To see the other types of publications on this topic, follow the link: Exacerbationer.
Dissertations / Theses on the topic 'Exacerbationer'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Exacerbationer.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Figueiredo, Neves Ferreira Rita Nair. "Fysioterapeutiska insatser och interprofessionell samverkan för personer med KOL inom privata och offentliga vårdcentraler i tre regioner i Sverige : En webbenkätstudie." Thesis, Umeå universitet, Avdelningen för fysioterapi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-183906.
Full textAbstract:
Introduktion: Majoriteten av personer med kroniskt obstruktiv lungsjukdom (KOL) diagnosticeras och behandlas inom primärvården i Sverige och enligt Socialstyrelsens riktlinjer bör interprofessionell samverkan (IPS) erbjudas. Fysioterapeuter har en viktig roll i KOL-behandling. Däremot är det fortfarande oklart vilka fysioterapeutiska insatser som används för personer med KOL i Sverige inom primärvården samt om insatserna skiljer sig mellan privata och offentliga vårdcentraler. Syftet med studien var att kartlägga fysioterapeutiska insatser för personer med KOL inom privata och offentliga vårdcentraler i tre regioner i Sverige. Ett delsyfte var att undersöka i vilken utsträckning dessa vårdcentraler erbjuder IPS. Metod: Tvärsnittsundersökning med enkät i webbformat med slutna frågor. Webbenkäten riktade sig till alla fysioterapeuter (n=289) som arbetade på privata och offentliga vårdcentraler i Region Västmanland, Sörmland och Örebro. Resultat: 96 fysioterapeuter deltog i studien. De mest använda fysioterapeutiska insatserna för personer med KOL var sex minuters gångtest, erbjudandet av träning på vårdcentraler, instruktion av andningsteknik och andningsgymnastik. Privata vårdcentraler erbjöd mest träning vid klinik och offentliga vårdcentraler utförde mest sex minuters gångtester. Resultaten visade på ojämlik användning av IPS mellan och inom regionerna. Slutsats: Studien visar att utvecklingspotential finns gällande användning av fysioterapeutiska insatser och IPS på vårdcentralerna för att kunna följa Socialstyrelsens riktlinjer och erbjuda en jämlik vård för personer med KOL i Sverige.Introduction: Most of the diagnosis and treatment for individuals with chronic obstructive pulmonary disease (COPD) take place in primary care centers in Sweden, and according to the Swedish National Health guidelines, interprofessional collaboration (IPC) should be offered to individuals with COPD. Physiotherapists have an important role in the treatment of COPD. However, it is still unclear which physiotherapeutic interventions are used in primary care and whether these interventions differ between private and public health care centers (HCC). The aim of this study was to identify which physiotherapeutic interventions are used for individuals with COPD in private and public HCC in three regions in Sweden. This study also investigated to what extent HCC are offering IPC. Methods: A cross-sectional study with an online format with closed-end questions. The online survey was aimed to reach all physiotherapists (n = 289) who worked at HCC in Västmanland, Sörmland and Örebro. Results: 96 physiotherapists participated in the study. The most used physiotherapeutic interventions for people with COPD were the six-minute walk test (6MWT), offer of training at HCC, instruction in breathing techniques and breathing exercises. Private HCC offered mostly exercise training and the public HCC mostly 6MWT. The results also show differences in healthcare interventions and IPC between and within the regions. Conclusion: The study shows that there is room for improvement regarding use of physiotherapeutic interventions and IPC in HCC in order to follow the National Health guidelines and offer equal care for individuals with COPD in Sweden.
2
Hanna, Bano. "Får KOL-patienter färre exacerbationer om de behandlas medtiotropium i sprayinhalator jämfört med pulverinhalator? - En litteraturstudie." Thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-385929.
Full text
3
Patel, Irem S. "Mechanisms of exacerbations and exacerbation frequency in chronic obstructive pulmonary disease." Thesis, Queen Mary, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.510887.
Full text
4
Bathoorn, Derk. "COPD exacerbations, inflammation and treatment." [S.l. : Groningen : s.n. ; University Library of Groningen] [Host], 2007. http://irs.ub.rug.nl/ppn/304982296.
Full text
5
Sheikh, Omer, MohD Ibrahim, Joseph Maguire, Shama Bano, Pradnya Bhattad, Dhruvil Radadiya, Amiksha Kad, et al. "COPD exacerbation induced Takotsubo Cardiomyopathy." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/75.
Full textAbstract:
Introduction:
Takotsubo cardiomyopathy or stress cardiomyopathy is a syndrome of transient left ventricular (LV) dysfunction mimicking myocardial infarction, but lacking obstruction of coronary artery disease (CAD) or acute plaque rupture. A characteristic differentiation from CAD is that regional motional abnormality extends beyond a territory perfused with a single epicardial coronary artery. Clinically, it is characterized by apical ballooning of the LV due to due to depression of mid and apical segments, with hyperkinesis of cardiac basal walls. Women are affected more than men, predominantly in the postmenopausal age.
Case Report:
A 54-year-old Caucasian female with a history of COPD, hypertension, uncontrolled diabetes mellitus, hyperlipidemia, depression and ongoing tobacco use presented with complaints of worsening shortness of breath two days prior to admission. She denied chest pain, worsened cough, palpitations, nausea or vomiting. On examination, she was in distress and anxious, with labored breathing. Upon examining the chest, decreased air entry was present in both lung fields with bibasilar wheezing. Initial lab tests showed mild respiratory acidosis, with pH of 7.24, pCO2 of 47.4 and pO2 of 65. Troponins on the day of admission was
Soon after admission, she started complaining of severe right neck pain. Repeat EKG revealed localized lateral J point, anteroseptal q waves and 4mm ST-segment elevation in leads V3 and V4 reciprocal changes and without chest pain. Repeat troponins were slightly elevated to 0.42 ng/ml and CK-MB was elevated to 20.2 ng/ml. A transthoracic echocardiogram showed regional abnormalities in left ventricle with the apex, mid to distal septum and the anterior part of septum was akinetic.
Discussion:
Takotsubo cardiomyopathy presents in 1 to 2 percent of troponin-positive acute coronary syndrome (ACS) with various clinical manifestations and various outcomes. Some patients have favorable outcomes based on their clinical performance and extent of cardiac muscle involvement. As in the case we presented, this syndrome can be entirely idiopathic, without a definitive underlying cause. Supportive management while hospitalized and early identification of complications improve the prognosis.
6
Johansson, Fanny, and Alexandra Djärf. "Personers upplevelse av KOL-exacerbation." Thesis, Luleå tekniska universitet, Omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-66951.
Full textAbstract:
Kronisk obstruktiv lungsjukdom även förkortat KOL, är en progressiv sjukdom ofta orsakat av tobaksrökning. KOL är en vanligt förekommande sjukdom hos patienter inom vården. Sjukdomen har stor påverkan på personens vardagliga liv och påverkar livskvaliteten på ett negativt sätt. En exacerbation är ett försämringstillstånd i grundsjukdomen KOL. Syftet med denna litteraturstudie var att beskriva personers upplevelse av en KOL- exacerbation. Resultatet baseras på elva vetenskapliga artiklar hämtade från Pubmed och Cinahl. Dessa har analyserats med kvalitativ innehållsanalys. Fyra huvudteman framkom genom analysen av de elva artiklarna: Att begränsas av rädsla och bristande ork; Att vara maktlös och inte bli tagen på allvar; Att kunskap, kontroll och gemenskap ger trygghet; Att känna skuld och skam för att själv orsakat sjukdomen. I resultatet framkom att exacerbationer var väldigt påfrestande då andnöd skapar stor ångest och oro. Det var även vanligt att känna en maktlöshet i sin situation och försämringar i grundsjukdomen innebar en hel del begränsningar i vardagen. Personer med kunskap i sin sjukdom hade bättre förutsättningar att hantera en excacerbation. Det var viktigt att som sjuksköterskan ha en förmåga att se hela människan och göra personen delaktig i sin vård och behandling. Sjuksköterskans kunskap och bemötande spelade en viktig roll i omvårdnaden genom att skapa trygghet.
7
Quint, J. K. "Determinants of exacerbation frequency in COPD." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/20188/.
Full textAbstract:
Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous collection of conditions characterized by irreversible expiratory airflow limitation. The disease is interspersed with exacerbations; periods of acute symptomatic, physiological and functional deterioration. There are large differences in yearly exacerbation incidence rates between patients of similar COPD severity giving rise to the concept of two distinct phenotypes; frequent and infrequent exacerbators. This thesis hypothesizes that frequent exacerbators are a distinct phenotype of COPD, and identifies some of the factors that influence exacerbation frequency. Method: 356 individuals from the London COPD cohort were included in the analyses in different subgroups. All patients completed daily diary cards and reported exacerbations to the study team for sampling and treatment. Blood and sputum were collected in the stable state and at exacerbation. Samples were processed for cytokines, genetic polymorphisms and viruses. A subset of patients also had endobronchial biopsies for epithelial cell work and immunohistochemistry. Results: Patient reported exacerbation frequency can be used to accurately stratify patients into frequent and infrequent exacerbators groups in subsequent years. Frequent exacerbators were more depressed and more likely to be female then infrequent exacerbators. There was no difference in social contacts, HRV positivity or load in sputum, Vitamin D levels, or cytokine variability between frequent and infrequent exacerbators. No differences in genetic polymorphisms (ICAM-1, IL-6, IL-8, VDR, Taq1 α1 –antitrypsin) were identified between the two groups. Conclusions: The frequent exacerbator phenotype exists. There is not one single determinant of exacerbation frequency, and determinants vary with underlying disease severity.
8
Gilkey, Justin Michael. "Exacerbation and Attenuation of Ego-Depletion." Bowling Green State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1352056734.
Full text
9
Habibzay, Maryam. "Asthma induced exacerbation of bacterial pneumonia." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/29847.
Full textAbstract:
Asthma and bacterial pneumonias are major causes of human mortality and morbidity throughout the world. To date many studies have investigated the possibility that bacteria exacerbate asthma but only a handful consider that asthma may cause bacterial infections. Recent clinical evidence suggests that bacterial infections cause serious complications in patients with asthma and that asthmatics show a 2-fold increased risk of invasive pneumococcal disease. This thesis examines the molecular mechanisms causing susceptibility of house dust mite (HDM) exposed lungs to bacterial infection. The main finding of this thesis is that HDM-induced allergic airways disease increases susceptibility to Streptococcus pneumoniae infection. Furthermore, the molecular pathways leading to the production of neutrophil chemoattractants in the lung are compromised and that despite the complexity of anti-bacterial pathways that are disrupted, the re-introduction of a single chemokine to the lungs with allergic airway disease enables clearance of S. pneumoniae that would otherwise prove fatal. However, a reduction in HDM-induced eosinophilia seen in ST2 deficient mice does not restore anti-bacterial immunity. This deficit in anti-bacterial immunity in HDM exposed lungs is associated with a change in resident alveolar macrophages into an alternatively activated phenotype, characterised by high mRNA and protein levels of RELMα, Ym1 and Arg1. These altered alveolar macrophages produce considerably less TNFα in response to Toll-Like Receptor (TLR) stimulation that is not a result of reduced TLR mRNA levels but due to an upregulation of TLR negative regulators particularly A20. A20 targets TRAF-6 that is found upstream of NF-κB activation. To prove a causal link naïve alveolar macrophages were transferred into allergic lungs prior to bacterial infection; such lungs handled the infection better confirming that alveolar macrophages are important in initiating the anti-bacterial response. Overall our findings highlight a change in specific innate immune pathways in the allergic lung that participate in susceptibility to bacterial pneumonia.
10
Bihl, Eva-Britt, and Lillemor Söderman. "Nutritionens betydelse för patienter med KOL - Kronisk Obstruktiv Lungsjukdom : Metoder för sjuksköterskans bedömning av nutritionsstatus." Thesis, Högskolan Dalarna, Omvårdnad, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:du-3274.
Full textAbstract:
Syftet med denna studie var att belysa hur viktig nutritionen är för patienter med diagnosen KOL (Kronisk Obstruktiv Lungsjukdom). Författarna ville även visa på enkla metoder för sjuksköterskan att bedöma nutritionsstatus för att förebygga malnutrition hos dessa patienter. Denna studie är en systematisk litteraturstudie där författarna använt sig av databaserna ELIN@Dalarna, CINAHL, Blackwell Synergy och SWEMED+ för att söka vetenskapliga artiklar. Sökorden som användes i olika kombinationer var: COPD, nutrition, malnutrition, undernutritioned, nutritionalstatus, nutritional supplement, BMI, energy expenditure, caring och nursing. Resultatet visade att nutritionen är av central betydelse i behandlingen av KOL patienter där sjuksköterskan har en viktig roll i samarbetet med andra yrkeskategorier såsom läkare, dietist, sjukgymnast, arbetsterapeut, kurator och psykolog. Bedömningen av patientens nutritionsstatus är en väsentlig del av sjuksköterskans omvårdnad av KOL patienter då det påverkar prognosen. Patienternas försämrade nutritionsstatus ökar risken för exacerbationer och därmed också risken för dödlighet.Sjuksköterskan kan använda sig av enkla mätmetoder för att upptäcka malnutrition, till exempel BMI (Body Mass Index) och MNA (Mini Nutritional Assessment). Ett steg i att förebygga malnutrition är regelbundna viktkontroller och att varje patient har en individuell åtgärdsplan då patientens behov alltid ska komma i första hand. Det är också viktigt att se till psykosociala aspekter runt måltiderna för dessa patienter. En noggrann planering krävs runt deras måltider som patienten kan behöva hjälp med då sjukdomen utgör ett hinder.För en ökad livskvalitet är det angeläget med information om nutritionens betydelse både till patienten och hans anhöriga.
11
Seda, Gombau Gemma. "Managing chronic care: how to decrease exacerbations." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/393932.
Full textAbstract:
The Spanish Health System and almost every single health system from developed countries, has to face a very important problem that is the raise of the healthcare demand.
In the past years, thanks to health and medical innovations, health systems have been able to save many lives. The counterpart however, is that before all the patients that were losing their life, now they remain chronically sick for life. This represents much higher costs for the health system because they have to treat those patients for a much longer period of time.
In addition to these medical costs it should also be added the fact that these people need someone who takes care of them. Before, that the person used to be a woman between 35 and 65 years, but now these women no longer remains at home to work. Not only that, but every time families have fewer children, which means there will be fewer people to take care of the elderly. To sum up, more elderly, fewer young people who can take care of them, higher demand for care.
Watching an elderly user of any European or American health system, we find that the vast majority (68% of patients aged 65 and above) have two chronic diseases. This type of patient is responsible for 91% of prescriptions prescribed or 76% of visits to doctors. In general terms, they are responsible of 75% of health expenditure.
The problem becomes when the Spanish health system and other systems, are not able to adapt the services offered to the needs of the population, especially if these population rang is expected to grow, in many cases even to duplicate in number by 2050.
The health systems are offering services that focus on single conditions, but most clients of this service suffer two or more diseases at the same time. This means that patients receive poorly coordinated service, which implies that they are not meeting their needs. In many cases (especially when patients suffer from various unrelated diseases), this can mean that patients do not recover as fast as they should, generating more costs.
In order to provide the service they need and deserve, many health systems are evolving towards a more integrated system of care. At a primary level, expanding the role of Nurse Case Managers, which promotes cooperation between different departments and also between the different professionals.
This thesis studies the role of the Nurse Case Manager, specifically studies the factors that make a patient to be derived to a Nurse Case Manager, as a tool to study the factors that make a patient have an exacerbations. Specifically, and after a first general study of all possible factors, focuses on social risk and non-adherence to treatment as two key factors in preventing exacerbations.El sistema sanitari es veu abocat a afrontar un altre problema, que és l’augment de demanda sanitària que s’està produint en el sector, però que encara serà molt més acusada en els propers anys. Ens els darrers anys, i gràcies a les millores sanitàries i les innovacions mèdiques, s’han pogut salvar moltes vides. Per altra banda, aquests malats ara queden crònics de per vida. Això pel sistema sanitari representa uns costos molts majors, ja que se’ls ha de tractar durant un període de temps molt més llarg. A més, també s’ha d’afegir el fet que aquestes persones necessiten algú que se’n faci càrrec, i degut els canvis demogràfics cada vegada n’hi haurà menys. Observant a un usuari d’edat avançada de qualsevol sistema sanitari europeu o nord-americà, ens trobem que en la seva gran majoria tenen dues malalties cròniques. Aquest pacients són els causants dels 75% de la despesa sanitària. El problema esdevé quan el sistema sanitari espanyol, i la majoria de la resta de sistemes, no són capaços d’adaptar els serveis que ofereixen a les necessitats de la població, i en especial, quan aquesta població creixerà fins en molts casos duplicar-se en nombre cap a l’any 2050. El sistemes sanitaris estan oferint serveis que es focalitzen en una sola malaltia, però la majoria de clients pateixen dues malalties o més a la vegada. Això provoca que aquest pacients rebin un servei poc planificat i pobrament coordinat. Per tal de poder oferir el servei que necessiten i es mereixen aquests usuaris, molts sistemes sanitaris estan evolucionant cap a un sistema de cures més integrades. Aquesta tesi estudia el rol de la infermera gestora de casos, en concret estudia els factors que fan que un pacient hagi de ser derivat a aquesta com a instrument per estudiar els factors que fan que un pacient tingui una crisi de salut. En concret, y després d’un primer estudi general de tots els possibles factors, es centra en el risc social i en la no adherència al tractament com a dos factors clau en la prevenció de l’aparició d’aquestes crisis de salut que pateixen els pacients.
12
Rothnie, K. "Relationship between COPD exacerbations and cardiovascular risk." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2016. http://researchonline.lshtm.ac.uk/2837730/.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD), is associated with an increased risk of myocardial infarction (MI), and additionally, cardiovascular disease is responsible for up to 1/3 of deaths in people with COPD. This may be attributable to the fact people with COPD are managed differently and have higher mortality after MI compared to people without COPD. One reason for the differences in management may be that prognostic risk scores after MI do not perform well in those with COPD. Another reason may be that acute exacerbations of COPD (AECOPD) are thought to be associated with a transiently increased risk of MI. The aims of this thesis are to: 1)systematically review the evidence for an increased risk of MI associated with COPD and AECOPD, and increased risk of death following MI for those with COPD; 2) investigate the potential contribution of differences in management after MI on differences in mortality; 3) investigate the performance of prognostic risk scores after MI for those with COPD; 4) validate the recording of AECOPD in UK electronic healthcare records (EHR); 5) investigate the recording of hospitalisations for AECOPD in UK primary and secondary care EHR; and 6) to conduct a self-controlled case series to investigate the risk of MI associated with AECOPD. This work showed an increased risk of MI associated with COPD independent of smoking, and evidence for an increased risk of death following hospital discharge for people with compared to those without COPD. This work demonstrated that differences in recognition and management of MI for those with COPD may explain some of the higher risk of death for COPD patients following MI. Additionally, the GRACE score (commonly used for risk stratification following MI) does not perform as well for COPD patients and may explain some of the differences in management. A validated algorithm was developed for identifying AECOPD both in primary care and resulting in hospital admission in electronic health records. Finally, using a self-controlled case series analysis, data showed that AECOPD is associated with increased risk of MI for approximately four weeks following AECOPD onset, and that the risk is modified by important patient characteristics.
13
George, S. N. "Human rhinovirus at naturally occurring COPD exacerbation." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1462147/.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) is an inflammatory condition of the lung caused by an abnormal response to particles and noxious gases, primarily cigarette smoke. Patients suffer daily symptoms and can have episodes of worsening symptoms termed acute exacerbations. Exacerbations are associated with impaired quality of life, faster lung function decline, higher mortality and increased risk of hospitalisation. The aetiology of COPD exacerbations is controversial; however respiratory viral and bacterial infections are an important feature of exacerbations. This study utilised real-time qPCR to measure prevalence and load of human rhinovirus (HRV) in stable COPD and during the time-course of naturally occurring exacerbations and their recovery. HRV was assessed in association with upper respiratory tract (URT) symptoms namely cold symptoms and sore throats, secondary bacterial infection, patient reported outcomes and exacerbation frequency. Additionally, respiratory syncytial virus (RSV) was semi-quantitatively examined in stable COPD and at exacerbation. The original contribution of this work to the field is that HRV prevalence and load are highest at exacerbation presentation and decrease during recovery. HRV load is higher in the presence of URT symptoms compared to the load without, and the load remains higher for longer with both symptoms compared to only one. This study described novel evidence for the development of secondary bacterial infection after HRV infection in natural exacerbations, and demonstrated that HRV infection is associated with patient reported outcomes. Patients with HRV had higher exacerbation frequencies compared to those without HRV. RSV prevalence did not change significantly between stable COPD and exacerbation. The findings from this thesis have important implications in terms of exacerbation therapy. The evidence provided may allow appropriate targeting of therapeutic interventions therefore reducing exacerbation severity and frequency. These findings emphasise the importance of rapid development of therapeutic targets for the prevention and treatment of HRV infection in COPD patients.
14
Wong, Ernie Hoi Cheung. "The lung microbiome in virus-induced asthma exacerbations." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/52544.
Full textAbstract:
Acute asthma exacerbations cause significant morbidity and healthcare burden. Up to 60% of acute exacerbations are associated respiratory viruses, particularly human rhinoviruses. The role of bacteria in acute exacerbations is unclear yet antibiotics are frequently prescribed. Recent studies revealed a greater abundance of potentially pathogenic bacteria (e.g. Haemophilus spp.) within the airway microbiota in asthma, whilst a greater abundance of commensals (e.g. Prevotella spp.) were observed in health. The current project examined the dynamics of the airway microbiota in the context of a virus-induced asthma exacerbation. The airway microbiota was assessed in a cohort of mild/ moderate asthmatic subjects. Sputum samples were obtained at baseline and following naturally-occurring cold and underwent 16S rRNA gene sequencing. During acute cold, increased relative abundance of Neisseria sp. (Neisseria_2974) significantly correlated with greater peak flow (PEF) decline and IL-1b level. In contrast, Prevotella and Veillonella sp. (Veillonella_10839) relative abundances correlated with reduced PEF decline and lower IL-1b and IL-8 levels respectively. To validate these findings and evaluate the impact of human rhinovirus on the airway microbiota, a cohort of moderate asthmatic and healthy subjects were experimentally infected with rhinovirus-16. Bronchoalveolar lavage was obtained at baseline and at two time-points post infection. The microbiota community between asthmatic and healthy subjects did not differ significantly at baseline or post rhinovirus-16 infection. Following rhinovirus-16 infection, increased Neisseria_2074 relative abundance again correlated with greater PEF decline whilst increased Prevotella relative abundance correlated with reduced clinical symptoms. Furthermore, rhinovirus-16 viral load exhibited a significant linear relationship with the extent of microbiota community change, suggesting that severity of rhinovirus-16 infection may directly impact on the microbiota. In conclusion, an imbalanced airway microbiota was associated with greater PEF decline and pro-inflammatory cytokine levels during a virus-induced asthma exacerbation, though the precise role of the microbiota remains to be determined.
15
Message, Simon David. "Lower airway immunological mechanisms of virus induced asthma exacerbations." Thesis, Imperial College London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428143.
Full text
16
Desgrandchamps, Daniel. "Antimicrobial therapy of Pseudomonas pulmonary exacerbations in cystic fibrosis /." [S.l : s.n.], 1986. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
Full text
17
Jubinville, Éric. "Caractérisation microbiologique des expectorations de patients MPOC en exacerbation." Master's thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/25995.
Full textAbstract:
Les patients atteints d’une maladie pulmonaire obstructive chronique (MPOC) ont des exacerbations menant à une perte de leur qualité de vie. La documentation est incomplète quant à l’identité des microorganismes responsables, due à l’utilisation d’approches classiques, telle la culture de microorganismes. L’utilisation de nouvelles approches telles les méthodes d’écologie microbienne et le séquençage de nouvelle génération basées sur la biologie moléculaire permet l’identification de microorganismes, et ce, sans culture. Le microbiome de patients MPOC contrôles, stables et exacerbés ont été comparés. Une diminution de Proteobacteria ou de Firmicutes vers une augmentation de Firmicutes ou de Proteobacteria respectivement a été observée lors des exacerbations. Le microbiome de patients MPOC contrôles a été comparé à trois mois d’intervalle. Un débalancement de leur microbiome vers les Proteobacteria a été observé après trois mois. Ces résultats pourront mener à des traitements plus appropriés et plus ciblés afin d’accroître la qualité de vie des patients.Chronic obstructive pulmonary disease (COPD) patients are often affected with exacerbation lowering their quality of life. The scientific community is unclear on which microorganism is responsible. This confusion is due mostly because of the culture techniques that are used to evaluate the presence of pathogens. The use of new approaches such as microbial ecology techniques and next generation sequencing based on molecular biology can identify the presence of bacteria without the need of culture. The microbiome of control, stable and exacerbated COPD patients was compared. Principal microbiome shift during exacerbation was a proportional reduction in Proteobacteria or Firmicutes and enrichment in Firmicutes or Proteobacteria respectively. The microbiome of control COPD patients was compared at baseline and three months later. Their microbiome shifted over a period of three months towards Proteobacteria. This study could lead to a better understanding of exacerbation and a better quality of life for COPD patients.
18
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.
Full textAbstract:
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.
19
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.
Full textAbstract:
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
20
Seemungal, Terence Anand Rao. "COPD exacerbations : aetiology, effects on the airways and plasma fibrinogen." Thesis, Queen Mary, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417818.
Full text
21
Mallia, Patrick. "An Experimental Model of Respiratory Virus-Induced Exacerbations of COPD." Thesis, Imperial College London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498492.
Full text
22
Beale, Janine Elizabeth. "The role of IL-25 in rhinovirus-induced asthma exacerbations." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/18679.
Full textAbstract:
Rhinovirus (RV) infections are the principal cause of asthma exacerbations. While Th2-mediated inflammation is clearly implicated in the asthmatic response, it is unknown how the immune response to RV infection interacts with Th2 immunity to enhance disease pathogenesis. The epithelial-derived cytokine, IL-25, has been identified as an initiator and regulator of Th2 immunity and plays a role in asthma pathogenesis. Based on the fact that RV infects bronchial epithelial cells, we hypothesized that RV induces IL-25 production providing a link between infection and Th2 driven allergic inflammation. RV-induced IL-25 expression was measured in human bronchial epithelial cells (HBECs) obtained from bronchoscopic brushings from atopic asthmatics and healthy patients. Mouse models of RV infection and RV-induced allergic airways disease were also employed to examine IL-25 induction in response to RV infection and/or OVA sensitisation and challenge. Finally, to define a mechanistic role for RV-induced IL-25, signalling mediated by IL-25 was blocked in our model of RV-induced allergic airways disease by neutralising the IL-25 receptor. RV-infected HBECs from asthmatics expressed significantly greater IL-25 gene and protein compared with cells from healthy controls. Furthermore, RV infection of mice induced IL-25 expression in the airway epithelium as well as in inflammatory cells in the airway lamina propia. Using a mouse model of RV-induced allergic disease, we demonstrated that RV enhanced allergen-driven IL-25 gene and protein expression which was associated with increased Th2 inflammation in the lung. Finally, by blocking IL-25 signalling in an RV-infected and OVA-sensitised and challenged mouse, several key features of the exacerbation phenotype were significantly reduced including airway leukocyte infiltration, BAL Th2 cytokines and chemokines and Th2 cells. These novel findings indicate that RV-induced IL-25 plays an important role in enhancing Th2 inflammation associated with the exacerbation phenotype which is mediated by binding to the IL-25 receptor.
23
Greening, Neil James. "Early pulmonary rehabilitation for exacerbations of chronic obstructive pulmonary disease." Thesis, University of Leicester, 2014. http://hdl.handle.net/2381/29155.
Full textAbstract:
Exacerbations are key events in the natural history of chronic obstructive pulmonary disease (COPD), with limited recovery of physical performance, and the highest cause of readmission in the UK. This thesis explores the impact of exacerbations in COPD and chronic respiratory disease. In the first study I have investigated the effects of an early rehabilitation intervention on healthcare utilisation, strength and exercise capacity by conducting a large randomised control trial. Using a sub-group of this cohort I have then explored factors that predict hospital readmission. Finally I have conducted a study of single leg neuromuscular electrical stimulation (NMES) in stable COPD, alongside a resistance training group. No difference was seen following early rehabilitation in hospitalisation, healthcare utilisation or physical performance. A number of unexpected findings were noted, including an increase in 12 month mortality in the intervention group and large functional recovery in the usual care group. Using multivariate analysis three risk factors for hospital readmission were identified, including quadriceps cross sectional area, using ultrasound. In the stable state NMES was seen to significantly increase muscle mass from baseline, comparable to changes seen using resistance training. In summary early rehabilitation in chronic respiratory disease does not impact on future hospitalisation. Identification of those with rehabilitation potential is required as the hospitalised population represent a frail group, with advanced disease.
24
McCourt, Fiona Louise. "Indicators of a pulmonary exacerbation in adults with cystic fibrosis." Thesis, University of Ulster, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573078.
Full textAbstract:
The literature review found that pulmonary exacerbations (PEXs) impact on the quality of life (QOL) of people with cystic fibrosis (CF). There is currently no standardised definition of a PEX in CF to inform patient care and QOL. Before a definition can be achieved agreement must be attained on the indicators of a PEX. This thesis aims to identify important indicators of a PEX in adults with CF (ACFs) and establish consensus among ACFs and CF health professionals (CFHPs). The Delphi technique was used to conduct parallel web surveys over a series of rounds across 13 CF centres in the UK and Ireland. A range of sources were utilised to develop 48 statements that informed the Delphi surveys in Round 1 (R1). A 75% consensus level was applied for R 1 and Round 2 (R2). R 1: Participants rated their level of agreement with each statement. ACFs (n=31): 21 consensus statements. CFHPs (n=38): 23 consensus statements. Five additional statements were generated through open questions and added to R2. R2: Statements not reaching consensus in R1 and the 5 additional statements were presented to participants to re-rate. ACFs (n=28): 1 0 consensus statements. CFHPs (n=38): 7 consensus statements. R3: Analysis of R 1 and R2 found 26 consensus statements common in both groups. Additional consensus statements were identified from each group (ACF: 5; CFHP: 4). 35 statements were presented to both participant groups in R3 to rate from 1-10. Results were averaged and ranked in importance. Agreement was established within each participant group on 35 important indicators of a PEX. Each group identified a different hierarchy of indicators. This consensus is an important step in the development of a tool to be used by CFHPs to identify when a PEX is occurring and provides a strong platform for further research into PEXs in CF.
25
Jones, Andrew. "The infective pulmonary exacerbation in cystic fibrosis : an ecological perspective." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/19230.
Full textAbstract:
Introduction: In CF, infective pulmonary exacerbations are common. Despite this, significant aspects of pathogenesis and patient responses to treatment remain poorly understood. This study examined a cohort of subjects receiving antibiotic therapy for exacerbations, correlated clinical findings with microbiological data and examined the factors leading to non-response to treatment. Methods: Subjects were recruited when they commenced IV antibiotics. Measures of lung function, inflammatory markers and quality of life scores were collected with sputum samples during treatment. Samples were analysed for (i) routine microbiology, (ii) Pseudomonas aeruginosa (PA) hypermutator frequency (ii) 16S rRNA gene sequences to identify bacteria present, (iv) PA quorum-sensing (QS) molecule concentrations using LC-MS/MS. Results: Patients who failed to return lung function to baseline at the end of treatment were shown to have a larger decline in FEV1 at exacerbation and a longer time since stable measures. In treatment success, no significant improvement in lung function was seen after 7 days treatment. No association was seen between severity of exacerbation or treatment response and PA mucoidy or presence of Staphylococcus aureus. Hypermutator PA was seen more in older patients and associated with milder exacerbations. Bacterial diversity was shown not to change significantly during antibiotic treatment but there was a significant relationship between the change in diversity and change in PA bacterial density. Meropenem was shown to have greater effect on diversity than ceftazidime. A significant association between QS molecule concentration and lung function decline at exacerbation was shown. QS concentrations were seen to decrease significantly during antibiotic treatment which was not associated with a decline in bacterial numbers. Discussion: Current durations of antibiotic treatment may not be appropriate as most improvement is seen within 7 days. The effect of repeated course of meropenem on bacterial diversity requires investigation. QS inhibition may provide alternative therapeutic options to exacerbation treatments.
26
Johnston, Sebastian L. "The association of upper respiratory tract infections with exacerbations of asthma." Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295871.
Full text
27
Kiyokawa, Hirofumi. "Impact of COPD exacerbations on osteoporosis assessed by chest CT scan." Kyoto University, 2013. http://hdl.handle.net/2433/174814.
Full text
28
Tanabe, Naoya. "Impact of Exacerbations on Emphysema Progression in Chronic Obstructive Pulmonary Disease." Kyoto University, 2012. http://hdl.handle.net/2433/157447.
Full text
29
Jackson, David. "The pathophysiology of rhinovirus induced exacerbations in mild and moderate asthma." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/29124.
Full textAbstract:
Rhinovirus infection is the most common cause of asthma exacerbations, however mechanisms underlying this remain poorly understood. A human model of experimental rhinovirus induced asthma exacerbation has been developed, however to date the exclusion of moderately-severe and poorly-controlled asthmatics has meant that the role of asthma severity and control on the outcome of rhinovirus infection is unknown. In addition, conventional sampling techniques such as bronchoalveolar lavage dilute many cytokines below limits of detection and consequently it has not been possible to measure key mediators of type 1 and 2 inflammation in-vivo. Thirty-two mild-to-moderate asthmatics and 14 healthy subjects were inoculated nasally with rhinovirus-16. Bronchoscopies were performed 2 weeks prior to inoculation and on day 4 post-inoculation. A novel technique to sample undiluted mucosal airway lining fluid called 'bronchosorption' was developed and performed via bronchoscopy to enable more accurate measurement of cytokines. A similar technique termed 'nasosorption' was performed in the nose. Levels of a range of type 1 and 2 mediators were measured simultaneously in both the upper and lower airway throughout the infection. Twenty-eight asthmatic and 11 healthy subjects developed objective evidence of infection. Asthmatics with moderately-severe disease and poor baseline control developed significantly greater lower respiratory symptoms and falls in lung function than milder and well-controlled asthmatics. The techniques of nasosorption and bronchosorption were able to identify significantly augmented type 2 immunity during infection in-vivo in asthmatic but not healthy subjects with levels of key mediators including IL-4, -5, -13, -33, TARC/CCL17, MDC/CCL22 all relating to exacerbation severity. Induction of type 1 mediators was comparable in the asthmatic and healthy nose but was increased in the asthmatic lung in keeping with the lower airway involvement by rhinovirus in asthma. This is the first study to have demonstrated that baseline asthma severity and control influences the outcome of rhinovirus infection highlighting the importance of maintaining good asthma control. It is also the first to have shown the significant induction of a range of type 2 mediators by rhinovirus in asthma in-vivo. The novel sampling techniques that have been developed will greatly advance our understanding of a range of respiratory conditions through the ability to measure previously undetectable inflammatory mediators.
30
Davies, Ceri Mark. "Examination of viral and bacterial exacerbations of airways inflammation and function." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/56382/.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) is an umbrella term that encompasses chronic bronchitis, emphysema and airway obstruction. COPD patients are also prone to acute exacerbations (AECOPD) caused primarily by viral and bacterial infection, which leads to an increase in inflammation, a worsening of symptoms and can lead to death. There is an unmet clinical to better understand and treat AECOPD as well as COPD in general, but this is hindered by unreliable animal models of COPD and AECOPD. The aim of this thesis was to establish an animal model of COPD that could be exacerbated by an infectious agent. Firstly an LPS model of COPD was established in the guinea pig, which resulted in a macrophage and neutrophil inflammatory profile, emphysematous changes, a decrease in lung function and partial steroid insensitivity that could be partially reversed with low dose theophylline. Human parainfluenza 3 virus failed to cause any infection in the guinea pig, so a model of AECOPD could not be established in this model. A chronic cigarette smoke model in the mouse was established, which again demonstrated a similar phenotype to COPD. This model was able to be exacerbated by the bacteria nontypeable Haemophilus influenza (NTHi) with increases in neutrophils and the neutrophil chemoattractant CXCL1. However, it was also observed that while NTHi could exacerbate the model, responses to NTHi in cigarette smoke challenged mice compared to sham challenged animals were impaired, with significant decreases in CXCL8, TNF-α, IFN-γ and IL-10. This impairment was also observed in monocyte derived macrophages (MDMs) challenged with cigarette smoke extract (CSE) with significant impairment of Il-1β, while chronic LPS challenge also impaired Il-6 and phagocytosis. The data in this thesis highlights a possible increase in steroid responses by low dose theophylline in an LPS model in the guinea pig. It has also demonstrated chronic cigarette smoke exposure in the mouse can be exacerbated by NTHi, however the inflammatory response is impaired compared to sham challenged animals suggesting that cigarette smoke impairs the innate immune response. MDMs also demonstrated an impaired response to NTHi after CSE or LPS challenge.
31
Perotin-Collard, Jeanne-Marie. "Caractérisation phénotypique au cours des exacerbations virales et du processus de réparation épithéliale dans la bronchopneumopathie chronique obstructive." Thesis, Reims, 2014. http://www.theses.fr/2014REIMS014/document.
Full textAbstract:
Le maintien de l'intégrité de l'épithélium des voies aériennes est assuré par un mécanisme de réparation épithéliale pouvant être dérégulé dans la bronchopneumopathie chronique obstructive (BPCO). La BPCO, définie par une obstruction irréversible des débits aériens et émaillée d'épisodes d'exacerbation, présente différents phénotypes, pour lesquels l'évaluation de la sévérité tient compte de la fonction respiratoire et de données cliniques. L'objectif de cette thèse était d'étudier du point de vue phénotypique des patients BPCO lors des exacerbations virales et au cours du processus de réparation épithéliale. Nous avons étudié prospectivement 51 patients BPCO suivis mensuellement et lors des exacerbations. Virus et bactéries étaient recherchés dans l'expectoration induite par PCR et culture. Les résultats analysés en fonction des données cliniques et fonctionnelles respiratoires ont montré qu'une coinfection, présente dans 25% des exacerbations, n'était pas associée au phénotype des patients ni à la sévérité ou à la récidive de l'exacerbation. Nous avons ensuite étudié la réparation de cellules épithéliales bronchiques primaires dans un modèle de réparation de lésion. L'analyse des paramètres de fermeture de lésion (vitesse de fermeture, sécrétions, prolifération cellulaire) en fonction des données cliniques, fonctionnelles et histologiques a montré notamment que la vitesse de fermeture était associée à la sévérité de l'obstruction bronchique. Ces résultats suggèrent le rôle d'anomalies de réparation épithéliale dans la physiopathologie de la BPCO et soulignent la complexité du phénotypage des patients atteints de BPCOThe integrity of airway epithelium is provided by a complex mechanism of epithelial repair that can be dysegulated in chronic obstructive pulmonary disease (COPD). COPD is a heterogeneous condition defined by an irreversible obstructive airflow limitation with frequent acute episodes of exacerbations. COPD patients can present different phenotypes, for which severity evaluation must take into account the severity of lung function and clinical data. The aim of this thesis was to study the COPD patients in a phenotypic point of view during viral exacerbations and during the process of epithelial repair.We prospectively studied 51 COPD patients monitored monthly and during exacerbations. Induce sputum were analyzed for viruses and bacteria detection by PCR and culture. These results analyzed according to the clinical and functional respiratory data showed that co-infection was present in 25 % of exacerbations and was not associated with the phenotype of patients or the severity or recurrence of exacerbation.We then studied primary bronchial epithelial cells repair in a model of wound closure. Associations between wound closure parameters (speed of wound closure, secretions, cell proliferation) and clinical, histological and functional data were analyzed. We showed that the speed of wound closure was associated with the severity of bronchial obstruction. These results suggest the role of abnormal epithelial repair in the pathogenesis of COPD and highlight the complexity of phenotypic characterization of COPD patients
32
Langsetmo, Lisa. "Under-reporting exacerbation of chronic obstructive pulmonary disease : incidence and predictors." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101596.
Full textAbstract:
Objective. to determine how patterns of respiratory symptom change, patient behavior, and health status are related among patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. Methods. The study population was 421 community-dwelling adults with moderate to severe COPD. Symptom-based events (exacerbations) were defined to be any increase in at least one key symptom (dyspnea, sputum amount, sputum color) recorded in the daily diary on at least two consecutive days. An event was reported if it resulted in an exacerbation phone call or documented health-care utilization. Predictors of reporting were assessed using a Cox proportional hazards model. Results. Two-thirds of all events and 40% of events with 4 or more symptoms were not reported. Reporting an event was positively associated with a greater number of respiratory symptoms (HR:1.58, 95% CI: 1.37-1.81), a younger age (HR:1.12, 95% Cl:1.02-1.22 each 5 years), a lower FEV1 (HR:1.20, 95% CI:1.01-1.43 each 10% of predicted FEV1), and weekdays versus weekend (HR:3.03 and 95% CI:1.89-4.76). Conclusion. There was a high incidence of unreported exacerbations and some were important enough (4 or more symptoms) to have an indication for treatment. Reporting was related to the severity of exacerbation and underlying disease.
33
Perera, Wayomi. "Time course of infective and inflammatory changes at exacerbation of COPD." Thesis, Queen Mary, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.552725.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) is associated with recurrent episodes of exacerbations that lead to increased morbidity and mortality. Exacerbations are associated with increased airway and systemic inflammation. This thesis examines the relationship between the infective and inflammatory changes at exacerbation of COPD and clinical non-recovery and recurrence of exacerbations. Patients were recruited from the London COPD cohort and sampled prospectively in the stable state, at exacerbation and after 7, 14 and 35 days. Clinical indices, airway and systemic inflammation and lower airway bacteria were analysed at each visit. Airway inflammation was assessed by sputum interleukin (IL)-6 and IL-8 levels, systemic inflammation was assessed by circulating leucocytes, serum C-reactive protein (CRP) and IL-6. Sputum bacteria were assessed by standard cultures and quantitative real time polymerase chain reaction (qr-PCR). The key findings were: 1) the persistence of heightened airway and systemic inflammation was associated with clinical non-recovery at exacerbation, 2) a higher level of serum CRP 14 days after an exacerbation was associated with a recurrent exacerbation within 50 days, 3) frequent exacerbators have reduced response to therapy and persistently high systemic inflammation compared' to infrequent exacerbators, 4) the presence of a significant relationship between the lower airway bacterial load and circulating leucocytes in stable COPD and 6) the detection of a potentially pathogenic micro-organism from sputum samples is higher by qr-PCR than by standard cultures. These new findings could form the basis of future therapeutic interventions and strategies for prevention of recurrent exacerbations. Further studies into the mechanisms explaining the differences observed between frequent and infrequent exacerbators may help reduce the high burden due to the disease. Finally refining the qr-PCR assay may help elucidate the complex links between lower airway bacteria and inflammation in COPD.
34
Xiujie, Luan. "Study of the bacteria associated with exacerbation of late-onset asthma." Thesis, University of Derby, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323640.
Full text
35
Scadding, Alys Jane. "Phenotyping bronchiectasis based on aetiology, exacerbation characteristics and response to erythromycin." Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/41268.
Full textAbstract:
Background: Recurrent infections and daily symptoms are the main features of non-cystic fibrosis bronchiectasis. The beneficial effect of low-dose macrolides in these patients had been noted but at the time of initiation of this study no clinical trials had been undertaken. The aims were to assess the response to the drug and to determine how best to monitor the response. Informal clinic data had suggested a large improvement in the FEV1 would be seen particularly in those with small airway disease, evident in the lung clearance index and the CT scoring data, and neutrophilic disease would have the best response to erythromycin. Methods: Forty participants with CT proven non-cystic fibrosis bronchiectasis were recruited onto a single centre, open label, non-randomised clinical trial involving 7 visits at 12 week intervals. The first year (visits 1-5) were observational and provided the control data for the intervention of 250mg daily erythromycin which was taken for 12 weeks between visits 5 and 6. The remaining 12 weeks were used to monitor whether the response was maintained. A further 28 participants were recruited to provide further baseline data. Data was collected to assess quality of life, lung function, airway inflammation and airway micro- and mycobiology. Results: The population predominantly had post-infectious and idiopathic bronchiectasis with normal spirometry but an abnormal lung clearance index. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the most commonly cultured bacteria and Aspergillus fumigatus the most commonly identified filamentous fungus. The primary end-point of a 200ml improvement in FEV1 was not found however a response to erythromycin was seen in terms of a reduction in sputum production, improved lung clearance index and transient bacterial clearance. The lung clearance index demonstrated a significantly negative correlation with FEV1 and a significantly positive correlation with the visual analogue scale scores but not the St George’s Respiratory Questionnaire or Leicester Cough Questionnaire. Conclusions: Erythromycin therapy was well-tolerated and had a beneficial effect on the daily symptoms of some participants so would be a useful therapy to trial in non-cystic fibrosis bronchiectasis.
36
Zverotic, Alma, and Anna Lidström. "Sjuksköterskors erfarenheter av att i telefonrådgivning på vårdcentral bedöma andningsförsämring hos patienter med KOL samt besluta åtgärd : - en kvalitativ intervjustudie." Thesis, Högskolan Kristianstad, Fakulteten för hälsovetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-21785.
Full textAbstract:
Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) sjukdom är ett växande problem världen över och kommer i framtiden att ställa primärvården inför utmaningar att kunna möta komplexa vårdbehov från den här patientgruppen. KOL innebär begränsningar i det dagliga livet och ger känslor av beroende vilket gör att många patienter är i behov av kontakt med primärvårdens vårdcentraler. Försämrad andning (exacerbation) är ofta anledning till att en patient med KOL ringer till vårdcentralen. Sjuksköterskan i telefonrådgivningen ställs inför utmaningar att kunna bedöma patientens försämrade andning. Syfte: Att beskriva sjuksköterskors erfarenheter att i telefonrådgivning på vårdcentralen bedöma andningsförsämring hos patienter med KOL och besluta om vidare åtgärd. Metod: En kvalitativ studie har genomförts med individuella semistrukturerade intervjuer där elva sjuksköterskor som arbetar med telefonrådgivning på vårdcentral deltog. En kvalitativ innehållsanalys användes för analys av intervjutexterna Resultat: Hur sjuksköterskorna erfor bedömningen av patienternas försämrade andning utmynnade i fyra huvudkategorier med tio underkategorier samt ett övergripande tema: Att utan sin kliniska blick bedöma andningsförsämring vid KOL innebär utmaningen att värdera patientens aktuella symtom, i förhållande till tidigare och ta beslut om åtgärd. Slutsats: Ett centralt fynd i den här studien är att det finns utmaningar i telefonrådgivning för att bedöma andningssvårigheter hos patienter med KOL. Avsaknaden av den kliniska blicken i telefonrådgivning ställer krav på kompetens och kommunikativa färdigheter hos sjuksköterskan. Samtidigt finns det möjlighet att hitta stöd för sin bedömning i formella beslutstöd och kollegor för att möjliggöra ett adekvat beslutsfattandeBackground: Chronic obstructive pulmonary disease (COPD) is a growing problem worldwide and will in the future pose primary care challenges to be able to meet complex care needs from this patient group. COPD means limitations in daily life and feelings of dependence, which means that many patients need contact with primary health care. Respiratory impairment (exacerbation) is often the reason why patients with COPD call the health care center. The nurse in the telephone counseling is faced with challenges to be able to assess the patient's respiratory impairment. Aim: To describe nurses' experiences of assessing respiratory impairment in patients with COPD in telephone counseling at the health care center and make further decision.Method: A study employed qualitative design using individual semi-structured interviews as data collection method with participation of eleven nurses working with telephone counseling at health care centers. A qualitative content analysis was used to analyze the interviews.Results: The way the nurses experienced the assessment of patients' respiratory impairment was revealed in terms of four main categories, ten subcategories and grasped by one overarching theme: Without visual contact, assessing respiratory impairment in patients with COPD presents a challenge to value the patient´s current symptoms, in relation to the past, and make decision. Conclusion: One core finding of this study is that there are challenges and difficulties in telephone counseling to assess respiratory impairment in patients with COPD. The lack of visual contact with the patients in telephone counseling places demands on the nurse's competence and communication skills. At the same time, nurses receive support for their assessment in decision-making tools and by colleagues.
37
Nunes, de Melo Magda. "Inhaled corticosteroids and the risk of exacerbations in chronic obstructive pulmonary disease." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=79058.
Full textAbstract:
In this thesis, composed of two separate articles, we studied the frequency of COPD exacerbations and assessed the effectiveness of inhaled corticosteroids in preventing a first exacerbation of COPD. We used an inception cohort of COPD patients, formed from the computerised databases of Saskatchewan.The rate of COPD exacerbations was 11.5 per 100 person-years. It increased with age and was 50% higher in men than women. Use of inhaled corticosteroids in the year prior to the index date and current use were associated with a small increase in the risk of a first exacerbation (adjusted RR = 1.27, 95% CI: 1.08--1.48 and 1.51, 95% CI: 1.22--2.87, respectively). The risk increased with increasing daily dose (adjusted RR per 1000 mug = 1.83, 95% CI: 1.47--2.28).
We did not find that the use of inhaled corticosteroids reduces the risk of a first exacerbation in patients with COPD.
38
Al-Amri, Mohammad Abdulla. "Atopic dermatitis : the role of contact allergy in disease and disease exacerbations." Thesis, King's College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274922.
Full text
39
Gahleitner, Florian. "Viral induced exacerbations of childhood asthma : clinical findings, virology and cytokine responses." Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/383589/.
Full text
40
Flight, William George. "The role of respiratory viruses in exacerbations of cystic fibrosis in adults." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/the-role-of-respiratory-viruses-in-exacerbations-of-cystic-fibrosis-in-adults(fb64b48e-1b68-48c1-9095-5fdf5e96f9b4).html.
Full textAbstract:
Viral respiratory infections (VRI) are common in children with cystic fibrosis (CF) and are associated with significant clinical deterioration. Little previous research has been conducted on VRI in adults with CF. This thesis describes a prospective study to determine the epidemiology and clinical impact of VRI among 100 adults with CF.The incidence of identifiable VRI was 1.66 cases/patient-year. Rhinovirus accounted for 72.5% of viruses. Identifiable VRI was associated with increased risk of pulmonary exacerbation, increased respiratory symptoms and higher C-reactive protein levels. Changes in the climate and seasons affected the incidence of identifiable VRI. Rhinovirus was most common in autumn and other viruses predominated during winter. Warmer ambient temperatures were associated with increased risk of rhinovirus infection while other viruses were more common in colder temperatures. Genetic sequencing of a subset of 42 rhinoviruses identified during the study showed that rhinovirus A accounted for 69% of cases and was associated with more severe respiratory symptoms and higher C-reactive protein levels than rhinovirus B.The impact of identifiable VRI on changes to bacterial communities within the lungs of patients with CF was investigated. Ribosomal intergenic spacer analysis (RISA) was developed as a tool to profile the bacterial diversity of CF sputum and was compared with standard culture and 16S rRNA gene pyrosequencing. No consistent effect of identifiable VRI on the microbial diversity of CF sputum was detected with any of these methods in longitudinal analysis of a subset of 18 patients.
41
Sunadome, Hironobu. "IL4Rα and ADAM33 as genetic markers in asthma exacerbations and type-2 inflammatory endotype." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264651.
Full text
42
Mason, Xenos. "Neural Circuit Mechanisms Underlying the Exacerbation of Alzheimer’s Disease by Chronic Stress." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:15821598.
Full textAbstract:
Both epidemiological and animal studies have demonstrated a strong association between Alzheimer’s disease (AD), neuropsychiatric symptoms such as depression and anxiety, and chronic psychological stress. The neurophysiological basis of fear, anxiety, and stress has been well studied and is thought to involve the basolateral amygdala (BLA) – a structure of the anterior temporal lobe, which interprets fearful stimuli and outputs a behavioral fear response. To determine if increased BLA activity could act to accelerate the progression of AD, we manipulated a direct BLA-to-hippocampus circuit using optogenetic (ChR2) and pharmacogenetic (GiDREADD) technologies, and subsequently examined hippocampal AD-related pathology, synaptic density, histone-deacetylase-2 expression, and hippocampus-dependent learning and memory abilities. We found that in wild-type mice, activation of glutamatergic BLA neurons was both necessary and sufficient to produce the molecular and cognitive effects of chronic stress. Terminal photostimulation of direct BLA afferents within the hippocampus was also sufficient. Chronic activation of BLA glutamatergic neurons in the 5xFAD model of AD accelerated the neuropathological and cognitive AD-like phenotype, while chronic BLA inactivation had opposite effects. Overall our results suggest that neuropsychiatric disease and chronic stress may act through enhanced BLA activation to accelerate the progression of AD.
43
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.
Full textAbstract:
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.
44
Geyser, Maria Magdalena. "Risk factors precipitating exacerbations in adult asthma patients presenting at Kalafong Hospital, Pretoria." Diss., Access to E-Thesis, 2006. http://upetd.up.ac.za/thesis/available/etd-08192008-110157/.
Full text
45
Lowe, Alexander Paul. "The role of viral and bacterial infections in asthma exacerbations and corticosteroid resistance." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47342/.
Full textAbstract:
Asthma is a chronic inflammatory disease of the airways characterised by early and late asthmatic responses (EAR & LAR) to allergen, airways hyperresponsiveness (AHR) to inhaled spasmogens, airway inflammation and airway oedema. Viral infections and lipopolysaccharide (LPS) from bacteria and environmental sources contribute to exacerbations of asthma and the development of insensitivity to corticosteroids. Complete insensitivity to oral corticosteroids is rare and most patients lie on a continuum of steroid responsiveness. This thesis aimed to examine the effect of viral infection and LPS in a guinea-pig model of asthma and determine the sensitivity to inhaled and systemic corticosteroids. Sensitised guinea-pigs challenged with ovalbumin displayed EAR, LAR, AHR to histamine, airways inflammation and airway oedema. Inoculation of guinea-pigs with parainfluenza-3 virus alone induced AHR to histamine and airway inflammation. However this response was not consistent. Inhaled LPS alone induced an immediate bronchoconstriction, AHR, airway inflammation and oedema and goblet cell hyperplasia. LPS co-administered with ovalbumin exacerbated the allergen response by lengthening the EAR, prolonging the bronchoconstrictor response to histamine, increasing airway inflammation and oedema and goblet cell hyperplasia. In guinea-pigs challenged with ovalbumin alone, treatment with inhaled fluticasone propionate (FP) and inhaled and systemic dexamethasone decreased the LAR, abolished AHR, airway inflammation and oedema. Responses to LPS alone were not reduced by inhaled dexamethasone or FP but partially reduced by systemic dexamethasone. Ovalbumin and LPS combined responses were insensitive to inhaled corticosteroids, except lavage fluid protein. These responses were partially sensitive to systemic dexamethasone, with the prolonged EAR, inflammation and airway oedema all reduced. The data in this thesis suggests that LPS inhalation exacerbates ovalbumin-induced functional and inflammatory responses rendering them insensitive to inhaled corticosteroids but partially sensitive to systemic corticosteroids. Thus, the experimental combination of ovalbumin with LPS might represent a useful preclinical model of corticosteroid-insensitive airway inflammation.
46
Needham, Michelle. "Exacerbations, health status and sibling pair comparisons in severe Alpha-1-Antitrypsin Deficiency." Thesis, University of Birmingham, 2007. http://etheses.bham.ac.uk//id/eprint/127/.
Full textAbstract:
Alpha-1-Antitrypsin Deficiency (AATD) is a risk factor for the development of early-onset emphysema and airflow obstruction. The current work defines exacerbations, lung function and health status in these patients including sibling pairs. Exacerbations occur commonly in AATD and are associated with worse health status. Exacerbations were associated with a decline in the gas transfer of the lung over time, but show no relationship to changes in forced expiratory volume in one second (FEV1). However, despite lung function decline, patients do not show a progressive loss in health status. Index patients have worse lung function and health status and more emphysema than non-index siblings. These differences are not solely explained by smoking or ascertainment. Although FEV1 values differ between sibling pairs, gas transfer does show significant correlation. Thus disease phenotype may also be influenced by other genetic modifiers. These results provide a firm basis upon which to design, power and implement trials of interventions that may reduce exacerbations and improve health status in patients. Furthermore sibling pairs, particularly those with discordant disease or concordant parenchymal disease, are an ideal group to further investigate the contribution of other genes in the development of COPD or its phenotype in AATD patients.
47
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.
Full textAbstract:
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.
48
Takahashi, Tamaki. "Relationship between periodontitis-related antibody and frequent exacerbations in chronic obstructive pulmonary disease." Kyoto University, 2013. http://hdl.handle.net/2433/174797.
Full text
49
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.
Full text
50
Norris, Gary. "Air pollution and the exacerbation of asthma in an arid, western, US city /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/10108.
Full text