Respiratory Medicine - Articles in Press

Cognitive dysfunction in patients with chronic obstructive pulmonary disease – A systematic review - Corrected Proof

2012-05-14

Summary: Background: Substantial healthcare resources are spent on chronic obstructive pulmonary disease (COPD). In addition, the involvement of patients in monitoring and treatment of their condition has been suggested. However, it is important to maintain a view of self-care that takes differences in cognitive ability into account.The aim of this study was to determine the occurrence and severity of cognitive dysfunction in COPD patients, and to assess the association between severity of COPD and the level of cognitive function.Methods: We conducted a systematic review, and a search in the following databases: Medline, PsychINFO, Cochrane Library, EMBASE, CINAHL, and SweMed up to July 2010. The articles were included if participants were patients with COPD, relevant outcome was cognitive function investigated by a neuropsychological test battery, and the severity of COPD had been assessed.Results: Fifteen studies were included, involving 655 COPD patients and 394 controls. Cognitive function was impaired in COPD patients as compared to healthy controls, but the level of functioning was better than in patients with Alzheimer's disease. There was a significant association between severity of COPD, as measured by lung function and blood gases, and cognitive dysfunction, but only in patients with severe COPD.Conclusions: Cognitive impairment can be detected in severe COPD patients, but the clinical relevance of the cognitive dysfunction is not yet known. Future studies should concentrate on the consequences of cognitive dysfunction for daily living in these patients, and solutions involving a high degree of self-care might require special support.

Lung function and anxiety in association with dyspnoea: The HUNT study - Corrected Proof

Linda Leivseth, Tom I.L. Nilsen, Xiao-Mei Mai, Roar Johnsen, Arnulf Langhammer — 2012-05-14

Summary: Background: Few studies from the general population have investigated the role of anxiety in reporting dyspnoea. We examined the independent and combined association of lung function and anxiety symptoms with the prevalence of dyspnoea in different situations.Methods: The study included 5627 women and 5066 men who participated in the Lung study of the Nord-Trøndelag Health Study second survey in 1995–97. In a cross-sectional design we used logistic regression to calculate adjusted odds ratios (ORs) for reporting dyspnoea associated with levels of percent predicted FEV1 (ppFEV1) and anxiety (Hospital Anxiety and Depression Scale).Results: Overall, there was a linear inverse association between ppFEV1 and dyspnoea (all Ptrend < 0.001), and a positive association between anxiety symptoms and dyspnoea (all Ptrend < 0.001). In combined analysis, using people with ppFEV1 ≥100 without anxiety as reference, the OR (95% confidence interval) for reporting dyspnoea when walking on flat ground was 6.23 (3.45–11.28) in women with ppFEV1 <80 without anxiety and 15.14 (7.13–32.12) in women with ppFEV1 <80 with anxiety. The corresponding ORs among men were 5.75 (2.23–14.18) and 15.19 (4.74–48.64), respectively. Similar patterns were seen for dyspnoea when sitting still and woken at night by dyspnoea.Conclusion: Impaired lung function and anxiety symptoms were independently associated with reporting dyspnoea. Within lung function levels, reporting dyspnoea was more common among people with anxiety symptoms than among people without. This suggests that, in addition to its relation to reduced lung function, the subjective experience of breathing discomfort may also influence or be influenced by anxiety.

The use of rhDNAse in severely ill, non-intubated adult asthmatics refractory to bronchodilators: A pilot study - Corrected Proof

Robert A. Silverman, Finbar Foley, Resul Dalipi, Myriam Kline, Martin Lesser — 2012-05-14

Summary: Introduction: Mucous plugging is associated with fatal asthma and may have a causative role for non-fatal cases of severe acute asthma. However, mucolytic agents have not been found effective in reversing the obstruction of acute asthma. We test the hypothesis that rhDNAse, an agent that reduces viscoelasticity of sputum in patients with cystic fibrosis, has a therapeutic role in acute asthma.Methods: Symptomatic asthmatics aged 18–55 years presenting to an Emergency Department with an FEV1 < 60% predicted after 2 nebulized albuterol and ipratropium treatments were included. Patients were randomized into one of three nebulized rhDNAse treatment groups of2.5, 5.0 or 7.5 mg, or placebo. Standardized bronchodilator therapy was continued throughout the protocol and the FEV1 at 6 h was the primary study endpoint.Results: 50 patients were enrolled. There were no significant differences in FEV1% predicted between the rhDNAse and placebo patients at any of the post-randomization time points. The dose of rhDNAse administered did not influence response. In a post-hoc stratification, patients with the lowest pre-randomization FEV1 tended to improve more from rhDNAse, particularly at times 60 and 120 min post-randomization.Conclusion: In this pilot study rhDNAse did not cause clinical improvement among severely ill adults refractory to standardized care. The observed trend to higher FEV1 among the most severely obstructed patients is an exploratory finding that may warrant further study.This clinical trial was registered as NCT00169962 under the name “Study of Pulmozyme to Treat Severe Asthma Episodes”.

“Feelings are facts”: Illness perceptions in patients with lung cancer - Corrected Proof

M.A. Hoogerwerf, M.K. Ninaber, L.N.A. Willems, A.A. Kaptein — 2012-05-14

Summary: Given the high degree of psychosocial problems in patients with lung cancer, quality medical care would benefit from exploring and addressing and providing potential solutions for these problems.Patients with recently diagnosed non-small-cell lung cancer filled out a questionnaire that assessed illness perceptions and made a drawing of how they perceived their diseased lungs look. They also participated in an interview about the impact of lung cancer in their lives.Scores on the Brief Illness Perception Questionnaire indicated that patients score low on ‘concern’, ‘emotional response’ and ‘timeline’, indicating they hope to be cured from lung cancer. Patients drew the tumor larger than it is on the chest radiograph. The drawings are moderately accurate representations of the patients' lungs. In the interviews patients often expressed their hopes of being cured and how thinking positively would help. Patients who made a more accurate drawing of their lungs had less optimistic views about their prognosis. These views are more in line with the prognosis their physician would give them. However, few patients made an accurate drawing.This study contributes to a better insight into what patients believe and feel about their disease. Suggestions for taking patient perceptions into account are provided.

Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia - Corrected Proof

2012-05-07

Summary: Background: Health care-associated pneumonia (HCAP) includes a broad range of patients having frequent or chronic contact with health care systems. However, the relationship between current defining criteria for HCAP and the risk of potentially drug-resistant (PDR) pathogens is controversial.Methods: We retrospectively evaluated patients admitted to Severance Hospital in South Korea with culture-positive pneumonia from January 2008 to December 2009. We analyzed the associations between risk factors for HCAP and infection with PDR pathogens, and developed a new scoring system to predict infection with PDR pathogens.Results: Among 339 patients, PDR pathogens were observed in 122 (36.0%). PDR pathogens were more common in HCAP than community-acquired pneumonia (CAP) (48.5% versus 23.8%, P<0.001). In a logistic regression, prior hospitalization within 90 days of pneumonia (OR=2.51, P=0.003), recent treatment with antimicrobials (OR=2.35, P=0.039), and nasogastric tube feeding (OR=15.28, P<0.001) were independently associated with PDR pathogens. For the prediction of PDR pathogens, the sensitivity and specificity of current HCAP criteria were 66.4% and 60.4%, respectively, and 68.0% and 67.3%, respectively, for the new scoring system. Moreover, the new scoring system showed better diagnostic accuracy than current HCAP criteria (area under curve=0.711 versus 0.634, P<0.001).Conclusions: The current HCAP criteria are poor predictors of PDR pathogens and all patients with HCAP should not be empirically treated for these pathogens. To avoid excessive antibiotic use, individual risk stratification approaches should be considered.

Rheumatoid lung disease: Prognostic analysis of 54 biopsy-proven cases - Corrected Proof

2012-05-07

Summary: Objective: To investigate the prognostic significance of histopathological characteristics in patients with biopsy-proven rheumatoid lung disease (RLD).Materials and methods: Retrospective analysis was conducted on samples from 54 RLD patients who underwent surgical lung biopsies (SLBs) at Hamamatsu University Hospital and affiliated hospitals between 1980 and 2009. The overall survival rate, the spectrum of histopathological diagnosis and their associated prognostic significance were investigated.Results: The study group consisted of 30 men and 24 women with a median age of 60.3 years. Histopathological analysis revealed the following: usual interstitial pneumonia (UIP), 15 cases; nonspecific interstitial pneumonia/fibrosis, 16 cases; organizing pneumonia, 4 cases; unclassifiable, 2 cases; desquamative interstitial pneumonia, 1 case; and bronchiolar disease, 16 cases. In survival outcome, 10 yr survival rate was 76.6%. Patients with UIP had significantly worse prognosis than those with non-UIP (RLD cases except those with UIP) (p = 0.0452).Conclusion: RLD includes several histopathological groups. Patients with UIP have worse survival than those with other types of RLD. Histopathological diagnosis may have a major impact on prognostication in patients with RLD.

Utility of fractional exhaled nitric oxide (FENO) measurements in diagnosing asthma - Corrected Proof

Sung-Il Woo, Ji-Hyuk Lee, Heon Kim, Jong-Won Kang, Yong-Han Sun, Youn-Soo Hahn — 2012-04-26

Summary: Background: To facilitate the use of fractional exhaled nitric oxide (FENO) as a clinical test, FENO measurements need more clarification.Aim: We sought to evaluate the yield of FENO measurement for the diagnosis of asthma and identify the determinants of FENO in children.Methods: Two hundred forty five consecutive steroid-naïve patients aged 8–16 years with symptoms suggestive of asthma were included. Children were evaluated using FENO measurements, questionnaires, skin prick tests, spirometries, and methacholine challenge tests.Results: Asthma was diagnosed in 167 children. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of FENO measurements for the diagnosis of asthma at the best cutoff value of 22 ppb were 56.9%, 87.2%, 90.5%, and 48.6%, respectively. At a cutoff value of 42 ppb, specificity and PPV were all 100% but at the cost of very low sensitivity (23.4%) and NPV (37.9%). Both atopy and asthma were identified as independent risk factors associated with high FENO. The association of asthma with high FENO was found only in atopic children because FENO was low in non-atopic children regardless of asthma status. Although highest FENO was observed in atopic asthmatic patients, 28% of these patients had FENO values lower than 22 ppb.Conclusion: Atopic asthmatic patients with low FENO values and non-atopic asthmatic patients were responsible for false-negative cases that might contribute to low sensitivity of FENO measurements in diagnosing asthma. High specificity of FENO measurements may help identify patients with atopic asthma among subjects with respiratory symptoms.

Efficacy and optimal dosing interval of the long-acting beta2 agonist, vilanterol, in persistent asthma: A randomised trial - Corrected Proof

2012-04-23

Summary: Background: Vilanterol (VI) is a novel once-daily long-acting beta2 agonist with inherent 24-h activity. The aim of this study was to evaluate the efficacy of three once-daily doses and one twice-daily dose of VI used concurrently with ICS in adult patients (≥18 years) with persistent asthma. Safety was also assessed.Methods: Multicentre, randomised, double-blind, placebo-controlled, five-period crossover study consisting of 7-day treatment periods separated by 7-day wash-out periods. Seventy-five patients, maintained on ICS, received VI 6.25, 12.5 and 25 mcg once-daily (evening), VI 6.25 mcg twice-daily (morning/evening), and placebo. The primary endpoint was trough forced expiratory volume in 1 s (FEV1) (mean of 23 h and 24 h post evening dose) on Day 7; secondary endpoint was weighted mean 24-h serial FEV1 on Day 7.Results: All VI groups demonstrated statistically significant increases in trough FEV1 versus placebo (p < 0.001). There was a statistically significant increase in weighted mean 24-h FEV1 for each VI group versus placebo (p < 0.001). The effects of once-daily VI on trough FEV1 and weighted mean 24-h FEV1 were dose dependent. The incidence of adverse events (AEs) was low in each VI treatment group and was not dose dependent (5–9%; placebo = 18%); no drug-related AEs or serious AEs were reported.Conclusion: Once-daily treatment with VI was well tolerated and associated with improvements in lung function. The VI 6.25 mcg twice-daily dose showed the greatest change in trough FEV1, however, similar changes in weighted mean 24-h FEV1 with VI 12.5 mcg once-daily were observed. Although our study was not powered to demonstrate non-inferiority of once- versus twice-daily dosing of VI, the data suggest no advantage over a 24-h period of twice-daily over once-daily dosing for the same total daily dose.ClinicalTrials.gov: NCT00980200.

Ventilator-associated sinusitis in adults: Systematic review and meta-analysis - Corrected Proof

2012-04-23

Summary: Objective: To review the epidemiology, risk factors for, treatment and outcome of ventilator-associated sinusitis (VAS).Methods: We performed a systematic review and meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs).Results: Out of 620 retrieved reports, 31 papers fulfilled our inclusion criteria. Infectious sinusitis affects 27% of mechanically ventilated patients and was found to be the cause of undetermined fever in 25% of the cases. Although radiographic VAS was higher in nasotracheally compared to orotracheally intubated patients (OR 4.66, 95% CI 1.35–16.13), clinical VAS was not (3.67, 0.80–6.81). The presence of VAS has been associated with the presence of VAP (3.66, 1.81–7.37) or bacteremia (6.85, 2.14, 21.92); however, it is unknown whether an etiologic relationship between them exists. In patients with concomitant VAS and VAP or bloodstream infections identical pathogens are isolated in 59% and 20% of the cases, respectively. The presence as opposed to absence of VAS was not associated with excess mortality (1.02, 0.35–3.01).Conclusion: VAS is a common infection in critically ill adults and correlates with other important infectious complications.

The treatment of pulmonary sarcoidosis - Corrected Proof

Marc A. Judson — 2012-04-11

Abstract: This manuscript offers an approach to the treatment of pulmonary sarcoidosis based on current available information. The treatment of pulmonary sarcoidosis is not mandatory as the disease may be self-limiting and therapy is often associated with significant drug side effects. The decision to treat rests predominantly on the presence of significant symptoms or functional limitation. Corticosteroids are the drug of choice. Alternative agents to corticosteroids may be useful primarily as corticosteroid sparing agents.

Efficacy and safety of Flutiform compared with individual fluticasone and formoterol reference products - Corrected Proof

Alfredo García Arieta — 2011-06-23

The paper by Bodzenta-Lukaszyk et al. published recently in Respiratory Medicine investigated the two indications of Flutiform: substitution treatment in patients already controlled with the individual components and maintenance in patients whose symptoms are not adequately controlled with ICS plus “as needed” SABA.

WITHDRAWN: A case of acute pneumonitis associated with leflunomide treatment - Corrected Proof

Gareth Collier, P. Flood-Page — 2005-03-01

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

WITHDRAWN: Endogenous lipoid pneumonia - Corrected Proof

D.G. Popov, N.I. Doncheva, V.I. Vlasov — 2005-02-02