Smoking Cessation Interventions for Chronic Obstructive Pulmonary Disease - A Review of the literature.

Respir Care. 2013 Feb 19;

Authors: Piresyfantouda R, Absalom G, Clemens F

Abstract
The aim of this systematic review is to establish the most effective stop smoking intervention approach for smokers with COPD. The search strategy included electronic databases: MEDLINE, EMBASE, AMED, PsycINFO, DARE, Cochrane Library and CINAHL between January, 2006 and January, 2010. References of the included studies were also screened for additional papers and further hand searches were conducted. The selection criteria included randomised controlled trials or quasi-randomised controlled trials with at least one group comprised of participants diagnosed with COPD. Two independent reviewers reviewed the included studies using a quality assessment form developed from the selection criteria. Divergence of quality assessment scores was resolved by the two reviewers and agreeing on a score. Four studies were selected. They indicated that psychosocial interventions combined with pharmacotherapy were effective in smoking cessation at 12 months post-intervention, although the effect was not statistically significant due to small sample size and heterogeneity between studies OR =2.35, 95% CI [0.25, 21.74],). However, despite this medium effect size, due to a lack of universal use of pharmacotherapies in most of the studies, it makes a definitive comparison of efficacy difficult to determine. The review also shows the effectiveness of psychosocial treatment for people with or without COPD symptoms at 12 months, although the effect of disease severity is not clear. The review also highlights the difficulty of maintaining attendance at community-based locations compared to acute or research settings.

PMID: 23431304 [PubMed - as supplied by publisher]

Responsiveness of Various Exercise-Testing Protocols to Therapeutic Interventions in COPD.

Pulm Med. 2013;2013:410748

Authors: Borel B, Provencher S, Saey D, Maltais F

Abstract
Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD). As such, evaluating exercise tolerance has become an important part of the management of COPD. A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics. This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD. This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols. Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD.

PMID: 23431439 [PubMed - in process]

Respiratory infections in HIV-infected adults: epidemiology, clinical features, diagnosis and treatment.

Curr Opin Pulm Med. 2013 Feb 15;

Authors: Capocci S, Lipman M

Abstract
PURPOSE OF REVIEW: Using the evidence published over the last 2 years, this review discusses the epidemiology, diagnosis, treatment and prevention of HIV-related pulmonary infections other than mycobacterial disease. RECENT FINDINGS: Longstanding, vertically acquired and apparently stable HIV infection is associated with significant and symptomatic small airways disease in African adolescents. The use of population-based pneumococcal vaccination in children is changing the severity and serotypes associated with HIV-related pneumococcal disease. Data on the use of blood 1,3,β-D-glucan show it has promise as a rule-out test for Pneumocystis pneumonia (PCP). SUMMARY: With widespread antiretroviral medication usage, the pattern of HIV-associated pulmonary disease is changing. Whereas opportunistic infections such as PCP still occur in people not using antiretroviral therapy (ART), HIV-related infections are similar to those present in the general population. Chronic lung disease is more prevalent, leading to its own infectious complications. The use of specific immunizations against infections is important, though their precise benefit with concomitant widespread ART and population-based vaccination programmes in the non-HIV community is undetermined.

PMID: 23422413 [PubMed - as supplied by publisher]

Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections.

JAMA. 2013 Feb 20;309(7):717-8

Authors: Schuetz P, Briel M, Mueller B

Abstract
CLINICAL QUESTION: In patients with respiratory tract infection, is measurement of procalcitonin to guide antibiotic prescriptions associated with reduced antibiotic exposure without increases in all-cause mortality or treatment failure? BOTTOM LINE: The measurement of procalcitonin to guide initiation and duration of antibiotic treatment in patients with respiratory tract infections of varying severity is associated with lower antibiotic exposure without increasing all-cause mortality or treatment failure.

PMID: 23423417 [PubMed - indexed for MEDLINE]