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https://www.readbyqxmd.com/read/29332320/the-role-of-tiotropium-olodaterol-dual-bronchodilator-therapy-in-the-management-of-chronic-obstructive-pulmonary-disease
#1
REVIEW
David M G Halpin
Bronchodilator therapy is central to the management of chronic obstructive pulmonary disease and are recommended as the preferred treatment by the Global Obstructive Lung Disease Initiative (GOLD). Long acting anti-muscarinics (LAMA) and long acting β₂ agonists (LABA) are both more effective than regular short-acting drugs but many patients remain symptomatic despite monotherapy with these drugs. Combination therapy with LAMA and LABA increases the therapeutic benefit while minimizing dose-dependent side effects of long-acting bronchodilator therapy...
January 2018: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/29330966/static-hyperinflation-is-associated-with-ventilatory-limitation-and-exercise-tolerance-in-adult-cystic-fibrosis
#2
Daniel Stevens
INTRODUCTION: Lung hyperinflation is a potential mechanism limiting exercise tolerance. However, available data on the impact of static hyperinflation on exercise performance in adult cystic fibrosis is lacking. Furthermore, the relative contribution of both static and dynamic hyperinflation to exercise performance is unknown. OBJECTIVES: To determine the impact of static hyperinflation on exercise tolerance and lung dynamics in adult cystic fibrosis. METHODS: Clinical data of 107 adult patients with cystic fibrosis, including pulmonary function, lung volumes, and cardiopulmonary exercise from the Toronto Cystic Fibrosis database were collected and analyzed...
January 13, 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29325586/high-frequency-percussive-ventilation-increases-alveolar-recruitment-in-early-acute-respiratory-distress-syndrome-an-experimental-physiological-and-ct-scan-study
#3
Thomas Godet, Matthieu Jabaudon, Raïko Blondonnet, Aymeric Tremblay, Jules Audard, Benjamin Rieu, Bruno Pereira, Jean-Marc Garcier, Emmanuel Futier, Jean-Michel Constantin
BACKGROUND: High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). METHODS: Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory...
January 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29322050/effects-of-umeclidinium-vilanterol-on-exercise-endurance-in-copd-a-randomised-study
#4
John H Riley, Chris J Kalberg, Alison Donald, David A Lipson, Muhammad Shoaib, Lee Tombs
This multicentre, randomised, double-blind, placebo-controlled, two-period crossover study assessed the effect of umeclidinium/vilanterol (UMEC/VI) on exercise capacity in patients with chronic obstructive pulmonary disease (COPD) using the endurance shuttle walk test (ESWT). Patients were randomised 1:1 to one of two treatment sequences: 1) UMEC/VI 62.5/25 µg followed by placebo or 2) placebo followed by UMEC/VI 62.5/25 µg. Each treatment was taken once daily for 12 weeks. The primary end-point was 3-h post-dose exercise endurance time (EET) at week 12...
January 2018: ERJ Open Research
https://www.readbyqxmd.com/read/29303905/effect-of-pressure-controlled-inverse-ratio-ventilation-on-dead-space-during-robot-assisted-laparoscopic-radical-prostatectomy-a-randomised-crossover-study-of-three-different-ventilator-modes
#5
Go Hirabayashi, Yukihiko Ogihara, Shoichi Tsukakoshi, Kiyoshi Daimatsu, Masaaki Inoue, Kiyoyasu Kurahashi, Koichi Maruyama, Tomio Andoh
BACKGROUND: Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume. OBJECTIVE: To investigate the effects of PC-IRV on the components of dead space during robot-assisted laparoscopic radical prostatectomy (RLRP). DESIGN: A randomised crossover study of three different ventilator modes. SETTING: A single university hospital from September 2014 to April 2015...
January 4, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29297365/regional-physiology-of-ards
#6
REVIEW
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29296080/microbiological-airway-colonization-in-copd-patients-with-severe-emphysema-undergoing-endoscopic-lung-volume-reduction
#7
Franziska C Trudzinski, Frederik Seiler, Heinrike Wilkens, Carlos Metz, Annegret Kamp, Robert Bals, Barbara Gärtner, Philipp M Lepper, Sören L Becker
Background: Endoscopic lung volume reduction (eLVR) is a therapeutic option for selected patients with COPD and severe emphysema. Infectious exacerbations are serious events in these vulnerable patients; hence, prophylactic antibiotics are often prescribed postinterventionally. However, data on the microbiological airway colonization at the time of eLVR are scarce, and there are no evidence-based recommendations regarding a rational antibiotic regimen. Objective: The aim of this study was to perform a clinical and microbiological analysis of COPD patients with advanced emphysema undergoing eLVR with endobronchial valves at a single German University hospital, 2012-2017...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29279363/lack-of-benefit-of-heliox-during-mechanical-ventilation-of-subjects-with-severe-air-flow-obstruction
#8
James W Leatherman, Ramiro Saavedra Romero, Robert S Shapiro
BACKGROUND: The value of heliox (helium-oxygen mixture) for patients with severe air-flow obstruction is uncertain. The purpose of this study was to determine whether heliox could reduce the degree of hyperinflation and hypercapnia in mechanically ventilated patients with severe air-flow obstruction. METHODS: This was a single-center, prospective observational study conducted in a medical ICU of an academic medical center. We assessed the impact of heliox (65-70% helium, 30-35% oxygen) on airway pressures and arterial blood gases of 13 subjects undergoing mechanical ventilation for severe asthma (n = 8) or exacerbation of COPD (n = 5)...
December 26, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29248880/constrictive-bronchiolitis-presenting-with-a-mixed-obstructive-and-restrictive-pattern-associated-with-acid-reflux
#9
Kristen Capel, Richard Dee Shih
A previously healthy 55-year-old woman presented with worsening dyspnoea on exertion. The patient lived at altitude, did not smoke and had no exposure to occupational or environmental toxins. Her physical examination, including pulmonary, was unremarkable. Pulmonary function tests showed forced expiratory volume in 1 s/forced vital capacity ratio 74% predicted, diffusing capacity for carbon monoxide (DLCO) 92% predicted and residual volume 213% predicted. Rheumatological workup was negative. Chest radiograph showed hyperinflation without consolidation, and high-resolution chest CT showed mosaic attenuation with air trapping on expiratory imaging...
December 15, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29227305/lung-transplantation-for-chronic-obstructive-pulmonary-disease-past-present-and-future-directions
#10
Faisal M Siddiqui, Joshua M Diamond
PURPOSE OF REVIEW: Lung transplantation offers an effective treatment modality for patients with end-stage chronic obstructive pulmonary disease (COPD). The exact determination of when to refer, list, and offer transplant as well as the preferred transplant procedure type remains unclear. Additionally, there are special considerations specific to patients with COPD being considered for lung transplantation, including the implications of single lung transplantation on lung cancer risk, native lung hyperinflation, and overall survival...
December 7, 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/29223424/outcome-after-lung-volume-reduction-surgery-in-patients-with-severely-impaired-diffusion-capacity
#11
Claudio Caviezel, Nadja Schaffter, Didier Schneiter, Daniel Franzen, Ilhan Inci, Isabelle Opitz, Walter Weder
BACKGROUND: Lung volume reduction surgery (LVRS) has been proven to be a successful procedure and can be performed with low mortality when defined selection criteria are met. We hypothesized good outcome and low mortality after LVRS for selected patients with severe hyperinflation and nonhomogeneous morphology even when diffusion capacity of the lung for carbon monoxide (Dlco) is less than 20%. METHODS: The study included all patients scheduled for LVRS between March 2005 and May 2014 with a preoperative Dlco of less than 20%...
December 6, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29210599/obesity-in-copd-revealed-and-unrevealed-issues
#12
S Zewari, P Vos, F van den Elshout, R Dekhuijzen, Y Heijdra
The interactions between obesity and chronic obstructive pulmonary disease (COPD) are being increasingly explored. In part, this is due to the globally increasing prevalence rates of obesity. The prevalence of obesity in COPD patients is variable, and it seems that obesity is more common in COPD patients compared with subjects who do not have COPD. However, further studies are encouraged in this area due to observed inconsistencies in the current data. In this review, we focus on the knowledge of the effects of obesity on dyspnea, pulmonary function, exercise capacity and exacerbation risk...
December 2017: COPD
https://www.readbyqxmd.com/read/29207814/congenital-lobar-emphysema-anaesthetic-challenges-and-review-of-literature
#13
Suman Saini, Smita Prakash, Meera Rajeev, K K Girdhar
Congenital Lobar Emphysema (CLE) is a developmental anomaly, characterized by hyperinflation of one or more pulmonary lobes. It presents in infancy with variable degree of respiratory distress due to compression atelectasis. It is most often associated with mediastinal shift with subsequent hypoxia. CLE poses a diagnostic and therapeutic dilemma. We report a case of five-month-old infant of CLE requiring left lobectomy, who was previously being treated for pneumonia which was unresponsive to medical therapy...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29181828/influence-of-inhaled-corticosteroids-on-bronchial-inflammation-and-pulmonary-function-in-chronic-obstructive-pulmonary-disease-with-moderate-obstruction
#14
Iza Toczyska, Ewa Zwolińska, Andrzej Chcialowski
Inflammation in the bronchial respiratory tract and lung parenchyma underlies the pathogenesis of chronic obstructive pulmonary disease (COPD). It consists of effector cell infiltration, changes in reticular basement membrane (RBM) thickness, and the content of inflammatory mediators. The aim of this study was to assess the influence of inhaled corticosteroids (ICS) on the number of inflammatory cells and RBM thickness in bronchial biopsies, and pulmonary function in patients with moderate COPD. Twenty four patients with newly diagnosed COPD were included into the study...
November 28, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29138547/efficacy-of-tiotropium-and-indacaterol-monotherapy-and-their-combination-on-dynamic-lung-hyperinflation-in-copd-a-random-open-label-crossover-study
#15
Keisaku Fujimoto, Haruna Yamazaki, Midori Ura, Yoshiaki Kitaguchi
Background and objective: The difference in efficacy of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) for dynamic lung hyperinflation (DLH) in COPD is unclear. The purpose of this study was to elucidate the difference in efficacy of LAMA and LABA alone and the combination thereof for DLH. Subjects and methods: Thirty stable patients were enrolled and randomly divided into two groups following baseline measurements. One group was treated with 5 μg tiotropium (Respimat inhaler) for 4 weeks following a 4-week treatment with 150 μg indacaterol, while the other group was treated with indacaterol for 4 weeks following a 4-week treatment with tiotropium...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29123390/hyperinflated-lungs-compress-the-heart-during-expiration-in-copd-patients-a-new-finding-on-dynamic-ventilation-computed-tomography
#16
Yanyan Xu, Tsuneo Yamashiro, Hiroshi Moriya, Maho Tsubakimoto, Nanae Tsuchiya, Yukihiro Nagatani, Shin Matsuoka, Sadayuki Murayama
Purpose: The aims of this study were to evaluate dynamic changes in heart size during the respiratory cycle using four-dimensional computed tomography (CT) and to understand the relationship of these changes to airflow limitation in smokers. Materials and methods: A total of 31 smokers, including 13 with COPD, underwent four-dimensional dynamic-ventilation CT during regular breathing. CT data were continuously reconstructed every 0.5 s, including maximum cross-sectional area (CSA) of the heart and mean lung density (MLD)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29122915/elevated-lung-clearance-index-in-infants-with-cystic-fibrosis-shortly-after-birth
#17
Elisabeth Kieninger, Sophie Yammine, Insa Korten, Pinelopi Anagnostopoulou, Florian Singer, Urs Frey, Anne Mornand, Maura Zanolari, Isabelle Rochat, Daniel Trachsel, Dominik Mueller-Suter, Alexander Moeller, Carmen Casaulta, Philipp Latzin
It is not known at what age lung function impairment may arise in children with cystic fibrosis (CF). We assessed lung function shortly after birth in infants with CF diagnosed by newborn screening.We performed infant lung function measurements in a prospective cohort of infants with CF and healthy controls. We assessed lung clearance index (LCI), functional residual capacity (FRC) and tidal breathing parameters. The primary outcome was prevalence and severity of abnormal lung function (±1.64 z-scores) in CF...
November 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29110280/body-weight-and-mortality-in-copd-focus-on-the-obesity-paradox
#18
REVIEW
Francesco Spelta, A M Fratta Pasini, L Cazzoletti, M Ferrari
The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present...
November 6, 2017: Eating and Weight Disorders: EWD
https://www.readbyqxmd.com/read/29108896/brazilian-intragastric-balloon-consensus-statement-bibc-practical-guidelines-based-on-experience-of-over-40-000-cases
#19
Manoel Galvao Neto, Lyz Bezerra Silva, Eduardo Grecco, Luiz Gustavo de Quadros, André Teixeira, Thiago Souza, Jimi Scarparo, Artur A Parada, Ricardo Dib, Rena Moon, Josemberg Campos
BACKGROUND: Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure. OBJECTIVES: To create a practical guideline for intragastric balloon usage. SETTING: Private and Academic Settings, Brazil...
September 28, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29106562/incomplete-fissures-are-associated-with-increased-alveolar-ventilation-via-spiracles-in-severe-emphysema
#20
Samih Khauli, Eric Abston, Hassan Sajjad, Servet Bolukbas, Julio Mott Ancona Lopez, Roberto Saad, Surya P Bhatt, Michael Eberlein
OBJECTIVES: In emphysema, air can flow preferentially via collateral pathways, which can connect an entire lung when incomplete fissures are present. Spiracles are openings through the chest wall into the lung parenchyma. We previously observed increased alveolar ventilation (VA) in subjects with severe emphysema, when spiracles occurred during lung transplant operations. In this study, we set out to identify a computed tomography (CT) imaging phenotype associated with improved VA via spiracles in severe emphysema...
July 6, 2017: Interactive Cardiovascular and Thoracic Surgery
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