The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Comparative Study
Protective effect of pneumococcal vaccine against death by pneumonia in elderly subjects.
The present study assessed the effectiveness of the 23-valent pneumococcal polysaccharide vaccine to prevent pneumonia and death in older adults in a first-time report between January and December 2002. A prospective cohort study was conducted including all individuals>or=65 yrs of age assigned to one of eight primary care centres in Tarragona, Spain (n=11,241). The primary outcomes were community-acquired pneumonia (hospitalised or outpatient) and death from pneumonia. ⋯ Pneumococcal vaccination did not alter the risk of hospitalisation from pneumonia (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.50-1.28) or overall pneumonia (HR: 0.86; 95% CI: 0.56-1.31), but the vaccine was associated with considerable reductions of death risk from pneumonia (HR: 0.28; 95% CI: 0.09-0.83). In conclusion, these results suggest that pneumococcal polysaccharide vaccine may not be effective in reducing the incidence of pneumonia, but may be able to diminish the severity of the infection. These findings support the effectiveness of the pneumococcal polysaccharide vaccine to prevent mortality caused by pneumonia in older adults, providing a new argument to recommend systematic vaccination in the elderly.
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Randomized Controlled Trial Comparative Study
Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD.
To assess the clinical impact of noninvasive mechanical ventilation (NIMV) on stable hypercapnic chronic obstructive pulmonary disease, changes in exercise capacity, dyspnoea and simple physiological parameters were evaluated. The time course of these effects during treatment and recovery was also assessed. Patients were randomly allocated to NIMV (n=27) or sham-NIMV (n=15), applied 3 h.day-1, 5 days a week, for 3 weeks. ⋯ Dyspnoea improved with a mean TDI of three points. Changes in 6MWD were highly related to TDI and to a lesser extent to changes in FEV1 (r=0.60). The current authors conclude that noninvasive mechanical ventilation has significant and sustained clinical impact in stable hypercapnic chronic obstructive pulmonary disease.
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Multicenter Study Comparative Study
Sentinel-site surveillance of Mycobacterium avium complex pulmonary disease.
The incidence of Mycobacterium avium complex (MAC) pulmonary disease in HIV-negative patients was studied prospectively from January 1, 2000 to December 31, 2002 through 32 sentinel sites distributed all over France. Among the 275 patients who yielded MAC isolates from respiratory clinical specimens, 101 (36.7%) met the bacteriological, radiographical and clinical criteria established by the American Thoracic Society for nontuberculous mycobacterial respiratory disease. ⋯ All patients with MAC respiratory disease had clinical symptoms, commonly cough and fatigue, and 52 (51.5%) were sputum smear positive for acid-fast bacillus. The ratio of patients with Mycobacterium avium complex pulmonary disease to patients with pulmonary tuberculosis in France was estimated to be 3% and the incidence of Mycobacterium avium complex pulmonary disease in France was 0.2 per 100,000 inhabitants.
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Comparative Study
Autofluorescence videothoracoscopy in exudative pleural effusions: preliminary results.
Videothoracoscopy has been proven to be a safe tool to establish the diagnosis in >90% of patients with exudative pleural effusions of unknown origin. In the majority of patients with malignant pleural diseases, the endoscopic appearance of pleural lesions during white light thoracoscopy is suggestive of malignancy, but could be misleading in some cases. The aim of the present study was to estimate whether the combination of thoracoscopy with autofluorescence modalities would be useful to further improve the diagnostic accuracy of the conventional method. ⋯ However, in two cases of chronic pleuritis, a colour change from white/pink to orange/red was recorded (specificity 75%). In conclusion, the calculated positive predictive value of colour change for malignant pleuritis during autofluorescence thoracoscopy in this study was 92%. However, the clinical value of autofluorescence thoracoscopy in daily practice remains to be proven.
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Comparative Study
Cytokine and chemokine expression in cigarette smoke-induced lung injury in guinea pigs.
The guinea pig model of cigarette smoke (CS)-induced lung injury is known to exhibit many pathophysiological similarities to chronic obstructive pulmonary disease (COPD), but the expression profiles of inflammatory mediators in the lung are poorly understood. Quantitative real-time RT-PCR was used in this study to investigate the pulmonary expression profiles of cytokine and chemokine mRNA in response to single or repeated CS exposure in guinea pigs. ⋯ In conclusion, in guinea pigs, inflammatory mediator changes in the lungs following cigarette smoke exposure are largely similar to those reported for smokers and/or chronic obstructive pulmonary disease patients. This model will therefore be useful to further understand the pathogenesis of chronic obstructive pulmonary disease.