Chest
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Background: The incremental shuttle walk test (ISWT) was developed > 20 years ago and has been used to assess peak exercise capacity in a variety of chronic diseases. The aim of this systematic review is to describe the measurement properties of the ISWT in a clinical population. Methods: Of 800 articles identified by electronic and hand searches, 35 were included. ⋯ Conclusions: The ISWT can be considered a valid and reliable test to assess maximal exercise capacity in individuals with chronic respiratory diseases. The ISWT has been shown to be responsive to pulmonary rehabilitation and bronchodilator use in individuals with COPD, cystic fibrosis,and asthma. Further studies examining responsiveness and the MCID of the ISWT in patients with conditions other than lung diseases are required for the interpretation of interventions in other populations.
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Atrial fibrillation (AF) is more likely to develop in patients with chronic kidney disease (CKD) than in individuals with normal renal function, and patients with CKD are more likely to suffer ischemic stroke (IS)/thromboembolism (TE). To our knowledge, no prior study has considered the impact of estimated glomerular filtration rate (eGFR) on bleeding. We investigated the relationship of eGFR to IS/TE, mortality, and bleeding in an AF population unrestricted by age or comorbidity. ⋯ Incidence rates of IS/TE, mortality, and bleeding increased with reducing eGFR across the whole range of renal function. OAC use was associated with a lower incidence of IS/TE and mortality at 1 year compared with individuals not receiving anticoagulants in all categories of renal function as measured by eGFR. The NCB balancing IS against serious bleeding was positive in favor of OAC use among patients with renal impairment.
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Background: The use of inhaled corticosteroids (ICSs) is associated with an increased risk of pneumonia in patients with COPD. However, the risks of other respiratory infections, such as TB and influenza, remain unclear. Methods: Through a comprehensive literature search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov from inception to July 2013, we identified randomized controlled trials of ICS therapy lasting at least 6 months. ⋯ Results were similar with each meta-analytic approach. Furthermore, the number needed to harm to cause one additional TB event was lower for patients with COPD treated with ICSs in endemic areas than for those in nonendemic areas (909 vs 1,667, respectively). Conclusions: This study raises safety concerns about the risk of TB and influenza associated with ICS use in patients with COPD, which deserve further investigation.
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Childhood OSA is a prevalent condition associated with raised BP as documented in cross-sectional studies. This study aimed to determine whether baseline or change in OSA severity was associated with ambulatory BP at 4-year follow-up. ⋯ This study provides longitudinal data as additional proof that childhood OSA is associated with elevated BP independent of obesity.
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Hyperinflation refers to a nonspecific increase in absolute lung volumes and has a poor prognosis in COPD. The relative contribution of increased airways resistance and increased parenchymal compliance to hyperinflation of each absolute lung volume is poorly understood. We hypothesized that increased residual volume (RV) and RV/total lung capacity (TLC) would be associated with reduced airway lumen dimensions, whereas increased functional residual capacity (FRC), TLC, and reduced inspiratory capacity (IC)/TLC would be associated with emphysema on CT scan. We examined whether clinical characteristics differed accordingly. ⋯ Gas trapping and hyperexpansion on plethysmography were associated with distinct differences in lung structure and clinical characteristics. Absolute lung volumes should not be considered equivalent in their estimation of hyperinflation and provide insight into the extent of airway and parenchymal abnormalities in COPD.