American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 1996
Multicenter StudyOutcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments)
In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective cohort of 1,016 adult patients from five hospitals who were admitted with an exacerbation of COPD and a PaCO2 of 50 mm Hg or more. Patient characteristics and acute physiology were determined. Outcomes were evaluated over a 6 mo period. ⋯ At 6 mo, only 26% of the cohort were both alive and able to report a good, very good, or excellent quality of life. Survival time was independently related to severity of illness, body mass index (BMI), age, prior functional status, PaO2/FI(O2), congestive heart failure, serum albumin, and the presence of cor pulmonale. Patients and caregivers should be aware of the likelihood of poor outcomes following hospitalization for exacerbation of COPD associated with hypercarbia.
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Am. J. Respir. Crit. Care Med. · Oct 1996
Comparative StudyAsthma among Puerto Rican Hispanics: a multi-ethnic comparison study of risk factors.
For a study of childhood asthma we interviewed 9,276 mothers during 1993-1994, ascertaining whether they had asthmatic children younger than 18 yr of age and asking about genetic and environmental risk factors for asthma. Independent risk factors for asthma in 7,776 children were: Hispanic and African American ethnicity, maternal history of asthma, lower socioeconomic status (SES) of the mother, and the presence of a cigarette smoker in the household. Hispanic ethnicity was also a strong risk factor for asthma in the mother. ⋯ The marked increased risk for asthma in children of Hispanic mothers was not explained by SES or maternal age. In addition, increased risk for asthma in these children was not associated with higher reporting of environmental tobacco smoke (ETS) exposure. In this study of asthma in primarily Puerto Rican Hispanics, the risk of physician-diagnosed asthma as reported by mothers was significantly associated with Hispanic ethnicity, and it was not confounded by SES or active smoking in the home.
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Am. J. Respir. Crit. Care Med. · Oct 1996
ReviewPertussis antigens that abrogate bacterial adherence and elicit immunity.
Infectious disease processes follow the initial steps of adherence of the organism to host tissues and subsequent colonization of the target tissues that can occur through specific adhesion-receptor systems. Bordetella pertussis, the human pathogen that causes whooping cough, has evolved a genetically controlled system whereby adhesins are expressed when they enter the human host. ⋯ Substantial evidence exists that the B. pertussis adhesins, FHA and pertactin, elicit immune responses that are protective in animal models for the disease, including serum antibody production and local immune responses in the respiratory tract following nasal administration of encapsulated antigens. Both of these adhesins are components of new acellular pertussis vaccines that have proven safe and highly effective for prevention of serious disease in infants.
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Am. J. Respir. Crit. Care Med. · Oct 1996
Mechanism of short-term improvement in lung function after emphysema resection.
We prospectively investigated the mechanism of airflow limitation before and after targeted emphysematous resection in 12 consecutively studied adult patients 68 +/- 4 yr of age (mean +/- SD) with very severe COPD undergoing bilateral thoracoscopic stapling techniques. Lung function, static lung elastic recoil, and airway conductance was measured 2 wk before and 5 to 6 mo after surgery. After surgery, there was a significant (p < 0.01) reduction in TLC (9.3 +/- 0.3 [mean +/- SEM] to 7.7 +/- 0.4 L), functional residual capacity, and residual volume. ⋯ Analysis of maximal expiratory flow-static elastic recoil pressure curve indicated that conductance of the S segment (Gs) increased from 0.20 +/- 0.03 (mean +/- SEM) to 0.27 +/- 0.03 L/s/cm H20 (p < 0.01), and the critical transmural pressure (Ptm') decreased from 3.1 +/- 0.2 to 2.4 +/- 0.2 cm H20 (p < 0.02). Mean airway conductance increased from 0.14 to 0.22 L/s/cm H20 (p < 0.01). The improvement in maximal expiratory airflow can be primarily attributed to increased lung elastic recoil and its secondary effect on enlarging airway diameter causing increased airway conductance, increased Gs, and decreased Ptm'.