Current opinion in pulmonary medicine
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Most patients with significant chronic obstructive pulmonary disease (COPD) have inspiratory and expiratory muscle weakness. In addition, hyperinflation induces functional weakening of the inspiratory muscles, increased elastic load to breathing, and intrinsic positive end expiratory pressure (PEEPi). Therefore, it was rational to expect that patients with COPD would benefit from specific inspiratory or expiratory muscle training (SIMT, SEMT respectively). However, the functional benefits of SIMT have remained equivocal. In recent years, a number of studies have demonstrated that, when training loads are controlled, SIMT results in important functional benefits. The role of SEMT is still unclear. ⋯ Inspiratory and expiratory muscles can be specifically trained yielding improvements in both strength and endurance. The improvement in inspiratory muscle performance is associated with an improvement in the sensation of dyspnea, exercise tolerance, and quality of life. When the expiratory muscles are specifically trained, a significant increase in exercise performance has also been shown. However, there is probably no additional benefit in combining SEMT with SIMT.
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Asthma is the most common potentially serious medical problem to complicate pregnancy. Asthmatic women have been shown to be at an increased risk of complications during pregnancy. Managing asthma during pregnancy is unique because the effects of both the illness and the treatment on the developing fetus and the patient must be considered. ⋯ The prevalence of asthma in pregnant women appears to be increasing. Recent evidence supports that pregnant asthmatic women with moderate to severe asthma may have an increased risk of adverse perinatal outcomes. The goal of asthma management during pregnancy is to optimize maternal and fetal health.
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Asthma and chronic obstructive pulmonary disease (COPD) are both defined by the presence of airflow obstruction, but they present distinguishing differences in terms of both risk factors and clinical phenotypes. Yet it is quite common in the clinical setting to observe patients with asthma showing COPD-like phenotypes, and vice versa, making it a priority to search for optimal prevention, treatment, and management strategies for these cases of coexisting lung obstructive diseases. ⋯ The nature of the association between asthma and COPD remains unclear and open to discussion. Further research is required to develop effective management algorithms for patients with multiple obstructive lung diseases, determine to what extent early treatment and optimal management of asthma may protect against progression into COPD, and identify genetic markers of individual susceptibility to specific lung disease phenotypes and pharmacologic treatments.
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With the improving survival of cystic fibrosis (CF) patients, the clinical spectrum of this complex multisystem disease continues to evolve. Epidemiologic studies have provided important insight into the disease course, prognosis, and complications. This review summarizes recent advances in our understanding of predictors of survival and outcome and modifiers of disease in CF. This review is not meant to be comprehensive, but highlights selected studies, many of which have particular relevance to the growing number of older CF patients. ⋯ Epidemiologic research in cystic fibrosis continues to inform patient care and clinical research, and to generate new hypotheses regarding pathophysiology. Survival and outcomes continue to improve in this multisystem disease. With continued improving survival, epidemiologic studies will be critical to tracking changes in prognosis and outcome.
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High-resolution CT (HRCT) imaging of the chest can provide both structural and functional lung analysis useful to evaluate initial and progressive cystic fibrosis (CF) lung disease. Chest HRCT scoring systems have been used to evaluate the extent and severity of CF specific airway and lung parenchymal disease. The purpose of this review is to summarize recent developments in HRCT and volumetric chest CT imaging, CF chest CT scoring systems, and review how HRCT/volumetric CT can provide useful outcome measures for future CF clinical research. ⋯ Chest HRCT and volumetric CT imaging can detect regional CF lung changes before changes in global pulmonary function measurements. Chest HRCT scoring has been used in descriptive studies defining CF lung disease severity, in longitudinal studies to define progression of disease, and in clinical intervention studies to evaluate treatment effects. In the last 2 years, CF CT research has evolved from solely using chest HRCT scoring systems to utilization of composite CT/PFT scores, quantitative airway and air trapping measurements, and the utilization of volumetric CT imaging to evaluate three-dimensional data sets in patients with CF lung disease.