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1.
Int J Chron Obstruct Pulmon Dis ; 16: 2783-2793, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34675503

RESUMO

Purpose: Chronic obstructive pulmonary disease (COPD) is a worldwide problem because of its high prevalence and mortality. However, there is no fundamental treatment to ameliorate their pathological change in COPD lung. Recently, adipose-derived mesenchymal stem cells (ADSCs) have attracted attention in the field of regenerative medicine to repair damaged organs. Moreover, their utility in treating respiratory diseases has been reported in some animal models. However, the detailed mechanism by which ADSCs improve chronic respiratory diseases, including COPD, remains to be elucidated. We examined whether human ADSCs (hADSCs) ameliorated elastase-induced emphysema and whether hADSCs differentiated into alveolar epithelial cells in a murine model of COPD. Methods: Female SCID-beige mice (6 weeks old) were divided into the following four groups according to whether they received an intratracheal injection of phosphate-buffered saline or porcine pancreatic elastase, and whether they received an intravenous injection of saline or hADSCs 3 days after intratracheal injection; Control group, hADSC group, Elastase group, and Elastase-hADSC group. We evaluated the lung function, assessed histological changes, and compared gene expression between hADSCs isolated from the lung of Elastase-hADSC group and naïve hADSCs 28 days after saline or elastase administration. Results: hADSCs improved the pathogenesis of COPD, including the mean linear intercept and forced expiratory volume, in an elastase-induced emphysema model in mice. Furthermore, hADSCs were observed in the lungs of elastase-treated mice at 25 days after administration. These cells expressed genes related to mesenchymal-epithelial transition and surface markers of alveolar epithelial cells, such as TTF-1, ß-catenin, and E-cadherin. Conclusion: hADSCs have the potential to improve the pathogenesis of COPD by differentiating into alveolar epithelial cells by mesenchymal-epithelial transition.


Assuntos
Enfisema , Células-Tronco Mesenquimais , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Animais , Modelos Animais de Doenças , Feminino , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos SCID , Elastase Pancreática , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/induzido quimicamente , Enfisema Pulmonar/genética , Enfisema Pulmonar/terapia , Suínos
2.
Int J Chron Obstruct Pulmon Dis ; 16: 2809-2815, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34675505

RESUMO

Background: Lung volume reduction with endobronchial coils treatment (ECT), for patients with severe emphysema, has shown modest improvement in exercise capacity and lung functions in clinical trials, yet the benefit of this procedure is still unclear. Methods: We conducted a multicenter retrospective cohort study including all patients who underwent ECT in Israel and a propensity score matched control group of patients with chronic obstructive pulmonary disease (COPD) that were treated with usual care. The primary outcome was six-minute walk test distance (6MWTD), secondary outcomes were lung function tests and patient survival. Results: Overall, 46 patients were included in the ECT group. Their mean 6MWTD at baseline and at 6 and at 24 months post procedure was 331.0±101.4, 372.9±76.8 and 338.8±104.8, respectively (overall P=0.04, pairwise comparison: baseline to 6 months (P=0.1), baseline to 24 months (P=1.0)). Mean FEV1 values at baseline and at 6 and at 24 months post procedure were 0.86±0.38, 0.92±0.37 and 0.82±0.36 liters, respectively (overall P=0.003, pairwise comparison: baseline to 6 months (P=0.04), baseline to 24 months (P=0.75)). The median 6MWTD for the ECT and control groups at 24 months were 333.0 (262.5-390) and 280 (210-405), respectively (P=0.16). There was no difference in overall survival (P=0.84). Heterogenous emphysema was a significant predictor of treatment success in univariate analysis (p=0.004). Conclusion: Lung volume reduction with endobronchial coils may improve the exercise capacity and FEV1 of COPD patients. However, the majority of the effect was diminished after 24 months. The current state of evidence does not support regulatory approval of ECT and warrant its use only after consideration of the benefit-harm ratio in a highly selected patient population.


Assuntos
Enfisema , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Broncoscopia , Tolerância ao Exercício , Volume Expiratório Forçado , Humanos , Pulmão , Pneumonectomia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/cirurgia , Enfisema Pulmonar/terapia , Estudos Retrospectivos , Resultado do Tratamento
3.
Lung ; 199(2): 195-198, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33687513

RESUMO

PURPOSE: For this study, we aimed to compare dynamic hyperinflation measured by cardiopulmonary exercise testing (CPET), a six-minute walking test (6-MWT), and a manually paced tachypnea test (MPT) in patients with severe emphysema who were treated with endobronchial coils. Additionally, we investigated whether dynamic hyperinflation changed after treatment with endobronchial coils. METHODS: Dynamic hyperinflation was measured with CPET, 6-MWT, and an MPT in 29 patients before and after coil treatment. RESULTS: There was no significant change in dynamic hyperinflation after treatment with coils. Comparison of CPET and MPT showed a strong association (rho 0.660, p < 0.001) and a moderate agreement (BA-plot, 202 ml difference in favor of MPT). There was only a moderate association of the 6-MWT with CPET (rho 0.361, p 0.024). CONCLUSION: MPT can be a suitable alternative to CPET to measure dynamic hyperinflation in severe emphysema but may overestimate dynamic hyperinflation possibly due to a higher breathing frequency.


Assuntos
Capacidade Inspiratória/fisiologia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Mecânica Respiratória/fisiologia , Adulto , Idoso , Broncoscopia , Teste de Esforço , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/instrumentação , Estudos Prospectivos , Enfisema Pulmonar/terapia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33536752

RESUMO

Background: Combined pulmonary fibrosis and emphysema (CPFE) is an underrecognized syndrome characterized by chronic, progressive disease with a dismal prognosis. Frequent co-morbidities with a higher incidence than in idiopathic pulmonary fibrosis or emphysema alone are pulmonary hypertension (WHO group 3) in 47-90% of the patients and lung cancer in 46.8% of the patients. Objective: Review current evidence and knowledge concerning diagnosis, risk factors, disease evolution and treatment options of CPFE. Methods: We searched studies reporting CPFE in original papers, observational studies, case reports, and meta-analyses published between 1990 and August 2020, in the PubMed, Embase, Cochrane Library, Wiley Online Library databases and Google Scholar using the search terms [CPFE], [pulmonary fibrosis] OR [IPF] AND [emphysema]. Bibliographies of retrieved articles were searched as well. Further inclusion criteria were publications in English, French, German and Italian, with reference to humans. In vitro data and animal data were not considered unless they were mentioned in studies reporting predominantly human data. Results: Between May 1, 1990, and September 1, 2020, we found 16 studies on CPFE from the online sources and bibliographies. A total of 890 patients are described in the literature. Although male/female ratio was not reported in all studies, the large majority of patients were male (at least 78%), most of them were current or former heavy smokers. Conclusion: CPFE is a syndrome presenting with dyspnea on exertion followed by disruptive cough and recurrent exacerbations. The disease may progress rapidly, be aggravated by pulmonary hypertension WHO group 3 and is associated with an increased risk of lung cancer. Smoking and male sex are important risk factors. There is a need for more research on CPFE especially relating to etiology, influence of genetics, treatment and prevention options. Antifibrotic therapy might be an interesting treatment option for these patients.


Assuntos
Enfisema , Fibrose Pulmonar Idiopática , Neoplasias Pulmonares , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Animais , Feminino , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/epidemiologia , Fibrose Pulmonar Idiopática/terapia , Masculino , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/terapia , Estudos Retrospectivos
5.
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395519

RESUMO

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.


Assuntos
Medicina Baseada em Evidências/normas , Medicina de Precisão/normas , Prática Profissional/normas , Qualidade da Assistência à Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios , Colecistectomia Laparoscópica , Competência Clínica/normas , Tomada de Decisões , Procedimentos Cirúrgicos do Sistema Digestório , Medicina Baseada em Evidências/métodos , Humanos , Relações Interprofissionais , Cuidados Pós-Operatórios/normas , Enfisema Pulmonar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
6.
Respiration ; 100(1): 52-58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33412545

RESUMO

Interventional treatment of emphysema offers a wide range of surgical and endoscopic options for patients with advanced disease. Multidisciplinary collaboration of pulmonology, thoracic surgery, and imaging disciplines in patient selection, therapy, and follow-up ensures treatment quality. The present joint statement describes the required structural and quality prerequisites of treatment centres. This is a translation of the German article "Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Thoraxchirurgie in Kooperation mit der Deutschen Röntgengesellschaft: Strukturvoraussetzungen von Zentren für die interventionelle Emphysemtherapie" Pneumologie. 2020;74:17-23.


Assuntos
Equipe de Assistência ao Paciente , Pneumonectomia/métodos , Enfisema Pulmonar , Pneumologia , Radiologia , Cirurgia Torácica , Técnicas de Diagnóstico do Sistema Respiratório , Alemanha , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Comunicação Interdisciplinar , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/terapia , Pneumologia/métodos , Pneumologia/organização & administração , Radiologia/métodos , Radiologia/organização & administração , Sociedades Médicas , Cirurgia Torácica/métodos , Cirurgia Torácica/organização & administração
7.
Pediatr Pulmonol ; 56(1): 83-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33080119

RESUMO

BACKGROUND: Pulmonary interstitial emphysema (PIE) is a pathological state when air escapes from ruptured alveoli and is trapped along the sheaths surrounding the bronchovascular bundle. PIE is not uncommon in infants who require mechanical ventilation and even less common in infants on noninvasive ventilatory support; however, it is extremely unusual in infants in room air. CASE PRESENTATION: A 2-week-old male infant developed worsening tachypnea in the special-care nursery. The patient was born at 33 weeks' gestation by induced vaginal delivery due to pre-eclampsia. He required positive pressure ventilation at birth and was admitted to the neonatal intensive care unit on nasal continuous positive airway pressure. On the second day of life, exogenous surfactant was administered via endotracheal tube due to increased oxygen requirement, and, soon after, he was weaned off all respiratory support. After 10 days of stability, he developed tachypnea with diminished air entry on the left side of the chest. Chest radiograph and chest computerized tomography confirmed left-sided unilateral PIE. The patient was treated conservatively with positional therapy alone. Significant clinical and radiographic improvement was noticed within 4 days; almost complete resolution by 10 days and the infant was discharged 23 days later. At follow-up at 7 months, the infant was found to be symptom-free with a normal chest radiograph. CONCLUSIONS: Traditional management of unilateral PIE generally involves a combination of invasive ventilatory support and positional therapy to break the vicious cycle pathophysiology of PIE. This report focuses on the insidious progression of PIE in nonventilated neonates and describes a nontraditional conservative management strategy for the management of unilateral PIE.


Assuntos
Enfisema Pulmonar/diagnóstico , Enfisema/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ventilação com Pressão Positiva Intermitente , Intubação Intratraqueal/efeitos adversos , Doenças Pulmonares Intersticiais/complicações , Masculino , Oxigênio , Respiração com Pressão Positiva/efeitos adversos , Gravidez , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/terapia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Tomografia Computadorizada por Raios X
8.
J Neonatal Perinatal Med ; 14(2): 299-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32986686

RESUMO

Pulmonary interstitial emphysema (PIE) is a severe complication of mechanical ventilation in preterm infants. Selective bronchial intubation is a rarely used treatment strategy, as it is challenging, especially left main stem bronchial intubation. We report our experience in an infant at 24 weeks gestation with bedside left main stem bronchial intubation using flexible fiberoptic bronchoscopy. We also describe in detail the procedural details involved in the selective left main stem bronchial intubation including the helpful technique of gently bending the tip of the endotracheal tube to create "memory" to better direct the tube into the left main-stem bronchus while using the flexible fiberoptic bronchoscope. A review of the literature regarding selective bronchial intubation in newborn infants is presented. This case report and literature review suggest that bedside left main stem bronchial intubation using a flexible fiberoptic bronchoscope is a viable option to successfully manage even the most unstable extreme premature infant with unilateral right lung cystic PIE. This may potentially prevent a rare but necessary invasive surgical procedure like lobectomy or even death.


Assuntos
Recém-Nascido Prematuro , Intubação Intratraqueal/métodos , Enfisema Pulmonar/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Brônquios , Idade Gestacional , Humanos
10.
Adv Respir Med ; 88(5): 433-442, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33169816

RESUMO

Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15-45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.


Assuntos
Pneumonectomia , Enfisema Pulmonar , Humanos , Pneumonectomia/efeitos adversos , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Pneumonia , Enfisema Pulmonar/terapia , Qualidade de Vida , Testes de Função Respiratória
12.
BMC Pulm Med ; 20(1): 254, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993591

RESUMO

BACKGROUND: The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients' health-related quality of life (HRQoL) according to their COPD phenotypes. METHODS: This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). RESULTS: Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p <  0.001). There were significantly more patients with mMRC 2-4 among AE (68.6%) (p <  0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p <  0.001) and SGRQ-c (both p <  0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p <  0.001) scores than those with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p <  0.001), and ACO [(p = 0.003-0.016; p = < 0.001-0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001-0.040; p <  0.001) except CAT 2 and activity components of SGRQ-c. CONCLUSIONS: The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.


Assuntos
Asma/diagnóstico , Bronquite Crônica/diagnóstico , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Enfisema Pulmonar/diagnóstico , Qualidade de Vida , Idoso , Asma/fisiopatologia , Asma/psicologia , Asma/terapia , Bronquite Crônica/fisiopatologia , Bronquite Crônica/psicologia , Bronquite Crônica/terapia , Estudos Transversais , Progressão da Doença , Feminino , Nível de Saúde , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Fenótipo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/psicologia , Enfisema Pulmonar/terapia , Índice de Gravidade de Doença , Inquéritos e Questionários
13.
Clinics (Sao Paulo) ; 75: e1698, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32556057

RESUMO

OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Pneumopatias/terapia , Transplante de Pulmão/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Bronquiectasia/epidemiologia , Bronquiectasia/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Hipertensão Arterial Pulmonar/epidemiologia , Hipertensão Arterial Pulmonar/terapia , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/terapia , Fibrose Pulmonar/epidemiologia , Fibrose Pulmonar/terapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Semin Respir Crit Care Med ; 41(2): 177-183, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32279289

RESUMO

Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the combination of upper lobe emphysema and lower lobe fibrosis, the latter owing to various interstitial lung diseases. These patients have a characteristic lung function profile, with relatively preserved dynamic and static lung volumes, contrasting with a significant reduction of carbon monoxide transfer. The pathogenic mechanisms leading to the coexistence of emphysema with fibrosis remain unclear and different theories have been proposed. CPFE is frequently complicated by pulmonary hypertension, acute exacerbations, and lung cancer leading to poor natural history and prognosis. The syndrome of CPFE represents a distinct pulmonary manifestation in the spectrum of lung diseases associated with connective tissue diseases. Currently, there are no established recommendations regarding the management of patients with CPFE. We provide a review on the existing knowledge of CPFE regarding the epidemiology, pathogenesis, clinical manifestations, radiologic appearance, complications, prognosis, and possible treatment options.


Assuntos
Hipertensão Pulmonar/complicações , Neoplasias Pulmonares/complicações , Enfisema Pulmonar/epidemiologia , Fibrose Pulmonar/epidemiologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Pulmão/patologia , Neoplasias Pulmonares/fisiopatologia , Prognóstico , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/terapia , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/fisiopatologia , Fibrose Pulmonar/terapia , Fumar/efeitos adversos , Fumar/epidemiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32184585

RESUMO

Purpose: Emphysema is a progressive and irreversible disease, proceeding with the decrease in elastic recoil which is connected to tissue damage caused by chronic inflammation. Lung volume reduction coil (LVRC) method in patients with an advanced level of emphysema and irresponsive to medical treatment is shown to provide increase in lung volumes and exercise capacity, decrease in dyspnea, and increase in quality of life. The purpose of this study is to reveal that LVRC treatment is also efficient in severe COPD patients with hypercapnic respiratory failure. Patients and Methods: Eleven cases with severe COPD and emphysema were included in the study. LVRC treatment method was applied in upper lobes of both lungs in patients with severe COPD (FEV1 < %45) and Type-2 respiratory insufficiency (PCO2 55-80 mmHg) who were having medical treatment and CPAP treatment. The patients were followed up for a period of twelve months using arterial blood gas analysis. Results: Beginning with the first month of the LVRC treatment, PCO2 levels were found to be significantly decreased in all patients using arterial blood gas analysis. Conclusion: LVRC method can provide physiological and functional recovery and progress in quality of life in severe COPD cases. It is demonstrated that LVRC treatment caused significant decreases in carbon dioxide levels as well as causing improvement in life quality and respiratory function tests in the patients with hypercapnic respiratory failure.


Assuntos
Broncoscopia/instrumentação , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/terapia , Insuficiência Respiratória/terapia , Idoso , Biomarcadores/sangue , Broncoscopia/efeitos adversos , Dióxido de Carbono/sangue , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/sangue , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Insuficiência Respiratória/sangue , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Capacidade Pulmonar Total , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-32021152

RESUMO

Introduction: The use of two quality-of-life questionnaires in a single clinical trial with an economic component can be challenging due to the associated workload in terms of data collection and an increased risk of missing data. The aim of our study was to determine whether the questionnaire chosen to measure health status, the St. George's Respiratory Questionnaire (SGRQ), could be administered on its own without adding the EuroQol five dimensions questionnaire (EQ-5D) for economic evaluation in emphysema studies. Materials and Methods: Data were prospectively collected during the REVOLENS trial assessing endobronchial coil treatment in severe emphysema. To quantify the association between the two questionnaires, correlations between the EQ-5D and the SGRQ were first tested and the concordance was then studied in order to know whether the two questionnaires were interchangeable. Finally, the Starkie et al algorithm predicting EQ-5D utility values from the SGRQ was used on REVOLENS's individual patient data. The Student's t-test, correlation and concordance between EQ-5D individual value (from the REVOLENS study) and predicted value (from the Starkie et al algorithm) were studied to test this algorithm. Results: Results showed a strong correlation but no concordance between the EQ-5D and the SGRQ, demonstrating that the two questionnaires are not interchangeable. Moreover, the algorithm predicting EQ-5D utilities from the SGRQ did not provide utility values comparable to those observed in the REVOLENS study. Indeed, our study demonstrated a strong correlation between predicted and individual EQ-5D values but no concordance. Conclusion: The use of both the EQ-5D and the SGRQ in a clinical study with an economic component is justified. Based on our results, the SGRQ should not be used to obtain a utility score to calculate the incremental cost-effectiveness ratio and conclude on the efficiency of an intervention in emphysema patients.


Assuntos
Indicadores Básicos de Saúde , Pulmão/fisiopatologia , Enfisema Pulmonar/diagnóstico , Qualidade de Vida , Inquéritos e Questionários , Idoso , Algoritmos , Broncoscopia/economia , Broncoscopia/instrumentação , Análise Custo-Benefício , Feminino , França , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Enfisema Pulmonar/economia , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/terapia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
18.
Respirology ; 25(3): 321-335, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32030868

RESUMO

AATD is a common inherited disorder associated with an increased risk of developing pulmonary emphysema and liver disease. Many people with AATD-associated pulmonary emphysema remain undiagnosed and therefore without access to care and counselling specific to the disease. AAT augmentation therapy is available and consists of i.v. infusions of exogenous AAT protein harvested from pooled blood products. Its clinical efficacy has been the subject of some debate and the use of AAT augmentation therapy was recently permitted by regulators in Australia and New Zealand, although treatment is not presently subsidized by the government in either country. The purpose of this position statement is to review the evidence for diagnosis and treatment of AATD-related lung disease with reference to the Australian and New Zealand population. The clinical efficacy and adverse events of AAT augmentation therapy were evaluated by a systematic review, and the GRADE process was employed to move from evidence to recommendation. Other sections address the wide range of issues to be considered in the care of the individual with AATD-related lung disease: when and how to test for AATD, changing diagnostic techniques, monitoring of progression, disease in heterozygous AATD and pharmacological and non-pharmacological therapy including surgical options for severe disease. Consideration is also given to broader issues in AATD that respiratory healthcare staff may encounter: genetic counselling, patient support groups, monitoring for liver disease and the need to establish national registries for people with AATD in Australia and New Zealand.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/terapia , Deficiência de alfa 1-Antitripsina/diagnóstico , Deficiência de alfa 1-Antitripsina/tratamento farmacológico , alfa 1-Antitripsina/uso terapêutico , Austrália , Progressão da Doença , Humanos , Transplante de Pulmão , Nova Zelândia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etiologia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/etiologia , Procedimentos Cirúrgicos Reconstrutivos , alfa 1-Antitripsina/genética , Deficiência de alfa 1-Antitripsina/complicações , Deficiência de alfa 1-Antitripsina/genética
19.
Medicine (Baltimore) ; 99(5): e18936, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000409

RESUMO

Bronchoscopic lung volume reduction (BLVR) offers alternative novel treatments for patients with emphysema. Comprehensive evidence for comparing different BLVR remains unclear. To estimate the effects of different BLVR on patients with emphysema. PubMed, EMBASE, Cochrane Library, and Web of Science databases from January 2001 to August 2017 were searched. Randomized clinical trials evaluated effects of BLVR on patients with emphysema. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk of bias tools. Pair-wise metaanalyses were made using the random-effects model. A random-effects network meta-analysis was applied within a Bayesian framework. The quality of evidence contributing to primary outcomes was assessed using the GRADE framework. 13 trials were deemed eligible, including 1993 participants. The quality of evidence was rated as moderate in most comparisons. Medical care (MC)was associated with the lowest adverse events compared with intrabronchial valve (IBV)(-2.5,[-4.70 to -0.29]), endobronchial valve (EBV) (-1.73, [-2.37 to -1.09]), lung volume reduction coils (LVRC) (-0.76, [-1.24 to -0.28]), emphysematous lung sealant (ELS) (-1.53, [-2.66 to -0.39]), and airway bypass(-1.57, [-3.74 to 0.61]). Adverse events in LVRC were lower compared with ELS (-0.77,[-2.00 to 0.47]). Bronchoscopic thermal vapor ablation (BTVA) showed significant improvement in FEV1 compared with MC (0.99, [0.37 to 1.62]), IBV (1.25, [0.25 to 2.25]), and LVRC (0.72, [0.03 to 1.40] ). Six  minute walking distance (6 MWD) in ELS was significantly improved compared with other four BLVR, sham control, and MC (-1.96 to 1.99). Interestingly, MC showed less improvement in FEV1 and 6MWDcompared with EBV (-0.45, [-0.69 to -0.20] and -0.39, [-0.71 to -0.07], respectively). The mortality in MC and EBV was lower compared with LVRC alone (-0.38, [-1.16 to 0.41] and -0.50, [-1.68 to 0.68], respectively). BTVA and EBV led to significant changes in St George's respiratory questionnaire (SGRQ) compared with MC alone (-0.74, [-1.43 to -0.05] and 0.44, [0.11 to 0.78], respectively). BLVR offered a clear advantage for patients with emphysema. EBV had noticeable beneficial effects on the improvement of forced expiratory volume 1, 6MWD and SGRQ, and was associated with lower mortality compared with MC in different strategies of BLVR.


Assuntos
Broncoscopia , Enfisema Pulmonar/terapia , Broncoscopia/métodos , Humanos , Metanálise em Rede
20.
Artigo em Inglês | MEDLINE | ID: mdl-32103933

RESUMO

Alpha-1 antitrypsin deficiency (AATD) is a rare and underdiagnosed genetic predisposition for COPD and emphysema and other conditions, including liver disease. Although there have been improvements in terms of awareness of AATD and understanding of its treatment in recent years, current challenges center on optimizing detection and management of patients with AATD, and improving access to intravenous (IV) AAT therapy - the only available pharmacological intervention that can slow disease progression. However, as an orphan disease with geographically dispersed patients, international cooperation is essential to address these issues. To achieve this, new European initiatives in the form of the European Reference Network for Rare Lung Diseases (ERN-LUNG) and the European Alpha-1 Research Collaboration (EARCO) have been established. These organizations are striving to address the current challenges in AATD, and provide a new platform for future research efforts in AATD. The first objectives of ERN-LUNG are to establish a quality control program for European AATD laboratories and create a disease management program for AATD, following the success of such programs in the United States. The main purpose of EARCO is to create a pan-European registry, with the aim of understanding the natural history of the disease and supporting the development of new treatment modalities in AATD and access to AAT therapy. Going further, other patient-centric initiatives involve improving the convenience of intravenous AAT therapy infusions through extended-interval dosing and self-administration. The present review will discuss the implementation of these initiatives and their potential contribution to the optimization of patient care in AATD.


Assuntos
Terapia de Reposição de Enzimas , Assistência Centrada no Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Enfisema Pulmonar/terapia , Deficiência de alfa 1-Antitripsina/terapia , alfa 1-Antitripsina/administração & dosagem , Terapia de Reposição de Enzimas/efeitos adversos , Humanos , Infusões Intravenosas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/epidemiologia , Qualidade de Vida , Resultado do Tratamento , alfa 1-Antitripsina/efeitos adversos , Deficiência de alfa 1-Antitripsina/diagnóstico , Deficiência de alfa 1-Antitripsina/epidemiologia
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