Therapy Of Obstructive Pulmonary Disease Research Articles

TIOTROPIUM BROMIDE IN THERAPY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RECIPE FOR SUCCESS

Tiotropium bromide in therapy of chronic obstructive pulmonary disease: a recipe for success

P0675 PREDICTORS OF MORTALITY AND MORBIDITY IN CLOSTRIDIUM DIFFICILE INFECTION

Background Clostridium difficile (CD) is implicated in 20 to 30% of patients with antibiotic-associated diarrhoea, in 50 to 70% of those with antibiotic-associated colitis and in more than 90% of those with antibiotic-associated pseudomembranous colitis 1-4 . The incidence of CD associated diarrhoea ranges from 1 in 100 to 1 in 1,000 hospital discharges depending on the antibiotic prescribing habits of the hospital 5-7 . The consequences of CD can be severe. At one academic medical center over a three-year period, 21 of 710 cases (3%) of CD colitis required intensive care unit admission or died as a result of their infection 8 . These deaths were associated with co-morbid conditions such as malignancy, chronic obstructive pulmonary disease or renal failure and therapies such as immunosuppressive drugs, anti-peristaltic medications or the prior administration of clindamycin 9 . At another university hospital the morbidity of the infection was higher and 24 of 157 patients (15.3%) with CD colitis died from their infection 10 . The new variant of CD - which is capable of secreting much higher amounts of toxin A & B and is more resistance to standard antibiotic therapy - results in greater incidence in hospitalized patients 11 , a greater need for urgent colectomy for toxic colitis and a significantly higher mortality rate 12 . The economic consequences of CD infection can also be severe, with one report finding a mean cost of $10,970 (US$) per patient for the treatment of the infection and its complications 13 .

Progressive increase in cavitation with the evolution of fungus ball: A clue to the diagnosis of chronic necrotizing pulmonary aspergillosis

Chronic necrotizing pulmonary aspergillosis (CNPA) is an uncommon pulmonary infection seen in the patients with chronic obstructive pulmonary disease, bronchiectasis, pneumoconiosis, diabetes mellitus, alcoholism, poor nutrition or low dose corticosteroid therapy. Here, we are presenting a case of CNPA with diabetes mellitus that was misdiagnosed as pulmonary tuberculosis.

Antioxidant therapy of chronic obstructive pulmonary disease at the Far North

The aim of this study was to investigate human antioxidant defense at various COPD stages and to substantiate administration of vitamins C and E as a part of complex treatment of COPD at the Far North. We followed-up 92 COPD patients aged 20 to 50 yrs (of them, 42 males). The control group consisted of 58 healthy persons of 20 to 45 yrs of age. A total blood antioxidant activity (TAA) was detected using G.I.Klebanov's method. Superoxide dismutase (SOD) and catalase levels in erythrocyte membrane were assessed with chemiluminescent methods. Lipid peroxide (LPO) activity was measured by malone dialdehyde (MDA) plasma concentration. We also investigated hepatic and renal functions, protein, lipoid, and carbohydrate metabolism. Patients with exacerbation of stage II COPD had increased LPO activity (2.97 ± 0.12 nmol/ml compared to 1.86 ± 0.09 nmol/ml in stable phase and 1.36 ± 0.06 nmol/ml in controls) with TAA increased by 40 %. The stage III COPD patients demonstrated more significant growth of LPO activity (2.04 ± 0.08 nmol/ml in stable phase and 3.44 ± 0.15 nmol/ml in exacerbation; p < 0.05) accompanied by less prominent increase in TAA. Early stages of COPD were characterized by increased levels of antioxidant enzymes (2.44 ± 0.06 μg/g of Hb for SOD and 8.30 ± 0.15 –g/g of Hb for catalase compared to 1.56 ± 0.02 and 7.36 ± 0.10 μg/g Hb in controls). At the later COPD stages, the SOD level was less high and catalase concentration even decreased. COPD patients had increased concentrations of oxyproline (1.76 ± 0.48 g/ml to 2.80 ± 0.50 μg/ml; р<0.05 for both when compared to the controls) and α1-antitripsin (for stage II COPD, 284 ± 47 μg/ml in stable phase and 240 ± 20 μg/ml in exacerbation, for stage III COPD, 245 ± 18 μg/ml and 223 ± 15 μg/ml, respectively). Administration of vitamins C and E 25 mg/kg and 5 mg/kg of body weight, respectively, as a part of a complex therapy of the disease exacerbation resulted in shortening of exacerbation, improvement in clinical status and lung function, TAA activation, and lowering of LPO activity. Therefore, COPD is accompanied by significant activation of oxidantive processes, which depend on the stage and phase of the disease. The results allow including antioxidant vitamins in programs of treatment of COPD to be recommended.

Overview of current therapies.

The therapy of chronic obstructive pulmonary disease has been comprehensively reviewed in a number of international treatment guidelines. There is consensus about what elements should be included, but the purposes of therapy and the timing of its introduction remain poorly defined. Major factors limiting effective treatment beyond those associated with the biology of the condition itself are poor diagnostic methodology, failure to identify relevant co-morbidities and reluctance to devote appropriate resources to maximizing patient gain. Too many patients are identified at the end-stages of their illness when treatment is relatively limited. Most therapy is directed at reducing the impact of the disease in terms of symptoms, exercise performance and exacerbations on the individual and only smoking cessation modifies the evolution of the disease. Treatment of hypoxaemic patients with domiciliary oxygen improves mortality and slows the development of pulmonary hypertension. Effective smoking cessation is relevant at all stages of the disease. It depends on the willingness of the individual to participate, and quit rates can be improved by the use of nicotine replacement therapy and possibly bupropion. Inhaled bronchodilator drugs palliate symptoms and improve exercise performance in pharmacologically predictable ways. In patients with severe disease, reduction in operating lung volumes is more important than 'bronchodilitation' and is better sustained by long acting beta agonists and anticholinergics. Inhaled corticosteroids reduce exacerbation rates and improve health status in established disease but do not modify disease evolution. Pulmonary rehabilitation improves exercise performance and health status without changing underlying pulmonary mechanics. Whether hospitalizations and exacerbations can be modified is still to be established. Nutritional therapy is in its infancy but calorie supplementation alone is insufficient to improve patient well being. Selected individuals can undergo lung volume reduction surgery with benefits extending up to two years but the risks are dependent on the skill of the operators and the appropriateness of patient selection. Lung transplantation is symptomatically helpful but does not modify the natural history of the disease. Hospitalization due to exacerbations of disease is frequent and their treatment with bronchodilators, antibiotics and corticosteroids now have a basis in randomized trial data. Mortality reflects the incidence of respiratory acidosis and noninvasive ventilation has a role in safely managing patients outside of the intensive care unit. Effective prevention of exacerbation should be possible with newer antiviral agents but data are presently lacking.

Aerosol Therapy of Obstructive and Parenchymal Pulmonary Disease: Principles and Clinical Aspects

ABSTRACT Aerosols are the mainstay of the pharmacotherapy of reversible airflow obstruction (RAO). They are available as a variety of bronchodilators and anti-inflammatory/anti-allergic drugs provided by several aerosol delivery systems, making ingested therapy almost unnecessary for control of asthma and COPD. Oral steroids are however, frequently required during exacerbations and in a minority of patients with very severe asthma. Metered dose inhalers (MDI) are the most convenient, efficient and inexpensive way to deliver therapeutic aerosols, however, many patients, particularly children, the elderly and handicapped are unable to manipulate these effectively, even after repeated instruction. Such patients benefit from powder inhalers or MDI add-on devices such as valved holding chambers that assure aerosol delivery and minimize local and systemic side effects. Future promising developments include sympathomimetic and anticholinergic bronchodilators with a 12 hour or greater duration of action, topicall...