scholarly journals A Randomized Trial to Evaluate the Sustained Efficacy of a Mucus Clearance Device in Ambulatory Patients with Chronic Obstructive Pulmonary Disease

2004 ◽  
Vol 11 (8) ◽  
pp. 567-572 ◽  
Author(s):  
Norman Wolkove ◽  
Marc A Baltzan ◽  
Hany Kamel ◽  
Michael Rotaple
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Exercise Performance ◽  
Forced Expiratory Volume ◽  
Ambulatory Setting ◽  
Chronic Obstructive ◽  
Baseline Measure ◽  
Obstructive Pulmonary Disease ◽  
Bronchodilator Response ◽  
Mucus Clearance

OBJECTIVE:To determine whether a mucus clearance device (MCD) (Flutter; Axcan Scandipharm, USA) could consistently improve the bronchodilator response and exercise performance in patients with chronic obstructive pulmonary disease (COPD) when used in an ambulatory setting over a one-week period.SUBJECTS:Fifteen patients with severe COPD (mean age 71±10 years) were studied.METHODS:A randomized crossover design compared an MCD with a sham MCD (SMCD), in which each were tested for one week. At the beginning and end of each study week, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and after MCD or SMCD. A bronchodilator aerosol (ipratropium bromide and salbutamol sulphate) was then given, and FEV1and FVC were remeasured 30 min, 60 min and 120 min later. A 6 min walk test (6MWT) was also performed.RESULTS:FEV1improved significantly (P<0.05) after bronchodilator administration with both the SMCD and MCD. The improvement was always greater with MCD use than with SMCD. At the baseline measure, 120 min postbronchodilator administration, the mean FEV1improved by 24±24% with SMCD use and 60±28% with MCD use (P<0.05). After one week of use, the corresponding values at 120 min were 19±24% and 43±26% (P<0.05). Similar findings were obtained for FVC. 6MWT distances increased by 29±12 m (P<0.05) after one week of MCD use, whereas it decreased slightly (by 16±18 m) after SMCD. The decline in saturation with the 6MWT was smaller with MCD use than with SMCD use. After one week, the decline in saturation with MCD use was similar to baseline levels, although patients were walking farther. After one week, dyspnea was lower on walking with MCD use than with SMCD use.CONCLUSION:Patients with COPD had an increased response to bronchodilator therapy after use of the MCD compared with SMCD use. The increase persisted after one week of use, and was associated with improved exercise performance as measured by the 6MWT.

scholarly journals Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (2) ◽  
pp. 269
Author(s):  
Elisabetta Zinellu ◽  
Alessandro G. Fois ◽  
Elisabetta Sotgiu ◽  
Sabrina Mellino ◽  
Arduino A. Mangoni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Serum Albumin ◽  
Pulmonary Disease ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Standard Mean Difference ◽  
Copd Patients

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airway inflammation and lung parenchyma damage. Systemic inflammation and oxidative stress also play a role in the pathogenesis of COPD. Serum albumin is a negative acute-phase protein with antioxidant effects and an important marker of malnutrition. The aim of this meta-analysis was to investigate differences in serum albumin concentrations between patients with stable COPD and non-COPD subjects. Methods: A systematic search was conducted, using the terms “albumin” and “chronic obstructive pulmonary disease” or “COPD”, in the electronic databases PubMed and Web of Science, from inception to May 2020. Results: Twenty-six studies were identified on a total of 2554 COPD patients and 2055 non-COPD controls. Pooled results showed that serum albumin concentrations were significantly lower in COPD patients (standard mean difference, SMD = −0.50, 95% CI −0.67 to −0.32; p < 0.001). No significant differences were observed in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) < 50% and those with FEV1 > 50%. Conclusions: Our systematic review and meta-analysis showed that serum albumin concentrations are significantly lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity

2009 ◽  
Vol 106 (6) ◽  
pp. 1902-1908 ◽  
Author(s):  
Roberto Rodríguez-Roisin ◽  
Mitra Drakulovic ◽  
Diego A. Rodríguez ◽  
Josep Roca ◽  
Joan Albert Barberà ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Gas Exchange ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Pulmonary Gas Exchange ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Gold Stage ◽  
Stage 1

Chronic obstructive pulmonary disease (COPD) is characterized by a decline in forced expiratory volume in 1 s (FEV1) and, in many advanced patients, by arterial hypoxemia with or without hypercapnia. Spirometric and gas exchange abnormalities have not been found to relate closely, but this may reflect a narrow range of severity in patients studied. Therefore, we assessed the relationship between pulmonary gas exchange and airflow limitation in patients with COPD across the severity spectrum. Ventilation-perfusion (V̇A/Q̇) mismatch was measured using the multiple inert gas elimination technique in 150 patients from previous studies. The distribution of patients according to the GOLD stage of COPD was: 15 with stage 1; 40 with stage 2; 32 with stage 3; and 63 with stage 4. In GOLD stage 1, AaPo2 and V̇A/Q̇ mismatch were clearly abnormal; thereafter, hypoxemia, AaPo2, and V̇A/Q̇ imbalance increased, but the changes from GOLD stages 1–4 were modest. Postbronchodilator FEV1 was related to PaO2 ( r = 0.62) and PaCO2 ( r = −0.59) and to overall V̇A/Q̇ heterogeneity ( r = −0.48) ( P < 0.001 each). Pulmonary gas exchange abnormalities in COPD are related to FEV1 across the spectrum of severity. V̇A/Q̇ imbalance, predominantly perfusion heterogeneity, is disproportionately greater than airflow limitation in GOLD stage 1, suggesting that COPD initially involves the smallest airways, parenchyma, and pulmonary vessels with minimal spirometric disturbances. That progression of V̇A/Q̇ inequality with spirometric severity is modest may reflect pathogenic processes that reduce both local ventilation and blood flow in the same regions through airway and alveolar disease and capillary involvement.

Exercise Performance of Polycythemic Chronic Obstructive Pulmonary Disease Patients

CHEST Journal ◽  
1990 ◽  
Vol 98 (5) ◽  
pp. 1073-1077 ◽  
Author(s):  
Kota G. Chetty ◽  
Richard W. Light ◽  
David W. Stansbury ◽  
Norah Milne
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Exercise Performance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 36 (5) ◽  
pp. 248-257
Author(s):  
H. Edward Davidson ◽  
Peter Radlowski ◽  
Lisa Han ◽  
Theresa I. Shireman ◽  
Carole Dembek ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Characteristics ◽  
Symptom Burden ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Nursing Facility ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Medication Delivery

OBJECTIVE AND DESIGN: To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD). PATIENTS AND SETTING: Residents 60 years of age and older with a COPD diagnosis and≥ 6 months' nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities. OUTCOME MEASURES: Data, extracted from residents' charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. At enrollment, residents completed the modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT™). Spirometry and PIFR were also assessed. RESULTS: Residents' (N = 179) mean age was 78.0 ± 10.6 years, 63.7% were female, and 57.0% had low PIFR. Most prevalent comorbidities were hypertension (79.9%), depression (49.2%), and heart failure (41.9%). The average forced expiratory volume in 1 second (FEV11) % predicted was 45.9% ± 20.9%. On the CAT, 78.2% scored≥ 10 and on the mMRC Dyspnea Scale, 74.1% scored≥ 2, indicating most residents had high COPD symptom burden. Only 49.2% were receiving a scheduled long-acting bronchodilator (LABD). Among those with low PIFR prescribed a LABD, > 80% used dry powder inhalers for medication delivery. CONCLUSION: This study highlights underutilization of scheduled LABD therapy in nursing facility residents with COPD. Low PIFR was prevalent in residents while the majority used suboptimal medication delivery devices. The findings highlight opportunities for improving management and outcomes for nursing facility residents with COPD.

Diagnosing asthma and chronic obstructive pulmonary disease with machine learning

2017 ◽  
Vol 25 (3) ◽  
pp. 811-827 ◽  
Author(s):  
Dimitris Spathis ◽  
Panayiotis Vlamos
Keyword(s):  
Machine Learning ◽  
Chronic Obstructive Pulmonary Disease ◽  
Random Forest ◽  
Pulmonary Disease ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Forced Expiratory Volume ◽  
Random Forest Classifier ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

This study examines the clinical decision support systems in healthcare, in particular about the prevention, diagnosis and treatment of respiratory diseases, such as Asthma and chronic obstructive pulmonary disease. The empirical pulmonology study of a representative sample (n = 132) attempts to identify the major factors that contribute to the diagnosis of these diseases. Machine learning results show that in chronic obstructive pulmonary disease’s case, Random Forest classifier outperforms other techniques with 97.7 per cent precision, while the most prominent attributes for diagnosis are smoking, forced expiratory volume 1, age and forced vital capacity. In asthma’s case, the best precision, 80.3 per cent, is achieved again with the Random Forest classifier, while the most prominent attribute is MEF2575.

scholarly journals Prognostic and Functional Impact of Perioperative LAＭA/LABA Inhaled Therapy In Patients With Lung Cancer and Chronic Obstructive Pulmonary Disease 

2021 ◽  
Author(s):  
Yoko Azuma ◽  
Atsushi Sano ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Postoperative Complications ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. The utility of several perioperative bronchodilators in patients with COPD requiring surgery for lung cancer has been reported, but the most suitable agent and its specific effect on postoperative long-term prognosis remain unclear. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.Methods: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical records. Patients were divided into 3 groups according to perioperative management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). Results: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p<0.001 for both forced expiratory volume in 1 second (FEV1) and percentage of predicted forced expiratory volume in 1 second (FEV1 %pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, 223.1 mL vs 130.0 mL, ΔFEV1 %pred, 10.8% vs 6.8%; both p<0.05). There was a trend toward a lower incidence of postoperative complications in the LAMA/LABA group compared with the LAMA and rehabilitation-only groups. In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with patients in the other groups. Perioperative LAMA/LABA therapy was also associated with lower recurrence rates. Conclusions: Patients who receive perioperative LAMA/LABA for moderate to severe COPD have improved prognosis and better pulmonary function with surgery for lung cancer. We believe this treatment combination is optimal for patients with lung cancer and COPD.

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