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1.
Can J Hosp Pharm ; 75(4): 302-308, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36246446

RESUMO

Background: Chronic obstructive pulmonary disease (COPD) is a cause of significant morbidity and mortality, and management of patients with this complex disease remains a challenge. Pharmacists work within an interdisciplinary health care team to coordinate services and ensure that standards of care are met. A pharmacist-initiated care bundle provided in the outpatient setting has shown promising results in improving COPD management. Objective: To evaluate, in the acute care setting, the effectiveness of a pharmacist-initiated COPD care bundle in improving compliance with health care measures known to improve outcomes in patients with COPD. Methods: This retrospective chart review included patients with acute exacerbation of COPD admitted from May 14, 2019, to February 29, 2020. Completion rates for the 6 individual components of the COPD care bundle were compared between patients who did and did not receive the pharmacist-initiated intervention. A subgroup of 22 patients received the following additional interventions: documentation of the modified Medical Research Council score, assessment of COPD medications, and vaccination review and administration. Results: A total of 106 patients were included in the analysis, 53 patients in each of the control and intervention groups. The pharmacist-initiated intervention increased completion rates for the overall COPD care bundle from 2% to 17% (p = 0.003), for provision of the COPD flare-up action plan from 4% to 79% (p < 0.001), and for provision of smoking cessation education from 0% to 36% (p = 0.04); however, there was no significant difference in assessment by a respiratory therapist. For the subgroup that received additional interventions, vaccination reviews were conducted for 21 (96%) of the 22 patients, which led to 9 (41%) receiving a guideline-recommended vaccine. Conclusions: Pharmacist involvement in initiation of the care bundle significantly increased completion rates for the activities included in the care bundle.


Contexte: La maladie pulmonaire obstructive chronique (MPOC) est une cause d'une morbidité et d'une mortalité importantes, et la prise en charge des patients atteints de cette maladie complexe demeure un défi. Les pharmaciens travaillent au sein d'une équipe interdisciplinaire de soins de santé pour coordonner les services et s'assurer du respect des normes de soins. Un ensemble de soins initié par le pharmacien en milieu ambulatoire a donné des résultats prometteurs dans l'amélioration de la prise en charge de la MPOC. Objectif: Évaluer, dans le cadre des soins aigus, l'efficacité d'un ensemble de soins pour la MPOC initié par un pharmacien pour améliorer le respect des mesures de soins de santé connues pour améliorer les résultats chez les patients atteints de MPOC. Méthodes: Cet examen rétrospectif des dossiers comprenait des patients présentant une exacerbation aiguë de la MPOC admis du 14 mai 2019 au 29 février 2020. Les taux de réussite pour les 6 composantes individuelles de l'ensemble de soins pour la MPOC ont été comparés entre les patients ayant reçu et ceux n'ayant pas reçu l'intervention initiée par le pharmacien. Un sous-groupe de 22 patients a reçu des interventions supplémentaires : documentation du score modifié du Medical Research Council (mMRC), évaluation des médicaments pour la MPOC, et examen et administration de la vaccination. Résultats: Au total, 106 patients ont été inclus dans l'analyse : 53 patients dans le groupe de contrôle et 53 dans le groupe d'intervention. L'intervention initiée par le pharmacien a augmenté les taux d'adhésion à l'ensemble de soins pour la MPOC de 2 % à 17 % (p = 0,003), de 4 % à 79 % (p < 0,001) pour l'offre du plan d'action en cas de poussée de MPOC et de 0 % à 36 % (p = 0,04) pour l'éducation au sevrage tabagique; cependant, l'évaluation par un inhalothérapeute n'a permis de déceler aucune différence significative. Dans le sous-groupe ayant reçu des interventions supplémentaires, des examens de vaccination ont été menés chez 21 (96 %) des 22 patients; 9 patients (41 %) ont ainsi reçu un vaccin recommandé par les lignes directrices. Conclusions: La participation du pharmacien à l'initiation de l'ensemble de soins a augmenté de manière significative les taux de réussite des activités incluses dans l'ensemble de soins.

2.
Ann Am Thorac Soc ; 15(12): 1427-1433, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30188737

RESUMO

RATIONALE: Previous studies have suggested that interstitial lung disease (ILD) progresses most rapidly early in the course of systemic sclerosis-associated (SSc)-ILD, and that SSc-ILD is often more stable or even "burned out" after the first 4 years following diagnosis. OBJECTIVES: Our objectives were to determine whether an apparent plateau in pulmonary function decline is due to survival bias and to identify distinct prognostic phenotypes of ILD progression. METHODS: Consecutive patients with SSc-ILD from a single center were included. Pulmonary function measurements were typically performed every 6 months. Study participants were categorized into long-term survivors (>8 yr survival from diagnosis), and those with medium-term and short-term mortality (4-8 and <4 yr survival, respectively). We excluded those censored with less than 8 years of follow-up. Subject-specific slopes for change in forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DlCO) were calculated using generalized linear models with mixed effects. The rate of decline in FVC was compared across prognostic groups. RESULTS: The cohort included 171 study participants with SSc-ILD. A plateau in the progression of FVC was apparent in the full cohort analysis but disappeared with stratification into prognostic subgroups to account for survival bias. Those with short-term mortality had a higher annual rate of decline in FVC (-4.10 [95% confidence interval (CI), -7.92 to -0.28] vs. -2.14 [95% CI, -3.31 to -0.97] and -0.94 [-1.46 to -0.42]; P = 0.003) and DlCO (-5.28 [95% CI, -9.58 to -0.99] vs. -3.13 [95% CI, -4.35 to -1.92] and -1.32 [95% CI, -2.01 to -0.63]; P < 0.001) than those with medium-term mortality and long-term survival with adjustment for age, sex, and pack-years. Change in FVC in the previous year did not predict FVC change in the subsequent year. CONCLUSIONS: Adults with SSc-ILD have distinct patterns of physiological progression that remain relatively consistent during long-term follow-up; however, recent change in FVC cannot be used to predict future change in FVC within shorter follow-up intervals. The findings of this study provide important information on the course of disease in SSc-ILD and identify specific phenotypes of progression that may improve clinical decision-making and design of future therapeutic trials.


Assuntos
Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Escleroderma Sistêmico/complicações , Adulto , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Pessoa de Meia-Idade , Fenótipo , Escleroderma Sistêmico/mortalidade , Escleroderma Sistêmico/patologia , Taxa de Sobrevida , Fatores de Tempo , Capacidade Vital
3.
Respir Med Case Rep ; 24: 173-175, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29977789

RESUMO

Hypersensitivity pneumonitis (HP) is characterized by inflammation of the lung parenchyma that is induced by exposure to an inhaled organic antigen. We present a case of recurrent, acute HP caused by repeated transient exposure to a down sleeping bag in a patient with a family history of chronic bird-associated hypersensitivity pneumonitis. The patient's recurrent symptoms, changes in physiology, and radiographic findings coincided with repeated exposure to this source. It was later confirmed that the patient's sister had also developed chronic HP from recurrent exposure to household birds. This case highlights recent studies implicating gene-exposure interactions in the development of HP.

4.
Respirology ; 23(10): 921-926, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29641847

RESUMO

BACKGROUND AND OBJECTIVE: It is unknown whether oesophageal disease is associated with systemic sclerosis-associated interstitial lung disease (SSc-ILD) severity, progression or mortality. METHODS: High-resolution computed tomography (HRCT) scans from 145 SSc-ILD patients were scored for fibrosis score, oesophageal diameter and presence of hiatal hernia. Fibrosis asymmetry was calculated as: (most affected side - least affected side)/(most affected side + least affected side). Mixed effects models were used for repeated measures analyses. RESULTS: Mean fibrosis score was 8.6%, and most patients had mild-to-moderate physiological impairment. Every 1 cm increase in oesophageal diameter was associated with 1.8% higher fibrosis score and 5.5% lower forced vital capacity (FVC; P ≤ 0.001 for unadjusted and adjusted analyses). Patients with hiatal hernia had 3.9% higher fibrosis score, with persistent differences on adjusted analysis (P = 0.001). Oesophageal diameter predicted worsening fibrosis score over the subsequent year (P = 0.02), but not when adjusting for baseline fibrosis score (P = 0.16). Oesophageal diameter was independently associated with mortality (P = 0.001). Oesophageal diameter was not associated with asymmetric disease or radiological features of gross aspiration. CONCLUSION: Oesophageal diameter and hiatal hernia are independently associated with SSc-ILD severity and mortality, but not with ILD progression or asymmetric disease. Oesophageal disease is unlikely to be a significant driver of ILD progression in SSc.


Assuntos
Esôfago/patologia , Doenças Pulmonares Intersticiais/fisiopatologia , Fibrose Pulmonar/fisiopatologia , Escleroderma Sistêmico/complicações , Adulto , Idoso , Progressão da Doença , Esôfago/diagnóstico por imagem , Feminino , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Humanos , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Capacidade Vital
5.
Chest ; 152(2): e21-e24, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28797395

RESUMO

Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory disorder primarily of children and adolescents that is characterized by multifocal nonpyogenic relapsing and remitting inflammatory bone lesions. Pulmonary abnormalities are rarely associated with CRMO, with two reported cases of consolidation on chest CT that occurred in children. We present a case of organizing pneumonia in an adult patient with CRMO. The concurrent worsening of pulmonary and bone disease suggests that CRMO may be a rare cause of organizing pneumonia.


Assuntos
Pneumonia em Organização Criptogênica/etiologia , Osteomielite/complicações , Doenças da Coluna Vertebral/complicações , Dor nas Costas/etiologia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnóstico
6.
Respir Med ; 129: 1-7, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28732817

RESUMO

BACKGROUND: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is characterized by multiple symptoms and comorbidities. The cumulative impact of these deficits can be summarized using the concept of frailty; however, frailty has not been characterized in patients with SSc-ILD. METHODS: Patients with SSc-ILD and non-CTD fibrotic ILD were recruited from specialized clinics. Frailty was assessed using a 42-item patient-reported Frailty Index, calculated as the proportion of reported deficits divided by the total number of surveyed items. Frailty was defined as a Frailty Index >0.21. Unadjusted and multivariate analyses were used to identify correlates of frailty. RESULTS: The study cohort included 86 patients with SSc-ILD and 167 patients with non-CTD fibrotic ILD. The mean age in SSc-ILD was 60.5 years, 80% were women, and on average patients had mild to moderate restrictive lung function impairment (mean FVC 78%-predicted, DLCO 51%-predicted). The mean Frailty Index was 0.23 ± 0.15, with 55% of the SSc-ILD population meeting criteria for frailty. Dyspnea had the strongest association with the Frailty Index (r = 0.62, p < 0.001) and was the only variable independently associated with frailty on multivariate analysis. Frailty severity was similar in SSc-ILD and non-CTD fibrotic ILD, including with adjustment for differences in baseline cohort characteristics. CONCLUSION: Frailty is highly prevalent in patients with SSc-ILD, indicating that chronological age significantly underestimates biological age in this population. Dyspnea is the variable with the strongest association with frailty in SSc-ILD; however, future studies are needed to identify additional modifiable determinants of frailty and the ability of frailty to predict outcomes in SSc-ILD.


Assuntos
Dispneia/fisiopatologia , Fragilidade/epidemiologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Pulmão/fisiopatologia , Fibrose Pulmonar/complicações , Escleroderma Sistêmico/complicações , Idoso , Comorbidade , Feminino , Volume Expiratório Forçado , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/fisiopatologia , Testes de Função Respiratória/métodos , Escleroderma Sistêmico/fisiopatologia , Índice de Gravidade de Doença , Capacidade Vital
7.
Respirology ; 22(4): 728-734, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27860036

RESUMO

BACKGROUND AND OBJECTIVE: Frailty is the age-related accumulation of deficits that decrease the ability to respond to biological stress. Patients with fibrotic interstitial lung disease (ILD) may be frail due to consequences of ILD, age, co-morbidities and adverse effects of pharmacotherapies. The objective of this study was to examine the prevalence and predictors of frailty in fibrotic ILD. METHODS: Fibrotic ILD patients were recruited from a specialized clinic. Patients with ILD secondary to a systemic disease were excluded. Frailty was determined using the Frailty Index based on the presence or absence of multiple deficits, including co-morbidities, symptoms and functional limitations. The Frailty Index was based on the proportion of deficits present, with frailty defined as a score >0.21. Cronbach's alpha was used to estimate the internal consistency of the Frailty Index. Dyspnoea was measured using the University of California San Diego Shortness of Breath Questionnaire. Multivariate analysis was used to determine independent predictors of frailty. RESULTS: The definition of frailty was met in 50% of the 129 patients. Cronbach's alpha for the Frailty Index was 0.87. The Frailty Index was associated with forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), diffusion capacity of the lung for carbon monoxide (DLCO ), ILD-gender, age and physiology (GAP) index, composite physiologic index and dyspnoea score. Dyspnoea severity was the strongest unadjusted predictor (r = 0.65, P < 0.001) and only independent predictor of the Frailty Index (0.034 increase in Frailty Index per 10-point increase in dyspnoea score; R2 = 0.37; P < 0.001). CONCLUSION: Frailty is highly prevalent and is strongly and independently associated with dyspnoea severity, demonstrating that dyspnoea is a more important determinant of frailty than pulmonary function.


Assuntos
Dispneia/fisiopatologia , Doenças Pulmonares Intersticiais/diagnóstico , Pulmão/fisiopatologia , Adulto , Idoso , Comorbidade , Feminino , Volume Expiratório Forçado , Idoso Fragilizado , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Inquéritos e Questionários
8.
Can Respir J ; 22(1): 13-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25493699

RESUMO

Pulmonary manifestations of cryoglobulinemia are uncommon and their clinical behaviour is unpredictable, ranging from mild dyspnea to life-threatening presentations. A patient with cryoglobulinemia who presented with hypoxic respiratory failure attributed to pulmonary hemorrhage is reported.


Assuntos
Crioglobulinemia/complicações , Hemorragia/etiologia , Pneumopatias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
9.
Chest ; 146(2): 422-436, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24576924

RESUMO

BACKGROUND: Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in patients with systemic sclerosis (SSc); however, prognostication of SSc-associated ILD (SSc-ILD) remains challenging. We conducted a systematic review to identify variables that predict mortality and ILD progression in SSc-ILD. METHODS: Three databases were searched to identify all studies relating to predictors of mortality or ILD progression in SSc-ILD. Studies were eligible if they were published in English and included ≥ 10 adults with SSc-ILD. Two authors independently reviewed and extracted data from acceptable studies. RESULTS: The initial search identified 3,145 unique citations. Twenty-seven studies, including six abstracts, met the inclusion criteria. A total of 1,616 patients with SSc-ILD were included. Patient-specific, ILD-specific, and SSc-specific variables predicted mortality and progression; however, most predictors were identified in only one study. Most studies did not fully account for potential confounders, and none of the studies included a validation cohort. Older age, lower FVC, and lower diffusing capacity of carbon monoxide predicted mortality in more than one study. Male sex, extent of disease on high-resolution CT (HRCT) scan, presence of honeycombing, elevated KL-6 values, and increased alveolar epithelial permeability were identified as predictors of both mortality and ILD progression on unadjusted analysis. The extent of disease on HRCT scan was the only variable that independently predicted both mortality and ILD progression. CONCLUSIONS: Mortality and ILD progression were predicted by several patient-specific, ILD-specific, and SSc-specific factors. Additional prospective studies are required to validate these preliminary findings and to identify combinations of variables that accurately predict the prognosis of SSc-ILD.


Assuntos
Doenças Pulmonares Intersticiais/mortalidade , Escleroderma Sistêmico/complicações , Progressão da Doença , Humanos , Doenças Pulmonares Intersticiais/etiologia , Prognóstico , Fatores de Risco , Escleroderma Sistêmico/mortalidade
10.
Chest ; 143(2): 305-314, 2013 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-23381313

RESUMO

The survival of patients with HIV infection has improved dramatically over the past 20 years, largely owing to a significant reduction in opportunistic infections and AIDs-defining malignancies, such as lymphoma and Kaposi sarcoma. However, with improved survival, patients with HIV are experiencing morbidity and mortality from other (non-AIDs-defining) complications, such as solid organ malignancies. Of these, the leading cause of mortality in the HIV-infected population is lung cancer, accounting for nearly 30% of all cancer deaths and 10% of all non-HIV-related deaths. Importantly, the average age of onset of lung cancer in the HIV-infected population is 25 to 30 years earlier than that in the general population and at lower exposure to cigarette smoke. This article provides an overview of the epidemiology of lung cancer in the HIV-infected population and discusses some of the important risk factors and pathways that may enhance the risk of lung cancer in this population.


Assuntos
Epidemias , Infecções por HIV/complicações , Neoplasias Pulmonares/epidemiologia , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Prognóstico , Fatores de Risco , Fumar/efeitos adversos
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