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ABSTRACT OBJECTIVE To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.
RESUMO OBJETIVO Estimar a prevalência dos tratamentos utilizados para o manejo da doença pulmonar obstrutiva crônica (DPOC) na população adulta brasileira. MÉTODOS Estudo transversal de base populacional com dados oriundos da Pesquisa Nacional de Saúde de 2013, incluindo indivíduos com 40 anos ou mais, com diagnóstico médico autorreferido de DPOC, bronquite crônica e/ou enfisema, os quais foram questionados sobre tratamentos utilizados para o manejo da doença. RESULTADOS Foram entrevistados 60.202 adultos, dos quais 636 tinham 40 ou mais anos de idade e haviam referido diagnóstico médico de DPOC, enfisema ou bronquite crônica. Menos da metade (49,4%) da população diagnosticada relatou utilizar algum tipo de tratamento, havendo diferenças quanto à macrorregião do país (Sul 53,8% - Nordeste 41,2%, p = 0,007). O tratamento medicamentoso foi o mais referido e portadores de enfisema apresentaram a maior proporção de mais de um tipo de tratamento utilizado. Entre os indivíduos que declararam ter apenas bronquite crônica, 55,1% (IC95% 48,7-61,4) usavam medicamento, 4,7% (IC95% 2,6-8,3) realizavam fisioterapia e 6,0% (IC95% 3,6-9,9) oxigenoterapia. Por outro lado, entre os enfisematosos, 44,1% (IC95% 36,8-51,7) realizavam tratamento medicamentoso, 8,8% (IC95% 5,4-14,2) fisioterapia e 10,0% (IC95% 6,3-15,6) oxigenoterapia. CONCLUSÕES As prevalências de tratamentos para o manejo da DPOC estavam aquém do ideal em 2013. O medicamentoso foi o principal tipo de tratamento, seguido de oxigenoterapia e fisioterapia.
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Humans , Male , Female , Adult , Pulmonary Emphysema , Health Surveys , Disease Management , Bronchitis, Chronic , Pulmonary Disease, Chronic Obstructive/epidemiologyABSTRACT
Objective To explore the effects of Fufang-Haqing capsule with formoterol in the treatment of elderly pulmonary emphysema combined with chronic wheezing bronchitis. Methods A total of 156 patients with elderly pulmonary emphysema combined with chronic wheezing bronchitis in our hospital were divided into control group (88 cases) and observation group (88 cases). The control group was treated with formoterol, the observation group was treated with Fufang-Haqing capsule combined with formoterol. Both group treatment last three months. In the 2 groups, the levels of lung function indicators (FEV1, FEV1/FVC, PEF and PEFR), inflammatory markers [Matrix metalloproteinase inhibitors-1 (TIMP-1), interleukin-17 (IL-17), matrix metalloproteinase-9 (MMP-9) and interleukin-8 (IL-8)], immune function indicators [T lymphocyte subgroup (CD3+ and CD4+), immunoglobulin (IgA, IgG and IgM)] were detected before and after the treatment. During the treatment, the adverse actions were observed. Results The effect rate in treatment group was 93.2% (82/88), significantly higher than 80.7% (71/88) in control group (Z=3.781, P<0.05). After the treatment, the levels of FEV1 (2.89 ± 0.37 L vs. 2.22 ± 0.33 L, t=3.781), FEV1/FVC (65.10% ± 6.67% vs. 57.56% ± 5.98%, t=3.894), PEF (6.76 ± 0.69 L/S vs. 5.57 ± 0.59 L/S, t=3.351) and PEFR (3.67 ± 0.39 L/S vs. 2.87 ± 0.32 L/S, t=3.561) in the treatment group were significantly higher than those in the control group (P<0.05). The TIMP-1, IL-17, IL-8 and MMP-9 in the treatment group were significantly lower than those in the control group (t were 3.567, 3.692, 3.491, 3.394, all Ps<0.05), while the levels of CD3+, CD4+, IgA, IgG and IgM were in the treatment group were significantly higher than those in the control group (t were 3.791, 3.593, 3.258, 3.682, 3.526, all Ps<0.05). There was no significantly difference between the 2 groups in the adverse actions. Conclusions The Fufang-Haqing capsule with formoterol in the treatment of elderly pulmonary emphysema combined with chronic wheezing bronchitis showd good effect, could promote the levels of lung function, inflammatory and immune function.
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Objective To investigate the pathogenesis of the production of anti-neutrophil cytoplasmic antibodies (ANCA) in the rat models of chronic bronchitis (CB) with recurrent infections. Methods The CB models were made by double element of smoking and lipopolysaccharide (LPS) stimulation. The rats were divided into four groups, including normal control group (n=5), phorbol-12-myristate-13-acetate (PMA)-treated healthy rats control group (n=5), CB rats group (n=5) and PMA-treated CB rats group (n=6). Renal function of rats was detected. The histopathological lung and kidney tissues were observed by HE staining of paraffin section. Immunological markers, including myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA), proteinase 3 anti-neutrophil cytoplasmic antibodies (PR3-ANCA) and citrullinated histone H3 (CitH3), were measured by enzyme-linked immune-sorbent assay (ELISA) at different time points. Correlation between CitH3 and MPO-ANCA was analyzed by the Spearman rank correlation. NETs components were further detected in lung and kidney tissue by confocal immunofluorescence and colocalization analysis. Results (1) The serum levels of CitH3 and MPO-ANCA in CB+PMA group showed an increased trend. Compared with those in the normal control group and CB rats group, the serum levels of CitH3 and MPO-ANCA in CB+PMA group increased significantly at the sixth week (both P＜0.05). Serum CitH3 levels in rats were positively correlated with serum MPO-ANCA levels (rs=0.490,P=0.024). (2) There were pathological manifestations of CB in the lung tissues of rats in CB group and CB+PMA group, and no obvious abnormalities in the lung tissues of rats in the normal control group and control group. In the rat kidney tissue of CB+PMA group, there were inflammatory cells infiltrated in the glomerular and around the renal tubules, but glomerular necrosis was not found. No obvious abnormalities were observed in the kidney tissues of rats in the normal control group, PMA-treated healthy rats control group and CB group. (3) In the lung and kidney tissues of CB+PMA group NETs could be detected by confocal immunofluorescence analysis. Conclusion CB rats with the recurrent infections can release large amounts of NETs, in which the exposure of MPO antigen will break the immune tolerance and result in the production of MPO-ANCA.
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BACKGROUND: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. METHODS: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. RESULTS: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. CONCLUSION: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.
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Animals , Cats , Humans , Bronchitis , Bronchitis, Chronic , Cohort Studies , Forced Expiratory Volume , Korea , Phenotype , Pulmonary Disease, Chronic Obstructive , Quality of Life , SputumABSTRACT
La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad prevenible y tratable, que se caracteriza por síntomas respiratorios persistentes secundarios a la exposición crónica a partículas. Los pilares fundamentales son la enfermedad de la vía aérea y la destrucción del parénquima pulmonar. Los cambios no siempre ocurren simultáneamente y progresan a diferentes velocidades en cada individuo. Las imágenes diagnósticas pueden ser consideradas como parte del diagnóstico y la valoración de los pacientes con EPOC, teniendo en cuenta que la radiografía de tórax no es útil para su diagnóstico, pero facilita la exclusión de los diagnósticos diferenciales, mientras que la tomografía computarizada se reserva para aquellos pacientes en quienes se debe valorar el parénquima pulmonar por sospecha de bronquiectasias o quienes por sus riesgos exposicionales tienen mayor probabilidad de desarrollar cáncer de pulmón. El enfisema, la bronquitis crónica y el asma son la clave para realizar un abordaje radiológico para el diagnóstico.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by the presence of persistent respiratory symptoms secondary to chronic exposure to particles. The main factors are airway disease and destruction of the lung parenchyma. Parenchymal abnormalities do not always occur simultaneously and progress at different speeds in each individual. Diagnostic imaging can be considered as part of the diagnosis and assessment in patients with COPD, taking into account that chest radiography is not useful for the diagnosis of COPD but is useful for the exclusion of differential diagnosis, while computed tomography is reserved for those patients in whom pulmonary parenchyma should be assessed for suspected bronchiectasis or those who are more likely to develop lung cancer due to expositional risk factors. Emphysema, chronic bronchitis and asthma are key to perform a radiological approach for diagnosis.
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Humans , Lung Diseases , Tomography, X-Ray Computed , Bronchitis, Chronic , Hypertension, PulmonaryABSTRACT
Objective To compare clinical characteristics between acute exacerbated chronic obstructive pulmonary disease (AECOPD) patients with chronic bronchitis phenotype and emphysema phenotype.Methods A total of 73 AECOPD patients with chronic bronchitis phenotype and 82 AECOPD patients with emphysema phenotype in Tibet Chengdu Branch Hospital,West China Hospital,Sichuan University from January 2014 to November 2016 were selected.All patients had completed lung function tests,basic information collection,modified medical research council dyspnea scale (MMRC),and COPD assessment test (CAT).The serum samples were collected to detect C-reactive protein (CRP).The clinical characteristics,lung function,complications and systemic inflammation between the two groups were compared.Results There was no difference in body mass index (BMI),CAT score,serum CRP level and length of hospital stay between the AECOPD patients with chronic bronchitis phenotype and emphysema phenotype (P＞0.05).Compared with AECOPD patients with chronic bronchitis phenotype,the AECOPD patients with emphysema phenotype have longer smoking history,higher MMRC score,and more severe lung function impairment (P＜0.05).Conclusion AECOPD patients with chronic bronchitis phenotype and emphysema phenotype have different clinical characteristics,those with emphysema phenotype have more severe dyspnea and lung function impairment.
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Objective To observe clinical effect of the hydrochloric acid ammonium bromide auxiliary treatment of acute exacerbation of chronic bronchitis.Methods From February 2014 to January 2016,60 patients with chronic bronchitis in the Second People's Hospital of Yuyao were selected as observation objects.They were randomly divided into control group(30 cases)and observation group(30 cases)by using digital table method.The control group was treated with amoxicillin on the basis of conventional treatment, the observation group was treated with hydrochloric acid ammonia bromine based on the control group.The symptoms integral, clinical curative effect,blood gas analysis and lung function index were observed between the two groups.Results After treatment, cough,sputum, asthma of the observation group were(0.87 ± 0.32)points,(0.85 ± 0.34)points,(0.86 ± 0.34)points,respectively ,which were lower than those of the control group[(1.78 ± 0.48)points,(1.80 ± 0.47)points,(1.82 ± 0.46)points], the differences between the two groups had statisticallly significant(t =8.40,8.97,9.19, all P ＜0.05);The forced expiratory volume in one second(FEV1), forced expiratory volume in one second(FEV1/FVC)and forced vital capacity ratio in the observation group were(2 344.51 ± 373.44)mL,(69.34 ± 7.56)％,respectively,which in the control group were(2 001.63 ± 368.61)mL,(53.98 ± 6.78)％, respectively, the differences were statistically significant between the two groups(t =3.58,8.28, all P ＜ 0.05);The arterial oxygen partial pressure(PaO2)and artery CO2 partial pressure(PaCO2)in the observation group were(73.58 ± 6.33)mmHg,(43.51 ± 6.24)mmHg, respectively, which in the control group were(66.87 ± 7.25)mmHg,(51.05 ±6.36)mmHg, respectively, differences betwee.n the two groups were statistically significant(t =3.82,4.64, all P ＜0.05);The total effective rate in the observation group was 96.67％ ,which was higher than 66.67％ of the control group(x2 =10.42, P ＜ 0.01).Condusion Hydrochloric acid ammonia bromine adjuvant therapy for patients with acute exacerbation of chronic bronchitis can improve arterial blood gas analysis and pulmonary function indexes,alleviate clinical symptoms and improve clinical efficacy.
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Objective To evaluate the effect of Yupingfeng powder for the patients with chronic bronchitis acute episodes. Method A total of 80 patients with chronic bronchitis acute phase were divided into two groups, 40 in each group, using the random number table method. The control group were treated with conventional western medicine therapy, and the treatment group were treated with Yupingfeng powder on the intervention of control group.Two groups were treated 2 weeks. The pulmonary function before and after treatment, the changes in inflammatory cytokines, and TCM syndrome scores, and clinical effect rates were detected and compared. Results The observation group total effective rate was 92.5% (37/40), and the control group was 72.5% (29/40). The difference was statistically significant (χ2=5.541, P=5.541). After treatment, the TCM syndrome scores(4.58 ± 1.16 vs.7.74 ± 2.35,t=3.256)in the observation group was significantly lower than that in the control group(P<0.05).The FVC(2.58 ± 0.35 L vs.2.15 ± 0.32 L,t=5.664),TLC(2.68 ± 0.49 L vs.2.41 ± 0.37 L,t=3.523),VC(2.43 ± 0.38 L vs.1.52 ± 0.35 L,t=11.152),MVV(72.5 ± 14.54 L vs.51.2 ± 12.47 L, t=7.305) in the observation group were significantly higher than those in the control group (Ps<0.01). The hs-CRP serum(12.55 ±4.55 mg/L vs.24.72 ± 5.70 mg/L,t=3.543),the WBC[(5.03 ± 1.10)×109/L vs.(7.52 ± 1.41)×109/L,t=2.347)],percentage of neutrophils(60.32% ± 4.49 % vs.71.13% ± 4.14%,t=3.651)levels in the observation group were significantly lower than those in the control group (P<0.01). Conclusions The Yupingfeng powder combined with conventional western medicine therapy can improve lung function in patients with chronic bronchitis acute, lower the levels of inflammatory cytokines, and improve the clinical effect.
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Objective To compare the treatment responses of the inhaled salmeterol and fluticasone (50/500 μg) for three months in the different clinical phenotypes of chronic obstructive pulmonary diseases (COPD) which were chronic bronchitis phenotype and emphysema phenotype and to explore the difference of the treatment responses.Methods To enroll and follow up the stable COPD patients from outpatient department who received the treatment of inhaled salmeterol and fluticasone (50/500 μg).Patients with low attenuation area (LAA,the density on CT scan ＜-950 HU) ≥15％ of the while lung area％ (LAA％) were defined as emphysema group,while patients with LAA％ ＜ 15％ were defined as chronic bronchitis group.All the subjects received lung function test before and after three-month treatment.Results Totally,84 patients (49 male and 35 female patients) with stable COPD were enrolled with an average age (61.04 ±9.23) years old,30 patients in emphysema group and 54 patients in chronic bronchitis group.Before treatment,forced expiratory volume in one second (FEV1) ％ predicted value and residual volume (RV) ％ predicted value in emphysema group were lower than those of chronic bronchitis group (P =0.04 and P =0.01),while inspiratory capacity (IC)％ predicted value was higher than that of chronic bronchitis group (P =0.02).After three-month salmeterol and fluticasone inhalation treatment,FEV1 and RV were improved in both groups,but FEV1 and RV in chronic bronchitis group were improved more significantly than those of emphysema group (P =0.02 and P =0.03).Conclusions The treatment responses of different clinical phenotypes of COPD to inhalation of combination of salmeterol and fluticasone were different,chronic bronchitis phenotype had better treatment response compared to emphysema phenotype.
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Objective To study the effects and the therapeutic mechanism of Humulus scandens particles ( HSP ) on the mice with chronic bronchitis ( CB ) . Methods Mice were divided into normal control group, dextromethorphan group or ammonium chloride group, the high-, middle-and low-dose of HSP groups ( These three groups received gavage administration of HSP at 3.00 g??kg-1, 1.50 g??kg-1 and 0.75 g??kg-1,respectively) randomly.The effects of HSP on ammonia-induced cough and trachea phenol red excretion in mice were observed.CB mouse model was established by inhaling smoke and formaldehyde.In total, 60 mice were divided into 6 groups by the method of random digits table: normal control group, model control group, Guilong kechuanning capsule group, the high-, middle-and low-dose HSP groups (n=10 each group).After modeling for 18 days, mice in normal control group and model control group were administered intragastrically with 0. 9% sodium chloride solution. Mice in the high-, middle-and low-dose HSP groups were daily treated with HSP at 3.00, 1.50 and 0.75 g??kg-1 ,respectively, by intragastric administration.Mice in Guilong kechuanning Capsule group were administered with Guilong kechuanning Capsule (600 mg??kg-1), once a day, for 15 days.The tumor necrosis factor alpha ( TNF-α) & interleukin-8 ( IL-8) contents in lung tissues of each group were determined. Results By hematoxylin-eosin (HE) staining, it was found that HSP alleviated the damage of CB in mice.The frequency of cough in 2 min in the normal control group, the high-, middle- and low-dose HSP groups were (17.50±5.38), (11.90±4.46), (12.60±3.47), (9.50±3.24), respectively, and the ecretion of phenol red were (0.52±0.11), (0.65±0.15), (0.64±0.14), (0.67±0.19) μg??mL-1, respectively.The content of TNF-α in lung tissues of the normal control group, model control group,the high dose HSP group was (25.8±6.9), (66.3±11.7), (43.5±7.7) ng??mg-1, respectively.The content of IL-8 in lung tissues of the normal control group, model control group, the high-dose HSP group were (27.1±9.1), (48.2±11.4) and (36.5±8.2) ng??mg-1, respectively.The contents of TNF-α and IL-8 in lung tissues of the model control group were significantly higher than those in normal control group (both P<0.01).Compared with the model control group, high-dose HSP could obviously decrease the contents of TNF-α and IL-8 in lung tissues (P<0.01 or P<0.05). Conclusion HSP can obviously alleviate the pathomorphological changes in mice with CB and has antitussive and expectorant effecs.The therapeutic mechanism of HSP for CB may be related to decreasing the contents of TNF-αand IL-8 in lung tissue.
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IgG4-related disease (IgG4-RD) is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasmacytes. We experienced a case of IgG4-RD developed in a patient with bronchial asthma (BA) and chronic rhinosinusitis (CRS). A 55-yr-old female patient with BA and CRS complained of both eyes and neck swelling as well as a recurrent upper respiratory infection in recent 1 yr. The serum levels of IgG4, creatinine, and pancreatic enzymes were elevated. A biopsy of the submandibular gland showed an abundant infiltration of IgG4-positive plasmacytes. Her symptoms remarkably improved after the treatment of a systemic steroid that has been maintained without recurrence. We report a rare case of IgG4-RD developed in a patient with BA and CRS.
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Female , Humans , Middle Aged , Asthma/complications , Chronic Disease , Creatinine/blood , Immunoglobulin G/blood , Pancreas/enzymology , Plasma Cells/physiology , Prednisolone/therapeutic use , Republic of Korea , Rhinitis/complications , Sinusitis/complications , Submandibular Gland/pathology , Tomography, X-Ray ComputedABSTRACT
Objective From the point of view of pharmaceutical economics,to analyze and compare the clinical efficacy,safety,compliance and economic effect of three kinds of scheme:1.moxifloxacin,2.moxifioxacin combined with ambroxol,3.azithromycin combined with levofloxacin in the treatment of acute exacerbation of chronic bronchitis (AECB).Methods Retrieval Chinese joumal full-text database,Wanfang medical database and Chinese science and technology periodical full-text database,included three options for the treatment of AECB randomized controlled trial (RCT) literature,through the analysis of the data to make drug economics evaluation.Results The total effective rates of three programs were 94.92％,95.08％,94.90％,the difference was not statistically significant (P ＞ 0.05).The cost-effectiveness ratios were 213.34,536.40,61.22.Conclusion The efficacy of three treatment options is similar,azithromycin combined with levofloxacin has economic advantages.
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Objective To explore the roles of IκBα and TGF-β1 on airway inflammation in rats with chronic bronchitis induced by smoking and study the effects and mechanism of anti-inflammation of pretreatment with ambroxol. Methods Sixty male wistar rats were randomly divided into four groups: Normal dosage group, model group, high dosage group and low dosage group. The rats with chronic bronchitis were established by smoking. For high and low dosage group, rats were pretreated respectively with ambroxol group, rats were pretreated with normal saline through peritoneal injection as much as the low dosage group.After 76 days, the histopathologic changes stained in hemotoxylin and eosin (H. E.) of bronchopulmonary tissues were observed under opticalmicroscope, white cell counts and differential analysis were performed in BALF, the expression of IκBα and TGF-β1 were detected by immunohistochemistry. Results The pathological changes of model group were in consistent with that of chronic bronchitis, but the degrees were significantly reduced in high and low dosage groups. Compared with those in normal group, the white cell count and the neutrophilic granulocyte count of BALF in model group were significantly increased and the macrophagocyte count decreased, and the expression of IκBαwas significantly decreased(t =3.24,3.31,3.29,3.48, P ＜0. 05) and the TGF-β1 significantly increased (P ＜0. 05). Compared with those in the model group, the white cell count and the neutrophilic granulocyte count of BALF in high and low dosage group were significantly decreased and the macrophagocyte count increased, the expression of IκBαwas significantly increased (t =2. 86,2. 97,2. 92,3.52,2.42,2. 88,2. 58,3.48, P ＜0. 05) and the TGF-β1 significantly decreased (P ＜0. 05) . Compared with those in low dosage group, the expression of TGF-β1 was decreased and the expression of IκBαincreased in high dosage group (t =2. 82,3.64, P ＜0. 05). Conclusions Down-regulating the expression of IκBα and up-regulating of TGF-β1 may be involved in the process of airway inflammation in rats with chronic bronchitis induced by smoking. Ambroxol might have better effects on ameliorating airway inflammation by up-regulating the expression of IκBα and down-regulating of TGF-β1.
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Objective To study the features and risk factors of ischemic leukoaraiosis (LA) progression in elderly patients aged 80 years and over. Methods The 56 elderly patients with ischemic LA confirmed by MRI were enrolled in this study. The characteristics and risk factors of ischemic LA were comparatively analyzed between baseline and 3 years later by single and multi-variable logistic regression analysis. Results Ischemic LA progressed mostly in the subcortical white matter in elderly patients, especially the frontal lobes (progression of white matter lesion was present in 40% in the frontal lobes at baseline and 52% after 3 years), followed by the parietal lobes (35% at baseline and 36% after 3 years); Furthermore, previous high homocysteine (Hcy) and chronic bronchitis were risk factors of ischemic LA progression. Conclusions Ischemic LA progresses mostly in the subcortical white matter in the elderly, especially the frontal lobes; High Hcy and chronic bronchitis are risk factors of ischemic LA progression in elderly patients.
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OBJETIVO: Determinar a associação de sintomas respiratórios e bronquite crônica com o uso de biocombustíveis entre mulheres habitantes de áreas rurais do estado de Ekiti, sudoeste da Nigéria. MÉTODOS: De janeiro a junho de 2009, realizou-se um estudo transversal com uma amostra de 269 mulheres adultas. Um questionário adaptado do European Community Respiratory Health Survey foi aplicado para a obtenção de dados sobre características sociodemográficas, tipo de combustível utilizado para a preparação de alimentos, sintomas respiratórios e história de tabagismo. Todas as participantes foram convidadas a realizar espirometria. RESULTADOS: Das 269 mulheres no estudo, 161 (59,9 por cento) utilizavam biocombustíveis para a preparação de alimentos. As mulheres que utilizavam biocombustíveis relataram mais sintomas respiratórios que aquelas que não os utilizavam - tosse (13,7 por cento vs. 3,7 por cento); sibilância (8,7 por cento vs. 2,8 por cento); dor no peito (7,5 por cento vs. 1,9 por cento); falta de ar (11,8 por cento vs. 6,5 por cento); sintomas nasais (9,3 por cento vs. 4,6 por cento); e bronquite crônica (10,6 por cento vs. 2,8 por cento). A análise multivariada por regressão logística confirmou que o uso de biocombustíveis está associado às seguintes variáveis: tosse (OR = 4,82; p = 0,01); bronquite crônica (OR = 3,75; p = 0,04); sibilância (OR = 2,22; p = 0,23); dor no peito (OR = 3,82; p = 0,09); falta de ar (OR = 1,54; p = 0,35); e sintomas nasais (OR = 2,32; p = 0,20). Todos os parâmetros espirométricos avaliados (VEF1, CVF, VEF1/CVF e PFE) foram menores nas mulheres que utilizavam biocombustíveis do que naquelas que não os utilizavam. CONCLUSÕES: Nossos resultados enfatizam a necessidade de se substituir o uso de biocombustíveis nos domicílios pelo de um tipo de combustível atóxico, como eletricidade ou gás.
OBJECTIVE: To determine whether respiratory symptoms and chronic bronchitis are associated with the use of biomass fuels (BMFs) among women residing in rural areas of the Ekiti State, in southwestern Nigeria. METHODS: From January to June of 2009, we carried out a cross-sectional study including 269 adult women. To collect data on sociodemographic status, type of fuel used for cooking in the household, respiratory symptoms, and smoking history, we used a questionnaire adapted from the European Community Respiratory Health Survey. All of the participants were invited to undergo spirometry. RESULTS: Of the 269 women in the study, 161 (59.9 percent) used BMFs for cooking. The proportion of women who reported respiratory symptoms was greater among those using BMFs than among those using a non-BMF-cough (13.7 percent vs. 3.7 percent); wheezing (8.7 percent vs. 2.8 percent); chest pain (7.5 percent vs. 1.9 percent); breathlessness (11.8 percent vs. 6.5 percent); nasal symptoms (9.3 percent vs. 4.6 percent); and chronic bronchitis (10.6 percent vs. 2.8 percent). Multivariate logistic regression analysis revealed that the use of BMFs was associated with the following variables: cough (OR = 4.82; p = 0.01); chronic bronchitis (OR = 3.75; p = 0.04); wheezing (OR = 2.22; p = 0.23); chest pain (OR = 3.82; p = 0.09); breathlessness (OR = 1.54; p = 0.35); and nasal symptoms (OR = 2.32; p = 0.20). All of the spirometric parameters evaluated (FEV1, FVC, FEV1/FVC ratio, and PEF) were lower in the women using BMFs than in those using a non-BMF. CONCLUSIONS: Our results underscore the need for women using BMFs in their households to replace them with a nontoxic type of fuel, such as electricity or gas.
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Adult , Aged , Female , Humans , Middle Aged , Biofuels/toxicity , Bronchitis, Chronic/etiology , Respiratory Tract Diseases/etiology , Air Pollution, Indoor/adverse effects , Biofuels/statistics & numerical data , Cross-Sectional Studies , Cooking/instrumentation , Logistic Models , Nigeria , Risk Factors , SpirometryABSTRACT
Chronic obstructive pulmonary disease (COPD) is commonly a combination of pulmonary emphysema and chronic bronchitis. Emphysema is a pathologically defined disease that can be accurately diagnosed using CT. Furthermore, CT is useful for determination of the subtypes, extent and distribution of emphysema. Objective quantification of emphysema is feasible using CT densitometry of lung parenchyma, that can be used for selection of adequate candidates and monitoring clinical results of various therapeutic measures for severe emphysema. Imaging parameters in CT densitometry should be kept constant in follow up examination for an effective comparison of the results. Chronic bronchitis is diagnosed by symptomatic criteria with nonspecific CT findings. Airway dimensions can be objectively measured using CT, enabling further understanding of pathophysiology of COPD.
Subject(s)
Bronchitis, Chronic , Densitometry , Emphysema , Follow-Up Studies , Lung , Lung Diseases, Obstructive , Pulmonary Disease, Chronic Obstructive , Pulmonary Emphysema , ThoraxABSTRACT
OBJETIVO: Comparar a eficácia, segurança e tolerabilidade da azitromicina e da amoxicilina no tratamento de pacientes com quadro clínico de exacerbação infecciosa da doença pulmonar obstrutiva crônica. MÉTODOS: Seis centros brasileiros incluíram 109 pacientes com idades entre 33 e 82 anos. Desses pacientes, 102 foram randomizados para receber azitromicina (500 mg por dia por três dias, n = 49) ou amoxicilina (500 mg a cada oito horas por dez dias, n = 53). Os pacientes foram avaliados no início do estudo, após dez dias e depois de um mês. A avaliação clínica, de acordo com os sinais e sintomas presentes após dez dias e após um mês, consistiu na classificação dos casos nas categorias cura, melhora ou falha terapêutica. A avaliação microbiológica foi feita pela cultura de amostras de escarro consideradas adequadas após contagem de leucócitos e coloração de Gram. Avaliações secundárias de eficácia foram feitas com relação aos sintomas (tosse, dispnéia e expectoração) e à função pulmonar. RESULTADOS: Não houve diferenças entre as proporções de casos classificados como cura ou melhora entre os grupos tratados com a azitromicina ou a amoxicilina. Essas proporções foram, respectivamente, de 85 por cento vs. 78 por cento (p = 0,368) após dez dias, e de 83 por cento vs. 78 por cento (p = 0,571) após um mês. Também não foram encontradas diferenças significativas entre os dois grupos quando comparadas as variáveis secundárias de eficácia e a incidência de eventos adversos. CONCLUSÃO: A azitromicina tem eficácia e tolerabilidade semelhantes às da amoxicilina para o tratamento da exacerbação aguda da Doença pulmonar obstrutiva crônica.
OBJECTIVE: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. METHODS: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. RESULTS: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85 percent vs. 78 percent (p = 0.368) on day ten; and 83 percent vs. 78 percent (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. CONCLUSION: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.