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Arrhythmias as trigger for acute exacerbations of chronic obstructive pulmonary disease

Publication year: 2012
Source:Respiratory Medicine

Surya P. Bhatt, Sudip Nanda, John S. Kintzer

Purpose Acute exacerbations of chronic obstructive pulmonary disease (COPD) sometimes appear to occur without a precipitating cause. Heterogeneous repolarization and arrhythmias occur in COPD patients. Given the close inter-relation between heart and lung, we hypothesized that unrecognized arrhythmias might be precipitants of acute exacerbations. Methods Electrocardiograms (ECG) of thirty patients during acute exacerbations were compared with ECG during stable phase. P wave dispersion was used to assess atrial depolarization heterogeneity, and dispersion of QT interval to assess ventricular repolarization. p < 0.05 was considered significant. Frequent exacerbations were defined as two or more exacerbations in a year. Results Mean age of patients was 70.3 ± 11.8 SD years. P wave dispersion was greater during acute exacerbation than during stable phase (56.7 ± 19.2 vs 47.7 ± 15.9 ms, p = 0.009). There was a trend toward greater QTc dispersion (108.3 ± 61.7 vs 90.3 ± 47.0 ms, p = 0.13) in acute exacerbation compared to stable phase. Sixteen (53%) had frequent exacerbations. There was a significant difference in PR interval during stable phase between those with frequent exacerbations and those without (163.9 + 17.4 vs. 145.1 + 22.8; p = 0.02). The P wave dispersion during stable phase was greater in those with frequent exacerbations, but did not reach statistical significance (52.6 + 18.8 vs. 42.2 + 9.8 ms; p = 0.06). Conclusions P wave dispersion is more in the acute phase than in stable phase, and is greater in patients with more frequent exacerbations. This does not prove, but suggests an intriguing possibility that P wave dispersion predates acute exacerbations. This might be a new target for prediction, prevention and therapy of acute exacerbations of COPD.




Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia

Publication year: 2012
Source:Respiratory Medicine

Seon Cheol Park, Young Ae Kang, Byung Hoon Park, Eun Young Kim, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Ji Ye Jung

Background Health care-associated pneumonia (HCAP) includes a broad range of patients having frequent or chronic contact with health care systems. However, the relationship between current defining criteria for HCAP and the risk of potentially drug-resistant (PDR) pathogens is controversial. Methods We retrospectively evaluated patients admitted to Severance Hospital in South Korea with culture-positive pneumonia from January 2008 to December 2009. We analyzed the associations between risk factors for HCAP and infection with PDR pathogens, and developed a new scoring system to predict infection with PDR pathogens. Results Among 339 patients, PDR pathogens were observed in 122 (36.0%). PDR pathogens were more common in HCAP than community-acquired pneumonia (CAP) (48.5% versus 23.8%, P <0.001). In a logistic regression, prior hospitalization within 90 days of pneumonia (OR=2.51, P =0.003), recent treatment with antimicrobials (OR=2.35, P =0.039), and nasogastric tube feeding (OR=15.28, P <0.001) were independently associated with PDR pathogens. For the prediction of PDR pathogens, the sensitivity and specificity of current HCAP criteria were 66.4% and 60.4%, respectively, and 68.0% and 67.3%, respectively, for the new scoring system. Moreover, the new scoring system showed better diagnostic accuracy than current HCAP criteria (area under curve=0.711 versus 0.634, P <0.001). Conclusions The current HCAP criteria are poor predictors of PDR pathogens and all patients with HCAP should not be empirically treated for these pathogens. To avoid excessive antibiotic use, individual risk stratification approaches should be considered.




Daily step counts in a US cohort with COPD

Publication year: 2012
Source:Respiratory Medicine, Volume 106, Issue 7

Marilyn L. Moy, Valery A. Danilack, Nicole A. Weston, Eric Garshick

Background Baseline values for daily step counts in US adults with COPD and knowledge of its accurate measurement, natural change over time, and independent relationships with measures of COPD severity are limited. Methods 127 persons with stable COPD wore the StepWatch Activity Monitor (SAM) for 14 days, and 102 of them wore it a median 3.9 months later. SAM counts were compared to manual counts in the clinic. We assessed change over time, the effect of season, and relationships with forced expiratory volume in 1 s (FEV1) % predicted, 6-min walk test (6MWT) distance, the modified Medical Research Council (MMRC) dyspnea score, and the St. George's Respiratory Questionnaire Total Score (SGRQ-TS). Results 98% of subjects were males, with mean age 71 ± 8 years and FEV1 1.48 ± 0.54 L (52 ± 19% predicted). All 4 GOLD stages were represented, with the most subjects in GOLD II (44%) and GOLD III (37%). The SAM had >90% accuracy in 99% of subjects. Average step count was 5680 steps/day, which decreased with increasing GOLD stage (p = 0.0046). Subjects walked 645 fewer steps/day at follow-up, which was partly explained by season of monitoring (p = 0.013). In a multivariate model, FEV1 % predicted, 6MWT distance and MMRC score were weakly associated with daily step counts, while SGRQ-TS was not. Conclusions These findings will aid the design of future studies using daily step counts in COPD. Accurately measured, daily step counts decline over time partly due to season and capture unique information about COPD status.




Cognitive dysfunction in patients with chronic obstructive pulmonary disease – A systematic review

Publication year: 2012
Source:Respiratory Medicine

Lone Schou, Birte Østergaard, Lars S. Rasmussen, Susan Rydahl-Hansen, Klaus Phanareth

Background Substantial healthcare resources are spent on chronic obstructive pulmonary disease (COPD). In addition, the involvement of patients in monitoring and treatment of their condition has been suggested. However, it is important to maintain a view of self-care that takes differences in cognitive ability into account. The aim of this study was to determine the occurrence and severity of cognitive dysfunction in COPD patients, and to assess the association between severity of COPD and the level of cognitive function. Methods We conducted a systematic review, and a search in the following databases: Medline, PsychINFO, Cochrane Library, EMBASE, CINAHL, and SweMed up to July 2010. The articles were included if 1 participants were patients with COPD, 2 relevant outcome was cognitive function investigated by a neuropsychological test battery, and 3 the severity of COPD had been assessed. Results Fifteen studies were included, involving 655 COPD patients and 394 controls. Cognitive function was impaired in COPD patients as compared to healthy controls, but the level of functioning was better than in patients with Alzheimer's disease. There was a significant association between severity of COPD, as measured by lung function and blood gases, and cognitive dysfunction, but only in patients with severe COPD. Conclusions Cognitive impairment can be detected in severe COPD patients, but the clinical relevance of the cognitive dysfunction is not yet known. Future studies should concentrate on the consequences of cognitive dysfunction for daily living in these patients, and solutions involving a high degree of self-care might require special support.




Robotic lobectomy ‘accepted’ technique for NSCLC

Robotic-based video-assisted thoracic surgery lobectomy produces similar survival rates as conventional lobectomy when used in patients with non-small-cell lung cancer, report researchers.

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