Respiratory Medicine: COPD Update最新文献_第6页

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.001

John Hurst

引用次数: 0

A new prognostic index for health outcomes in COPD COPD健康结局的新预后指标

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.011

{"title":"A new prognostic index for health outcomes in COPD","authors":"","doi":"10.1016/j.rmedu.2008.08.011","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.08.011","url":null,"abstract":"<div><h3>Background</h3><p>Chronic obstructive pulmonary disease (COPD) is a debilitating and progressive disease. The severity of the condition has typically been characterized by a single physiological measurement: forced expiratory volume in 1second, which has been shown to be prognostic for mortality.</p></div><div><h3>Methods</h3><p>To develop a prognostic tool for COPD that is sensitive not only to mortality but also to other important drivers of health status and cost, data were obtained from a pooled analysis of 12 randomized controlled trials and 3 main outcomes were chosen: mortality, hospitalization, and number of exacerbations. Cox models were employed for the time-to-event data (death or hospitalization), and a negative binomial model was used for calculating the count data (exacerbations). From these models, 3 specific indexes were developed on a 100-point scale, and 1 composite index was obtained as a mean of the specific indexes. One-third of the data was reserved for validation purposes.</p></div><div><h3>Results</h3><p>All indexes provided good discrimination among tertiles in the training and validation samples. The composite index had a performance very similar to that of the specific index in both the training and validation samples: the overall C statistic was estimated as 0.71 for both mortality and hospitalization. Each 10-point change in the composite index corresponds to an increase of 54% in the hazard ratio of death, 57% in the hazard ratio of hospitalization, and 21% in the incidence rate of exacerbations.</p></div><div><h3>Conclusions</h3><p>A composite index for COPD prognosis (the COPD Prognostic Index) has been validated in data not used in its development and is capable of predicting not only mortality, but also hospitalizations and exacerbations. All factors included in the index are straightforward to obtain, which should make the index suitable for use in primary as well as secondary care settings.<br>Reproduced with permission from the American Medical Association</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.08.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137086983","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}

引用次数: 0

Pulmonary rehabilitation works in elderly patients. Whether it works in all elderly COPD patients in the community remains an issue 老年患者肺康复工作。它是否对社区中所有老年COPD患者都有效仍然是一个问题

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.007

引用次数: 0

Up date nutritional support for patients with COPD COPD患者的最新营养支持

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.004

Ivone Martins Ferreira

{"title":"Up date nutritional support for patients with COPD","authors":"Ivone Martins Ferreira","doi":"10.1016/j.rmedu.2008.08.004","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.08.004","url":null,"abstract":"<div><p>Chronic Obstructive Pulmonary disease (COPD) is associated with multiple comorbid conditions including ischemic heart disease, peripheral muscular dysfunction, osteoporosis, osteopenia, glaucoma, anemia, anxiety , depression, caquexia and malnutrition. A number of individuals with COPD experience involuntary weight loss as the condition progresses and weight loss, muscle wasting and tissue depletion are commonly seen.</p><p>Malnutrition has a negative impact on the clinical course of COPD. The negative impact of malnutrition has led to interest in nutritional assessment and supplementation, alone or in combination with anabolic substances or appetite stimulants, in an effort to improve disease outcome. The effects of nutritional supplementation on weigh gain and anthropometric parameters were small suggesting that oral supplementation alone is of limited efficacy. The studies with anabolic steroids or growth hormone showed improvement in nutritional parameters but no improvement in exercise capacity.</p><p>Large randomized trials that include measure of lean body mass, exercise capacity and quality of life should be stimulated.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91679359","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}

引用次数: 11

A non-typeable Haemophilus influenzae (NTHi) causes COPD-like changes in mice 一种不可分型的流感嗜血杆菌(NTHi)在小鼠中引起copd样变化

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.012

{"title":"A non-typeable Haemophilus influenzae (NTHi) causes COPD-like changes in mice","authors":"","doi":"10.1016/j.rmedu.2008.08.012","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.08.012","url":null,"abstract":"<div><p>Nontypeable Haemophilus influenzae (NTHi) commonly colonizes the lower airways of patients with chronic obstructive pulmonary disease (COPD). Whether it contributes to COPD progression is unknown. Here, we determined which aspects of the COPD phenotype can be induced by repetitive exposure to NTHi products. Mice were exposed weekly to an aerosolized NTHi lysate, and inflammation was evaluated by measurement of cells and cytokines in bronchoalveolar lavage fluid (BALF) and immunohistochemical staining; structural changes were evaluated histochemically by periodic acid fluorescent Schiff's reagent, Masson's trichrome, and Picrosirius red staining; mucin gene expression was measured by quantitative RT-PCR; and the role of TNF-<em>α</em> was examined by transgenic airway overexpression and use of an inhibitory antibody. NTHi lysate induced rapid activation of NF-kappaB in airway cells and increases of inflammatory cytokines and neutrophils in BALF. Repetitive exposure induced infiltration of macrophages, CD8+ T cells, and B cells around airways and blood vessels, and collagen deposition in airway and alveolar walls, but airway mucin staining and gel-forming mucin transcripts were not increased. Transgenic overexpression of TNF-<em>α</em> caused BALF neutrophilia and inflammatory cell infiltration around airways, but not fibrosis, and TNF-<em>α</em> neutralization did not reduce BALF neutrophilia in response to NTHi lysate. In conclusion, NTHi products elicit airway inflammation in mice with a cellular and cytokine profile similar to that in COPD, and cause airway wall fibrosis but not mucous metaplasia. TNF-<em>α</em> is neither required for inflammatory cell recruitment nor sufficient for airway fibrosis. Colonization by NTHi may contribute to the pathogenesis of small airways disease in patients with COPD.</p><p>Reproduced with permission from the American Thoracic Society.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.08.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137086984","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}

引用次数: 0

Social ties and smoking cessation 社会关系和戒烟

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.018

引用次数: 0

What is the survival benefit in COPD from lung transplantation? 肺移植对COPD患者的生存益处是什么?

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.013

{"title":"What is the survival benefit in COPD from lung transplantation?","authors":"","doi":"10.1016/j.rmedu.2008.08.013","DOIUrl":"10.1016/j.rmedu.2008.08.013","url":null,"abstract":"<div><h3>Rationale</h3><p>Although chronic obstructive pulmonary disease is the first indication for lung transplantation, the benefit of the procedure in terms of survival remains debated.</p></div><div><h3>Objectives</h3><p>To estimate the determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.</p></div><div><h3>Methods</h3><p>Using information from the United Network for Organ Sharing database on 8182 patients, we developed an approach based on numerical simulations to estimate the survival effect of lung transplantation.</p></div><div><h3>Measurements and main results</h3><p>The main outcome measure was the difference between median survival with transplantation and that without transplantation measured from time of transplant list registration. Survival benefit was greater with double than with single lung transplantation (mean difference, 307d [95% confidence interval, 217–523]). With double lung transplantation, 44.6% of patients would gain 1 year or more, 29.4% would gain or lose less than 1 year, and 26% would lose 1 year or more. Major determinants of the survival effect of transplantation were systolic pulmonary artery pressure, FEV<sub>1</sub>, body mass index, exercise capacity, functional status, and the need for continuous mechanical ventilation or oxygen. For instance, 79% of patients with an FEV<sub>1</sub> less than 16% of the predicted value would gain 1 year or more with double lung transplantation as compared with only 11% of patients with an FEV<sub>1</sub> of more than 25%.</p></div><div><h3>Conclusions</h3><p>We identified several factors associated with the survival benefit of lung transplantation. External validation of our models is required before translating these results into clinical practice.</p><p>Reproduced with permission from the American Thoracic Society.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.08.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75784868","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}

引用次数: 0

ATS 2008 Conference Report: Much PROgress ATS 2008年会议报告:取得很大进展

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.002

J.K. Quint, J.R. Hurst

引用次数: 0

Tiotropium is better than ipratropium at reducing exacerbations, hospital referrals and hospital admissions in patients in general practice 在一般实践中，噻托溴铵比异丙托溴铵在减少病情恶化、医院转诊和住院方面更好

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.009

引用次数: 0

Pulmonary rehabilitation: Greatest benefit for those who live alone? 肺康复:对独居者最大的益处?

Respiratory Medicine: COPD Update Pub Date : 2008-11-01 DOI: 10.1016/j.rmedu.2008.08.019

引用次数: 0