Chronic respiratory disease
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Of the idiopathic interstitial pneumonias, idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) have provoked the most debate and discussion. Although the two diseases are distinct entities, diagnosis is not always straightforward and requires a multidisciplinary approach, integrating clinical, radiological and histologic information. Although there is currently no effective treatment for either disease, the importance of differentiating NSIP from IPF lies in the management of the individual patient, with particular focus on outcome and pace of change, and enrollment into novel treatment trials of IPF.
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There is a growing understanding that chronic respiratory diseases in adults have their origins in early life. Adverse environmental exposures occurring in vulnerable periods during lung growth and development in the fetal period and in early childhood that alter lung structure and limit the growth in lung function may have lifelong consequences. ⋯ These exposures generally interact with a genetic predisposition, and gene-environment interactions and epigenetic phenomena are attracting considerable study. An understanding of how ambient exposures impact on normal lung growth and development will aid in understanding of how chronic respiratory diseases of adults develop and may lead to new preventative strategies.
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COPD is characterized by airflow limitation that is usually progressive. The present study investigated the cause of death and the effect of airflow limitation on all-cause mortality in COPD patients. A prospective cohort of 600 COPD patients were followed for 3 years. ⋯ Deaths were due to respiratory failure (29%), cardiovascular disease (25.6%), cancer (17.9%), infection (11%), gastrointestinal disease (9.4%), and other causes (6.7%). According to the Cox regression analysis, the following independent factors were related to mortality: age (years), hazards ratio (HR) 1.046 (confidence interval [CI] 95% 1.021, 1.072); current smoking status, HR 1.535 (CI 95% 1.003, 2.350); cancer, HR 7.172 (CI 95% 4.515, 11.395); cardiovascular disease, HR 2.623 (CI 95% 1.821, 3.778); severe airflow limitation (GOLD 4), HR 2.378 (CI 95% 1.605, 3.525); and highest quartile of acute exacerbations, HR 1.852 (CI 95% 1.236, 2.775). The present study shows that severe airflow limitation, current smoking status, the presence of cardiovascular disease, cancer, and a high frequency of acute exacerbations have an independent negative impact on the prognosis of COPD patients.
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Clinical Trial
Respiratory muscle pressures in non-CF bronchiectasis: repeatability and reliability.
Respiratory muscle strength is used diagnostically in clinical practice and as an outcome measure in clinical trials in various chronic lung diseases. There is limited data on its repeatability in people with non-CF bronchiectasis. The aim of the present study was to assess the repeatability of maximal inspiratory (P( I)max) and expiratory pressures (P(E)max) in a group of patients with stable, moderate-to-severe non-CF bronchiectasis. ⋯ Maximal inspiratory pressure measurements were repeatable during a period of clinical stability in moderate-to-severe non-CF bronchiectasis, suggesting this may be a useful outcome measure in non-CF bronchiectasis. Once a baseline has been established, a second visit is not required. P(E)max was not a repeatable measure and further study is necessary to ascertain how much practice testing is required to obtain an accurate value.