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1.
Arch. argent. pediatr ; 119(4): e340-e344, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281780

ABSTRACT

La acrodisostosis es una displasia esquelética rara, de herencia autosómica dominante, que se caracteriza por la presencia de disostosis facial y periférica, talla baja y diferentes grados de obesidad. La acrodisostosis de tipo 1, secundaria a la mutación heterocigota en el gen PRKAR1A (17q24.2), se caracteriza por la asociación de resistencia hormonal múltiple con anomalías esqueléticas. Su incidencia está infradiagnosticada debido a que comparte rasgos clínicos y de laboratorio con otras entidades como el seudohipoparatiroidismo. Presentamos el caso de una niña de 8 años, con acrodisostosis tipo 1, confirmada mediante estudio genético. Además del fenotipo característico descrito, la talla baja y la resistencia hormonal, la paciente presentó una afectación progresiva de la función pulmonar: un patrón pulmonar obstructivo no reversible. En la literatura revisada, no se han encontrado otros casos que describan esta asociación entre acrodisostosis y afectación respiratoria.


Acrodysostosis is a rare skeletal displasia, of autosomal dominant inheritance, characterized by the presence of facial and peripheral dysostosis, short stature and obesity. Type 1 acrodysostosis is secondary to a mutation in the PRKAR1A (17q24.2) gene, which results in multi hormonal resistance and skeletal anomalities. This syndrome is under-diagnosed as it shares analytical and clinical characteristics with other entities, such as pseudohypoparathyroidism. We report the case of an eight-year-old girl with genetically confirmed type 1 acrodysostosis. In addition to the characteristic phenotype described, the short stature and the hormonal resistance, the patient suffered a progressive lung function deterioration: an irreversible pulmonary obstructive pattern. We have not found in previous literature cases reporting an association between acrodysostosis and lung function impairement.


Subject(s)
Humans , Female , Child , Osteochondrodysplasias/complications , Dysostoses/complications , Lung Diseases, Obstructive/complications , Osteochondrodysplasias/genetics , Osteochondrodysplasias/diagnostic imaging , Spirometry , Diagnosis, Differential , Dysostoses/genetics , Dysostoses/diagnostic imaging , Dyspnea/complications , Mutation/genetics
2.
Nursing (Säo Paulo) ; 23(260): 3537-3542, jan.2020.
Article in Portuguese | LILACS, BDENF | ID: biblio-1095562

ABSTRACT

O objetivo do estudo foi avaliar a técnica de uso dos dispositivos inalatórios em pacientes portadores de DPOC, atendidos no ambulatório de pneumologia de um Hospital Terciário na cidade do Recife-PE. Trata-se de uma pesquisa descritiva, prospectiva, de corte transversal. Participaram da pesquisa 150 pessoas com diagnóstico de DPOC. Foram utilizados 02 instrumentos estruturados, um questionário demográfico e um checklist observacional. Para análise dos dados foi utilizado o software SPSS, versão 18. Os principais erros encontrados da técnica inalatória são: "Expirar o ar normalmente" e "Fazer pausa inspiratória de 10 segundos" (p-valor < 0,005). Em geral, a renda salarial baixa e o baixo nível de escolaridade foram determinantes para a inadequacidade da técnica inalatória. Estudos anteriores, nacionais e internacionais, corroboram na reprodução desses condicionantes.(AU)


The aim of this study was to evaluate the technique of inhaled devices used in patients with COPD, treated at a pulmonary outpatient clinic at a Tertiary Hospital in Recife, PE. It is a descriptive, prospective cross-sectional study. 150 people with a diagnosis of COPD participated in the study. We used 02 structured instruments, a demographic questionnaire and an observational checklist. The SPSS version 18 software was used to analyze the data. The main errors found in the inhalation technique were: "Exhale the air normally" and "Take a 10 second inspiratory pause" (p-value <0.005). In general, low wage income and low level of schooling were decisive for the inadequacy of the inhalation technique. Previous national and international studies corroborate the reproduction of these conditions.(AU)


El objetivo de este estudio fue evaluar el uso de dispositivos de inhalación en pacientes con EPOC tratados en la clínica de neumología ambulatoria de un hospital terciario en Recife-PE. Esta es una investigación descriptiva, prospectiva, transversal. 150 personas diagnosticadas con EPOC participaron en el estudio. Se utilizaron dos instrumentos estructurados, un cuestionario demográfico y una lista de verificación observacional. El software SPSS versión 18 se utilizó para el análisis de datos. Los principales errores encontrados en la técnica de inhalación fueron: "Exhalar normalmente" y "Tomar una pausa inspiratoria de 10 segundos" (valor de p <0,005). En general, los bajos ingresos salariales y el bajo nivel de educación fueron determinantes para la insuficiencia de la técnica de inhalación. Estudios nacionales e internacionales anteriores corroboram la reproducción de estas condiciones.(AU)


Subject(s)
Humans , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive , Lung Diseases, Obstructive , Socioeconomic Factors , Nursing Care
3.
Article in English | WPRIM | ID: wpr-810962

ABSTRACT

BACKGROUND: Although the association of hyperuricemia with an increased risk of mortality has been demonstrated in the context of acute exacerbation of chronic obstructive pulmonary disease (COPD), the long-term outcomes of hyperuricemia have not been studied in the case of stable COPD.METHODS: We retrospectively analyzed baseline data of 240 men with stable COPD enrolled in the Korea Obstructive Lung Disease cohort. We evaluated associations between serum uric acid levels and clinical parameters, risk factors for all-cause mortality, and acute exacerbation of COPD.RESULTS: The mean age of subjects was 66.4 ± 7.7 years, and the median follow-up time was 5.9 years. We identified no significant difference in terms of lung function or laboratory findings between patients with hyperuricemia and those without. Serum uric acid level was negatively associated with systemic inflammation indicated by neutrophil–lymphocyte ratio (r = −0.211, P = 0.001). Univariate Cox regression analysis revealed hyperuricemia to not be associated with an increased risk of all-cause mortality in men with stable COPD (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.250–1.370; P = 0.213). In the multivariate Cox regression model, hyperuricemia was not an independent predictor of acute exacerbation (HR, 1.383; 95% CI, 0.977–1.959; P = 0.068).CONCLUSION: Among men with stable COPD, hyperuricemia is not an independent predictor of all-cause mortality or future acute exacerbation of COPD. These results differ from those of previous studies on patients with acute exacerbation of COPD.


Subject(s)
Cohort Studies , Follow-Up Studies , Humans , Hyperuricemia , Inflammation , Korea , Lung , Lung Diseases, Obstructive , Male , Mortality , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Risk Factors , Uric Acid
4.
J. bras. pneumol ; 46(1): e20180328, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056628

ABSTRACT

ABSTRACT Objective: To evaluate the relationship that the difference between slow vital capacity (SVC) and FVC (ΔSVC-FVC) has with demographic, clinical, and pulmonary function data. Methods: This was an analytical cross-sectional study in which participants completed a respiratory health questionnaire, as well as undergoing spirometry and plethysmography. The sample was divided into two groups: ΔSVC-FVC ≥ 200 mL and ΔSVC-FVC < 200 mL. The intergroup correlations were analyzed, and binomial logistic regression analysis was performed. Results: The sample comprised 187 individuals. In the sample as a whole, the mean ΔSVC-FVC was 0.17 ± 0.14 L, and 61 individuals (32.62%) had a ΔSVC-FVC ≥ 200 mL. The use of an SVC maneuver reduced the prevalence of nonspecific lung disease and of normal spirometry results by revealing obstructive lung disease (OLD). In the final logistic regression model (adjusted for weight and body mass index > 30 kg/m2), OLD and findings of air trapping (high functional residual capacity and a low inspiratory capacity/TLC ratio) were predictors of a ΔSVC-FVC ≥ 200 mL. The chance of a bronchodilator response was found to be greater in the ΔSVC-FVC ≥ 200 mL group: for FEV1 (OR = 4.38; 95% CI: 1.45-13.26); and for FVC (OR = 3.83; 95% CI: 1.26-11.71). Conclusions: The use of an SVC maneuver appears to decrease the prevalence of nonspecific lung disease and of normal spirometry results. Individuals with a ΔSVC-FVC ≥ 200 mL, which is probably the result of OLD and air trapping, are apparently more likely to respond to bronchodilator administration.


RESUMO Objetivo: Avaliar a relação da diferença entre a capacidade vital lenta (CVL) e CVF (ΔCVL-CVF) com dados demográficos, clínicos e de função pulmonar. Métodos: Estudo analítico, transversal, no qual os participantes responderam a um questionário de saúde respiratória e foram submetidos a espirometria e pletismografia. A amostra foi dividida em dois grupos: ΔCVL-CVF ≥ 200 mL e ΔCVL-CVF < 200 mL. Foram realizadas análises de correlações entre os grupos e de regressão logística binominal. Resultados: Foram selecionados 187 indivíduos. Na amostra total, a média da ΔCVL-CVF foi de 0,17 ± 0,14 L. Na amostra, 61 indivíduos (32,62%) apresentaram ΔCVL-CVF ≥ 200 mL. O uso da manobra expiratória lenta reduziu a prevalência de distúrbio ventilatório inespecífico e resultados espirométricos normais, ao revelar distúrbio ventilatório obstrutivo (DVO). DVO e achados de aprisionamento aéreo (capacidade residual funcional elevada e capacidade inspiratória/CPT reduzida) foram preditores de ΔCVL-CVF ≥ 200 mL no modelo final da regressão logística (ajustada para peso e índice de massa corpórea > 30 kg/m2). Foi observada maior chance de resposta ao broncodilatador no grupo ΔCVL-CVF ≥ 200 mL: VEF1 (OR = 4,38; IC95%: 1,45-13,26) e CVF (OR = 3,83; IC95%: 1,26-11,71). Conclusões: O uso da manobra expiratória lenta diminuiu a prevalência de distúrbio ventilatório inespecífico e de resultados espirométricos normais, podendo a ΔCVL-CVF ≥ 200 mL ser resultado de DVO e aprisionamento aéreo, tendo maior chance de resposta ao broncodilatador.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vital Capacity/physiology , Forced Expiratory Volume/physiology , Lung Diseases, Obstructive/physiopathology , Plethysmography , Respiratory Function Tests , Spirometry , Cross-Sectional Studies , Surveys and Questionnaires , Statistics, Nonparametric
5.
Article in Korean | WPRIM | ID: wpr-719466

ABSTRACT

Patients undergoing thoracic surgery show various lesions such as chronic obstructive lung diseases, pleural adhesion, pneumonia, acute respiratory distress syndrome, atelectasis, pleural effusion, pulmonary edema, and pneumothorax throughout preoperative, operative, and recovery periods. Therefore, lung ultrasonography has potential for perioperative use in thoracic surgery. Benefits of lung ultrasonography over conventional chest X-ray are convincing. First, ultrasonography has higher sensitivity than X-ray in various lesions. Second, it can be performed at bed side to obtain diagnosis immediately. Third, it does not expose patients to radiologic hazard. If anesthesiologists can obtain necessary skills and perform lung ultrasonography as a routine evaluation process for patients, territory of anesthesia would become broader and patients would obtain more benefit.


Subject(s)
Anesthesia , Diagnosis , Humans , Lung Diseases, Obstructive , Lung , Pleural Effusion , Pneumonia , Pneumothorax , Pulmonary Atelectasis , Pulmonary Edema , Respiratory Distress Syndrome , Thoracic Surgery , Thorax , Ultrasonography
6.
Article in Korean | WPRIM | ID: wpr-759845

ABSTRACT

BACKGROUND: Handgrip strength is a simple, convenient and economic tool measuring the muscle strength. A few studies investigated the relationship between diabetes and handgrip strength but the results are conflicting. This study investigated the association of handgrip strength with diabetes among the adult Koreans. METHODS: This cross-sectional study analyzed data from participants aged 20 years or more (n=8,082) who measured height, weight, handgrip strength and fasting blood glucose in the 2014–2015 Korea National Health and Nutrition Examination Survey. Relative handgrip strength (RHGS) was defined as the sum of the greatest handgrip strengths in both hands divided by body mass index. To investigate the association of diabetes with handgrip strength, complex sample multivariate logistic regression analyses were done after adjusting for socioeconomic (age, sex, education), lifestyle (smoking, alcohol drinking, physical activity, obesity) and comorbid (chronic obstructive pulmonary disease, stroke, coronary artery disease, arthritis) variables. Stratified analysis were done according to socioeconomic and lifestyle variables. RESULTS: The prevalence of diabetes was 8.3% (standard error, 0.4). After adjusting for socioeconomic, lifestyle, and comorbid variables, the risk of diabetes increased according to the decrease in sex-specific quartile of RHGS (P(trend)<0.001). Individuals with lower RHGS (per 1 standard deviation decrease) had higher odds of diabetes (adjusted odds ratio, 1.6; 95% confidence interval, 1.3–2.0). Furthermore, lower RHGS was associated with higher odds for diabetes throughout the strata of socioeconomic and lifestyle variables. CONCLUSIONS: This population-based, nationally representative study suggests that lower RHGS is associated with the increased risk of diabetes regardless of socioeconomic and lifestyle variables.


Subject(s)
Adult , Alcohol Drinking , Blood Glucose , Body Mass Index , Coronary Artery Disease , Cross-Sectional Studies , Diabetes Mellitus , Fasting , Hand , Hand Strength , Humans , Korea , Life Style , Logistic Models , Lung Diseases, Obstructive , Motor Activity , Muscle Strength , Nutrition Surveys , Odds Ratio , Prevalence , Stroke
7.
Yonsei Medical Journal ; : 554-560, 2019.
Article in English | WPRIM | ID: wpr-762079

ABSTRACT

PURPOSE: In general, the prevalence of metabolic syndrome (MS) and tooth loss increases with age. We investigated the relationship between the presence of MS, its elements, and tooth loss in middle-aged Korean adults. MATERIALS AND METHODS: This study included Korean adults between 30 and 64 years of age who resided in the capital area of Seoul. From January to June 2014, individuals interested in participating in the oral health survey among those who visited the university hospital's cardiovascular center and provided informed consent were selected. Among 748 subjects who responded to the oral health questionnaires, 30 were excluded due to unclear responses; therefore, a total of 718 were included in the final analysis. RESULTS: The crude odds ratio (OR) of ≥one MS component affecting tooth loss was 1.45 [95% confidence interval (CI), 1.06–2.00]. After adjusting for sex, age, education, income level, occupation, smoking status, kidney disease, chronic obstructive pulmonary disease, and rheumatic disease, the adjusted OR was 1.47 (95% CI, 1.06–2.05), which was statistically significant (p<0.05). The OR for tooth loss was higher in the presence of ≥one component of MS (50–64 years of age) in females. CONCLUSION: This study suggests that female aged 50–64 years may have higher likelihood of tooth loss upon the presence of at least one MS component. Prevention against MS among female of older age could contribute to maintenance of remaining teeth. Further well-designed studies are needed.


Subject(s)
Adult , Education , Female , Humans , Informed Consent , Lung Diseases, Obstructive , Middle Aged , Occupations , Odds Ratio , Oral Health , Prevalence , Renal Insufficiency, Chronic , Rheumatic Diseases , Seoul , Smoke , Smoking , Tooth Loss , Tooth
8.
Article in English | WPRIM | ID: wpr-760707

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate whether the waist circumference of patients with chronic obstructive pulmonary disease (COPD), had an impact on lung function. METHODS: There were 180 patients with COPD recruited into this prospective cross-sectional study. The age, weight, body mass index and waist circumference (WC) were measured. Spirometry parameters including forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), were measured and FEV1/FVC calculated. RESULTS: The mean FEV1/FVC in both normal weight and overweight patients, did not statistically significantly correlate with WC. The COPD assessment test, positively correlated with WC ( p = 0.031). A positive correlation with body mass index ( p < 0.001), smoking ( p = 0.027), and global initiative for chronic obstructive lung disease score ( p = 0.009), were observed to positively associate with WC. WC, age, C-reactive protein, duration of disease, and gender (male), were observed to be statistically significant risk factors for the severity of COPD. CONCLUSION: WC was not observed to impact upon lung function in this study but it was a predictive factor for COPD severity in patients.


Subject(s)
Body Mass Index , Body Weight , C-Reactive Protein , Cross-Sectional Studies , Forced Expiratory Volume , Humans , Lung , Lung Diseases, Obstructive , Overweight , Prospective Studies , Pulmonary Disease, Chronic Obstructive , Risk Factors , Smoke , Smoking , Spirometry , Vital Capacity , Waist Circumference
9.
Article in English | WPRIM | ID: wpr-741396

ABSTRACT

OBJECTIVE: To determine the predictive factors for treatment responsiveness in patients with chronic obstructive pulmonary disease (COPD) at 1-year follow-up by performing quantitative analyses of baseline CT scans. MATERIALS AND METHODS: COPD patients (n = 226; 212 men, 14 women) were recruited from the Korean Obstructive Lung Disease cohort. Patients received a combination of inhaled long-acting beta-agonists and corticosteroids twice daily for 3 months and subsequently received medications according to the practicing clinician's decision. The emphysema index, air-trapping indices, and airway parameter (Pi10), calculated using both full-width-half-maximum and integral-based half-band (IBHB) methods, were obtained with baseline CT scans. Clinically meaningful treatment response was defined as an absolute increase of ≥ 0.225 L in the forced expiratory volume in 1 second (FEV1) at the one-year follow-up. Multivariate logistic regression analysis was performed to investigate the predictors of an increase in FEV1, and receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the suggested models. RESULTS: Treatment response was noted in 47 patients (20.8%). The mean FEV1 increase in responders was 0.36 ± 0.10 L. On univariate analysis, the air-trapping index (ATI) obtained by the subtraction method, ATI of the emphysematous area, and IBHB-measured Pi10 parameter differed significantly between treatment responders and non-responders (p = 0.048, 0.042, and 0.002, respectively). Multivariate analysis revealed that the IBHB-measured Pi10 was the only independent variable predictive of an FEV1 increase (p = 0.003). The adjusted odds ratio was 1.787 (95% confidence interval: 1.220–2.619). The area under the ROC curve was 0.641. CONCLUSION: Measurement of standardized airway dimensions on baseline CT by using a recently validated quantification method can predict treatment responsiveness in COPD patients.


Subject(s)
Adrenal Cortex Hormones , Cohort Studies , Emphysema , Follow-Up Studies , Forced Expiratory Volume , Humans , Logistic Models , Lung Diseases, Obstructive , Male , Methods , Multivariate Analysis , Odds Ratio , Pulmonary Disease, Chronic Obstructive , ROC Curve , Tomography, X-Ray Computed
10.
Med. UIS ; 31(3): 27-36, sep.-dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-1002517

ABSTRACT

Resumen Introducción: la rehabilitación pulmonar mejora la sintomatología y disminuye el impacto de la enfermedad pulmonar en las actividades cotidianas. Objetivo: determinar el efecto de un programa de rehabilitación pulmonar de cuatro fases, realizado en un centro ambulatorio, sobre la tolerancia al ejercicio y la calidad de vida en pacientes con enfermedad obstructiva, restrictiva y vascular pulmonar. Materiales y métodos: estudio observacional prospectivo en 57 pacientes que completaron un programa de rehabilitación pulmonar de cuatro meses. Al inicio y al final del programa se realizó caminata de seis minutos y el test de calidad de vida de Saint George. Para la evaluación de las diferencias de medianas entre grupos fue utilizada la prueba no paramétrica de Wilcoxon. Resultados: la mediana de la edad fue 69 años, el 50,9% eran del género femenino y posterior al programa se observó un aumento en la distancia recorrida en la caminata de seis minutos, con una diferencia de 15,6 metros (p = 0,07). El test de calidad de vida de Saint George al finalizar el programa presentó disminución en el dominio de síntomas [18,5% (p<0,01)], actividad [4,1 % (p<0,01)], impacto [5,4% (p<0,01)] y total [7,6% (p<0,01)]. Discusión: se evidenció que las patologías respiratorias logran una estabilización de síntomas con la rehabilitación pulmonar, hallazgos que son congruentes a los reportados por otros autores. Conclusión: la rehabilitación pulmonar mejora la tolerancia al ejercicio y la calidad de vida en términos de reducción de síntomas e impacto de la enfermedad en pacientes con patología pulmonar. MÉD.UIS. 2018;31(3):27-36.


Abstract Introduction: pulmonary rehabilitation is a multidisciplinary approach that improves symptoms and decreases the impact of lung disease in everyday activities. Objective: to determine the effect of a 4-phase pulmonary rehabilitation program, performed in an outpatient center, on exercise tolerance and quality of life in patients with obstructive, restrictive and pulmonary vascular disease. Materials and methods: prospective study in 57 patients that completed a 4-month pulmonary rehabilitation program. At the beginning and at the end of the program, a 6-minute walk and the Saint George quality of life test were carried out. For the evaluation of the difference of medians between groups, the non-parametric Wilcoxon test was used. Results: the median age was 69 years, 50.9% were female and after the program an increase in the distance traveled in the 6-minute walk was observed, with a difference of 15,6 meters (p=0,07). The Saint George quality of life test at the end of the program showed a decrease in the symptoms domain [18,5% (p<0,01)], activity [4,1% (p<0,01)], impact [5,4% (p<0,01)] and total [7,6% (p<0,01)]. Discussion: it was evidenced that the respiratory pathologies achieve a stabilization of symptoms with the pulmonary rehabilitation, findings congruent to those reported by other authors. Conclusion: pulmonary rehabilitation improves the exercise tolerance and the quality of life in terms of reduction of symptoms and the impact of the disease in patients with pulmonary disease. MÉD.UIS. 2018;31(3):27-36.


Subject(s)
Humans , Female , Middle Aged , Aged , Rehabilitation , Lung Diseases, Obstructive , Quality of Life , Breathing Exercises , Exercise Tolerance
11.
Article in English | WPRIM | ID: wpr-714724

ABSTRACT

PURPOSE: Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey. METHODS: Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online. RESULTS: The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS. CONCLUSIONS: Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.


Subject(s)
Allergy and Immunology , Asthma , Diagnosis , Electronic Mail , Forced Expiratory Volume , Humans , Hypersensitivity , Lung Diseases, Obstructive , Population Characteristics , Pulmonary Disease, Chronic Obstructive , Smoke , Smoking , Specialization , Tuberculosis
12.
Article in English | WPRIM | ID: wpr-717912

ABSTRACT

BACKGROUND: Obstructive airway disease patients with increased variability of airflow and incompletely reversible airflow obstruction are often categorized as having asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). ACOS is heterogeneous with two sub-phenotypes: asthma-ACOS and COPD-ACOS. The objective of this study was to determine the difference in risk of exacerbation between the two sub-phenotypes of ACOS. METHODS: A total of 223 patients exhibiting incompletely reversible airflow obstruction with increased variability (spirometrically defined ACOS) were enrolled. These patients were divided into asthma-ACOS and COPD-ACOS according to their physician's diagnosis and smoking history of 10 pack-years. Within-group comparisons were made for asthma-ACOS versus COPD-ACOS and light smokers versus heavy smokers. RESULTS: Compared to patients with COPD-ACOS, patients with asthma-ACOS experienced exacerbation more often despite their younger age, history of light smoking, and better lung function. While the light-smoking group showed better lung function, they made unscheduled outpatient clinic visits more frequently. On multivariate analysis, asthma-ACOS and poor inhaler compliance were significantly associated with more than two unscheduled clinic visits during the previous year. CONCLUSION: Spirometrically defined ACOS includes heterogeneous subgroups with different clinical features. Phenotyping of ACOS by physician's diagnosis could be significant in predicting future risk of exacerbation.


Subject(s)
Ambulatory Care , Ambulatory Care Facilities , Asthma , Compliance , Diagnosis , Humans , Lung , Lung Diseases, Obstructive , Multivariate Analysis , Nebulizers and Vaporizers , Phenotype , Pulmonary Disease, Chronic Obstructive , Smoke , Smoking
13.
Article in Korean | WPRIM | ID: wpr-758503

ABSTRACT

Tracheal cancer is rare and accounts for approximately 0.03% of all malignancies. Because of atypical symptoms, tracheal cancer can be misdiagnosed as obstructive lung disease, or tumors of thyroid or lung. Among patients of previous head and neck cancer, other primary cancer may accompany which called “second primary cancer”. We report a case of patient with tracheal cancer 3 years after definite radiation therapy of laryngeal cancer with a review of related literatures.


Subject(s)
Head and Neck Neoplasms , Humans , Laryngeal Neoplasms , Lung , Lung Diseases, Obstructive , Thyroid Gland
14.
Article in English | WPRIM | ID: wpr-713774

ABSTRACT

When it comes to the use in inhalers in the management of chronic obstructive pulmonary diseases, there are many options, considerations and challenges, which health care professionals need to address. Considerations for prescribing and dispensing, administering and following up, education, and adherence; all of these factors impact on treatment success and all are intrinsically linked to the device selected. This review brings together relevant evidence, real-life data and practice tools to assist health care professionals in making decisions about the use of inhalers in the management of chronic obstructive pulmonary diseases. It covers some of the key technical device issues to be considered, the evidence behind the role of inhalers in disease control, population studies which link behaviors and adherence to inhaler devices as well as practice advice on inhaler technique education and the advantages and disadvantages in selecting different inhaler devices. Finally, a list of key considerations to aid health care providers in successfully managing the use of inhaler devices are summarized.


Subject(s)
Delivery of Health Care , Education , Health Personnel , Humans , Lung Diseases, Obstructive , Nebulizers and Vaporizers , Population Control , Pulmonary Disease, Chronic Obstructive
15.
Article in English | WPRIM | ID: wpr-742439

ABSTRACT

Bronchodilator therapy is central to the management of chronic obstructive pulmonary disease and are recommended as the preferred treatment by the Global Obstructive Lung Disease Initiative (GOLD). Long acting anti-muscarinics (LAMA) and long acting β₂ agonists (LABA) are both more effective than regular short-acting drugs but many patients remain symptomatic despite monotherapy with these drugs. Combination therapy with LAMA and LABA increases the therapeutic benefit while minimizing dose-dependent side effects of long-acting bronchodilator therapy. The TOviTO programme has investigated the benefits of treatment with a combination of tiotropium and olodaterol administered via a single inhaler. Tiotropium+olodaterol 5/5 µg significantly improved forced expiratory volume in 1 second (FEV₁) area under the curve from 0 to 3 hours, trough FEV₁ health status and breathlessness versus the mono-components and placebo. Tiotropium+olodaterol 5/5 µg also increased endurance time and reduced dynamic hyperinflation during constant work rate cycle ergometry. On the basis of these and other studies the 2017 GOLD report recommends escalating to dual bronchodilator therapy in patients in groups B and C if they remain symptomatic or continue to have exacerbations and as initial therapy for patients in group D.


Subject(s)
Dyspnea , Ergometry , Forced Expiratory Volume , Humans , Lung Diseases , Lung Diseases, Obstructive , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive , Tiotropium Bromide
16.
Article in English | WPRIM | ID: wpr-742433

ABSTRACT

BACKGROUND: Osteoporosis is a common disease that occurs comorbidly in patients with chronic inflammatory airway diseases, including asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap syndrome (ACOS). However, the prevalence of osteoporosis in patients with ACOS has not widely been evaluated. Therefore, we investigated the prevalence of osteoporosis and its relationship with the clinical parameters of patients with asthma, COPD, and ACOS. METHODS: This was a retrospective, cross-sectional study. Bone mineral density (BMD), lung function tests, and disease status evaluations were conducted. RESULTS: A total of 321 patients were enrolled: 138 with asthma, 46 with ACOS, and 137 with COPD. One hundred and ninety-three patients (60.1%) were diagnosed with osteoporosis (53.6% of asthma, 65.2% of ACOS, and 65.0% of COPD). Patients with ACOS showed a significantly lower BMD and T-score than did those with asthma. In addition to age, sex, and body mass index (BMI), which were previously reported to be associated with BMD, BMD also had a negative correlation with the diagnosis of ACOS, as compared to a diagnosis of asthma, after adjusting for age, sex, BMI, smoking, and inhaled corticosteroid use (p=0.001). Among those patients with COPD and ACOS, BMD was negatively associated with the COPD Assessment Test (CAT) after adjustment (p < 0.001). Inhaled corticosteroid was not associated with the prevalence of osteoporosis and BMD. CONCLUSION: Patients with ACOS, particularly aged and lean women, should be more carefully monitored for osteoporosis as compared to patients with asthma.


Subject(s)
Asthma , Body Mass Index , Bone Density , Cross-Sectional Studies , Diagnosis , Female , Humans , Lung Diseases, Obstructive , Osteoporosis , Prevalence , Pulmonary Disease, Chronic Obstructive , Respiratory Function Tests , Retrospective Studies , Smoke , Smoking
17.
Arq. bras. cardiol ; 109(6): 569-578, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-887974

ABSTRACT

Abstract Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure. Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario. Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant. Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation. Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.


Resumo Fundamento: Estudos Clínicos demonstram que até 40% dos pacientes não respondem à terapia de ressincronização cardíaca (TRC), assim a seleção apropriada dos pacientes é fundamental para o sucesso da TRC na insuficiência cardíaca. Objetivo: Avaliação de preditores de mortalidade e resposta à TRC no cenário brasileiro. Métodos: Estudo de coorte retrospectivo incluindo os pacientes submetidos à TRC em hospital terciário no Sul do Brasil entre 2008-2014. A sobrevida foi avaliada através de banco de dados da Secretaria Estadual de Saúde (RS). Os preditores de resposta ecocardiográfica foram avaliados utilizando método de regressão de Poisson. A análise de sobrevida foi feita por regressão de Cox e curvas de Kaplan Meyer. Um valor de p bicaudal inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Foram incluídos 170 pacientes com seguimento médio de 1011 ± 632 dias. A mortalidade total foi de 30%. Os preditores independentes de mortalidade identificados foram idade (hazzard ratio [HR] de 1,05; p = 0,027), infarto agudo do miocárdio (IAM) prévio (HR de 2,17; p = 0,049) e doença pulmonar obstrutiva crônica (DPOC) (HR de 3,13; p = 0,015). O percentual de estimulação biventricular em 6 meses foi identificado com fator protetor de mortalidade ([HR] 0,97; p = 0,048). Os preditores independentes associados à reposta ecocardiográfica foram ausência de insuficiência mitral, presença de bloqueio de ramo esquerdo e percentual de estimulação biventricular. Conclusão: A mortalidade nos pacientes submetidos à TRC em hospital terciário foi independentemente associada à idade, presença de DPOC e IAM prévio. O percentual de estimulação biventricular avaliado 6 meses após o implante do ressincronizador foi independentemente associado a melhora da sobrevida e resposta ecocardiográfica.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Bundle-Branch Block/surgery , Bundle-Branch Block/mortality , Defibrillators, Implantable/adverse effects , Cardiac Resynchronization Therapy/mortality , Brazil/epidemiology , Echocardiography , Survival Analysis , Survival Rate , Retrospective Studies , Risk Factors , Cardiac Resynchronization Therapy/methods , Heart Failure/physiopathology , Hospitals , Lung Diseases, Obstructive/physiopathology , Myocardial Infarction/physiopathology
18.
Arch. argent. pediatr ; 115(3): 241-248, jun. 2017. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887319

ABSTRACT

Introducción. En pediatría, es determinante establecer precozmente la gravedad de la obstrucción bronquial (GOB). Objetivo. Evaluar las propiedades psicométricas de escalas de medición de GOB en pacientes pediátricos. Población y método. Revisión sistemática de estudios sobre validez y confiabilidad de escalas de GOB realizados en niños menores de 3 años. Se buscó en Medline, WoS, EMBASE, SciELO, Google Scholar. Los coeficientes de correlación de cada artículo fueron metaanalizados mediante el modelo de efectos aleatorios para determinar la validez de criterio y la confiabilidad a través de promedios ponderados de los coeficientes según el tamaño de la muestra. Resultados. Se incluyeron 9 artículos con un total de 2699 niños; 3 artículos presentaron calidad metodológica buena o excelente. Cuatro artículos determinaron la validez de criterio concurrente considerando la saturación de oxígeno; coeficiente de correlación ponderado -0,627 (IC 95%: de -0,767 a -0,431; p < 0,001); 2 artículos determinaron la validez de criterio convergente; coeficiente de correlación ponderado 0,809 (IC 95%: de 0,721 a 0,871; p < 0,001); 6 artículos determinaron la confiabilidad interobservador; coeficiente de correlación ponderado de 0,500 para kappa y 0,891 para coeficiente de correlación intraclase. Conclusión. La evaluación de las propiedades psicométricas para apoyar la utilidad de escalas para la estimación del constructo GOB mostró una validez de criterio de moderada a adecuada. El porcentaje de acuerdo entre observadores respecto de la medida observada (GOB) se muestra adecuado; sin embargo, hay que considerar las debilidades presentadas en el diseño de los artículos, lo cual podría afectar a la validez interna de los resultados.


Introduction. In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor. Objective. To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients. Population and Method. This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size. Results. A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval --#91;CI--#93;: -0.767 to -0.431, p 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient. Conclusion. The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.


Subject(s)
Humans , Infant , Child, Preschool , Child , Bronchiolitis/diagnosis , Psychometrics , Severity of Illness Index , Lung Diseases, Obstructive/diagnosis
19.
S. Afr. med. j. (Online) ; 107(2): 123-126, 2017. tab
Article in English | AIM, AIM | ID: biblio-1271148

ABSTRACT

Background. Viruses have emerged as important aetiological agents of childhood pneumonia.Objective. To investigate the clinical presentation, severity and outcome of adenovirus-associated pneumonia (AVP) in children.Methods. A retrospective analysis of AVP cases over 12 months was performed, including demographic, clinical course and outcome (death, persistent lung disease (PLD)) data.Results. Two hundred and six AVP cases (median age 12 months, interquartile range 6 - 24) were identified; 70 children (34.0%) were malnourished and 14 (6.8%) were HIV-infected. Twenty-nine children (14.1%) developed PLD, which was associated with hypoxia at presentation in 26 cases (89.7%; p=0.01) and necessitated admission to the intensive care unit (ICU) in 18 (62.1%; p<0.01); 18/206 children (8.7%) died. Admission to the ICU (odds ratio (OR) 8.3, 95% confidence interval (CI) 2.3 - 29.0) and a positive blood culture (OR 11.2, 95% CI 2.3 - 54.1) were independent risk factors for mortality.Conclusions. Adenovirus is a potential cause of pneumonia and PLD in young children in South Africa. ICU admission and a positive blood culture were associated with poor outcome


Subject(s)
Adenovirus Infections, Human , Child , Lung Diseases, Obstructive , Pneumonia
20.
Article in English | AIM, AIM | ID: biblio-1258798

ABSTRACT

Background: are responsible for considerable morbidity and mortality in children with sickle cell anaemia (SCA). Spirometry is a useful tool for the detection and monitoring of respiratory disorders, but it is under-utilized by healthcare workers who care for children with sickle cell anaemia. Most of the studies assessing pulmonary functions in sickle cell anaemia were conducted among adults.Objective: To describe the lung functions profile of children with sickle cell anaemia in steady state.Methodology: In this study, spirometric indices of 100 children with SCA (HbSS) aged five years to 12 years were compared with 100 matched normal children (HbAA) in the control group.Results: Irrespective of gender, the mean Peak Expiratory Flow Rate (PEFR) values were significantly higher among the HbAA controls than their HbSS counterparts. The mean Forced Expiratory Volume in one second (FEV1) values of males and all subjects irrespective of gender were also significantly higher among the controls compared to HbSS subjects. The mean Forced Vital Capacity (FVC) values were higher among HbSS subjects than the HbAA controls, but the observed differences were not significant. The mean FEV1/FVC values were also not significantly different between the SCA subjects and the controls. The overall prevalence of restrictive pulmonary abnormalities among the HbSS group was 6.0% whereas none of the HbAA group had restrictive pulmonary disorders.Conclusion: Children with SCA, irrespective of gender, have significantly lower PEFR and FEV1. Restrictive lung abnormalities occur exclusively among subjects with SCA


Subject(s)
Anemia, Sickle Cell , Lakes , Lung Diseases, Obstructive , Nigeria , Peak Expiratory Flow Rate , Spirometry
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