Chronic obstructive pulmonary diseases最新文献

{"title":"Editorial--How Important Are Inhaler Technique Errors?","authors":"B. Bender","doi":"10.15326/jcopdf.6.3.2019.0142","DOIUrl":"https://doi.org/10.15326/jcopdf.6.3.2019.0142","url":null,"abstract":"Treatment of respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, depends primarily on inhaled medications. Because of the complexity of inhaled medication delivery, patients’ mastery of inhalers presents a major challenge to these treatments. Further, the skill requirements vary across medication devices, including metered-dose inhalers (MDIs), breath-activated MDIs, soft-mist inhalers, dry-powder inhalers (DPIs), and nebulizers, adding further potential confusion for both prescribers and patients. A large body of literature has documented the frequency of patient inhaler errors and the correlation of these with worsening outcomes1 accounting for nearly $900 million in direct and indirect costs.2 The manuscript by Cho-Reyes et al in this issue of the Journal of the COPD Foundation adds to this literature, combining a systematic review and meta-analysis. Ten previously published reports including 1360 patients revealed that 86.7% of patients made at least 1 inhalation technique error, and that 76.8% of patients made multiple errors. These results confirm a previous report of 54 studies showing that 86.8% of patients using an MDI and 60.9% of patients using a DPI made at least 1 error.3","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"31 1","pages":"203-205"},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89871561","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":"Journal Club-Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really?","authors":"R. Balkissoon","doi":"10.15326/jcopdf.6.3.2019.0143","DOIUrl":"https://doi.org/10.15326/jcopdf.6.3.2019.0143","url":null,"abstract":"In the last few months I have seen 2 patients who presented with significant respiratory symptoms, (cough, shortness of breath and chest pain) that they temporally associated with use of electronic cigarettes (e-cigarettes). They were relatively new to e-cigarette use: one was a former cigarette smoker and the other was a never smoker but had a history of asthma. The severity of their symptoms had abated but they still had residual symptoms and were worried about the long-term consequences. When I went to review the literature regarding the latest data on the long-term health risks of using e-cigarettes, I noted an explosion of information being published in just the past few years. It is clear there is a great deal of controversy and concern about the introduction of these products into the marketplace without sufficient information about potential health risks nor adequate regulation over their indications, contents, and the technology used to generate their aerosol. Currently there are regular advertisements for e-cigarettes promoting them as viable and safe alternatives to cigarette smoking. One of the key initial promotions for these devices was as a smoking cessation tool despite an absence of any large double-blinded, randomized placebo-controlled trials to prove any superior efficacy to conventional smoking cessation strategies (such as nicotine replacement, bupropion hydrochloride, or the nicotine receptor partial agonists such as varenicline and counseling). More recently however, since their entry into the marketplace in the United States in 2006, manufacturers, many users, and some tobacco control experts, advocate e-cigarettes as a viable long-term harm reduction alternative to cigarette smoking without any long-term safety data. E-cigarettes have become a multi-billion-dollar industry (U.S. $ 11.3 billion in 2018) and projections suggest that their sales will surpass combustible cigarettes by 2023.1 There are few regulations concerning access to these devices and there is high utilization by teenagers and reports of use by middle school children.2 The question has been raised of whether these companies are specifically targeting this population with flavors such as “bubble gum.” There is also data to suggest that rather than reducing the risk of teenagers smoking cigarettes, use of e-cigarettes may act as a gateway to young people transitioning to smoking tobacco cigarettes. Recent studies show that adolescents and young adult e-cigarette users are at a 3 times greater risk of starting cigarette smoking compared to those who had never used e-cigarettes.3-8 (See abstracts below). \u0000 \u0000The essential design of e-cigarettes includes an atomizer that uses an electrical current, generated by a battery, to heat a metal coil which aerosolizes the e-liquid conducted from a reservoir to the coil via a wick, typically made of cotton or silica. The user presses a button on the device, inhales and a plume of droplets carry the aerosol to the oroph","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"123 1","pages":"281-291"},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77099345","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":"Pulmonary Predictors of Incident Diabetes in Smokers.","authors":"G. Kinney, E. Baker, O. Klein, J. Black-Shinn, E. Wan, B. Make, E. Regan, R. Bowler, S. Lutz, K. Young, L. Duca, G. Washko, E. Silverman, J. Crapo, J. Hokanson","doi":"10.15326/JCOPDF.3.4.2016.0137","DOIUrl":"https://doi.org/10.15326/JCOPDF.3.4.2016.0137","url":null,"abstract":"BACKGROUND Diabetes mellitus and its complications are a large and increasing burden for health care worldwide. Reduced pulmonary function has been observed in diabetes (both type 1 and type 2), and this reduction is thought to occur prior to diagnosis. Other measures of pulmonary health are associated with diabetes, including lower exercise tolerance, greater dyspnea, lower quality of life (as measured by the St. George's Respiratory Questionaire [SGRQ]) and susceptibility to lung infection and these measures may also predate diabetes diagnosis. METHODS We examined 7080 participants in the COPD Genetic Epidemiology (COPDGene) study who did not report diabetes at their baseline visit and who provided health status updates during 4.2 years of longitudinal follow-up (LFU). We used Cox proportional hazards modeling, censoring participants at final LFU contact, reported mortality or report of incident diabetes to model predictors of diabetes. These models were constructed using known risk factors as well as proposed markers related to pulmonary health, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, respiratory exacerbations (RE), 6-minute walk distance (6MWD), pulmonary associated quality of life (as measured by the SGRQ), corticosteroid use, chronic bronchitis and dyspnea. RESULTS Over 21,519 person years of follow-up, 392 of 7080 participants reported incident diabetes which was associated with expected predictors; increased body mass index (BMI), high blood pressure, high cholesterol and current smoking status. Age, gender and accumulated smoking exposure were not associated with incident diabetes. Additionally, preserved ratio with impaired spirometry (PRISm) pattern pulmonary function, reduced 6MWD and any report of serious pulmonary events were associated with incident diabetes. CONCLUSIONS This cluster of pulmonary indicators may aid clinicians in identifying and treating patients with pre- or undiagnosed diabetes.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"28 1","pages":"739-747"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75756666","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":"Abdominal Visceral Adipose Tissue is Associated with Myocardial Infarction in Patients with COPD.","authors":"A. Díaz, Thomas P. Young, Sila Kurugol, Eric Eckbo, Nina Muralidhar, Joshua K Chapman, G. Kinney, J. Ross, Raúl San José Estépar, R. Harmouche, J. Black-Shinn, M. Budoff, R. Bowler, J. Hokanson, G. Washko","doi":"10.15326/jcopdf.2.1.2015.0127","DOIUrl":"https://doi.org/10.15326/jcopdf.2.1.2015.0127","url":null,"abstract":"BACKGROUND Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD. METHODS We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group. RESULTS Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm2; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41). CONCLUSION Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"27 1","pages":"8-16"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82757751","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":"Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics.","authors":"K. Iyer, Randall W. Grout, G. Zamba, E. Hoffman","doi":"10.15326/JCOPDF.1.1.2014.0111","DOIUrl":"https://doi.org/10.15326/JCOPDF.1.1.2014.0111","url":null,"abstract":"RATIONALE AND OBJECTIVES Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. MATERIALS AND METHODS Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). RESULTS Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred subjects, respectively. CONCLUSION A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"11 1","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72926225","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":"Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in The COPDGene® Study.","authors":"S. Kim, Kunihiro Yagihashi, Douglas S Stinson, J. Zach, Alexander S McKenzie, D. Curran-Everett, E. Wan, E. Silverman, J. Crapo, D. Lynch","doi":"10.15326/JCOPDF.1.1.2013.0001","DOIUrl":"https://doi.org/10.15326/JCOPDF.1.1.2013.0001","url":null,"abstract":"Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"48 1","pages":"88-96"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79181833","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":"Morphologic Response of the Pulmonary Vasculature to Endoscopic Lung Volume Reduction.","authors":"F. Rahaghi, C. E. Come, J. Ross, R. Harmouche, A. Díaz, Raúl San José Estépar, G. Washko","doi":"10.15326/JCOPDF.2.3.2014.0164","DOIUrl":"https://doi.org/10.15326/JCOPDF.2.3.2014.0164","url":null,"abstract":"INTRODUCTION\u0000Endoscopic Lung Volume Reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used CT based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature.\u0000\u0000\u0000METHODS\u0000Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe.\u0000\u0000\u0000RESULTS\u0000There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity.\u0000\u0000\u0000CONCLUSION\u0000In the subjects studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"50 1","pages":"214-222"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82649830","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}