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1.
Respiration ; 79(5): 377-82, 2010.
Article in English | MEDLINE | ID: mdl-19786728

ABSTRACT

BACKGROUND: Nonselective systemic vasodilators worsen ventilation perfusion (V/Q) matching and gas exchange in patients with chronic obstructive pulmonary disease (COPD). Inhaled iloprost has the potential to act preferentially in ventilated regions of the lung, thereby reducing pulmonary hypertension (PH) while alveolar ventilation is still maintained. OBJECTIVES: To investigate the acute effects of inhaled iloprost on V/Q matching in patients with COPD and PH. METHODS: Ten males with COPD and PH on echocardiography were evaluated before and after inhaling 2 doses of iloprost (2.5 microg). Measurements included lung function, arterial blood gas, 6-min walk test (6MWT) as well as ventilatory equivalents for oxygen (V(E)/VO(2)) and carbon dioxide (V(E)/VCO(2)) taken at baseline, 30 min following each dose of iloprost, and 2 h after the second dose. RESULTS: Mean differences in V(E)/VCO(2) and V(E)/VO(2) were -13.3 (95% CI -36.5 to -2.7; p = 0.002) and -15.0 (95% CI -36.7 to -0.4; p = 0.02), respectively, and the mean change in (A-a) gradient was -3.7 mm Hg (95% CI -6.1 to -1.0; p = 0.01) after a single dose of iloprost, whereas mean improvement in 6MWT was 49.8 m (95% CI 14.8 to 84.7; p = 0.02). Arterial blood gas, venous admixture, dead space fraction and lung functions were maintained after iloprost. The effects of iloprost were reproducible after the second dose. All measurements returned to baseline 2 h after the last dose. No adverse effects on systemic blood pressure or oxygen saturation were seen. CONCLUSIONS: Iloprost inhalation was safe in patients with COPD and PH, and was associated with improved V/Q matching and exercise tolerance.


Subject(s)
Exercise Tolerance , Hypertension, Pulmonary/drug therapy , Iloprost/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Gas Exchange , Vasodilator Agents/therapeutic use , Administration, Inhalation , Aged , Blood Gas Analysis , Humans , Male , Nebulizers and Vaporizers , Oxygen Consumption
2.
J Clin Sleep Med ; 5(2): 103-7, 2009 Apr 15.
Article in English | MEDLINE | ID: mdl-19968040

ABSTRACT

STUDY OBJECTIVE: To examine the long-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure (BP) in patients with obstructive sleep apnea and resistant hypertension. METHODS: Study subjects were 98 patients with obstructive sleep apnea syndrome and hypertension who had 3 or more documented daytime BP measurements taken within 3 months of enrollment and every 3 months after CPAP initiation for 1 year. Resistant hypertension was defined as daytime BP of at least 140 mm Hg systolic or 90 mm Hg diastolic, despite the use of 3 or more antihypertensive medications. Patients in the resistant hypertension group (n = 42) were compared with subjects with controlled hypertension (n = 56). RESULTS: Mean difference in mean arterial pressure was -5.6 (95% confidence interval [CI] -2.0 to -8.7 mm Hg; p = 0.03) in the resistant group and -0.8 mm Hg (95% CI -2.9 to 3.3 mm Hg; p = 0.53) in patients with controlled BP at the end of follow up period. CPAP permitted de-escalation of antihypertensive treatment in 71% of subjects with resistant hypertension but did not significantly alter the antihypertensive regimen in the controlled group. Multivariate regression analysis showed that baseline BP (odds ratio 5.4, 95% CI 2.3 to 8.9; p = 0.01) and diuretic therapy (odds ratio = 3.2, 95% CI 1.8 to 6.1; p = 0.02), but not apnea-hypopnea index or hours of CPAP use, were independently associated with a decrease in mean arterial pressure after 12 months of CPAP therapy. CONCLUSION: In this observational study, CPAP was associated with different effects on blood pressure control in hypertensive patients with sleep apnea. A beneficial response to CPAP therapy was found mainly in subjects with the most severe hypertensive disease.


Subject(s)
Continuous Positive Airway Pressure , Hypertension/therapy , Sleep Apnea, Obstructive/therapy , Antihypertensive Agents/pharmacology , Comorbidity , Drug Resistance , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Sleep Apnea, Obstructive/epidemiology
4.
Crit Care Med ; 37(4): 1495-6, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19318834

Subject(s)
Quality of Life , Sepsis , Humans
6.
Respir Care ; 53(4): 466-70, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18364059

ABSTRACT

We report the case of a patient with rheumatoid arthritis who presented with endobronchial nodules. Endobronchial biopsy showed a large B cell lymphoma. Non-Hodgkin lymphoma rarely involves the endobronchial tree, and is typically treated with systemic chemotherapy, but in this case additional treatment with argon plasma coagulation was used for local control of the disease.


Subject(s)
Arthritis, Rheumatoid , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/physiopathology , Bronchoscopy , Female , Humans , Lymphoma, B-Cell/pathology , Middle Aged
7.
Respir Care ; 53(3): 351-4, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18291052

ABSTRACT

Idiopathic unilateral diaphragmatic paralysis is a rare condition that typically causes minimal symptoms, especially during exercise. Several reports indicated progressive improvement or even complete recovery to normal function of diaphragmatic paralysis that complicated various thoracic and extrathoracic conditions. In this case we describe a 57-year-old male with spontaneous recovery of idiopathic right hemidiaphragm paralysis and review reported cases of reversible diaphragmatic dysfunction.


Subject(s)
Respiratory Paralysis/therapy , Humans , Male , Middle Aged , Radiography , Remission, Spontaneous , Respiratory Function Tests , Respiratory Paralysis/diagnostic imaging , Respiratory Paralysis/physiopathology , Spirometry
9.
Chest ; 132(6): 1764-71, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17908708

ABSTRACT

BACKGROUND: Smokers are affected by a variety of inflammatory diseases, including COPD. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, are used for their lipid-lowering characteristics but also appear to have antiinflammatory and immunomodulatory activities. We assessed their ability to preserve lung function in current and former smokers. METHODS: All smokers and ex-smokers seen at the Oklahoma City VA hospital in 2005 with abnormal baseline spirometry findings and two or more pulmonary function tests done 6 months apart were classified into obstructive and restrictive groups based on the initial PFT result. Statin use, annual decline in FEV(1) and FVC, and need for respiratory-related urgent care (emergency department or inpatient) were compared. RESULTS: Approximately one half, 215 of 418 patients, were receiving a statin. Compared to the control group, statin users had a lower decline in FEV(1) (- 0.005 +/- 0.20 L/yr vs 0.085 +/- 0.17 L/yr, p < 0.0001) and FVC (- 0.046 +/- 0.45 L/yr vs 0.135 +/- 0.32 L/yr, p < 0.0001) [mean +/- SD]. This difference remained significant irrespective of whether the patient had obstructive (n = 319), or restrictive (n = 99) disease, and regardless of whether the patient continued or stopped smoking. In patients with an obstructive spirometry finding, we found a lower incidence of respiratory-related urgent care in favor of the statin group (0.12 +/- 0.29 patient-years vs 0.19 +/- 0.32/patient-years; p = 0.02). CONCLUSION: In smokers and former smokers, statins are associated with a slower decline in pulmonary function, independent of the underlying lung disease. CLINICAL IMPLICATION: Prospective, randomized trials are needed to study the effect of statins on lung function.


Subject(s)
Forced Expiratory Volume/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Lung Diseases, Obstructive/physiopathology , Smoking/physiopathology , Vital Capacity/drug effects , Aged , Female , Forced Expiratory Volume/physiology , Humans , Lung Diseases, Obstructive/drug therapy , Male , Middle Aged , Regression Analysis , Respiratory Function Tests , Retrospective Studies , Vital Capacity/physiology
11.
Respir Care ; 51(7): 761-3, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16856243

ABSTRACT

Rounded atelectasis is atelectasis of the peripheral part of the lung, typically in contact with thickened pleura, featuring characteristic computed tomography findings. In this case, a 61-year-old man with history of asbestos exposure presented with a right-middle-lobe nodule on chest radiograph, with computed tomography findings suspicious for neoplasm. The patient underwent surgical resection, which revealed rounded atelectasis. Our case raises a question about the sensitivity of radiographic criteria used in identifying rounded atelectasis, and it emphasizes the need to keep rounded atelectasis in the differential diagnosis of a single pulmonary nodule in a patient with a history of asbestos exposure.


Subject(s)
Diagnostic Errors , Lung Neoplasms/diagnostic imaging , Pneumonectomy , Pulmonary Atelectasis/diagnostic imaging , Solitary Pulmonary Nodule/diagnostic imaging , Diagnosis, Differential , Humans , Lung Neoplasms/surgery , Male , Middle Aged , Pulmonary Atelectasis/surgery , Sensitivity and Specificity , Solitary Pulmonary Nodule/surgery , Tomography, X-Ray Computed
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