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Chen, Roy Yu-Wei. "Biomarkers for acute exacerbation of chronic obstructive pulmonary disease." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/57759.
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Rationale: There are currently no generally accepted and validated blood tests available for diagnosing acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is an urgent need of biomarkers that can guide therapeutic management in AECOPD. Based on literature review, systemic inflammation and mild cardiac dysfunction are often associated with AECOPD. We hypothesized that certain protein markers can indeed be useful in tracking and diagnosing AECOPD progression.
Methods: The study cohort consisted of 368 patients recruited in the chronic obstructive pulmonary disease (COPD) Rapid Transition Program who were hospitalized with a primary diagnosis of AECOPD, and 76 stable COPD patients who served as controls. We first determined the relationship of AECOPD of C-reactive protein (CRP) and the N-terminal of the prohormone brain natriuretic peptide (NT-proBNP). We then performed a discriminatory analysis using receiver-operating characteristics (ROC) curve in a logistic regression model. We compared the area under the curve (AUC) of 4 different combinations of CRP and NT-proBNP models. Lastly, we examined several potential biomarkers that were implicated in AECOPD.
Results: The demographic data of the cohort and the controls were well matched, with an average age of 68 versus 65 years old, 64% versus 77% male, and a forced expiratory volume in 1 second (FEV1) % predicted of 52% versus 58%. The CRP and NT-proBNP levels at exacerbation onset were found to be the highest and progressively decreased over time. Of the 4 models of ROC curves, the leave-one-out cross-validated model including both CRP and NT-proBNP had an AUC of 0.80. This model replicated well in an external LEUKO dataset. On the ii
other hand, D-Dimer, pulmonary and activation-regulated chemokine (PARC) and troponin I, showed minimal or no temporal changes during hospitalization and were no different than those with stable COPD.
Conclusions: In summary, this thesis demonstrated that biomarkers such as CRP and NT-proBNP are significantly elevated during AECOPD and decreased with recovery. Secondly, a combination of CRP and NT-proBNP could discriminate patients who were hospitalized for their AECOPD from stable patients. Together, these two biomarkers show promise in diagnosing and tracking AECOPD.Medicine, Faculty of
Medicine, Department of
Experimental Medicine, Division of
Graduate
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Jenkins, Bradlee A., and L. Lee Glenn. "Variability of FEV and Criterion for Acute Pulmonary Exacerbation." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7465.
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Excerpt: Morgan et al. (1) concluded that cystic fibrosis (CF) in children and adolescents with a high baseline forced expiratory volume (FEV1) were less likely to have a therapeutic intervention or slower rate of FEV1 decline after a single acute decline in FEV1 of 10%. This conclusion is not well supported due to the arbitrary criteria used for defining a pulmonary exacerbation, as explained below.
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Chang, Catherina Li-Lin. "Hospitalisations for acute exacerbation of COPD: patterns of disease, risk prediction and treatment." Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/7118.
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Flaherty, Helen M. "Informal Caregivers’ Experience During Acute Exacerbation of COPD in Older Adults: A Dissertation." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsn_diss/51.
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Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.
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Reavell, Colleen Frances. "Resolution of muscle wasting during an acute exacerbation of chronic obstructive pulmonary disease (COPD)." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0031/MQ64435.pdf.
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Bailey, Patricia Hill. "Patients', family caregivers', and nurses' stories of acute exacerbation events of Chronic Obstructive Pulmonary Disease." Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/21379.
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Chin, Elizabeth D. "Symptom Experience and Treatment Delay during Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Dissertation." eScholarship@UMMS, 2012. https://escholarship.umassmed.edu/gsn_diss/30.
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Chronic obstructive pulmonary disease (COPD) is a major health problem in the United States. Acute exacerbations of COPD are primarily responsible for the physical, psychological and economic burden of this disease. Early identification and treatment of exacerbations is important to improve patient and healthcare outcomes. Little is known about how patients with COPD recognize an impending exacerbation and subsequently decide to seek treatment. The purpose of this qualitative descriptive study was to explore and describe symptom recognition and treatment delay in individuals experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Leventhal’s Common Sense Model of illness representation undergirded this study. Using semi-structured interviews, adults hospitalized with an acute exacerbation of COPD were asked to describe their symptom experience and self care behaviors, including treatment seeking, in the days to weeks prior to hospitalization. Data analysis revealed one main theme: Recognizing, responding and reacting to change, and six subthemes: Something’s coming, Here we go again, Seeking urgent treatment, Riding it out, Not in charge anymore and My last day that richly described the COPD exacerbation experience. The study revealed that patients experience an illness prodrome prior to exacerbation and have a recurrent exacerbation symptom pattern that was self-recognized. Treatment seeking was most influenced by the speed and acuity of exacerbation onset, severity of breathlessness, fears of death, nature of patient-provider relationship and the perception of stigmatization during prior healthcare encounters. These findings are important for the development of interventions to improve patient recognition and management of COPD exacerbations in the future.
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Mirza, Mohd Tahir Beg Fatim Tahirah. "Optimising Assessment and Rehabilitation in People Hospitalised with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease." Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/76705.
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This research; (i) evaluated the measurement properties of the two-minute walk test (2MWT), including the effect of test repetition, coefficient of repeatability and validity, and compared the cardiorespiratory responses and symptoms reported during the 2MWT and the six-minute walk test, (ii) developed regression equations to estimate the two-minute walk distance and (iii) evaluated the effectiveness of an exercise program in people hospitalised with an AECOPD on exercise capacity, muscle force, functional performance and physical activity.
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Knaut, Caroline. "Avaliação dos efeitos do programa de exercício físico aeróbico de curta duração em pacientes hospitalizados por exacerbação aguda da dpoc nos diferentes desfechos clínicos." Botucatu, 2019. http://hdl.handle.net/11449/181469.
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Orientador: Suzana Erico Tanni MinamotoResumo: Introdução: A exacerbação aguda é uma importante causa de perda de função em pacientes com doença pulmonar obstrutiva crônica (DPOC). Afeta negativamente a qualidade de vida, a função pulmonar, a fraqueza muscular, o uso de recursos de saúde e a sobrevivência. Acredita-se que o exercício físico realizado durante a exacerbação pode melhorar a qualidade de vida e a capacidade física do paciente sem aumento do processo inflamatório. Objetivo: Avaliar a influência do exercício físico aeróbico de curta duração durante a internação em marcadores inflamatórios, qualidade de vida e capacidade física, além de re-hospitalização e taxas de mortalidade seis meses após a alta hospitalar em pacientes com DPOC exacerbada. Pacientes e Métodos: 26 pacientes foram avaliados 24 horas após a hospitalização por características demográficas, história de tabagismo, índice de Charlson, qualidade de vida, marcadores inflamatórios sistêmicos e composição corporal. Após 48 horas de internação, todos os pacientes realizaram o teste de caminhada de 6 minutos e um novo teste de espirometria, sendo calculado o índice BODE. Após 72 horas de internação, os pacientes do grupo de intervenção foram submetidos a exercícios aeróbicos em esteira por 15 minutos, duas vezes ao dia. Por fim, um mês após a alta hospitalar, todos os pacientes foram reavaliados segundo a qualidade de vida, marcadores inflamatórios sistêmicos, composição corporal, espirometria, teste de caminhada de 6 minutos e índice BODE. Resultados: O... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Acute exacerbation is an important cause of loss of function in patients suffering from chronic obstructive pulmonary disease (COPD). It negatively affects the quality of life, lung function, muscle weakness, use of health resources and survival. It is believed that the physical exercise performed during the exacerbation can improve the quality of life and the physical capacity of the patient without an increase in the inflammatory process. Objective: To evaluate the influence of short-term aerobic physical exercise during hospitalization on inflammatory markers, quality of life and physical capacity, as well re-hospitalization and mortality rates six months after hospital discharge in patients with exacerbated COPD. Patients and Methods: 26 patients were evaluated 24 hours after hospitalization for demographic characteristics, smoking history, Charlson index, quality of life, systemic inflammatory markers and body composition. After 48 hours hospitalization, all patients performed a 6-minute walk test and a new spirometry test, and BODE index was calculated. After 72 hours of hospitalization, patients in the intervention group underwent aerobic exercise on a treadmill for 15 minutes twice daily. Finally, a month after hospital discharge, all patients were re-evaluated according to quality of life, systemic inflammatory markers, body composition, spirometry, 6-minute walk test and BODE index. Results: Patients in the intervention and control group did not differ... (Complete abstract click electronic access below)
Doutor
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Gau, Jen-Tzer, Utkarsh H. Acharya, M. Salman Khan, and Tzu-Cheg Kao. "Risk factors associated with lower defecation frequency in hospitalized older adults: a case control study." BioMed Central Ltd, 2015. http://hdl.handle.net/10150/610289.
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BACKGROUND: Constipation is highly prevalent in older adults and may be associated with greater frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We investigated the prevalence of lower defecation frequency (DF) and risk factors (including AECOPD) associated with lower DF among hospitalized elderly patients. METHODS: We conducted a retrospective case-control study in a community hospital of Southeast Ohio. Adults aged 65 years or older admitted during 2004 and 2006 were reviewed (N = 1288). Patients were excluded (N = 212) if their length of stay was less than 3 days, discharge diagnosis of Clostridium difficile-associated diarrhea, death or ventilator- dependent respiratory failure during hospitalization. Lower DF was defined as either an average DF of 0.33 or less per day or no defecation in the first three days of hospitalization; cases (N = 406) and controls (N = 670) were included for the final analysis. RESULTS: Approximately 38% had lower DF in this patient population. Fecal soiling/smearing of at least two episodes was documented in 7% of the patients. With the adjustment of confounders, AECOPD (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.01-2.13) and muscle relaxant use (AOR =2.94; 95% CI =1.29-6.69) were significantly associated with lower DF. Supplementation of potassium and antibiotic use prior to hospitalization was associated with lower risk of lower DF. CONCLUSIONS: Approximately 38% of hospitalized older adults had lower DF. AECOPD and use of muscle relaxant were significantly associated with lower DF; while supplementation of potassium and antibiotic use were protective for lower DF risk after adjusting for other variables.
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Johnson, Laurie. "Factors affecting the timing of systemic corticosteroid administration in acute asthma exacerbations in an urban pediatric emergency department." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1393237034.
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Pienaar, Lunelle Lanine. "COPD patients in the northern suburbs of the Western Cape Metropole hospitalised due to acute exacerbation : baseline study." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/21897.
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Thesis (MScPhysio)--Stellenbosch University, 2008.ENGLISH ABSTRACT: Acute exacerbation is an important event of COPD as it causes significant disability and mortality. Especially repeated hospitalisation of patients with acute exacerbation has been associated with reduce quality of life and excessive hospitalisation cost. Chronic Obstructive Pulmonary Disease causes significant functional limitations that translate into enormous economic and societal burden. Study Aim: To describe the profile and selected outcomes of Chronic Obstructive Pulmonary Disease (COPD) patients admitted with acute exacerbation to hospitals in the northern suburbs of the Western Cape. Study design: A multicenter retrospective descriptive single subject design was used. Method: Patients admitted with the diagnosis of COPD with acute exacerbation in the time period 01June 2004-01June 2005 were followed up retrospectively for a period of 12 months. The demographics, medical condition on admission and past presentation of acute exacerbation, length of stay in hospital and the number of readmissions for acute exacerbation in the 12 month period were collected and recorded on a self designed data capture sheet. Results: One hundred and seventy eight patients were admitted with acute exacerbation at the three hospitals. The mean age of the patients were 63 (±11.73), more males than females (103: 75) were admitted. Subjects spent a mean of 5.67 (±6.55), days in hospital with every admission and admission frequency of up to eight periods were recorded. Of the n=178 admitted, 56% had one admission and 44% had 2 or more admissions in the study year. This resulted in a total of 338 hospital admissions with the 78 subjects responsible for the majority of admissions (238) Subjects presenting with two or more co-morbidities had a significantly greater risk of multiple re admissions. Subjects with three or more admissions had two or more co morbidities (p=0.001), comparatively those with one admission had only one co morbidity. Congestive cardiac failure (p=0.01) as well as the lack of Long Term Oxygen Therapy p=0.017) were associated with increase risk of three or more admissions. Conclusion: Patients admitted with acute exacerbation to the hospitals where the study was conducted presented with an age ranging from 30-95 years. Patients with 2 or more admissions experience up to eight readmissions episodes in the study year. This is a cause of concern in respect of the burden of disease on especially the younger economically viable South African population. In the current study factors that influenced readmission were the presence of two or more co morbid diseases, specifically the presence of congestive cardiac failure as well as the lack of LTOT. Interventions including a pulmonary rehabilitation programme post discharge should be aimed at decreasing frequency of hospitalisation especially in those patients who are a risk of readmission.
AFRIKAANSE OPSOMMING: Verergering van simptome in Kroniese Obstruktiewe Lugweg Siekte (KOLS) is baie belangrik as gevolg van die ongeskiktheid en mortalitieit wat dit veroorsaak. Dit veroorsaak vermindering in die kwaliteit van lewe en verhoog hospitaal koste verbind met die siekte. Die beperkings toe te skrywe aan die Kroniese Obstruktiewe Lugweg Siekte veroorsaak ontsettende ekonomiese en sosiale druk. Doelstelling: Om die profiel en geselekteerde uitkomste van pasiente met Kroniese Obstruktiewe Lugweg Siekte toegelaat met verergering in die hospitale van die noordelike voorstede van die Wes Kaap te beskryf. Studie ontwerp: ʼn Multisentrum retrospektiewe beskrywende enkel persoon studie. Studie metode: Pasiente toegelaat met verergering van Kroniese Obstruktiewe Lugweg Siekte in die periode 01Junie 2004-01Junie 2005 was retrospektief opgevolg vir ‘n periode van 12-maande. Demografiese data, mediese toestand op toelating en ontslag, lengte van hospitaal verblyf en getal toelatings in die 12- maande was gekollekteer en gedokumenteer op self ontwerpde vorms. Resultate: Een-honderd agt en seventig pasiente was toegelaat met verergering by die drie hospitale. Die gemiddelde ouderdom van die studie populasie was 63 (±11.73) met meer mans as vrouens (103: 75) toegelaat. Die studie populasie het gemiddelde dae van 5.67 (±6.55), in die hospitaal deurgebring en toelating frekwensie van agt episodes was gedokumenteer. Van die n=178 toegelaat was 56% eenkeer toegelaat en 44% het 2 of meer toelatings in die studie jaar gehad. Dit het in 338 hospital toelaatings veroorsaak en 78 van die studie populasie verantwoordelik vir die meeste van die toelatings (238). Die groep met drie of meer toelatings in die studie jaar het twee of meer siektetoestande (p=0.001) gehad, teenorgesteld met die wat net een toelaat was met een siektetoestand. Hart versaaking (p=0.01) en die gebrek aan suurstof by die huis (p=0.017) was verbind met meer risiko van drie of meer toelating. Samevatting: Die ouderdoms verskil was wydbeskrywend van 30-95 jaar van die pasiente wat in die studie jaar toegelaat is by die drie hospitale. Pasiente wat 2 of meer keer toegelaat is het tot agt hertoelatings in die studie jaar gehad. Kommerwekkend is die uitwerking van die siekte op die jonger werkend populasie in Suid Afrika. In die studie was hertoelating beinvloed deur die teenwoordigheid van twee of meer siektetoestande, spesifiek hart versaaking sowel as die gebrek aan suurstof by die huis. Intervensies insluitende pulmonale rehabilitasie na ontslag se doel moet wees om vermindering van heraaldelike hospitalisasie in hoë risiko pasiente vir hospitalisasie.
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Saudny-Unterberger, Helga. "Impact of nutritional support on changes in functional status during an acute exacerbation of chronic obstructive pulmonary disease (COPD)." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23294.
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Despite the acknowledged importance of nutritional support for COPD patients, it is difficult to accomplish in acutely stressed individuals. A randomized trial of nutritional supplementation during an acute exacerbation was carried out in 16 hospitalized patients for a 2 week period. Six control patients consumed a standard diet supplying 1,951 $ pm$ 130 (mean $ pm$ SEM) kcal and 80 $ pm$ 6 g protein/d, while ten treatment patients, in addition to the usual diet received oral supplements (Ensure) or snacks, resulting in an intake of 2,516 $ pm$ 129 kcal (p = 0.012) and 99 $ pm$ 6 g protein/d (p = 0.059). Although the treatment subjects improved their intake over the control group, no significant improvement in nutritional status occurred in either group.Forced vital capacity (FVC % predicted) improved significantly over the study period in treated vs control subjects (+11.10 $ pm$ 4.63 vs $-$4.50 $ pm$ 2.14; p = 0.026). Nitrogen balances were calculated for 9 subjects, and all were in negative balance ($-$8.42 $ pm$ 1.74 g nitrogen/d) with no difference between groups.
Because of the high doses of methylprednisolone administered (69.6 $ pm$ 8.3 mg/d), and their known catabolic effects, we examined whether the dose affected nitrogen balance and muscle strength. Both nitrogen balance (r = $-$0.73; p = 0.025) and grip strength (r = $-$0.76; p $<$ 0.001) worsened with higher doses of steroids. The catabolic process may have resulted from elevated energy requirements, inadequate intake of protein and energy or been induced by high doses of steroids.
Hospitalized COPD patients are highly stressed and catabolic, and the means to preventing protein wasting during an acute exacerbation of their disease remains to be established. (Abstract shortened by UMI.)
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Tsai, Ling Ling. "Novel Technologies to Measure Physical Activity and Improve Health Outcomes in People with Chronic Obstructive Pulmonary Disease." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/19974.
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Chronic obstructive pulmonary disease (COPD) is a common disease characterised by airflow limitation. In people with COPD, objectively measured physical activity is the strongest predictor of all-cause mortality. The effect of hospitalisation for an acute exacerbation of COPD (AECOPD) on physical activity levels is not well studied. Chapter 2 was a prospective observational study which determined the physical activity level of people hospitalised with an AECOPD (T1) and whether physical activity changed immediately after discharge (T2) and six weeks post hospital admission (T3). Physical activity levels were monitored using the SenseWear Armband and results showed a significant linear increase in steps per day from T1 to T3 (T1, mean (SD) 1385 (1972) steps/day; T2, 2040 (2680); T3, 2328 (2745), p=0.001). Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with stable COPD that increases exercise capacity but access to PR is poor in Australia. Alternative ways to deliver PR need to be developed and real-time videoconferencing technology offers a way to supervise exercise training in the home environment. The study in Chapter 3 determined the effect of supervised, home-based, real-time videoconferencing telerehabilitation on exercise capacity in people with stable COPD compared to usual care without exercise training. People randomised to the telerehabilitation group (TG) received exercise training three times a week for eight weeks. Results showed a significant increase in endurance shuttle walk test time in the TG compared to usual care (mean difference = 340s (95%CI: 153-526, p<0.001). Chapter 4 determined the level of satisfaction and experience in the people who completed the telerehabilitation program in Chapter 3. Results showed a high level of satisfaction with the quality of exercise sessions delivered via real-time videoconferencing technology.
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Harrison, Samantha Louise. "Exploring patients' perceptions following an acute exacerbation of chronic obstructive pulmonary disease to inform tailored strategies to enhance pulmonary rehabilitation." Thesis, University of Leicester, 2014. http://hdl.handle.net/2381/29317.
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Background: Patient attrition to Pulmonary Rehabilitation (PR) is significant. Whilst biomedical variables have been examined as potential predictors, their explanatory power is not substantial and increasingly psychological constructs have been considered as determinants of PR adherence. Aim: This thesis aimed to increase understanding of how PR can be facilitated and enhanced for patients following hospitalisation with an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) by exploring issues around patient access, engagement and assessment of psychological appraisals. Methods: An observational mixed-methods design was utilised informed by a review of the published literature and a retrospective observation of stable patients. Participants in the prospective studies had recently been hospitalised with an acute exacerbation of COPD. Qualitative component: Patients who refused a referral to PR participated in in-depth interviews exploring appraisals of an exacerbation. Transcripts were subjected to Interpretative Phenomenological Analysis. Quantitative component: Questionnaires relating to illness perceptions, mood, health status and self-efficacy were completed soon after hospital discharge. At six months acceptance and uptake of PR was documented. Cluster analysis was conducted using the domains of the Illness Perceptions Questionnaire-Revised. Results: Qualitative component: Conceptual themes included: ‘Construction of the self’, ‘Relinquishing control’ and ‘Engagement with others’. Quantitative component: Three distinct illness profiles exist in patients following an acute exacerbation of COPD: ‘in control’, ‘disengaged’ and ‘distressed’. There were no differences between ‘clusters’ in acceptance or uptake of PR. Conclusion: Adherence to post-exacerbation PR is poor and may reflect the intense emotional distress reported by patients following an acute exacerbation of COPD. Health care professionals need to be mindful of how they address patients who, during a period of vulnerability, are sensitive of perceived dismissive behaviour. Targeted psychological strategies which enhance partnership working and trust, address intense fear and elicit control may be beneficial in reducing distress and supporting uptake of PR.
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Ivashchuk, S. I. "Association of red blood cell distribution width with the acute pancreatitis and chronic pancreatitis exacerbation from the position of the prognosis." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19570.
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Krug-Gourley, Susan Lorraine. "Evaluation of the Relationship between Ambient Air Pollution and Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease at Temple University Hospital." Diss., Temple University Libraries, 2012. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/209333.
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Public HealthPh.D.
Background: Air pollution has been associated with adverse health effects for all-cause and specific respiratory morbidity and mortality outcomes. Acute exacerbations of COPD (AE-COPD) accelerate the decline in pulmonary function and are associated with greater mortality, morbidity, health care utilization, and reduced quality of life. Since the 1970 Clean Air Act was implemented, important reductions in air pollution have been achieved, but no safe threshold has been identified. Objectives: The study was planned to evaluate associations between exposure to ambient concentrations of five criteria air pollutants (CO, SO2/, NO2/, ozone, PM2.5/) in Philadelphia, Pennsylvania, and visits to Temple University Hospital for AE-COPD, from January 1, 2005 through March 31, 2007. To identify subgroups with greater susceptibility to air pollution, associations were examined according to age, gender, race, residence, and antibiotic prescription. Methods: Average daily air pollutant concentrations were obtained from the EPA's Air Quality Services Data Mart. Air pollutant exposures were evaluated for the day of the visit (lag0), one and two days preceding the visit (lag1 and lag2), and the average concentration over three days (lag012). Poisson regression provided rate ratios (RRs) to estimate associations between air pollution exposures and AE-COPD hospital visits. Results: Of 1546 hospital visits for AE-COPD, 43% were from persons 65 years or older, 50% of each gender, and 90% from Philadelphia. In single pollutant models, increased RRs were present at all lags for NO2/ (e.g., RR = 2.27 [95%CI: 1.52, 3.38] at lag012) and SO2/ (e.g., RR = 1.70 [95%CI: 1.38, 2.08] at lag012). For PM2.5/, the direct effect was present only during the winter at lag1, lag2, and lag012 (RR = 1.79 [95%CI: 1.08, 2.96]). Inverse associations were present for ozone at all lags (e.g., RR = 0.64 [95%CI: 0.53, 0.76] at lag012). Compared to the cohort as a whole, those ≥ 65 years of age were at greater risk of an AE-COPD hospital visit associated with PM2.5/ and CO at lag012, with NO2/ and SO2/ at lag0 and lag012, but there was no difference in ozone effect. Conclusions: Primary gaseous air pollution exposures (SO2/, CO, NO2/) were associated with increased AE-COPD hospital visits among COPD patients at Temple University Hospital. The effects of SO2/, CO, NO2/, and PM2.5 were greater for the subgroup ≥ 65 years of age compared to the cohort as a whole. Inverse associations with ozone were consistent across subgroups. These results suggest that air quality during the study period was insufficient to protect the health of COPD patients, especially those ≥ 65 years old. Further study is needed to understand generalizability to other populations and to evaluate lower ranges of exposure from current levels of air pollution.
Temple University--Theses
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Aaron, Shawn D. "Controlled trial of oral glucocorticoids in outpatients with acute COPD exacerbation who present to the emergency department: A randomized, double-blind, placebo-controlled pilot study." Thesis, University of Ottawa (Canada), 1999. http://hdl.handle.net/10393/8525.
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Background. In North America, the prevalence of chronic obstructive pulmonary disease (COPD) amongst elderly patients is increasing, and COPD exacerbation is now a common cause for Emergency Department (ED) patient visits. Over 900 patient visits were logged at the Ottawa General and Civic Hospital's Emergency Departments in 1996 because of COPD exacerbation. Fifty-two percent of these ED patient visits for COPD resulted in a discharge home. Although exacerbations of COPD occur commonly, the optimal therapy of this condition remains unknown. It was felt that a state of clinical equipoise exists which justifies the need for a randomized, double-blind, placebo-controlled trial examining whether oral glucocorticoids should be used to treat patients with COPD exacerbation who are discharged home from the ED. This thesis will report on the results of the pilot study which was undertaken to establish the feasibility of a larger, definitive clinical trial. Objectives. The primary objective of the pilot study was to ensure that a larger clinical trial will be feasible. Secondary objectives of the pilot study were: to assess the rate of patient relapse in order to determine whether this clinical variable could serve as the primary outcome variable for the definitive study, to verify the sample size estimates for the larger trial, to evaluate patient referral rates and trial recruitment, and to verify the enrollment process and allow for pre-testing of the data collection and data analysis process. (Abstract shortened by UMI.)
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Aaron, Shawn David. "Controlled trial of oral glucocorticoids in outpatients with acute COPD exacerbation who present to the emergency department, a randomized, double-blind, placebo-controlled pilot study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0003/MQ45203.pdf.
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Vaitkus, Mindaugas. "Nespecifinis uždegimas paūmėjus lėtinei obstrukcinei plaučių ligai." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140904_150407-13493.
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Lėtinė obstrukcinė plaučių liga (LOPL) – šiuo metu pasaulyje viena svarbiausių didelį sergamumą ir mirtingumą sąlygojančių ligų. Pacientams, kuriems pasunkėja kasdieniai LOPL simptomai pasireiškia LOPL paūmėjimas. Šio tyrimo tikslas – įvertinti nespecifinį uždegimą paūmėjus lėtinei obstruk¬cinei plaučių ligai. Nustatyti periferinio kraujo ir indukuotų skreplių ląstelių sudėties skirtumai ir įvertintos sąsajos su plaučių funkcijos rodikliais bakterinio ir nebakterinio lėtinės obstrukcinės plaučių ligos paūmėji¬mo metu. Tirtos sergančiųjų bakterinės kilmės lėtinės obstrukcinės plaučių li¬gos paūmėjimo indukuotų skreplių neutrofilų ir makrofagų funkcijos (apoptozė, fagocitozė ir reaktyvių deguonies formų susidarymas) bei palygintos su nebakteriniu paūmėjimu. Įvertinti sergančiųjų bakterinės ir nebakterinės kilmės lėtinės obs¬trukcinės plaučių ligos paūmėjimo periferinio kraujo neutrofilų ir monocitų apoptozė ir chemotaksis, bei periferinio kraujo neutrofilų fagocitozė ir reaktyvių deguonies formų susidarymas. Ištirta sergančiųjų bakterinės ir nebakterinės kilmės lėtinės obstruk¬cinės plaučių ligos paūmėjimu interleukino-8 koncentracija ir sąsajos su periferinio kraujo neutrofilų chemotaksiu bei C reaktyviojo baltymo koncentracijos periferinio kraujo serume sąsajos su plaučių funkcija ir rūkymo intensyvumu.Chronic obstructive pulmonary disease (COPD) – a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. An acute exacerbation of COPD (AECOPD) is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication. The aim of this study was to evaluate the non-specific inflammation during acute exacerbation of COPD to investigate change of cellular activity (apoptosis, chemotaxis, phagocytosis and production of reactive oxygen species) during AECOPD depending on infection agent. Subjects with AECOPD and the same in remission were investigated. Increased count of induced sputum neutrophils and macrophages as well peripheral blood neutrophils and monocytes during bacterial and non-bacterial AECOPD was related with impaired pulmonary function and smoking history. Induced sputum neutrophils and macrophage apoptosis and phagocytosis were weaker, but production of reactive oxygen species was strongly activated during bacterial acute exacerbation of chronic obstructive pulmonary disease than non-bacterial AECOPD. This study showed differences of peripheral blood neutrophil and monocyte apoptosis, chemotaxis, as well as peripheral blood neutrophil phagocytosis and the production of reactive oxygen species... [to full text]
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Costa, Lusmaia Damaceno Camargo. "Pesquisa de vírus respiratórios em crianças asmáticas (exacerbadas e não exacerbadas) e em crianças não asmáticas com sintomas de infecção respiratória aguda, em Goiânia-Goiás." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/4452.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Objective: to describe the prevalence of respiratory viruses in children with asthma during exacerbation and compare with those non-exacerbated and nonasthmatic children during acute respiratory infection. Methods: In this cross-sectional study nasopharyngeal aspirate/swab from children (4-14 years) was collected between August-2012 and August-2013 in a city (Goiânia) in Center-Brazil. There were 92 with exacerbated asthma (EA), 72 non-asthmatic with acute respiratory infection (ARI) in emergency room, and 61 non exacerbated asthmatic (NEA) treated in specialized clinics. The samples were tested to indirect immunofluorescence using the Respiratory Panel I (Chemicon. MA, USA) and RT-PCR kit rhinovirus. The study was approved by the ethics committee of the HC / UFG and statistical analysis performed with the SPSS v.20 software (SPSS Inc., Chicago, IL). The chi-square test was used to compare categorical variables and Kruskal-Wallis test to compare medians, pvalue< 0.05 was considered significant. Results: the sample consisted of 225 children, mostly male (59.5%) with median age of seven years. The viral prevalence was 91.1% and rhinovirus was the most commonly detected (67.6%), with no significant difference in incidence among all groups. Other viruses were identified: influenza A (13.2%), adenovirus (7.5%), influenza B (3.5%), respiratory syncytial virus (2.8%), parainfluenza 2 (2.8%) and parainfluenza 1 (2.5%). Adenovirus were more frequent in ARI (p=0.25). The EA group compared to the NEA group had cough at night (p<0.01), symptoms on exertion (p<0.01), medical visits (p<0.01) and hospitalizations for asthma (p<0.01) in the last 12 months and less use of medication (8.6%) for asthma control (p<0.01). Conclusions: the prevalence of viral detection was high (90.1%) in all patients (EA, NEA and ARI) and rhinovirus was the most prevalent agent, without differences between groups while adenovirus was more common in nonasthmatic children. Children with exacerbated asthma had parameters of uncontrolled disease in the last 12 months. Asthmatic children with nonexacerbated disease had no exacerbation although most of them had viruses in their nasopharynx, probable because of the regular use of inhaled corticosteroids.
Objetivo: descrever a prevalência de vírus respiratórios em crianças asmáticas durante exacerbação e comparar com grupo de crianças asmáticas não exacerbadas e crianças não asmáticas durante episódio de infecção respiratória aguda. Métodos: Em um estudo transversal foram realizadas coletas de aspirado/swabnasofaríngeo de crianças com idade entre 4 e 14 anos no período de agosto/2012 a agosto/2013, na cidade de Goiânia. Foram estudados 92 asmáticas exacerbadas (AE) e 72 crianças não asmáticas com sintomas de infecção respiratória aguda (IRA), atendidas em unidades de emergência em Goiânia-GO. No mesmo período, foram coletadas amostras de 61 crianças asmáticas não exacerbadas (ANE) atendidas em ambulatório especializado. As amostras foram submetidas à reação de imunofluorescência indireta utilizando o kit RespiratoryPanel I (Chemicon. MA, USA) para os vírus influenza A e B, parainfluenza 1 a 3, adenovírus e vírus sincicial respiratório e o RT-PCR para o rinovírus. O trabalho foi aprovado pelo comitê de ética do HC/UFG. A análise estatística foi realizada com o auxílio do software SPSS v.20 (SPSS Inc.; Chicago, IL) e o STATA v 12.0 (StataCorp, CollegeStation, TX, EUA). O teste qui-quadrado foi utilizado para comparar variáveis categóricas e aquelas com p<0,10 foram submetidas à análise de regressão logística. O teste de Kruskal-Wallis foi utilizado para comparar as medianas de idade. Para todos os testes, o valor de p<0,05 foi considerando significativo. Resultados: a amostra final foi constituída por 225 crianças, a maioria do sexo masculino (59,5%) e a mediana de idade foide sete anos. A prevalência de detecção viral foi 91,1% e o rinovírus foi o mais frequente (67,6%), sem diferença significativa entre os três grupos. Outros vírus identificados foram: influenza A (13,2%), adenovírus (7,5%), influenza B (3,5%), sincicial respiratório (2,8%), parainfluenza2 (2,8%) e parainfluenza 1 (2,5%). O adenovírus foi mais frequente no grupo com IRA (p=0,25). O grupo AE quando comparado ao grupo ANE apresentou mais tosse noturna (p<0,01), sintomas aos esforços (p<0,01), consultas (p<0,01) e internações por asma (p<0,01) nos últimos 12 meses e menor uso de medicamento (8,6%) para controle da asma (p<0,01). Após análise de regressão, os parâmetros consulta prévia (≥3) no último ano (p= 0,42) e ausência de uso de corticosteróide inalatório (p<0,01) permaneceram significativamente associados à exacerbação. Conclusões: prevalência de identificação viral foi elevada (91,1%) de forma homogênea entre os pacientes (AE, ANE e IRA) e o rinovírus foi o agente mais prevalente, em todos os grupos. O adenovírus esteve mais presente nas crianças não asmáticas com sintomas de infecção respiratória (IRA). As crianças exacerbadas apresentavam parâmetros de não controle da doença e menor uso de corticosteroide inalatório, enquanto as não exacerbadas, apesar de apresentarem o vírus na secreção nasofaríngea, não apresentaram exacerbação, possivelmente pelo uso regular de corticosteroide inalatório.
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Hemat, Aria [Verfasser], Christian [Gutachter] Jung, Philipp [Gutachter] Sewerin, Stefan [Gutachter] Krüger, and Stefanie [Akademischer Betreuer] Keymel. "Increased risk of atrial fibrillation in patients with acute exacerbation of chronic obstructive pulmonary disease and sinus rhythm / Aria Hemat ; Gutachter: Christian Jung, Philipp Sewerin, Stefan Krüger ; Betreuer: Stefanie Keymel." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2020. http://d-nb.info/1218780576/34.
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GERMINI, FEDERICO. "COPD EXACERBATIONS IN THE EMERGENCY DEPARTMENT: EPIDEMIOLOGY, RELATED COSTS, AND VALIDATION OF THE RISK ASSESSMENT MODEL BAP-65." Doctoral thesis, Università degli Studi di Milano, 2020. http://hdl.handle.net/2434/699516.
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Sintesi in lingua italiana – Parte prima Nei pazienti con BPCO, le riacutizzazioni sono una frequente causa di accesso in pronto soccorso e possono condizionarne negativamente la prognosi. Obiettivi dello studio erano: 1) descrivere le caratteristiche socio-demografiche e cliniche, nonché la gestione in pronto soccorso dei pazienti con riacutizzazione di bronco-pneumopatia ostruttiva cronica (BPCO); 2) stimarne i costi. Abbiamo condotto uno studio di coorte retrospettivo in Italia, raccogliendo dati su 4,396 pazienti da 34 centri. I pazienti avevano un’età media (deviazione standard [DS]) di 77 (11) anni, ed erano femmine nel 39% dei casi. Oltre il 70% dei pazienti presentava un indice di comorbidità moderato o severo, e nel 26% dei casi era presenta anche una diagnosi di scompenso cardiaco. Il 65% dei pazienti è stato ospedalizzato, per una durata media (DS) di 11 (10) giorni. Il costo stimato per paziente è 2.617 €. In conclusione, I pazienti che afferiscono in pronto soccorso con una riacutizzazione di BPCO sono anziani e gravate da importanti comorbidità. Il tasso di ricovero in questi pazienti è alto, e i costi onerosi. Sintesi in lingua italiana – Parte seconda Le riacutizzazioni di BPCO esitano frequentemente in ospedalizzazione, possono richiedere il trattamento con ventilazione invasiva e sono associate a elevata mortalità intraospedaliera. Il BAP-65 è modello di predizione del rischio di eventi avversi per pazienti con riacutizzazione di BPCO. Il BAP-65 è semplice da utilizzare e, se la sua accuratezza prognostica fosse confermata, potrebbe essere utilizzato per guidare la gestione dei pazienti. Abbiamo condotto uno studio retrospettivo, multicentrico in pazienti che afferivano in pronto soccorso per una riacutizzazione di BPCO durante il 2014. Lo scopo dello studio era validare il modello BAP-65 per la predizione dell’outcome combinato mortalità intraospedaliera e ricorso alla ventilazione invasiva. Abbiamo arruolato 2.908 pazienti da 20 centri Italiani. L’età media (DS) era 76 (11) anni, e il 38% dei pazienti era femmina. L’outcome combinato si è verificato nel 5% dei pazienti. L’area sotto la curva (AUROC) stimata per l’outcome combinato è risultata pari a 0,64 (95%CI 0,59-0,68). Un punteggio BAP-65 ≥ 4 ha mostrato una sensibilità pari a 44% (95% CI 34%-55%) nel predire la mortalità intraospedaliera, con specificità 84% (95% CI 82%-85%), valore predittivo positivo 9% (95% CI 6%-12%) e valore predittivo negativo 98% (95% CI 97%-98%). In conclusione, il modello BAP-65 non ha dimostrato accuratezza sufficiente per un’efficacie stratificazione del rischio di prognosi infausta nella popolazione studiata. DOI del primo articolo: https://doi.org/10.1016/j.ejim.2018.01.010 DOI del secondo articolo: https://doi.org/10.1016/j.ejim.2018.10.018.Abstract part 1 Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) frequently cause patients with COPD to access the emergency department and have a negative impact on the course of the disease. The objectives of our study were: 1) describing the socio-demographic and clinical characteristics, and the clinical management, of patients with AECOPD, when they present to the emergency department; and 2) estimating the costs related to the management of these patients. We conducted a retrospective cohort study in Italy, collecting data on 4,396 patients, from 34 centres. Patients had a mean (SD) age of 76,6 (10.6) years, and 61.2 % of them where males. More than 70 % of the patients had a moderate to very high comorbidity burden, and heart failure was present in 26.4 % of the cohort. The 64.6 % of patients were admitted to hospital wards, with a mean (SD) length of stay of 10.8 (9.8) days. The estimated cost per patient was 2617 €. Conclusions: Patients attending the ED for an AECOPD are old and present important comorbidities. The rate of admission is high, and costs are remarkable. Abstract part 2 Exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently require hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment model (RAM) based on simple variables, that has been proposed for the prediction of these adverse outcomes in patients with AECOPD. If showed to be accurate, the BAP-65 RAM might be used to guide the patients management, in terms of destination and treatment. We conducted a retrospective, multicentre, chart-review study, on patients attending the ED for an AECOPD during 2014. The aim of the study was the validation of the BAP-65 RAM for the prediction of in-hospital death or use of IMV (composite primary outcome). We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation) age was 76 (11) years, and 38% of patients were female. The composite outcome occurred in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI 0.59-0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was 44% (95% CI 34%-55%), the specificity was 84% (95% CI 82%-85%), the positive predictive value was 9% (95% CI 6%-12%), and the negative predictive value was 98% (95% CI 97%-98%). Conclusions: In patients attending Italian EDs with an AECOPD, we found that the BAP-65 score did not have sufficient accuracy to stratify patients upon their risk of severe in-hospital outcomes. DOI of published article # 1: https://doi.org/10.1016/j.ejim.2018.01.010 DOI of published article # 2: https://doi.org/10.1016/j.ejim.2018.10.018.
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Patout, Maxime. "Evaluation des techniques pour la prise en charge diagnostique et thérapeutique de l'insuffisance respiratoire chronique A Randomized controlled trial on the effect of needle gauge on the pain and anxiety experienced during radial arterial puncture Long term survival following initiation of home non-invasive ventilation : a European study Neural respiratory drive predicts long-term outcome following admission for exacerbation of COPD : a post hoc analysis Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation Polysomnography versus limited respiratory monitoring and nurse-led titration to optimise non-invasive ventilation set-up a pilot randomised clinical trial Chronic ventilator service Step-down from non-invasive ventilation to continuous positive airway pressure : a better phenotyping is required AVAPS-AE versus ST mode : a randomized controlled trial in patients with obesity hypoventilation syndrome Technological advances in home non-invasive ventilation monitoring : reliability of data and effect on patient outcomes Efficacy of a home discharge care bundle after acute exacerbation of COPD Prediction of severe acute exacerbation using changes in breathing pattern of COPD patients on home noninvasive ventilation Charasteristics and outcome of patients set up on high-flow oxygen therapy at home Trial of portable continuous positive airway pressure for the management of tracheobronchomalacia." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR115.
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L’insuffisance respiratoire chronique est un syndrome défini par une défaillance monoviscéralerespiratoire. Sa principale origine est aujourd’hui le syndrome obésité-hypoventilation qui concerne 4 à 5% des patients obèses. L’IRC est aussi le stade évolutif terminal de la bronchopneumopathie chronique obstructive qui touche 6 à 8% de la population adulte. L’incidence de ces pathologies et donc de l’insuffisance respiratoire est en augmentation constante. Dans cette thèse, nous avons évalué les nouvelles modalités diagnostiques et thérapeutiques qui pourraient améliorer la prise en charge des patients atteints d’insuffisance respiratoire chronique.Concernant la prise en charge diagnostique, nous avons montré que les données fournies par l’électromyographie de surface des muscles intercostaux, outil qui évalue le travail respiratoire, constituent un marqueur pronostique indépendant chez les patients atteints de bronchopneumopathie chronique obstructive. Nous avons également montré leur pertinence pour prédire l’efficacité clinique et l’observance à la ventilation non-invasive à domicile.Concernant la prise en charge thérapeutique, nous avons montré que l’utilisation d’un mode semi-automatisé de ventilation non-invasive a la même efficacité que celle de modes classiques en permettant une mise en place plus rapide du traitement. Nous avons également rapporté l’intérêt de l’oxygénothérapie à haut débit au domicile alors que ce traitement était utilisé jusque-là dans le seul cadre des soins intensifs. Enfin, nous avons rapporté les bénéfices de la pression positive continue au cours de l’effort chez les patients ayant une trachéobronchomalacie. Concernant le suivi des patients, nous avons montré que les données des logiciels de ventilation non invasive permettent de prédire la survenue d’une exacerbation sévère de BPCO mais que l’utilisation de la télémédecine chez les patients insuffisants respiratoires chroniques ne peut être encore pleinement intégrée dans la pratique clinique. Au cours de cette thèse, nous avons identifié de nouveaux outils physiologiques, de nouvelles modalités d’administration des traitements et de nouveaux outils de suivi à domicile, à même d’améliorer la prise en charge des patients insuffisants respiratoires chroniquesSingle-organ respiratory failure defines chronic respiratory failure. Obesity hypoventilation syndrome is the main cause of chronic respiratory failure and occurs in 4 to 5% of obese patients. Chronic respiratory failure is also the end-stage evolution of chronic obstructive pulmonary disease that has a prevalence of 6 to 8% in the adult population. The incidence of these diseases increases so does the incidence of chronic respiratory failure. In this thesis, we will evaluate novel diagnostic and therapeutic modalities that could improve the care of patients with chronic respiratory failure. Regarding diagnostic modalities, we have seen that evaluating the work of breathing with surface parasternal electromyography was an independent prognostic marker in patients with chronic obstructive pulmonary disease. We have also seen that it was a relevant tool to predict the clinicalefficacy and compliance to home non-invasive ventilation. Regarding therapeutic modalities, we have shown that the use of a semi-automatic mode of non-invasive ventilation had the same efficacy of a standard mode with a shorter length of stay for its setup. We have shown the relevance and feasibility of the use of high-flow oxygen therapy in the home setting whilst it was only used in intensive care units. Finally, we have shown the benefits of continuous positive airway pressure during exertion in patients with tracheobronchomalacia. Regarding patients’ follow-up, we have shown that the use of data from built-in software could predict the onset of a severe exacerbation of chronic obstructive pulmonary disease. However, we also show that the implementation of tele-medicine in patients with chronic respiratory failure cannot be included in daily clinical practice yet. In this thesis, we have identified novel physiological tools, novel ways to administer treatments and novel follow-up tools that can improve the management of patients with chronic respiratory failure
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Passarini, Juliana Nalin de Souza 1977. "Ventilação não invasiva (VNI) em emergência : preditores de sucesso ou insucesso em casos de insuficiência respiratória aguda decorrente oo edema agudo de pulmão (EAP) e exacerbação da doença pulmonar obstrutiva crônica (DPOC) = Noninvasive ventilation (NIV) in emergency : predictors of success or failure in cases of acute respiratory failure arising out of acute pulmonary edema (EAP) and exacerbation of chronic obstructive pulmonary disease (COPD)." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309758.
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Orientadores: Ivete Alonso Bredda Saad, Lair ZambonDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O objetivo deste estudo foi analisar os casos de insuficiência respiratória aguda (IRpA) decorrente do Edema Agudo de Pulmão (EAP) e agudização da Doença Pulmonar Obstrutiva Crônica (DPOC) submetidos a ventilação mecânica não invasiva (VNI) a fim de identificar fatores associados ao sucesso ou insucesso do método em um serviço de urgência e emergência. Trata-se de um estudo descritivo e analítico prospectivo. Estabeleceu-se uma pressão expiratória entre 5 e 8 cmH2O, e pressão inspiratória entre 10 e 12 cmH2O, com suplementação de oxigênio para manter a saturação periférica de oxigênio (SpO2) superior a 90%. A variável desfecho considerada foi a intubação endotraqueal (IE). Foram incluídos 152 pacientes, o tempo de VNI foi de 10 horas para os pacientes com DPOC (n=60) e de 7,5 para os pacientes com EAP (n=92). Foi observada diferença estatisticamente significante nos pacientes que evoluíram para IE quanto menor SpO2 e pior escore de APACHE II (p<0,001). O uso de BiPAP mostrou 2,3 vezes mais chance de ocorrência de IE em comparação com os pacientes que usaram CPAP (p=0,032). Entre os pacientes com diagnóstico de EAP a chance de evolução para IE foi 63% menor. Dos 152 casos, 75,7% evoluíram com sucesso. As variáveis associadas a IE foram taquipneia, SpO2 abaixo de 80%, pacientes que receberam BiPAP, com maior valor de APACHE II, menor valor de escala de coma de Glasgow (ECG) e aqueles com diagnóstico de DPOC
Abstract: The objective of this study was to analyze the cases of acute respiratory failure (ARF) due to acute pulmonary edema and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) undergoing noninvasive ventilation (NIV) to identify factors associated with success or failure of the method in an emergency department. This is a prospective descriptive and analytical study. It was established an expiratory pressure of 5 to 8 cmH2O, inspiratory pressure of 10 to 12 cmH2O and supplemental oxygen to maintain oxygen saturation (SpO2) above 90%. The outcome variable was considered endotracheal intubation (EI). The study included 152 patients NIV time was 10 hours for COPD patients (n = 60) and 7.5 hours to APE patients (n = 92). Statistically significant difference was observed in patients who developed EI for the lower SpO2 and worse APACHE II score (p <0.001). The use of BiPAP showed 2.3 times greater chance of occurrence of IE compared with patients who used CPAP (p = 0.032). Among patients diagnosed with EAP the chance of developing into IE was 63% lower. Of the 152 cases, 75.7% progressed successfully. Variables associated with IE were tachypnea, SpO2 below 80%, patients who received BiPAP, with the highest APACHE II, lower value of Glasgow coma scale (GCS) and those diagnosed with COPD
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências
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Johnson, Robin Ranee. "Social stress exacerbations on acute Theiler's virus infection: a role for Interleukin-6." Texas A&M University, 2006. http://hdl.handle.net/1969.1/4362.
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Neurodegenerative diseases, such as multiple sclerosis (MS), are
adversely affected by both stress and inflammation. Theiler's murine
encephalomyelitis virus infection is an excellent animal model of MS, allowing
examination of central nervous system inflammation during the acute phase of
infection. Social disruption stress exacerbates acute Theiler's virus infection.
Both social disruption stress and Theiler's virus infection elevate the proinflammatory
cytokine, Interleukin-6 (IL-6). The current study examined the
necessity and sufficiency of IL-6 in mediating the negative effects of social
disruption stress in acute Theiler's virus infection. Experiment 1 blocked IL-6
function with a neutralizing antibody administered simultaneously with social
disruption stress. All mice were then infected, and measures of illness, motor
impairment and physiological signs of disease were collected up to 21 d postinfection.
Experiment 2 administered exogenous IL-6 for one week (replacing
social disruption with the cytokine treatment), followed by infection. Measures identical to those collected in Experiment 1 were collected for up to 21 d postinfection.
Results indicate that IL-6 is necessary for the development of the
sickness, motor impairment, and immunological effects of social stress in acute
Theiler's virus infection. In contrast, IL-6 alone can induce some, but not all, of
the sickness behavior exacerbations, and was not sufficient for the development
of either motor impairment or immunological effects previously associated with
social disruption stress. These results have many important implications for
further research in the effects of social stress on Theiler's virus infection, as well
as clinical implications for both MS and other inflammatory mediated diseases,
such as Alzheimer's disease and Parkinson's disease.
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Kinnunen, T. (Tuija). "Keuhkoahtaumataudin sairaalahoito Suomessa: hoitoajan pituus ja sen yhteys ennusteeseen." Doctoral thesis, University of Oulu, 2007. http://urn.fi/urn:isbn:9789514283864.
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Abstract The purpose of this work was to determine on the basis of the national hospital discharge register and cause-of-death statistics the extent of the hospital treatment required for chronic obstructive pulmonary disease (COPD) in Finland over the period 1972–2001, i.e. the use made of hospital services, factors affecting the length of stay in hospital and the correlation of length of stay with the prognosis. Different intervals within this period were taken for study according to the themes of the individual papers. The results suggest that the length of stay in hospital varies both geographically and seasonally in Finland, the shortest times being recorded in Northern Finland in summer. The main explanations for this would appear to lie in regional differences in health care resources and treatment practises and in climatic variations. The mean length of stay in hospital in the total material in 1987–1998 was nine days. The longest periods applied to cases with concurrent pneumonia or a cerebrovascular disorder. The duration of treatment for the exacerbation stage of COPD decreased by two days between 1993 and 2001, with the longest periods of treatment observed in the case of elderly women. One week of treatment with current modalities may be regarded as optimal, as this was associated with the longest interval before the next exacerbation, just over six months. About 3% of all emergency admissions ended in death, most commonly on a Friday in winter or spring. Patients admitted at a weekend died within the first 24 hours more frequently than did those admitted on a weekday. The mean duration of treatment and frequency of hospitalization increased towards the terminal stage. About one fourth of the patients had died within a year of the first admission for COPD and about a half within five years. Hospital treatment for COPD intensified in Finland during the 1990s as the numbers of hospital beds decreased. Treatment times became shorter and deaths in hospital during exacerbation became less frequent. It will be necessary from now onwards, however, to anticipate the ageing of the population and to develop treatment modalities to replace hospitalization, in order to reduce the costs accruing from this disease. Early diagnosis and outpatient rehabilitation should be developed, and special attention should be paid to appropriate treatment at the terminal stageTiivistelmä Tutkimuksen tarkoituksena oli selvittää valtakunnallisen hoitoilmoitusrekisterin ja kuolemansyytilaston avulla keuhkoahtaumataudista (KAT) aiheutunutta sairaalahoitoa Suomessa 1972–2001: sairaalapalvelujen käyttöä, hoitojakson pituuteen vaikuttavia tekijöitä sekä hoitoajan yhteyttä ennusteeseen. Lähdeaineistosta valittiin erilaisia ajanjaksoja tutkimusasetelman mukaan. Tulokset viittaavat siihen, että hoitoajan pituus vaihtelee Suomessa maantieteellisesti ja vuodenaikojen mukaan: lyhyin hoitoaika on Pohjois-Suomessa kesällä. Ilmiötä selittänevät pääosin terveydenhuollon resurssien ja hoitokäytäntöjen alueelliset erot sekä ilmasto-olosuhteiden vaihtelu. Vuosina 1987–1998 keskimääräinen hoitoaika koko aineistossa oli yhdeksän vuorokautta. Jos potilaalla oli samanaikaisina sairauksina keuhkokuume tai aivoverenkiertohäiriö, nämä johtivat pisimpiin hoitoaikoihin. KAT:n pahenemisvaiheen hoitoaika lyheni kaksi vuorokautta vuodesta 1993 vuoteen 2001. Iäkkäitten naisten hoitoajat olivat pisimmät. Viikon pituinen hoitoaika nykyisillä hoitomuodoilla oli optimaalinen, sillä tällöin aika seuraavan pahenemisvaiheen hoitojakson alkuun oli pisin: vähän yli puoli vuotta. Kaikista päivystyshoitojaksoista potilaan kuolemaan päättyi kolmisen prosenttia. Yleisimmin tällainen hoitojakso päättyi potilaan kuolemaan perjantaisin ja todennäköisimmin talvella tai keväällä. Viikonloppuna sairaalaan tulleista potilaista kuoli ensimmäisen vuorokauden aikana enemmän kuin arkipäivinä tulleista. Keskimääräinen hoitoaika oli pisin ja sairaalahoito runsainta sairauden loppuvaiheessa kuoleman lähestyessä. Ensimmäisen KAT:n aiheuttaman hoitojakson jälkeen noin neljännes potilaista oli kuollut vuoden sisällä ja viiden vuoden kuluessa noin puolet. Keuhkoahtaumataudin sairaalahoito on tehostunut Suomessa 1990-luvulla sairaansijojen vähentyessä. Hoitoajat ovat lyhentyneet ja pahenemisvaiheiden sairaalakuolleisuus on vähäistä. Väestön ikääntyminen on kuitenkin ennakoitava ja sairaalaa korvaavia hoitomuotoja kehitettävä taudista aiheutuneiden kustannusten hillitsemiseksi. Varhaisdiagnostiikkaa ja avokuntoutusta on kehitettävä ja erityinen huomio kiinnitettävä sairauden loppuvaiheen asianmukaiseen hoitoon
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Stell, Ian Michael. "Extending the role of noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406692.
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Moragas, Moreno Ana. "Situations in which treatment of acute exacerbations of non-severe copd with antibiotics is not necessary." Doctoral thesis, Universitat Rovira i Virgili, 2011. http://hdl.handle.net/10803/63590.
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Fonament. La malaltia pulmonar obstructiva crònica (MPOC) representa un dels principals motius de salut en atenció primària. Les exacerbacions són events típics que caracteritzen el curs de l’MPOC. El tractament antimicrobià és un tema controvertit, principalment en les exacerbacions de l’MPOC lleu-moderada. Encara que la majoria dels pacients atesos a la comunitat presenten MPOC lleu i moderada, la prescripció antibiòtica en les exacerbacions és molt elevada a Espanya.
Objectius. L’objectiu principal fou avaluar l’efectivitat de l’antibioteràpia en comparació amb el placebo en el dia 9-11 en les exacerbacions de l’MPOC lleu a moderada. Els objectius secundaris foren avaluar la taxa d’èxit clínic de la teràpia antibiòtica en comparació amb el placebo en el dia 20 i avaluar l’interval lliure de símptomes; és a dir, nombre de dies fins a la següent exacerbació, en ambdós grups.
Disseny. Assaig clínic aleatori, controlat amb placebo, doble cec, paral·lel i multicèntric, dut a terme des de gener de 2006 fins a juny de 2011.
Emplaçament. Vint-i-tres centres de salut de Catalunya.
Subjectes. Pacients de 40 o més anys, fumadors o exfumadors de deu paquets-any o més, amb diagnòstic espiromètric d’MPOC lleu-moderada (volum espiratori forçat en un segon (FEV1) > 50% esperat i raó FEV1/capacitat vital forçada < 0,7% esperat) basat en una espirometría feta en els 24 mesos previs a la inclusió i presència d’exacerbació definida com la presència d'almenys un dels següents signes i símptomes: augment de la dispnea, augment del volum d'expectoració i/o augment de la purulència de l'esput. Es van excloure als pacients amb asma bronquial, hipersensibilitat als β-lactàmics, bronquièctasis d'origen diferent d’MPOC, neoplàsia, traqueotomia, presència de signes radiològics de pneumònia o criteris d'hospitalització i aquells que van declinar participar.
Mesuraments i intervencions. Els pacients s’aleatoritzaren en dos grups: amoxicil·lina i àcid clavulànic (500/125 mg/8 hores, 8 dies) o placebo (cada 8 hores, 8 dies). Es va permetre ús d’antitèrmics, analgèsics, β-adrenèrgics d'acció llarga i curta, anticolinèrgics, teofil·lines, corticoides inhalats o orals i qualsevol altra medicació que
iv | P a g e
el pacient estigués prenent per a una malaltia crònica i s'hagués iniciat tres mesos abans de la inclusió en l'estudi, menys antibiòtics. Es va definir guariment quan va haver-hi desaparició dels signes aguts i els símptomes relacionats amb la infecció, millora com a falta de resolució completa dels símptomes i fracàs com a reducció insuficient dels signes i símptomes de la infecció. Es va considerar èxit clínic quan es va observar guariment o millora.
Resultats. S’inclogueren en l’estudi un total de 353 subjectes, dels quals 43 es van excloure per no complir els criteris d’inclusió. Un total de 310 (158 pacients en el grup assignat a amoxicil·lina i àcid clavulànic i 152 pacients a placebo) resultaren ser avaluables en l’anàlisi d’eficàcia. L’edat mitjana fou de 68,1 anys (DE: 10,4 anys) i el FEV1 mig va ser del 65% (DE: 11,9%). No s’observaren diferències entre els dos grups quant a les distintes variables basals analitzades. Es guariren en el dia 9-11 un total de 117 pacients en el grup d’intervenció (74,1%) i 91 del grupo control (59,9%; p<0.05). En l'anàlisi de regressió logística multivariant es va observar una associació entre el fracàs clínic amb les concentracions de proteïna C reactiva (PCR) ≥ 40 mg/l (OR: 7,9; IC 95%: 3,9 –16,3), estar assignat al grup placebo (OR: 2,9; IC 95%: 1,4 – 6) i presència de cardiopatia isquémica (OR: 2,6; IC 95%: 1 – 6,7). Els predictors clínics de fracàs entre els pacients no tractats amb antibiòtics van ser la PCR ≥ 40 mg/l (OR de guariment: 0,1; IC 95%: 0 – 0,2) i la purulència de l’esput (OR: 0,2; IC 95%: 0 – 0,7). El valor dels criteris d’Anthonisen per predir resultat clínic en aquests pacients, amb l’àrea sota la corba ROC, fou de 0,708 (IC 95%: 0,616 – 0,801) i va pujar a 0,842 (IC 95%: 0,76 – 0,924; p<0,001) quan es va afegir la PCR ≥ 40 mg/l. Amb independència del nombre de criteris d’Anthonisen, la presència de valors baixos de PCR i esput no purulent s’associaren amb un percentatge d’èxit del 90% entre els pacients no tractats amb antibiòtics.
Conclusions. El tractament de les exacerbacions de l’MPOC lleu-moderada amb amoxicil·lina i àcid clavulànic és més efectiu que el placebo. No obstant això, aquesta tesi aclareix quan una exacerbació d’MPOC lleu-moderada pot ser tractada sense necessitat de donar antibiòtics.
Paraules clau. Exacerbació aguda. MPOC lleu-moderada. Antibiòtic. Efectivitat. Assaig clínic aleatori.Background. Chronic obstructive pulmonary disease (COPD) constitutes one of the principal demands on healthcare in primary care. Acute exacerbations of COPD are typical events that characterize the course of the disease. Antimicrobial therapy remains a controversial issue, mainly in acute exacerbations of mild-to-moderate COPD. Even though most of the patients attended in the community correspond to mild and moderate COPD, antibiotics are highly prescribed for exacerbations in Spain. Aims. The main objective was to evaluate the effectiveness of antibiotic therapy compared with placebo at day 9-11 in acute exacerbations of mild-to-moderate COPD. The secondary objectives were to evaluate the rate of clinical success of antibiotic therapy compared with placebo at day 20 and assess the symptom-free interval, i.e. days till next exacerbation in both groups. Design. Multicentre, parallel, double-blinded placebo-controlled randomized clinical trial carried out from January 2006 to June 2011. Study setting: Twenty-three primary care centres in Catalonia. Subjects. Patients aged 40 or older, smokers or ex-smokers of ten packs-year or more, with spirometrically-based diagnosis of mild-to-moderate COPD (forced expiratory volume in one second (FEV1) > 50% expected and FEV1/forced vital capacity ratio < 0.7% expected) from a lung function test performed within 24 months prior to inclusion, and the presence of an acute exacerbation defined as the presence of at least one of the following signs and symptoms: increase of dyspnoea, increase in sputum volume and/or increase of sputum purulence. Patients with bronchial asthma, hypersensitivity to β-lactams, bronchiectasis of origin other than COPD, active neoplasm, tracheotomy, presence of radiological signs of pneumonia or hospital admission criteria, and those who refused to participate in the study were all excluded. Measurements and interventions. The patients were randomised into two treatment groups: amoxicillin and clavulanic acid (500/125 mg three times daily for 8 days) or placebo three times daily for 8 days). The use of antithermics or analgesics was allowed as were short-acting and long-acting β-adrenergics, anticholinergics, ii | P a g e theophyllines, inhaled or oral corticosteroids and any medication that the patient may been have taken for chronic disease and which had been initiated three months prior to inclusion in the study, except for antibiotics. Cure was defined as the disappearance of the acute signs and symptoms related to the infection, improvement, as the non-complete resolution of the symptoms and failure was defined as with an insufficient reduction in the signs and symptoms of infection. Clinical success was considered when either cure or improvement was observed. Results. A total of 353 subjects were included in the study. Forty-three patients were excluded as they did not fulfil the inclusion criteria. Three hundred ten (158 patients in the amoxicillin and clavulanic acid arm and 152 patients in the placebo arm) fulfilled all the criteria for efficacy analysis. The mean age was 68.1 years (SD: 10.4 years) and the mean FEV1 was 65% (SD: 11.9%). No differences were found between the two groups regarding the different basal variables analysed. A total of 117 patients assigned to the intervention group (74.1%) and 91 to control group (59.9%) were considered cured at days 9-11 (p<0.05). In the multivariate regression analysis failure was associated with C-reactive protein (CRP) concentrations ≥ 40 mg/l (OR: 7.9; 95% CI: 3.9 –16.3), placebo treatment (OR: 2.9; 95% CI: 1.4 – 6) and presence of coronary heart disease (OR: 2.6; 95%CI: 1 – 6.7). Among patients treated with placebo clinical predictors for failure were CRP ≥ 40 mg/l (OR of cure: 0.1; 95% CI: 0 – 0.2) and purulent sputum (OR: 0.2; 95% CI: 0 – 0.7). The predictive value of Anthonisen criteria for clinical outcome in those patients was 0.708 (95% CI: 0.616 – 0.801) and rose to 0.842 (95% CI: 0.76 – 0.924; p<0.001) when CRP ≥ 40 mg/l was added. Regardless of the number the Anthonisen criteria, the presence of both CRP low levels and uncoloured sputum was associated with a clinical success of 90% among patients not treated with antibiotics. Conclusions. Treatment of acute exacerbations of mild-to-moderate COPD with amoxicillin and clavulanic acid is more effective than placebo. Nonetheless, this thesis indicates when antibiotic therapy may be safely withheld in acute exacerbations of mild-to-moderate COPD. Key words. Acute exacerbations. Mild-to-moderate COPD. Antibiotic. Effectiveness.Randomised clinical trial.
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Lo, Iek-long, and 羅奕龍. "Impacts of cognitive impairment on acute exacerbations of chronic obstructive pulmonary disease among Chinese elderly patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45830770.
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Promwong, Charuporn. "The effect of viral respiratory tract infections on inflammatory cell responses in acute exacerbations of asthma." Thesis, University of Southampton, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242109.
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Prather, April S. "ASSOCIATION BETWEEN DISPENSING CHANNEL AND CHRONIC OBSTRUCTIVE PULMONARY DISORDER EXACERBATIONS AMONG MEDICARE BENEFICIARIES." UKnowledge, 2018. https://uknowledge.uky.edu/pharmacy_etds/80.
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Elderly patients with chronic obstructive pulmonary disease may be at increased risk of exacerbation due to physical and cognitive deficits that make proper inhaled medication adherence more difficult despite consistent medication access. This retrospective study utilized administrative medical and pharmacy claims data to examine the likelihood of having a COPD exacerbation requiring acute medical care by means of an emergency room visit or hospitalization in elderly patients receiving maintenance COPD medications from mail order and retail pharmacies. It was hypothesized that mail order patients would be more likely to experience exacerbations despite differences in medication access when compared to retail patients. The primary outcome of interest was exacerbation frequency expressed as the incidence density rate, and the secondary outcome was the proportion of days covered (PDC). The incidence rate ratio for acute exacerbations was not significantly different for mail order and retail groups, indicating patients using mail-order pharmacies were not significantly more likely to experience an exacerbation requiring acute medical care. Despite insignificant differences in incidence rates, mail order patients had significantly higher adherence rates.
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Steer, Alan John. "Survival, quality of life and health resource use following hospitalisation for acute exacerbations of chronic obstructive pulmonary disease." Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/2036.
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Background Hospital admissions with acute exacerbations of chronic obstructive pulmonary disease are common and associated with high mortality rates, frequent readmission and worse quality of life. An ability to identify patients at risk of subsequent poor outcome is lacking and the longitudinal change in quality of life following discharge is uncertain. Methods The study consisted of two parts: 1) Clinical data were collected on 920 consecutive patients hospitalised with exacerbations. The ability of a novel modification of the traditional MRC dyspnoea scale (the extended MRC dyspnoea scale, eMRCD) to identify patients at risk of poor outcome was assessed. Independent predictors of important clinical outcomes were recorded and clinical prediction tools derived. 2) A subgroup of 183 patients underwent longitudinal assessment of quality of life following hospital discharge and predictors of quality of life decline were identified. Results The study population was similar to that reported in UK national audits. 96 (10.4%) patients died in-hospital and 37.3% were readmitted to hospital, or died without being readmitted, within 90-days of discharge. The eMRCD was a better predictor of outcome than the traditional scale and, compared to all clinical variables, was the single strongest predictor of mortality and readmission Strong independent predictors of many important clinical outcomes were identified and, notably, the DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) predictive tool was derived and shown to be an excellent, and internally valid, mortality predictor (area under ROC curve = 0.858). Most patients who survived to discharge reported an improvement in respiratory symptoms and quality of life during follow-up. We defined a subgroup of patients who experienced poor post-discharge quality of life and identified robust, simple-to- measure predictors of poor quality of life. Conclusions Important patient outcomes can be accurately predicted in this population. Application of our results may reduce morbidity and mortality in this common and frequently fatal condition by improving clinical decision making regarding appropriate level of care, location of care and resource allocation.
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Bourne, Simon Charles. "The effect of smoking on the severity, and mechanisms of acute exacerbations of chronic obstructive pulmonary disease (COPD)." Thesis, University of Southampton, 2008. https://eprints.soton.ac.uk/67617/.
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COPD (Chronic Obstructive Pulmonary Disease) worldwide has a prevalence of 10% in men and 8.5% in women. Exacerbations of COPD account for approximately 10% of all acute medical admissions. Projected prevalence figures suggest that by 2020 COPD will be the third leading cause of mortality worldwide thus imposing a significant burden on healthcare resources in the future. Acute exacerbations are not only responsible for a decline in the patient’s quality of life, but have a major socioeconomic impact. Following a pilot study that showed current smokers recover lung function much more slowly from their exacerbation than ex smokers, I initiated a properly powered prospective study to investigate the difference between the two groups. A total of 58 patients admitted with acute infectious exacerbations of COPD were recruited to the study to determine the effect of smoking status on their exacerbation. Throughout the admission lung function was measured. Sputum was cultured for bacteria, and PCR used to detect viral infection. Blood and sputum cells were analyzed by flow cytometry. Serum was collected for CRP levels. Ex-smokers recovered significantly more quickly than current smokers in all spirometric parameters (P<0.01), and were discharged sooner (mean 3.08 vs 5.59 days, P<0.001). Sputum culture was positive for more pathogenic bacteria in current smokers, especially H. influenzae, which was associated with a significantly higher CRP rise (p<0.05) than any other organism. CD8+ T cells predominated in the sputum of ex-smokers while CD4+ T cells were the dominant cell type in current smokers (p<0.01). Current smoking is a risk factor for more severe exacerbations, delayed recovery and prolonged hospitalization. This may result from a variety of factors including bacterial, immune mediated responses and systemic inflammation.
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Tien, Quang, Jared Sivinski, and Darren Lew. "Evaluation of Safety and Efficacy Outcomes from use of Extended Infusion of Beta-Lactam in the treatment of Acute Pulmonary Exacerbations in Cystic Fibrosis." The University of Arizona, 2017. http://hdl.handle.net/10150/624204.
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Class of 2017 AbstractObjectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.
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Sharma, Vibhu. "The clinical utility of daily B-type natriuretic peptide testing in patients admitted with acute exacerbations of congestive heart failure /." Access full-text from WCMC :, 2008. http://proquest.umi.com/pqdweb?did=1527840061&sid=12&Fmt=2&clientId=8424&RQT=309&VName=PQD.
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Footitt, Joseph. "The role of oxidative and nitrative stress and histone de-acetylation in rhinovirus induced acute exacerbations of Chronic Obstructive Pulmonary Disease." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9235.
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Acute exacerbations are the major cause of morbidity and mortality in COPD and respiratory virus infection is believed to be a leading aetiology. However mechanisms by which viruses induce acute exacerbations are poorly understood. This study reports the experimental inoculation with rhinovirus (RV) of COPD and non-obstructed smoking and non-smoking control subjects, of whom 9 COPD, 10 smoking and 11 non-smoking controls were later judged to have been successfully infected. The hypothesis tested was that RV infection led to the induction of oxidative and nitrative stress which resulted in degradation of histone deacetylase (HDAC) enzymes in COPD subjects but not controls. Subsequent histone hyperacetylation would then result in prolonged inflammatory gene transcription and therefore generate clinical features of an acute exacerbation. Following experimental RV inoculation the COPD subjects experienced excess lower respiratory tract symptoms and elevated virus load compared to the control groups. There was an associated acute inflammatory response and a greater burden of redox stress measured using the Griess and Potential of Antioxidant assays. HDAC2 activity was found to be reduced only in the COPD subjects following experimental RV infection. These findings would suggest that RV induced oxidative and nitrative stress results in reduced HDAC2 activity in COPD subjects leading to increased inflammation and symptoms consistent with the clinical phenotype of a COPD exacerbation.
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Edwards, Llifon. "Three aspects in the treatment of acute exacerbations of chronic obstructive pulmonary disease : the rôle of nebulised magnesium, the risks of oxygen and the utility of the CRB-65 score." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/60162/.
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Chronic Obstructive Pulmonary Disease (COPD) is one of the commonest long-term conditions worldwide. It is characterised by chronic airflow limitation, pathological changes in the lung and significant extra-pulmonary manifestations. The treatment of an acute exacerbation of COPD (AECOPD), involves glucocorticoids and bronchodilators supplemented by antibiotics if needed. In-hospital, oxygen, which has potential risks as well as benefits, and additional respiratory support can be given if the patient deteriorates. Clinicians need to decide which treatment to provide and who can be safely discharged. This has led to the advent of scoring systems to define severity in COPD This thesis examines the evidence base for the use of magnesium in airways disease and presents the results of the first randomised double-blind placebo-controlled trial using nebulised magnesium in the treatment of AECOPD. 116 patients were randomised, but after 3 nebulisations over 90 minutes, there was no significant difference in FEV1 compared to placebo (p=0.67). In a second study, the CRB65 score was retrospectively assigned to a cohort of patients presenting to the emergency department with AECOPD, using data collected from a previous audit. Patients with a CRB65 score of 0 or 1 had a low risk of in-hospital and 30- day mortality and could be considered for discharge, whereas those with scores between 2-4 required admission with mortality increasing with the score. The CRB65 score showed a similar utility in AECOPD as it does in pneumonia. Finally, 18 subjects with stable but severe COPD were randomised in a crossover study to two nebulisations with salbutamol and ipratropium over 15 minutes with a five minute interval between nebulisations, using air or oxygen as the driving gas. When oxygen was used there was a 3.1mmHg difference (p<0.001) at 35 minutes, compared to air, illustrating the potential risks of repeated nebulisations to those with severe COPD.
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Tsou, Yu-Huan, and 鄒雨寰. "Ketorolac-induced Asthma with Acute Exacerbation: A Case Report." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/su6z4h.
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碩士中國醫藥大學
公共衛生學系碩士班
102
Asthma may be described broadly as a chronic inflammatory disorder of the airways. Most patients could have stable asthma for weeks or months, and then suddenly develop an episode of acute asthma. As we know, different patients may react to various factors and several triggering agents, like house dust mite, emotional stress, and iatrogenic factor. Ketorolac is an analgesic that belongs to the class of non-steroidal anti-inflammatory drugs (NSAIDs). It is frequently used in medicine for the patients who need pain control. However, the drug was suspected in previous study that it may induce adverse reaction after injection the drug. In this case report, we describe that a patient with the past history of asthma had asthmatic exacerbation after administering the Ketorolac, and then she experienced the life-threatening complication. According to previous reports and our case experience, we suggest that healthcare professionals should pay great attention to the patient with past history of asthma before prescribing Ketorolac. Detail history taking and closely monitoring after injecting the drug are required.
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Cheng, Pei-Yun, and 鄭佩芸. "Viral Polymerase Genetic Variation and Acute Exacerbation in Chronic Hepatitis B: Longitudinal Study." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/70013906293693893816.
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碩士國立臺灣大學
流行病學與預防醫學研究所
100
Background and Aims: Acute exacerbation (AE) occurs frequently in hepatitis B surface antigen (HBsAg) carriers, especially in those positive for HBeAg. During the course of persistent hepatitis B virus (HBV) infection, AE is likely related to the break of balance between virus and host immune response, and HBV genetic variation may trigger AE. The aim of this study was to clarify the association between HBV sequence variations and AE, and to investigate change in Pol gene sequence before, during, and after exacerbation. Materials and Methods: We prospectively studied 52 patients with exacerbation of hepatitis B Pol gene sequence using plasma sample collected at baseline, before alanine aminotransferase (ALT) peak, ALT peak, and after ALT peak, respectively. Fifty-two subjects who h ad persistently normal serum ALT during follow-up served as controls. A total of 160 HBV DNA samples were amplified by nested polymerase chain reaction (PCR) from sera and were directly sequenced. We then analyze the relationship between HBV evolutionary pattern and specific nucleotide/amino acid variants and acute exacerbation. Results: AE cases had a significantly higher level of serum ALT and HBV DNA than controls at baseline. Baseline genetic distance was statistically lower in cases than in controls at the nucleotide level (9.68*10-3 vs. 11.7*10-3, p=0.031), but no such association was found at ALT peak (12.1*10-3 vs. 13.8*10-3, p=0.329). Among AE cases, the genetic distance was also higher at ALT peak when compare with other time points at marginal statistical significance (12.1*10-3 vs. 10.2 *10-3, p=0.071). After point-by-point screening the nucleotide/amino acid positions in the whole Pol gene region, we have revealed the association between AE and variant types at nucleotide and amino acid positions, nt1080 (OR 0.32, p 0.0288), nt1126 (OR 0.33, p 0.0453), nt1242 (OR 0.34, p 0.0346), nt2619 (OR 0.32, p 0.0433), nt2444 (OR 4.07, p 0.0157), aa17 (OR 0.28, p 0.048), aa46 (OR 4.28, p 0.0116) . Conclusion: Our data suggest no clear evidence for the association between rate of viral divergence and the occurrence of AE. Certain single nucleotide polymorphism may serve as predictive of AE.
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Kuo, Chun-Fu, and 郭純甫. "Factors Associated with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Medical Center." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/ht94pp.
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碩士國立臺灣大學
公共衛生碩士學位學程
106
Background: The prevalence and mortality rates of Chronic Obstructive Pulmonary Disease (COPD) have been increasing in recent years. In order to prevent frequent acute exacerbation (AE) and enhance the quality of health care, the National Health Insurance Administration has implemented “Chronic Obstructive Pulmonary Disease Pay-for performance Program” in 2017. Purpose: The purpose of this study is to explore the related factors of acute exacerbation in the practicum hospital to provide information for caring and management of COPD patients. Method: This study is a secondary data analysis study using a retrospective cohort from the practicum hospital. We used Chi-Squared test, Student’s t-test, ANOVA test, Kaplan-Meier Survival Curve and Cox Proportional Hazard Regression to analyze the correlation between personal characteristics, severity of COPD, comorbidities and probability of having AEs, number of AEs, and related risk factors. Results: A total of 293 COPD patients were included in the study and 101(34.5%) of them had at least one acute exacerbation during research period. The results indicate that probability, number and risk of having acute exacerbation became more frequent and higher as the severity of COPD increased and BMI decreased. Patients with diabetes and hypertension also have higher probability and more frequent acute exacerbation than patients without those two comorbidities. The risk of acute exacerbation increased 1.023 times (95%CI, 1.00-1.04) as age increase by 1 year, and increase 0.941 times (95%CI, 0.90-0.99) as BMI increased by 1 unit. Compared to mild, the probability of having AEs also increases: moderate by 1.192 times (95%CI, 0.725-1.958); severe by 2.671 times (95%CI, 1.528-4.671); and very severe increase by 4.101 times (95%CI, 1.582-10.634). Conclusion: Through the results of this research we can understand that the factors associate with acute exacerbation of COPD patients in the practicum hospital. In order to reduce the probability of having AEs, it is recommended that the practicum hospital can integrate related resources to provide more comprehensive and higher quality care in the future.
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Kuo, Chia-Chi, and 郭嘉琪. "Effects of self-regulation protocol on the physiologic and psychologic measures of COPD with acute exacerbation." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/30113537599755275292.
Full textAbstract:
碩士高雄醫學大學
護理學研究所
96
The purpose of this study was to investigate the effects of self- regulation protocol on the physiologic and psychologic measures of COPD with acute exacerbation. Sixty-four patients of COPD were randomly divided into an experimental group ( thirty-three patients) and a control group( thirty-one patients) in a medical center in southern Taiwan. The experimental group received 4-week self-regulation protocol which included: 15-20 minutes individual COPD education and 5-7 phones follow up. The control group received routine care and self-regulation manual only. Two group patients all received pre-test and post-test 1, post-test 2 after 5th -9th week intervention started. The data were SPSS 12.0 analyzed by: descriptive statistics; chi-square tests; paired t-tests; independent t-tests; nonparametric method; two-way repeated measures ANOVA. Resultantly, the difference in experimental group on physiologic and psychologic measures during posttest was significant (p<.05). The difference between the groups on physiologic and psychologic measures during posttest 2 and pretest was significant (p<.05). Consequently, the study could help the subjects differentiate and control the exacerbating factors and attain the goals concerning controlling the symptoms and avoiding acute exacerbation, besides recommended apply the theory-driven intervention in practical and researchful fields.
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Wang, Pin-Chun, and 王品鈞. "Effects of Respiratory Sinus Arrhythmia Biofeedback in Patients with Chronic Obstructive Pulmonary Disease after Acute Exacerbation." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/22543810750697127452.
Full textAbstract:
碩士國防醫學院
護理研究所
101
Background: Chronic Obstructive Pulmonary Disease (COPD) is an incurable disease, and its prevalence is rising year after year. COPD patients usually have dyspnea, anxiety, and depression, which lead to lower quality of life, decline physical function, and increase autonomic dysfunction and mortality rate. Even though Global Initiative for Chronic Obstructive Lung Disease (GOLD) has suggested pulmonary rehabilitation as one of non-pharmacological therapy to stabilize COPD patients, which is confirmed to improve the exercise capacity, quality of life, survival rate and also reduce the sense of difficulty in breathing, anxiety and depression. However, it is hard to drive COPD patients to keep long-term and regular exercise that has become the issue worth concerning the most. Perceived more difficulties in breathing and caused more anxious after exercise is one of the major reasons that patients with COPD are unable to exercise regularly. Accordingly, COPD might be conditioned by exercise and difficulty in breathing and lead to increase anxiety, which might worsen patients’ self-efficacy in exercise. In short, the factors influencing patients’ inability to keep regular exercise are closely related to individual self-efficacy. Some studies confirmed that Respiratory Sinus Arrhythmia (RSA) Biofeedback may promote gas exchange rate, circulation of lung, better energy use, and significant reduction in dyspnea, improvement in anxiety, depression and autonomic dysfunction. In addition, previous study results found that after the acute exacerbation of COPD patients was easier to accept education and intervention related to pulmonary rehabilitation, and the effect was more significant compared to they were not. However, there is lack of interventions implemented to relieved these physiological and psychological distress in patients with COPD in Taiwan. With anticipation, RSA biofeedback might be used to facilitate the self-efficacy in exercise and sustain the regular exercise habits for patients with COPD. Purpose: The main purpose of this study is to test the effectiveness of RSA Biofeedback training on improving anxiety, depression, reducing the feeling of dyspnea enhanceing exercise self-regulatory efficacy in COPD patients after the acute exacerbation, and further driving them to keep regular exercise after discharge. Methods: This is an experimental study, and subjects will recruit from a medical center in Taipei. With patients’ consent, they are randomly divided into RSA Biofeedback with abdominal breathing group and abdominal breathing group. The RSA Biofeedback with abdominal breathing group received two weeks a total of 4sessions of RSA Biofeedback coupled with home training and the other group received abdominal breathing training. We compared pre- and post-test of psychophysiological indices between two groups by using the following measures, which were including the Chinese Mandarin version State-Trait Anxiety Inventory Y (CMSTAI-Y), the Chinese Version of the Beck Depression Inventory-II (BDI-II), the Exercise Self-regulation Efficacy Scale (Ex-SRES), the Borg modified dyspnea scale, time-domain and frequency-domain analysis of heart rate variability (HRV), the six minute walk test (6MWT) and record the number of steps one week. With the aid of software package SPSS 18.0, the Chi-square test, independent samples T-test, paired T-test and Pearson correlation were used to analyze the results. Results: The results indicated that RSA Biofeedback could reduce anxiety (-5.75±6.96, p <.01), depression (-3.81±2.83, p <.01), dyspnea (-1.56±1.15, p <.01), and improve exercise self-regulation efficacy (137.5±129.95, p <.01), six-minute walking distance ( 8.23±7.30, p <.01), the number of walking steps within one week (1543.54±2419.17, p <.05) in patients with COPD after the acute exacerbation; while the abdominal breathing training equally in COPD patients reduce the anxiety (-6.33±4.66, p <.01), depression (-1.00±1.12, p <.05), dyspnea (-1.39±1.05, p <.01), increase six-minute walk distance (6.88±4.88, p <.01). However, the effects in heart rate variability were not confirmed in this study. The magnitude of the changes under 4 sessional intervention was significantly better in RSA Biofeedback with abdominal breathing group than the abdominal breathing group (p <.05). Conclusion： Both the RSA biofeedback and abdominal breathing were benefits in the psychological state for patients with COPD, but RSA biofeedback improve exercise self-regulation efficacy and depression was better than abdominal breathing did. These results suggest that RSA biofeedback can be applied for caring of patients with COPD after the acute exacerbation and to drive those patients to keep long-term and regular exercise, prompting the adherence of exercise after pulmonary rehabilitation.
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Jih, Kuen-Shan, and 紀崑山. "Study of Malnutrition and Refeeding Syndrome in Chronic Obstructive Pulmonary Disease (COPD) Patients with Acute Exacerbation." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/60718319059726886500.
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博士靜宜大學
食品營養學系
104
The American Thoracic Society (ATS) statement in 1987 documented that chronic obstructive pulmonary disease (COPD) comprised three categories of diseases based on clinical symptoms and histopathological findings：chronic bronchitis、pulmonary emphysema and peripheral airway disease. The first GOLD (Global initiative of chronic Obstructive Lung Diseases) clinical guideline released in 2001 defined COPD as a disease state characterized by progressive development of airflow limitation that is not fully reversible. The airflow limitation is usually progressive and usually results from an abnormal response of the lungs to noxious particles or gases. COPD is a heterogeneous disease in terms of clinical, physiological, and pathological presentation. Weight loss in patients with COPD is a common phenomenon, it is known that loss of weight in patients with COPD is associated with higher morbidity and mortality rates. Weight loss in patients with COPD may be a multifactorial phenomenon, resulting from a combination of various pathophysiological events. Abnormalities in energy balance, increased levels of cytokines, chronic hypoxia, COPD acute exacerbation, and medications with corticosteroids, β-2 adrenergics and theophylline can influence food intake, substrate utilization and metabolic efficiency. It had been confirmed that the incidence or prevalence of malnutrition in COPD patients was negatively correlated with the post-bronchodilator FEV1. Previous studies in COPD patients had shown us that advanced ageing, post-bronchodilator FEV1 and body weight loss were three independent risk factors for patients’ mortality. Among these three risk factors, ageing is unavoidable and unmodifiable, post-bronchodilator FEV1 could not improve a lot despite pharmaceutical intervention based on the progressive not fully irreversible flow limitation characteristic of COPD. There was one promising study that showed nutritional supplementation to increase body weight in COPD patients could decreased the risk of mortality. Body weight loss in COPD patients was reversible after nutritional support, and an important modifiable factor for survival. Pharmacotherapy, nutriceuticals and aerobic exercise constitute the current three pillars of COPD management. When malnourished COPD patients are encouraged to increase their food intake, or refed through nasogastric route, or supported with parenteral nutrition, they encounter the risk of refeeding syndrome (RFS) associated with morbidities and mortality. There is currently no data concerning the incidence, risk factors for and impacts of RFS in COPD patients with acute exacerbation after searching journal research papers from the PubMed of the NCBI of the National Library of Medicine of the NIH of USA, a retrospective cohort study was launched to answer those questions. The discharge notes of patients with primary diagnosis of COPD with acute exacerbation admitted from August 2014 to December 2015 were reviewed. Demographic data (age and sex), body mass index (BMI), average daily total energy intake (TEI) of the first four hospitalization days, average daily total energy intake adjusted by current body weight (TEII) of the first four hospitalization days, the last post-bronchodilator FEV1, CMI (case-mixed index), APACHE-II (Acute Physiology and Chronic Health Evaluation, 2nd edition) score, Charlson Comorbidity Index (CCI), the initial arterial blood gas data with calculated P1O2/FiO2 were collected. Laboratory RFS was arbitrarily defined as any of the serum P, Mg, or K declined 15% or more after feeding in comparison with the pre-feeding one and fell below the lower limit of normal ranges. During this period 61 COPD patients with acute exacerbation were eligible for analysis and 38% (23 patients) had RFS. The risk factors for RFS in COPD patients with acute exacerbation after admission were advanced age, low BMI, high TEII, low post-bronchodilator FEV1, high APACHE-II score, low PaO2/FiO2, high PaCO2, low pH, and leukocytosis at admission. Patients with more comorbidities were prone to developing RFS.Those who developed RFS had high risk to suffer from delirium, be intubated and receive invasive mechanical ventilation with difficult weaning from the ventilator, and have longer length of stay (LOS) in hospital. No in-hospital mortality was found. We concluded that RFS should not be overlooked in COPD patients with acute exacerbation. Awareness of this feeding-related complication is necessary for early diagnosis and appropriate management to prevent morbidity and mortality. Initial calorie intake from 10 Kcal/kg/day with slow progression and monitoring of P, Mg and K are mandatory.
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Yang, You-Lan, and 楊幼蘭. "Mechanisms of Wood Smoke-induced Acute Lung Injury and Its Exacerbation by Mechanical Ventilation in Mice." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/84760409200818487944.
Full textAbstract:
博士國立陽明大學
生理學研究所
96
Inhalation of toxic smoke generated from house fires produces lung inflammation and acute lung injury (ALI). Patients with this ALI often require assistance from mechanical ventilation (MV) as a supportive modality. It is known that MV with a large tidal volume (VT) may itself produce ALI. However, the possibility of exacerbation effects of inadequate MV on smoke-induced ALI is still unclear. Alveolar macrophages play an important role in pathogenesis of inflammatory ALI. However, the cellular responses of macrophages to toxic smoke remain to be determined. In the first study series, we investigated the effects of mechanical ventilation with a moderate VT on ALI induced by wood smoke inhalation in anesthetized mice. Animals received challenges of air, 30 breaths of smoke (30SM) or 60 breaths of smoke (60SM) and were then ventilated with a VT of 10 ml/kg (10VT) or 16 ml/kg (16VT). After 4-h mechanical ventilation, the bronchoalveolar-capillary permeability, pulmonary infiltration of inflammatory cells, total lung injury score and pulmonary expressions of interleukin-1β and macrophage inflammatory protein-2 (MIP-2) mRNA and proteins in the 30SM+16VT and 60SM+16VT groups were greater than those in the 30SM+10VT and 60SM+10VT groups, respectively. Additionally, the wet/dry weight ratio of lung tissues and lung epithelial cell apoptosis in the 60SM+16VT group were greater than those in the 60SM+10VT group. These differences between the 16VT and 10VT groups were not seen in animals with air challenge. In the second study series, we investigated whether 1) wood smoke extract (SE) induces an increase in MIP-2 secretion from macrophages and 2) reactive oxygen species (ROS) and mitogen-activated protein kinases (MAPKs) are involved in the signaling pathways of SE-induced increase in MIP-2 secretion from macrophages. We found that SE induced time-dependent and dose-dependent increase in MIP-2 secretion from macrophages. Additionally, SE also produced an increase in cellular ROS, a decrease in glutathione and activation of activations of ERK, JNK, and p38, 3 major subfamilies of MAPKs. Furthermore, pretreatment of antioxidant N-acetyl-cysteine (NAC, an antioxidant) reduced the SE-induced increase in MIP-2 secretion, reversed the SE-induced decrease in glutathione and prevented the SE-induced p38 activation. Moreover, the SE-induced increase in MIP-2 secretion from macrophages was inhibited or attenuated by pretreatment with p38 inhibitor SB203580 or ERK inhibitor PD98059, but was not significantly affected by pretreatment with JNK inhibitor SP600125. In conclusion, these results suggested that 1) mechanical ventilation with a moderately high VT exacerbates ALI induced by wood smoke inhalation in mice and 2) SE induces increase in MIP-2 secretion from macrophages via the ROS/p38 pathway.
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TUNG, Lan-Fang, and 董蘭芳. "To investigation the effect of pulmonary rehabilitation in acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/z3kpx6.
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LIU, CHUN-JEN, and 劉俊人. "Role of Hepatitis B Virus Genomic Variation in the Development of Acute Exacerbation of Chronic Hepatitis B." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/38456654191326561383.
Full textAbstract:
博士國立臺灣大學
臨床醫學研究所
91
The onset of acute exacerbation (AE) during the course of chronic hepatitis B is likely related to the break of balance between virus and host immune responses. Whether such a break of immune tolerance is triggered major by the changes of host immune status or by an alteration of HBV hepatitis B virus (HBV) genome still remains controversial. To address this issue, a prospective study from silent (asymptomatic) stage to acute exacerbation and a full-length sequencing strategy are needed. Although the underlying mechanism remains unknown, clinical observations and animal studies clearly show that an upsurge of viral load always precedes or sometimes coincides with AE in chronic hepatitis B. Thereby, a key to the understanding of these AEs seems to unravel the origin and identity of such a viral surge. To study this, we investigated full-length viral sequences before, during and after the exacerbation. We prospectively collected 14 patients with hepatitis B exacerbation, either spontaneously (n=4), or after receiving various medical interventions (n=10), and followed their serum alanine aminotransferase (ALT) and HBV DNA levels monthly. Full-length HBV genomes at baseline, at the peak of serum viral load, at and after ALT peak, were obtained by polymerase chain reaction and sequenced, and compared. Replication activities of serial HBV variants were assayed by in vitro transfection. In addition, we studied the sequential serum dominant viral sequences in 2 individuals with several episodes of AE to clarify if the viral variant selected during first AE triggered a new AE. Finally, the representation of the serum viral genome to the intra-hepatic one was determined by comparing the dominant viral sequences in the serum and liver specimens obtained simultaneously from 8 individuals with chronic hepatitis B. We found that an increase of serum viral load was observed in all exacerbations. Viral peak preceded ALT peak in 13 (93%) of the 14 patients. At virologic peak, 12 (86%) patients harbored viral genome identical to the corresponding baseline one. At and after ALT peak, 9 (64%) and 7 (50%) of the viral genomes remained identical to baseline one, respectively. Mean nucleotide change per genome was 0.2 at virologic peak, but increased to 4.4 and 8.1 at and after ALT peak, respectively. The replication potential of the viral variant emerged during or after exacerbation was equivalent to that at baseline. In 2 patients with recurrent AE, the viral variant selected after AE was not identical to the surged one in the following AE. The dominant full-length viral genome and the HBV quasispecies in the serum samples were comparable to those in the liver biopsy specimens. In conclusion, most exacerbations were preceded by an upsurge of serum HBV identical to the pre-existing HBV strain. After exacerbation, about half of the patients were repopulated by a different viral variant, that was likely just a result of immune selection, but not related to subsequent episode of AE. Future studies should focus on the role of host immune reaction to HBV on the development of AE.
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Mehta, Saurabhkumar. "Kinematic and functional analysis during gait following intraarticular corticosteriod injection in patients with acute exacerbation of knee arthritis." 2008. http://hdl.handle.net/1993/21194.
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HSIEH, HUI-CHEN, and 謝惠珍. "The Exploration of Coping Process of Illness for Acute Exacerbation and Re-hospitalization among the Patients with COPD." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/8qu82w.
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碩士中臺科技大學
護理系碩士班
105
Abstract Background: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. Poor disease control results in increases in overall severity, death rates, and medical expenses. The acute care received in hospitals by COPD patients extends into home or community care, and considering that there are differences between these forms of care, there are also differences in disease response process between these forms of care for patients with acute ex-acerbations. Aim: This study aims to investigate the disease coping process for re-hosp italized COPD patients with acute exacerbations. Research method: The qualitative research employed in this study was collected from the department of Chest Medicine of a regional hospital in central Taiwan from September 2015 to September 2016. Data were collected using purposive sampling, and in-depth interviews were conducted using semi-stru ctured guidelines for interviews. The whole interview process lasted 30–40 min -utes was recorded. The content analysis method was used to interpret and code data until data saturation. A concept map was applied to describe the process of re-hospitalized COPD patients with acute exacerbations. Findings: There were nine re-hospitalized COPD patients with acute exac-erbations interviewed in this study. Three main topics and eleven sub-topics were found via content analysis, as following: (1)suffering from the disease: due to symptomatic interferences, external factors, and impaired self-responsiveness; (2)hardships of life: impacts of re-hospitalization on physical, habitual, psycho-logical, spiritual and social aspects; (3)striving with the disease: physical re-sponses, lifestyle management, and psychological, spiritual and social system responses to re-hospitalization. Suggestions: In consideration of the care requirements for common symp-toms and co-morbidities for COPD patients with acute exacerbations, COPD pa-tients must be empowered with the ability and knowledge for self-care. There is also a need to improve the on-job training of COPD management in medical units, and construct an emergency medical network between hospitals and communities, in order to provide an avenue for immediate medical attention, maintain good relationship between the physicians, nurses and patients, provide timely care in-formation regarding palliative care and personalized care. In the future, Chinese and western medical care could be combined to conduct relevant research, in order to provide clinical evidence as a basis for care. Conclusion: The findings of this study showed that there are differences between hospital acute care, home care and community care. In the future, this can be used to defer disability of COPD patients and serve as a reference for contin-uous care programs for patients. Key words: chronic obstructive pulmonary disease, re-hospitalization, disease coping process
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Liu, Sin-Yin, and 劉思吟. "Airway microbiome dynamic in chronic obstructive pulmonary disease patients with acute exacerbation and respiratory failure- A longitudinal study." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/36293914599942083277.
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碩士國立中興大學
生命科學系所
103
Objectives: This study aimed to examine the pulmonary complex bacterial diversity dynamics in patients with chronic obstructive pulmonary disease (COPD) acute exacerbation and to explore the relationships between complex bacterial diversity dynamics and clinical outcomes in patients with COPD acute exacerbation. Materials & Methods: The serial endotracheal aspirates (EA) were collected via endotracheal tubes or tracheostomy to minimize upper airway contamination. We also collected anthropometric and demographic data, results of chest X-ray and pulmonary function tests, and COPD-associated clinical findings of the enrolled subjects. Using culture-independent molecular methods, including DNA extraction, PCR-16SrDNA, and new-generation sequence, the pulmonary complex bacterial diversity dynamics were analyzed. The relationships between complex bacterial diversity dynamics and clinical outcomes were also examined. Results: A total of 9 COPD patients with acute exacerbation-related respiratory failure were enrolled. Increased pulmonary complex bacterial diversity of serial EA samples, as determined by Simpson scores and Shannon scores, was found in 6subjects with weaning success. Decreased pulmonary complex bacterial diversity was found in 3 subjects with weaning failure. Conclusion: The dynamics of pulmonary complex bacterial diversity might predict the weaning outcomes in COPD patients with acute exacerbation-related respiratory failure.