Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature

The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.

We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects models.

We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1–1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0–4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5–4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7–5.9) and 4.1 (95% CI 2.1–8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1–8.4).

The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ~3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.

Neuromuscular weakness in chronic obstructive pulmonary disease: chest wall, diaphragm, and peripheral muscle contributions

Purpose of review: Chronic obstructive lung disease affects the lung parenchyma and airways leading to well described effects in respiratory function. This review describes the current knowledge and advances regarding neuromuscular function and chest wall mechanics, which are affected in chronic obstructive pulmonary disease (COPD).

Recent findings: In COPD, progressive lung hyperinflation becomes constrained by a chest wall with decreasing capacity to expand, resulting in respiratory muscle inefficiency. There is evidence of neuromuscular uncoupling, that is, the respiratory muscle is unable to increase its output in proportion to increasing neural signals. COPD patients also have evidence of altered peripheral muscles function. The end effect of all these pathological changes is neuromuscular weakness.

Summary: Respiratory and peripheral muscles dysfunction is found in patients with COPD. This manifests clinically as dyspnea, poor exercise capacity, and decreased quality of life. We have clear evidence that rehabilitation helps several aspects of patients with COPD. Further understanding of the physiopathology is needed to improve our therapeutic and rehabilitation strategies.

Chronic obstructive pulmonary disease and sleep related disorders

Purpose of review: Sleep related disorders are common and under-recognized in the chronic obstructive pulmonary disease (COPD) population. COPD symptoms can disrupt sleep. Similarly, sleep disorders can affect COPD. This review highlights the common sleep disorders seen in COPD patients, their impact, and potential management.

Recent findings: Treatment of sleep disorders may improve quality of life in COPD patients. Optimizing inhaler therapy improves sleep quality. Increased inflammatory markers are noted in patients with the overlap syndrome of COPD and obstructive sleep apnea versus COPD alone. There are potential benefits of noninvasive positive pressure ventilation therapy for overlap syndrome patients with hypercapnia. Nocturnal supplemental oxygen may be beneficial in certain COPD subtypes. Nonbenzodiazepine hypnotic therapy for insomnia has shown benefit without associated respiratory failure or worsening respiratory symptoms. Melatonin may provide mild hypnotic and antioxidant benefits.

Summary: This article discusses the impact of sleep disorders on COPD patients and the potential benefits of managing sleep disorders on respiratory disease control and quality of life.

Obesity and chronic obstructive pulmonary disease: recent knowledge and future directions

Purpose of review: Obesity has been shown to have a significant impact on lung diseases, including chronic obstructive pulmonary disease (COPD). The purpose of this review is to discuss the most recent findings regarding the association between obesity, COPD, and COPD-related outcomes.

Recent findings: Evidence indicates that obese patients with COPD may compose a unique disease phenotype who are more susceptible than their lean counterparts to environmental exposures. The contribution of the visceral fat mass, irrespective of the total body fat mass, to the pathophysiology of COPD needs to be further explored in future studies.

Summary: Recent evidence supports a link between obesity and outcomes in COPD. Whether treatment of obesity also results in positive long-term effects in patients with COPD needs further investigation.

Chronic obstructive pulmonary disease: the impact of gender

imagePurpose of review: Chronic obstructive pulmonary disease (COPD) is a widely prevalent and potentially preventable cause of death worldwide. The purpose of this review is to summarize the influence of gender on various attributes of this disease, which will help physicians provide more personalized care to COPD patients.

Recent findings: Cultural trends in smoking have morphed the epidemiology of this traditionally male disease. There is an increasing ‘disease burden’ among women with COPD as suggested by the higher prevalence and slower decline in death rates as compared with men. Biologic differences between the genders account for some, but not all of these differences. In women, distinct features need to be considered to boost success of therapeutic interventions such as smoking cessation, addressing comorbidities, and attendance to pulmonary rehabilitation.

Summary: COPD in women is distinct from that in men with respect to phenotype, symptom burden, and comorbidities. Women are more predisposed to develop chronic bronchitis, have more dyspnea, and suffer more frequently from coexistent anxiety or depression. They may be more subject than men to misdiagnoses and/or underdiagnoses of COPD, often as a result of physician bias. Knowledge of these gender differences can lead to more effective tailored care of the COPD patient.

Search

Search