scholarly journals Tiotropio ir olodaterolio derinio vaidmuo lėtinės obstrukcinės plaučių ligos gydyme

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Laima Kondratavičienė
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Area Under The Curve ◽  
Forced Expiratory Volume

Įkvepiamieji bronchus plečiamieji vaistai yra lėtinės obstrukcinės plaučių ligosmedikamentinio gydymo pagrindas, siūlomas ir Pasaulinės lėtinės obstrukcinės plaučių ligos iniciatyvos (angl. Global Obstructive Lung Disease Initiative, GOLD). Ilgo veikimo įkvepiamieji muskarino receptorių blokatoriai (IVMB) ir ilgo veikimo β2 agonistai (IVBA) kartu derinyje yra veiksmingesni nei įprasti trumpo veikimo vaistai, o jų farmokologiniai profiliai efektyviai vienas kitą papildo. Rezultatai, gauti atlikus dvigubos terapijos tyrimus, parodė, kad šie vaistai gali būti derinami, o kompleksinė IVMB ir IVBA terapija sustiprina gydomąjį poveikį. Remiantis šiais duomenimis, pradėta dešimties III fazės klinikinių tyrimų programa ToviTO, kuri plačiai ištyrė kompleksinio gydymo tiotropio su olodateroliu viename inhaliatoriuje naudą. Tiotropio ir olodotareolio 5/5 µg derinys reikšmingai pagerino forsuoto iškvėpimo tūrio per pirmąją sekundę (angl. Forced Expiratory Volume in First Second, FEV1) plotą po kreive (angl. Area Under the Curve) nuo 0 iki 3 val. (FEV1 AUC0–3 val.), FEV1 rodiklius prieš kitos tiriamo vaisto dozės suvartojimą, gyvenimo kokybę, sumažino dusulio pojūtį bei padidino fizinio krūvio toleranciją, lyginant sumonoterapija ir placebu.

scholarly journals Pulmonary ventilation defects in older never-smokers

2014 ◽  
Vol 117 (3) ◽  
pp. 297-306 ◽  
Author(s):  
Khadija Sheikh ◽  
Gregory A. Paulin ◽  
Sarah Svenningsen ◽  
Miranda Kirby ◽  
Nigel A. M. Paterson ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Pulmonary Function Tests ◽  
Pulmonary Ventilation ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Second Hand Smoke ◽  
Chronic Obstructive ◽  
Never Smokers

Hyperpolarized 3He MRI previously revealed spatially persistent ventilation defects in healthy, older compared with healthy, younger never-smokers. To understand better the physiological consequences and potential relevance of 3He MRI ventilation defects, we evaluated 3He-MRI ventilation-defect percent (VDP) and the effect of deep inspiration (DI) and salbutamol on VDP in older never-smokers. To identify the potential determinants of ventilation defects in these subjects, we evaluated dyspnea, pulmonary function, and cardiopulmonary exercise test (CPET) measurements, as well as occupational and second-hand smoke exposure. Fifty-two never-smokers (71 ± 6 yr) with no history of chronic respiratory disease were evaluated. During a single visit, pulmonary function tests, CPET, and 3He MRI were performed and the Burden of Obstructive Lung Disease questionnaire administered. For eight of 52 subjects, there was spirometry evidence of airflow limitation (Global Initiative for Chronic Obstructive Lung Disease-Unclassified, I, and II), and occupational exposure was reported in 13 of 52 subjects. In 13 of 52 (25%) subjects, there were no ventilation defects and in 39 of 52 (75%) subjects, ventilation defects were observed. For those subjects with ventilation defects, six of 39 showed a VDP response to DI/salbutamol. Ventilation heterogeneity and VDP were significantly greater, and forced expiratory volume in 1 s (FEV1)/forced vital capacity was significantly lower ( P < 0.05) for subjects with ventilation defects with a response to DI/salbutamol than subjects with ventilation defects without a response to DI/salbutamol and subjects without ventilation defects. In a step-wise, forward multivariate model, FEV1, inspiratory capacity, and airway resistance significantly predicted VDP ( R2 = 0.45, P < 0.001). In conclusion, most never-smokers had normal spirometry and peripheral ventilation defects not reversed by DI/salbutamol; such ventilation defects were likely related to irreversible airway narrowing/collapse but not to dyspnea and decreased exercise capacity.

Clinical Use of Controlled-Release Theophylline in Chronic Airways Obstruction

1987 ◽  
Vol 15 (6) ◽  
pp. 391-396 ◽  
Author(s):  
R. Dal Negro ◽  
P. Turco ◽  
C. Pomari ◽  
C. I. Cordaro
Keyword(s):  
Steady State ◽  
Controlled Release ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Plasma Concentrations ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Clinical Severity ◽  
Chronic Obstructive ◽  
Post Marketing

Daily general practice of theophylline dosing in chronic obstructive lung disease seems not strictly to follow therapeutic guidelines. To evaluate the efficacy of such an approach with regard to attaining therapeutic and safe plasma theophylline concentrations and clinical benefit, 103 patients with chronic obstructive lung disease were selected from the computerized database of a post-marketing survey. Dosing of theophylline was found to be independent of reference parameters, i.e. anthropometric data, age and clinical severity of the disease. Standard doses of 400 and/or 600 mg controlled-release theophylline, i.e. 7.9 mg/kg·day resulted in steady-state plasma concentrations of 10–20 μg/ml in 45.1% of patients and 5–10 μg/ml in 52.9% of cases. The increase in forced expiratory volume in 1 s at steady-state, evaluated by the percentage frequency distribution of changes from baseline was significant in all patients. In conclusion, not withstanding the daily therapeutic practice of controlled-release theophylline dosing and, at times, lower than optimal plasma levels, clinical and functional recovery was obtained in a large percentage of cases.

Reassessment of the interruption technique for measuring flow resistance in humans

1989 ◽  
Vol 67 (3) ◽  
pp. 933-937 ◽  
Author(s):  
G. Liistro ◽  
D. Stanescu ◽  
D. Rodenstein ◽  
C. Veriter
Keyword(s):  
Lung Disease ◽  
Healthy Subjects ◽  
Obstructive Lung Disease ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Whole Body ◽  
Quiet Breathing ◽  
Flow Interruption ◽  
Whole Body Plethysmography ◽  
Closed Airway

We have previously produced evidence that, in patients with obstructive lung disease, compliance of extrathoracic airways is responsible for lack of mouth-to-alveolar pressure equilibration during respiratory efforts against a closed airway. The flow interruption method for measuring respiratory resistance (Rint) is potentially faced with the same problems. We reassessed the merits of the interruption technique by rendering the extrathoracic airways more rigid and by using a rapid shutter. We measured airway resistance (Raw) with whole body plethysmography during panting (at 2 Hz) and Rint during quiet breathing. Rint and Raw were expressed as specific airway (sGaw) and interruptive conductance (sGint), respectively. In nine healthy subjects (cheeks supported), sGint (0.140 +/- 0.050 s-1.cmH2O-1) was lower (P less than 0.02) than sGaw (0.182 +/- 0.043 s-1.cmH2O-1). By contrast, in 12 patients with severe obstructive lung disease (forced expiratory volume in 1 s/vital capacity = 41.0 +/- 19.8%), sGint (0.058 +/- 0.012 s-1.cmH2O-1) was higher (P less than 0.05) than sGaw (0.047 +/- 0.007 s-1.cmH2O-1), when the cheeks were supported. When the mouth floor was also supported, average values of sGaw (0.048 +/- 0.008 s-1.cmH2O-1) and sGint (0.049 +/- 0.014 s-1.cmH2O-1) became similar. In conclusion, we confirm previous findings in healthy subjects of higher values of Rint, with respect to Raw, probably because of differences in glottis opening between quiet breathing and panting. In airflow obstruction, supporting both the cheeks and the mouth floor decreased sGint, which became similar to sGaw.

scholarly journals Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results

2020 ◽  
Vol 24 (2) ◽  
pp. 202-206
Author(s):  
M. Atassi ◽  
A. C. F. Kava ◽  
C. Nejjari ◽  
M. C. Benjelloun ◽  
M. El Biaze ◽  
...  
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Economic Status ◽  
Airflow Obstruction ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Socio Economic Status ◽  
Unit Increase ◽  
Disease Study

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0–10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01–0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

scholarly journals Early respiratory diagnosis: benefits of enhanced lung function assessment

2021 ◽  
Vol 8 (1) ◽  
pp. e001012
Author(s):  
Karl P Sylvester ◽  
Luke Youngs ◽  
M A Rutter ◽  
Ross Beech ◽  
Ravi Mahadeva
Keyword(s):  
Carbon Monoxide ◽  
Lung Function ◽  
Gas Exchange ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Gas Transfer ◽  
Function Assessment

IntroductionThe National Health Service for England Long Term Plan identifies respiratory disease as one of its priority workstreams. To assist with earlier and more accurate diagnosis of lung disease they recommend improvement in delivery of quality-assured spirometry. However, there is a likelihood that patients will present with abnormal gas exchange when spirometry results are normal and therefore there will be a proportion of patients whose time to diagnosis is still protracted. We wished to determine the incidence rate of this occurring within our Trust.MethodsA retrospective review of all patients attending the lung function laboratory for their first pulmonary function assessment from June 2006 to December 2020 was undertaken. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) >−1.64 standardised residual (SR) was used to confirm no obstructive lung function abnormality and FVC >−1.64 SR to confirm no suggestion of a restrictive lung function abnormality. Lung gas transfer for carbon monoxide (TLCO) and transfer coefficient of the lung for carbon monoxide (KCO) <−1.64 SR confirmed the presence of a gas exchange abnormality. Spirometry and gas transfer reference values generated by the Global Lung Initiative were used to determine normality.ResultsOf 12 835 eligible first visits with normal FEV1/FVC and FVC, 4856 (37.8%) were identified as having an abnormally low TLCO and 3302 (25.7%) presenting with an abnormally low KCO. Of 3494 with FEV1/FVC SR <−1.64, 3316 also had a ratio of <0.70, meaning 178 (5%) of patients in this cohort would have been misclassified as having obstructive lung disease using the 0.70 cut-off recommended by the Global Initiative for Chronic Obstructive Lung Disease for diagnosing obstructive lung disease.DiscussionIn conclusion, to assist with ensuring more accurate and timely diagnosis of lung disease and enhance patients’ diagnostic pathway, we recommend the performance of lung gas transfer measurements alongside spirometry in all healthcare settings. To assess and monitor gas transfer at the earliest opportunity we recommend this is implemented into new models being developed within community hubs. This will increase the identification of lung function abnormalities and provide patients with a definitive diagnosis earlier.

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