Related Articles

Nonventilatory strategies to prevent postoperative pulmonary complications.

Curr Opin Anaesthesiol. 2013 Feb 3;

Authors: Güldner A, Pelosi P, Abreu MG

Abstract
PURPOSE OF REVIEW: In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. RECENT FINDINGS: Although nonavoidable, most comorbidities can be modified in order to reduce the incidence of pulmonary events postoperatively. The physical status of patients suffering from chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, and congestive heart failure can be improved preoperatively, and a number of measures can be undertaken to prevent PPCs, including physiotherapy for pulmonary rehabilitation and drug therapies. Also, smokers may benefit from both short and long-term smoke cessation. Furthermore, the risk of PPCs may be reduced upon: choice of an adequate anesthesia strategy (e.g. regional vs. general); appropriate neuromuscular blockade and reversal; use of volatile instead of intravenous anesthetics in lung surgery; judicious intravascular volume expansion (restrictive vs. liberal strategy); regional instead of systemic analgesia after major surgery in high-risk patients; more strict indication for nasogastric decompression in order to avoid silent aspiration; and laparoscopic instead of open bariatric surgery. SUMMARY: Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.

PMID: 23385322 [PubMed - as supplied by publisher]

Prognostic Value of Bronchiectasis in Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2013 Feb 7;

Authors: Martinez-Garcia MA, de la Rosa D, Soler-Cataluña JJ, Donat-Sanz Y, Catalán Serra P, Agramunt Lerma M, Ballestín J, Valero Sánchez I, Selma Ferrer MJ

Abstract
RATIONALE: The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in COPD patients but no information about the relationship between bronchiectasis and mortality in COPD patients is currently available. OBJECTIVE: To assess the prognostic value of bronchiectasis in moderate-to-severe COPD patients. METHODS AND MEASUREMENTS: Multicenter prospective observational study in consecutive moderate-to-severe COPD patients. Bronchiectasis was diagnosed by high-resolution CT scan. A complete standardized protocol was used in all patients, covering general, anthrophometric, functional, clinical, and microbiological data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MAIN RESULTS: Ninety-nine patients in GOLD II, 85 in GOLD III and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) of patients. During the follow-up (median 48 months [IQR, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (HR 2.54, 95%CI, 1.16-5.56; p=0.02). CONCLUSIONS: Bronchiectasis was associated with an independent increased risk of all-cause mortality in moderate-to-severe COPD patients.

PMID: 23392438 [PubMed - as supplied by publisher]

The use of long-acting?2- agonists as monotherapy in children and adults.

J Popul Ther Clin Pharmacol. 2013;20(1):e1-e12

Authors: Camp PG, Zhang T, Smith MA, Carleton BC

Abstract
Background   In asthma, it is recommended that long-acting β2-agonists (LABAs) not be used as monotherapy, but, be used with inhaled corticosteroids (ICS) to minimize the risk of serious adverse events.   Objective  To test the hypothesis that if clinical recommendations were followed, LABA monotherapy would not occur in children and would only occur in COPD, where it is not contraindicated.  Methods  We analyzed LABA and ICS dispensing for British Columbians with respiratory conditions in 2004.  LABA use was classified as "LABA Monotherapy", "LABA with Concurrent ICS", or "Mixed" (LABA use, occasional ICS use). Using physician and hospital billing records, children < 18 years were classified as having "asthma" or "other respiratory condition". Adults were classified as having "asthma", "COPD", "asthma and COPD", or "other respiratory condition". We calculated the prevalence of LABA monotherapy, and the association between LABA monotherapy and diagnosis, age, gender, and location of residence.  Results  LABA monotherapy occurred in 3.4% (n=140) of pediatric and 3.9% (n=1837) of adult LABA users and in 3.4% of children with asthma and 3.0% of adults with asthma. In children, LABA monotherapy was associated with female gender (odds ratio (OR) 1.62; 95% confidence interval (CI) 1.14, 2.82; p<0.0065) and adolescence (age 12-18 years; 2.30; CI 1.53,3.46; p<0.0001). In adults, LABA monotherapy was associated with a COPD diagnosis, and being greater than 60 years old (p<0.0001).  Conclusion  LABA monotherapy occurs in children and adults. LABA monotherapy in children, especially in girls and adolescents, could expose them to serious adverse events and requires further study. 

PMID: 23392793 [PubMed - in process]

MUSCLE DYSFUNCTION IN COPD.

J Appl Physiol. 2013 Feb 7;

Authors: Barreiro E, Sieck GC

Abstract
Although it has been well characterized that COPD muscle dysfunction is the result of the complex interaction between systemic and local factors, the etiology of muscle dysfunction remains to be fully identified. Interestingly, while hyperinflation and an increased work of breathing appear to be the main contributing events to respiratory muscle dysfunction, deconditioning seems to play a major role in the dysfunction of peripheral muscles in COPD. Other factors such as cigarette smoke, nutritional abnormalities, exacerbations, drugs, hypoxia, hypercapnia, comorbidities, and physical activity also influence muscle mass and function in COPD patients (1-3; 5; 9; 15). Besides, derangements of key molecular and cellular processes such as redox imbalance, mitochondrial dysfunction, enhanced protein catabolism and reduced protein anabolism, structural alterations, and systemic inflammation also modify muscle phenotype and function in COPD patients.

PMID: 23393064 [PubMed - as supplied by publisher]