Predictor Of Respiratory Mortality Research Articles

Treatment outcomes of pneumothorax with chronic obstructive pulmonary disease

Coexisting pulmonary fibrosis and emphysema in the same individual has received increased attention. We retrospectively investigated treatment outcomes of secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with both pulmonary fibrosis and emphysema. Among 362 consecutive secondary spontaneous pneumothorax patients treated at our hospital from 2003 to 2012, 58 with emphysema-dominant chronic obstructive pulmonary disease (all elderly men with a smoking history) were enrolled and divided into 2 groups based on computed tomography images: emphysema alone (n = 51) and coexisting emphysema and pulmonary fibrosis (n = 7). The clinical characteristics and mortality were compared between the 2 groups. There was no significant difference in the recurrence rate after nonsurgical treatment. No patient died of pneumothorax-related complications, but one of 2 with pulmonary fibrosis who underwent surgery died of a postoperative respiratory complication. The mortality rate from respiratory failure during follow-up was significantly higher in the group with pulmonary fibrosis (6/7) than in the group without pulmonary fibrosis (11/51, p = 0.002). The median survival was 0.8 years in the group with pulmonary fibrosis vs. and 5.4 years in the group without pulmonary fibrosis. The coexistence of pulmonary fibrosis and emphysema on computed tomography images may represent a predictor of respiratory mortality in elderly chronic obstructive pulmonary disease patients with secondary spontaneous pneumothorax. Because of the potential risk of respiratory failure, we recommend nonsurgical treatment for secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with these radiological features.

Relationship between respiratory mortality and self-perceptions of aging

Although there is growing evidence that psychological factors affect an individual's susceptibility to respiratory illnesses, psychological predictors of respiratory mortality have received little attention. This study investigated whether an age-specific psychological factor, older individuals’ beliefs about their own aging, predicted the likelihood of their dying from respiratory causes (ICD-9: 460–519). The sample was composed of 620 individuals, aged 50–87 years at baseline, who participated in a longitudinal study with six waves. Our research found that individuals with higher baseline positive self-perceptions of aging were significantly less likely to die of respiratory causes over the next 23 years, after controlling for age, functional health, gender, loneliness, marital status, self-rated health, and socioeconomic status (hazard ratio = 0.695; p < 0.005). This is the first study to link individual beliefs about aging to cause-specific mortality. Future research is warranted to further elucidate the relationship between self-perceptions of aging and resistance to respiratory mortality.

Nutritional status and mortality in chronic obstructive pulmonary disease.

The role of nutritional status in the prognosis of subjects with severe chronic obstructive pulmonary disease was studied in a cohort of Canadian men and women followed for 3 to 5 yr. A total of 348 subjects who were recruited for a study of negative pressure ventilation were evaluated for lung function and body weight, and a subset who entered hospital for the study (n=184) had baseline measures of diffusing capacity, maximal inspiratory and expiratory mouth pressure (PImax and PEmax), and blood gases. Predictors of survival were analyzed using Cox regression models. In the total cohort, low body mass index (BMI) and use of home oxygen were independently associated with reduced survival. In the hospitalized group, predictors of respiratory mortality were elevated PaCO2 and low BMI, PImax, and diffusing capacity. PaO2 (measured on oxygen therapy), FEV1, PEmax, age, smoking behavior, and gender were not associated with survival. The predictors of total mortality were similar, except that BMI was no longer significant. In conclusion, low body weight, a potentially modifiable factor, was associated with respiratory mortality, but whether it has a casual effect or is a marker of declining health can only be resolved through an intervention trial.