1,720,997 research outputs found
Roflumilast:un nuovo farmaco per il trattamento della BPCO
No full textLa broncopneumopatia cronica ostruttiva (BPCO) è una malattia respiratoria cronica il cui principale fattore di rischio è il fumo di sigaretta. La patologia è caratterizzata da una progressiva limitazione del flusso aereo non completamente reversibile, da sintomi respiratori quali tosse e dispnea e da frequenti riacutizzazioni cliniche che possono richiedere il ricovero ospedaliero con ulteriore compromissione dello stato di salute, declino della funzionalità respiratoria e aumento del tasso di mortalità. I farmaci attualmente disponibili per il trattamento della BPCO sono i broncodilatatori inalatori a breve (SABA) e a lunga durata d’azione (LABA). Nei pazienti con BPCO grave e molto grave e con frequenti riacutizzazioni i LABA sono somministrati in associazione con gli steroidi inalatori. L’infiammazione cronica dei polmoni gioca un ruolo cruciale nella patogenesi della BPCO. Gli inibitori della fosfodiesterasi 4 (PDE4) sono una nuova classe di farmaci ad azione antinfiammatoria che sono stati sviluppati per controllare l’infiammazione cronica correlata alla BPCO.Gli inibitori della fosfodiesterasi 4 hanno mostrato una buona efficacia e tollerabilità in studi preclinici e clinici condotti nei pazienti con BPC
Influence of frailty on cardiovascular events and mortality in patients with Chronic Obstructive Pulmonary Disease (COPD): Study Protocol for a multicentre European observational study.
Full text linkBackground- Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary
Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or conditions are common in COPD and may increase the risk of death.
Methods- This protocol describes a European prospective cohort study of community-based
people, in a stable condition with diagnosis of COPD (as defined by GOLD guidelines) across hospitals in Italy and UK. Frailty prevalence will be assessed using the Clinical Frailty Scale. At 1- and 2-year follow up, primary outcome will be the impact of frailty on the number of cardiovascular events; secondary outcomes: the influence of frailty on cardiovascular mortality, all-cause mortality, and deaths due to COPD. For the primary outcome a zero-inflated Poisson regression will compare the number of cardiovascular events at 1 year. Secondary outcomes will be analysed using the time to mortality.
Discussion- This multicentre study will assess the association between frailty and cardiovascular events and mortality in population with COPD. Data collection is prospective and includes routine clinical data. This research will have important implications for the
management of patients with COPD to improve their quality of care, and potentially prognosis
Exacerbation of respiratory Symptoms in COPD patients may not be exacerbations of COPD
No full textExacerbations of chronic obstructive pulmonary disease (COPD) are defined as acute events characterised by a worsening of the patient's respiratory symptoms, particularly dyspnoea, beyond day-to-day variation, leading to a change in medical treatment and/or hospitalisation. Exacerbations of COPD are a leading cause of hospitalisation and healthcare expenditures, particularly in frail, elderly patients. They alter the health-related quality of life and the natural course of disease, increasing the risk of mortality, both during and after the acute event. Patients with COPD frequently have chronic comorbidities. Several of these comorbidities may produce acute events, contributing to the increased morbidity and mortality in COPD exacerbations: acute myocardial infarction, congestive heart failure, cerebrovascular disease, cardiac arrhythmias and pulmonary circulation disorders
High resolution CT (HRCT) of the lung in adults. Defining the limits between normal and pathologic findings.
No full textUnder normal conditions, HRCT shows secondary lobule structures and allows for a precise evaluation, with inspiratory and expiratory scans, of central airways dimensions, lung area and parenchymal density. Frequently, asymptomatic smokers with normal lung function tests, present with mild abnormalities not visible at chest X-ray: bronchial thickening, bronchiolectasis, respiratory bronchiolitis and centrilobular or paraseptal emphysema. In the elderly, HRCT studies often show borderline findings such as age-related tracheo-bronchial calcifications and emphasise the progressive increase in the bronchoarterial ratio. Another frequent finding is expiratory air trapping, which can be associated with a variety of lung diseases, but can also represent a physiologic and temporary finding, during an episode of sub-clinical bronchospasm or related to local variation of bronchiolar dynamic compliance. The knowledge of the boundaries between normality and pathology is an essential prerequisite for the correct interpretation HRCT findings
Impact of frailty on symptom burden in chronic obstructive pulmonary disease
Full text linkChronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnoea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a random-effects meta-analysis of mean differences (MDs). There was an association between COPD patients living with frailty and increased CAT score versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72–2.87); I2 = 99%]. A lower association was found between frailty and dyspnoea measured by the mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15–2.66); I2 = 98%]. The prevalence of frailty ranged from 8.8% to 82% and that of pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsening symptom burden in COPD patients living with frailty. The review shows that frailty is common in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population
Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease
Full text linkExacerbations of chronic obstructive respiratory disease (ECOPD) are acute events characterized by worsening of the patient's respiratory symptoms, particularly dyspnoea, leading to change in medical treatment and/or hospitalisation. AECOP are considered respiratory diseases, with reference to the respiratory nature of symptoms and to the involvement of airways and lung. Indeed respiratory infections and/or air pollution are the main causes of ECOPD. They cause an acute inflammation of the airways and the lung on top of the chronic inflammation that is associated with COPD. This acute inflammation is responsible of the development of acute respiratory symptoms (in these cases the term ECOPD is appropriate). However, the acute inflammation caused by infections/pollutants is almost associated with systemic inflammation, that may cause acute respiratory symptoms through decompensation of concomitant chronic diseases (eg acute heart failure, thromboembolism, etc) almost invariably associated with COPD. Most concomitant chronic diseases share with COPD not only the underlying chronic inflammation of the target organs (i.e. lungs, myocardium, vessels, adipose tissue), but also clinical manifestations like fatigue and dyspnoea. For this reason, in patients with multi-morbidity (eg COPD with chronic heart failure and hypertension, etc), the exacerbation of respiratory symptoms may be particularly difficult to investigate, as it may be caused by exacerbation of COPD and/or ≥ comorbidity, (e.g. decompensated heart failure, arrhythmias, thromboembolisms) without necessarily involving the airways and lung. In these cases the term ECOPD is inappropriate and misleading
How much do GOLD stages reflect CT abnormalities in COPD patients?
No full textSeverity of chronic obstructive pulmonary disease (COPD) can be graded using the classification released in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report. Such classification is essentially based on spirometry and does not recognise the role of other measures. The aim of this study was to assess whether the GOLD stages correlate with the extent of pulmonary emphysema and other ancillary computed tomography CT features in a population of smokers with stable COPD.Based on clinical assessment and lung-function testing, patients were classified according to the GOLD criteria. CT scans were visually evaluated for extent of emphysema and airway abnormalities.A total of 43 patients were enrolled. The amount of emphysema was described as minimal in six patients with stage 0, and as moderate in seven patients with stage 0. In stages I and II, the extent of emphysema ranged from minimal to severe, whereas we observed the presence of severe emphysema in most patients in stages III and IV. According to the regression model, only CT emphysema extent independently predicted the GOLD stage (r2 = 0.58; p or = III.Although we found a significant correlation between CT emphysema extent and GOLD stages, different percentage of emphysema extent can be observed among each GOLD stage. The upper limit of 31.5\% of emphysema extent may indicate a boundary for a clinically worsening status
Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing
No full textTo evaluate the prevalence and significance of the pathological effects of cigarette smoking on the lung and the sensitivity of high-resolution CT (HRCT) in the recognition of early smoking-induced lesions in asymptomatic former or current smokers
Prognostic Impact of COVID-19 Inflammation Score Response: A Sub-Group Analysis on Critically Ill Patients of the RuxCoFlam Trial
Full text linkThis study aims to identify parameters predicting COVID-19 inflammation score (CIS) response and survival probability in critically ill patients with hyperinflammation treated with the Janus kinase (JAK) 1/2 inhibitor ruxolitinib. This is a single arm, non-randomized, open-label, phase-II study for frontline treatment in adults in the intensive care unit (ICU). Ninety-two critically ill COVID-19 patients with CIS ≥ 10 were treated in the RuxCoFlam trial (NCT04338958) with ruxolitinib between April 2020 and June 2021. Median ICU treatment duration was 15 days (range, 2–73). Out of 81 evaluable patients, 62 (77%) showed CIS reduction ≥ 25% on day 7 (CIS response). In multiple logistic regression analyses, higher CIS on day 0 (odds ratio (OR), 1.56; 95% confidence interval (CI), 1.01–2.41; p = 0.046) and male gender (OR, 4.76; 95% CI, 1.22–16.67; p = 0.024) were significantly associated with CIS response. Sixty-day survival probability was higher in CIS-responders compared to non-responders (74% vs. 32%; p < 0.001). Multiple Cox regression analysis revealed younger age (10-year difference) (hazard ratio (HR), 0.65; 95% CI, 0.46–0.91; p = 0.012) and CIS response (HR, 0.19; 95% CI, 0.08–0.45; p < 0.001) as significant parameters for survival probability. In conclusion, reduced risk of death in CIS-responders underlines the usefulness of CIS for the assessment of hyperinflammatory disorders, such as COVID-19, under JAK1/2 inhibitor therapy
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