Takashi Motegi

Nippon Medical School, Tokyo, Tokyo-to, Japan

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Publications (25)17.7 Total impact

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    ABSTRACT: Background and objectiveVitamin D supplementation can decrease the vulnerability to pulmonary infections. Therefore, it is speculated that the genes related to vitamin D metabolism are associated with an exacerbation-prone phenotype in chronic obstructive pulmonary disease (COPD). Because genetic variations of group component (GC) affect immunological capacity and serum vitamin D concentration, they could also affect the susceptibility to COPD exacerbation and the disease progression. We investigated the association between GC genetic variations and COPD and its exacerbation frequency in a Japanese population.Methods We performed genotype analysis of 361 COPD patients and 219 controls to identify two coding single nucleotide polymorphisms of GC, rs4588 and rs7041. We examined whether these polymorphisms were associated with the frequency of COPD exacerbation and analysed the correlation between the genotypes, COPD, emphysema severity and COPD progression, namely, the annual decline in airflow obstruction and diffusing capacity.ResultsSubjects with a C allele at rs4588 exhibited a higher frequency of exacerbations (P = 0.0048), greater susceptibility to chronic obstructive pulmonary disease (P = 0.0003), and emphysema (P = 0.0029), and a tendency for rapid decline of airflow obstruction (P = 0.0927).ConclusionsGC variations may affect exacerbation susceptibility, possibly leading to COPD worsening and its progression.
    Respirology 05/2014; 19(4). · 2.78 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. COPD exacerbation, or episodic worsening of symptoms, often results in hospitalization and increased mortality rates. Airway infections by new bacterial strains, such as nontypeable Haemophilus influenzae (NTHi), are a major cause of COPD exacerbation. NTHi express lipooligosaccharides that contain sialic acids, and may interact with Siglec-14, a sialic acid recognition protein on myeloid cells that serves as an activating signal transduction receptor. A null allele polymorphism in SIGLEC14 may attenuate the inflammatory responses to NTHi by eliminating Siglec-14 expression. We asked if the loss of Siglec-14 attenuates the inflammatory response by myeloid cells against NTHi, and if the SIGLEC14-null polymorphism has any effect on COPD exacerbation. We found that NTHi interacts with Siglec-14 to enhance proinflammatory cytokine production in a tissue culture model. Inhibitors of the Syk tyrosine kinase suppress this response. Loss of Siglec-14, due to SIGLEC14-null allele homozygosity, is associated with a reduced risk of COPD exacerbation in a Japanese patient population. Taken together, Siglec-14 and its downstream signaling pathway facilitate the "infection-inflammation-exacerbation" axis of COPD disease progression, and may represent promising targets for therapeutic intervention.
    Cellular and Molecular Life Sciences CMLS 03/2013; · 5.62 Impact Factor
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    ABSTRACT: AIM: Age-associated changes of the lung might increase pathogenetic susceptibility to chronic obstructive pulmonary disease (COPD). Decrement in serum transforming growth factor (TGF)-β1 concentration is reported in elderly people. As impaired TGF-β1 signaling could cause emphysema-like changes, we hypothesized that decreased TGF-β1 with aging is correlated with emphysema. METHODS: Symptomatic patients with or without COPD and healthy normal subjects without COPD were recruited (COPD, n = 182; smoking controls, n = 73; normal, n = 26). We investigated the correlation between TGF-β1 and extent of emphysema and airway wall thickness, which were defined as the percentage of low-attenuation area (LAA%) and large airway wall area (WA%) on pulmonary high-resolution computed tomography, respectively. The correlation of pulmonary function test parameters and TGF-β1 was evaluated. TGF-β1 was determined by enzyme-linked immunosorbent assay. RESULTS: TGF-β1 significantly decreased with age (P = 0.0009). When the correlation between age and TGF-β1 was analyzed in each group, a significant inverse correlation was found in COPD patients and smoking controls (P = 0.0095 and 0.0132, respectively), whereas no correlation was observed in healthy older adults. Among COPD patients with severe emphysema, LAA% was inversely correlated with TGF-β1 (n = 89, P = 0.0104), whereas WA% and pulmonary function test parameters were not. CONCLUSIONS: Although no correlation was found between TGF-β1 and the severity of COPD, TGF-β1 significantly decreased as emphysema became more severe. Age-related decrease of TGF-β1 in COPD might be associated with emphysematous alterations of the lungs in elderly subjects. Geriatr Gerontol Int 2013; ●●: ●●-●●.
    Geriatrics & Gerontology International 02/2013;
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    ABSTRACT: Prediction of future exacerbations of chronic obstructive pulmonary disease (COPD) is a major concern for long-term management of this disease. To determine which of three multidimensional assessment systems (the body mass index, obstruction, dyspnea, and exercise capacity [BODE] index; dyspnea, obstruction, smoking, exacerbations [DOSE] index; or age, dyspnea, obstruction [ADO] index) is superior for predicting exacerbations. This was a 2-year prospective cohort study of COPD patients. Pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council (MMRC) dyspnea scores, chest computed-tomography measurements, and body composition were analyzed, and predictions of exacerbation by the three assessment systems were compared. Among 183 patients who completed the study, the mean annual exacerbation rate was 0.57 events per patient year, which correlated significantly with lower predicted forced expiratory volume in 1 second (FEV1) (P < 0.001), lower transfer coefficient of the lung for carbon monoxide (%DLco/VA) (P = 0.021), lesser 6MWD (P = 0.016), higher MMRC dyspnea score (P = 0.001), higher DOSE index (P < 0.001), higher BODE index (P = 0.001), higher ADO index (P = 0.001), and greater extent of emphysema (P = 0.002). For prediction of exacerbation, the areas under the curves were larger for the DOSE index than for the BODE and ADO indices (P < 0.001). Adjusted multiple logistic regression identified the DOSE index as a significant predictor of risk of COPD exacerbation. In this study, the DOSE index was a better predictor of exacerbations of COPD when compared with the BODE and ADO indices.
    International Journal of COPD 01/2013; 8:259-71.
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    ABSTRACT: Historically, the progress of long term-oxygen therapy (LTOT) in Japan has been characterized by collaboration among academic groups, policy makers, and industrial companies. The public health insurance program has covered the cost of LTOT since 1985. Thomas Petty's group in Denver enthusiastically carried out the public implementation of LTOT and conveyed the concept of pulmonary rehabilitation for the processing with LTOT. Although the target diseases of LTOT in Japan tended to be chronic obstructive pulmonary disease or sequelae of primary lung tuberculosis, it was soon applied for cardiac diseases as well as other pulmonary diseases. Together with increasing medical costs for geriatric patients, the political conversion from hospital based care of a traditional style to home care system has been performed, with two background reasons: the improvement of quality of life of patients and the reduction of the medical expense. Presently, LTOT plays a pivotal role in the successful implementation of home respiratory care for elderly patients. In addition, this promotes comprehensive pulmonary rehabilitation, a team approach, and close liaisons between primary care and hospitals. Currently, the total number of patients using LTOT exceeds 150,000. In Japan, LTOT resulted in an advancement in the medical care as well as in administrative decision to introduce it as a nationwide system after analyzing the results of opinion polls of patients with respiratory failure. However, the recent great earthquake in East Japan revealed that many unresolved problems remain for these patients, and these issues are of great concern.
    Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc 01/2013; 81(5):468-78.
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    ABSTRACT: This study evaluated the implementation of pulmonary rehabilitation (PR), and the extent of the collaboration between primary care and chest physicians involved in the management of chronic obstructive pulmonary disease (COPD) in Japan. The survey was conducted in 2006 via post and facsimile and included all medical institutions approved by the Japan Respiratory Society. In total, 176 institutions responded (response rate, 27%); a PR program was conducted at 55.1% of these institutions throughout Japan, but with regional differences. The mean duration of each session in an outpatient setting was 30min with 2 sessions per week, and the mean length of hospitalization was 2-3 weeks. Although 33% of the hospitals adopted PR programs, on a scale from none (0) to maximum achievement (100), the accomplishment score was 48. Similarly, the mean satisfaction level score for collaboration was 44. The main problem arising with regards to chest physicians' referral to general physicians was the reluctance of patients or family members (88%). Chest physicians believed that general physicians should perform early screening of patients and manage early exacerbations, including educating patients of the need to discontinue smoking. Most chest physicians in Japan were not satisfied with the status of long-term COPD management. PR for COPD patients and collaboration between primary care physicians and specialists remain problematic in Japan. Moreover, there are widespread regional differences in terms of implementation. Sharing and implementing appropriate clinical information with primary care physicians according to current clinical guidelines should be emphasized.
    Respiratory investigation. 09/2012; 50(3):98-103.
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    ABSTRACT: Fut8 (α1,6-Fucosyltransferase) heterozygous knock-out (Fut8(+/-)) mice had an increased influx of inflammatory cells into the lungs, and this was associated with an up-regulation of matrix metalloproteinases, MMP-2 and MMP-9, after treatment with porcine pancreatic elastase (PPE), exhibiting an emphysema-prone phenotype as compared with wild type mice (Fut8(+/+)). The present data as well as our previous data on cigarette-smoke-induced emphysema [8] led us to hypothesize that reduced Fut8 levels leads to COPD with increased inflammatory response in humans and is associated with disease progression. To test this hypothesis, symptomatic current or ex-smokers with stable COPD or at risk outpatients were recruited. We investigated the association between serum Fut8 activity and disease severity, including the extent of emphysema (percentage of low-attenuation area; LAA%), airflow limitation, and the annual rate of decline in forced expiratory volume in 1 s (FEV(1)). Association with the exacerbation of COPD was also evaluated over a 3-year period. Serum Fut8 and MMP-9 activity were measured. Fut8 activity significantly increased with age among the at risk patients. In the case of COPD patients, however, the association was not clearly observed. A faster annual decline of FEV(1) was significantly associated with lower Fut8 activity. Patients with lower Fut8 activity experienced exacerbations more frequently. These data suggest that reduced Fut8 activity is associated with the progression of COPD and serum Fut8 activity is a non-invasive predictive biomarker candidate for progression and exacerbation of COPD.
    Biochemical and Biophysical Research Communications 06/2012; 424(1):112-7. · 2.41 Impact Factor
  • Journal of Nippon Medical School 01/2012; 79(6):498-500.
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    ABSTRACT: Education is a key issue for the long-term management of chronic obstructive pulmonary disease in older patients. We tested the hypothesis that integrated care focusing on patient information needs for self-management can improve patient information needs and health outcomes.   Patients with chronic obstructive pulmonary disease (n=102) were randomized into integrated care (group I) and usual care (group U) groups. Group I underwent a program of educational sessions for 6months (integrated education period), and then repeatedly received an individually tailored education according to the Lung Information Needs Questionnaire score. Both groups were followed up monthly for 6months.   A total of 85 patients (mean age: 71.7years) were followed up for 12months. The total Lung Information Needs Questionnaire score was significantly better in group I than in group U at 12months (P<0.03). Activities of daily living scores were significantly improved in group I at 6months (P<0.03). The dyspnea score and the BODE index (body mass index, dyspnea, airflow obstruction and exercise capacity) were significantly improved in group I at 12months (P<0.01 and P<0.02, respectively). During the integrated education period, the frequency of hospitalization was significantly lower in group I than in group U (P=0.033). Integrated education for older patients with chronic obstructive pulmonary disease effectively improved patients' information needs, activities of daily living, dyspnea score, BODE index and reduced hospitalizations during the observed period. Geriatr Gerontol Int 2011; 11: 422-430.
    Geriatrics & Gerontology International 03/2011; 11(4):422-30.
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    ABSTRACT: To determine whether the presence of in-home caregivers is associated with changes in the health outcomes of older adults with chronic obstructive pulmonary disease (COPD). Cross-sectional study. Geriatric medical center and academic respiratory clinic in Japan. Community-dwelling adults with COPD and their caregivers. Outcome measures (pulmonary function tests, distance on the 6-minute walking test (6MWT), activities of daily living (ADLs), quality of life (Medical Outcomes Study 36-item Short Form Survey and St. George's Respiratory Questionnaire), and frequencies of emergency visits and hospitalizations of those living alone (group A), those living with one caregiver (group B), and those living with two or more caregivers (group C) were compared. Three hundred eighty-nine participants (315 men and 74 women; mean age 73.3) were enrolled. Mean predicted forced expiratory volume in 1 second was 57.5%. The numbers of participants allocated into the global initiative for chronic obstructive lung disease stages I, II, III, and IV were 105, 107, 122, and 55, respectively. Group A had 87 participants; group B, 125; and group C, 177. Instrumental ADL scores were highest in group A (P < .001), whereas 6MWT distance was longest in group B and shortest in group A. The frequency of emergency visits was highest in group A (P < .001). Participants with COPD living alone were higher functioning in terms of instrumental ADLs, but they had less exercise capacity and more-frequent emergency visits than participants in the in-home caregiver groups and no difference in hospitalizations.
    Journal of the American Geriatrics Society 01/2011; 59(1):44-9. · 3.98 Impact Factor
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    ABSTRACT: Early diagnosis is a key factor in the management of chronic obstructive pulmonary disease (COPD). Although mass screening is widely used, little is known about its accuracy and efficacy. This study investigated whether using spirometry during mass screening to detect COPD among community residents might be ineffective because of variability in the training and experience of examiners. Both spirometry and a self-written questionnaire-based survey, including questions designed to detect respiratory symptoms, were conducted on community residents. Two separate studies were conducted on islanders living in similar environments. Study I was performed from 2004 to 2007 on Hachijyo Island residents, while study II, with a similar study design, was performed in 2003 on Inno Island residents. In study I, 3,592 subjects underwent examination over the 4-year study period; of these, 378 subjects underwent repeated examinations. Approximately 25% of the subjects had respiratory symptoms. Acceptable spirometry recordings were obtained for 62.0% (2004) to 84.1% (2006) of the subjects. In study II, 167 of the 254 subjects (65.7%) had respiratory symptoms. Acceptable assessment recordings were achieved in 254 subjects (95.5%). The suitability of the recordings was influenced by the extent/level of training of the examiners and the accompanying thoracic specialists. We concluded that the effectiveness of health check-ups for COPD evaluation using spirometry was greatly influenced by the quality of the examiners, even when the subjects had respiratory symptoms. Thus, we recommend caution when screening for early signs of COPD during health check-ups.
    Internal Medicine 01/2011; 50(19):2135-41. · 0.97 Impact Factor
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    ABSTRACT: Previous studies have suggested links between chronic obstructive pulmonary disease (COPD), cardiovascular disease, and abdominal obesity. Although abdominal visceral fat is thought to be associated with cardiovascular risk factors, the degree of visceral fat accumulation in patients with COPD has not been directly studied. The aim of this study was to investigate the abdominal visceral fat accumulation and the association between visceral fat and the severity and changes in emphysema in COPD patients. We performed clinical and laboratory tests, including pulmonary function, dyspnea score, and the six-minute walking test in COPD patients (n = 101) and control, which included subjects with a smoking history but without airflow obstruction (n = 62). We used computed tomography to evaluate the abdominal visceral fat area (VFA), subcutaneous fat area (SFA), and the extent of emphysema. The COPD group had a larger VFA than the control group. The prevalence of non-obese subjects with an increased VFA was greater in the Global Initiative for Chronic Obstructive Lung Disease Stages III and IV than in the other stages of COPD. The extent of emphysema was inversely correlated with waist circumference and SFA. However, VFA did not decrease with the severity of emphysema. VFA was positively correlated with the degree of dyspnea. COPD patients have excessive visceral fat, which is retained in patients with more advanced stages of COPD or severe emphysema despite the absence of obesity.
    International Journal of COPD 01/2011; 6:423-30.
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    ABSTRACT: Limited data are available on the association between the severity of emphysema or airway narrowing, and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), which has been seen to be more prevalent among elderly subjects. The aim of this study was to examine the association between HRQOL, physical parameters and structural alterations in lung of COPD patients. Stable COPD patients (n = 125; mean age 71.0) were studied. Both the severity of emphysema, which was expressed as the extent of the low-attenuation area (LAA%), and percentage of the large airway wall area (WA%) on high-resolution computed tomography (HRCT) were compared with various parameters of the generic and HRQOL, respectively, together with pulmonary function tests and exercise capacity. The predicted value of forced expiratory volume in 1 s was significantly associated with both LAA% and WA%, but the diffusion capacity was strongly correlated with LAA% alone. Parameters of the generic and HRQOL, and almost all other parameters appeared to be significantly associated with LAA% alone, whereas no association was observed between WA% and QOL. We concluded that the severity of emphysema, but not that of large airway narrowing on HRCT, is associated with both generic and health-related QOL and reduced diffusion capacity. This notion might provide useful information in practice among elderly subjects who are unable to perform a spirometry.
    Geriatrics & Gerontology International 01/2010; 10(1):17-24.
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    ABSTRACT: Although muscle loss is thought to be a prognostic factor in chronic obstructive pulmonary disease (COPD), its determinants remain unclear. To verify the hypothesis that fat-free mass (FFM) and fat mass (FM) are associated with the extent of emphysema in COPD patients. A total of 112 stable, male current or ex-smokers with or without COPD attending a secondary care specialist COPD clinic were studied. FFM and FM were measured by bioelectrical impedance analysis. We also assessed the nutrition status, muscle strength by the handgrip test, exercise tolerance by the 6-minute walking test, airflow limitation and diffusion capacity, the extent of emphysema by high-resolution CT scan, systemic inflammation status using C-reactive protein, and a lipid-related hormone (adiponectin). The FFM index (FFMI), which was defined as the FFM divided by the square of the body height, was significantly correlated with age, the total number of lymphocytes, handgrip strength, distance on 6-minute walking, airflow limitation, diffusion capacity, extent of emphysema, and C-reactive protein. On multivariate analysis, the FFMI was associated with handgrip strength and inversely correlated with the extent of emphysema. The FM index (FMI) was positively correlated with pack-years, and was inversely correlated with the extent of emphysema and concentrations of adiponectin. The extent of emphysema was correlated with skeletal muscle loss and also the FM.
    Internal Medicine 02/2009; 48(1):41-8. · 0.97 Impact Factor
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    ABSTRACT: Low-dose, long-term macrolide therapy has been shown to be effective for the treatment of diffuse panbronchiolitis (DPB) and similar disorders in terms of the presence of airway mucus hypersecretion such as bronchiectasis, chronic bronchitis and sinobronchial syndrome. However, there are some patients, especially advanced cases, whose volume of sputum does not decrease sufficiently with macrolide therapy. These patients suffer from copious expectoration. There is currently no effective treatment, and an effective therapy is therefore urgently required. The aim of this study was to clarify whether or not the inhalation of tiotropium improves the symptoms in these cases. Tiotropium (18 microg/day) was administered to patients with DPB and similar disorders with airway mucus hypersecretion who did not respond to macrolide. The symptoms were evaluated by a visual analog scale (VAS) prior to and at 1 and 3 months after tiotropium administration. Radiological and pulmonary function tests were also performed to evaluate the effects of tiotropium. Thirteen patients (DPB 5, sinobronchial syndrome 5, bronchiectasis 3) were enrolled. The VAS scores were dramatically improved after the introduction of tiotropium. FEV(1) was significantly improved after 3 months of treatment with tiotropium. In contrast, the radiological findings remained unchanged. Tiotropium improved the symptoms of cough, sputum and breathlessness in the macrolide-resistant cases of DPB or similar disorders. These beneficial effects might be due to the suppression of airway secretion through the anticholinergic effect of tiotropium on the submucosal gland, however, the long-term efficiency of this treatment still needs to be further assessed.
    Internal Medicine 02/2008; 47(7):585-91. · 0.97 Impact Factor
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    ABSTRACT: Measuring exhaled nitric oxide (eNO) is a noninvasive and useful method for evaluating the correlation between airway inflammation and air pollution. The method is being used in studies; however, the effects of polluted air on eNO values are poorly understood. If polluted air significantly affects eNO concentrations, then it would be hard to evaluate the concentration of eNO, particularly in epidemiological measurements to detect the effects of airway inflammation, such as that in bronchial asthma. Thus, we hypothesized that short-term exposure to air pollution affects eNO values. To study the effects of environmental nitrogen oxides on the measurement of eNO concentration. A total of 19 school children who lived on a large street with heavy traffic with random allocation were studied. Subjects with bronchial asthma were identified with a questionnaire. Suspended particulate matter. including particulate matter with an aerodynamic diameter < or =2.5 microm (PM(2.5)), optical black carbon, nitric oxide (NO), nitric dioxide (NO(2)), and nitrogen oxides (NO(X)), were measured at a fixed place along the street every hour for 11 consecutive days. The concentrations of NO and NO(2) for each subject were measured by an individual 2-pyenyl-4,4,5,5-tetramethylimidazoline-3-oxide-1-oxyl sampler, and the concentration of eNO was measured with the off-line method. Of 19 subjects, 3 were found to have bronchial asthma. The level of each pollutant for 11 days peaked during the mornings (6;9 a.m.) and evenings (6;9 p.m.) due to traffic jams; average eNO values in healthy subjects and those with asthma were 27.1 +/- 9.7 and 57.7 +/- 18.6 ppb (p=0.098), respectively. It was found that the eNO value remained high when the mean values of various pollutants remained high for 8 hours before the measurements. It was estimated that the mean eNO values increased by 1.08 ppb (95% CI: 0.72;1.45) when the mean NO(X) value for the previous 8 hours reached approximately 10 ppb. We conclude that short-term exposure to polluted air of at least 8 hours before measurement affects eNO values. Therefore, caution should be exercised when measuring eNO value in epidemiological studies.
    Journal of Nippon Medical School 03/2007; 74(1):30-6.
  • Takashi Motegi, Koichi Yamada, Kozui Kida
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    ABSTRACT: Acute exacerbation of COPD (AE-COPD) is a major problem influencing patient outcome, increasing both economic burden and mortality. We investigated: 1) the direct medical cost for inpatients with AE-COPD, and 2) factors that contribute to the higher cost of AE-COPD. A total of 131 episodes in 99 patients (mean age: 77.9 yr) with AE-COPD (79 men and 20 women) were investigated. Mean FEV1 and FEV1% pred were 0.97L and 42.7%, respectively. Mean length of stay (LOS) was 23.9 days and longer LOS was correlated with poorer basic activities of daily living (ADL). Mortality during admission and one month after discharge was 4.8%, however, it reached 20.2% one year later. The mean total cost for each admission was 690,000 yen (median 613,000 yen). Univariate analysis indicated that advanced age, hypoxemia, hypercapnea, systemic steroid use and reduction of ADL significantly correlated with increased total cost over the median cost. Multivariate analysis showed that factors significantly correlated with high medical cost over the median cost were observed in patients with a reduction of ADL (p < 0.001), hypoxemia OR 4.13 (95% CI: 1.54-11.05), systemic steroid use OR 3.14 (95% CI: 1.07-9.26), and reduced ADL OR 2.76 (95% CI: 1.04-7.30). However, neither advanced age nor severity of COPD, body mass index, or comorbidity significantly correlated with the total cost. We concluded that reduction of ADL in elderly COPD patients closely correlated with increased cost due to acute exacerbation. Therefore, pulmonary rehabilitation should be implemented from the perspective of reducing economic health burden.
    Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 12/2006; 44(11):787-94.
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    ABSTRACT: A 31-year-old woman was admitted to our hospital because of progressive dyspnea and chest X-ray abnormality. She was given a diagnosis of bronchial asthma 3 years previously. She had received medical treatment, but her dyspnea did not improve. Chest CT showed multiple thin-walled cysts and centrilobular nodules throughout both lungs. Video-assisted thoracoscopic lung biopsy revealed remarkable plasmacytic infiltration in the bronchioles and its surrounding interstitium. Small cystic lesions were detected and with remarkable mural plasmacytic infiltration. The immunohistochemistry showed infiltrated plasmacytes with polyconal characteristics. Her biochemical examinations showed polyclonal hyperimmunoglobulinemia and a high range of serum IL-6. In addition, CT scans showed multiple mediastinal and intraperitoneal lymphadenopathy. From these examinations, she was given a diagnosis of multicentric Castleman disease (MCD) with pulmonary involvement showing diffuse cystic change. This case showed an unusual pattern of MCD with pulmonary involvement. However, we suggest that MCD also should be considered as a differential diagnosis in cases with diffuse lung cystic changes.
    Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 07/2006; 44(6):468-73.
  • Takashi Motegi, Kozui Kida, Shoji Kudoh
    Geriatrics & Gerontology International - GERIATR GERONTOL INT. 01/2005; 5(1):29-36.
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    ABSTRACT: To evaluate the long-term effects of pulmonary rehabilitation in elderly COPD patients, we monitored patients for 1 year after they completed a 2-week inpatient pulmonary rehabilitation program. We also compared the effects of pulmonary rehabilitation on young-elderly (age 65-74 years) and old-elderly (age 75 years or over) COPD patients. Fifty-nine elderly COPD patients (mean age 72.8 years) were studied. They underwent a comprehensive 2-week inpatient pulmonary rehabilitation program incorporating 10 exercise sessions, each of which included endurance training of the lower extremities, peripheral muscle conditioning training of the upper and lower extremities, and stretching, along with various education sessions. The effects of pulmonary rehabilitation were evaluated at 3, 6, and 12 months after completion of the program. Overall, patient health-related quality of life (HRQoL) as assessed by a QoL scale, and dyspnoea as assessed by an oxygen cost diagram, improved significantly over the 12-month period. Exercise capacity assessed by a 6-min walking distance test (6MWD) was similarly significantly improved. However, there was some fall-off in terms of the distance walked 12 months after pulmonary rehabilitation. The improvements in exercise capacity, dyspnoea, and HRQoL did not differ between the two groups, with the exception that the 6MWD (P < 0.01) and the QoL scale (P < 0.05) at 3 months post-pulmonary rehabilitation were significantly higher in the old-elderly group. Pulmonary rehabilitation is an effective treatment in terms of improving dyspnoea, exercise capacity and HRQoL in elderly COPD patients, and the benefits are almost comparable for young-elderly and old-elderly patients.
    Respirology 06/2004; 9(2):230-6. · 2.78 Impact Factor