Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Aug 2015
ReviewThe Role of Noninvasive Ventilation in the Hospital and Outpatient Management of Chronic Obstructive Pulmonary Disease.
Positive pressure noninvasive ventilation (NIV) has become widely accepted in the treatment of both hospitalized and outpatient subjects with chronic obstructive pulmonary disease (COPD). The support has evolved over the past two decades to be part of first-line management in acute exacerbations of COPD and is also instrumental in discontinuing mechanical ventilation in COPD patients with acute respiratory failure. It is also suitable for treatment of COPD with other associated conditions including pneumonia, following lung resectional surgery, with concomitant obstructive sleep apnea and as part of end-of-life care. ⋯ However, an approach with higher pressures with a goal of significant reduction in daytime PaCO2 may be an effective strategy. NIV can also facilitate exercise training in pulmonary rehabilitation. A portable device which can augment tidal volume during ambulation and other activities of daily living may further expand the use of NIV in COPD patients.
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Semin Respir Crit Care Med · Aug 2015
ReviewThe Promise of Observational Studies (ECLIPSE, SPIROMICS, and COPDGene) in Achieving the Goal of Personalized Treatment of Chronic Obstructive Pulmonary Disease.
Personalized medicine is based on the concept that individuals differ from one another. Chronic obstructive pulmonary disease (COPD) is particularly in need of a personalized medicine strategy. ⋯ These studies have accumulated a uniquely rich set of clinical and biological data on relatively large cohorts of patients who have already influenced the way in which COPD is viewed. These studies have great potential to advance understanding of COPD so that the goal of personalized treatment can be pursued.
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Semin Respir Crit Care Med · Aug 2015
ReviewSurgical Approaches to Treating Emphysema: Lung Volume Reduction Surgery, Bullectomy, and Lung Transplantation.
Chronic obstructive pulmonary disease (COPD) is a common and morbid progressive disease where treatment is focused on improving dyspnea, reducing exacerbations, attenuating comorbidities, and improving quality of life. Surgical therapy can be beneficial to a carefully selected subset of individuals and is the subject of this review. The National Emphysema Treatment Trial (NETT) has not only demonstrated the efficacy of lung volume reduction surgery (LVRS) but has also provided many lessons regarding advanced emphysema. ⋯ Careful patient selection is paramount to success, as there clearly are patients in whom LVRS increases mortality. Giant bullae are rare, but bullectomy has been demonstrated to improve dyspnea and lung function in cases where the bulla occupies at least one-third of the hemithorax and compresses some adjacent lung tissue. For patients with chronic respiratory failure due to COPD who have not improved despite maximal surgical and medical therapy, lung transplantation remains an option in those without significant comorbid conditions.
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Semin Respir Crit Care Med · Aug 2015
ReviewSupplemental Oxygen Therapy for Patients with Chronic Obstructive Pulmonary Disease.
Oxygen is necessary for aerobic metabolism. Since the human body cannot produce or store oxygen, a continuous and adequate delivery of oxygen needs to be secured by oxygen uptake from inhaled air via the respiratory system and oxygen delivery to body tissues via the circulation. ⋯ In this article, we review the physiological effects and discuss the clinical benefits of oxygen therapy. We also evaluate the evidence supporting and arguing against its use in the published literature, discuss its risks and benefits, define criteria for prescribing oxygen therapy, and review methods of oxygen delivery in home settings.