allow further expansion of knowledge regarding the complexity of protease regulation in the lung and may provide wider opportunity for their use as therapeutics to aid the management of COPD and other chronic airways diseases.


Assuntos
Doença Pulmonar Obstrutiva Crônica/metabolismo , Serina Proteases/metabolismo , Serpinas/metabolismo , Animais , Modelos Animais de Doenças , Humanos , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Serpinas/química , Serpinas/uso terapêutico
7.
COPD ; 18(4): 469-475, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34223780

RESUMO

Healthcare access and delivery for individuals with chronic obstructive pulmonary disease (COPD) who live in remote areas or who are susceptible to contracting communicable diseases, such as COVID-19, may be a challenge. Telehealth and remote monitoring devices can be used to overcome this issue. However, the accuracy of these devices must be ensured before forming healthcare decisions based on their outcomes. Therefore, a systematic review was performed to synthesize the evidence on the reliability, validity and responsiveness of digital devices used for tracking oxygen saturation (SpO2) and/or respiratory rate (RR) in individuals with COPD, in remote settings. Three electronic databases were searched: MEDLINE (1996 to October 8, 2020), EMBASE (1996 to October 8, 2020) and CINAHL (1998 to October 8, 2020). Studies were included if they aimed to evaluate one or more measurement properties of a digital device measuring SpO2 or RR in individuals with COPD. Six-hundred and twenty-five articles were identified and after screening, 7 studies matched the inclusion criteria; covering 11 devices measuring SpO2 and/or RR. Studies reported on the reliability (n = 1), convergent validity (n = 1), concurrent validity (n = 2) and predictive validity (n = 2) of SpO2 devices and on the convergent validity (n = 1), concurrent validity (n = 1) and predictive validity (n = 1) of RR devices. SpO2 and RR devices were valid when compared against other respiration monitoring devices but were not precise in predicting exacerbation events. More well-designed measurement studies are needed to make firm conclusions about the accuracy of such devices.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1945021 .


Assuntos
COVID-19/prevenção & controle , Oximetria/instrumentação , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Taxa Respiratória , Telemedicina/instrumentação , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , Monitorização Fisiológica , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Reprodutibilidade dos Testes
8.
Rev Cardiovasc Med ; 22(2): 315-327, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34258900

RESUMO

There has been an apparent association between the risks of complications with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with a history of existing chronic respiratory diseases during the pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 poses a severe risk in cardiopulmonary management. Moreover, chronic respiratory diseases may further amplify the risk of morbidity and mortality among the afflicted population in the pandemic era. The present review outlines the importance of pulmonary rehabilitation (PR) in persons with chronic respiratory diseases (Chronic obstructive pulmonary disease (COPD) and Asthma) during the COVID-19 era. In this context, amongst the population with a pre-existing pulmonary diagnosis who have contracted SARS-CoV-2, following initial medical management and acute recovery, exercise-based pulmonary rehabilitation (PR) may play a crucial role in long-term management and recovery. The energy conservation techniques will play a pragmatic role in PR of mild to moderate severity cases to counter post-COVID-19 fatigue. Moreover, there is also an urgent need to effectively address post-COVID-19 anxiety and depression, affecting the PR delivery system.


Assuntos
Asma/reabilitação , COVID-19/terapia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Terapia Respiratória , Asma/fisiopatologia , COVID-19/fisiopatologia , COVID-19/virologia , Interações Hospedeiro-Patógeno , Humanos , Pulmão/virologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Recuperação de Função Fisiológica , SARS-CoV-2/patogenicidade , Fatores de Tempo , Resultado do Tratamento
9.
COPD ; 18(4): 443-448, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34180766

RESUMO

Since the outbreak of the SARS-CoV-2 pandemic in 2020, many governments have been imposing confinement and physical distancing measures. No data exist on the effects of lockdowns on the health status of patients affected by chronic pathologies, specifically those with Chronic Obstructive Pulmonary Disease (COPD). Our study aims to establish variations across the psychological and cognitive profile of patients during the isolation period in Italy, in a cohort of patients affected by COPD, between February and May 2020. Forty patients with established COPD were comprehensively evaluated by geriatric multidimensional assessment before the spread of the epidemic in Italy, and submitted to a second evaluation during the subsequent lockdown. We assessed functional ability, basic and instrumental Activities of Daily Living (ADL and IADL), cognition and mood status. We compared the scores obtained at baseline against those obtained during the pandemic, and used mean differences for correlation with major clinical and functional indexes. The score differences from MMSE, ADL and IADL were statistically significant. Such differences were correlated to the presence of a caregiver and to the total number of family members living together. Remarkably, the loneliness dimension, more than the restrictions themselves, seemed to represent the major determinant of altered health status and depressed psycho-cognitive profile in our population. Also remarkably, we detected no correlation between the score variation and the respiratory function indexes of disease severity. The isolation measures adopted during the SARS-CoV-2 pandemic have triggered the classic clinical string associated to geriatric isolation, which leads to a deterioration of cognitive functions, independence and frailty levels in a population affected by a chronic degenerative disease, such as COPD. If considered from a multidimensional geriatric point of view, the individual benefit of isolation measures could be small or non-existent.


Assuntos
COVID-19/prevenção & controle , Cognição/fisiologia , Solidão/psicologia , Saúde Mental , Distanciamento Físico , Doença Pulmonar Obstrutiva Crônica/psicologia , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/psicologia , Estudos de Coortes , Feminino , Avaliação Geriátrica , Nível de Saúde , Humanos , Itália , Masculino , Testes de Estado Mental e Demência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Inquéritos e Questionários
10.
J Cachexia Sarcopenia Muscle ; 12(4): 1056-1063, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34102017

RESUMO

BACKGROUND: There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). METHODS: A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2 peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. RESULTS: A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2 peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO2 , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO2 peak and DE and between the peak power output and DE (P < 0.001). CONCLUSIONS: Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO2 at each intensity. Resistance training should be considered during the early phase of rehabilitation.


Assuntos
COVID-19/fisiopatologia , Teste de Esforço/métodos , Exercício Físico/fisiologia , Pulmão/fisiopatologia , Consumo de Oxigênio/fisiologia , COVID-19/virologia , Cardiopatias/fisiopatologia , Humanos , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Treinamento de Força/métodos , Testes de Função Respiratória/métodos , SARS-CoV-2/fisiologia
11.
PLoS One ; 16(6): e0251783, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34111131

RESUMO

In this work, we aimed to develop an automatic algorithm for the quantification of total volume and lung impairments in four different diseases. The quantification was completely automatic based upon high resolution computed tomography exams. The algorithm was capable of measuring volume and differentiating pulmonary involvement including inflammatory process and fibrosis, emphysema, and ground-glass opacities. The algorithm classifies the percentage of each pulmonary involvement when compared to the entire lung volume. Our algorithm was applied to four different patients groups: no lung disease patients, patients diagnosed with SARS-CoV-2, patients with chronic obstructive pulmonary disease, and patients with paracoccidioidomycosis. The quantification results were compared with a semi-automatic algorithm previously validated. Results confirmed that the automatic approach has a good agreement with the semi-automatic. Bland-Altman (B&A) demonstrated a low dispersion when comparing total lung volume, and also when comparing each lung impairment individually. Linear regression adjustment achieved an R value of 0.81 when comparing total lung volume between both methods. Our approach provides a reliable quantification process for physicians, thus impairments measurements contributes to support prognostic decisions in important lung diseases including the infection of SARS-CoV-2.


Assuntos
Algoritmos , COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Paracoccidioidomicose/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , COVID-19/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos
12.
Expert Rev Clin Pharmacol ; 14(8): 1015-1027, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33957839

RESUMO

INTRODUCTION: The persistent inflammation that characterizes COPD and affects its natural course also impacting on symptoms has prompted research to find molecules that can regulate the inflammatory process but still available anti-inflammatory therapies provide little or no benefit in COPD patients. Consequently, numerous anti-inflammatory molecules that are effective in animal models of COPD have been or are being evaluated in humans. AREAS COVERED: In this article we describe several classes of drugs that target the cellular components of inflammation under clinical development for COPD. EXPERT OPINION: Although the results of many clinical trials with new molecules have often been disappointing, several studies are underway to investigate whether some of these molecules may be effective in treating specific subgroups of COPD patients. Indeed, the current perspective is to apply a more personalized treatment to the patient. This means being able to better define the patient's inflammatory state and treat it in a targeted manner. Unfortunately, the difficulty in translating encouraging experimental data into human clinical trials, the redundancy in the effects induced by signal-transmitting substances and the nonspecific effects of many classes that are undergoing clinical trials, do not yet allow specific inflammatory cell types to be targeted.


Assuntos
Anti-Inflamatórios/administração & dosagem , Inflamação/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Animais , Anti-Inflamatórios/farmacologia , Modelos Animais de Doenças , Desenvolvimento de Medicamentos , Humanos , Inflamação/fisiopatologia , Medicina de Precisão , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
13.
Medicine (Baltimore) ; 100(18): e25336, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950922

RESUMO

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is the fourth and third leading cause of death worldwide and in China, respectively. Sedentary behavior has been shown to increase the risk of respiratory disease, such as asthma. However, the relationship between sedentary behavior and COPD is unclear. This study aimed to investigate the association between sedentary behavior and COPD.Data was extracted from the 2018 a large-scale cross-sectional study of Chronic Disease and Lifestyle Population Survey in Sichuan Province of China, in which sedentary behavior and chronic diseases were self-reported according to medical records. The association between sedentary behavior on risk of COPD was estimated using multivariable regression model in non-matching cohorts and generalized propensity score-weighted (GPSW)cohorts, respectively, controlling for potential confounders.Individuals who remained sedentary for more than 7 hours per day were more likely to have COPD than the control group (<3 hours) both in conventional multivariate logistic regression analysis (OR = 2.020, 95%CI: 1.575-2.585, P < .001) and GPSW analysis (OR = 2.381, 95%CI: 1.778-3.188, P < .001). After GPSW and the sensitivity analysis using refined smoking variable further found a dose-effect between sedentary behavior and COPD, with 1.242 (95%CI: 1.006-1.532, P < .05) times risk of COPD in those sedentary behavior of more than 5 hours per day (GPSW) and 1.377 (95%CI: 1.092-1.736, P < .05) times risk in those sedentary behavior above 5 hours per day (sensitivity analysis), comparing with the control group.Sedentary behavior is independently associated with increased risk of COPD, adjusting for other confounders. The findings of this study have important implications for future research and public health guidance. Reducing sedentary time may have a significant role in COPD prevention.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Comportamento Sedentário , Adolescente , Adulto , Idoso , China/epidemiologia , Fatores de Confusão Epidemiológicos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
14.
Clin Immunol ; 227: 108754, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33964432

RESUMO

Recently, a continuous increase in environmental pollution has been observed. Despite wide-scale efforts to reduce air pollutant emissions, the problem is still relevant. Exposure to elevated levels of airborne particles increased the incidence of respiratory diseases. PM10 constitute the largest fraction of air pollutants, containing particles with a diameter of less than 10 µm, metals, pollens, mineral dust and remnant material from anthropogenic activity. The natural airway defensive mechanisms against inhaled material, such as mucus layer, ciliary clearance and macrophage phagocytic activity, may be insufficient for proper respiratory function. The epithelium layer can be disrupted by ongoing oxidative stress and inflammatory processes induced by exposure to large amounts of inhaled particles as well as promote the development and exacerbation of obstructive lung diseases. This review draws attention to the current state of knowledge about the physical features of PM10 and its impact on airway epithelial cells, and obstructive pulmonary diseases.


Assuntos
Asma/imunologia , Imunidade Inata/imunologia , Inflamação/imunologia , Estresse Oxidativo/imunologia , Material Particulado/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Mucosa Respiratória/imunologia , Poluentes Atmosféricos , Poluição do Ar , Poluição do Ar em Ambientes Fechados , Asma/metabolismo , Asma/fisiopatologia , Progressão da Doença , Células Epiteliais/metabolismo , Humanos , Inflamação/metabolismo , Padrões Moleculares Associados a Patógenos , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Receptores de Reconhecimento de Padrão/imunologia , Receptores de Reconhecimento de Padrão/metabolismo , Mucosa Respiratória/metabolismo , Mucosa Respiratória/fisiopatologia
15.
Am J Cardiol ; 150: 69-76, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34001343

RESUMO

Heart failure (HF) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are considered significant causes of morbidity and mortality worldwide. Concurrent presentation of HF with AECOPD can pose a diagnostic challenge due to an overlap in symptomatology. We queried the National Inpatient Sample (NIS) database to assess outcomes of HF hospitalizations with a secondary diagnosis of AECOPD. We performed a retrospective analysis of discharge data from the Healthcare Cost Utilization Project NIS between January 1, 2004, and December 31, 2014, with a primary diagnosis of HF with and without a secondary diagnosis of AECOPD. Data was abstracted from the NIS using International Classification of Disease 9 codes. Primary outcomes included mortality, length of stay, and inflation-adjusted cost of stay. During 2004-2014, a total of (n = 10,392,628) HF hospitalizations were identified without a secondary diagnosis of AECOPD while (n = 989,713) HF hospitalizations were identified with a secondary diagnosis of AECOPD. We identified higher mortality (3.25% vs 3.56%, p <0.001), length of stay (5.2 vs 6.1 days, p <0.001) and inflation-adjusted cost of stay (12,562 vs 13,072 USD, p <0.001) in HF hospitalizations with AECOPD when compared to HF without AECOPD from 2004 to 2014. We presented AECOPD as an independent predictor of mortality in patients admitted for HF. In conclusion, further interdisciplinary collaboration between pulmonologists and cardiologists is needed for the identification and stratification of patients who present with concurrent HF and COPD for better outcomes.


Assuntos
Insuficiência Cardíaca/complicações , Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Exacerbação dos Sintomas , Idoso , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/mortalidade , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Pacientes Internados , Tempo de Internação/estatística & dados numéricos , Masculino , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Respir Res ; 22(1): 164, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34051791

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients are at increased risk of poor outcome from Coronavirus disease (COVID-19). Early data suggest elevated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) receptor angiotensin converting enzyme 2 (ACE2) expression, but relationships to disease phenotype and downstream regulators of inflammation in the Renin-Angiotensin system (RAS) are unknown. We aimed to determine the relationship between RAS gene expression relevant to SARS-CoV-2 infection in the lung with disease characteristics in COPD, and the regulation of newly identified SARS-CoV-2 receptors and spike-cleaving proteases, important for SARS-CoV-2 infection. METHODS: We quantified gene expression using RNA sequencing of epithelial brushings and bronchial biopsies from 31 COPD and 37 control subjects. RESULTS: ACE2 gene expression (log2-fold change (FC)) was increased in COPD compared to ex-smoking (HV-ES) controls in epithelial brushings (0.25, p = 0.042) and bronchial biopsies (0.23, p = 0.050), and correlated with worse lung function (r = - 0.28, p = 0.0090). ACE2 was further increased in frequent exacerbators compared to infrequent exacerbators (0.51, p = 0.00045) and associated with use of ACE inhibitors (ACEi) (0.50, p = 0.0034), having cardiovascular disease (0.23, p = 0.048) or hypertension (0.34, p = 0.0089), and inhaled corticosteroid use in COPD subjects in bronchial biopsies (0.33, p = 0.049). Angiotensin II receptor type (AGTR)1 and 2 expression was decreased in COPD bronchial biopsies compared to HV-ES controls with log2FC of -0.26 (p = 0.033) and - 0.40, (p = 0.0010), respectively. However, the AGTR1:2 ratio was increased in COPD subjects compared with HV-ES controls, log2FC of 0.57 (p = 0.0051). Basigin, a newly identified potential SARS-CoV-2 receptor was also upregulated in both brushes, log2FC of 0.17 (p = 0.0040), and bronchial biopsies, (log2FC of 0.18 (p = 0.017), in COPD vs HV-ES. Transmembrane protease, serine (TMPRSS)2 was not differentially regulated between control and COPD. However, various other spike-cleaving proteases were, including TMPRSS4 and Cathepsin B, in both epithelial brushes (log2FC of 0.25 (p = 0.0012) and log2FC of 0.56 (p = 5.49E-06), respectively) and bronchial biopsies (log2FC of 0.49 (p = 0.00021) and log2FC of 0.246 (p = 0.028), respectively). CONCLUSION: This study identifies key differences in expression of genes related to susceptibility and aetiology of COVID-19 within the COPD lung. Further studies to understand the impact on clinical course of disease are now required.


Assuntos
COVID-19/genética , Pulmão/metabolismo , Doença Pulmonar Obstrutiva Crônica/genética , Transcriptoma , Idoso , Enzima de Conversão de Angiotensina 2/genética , Enzima de Conversão de Angiotensina 2/metabolismo , Basigina/genética , Basigina/metabolismo , COVID-19/diagnóstico , COVID-19/metabolismo , COVID-19/fisiopatologia , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Regulação da Expressão Gênica , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Receptor Tipo 1 de Angiotensina/genética , Receptor Tipo 1 de Angiotensina/metabolismo , Receptor Tipo 2 de Angiotensina/genética , Receptor Tipo 2 de Angiotensina/metabolismo , Capacidade Vital
17.
PLoS One ; 16(4): e0249263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831022

RESUMO

PURPOSE: Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control. METHODS: We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached. RESULTS: A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains. CONCLUSIONS: Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD. TRIAL REGISTRATION: This trial is registered in Clinical Trials.gov, ID number NCT01551953.


Assuntos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração , Tai Ji , Idoso , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
18.
Respiration ; 100(7): 594-599, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33878758

RESUMO

BACKGROUND AND OBJECTIVES: The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs). METHOD: 6MWDs of 64 patients with end-stage lung diseases wearing an oronasal surgical mask were retrospectively compared to previously investigated 6MWDs of the same cohort, in a pre-COVID-19 pandemic era, without wearing a mask. Four patients were excluded due to a primary vascular disease, 29 patients due to clinically unstable pulmonary functions, and 1 patient due to a psychiatric disorder. RESULTS: The median age of the patients included was 55 (46-58) years; 15 (48%) were male. Ten (32.2%) were on the Eurotransplant lung transplant waiting list with a median LAS of 34.3 (31.9-36.2). Twenty (64.5%) patients had chronic obstructive pulmonary diseases, 7 (22.6%) had interstitial lung diseases, and 4 (12.9%) had other end-stage lung diseases. The mean 6MWD without versus with wearing a mask was 306.9 (101.9) versus 305.7 (103.8) m, with a mean difference of -1.19 m (95% confidence interval -13.4 to 11.03). The observed difference is statistically equivalent to zero (p < 0.001). No significant differences in 6MWDs were observed between the clinical groups. CONCLUSION: Wearing an oronasal surgical mask did not affect the 6MWDs of patients with advanced lung diseases. Therefore, a masked 6MWT appears to provide a reliable examination of functional exercise capacity in this cohort.


Assuntos
COVID-19/prevenção & controle , Doenças Pulmonares Intersticiais/fisiopatologia , Máscaras , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Teste de Caminhada/métodos , Gasometria , Doença Crônica , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Pneumopatias/fisiopatologia , Pneumopatias/cirurgia , Doenças Pulmonares Intersticiais/cirurgia , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Pletismografia Total , Doença Pulmonar Obstrutiva Crônica/cirurgia , Reprodutibilidade dos Testes , Insuficiência Respiratória/cirurgia , Estudos Retrospectivos , SARS-CoV-2 , Capacidade Vital
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