1,721,046 research outputs found
Care-Related intervention in Rehabilitative Pneumology: Pulmonary Rehabilitation in Chronic Obstructive Broncopneumopathies (COPD) can benefit from a multidisciplinary approach? [Cure correlate in Pneumologia Riabilitativa: La Riabilitazione Polmonare nelle Broncopneumopatie Croniche Ostruttive (BPCO) può trarre beneficio da un approccio multidisciplinare?]
No full textLa Broncopneumopatia Cronica Ostruttiva (BPCO) è una comune malattia, prevenibile e trattabile, caratterizzata da persistenti sintomi respiratori e limitazione al flusso aereo. Patologie cardiovascolari, osteoporosi, depressione e ansia,
condizionamento neuromuscolare e apnee ostruttive del sonno sono comorbilità frequenti e importanti nella BPCO,
spesso sotto diagnosticate e associate a peggiore stato di salute e prognosi. La riabilitazione respiratoria migliora i sintomi, la qualità della vita, la funzione polmonare e lo stato di salute in pazienti con patologie croniche ostruttive. Per definizione è un intervento ad ampio spettro che si basa su una valutazione del paziente seguita da terapie personalizzate, essa include inoltre riallenamento allo sforzo, intervento educazionale e modifica dello stile di vita volto al miglioramento della condizione fisica e psicologica di persone affette da patologie croniche respiratorie e al
miglioramento della aderenza alla terapia e allo stile di vita. La limitazione all’esercizio fisico in pazienti con BPCO è
multifattoriale, è dovuta a una limitazione ventilatoria, alterazione degli scambi intrapolmonari dei gas, alterazione
vascolare polmonare e cardiaca, disfunzione muscolare e a presenza di comorbilità. La riabilitazione pneumologica ha come obiettivo il miglioramento della funzione cardiorespiratoria e muscolare, miglioramento dei sintomi e della qualità di vita nelle attività quotidiane, agendo in sinergia con l’effetto della terapia inalatoria. La BPCO ha una storia naturale variabile, spesso l’insufficienza respiratoria cronica complica le fasi di progressione della malattia. È stato dimostrato che il supplemento di ossigeno e la ventilazione meccanica non invasiva migliorano la sopravvivenza e riducono il rischio di ricoveri ospedalieri in pazienti affetti da BPCO. Studi successivi hanno poi evidenziato il ruolo benefico di utilizzare supplemento di ossigeno e NIV durante sia i programmi di fisioterapia respiratoria sia durante le ore notturne. In conclusione, un approccio ad ampio spettro per diagnosi e stadiazione della BPCO anche alla luce delle comorbidità spesso presenti potrebbe convogliare verso un approccio multidisciplinare e sinergico sia in termini di trattamento farmacologico che non farmacologico di una sindrome infiammatoria sistemicaCardiovascular diseases, osteoporosis, depression/anxiety, musculoskeletal impairment and obstructive sleep apnea are frequent and important comorbidities in COPD, often under-diagnosed, and associated with poor health status and prognosis. Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care in patients with chronic respiratory disease. By definition it is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change and designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors. Exercise limitation in patients with COPD is multifactorial and includes ventilatory limitation, gas transfer abnormalities, pulmonary vascular and cardiac dysfunction, limb muscle dysfunction, and comorbid impairments. Overall, pulmonary rehabilitation aims to improve cardiorespiratory and skeletal muscle function improving respiratory symptoms and quality of life in daily life activities adding a synergic support to the pharmacologic inhaled therapy. COPD has a variable natural history, but most of the time chronic respiratoryfailure complicates disease progression. Supplemental oxygen and noninvasive mechanical ventilation have been proven to improve survival and reduce hospital admissions in COPD patients. Furthermore additional studies have shown that exercise performance benefit from supplemental oxygen and NIV used both during rehabilitation exercise programs and over the night. In conclusion, an overarching approach to diagnosis, assessment of severity of COPD and its frequent comorbidities should guide to a multidisciplinary and synergic approach in terms of pharmacological and nonpharmacological management of a systemic inflammatory syndrome
Mycobacterium chimaera: a case report from Italy
No full textMycobacterium chimaera is an environmental non-tuberculous mycobacterium belonging to Mycobacterium avium complex (MAC). It has been widely known to be associated with disseminated infection after cardiac surgery, related to heater-cooler units used during these procedures. Although M. chimaera seems to be a less virulent species compared to M. avium and M. intracellulare among MAC, several cases of M. chimaera lung infections have been reported in settings of chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis, malignancy, or immunosuppression. Here, we present an Italian case report in association with newly diagnosed COPD
Cardiovascular function in pulmonary emphysema
Full text linkChronic obstructive pulmonary disease (COPD) and chronic cardiovascular disease, such as coronary artery disease, congestive heart failure, and cardiac arrhythmias, have a strong influence on each other, and systemic inflammation has been considered as the main linkage between them. On the other hand, airflow limitation may markedly affect lung mechanics in terms of static and dynamic hyperinflation, especially in pulmonary emphysema, and they can in turn influence cardiac performance as well. Skeletal mass depletion, which is a common feature in COPD especially in pulmonary emphysema patients, may have also a role in cardiovascular function of these patients, irrespective of lung damage. We reviewed the emerging evidence that highlights the role of lung mechanics and muscle mass impairment on ventricular volumes, stroke volume, and stroke work at rest and on exercise in the presence of pulmonary emphysema. Patients with emphysema may differ among COPD population even in terms of cardiovascular function
Is bronchodilator the correct treatment for COPD subjects before EBUS?
Full text linkEndobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a reliable and commonly established technique, enabling real-time guidance of transbronchial needle aspiration of mediastinal and hilar structures and parabronchial lung masses. As EBUS-TBNA became more available and adopted by clinicians, questions emerged about the optimal performance of the procedure. Although EBUS is considered safe, there are few complications that could occur during the test, correlated with both the procedure itself and the patient's characteristics. Moreover, this technique is often addressed to patients with overlapping airways diseases, which might have higher risk of complications during the procedure. Chronic obstructive pulmonary disease (COPD) patients could experience EBUS-TBNA with a relative high frequency due to their risk of developing lung cancer. The irreversible bronchial constriction characteristic of the disease raises some questions on premedication before bronchoscopic procedures. It is mandatory to optimize every aspect of the procedure in order to minimize the risk of complications, especially for fragile patients. Whether the use of inhaled bronchodilators before the procedure could improve the outcome of the procedure in COPD patients is reviewed in this article. No clear indication emerged from the literature suggesting the need of more studies in order to clarify this point
When kidneys and lungs suffer together
Full text linkA significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients may have normal serum creatinine concentration. Lungs and kidneys participate in maintaining the acid-base balance. Compensatory role of the lungs rapidly expresses through an increase or reduction of ventilation. Renal compensation usually requires a few days as it is achieved through changes in bicarbonate reabsorption. Chronic kidney disease and end-stage renal diseases increase the risk of pneumonia. Vaccination against Streptococcus pneumonia and seasonal influenza is recommended for these patients. Vaccines against the last very virulent H1N1 influenza A strain are also available and effective. Acute lung injury and acute kidney injury are frequent complications in critical illnesses, associated with high morbidity and mortality. The concomitant failure of kidneys and lungs implies a multidisciplinary approach, both in terms of diagnostic processes and therapeutic management
An Unusual Cause Of Bimodal Pattern Of Nocturnal Hypoxemia In An Obstructive Sleep Apnea Patient.
No full textBackground.
Venous return and right atrial pressure are increased by clinostatism and by the intrathoracic negative pressure during obstructive sleep apneas. In presence of a interatrial defect this may results in right-to-left shunt.
Case report. A 51-yrs obese male was admitted to the cardiology department of our hospital for evaluation of arrhythmias and exertional dyspnoea. He was also referred to the Respiratory unit because of dry mouth and sore throat upon awakening, daytime sleepiness and fatigue, snoring, restlessness during sleep, with a story of wheezing and recurrent bronchitis for years. He had a history of former smoking (20pack/yrs) and a prolonged occupational exposure to wheat.
Lung function tests documented a mild chronic obstructive pulmonary disease and high values of the carbon monoxide transfer coefficient. Arterial blood gas analysis in ambient air and in spontaneous breathing was normal.
A nocturnal cardiorespiratory polygraphy (CRP) documented a severe pattern of obstructive sleep apnoea syndrome (OSAS) (AHI=83/h, ODI=71/h), with hypoxemia (time with SpO2<90%=89%, <80%=53%). There were different fasis of severe prolonged hypoxemia with superimposed typical apnoeic desaturations (Fig.1). After a short awakening in standing position the hypoxemia recurred after about 1 hour of sleep. The deepest desaturations occurred in both right and left lateral positions. The number of hypo-apnoeic episodes was similar in both normoxemic and hypoxemic phases. The distribution of hypoxemia showed a bimodal pattern (Fig.2).
A chest TC scan showed signs of COPD and air trapping during the expiratory phase, with no abnormal findings in the pulmonary circulation. A transthoracic ecocardiography documented a suspected interatrial right-to-left shunt with normal values of pulmonary artery systolic pressure (20 mmHg). A transesophageal ecocardiography confirmed the presence of an interatrial right-to-left shunt which occurred only during deep inspirations.
After a 4 days progressive pressure titration, we prescribed the application of a continuous positive airway pressure (CPAP) of 13cmH2O with an oronasal mask during sleep. After 6 days a CRP with CPAP documented a marked improvement: AHI=9.3/h, ODI=8.1/h, time with SpO2<90%=7.6%, SpO2<80%=0%, with the usual unimodal pattern. A significant subjective improvement was reported.
Conclusion. Our observation confirms the efficacy of CPAP therapy in reducing intermittent right-to-left shunt in interatrial defects in presence of OSAS. In our case sustained but inconstant hypoxemia was not explained by supine position or number of apnoeas and was temporarily reversed by a short standing period. Variable right-to-left shunt is a possible cause of a bimodal pattern of SpO2 distribution
Revealing the gap: fractional exhaled nitric oxide and clinical responsiveness to biological therapy in severe asthma – a retrospective study
No full text: A proportion of patients with severe asthma treated with biological drugs undergoes a significant decline in F ENO. However, variations in F ENO are largely independent of the clinical efficacy of the biological drug therapy. https://bit.ly/3xWszYJ
Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum
No full textBackground: Patients with asthma usually present airway inflammation classified as eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic pattern according to sputum inflammatory cells. Objective: The aim of the study was to analyze clinical and biological characteristics of patients with asthma and mixed granulocytic pattern in comparison with the other groups. Methods: Induced sputum was used to assess airway inflammation; lung function was evaluated as well as blood leukocytes and disease control. History of comorbidities was collected. Results: We retrospectively analyzed 231 subjects with asthma; patients with mixed granulocytic pattern were more frequently male compared with paucigranulocytic subjects, older than eosinophilic and paucigranulocytic patients with increased number and vitality of sputum cells compared to eosinophilic and paucigranulocytic patients and higher cumulative illness rating score, related to increased age. Smoking history, age of disease onset, and ICS treatment were not associated with higher mixed granulocytic pattern occurrence. Subjects with neutrophilic inflammation (mixed granulocytic and neutrophilic patterns considered altogether) were more frequently obese. In subjects under 67 years of age (median of the enrolled subjects), arterial hypertension was the only comorbidity more frequent in mixed granulocytic than in the other groups. 137/231 subjects were re-valuated during follow-up. Lung function of patients with mixed granulocytic, neutrophilic, and paucigranulocytic patterns improved less than that of eosinophilic patients. Conclusion: Aging and presence of comorbidities, in particular obesity and hypertension, are characteristics of patients with asthma and mixed granulocytic pattern. They could respond less well to treatment than eosinophilic patients
Control of breathing in obstructive sleep apnoea patients: Role of CPAP therapy
No full textControl of breathing in obstructive sleep apnoea patients: Role of CPAP therapy
A. Re, F. Mormile, A. Di Marco Berardino, D. Visca, B. Iovene, S. Valente (Rome, Italy)
Aim: Control of breathing during wakefulness in obstructive sleep apnoea (OSA) and the role of CPAP therapy is an ongoing controversy. We studied the ventilatory response of healthy controls and OSA patients before and after at least 1 year of CPAP therapy.
Methods: 17 never treated OSA patients (16 M; 53±13.2yrs; BMI=34.5±8.1; AHI=45±14.7) underwent nocturnal cardiopulmonary monitoring, spirometry and blood gas analysis. Read's rebreathing test was used to evaluate hypercapnic ventilatory response (HVR CO2); hypoxic ventilator response (HVRO2) was studied by both progressive and transient methods, to explore both peripheral oxygen chemoceptors and the central modulation. The relationship between minute ventilation (VE) or mean inspiratory flow (VT/Ti) and PETCO2 or PETO2 was expressed in terms of slope of linear regression for HVRCO2 and of parameter A of hyperbolic relation for HVRO2.
Results: OSA patients showed an increased responsiveness to transient, but not to progressive, hypoxemia, and a reduced response to hypercapnia when compared to controls. Transient HVRO2 showed a significant reduction during CPAP therapy (p<0.01), whereas HVRCO2 increased only slightly. Progressive HVRO2 was not modified by CPAP [Tab 1].
Conclusions: the daytime glomic reactivity to transient hypoxia is increased by repeated nocturnal hypoxic stimuli; CPAP significantly restores the ventilatory stability during sleep.
Chemosensitivity in Controls and in OSAS pre e post CPAP
Controls(a) OSAS Pre CPAP(b) p(a vs b) OSAS Post CPAP(c) p(b vs c)
HVR CO2(l/min/mmHg) 2.7±1.2 2.0±0.9 <0.05 2.2±0.9 0.63
HPVRO2(l/min*mmHg) 355.3±115.2 357.5±117.9 0.46 336.9±129.9 0.99
HTVRO2(l/min*mmHg) 119.2±62.7 217.7±107.7 <0.01 97.5±24.1 <0.01
TAB
Correlation between measures of sleep-disorded breathing and cognitive impairment.
No full textRationale:To analyse relationships between measures of sleep-disordered breathing and neuropsychological functioning in OSA patients with different parameters of hypoxic burden.
Patients and methods:In 136 newly diagnosed OSA patients(mean age 60yrs,mean BMI 33)we studied apnoea hypopnoea index(AHI),oxygen desaturation index(ODI),mean and minimum nocturnal saturation(SpO2mean),mean of the minimum nocturnal saturations,time with an O2 saturation below 90%(TD90),mean decrease from mean saturation,mini-mental state examination (MMSE),the Rey auditory verbal learning test (RAVLT),the Corsi block-tapping and the digit span task exercises,the speed and capacity of language processing test(SCOLP),Multiple Features Targets Cancellation(MFTC),Raven’s matrices,Stroop test.
Results:34% of patients had neuropsycological deficits.At the univariate linear regression,but not at the multivariate regression,partial pressure of oxygen in the blood during awakening and minimum nocturnal saturation during sleep represented the most number of the abnormal cognitive functions.RAVLT,SCOLP and Raven’s matrices were affected the most.At the multivariate regression SpO2mean correlated with the digit span task exercises,SCOLP test and the Stroop test,whereas AHI correlated only with RAVLT and ODI only with Stroop test.BMI correlated with RAVLT and SCOLP;TD90 with RAVLT.The mean decrease from mean saturation correlated with Corsi and MTFC tests both in severe and in mild-moderate OSA patients.
Conclusion:not only the total time in hypoxia and its severity but also the amplitude of hypoxiemic swings are associated with the cognitive impairment of OSA patients, and this effect is significant also in mild to moderate cases
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