- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Bronchodilators are indicated for individuals that have lower than optimal air flow through the lungs. The mainstay of treatment is beta-2 agonists that target the smooth muscles in the bronchioles o...
Bronchodilators are indicated for individuals that have lower than optimal air flow through the lungs. The mainstay of treatment is beta-2 agonists that target the smooth muscles in the bronchioles of the lung. There are various respiratory conditions that from bronchodilators that include asthma, and chronic obstructive pulmonary disease (COPD). They are used to either reverse the symptoms of asthma or improve lung function in COPD. Because lung function is assessed through pulmonary function tests, bronchodilators have an important role in the diagnosis and treatment of lung conditions based on their effect of pulmonary function tests (PFTs). FEV1/FVC ratio (based on how much air flows during the first second of exhalation over the theoretical air someone can push out in a maximum exhalation (FVC). A normal ratio is 0.7 In reversible increased airway resistance like asthma, pre-bronchodilator PFTs will typically be lower than 0.7, but after administration of a short-acting bronchodilator, the PFTs should normalize. This is different from non-reversible conditions like COPD where giving a short-acting bronchodilator may not normalize PFT levels in patients. Commonly, inhaled corticosteroids are added to beta-2 agonists to reduce inflammation and pro-inflammatory agents that will further constrict airways. Because bronchodilators that are the beta-2 agonist class have no effect on the underlying pathology of lung disease, and are only symptomatic treatment, adding inhaled corticosteroids to the regimen has been the mainstay of mild-moderate reversible lung diseases with or without long-acting beta-2 agonists. The step theory in managing reversible lung diseases like asthma incorporate both short and long-acting bronchodilators. Those with intermittent asthma should receive a short-acting bronchodilator (albuterol for example) as needed. Adding a low-dose, inhaled corticosteroid is the next step to more symptomatic disease, followed by adding a long-acting bronchodilator with the inhaled steroid. More and more aggressive treatment is deferred to those in the field of asthma and allergy. Once control is achieved, the patient will consult with their doctor on weaning them off these medicine to a smaller dose that will not have as many side effects. Failure to control symptoms with short/long-acting bronchodilators and corticosteroids can result in irreversible lung injury. Frequent monitoring by pulmonary function tests and peak airway flow is the mainstay of treatment success.
- Comorbidities in coexisting chronic obstructive pulmonary disease and obstructive sleep apnea - overlap syndrome. [Journal Article]
- EREur Rev Med Pharmacol Sci 2018; 22(13):4325-4331
- CONCLUSIONS: We conclude that comorbidities, especially cardiovascular, in patients with overlap syndrome are at least as prevalent as in sleep apneic only patients and may contribute to the overall severity and prognosis of the disease.
- Sleepiness, fatigue, anxiety and depression in Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea - Overlap - Syndrome, before and after continuous positive airways pressure therapy. [Journal Article]
- PlosPLoS One 2018; 13(6):e0197342
- Patients with Chronic Obstructive Pulmonary Disease (COPD) and / or Obstructive Sleep Apnea (OSA) often complain about sleepiness, fatigue, anxiety and depression. However, common screening questionn...
Patients with Chronic Obstructive Pulmonary Disease (COPD) and / or Obstructive Sleep Apnea (OSA) often complain about sleepiness, fatigue, anxiety and depression. However, common screening questionnaires, like Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS) and Hospital Anxiety and Depression Scale (HADS) have not been previous evaluated in patients with overlap-coexisting COPD and OSA-syndrome versus patients with OSA alone. Our study compared ESS, FSS and HADS between patients with overlap syndrome and patients with OSA, before and after treatment with Continuous Positive Airways Pressure (CPAP). We examined 38 patients with coexisting COPD and OSA versus 38 patients with OSA-only and 28 subjects without respiratory disease, serving as controls. All patients underwent pulmonary function tests (PFTs), oximetry and overnight polysomnography and completed the questionnaires, before and after 3 months of CPAP therapy. The two patient groups did not differ significantly in terms of age, Body Mass Index (BMI), neck, waist and hip circumferences, and arterial blood pressure values. They also had similar comorbidities. They differed significantly, as expected, in PFTs (Forced Vital Capacity-FVC, 2.53±0.73 vs 3.08±0.85 lt, p = 0.005, Forced Expiratory Volume in 1sec-FEV1, 1.78±0.53 vs 2.60±0.73 lt/min, p<0.001) and in daytime oximetry (94.75±2.37 vs 96.13±1.56%, p = 0.007). ESS, HADS-Anxiety and HADS-Depression scores did not differ statistically significant between these two groups, whereas overlap syndrome patients expressed significantly more fatigue (FSS) than OSA-only patients, a finding that persisted even after 3 months of CPAP therapy. We conclude that sleepiness, anxiety and depression were similar in both groups, whereas fatigue was more prominent in patients with overlap syndrome than in sleep apneic patients and did not ameliorate after treatment.
- Prevalence and spectrum of symptomatic pulmonary involvement in primary Sjögren's syndrome. [Journal Article]
- CEClin Exp Rheumatol 2018 May 29
- CONCLUSIONS: Approximately one fifth of a large cohort of pSS patients presented chronic respiratory symptoms. Small airway disease was the most commonly recognized pulmonary disorder among symptomatic pSS patients, followed by xerotrachea and interstitial lung disease.
- Usefulness of the forced oscillation technique in assessing the therapeutic result of tracheobronchial central airway obstruction. [Journal Article]
- RIRespir Investig 2018; 56(3):222-229
- CONCLUSIONS: The FOT is suitable and convenient for assessing therapeutic results in patients with tracheobronchial CAO. The alteration of R20 is useful for estimating the airway dilation of CAO after interventional bronchoscopy.
- Chronic obstructive pulmonary disease in patients with chronic thromboembolic pulmonary hypertension: Prevalence and implications for surgical treatment outcome. [Journal Article]
- CRClin Respir J 2018; 12(7):2242-2248
- CONCLUSIONS: COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension, in-hospital mortality and increases the duration of hospital stay after PEA.
- Quantitative Computed Tomography (CT) Assessment of Emphysema in Patients with Severe Chronic Obstructive Pulmonary Disease (COPD) and its Correlation with Age, Sex, Pulmonary Function Tests, BMI, Smoking, and Biomass Exposure. [Journal Article]
- PJPol J Radiol 2017; 82:760-766
- CONCLUSIONS: Smoking is associated with a relatively homogenous distribution of emphysema with no regional predilection. Biomass exposure produces predominantly right-sided emphysema. BMI decreases with increasing levels of emphysema in the right lower lobe. These risk factors of emphysema patterns are helpful in deciding on the management, including surgical options.
- Quality-of-Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis. [Journal Article]
- LLaryngoscope 2018 Mar 07
- CONCLUSIONS: Quality of life is correlated to PEF% in ISGS. Using a limited number of QOL questions, clinicians can predict objective worsening or improvement of disease severity, as measured by spirometry.
- Nitrogen single-breath washout test for evaluating exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease. [Journal Article]
- BJBraz J Med Biol Res 2018; 51(4):e7059
- Pulmonary function tests (PFTs) traditionally used in clinical practice do not accurately predict exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this s...
Pulmonary function tests (PFTs) traditionally used in clinical practice do not accurately predict exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess whether the nitrogen single-breath washout (N2SBW) test explains exercise intolerance and poor quality of life in stable COPD patients. This cross-sectional study included 31 patients with COPD subjected to PFTs (including the N2SBW test) and a cardiopulmonary exercise test (CPET). Patients were also evaluated using the following questionnaires: the COPD assessment test (CAT), the 36-Item Short Form Health Survey (SF36) and St. George's Respiratory Questionnaire (SGRQ). Peak oxygen uptake (peak VO2) was negatively correlated with the phase III slope of the N2SBW (SIIIN2) (r=-0.681, P<0.0001) and positively correlated with forced expiratory volume in one second (FEV1; r=0.441, P=0.013). Breathing reserve was negatively correlated with SIIIN2, closing volume/vital capacity, and residual volume (RV) (r=-0.799, P<0.0001; r=-0.471, P=0.007; r=-0.401, P=0.025, respectively) and positively correlated with FEV1, forced vital capacity (FVC) and FEV1/FVC (r=0.721; P<0.0001; r=0.592, P=0.0004; r=0.670, P<0.0001, respectively). SIIIN2 and CAT were independently predictive of VO2 and breathing reserve at peak exercise. RV, FVC, and FEV1 were independently predictive of the SF36-physical component summary, SF36-mental component summary, and breathing reserve, respectively. The SGRQ did not present any independent variables that could explain the model. In stable COPD patients, inhomogeneity of ventilation explains a large degree of exercise intolerance assessed by CPETs and, to a lesser extent, poor quality of life.
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- Chronic Lung Disease and Mortality after Cardiac Surgery: A Prospective Cohort Study. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2017 Dec 11
- CONCLUSIONS: Combination of confirmed preexisting lung disease and newly diagnosed cases provides a clear link to mid-term mortality.