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BACKGROUND: Pulmonary rehabilitation (PR) is effective in improving exercise capacity and health-related quality of life (HRQOL) in patients with moderate-to-very-severe COPD. Quadriceps strength and HRQOL can be impaired in patie...
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BACKGROUND: Pulmonary rehabilitation (PR) is effective in improving exercise capacity and health-related quality of life (HRQOL) in patients with moderate-to-very-severe COPD. Quadriceps strength and HRQOL can be impaired in patients with mild COPD, therefore, patients at this grade may already benefit from PR. However, the impact of PR in patients with mild COPD remains unestablished. Thus, this systematic review assessed the impact of PR on exercise capacity, HRQOL, health-care resource use and lung function in patients with mild COPD. METHODS: The Web of Knowledge, EBSCO, MEDLINE, and SCOPUS databases were searched up to April 2013. Reviewers independently selected studies according to the eligibility criteria. RESULTS: Three studies with different designs (retrospective, one group pretest-posttest, and randomized controlled trial) were included. Out-patient PR programs were implemented in two studies, which included mainly aerobic, strength, and respiratory muscle training. The randomized controlled trial compared a PR home-based program, consisting of 6 months of walking and participating in ball games, with standard medical treatment. Significant improvements in exercise capacity (effect size [ES] 0.87-1.82) and HRQOL (ES 0.24-0.86) were found when comparing pretest-posttest data and when comparing PR with standard medical treatment. In one study, a significant decrease in hospitalization days was found (ES 0.38). No significant effects were observed on the number of emergency department visits (ES 0.32), number of hospitalizations (ES 0.219), or lung function (ES 0.198). CONCLUSIONS: Most of the PR programs had significant positive effects on exercise capacity and HRQOL in patients with mild COPD; however, their effects on health-care resource use and lung function were inconclusive. This systematic review suggests that patients with mild COPD may benefit from PR; however, insufficient evidence is still available. Studies with robust designs and with longer follow-up times should be conducted.
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摘要 :
BACKGROUND: Pulmonary rehabilitation (PR) is effective in improving exercise capacity and health-related quality of life (HRQOL) in patients with moderate-to-very-severe COPD. Quadriceps strength and HRQOL can be impaired in patie...
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BACKGROUND: Pulmonary rehabilitation (PR) is effective in improving exercise capacity and health-related quality of life (HRQOL) in patients with moderate-to-very-severe COPD. Quadriceps strength and HRQOL can be impaired in patients with mild COPD, therefore, patients at this grade may already benefit from PR. However, the impact of PR in patients with mild COPD remains unestablished. Thus, this systematic review assessed the impact of PR on exercise capacity, HRQOL, health-care resource use and lung function in patients with mild COPD. METHODS: The Web of Knowledge, EBSCO, MEDLINE, and SCOPUS databases were searched up to April 2013. Reviewers independently selected studies according to the eligibility criteria. RESULTS: Three studies with different designs (retrospective, one group pretest-posttest, and randomized controlled trial) were included. Out-patient PR programs were implemented in two studies, which included mainly aerobic, strength, and respiratory muscle training. The randomized controlled trial compared a PR home-based program, consisting of 6 months of walking and participating in ball games, with standard medical treatment. Significant improvements in exercise capacity (effect size [ES] 0.87-1.82) and HRQOL (ES 0.24-0.86) were found when comparing pretest-posttest data and when comparing PR with standard medical treatment. In one study, a significant decrease in hospitalization days was found (ES 0.38). No significant effects were observed on the number of emergency department visits (ES 0.32), number of hospitalizations (ES 0.219), or lung function (ES 0.198). CONCLUSIONS: Most of the PR programs had significant positive effects on exercise capacity and HRQOL in patients with mild COPD; however, their effects on health-care resource use and lung function were inconclusive. This systematic review suggests that patients with mild COPD may benefit from PR; however, insufficient evidence is still available. Studies with robust designs and with longer follow-up times should be conducted.
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The prediction that chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020 has enormous economic repercussions. Yet many issues and questions remain unresolved. For example, how can...
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The prediction that chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020 has enormous economic repercussions. Yet many issues and questions remain unresolved. For example, how can population studies of morbidity and mortality be viewed as comparable, without a worldwide consensus on the definition of COPD? How can the early diagnosis of COPD be improved? Why is it that only a minority of smokers develop COPD, despite tobacco smoking being the primary risk factor for chronic bronchitis and emphysema? How can the efficacy of smoking cessation interventions be improved? To what extent are the pathologic changes in the lungs reversible - and, if so, at what stage? And to what degree is it appropriate to emphasize the similar features of COPD and asthma? It is to be hoped that the emerging post-genomic and proteomic climate will facilitate the unlocking of the genetic substrate for COPD, and thus promote greater therapeutic specificity and efficacy. Copyright 2001 S. Karger AG, Basel
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Background Spirometrically-defined chronic obstructive pulmonary disease (COPD) is considered progressive but its natural history is inadequately studied. We hypothesized that spirometrically-defined COPD states could undergo bene...
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Background Spirometrically-defined chronic obstructive pulmonary disease (COPD) is considered progressive but its natural history is inadequately studied. We hypothesized that spirometrically-defined COPD states could undergo beneficial transitions. Methods Participants in the Lovelace Smokers’ Cohort ( n =?1553), primarily women, were longitudinally studied over 5?years. Spirometric states included normal postbronchodilator spirometry, COPD Stage I, Unclassified state, and COPD Stage II+, as defined by GOLD guidelines. Beneficial transitions included either a decrease in disease severity, including resolution of spirometric abnormality, or maintenance of non-diseased state. ‘All smokers’ ( n =?1553) and subgroups with normal and abnormal spirometry at baseline ( n =?956 and 597 respectively) were separately analyzed. Markov-like model of transition probabilities over an average follow-up period of 5?years were calculated. Results Among ‘all smokers’, COPD Stage I, Unclassified, and COPD Stage II+ states were associated with probabilities of 16, 39, and 22?% respectively for beneficial transitions, and of 16, 35, and 4?% respectively for resolution. Beneficial transitions were more common for new-onset disease than for pre-existing disease ( p <?0.001). Beneficial transitions were less common among older smokers, men, or those with bronchial hyperresponsiveness but more common among Hispanics and smokers with excess weight. Conclusions This observational study of ever smokers, shows that spirometrically-defined COPD states, may not be uniformly progressive and can improve or resolve over time. The implication of these findings is that the spirometric diagnosis of COPD can be unstable. Furthermore, COPD may have a pre-disease state when interventions might help reverse or change its natural history. Trial registration NA.
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Purpose of review Asthma/chronic obstructive pulmonary disease overlap (ACO) continues to be a poorly understood condition. This review discusses newly proposed criteria and potential biomarkers in ACO, to aid in diagnosis and res...
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Purpose of review Asthma/chronic obstructive pulmonary disease overlap (ACO) continues to be a poorly understood condition. This review discusses newly proposed criteria and potential biomarkers in ACO, to aid in diagnosis and research studies, and prudent therapeutic approaches. Recent findings A global expert panel proposed an operational definition consisting of major and minor criteria as a step toward defining ACO. Serum periostin and YKL-40 may serve as biomarkers for ACO. Clinically, a reasonable therapeutic approach to ACO is the early addition of a long-acting p-agonist (LABA) and/or a long-acting muscarinic antagonist (LAMA) to an inhaled corticosteroid (ICS). Summary Both the proposed criteria and the described biomarkers for ACO can help guide clinicians in identifying this condition as well as aid researchers in designing much needed future studies. In the meantime, clinicians can treat potential ACO patients using the above approach, until therapeutic studies in clearly defined ACO patients are performed.
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The annual cost of chronic obstructive pulmonary disease (COPD) in the United States in 2008 was $53.7 billion, largely due to visits to a medical facility for exacerbations. In this article, we explore the most recent updates on ...
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The annual cost of chronic obstructive pulmonary disease (COPD) in the United States in 2008 was $53.7 billion, largely due to visits to a medical facility for exacerbations. In this article, we explore the most recent updates on the medical management of COPD, including the most recently released inhalers. We also explore the role of COPD self-management and integrated disease management, and discuss the most recent studies pertaining to those. In addition, we discuss the most recent updates on bronchoscopic interventions for lung volume reduction. We also discuss the results of our study assessing the role of protocolized COPD management on the basis of Global Chronic Obstructive Lung Disease guidelines and its effects on COPD exacerbation rates, quality of life, and depression scores.
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To support the USPSTF recommendation in this issue, Lin and colleagues reviewed the evidence on screening for COPD by using spirometry. Spirometry has not been shown to independently improve smoking cessation rates, and hundreds o...
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To support the USPSTF recommendation in this issue, Lin and colleagues reviewed the evidence on screening for COPD by using spirometry. Spirometry has not been shown to independently improve smoking cessation rates, and hundreds of patients would need to undergo spirometry to defer 1 COPD exacerbation. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy.
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Current trends in chronic obstructive pulmonary disease (COPD) in the UK differ from those in many other countries because, in the past, COPD was much more common than in other countries undergoing a smoking epidemic at the same t...
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Current trends in chronic obstructive pulmonary disease (COPD) in the UK differ from those in many other countries because, in the past, COPD was much more common than in other countries undergoing a smoking epidemic at the same time, and peak cigarette consumption in men and women occurred more 25 years ago. Male mortality from COPD has been falling for 30 years, while female mortality has risen steadily during the same period. A strong socioeconomic gradient in morbidity and mortality persists. Emergency hospital admissions for exacerbations and home oxygen account for a large proportion of the healthcare costs.
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Purpose of review Pulmonary hypertension is common (25–90%) in chronic obstructive pulmonary diseases (COPDs). Severe pulmonary hypertension, however, is quite rare (1–3%). The term ‘out of proportion’ pulmonary hypertension i...
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Purpose of review Pulmonary hypertension is common (25–90%) in chronic obstructive pulmonary diseases (COPDs). Severe pulmonary hypertension, however, is quite rare (1–3%). The term ‘out of proportion’ pulmonary hypertension is still widely used. New guidelines instead propose to use the term ‘ Severe pulmonary hypertension’ if mean pulmonary arterial pressure at least 35 mmHg or cardiac index ( CI ) is less than 2.0?l/min/m~(2)on right heart catheterization (RHC). Why only a minority of COPD patients develop severe pulmonary hypertension is unclear. Recent findings When present, severe pulmonary hypertension in COPD is associated with increased dyspnea and decreased survival and often does not closely correlate with degree of obstructive abnormality on pulmonary function testing. COPD patients with severe pulmonary hypertension experience circulatory limitation at maximum exercise, and not ventilatory limitation, which is typical for moderate-to-severe COPD patients with no or moderate pulmonary hypertension. Summary There is no conclusive evidence to support or completely reject the possibility of the use of specific pulmonary arterial hypertension (PAH) therapies in pulmonary hypertension associated with COPD. In mild-to-moderate COPD patients who have severe and progressive symptoms, and have evidence of severe pulmonary hypertension on RHC, specific PAH therapies may be used similar to WHO group-I PAH guidelines.
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Aging is one of the most important risk factors for most chronic diseases. The worldwide increase in life expectancy has been accompanied by an increase in the prevalence of age-related diseases that result in significant morbidit...
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Aging is one of the most important risk factors for most chronic diseases. The worldwide increase in life expectancy has been accompanied by an increase in the prevalence of age-related diseases that result in significant morbidity and mortality and place an enormous burden on healthcare and resources. Aging is a progressive degeneration of the tissues that has a negative impact on the structure and function of vital organs. The lung ages, resulting in decreased function and reduced capacity to respond to environmental stresses and injury. Many of the changes that occur in the lungs with normal aging, such as decline in lung function, increased gas trapping, loss of lung elastic recoil, and enlargement of the distal air spaces, also are present in chronic obstructive pulmonary disease (COPD). The prevalence of COPD is two to three times higher in people over the age of 60 years than in younger age groups. Indeed, COPD has been considered a condition of accelerated lung aging. Several mechanisms associated with aging are present in the lungs of patients with COPD. Cell senescence is present in emphysematous lungs and is associated with shortened telomeres and decreased antiaging molecules, suggesting accelerated aging in the lungs of patients with COPD. Increasing age leads to elevated basal levels of inflammation and oxidative stress (inflammaging) and to increased immunosenescence associated with changes in both the innate and adaptive immune responses. These changes are similar to those that occur in COPD and may enhance the activity of the disease as well as increase susceptibility to exacerbations in patients with COPD. Understanding the mechanism of age-related changes in COPD may identify novel therapies for this condition.
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