An Integrated Approach to the Medical Treatment of Chronic Obstructive Pulmonary Disease
Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. The Medical clinics of North America
(Impact Factor: 2.61).
07/2012; 96(4):811-26. DOI: 10.1016/j.mcna.2012.05.002
COPD is a treatable condition for which careful and objective evaluation of patients’ lung function, symptoms, exercise capacity, and exacerbation history on an ongoing basis is essential so that treatments may be individualized as much as possible. Although the comparative effectiveness of drug classes has not yet been tested completely in COPD, virtually all inhaled COPD therapies improve lung function, quality of life, and reduce COPD exacerbations, which fulfills the major goals of care. Pulmonary rehabilitation is safe, effective, and a crucial component of COPD therapy. Newer therapies have been developed with the specific purpose of reducing COPD exacerbations and should be prescribed to individuals who have evidence of recurrent exacerbations despite maximal inhaled maintenance medications.
Available from: Sergio Victor Perrone
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ABSTRACT: Pulmonary hypertension (PH) presented in the last decade, significant progress in terms of their interpretation pathophysiological, clinical practice, and especially for diagnosis and treatment, which results in a significant improvement in the quality and life expectancy of patients even those who are in the later stages of the disease. These developments are reflected in the development of clinical guidelines based on evidence that has been developed by scientific societies and working groups of national and international, constituting the current reference for the diagnosis and treatment of this disease. However, these guidelines and recommendations are not addressed some issues that affect the daily clinical practice and how to contribute to this pathology. And, in addition, require technical and personal with solid experience in disease management for proper diagnosis and treatment of PH, especially in its more severe forms. The creation of interdisciplinary teams for early detection and early treatment of patients with PH of different etiologies contribute to better management of this disease which until very recently had no specific treatment. Creating models to educate the population to agree an early warning of disease, a rare and devastating, contribute significantly to this purpose. The working groups should work not only program of health care need, but also in a social educational task, to achieve the ultimate goal: a better quality of life and longer survival.
Available from: Irene Torres Sánchez
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ABSTRACT: Anxiety and depression are highly prevalent comorbid complications in COPD. Breathing techniques can improve anxiety and depression in subjects hospitalized due to COPD exacerbation. We conducted a randomized clinical study using two groups. The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups.The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups.
Baseline and post-intervention recordings of Dyspnea, Anxiety and depression, Quality of life (SGRQ and EURQoL), Respiratory pressures (PImax-PEmax), Hand-grip test and Sleep quality were taken in all subjects. Subjects hospitalized due to acute COPD exacerbation showed high levels of dyspnea and low values in overall quality of life as measured with the St. George's Respiratory Questionnaire (SGRQ).
Controlled breathing techniques had a significant effect on dyspnea, anxiety and mobility (p<0.05). All the measured areas were improved in the intervention group. The control group had poorer values in all the areas after the hospitalization period.
Controlled breathing exercises benefit patients hospitalized due to COPD exacerbation in anxiety and depression values.
Available from: PubMed Central
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The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization.
The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge.
There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57).
Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.
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