Respiratory Medicine: COPD Update最新文献

{"title":"Depression is worse in COPD patients who are frequent exacerbators, and at the time of COPD exacerbations: Cause or effect?","authors":"","doi":"10.1016/j.rmedu.2008.08.006","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.08.006","url":null,"abstract":"","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.2008.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137007167","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":"Up date nutritional support for patients with COPD","authors":"I. Ferreira","doi":"10.1016/J.RMEDU.2008.08.004","DOIUrl":"https://doi.org/10.1016/J.RMEDU.2008.08.004","url":null,"abstract":"","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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80417986","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":"COPD news","authors":"","doi":"10.1016/j.rmedu.2008.08.015","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.08.015","url":null,"abstract":"","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.2008.08.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137086988","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":"Screening asymptomatic adults for COPD using spirometry—A good idea or not?","authors":"","doi":"10.1016/j.rmedu.2008.06.004","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.06.004","url":null,"abstract":"<div><p>Article 1</p></div><div><h3>Description</h3><p>New US Preventive Services Task Force (USPSTF) recommendation about screening for chronic obstructive pulmonary disease (COPD) using spirometry.</p></div><div><h3>Methods</h3><p>The USPSTF weighed the benefits (prevention of&gt;or=1 exacerbation and improvement in respiratory-related health status measures) and harms (time and effort required by both patients and the health care system, false-positive screening tests, and adverse effects of subsequent unnecessary therapy) of COPD screening identified in the accompanying review of the evidence. The USPSTF did not consider the financial costs of spirometry testing or COPD therapies.</p></div><div><h3>Recommendation</h3><p>Do not screen adults for COPD using spirometry. (Grade D recommendation).</p><p>Article 2</p></div><div><h3>Background</h3><p>Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24<!--> <!-->million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease.</p></div><div><h3>Purpose</h3><p>To summarize the evidence on screening for COPD using spirometry for the US Preventive Services Task Force (USPSTF).</p></div><div><h3>Data sources</h3><p>English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles.</p></div><div><h3>Study selection</h3><p>Explicit inclusion and exclusion criteria were used for each of the 8 key questions on benefits and harms of screening. Eligible study types varied by question.</p></div><div><h3>Data extraction</h3><p>Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.</p></div><div><h3>Data synthesis</h3><p>Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general US population. Spirometry has not been shown to independently increase smoking cessation rates. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy. Data on the prevalence of airflow obstruction in the US population were used to calculate projected outcomes from screening groups defined by age and smoking status. Limitation: No studies provide direct evidence on health outcomes associated with screening for COPD.</p></div><div><h3>Conclusion</h3><p>Screening for COPD using spirometry is likely to identify a predominance of patients with mild to moderate airflow obstruction who would not experience additional health benefits if labeled as having COPD. Hundreds of patients would need to undergo spirometry to defer a single exacerbation.</p><p>These articles are available free of charge on the US Agency for Healthcare Research and Quality website <span>www.ahrq.gov/clinic/uspstf/uspscop","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134670599","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":"The role and effectiveness of pulmonary rehabilitation in COPD","authors":"","doi":"10.1016/j.rmedu.2008.06.018","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.06.018","url":null,"abstract":"<div><p>Although the benefits of pulmonary rehabilitation (PR) have been demonstrated in patients with COPD, most studies suggest that short-term programs are insufficient to maintain the benefits beyond a post-discharge period of 6 months to 1 year. We were interested to evaluate the effects of an innovative maintenance intervention compared with a usual after-care. Forty moderate to severe COPD patients, who had just completed their first inpatient PR, were consecutively included in either a maintenance group (MG) or a standard after-care group. The maintenance program was coordinated within a health-care network including self-help associations, and offered weekly activities. We measured the 6-min walk distance (6MWD), the quality of life using the St George Respiratory Questionnaire (SGRQ), the dyspnea, the maximal workload and the health-care utilization. Data were collected at respiratory clinic admission and discharge, and at 6- and 12-month visits after the PR. After 12 months, we found statistically and clinically significant differences in favor of the MG in 6MWD (74<!--> <!-->m; <em>p</em>⩽0.01) and in the three domains of SGRQ: symptom (19%; <em>p</em>⩽0.01), activity (27%; <em>p</em>⩽0.01) and impact (32%; <em>p</em>⩽0.01). The results showed no difference between groups in dyspnea and maximal workload. We also found that the number of days spent in hospital for respiratory disorders was significantly lower in the MG after 12 months (<em>p</em>⩽0.03). The multidisciplinary management of COPD patients in the post-rehabilitation period within a health-care network including self-help associations seems to be an effective strategy for maintaining, and even improving, the benefits of a first initial structured program.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134670626","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":"Forthcoming events","authors":"","doi":"10.1016/j.rmedu.2008.06.013","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.06.013","url":null,"abstract":"","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134670606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, severity and underdiagnosis of COPD","authors":"","doi":"10.1016/j.rmedu.2008.06.017","DOIUrl":"10.1016/j.rmedu.2008.06.017","url":null,"abstract":"<div><h3>Background</h3><p>Chronic obstructive pulmonary disease (COPD) is a common disease with a steadily increasing prevalence and mortality. However, recent epidemiological estimates differ depending on the population studied and methods used.</p></div><div><h3>Aim</h3><p>To investigate the prevalence, severity and burden of COPD in a primary care setting.</p></div><div><h3>Methods</h3><p>From 4730 patients registered in a single primary care practice, all 2250 patients aged 40 years or more were invited to participate. Participants completed a questionnaire on smoking, respiratory symptoms, education and social status. A physical examination was followed by pre- and post-bronchodilator (BD) spirometry.</p></div><div><h3>Results</h3><p>Of the eligible patients, 1960 (87%) participated. Ninety-two percent of spirometric tests met the ATS criteria. Airflow limitation was demonstrated in 299 (15%) of the participants pre-BD and in 211 (11%) post-BD. COPD was diagnosed in 183 patients (9.3%). Of these patients, the degree of post-BD airflow limitation was mild in 30.6%, moderate in 51.4%, severe in 15.3% and very severe in 2.7%. Only 18.6% of these patients had previously been diagnosed with COPD; almost all of these had severe or very severe airflow limitation. As a result of the study, a diagnosis of asthma was made in 122 patients.</p></div><div><h3>Conclusions</h3><p>The prevalence and underdiagnosis of COPD in adult patients in this primary care setting made case finding worthwhile. Large numbers of newly detected patients were symptomatic and needed treatment. Limiting investigations to smokers would have reduced the number of COPD diagnoses by 26%.</p><p>Reproduced with permission from the BMJ Publishing Group.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107958361","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":"Reduced physical activity: Is there any association with extra-pulmonary effects of COPD?","authors":"","doi":"10.1016/j.rmedu.2008.06.003","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.06.003","url":null,"abstract":"<div><h3>Rationale</h3><p>Physical activity is reduced in patients with chronic obstructive pulmonary disease (COPD). COPD has a systemic component that includes significant extrapulmonary effects that may contribute to its severity in individual patients.</p></div><div><h3>Objectives</h3><p>To investigate the association of extrapulmonary effects of the disease and its comorbidities with reduced physical activity in patients with COPD.</p></div><div><h3>Methods</h3><p>In a cross-sectional study, 170 outpatients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages I-IV; BODE [body mass index, airway obstruction, dyspnea, and exercise capacity] score 0-10) underwent a series of tests. Physical activity was assessed over 5 to 6 consecutive days by using a multisensor accelerometer armband that records steps per day and the physical activity level (total daily energy expenditure divided by whole-night sleeping energy expenditure). Cardiovascular status was assessed by echocardiography, vascular Doppler sonography, and levels of N-terminal pro-B-type natriuretic peptide. Mental status, metabolic/muscular status, systemic inflammation, and anemia were assessed by Beck Depression Inventory, bioelectrical impedance analysis, handgrip strength, high-sensitivity C-reactive protein/fibrinogen, and hemoglobin, respectively.</p></div><div><h3>Measurements and main results</h3><p>In a multivariate linear regression analysis using either steps per day or physical activity level as a dependent variable, the extrapulmonary parameters that were associated with reduced physical activity in patients with COPD independently of GOLD stages or BODE score were N-terminal pro-B-type natriuretic peptide levels, echocardiographically measured left ventricular diastolic function, and systemic inflammation.</p></div><div><h3>Conclusions</h3><p>Higher values of systemic inflammation and left cardiac dysfunction are associated with reduced physical activity 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":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134670598","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":"Exhaled nitric oxide measurements and diagnosis of non-specific respiratory symptoms","authors":"","doi":"10.1016/j.rmedu.2008.06.015","DOIUrl":"https://doi.org/10.1016/j.rmedu.2008.06.015","url":null,"abstract":"<div><h3>Aims</h3><p>To assess whether exhaled nitric oxide (FENO) measurements improve management and clinician confidence in patients presenting with non-specific respiratory symptoms.</p></div><div><h3>Methods</h3><p>This observational study was based in a large primary care practice (15,500 patients, 14 GPs). Patients had non-specific respiratory symptoms for at least 6 weeks. FENO and spirometry measurements were performed at initial assessment. An algorithm was employed to assist interpretation of FENO and spirometry results. GPs evaluated the diagnostic contribution of FENO and spirometry at 3-month follow-up.</p></div><div><h3>Results</h3><p>In 48/51 (94%) of cases, FENO was considered significant in formulating a diagnosis. Spirometry was deemed helpful in 27/51 (54%).</p></div><div><h3>Conclusion</h3><p>FENO measurements improved diagnostic confidence when assessing non-specific respiratory symptoms. This may be because, in contrast to spirometry, both low and high FENO values have clinical significance. Trial registration: Australian Clinical Trials Registry ACTRN012605000354684.</p><p>Reproduced with the permission of the General Practice Airways Group (awaiting permission).</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134670624","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":"Effects of non-invasive positive pressure ventilation (NIPPV) in stable chronic obstructive pulmonary disease (COPD)","authors":"F.M. Struik,&nbsp;M.L. Duiverman,&nbsp;G. Bladder,&nbsp;P.J. Wijkstra","doi":"10.1016/j.rmedu.2008.06.001","DOIUrl":"10.1016/j.rmedu.2008.06.001","url":null,"abstract":"<div><p>This review provides an overview of the randomised controlled trials covering the topic of chronic non-invasive positive pressure ventilation (NIPPV) in severe stable COPD patients. Studies investigating patients receiving bilevel NIPPV via nasal, oronasal or total face mask interfaces for at least 1 week or more, were described.</p><p>Eight RCTs were included, from which six trials used NIPPV for up to 3 months (short-term) and two trials also obtained long-term effects (3 months to ⩾2 years).</p><p>Outcome parameters were: arterial blood gases, pulmonary function, respiratory mechanics, respiratory muscle strength, dyspnoea, exercise tolerance, health-related quality of life, neuropsychologic function, sleep quality, hospital admissions and survival.</p><p>We found that NIPPV in addition to standard care can have beneficial effects on certain outcome measures, however results are conflicting. Therefore, evidence is insufficient to recommend NIPPV routinely in stable but severe COPD patients. Nevertheless, it seems that hypercapnic patients, who receive enough time to adjust to the ventilator and so obtain improved ventilation, could benefit from NIPPV.</p></div>","PeriodicalId":101083,"journal":{"name":"Respiratory Medicine: COPD Update","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rmedu.2008.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76404179","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}