The American journal of medicine
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We aimed to elucidate the prevalence of and risk factors for work disability in severe adult asthma and to evaluate the impact of work disability on downstream health outcomes. ⋯ Work disability is common among adults with severe asthma. There are three sets of risk factors for work disability that are potentially modifiable: smoking, workplace exposures, and asthma severity.
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In chronic obstructive pulmonary disease (COPD), the rate of decline in forced expiratory volume in 1 second (FEV1) and progression to disability and death are accelerated. COPD management goals include preventing or slowing the progressive loss of lung function, relieving symptoms, improving exercise tolerance and the patient's health status, preventing and treating exacerbations and complications, minimizing side effects of treatment, and reducing mortality. Although lung function is important for diagnosis of COPD and classification of its severity, clinicians and patients are also very interested in symptoms, ability to function, and general well-being (health status). ⋯ The TORCH study examines the long-term effects of combination therapy with an inhaled long-acting beta-agonist (salmeterol) and a corticosteroid (fluticasone) on reduction of all-cause mortality over 3 years. The 4-year UPLIFT study examines the effects of maintenance treatment with the once-daily anticholinergic bronchodilator tiotropium on the yearly rate of decline in trough FEV1 and the yearly rate of decline in FEV1 90 minutes after maximal or near-maximal bronchodilator administration. This article examines the rationale for each of these studies and provides an overview of study methodology as well as preliminary demographic data.
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Forced expiratory volume in 1 second (FEV1) declines normally with aging by approximately 30 mL/yr, but in susceptible smokers, the decline is greater (about 60 mL/yr), resulting in the development of chronic obstructive pulmonary disease (COPD). Smoking cessation usually restores the normal or near-normal rate of FEV1 decline, whereas intermittent quitting provides less benefit. Thus, smoking cessation is a critical component for the prevention of COPD progression. ⋯ Genetic components of the decline in FEV1 are being actively explored, but none has been extensively validated other than alpha1-antitrypsin deficiency. To date, only smoking cessation has been definitively shown to be effective in reducing the rate of FEV1 decline, but other therapeutic strategies are under active research. Consequently, FEV1 and its change over time are important outcomes in COPD and valuable measures for the assessment of disease progression.
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We evaluated the impact of guideline-concordant empiric antibiotic therapy on time to clinical stability, time to switch therapy, length of hospital stay, and mortality among patients with community-acquired pneumonia. ⋯ Among hospitalized community-acquired patients, guideline-concordant antibiotic therapy is associated with improved in-hospital survival and shorter time to clinical stability, time to switch therapy, and length of hospital stay.