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copd and elderly care

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By Marianne De Nobel i'm a physician in the elderly care at an Hospice and in a nursing home, with people with dementia and /or chronic diseases also i'm working in the primary care
Evan J Lilly, Helen Senderovich
Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer...
October 2016: Journal of Critical Care
Fanny W Ko, Ka Pang Chan, David S Hui, John R Goddard, Janet G Shaw, David W Reid, Ian A Yang
The literature of acute exacerbation of chronic obstructive pulmonary disease (COPD) is fast expanding. This review focuses on several aspects of acute exacerbation of COPD (AECOPD) including epidemiology, diagnosis and management. COPD poses a major health and economic burden in the Asia-Pacific region, as it does worldwide. Triggering factors of AECOPD include infectious (bacteria and viruses) and environmental (air pollution and meteorological effect) factors. Disruption in the dynamic balance between the 'pathogens' (viral and bacterial) and the normal bacterial communities that constitute the lung microbiome likely contributes to the risk of exacerbations...
October 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Helen E Jo, Sharan Randhawa, Tamera J Corte, Yuben Moodley
Idiopathic pulmonary fibrosis (IPF) is a severe and progressive fibrosing interstitial lung disease, which ultimately results in respiratory failure and death. The median age at diagnosis is 66 years, and the incidence increases with age, making this a disease that predominantly affects the elderly population. IPF can often be difficult to diagnose, as its symptoms--cough, dyspnoea and fatigue--are non-specific and can often be attributed to co-morbidities such as heart failure and chronic obstructive pulmonary disease...
May 2016: Drugs & Aging
Ian D Pavord, Paul W Jones, Pierre-Régis Burgel, Klaus F Rabe
Exacerbations of chronic obstructive pulmonary disease (COPD) are defined as sustained worsening of a patient's condition beyond normal day-to-day variations that is acute in onset, and that may also require a change in medication and/or hospitalization. Exacerbations have a significant and prolonged impact on health status and outcomes, and negative effects on pulmonary function. A significant proportion of exacerbations are unreported and therefore left untreated, leading to a poorer prognosis than those treated...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Rob Mac Sweeney, Daniel F McAuley
Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided...
April 28, 2016: Lancet
Marc Miravitlles, Claus Vogelmeier, Nicolas Roche, David Halpin, João Cardoso, Alexander G Chuchalin, Hannu Kankaanranta, Thomas Sandström, Paweł Śliwiński, Jaromir Zatloukal, Francesco Blasi
The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process...
February 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Denis E O'Donnell, Katherine A Webb, Ingrid Harle, J Alberto Neder
INTRODUCTION: Activity-related breathlessness is often the dominant symptom in patients with chronic obstructive pulmonary disease (COPD) and usually persists despite optimal medical therapy. Currently, our inability to meaningfully alter the pathophysiology of the underlying disease means that we must focus our attention on relieving this distressing symptom so as to improve exercise tolerance and quality of life. AREAS COVERED: The current review examines the neurobiology of breathlessness and constructs a solid physiological rationale for amelioration of this distressing symptom...
July 2016: Expert Review of Respiratory Medicine
Ayse Bilge Ozturk, Sinem Iliaz
Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic and therapeutic approaches, as well as management of severe allergic asthma in the elderly, are also discussed.
2016: Journal of Asthma and Allergy
Jaap C A Trappenburg, Lieselotte Koevoets, Gerdien H de Weert-van Oene, Evelyn M Monninkhof, Jean Bourbeau, Thierry Troosters, Theo J M Verheij, Jan-Willem J Lammers, Augustinus J P Schrijvers
BACKGROUND: Early detection of exacerbations by COPD patients initiating prompt interventions has shown to be clinically relevant. Until now, research failed to identify the effectiveness of a written individualized Action Plan (AP) to achieve this. METHODS/DESIGN: The current multicenter, single-blind RCT with a follow-up period of 6 months, evaluates the hypothesis that individualized AP's reduce exacerbation recovery time. Patients are included from regular respiratory nurse clinics and allocated to either usual care or the AP intervention...
2009: BMC Pulmonary Medicine
Eléonore F van Dam van Isselt, Monica Spruit, Karin H Groenewegen-Sipkema, Niels H Chavannes, Wilco P Achterberg
In view of the worldwide aging population, disease-specific geriatric rehabilitation (GR) programs are needed. Therefore, we developed and implemented a postacute GR program for patients with advanced chronic obstructive pulmonary disease (COPD) (the GR-COPD program). The aim of this study is to investigate the feasibility of the GR-COPD program and to present clinical data on patient characteristics and course of functional capacity and health status. This is a naturalistic prospective cohort study of patients with advanced COPD...
May 2014: Chronic Respiratory Disease
N Smallwood, B Le, D Currow, L Irving, J Philip
Chronic obstructive pulmonary disease (COPD) is a progressive, incurable illness, which leads to significant morbidity over long periods of time and mortality. Treatment aims to reduce symptoms, improve exercise capacity and quality of life, reduce exacerbations, slow disease progression and reduce mortality. However, breathlessness is common in patients with advanced COPD and remains undertreated. As all reversible causes of breathlessness are being optimally managed, consideration should be given to specific non-pharmacological and pharmacological treatment strategies for breathlessness...
September 2015: Internal Medicine Journal
Gerard J Criner, Jean Bourbeau, Rebecca L Diekemper, Daniel R Ouellette, Donna Goodridge, Paul Hernandez, Kristen Curren, Meyer S Balter, Mohit Bhutani, Pat G Camp, Bartolome R Celli, Gail Dechman, Mark T Dransfield, Stanley B Fiel, Marilyn G Foreman, Nicola A Hanania, Belinda K Ireland, Nathaniel Marchetti, Darcy D Marciniuk, Richard A Mularski, Joseph Ornelas, Jeremy D Road, Michael K Stickland
BACKGROUND: COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD...
April 2015: Chest
Paul W Jones
Exacerbations of chronic obstructive pulmonary disease (COPD) have important consequences for lung function, health status and mortality. Furthermore, they are associated with high economic costs, predominantly related to hospitalization. They are managed acutely with short-acting bronchodilators, systemic corticosteroids or antibiotics; however, a large proportion of COPD exacerbations are unreported and therefore untreated or self-managed. There is evidence to suggest that these unreported exacerbations also have important consequences for health status; therefore, reducing exacerbation risk is an important goal in the management of COPD...
June 2015: Therapeutic Advances in Respiratory Disease
Shawn D Aaron
Patients with chronic obstructive pulmonary disease (COPD) are prone to acute respiratory exacerbations, which can develop suddenly or subacutely over the course of several days. Exacerbations have a detrimental effect on patients' health status and increase the burden on the healthcare system. Initial treatment is unsuccessful in 24-27% of patients, who have a relapse or a second exacerbation within 30 days of the initial event. No obvious benefit has been seen in recent clinical trials of anti-tumour necrosis factor therapy, anti-leukotriene therapy, intensive chest physiotherapy, or early inpatient pulmonary rehabilitation for treatment of exacerbations...
2014: BMJ: British Medical Journal
Supparerk Disayabutr, Carolyn S Calfee, Harold R Collard, Paul J Wolters
BACKGROUND: Interstitial lung diseases (ILDs) are disorders of the lung parenchyma. The pathogenesis, clinical manifestations, and prognosis of ILDs vary depending on the underlying disease. The onset of most ILDs is insidious, but they may also present subacutely or require hospitalization for management. ILDs that may present subacutely include acute interstitial pneumonia, connective tissue disease-associated ILDs, cryptogenic organizing pneumonia, acute eosinophilic pneumonia, drug-induced ILDs, and acute exacerbation of idiopathic pulmonary fibrosis...
2015: BMC Medicine
Shinji Teramoto, Kazufumi Yoshida, Nobuyuki Hizawa
Pneumonia in the elderly results in the highest mortality among cases of community-acquired pneumonia (CAP). The pathophysiology of pneumonia in the elderly is primarily due to aspiration pneumonia (ASP). ASP comprises two pathological conditions: airspace infiltration with bacterial pathogens and dysphagia-associated miss-swallowing. The first-line therapy for the treatment of bacterial pneumonia in the elderly is a narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes...
September 2015: Respiratory Investigation
Isabel S Bazan, Wassim H Fares
Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic state that can be found in multiple conditions with associated symptoms of dyspnea, decreased exercise tolerance, and progression to right heart failure. The World Health Organization has classified PH into five groups. The first group is pulmonary arterial hypertension (PAH), which can be idiopathic, heritable, due to drugs and toxins, or associated with conditions such as connective tissue diseases, congenital heart disease, portal hypertension, and others...
2015: Therapeutics and Clinical Risk Management
Nicola Scichilone, Maria T Ventura, Matteo Bonini, Fulvio Braido, Caterina Bucca, Marco Caminati, Stefano Del Giacco, Enrico Heffler, Carlo Lombardi, Andrea Matucci, Manlio Milanese, Roberto Paganelli, Giovanni Passalacqua, Vincenzo Patella, Erminia Ridolo, Giovanni Rolla, Oliviero Rossi, Domenico Schiavino, Gianenrico Senna, Gundi Steinhilber, Alessandra Vultaggio, Giorgio Canonica
The prevalence of asthma in the most advanced ages is similar to that of younger ages. However, the concept that older individuals may suffer from allergic asthma has been largely denied in the past, and a common belief attributes to asthma the definition of "rare" disease. Indeed, asthma in the elderly is often underdiagnosed or diagnosed as COPD, thus leading to undertreatment of improper treatment. This is also due to the heterogeneity of clinical and functional presentations of geriatric asthma, including the partial loss of reversibility and the lower occurrence of the allergic component in this age range...
2015: Clinical and Molecular Allergy: CMA
P Santus, D Radovanovic, P Paggiaro, A Papi, A Sanduzzi, N Scichilone, F Braido
Long-acting β2-adrenoceptor agonists, formoterol and salmeterol, represent a milestone in the treatments of chronic obstructive lung diseases. Although no specific indications concerning the choice of one molecule rather than another are provided by asthma and COPD guidelines, they present different pharmacological properties resulting in distinct clinical employment possibilities. In particular, salmeterol has a low intrinsic efficacy working as a partial receptor agonist, while formoterol is a full agonist with high intrinsic efficacy...
July 2015: European Journal of Internal Medicine
Prescott G Woodruff, Alvar Agusti, Nicolas Roche, Dave Singh, Fernando J Martinez
Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms...
May 2, 2015: Lancet
2015-10-14 17:06:00
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