Obstructive Lung Disease (obstructive + lung_disease)

Distribution by Scientific Domains

Kinds of Obstructive Lung Disease

  • chronic obstructive lung disease


  • Selected Abstracts


    A review of the GOLD guidelines for the diagnosis and treatment of patients with COPD

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2008
    L. Fromer
    Summary Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the USA, and represents a major health, social and economic burden. COPD is underdiagnosed and often misdiagnosed, which likely contributes to the continuing increases in the prevalence, morbidity and mortality associated with this disease. This is unfortunate because whereas COPD cannot be cured, it can be treated effectively, particularly during the earlier stages of the disease. Evidence-based guidelines, developed to assist in the prevention, diagnosis and management of COPD, are available to healthcare professionals interested in learning more about COPD. These guidelines are updated and revised on a regular basis to reflect recent advances in our understanding of the pathophysiology of and treatments available for COPD. Nevertheless, primary-care physicians have reported a lack of awareness of the fundamental concepts underpinning the optimal treatment and management of COPD presented in the guidelines. Thus, the objective of this article is to summarise key physiologic, diagnostic and management concepts provided in the most recent update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, which were published in November 2006. [source]


    Chronic obstructive pulmonary disease: Diagnosis and management

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2007
    Acute, CCRN (Adjunct Faculty, Charles A. Downs MSN, Continuing Care Nurse Practitioner Program, Nurse Practitioner)
    Abstract Purpose: The purpose of this article is to provide a comprehensive review of the current modalities employed in diagnosing and treating chronic obstructive pulmonary disease (COPD). Special emphasis is placed on current guidelines, as defined by the Global Initiative for Chronic Obstructive Lung Disease. Data source: A comprehensive literature review for COPD serves as the basis for this article. Conclusions: According to the National COPD Coalition (2004), there are nearly 24 million Americans who suffer from COPD. The incidence of COPD is rising globally and is associated with increased morbidity and mortality. COPD is characterized by progressive decline in function, resulting in concomitant diseases, which increase healthcare dollar expenditures, thus making COPD a concern for healthcare providers in the United States and abroad. Implications for practice: Once a diagnosis of COPD is made, healthcare providers should explore multiple treatment options in an effort to find the most beneficial regimen. It is only when the treatments are individualized, including physiological therapies and cognitive approaches to lessen risks as well as to reduce exacerbations, that the patient with COPD is able to potentially experience a reasonable quality of life. [source]


    Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

    ACADEMIC EMERGENCY MEDICINE, Issue 1 2007
    Chu-Lin Tsai MD
    Abstract Objectives To determine the patient factors associated with hospital admission among adults who present to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease (COPD) and to determine whether admissions were concordant with recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Methods The authors performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. By using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Predictors of admission were determined by multivariate logistic regression. Results Of 384 patients, 233 (61%; 95% confidence interval = 56% to 66%) were admitted. Multivariate analysis showed that a higher likelihood of admission was associated with older age, female gender, more pack-years of smoking, recent use of inhaled corticosteroid, self-reported activity limitation in the past 24 hours, higher respiratory rate at ED presentation, and a concomitant diagnosis of pneumonia. Patients who reported the ED as their usual site for problem COPD care, or who had mixed COPD and asthma, were less likely to be admitted. The authors confirmed five of the seven testable indications for hospital admission in the GOLD guidelines. Conclusions Several patient factors were independently associated with hospital admission among ED patients with COPD exacerbations. Overall, concordance with admission recommendations in the GOLD guidelines was high. The authors also identified a few novel predictors of admission (female gender, ED as the usual site for problem COPD care, mixed diagnosis of COPD and asthma, recent use of inhaled corticosteroid) that require replication in future studies. [source]


    Workshop on the Epidemiological Survey of Chronic Obstructive Lung Diseases and Alpha-1-antitrypsin Deficiency in the Asian-Pacific Region

    RESPIROLOGY, Issue 2001
    Yoshin Fukuchi
    No abstract is available for this article. [source]


    Longitudinal pulmonary status of cystic fibrosis children with meconium ileus

    PEDIATRIC PULMONOLOGY, Issue 4 2004
    Zhanhai Li PhD
    Abstract Although meconium ileus (MI) is the earliest manifestation of cystic fibrosis (CF), and is associated with poorer growth, the longitudinal pulmonary progression of CF children with MI is not clear. To test the hypothesis that MI is associated with worse pulmonary outcomes, we prospectively compared from diagnosis to 12 years of age 32 CF children with MI to 50 CF children without MI who were diagnosed during early infancy through neonatal screening. Pulmonary outcome measures included respiratory symptoms, respiratory infections, pathogens, antibiotic usage, hospitalizations, quantitative chest radiology, spirometry, and lung volume determinations. Obstructive lung disease was defined as percent predicted spirometry values below the lower limits of normal. Longitudinal analyses revealed no significant differences in cough, wheezing, respiratory infections, prevalence of and median times to acquisition of Pseudomonas aeruginosa or Staphylococcus aureus, antibiotic usage, and chest radiograph scores between the two groups. However, MI children showed significantly worse forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), forced expiratory flow between 25,75% of FVC (FEF25,75), % predicted FEV1, % predicted FEF25,75, and total lung capacity (TLC). These differences were particularly apparent beginning at age 8,10 years. MI children also had higher rates of and shorter median times to obstructive lung disease. Subgroup analyses showed MI children treated surgically and those treated medically had similar pulmonary outcomes. In conclusion, MI children have worse lung function and more obstructive lung disease than those without MI. Such abnormalities are accompanied by reduced lung volume. MI is a distinct CF phenotype with more severe pulmonary dysfunction. Pediatr Pulmonol. 2004; 38:277,284. © 2004 Wiley-Liss, Inc. [source]


    Association between respiratory symptom score and 30-year cause-specific mortality and lung cancer incidence

    THE CLINICAL RESPIRATORY JOURNAL, Issue 2008
    A. Frostad
    Abstract Introduction:, Respiratory symptoms are among the main reasons why patients make contact with healthcare professionals and they are associated with several diseases. Objective:, The aim of this study was to investigate the relationship between respiratory symptoms reported at one time and 30 years cause-specific mortality and incidence of lung cancer in an urban Norwegian population. Materials and Methods:, A total of 19 998 men and women, aged 15,70 years, were in 1972 selected from the general population of Oslo. They received a postal respiratory questionnaire (response rate 89%). All were followed for 30 years for end-point mortality and for lung cancer. The association between respiratory symptoms, given as a symptom load, and end point of interest were investigated separately for men and women by multivariable analyses, with adjustment for age, occupational exposure to air pollution and smoking habits. Results:, A total of 6710 individuals died during follow-up. Obstructive lung diseases (OLDs) and pneumonia accounted for 250 and 293 of the total deaths, respectively. Ischaemic heart disease (IHD) accounted for 1572; stroke accounted for 653 of all deaths. Lung cancer developed in 352 persons during follow-up. The adjusted hazard ratio for mortality from OLD and pneumonia, IHD and stroke increased in a dose,response manner with symptom score, more strongly for OLD and IHD than for pneumonia and stroke. Conclusions:, Respiratory symptoms were positively associated with mortality from OLD, pneumonia, IHD and stroke, and incidence of lung cancer. This association was significant for mortality from OLD and IHD. Please cite this paper as: Frostad A. Association between respiratory symptom score and 30-year cause-specific mortality and lung cancer incidence. The Clinical Respiratory Journal 2008; 2: 53,58. [source]


    The effects of exercise during hemodialysis on adequacy

    HEMODIALYSIS INTERNATIONAL, Issue 1 2005
    C. Caner
    Pedalling during hemodialysis (HD) has been shown to increase solute clearance in a previous study. In the present study, we aimed to test whether an easy to perform exercise program, not requiring a special device, could yield similar outcomes. Fifteen HD patients with the mean age of 48.4 ± 3.8 years were enrolled into the study. Patients with significant access recirculation (>10%), moderate to severe coronary artery disease, moderate to severe heart failure, severe chronic obstructive lung disease, and history of lower extremity surgery during last three month period were excluded. All patients were studied on two consecutive HD sessions with identical prescriptions. At the first session, standard HD was applied without exercise, whereas in the second session lower extremity exercise of 30 minutes duration was added. Reduction rates and rebound for urea, creatinine, and potassium and Kt/V were calculated. Wilcoxon signed rank test was applied in analysis and p < 0.05 was accepted as significance level. All patients completed the study. When both sessions were compared, mean arterial blood pressure (97 ± 3 mmHg vs 120 ± 4 mmHg, p < 0.001) and heart rate (77 ± 1 beats/min vs 92 ± 3 beats/min, p < 0.001) were higher in the exercise group. On the other hand, urea reduction rates, rebound values of urea, creatinine, and potassium were similar in both groups. Conclusion:,In the study, we did not observe any changes in solute rebound and clearance with the exercise. Shorter duration of the exercise may be the explanation of failure to achieve desired outcomes. Increasing patients' tolerance and fitness levels by means of steadily increasing exercise programs may be of help. Additionally, mode of exercise may also be responsible for different outcomes. [source]


    Coronary Artery Bypass Surgery in Patients with Malignancy: A Single-Center Study with Comparison to Patients Without Malignancy

    JOURNAL OF CARDIAC SURGERY, Issue 2 2009
    Nezihi Kucukarslan M.D.
    In this study, we compared the outcome of coronary artery bypass graft (CABG) in such patients with those without malignancy. Methods: The patients were selected from those who had undergone coronary artery bypass surgery in the last decade. The study group (group I) included the patients with malignancy in remission. The control group comprised those patients who were selected randomly from those without any malignancy. The patients were retospectively examined with regard to preoperative, operative, and postoperative data from personal files, computerized recording system, and operation reports. Results: Group I included 48 patients (age 48 to 69; 29 male) while group II included 50 patients (age = 38 to 73; 35 male). In group I, comorbidity rates were: renal dysfunction in 12 (25%), obstructive lung disease 10 (21%), congestive failure in four (8%) patients. The malignancy rates were: lung in 15 (31%), breast in 10 (21%), stomach in five (10%), colon in four (8%), renal in one (2%), Hodgkin's lyphoma in three (6%), leukemia in two (4%), ovarian in three (6%), and prostate in five (10%) patients. In group II, the comorbidity rates were: diabetes mellitus 18 (36%), renal dysfunction in five (10%) and obstructive lung disease in 13 (26%) patients. In group I, chemotherapy and radiotherapy were performed in 38 and 34 patients, respectively. In groups I and II, the CABG was elective in 47 (98%) and in 45 patients (90%); the off-pump surgery was performed in 27 (56%) and 12 (24%) patients, respectively. The total duration of bypass was 37 ± 6 minutes and 44 ± 5 minutes; the duration of aortic clamp was 26 ± 4 and 29 ± 7 minutes, respectively, in groups I and II. Posoperative complication rates were: infection in 12 (25%), bleeding in eight (17%), acute renal insufficiency in eight (17%), prolonged air escape in five (10%), and prolonged entubation in 17 (35%) patients in group I and atrial fibrillation in 11 (22%) patients in group II. Mortality rates in both groups were two (4%). Conclusion: CABG in patients with comorbid malignancy is as safe as the other patients. In patients with full remission of malignancy, the surgeons should be encouraged about the safety of CABG. [source]


    Living with a spouse with chronic obstructive pulmonary disease: the meaning of wives' experiences

    JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 4 2009
    Anne H Boyle PhD
    Aim., To describe and understand the meaning of the experience of living with a spouse who has chronic obstructive pulmonary disease. Background., Living with a spouse with a chronic illness may have a profound effect on women's lives since society expects families, and especially women, to care for the chronically ill. The family member providing care and support is usually the wife. Design., This study investigated the wife's experience of living with a husband's chronic illness. A hermeneutic phenomenological approach was used to describe and understand the experience of women living with a spouse who has chronic obstructive pulmonary disease to determine the meaning this experience has for their lives. Methods., In-depth interviews were conducted with ten women whose husbands had mild to severe obstructive lung disease. Thematic analysis was based on interpretive methods. Data were collected in 1997. Results., The findings are presented as two clusters, living with everyday illness and surviving the illness. Everyday illness includes monitoring, regulating activity, integrating illness effects, and managing technologies. Surviving the illness includes riding the roller coaster, keep on going, garnering support and finding explanations. Conclusions., The spouse's illness had a major influence on these women's lives, and the effects are very complex and interwoven with one another. Relevance to clinical practice., Health professionals can have a major role in assisting women to both live with the everyday illness and to survive its effects. Women were eager to tell their stories. Health professionals can help women deal with the experience by forming support groups and by asking the ,How can I help?' question more often and then actively listening to expressed concerns. Supporting women in their monitoring and regulating role is especially critical. [source]


    Allergic asthma in patients with common variable immunodeficiency

    ALLERGY, Issue 4 2010
    R. C. Agondi
    To cite this article: Agondi RC, Barros MT, Rizzo LV, Kalil J, Giavina-Bianchi P. Allergic asthma in patients with common variable immunodeficiency. Allergy 2010; 65: 510,515. Abstract Background:, Many patients with common variable immunodeficiency (CVID) have a clinical history suggestive of allergic respiratory disease. However, in such individuals, the prevalence of asthma and the role of atopy have not been well established. The objective of this study was to evaluate pulmonary function and identify asthma in patients with CVID. We also investigated the role of IgE as a trigger of asthma in these patients. Methods:, Sixty-two patients diagnosed with CVID underwent spirometry, as well as skin prick testing and in vitro determination of serum-specific IgE levels for aeroallergens, together with bronchial provocation with histamine and allergen. Results:, The most common alteration identified through spirometry was obstructive lung disease, which was observed in 29 (47.5%) of the 62 patients evaluated. Eighteen (29.0%) of the 62 patients had a clinical history suggestive of allergic asthma. By the end of the study, asthma had been diagnosed in nine (14.5%) patients and atopy had been identified in six (9.7%). In addition, allergic asthma had been diagnosed in four patients (6.5% of the sample as a whole; 22.2% of the 18 patients with a clinical history suggestive of the diagnosis). Conclusion:, In this study, CVID patients testing negative for specific IgE antibodies and suspected of having allergic asthma presented a positive response to bronchial provocation tests with allergens. To our knowledge, this is the first such study. When CVID patients with a history suggestive of allergic asthma test negative on traditional tests, additional tests designed to identify allergic asthma might be conducted. [source]


    Pulmonary function in long-term survivors of pediatric hematopoietic cell transplantation

    PEDIATRIC BLOOD & CANCER, Issue 5 2006
    Paul A. Hoffmeister MPH
    Abstract Background The purpose of this study was to determine the prevalence of pulmonary dysfunction in pediatric hematopoietic cell transplant (HCT) survivors and to identify associated risk factors. Procedure In a cross-sectional study, patients surviving at least 5 years after pediatric HCT were requested to undergo pulmonary function testing (PFT). Risk factors for restrictive lung disease (RLD) and obstructive lung disease (OLD) were analyzed using multivariate analysis. Results Among 472 patients contacted, 260 (55%) participated and 215 were selected for analysis. These patients were transplanted at a median age of 8.3 (0.3,18.0) years; 175 for hematologic malignancies and 40 for non-malignant diseases. The preparative regimens for 133 patients included fractionated TBI (FTBI), 29 single-fraction TBI (SFTBI), and 53 non-TBI regimens. PFT was performed at a median of 10 (5.0,27.5) years after HCT. Forty percent of patients had either RLD or OLD (28% RLD, 9% OLD, 3% mixed RLD/OLD) and at least 15% had an isolated low-DLCO. Moderate-to-severe impairment was present in 45% of patients with RLD or OLD. In multivariate analysis, risk factors associated with RLD included transplant regimen, transplant diagnosis, scleroderma/contracture, and donor relation. Patients treated with SFTBI had the highest risk of RLD. Risk factors for OLD included chronic graft-versus-host disease, transplant regimen, and time after HCT. Patients surviving 20 or more years after HCT had the highest risk of OLD. Conclusions Fifty-five percent of long-term pediatric HCT survivors had pulmonary dysfunction. These findings stress the need for long-term follow-up to detect pulmonary dysfunction. Pediatr Blood Cancer 2006; 47:594,606. © 2005 Wiley-Liss, Inc. [source]


    Longitudinal pulmonary status of cystic fibrosis children with meconium ileus

    PEDIATRIC PULMONOLOGY, Issue 4 2004
    Zhanhai Li PhD
    Abstract Although meconium ileus (MI) is the earliest manifestation of cystic fibrosis (CF), and is associated with poorer growth, the longitudinal pulmonary progression of CF children with MI is not clear. To test the hypothesis that MI is associated with worse pulmonary outcomes, we prospectively compared from diagnosis to 12 years of age 32 CF children with MI to 50 CF children without MI who were diagnosed during early infancy through neonatal screening. Pulmonary outcome measures included respiratory symptoms, respiratory infections, pathogens, antibiotic usage, hospitalizations, quantitative chest radiology, spirometry, and lung volume determinations. Obstructive lung disease was defined as percent predicted spirometry values below the lower limits of normal. Longitudinal analyses revealed no significant differences in cough, wheezing, respiratory infections, prevalence of and median times to acquisition of Pseudomonas aeruginosa or Staphylococcus aureus, antibiotic usage, and chest radiograph scores between the two groups. However, MI children showed significantly worse forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), forced expiratory flow between 25,75% of FVC (FEF25,75), % predicted FEV1, % predicted FEF25,75, and total lung capacity (TLC). These differences were particularly apparent beginning at age 8,10 years. MI children also had higher rates of and shorter median times to obstructive lung disease. Subgroup analyses showed MI children treated surgically and those treated medically had similar pulmonary outcomes. In conclusion, MI children have worse lung function and more obstructive lung disease than those without MI. Such abnormalities are accompanied by reduced lung volume. MI is a distinct CF phenotype with more severe pulmonary dysfunction. Pediatr Pulmonol. 2004; 38:277,284. © 2004 Wiley-Liss, Inc. [source]


    What is the role of tests of lung function in the management of infants with lung disease?

    PEDIATRIC PULMONOLOGY, Issue 1 2003
    S. Godfrey MD
    This review considers whether there is a role for lung function tests in the clinical management of infants with lung disease. The purpose of testing lung function in older subjects, the tests available for infants, and the practical problems of testing lung function in infants are considered. After reviewing all the facts, we suggest that there are four situations in which lung function testing should be recommended for infants, as follows: 1) the infant who presents with unexplained tachypnea, hypoxia, cough, or respiratory distress in whom a definitive diagnosis is not apparent from physical examination and other, less difficult investigations; 2) the infant with severe, continuous, chronic obstructive lung disease who does not respond to an adequate clinical trial of combined corticosteroid and bronchodilator therapy; 3) the infant with known respiratory disease of uncertain severity in whom there is need to justify management decisions; and 4) research and development. A review of 62 recent publications to determine how lung function tests are being used at the present time showed that they are being used overwhelmingly for research. The role of lung function testing in the clinical management of infants has not been established, and research is needed to clarify this situation. We suggest that such studies should explore the role of lung function tests in infants with specific symptoms, signs, or diagnoses, taking into account information from other types of investigation and the cost/benefit/risk ratios. Pediatr Pulmonol. 2003; 36:1,9. © 2003 Wiley-Liss, Inc. [source]


    Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis,

    PEDIATRIC PULMONOLOGY, Issue 5 2001
    Margaret Rosenfeld MD
    Abstract A thorough understanding of the early natural history of cystic fibrosis (CF) lung disease is critical for the development of effective interventions in the youngest patients. We assessed the evolution of pulmonary infection, inflammation, and clinical course among 40 infants over a 2-year period through annual bronchoalveolar lavage (BAL) for culture and measurements of pro- and anti-inflammatory cytokines, semiannual infant pulmonary function testing, and quarterly clinical evaluations. Both the prevalence of CF pathogens and their density in BAL fluid increased with age. Infants had neutrophilic lower airway inflammation and elevated IL-8 concentrations independent of whether CF pathogens were recovered. Total leukocyte and neutrophil densities and IL-8 concentrations increased with density of CF pathogens in BAL fluid, whether the isolated organism was P. aeruginosa or another pathogen. IL-10 concentrations were similar in CF subjects and non-CF historical controls. Infants generally had suboptimal growth (low weight and height percentiles) and obstructive lung disease (decreased expiratory flows and air trapping). Subjects from whom CF pathogens were isolated at >,105 cfu/mL had the worst air trapping and lowest Brasfield chest X-ray scores. Our findings provide a foundation for future studies of early intervention in CF lung disease, including antimicrobial and anti-inflammatory therapy. Pediatr Pulmonol. 2001; 32:356,366. © 2001 Wiley-Liss, Inc. [source]


    Five Fanconi anemia patients with unusual organ pathologies

    AMERICAN JOURNAL OF HEMATOLOGY, Issue 1 2004
    Selma Unal
    Abstract Fanconi anemia (FA) is a rare autosomal recessive disorder that presents with variable organ abnormalities, progressive cytopenia, and susceptibility to the development of several malignancies. Although some of the organ pathologies such as microcephaly, microphthalmia, skin dyspigmentation, urogenital system involvement, and radial ray skeletal abnormalities are relatively common, there are some other abnormalities that are rarely associated with the disease [Alter BP. In: Nathan DG, Oski FA, editors. Hematology of infancy and childhood. Philadelphia: Saunders; 2003. p 259,273]. In this paper, five cases of unrelated FA patients with unusual organ pathologies, including chronic obstructive lung disease, lipodystrophy, Sprengel's deformity, diaphragmatic hernia, and inflammatory linear verrucous epidermal nevus (ILVEN) are presented. Recognition of unusual pathologies associated with FA is important in order to improve our understanding of the relationship between the disease and presenting organ pathologies. Am. J. Hematol. 77:50,54, 2004. © 2004 Wiley-Liss, Inc. [source]


    Mortality among Ontario members of the International Union of Bricklayers and Allied Craftworkers

    AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2005
    Murray M. Finkelstein PhD
    Abstract Background Dust exposed workers may be at increased risk of pneumoconiosis, stomach cancer, lung cancer, and obstructive lung disease. Bricklayers may experience high exposures to silica and inorganic dusts. The aim of this study was to examine the mortality pattern of bricklayers to identify occupational associations with mortality. Methods A cohort of 10,953 workers was assembled from records of the International Union of Bricklayers and Allied Craftworkers (IUBAC). Mortality was ascertained by linkage to the Canadian Mortality Registry at Statistics Canada. Standardized Mortality Ratios (SMRs) were computed using Ontario general population mortality rates as the reference. Results Twenty or more years from first membership, SMRs for lung (158; 130,190) and stomach (235; 140,370) cancers were significantly elevated. There were four deaths from pneumoconiosis, but non-malignant respiratory mortality SMRs were not increased. Conclusions Bricklayers and Allied Craftworkers are at risk from diseases associated with heavy exposure to inorganic dust: lung cancer, stomach cancer, and pneumoconiosis. Dust control as well as education and training of these workers to protect themselves against inhalation hazards is necessary. Am. J. Ind. Med. 47:4,9, 2005. © 2004 Wiley-Liss, Inc. [source]


    The burden of lung disease in Hong Kong: A report from the Hong Kong Thoracic Society

    RESPIROLOGY, Issue 2008
    Moira CHAN-YEUNG
    Background and objective: The burden of lung disease in Hong Kong is not known. This study determined the mortality and hospitalization rates of respiratory diseases in Hong Kong in 2005, their trend in the past decade and their incidence/prevalence. Methods: Mortality data were obtained from the Department of Health and hospitalization data from the Hospital Authority, Hong Kong. Incidence/prevalence data were obtained from local registries or local studies. Trends of mortality and hospitalization rates of various respiratory diseases from 1997 and 2005 were calculated after age standardization and were tested for significance using negative binomial regression analysis. Age standardized mortality rates in Hong Kong were compared with those of the UK and globally. Results: Respiratory disease was the most common cause of mortality and hospitalization in Hong Kong in 2005. Globally and in the UK, cardiovascular disease ranked first in mortality. Respiratory infections ranked first in respiratory mortality, followed by respiratory tract cancer and chronic obstructive lung disease. Respiratory infections also ranked first followed by chronic obstructive lung disease in the utilization of respiratory inpatient bed-days. While mortality rates from all respiratory diseases decreased in the past decade, hospitalization rates remained unchanged. Unlike other respiratory diseases, mortality from respiratory infections have increased since 2001. Smoking is the most important risk factor in non-communicable respiratory diseases. Conclusions: Respiratory disease is responsible for the highest health-care burden locally. Increased efforts in improving management and prevention of these diseases, including tobacco control, improving air quality and vaccination against influenza and pneumococci, are necessary. [source]


    Erythromycin attenuates MUC5AC synthesis and secretion in cultured human tracheal cells infected with RV14

    RESPIROLOGY, Issue 2 2008
    Daisuke INOUE
    Background and objective: The common cold is a major cause of asthma exacerbation and chronic obstructive lung disease. Rhinovirus is reported to be responsible for more than 50% of cases of the common cold. In a previous study, we reported that rhinovirus infection of cultured airway cells induced MUC5AC mucin overproduction and hypersecretion by activating the p44/42 mitogen-activated protein kinase (p44/42 MAPK) pathway. The aim of this study was to examine the effect of erythromycin on RV14-induced airway mucin overproduction and hypersecretion. Methods: RV14-infected human tracheal epithelial cells were treated with erythromycin. Results: Erythromycin blocked RV14-induced MUC5AC protein overproduction and hypersecretion, and also blocked RV14-induced p44/42 MAPK activation in the cells. Conclusions: Erythromycin may attenuate RV14-induced MUC5AC overproduction and hypersecretion by blocking the p44/42 MAPK pathway or its upstream regulators. [source]


    The global initiative for chronic obstructive lung disease: Gold standards and the Asia,Pacific perspective

    RESPIROLOGY, Issue 1 2002
    Article first published online: 11 MAR 200
    No abstract is available for this article. [source]


    Phenotypes of obstructive lung disease

    THE CLINICAL RESPIRATORY JOURNAL, Issue 2008
    C. Janson
    Abstract Recently, there has been much emphasis on the fact that there are many different phenotypes in asthma and chronic obstructive pulmonary disease (COPD). The aim of this review is to investigate some aspects of phenotyping in these two diseases. Epidemiological studies show a quite different risk factor pattern in allergic and non-allergic asthma. Several studies also indicated that there are pathophysiological differences between these two types of asthma: such as eosinophil inflammation in allergic and neutrophil predominance in non-allergic asthma. Neutrophil inflammation may also be a marker of severe asthma. At least one study indicates that non-allergic asthmatics are less responsive to inhaled corticosteroids than allergic asthmatics. Recently, it has been emphasized that COPD also has manifestations other than lung function decline and that this also needs to be taken into account in severity characterisation. Dyspnea, weight loss, psychological status and co-morbidity are factors that seem to be of large prognostic importance independently of the level of airflow obstruction in COPD. Progress has been made in understanding how asthma develops, but effective measures for primary preventions is still lacking. Better phenotyping in asthma will hopefully enable us to make progress in this area. Phenotyping is also important for assessment of prognosis in both asthma and COPD. Please cite this paper as: Janson C. Phenotypes of obstructive lung disease. The Clinical Respiratory Journal 2008; 2: 88,91. [source]


    Laryngotracheal Anastomosis: Primary and Revised Procedures

    THE LARYNGOSCOPE, Issue 4 2001
    Michael Wolf MD
    Abstract Objectives Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success. Study Design A cohort study in a tertiary referral medical center. Methods The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency). Results Twenty-two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily-activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant. Conclusions The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity. [source]


    Respiratory muscle strength and muscle endurance are not affected by acute metabolic acidemia

    CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 6 2009
    Tessa A. C. Nizet
    Summary Respiratory muscle fatigue in asthma and chronic obstructive lung disease (COPD) contributes to respiratory failure with hypercapnia, and subsequent respiratory acidosis. Therapeutic induction of acute metabolic acidosis further increases the respiratory drive and, therefore, may diminish ventilatory failure and hypercapnia. On the other hand, it is known that acute metabolic acidosis can also negatively affect (respiratory) muscle function and, therefore, could lead to a deterioration of respiratory failure. Moreover, we reasoned that the impact of metabolic acidosis on respiratory muscle strength and respiratory muscle endurance could be more pronounced in COPD patients as compared to asthma patients and healthy subjects, due to already impaired respiratory muscle function. In this study, the effect of metabolic acidosis was studied on peripheral muscle strength, peripheral muscle endurance, airway resistance, and on arterial carbon dioxide tension (PaCO2). Acute metabolic acidosis was induced by administration of ammonium chloride (NH4Cl). The effect of metabolic acidosis was studied on inspiratory and expiratory muscle strength and on respiratory muscle endurance. Effects were studied in a randomized, placebo-controlled cross-over design in 15 healthy subjects (4 male; age 33·2 ± 11·5 years; FEV1 108·3 ± 16·2% predicted), 14 asthma patients (5 male; age 48·1 ± 16·1 years; FEV1 101·6 ± 15·3% predicted), and 15 moderate to severe COPD patients (9 male; age 62·8 ± 6·8 years; FEV1 50·0 ± 11·8% predicted). An acute metabolic acidemia of BE ,3·1 mmol.L,1 was induced. Acute metabolic acidemia did not significantly affect strength or endurance of respiratory and peripheral muscles, respectively. In all subjects airway resistance was significantly decreased after induction of metabolic acidemia (mean difference ,0·1 kPa.sec.L,1 [95%-CI: ,0·1 ,,0·02]. In COPD patients PaCO2 was significantly lowered during metabolic acidemia (mean difference ,1·73 mmHg [,3·0 ,,0·08]. In healthy subjects and in asthma patients no such effect was found. Acute metabolic acidemia did not significantly decrease respiratory or peripheral muscle strength, respectively muscle endurance in nomal subjects, asthma, or COPD patients. Metabolic acidemia significantly decreased airway resistance in asthma and COPD patients, as well as in healthy subjects. Moreover, acute metabolic acidemia slightly improved blood gas values in COPD patients. The results suggest that stimulation of ventilation in respiratory failure, by induction of metabolic acidemia will not lead to deterioration of the respiratory failure. [source]


    Study of human metapneumovirus-associated lower respiratory tract infections in Egyptian adults

    MICROBIOLOGY AND IMMUNOLOGY, Issue 11 2009
    Maysaa El Sayed Zaki
    ABSTRACT There is a deficiency in the data concerning the role of hMPV in lower respiratory tract infections in adults, and until now there has been no data available regarding the prevalence of hMPV in adults in our region. In the present study the association of hMPV with varieties of lower respiratory tract disorders in immunocompetent adult patients, either alone or with bacterial pathogens, has been highlighted. Eighty-eight patients were included in the study. They included 46 males and 42 females with an age range of 38,65 years. Patients presented with lower respiratory tract infections associated with acute exacerbation of asthma (67%), pneumonia (17%), and acute exacerbation of chronic obstructive lung diseases. Sputum and nasopharyngeal samples were obtained from the patients and subjected to a full microbiological study. In addition, detection of hMPV was performed by nested reverse transcriptase polymerase chain reaction. The pathogens isolated were Streptococcus pneumoniae 46.6%, Staphylococci aureus 35.2%, and human metapneumovirus 13.6%. Influenza virus and rhinovirus were each isolated from 4.5% of patients. Human metapneumovirus was associated with S. pneumoniae in 4.5% in studied patients, while in 9.1% it was the only pathogen found in those patients. The commonest clinical condition with significant association with human metapneumovirus was pneumonia. The clinical and laboratory studies demonstrated an association between lower respiratory tract infections in adults and hMPV either as sole pathogen or in association with Streptococcus pneumoniae. It was a common pathogen in community-acquired pneumonia. [source]