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1.
JAMA ; 324(14): 1439-1450, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048152

RESUMO

Importance: The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear. Objective: To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses. Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020. Study Selection: Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded. Data Extraction and Synthesis: Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis. Main Outcomes and Measures: Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points). Results: Twenty-eight trials provided data on 13 664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n = 4068 patients), 11 of mixed disease (n = 8119), 4 of dementia (n = 1036), and 3 of chronic obstructive pulmonary disease (n = 441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n = 2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2 = 3%), less hospitalization (14 trials [n = 3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2 = 41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), -0.12; [95% CI, -0.20 to -0.03]; I2 = 0%; Edmonton Symptom Assessment Scale score mean difference, -1.6 [95% CI, -2.6 to -0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n = 1334]; SMD, 0.18 [95% CI, -0.24 to 0.61]; I2 = 87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, -6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n = 2204]; SMD, 0.07 [95% CI, -0.09 to 0.23]; I2 = 68%). Conclusions and Relevance: In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses.


Assuntos
Demência/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Cuidados Paliativos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Idoso , Viés , Doença Crônica , Demência/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Avaliação de Sintomas/estatística & dados numéricos
2.
Int J Mol Sci ; 21(17)2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32899381

RESUMO

Respiratory and pulmonary diseases are among the leading causes of death globally. Despite tremendous advancements, there are no effective pharmacological therapies capable of curing diseases such as COPD (chronic obstructive pulmonary disease), ARDS (acute respiratory distress syndrome), and COVID-19. Novel and innovative therapies such as advanced therapy medicinal products (ATMPs) are still in early development. However, they have exhibited significant potential preclinically and clinically. There are several longitudinal studies published, primarily focusing on the use of cell therapies for respiratory diseases due to their anti-inflammatory and reparative properties, thereby hinting that they have the capability of reducing mortality and improving the quality of life for patients. The primary objective of this paper is to set out a state of the art review on the use of aerosolized MSCs and their potential to treat these incurable diseases. This review will examine selected respiratory and pulmonary diseases, present an overview of the therapeutic potential of cell therapy and finally provide insight into potential routes of administration, with a focus on aerosol-mediated ATMP delivery.


Assuntos
Infecções por Coronavirus/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Animais , Humanos , Transplante de Células-Tronco Mesenquimais/instrumentação , Nebulizadores e Vaporizadores , Pandemias
3.
Respir Med ; 171: 106085, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32917356

RESUMO

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


Assuntos
Infecções por Coronavirus , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Infecções Respiratórias , Poluição do Ar/análise , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Distância Social , Exacerbação dos Sintomas
4.
Medicine (Baltimore) ; 99(37): e22134, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925765

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is an illness characterized by progressive aggravation of airflow limitation, which seriously affects patients' quality of life, and even life-threatening. The lung function of COPD patients is chronically and progressively deteriorated. Among them, the lung function of early COPD patients deteriorates rapidly, and forced expiratory volume in 1 second (FEV1) declines faster than other stages. If diagnosed early and effectively treated in time, it can greatly affect the prognosis. As a traditional exercise regimen, Baduanjin can improve lung function, exercise capacity, and quality of life of COPD patients. However, high-quality evidence-based medical evidence is so far be lacking to confirm the effectiveness of Baduanjin in reducing or preventing mild COPD lung function decline. METHODS: This study is a randomized controlled trial, 192 patients with mild COPD were randomly divided into experimental group and control group. Both of them will receive basic treatment (health education and Tiotropium bromide), the experimental group will receive Baduanjin exercise training, and the control group will be told to maintain the original lifestyle and control the exercise. The Baduanjin exercise will last for 24 weeks and will be followed up for 72 weeks. The primary outcome is the change in lung function, including FEV1, FEV1/forced vital capacity (FVC), and FEV1/predicted. The secondary results included COPD assessment test, 6-minute walk test, St. George Respiratory Questionnaire, and Dyspnea Scale. Safety will also serve as assessing during the test. DISCUSSION: The results of this trial will provide that traditional Baduanjin exercises can prevent COPD lung function deterioration, and provide a simple, inexpensive, and daily pulmonary rehabilitation measure for the patients with mild COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qigong/métodos , Tolerância ao Exercício , Humanos , Seleção de Pacientes , Qualidade de Vida , Testes de Função Respiratória , Tamanho da Amostra
5.
Praxis (Bern 1994) ; 109(12): 985-990, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933396

RESUMO

Physical and Clinical Aspects of Inhalation Therapy for Asthma and COPD Abstract. Inhalations form the basis of the medicinal treatment of respiratory diseases. In recent years, therapy has become more complex for patients, but also for medical professionals, as new systems have come onto the market. The knowledge required for this shall be conveyed in this article.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Terapia Respiratória , Administração por Inalação , Asma/terapia , Humanos , Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica/terapia
6.
Adv Respir Med ; 88(4): 364-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869273

RESUMO

There is increased evidence that the massive release of pro-inflammatory cytokines leading to the cytokine storm syndrome shapes the evolution of COVID-19 and is responsible of the severity of COVID-19 in some patients. A recent review argued that vitamin D deficiency could have increased the COVID-19 outbreak and suggested vitamin D supplementation as a preventive action. In fact, many factors seem to be correlated both to low vitamin D levels and the importance of COVID-19 spreading and severity. It is also important to highlight that the lockdown, implemented in many countries, prevents people to go out and then increases the risk of vitamin D deficiency. COPD patients are particularly at risk to have low levels of vitamin D due to multiple risk factors. COPD may generate a systemic inflammatory process responsible of secondary extra-pulmonary impairments. Vitamin D deficiency could sustain and aggravate the systemic inflammation associated to COPD. Reports have also shown that vitamin D deficiency was associated to exacerbations and hospital admissions, as well as lung function. Recent research showed that vitamin D supplementation significantly reduced COPD exacerbations. Although vitamin D deficiency was not proved to be neither a risk factor of COVID-19, nor a determinant of its severity, vitamin D supplementation represents a preventive perspective that needs to be further studied.


Assuntos
Colecalciferol/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Suplementos Nutricionais/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pneumonia Viral/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Deficiência de Vitamina D/prevenção & controle
7.
Ther Adv Respir Dis ; 14: 1753466620951053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32873175

RESUMO

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


Assuntos
Adenocarcinoma de Pulmão/complicações , Infecções por Coronavirus/tratamento farmacológico , Doxiciclina/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/complicações , Sarcoidose Pulmonar/complicações , Adenocarcinoma de Pulmão/diagnóstico , Adenocarcinoma de Pulmão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Medição de Risco , Amostragem , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/terapia , Resultado do Tratamento
8.
COPD ; 17(5): 601-617, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32892650

RESUMO

COPD is a major cause of morbidity and mortality worldwide and carries a huge and growing economic and social burden. Telemedicine might allow the care of patients with limited access to health services and improve their self-management. During the COVID-19 pandemic, patient's safety represents one of the main reasons why we might use these tools to manage our patients. The authors conducted a literature search in MEDLINE database. The retrieval form of the Medical Subject Headings (Mesh) was ((Telemedicine OR Tele-rehabilitation OR Telemonitoring OR mHealth OR Ehealth OR Telehealth) AND COPD). We only included systematic reviews, reviews, meta-analysis, clinical trials and randomized-control trials, in the English language, with the selected search items in title or abstract, and published from January 1st 2015 to 31st May 2020 (n = 56). There was a positive tendency toward benefits in tele-rehabilitation, health-education and self-management, early detection of COPD exacerbations, psychosocial support and smoking cessation, but the heterogeneity of clinical trials and reviews limits the extent to which this value can be understood. Telemonitoring interventions and cost-effectiveness had contradictory results. The literature on teleconsultation was scarce during this period. The non-inferiority tendency of telemedicine programmes comparing to conventional COPD management seems an opportunity to deliver quality healthcare to COPD patients, with a guarantee of patient's safety, especially during the COVID-19 outbreak.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Telemedicina/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Autogestão
9.
Med Sci Monit ; 26: e927212, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32883943

RESUMO

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


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Distribuição por Idade , Idoso , Biomarcadores , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Cuidados Críticos , Diabetes Mellitus/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Respiração Artificial , Distribuição por Sexo , Sobreviventes , Resultado do Tratamento
10.
Monaldi Arch Chest Dis ; 90(4)2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32960000

RESUMO

Patients of chronic obstructive pulmonary disease (COPD) during COVID-19 pandemic have higher morbidity. Treatment of these patients require aerosolization procedures like nebulization and noninvasive modalities for ventilation like non-invasive ventilation (NIV) and high flow nasal cannula (HFNC). Role of these procedures in corona virus transmission when treating a case of acute exacerbation of chronic obstructive pulmonary disease should be further studied.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Hospitalização , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Cânula , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Progressão da Doença , Humanos , Ventilação não Invasiva , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
11.
BMC Fam Pract ; 21(1): 203, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988371

RESUMO

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


Assuntos
Infecções por Coronavirus , Educação a Distância/métodos , Educação Médica Continuada , Clínicos Gerais/educação , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Ensino , Atitude do Pessoal de Saúde , Bangladesh/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Instrução por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/organização & administração , Educação Médica Continuada/tendências , Estudos de Viabilidade , Humanos , Modelos Educacionais , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Ensino/normas , Ensino/tendências
12.
N Z Med J ; 133(1522): 30-41, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994614

RESUMO

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


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia Respiratória/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
13.
N Engl J Med ; 383(12): 1129-1138, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32937046

RESUMO

BACKGROUND: Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain. METHODS: We designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population. RESULTS: Recruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, -3.0 percentage points; 95% confidence interval, -15.1 to 9.1). CONCLUSIONS: Our underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628.).


Assuntos
Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Progressão da Doença , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hipóxia/terapia , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Cooperação do Paciente , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia
14.
Medicine (Baltimore) ; 99(30): e21302, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791715

RESUMO

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


Assuntos
Coração/fisiologia , Pulmão/metabolismo , Moxibustão/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Espectrofotometria Infravermelho/métodos , Pontos de Acupuntura , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Humanos , Masculino , Meridianos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Oxigênio/metabolismo , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Sensibilidade e Especificidade
15.
Pflege ; 33(4): 237-245, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32811328

RESUMO

Health behaviours and needs of people with COPD during COVID-19 pandemic: a document analysis Abstract. Background: The government's guidelines affected people with COPD on different levels during the COVID-19 pandemic. In addition to belonging to a group of particularly vulnerable persons, they had to adapt their health behaviours, in particular physical activity, to recommendations provided in order to prevent negative effects on disease progression. There is little knowledge regarding how this group of patients coped with these challenges during the COVID-19 pandemic. OBJECTIVE: To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out. METHODS: A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically. RESULTS: The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments. CONCLUSION: The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Autocuidado/psicologia , Adaptação Psicológica , Comportamentos Relacionados com a Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/enfermagem
16.
BMC Infect Dis ; 20(1): 600, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795251

RESUMO

BACKGROUND: BK virus-associated nephropathy (BKVAN) is a relatively common cause of renal dysfunction in the first six months after renal transplantation. It arises from reactivation of the latent and usually harmless BK virus (BK virus) due to immunosuppression and other factors including some that are unique to renal transplantation such as allograft injury. BKVAN is much rarer in non-renal solid organ transplantation, where data regarding diagnosis and management are extremely limited. CASE PRESENTATION: We report a case of a 58-year-old man found to have worsening renal dysfunction nine months after bilateral sequential lung transplantation for chronic obstructive pulmonary disease (COPD). He had required methylprednisolone for acute allograft rejection but achieved good graft function. Urine microscopy and culture and renal ultrasound were normal. BK virus PCR was positive at high levels in urine and blood. Renal biopsy subsequently confirmed BKVAN. The patient progressed to end-stage renal failure requiring haemodialysis despite reduction in immunosuppression, including switching mycophenolate for everolimus, and the administration of intravenous immunoglobulin (IVIG). CONCLUSIONS: This very rare case highlights the challenges presented by BK virus in the non-renal solid organ transplant population. Diagnosis can be difficult, especially given the heterogeneity with which BKV disease has been reported to present in such patients, and the optimal approach to management is unknown. Balancing reduction in immunosuppression against prevention of allograft rejection is delicate. Improved therapeutic options are clearly required.


Assuntos
Transplante de Pulmão , Infecções por Polyomavirus/diagnóstico , Infecções Tumorais por Vírus/diagnóstico , Vírus BK/genética , Vírus BK/isolamento & purificação , DNA Viral/metabolismo , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Pulmão/efeitos adversos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Infecções por Polyomavirus/virologia , Doença Pulmonar Obstrutiva Crônica/terapia , Infecções Tumorais por Vírus/virologia
17.
Praxis (Bern 1994) ; 109(10): 788-793, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32752963

RESUMO

Implementing Chronic Care for Patients with COPD in Switzerland Abstract. Effective COPD disease management needs an approach that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems, where patient counseling, coordination and standardization of care are key components. This article reports about COPD chronic care approaches in Switzerland.


Assuntos
Assistência de Longa Duração , Doença Pulmonar Obstrutiva Crônica , Assistência à Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Suíça
18.
Crit Care ; 24(1): 489, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762701

RESUMO

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent post-extubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. METHODS: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). RESULTS: Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group-risk difference of - 5.8% (95% CI, - 23.8-12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of - 50.0% (95% CI, - 74.6 to - 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p < 0.050). Twenty-four hours after extubation, the respiratory rate of the HFNC group had returned to baseline, but the NIV group was still higher than the baseline. Forty-eight hours after extubation, the respiratory rates of both groups were not significantly different from the baseline. The average number of daily airway care interventions in the NIV group was 7 (5-9.3), which was significantly higher than 6 (4-7) times in the HFNC group (p = 0.006). The comfort score and incidence of nasal and facial skin breakdown of the HFNC group was also significantly better than that of the NIV group [7 (6-8) vs 5 (4-7), P < 0.001] and [0 vs 9.6%, p = 0.027], respectively. CONCLUSION: Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC after extubation did not result in increased rates of treatment failure compared with NIV. HFNC also had better tolerance and comfort than NIV. TRIAL REGISTRATION: chictr.org ( ChiCTR1800018530 ). Registered on 22 September 2018, http://www.chictr.org.cn/usercenter.aspx.


Assuntos
Extubação , Cânula , Ventilação de Alta Frequência/métodos , Ventilação não Invasiva , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Feminino , Humanos , Masculino , Insuficiência Respiratória/prevenção & controle , Falha de Tratamento
19.
Crit Care ; 24(1): 490, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32768001

RESUMO

BACKGROUND: With recent advances in technology, patients with acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (ae-COPD) could benefit from extracorporeal CO2 removal (ECCO2R). However, current evidence in these indications is limited. A European ECCO2R Expert Round Table Meeting was convened to further explore the potential for this treatment approach. METHODS: A modified Delphi-based method was used to collate European experts' views to better understand how ECCO2R therapy is applied, identify how patients are selected and how treatment decisions are made, as well as to identify any points of consensus. RESULTS: Fourteen participants were selected based on known clinical expertise in critical care and in providing respiratory support with ECCO2R or extracorporeal membrane oxygenation. ARDS was considered the primary indication for ECCO2R therapy (n = 7), while 3 participants considered ae-COPD the primary indication. The group agreed that the primary treatment goal of ECCO2R therapy in patients with ARDS was to apply ultra-protective lung ventilation via managing CO2 levels. Driving pressure (≥ 14 cmH2O) followed by plateau pressure (Pplat; ≥ 25 cmH2O) was considered the most important criteria for ECCO2R initiation. Key treatment targets for patients with ARDS undergoing ECCO2R included pH (> 7.30), respiratory rate (< 25 or < 20 breaths/min), driving pressure (< 14 cmH2O) and Pplat (< 25 cmH2O). In ae-COPD, there was consensus that, in patients at risk of non-invasive ventilation (NIV) failure, no decrease in PaCO2 and no decrease in respiratory rate were key criteria for initiating ECCO2R therapy. Key treatment targets in ae-COPD were patient comfort, pH (> 7.30-7.35), respiratory rate (< 20-25 breaths/min), decrease of PaCO2 (by 10-20%), weaning from NIV, decrease in HCO3- and maintaining haemodynamic stability. Consensus was reached on weaning protocols for both indications. Anticoagulation with intravenous unfractionated heparin was the strategy preferred by the group. CONCLUSIONS: Insights from this group of experienced physicians suggest that ECCO2R therapy may be an effective supportive treatment for adults with ARDS or ae-COPD. Further evidence from randomised clinical trials and/or high-quality prospective studies is needed to better guide decision making.


Assuntos
Dióxido de Carbono/sangue , Circulação Extracorpórea/métodos , Unidades de Terapia Intensiva , Doença Pulmonar Obstrutiva Crônica/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Consenso , Técnica Delfos , Europa (Continente) , Humanos
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1009-1013, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741162

RESUMO

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


Assuntos
Vigilância da População , Doença Pulmonar Obstrutiva Crônica , Adulto , China/epidemiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Espirometria
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