Société Tunisienne des Maladies Respiratoires et d'Allergologie STMRA

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts.

OBJECTIVE: To review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART).

DESIGN: Two large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women's Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively.

METHODS: Adjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era.

RESULTS: Compared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2-2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3-1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8-2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02-8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3-1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5-2.4; p<0.001).

CONCLUSION: HIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality.

Bronchodilator responsiveness and reported respiratory symptoms in an adult population.

The relationship between patient-reported symptoms and objective measures of lung function is poorly understood.

AIM: To determine the association between responsiveness to bronchodilator and respiratory symptoms in random population samples.

METHODS: 4669 people aged 40 years and older from 8 sites in Canada completed interviewer-administered respiratory questionnaires and performed spirometry before and after administration of 200 ug of inhaled salbutamol. The effect of anthropometric variables, smoking exposure and doctor-diagnosed asthma (DDA) on bronchodilator responsiveness in forced expiratory volume in 1 second (FEV1) and in forced vital capacity (FVC) were evaluated. Multiple logistic regression was used to test for association between quintiles of increasing changes in FEV1 and in FVC after bronchodilator and several respiratory symptoms.

RESULTS: Determinants of bronchodilator change in FEV1 and FVC included age, DDA, smoking, respiratory drug use and female gender [p<0.005 to p<0.0001 ]. In subjects without doctor-diagnosed asthma or COPD, bronchodilator response in FEV1 was associated with wheezing [p for trend<0.0001], while bronchodilator response for FVC was associated with breathlessness. [p for trend <0.0001].

CONCLUSIONS: Bronchodilator responsiveness in FEV1 or FVC are associated with different respiratory symptoms in the community. Both flow and volume bronchodilator responses are useful parameters which together can be predictive of both wheezing and breathlessness in the general population.

Treadmill Endurance During 2 Years' Treatment With Tiotropium in Patients With COPD: A Randomized Trial.

Disease progression in chronic obstructive pulmonary disease (COPD) is associated with decline in exercise performance over time. We assessed whether tiotropium might mitigate this by determining its effect on treadmill endurance time (ET) over 2 years.

METHODS: Randomized, double-blind, placebo-controlled trial of tiotropium 18 µg daily in patients with COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 70%; postbronchodilator FEV1 < 65%). Primary endpoint: ET at 90% of baseline maximum work rate at 96 weeks. Secondary endpoints: ET at other visits, ET by smoking status, spirometry, St George Respiratory Questionnaire (SGRQ).

RESULTS: 519 patients randomized (tiotropium 260, placebo 259), mean 65 years, 77% men, 34% continuing smokers, FEV1 1.25 L (44% predicted). Significantly more patients discontinued placebo: hazard ratio (95% CI) 0.61 (0.44, 0.83). Baseline ET was 301 s (improvement tiotropium/placebo: 13% overall, P = 0.009; 18% at 48 weeks, P = 0.004; 13% at 96 weeks, P = 0.106). In patients with baseline ET between 2-10 minutes (n = 404), improvement at 96 weeks was 19% (P = 0.04). Current smokers had higher ET with tiotropium vs placebo (P = 0.018). FEV1/FVC improved with tiotropium (P < 0.01). SGRQ total score at 96 weeks improved with tiotropium vs placebo by 4.03 units (P = 0.007).

CONCLUSIONS: Treadmill ET was numerically greater over 2 years with tiotropium vs placebo. However, 96-week difference was not statistically significant. Spirometry and health status also improved with tiotropium over 2 years, attesting to the benefits of long-acting bronchodilator therapy.ClinicalTrials.gov: NCT00525512.

A pilot randomised study comparing two methods of NIV withdrawal after acute COPD with respiratory failure.

Patients with COPD presenting with acute hypercapnic respiratory failure (AHcRF) benefit from non-invasive ventilation (NIV). The best way to withdraw NIV is not known and we conducted a pilot study comparing stepwise versus immediate withdrawal of NIV in these patients.

METHODS: This was a prospective, single-centre, open-labelled randomised study comparing stepwise versus immediate withdrawal of NIV in patients with COPD exacerbation recovering from AHcRF. The primary end-point was the success rate of NIV withdrawal, defined as no re-starting of NIV from randomisation to 48 hours after complete withdrawal of NIV.

RESULTS: Sixty patients were randomised, 35 patients to stepwise withdrawal and 25 patients to immediate withdrawal. The two study arms were clinically comparable. There was no statistically significant difference in the success rate, with NIV successfully stopped in 74.3% and 56% in the stepwise and immediate withdrawal groups respectively (p = 0.139).

CONCLUSIONS: We could not show any benefits for either strategy to withdraw NIV. The study may have been underpowered to detect differences and larger prospective studies are required.

Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy.

Non-invasive mechanical ventilation (NIV) in patients with acute respiratory failure has been traditionally determined based on clinical assessment and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adjusts to a patient's needs. Our study assessed the use of BiPAP S/T with AVAPS in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic encephalopathy as compared to BiPAP S/T alone, upon immediate arrival in the Emergency-ICU.

METHODS: We carried out a prospective interventional match-controlled study in Guayaquil, Ecuador. A total of 22 patients were analyzed. Eleven with COPD exacerbations and hypercapnic encephalopathy with a Glasgow Coma Scale (GCS) <10 and a pH of 7.25-7.35 were assigned to receive NIV via BiPAP S/T with AVAPS. Eleven patients were selected as paired controls for the initial group by physicians who were unfamiliar with our study, and these patients were administered BiPAP S/T. Arterial blood gases, GCS, vital signs, and ventilatory parameters were then measured and compared between the two groups.

RESULTS: We observed statistically significant differences in favor of the BiPAP S/T + AVAPS group in GCS (P = .00001), pCO2 (P = .03) and maximum inspiratory positive airway pressure (IPAP) (P = .005), among others. However, no significant differences in terms of length of stay or days on NIV were observed.

CONCLUSIONS: BiPAP S/T with AVAPS facilitates rapid recovery of consciousness when compared to traditional BiPAP S/T in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy.Trial registration: Current Controlled Trials application ref is ISRCTN 05135218.

Blog With Right Sidebar

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts.

Bronchodilator responsiveness and reported respiratory symptoms in an adult population.

Treadmill Endurance During 2 Years' Treatment With Tiotropium in Patients With COPD: A Randomized Trial.

A pilot randomised study comparing two methods of NIV withdrawal after acute COPD with respiratory failure.

Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy.

Search

Search

Login to your account

Blog With Right Sidebar

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts.

Bronchodilator responsiveness and reported respiratory symptoms in an adult population.

Treadmill Endurance During 2 Years' Treatment With Tiotropium in Patients With COPD: A Randomized Trial.

A pilot randomised study comparing two methods of NIV withdrawal after acute COPD with respiratory failure.

Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy.

Search

Search