Respiration; international review of thoracic diseases
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Review
Relation of chronic obstructive pulmonary disease exacerbations to FEV(1)--an intricate tango.
This article provides a brief review of the complex interrelationships that surround chronic obstructive pulmonary disease exacerbations and lung function, particularly FEV(1). Areas of discussion include a consideration of baseline lung function as a risk factor for exacerbation, the magnitude and duration of lung function abnormalities after onset and during recovery from exacerbations, the relation between changes in lung function during an exacerbations and clinical outcomes, and the potential impact of recurrent exacerbations on long-term deterioration in lung function.
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Airway stenting is nowadays an established method for the palliative and/or curative treatment of central airways obstruction. However, complications related to the use of airway stents have been reported. ⋯ The accumulated and evaluated evidence suggests that SARTI probably involves 1 in 5 patients with airway stent. Although the possibility of SARTI should not discourage the interventional pneumologists from inserting airway stents, the data seem to underline the urgent need for establishing a consensus definition and diagnostic criteria for SARTI.
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Disabled patients with chronic respiratory disease and peripheral skeletal muscle disorders have limitations in their exercise capacity, which may be improved after specific training in a pulmonary rehabilitation (PR) program. Individual assessment of exercise capacity by clinically available exercise tests represents an important patient-centered outcome that should be embedded in the rehabilitation process. These measurements include laboratory (treadmill and/or cycle ergometer) and field (walking) tests. ⋯ These tests are inexpensive and provide information on an individual's functional abilities: the 6-min walking test has been shown to provide level of disability and functional status, whereas the shuttle walking test has been shown to be more suitable to detect change of physical performance following PR. Overall, several available physiologically targeted tests are useful to measure the patient's tolerance to exercise, and many are even sensitive to change once intervention has taken place. In particular, endurance modality tests seem to provide better measurement of changes after PR than incremental exercise tests.
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Obstructive sleep apnoea syndrome (OSAS) has been suggested to be an independent risk factor for non-alcoholic fatty liver disease (NAFLD), possibly via intermittent hypoxia that influences blood pressure, lipid levels and insulin resistance, factors themselves known to cause NAFLD. In observational studies, OSAS has been associated with elevated levels of liver enzymes. Continuous positive airway pressure (CPAP) is the treatment for OSAS, but the effects of CPAP on liver enzymes have not been studied in a randomized controlled trial. ⋯ Four weeks of active CPAP has no beneficial effect on aminotransferase levels when compared to sub-therapeutic CPAP in patients with OSAS. Therefore, CPAP does not seem to improve biochemical markers of potential NAFLD in OSAS patients.
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Acute respiratory distress syndrome (ARDS) is a common diagnosis in intensive care units (ICUs) and is frequently correlated with acute kidney injury (AKI). ⋯ In patients with ARDS undergoing OLB, the use of the RIFLE score improves prediction of outcome.