Related Articles

Statins, systemic inflammation and risk of death in COPD: The Rotterdam study.

Pulm Pharmacol Ther. 2012 Nov 7;

Authors: Lahousse L, Loth DW, Joos GF, Hofman A, Leufkens HG, Brusselle GG, Stricker BH

Abstract
BACKGROUND: Studies suggest that statins decrease mortality in COPD patients but it is unknown which patients might benefit most. OBJECTIVES: We investigated whether statins were associated with reduced mortality in COPD patients and whether effects differed according to baseline high-sensitivity C-reactive protein (hsCRP) concentration, a marker of systemic inflammation. METHODS: This nested case-control study was part of the Rotterdam Study, a prospective population-based cohort study among 7983 subjects ≥ 55 years. Using automated pharmacy records, we evaluated statin use of 363 cases (COPD patients who died during follow-up of 17 years) with 2345 age and sex matched controls (COPD patients who survived the follow-up period of the index case). RESULTS: Compared to never use, long-term statin use (>2 years) was associated with a 39% decreased risk of death in COPD patients. Stratified according to the level of systemic inflammation, long-term statin use was associated with a 78% reduced mortality if hsCRP level > 3 mg/L, versus a non significant 21% reduced mortality if hsCRP level ≤ 3 mg/L. CONCLUSIONS: Statin use is associated with a beneficial effect on all-cause mortality in COPD, depending on the baseline level of systemic inflammation.

PMID: 23142156 [PubMed - as supplied by publisher]

Surgical treatment of CTEPH.

Eur Respir J. 2012 Nov 8;

Authors: Jenkins D, Madani M, Mayer E, Kerr K, Kim N, Klepetko W, Morsolini M, Dartevelle P

Abstract
It is likely that chronic thromboembolic pulmonary hypertension (CTEPH) is more prevalent than currently recognised. Imaging studies are fundamental to decision making with respect to operability. All patients with suspected CTEPH should be referred to an experienced surgical centre. Currently there is no risk scoring stratification system to guide operability assessment and it is predominantly based on surgical experience.The aim of the pulmonary endarterectomy (PEA) operation is the removal of obstructive material to immediately reduce pulmonary vascular resistance (PVR). PEA affords the best chance of cure, but is difficult to perfect. Recognition and clearance of, especially distal segmental and subsegmental disease is the main problem. The basic surgical techniques include: median sternotomy incision, cardiopulmonary bypass, arteriotomy incisions within pericardium and a true endarterectomy with meticulous full distal dissection. Deep hypothermic circulatory arrest (DHCA) is recommended as the best means of reducing blood flow in the pulmonary artery to allow a clear field for dissection. In the recent PEACOG trial (PEA and COGnition) there was no evidence of cognitive impairment post PEA.Reperfusion pulmonary oedema and residual pulmonary hypertension are unique post-operative complications post PEA and are associated with increased mortality. However, in-hospital mortality is now <5% in experienced centres.

PMID: 23143539 [PubMed - as supplied by publisher]

Responsiveness of the six-minute step test to a physical training program in patients with COPD.

J Bras Pneumol. 2012 Oct;38(5):579-587

Authors: Marrara KT, Marino DM, Jamami M, Oliveira Junior AD, Di Lorenzo VA

Abstract
OBJECTIVE: To evaluate the responsiveness of the six-minute step test (6MST) to an aerobic physical training program (PTP) and to determine the efficacy of the PTP regarding spirometric variables during the 6MST, as well as physical performance, sensation of dyspnea, and SpO2 during the 6MST and the six-minute walk test (6MWT), in patients with COPD. METHODS: This was a controlled, prospective randomized study involving patients clinically diagnosed with COPD, with an FEV1/FVC ratio < 70%, and having been clinically stable in the last two months. The patients were randomized to undergo a PTP on a treadmill, three times a week, for six weeks (PTP group) or not (control group). Histories were taken from all of the patients, who received regular respiratory therapy during the study period, undergoing physical examination and spirometry before and after bronchodilator use; incremental symptom-limited cardiopulmonary exercise testing; the 6MST; and the 6MWT. RESULTS: Of the 36 patients that completed the study, 21 and 15 were in the PTP and control groups, respectively. In the PTP group, there was a significant increase in the number of steps climbed during the 6MST and in the six-minute walk distance (in m and % of predicted), as well as a significant decrease in the sensation of dyspnea during the 6MWT. CONCLUSIONS: The 6MST showed responsiveness to the PTP. However, the 6MWT appears to be more responsive to the PTP proposed.

PMID: 23147050 [PubMed - as supplied by publisher]

Air pollution and the respiratory system.

J Bras Pneumol. 2012 Oct;38(5):643-655

Authors: Arbex MA, Santos UD, Martins LC, Saldiva PH, Pereira LA, Braga AL

Abstract
Over the past 250 years-since the Industrial Revolution accelerated the process of pollutant emission, which, until then, had been limited to the domestic use of fuels (mineral and vegetal) and intermittent volcanic emissions-air pollution has been present in various scenarios. Today, approximately 50% of the people in the world live in cities and urban areas and are exposed to progressively higher levels of air pollutants. This is a non-systematic review on the different types and sources of air pollutants, as well as on the respiratory effects attributed to exposure to such contaminants. Aggravation of the symptoms of disease, together with increases in the demand for emergency treatment, the number of hospitalizations, and the number of deaths, can be attributed to particulate and gaseous pollutants, emitted by various sources. Chronic exposure to air pollutants not only causes decompensation of pre-existing diseases but also increases the number of new cases of asthma, COPD, and lung cancer, even in rural areas. Air pollutants now rival tobacco smoke as the leading risk factor for these diseases. We hope that we can impress upon pulmonologists and clinicians the relevance of investigating exposure to air pollutants and of recognizing this as a risk factor that should be taken into account in the adoption of best practices for the control of the acute decompensation of respiratory diseases and for maintenance treatment between exacerbations.

PMID: 23147058 [PubMed - as supplied by publisher]