Nihon rinsho. Japanese journal of clinical medicine
-
Review Randomized Controlled Trial
[Evidence of pharmacotherapy in COPD--key findings from recently-conducted randomized clinical studies].
The primary aim of pharmachotherapy in COPD is improvement of exertional dyspnea and quality of life through its bronchodilator effects. However, there is emerging evidence that pharmacotherapy may reduce exacerbations, alleviate annual decline of pulmonary function, and even favorably affect mortality, thus changing natural history of COPD. ⋯ In addition, carbocisteine, which is a mucolytic and anti-oxidant agent, has been shown to reduce exacerbations in COPD. Future directions on pharmacotherapy are personalized medicine based on phenotyping of the disease and development of new agents which may cure airway inflammation in COPD.
-
The prevalence of COPD in Japan is revealed to be 8.6 % which is almost the same as foreign countries. However, there are many undiagnosed COPD patients. More than half of undiagnosed COPD patients go regularly to medical institution with other diseases. ⋯ If they have smoking history or some respiratory symptoms, the prevalence of COPD is 22 %. In Japanese reports, atherosclerosis is detected in 73.8 % of COPD patients, and the prevalence of COPD is high in heart failure, ischemic heart failure and liver diseases. The effort to decrease the mortality of COPD in Japan is necessary.
-
Review
[Guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 3rd edition].
The third edition of COPD guidelines of the Japanese Respiratory Society can provide clinicians with practically applicable information covering all the main points such as definition, stage classification and severity, treatment and management, COPD with asthma, and clinical care system. The guidelines are clear and useful in the diagnosis and management for COPD as complex disease or syndrome.
-
[Further examination of COPD using spirometry, respiratory function test, and impulse oscillometry].
Spirometry is essential for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Characteristic of physiological change of small airways in COPD is heterogeneous distribution of small airway narrowing, resulting in air-trapping and nonhomogeneous ventilation. ⋯ Impulse oscillometry is also useful for assessment of small airways disease, especially indices of frequent resonance (Fres) and frequent dependent of resistance change of R5-R20; resistance at 5 Hz minus resistance at 20 Hz. Impulse oscillometry seems to have a complemental role of spirometry in managing COPD.
-
Non-drug treatments such as long term oxygen therapy (LTOT) and non-invasive positive pressure ventilation (NPPV) are thought important for patients with chronic obstructive pulmonary disease (COPD). It is reported that LTOT can improve the prognosis of patients with COPD, particularly who have severe respiratory failure. NPPV attracted attention to avoid endotracheal intubation and high efficacy in patients with acute exacerbation of COPD. In chronic phase of COPD, NPPV may improve the quality of life in patients with hypercapnia, selected carefully.