{"title":"Lung volume reduction surgery and bronchoscopic lung volume reduction in severe emphysema","authors":"A. James Mamary, Gerard J. Criner","doi":"10.1016/j.rmedu.2008.02.010","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.02.010","url":null,"abstract":"<div><p>Lung volume reduction surgery<span><span><span> (LVRS) improves the fit of severely hyperinflated emphysematous lungs to the surrounding chest cavity<span> and thereby improves respiratory mechanics and expiratory airflow. LVRS is a potent and life extending therapy for some patients with severe emphysema<span><span> and has a low associated operative mortality. The national emphysema </span>treatment trial (NETT) identified characteristics of patients for whom LVRS improves survival, function and health-related </span></span></span>quality of life and characteristics of patients who should not have surgery. Patients with upper-lobe predominant distribution of emphysema on high-resolution computed tomogram are most likely to benefit from LVRS vs. optimal medical therapy and rehabilitation. At long-term follow-up, the survival and functional benefits derived from LVRS are durable. In efforts to make lung volume reduction safer and more broadly accessible physician-scientists have developed bronchoscopic lung volume reduction (BLVR) procedures. Early </span>clinical trials<span><span> of BLVR performed with endobronchial valves<span> (EVB) and sclerosant biogels demonstrate their safety. The ability of BLVR EBV techniques to produce desired </span></span>atelectasis and lung volume loss is likely limited in those patients with collateral ventilation, incomplete fissures and those unable to achieve complete lobar exclusion. Results from a phase III BLVR EBV trial are in analysis.</span></span></p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Pages 44-59"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.02.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91678319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lung volume reduction surgery and bronchoscopic lung volume reduction in severe emphysema","authors":"A. Mamary, G. Criner","doi":"10.1016/J.RMEDU.2008.02.010","DOIUrl":"https://doi.org/10.1016/J.RMEDU.2008.02.010","url":null,"abstract":"","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"14 1","pages":"44-59"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75127692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there any benefit to using a spirometry expert system to support GPs’ diagnosis of COPD?","authors":"","doi":"10.1016/j.rmedu.2008.02.014","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.02.014","url":null,"abstract":"<div><p>The present study assessed the impact of computerised spirometry interpretation expert support on the diagnostic achievements of general practitioners (GPs), and on GPs’ decision making in diagnosing chronic respiratory disease. A cluster-randomised controlled trial was performed in 78 GPs who each completed 10 standardised paper case descriptions. Intervention consisted of support for GPs’ spirometry interpretation either by an expert system (expert support group) or by sham information (control group). Agreement of GPs’ diagnoses was compared with an expert panel judgement, which served as the primary outcome. Secondary outcomes were: additional diagnostic test rates; width of differential diagnosis; certainty of diagnosis; estimated severity of disease; referral rate; and medication or nonmedication changes. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). There were no differences between the expert support and control groups in the agreement between GPs and expert panel diagnosis of chronic obstructive pulmonary disease (OR (95% CI) 1.08 (0.70–1.66)), asthma (1.13 (0.70–1.80)), and absence of respiratory disease (1.32 (0.61–2.86)). A higher rate of additional diagnostic tests was observed in the expert support group (2.5 (1.17–5.35)). Computerised spirometry expert support had no detectable benefit on general practitioners’ diagnostic achievements and the decision-making process when diagnosing chronic respiratory disease.<br></p><p>Reproduced with permission from European Respiratory Society Journals Ltd.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Page 69"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.02.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137346742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is a new diagnostic questionnaire useful for identifying patients with COPD?","authors":"","doi":"10.1016/j.rmedu.2008.02.012","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.02.012","url":null,"abstract":"<div><p>The aim of the present study was to determine the external validity of a recently developed questionnaire for the identification of patients at increased risk of airflow limitation in smokers from the general population in the provinces of Dutch and Belgian Limburg (regions surrounding Maastricht, the Netherlands). As part of a study on the early detection of airflow limitation and subsequent smoking cessation treatment (International Standard Randomised Controlled Trial Number: 64481813), the recently developed chronic obstructive pulmonary disease (COPD) diagnostic questionnaire was used in current smokers aged 40–70<!--> <!-->yrs, with a smoking history of >or=10 pack-yrs, who reported one or more respiratory symptom (cough, sputum production or dyspnoea), but who had no diagnosis of a respiratory disease (COPD or asthma). Spirometry performed according to American Thoracic Society/European Respiratory Society criteria served as a reference test. Of the 676 subjects who entered the analyses, 398 showed normal lung function and 278 had a diagnosis of COPD (post-bronchodilator forced expiratory volume in one second/forced vital capacity of <0.70). The ability of the COPD diagnostic questionnaire to discriminate between subjects with and without COPD was poor (area under the receiver operating characteristic curve of 0.65). In a high-risk population consisting of middle-aged current smokers with a smoking history of >or=10 pack-yrs, the chronic obstructive pulmonary disease diagnostic questionnaire is probably not useful as a diagnostic tool for the identification of patients with an increased risk of airflow limitation.<br></p><p>Reproduced with permission from European Respiratory Society Journals Ltd.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Pages 66-67"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.02.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91678320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Could KGF prevent pulmonary emphysema development?","authors":"","doi":"10.1016/j.rmedu.2008.02.003","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.02.003","url":null,"abstract":"<div><p>Pulmonary emphysema is characterized by persistent inflammation and progressive alveolar destruction. The keratinocyte growth factor (KGF) favorably influences alveolar maintenance and repair and possesses anti-inflammatory properties. We aimed to determine whether exogenous KGF prevented or corrected elastase-induced pulmonary emphysema in vivo. Treatment with 5<!--> <!-->mg<!--> <!-->kg<sup>−1</sup> <!-->day<sup>−1</sup> KGF before elastase instillation prevented pulmonary emphysema. This effect was associated with <em>1</em>) a sharp reduction in bronchoalveolar lavage fluid total protein and inflammatory cell recruitment, <em>2</em>) a reduction in the pulmonary expression of the chemokines CCL2 (or monocyte chemoattractant protein-1) and CXCL2 (or macrophage inflammatory protein-2<em>α</em>) and of the adhesion molecules ICAM-1 and VCAM-1, <em>3</em>) a reduction in matrix metalloproteinase (MMP)-2 and MMP-9 activity at <em>day 3</em>, and <em>4</em>) a major reduction in DNA damage detected by terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) in alveolar cells at <em>day 7</em>. Treatment with KGF after elastase instillation had no effect on elastase-induced emphysema despite the conserved expression of the KGF receptor in the lungs of elastase-instilled animals as determined by immunohistochemistry. In vitro, KGF abolished the elastase-induced increase in CCL2, CXCL2, and ICAM-1 mRNA in the MLE-12 murine alveolar epithelial cell line. We conclude that KGF pretreatment protected against elastase-induced pulmonary inflammation, activation of MMPs, alveolar cell DNA damage, and subsequent emphysema in mice.<br></p><p>Abstract used with permission from the American Physiological Society</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Page 73"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91678314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dietary fiber: A new “protective” factor for COPD?","authors":"","doi":"10.1016/j.rmedu.2008.02.005","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.02.005","url":null,"abstract":"<div><p>Recent data suggest beneficial effects of fiber intake on chronic respiratory symptoms in adults that are independent of antioxidant vitamin intake, but little is known about fiber consumption in relation to lung function and chronic obstructive pulmonary disease (COPD). The authors investigated the association of fiber intake with lung function and COPD in 11,897 US men and women from the Atherosclerosis Risk in Communities study (1987–1989). After control for potential confounders, positive associations were found between lung function and fiber intake from all sources as well as from cereal or fruit alone. Compared with those in the lowest quintile, participants in the highest quintile of total fiber intake had a 60.2-ml higher forced expiratory volume in 1<!--> <!-->s (FEV(1)) (p for trend <0.001), 55.2-ml higher forced vital capacity (FVC) (p=0.001), 0.4% higher FEV(1)/FVC ratio (p=0.040), 1.8% higher percent predicted FEV(1) (p<0.001), and 1.4% higher percent predicted FVC (p=0.001). Adjusted odds ratios of COPD for the highest versus lowest quintiles of intake were 0.85 (p=0.044) for total fiber, 0.83 (p=0.021) for cereal fiber, and 0.72 (p=0.005) for fruit fiber. This study provides the first known evidence that dietary fiber is independently associated with better lung function and reduced prevalence of COPD.<br></p><p>Reproduced with permission from Oxford University Press</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Page 75"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91678315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nurse-led self-management of COPD exacerbations reduces mortality and is cost effective","authors":"","doi":"10.1016/j.rmedu.2008.01.005","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.01.005","url":null,"abstract":"<div><p>A Nurse-Led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease.</p></div><div><h3>Objectives</h3><p>To determine the effects of a nurse-led intermediate care programme in the management of patients who have been hospitalised with an acute exacerbation of COPD (AECOPD).</p></div><div><h3>Design</h3><p>Randomised controlled trial.</p></div><div><h3>Setting</h3><p>Care in the community and a teaching hospital in West London.</p></div><div><h3>Participants</h3><p>One hundred and twenty-two patients who had been admitted to Hammersmith Hospitals NHS Trust with a diagnosis of AECOPD.</p></div><div><h3>Intervention</h3><p>A care package incorporating initial pulmonary rehabilitation and self-management education followed by the provision of a written, personalised COPD action plan, monthly telephone calls and three monthly home visits by a specialist nurse for a period of two years.</p></div><div><h3>Main outcome measure</h3><p>Hospital readmission rate.</p></div><div><h3>Secondary outcomes</h3><p>Unscheduled consultations with general practitioners and disease-specific health-related quality of life.</p></div><div><h3>Results</h3><p>There were no differences in hospital admission rates or in exacerbation rates between the intervention and control groups. Self-management of exacerbations was, however, significantly different and patients in the intervention group were more likely to have exacerbations treated with oral steroids alone or oral steroids and antibiotics than the control group, and the initiator of treatment for exacerbations was statistically more likely to be the patient themselves in the intervention group. Twelve patients in the control group died during the two-year period, eight as a result of COPD, compared with six patients dying in the intervention group, of which one died from COPD. This is a significant difference. When the numbers in the intervention and control groups are adjusted to reflect the numbers still alive, at two years, 55 of the 61 patients of the intervention group were still alive and these patients had had a total of 171 unscheduled contacts with their GP. In the control group, 49 of the 61 patients were still alive and they had 280 contacts with their GP. The number needed to treat equals 0.558. That is to say, for every one COPD patient receiving the intervention and self-management advice, there was 1.79 less unscheduled contacts with the GP. There were no important differences in quality of life.</p></div><div><h3>Conclusions</h3><p>An intermediate care package incorporating pulmonary rehabilitation, self-management education and the receipt of a written COPD action plan, together with regular nurse contact, is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate.<br></p><p>Reproduced with permission from the BMJ Pub","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":"4 2","pages":"Pages 85-86"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.01.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137346740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}