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1.
Elife ; 102021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33720009

RESUMO

Measures of lung function are heritable, and thus, we sought to utilise genetics to propose drug-repurposing candidates that could improve respiratory outcomes. Lung function measures were found to be genetically correlated with seven druggable biochemical traits, with further evidence of a causal relationship between increased fasting glucose and diminished lung function. Moreover, we developed polygenic scores for lung function specifically within pathways with known drug targets and investigated their relationship with pulmonary phenotypes and gene expression in independent cohorts to prioritise individuals who may benefit from particular drug-repurposing opportunities. A transcriptome-wide association study (TWAS) of lung function was then performed which identified several drug-gene interactions with predicted lung function increasing modes of action. Drugs that regulate blood glucose were uncovered through both polygenic scoring and TWAS methodologies. In summary, we provided genetic justification for a number of novel drug-repurposing opportunities that could improve lung function.


Assuntos
Reposicionamento de Medicamentos/métodos , Hiperglicemia/genética , Pneumopatias/tratamento farmacológico , Pneumopatias/genética , Glicemia/metabolismo , Causalidade , Bases de Dados Genéticas , Estudo de Associação Genômica Ampla/métodos , Humanos , Hiperglicemia/metabolismo , Hiperglicemia/fisiopatologia , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Pulmão/fisiopatologia , Pneumopatias/metabolismo , Pneumopatias/fisiopatologia , Herança Multifatorial , Fenótipo , Polimorfismo de Nucleotídeo Único , Testes de Função Respiratória/métodos , Transcriptoma
2.
NeuroRehabilitation ; 48(2): 243-245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33664161

RESUMO

BACKGROUND: Progressive muscle weakness is a feature of neuromuscular diseases (NMDs), a heterogeneous group of conditions with variable onset, presentation and prognosis that affect both children and adults. Respiratory muscle weakness compromises respiratory function and may lead to respiratory failure. OBJECTIVE: To assess the effects of respiratory muscle training (RMT) in adults and children with NMD. METHODS: A Cochrane Review by Silva et al. was summarized with comments. RESULTS: Eleven studies involving 250 randomized participants with NMD were included. While the studies showed that RMT may lead to improvements in lung function and respiratory muscle strength in people with ALS and DMD, this was not a consistent finding. The evidence from all the included trials was of low or very low certainty. CONCLUSIONS: There may be some improvement in lung capacity and respiratory muscle strength following RMT in some NMD. There appears to be no clinically meaningful effect of RMT on physical functioning and quality of life in ALS. The low certainty of the evidence means that the results need to be interpreted with caution.


Assuntos
Exercícios Respiratórios/métodos , Força Muscular/fisiologia , Doenças Neuromusculares/terapia , Músculos Respiratórios/fisiologia , Adulto , Criança , Feminino , Humanos , Masculino , Debilidade Muscular/fisiopatologia , Debilidade Muscular/terapia , Doenças Neuromusculares/fisiopatologia , Qualidade de Vida , Testes de Função Respiratória/métodos
3.
Medicine (Baltimore) ; 100(5): e23878, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592843

RESUMO

BACKGROUND: Lung cancer screening in high-risk population increases the proportion of patients diagnosed at a resectable stage. AIMS: To optimize the selection criteria and quality indicators for lung cancer screening by low-dose CT (LDCT) in the Czech population of high-risk individuals. To compare the influence of screening on the stage of lung cancer at the time of the diagnosis with the stage distribution in an unscreened population. To estimate the impact on life-years lost according to the stage-specific cancer survival and stage distribution in the screened population. To calculate the cost-effectiveness of the screening program. METHODS: Based on the evidence from large national trials - the National Lung Screening Trial in the USA (NLST), the NELSON study, the recent recommendations of the Fleischner society, the American College of Radiology, and I-ELCAP action group, we developed a protocol for a single-arm prospective study in the Czech Republic for the screening of high-risk asymptomatic individuals. The study commenced in August 2020. RESULTS: The inclusion criteria are: age 55 to 74 years; smoking: ≥30 pack-years; smoker or ex-smoker <15 years; performance status (0-1). The screening timepoints are at baseline and 1 year. The LDCT acquisition has a target CTDIvol ≤0.5mGy and effective dose ≤0.2mSv for a standard-size patient. The interpretation of findings is primarily based on nodule volumetry, volume doubling time (and related risk of malignancy). The management includes follow-up LDCT, contrast enhanced CT, PET/CT, tissue sampling. The primary outcome is the number of cancers detected at a resectable stage, secondary outcomes include the average cost per diagnosis of lung cancer, the number, cost, complications of secondary examinations, and the number of potentially important secondary findings. CONCLUSIONS: A study protocol for early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE) study using LDCT has been described.


Assuntos
Doenças Assintomáticas , Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico , Idoso , Doenças Assintomáticas/economia , Biópsia/economia , Biópsia/métodos , Análise Custo-Benefício , República Tcheca , Detecção Precoce de Câncer/economia , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/economia , Estadiamento de Neoplasias/métodos , Seleção de Pacientes , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/economia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Testes de Função Respiratória/economia , Testes de Função Respiratória/métodos , Medição de Risco/economia , Medição de Risco/métodos , Fatores de Risco , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodos
4.
Arch. bronconeumol. (Ed. impr.) ; 57(1): 61-69, ene. 2021. tab, graf, mapas
Artigo em Inglês | IBECS | ID: ibc-200202

RESUMO

BACKGROUND: Two previous national epidemiological studies, IBERPOC in 1997 and EPISCAN in 2007, determined the COPD burden in Spain. Changes in demographics and exposure to risk factors demand the periodic update of COPD prevalence and its determinants. METHODS: EPISCAN II aimed to estimate the prevalence of COPD in the general population aged 40 years or older in all 17 regions of Spain. A random population screening sample, requiring 600 participants per region performed a questionnaire plus post-bronchodilator (post-BD) spirometry. RESULTS: A total of 12,825 subjects were initially contacted, and 9433 (73.6%) agreed to participate, of whom 9092 performed a valid spirometry. Baseline characteristics were: 52.6% women, mean ± SD age 60 ± 11 years, 19.8% current- and 34.2% former-smokers. The prevalence of COPD measured by post-BD fixed ratio FEV1/FVC < 0.7 was 11.8% (95% C.I. 11.2-12.5) with a high variability by region (2.4-fold). Prevalence was 14.6% (95% C.I. 13.5-15.7) in males and 9.4% (95% C.I. 8.6-10.2) in females; according to the lower limit of normal (LLN) was 6.0% (95% C.I. 5.5-6.5) overall, by sex being 7.1% (95% C.I. 6.4-8.0) in males and 4.9% (95% C.I. 4.3-5.6) in females. Underdiagnosis of COPD was 74.7%. Cases with COPD were a mean of seven years older, more frequently male, of lower attained education, and with more smokers than the non-COPD population (p < 0.001). However, the number of cigarettes and pack-years in non-COPD participants was substantial, as it was the reported use of e-cigarettes (7.0% vs. 5.5%) (p = 0.045). There were also significant social and clinical differences including living alone, previous respiratory diagnoses, more comorbidities measured with the Charlson index, greater BODE and COTE scores, cognitive impairment, and depression (all p < 0.001). CONCLUSIONS: COPD remains prevalent in Spain and frequently underdiagnosed


ANTECEDENTES: Dos estudios epidemiológicos nacionales anteriores, IBERPOC en 1997 y EPISCAN en 2007, determinaron la carga de EPOC en España. Los cambios en la demografía y la exposición a factores de riesgo exigen una actualización periódica de la prevalencia de EPOC y sus determinantes. MÉTODOS: EPISCAN II tuvo como objetivo estimar la prevalencia de EPOC en la población general de 40 años o más en las 17 Comunidades Autónomas de España. Una muestra aleatoria de población para cribado, que requirió 600 participantes por región, realizó un cuestionario y una espirometría tras la administración de un broncodilatador (post-BD). RESULTADOS: Un total de 12.825 sujetos fueron contactados inicialmente, y 9.433 (73,6%) aceptaron participar, de los cuales 9.092 realizaron una espirometría válida. Las características sociodemográficas basales fueron: un 52,6% eran mujeres, la edad media ± DE era de 60 ± 11 años, un 19,8% eran fumadores activos y un 34,2% eran exfumadores. La prevalencia de EPOC medida por el criterio de cociente fijo post-BD FEV1/FVC < 0,7 fue del 11,8% (IC 95%: 11,2-12,5) con una alta variabilidad por región (2,4 veces). La prevalencia fue del 14,6% (IC 95%: 13,5-15,7) en varones y del 9,4% (IC 95%: 8,6-10,2) en mujeres; considerando el límite inferior de la normalidad (LIN), fue del 6,0% (IC 95%: 5,5-6,5) en la muestra global y, por sexos, del 7,1% (IC 95%: 6,4-8,0) en varones y del 4,9% (IC 95%: 4,3-5,6) en mujeres. El infradiagnóstico de la EPOC fue del 74,7%. Los casos con EPOC tenían de media 7 años más, eran con mayor frecuencia varones, tenían menor nivel educativo y había más fumadores que en la población sin EPOC (p < 0,001). Sin embargo, el número de cigarrillos y paquetes/año en los participantes que no tenían EPOC fue sustancial, como también fue elevado el uso de cigarrillos electrónicos (7,0 vs. 5,5%) (p = 0,045). También hubo diferencias sociales y clínicas significativas que incluyeron: vivir solo, diagnósticos previos de enfermedad respiratoria, más comorbilidades medidas con el índice de Charlson, puntuaciones más altas en el índice BODE y la escala COTE, deterioro cognitivo y depresión (todos p < 0,001). CONCLUSIONES: La EPOC sigue siendo prevalente en España y con frecuencia está infradiagnosticada


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria/métodos , Broncodilatadores/administração & dosagem , Espanha/epidemiologia , Inquéritos e Questionários , Fumantes/estatística & dados numéricos , Testes de Função Respiratória/métodos
5.
Respir Res ; 22(1): 15, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441106

RESUMO

BACKGROUND: Elderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients. METHODS: We conducted a retrospective analysis on a series of 758 asthmatics subdivided in three groups: lower than 40, between 40 and 70 and older than 70. All the patients who had a successful sputum induction were included in the study. RESULTS: Older patients had a higher Body Mass Index, had less active smokers and were more often treated with Long Acting anti-Muscarinic Agents. We found a significant increase in sputum neutrophil counts with ageing. There was no significant difference in blood inflammatory cell counts whatever the age group. Forced expiratory volume in one second (FEV1) and FEV1/FVC values were significantly lower in elderly who had lower bronchial hyperresponsiveness and signs of air trapping. We found a lower occurrence of the allergic component in advanced ages. Asthmatics older than 70 years old had later onset of the disease and a significant longer disease duration. CONCLUSION: Our study highlights that asthmatics older than 70 years old have higher bronchial neutrophilic inflammation, a poorer lung function, signs of air trapping and lower airway variability. The role of immunosenescence inducing chronic low-grade inflammation in this asthma subtype remains to be elucidated.


Assuntos
Asma/metabolismo , Volume Expiratório Forçado/fisiologia , Mediadores da Inflamação/metabolismo , Neutrófilos/metabolismo , Testes de Função Respiratória/métodos , Escarro/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/diagnóstico , Asma/imunologia , Feminino , Humanos , Mediadores da Inflamação/imunologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Estudos Retrospectivos , Escarro/imunologia
7.
Mol Immunol ; 132: 209-216, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33483086

RESUMO

Epithelial barrier dysfunction is involved in allergic inflammation and asthma, due to increased exposure of sub-epithelial tissues to inhaled allergens and air pollutants. The tight junction proteins claudins (CLDNs) are important regulators of paracellular permeability. CLDN7 is expressed in the alveolar epithelium; however, its contribution to airway barrier function remains unclear. The aim of this study was to assess the effects of TiO2 on epithelial barrier function in asthma. Mice were sensitized and challenged with OVA or exposed to TiO2 on days 21-23. The effect of TiO2 on CLDN7 was assessed by ELISA, immunoblotting, and immunohistochemical analysis. The levels of CLDN7 in the plasma of patients with asthma and healthy individuals were also examined. CLDN7 levels were lower in plasma from patients with asthma compared with healthy individuals. CLDN7 levels were associated with FEV1/FVC and the blood eosinophils (%) in patients with asthma. Although CLDN7 expression was elevated in the lungs of mice with asthma and in NHBE cells treated with HDM extracts, its expression was suppressed by exposure to TiO2. p-AKT and p-ERK was increased in asthmatic mice and decreased in mice with TiO2 treatment. p-AKT and p-ERK was decreased in NHBE cells treated with TiO2 and HDM extracts. Trans-epithelial electrical resistance (TEER) was higher in NHBE cells treated with TiO2 or HDM extracts; however, this was decreased by concurrent TiO2 and HDM extracts treatment. Our data suggest that particulate matter contributes to airway epithelial barrier dysfunction and results in airway inflammation and responsiveness.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Asma/metabolismo , Claudinas/metabolismo , Células Epiteliais/efeitos dos fármacos , Material Particulado/efeitos adversos , Titânio/efeitos adversos , Animais , Eosinófilos/efeitos dos fármacos , Eosinófilos/metabolismo , Células Epiteliais/metabolismo , Feminino , Humanos , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Masculino , Camundongos , Pessoa de Meia-Idade , Testes de Função Respiratória/métodos , Mucosa Respiratória/efeitos dos fármacos , Mucosa Respiratória/metabolismo
8.
J Intern Med ; 289(5): 738-746, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33511686

RESUMO

BACKGROUND: Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS: This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS: Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS: Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.


Assuntos
Anticorpos Monoclonais Humanizados , Biomarcadores Farmacológicos/análise , Monitoramento de Medicamentos/métodos , Interleucina-6 , Pneumonia Viral , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/farmacocinética , /epidemiologia , /terapia , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/farmacocinética , Infusões Intravenosas , Interleucina-6/antagonistas & inibidores , Interleucina-6/sangue , Itália/epidemiologia , Masculino , Oximetria/métodos , Oxigenoterapia/métodos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Valor Preditivo dos Testes , Testes de Função Respiratória/métodos , Resultado do Tratamento
9.
J Pediatr Orthop ; 41(1): 1-5, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32804864

RESUMO

BACKGROUND: Children with spinal muscular atrophy (SMA) sustain a progressive reduction in pulmonary function (PF) related to both muscular weakness and the concomitant effects of spinal deformity on the thorax. Growth-friendly instrumentation is commonly utilized for younger patients with scoliosis and SMA to halt the progression of spinal curvature, but its effect on PF in these patients has not previously been investigated. Using the change in Early Onset Scoliosis 24-Item Questionnaire (EOSQ-24) PF subdomain scores, the authors will investigate whether PF improves in patients with SMA after a growth-friendly intervention. METHODS: This was a multicenter retrospective cohort study from 2 international registries of patients with SMA undergoing spinal deformity surgery from 2005 to 2015. Data collected were age, sex, degree of major coronal curve, type of growth-friendly construct, forced vital capacity (FVC), and EOSQ-24 scores at the patient's preoperative, 1-year postoperative, and 2-year postoperative visits. Differences in EOSQ-24 PF scores and FVC between baseline and postoperative assessment were examined by paired tests. RESULTS: A total of 74 patients were identified (mean age, 7.6±2.3 y, major curve 68.1±22.4 degrees, 51.4% female individuals). The mean EOSQ-24 PF scores improved significantly from 70.6 preoperatively to 83.6 at 1 year (P=0.092) and 86.5 at 2 years postoperatively (P=0.020). The scores in patients with rib-based constructs showed steeper increases at 1-year assessments than those in patients with spine-based constructs. The mean paired FVC value decreased from 63.9% predicted preoperatively, to 57.6% predicted at 1 year postoperatively (P=0.035), and 61.9% predicted preoperatively, to 56.3% predicted at 2 years postoperatively (P=0.178). CONCLUSIONS: Patients with SMA who received growth-friendly instrumentation did experience improvements in PF as measured by EOSQ-24 assessing the caregivers' perception. Given the uncertain reliability of PFTs in this young population, EOSQ-24 is an important tool for measuring improvements in health-related quality of life. LEVEL OF EVIDENCE: Level III-retrospective study.


Assuntos
Atrofia Muscular Espinal/complicações , Aparelhos Ortopédicos , Qualidade de Vida , Escoliose , Atrofias Musculares Espinais da Infância , Criança , Desenvolvimento Infantil , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Reprodutibilidade dos Testes , Testes de Função Respiratória/métodos , Escoliose/etiologia , Escoliose/fisiopatologia , Escoliose/psicologia , Escoliose/cirurgia , Atrofias Musculares Espinais da Infância/fisiopatologia , Atrofias Musculares Espinais da Infância/psicologia , Atrofias Musculares Espinais da Infância/cirurgia , Resultado do Tratamento
10.
Br J Radiol ; 94(1118): 20201218, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33320729

RESUMO

OBJECTIVE: To evaluate CT-ventilation imaging (CTVI) within a well-characterized, healthy cohort with no respiratory symptoms and examine the correlation between CTVI and concurrent pulmonary function test (PFT). METHODS: CT scans and PFTs from 77 Caucasian participants in the NORM dataset (clinicaltrials.gov NCT00848406) were analyzed. CTVI was generated using the robust Integrated Jacobian Formulation (IJF) method. IJF estimated total lung capacity (TLC) was computed from CTVI. Bias-adjusted Pearson's correlation between PFT and IJF-based TLC was computed. RESULTS: IJF- and PFT-measured TLC showed a good correlation for both males and females [males: 0.657, 95% CI (0.438-0.797); females: 0.667, 95% CI (0.416-0.817)]. When adjusting for age, height, smoking, and abnormal CT scan, correlation moderated [males: 0.432, 95% CI (0.129-0.655); females: 0.540, 95% CI (0.207-0.753)]. Visual inspection of CTVI revealed participants who had functional defects, despite the fact that all participant had normal high-resolution CT scan. CONCLUSION: In this study, we demonstrate that IJF computed CTVI has good correlation with concurrent PFT in a well-validated patient cohort with no respiratory symptoms. ADVANCES IN KNOWLEDGE: IJF-computed CTVI's overall numerical robustness and consistency with PFT support its potential as a method for providing spatiotemporal assessment of high and low function areas on volumetric non-contrast CT scan.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Pulmão/fisiologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes
11.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33372742

RESUMO

COVID-19 pneumonia has a significant case fatality rate and no effective antiviral drugs are available even after 9 months of the pandemic. The spectrum of COVID-19 disease ranges from asymptomatic cases to severe ARDS with myriad manifestations. Here we report a case of a male patient with severe COVID-19 ARDS who improved after receiving standard therapy but again 'deteriorated' after being stepped down to ward. He complained of worsening shortness of breath and hypoxemia which was found to be mainly positional. After ruling out other causes, he was labeled as a case of platypnea-orthodeoxia syndrome due to underlying lung involvement.  It is important to be aware of this condition in the context of COVID-19 which can be easily diagnosed bedside with pulse oximetry.


Assuntos
Dispneia , Hipóxia , Pulmão , Posicionamento do Paciente/métodos , Pneumonia Viral , Idoso , /fisiopatologia , Deterioração Clínica , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Oximetria/métodos , Oxigenoterapia/métodos , Administração dos Cuidados ao Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Testes de Função Respiratória/métodos , Síndrome , Tomografia Computadorizada por Raios X/métodos
12.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33372741
13.
J. negat. no posit. results ; 5(10): 1195-1220, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199391

RESUMO

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) es una de las patologías que mayores tasas de prevalencia y mortalidad presenta a nivel mundial, en España representa la 3ª causa de muerte. El tabaco es su principal causa, por lo que es una enfermedad prevenible. Se define como un síndrome complejo y heterogéneo que condiciona tanto calidad de vida como envejecimiento de los que la padecen, especialmente en las últimas décadas de la vida ya que se acompaña de un número de comorbilidades que agravan la propia evolución de la enfermedad. OBJETIVOS: Conocer las comorbilidades más prevalentes en la EPOC, así como su relación y posible influencia en el progreso de esta. MATERIAL Y MÉTODOS: Búsqueda bibliográfica en Pubmed y Crochrane haciendo uso de los términos "chronic obstructive pulmonary disease" AND "comorbidities", aplicando diferentes filtros durante la misma. RESULTADOS: La presencia de comorbilidad en los pacientes con EPOC afecta a la mortalidad a largo y corto plazo. Según la bibliografía resultante la relación existente entre comorbilidad y EPOC puede explicarse por la existencia de inflamación sistémica. DISCUSIÓN: Hay evidencias suficientes para afirmar que la presencia de comorbilidad es un hecho desfavorable en cuanto a evolución del paciente con EPOC


INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the diseases with the highest prevalence and mortality rates worldwide. In Spain, it is the third leading cause of death. Tobacco is its main risk factor, so it is a preventable disease. We can define it as a complex and heterogeneous syndrome that conditions both quality of life and the aging of those who suffer from it, especially in the last decades of life, since it is accompanied by a not inconsiderable number of comorbidities that aggravate the evolution of the it. OBJECTIVES: To understand the most prevalent comorbidities in COPD, as well as their relationship and possible influence on the progress of the disease. MATERIAL AND METHODS: Bibliographic search in Pubmed and Cochrane using the terms "chronic obstructive pulmonary disease" AND "comorbidities", applying different filters during the search. RESULTS: The presence of comorbidity affects short and long term mortality. The relationship between comorbidity and COPD can be explained by the existence of systemic inflammation. DISCUSSION: There is enough evidence to affirm that the presence of comorbidity is an unfavourable fact in terms of the evolution of the patient with COPD. CONCLUSIONS: A multidimensional assessment of the COPD patient is necessary, as well as comprehensive and individualized care


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Comorbidade , Enfisema Pulmonar/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Indicadores de Morbimortalidade , Estatísticas de Sequelas e Incapacidade , Testes de Função Respiratória/métodos , Fatores de Risco
14.
J Cancer Res Ther ; 16(4): 788-792, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930119

RESUMO

Context: Spirometry is an important tool to monitor treatment response in diseases such as chronic obstructive pulmonary disease and asthma. However, there is lack of evidence to support its application to evaluate response to chemotherapy in advanced lung cancer. It might be a useful adjunct to the imaging-based response evaluation which lacks functional assessment of lungs. Aims: The study was conducted to evaluate the change in spirometry in lung cancer patients after chemotherapy and to find its correlation with change in physical tumor size. Subjects and Methods: Sixty-two advanced lung cancer patients who were eligible for palliative chemotherapy were enrolled. Baseline tumor size evaluation using Response Evaluation Criteria in Solid Tumor (RECIST)-based scoring system, and spirometry was done. Four cycles of double agent (platinum doublets) chemotherapy were administered, after which treatment response was evaluated. Repeat spirometry was analyzed and correlated with changes in physical tumor size. Results: Twenty-five patients showed a response (all partial response) to four cycles of chemotherapy. Small cell carcinoma showed a better response rate than non-small cell carcinoma (78% vs. 39%). There was statistically significant improvement in forced expiratory volume in 1 (FEV1) (P = 0.01) and forced vital capacity (P = 0.03) in responders as compared to nonresponders. Change in FEV1 showed a statistically significant correlation with the change in tumor size (RECIST score) (r = -0.34; P = 0.04). Conclusions: Improvement in spirometry correlates with the tumor response as judged using RECIST criteria after chemotherapy. Further studies with bigger sample size are required to consolidate the results.


Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Testes de Função Respiratória/métodos , Espirometria/métodos , Resultado do Tratamento , Carga Tumoral/efeitos dos fármacos
15.
Lung ; 198(5): 771-775, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32915271

RESUMO

PURPOSE: To investigate whether sarcoidosis patients infected with SARS-CoV-2 are at risk for adverse disease outcomes. STUDY DESIGN AND METHODS: This retrospective study was conducted in five hospitals within the Mount Sinai Health System during March 1, 2020 to July 29, 2020. All patients diagnosed with COVID-19 were included in the study. We identified sarcoidosis patients who met diagnostic criteria for sarcoidosis according to accepted guidelines. An adverse disease outcome was defined as the presence of intubation and mechanical ventilation or in-hospital mortality. In sarcoidosis patients, we reported (when available) the results of pulmonary function testing measured within 3 years prior to the time of SARS­CoV­2 infection. A multivariable logistic regression model was used to generate an adjusted odds ratio (aOR) to evaluate sarcoidosis as a risk factor for an adverse outcome. The same model was used to analyze sarcoidosis patients with moderate and/or severe impairment in pulmonary function. RESULTS: The study included 7337 patients, 37 of whom (0.5%) had sarcoidosis. The crude rate of developing an adverse outcome was significantly higher in patients with moderately and/or severely impaired pulmonary function (9/14 vs. 3/23, p = 0.003). While the diagnosis of sarcoidosis was not independently associated with risk of an adverse event, (aOR 1.8, 95% CI 0.9-3.6), the diagnosis of sarcoidosis in patients with moderately and/or severely impaired pulmonary function was associated with an adverse outcome (aOR 7.8, 95% CI 2.4-25.8). CONCLUSION: Moderate or severe impairment in pulmonary function is associated with mortality in sarcoidosis patients infected with SARS­CoV­2.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Testes de Função Respiratória/métodos , Sarcoidose Pulmonar , Comorbidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/epidemiologia , Sarcoidose Pulmonar/fisiopatologia , Estados Unidos/epidemiologia
16.
Clin Chest Med ; 41(3): 347-366, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32800190

RESUMO

Lung function testing has undisputed value in the comprehensive assessment and individualized management of chronic obstructive pulmonary disease, a pathologic condition in which a functional abnormality, poorly reversible expiratory airway obstruction, is at the core of its definition. After an overview of the physiologic underpinnings of the disease, the authors outline the role of lung function testing in this disease, including diagnosis, assessment of severity, and indication for and responses to pharmacologic and nonpharmacologic interventions. They discuss the current controversies surrounding test interpretation with these purposes in mind and provide balanced recommendations to optimize their usefulness in different clinical scenarios.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico , Testes de Função Respiratória/métodos , Feminino , Humanos , Masculino
19.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(5): 347-354, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197322

RESUMO

El asma es la enfermedad respiratoria más prevalente en el mundo; puede afectar a personas de todas las edades y es potencialmente mortal. En la actualidad, contamos con tratamientos de mantenimiento que son efectivos en la mayoría de los pacientes con asma y, sin embargo, una proporción importante no tiene bien controlada su enfermedad a pesar de los medios disponibles. En este documento, con el respaldo de las sociedades de los médicos que tratan el asma en España, se quiere llamar la atención de la sociedad y los profesionales sobre este problema en nuestro país. Se pone el foco sobre los aspectos clínicos, diagnósticos y terapéuticos del asma y se plantean algunas acciones de mejora en el ámbito de los pacientes y en el profesional sanitario que, en vista de los resultados actuales derivados de la falta de control del asma, podrían ser beneficiosas tanto en los resultados clínicos para los pacientes como en los de salud pública


Asthma is the most prevalent respiratory disease worldwide and it can affect people of all ages and is potentially fatal. Today, maintenance treatments are available that are effective in most patients, yet a significant proportion have poorly controlled disease, despite the resources on offer. This document, endorsed by members of the Spanish medical societies involved in the treatment of asthma, is intended to draw the attention of society and professionals to this problem in Spain. It focuses on the clinical, diagnostic and therapeutic aspects of asthma, and proposes some actions for improvement as regards patients and healthcare professionals which, in view of the current results arising from inadequate asthma control, might be beneficial to improve outcomes for both patients and public health


Assuntos
Humanos , Asma/diagnóstico , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Glucocorticoides/administração & dosagem , Hiper-Reatividade Brônquica/fisiopatologia , Exacerbação dos Sintomas , Espirometria/métodos , Testes de Função Respiratória/métodos , Testes de Provocação Brônquica/métodos , Abandono do Uso de Tabaco/métodos , Indicadores de Morbimortalidade , Agonistas Adrenérgicos beta/uso terapêutico
20.
Anesthesiology ; 133(4): 867-878, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32701573

RESUMO

BACKGROUND: Complete airway closure during expiration may underestimate alveolar pressure. It has been reported in cases of acute respiratory distress syndrome (ARDS), as well as in morbidly obese patients with healthy lungs. The authors hypothesized that complete airway closure was highly prevalent in obese ARDS and influenced the calculation of respiratory mechanics. METHODS: In a post hoc pooled analysis of two cohorts, ARDS patients were classified according to body mass index (BMI) terciles. Low-flow inflation pressure-volume curve and partitioned respiratory mechanics using esophageal manometry were recorded. The authors' primary aim was to compare the prevalence of complete airway closure according to BMI terciles. Secondary aims were to compare (1) respiratory system mechanics considering or not considering complete airway closure in their calculation, and (2) and partitioned respiratory mechanics according to BMI. RESULTS: Among the 51 patients analyzed, BMI was less than 30 kg/m2 in 18, from 30 to less than 40 in 16, and greater than or equal to 40 in 17. Prevalence of complete airway closure was 41% overall (95% CI, 28 to 55; 21 of 51 patients), and was lower in the lowest (22% [3 to 41]; 4 of 18 patients) than in the highest BMI tercile (65% [42 to 87]; 11 of 17 patients). Driving pressure and elastances of the respiratory system and of the lung were higher when complete airway closure was not taken into account in their calculation. End-expiratory esophageal pressure (ρ = 0.69 [95% CI, 0.48 to 0.82]; P < 0.001), but not chest wall elastance, was associated with BMI, whereas elastance of the lung was negatively correlated with BMI (ρ = -0.27 [95% CI, -0.56 to -0.10]; P = 0.014). CONCLUSIONS: Prevalence of complete airway closure was high in ARDS and should be taken into account when calculating respiratory mechanics, especially in the most morbidly obese patients.


Assuntos
Obstrução das Vias Respiratórias/epidemiologia , Obstrução das Vias Respiratórias/fisiopatologia , Índice de Massa Corporal , /fisiopatologia , Mecânica Respiratória/fisiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/fisiopatologia , Respiração com Pressão Positiva/métodos , Prevalência , Estudos Prospectivos , Testes de Função Respiratória/métodos , Estudos Retrospectivos
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