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1.
Praxis (Bern 1994) ; 110(11): 629-636, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34465192

RESUMO

Spirometry in the Medical Practice - Part 1: Measuring Abstract. Today, every practitioner, as well as every hospital emergency, should be able to perform spirometry. However, the measurement requires solid basic knowledge as well as a certain amount of experience so that consistent and reproducible measurements are possible. Since the measurement depends heavily on the cooperation of the patient, typical errors must be recognised and corrected immediately. A rounded forced expiratory flow volume curve, or a sudden drop of the curve towards zero at the end of exhalation as well as clearly deviating curves or values in the minimum required three measurement manoeuvres are clear hints for an insufficiently forced expiration or an expiration that was stopped too early. Pulmonary function assistants need instructions as to when application of a rapid acting beta agonist with repeated spirometry to detect possible reversibility is necessary. This includes knowing how long therapeutic bronchodilators must be stopped prior to the test.


Assuntos
Broncodilatadores , Pulmão , Volume Expiratório Forçado , Humanos , Espirometria , Inquéritos e Questionários , Capacidade Vital
2.
Isr Med Assoc J ; 23(9): 584-589, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472235

RESUMO

BACKGROUND: Adherence to treatment by adolescents and adults with cystic fibrosis (CF) is often poor. OBJECTIVES: To assess the impact of a focused clinical intervention on adherence in individual patients, including help in problem-solving key barriers to adherence. To implement a patient-centered problem-solving intervention using CF My Way tools. To identify and overcome a selected barrier to adherence. METHODS: Medication possession ratios (MPRs), number of airway clearance sessions, forced expiratory volume (FEV1), body mass index (BMI), and health-related quality of life (HRQoL) were measured before and after the intervention. RESULTS: Sixteen patients with CF, aged 23.4 ± 6.7 years, participated. MPR increased for colistimethate sodium and tobramycin inhalations from a median of 21 (range 0-100) to 56 (range 0-100), P = 0.04 and 20 (range 0-100) to 33.3 (range 25-100), P = 0.03, respectively. BMI standard deviation score rose from -0.37 to -0.21, P = 0.05. No significant improvements were found in FEV1, airway clearance, or HRQoL scores. CONCLUSIONS: The CF My Way problem-solving intervention increased adherence to medical treatments by removing barriers directly related to the needs and goals of young adults with CF.


Assuntos
Antibacterianos/administração & dosagem , Fibrose Cística/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , Resolução de Problemas , Adolescente , Adulto , Índice de Massa Corporal , Colistina/administração & dosagem , Colistina/análogos & derivados , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Qualidade de Vida , Tobramicina/administração & dosagem , Adulto Jovem
3.
Codas ; 33(6): e20200062, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34524362

RESUMO

PURPOSE: To relate pharyngeal transit time and the presence of residues with dyspnea and lung function in individuals with Chronic Obstructive Pulmonary Disease COPD. METHODS: Study conducted with 19 adults (11 men, 8 women) with a clinical and spirometric diagnosis of COPD and a mean age of 63.8 years (SD = 9.3). Data collection was performed using the COPD Assessment Test (CAT) questionnaire, the modified Medical Research Council scale (mMRC) and a digital manovacuometer, to characterize the impact of the disease on the individual, dyspnea and lung function. The data related to pharyngeal transit time and pharyngeal residue were collected through the analysis of videofluoroscopic images performed by three blinded judges. RESULTS: No significant relationship was found between pharyngeal transit time (PTT) with lung function (r = -0.71), pharyngeal residue and dyspnea (r = -0.06). PTT, when compared to normality, was increased. CONCLUSION: Individuals with COPD, regardless of the severity of the disease, showed no association between PTT and pharyngeal residue and dyspnea and lung function.


Assuntos
Dispneia , Doença Pulmonar Obstrutiva Crônica , Dispneia/etiologia , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/complicações , Índice de Gravidade de Doença , Inquéritos e Questionários
4.
Percept Mot Skills ; 128(5): 2097-2116, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338055

RESUMO

Little is known about motor competence and the longitudinal development of motor performance among youth with cystic fibrosis (CF). In this study, we assessed aspects of motor performance in different age groups of young patients with CF and compared them with a healthy reference group of same aged children. We also examined the development of motor performance among different age groups of these children with CF, using The Deutscher Motorik Test (DMT) to assess attributes of health-related and motor performance-related fitness. We used an incremental ergometer cycle test to determine maximal exercise capacity (expressed as peak workload). We evaluated and recorded habitual physical activity (PA) as measured by the number of steps per day and the time spent in different PA intensities (expressed in metabolic equivalents). In total, 31 children and adolescents with CF agreed to participate (13 girls,18 boys) aged 6-17 years (M = 11.3, SD =3.3 years); they had a mean one second forced expiratory volume (expressed as a percentage of predicted value [% pred]) of 87.2% (SD = 22.3%). We found their values of health-related and motor performance-related fitness to be significantly lower (p < 0.05) than those of their healthy peer participants. In contrast to the reference group, participants with CF up to 14 years of age showed a linear improvement in these values and in their PA, followed by a plateau or even a nonsignificant decrease after age 14. These findings have important implications for the development and prescription of exercise programs for children with CF. Besides aerobic and strength exercises, we recommend that neuromuscular training be integrated into exercise programs to improve the coordinative abilities of youth with CF. More attention should be paid to vulnerable older adolescents to ensure their long-term motivation to maintain exercise participation.


Assuntos
Fibrose Cística , Adolescente , Criança , Exercício Físico , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Aptidão Física
5.
BMJ Open ; 11(8): e043860, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376437

RESUMO

OBJECTIVE: Asthma often coexists with gastro-oesophageal reflux disease (GERD). The effect of proton pump inhibitors (PPIs) treatment on asthma concomitant with GERD was inconsistent. This study aimed to assess whether PPIs treatment improved morning peak expiratory flow (mPEF) in asthma patients with GERD. DATA SOURCES: PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library and ClinicalTrials.gov; hand searching for reference lists; contacted with authors if necessary. STUDY SELECTION: All eligible trials were randomised clinical trials comparing PPIs with placebo in asthma patients accompanying with GERD. RESULTS: Fourteen randomised clinical trials (2182 participants) were included. Overall, PPIs versus placebo did not affect mPEF in patients with asthma having GERD (weighted mean difference 8.68 L/min, 95% CI -2.02 to 19.37, p=0.11). Trial sequential analysis (TSA) further confirmed this finding (TSA adjusted 95% CI -1.03 to 22.25). Subgroups analyses based on the percentage of patients with symptomatic GERD≥95%, treatment duration >12 weeks also found no statistically significant benefit on mPEF. Similarly, analyses of secondary outcomes (evening PEF, forced expiratory volume in 1 s, asthma symptoms score, asthma quality of life score and episodes of asthma exacerbation) did not show significant difference between PPIs and placebo. CONCLUSION: In this meta-analysis, PPIs therapy did not show a statistically significant improvement on mPEF in asthma patients having GERD, neither in subgroup with symptomatic GERD nor in subgroup with treatment duration >12 weeks. This analysis does not support a recommendation for PPIs therapy as empirical treatment in asthma patients with GERD. PROSPERO REGISTRATION NUMBER: CRD42020177330.


Assuntos
Asma , Refluxo Gastroesofágico , Asma/complicações , Asma/tratamento farmacológico , Volume Expiratório Forçado , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Indian J Med Res ; 153(4): 465-474, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34380793

RESUMO

Background & objectives: Upregulation of matrix metalloproteinases (MMPs) is related to the pathogenesis of chronic obstructive pulmonary disease (COPD). We aimed at assessing the tolerability and impact of long-term use of MMP inhibitor doxycycline in COPD. Methods: A cohort of COPD patients was randomized to continue a uniform COPD treatment with or without add-on long-term oral doxycycline. The lung exacerbations (spirometry), adverse events and health status (COPD Assessment Test score) were noted at 3, 6, 9 and 12 months of therapy. Measurement of the serum MMP-2, and 9 and high-sensitive C-reactive protein (hs-CRP) levels was done at the start of the study and at three months, whenever possible. Results: There were 27, 19, 13 and 10 patients with add-on doxycycline group and 22, 19, 11 and 7 patients with COPD treatment alone at 3, 6, 9 and 12 months of treatment respectively. The improvement was obvious and mostly (at 6 and 12 months) significant (P >0.05) for lung function parameters [forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) and forced expiratory flow at 25-75% of FVC (FEF25-75)] and universal for health status at all measurements, with an overall 26.69 per cent reduction in exacerbations. The analysis with the lung function changes in the available population with protocol violation also supported the same trend. The concomitant reduction in serum MMP-9 (P =0.01), MMP-2 (P =0.01) and hs-CRP (P =0.0001) levels (n=21) at three months was also significant. The adverse reactions with add-on doxycycline appeared acceptable. Interpretation & conclusions: Long-term doxycycline appears well tolerated and seems to improve lung function, health status and exacerbations in COPD. The claim needs further scientific validations.


Assuntos
Doxiciclina , Doença Pulmonar Obstrutiva Crônica , Progressão da Doença , Doxiciclina/efeitos adversos , Volume Expiratório Forçado , Humanos , Pulmão , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Capacidade Vital
7.
Artigo em Inglês | MEDLINE | ID: mdl-34406290

RESUMO

Even when treated adequately, pulmonary tuberculosis can lead to pulmonary sequelae. Patients treated for PTB between 2012 and 2016 answered a standardized questionnaire and underwent chest radiography and spirometry, measurement of absolute pulmonary volume, Diffusing Capacity for Carbon Monoxide (DLCO) and the 6-min walk test (6MWT) on two occasions: within the first year after the end of treatment (follow-up 1), and one and two years after follow-up 1 (follow-up 2). A total of 55 patients they underwent spirometry, 23 (41.82%) had obstructive ventilatory disorder (OVD) and eight (14.5%) had moderate OVD. In total, 29 patients underwent pulmonary function tests (PFTs) and 24 patients underwent the 6MWT on two occasions. The functional changes after PTB treatment appear not to have varied between one and two years of follow-up. There was a correlation between low FEV1 and low DLCO (p<0.001); low DLCO and low 6MWT (p<0.001) and radiographic abnormalities and low FEV1 (p=0.033). The most frequently observed change in spirometry was found in patients with OVD.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Tuberculose Pulmonar , Volume Expiratório Forçado , Humanos , Estudos Longitudinais , Capacidade de Difusão Pulmonar , Tuberculose Pulmonar/tratamento farmacológico
8.
Zhongguo Zhen Jiu ; 41(8): 861-5, 2021 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-34369695

RESUMO

OBJECTIVE: To observe the regulatory effect of electroacupuncture (EA) on small airway function and exercise tolerance in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: A total of 62 patients with stable COPD were randomized into an observation group (31 cases, 1 case dropped off) and a control group (31 cases, 5 cases dropped off). On the base of routine medication and aerobic exercise, the patients of the two groups all received EA at Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and Yingchuang (ST 16). In the observation group, filiform needles were used and inserted perpendicularly, 3 mm in depth. In the control group, the placebo needling method was performed, in which the needle was not inserted through skin at each point. In both groups, electric stimulation with low-frequency electronic pulse instrument was exerted, with continuous wave, 2 Hz in frequency, lasting 30 min each time in the two groups. The treatment was given once every other day, 3 times a week, for 14 treatments totally. Before and after treatment, the following indexes were compared in patients between the two groups, i.e. the lung function indexes (forced expiratory volume in first second [FEV1], forced vital capacity [FVC], the ratio of FEV1 to FVC [FEV1/FVC], maximal voluntary ventilation [MVV], the percentage of maximal expiratory flow [MEF] at 25% of FVC exhaled [MEF25], MEF50 and MEF75 in predicted value), cardiopulmonary exercise test indexs (metabolic equivalent [METS], oxygen uptake per kg body weight [VO2/kg], minute ventilation [VE], the percentage of oxygen pulse [VO2/HR] in predictd value, maximal minute ventilation [VEmax], ventilatory equivalent for oxygen [VE/VO2], ventilatory equivalent for carbon dioxide [VE/VCO2]), 6-minute walk distance (6MWD), the total score of COPD assessment test (CAT), the modified British Medical Research Council (mMRC) score and COPD comprehensive grade. RESULTS: After treatment, FVC%, MVV%, MEF75%, MEF50%, VO2/kg%, METs%, VEmax, VO2/HR%, 6MW and the total CAT score were all improved as compared with those before treatment in the observation group (P<0.05, P<0.01). After treatment, MEF75% and the total CAT score were reduced as compared with those before treatment in the control group (P<0.05). After treatment, MVV%, MEF50%, VO2/kg%, METs%, VEmax and 6MWD in the observation group were all better than those in the control group (P<0.05, P<0.01). CONCLUSION: Electroacupuncture can improve the respiratory function and exercise tolerance in COPD patients through removing small airway obstruction and increasing ventilation.


Assuntos
Eletroacupuntura , Doença Pulmonar Obstrutiva Crônica , Tolerância ao Exercício , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Respiratória
9.
BMJ Open ; 11(8): e053446, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34452971

RESUMO

INTRODUCTION: Heart disease in chronic obstructive pulmonary disease (COPD) is a common but neglected comorbidity. Patients with COPD are frequently excluded from clinical trials of treatments aimed at reducing cardiac morbidity and mortality, which has led to undertreatment of cardiovascular disease in patients with COPD. A particular concern in COPD is the underuse of beta (ß)-blockers. There is observational evidence that cardioselective ß-blockers are safe and may even reduce mortality risk in COPD, although some evidence is conflicting. There is an urgent need to answer the research question: Are cardioselective ß-blockers safe and of benefit in people with moderately severe COPD? The proposed study will investigate whether cardioselective ß-blocker treatment in patients with COPD reduces mortality and cardiac and respiratory morbidity. METHODS AND ANALYSES: This is a double-blind, randomised controlled trial to be conducted in approximately 26 sites in Australia, New Zealand, India, Sri Lanka and other countries as required. Participants with COPD will be randomised to either bisoprolol once daily (range 1.25-5 mg, dependent on tolerated dose) or matched placebo, in addition to receiving usual care for their COPD over the study duration of 24 months.The study will enrol 1164 participants with moderate to severe COPD, aged 40-85 years. Participants will be symptomatic from their COPD and have a postbronchodilator forced expiratory volume in 1 s (FEV1) ≥30% and ≤70% predicted and a history of at least one exacerbation requiring systemic corticosteroids, antibiotics or both in the prior 24 months. ETHICS AND DISSEMINATION: The study protocol has been approved by the Sydney Local Health District Human Research Ethics Committee at The Concord Repatriation General Hospital. TRIAL REGISTRATION NUMBERS: NCT03917914; CTRI/2020/08/027322.


Assuntos
Bisoprolol , Doença Pulmonar Obstrutiva Crônica , Bisoprolol/uso terapêutico , Progressão da Doença , Método Duplo-Cego , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Adv Ther ; 38(9): 4815-4835, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34347255

RESUMO

INTRODUCTION: Smoking may reduce the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), but its impact on bronchodilator efficacy is unclear. This analysis of the EMAX trial explored efficacy and safety of dual- versus mono-bronchodilator therapy in current or former smokers with COPD. METHODS: The 24-week EMAX trial evaluated lung function, symptoms, health status, exacerbations, clinically important deterioration, and safety with umeclidinium/vilanterol, umeclidinium, and salmeterol in symptomatic patients at low exacerbation risk who were not receiving ICS. Current and former smoker subgroups were defined by smoking status at screening. RESULTS: The analysis included 1203 (50%) current smokers and 1221 (50%) former smokers. Both subgroups demonstrated greater improvements from baseline in trough FEV1 at week 24 (primary endpoint) with umeclidinium/vilanterol versus umeclidinium (least squares [LS] mean difference, mL [95% CI]; current: 84 [50, 117]; former: 49 [18, 80]) and salmeterol (current: 165 [132, 198]; former: 117 [86, 148]) and larger reductions in rescue medication inhalations/day over 24 weeks versus umeclidinium (LS mean difference [95% CI]; current: - 0.42 [- 0.63, - 0.20]; former: - 0.25 - 0.44, - 0.05]) and salmeterol (current: - 0.28 [- 0.49, - 0.06]; former: - 0.29 [- 0.49, - 0.09]). Umeclidinium/vilanterol increased the odds (odds ratio [95% CI]) of clinically significant improvement at week 24 in Transition Dyspnea Index versus umeclidinium (current: 1.54 [1.16, 2.06]; former: 1.32 [0.99, 1.75]) and salmeterol (current: 1.37 (1.03, 1.82]; former: 1.60 [1.20, 2.13]) and Evaluating Respiratory Symptoms-COPD versus umeclidinium (current: 1.54 [1.13, 2.09]; former: 1.50 [1.11, 2.04]) and salmeterol (current: 1.53 [1.13, 2.08]; former: 1.53 [1.12, 2.08]). All treatments were well tolerated in both subgroups. CONCLUSIONS: In current and former smokers, umeclidinium/vilanterol provided greater improvements in lung function and symptoms versus umeclidinium and salmeterol, supporting consideration of dual-bronchodilator therapy in symptomatic patients with COPD regardless of their smoking status.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Fumantes , Administração por Inalação , Álcoois Benzílicos , Broncodilatadores/uso terapêutico , Clorobenzenos/uso terapêutico , Método Duplo-Cego , Combinação de Medicamentos , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Quinuclidinas/uso terapêutico , Resultado do Tratamento
11.
Int J Chron Obstruct Pulmon Dis ; 16: 2351-2362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34429593

RESUMO

Purpose: This study aimed to identify the COPD molecular subtypes reflecting pulmonary function damage on the basis of metabolism-related gene expression, which provided the opportunity to study the metabolic heterogeneity and the association of metabolic pathways with pulmonary function damage. Methods: Univariate linear regression and the Boruta algorithm were used to select metabolism-related genes associated with forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity (FVC) in the Evaluation of COPD to Longitudinally Identify Predictive Surrogate Endpoints (ECLIPSE) cohort. COPD subtypes were further identified by consensus clustering with best-fit. Then, we analyzed the differences in the clinical characteristics, metabolic pathways, immune cell characteristics, and transcription features among the subtypes. Results: This study identified two subtypes (C1 and C2). C1 exhibited higher levels of lower pulmonary function and innate immunity than C2. Ten metabolic pathways were confirmed as key metabolic pathways. The pathways related to N-glycan, hexosamine, purine, alanine, aspartate and glutamate tended to be positively associated with the abundance of adaptive immune cells and negatively associated with the abundance of innate immune cells. In addition, other pathways had opposite trends. All results were verified in Genetic Epidemiology of COPD (COPDGene) datasets. Conclusion: The two subtypes reflect the pulmonary function damage and help to further understand the metabolic mechanism of pulmonary function in COPD. Further studies are needed to prove the prognostic and therapeutic value of the subtypes.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Volume Expiratório Forçado , Humanos , Pulmão , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/genética , Testes de Função Respiratória , Capacidade Vital
12.
Zhen Ci Yan Jiu ; 46(7): 598-604, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34369681

RESUMO

OBJECTIVE: To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on lung function, clinical symptoms, exercise tolerance and risk of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 49 outpatients with COPD were randomly divided into TEAS group and control group by using a digital table. The clinical trials were conducted by using randomized, single-blinded and placebo-controlled method. Patients in the TEAS group were treated by TEAS of Feishu (BL13), Dingchuan (EX-B1), Zusanli (ST36) and Pishu (BL20) for 40 min, once every other day for 4 weeks, while patients in the control group were treated with placebo TEAS which the electrode plates were adhered to the same acupoints but without electrical current outputs. The treatment was conducted every 3 months in one year. In addition, patients of the two groups had no restriction on their original treatment with conventional western medicines and Chinese Materia medica. The lung function (forced expiratory volume in 1 second predicted,FEV1%, forced vital capacity predicted,FVC%) was detected using a spirometer), clinical symptom scores (CAT) for coughing, phlegm, chest tightness, climbing, family activities, out-door activities, sleeping and energy status were given. The patient's exercise tolerance was assessed using walking distance in 6 min, and the risks of acute exacerbation (times of exacerbation and hospitalization in 1 year) were recorded. RESULTS: Correlative analysis showed a negative correlation between the risks of acute exacerbation and the levels of FEV1% and FVC% (P<0.01) and a positive correlation between the risks of acute exacerbation and CAT score (P<0.01). Self-comparison showed that 1 month after the treatment, the FEV1% and FVC% levels, 6MWD in the control group were significantly decreased (P<0.001, P<0.01), while the CAT score in the control group, and FEV1% and 6MWD in the TEAS group were obviously increased in comparison with their own pretreatment (P<0.05, P<0.001), but FVC% in the TEAS group and the times of exacerbation and hospitalization in the control group had no obvious changes in comparison with their own pre-treatment (P>0.05). One year (1 year) after the treatment, FEV1% and FVC% levels, 6MWD in the control group, and CAT score and times of exacerbations and hospitalization in the TEAS group were significantly decreased (P<0.001, P<0.01, P<0.05), while CAT score in the control group and 6MWD in the TEAS group were markedly increased (P<0.05, P<0.01), but FEV1% in the TEAS group and the times of exacerbation and hospitalization in the control group had no significant change compared with their own pretreatment (P>0.05). Comparison between two groups showed that after the treatment, the FEV1% (1 month) and FVC% (1 month and 1 year), 6MWD (1 month and 1 year) were significantly higher in the TEAS group than in the control group (P<0.05), while the CAT (1 month and 1 year) and times of exacerbation and hospitalization (1 year) were significantly lower in the TEAS group than in the control group (P<0.05, P<0.01, P<0.001), without significant difference in the FEV1% (1 year) level (P>0.05). CONCLUSION: TEAS can improve the lung function, clinical symptoms, exercise tolerance, and reduce the risks of acute exacerbation in patients with COPD.


Assuntos
Pontos de Acupuntura , Doença Pulmonar Obstrutiva Crônica , Volume Expiratório Forçado , Humanos , Pulmão , Doença Pulmonar Obstrutiva Crônica/terapia , Capacidade Vital
13.
Respir Res ; 22(1): 237, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446020

RESUMO

Follow-up studies of COVID-19 patients have found lung function impairment up to six months after initial infection, but small airway function has not previously been studied. Patients (n = 20) hospitalised for a severe SARS-CoV-2 infection underwent spirometry, impulse oscillometry, and multiple measurements of alveolar nitric oxide three to six months after acute infection. None of the patients had small airway obstruction, nor increased nitric oxide concentration in the alveolar level. None of the patients had a reduced FEV1/FVC or significant bronchodilator responses in IOS or spirometry. In conclusion, we found no evidence of inflammation or dysfunction in the small airways.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Doenças Respiratórias/fisiopatologia , Adulto , Idoso , Feminino , Finlândia , Seguimentos , Volume Expiratório Forçado , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Alvéolos Pulmonares/metabolismo , Testes de Função Respiratória , Doenças Respiratórias/etiologia , Espirometria , Sobreviventes , Capacidade Vital
14.
Ann Palliat Med ; 10(6): 6564-6576, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237968

RESUMO

BACKGROUND: Whether N-acetylcysteine (NAC) therapy can promote the improvement of clinical symptoms and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has not been verified by large-scale randomized controlled trials, only a few small sample studies. METHODS: English databases were searched using a combination of the following terms: "chronic obstructive pulmonary disease", "acute exacerbation of chronic obstructive pulmonary disease", and "N-acetylcysteine". Studies examining NAC in the treatment of AECOPD were screened, so as to be a reference for the experimental group. Meta-analysis was performed using RevMan 5.3 software (Cochrane, Northern Europe), with a total of 15 included literatures. RESULTS: The heterogeneity test of improvement rate showed Chi2=1.89, df=7, I2=0% <50%, and P=0.97 (>0.01); the risk rate was 1.09, the 95% confidence interval (CI) was (1.04-1.14), Z=3.93, and P<0.0001. The heterogeneity test of forced expiratory volume in the first second (FEV1) showed that Tau2=63.39, Chi2=118.66, df=9, I2=92% >50%, and P=0.88 (<0.0001); the mean difference was 30.63 (95% CI: 25.48-35.78), Z=11.65, and P<0.0001. The results of the heterogeneity test of forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) showed that Tau2=60.03, Chi2=74.09, df=5, I2=93% >50%, and P<0.0001; the mean difference was 30.42 (95% CI: 24.00-36.85), Z=9.28, and P<0.0001. The heterogeneity test for glutathione sulfur transferase (GSH-ST) activity showed that Tau2=4.12, Chi2=58.12, df=5, I2=91% >50%, and P<0.0001; the mean difference was 3.10 (95% CI: 1.38-4.82), Z=3.63, and P=0.0004. CONCLUSIONS: Our meta-analysis confirmed that NAC could promote the symptom improvement rate of patients with AECOPD, improve lung function in FEV1 and FEV1/FVC, and enhance the body's antioxidant capacity.


Assuntos
Acetilcisteína , Doença Pulmonar Obstrutiva Crônica , Acetilcisteína/uso terapêutico , Europa (Continente) , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Testes de Função Respiratória
15.
Chin Med J (Engl) ; 134(13): 1552-1560, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34250960

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD. METHODS: A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES. RESULTS: The mean age of the 2421 participants was 56.63 ±â€Š9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%-13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43-0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49-0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index. CONCLUSIONS: Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Classe Social , Espirometria , Capacidade Vital
16.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(7): 818-826, 2021 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-34304417

RESUMO

Objective: To evaluate the clinical efficacy of the combined diagnosis and management in children with airway allergic diseases(bronchial asthma, allergic rhinitis). Methods: This observational study belongs to cluster sampling cases, which included the clinical data from children with airway allergic diseases in Allergy Department and Otorhinolaryngology Department of Beijing Children's Hospital from April to December in 2015. They were followed up every three months during 12 months. All the subjects were required to continuously record daily symptom by diary card. ACT/c-ACT, VAS, treatment steps to control asthma, respiratory infections, wheeze, pulmonary function(FEV1%pred,FEV1/FVC,PEF%pred,FEF25%pred,FEF50%pred,FEF75%pred,MMEF%pred), FeNO were assessed in every visiting. The mean±standard deviation was used for the measurement data in accordance with normal distribution. Comparing the pulmonary function indexes at every point, the measurement data with normal distribution and uniform variance were analyzed by single factor analysis of variance, and the measurement data with uneven variance were tested by non-parametric rank sum test. Results: Among 147 recruited participants, 106 completed the combined diagnosis and management. The airway allergic diseases control rate was 87.7% at 12 months after the combined diagnosis and management. At every point, the average daily symptom score and VAS score which were significantly lower than at the baseline(H=35.854,P=0.000)[ 1.2(0.7,2.2),0.6(0.2,1.5),0.4(0.1,1.0),0.5(0.1,1.1) vs 2.0(1.0,3.5)],(H=39.559,P=0.000)[2.5(0.5,4.7),2.2(0.3,4.4),1.8(0.2,4.6),1.6(0.3,3.8) vs 6.9(4.1,9.8)]. ACT/c-ACT score at 3, 6, 9, 12 months were significantly higher than at the baseline (H=79.695,P=0.000) [25.0(22.5,27.0),26.0(24.0,27.0),25.0(23.0,27.0),25.0(24.0,27.0) vs 20.0(17.0,22.0)]. FEV1%pred and FEF25%pred at 3, 6 months were significantly higher than at the baseline (F=3.563,P=0.007)(104.7±12.6 vs 96.8±14.5,103.0±10.3 vs 96.8±14.5),(F=2.456,P=0.046)(96.6±22.0 vs 85.0±21.9,93.3±18.0 vs 85.0±21.9). PEF%pred at 3, 6, 9, 12 months after the combined diagnosis and management were significantly higher than at the baseline(F=5.497,P=0.000)(105.1±18.1,101.2±15.3,99.7±17.1,99.8±17.5 vs 90.3±17.8). FeNO at 3, 6, 9, 12 months respectively were no significantly differences at the baseline(F=0.751,P=0.558)(25.7±23.6 vs 30.7±25.6,25.9±16.5 vs 30.7±25.6,27.5±20.2 vs 30.7±25.6,30.6±19.6 vs 30.7±25.6).The respiratory infections rate were 69.8%(74/106),67.0%(71/106),60.4%(64/106),51.9%(55/106) at 3, 6, 9, 12 months respectively. The wheezing rate was 24.5%(26/106),14.2%(15/106),11.3%(12/106),7.5%(8/106) at 3, 6, 9, 12 months respectively. Conclusions: The combined diagnosis and management can significantly improve the control level of children's airway allergic diseases, which should be implemented in the management of children's airway allergic diseases.


Assuntos
Asma , Asma/diagnóstico , Criança , Volume Expiratório Forçado , Humanos , Pulmão , Testes de Função Respiratória , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-34209104

RESUMO

Nickel is a well-known skin allergen; however, few studies to date have investigated the association between nickel exposure and lung function impairment. The present study, therefore, evaluated the relationship between blood nickel concentrations and lung function profiles in the Korean general population (n = 1,098). Dose-response relationships between blood nickel quartiles and pulmonary function were assessed by sex in multivariate models, after adjustment for potentially confounding factors such as age, height, and smoking status. Quartiles of blood nickel concentrations were significantly associated with markers of pulmonary function in Korean men, such as forced expiratory volume in 1 second (FEV1) and forced expiratory flow 25-75% (FEF25-75%). Relative to the first quartile, the estimated coefficients (standard error (SE)) of blood nickel levels for FEV1 in the third and fourth quartiles of Korean men were -126.6 mL (59.1) and -138.5 mL (59.8), respectively (p < 0.05). Relative to the first quartile, the estimated coefficients (SE) of blood nickel levels for FEF25-75% in the second and fourth quartiles were -244.9 mL (109.5) and -266.8 mL (111.5), respectively (p < 0.05). Dose-response relationships were observed between quartiles of blood nickel concentrations and the pulmonary function markers FEV1 and FEF25-75% in Korean men aged 40 or older.


Assuntos
Pulmão , Níquel , Exposição Ambiental/efeitos adversos , Volume Expiratório Forçado , Humanos , Masculino , Níquel/toxicidade , República da Coreia/epidemiologia , Capacidade Vital
18.
Artigo em Inglês | MEDLINE | ID: mdl-34209922

RESUMO

Diabetes mellitus is a highly challenging global health care problem. This study aimed to assess the effect of glycated hemoglobin (HbA1c) and duration of diabetes on lung function in type 2 diabetic patients and assess whether duration or high HbA1c is more noxious to damage the lung functions. A total of 202 participants, 101 patients with type 2 diabetes mellitus (T2DM), and 101 age-, gender-, height-, and weight-matched controlled subjects were recruited. The HbA1c was measured through a clover analyzer, and lung function test parameters were recorded by spirometry. The results revealed a significant inverse correlation between HbA1c and Vital Capacity (VC) (r = -0.221, p = 0.026), Forced Vital Capacity (FVC) (r = -0.261, p = 0.008), Forced Expiratory Volume in First Second (FEV1) (r = -0.272, p = 0.006), Forced Expiratory Flow 25% (FEF-25%) (r = -0.196, p = 0.050), Forced Expiratory Flow 50% (FEF-50%) (r = -0.223, p = 0.025), and Forced Expiratory Flow 75% (FEF-75%) (r = -0.169, p = 0.016). Moreover, FEV1 (p = 0.029), FEV1/FVC% (p = 0.006), FEF-50% (p = 0.001), and FEF-75% (p = 0.003) were significantly lower in the diabetic group with duration of disease 5-10 and >10 years compared to the control group. The overall results concluded that high HbA1c or uncontrolled diabetes mellitus has a more damaging effect on lung function impairment compared to the duration of diabetes mellitus. Physicians must regularly monitor the HbA1c level while treating diabetic patients, as good glycemic control is essential to minimize the complications of DM, including lung function impairment in patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Volume Expiratório Forçado , Hemoglobina A Glicada/análise , Humanos , Pulmão , Espirometria , Capacidade Vital
19.
Artigo em Inglês | MEDLINE | ID: mdl-34281018

RESUMO

Patients with chronic obstructive pulmonary disease (COPD) have been reported to have poor sleep quality. However, total sleep time has not been evaluated in detail among patients with COPD. This retrospective, observational, multicenter research study was performed across six participating hospitals in Taiwan, with a total of 421 adult patients enrolled. Pulmonary function, the Modified British Medical Research Council Dyspnea Scale, the COPD Assessment Test and basic clinical data were assessed. The Pittsburgh Sleep Quality Index was also administered to patients, and the total sleep time was extracted for further analysis. The patients whose total sleep time was between 6 and 7 h had better pulmonary function, and the patients who slept less than 5 h had worse comorbidities. There was a significant higher total sleep time in Global Initiatives for Chronic Obstructive Lung Disease (GOLD) group B compared to GOLD group A. COPD patients who sleep between 5 and 6 h used fewer oral steroids and were less likely to use triple therapy (long-acting beta-agonist, long-acting muscarinic antagonist, inhaled cortical steroid). COPD patients sleeping from 5 to 7 h had better clinical features than those sleeping less than 5 h in terms of pulmonary function, comorbidities and medication usage.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Sono , Taiwan/epidemiologia
20.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205308

RESUMO

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


Assuntos
Insegurança Alimentar , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Índice de Massa Corporal , Dieta Saudável , Grupos Étnicos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Fumar/epidemiologia , Espirometria , Estados Unidos/epidemiologia , Capacidade Vital
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