Respiratory medicine
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Respiratory medicine · Nov 2011
Comparative StudyNADPH oxidase p22phox polymorphisms and oxidative stress in patients with obstructive sleep apnoea.
Obstructive Sleep Apnoea (OSA) is associated with increased oxidative stress. NADPH oxidases are the main source of Reactive Oxygen Species (ROS) in the vasculature. Several polymorphisms related to NADPH oxidase expression or activity have been identified. We compared the distribution of the allelic frequencies of A-930G and C242T polymorphisms and their possible relationship with the levels of 8-isoprostanes as a marker of oxidative stress in patients with OSA and in a control group without OSA. ⋯ the A-930G polymorphism of the p22phox gene may play an important role in genetic susceptibility to OSA. Furthermore, the C242T and A-930G polymorphisms of the p22phox gene have a synergic effect on the 8-isoprostane levels, suggesting that they may be involved in the development of oxidative stress in these patients.
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Respiratory medicine · Nov 2011
The health, activity, dyspnea, obstruction, age, and hospitalization: prognostic score for stable COPD patients.
Multidimensional instruments for determining the severity and prognosis of chronic obstructive pulmonary disease (COPD) must be used in daily clinical practice. ⋯ To develop and validate a new COPD severity score using variables readily obtained in clinical practice and to compare its predictive capacity with that of other multidimensional indexes. Data collected from a prospective cohort of 611 stable COPD patients were used to derive a clinical prediction rule that was later validated in a separate prospective cohort of 348 patients. In the multivariate analyses, six independent predictive factors were correlated with overall and respiratory mortality: health status, physical activity, dyspnea, airway obstruction (FEV(1)), age, and hospitalizations for COPD exacerbations in the previous two years. These create the HADO-AH score. Based on the β parameter obtained in the multivariate model, a score was assigned to each predictive variable. The area under the curve for 5-year mortality was 0.79 (95% CI, 0.74-0.83) in the derivation cohort and 0.76 (95% CI, 0.71-0.81) in the validation cohort. The HADO-AH score was a significantly better predictor of mortality than the HADO-score and the Body-mass index, Obstruction, Dyspnea, Exercise-index were statistically significant (p < 0.0004 and p = 0.021, respectively), but was similar to the Age, Dyspnea, and Obstruction-index (p = 0.345). The HADO-AH score provides estimates of all-cause and respiratory mortality that are equal to, or better than, those of other multidimensional instruments. Because it uses only easily accessible measures, it could be useful at all levels of care.
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Respiratory medicine · Nov 2011
Randomized Controlled TrialEffects of inspiratory muscle training in patients with heart failure.
To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients. ⋯ The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.
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Respiratory medicine · Nov 2011
Comparative StudyCost-utility analysis of indacaterol in Germany: a once-daily maintenance bronchodilator for patients with COPD.
Indacaterol is a novel inhaled once-daily long-acting beta(2)-agonist (LABA) for the maintenance treatment of COPD that has been compared to existing inhaled monotherapies on a number of symptomatic endpoints in clinical studies. With constrained healthcare budgets, the objective of this analysis was to evaluate the cost-effectiveness of indacaterol 150 μg, the approved starting dose for maintenance therapy, from a German heath service perspective against the most widely used bronchodilator tiotropium, and the twice-daily LABA, salmeterol. ⋯ Indacaterol is cost-effective compared to tiotropium and salmeterol.
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Respiratory medicine · Oct 2011
Weight of the IDSA/ATS minor criteria for severe community-acquired pneumonia.
The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria. ⋯ The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.