0000000000017156
AUTHOR
Cruz González
Multicentric study on the beta-blocker use and relation with exacerbations in COPD
SummaryChronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment.In patients with indication 58% (95%CI, 52–64%) of the COPD patients and 97% of the non-COPD patients were …
Importance of noninvasively measured respiratory muscle overload among the causes of hospital readmission of COPD patients.
To evaluate the influence of respiratory muscle overload and right cardiac overload among the possible risk factors of hospital readmission in a 1-year follow-up of a cohort of patients with moderate-to-severe COPD.A total of 112 COPD patients who were admitted consecutively to the hospital for acute exacerbation. At hospital discharge, we evaluated the conventional clinical and functional determinations in addition to the pressure-time index (PTI), which is obtained using the equation PTI = (Pawo/Pimax) x (Ti/Ttot) x 100, where Pawo represents the mean airway pressure measured at the mouth during spontaneous breathing, Pimax is the maximal inspiratory pressure, Ti is the inspiratory time, …
Critical role of fractalkine (CX3CL1) in cigarette smoke-induced mononuclear cell adhesion to the arterial endothelium.
Background Cigarette smoking is an important risk factor for the development of cardiovascular disease, yet the pathways through which this may operate are poorly understood. Therefore, the mechanism underlying cigarette smoke (CS)-induced arterial endothelial dysfunction and the potential link with fractalkine/CX3CL1 upregulation were investigated. Methods and results Stimulation of human arterial umbilical endothelial cells (HUAECs) with pathophysiological concentrations of CS extract (1% CSE) increased CX3CL1 expression. Neutralisation of CX3CL1 activity under dynamic flow conditions significantly inhibited CSE-induced mononuclear cell adhesion to HUAECs (67%). The use of small interferi…
Gene Therapy in Rare Respiratory Diseases: What Have We Learned So Far?
Gene therapy is an alternative therapy in many respiratory diseases with genetic origin and currently without curative treatment. After five decades of progress, many different vectors and gene editing tools for genetic engineering are now available. However, we are still a long way from achieving a safe and efficient approach to gene therapy application in clinical practice. Here, we review three of the most common rare respiratory conditions—cystic fibrosis (CF), alpha-1 antitrypsin deficiency (AATD), and primary ciliary dyskinesia (PCD)—alongside attempts to develop genetic treatment for these diseases. Since the 1990s, gene augmentation therapy has been applied in multiple clinical tria…
A simple noninvasive pressure–time index at the mouth to measure respiratory load during acute exacerbation of COPD A comparison with normal volunteers
We assessed the validity of the pressure-time index (PTI) measured at the mouth as a noninvasive and simplified alternative to conventional tension-time index for assessing respiratory load and inspiratory muscle force reserve. PTI was measured within 48 h of hospital admission and at 24 h before discharge in 37 consecutive patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) using the equation PTI = (P(awo)/MIP)(T(I)/T(T)) 100, where P(awo) is the mean airway pressure measured at the mouth, MIP the maximal inspiratory pressure, and T(I)/T(T) the inspiratory time (T(I)) to total cycle length (T(T)) ratio. Controls were 30 normal volunteers with similar anthropome…
Predictors for early readmission after COPD exacerbation
Aim: Identify predictors for early readmission in patients with COPD and severe exacerbation. Material and methods: Prospective study (July 2017-June 2018) that included all patients hospitalized for an acute exacerbations of COPD. Demographic date, clinical and spirometric parameters, arterial blood gases, length of stay, and evolutive parameters were collected. We used univariate and multivariate statistical techniques to identify risks for readmission. Results: 278 consecutive patients were enrolled. During the follow-up 31 (11%) patients were admitted within 30 days of discharge (early readmission). Univariate analysis showed that FEV1 (p=0.02), FEV1 (%) (p=0.01), total dose of steroids…
Kyphoscoliotic Ventilatory Insufficiency
Objectives: To determine the effects of long-term nocturnal intermittent positive-pressure ventilation (NIPPV) on symptoms, pulmonary function test results, sleep, and respiratory muscle performance in patients with ventilatory insufficiency due to severe kyphoscoliosis. Design: A prospective study in which 16 severe kyphoscoliotic patients were treated with NIPPV delivered by volume-cycled and pressure-cycled ventilators, over a period of 36 months. Interventions and measurements: At baseline, pulmonary function tests, blood gas measurements, polysomnography, and respiratory muscle strength (measured by noninvasive indexes) were obtained. Symptoms and the number of hospitalizations in the …
Factores predictivos de reingreso hospitalario en la agudización de la EPOC moderada-grave
Objetivos: Conocer los factores asociados a la exacerbacion de la enfermedad pulmonar obstructiva (EPOC) es importante para mejorar la supervivencia de los pacientes y conseguir mayor efectividad en su tratamiento. El objetivo de este estudio es identificar las variables asociadas con el reingreso hospitalario en la agudizacion de la EPOC moderada-grave. Pacientes y metodos: Se estudio de forma prospectiva a 90 pacientes con EPOC moderada-grave ingresados de manera consecutiva en nuestro Servicio de Neumologia por exacerbacion de su enfermedad. En el momento del alta se evaluaron las variables clinicas, espirometricas y gasometricas, asi como el estado muscular, mediante medidas no invasiva…
[Risk factors of readmission in acute exacerbation of moderate-to-severe chronic obstructive pulmonary disease].
More effective management of chronic obstructive pulmonary disease (COPD) and improved survival of COPD patients requires a better understanding of the risk factors for exacerbation. The aim of this study was to identify factors related to readmission in patients with moderate-to-severe COPD.Ninety patients with moderate-to-severe COPD hospitalized consecutively for acute exacerbation were studied prospectively. At discharge, the following potential predictors were assessed: clinical and spirometric variables, arterial blood gases, and respiratory muscle strength determined noninvasively. The patients were followed for a period of 3 months. Readmission for exacerbation and time intervals fr…
Oxidative Stress and Endoplasmic Reticulum Stress in Rare Respiratory Diseases
Several studies have shown that some rare respiratory diseases, such as alpha-1 antitrypsin deficiency (AATD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), and primary ciliary dyskinesia (PCD) present oxidative stress (OS) and endoplasmic reticulum (ER) stress. Their involvement in these pathologies and the use of antioxidants as therapeutic agents to minimize the effects of OS are discussed in this review.
Cigarette Smoke Increases Endothelial CXCL16-Leukocyte CXCR6 Adhesion In Vitro and In Vivo. Potential Consequences in Chronic Obstructive Pulmonary Disease
Cardiovascular disease (CVD) is a major comorbidity in chronic obstructive pulmonary disease (COPD). Although the mechanism of its development remains largely unknown, it appears to be associated with cigarette consumption and reduced lung function. Therefore, the aim of this study was to investigate the potential link between water-soluble cigarette smoke extract (CSE)-induced endothelial dysfunction and the function of CXCL16/CXCR6 axis on the initial attachment of leukocytes, in addition to its possible impact on COPD-associated systemic inflammation. To do this, we employed several experimental approaches, including RNA silencing and flow cytometry analysis, the dynamic flow chamber tec…
Hypoxia induces proinflammatory cytokines production in alpha-1 antitrypsin deficiency patients
Introduction: Alpha-1 antitrypsin deficiency (AATD) is a rare respiratory condition characterized by abnormal inflammation, where neutrophils play a key role. Excessive neutrophil activation leads to an increase in the oxygen (O2) intake, causing local hypoxia and increased tissue-injury capacity. Tissue hypoxia is part of the inflammatory process so neutrophils can function effectively under these conditions. However, the mechanisms by which neutrophils mediate tissue damage under hypoxia remain unclear. The study aimed to determine whether hypoxia modifies the cytokine profile in AATD patients. Methods: Neutrophils from 22 AATD patients (6 MZ; 9 SZ; 7 ZZ) and 7 controls (MM) were exposed …
Predictors of mortality in COPD patients after hospitalization due to an exacerbation
Aim: Identify factors related to mortality at 6 months after hospitalization by an acute COPD exacerbation (AECOPD). Method: We performed a 12-month prospective, observational study (July 2017-June 2018) that included COPD patients admitted by an AECOPD. Sociodemographic data, comorbidities, functional and clinical parameters were collected. Mortality at 6 months of admission was considered the end point. Results: 278 consecutive patients were enrolled, of whom 48 (16.2%) died during 6 months after AECOPD. Univariate analysis showed that age (p Conclusions: In COPD patients, Barthel Index, grade of dyspnea and previous hospitalizations are independent risk factors for mortality at 6 months,…