Related Articles

Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease.

Eur J Clin Invest. 2013 Feb 11;

Authors: Roca M, Verduri A, Corbetta L, Clini E, Fabbri LM, Beghé B

Abstract
Exacerbations of chronic obstructive respiratory disease (ECOPD) are acute events characterized by worsening of the patient's respiratory symptoms, particularly dyspnoea, leading to change in medical treatment and/or hospitalisation. AECOP are considered respiratory diseases, with reference to the respiratory nature of symptoms and to the involvement of airways and lung. Indeed respiratory infections and/or air pollution are the main causes of ECOPD. They cause an acute inflammation of the airways and the lung on top of the chronic inflammation that is associated with COPD. This acute inflammation is responsible of the development of acute respiratory symptoms (in these cases the term ECOPD is appropriate). However, the acute inflammation caused by infections/pollutants is almost associated with systemic inflammation, that may cause acute respiratory symptoms through decompensation of concomitant chronic diseases (eg acute heart failure, thromboembolism, etc) almost invariably associated with COPD. Most concomitant chronic diseases share with COPD not only the underlying chronic inflammation of the target organs (i.e. lungs, myocardium, vessels, adipose tissue), but also clinical manifestations like fatigue and dyspnoea. For this reason, in patients with multi-morbidity (eg COPD with chronic heart failure and hypertension, etc), the exacerbation of respiratory symptoms may be particularly difficult to investigate, as it may be caused by exacerbation of COPD and/or ≥ comorbidity, (e.g. decompensated heart failure, arrhythmias, thromboembolisms) without necessarily involving the airways and lung. In these cases the term ECOPD is inappropriate and misleading.

PMID: 23489139 [PubMed - as supplied by publisher]

Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population.

Am J Respir Crit Care Med. 2013 Mar 14;

Authors: Anderson GB, Dominici F, Wang Y, McCormack MC, Bell ML, Peng RD

Abstract
RATIONALE: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. OBJECTIVES: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the US elderly. METHODS: An observational study of ~12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999-December 31, 2008. We estimate a national average relative risk of hospitalization for each 10oF (5.6oC) increase in daily outdoor temperature using Bayesian hierarchical models. MEASUREMENTS AND MAIN RESULTS: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (ICD-9 464-466, 480-487, 490-492) in 213 United States counties for 1999-2008. Overall, each 10oF increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval: 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures. CONCLUSIONS: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.

PMID: 23491405 [PubMed - as supplied by publisher]

Related Articles

Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease.

Cochrane Database Syst Rev. 2013;1:CD009419

Authors: Maddocks M, Gao W, Higginson IJ, Wilcock A

Abstract
BACKGROUND: Patients with progressive diseases often experience muscle weakness, which impacts adversely on levels of independence and quality of life. In those who are unable or unwilling to undertake traditional forms of exercise, neuromuscular electrical stimulation (NMES) may provide an alternative method of enhancing leg muscle strength. Programmes appear to be well tolerated and have led to improvements in muscle function, exercise capacity and quality of life. However, estimates regarding the effectiveness of NMES from individual studies lack power and precision.
OBJECTIVES: Primary objective: to evaluate the effectiveness of NMES for improving muscle strength in adults with advanced disease. Secondary objective: to examine the acceptability and safety of NMES, and changes in muscle function (strength or endurance), muscle mass, exercise capacity, breathlessness and health-related quality of life.
SEARCH METHODS: Studies were identified from searches of The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO databases to July 2012, citation searches, conference proceedings and previous systematic reviews.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) in adults with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure, cancer or human immunodeficiency virus/acquired immunodeficency syndrome (HIV/AIDS) comparing a programme of NMES as a sole or adjunct intervention to no treatment, placebo NMES or an active control. We imposed no language restriction.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data on study design, participants, interventions and outcomes. We assessed risk of bias using the Cochrane Collaboration's tool. We calculated mean differences (MD) or standardised mean differences (SMD) between intervention and control groups for outcomes with sufficient data; for other outcomes we described findings from individual studies.
MAIN RESULTS: Eleven studies involving a total of 218 participants met the inclusion criteria across COPD, chronic heart failure and thoracic cancer. NMES significantly improved quadriceps strength by a SMD of 0.9 (95% confidence interval (CI) 0.33 to 1.46), equating to approximately 25 Newton metres (Nm) (95% CI 9 to 41). Mean differences across various walking tests, favouring NMES, were 40 m (95% CI -4 to 84) for the six-minute walk test, 69 m (95% CI 19 to 119) for the incremental shuttle walk test and 160 m (95% CI 34 to 287) for the endurance shuttle walk test. Limited evidence was available for the assessment of other secondary outcomes.
AUTHORS' CONCLUSIONS: NMES appears an effective means of improving muscle weakness in adults with progressive diseases such as COPD, chronic heart failure and cancer. Further research is required to clarify its place in clinical practice, by determining the optimal parameters for a NMES programme, the patients most likely to benefit, and its impact on morbidity and service use.

PMID: 23440837 [PubMed - indexed for MEDLINE]

Aclidinium bromide / formoterol fumarate fixed-dose combination for the treatment of chronic obstructive pulmonary disease.

Expert Opin Pharmacother. 2013 Mar 9;

Authors: Cazzola M, Rogliani P, Matera MG

Abstract
Introduction: Combining a long-acting β2-agonist (LABA) and a long-acting antimuscarinic agent (LAMA) is potentially a good pharmacological approach to improve clinical results in stable moderate chronic obstructive pulmonary disease (COPD) patients when symptoms are not adequately controlled with tiotropium monotherapy. Consequently, there is a strong interest in developing a LABA/LAMA fixed-dose combination therapy in an attempt to simplify the treatment. Areas covered: An aclidinium bromide / formoterol fumarate fixed-dose combination is under development. The few clinical data at our disposal suggest that the addition of formoterol fumarate to aclidinium bromide results in greater bronchodilation than formoterol fumarate or aclidinium bromide alone. However, a large Phase III program is involving a huge number of patients with moderate-to-severe COPD and consists of large long-term (from 24 to 52 weeks) pivotal clinical trials that have been designed to fulfil both European Medicines Agency (EMA) and Food and Drug Administration (FDA) requirements and are evaluating the efficacy and safety of this fixed-dose combination. Expert opinion: Studies assessing the impact of aclidinium bromide/formoterol fumarate fixed-dose combination on COPD exacerbations, exercise capacity and hospitalisations are clearly needed to better detect its potential effects of disease modification in COPD. Moreover, it seems pragmatic to proceed with its introduction in the market at a highly competitive price.

PMID: 23472632 [PubMed - as supplied by publisher]