Current opinion in pulmonary medicine
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Review Meta Analysis
Risk of pneumonia associated with long-term use of inhaled corticosteroids in chronic obstructive pulmonary disease: a critical review and update.
The aim was to determine the effects of long-term inhaled corticosteroid use on pneumonia in patients with chronic obstructive pulmonary disease (COPD) via systematic searches of MEDLINE, EMBASE, ISI, regulatory documents and manufacturers' trial registries. ⋯ Clinicians should consider the long-term risks of pneumonia with the use of inhaled corticosteroids in patients with COPD. Adequately powered long-term head-to-head trials with objective pneumonia definitions, active ascertainment and radiologic and microbiologic confirmation are needed to clarify any intraclass differences in the risk of pneumonia.
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Review
Exertional dyspnea in chronic obstructive pulmonary disease: mechanisms and treatment approaches.
The purpose of this review is to identify new advances in our understanding of dyspnea in patients with chronic obstructive pulmonary disease (COPD). Specifically, we highlight new scientific discoveries concerning the language of dyspnea, its underlying mechanisms and its clinical management. ⋯ The effective management of dyspnea in COPD remains a significant challenge for caregivers but recent treatment innovations such as helium-oxygen, inhaled furosemide and breathing feedback techniques have yielded early positive results.
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Review
Opioids for palliation of refractory dyspnea in chronic obstructive pulmonary disease patients.
Dyspnea, a distressing symptom, in chronic obstructive pulmonary disease patients is often unrelieved. The purpose of this article is to examine the efficacy of opioids administered orally, in nebulized form and other routes in dyspnea relief. Additionally, factors that inhibit the prescription of opioids and use of opioids are explored. ⋯ Opioid is an effective palliative drug in chronic obstructive pulmonary disease patients with distressing dypnea that is refractory to standard modalities of treatment.
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Home-based pulmonary rehabilitation programs have been proposed as an alternative to hospital-based programs for patients with chronic obstructive pulmonary disease (COPD). We undertook a systematic review of randomized studies on home-based pulmonary rehabilitation in patients with COPD which report health-related quality of life and/or exercise capacity, in order to assess the benefits of this intervention. ⋯ Self-monitored, home-based rehabilitation may be an alternative to outpatient rehabilitation. These findings can help expand the recognition, application and accessibility of pulmonary rehabilitation for patients with COPD.
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Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significant morbidity and mortality. Their coexistence is more frequent than previously recognized and poses important diagnostic and therapeutic challenges. Prognosis of patients with concurrent heart failure and COPD has not been comprehensively addressed. With this review, we intend to emphasize the diagnosis and prognosis implications of the two coexisting conditions and to highlight the therapeutic constraints posed by the combination. ⋯ COPD and heart failure coexistence is often overlooked. COPD diagnosis can remain unsuspected in heart failure patients due to similar symptoms. Although beta-blockers are well tolerated in COPD patients, they are overall less prescribed in this challenging population. COPD, at least at severe degrees of airflow obstruction, predicts a worse prognosis in heart failure patients.