COPD Chronic Obstructive Pulmonary Disease Research Articles

Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland

Asthma and COPD are common chronic obstructive respiratory diseases. COPD is associated with increased mortality, but for asthma the results are varying. Their combination has been less investigated, and the results are contradictory. The aim of this prospective study was to observe the overall mortality in obstructive pulmonary diseases and how mortality was related to specific causes using postal questionnaire data. This study included data from 6,062 participants in the FinEsS Helsinki Study (1996) linked to mortality data during a 24-year follow-up. According to self-reported physician diagnosed asthma, COPD, or smoking status, the population was divided into five categories: combined asthma and COPD, COPD alone and asthma alone, ever-smokers without asthma or COPD and never-smokers without asthma or COPD (reference group). For the specific causes of death both the underlying and contributing causes of death were used. Participants with asthma and COPD had the highest hazard of mortality 2.4 (95% CI 1.7–3.5). Ever-smokers without asthma or COPD had a 9.5 (3.7–24.2) subhazard ratio (sHR) related to lower respiratory tract disease specific causes. For asthma, COPD and combined, the corresponding figures were 10.8 (3.4–34.1), 25.0 (8.1–77.4), and 56.1 (19.6–160), respectively. Ever-smokers without asthma or COPD sHR 1.7 (95% CI 1.3–2.5), and participants with combined asthma and COPD 3.5 (1.9–6.3) also featured mortality in association with coronary artery disease. Subjects with combined diseases had the highest hazard of overall mortality and combined diseases also showed the highest hazard of mortality associated with lower respiratory tract causes or coronary artery causes. Abbreviations: Cig Cigarette COPD Chronic obstructive pulmonary disease CVD Cardiovascular disease FEV1 Forced Expiratory Volume in one second FVC Forced Vital Capacity FinEsS Finland, Estonia, and Sweden study on chronic obstructive pulmonary diseases HR Hazard Ratio sHR Subhazard Ratio ICD-10 International Statistical Classifications of Diseases and Related Health Problems (Version 10)

Diagnosing COPD in general practice

COPD prevalence is likely to be underestimated in the UK. Anne Rodman explores the current evidence base for diagnosing COPD Chronic obstructive pulmonary disease (COPD) is an umbrella term for several different pathological processes in the lungs of susceptible individuals. COPD should be considered in any patient who has symptoms and a history of exposure to risk factors for the disease. The cornerstone of COPD diagnosis is to identify risk factors for this preventable condition, recognise and investigate any symptoms that are not commonly found in COPD, and confirm that obstruction is present with correctly performed and interpreted spirometry. This article explores the current evidence base for diagnosing COPD, how to differentiate it from asthma and other conditions with similar symptoms, and the rationale for specialist referral.

A brief review in dental management of medically compromised patients

With advancement in the technology & medical science there has been also increase in the various diseases & disorders due to lifestyle changes, dietary changes, etc. Due to increase in the aspect of dentistry, there is a need to know about the medical condition of patients because many dental procedures may cause stress to the patient and their proper management is required in case if patient health status is not so good. Also, in invasive dental procedures that involve implants, extractions or jaw surgeries also need a proper dental as well medical management depending upon different conditions likewise there is a risk of bleeding that could be fatal in bleeding disorders, overdose of LA may precipitate the epileptic attack and many more. Here in this article we are going to discuss briefly about dental management in medically compromised patients, and also it’s the duty of dentist to have the knowledge of such conditions and he should know how to manage those patients in his or her dental operatory. Keywords: COPD Chronic obstructive pulmonary disease (COPD).

Economic Impact of Leading Prosperity Diseases: COPD in South East Europe

ECONOMIC BURDEN OF COPD Chronic obstructive pulmonary disease is one of the leading “prosperity diseases” worldwide. Pooled global prevalence rates based on clinical assessments and spirometry ranged from 7.6 to 8.9%, reported in a sound meta-analytical study design (1). It has far reaching consequences, not only for an affected patient’s health but also for the entire national health systems (2). These refer to the substantial work load for the medical facilities due to chronic clinical course of illness and modest success of available treatment approaches. COPD attributable resource utilization patterns are particularly substantial if large university tertiary care hospitals, specialist clinics, and intensive care units are observed (3). According to most of published evidence the key cost driver are periodic exacerbations followed by intensive care unit admissions and episodes of infectious complications (4). Among major cost domains, physician consultations and surgery dominate in high-income settings. Unlike in the West, within the most of South Eastern European region, COPD medical care is still dominated with acquisition costs of pharmaceuticals and oxygen (5) and imaging diagnostics (6). Outpacing of indirect productivity-related opportunity costs by the direct costs of inand outpatient medical care is common to this region due to substantially lower wages of physicians and nursing staff (7). Apart from direct costs of COPD, mainly constituted from the resources consumed in the health care process, including costs of ambulatory care, drug treatment, hospital care, rehabilitation, and long-term home care, there are substantial indirect costs of COPD, which are incurred by productivity losses, premature retirement, and premature mortality from this disease. The indirect costs for premature mortality are being calculated through human capital approach, with the life years lost up to the age of 65 multiplied by the gross annual income. An insight into the economic reality of SEE region, particularly Serbia, with average wages significantly lower than in countries of the Western Europe, but at the same time with high unemployment rates in younger age groups, where some 50% of the working population is currently outside of the workforce (8), being in their most productive decades of life but at the same time most prevalent tobacco users, makes indirect cost of COPD in SEE region very difficult to calculate or even predict, but clearly shows significant magnitude of this burden in present years, and probable rise of these costs in the future. Intangible costs are not convertible into monetary terms and units, they are specifically related to the distress and suffering, which is caused by the disease. General lack of insight into patients’ perception of the disease and limitation and incapability, which it imposes, while healthcare workers are being focused mainly on physical burden of the disease, with very few patients being provided with structurised psychosocial aid in the attempt to overcome significant yet underestimated mental and emotional burden of the disease, makes these costs impossible to predict and foresee.

Hyperpolarized (3)He ventilation defects used to predict pulmonary exacerbations in mild to moderate chronic obstructive pulmonary disease.

To evaluate the predictive value of imaging and clinical and physiological measurements of chronic obstructive pulmonary disease ( COPD chronic obstructive pulmonary disease ) in patients monitored for more than 5 years for pulmonary exacerbations that required hospitalization. Exacerbations requiring hospitalization were monitored over 5 years in 91 subjects who provided written informed consent. Study was local research ethics board and Health Canada approved and HIPAA compliant. Subjects with COPD chronic obstructive pulmonary disease underwent spirometry, plethysmography, diffusing capacity of carbon monoxide, St George's Respiratory Questionnaire, 6-minute walk test, and imaging. Computed tomographic (CT) wall area and relative area with attenuation values less than -950 HU ( RA950 relative area with attenuation values less than -950 HU ), helium 3 ((3)He) magnetic resonance (MR) imaging ventilation defect percentage ( VDP ventilation defect percentage ), and apparent diffusion coefficient were generated. Zero-inflated Poisson model was used to compare number of hospitalizations with lung function and imaging measurements. Twenty-four subjects were hospitalized 58 times and had significantly worse forced expiratory volume in 1 second ( FEV1 forced expiratory volume in 1 second ) (P < .0001), CT RA950 relative area with attenuation values less than -950 HU (P = .02), and (3)He VDP ventilation defect percentage (P < .0001) than values in 67 subjects who were not hospitalized. In mild to moderate COPD chronic obstructive pulmonary disease , nine hospitalized subjects had significantly worse FEV1 forced expiratory volume in 1 second (P = .02) and (3)He VDP ventilation defect percentage (P = .02) than values in 52 subjects who were not hospitalized. (3)He VDP ventilation defect percentage was quantitatively related to CT airway morphology (r = 0.26, P = .01) and quantitatively (r = 0.61, P < .0001) and spatially related to emphysema; this spatial relationship was significantly greater for hospitalized patients with COPD chronic obstructive pulmonary disease than unhospitalized patients (P = .0006). For all subjects, number of prior hospitalizations (P < .0001), 6-minute walk test distance (P < .0001), CT RA950 relative area with attenuation values less than -950 HU (P = .03), and (3)He VDP ventilation defect percentage (P = .002) were significantly related to number of hospitalizations. For 61 subjects with mild to moderate COPD chronic obstructive pulmonary disease , only (3)He VDP ventilation defect percentage was significantly associated with COPD chronic obstructive pulmonary disease exacerbations (P = .01). (3)He MR imaging VDP ventilation defect percentage represents a mixed airways-emphysema phenotype and helps identify subjects with mild to moderate COPD chronic obstructive pulmonary disease who are at risk for exacerbation that requires hospitalization.

Stenotrophomonas maltophilia infection in patients receiving continuous ambulatory peritoneal dialysis.

BackgroundStenotrophomonas maltophilia is a gram-negative bacillus that has become increasingly recognized as an important nosocomial pathogen, particularly in individuals with severe debilitation or immunosuppression. S. maltophilia is also characterized by its resistance to multiple antibiotics. S. maltophilia peritonitis in CAPD (continuous ambulatory peritoneal dialysis) patients is associated with a poor prognosis and loss of CAPD catheter. No report concerning this entity has been presented in Korea. Therefore, we describe and discuss five cases of the S. maltophilia infection associated with CAPD in three patients with peritonitis and two with exit-site infections.MethodsWe performed a retrospective search for episodes of S. maltophilia infections related to CAPD in our renal unit. The baseline levels of hemoglobin, albumin, cholesterol, BUN and creatinine were compared with age, sex and, if possible, the underlying disease-matched controls.ResultsAll the patients with S. maltophilia peritonitis had diabetes mellitus as the underlying disease. The individual patients also had other significant combined morbidities, such as panhypopituitarism, COPD chronic obstructive pulmonary disease, cerebrovascular accident and myocardial infarction. The level of hemoglobin in these patients was significantly lower than in the controls, and the mean values of serum albumin, creatinine and BUN were also low.ConclusionImmune dysfunction due to uremia, anemia, malnutrition, other comorbidities (e.g. diabetes mellitus), and also, an indwelling peritoneal catheter may be predisposing factors for the S. maltophilia infection in CAPD patients. Once the S. maltophilia infection is diagnosed in CAPD patient, the patient should be treated based on the understanding of this particular organism.