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Claus F Vogelmeier, Gerard J Criner, Fernando J Martinez, Antonio Anzueto, Peter J Barnes, Jean Bourbeau, Bartolome R Celli, Rongchang Chen, Marc Decramer, Leonardo M Fabbri, Peter Frith, David M G Halpin, M Victorina López Varela, Masaharu Nishimura, Nicolas Roche, Roberto Rodriguez-Roisin, Don D Sin, Dave Singh, Robert Stockley, Jørgen Vestbo, Jadwiga A Wedzicha, Alvar Agusti
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: i) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; iv) nonpharmacologic therapies are comprehensively presented and; v) the importance of comorbid conditions in managing COPD is reviewed...
January 27, 2017: American Journal of Respiratory and Critical Care Medicine
Anna M May, David R Van Wagoner, Reena Mehra
A surge of data has reproducibly identified strong associations of OSA with cardiac arrhythmias. As an extension of epidemiologic and clinic-based findings, experimental investigations have made strides in advancing our understanding of the putative OSA and cardiac arrhythmogenesis mechanistic underpinnings. Although most studies have focused on the links between OSA and atrial fibrillation (AF), relationships with ventricular arrhythmias have also been characterized. Key findings implicate OSA-related autonomic nervous system fluctuations typified by enhanced parasympathetic activation during respiratory events and sympathetic surges subsequent to respiratory events, which contribute to augmented arrhythmic propensity...
January 2017: Chest
Gaëlle Coureau, L Rachid Salmi, Cécile Etard, Hélène Sancho-Garnier, Catherine Sauvaget, Simone Mathoulin-Pélissier
Low-dose computed tomography (LDCT) screening recommendations for lung cancer are contradictory. The French National Authority for Health commissioned experts to carry a systematic review on the effectiveness, acceptability and safety of lung cancer screening with LDCT in subjects highly exposed to tobacco. We used MEDLINE and Embase databases (2003-2014) and identified 83 publications representing ten randomised control trials. Control arms and methodology varied considerably, precluding a full comparison and questioning reproducibility of the findings...
July 2016: European Journal of Cancer
Mahdi Bijanzadeh, Nallur B Ramachandra, P A Mahesh, Mysore R Savitha, B S Manjunath, B S Jayaraj
ABO is the most important blood group system in transfusion and transplantation practices. Glycosyltransferases are controlled by the ABO system which is helpful in building oligosaccharide structures on the cell surface of erythrocytes and vascular endothelium and in the exocrine secretion system, including the respiratory tract. We analyzed the ABO blood group of 200 children and adults with asthma as well as that of 2000 healthy subjects as controls. The most common blood group among the patients and controls was "O" (43...
November 2009: Lung
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
Mei Jiang, Wei-Jie Guan, Zhang-Fu Fang, Yan-Qing Xie, Jia-Xing Xie, Hao Chen, Dang Wei, Ke-Fang Lai, Nan-Shan Zhong
BACKGROUND: Clinical practice guidelines (CPGs) have been developed to provide health-care practitioners with the best possible evidence, but the quality of these CPGs varies greatly. OBJECTIVE: The goal of this study was to systematically evaluate the quality of cough CPGs and identify gaps limiting evidence-based practice. METHODS: Systematic searches were conducted to identify cough CPGs in guideline databases, developers' Websites, and Medline...
October 2016: Chest
Christopher G Slatore, Renda Soylemez Wiener, Amber D Laing
No abstract text is available yet for this article.
April 1, 2016: American Journal of Respiratory and Critical Care Medicine
Edward F Patz, Erin Greco, Constantine Gatsonis, Paul Pinsky, Barnett S Kramer, Denise R Aberle
BACKGROUND: Annual low-dose CT screening for lung cancer has been recommended for high-risk individuals, but the necessity of yearly low-dose CT in all eligible individuals is uncertain. This study examined rates of lung cancer in National Lung Screening Trial (NLST) participants who had a negative prevalence (initial) low-dose CT screen to explore whether less frequent screening could be justified in some lower-risk subpopulations. METHODS: We did a retrospective cohort analysis of data from the NLST, a randomised, multicentre screening trial comparing three annual low-dose CT assessments with three annual chest radiographs for the early detection of lung cancer in high-risk, eligible individuals (aged 55-74 years with at least a 30 pack-year history of cigarette smoking, and, if a former smoker, had quit within the past 15 years), recruited from US medical centres between Aug 5, 2002, and April 26, 2004...
May 2016: Lancet Oncology
M Ruparel, S L Quaife, N Navani, J Wardle, S M Janes, D R Baldwin
Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention...
April 2016: Thorax
Peter Gibson, Gang Wang, Lorcan McGarvey, Anne E Vertigan, Kenneth W Altman, Surinder S Birring
BACKGROUND: Unexplained chronic cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC. METHODS: This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for cough severity, cough frequency, and cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a chronic cough of > 8 weeks' duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality...
January 2016: Chest
Wim A Wuyts, Alberto Cavazza, Giulio Rossi, Francesco Bonella, Nicola Sverzellati, Paolo Spagnolo
Idiopathic pulmonary fibrosis (IPF), the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological and/or pathological pattern of usual interstitial pneumonia (UIP). However, UIP is not synonymous with IPF as other clinical conditions may be associated with UIP, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug toxicity, asbestosis, familial IPF and Hermansky-Pudlak syndrome. Differentiating IPF ("idiopathic UIP") from conditions that mimic IPF ("secondary UIP") has substantial therapeutic and prognostic implications...
September 2014: European Respiratory Review: An Official Journal of the European Respiratory Society
Lisa K Torres, Saadia A Faiz
A 29-year-old man presented with an acute onset of right pleuritic chest pain and a 3-month history of dyspnea, cough, and skin lesions. Physical examination revealed crackles in both lungs and multiple nonerythematous papules along the ink lines of a tattoo (Panel A). A chest radiograph (Panel B)..
June 5, 2014: New England Journal of Medicine
Hoi Nam Tse, Luca Raiteri, King Ying Wong, Lai Yun Ng, Kwok Sang Yee, Cee Zhung Steven Tseng
BACKGROUND: Although high-dose N-acetylcysteine (NAC) has been suggested to reduce COPD exacerbations, it is unclear which category of patients with COPD would benefit most from NAC treatment. The objective of this study was to compare the effect of high-dose NAC (600 mg bid) between high-risk and low-risk Chinese patients with COPD. METHODS: Patients with spirometry-confirmed stable COPD were randomized to treatment with either NAC 600 mg bid or placebo in addition to their usual treatments...
September 2014: Chest
Fahy Bonnie, Sockrider Marianna, Lareau Suzanne
No abstract text is available yet for this article.
May 15, 2014: American Journal of Respiratory and Critical Care Medicine
Manu Jain, Christopher H Goss
No abstract text is available yet for this article.
May 15, 2014: American Journal of Respiratory and Critical Care Medicine
Erika D Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, Robert F Miller, Najib M Rahman
BACKGROUND: Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. METHODS: Using data from the clinical trial, we compared costs associated with use of IPCs and with talc pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up...
October 2014: Chest
Scott C Woller, Scott M Stevens, Daniel M Adams, R Scott Evans, James F Lloyd, Gregory L Snow, Joseph R Bledsoe, David Z Gay, Richard M Patten, Valerie T Aston, C Gregory Elliott
BACKGROUND: D-dimer levels increase with age, and research has suggested that using an age-adjusted D-dimer threshold may improve diagnostic efficiency without compromising safety. The objective of this study was to assess the safety of using an age-adjusted D-dimer threshold in the workup of patients with suspected pulmonary embolism (PE). METHODS: We report the outcomes of 923 patients aged > 50 years presenting to our ED with suspected PE, a calculated Revised Geneva Score (RGS), and a D-dimer test...
December 2014: Chest
Yun Liu, Hongyang Shi, Xiuzhen Sun, Dexin Zhang, Yuping Zhang, Kunzheng Yang, Liehan Mi, Manxiang Li
OBJECTIVE: This meta-analysis was performed to evaluate the efficacy and safety of adding fluticasone propionate/salmeterol (FSC) to tiotropium (Tio) in COPD patients. METHODS: A systematic search was made of MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases, and a hand search of leading respiratory journals. Randomized clinical trials on treatment of stable COPD with the addition of FSC, compared with tiotropium alone, were reviewed. Studies were pooled to odds ratio (OR) and weighted mean differences (WMD), with 95% confidence interval (CI)...
June 2014: European Journal of Internal Medicine
Salvador Bello, Rosario Menéndez, Antoni Torres, Soledad Reyes, Rafael Zalacain, Alberto Capelastegui, Javier Aspa, Luis Borderías, Juan J Martin-Villasclaras, Immaculada Alfageme, Felipe Rodríguez de Castro, Jordi Rello, Luis Molinos, Juan Ruiz-Manzano
BACKGROUND: Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality. METHODS: We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22...
October 2014: Chest
2016-05-18 12:35:49
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