Respiratory medicine
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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in adults. Although FEV(1) remains the most important physiologic indicator of the severity of airflow obstruction in COPD, its predictive value for mortality is weak when it is higher than 50% of predicted. ⋯ The validated multidimensional BMI (B), degree of airflow obstruction as expressed by the FEV(1) (O), dyspnea with the modified medical research council (D), and exercise (E) measured with the 6min walk or BODE index encompasses the predictive validity of the best of these variables into a single surrogate measure of disease severity and survival. This article reviews these predictors of mortality in COPD.
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Respiratory medicine · Jun 2010
Multicenter StudyDeterminants of poor 6-min walking distance in patients with COPD: the ECLIPSE cohort.
The 6-min walking test (6MWT) is widely used to assess exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Given the prognostic significance of the 6MWT, it is important to identify why some COPD patients perform poorly in terms of this outcome. We aimed to identify clinical determinants of a poor 6-min walking distance (<350 m) in patients with COPD. ⋯ The determinants of poor 6MWD are complex and depend on both physical (both pulmonary and non-pulmonary factors) and psychological factors as evaluated from a large multinational cohort of well-characterised patients with clinically stable moderate to very severe COPD.
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Respiratory medicine · Jun 2010
Mechanical ventilation induces changes in exhaled breath condensate of patients without lung injury.
Measurement of biomarkers in exhaled breath condensate (EBC) may be useful for monitoring lung inflammation and injury in mechanically ventilated patients. The aim of this study was to analyze changes in biomarkers of inflammation in EBC associated with prolonged mechanical ventilation. ⋯ EBC analysis is a non-invasive technique that can be used to monitor ventilated patients. Mechanically ventilated patients had higher EBC acidity and nitrogen oxide concentrations. Duration of ventilation correlated with breath condensate pH.
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Respiratory medicine · Jun 2010
HSP47 in lung fibroblasts is a predictor of survival in fibrotic nonspecific interstitial pneumonia.
The histopathologic pattern is currently the most important prognostic marker for idiopathic interstitial pneumonia (IIP). However, more highly sensitive markers are now required. Heat shock protein (HSP) 47, a collagen-specific molecular chaperone, is involved in the processing and/or secretion of procollagens, and it has been demonstrated that HSP47 expression is significantly higher in the lung specimens of idiopathic UIP than in UIP associated with collagen vascular diseases (CVD). However, its expression in nonspecific interstitial pneumonia (NSIP), the other common pathological pattern of IIP, has not been well investigated. Therefore, the association between lung fibroblast HSP47 expression and prognosis in fibrotic NSIP was evaluated. ⋯ The present results suggest that lung fibroblast HSP47 expression may be a useful new prognostic marker for idiopathic fibrotic nonspecific interstitial pneumonia.