Thorax
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This review presents the evidence that chronic obstructive pulmonary disease (COPD) is associated with significant sinonasal symptoms, inflammation and airway obstruction. Upper airway symptoms in COPD cause impairment to quality of life. The severity of upper airway involvement relates to that present in the lower airway, suggesting that the nose may be used to model the lung in COPD. More importantly, relationships between upper and lower airway bacteria and inflammation, and the association between sinusitis and treatment failure at exacerbation raise the possibility that nasal intervention in COPD may not only improve health status but may also affect important clinical outcomes such as exacerbation frequency.
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Multicenter Study
Body mass index is associated with the development of acute respiratory distress syndrome.
The relationship between body mass index (BMI) and development of acute respiratory distress syndrome (ARDS) is unknown. ⋯ BMI was associated with increased risk of ARDS in a weight-dependent manner and with increased length of stay, but not with mortality. Additional studies are needed to determine whether differences in initial ventilator settings may contribute to ARDS development in the obese.
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Early life development may influence subsequent respiratory morbidity. The impact of factors determined in childhood on adult lung function, decline in lung function and chronic obstructive pulmonary disease (COPD) was investigated. ⋯ People with early life disadvantage have permanently lower lung function, no catch-up with age but a slightly larger decline in lung function and a substantially increased COPD risk. The impact of childhood disadvantage was as large as that of heavy smoking. Increased focus on the early life environment may contribute to the prevention of COPD.
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Host- and pathogen-related factors associated with septic shock in pneumococcal pneumonia are not well defined. The aim of this study was to identify risk factors for septic shock and to ascertain patient outcomes. Serotypes, genotypes and antibiotic resistance of isolated strains were also analysed. ⋯ Septic shock is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Current tobacco smoking, chronic corticosteroid treatment and infection caused by serotype 3 are independent risk factors for this complication.