ABSTRACT
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Subject(s)
Humans , Aged , Bronchial Fistula/surgery , Wound Closure Techniques , Bronchoscopy , Thoracostomy , Postoperative ComplicationsSubject(s)
Bronchial Fistula/surgery , Fistula/surgery , Pleural Diseases/surgery , Postoperative Complications/surgery , Septal Occluder Device , Adenocarcinoma/surgery , Aged , Bronchial Fistula/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Humans , Lung Neoplasms/surgery , Male , Pleural Diseases/diagnostic imaging , Pneumonectomy , Postoperative Complications/diagnostic imagingABSTRACT
El control colinérgico de la vía aérea en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hace que los fármacos anticolinérgicos sean el tratamiento de elección de la obstrucción crónica del flujo aéreo en estos pacientes. El tiotropio, un anticolinérgico de acción prolongada y con afinidad específica por los receptores M3, permite una dosificación única que, junto con la ausencia de efectos secundarios y la carencia de taquifilaxia, favorece el cumplimiento y lo convierte en el fármaco de elección en el tratamiento de la EPOC estable. Este fármaco ha demostrado diversas acciones beneficiosas como efecto broncodilatador, con mejoría del volumen espiratorio forzado en el primer segundo y la capacidad vital forzada; reducción de la hiperinsuflación pulmonar; disminución del número, la intensidad y la gravedad de las exacerbaciones agudas de la EPOC, así como mejoría de la disnea, de la tolerancia al ejercicio y de la calidad de vida relacionada con la salud. Su asociación con agonistas β2 de larga duración y su efecto sobre la caída del flujo aéreo parecen las acciones más prometedoras (AU)
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Subject(s)
Humans , Cholinergic Antagonists/pharmacokinetics , Pulmonary Disease, Chronic Obstructive/drug therapy , Bronchodilator Agents/pharmacokinetics , Dyspnea/drug therapy , Quality of Life , Sickness Impact Profile , Receptors, Cholinergic , Exercise Tolerance/physiology , Exercise/physiology , Ipratropium/therapeutic useABSTRACT
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for arterial hypertension. Several controlled trials have investigated the effect of continuous positive airway pressure (CPAP) on BP in patients with OSAS, but its effect on hypertensive patients has not been analyzed specifically. OBJECTIVE: To analyze the effect of CPAP on ambulatory BP in patients with OSAS and hypertension who were undergoing antihypertensive treatment. DESIGN AND PATIENTS: We conducted a parallel, randomized, placebo-controlled trial in 68 patients with OSAS and hypertension, who were receiving treatment with antihypertensive medication. Patients were randomly allocated to either therapeutic or subtherapeutic CPAP for 4 weeks. Ambulatory BP was registered at baseline and after treatment. Antihypertensive treatment was not changed during the study. Changes in BP were assessed on an intention-to-treat basis. RESULTS: There were no baseline differences in the apnea-hypopnea index, comorbidities, or ambulatory BP between groups. Objective compliance with CPAP was similar in both the therapeutic and subtherapeutic groups (5.0 +/- 1.4 h/d vs 4.4 +/- 1.9 h/d, respectively; p = 0.13 [mean +/- SD]). There was a small and statistically nonsignificant decrease (- 0.3 +/- 6.3 mm Hg vs - 1.1 +/- 7.9 mm Hg; difference, - 0.8 mm Hg [95% confidence interval, - 2.7 to 4.3]; p = 0.65) in 24-h mean BP (24hMBP) in both subtherapeutic and therapeutic groups after 4 weeks of treatment. No significant changes in systolic, diastolic, daytime, or nighttime BP were observed. The normal circadian dipper pattern was restored in a higher proportion of patients in the therapeutic group compared to the subtherapeutic CPAP group, although differences were not significant (11 of 32 patients vs 3 of 25 patients; odds ratio, 3.84; 95% confidence interval, 0.82 to 20.30; p = 0.10). There was no correlation between the magnitude of change in 24hMBP and CPAP compliance, OSAS severity, or number of antihypertensive drugs used. CONCLUSION: Four weeks of CPAP did not reduce BP in patients with OSAS and hypertension who were treated with antihypertensive medication, compared to placebo group.
