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1.
PLoS One ; 15(5): e0233147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392262

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarized the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers. METHODS: We systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI). RESULTS: In total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 7.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%-3%) and 9% (95% CI, 4%-14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4-2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03-2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%. CONCLUSION: Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Prevalência , Índice de Gravidade de Doença , Fumar , Taxa de Sobrevida
2.
BMJ Open ; 10(4): e037509, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32300001

RESUMO

OBJECTIVES: Inhaled corticosteroids (ICS) reduce exacerbation rates and the decline in lung function in people with chronic obstructive pulmonary disease (COPD). There is evidence that smoking causes 'steroid resistance' and thus reduces the effect of ICS. This systematic review aimed to investigate the effect of smoking on efficacy of ICS in COPD in terms of lung function and exacerbation rates. DESIGN: Systematic review. DATA SOURCES: An electronic database search of PubMed, Ovid MEDLINE, Ovid Embase and Cochrane Library (January 2000 to January 2020). ELIGIBILITY CRITERIA: Fully published randomised controlled trials (RCTs), in the English language, evaluating the use of ICS in COPD adults that stratified the participants by smoking status. Trials that included participants with asthma, lung cancer and pneumonia were excluded. The primary outcome measures were changes in lung function and yearly exacerbation rates. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias using the Cochrane Collaboration's tool. RESULTS: Seven studies were identified. Four trials (17 892 participants) recorded change in forced expiratory volume in one second (FEV1) from baseline to up to 30 months after starting treatment. Heavier smokers (>36 pack years) using ICS had a greater decline in FEV1 that ranged from -22 mL to -75 mL in comparison to lighter smokers. Smokers using ICS had mixed results in FEV1 change: -8 mL to +77 mL in comparison to ex-smokers. Four trials (21 270 participants) recorded difference in COPD exacerbation rates at 52 weeks. The rate ratios favoured more exacerbations in ICS users who were current or heavier smokers than those who were ex-smokers or lighter smokers (0.81 to 0.99 vs 0.92 to 1.29). CONCLUSIONS: In COPD, heavier or current smokers do not gain the same benefit from ICS use on lung function and exacerbation rates as lighter or ex-smokers do, however effects may not be clinically important. PROSPERO REGISTRATION NUMBER: CRD42019121833.

3.
Public Health Nurs ; 37(3): 453-460, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31899558

RESUMO

Greenness such as trees, plants, and shrubs may positively influence mental and physical health, but the relationship between greenness and asthma is poorly understood. Because asthma is the most prevalent child respiratory disease internationally, elucidating the role of greenness may substantially benefit public health. The purpose of this systematic review was to synthesize findings related to effects of greenness on asthma in children. Following PRISMA guidelines, six databases were searched for international publication of primary research results relevant to the relationship between greenness and child asthma. Of 82 initial results, seven articles remained after removal of duplicates and applying exclusion criteria. Six reported no direct association between greenness and child asthma, while one found increased greenness protective for asthma. None found a negative direct association between greenness and child asthma. Evidence supported benefits of greenness on child asthma through mediation of factors such as exposure to tobacco smoke, high traffic volume, and difficult family relationships. Even without a direct association, greenness can be considered a public health asset as it may mediate other factors contributing to asthma in children. Public health nurses can use these findings to educate clients and partners while advocating for policies to protect greenness.

4.
BMC Pulm Med ; 19(1): 186, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660921

RESUMO

INTRODUCTION: There is evidence of an association between inflammatory bowel disease (IBD) and lung conditions such as chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis explored the risk of new onset IBD in patients with COPD and new onset COPD in IBD patients. METHODS: We performed a systematic review of observational studies exploring the risk of both associations. Two independent reviewers explored the EMBASE, MEDLINE, LILACS and DOAJ databases, and the risk of bias was evaluated using the ROBBINS-I tool. Data from included studies was pooled in a random effect meta-analysis following a DerSimonian-Laird method. The quality of the evidence was ranked using GRADE criteria. RESULTS: Four studies including a pooled population of 1355 new cases were included. We found association between new onset IBD in COPD population. The risk of bias was low in most of them. Only one study reported tobacco exposure as a potential confounding factor. The pooled risk ratio (RR) for a new diagnosis of IBD in COPD patients was 2.02 (CI, 1.56 to 2.63), I2 = 72% (GRADE: low). The subgroup analyses for Crohn's disease and ulcerative colitis yielded RRs of 2.29 (CI, 1.51 to 3.48; I2 = 62%), and 1.79 (CI, 1.39 to 2.29; I2 = 19%.), respectively. DISCUSSION: According to our findings, the risk of new onset IBD was higher in populations with COPD compared to the general population without this condition. Based on our analysis, we suggest a potential association between IBD and COPD; however, further research exploring the potential effect of confounding variables, especially cigarette smoking, is still needed. REVIEW REGISTER: (PROSPERO: CRD42018096624).


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Comorbidade , Fatores de Confusão Epidemiológicos , Humanos
5.
COPD ; 16(3-4): 292-302, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31581921

RESUMO

The comorbidity of peripheral arterial disease (PAD) and chronic obstructive pulmonary disease (COPD) is obvious from a clinical point of view, especially as smoking is an important risk factor for both. Another factor connecting these two clinical conditions is chronic inflammation, which plays a crucial role in their pathophysiology. The aim of this study was to present the prevalence of COPD in patients with PAD, as well as the prevalence of PAD in COPD patients confirmed in all patients by two reliable methods: spirometry and ankle-brachial index (ABI), respectively. The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched to identify the potentially eligible publications from the previous 10 years. The published characteristics of different PAD and COPD populations were analyzed. A database search identified 894 records. Reliable criteria of both COPD and PAD diagnosis were used only in seven publications. The prevalence of PAD among patients with COPD ranged from 8.5 to 81.4%. The severity of the disease and the exclusion of nonsmokers or symptomatic patients from the analyses were important factors affecting this parameter. The prevalence of COPD in patients with PAD was measured reliably only in one study and assessed as 27.2%. The comorbidity of COPD and PAD is a relatively common occurrence. There are very few publications addressing this issue based on reliable diagnostic criteria, especially in the field of PAD. In the case of COPD and PAD patients, spirometry and ABI measurements are worth considering as noninvasive screening tests for COPD and PAD, respectively.

6.
Respir Res ; 20(1): 144, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288799

RESUMO

BACKGROUND: The risk and prevalence of chronic obstructive pulmonary disease (COPD) in rheumatoid arthritis (RA) is still obscure. The current study was aimed to systematically review and meta-analyse the risk ratio (RR) and prevalence of COPD in RA. METHODS: A comprehensive systematic review was conducted based on PubMed, Web of Science and Cochrane Library from inception to April 30, 2018. The primary outcome of our study was the RR of COPD in RA patients compared with controls, and secondary was the prevalence of COPD in RA patients. Pooled effect sizes were calculated according to fixed effect model or random effects model depending on heterogeneity. RESULTS: Six and eight studies reported the RR and prevalence of COPD in RA respectively. Compared with controls, RA patients have significant increased risk of incident COPD with pooled RR 1.82 (95% CI = 1.55 to 2.10, P <  0.001). The pooled prevalence of COPD in RA patients was 6.2% (95% CI = 4.1 to 8.3%). Meta-regression identified that publication year was an independent covariate negatively associated with the RR of COPD, and smoker proportion of RA population was also positively associated with the prevalence of COPD significantly in RA patients. CONCLUSIONS: The present meta-analysis has demonstrated the significant increased risk and high prevalence of COPD in RA patients. Patients with RA had better cease tobacco use and rheumatologists should pay attention to the monitoring of COPD for the prevention and control of COPD.


Assuntos
Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos de Coortes , Humanos , Prevalência , Fatores de Risco
7.
BMJ Open ; 9(5): e027935, 2019 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-31061055

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease, usually caused by tobacco smoking, but other important risk factors include exposures to combustion products of biomass fuels and environmental pollution. The introduction of several new (combination) inhaler therapies, increasing uncertainty about the role of inhaled corticosteroids and a rapid proliferation of the literature on management of stable COPD in general, call for novel ways of evidence synthesis in this area. A systematic review and evidence map can provide the basis for shared decision-making tools and help to establish a future research agenda. METHODS AND ANALYSIS: This systematic review will follow an umbrella systematic review design (also called overview of reviews). We plan to conduct a comprehensive literature search of Ovid MEDLINE (including epub ahead of print, in process and other non-indexed citations), Ovid Embase, Ovid Cochrane Database of Systematic Reviews and Scopus from database inception to the present. We will include systematic reviews that assessed the effectiveness of any pharmacological or non-pharmacological intervention on one or more patient-important outcomes and/or lung function in patients with stable COPD. For every intervention/outcome pair, one systematic review will be included. An a priori protocol will guide, which systematic reviews will be chosen, how their credibility will be evaluated, and how the quality of the body of evidence will be rated. Data will be synthesised into an evidence map that will present a matrix that depicts each available treatment for stable COPD with a quantitative estimate on symptoms/outcomes from the patient perspective, along with an indication of the size and certainty in the evidence. ETHICS AND DISSEMINATION: Approval by a research ethics committee is not required since the review will only include published data. The systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018095079.

8.
Cureus ; 11(1): e3970, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30956922

RESUMO

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity in low- and middle-income countries (LMICs) including Bangladesh. But no systematic review has been carried out in Bangladesh, which portraits the burden of COPD and its risk factors. Therefore, this systematic review was conducted to find out the prevalence and risk factors of COPD in Bangladesh. We searched PubMed, Google Scholar, Popline, and Banglajol from January 1, 1972 to April 30, 2017. We included studies that reported the prevalence and/or risk factors of COPD among Bangladeshi people. Two researchers independently searched and screened all the articles and extracted data from nine eligible studies. The whole process was verified by another researcher. Quality assessment was performed using a checklist adopted from published articles on quality assessment guidelines of observational studies. Discrepancies were resolved by consensus. Data analysis was done thematically. The pooled COPD prevalence among Bangladeshi adult was 12.5% (95% CI, 10.9-14.1) using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and 11.9% (95% CI, 11.4-13.6) using the lower limit of the normality (LLN) criteria. The prevalence was higher among males, low socio-economic group, rural residents, and biomass fuel users. Tobacco consumption, exposure to biomass fuel, old age, and history of asthma were identified as major risk factors of COPD. COPD prevalence is high in Bangladesh. It is a timely need for the policy-makers and public health professionals to take pertinent steps for prevention and control of COPD in Bangladesh.

9.
J Breath Res ; 13(3): 034003, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-30861509

RESUMO

Fractional exhaled nitric oxide (FeNO) reflects eosinophilic airway inflammation and it can be used to diagnose and phenotype asthma and predict treatment responses. However, smoking decreases FeNO and it is not clear if FeNO has clinical value in smoking subjects with asthma. We conducted a systematic review focusing on four basic characteristics and five clinical questions on using FeNO in smokers with asthma. At least two authors independently screened search results, extracted data and assessed the quality of the included studies. Data were synthesised mainly by qualitative methods. Twenty-two studies were included. FeNO is lower in smoking than in non-smoking asthmatics, but importantly FeNO is higher in untreated smoking asthmatics than in healthy smokers. Information was incomplete but there is some indication that FeNO might be useful in detecting eosinophilic airway inflammation and in diagnosing asthma in smoking subjects. There was no data available to four of the five clinical questions. In conclusion, at the moment there is insufficient data to give specific guidelines on using FeNO in smoking subjects, but although smoking decreases FeNO it does not seem to make FeNO measurement redundant. FeNO is also associated with asthma in smokers and current results encourage conducting clinical trials on FeNO in smokers with asthma.


Assuntos
Asma/fisiopatologia , Testes Respiratórios/métodos , Óxido Nítrico/química , Adulto , Feminino , Humanos , Masculino
10.
Artigo em Inglês | MEDLINE | ID: mdl-30605063

RESUMO

BACKGROUND: The morbidity and mortality associated with tobacco smoking is well established. Nicotine is the addictive component of tobacco. Nicotine, through the non-neuronal α7nicotinic receptor, induces cell proliferation, neo-angiogenesis, epithelial to mesenchymal transition, and inhibits drug-induced apoptosis. OBJECTIVE: To understand the genetic, molecular and cellular biology of addiction, chronic obstructive pulmonary disease and lung cancer. METHODS: The search for papers to be included in the review was performed during the months of July- September 2018 in the following databases: PubMed (http://www.ncbi.nlm.nih.gov), Scopus (http://www.scopus.com), EMBASE (http://www.elsevier.com/online-tools/embase), and ISI Web of Knowledge (http://apps.webofknowledge.com/). The following searching terms: "nicotine", "nicotinic receptor", and "addiction" or "COPD" or "lung cancer" were used. Patents were retrieved in clinicaltrials.gov (https://clinicaltrials.gov/). All papers written in English were evaluated. The reference list of retrieved articles was also reviewed to identify other eligible studies that were not indexed by the above-mentioned databases. New experimental data on the ability of nicotine to promote transformation of human bronchial epithelial cells, exposed for one hour to Benzo[a]pyrene-7,8-diol-9-10-epoxide, are reported. RESULTS: Nicotinic receptors variants and nicotinic receptors upregulation are involved in addiction, chronic obstructive pulmonary disease and/or lung cancer. Nicotine through α7nicotinic receptor upregulation induces complete bronchial epithelial cells transformation. CONCLUSION: Genetic studies highlight the involvement of nicotinic receptors variants in addiction, chronic obstructive pulmonary disease and/or lung cancer. A future important step will be to translate these genetic findings to clinical practice. Interventions able to help smoking cessation in nicotine dependence subjects, under patent, are reported.


Assuntos
Neoplasias Pulmonares/metabolismo , Doença Pulmonar Obstrutiva Crônica/metabolismo , Agentes de Cessação do Hábito de Fumar/metabolismo , Fumar Tabaco/metabolismo , Tabagismo/metabolismo , Animais , Humanos , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Antagonistas Nicotínicos/metabolismo , Antagonistas Nicotínicos/farmacologia , Antagonistas Nicotínicos/uso terapêutico , Patentes como Assunto , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Receptores Nicotínicos/metabolismo , Fatores de Risco , Abandono do Hábito de Fumar/métodos , Agentes de Cessação do Hábito de Fumar/farmacologia , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Fumar Tabaco/tratamento farmacológico , Tabagismo/tratamento farmacológico
11.
Int J Tuberc Lung Dis ; 23(1): 58-66, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30674376

RESUMO

Chronic obstructive pulmonary disease (COPD) is commonly attributed to smoking, and other potential risk factors are ignored. We aimed to critically appraise the epidemiological credibility of the risk factors for COPD that have been examined in published meta-analyses. We performed a systematic search to capture systematic reviews and meta-analyses of observational studies on environmental factors and biomarkers for risk of COPD. We applied a set of standardised methodological criteria based on the level of statistical significance, sample size, between-study heterogeneity and statistical biases. Our search yielded 11 eligible papers, including 18 meta-analyses on environmental factors or biomarkers for COPD risk, and eight eligible papers with systematic reviews only. Eleven associations achieved statistical significance at P < 0.001 and six associations at P < 1 × 10-6. Thirteen associations presented an I²  50%, while six associations had evidence of small-study effects and/or excess significance bias. History of tuberculosis or rheumatoid arthritis, exposure to biomass fuels, tobacco smoking and second hand smoking were supported by high epidemiological credibility for an increased risk of COPD. Furthermore, highly suggestive evidence was found for increased levels of serum C-reactive protein, and serum fibrinogen in COPD patients compared with healthy controls. To summarise, our approach suggests that, while a proportion of COPD patients are non-smokers, only a narrow range of risk factors not related to smoking have been studied for an association with COPD. There is also a need to decipher possible protective factors in COPD pathogenesis given that more than a half of ever-smokers do not develop COPD.


Assuntos
Biomarcadores/análise , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Fatores de Proteção , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Fatores de Risco , Fumar/efeitos adversos , Revisões Sistemáticas como Assunto
12.
Artigo em Espanhol | LILACS | ID: biblio-1100525

RESUMO

Introducción. La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una patología no transmisible, caracterizada por una limitación de flujo de aire en las vías respiratorias debido a una respuesta inmunológica anormal frente a partículas. Objetivo. Conocer la eficacia que tiene la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar en personas mayores de 40 años con Enfermedad Pulmonar Obstructiva Crónica. Materiales y métodos. Se realizó una revisión sistemática de documentos producidos entre el año 2000 y 2018 en distintas bases de datos, donde se incluyeron ensayos clínicos. Se identificaron cuatro artículos para el análisis final. Resultados. Durante la evaluación comparativa de budesonida con formoterol, los artículos muestran un total de 709 personas evaluadas, con un promedio de edad de 53,5 años. El 65,4 % eran varones, el 21 % manifestaba no haber consumido tabaco, todos con diagnóstico de Enfermedad Pulmonar Obstructiva Crónica moderada-severa, según la escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Los estudios determinaron que al administrar budesonida/formoterol de 400/12 mcg y 320/9 mcg, los pacientes tuvieron una leve mejoría en el Volumen Espiratorio Forzado del primer segundo (VEF1). Solo dos pacientes presentaron efectos adversos. No obstante, para los resultados mencionados anteriormente no se encontró diferencias significativas. Conclusiones. El uso de budesonida/formoterol es eficaz al mejorar la capacidad ventilatoria pulmonar, disminuye el número de exacerbaciones anuales y genera un adecuado control de los síntomas, sin embargo, es igual de efectivo a la fluticasona/salmeterol.


Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a not transmissible disease, characterized by a limitation of airflow in the respiratory tract, due to an abnormal immune response to particles. Objective. This article aims to show that the application of budesonide / formoterol improves lung capacity in people over 40 years with Chronic Obstructive Pulmonary Disease. Materials and methods. A systematic review was conducted in the period between 2000 and 2018 in different databases where clinical trials were included. Four articles were identified for the final analysis. Results. During the comparative evaluation of budesonide with formoterol, a total of 709 people were evaluated, with an average age of 53.5 years, 65.4% were male, 21% reported not having used tobacco, all with a diagnosis of moderate-severe Chronic Obstructive Pulmonary Disease according to the GOLD scale (Global Initiative For Chronic Obstrutive Lung Disease). The studies determined that when budesonide / formoterol of 400/12 mcg and 320/9 mcg was administered, the patients had a slight improvement in the Forced Expiratory Volume of the first second (FEV1). Only two patients presented adverse effects. However, for the results mentioned above no significant differences were found. Conclusions. The use of budesonide / formoterol is effective in improving pulmonary ventilatory capacity, decreases the number of annual exacerbations and generates adequate control of symptoms, however, it is equally effective in fluticasone / salmeterol.


Introdução. A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia não transmissível, caraterizada por uma limitação do fluxo de ar nas vias aéreas devido a uma resposta imune anormal contra partículas. Objetivo. Conhecer a eficiência que apresenta a budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar em pessoas com mais de 40 anos com Doença Pulmonar Obstrutiva Crônica. Materiais e métodos. Foi realizada uma revisão sistemática dos documentos produzidos entre 2000 e 2018 em diferentes bancos de dados, onde foram incluídos ensaios clínicos. Quatro artigos foram identificados para a análise final. Resultados. Durante a avaliação comparativa de budesonida com formoterol, os artículos mostram um total de 709 pessoas avaliadas, com uma idade média de 53,5 anos. O 65,4 % eram do sexo masculino, o 21 % disseram que não usavam tabaco, todos diagnosticados com Doença Pulmonar Obstrutiva Crônica moderada a grave, de acordo com a escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Os estudos determinaram que administrar budesonida/formoterol de 400/12 mcg e 320/9 mcg, os pacientes apresentaram uma leve melhora no Volume Expiratório Forçado no primeiro segundo (VEF1). Apenas dois pacientes tiveram efeitos adversos. No entanto, não foram encontradas diferenças significativas para os resultados mencionados acima. Conclusões. O uso de budesonida/formoterol é eficaz na melhora da capacidade ventilatória pulmonar, diminui o numero de exacerbações anuais e gera controle adequado dos sintomas, no entanto, é igualmente eficaz para a fluticasona/salmeterol.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Eficácia , Budesonida , Bronquite Crônica , Xinafoato de Salmeterol , Fumarato de Formoterol , Fluticasona
13.
Respir Res ; 19(1): 256, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563522

RESUMO

We performed a post-hoc analysis of the OLiVIA-study investigating whether current and ex-smoking asthmatics with small airways dysfunction (SAD) show a better response in airway hyperresponsiveness (AHR) to small particle adenosine after treatment with extrafine compared to non-extrafine particle inhaled corticosteroids (ICS), and to investigate which clinical parameters predict a favorable response to both treatments. We show that smoking and ex-smoking asthmatics with and without SAD have a similar treatment response with either extrafine or non-extrafine particle ICS. We also found that lower blood neutrophils are associated with a smaller ICS-response in smokers and ex-smokers with asthma, independent from the level of blood eosinophils.


Assuntos
Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Ex-Fumantes , Tamanho da Partícula , Fumantes , Fumar/tratamento farmacológico , Administração por Inalação , Adulto , Remodelação das Vias Aéreas/efeitos dos fármacos , Remodelação das Vias Aéreas/fisiologia , Asma/sangue , Asma/diagnóstico , Eosinófilos/efeitos dos fármacos , Eosinófilos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fumar/sangue , Resultado do Tratamento
14.
Brasília; CONITEC; out. 2018. ilus, tab.
Não convencional em Português | BRISA/RedTESA | ID: biblio-997882

RESUMO

INTRODUÇÃO: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um estado patológico caracterizado por uma limitação do débito aéreo que não é totalmente reversível. A limitação ventilatória é, geralmente, progressiva e está associada a uma resposta inflamatória anómala dos pulmões à inalação de partículas ou gases nocivos. As doenças cardiovasculares (DCV) são alterações no funcionamento do sistema cardíaco, sendo este responsável por transportar oxigênio e nutrientes necessários às células para essas executarem suas tarefas. O tabagismo está associado a 1.147.037 anos potenciais de vida perdidos por morte prematura (APVP) ao ano, concentrados em infarto agudo do miocárdio (IAM) (239.456), câncer de pulmão (187.865), DPOC (177.329) e AVC (164.618). TECNOLOGIA: Champix® (tartarato de vareniclina). PERGUNTA: O uso do tartarato de vareniclina é eficaz e seguro em adultos fumantes com DCV ou DPOC, quando comparado à terapia de reposição de nicotina ou cloridrato bupropiona para o tratamento adjuvante na interrupção do tabagismo? EVIDÊNCIAS CIENTÍFICAS: No estudo observacional de Melzer et al., 2016, a farmacoterapia foi dispensada a uma minoria de fumantes de alto risco admitidos para DPOC e não estava associada à cessação do tabagismo nos 6 a 12 meses. Em comparação com o adesivo de nicotina, a vareniclina estava associada a uma maior probabilidade de cessação, com diminuição da probabilidade de cessação entre os pacientes tratados com TRN de curta ação. Jimenez Ruiz e colaboradores realizaram uma revisão dos registros clínicos de fumantes com DPOC grave ou muito grave. Neste estudo, a vareniclina não difere em eficácia da bupropiona, medicamento disponibilizado no SUS. A taxa de abstinência contínua nas semanas 9-24 para TRN, bupropiona e vareniclina foram 44%, 60% e 61%, respectivamente. No entanto, a diferença entre as taxas só foi significante na comparação de vareniclina e adesivo de nicotina. O estudo EUROACTION PLUS (EA) avaliou a eficácia de um programa de cardiologia preventiva, que oferece terapia intensiva para cessar o tabagismo, além da vareniclina opcional para fumantes com risco elevado de doença cardiovascular, em comparação com os cuidados habituais na prática geral. Dentre as limitações, ressalta-se que o estudo avaliou a eficácia do programa de tratamento, portanto os resultados de efetividade apresentados não refletem a efetividade do fármaco em si. Um mínimo de 6 meses de abstinência prolongada é recomendado como medida para avaliar os ensaios de cessação do tabagismo. Os resultados foram avaliados no final de 16 semanas apenas. AVALIAÇÃO ECONÔMICA: Como resultado da avaliação econômica, o demandante encontrou uma razão de custo-efetividade incremental que, para cada ex-fumante adicional, a vareniclina gera uma necessidade de investimento de R$ 4.156, 70. Em 24 semanas, quando compara da com a bupropiona, e, um RCEI de R$ 3.111,45, quando comparada com terapia de reposição de nicotina. Após o ajuste realizado pela Secretaria Executiva da Conitec, na população e custo dos medicamentos, a razão de custo-efetividade incremental da comparação entre vareniclina e cloridrato de bupropiona em pacientes com DPOC, aponta que, para cada ex-fumante adicional, a vareniclina gera uma necessidade de investimento de R$ 84.925,20. A RCEI da comparação terapia de reposição de nicotina em pacientes com DPOC aponta que, para cada ex-fumante adicional, a vareniclina gera uma necessidade de investimento de R$ 3.784,78. A RCEI da comparação entre tartarato de vareniclina e cloridrato de bupropiona em pacientes com DC, aponta que, para cada ex-fumante adicional, a vareniclina gera uma necessidade de investimento de R$ 2.621,15. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Ao considerar o cenário, considerando 100% dos pacientes utilizando vareniclina nos cinco anos de impacto, a análise apresentou um AIO de R$ 34 milhões no primeiro ano após a incorporação, chegando a, R$ 181,33 milhões em cinco anos. Após ajustes no modelo, o custo incremental, considerando as mesmas premissas, a AIO foi de 2,7 bilhões em cinco anos, sendo 2,5 bilhões de reais a mais do que o valor apresentado pelo demandante. CONSIDERAÇÕES: Existe incerteza quanto à opção de tratamento mais seguro para pessoas com DCV. Há evidências limitadas sobre o uso de vareniclina em fumantes com DPOC. Faltam dados de manutenção da cessação do tabagismo a longo prazo e de possíveis recaídas. Nenhum estudo randomizado comparou ainda a eficácia da vareniclina com uma combinação de TRN, que, é mais eficaz do que em monoterapia. Existem dados limitados que comparam a eficácia da vareniclina com bupropiona nessa população específica. Sintomas psiquiátricos, incluindo comportamento suicida, foram relatados com vareniclina, mas um nexo de causalidade não foi estabelecido. Eventos cardiovasculares graves foram relatados com vareniclina, mas o tamanho de qualquer risco aumentado é incerto. RECOMENDAÇÃO INICIAL DA CONITEC: A recomendação inicial da Comissão Nacional de Incorporação de Tecnologias no SUS, na 67ª reunião ordinária no dia 13 de junho de 2018, foi por unanimidade, não incorporar o tartarato de vareniclina, entendendo que, faltam evidências robustas de eficácia e segurança no tratamento do tabagismo em pacientes com DPOC ou com doenças cardiovasculares. CONSULTA PÚBLICA: Foram recebidas 62 contribuições, sendo 13 técnico-científicas e 49 contribuições de experiência ou opinião, onde 46% e 64% discordaram da recomendação preliminar da CONITEC, respectivamente. O principal motivo de discordância foi a necessidade de se oferecer mais uma alternativa terapêutica para tratamento do tabagismo. Equivalência terapêutica e eventos adversos foram os principais motivos para concordarem com a recomendação da Conitec. Evidências foram apresentadas e analisadas, porém ainda faltam dados demostrando superioridade da vareniclina em relação aos disponíveis no SUS. DELIBERAÇÃO FINAL DA CONITEC: Os membros da CONITEC presentes na 71ª reunião ordinária da plenária, realizada no dia 07/10/2018, deliberaram por unanimidade recomendar a não incorporação de vareniclina para o tratamento ddo tabagismo em indivíduos com doença cardiovascular ou Doença Pulmonar Obstrutiva Crônica. Foi assinado o Registro de Deliberação nº 380/2018. DECISÃO: A Portaria nº 49, de 16 de outubro de 2017, tornou pública a decisão de não incorporar o tartarato de vareniclina para tratamento adjuvante da cessação do tabagismo em pacientes adultos com doença pulmonar obstrutiva crônica ou doenças cardiovasculares, no âmbito do Sistema Único de Saúde ­ SUS.


Assuntos
Humanos , Doenças Cardiovasculares/etiologia , Abandono do Hábito de Fumar/métodos , Doença Pulmonar Obstrutiva Crônica/etiologia , Vareniclina/uso terapêutico , Avaliação da Tecnologia Biomédica , Avaliação em Saúde/economia , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
15.
Int J Chron Obstruct Pulmon Dis ; 13: 2695-2705, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30214187

RESUMO

Background: Fractional exhaled nitric oxide (FENO) is a useful and noninvasive biomarker for eosinophilic airway inflammation, particularly in asthma. However, its utility in chronic obstructive pulmonary disease (COPD) remains controversial. In this study, we performed a systematic review and meta-analysis to evaluate FENO levels in COPD. Methods: A search of PubMed, Embase, Cochrane Library, and clinical trial registry was conducted from inception to January 2018. Studies were included if they reported FENO levels in patients with COPD and healthy controls. We then extracted relevant information and analyzed data. Standard mean difference (SMD) with 95% confidence interval (CI) was applied in this meta-analysis. Results: A total of 2,073 studies were reviewed for eligibility, with 24 studies pooled for analysis. The FENO levels in patients with COPD were elevated mildly compared with healthy controls (SMD 1.28, 95% CI 0.60-1.96). A similar result was also observed in stable COPD, with an SMD of 1.21 (95% CI 0.47-1.96). On the other hand, we found no association between FENO levels and exacerbated COPD. Additionally, for patients with COPD, ex-smokers had higher levels of FENO than current smokers (SMD 2.05, 95% CI 1.13-2.97). Conclusion: Our studies demonstrated a mild elevation of FENO in COPD, and the association between exacerbated COPD and FENO levels needs to be further explored. The potential mechanism is still unknown and conflicting.


Assuntos
Óxido Nítrico/análise , Doença Pulmonar Obstrutiva Crônica/metabolismo , Biomarcadores/análise , Testes Respiratórios , Estudos de Casos e Controles , Estudos Transversais , Ex-Fumantes/estatística & dados numéricos , Expiração , Humanos , Fumantes/estatística & dados numéricos
16.
Clin Exp Allergy ; 48(11): 1378-1390, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30244507

RESUMO

BACKGROUND: The prevalence of asthma and chronic obstructive pulmonary disease (COPD) has risen markedly over the last decades and is reaching epidemic proportions. However, underlying molecular mechanisms are not fully understood, hampering the urgently needed development of approaches to prevent these diseases. It is well established from epidemiological studies that prenatal exposure to cigarette smoke is one of the main risk factors for aberrant lung function development or reduced fetal growth, but also for the development of asthma and possibly COPD later in life. Of note, recent evidence suggests that the disease risk can be transferred across generations, that is, from grandparents to their grandchildren. While initial studies in mouse models on in utero smoke exposure have provided important mechanistic insights, there are still knowledge gaps that need to be filled. OBJECTIVE: Thus, in this review, we summarize current knowledge on this topic derived from mouse models, while also introducing two other relevant animal models: the fruit fly Drosophila melanogaster and the zebrafish Danio rerio. METHODS: This review is based on an intensive review of PubMed-listed transgenerational animal studies from 1902 to 2018 and focuses in detail on selected literature due to space limitations. RESULTS: This review gives a comprehensive overview of mechanistic insights obtained in studies with the three species, while highlighting the remaining knowledge gaps. We will further discuss potential (dis)advantages of all three animal models. CONCLUSION/CLINICAL RELEVANCE: Many studies have already addressed transgenerational inheritance of disease risk in mouse, zebrafish or fly models. We here propose a novel strategy for how these three model organisms can be synergistically combined to achieve a more detailed understanding of in utero cigarette smoke-induced transgenerational inheritance of disease risk.


Assuntos
Asma/etiologia , Reações Cruzadas/imunologia , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Alérgenos/imunologia , Animais , Asma/epidemiologia , Modelos Animais de Doenças , Feminino , Humanos , Fenótipo , Gravidez
17.
Thorax ; 73(9): 813-824, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29871982

RESUMO

INTRODUCTION: Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care. METHODS: We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. RESULTS: From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. DISCUSSION: Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. TRIAL REGISTRATION NUMBER: CRD42016037464.


Assuntos
Asma/etiologia , Asma/terapia , Asma/diagnóstico , Criança , Humanos , Fatores de Risco
18.
Pediatr Pulmonol ; 53(9): 1179-1192, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29870146

RESUMO

BACKGROUND: Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature. METHODS: We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. RESULTS: Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission. CONCLUSION: Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.


Assuntos
Asma/terapia , Hospitalização/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , América do Norte , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Poluição por Fumaça de Tabaco , Resultado do Tratamento
19.
Artigo em Inglês | MEDLINE | ID: mdl-29714636

RESUMO

Extracellular vesicles (EV) are secreted signaling entities that enhance various pathological processes when released in response to cellular stresses. Respiratory exposures such as cigarette smoke and air pollution exert cellular stresses and are associated with an increased risk of several chronic diseases. The aim of this review was to examine the evidence that modifications in EV contribute to respiratory exposure-associated diseases. Publications were searched using PubMed and Google Scholar with the search terms (cigarette smoke OR tobacco smoke OR air pollution OR particulate matter) AND (extracellular vesicles OR exosomes OR microvesicles OR microparticles OR ectosomes). All original research articles were included and reviewed. Fifty articles were identified, most of which investigated the effect of respiratory exposures on EV release in vitro (25) and/or on circulating EV in human plasma (24). The majority of studies based their main observations on the relatively insensitive scatter-based flow cytometry of EV (29). EV induced by respiratory exposures were found to modulate inflammation (19), thrombosis (13), endothelial dysfunction (11), tissue remodeling (6), and angiogenesis (3). By influencing these processes, EV may play a key role in the development of cardiovascular diseases and chronic obstructive pulmonary disease and possibly lung cancer and allergic asthma. The current findings warrant additional research with improved methodologies to evaluate the contribution of respiratory exposure-induced EV to disease etiology, as well as their potential as biomarkers of exposure or risk and as novel targets for preventive or therapeutic strategies.


Assuntos
Poluição do Ar/efeitos adversos , Doença Crônica , Vesículas Extracelulares/efeitos dos fármacos , Doenças Respiratórias/induzido quimicamente , Humanos
20.
Int J Chron Obstruct Pulmon Dis ; 13: 1353-1364, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29731623

RESUMO

Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76%) than women (4.07%). The disease was more prevalent in rural areas (7.62%) than in urban areas (6.09%). The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL) included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures need to be taken to improve disease prevention and management to reduce disease burdens raised by COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Comorbidade , Poluentes Ambientais/efeitos adversos , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Fatores de Risco , Saúde da População Rural , Distribuição por Sexo , Fumar/efeitos adversos , Saúde da População Urbana , Adulto Jovem
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