COPD
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There is little evidence that the guideline-recommended oxygen saturation of 92% is the best cut-off point for detecting hypoxemia in COPD exacerbations. ⋯ Our results support current recommendations for ordering blood gasometry based on pulse oximetry oxygen saturation cut-offs for hypoxemia. We also provide easy to use formulae to calculate pO2 from oxygen saturation measured by pulse oximetry.
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Chronic Obstructive Pulmonary Disease exacerbations are associated with worsening of airway inflammation, the nature of which may be neutrophilic, eosinophilic, or both. ⋯ This non-intervention study suggests that the cellular nature of bronchitis is largely unpredictable and needs to be examined at each COPD exacerbation This has important implications in choosing the appropriate therapy. Future intervention studies would provide further evidence.
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The aims of this study were to test the reproducibility of the 6-minute stepper test (6MST), and evaluate its accuracy in detecting improved functional capacity after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five COPD outpatients performed two 6MSTs in the same session, before (6MST1 and 6MST2) and after (6MST3 and 6MST4) PR. The performance, perceived exertion, heart rate and arterial oxygen saturation were measured during each 6MST. ⋯ The perceived exertions were lower after PR (P < 0.02). The systematic improvement of performance (8-10%) during the second 6MST of the each session may be explained from the warming of hydraulic jacks of the stepper and/or learning effect. On the other hand, the 6MST seems sufficiently sensitive to detect functional capacity improvements after PR in patients with COPD.
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Little is known about trends in prescriptions for benzodiazepines among patients with chronic obstructive pulmonary disease (COPD). Our objective was to examine trends of office/outpatient department visits with a mention of a benzodiazepine made by patients aged ≥40 years with COPD in the United States. We used data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1999-2010. ⋯ The unadjusted percentage of all office/outpatient department visits by patients with COPD with a mention of a benzodiazepine increased from 4.6% during 1999-2002 to 10.2% during 2007-2010 (P trend < 0.001). After adjustment for age, sex, and race, the adjusted prevalence ratio for 2007-2010 compared with 1999-2002 was 2.26 (95% confidence interval: 1.60-3.17). Since 1999, the number and percentage of office/outpatient department visits with a mention of a benzodiazepine by patients with COPD and all patients may have increased in the United States.
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The large surface area for gas exchange makes the respiratory system particularly susceptible to oxidative stress-mediated injury. Both endogenous and exogenous pro-oxidants (e.g. cigarette smoke) trigger activation of leukocytes and host defenses. These mechanisms interact in a "multilevel cycle" responsible for the control of the oxidant/antioxidant homeostasis. ⋯ Nevertheless, several clinical trials indicate that NAC may reduce the rate of COPD exacerbations and improve small airways function. The most plausible explanation for the beneficial effects observed in patients with COPD treated with NAC lies in the mucolytic and antioxidant effects of this drug. Modulation of bronchial inflammation by NAC may further account for these favorable clinical results.