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Medical pneumoplasty, surgical resection, or lung transplant.

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Medical pneumoplasty, surgical resection, or lung transplant.

Med Clin North Am. 2012 Jul;96(4):827-47

Authors: Cordova FC

Abstract
Bullectomy, lung volume reduction surgery and lung transplantation have been shown to improve lung function, exercise capacity and quality of life in patients with advanced COPD. Careful patient selection and the use of optimal surgical procedure are important to ensure good clinical outcome. Advances in bronchoscopic techniques have allowed non-surgical lung volume reduction that replicate the clinical benefit of LVRS without its' associated morbidity and mortality. Promising endoscopic lung volume reduction techniques that are in various phases of development include the deployment of unidirectional endobronchial valves, instillation of biodegradable gel, and creation of airways bypass tracts.

PMID: 22793947 [PubMed - in process]

Breath Biomarkers in Diagnosis of Pulmonary Diseases.

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Breath Biomarkers in Diagnosis of Pulmonary Diseases.

Clin Chim Acta. 2012 Jul 13;

Authors: Zhou M, Liu Y, Duan Y

Abstract
Breath analysis provides a convenient and simple alternative to traditional specimen testing in clinical laboratory diagnosis. As such, substantial research has been devoted to the analysis and identification of breath biomarkers. Development of new analytes enhances the desirability of breath analysis especially for patients who monitor daily biochemical parameters. Elucidating the physiologic significance of volatile substances in breath is essential for clinical use. This review describes use of breath biomarkers in diagnosis of asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), lung cancer, as well as other pulmonary diseases. A number of breath biomarkers in lung pathophysiology will be described including nitric oxide (NO), carbon monoxide (CO), hydrogen peroxide (H(2)O(2)) and other hydrocarbons.

PMID: 22796631 [PubMed - as supplied by publisher]

Association between Antibiotic Treatment and Outcomes in Patients Hospitalized with Acute Exacerbation of COPD Treated with Systemic Steroids.

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Antibiotics are widely used in acute exacerbation of COPD (AE-COPD), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of steroid treated patients who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens.

METHODS: Retrospective cohort study of patients aged ≥ 40 years hospitalized for AE-COPD from January 1, 2006 through December 1, 2007 at 410 acute care hospitals throughout the United States.

RESULTS: Of the 53,900 patients who met the inclusion criteria 85% were treated with antibiotics in the first 2 hospital days; 50% were treated with a quinolone, 22% with macrolides plus cephalosporin and 9% with macrolide monotherapy. Compared to patients not treated with antibiotics, those who received antibiotics had lower mortality (1% vs. 1.8%, p<0.0001). In multivariable analysis, receipt of antibiotics was associated with a 40% reduction in the risk of in-hospital mortality (RR 0.60, 95% CI, 0.50-0.73) and a 13% reduction in the risk of 30-day readmission for COPD (RR 0.87, 95% CI, 0.79-0.96). The risk of late ventilation and readmission for C difficile colitis was not significantly different between the two groups. We found little difference in the outcomes associated with 3 common antibiotic treatment choices.

CONCLUSIONS: Our results suggest that the addition of antibiotics to a regimen that includes steroids may have a beneficial effect on short-term outcomes for patients hospitalized with AE-COPD.

Left Ventricular Hypertrophy in Chronic Obstructive Pulmonary Disease without Hypoxaemia: The Elephant in the Room?

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Chronic obstructive pulmonary disease (COPD) is associated with significant cardiovascular mortality. Left ventricular hypertrophy (LVH) is a pivotal cardiovascular risk factor. The prevalence of LVH in COPD is currently unknown.

METHODS: We performed a pilot study of 93 normoxaemic COPD patients and 34 controls. Patients underwent echocardiography to measure left ventricular (LV) dimensions; electrocardiography; 24-hour blood pressure (BP) recording; and serum B-type natriuretic peptide (BNP) levels, along with spirometry and oxygen saturations.

RESULTS: COPD patients' oxygen saturations were normal at 96.5% (95%CI: 96.1-97.0%), with a mean FEV1 of 70.0% predicted (95% CI: 65.2-74.8%). 30.1% of COPD patients met echocardiographic criteria for LVH based on LV mass index, with more LVH in females than males (43.2% vs. 21.4%, p=0.02). LV mass index in COPD was 96.2g/m2 (95%CI: 90.1-102.7g/m2) vs. controls 82.9g/m2 (95%CI: 75.8-90.6g/m2), p=0.017. LV mass index remained high in COPD patients in the absence of hypertension history (94.5g/m2 vs. 79.9g/m2, p=0.015) and with 24-hr systolic BP<135mmHg (96.7g/m2 vs. 82.5g/m2, p=0.024). LV ejection fraction (mean=63.4%) and BNP (mean=28.7pg/ml) were normal in COPD patients. Mean 24hr BP was normal in COPD patients at 125/72mmHg. Electrocardiography was less sensitive for detecting LVH than echocardiography.

CONCLUSION: LVH was present in a significant proportion of normotensive, normoxaemic COPD patients, especially in females, along with normal LV ejection fraction and BNP levels. Clinical trials are therefore indicated to evaluate treatments to regress LVH in patients with COPD.

Using opioids to treat dyspnea in advanced COPD: Attitudes and experiences of family physicians and respiratory therapists.

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OBJECTIVES : To explore the experiences of family physicians and respiratory therapists in treating advanced chronic obstructive pulmonary disease (COPD) and their attitudes to the use of opioids for dyspnea in this context.

DESIGN: Qualitative methodology using one-on-one semistructured interviews.

SETTING: Southern New Brunswick (St Stephen to Sussex).
PARTICIPANTS: Ten family physicians and 8 respiratory therapists who worked in primary care settings.

METHODS: Participant interviews were audiorecorded, transcribed verbatim, coded conceptually, and thematically analyzed using interpretive description.

MAIN FINDINGS: Participants reported that patients with advanced COPD often suffered from inadequate control of their dyspnea in advanced stages and that they saw the potential value of opioids in this context; however, family physicians described discomfort prescribing opioids. Barriers included insufficient knowledge, lack of education and guidelines, and fear of censure. Those with palliative care experience tended to be more comfortable with opioid prescribing.

CONCLUSION: Findings suggest an important need to address barriers related to more effective treatment of refractory dyspnea in advanced COPD. Further, findings indicate these efforts should focus on effective palliation and innovative educational initiatives, as well as the development, promotion, and uptake of evidence-based practice guidelines related to prescribing opioids for these patients.

 

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