Respiratory medicine
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Respiratory medicine · Jun 2008
ReviewIt's about time--directing our attention toward modifying the course of COPD.
The course of COPD has traditionally been equated with an accelerated decline in the forced expiratory volume in one second (FEVi) over time in patients with COPD, compared to healthy individuals. However, other important clinical outcomes associated with COPD also worsen over time and should also be considered in conceptualizing the course of COPD. These include health status, breathlessness related to activities of daily living, exercise capacity, the frequency of exacerbations, and peripheral muscle weakness. ⋯ As novel therapeutic agents become available that may alter the underlying pathology of COPD, additional markers and outcomes of disease progression will be needed to provide a more comprehensive assessment. There has been increasing interest in predicting and assessing mortality as it is the final outcome of disease progression. In this review we have considered three approaches toward modifying the course of COPD: smoking cessation, reduction in lung hyperinflation through medical and surgical approaches, and long-term pharmacotherapy.
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Respiratory medicine · Jun 2008
ReviewInhaled corticosteroids during pregnancy: a review of methodologic issues.
There is evidence in the literature that inhaled corticosteroids (ICSs) are safe for pregnant women with asthma and their infants. Although this is useful information about ICS use during pregnancy, some articles must be viewed cautiously because of lack of power and adjustment for potentially important confounding variables. ⋯ While there currently is some degree of evidence to support the safety of ICS use during pregnancy, this review highlights the limited statistical power of several studies published in this area.
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Respiratory medicine · Jun 2008
Randomized Controlled TrialAntioxidant effect of zinc picolinate in patients with chronic obstructive pulmonary disease.
An imbalance between oxidative stress and antioxidant capacity is thought to play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, studies in regard to stable COPD patients and effect of zinc supplementation are lacking. We investigated the effects of zinc picolinate supplementation on the oxidant stress, and pulmonary function tests (PFTs) of patients with stable COPD. ⋯ In conclusion, the results indicate that zinc supplementation may have favorable effects on oxidant-antioxidant balance in patients with COPD. The lack of an effect on PFT may be due to the short duration of the supplementation. Longer duration of zinc supplementation may be necessary to see clinical benefit.
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Respiratory medicine · Jun 2008
Clinical TrialOne-year non-invasive ventilation in chronic hypercapnic COPD: effect on quality of life.
The data on long-term application of non-invasive ventilation (NIV) in patients with chronic respiratory failure due to COPD are contradictory. We evaluated the effect of the addition of NIV to optimal treatment for 1 year on the quality of life of stable hypercapnic COPD patients. NIV was offered to 49 of 58 initially enrolled consecutive patients, of whom 22 refused NIV and comprised the standard treatment group whereas 27 received NIV. ⋯ No significant improvements were observed in the control group. Patients on NIV spent less days in the hospital compared to controls. NIV when added to optimal medical treatment has beneficial effects on quality of life in stable hypercapnic COPD patients, with additional improvements in arterial blood gases, dyspnea and daytime sleepiness.
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Respiratory medicine · Jun 2008
Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life.
Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death. ⋯ Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD.