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Neuromotor Control in Chronic Obstructive Pulmonary Diseas.

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Neuromotor Control in Chronic Obstructive Pulmonary Diseas.

J Appl Physiol. 2013 Jan 17;

Authors: Mantilla CB, Sieck GC

Abstract
Neuromotor control of skeletal muscles, including respiratory muscles, is ultimately dependent on the structure and function of the motor units (motoneurons and the muscle fibers they innervates) comprising the muscle. In most muscles, considerable diversity of contractile and fatigue properties exists across motor units, allowing a range of motor behaviors. In diseases such as chronic obstructive pulmonary disease (COPD), there may be disproportional primary (disease-related) or secondary effects (related to treatment or other concomitant factors) on the size and contractility of specific muscle fiber types that would influence the relative contribution of different motor units. For example, with COPD there is a disproportionate atrophy of type IIx and/or IIb fibers that comprise more fatigable motor units. Thus, fatigue resistance may appear to improve, while overall motor performance (e.g., 6-min walk test) and endurance (e.g., reduced aerobic exercise capacity) are diminished. There are many coexisting factors that might also influence motor performance. For example, in COPD patients, there may be concomitant hypoxia and/or hypercapnia, physical inactivity and unloading of muscles, and corticosteroid treatment, all of which may disproportionately affect specific muscle fiber types; thereby influencing neuromotor control. Future studies should address how plasticity in motor units can be harnessed to mitigate the functional impact of COPD-induced changes.

PMID: 23329816 [PubMed - as supplied by publisher]

Epidemiology and outcomes of acute respiratory failure in the United States, 2001 to 2009: A national survey.

Epidemiology and outcomes of acute respiratory failure in the United States, 2001 to 2009: A national survey.

J Hosp Med. 2013 Jan 18;

Authors: Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Steingrub JS, Lagu T, Lindenauer PK

Abstract
BACKGROUND: The objective of this study was to evaluate trends in hospitalization, cost, and short-term outcomes in acute respiratory failure (ARF) between 2001 and 2009 in the United States. METHODS: Using the Nationwide Inpatient Sample we identified cases of ARF based on International Classification for Diseases, Ninth Revision, Clinical Modification codes. We calculated weighted frequencies of ARF hospitalizations by year and estimated population-adjusted incidence and mortality rates. We used logistic regression to examine hospital mortality rates over time while adjusting for changes in demographic characteristics and comorbidities of patients. RESULTS: The number of hospitalizations with a diagnosis of ARF rose from 1,007,549 in 2001 to 1,917,910 in 2009, with an associated increase in total hospital costs from $30.1 billion to $54.3 billion. During the same period we observed a decrease in hospital mortality from 27.6% in 2001 to 20.6% in 2009, a slight decline in average length of stay from 7.8 days to 7.1 days, and no significant change in the mean cost per case ($15,900). Rates of mechanical ventilation (noninvasive [NIV] or invasive mechanical ventilation [IMV]) remained stable over the 9-year period, and the use of NIV increased from 4% in 2001 to 10% in 2009. CONCLUSIONS: Over the period of 2001 to 2009, there was a steady increase in the number of hospitalizations with a discharge diagnosis of ARF, with a decrease in inpatient mortality. There was a significant shift during this time toward the use of NIV, with a decrease in the rates of IMVuse. Journal of Hospital Medicine 2013. © 2013 Society of Hospital Medicine.

PMID: 23335231 [PubMed - as supplied by publisher]

Tabagisme et sévérité du syndrome d’apnées hypopnées obstructives du sommeil

January 2013
Publication year: 2013
Source:Revue des Maladies Respiratoires, Volume 30, Issue 1



Introduction Le tabagisme est un fléau mondial. Il est établi que le tabac est un facteur de risque du syndrome d’apnées hypopnées obstructives du sommeil (SAHOS). L’influence du tabac sur la sévérité du SAHOS reste peu documentée. But Évaluer l’influence du tabagisme sur la sévérité du SAHOS. Patients et méthodes 307 patients ont été exploré pour une suspicion de SAHOS sur une période de quatre ans. Cent cinquante et un patients seulement avaient présenté un SAHOS confirmé par polygraphie de ventilation. Les données cliniques, spirométriques et le statut tabagique ont été recueillis chez ces 151 patients. Résultats Parmi les 151 patients, 101 étaient non fumeurs et 50 étaient fumeurs. La comparaison de ces deux groupes de patients a permis de conclure à un index apnées hypopnées (IAH) plus élevé dans le groupe fumeur par rapport au groupe non fumeur (42,96/h versus 28,77/h avec p <0,0001). Le pourcentage de sujets ayant un SAHOS non sévère (léger ou modéré) était plus important chez les sujets non tabagiques par rapport aux sujets tabagiques (p =0,009). Par ailleurs les sujets tabagiques ont 3,7 fois plus de risque de développer un SAHOS par rapport aux sujets non tabagiques (OR=3,7 avec p =0,001). Conclusion Le tabagisme est un facteur de risque de survenue et de sévérité du SAHOS. Le sevrage tabagique a donc une place importante dans la prise en charge thérapeutique du SAHOS. Introduction Smoking habits have many adverse health effects. The effect of tobacco on obstructive sleep apnea hypopnea syndrome is well-documented but the effect on the severity of this syndrome has not been completely established. Aim of this study Evaluate the effect of tobacco on the severity of sleep apnea hypopnea syndrome. Patients and methods During 4 years 307, patients were referred to our department for a suspicion of obstructive sleep apnea hypopnea syndrome. Among these patients, only 151 patients had an obstructive sleep apnea syndrome confirmed by nocturnal polygraph. Smoking status, clinical and spirometric data were determined in these 151 patients. Results Among these 151 patients, 101 were non-smokers and 50 current smokers. The apnea and hypopnea index (AHI) were higher among current smokers than non-smokers (42.96/h versus 28.77/h; P <0.0001). The percent of patients who had a not severe obstructive sleep apnea syndrome were higher among non-smokers than current smokers patients (P =0.009). Current smokers were 3.7 times more likely having severe obstructive sleep apnea hypopnea syndrome than non-smokers (OR=3.7; P =0.001). Conclusion Smoking habits seems to be associated with the severity of obstructive sleep apnea syndrome that's why smoking cessation is very important in the treatment of obstructive sleep apnea hypopnea syndrome.




Le tiotropium améliore la bronchodilatation chez les patients asthmatiques avec obstruction persistante malgré un traitement par CSI/LABA

January 2013
Publication year: 2013
Source:Revue des Maladies Respiratoires, Volume 30, Supplement 1






Biopsies médiastinales à la pince en échoendobronchique : une nouvelle approche en pratique quotidienne

January 2013
Publication year: 2013
Source:Revue des Maladies Respiratoires, Volume 30, Supplement 1






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