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1.
Rev Med Suisse ; 15(671): 2087-2089, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742939

RESUMO

Overlap syndrome (OVS) is defined by the co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a same patient. This condition is associated with increased mortality and a higher risk of respiratory exacerbation, compared to patients with COPD or OSA alone. Nocturnal positive PAP treatment is effective to mitigate the additional risk related to OSA. Identification of OVS is a major challenge for clinicians because of the many phenotypes of OVS patients, with atypical OSA presentation, whose sleep quality is already impacted by COPD itself. Dedicated prospective studies are mandatory to improve our understanding of OVS patients and to optimize their medical care.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Apneia Obstrutiva do Sono/complicações , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Apneia Obstrutiva do Sono/terapia
2.
Medicine (Baltimore) ; 98(38): e17291, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568014

RESUMO

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a clinically common chronic disease with the characteristic of recurrent attacks, difficulty of cure and high morbidity, disability, death rates. COPD exerts a great burden on patients, families and society. Acupoint Autohemotherapy (AA) is a traditional Chinese medicine (TCM) treatment by taking the patient's own venous blood and injecting them at acupoints, combined with the continuous stimulation of blood and the specific efficacy of the acupoint itself. It has been proved to be useful in pulmonary treatment and rehabilitation of COPD patients. However, the efficacy of AA on COPD patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of AA for COPD patients. METHODS: Data from all English and Chinese databases, including Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database and Chongqing VIP information, will be used to conduct a systematic and comprehensive literature search. The range of date is from inception to July 2019. Randomized controlled trials (RCTs) related to AA and western medicine in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilized to assess the quality of evidence. RESULTS: This systematic review and meta-analysis aims to summarize the direct and indirect outcomes for AA and western medicine on COPD patients and evaluate its efficacy and safety. The results will be submitted to a peer-reviewed journal once completed. CONCLUSION: The systematic review will provide evidence to assess the efficacy and safety of AA and western medicine in the treatment of COPD patients. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019137189.


Assuntos
Pontos de Acupuntura , Transfusão de Sangue Autóloga/métodos , Medicina Tradicional Chinesa/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Transfusão de Sangue Autóloga/efeitos adversos , Humanos , Medicina Tradicional Chinesa/efeitos adversos , Resultado do Tratamento
3.
JAMA ; 322(14): 1371-1380, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31593271

RESUMO

Importance: Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life. Objective: To evaluate whether a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers can improve outcomes. Design, Setting, and Participants: Single-site randomized clinical trial conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. Interventions: The intervention (n = 120) involved a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by nurses with special training on supporting patients with COPD using standardized tools. Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. Main Outcomes and Measures: The primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). Results: Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; 61.7% women), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 62.3 (18.8) in the intervention group and 63.6 (17.4) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 1.40 (95% CI, 1.01-1.79) in the intervention group vs 0.72 (95% CI, 0.45-0.97) in the usual care group (difference, 0.68 [95% CI, 0.22-1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was 2.81 in the intervention group and -2.69 in the usual care group (adjusted difference, 5.18 [95% CI, -2.15 to 12.51]; P = .11). During the study period, there were 15 deaths (intervention: 8; usual care: 7) and 339 hospitalizations (intervention: 202; usual care: 137). Conclusions and Relevance: In a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly greater COPD-related hospitalizations and emergency department visits, without improvement in quality of life. Further research is needed to determine reasons for this unanticipated finding. Trial Registration: ClinicalTrials.gov Identifier: NCT02036294.


Assuntos
Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Autogestão , Cuidado Transicional , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos
4.
Medicine (Baltimore) ; 98(38): e17241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567989

RESUMO

BACKGROUND: Previous studies have reported that physical therapy (PT) can be used for the treatment of chronic obstructive pulmonary disease (COPD). However, its effectiveness is still inconclusive. This systematic review will aim to assess its effectiveness and safety for the treatment of patients with COPD. METHODS: All randomized controlled trials (RCTs) literatures of PT for COPD will be searched from the databases of Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDILINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to the present without any language restrictions. Two reviewers will independently perform the study selection, data extraction, and methodological quality assessment. A third reviewer will be invited to resolve any disagreements occurred between 2 reviewers. RESULTS: The primary outcome is lung function. The secondary outcomes include symptoms, health-related quality of life, mortality, and adverse events. The outcome data will be pooled by using the models of random-effects or fixed-effects according to the detected heterogeneity. CONCLUSION: The findings of this study will provide up-todated summary evidence for assessing the effectiveness and safety of PT for COPD.


Assuntos
Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Zhongguo Zhen Jiu ; 39(9): 918-22, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31544376

RESUMO

OBJECTIVE: To verify the effect of warm acupuncture combined with western medicine in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) with phlegm-turbid obstructing of the lung. METHODS: Ninety patients with AECOPD were randomly divided into a western medicine group, a warm acupuncture group and a sham acupuncture group, 30 cases in each group. Routine treatment according to the Global initiative for chronic obstructive lung disease (GOLD) guidelines was used in the western medicine group. On the basis of the routine treatment, the warm acupuncture was applied at Fenglong (ST 40), Feishu (BL 13), Zusanli (ST 36) and other acupoints in the warm acupuncture group. In the sham acupuncture group, non-acupoints were taken on the basis of conventional treatment, and superficial acupuncture was performed for 1-3 mm, once a day for 2 weeks. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, cough and sputum assessment questionnaire (CASA), COPD assessment test (CAT), and the change of TCM syndrome score were observed before and after treatment in all groups. RESULTS: After treatment, the FEV1, FVC and FEV1/FVC in each group were higher than those before treatment (P<0.05), there was no significant difference among groups after treatment (P>0.05). The CASA score, CAT score and TCM syndrome score in each group were lower than those before treatment (P<0.05). The change of the scores before and after treatment in the warm acupuncture group was higher than that in the sham acupuncture group and the western medicine group (P<0.05). There was no significant difference between the sham acupuncture group and the western medicine group (P>0.05). CONCLUSION: Warm acupuncture has a significant effect on the improvement of symptoms in patients with AECOPD with phlegm-turbid obstructing of the lung.


Assuntos
Terapia por Acupuntura , Doença Pulmonar Obstrutiva Crônica , Pontos de Acupuntura , Volume Expiratório Forçado , Humanos , Pulmão , Doença Pulmonar Obstrutiva Crônica/terapia
6.
Medicine (Baltimore) ; 98(37): e17112, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517846

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increasing morbidity and mortality that cause huge social and economic loss. Although recommended by guidelines, pulmonary rehabilitation has not been widely applied in clinics because of its inherent limitations. Acupuncture therapy (AT) as one of the most popular treatments in traditional Chinese medicine has been used to treat COPD. We aim to evaluate the safety and efficacy of acupuncture in the treatment of COPD. METHODS: Web of science, PubMed, Springer, Medline, Cochrane Library, EBASE, WHO International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure Database (CNKI), Wan Fang Database, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database will be searched from their inception to May 10, 2019. Randomized controlled trials that evaluated the safety and efficacy of acupuncture for the treatment on patients with COPD will be included. The primary outcome measures will include Dyspnea scores, lung function and blood eosinophils. The secondary outcome measures will include St George's Respiratory Questionnaire and 6-minute walk distance. Study selection, data extraction, and risk of bias assessment will be independently undertaken, respectively. Statistical analysis will be conducted by RevMan software (version 5.3). RESULTS: This study will provide high-quality synthesis based on current evidence of acupuncture treatment for COPD in several aspects, including symptom score, quality of life score, side effects and laboratory examination, such as lung function text, blood eosinophils (EOS) etc. CONCLUSION:: The results of this study will provide updated evidence for weather acupuncture is an effective and safe intervention for COPD. ETHICS AND DISSEMINATION: It is not necessary for this systematic review to acquire an ethical approval. This review will be disseminated in a peer-reviewed journal or conference presentation. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019136087.


Assuntos
Terapia por Acupuntura/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia por Acupuntura/métodos , Humanos , Segurança do Paciente/normas , Qualidade de Vida/psicologia , Inquéritos e Questionários
7.
Praxis (Bern 1994) ; 108(11): 737-740, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480963

RESUMO

Long-Term Non-Invasive Ventilation for Chronic Respiratory Failure Abstract. Non-invasive long-term ventilation (NIV) may be helpful for selected patients with severe COPD and chronic respiratory lailure (chronic hypercapnia and hypoxemia). The patient described in the case report became normocapnic under long-term NIV and both her sleep and quality of life improved significantly. She also suffered fewer COPD exacerbations and was better able to cope with them herself with the help of NIV.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Feminino , Humanos , Hipercapnia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Insuficiência Respiratória/terapia
9.
Tuberk Toraks ; 67(2): 83-91, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414638

RESUMO

Introduction: The goals of chronic obstructive pulmonary disease (COPD) treatment are to relieve dyspnea, increase exercise capacity, and improve quality of life. The relation of exercise capacity, dyspnea level, and quality of life with long-term mortality is unclear. Aim of the study was to assess the effect of exercise capacity, dyspnea level and quality of life on long-term mortality risk in patients with COPD. Materials and Methods: Dyspnea level was assessed using the modified Medical Research Council (mMRC), Borg and Baseline Dyspnea Index (BDI) and Body Obstruction Dyspnea Exercise (BODE), health-related quality of life with St. George's Respiratory Questionnaire, and exercise capacity with the 6-minute walking test (6MWT) and cardiopulmonary exercise test. At the end of 8-year follow-up period, the relation between these tests and mortality was examined. Result: A total of 42 patients with stable COPD were included in the study. Sixteen patients died during the approximately 8-year follow-up period. Univariate analysis revealed that VO2 peak [HR: 1.845; CI: (1.336-2.55); p<0.001], BODE index [HR: 0.787; CI: (0.703-0.880); p<0.001], and SGRQ [HR: 1.073; CI: (1.028-1.119); p= 0.001] were significantly correlated to mortality risk. Multivariate Cox regression analysis revealed VO2 peak [HR: 1.031; CI: (0.683-1.120); p= 0.01] as the single significant predictor of mortality. VO2 peak less than 22.5 had a sensitivity of 82%, specificity of 80%, and area under the curve of 0.142 [95% CI: (0.027-0.257); p< 0.001] for mortality risk with ROC analysis. Conclusions: Cardiopulmonary disturbances during maximal exercise may be an important indicator of mortality risk.


Assuntos
Dispneia/fisiopatologia , Tolerância ao Exercício/fisiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Idoso , Análise de Variância , Exercício , Teste de Esforço , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Curva ROC , Sensibilidade e Especificidade , Inquéritos e Questionários
10.
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
11.
J Bras Pneumol ; 45(3): e20180314, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271604

RESUMO

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.


Assuntos
Doenças Respiratórias/etiologia , Doenças Respiratórias/terapia , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Tabagismo/complicações , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Tabagismo/terapia , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/terapia
12.
Medicine (Baltimore) ; 98(30): e16633, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348315

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that represents an important public health challenge nowadays. Despite the growing number of studies assessing the rehabilitation outcome of Wuqinxi for COPD, their many variables and observations are often explored with a relatively small sample size, accordingly maybe lead to potential false-positive results. The aim of this systematic review and meta-analysis is to evaluate the rehabilitation efficacy of Wuqinxi for COPD. METHODS: A detailed search for articles up to June 2019 will be performed to identify randomized controlled trials for Wuqinxi in COPD. The following database will be used: PUBMED, Embase, Scopus, Web of Science, Google Scholar, Cochrane Library, Sino Med, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, and Wanfang Database. Grey literature will be explored and the selection of studies, data extraction and validation will performed independently by 2 reviewers using predefined selection criteria and quality indicators. Stata V.13.0 and Review manager 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence. RESULTS: This research will update previous evidence summaries and provide a quantitative and standardized assessment of the rehabilitation efficacy of Wuqinxi for COPD. CONCLUSION: This systematic review will generate the latest evidence for determining whether Wuqinxi has a positive rehabilitation effect for COPD.PROSPERO registration number: PROSPERO CRD 42019120960.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Qigong/métodos , Humanos , Projetos de Pesquisa
13.
Medicine (Baltimore) ; 98(26): e16097, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261524

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increasing morbidity and mortality that cause huge social and economic loss. Although recommended by guidelines, pulmonary rehabilitation has not been widely applied in clinics because of its inherent limitations. Free from restrictions of specific training venues and equipment, Tai Chi, as a kind of pulmonary rehabilitation, has been used to cure the COPD, yet the efficacy and safety of Tai Chi remains to be assessed. In this study, we aim to draw up a protocol for systematic review to evaluate the efficacy and safety of Tai Chi for COPD. METHODS: We will search the following electronic databases from inception to December 31, 2018: PubMed, Web of Science, Medline, Cochrane Central Register of Controlled Trials, Springer, EMBASE, the China National Knowledge Infrastructure Database, Wan Fang Database, the Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Clinical trial registrations, potential gray literatures, relevant conference abstracts and reference list of identified studies will also be searched. The literature selection, data extraction, and quality assessment will be completed by 2 independent authors. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. Changes in lung function will be evaluated as the primary outcome. Symptom assessment, quality of life (SGRQ), medication usage, exacerbations, and adverse events will be assessed as the secondary outcomes. The RevMan V.5.3.5 will be used for Meta-analysis. RESULTS: This study will provide a synthesis of current evidence of Tai Chi for COPD from several aspects, such as lung function, SGRQ, medication usage, exacerbations, and adverse events. CONCLUSION: The conclusion of our study will provide updated evidence to judge whether Tai Chi is an effective solution to COPD patients. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019122791.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Revisão Sistemática como Assunto , Tai Ji , Humanos , Projetos de Pesquisa
14.
Br J Nurs ; 28(14): 912-917, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31348713

RESUMO

Two landmark studies demonstrated survival benefit in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxaemia with the prescription of long-term oxygen therapy (LTOT). Best practice evidence therefore recommends that individuals with stable COPD and resting hypoxaemia (PaO2≤7.3 kPa) should be assessed for long-term oxygen therapy. However, it is estimated that up to one-quarter of COPD patients prescribed LTOT continue to smoke. Oxygen therapy consequently presents an obvious fire hazard in the case of such patients, who are therefore at greater risk of death or sustaining devastating head and neck burns. This article critically analyses, through the context of a care study, the professional, ethical and legal issues involved in making a safe prescribing decision for LTOT in an individual with COPD who is a current smoker. Home oxygen prescription is a growing trend in the COPD population, and it is important for nurse prescribers to be aware of the issues highlighted in the article to ensure safe prescribing practices.


Assuntos
Serviços de Assistência Domiciliar , Oxigenoterapia/enfermagem , Prescrições/enfermagem , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Oxigenoterapia/efeitos adversos , Segurança do Paciente , Doença Pulmonar Obstrutiva Crônica/enfermagem , Fumantes
15.
Rev Esp Salud Publica ; 932019 Jul 18.
Artigo em Espanhol | MEDLINE | ID: mdl-31309932

RESUMO

OBJECTIVE: World Health Organization deem Chronic Obstructive Pulmonary Disease as the fourth leading cause of death in the world. Because of its impact on Public Health, it represents a great burden from an international economic point of view, despite it is an avoidable and treatable disease. Hence it is suitable to use Clinical Practice Guidelines which are recommendations systematically developed to aid decision making about health care to improve quality, and they must be subject to a review and update of an enriching methodological rigor. There is currently many Clinical Practice Guidelines for Chronic Obstructive Pulmonary Disease but there is insufficient evidence to determine if they have the degree of methological quality for been used in clinical practice. For which, we have evaluated the quality of these Clinical Practice Guidelines in Spanish using the AGREE II instrument. METHODS: We carried out a systematic search to find the Clinical Practice Guidelines for Chronic Obstructive Pulmonary Disease published in Spanish between 2010-2017 and put a quality evaluation into effect by means of AGREE II instrument. RESULTS: We got six guidelines wich achieved inclusion criteria of the study and we draw the compliance of the domains in these guidelines by means of AGREE II instrument: Scope and purpose (55.56-92.59%), Stakeholder involvement (37.04-79.63%), Rigour of development (29.86-84.72%), Clarity of presentation (90.74-100%), Applicability (5.56-63.89%) and Editorial independence (5.56-94.44%). CONCLUSIONS: Only one guideline got the score to classify as Very Good Fulfilling/Very Hight Score; another four got Good Fulfilling/Hight Score; and last one got Low Fulfilling/Low Score.


Assuntos
Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologia/normas , Qualidade da Assistência à Saúde , Tomada de Decisões , Humanos , Saúde Pública , Garantia da Qualidade dos Cuidados de Saúde , Reprodutibilidade dos Testes , Espanha , Inquéritos e Questionários
18.
Rev. esp. patol. torac ; 31(2): 113-123, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183652

RESUMO

Objetivo: comprobar el efecto beneficioso sobre la capacidad de esfuerzo de un programa de entrenamiento al ejercicio combinado (RR) con tratamiento de ventilación mecánica no invasiva (VMNI), frente a cada uno de ellos de forma aislada, en pacientes con síndrome overlap EPOC-SAHS. Método: estudio analítico experimental en el que los pacientes se incluyeron de forma prospectiva y con asignación aleatoria a seguir la terapia habitual con VMNI o formar parte del grupo en programa RR. Un tercer grupo tuvo las dos intervenciones; RR y VMNI. Se estudió la repercusión sobre el tiempo de resistencia (test de ejercicio submáximo) y la distancia recorrida (prueba de paseo de los 6 minutos). Se midió también repercusión sobre síntomas medidos con mMRC y CRDQ así como el intercambio gaseoso. Se analizaron parámetros inflamatorios como IL6, IL8, PCR y TNF. Resultados: se analizaron un total de 30 pacientes distribuidos de forma homogénea en los 3 brazos del estudio. Los pacientes sometidos a RR, tanto de forma aislada como combinada con VMNI obtuvieron una mejoría en el tiempo de endurance (grupo RR 8,89 min pre, 25,9 min post, p = 0,008; grupo RRVMNI 6,8 min pre, 12,2 min post, p= 0,03) mientras que sólo el grupo sometido a VMNI-RR obtuvo mejoría estadísticamente significativa en el T6MM (282 m pre, 323 m post, p = 0,017). Los tres grupos obtuvieron mejoría en los cuestionarios de calidad de vida medidos por el CRDQ mientras que sólo el grupo sometido a VNI y el grupo mixto obtuvieron mejoría en la mMRC. En cuanto a parámetros gasométricos, sólo el grupo mixto obtuvo mejoría en los niveles de pCO2 (56 mmHg pre, 48 mmHg post, p = 0,02). No hubo mejorías estadísticamente significativas en cuanto a la evolución de parámetros inflamatorios. Conclusiones: este trabajo demuestra el efecto beneficioso sobre la capacidad de esfuerzo de un programa de entrenamiento al ejercicio combinado con tratamiento de VMNI, frente a cada uno de ellos de forma aislada, en pacientes con síndrome overlap


Objective: To compare the beneficial effect of an exercise training program (RR) combined with non-invasive mechanical ventilation (NIMV) on effort capacity, compared to each treatment separately, in patients with COPD-SAHS overlap syndrome. Methods: An experimental analytical study in which patients were prospectively included and randomly assigned to receive habitual NIMV therapy or form a part of the RR program group. A third group underwent both RR and NIMV treatments. The effects on endurance time (submaximal exercise test) and distance covered (6-minute walk test) were studied. The effect on symptoms measured with mMRC and CRDQ as well as gas exchange were also studied. Inflammatory parameters like IL6, IL8, CRP and TNF were analyzed. Results: A total of 30 patients homogeneously distributed between the three arms of the study were analyzed. Patients who underwent RR, both alone and in combination with NIMV, showed an improvement in endurance time (RR group: 8.89 min pre, 25.9 min post, p = 0.008; RR-NIMV group: 6.8 min pre, 12.2 min post, p = 0.03) while only the group undergoing RR-NIMV showed statistically significant improvement in the 6MWT (282 m pre, 323 m post, p = 0.017). All three groups showed improvement with regard to quality of life measured by the CRDQ while only the group undergoing NIMV and the mixed group showed improvement in the mMRC. With regard to gasometric parameters, only the mixed group showed improvement in pCO2 levels (56 mmHg pre, 48 mmHg post, p = 0.02). There were no statistically significant improvements with regard to the evolution of inflammatory parameters. Conclusions: This study shows the beneficial effect of an exercise training program combined with NIMV treatment on effort capacity, compared to each treatment separately, in patients with COPD-SAHS overlap syndrome


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia por Exercício/métodos , Síndromes da Apneia do Sono/terapia , Respiração Artificial/métodos , Estudos Prospectivos , Inquéritos e Questionários , Qualidade de Vida
19.
Rev. esp. patol. torac ; 31(2): 124-131, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183653

RESUMO

Objetivo: determinar si la lectura del software de equipos de ventilación no invasiva (VMNI) domiciliaria puede predecir una exacerbación mediante la evaluación de los siguientes parámetros: frecuencia respiratoria, número de respiraciones activadas por el paciente, fuga y cumplimiento. Metodología: estudio prospectivo observacional en el que se compararon variables del software del ventilador en pacientes ventilados en domicilio. Se detectaron las exacerbaciones que requirieron ingreso hospitalario por acidosis respiratoria y se compararon las variables recogidas en este grupo de pacientes en situación estable y en los 10 días previos al ingreso. Resultados: se analizaron 43 pacientes (18 con diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) y 25 con síndrome de obesidad-hipoventilación (SOH)). No se encontraron diferencias significativas en los parámetros estudiados en situación estable al comparar los pacientes que no ingresaron con los pacientes que precisaron un ingreso posteriormente. La tasa de exacerbación global fue de 32,55% (el 44% de los pacientes diagnosticados de EPOC y el 24% del total de los pacientes con SOH) Al comparar las variables del software en los pacientes exacerbados, en situación estable y previas al ingreso, encontramos diferencias significativas (p = 0,017) en la frecuencia respiratoria, que se mostró más elevada previo a la exacerbación, con una diferencia entre medianas de 2 (0,75 - 3,5). Respecto a las respiraciones activadas, no se encontró una significación estadística, aunque sí una tendencia a la significación (p = 0,055), de forma que existía un mayor porcentaje de respiraciones activadas por el paciente previo a la exacerbación, con una diferencia entre medianas de 8 (-1- 21). Conclusiones: el estudio de variables asociadas a la monitorización de la VMNI domiciliaria puede ser útil como predictor de exacerbaciones. En nuestro caso la frecuencia respiratoria fue la más sensible mostrando un aumento previo al ingreso hospitalario


Objective: to determine if the readings from the built-in software (BIS) used in non-invasive ventilation (NIV) at home can predict an exacerbation by evaluating of parameters like respiratory rate, percentage of respiratory cycles triggered by the patient, leaks and daily use. Method: an observational prospective study comparing the variables of the BIS obtained from patients using NIV at home. Exacerbations that required hospitalization for respiratory acidosis were detected, and the variables collected in this group of patients in a stable situation were compared with the variables collected 10 days prior to admission. Results: we analyzed 43 patients (18 with chronic obstructive pulmonary disease (COPD) and 25 with obesityhypoventilation syndrome (OHS)). There were no significant differences in the parameters studied in stable situation when we compared patients who did not need an admission with patients who required admission later. The overall exacerbation rate was 32.55% (44% of patients diagnosed with COPD and 24% of patients diagnosed with SOH). When comparing the software variables in the exacerbated patients, both in a stable situation and prior to admission, we found significant differences (p= 0.017) in the respiratory rate, which was higher prior to the exacerbation, presenting a difference between medians of 2 (0.75 - 3.5). Regarding respiratory cycles triggered by the patient no statistical significance was found, although a trend towards statistical significance was found (p = 0.055), so that there was a higher percentage of respirtory cycles triggered by the patient prior to exacerbation, presenting a difference between medians of 8 (-1 - 21). Conclusions: the study of variables associated with the monitoring of NIV at home may be useful as a predictor of exacerbations. In our case the respiratory rate was the most sensitive, showing an increment of their values prior to a hospital admission


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Respiração Artificial/métodos , Exacerbação dos Sintomas , Acidose Respiratória/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Síndrome de Hipoventilação por Obesidade/complicações , Respiração Artificial/instrumentação , Estudos Prospectivos , Síndrome de Hipoventilação por Obesidade/terapia , Estudos de Coortes
20.
Dtsch Med Wochenschr ; 144(11): 743-747, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163473

RESUMO

DEVELOPMENT OF HOME MECHANICAL VENTILATION (HMV) IN GERMANY: HMV has become a well-established treatment option in Germany. However, during the last decade the number of patients established on HMV is exploding, and this has reached economical and ethical limits. Consequently, a discussion within the health policy concerning this issue is urgently needed. REVISION OF GUIDELINES: The German Respiratory Society has completely revised and thematically complemented its guidelines on HMV. Concerning the professional policy perspective, these guidelines cover essential aspects of the organisation and implementation of HMV, while simultaneously summarizing the current scientific evidence. Based on this, treatment algorithms for different entities are provided. NEW EVIDENCE FOR NON-INVASIVE VENTILATION (NIV) IN COPD: Current data provide evidence that the prognosis of COPD patients can be improved by NIV. This is true for patients with both chronic hypercapnia and persistent hypercapnia following exacerbation treated in the hospital.


Assuntos
Serviços de Assistência Domiciliar , Respiração Artificial/métodos , Alemanha , Humanos , Guias de Prática Clínica como Assunto , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologia/organização & administração
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