COPD
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The measurements of lung compliance, airway resistance and respiratory dead space as clinical tests have gradually fallen into disuse as the standard pulmonary function testing procedures; spirometry, lung volume and diffusing capacity measurement, followed, if necessary, by imaging have become the norm for diagnosis of COPD and other lung diseases. To have a real understanding of what spirometry and lung volume tests measure requires some knowledge of compliance and airway resistance. The respiratory dead space is an important global indicator of ventilation/perfusion relationships that remains of interest in the early detection of pulmonary emboli. There are other situations as well where it is clinically useful to perform the measurements described here, so these techniques, although generally set aside from the commonly used tests, should not be forgotten.
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The purpose of this endeavor is to compare the morbidity, mortality and costs of LVRS versus transplantation in severe emphysema. This was a retrospective review of severe emphysema patients who received LVRS (n = 70) from 1994-1999, or transplant (n = 87) from 1994-2004. Change in functional status was calculated by the change in modified BODE (mBODE) score. ⋯ During a mean follow-up of 2.4 +/- 2.5 years after transplant and 5.0 +/- 3.1 years after LVRS, transplantation mean total costs were greater ($381,732 vs. $140,637, p < 0.0001). Transplantation patients spent more time in the hospital (74.3 +/- 81.3 vs. 39.5 +/- 66.7 days, p = 0.009) and had more outpatient visits (29.9 +/- 28.8 vs. 12.3 +/- 12.6 visits, p < 0.0001). In patients who survive over 1 year, transplantation provides a higher level of functional status and a greater improvement in airflow obstruction, dyspnea, exercise tolerance, and mBODE score, but costs more and carries greater mortality.
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Multicenter Study
Decline in FEV1 in relation to incident chronic obstructive pulmonary disease in a cohort with respiratory symptoms.
Data on the relationship between decline in lung function and development of COPD are sparse. We assessed the decline in FEV1 during 10 years among subjects with respiratory symptoms by two different methods and evaluated risk factors for decline and its relation to incident Chronic Obstructive Pulmonary Disease, COPD. A cross-sectional postal questionnaire was in 1986 sent to 6610 subjects of three age strata. ⋯ Gender-specific analysis revealed that smoking was a stronger risk factor in women than in men, while higher age was a significant risk factor in men only. In conclusion, decline in FEV1 was associated with age, smoking, and chronic productive cough, but the risk factor pattern was gender-dependent. Among incident cases of COPD the decline was steeper and close to a quarter had a rapid decline.
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Increased bronchial epithelial cell apoptosis and CD8+ T-cell numbers in the blood and airways have been reported in COPD. These cells can induce apoptosis via the granzyme-b/perforin-mediated pathway. We hypothesized that increased levels of granzyme-b/perforin would be detected in COPD, contributing to apoptosis and tissue damage. ⋯ Most circulating NK cells expressed granzyme-b/perforin, with the median fluorescence intensity of staining increased in both COPD groups and asymptomatic smokers. Granzyme-mediated apoptosis may thus be one mechanism of lung injury in COPD. The changes that persist despite smoking cessation in COPD likely reflect pathophysiological changes in COPD as opposed to the effects of smoking per se.
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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States. In 2000, an estimated 10.5 million people had COPD, of which more than 7.2 million were from the under-age 65 employed population. The prevalence of COPD in the workforce population was substantial with 46.5% of current employment among adults having the disease. ⋯ COPD-related per patient total medical costs decreased from $1460 in 1999 to $1138 in 2003 largely because of a decrease in the cost of hospitalizations for COPD. In contrast, mean per patient expenditures for outpatient services increased over the same period from $243 in 1999 to $295 in 2003. The cost of COPD to employers is high, but the cost could be reduced by programs aimed at preventing new cases of COPD, reducing hospitalizations, and providing more outpatient services to COPD patients.