Systematic Review and Meta-Analysis of Pulmonary Hypertension Specific Therapy for Exercise Capacity in Chronic Obstructive Pulmonary Disease

Some patients with chronic obstructive pulmonary disease (COPD) have pulmonary hypertension (PH) that adversely affects survival. We performed a systematic review and meta-analysis to assess whether PH-specific therapies have an effect for stable COPD. Data sources were Medline, EMBASE, Cochrane Central Register of Controlled Trials, Korea med and references from relevant publications. Randomized prospective trials that compared PH specific therapy in COPD for more than 6 weeks with placebo were included. The outcomes were the exercise capacity and adverse events. Four randomized controlled trials involving 109 subjects were included in the analysis. Two trials involved bosentan, one sildenafil and one beraprost. The studies varied in duration of treatment from 3 to 18 months. In a pooled analysis of four trials, exercise-capacity was not significantly improved with PH-specific treatment for COPD (risk ratio, -5.1; 95% CI, -13.0 to 2.8). COPD with overt PH significantly improved the exercise capacity (mean difference, 111.6; 95% CI, 63.3 to 159.9) but COPD with PH unknown did not (mean difference, 26.6; 95% CI, -24.3 to 77.5). There was no significant difference in hypoxemia (mean difference, 2.6; 95% CI, -3.7 to 8.8). PH specific treatments have a significant effect in improving exercise capacity in COPD with overt PH.

Diseases Concomitant With Asthma in Middle-Aged and Elderly Subjects in Korea: A Population-Based Study

PURPOSE: Asthma is prevalent in many countries. Few studies have investigated the association between asthma and concomitant diseases. We retrospectively analyzed the fourth Korean National Health and Nutrition Survey database, performed in 2008 using nationwide stratified random sampling to obtain a representative cohort of the Korean population. METHODS: We evaluated the association between both self-reported ever-asthmatics and wheezers and concomitant diseases such as arthritis, hypertension, gastrointestinal (GI) ulcers, dyslipidemia, diabetes mellitus, rhinitis, depression, stroke, and obesity in subjects aged > or =40 years. A multivariate analysis was performed to identify concomitant diseases independently associated with asthma, after adjustment for age, gender, income, cigarette smoking, and other chronic diseases. RESULTS: Of the total of 4,445 subjects, 2,596 (58.4%) were female and the mean age was 58.3 years. Of the 4,445 subjects, 195 (4.4%) had been diagnosed with asthma at some point, and 444 (10%) were wheezers. Multivariate analysis showed that arthritis (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.26-2.42), rhinitis (OR 1.78, 95% CI 1.14-2.78), depression (OR 1.45, 95% CI 1.05-2.07), and obesity (OR 1.61, 95% CI 1.08-2.40) were significantly associated with self-reported ever-asthma, and arthritis (OR 1.50, 95% CI 1.19-1.909), hypertension (OR 1.34, 95% CI 1.07-1.67), GI ulcers (OR 1.48, 95% CI 1.05-2.08), rhinitis (OR 1.60, 95% CI 1.16-2.19), depression (OR 1.94, 95% CI 1.51-2.48), and obesity (OR 1.56, 95% CI 1.17-2.09) were significantly associated with wheezers. CONCLUSIONS: These findings indicate that arthritis, rhinitis, depression, and obesity may be associated with both self-reported ever asthma and wheezers in the Korean population.

The Incidence of Abnormal Electrocardiogram Findings in Preoperative Screening Tests / 대한마취과학회지

BACKGROUD: To study the prevalence of abnormalities found in routine preoperative eletrocardiograms (ECGs) and to analyze abnormal ECG findings in different age groups. METHODS: 9,709 patients undergoing elective surgery requiring anesthesia at Busan Paik Hospital from January to December 2002 were retrospectively studied. Preoperative ECGs were analyzed in terms of age, sex and specific abnormal ECG findings that might alter anesthetic management. RESULTS: 1,683 of 9,709 patients (17.3%) had abnormal electrocardiogram findings. The incidences of ventricular hypertrophy, bundle branch block, myocardial ischemia, arrhythmia, myocardial infarction and atrioventricular block were 5.3%, 4.1%, 3.9%, 2.5%, 1.0% and 0.5%. Those over 75 years, 43% had abnormal findings and the incidence of myocardial ischemia, arrhythmia and ventricular hypertrophy were 11.7%, 9.7% and 8.7%. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among elective surgery patients is high, especially among older patients. Given the wealth of information provided by preoperative ECG at low cost, ECG is necessary to establish the components of routine preoperative assessment for cardiovascular disease, especially for older adults.