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Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease.

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Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease.

COPD. 2015 Oct 2;:1-9

Authors: Svenningsen S, Paulin GA, Sheikh K, Guo F, Hasany A, Kirby M, Etemad-Rezai R, McCormack DG, Parraga G

Abstract
Evidence-based guidance for the use of airway clearance techniques (ACT) in chronic obstructive pulmonary disease (COPD) is lacking in-part because well-established measurements of pulmonary function such as the forced expiratory volume in 1s (FEV1) are relatively insensitive to ACT. The objective of this crossover study was to evaluate daily use of an oscillatory positive expiratory pressure (oPEP) device for 21-28 days in COPD patients who were self-identified as sputum-producers or non-sputum-producers. COPD volunteers provided written informed consent to daily oPEP use in a randomized crossover fashion. Participants completed baseline, crossover and study-end pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ), Patient Evaluation Questionnaire (PEQ), Six-Minute Walk Test and (3)He magnetic resonance imaging (MRI) for the measurement of ventilation abnormalities using the ventilation defect percent (VDP). Fourteen COPD patients, self-identified as sputum-producers and 13 COPD-non-sputum-producers completed the study. Post-oPEP, the PEQ-ease-bringing-up-sputum was improved for sputum-producers (p = 0.005) and non-sputum-producers (p = 0.04), the magnitude of which was greater for sputum-producers (p = 0.03). There were significant post-oPEP improvements for sputum-producers only for FVC (p = 0.01), 6MWD (p = 0.04), SGRQ total score (p = 0.01) as well as PEQ-patient-global-assessment (p = 0.02). Clinically relevant post-oPEP improvements for PEQ-ease-bringing-up-sputum/PEQ-patient-global-assessment/SGRQ/VDP were observed in 8/7/9/6 of 14 sputum-producers and 2/0/3/3 of 13 non-sputum-producers. The post-oPEP change in (3)He MRI VDP was related to the change in PEQ-ease-bringing-up-sputum (r = 0.65, p = 0.0004) and FEV1 (r = -0.50, p = 0.009). In COPD patients with chronic sputum production, PEQ and SGRQ scores, FVC and 6MWD improved post-oPEP. FEV1 and PEQ-ease-bringing-up-sputum improvements were related to improved ventilation providing mechanistic evidence to support oPEP use in COPD. Clinical Trials # NCT02282189 and NCT02282202.

PMID: 26430763 [PubMed - as supplied by publisher]

Etiology of Non-Cystic Fibrosis Bronchiectasis in Adults and Its Correlation to Disease Severity.

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Etiology of Non-Cystic Fibrosis Bronchiectasis in Adults and Its Correlation to Disease Severity.

Ann Am Thorac Soc. 2015 Oct 2;

Authors: Lonni S, Chalmers JD, Goeminne PC, McDonnell MJ, Dimakou K, De Soyza A, Polverino E, Van de Kerkhove C, Rutherford R, Davison J, Rosales E, Pesci A, Restrepo MI, Aliberti S

Abstract
RATIONALE: Testing for underlying etiology is a key part of bronchiectasis management, but it is unclear whether the same extent of testing is required across the spectrum of disease severity.
OBJECTIVES: The aim of the study was to identify the etiology of bronchiectasis across European cohorts and according to different levels of disease severity.
METHODS: This was an analysis of seven databases of adult outpatients with bronchiectasis prospectively enrolled at the bronchiectasis clinics of university teaching hospitals in Monza (Italy), Dundee and Newcastle (UK), Leuven (Belgium), Barcelona (Spain), Athens (Greece) and Galway (Ireland). All the patients underwent the same comprehensive diagnostic work-up as suggested by the British Thoracic Society in every site.
MEASUREMENTS AND MAIN RESULTS: Among the 1,258 patients enrolled, an etiology of bronchiectasis was determined in 60%, including post-infective (20%), COPD-related (15%), connective tissue disease-related (10%), immunodeficiency (5.8%) and asthma-related (3.3%). An etiology leading to a change in patient's management was identified in 13% of the cases. No significant differences in etiology of bronchiectasis were present across different levels of disease severity, with the exception of a higher prevalence of COPD-related (p<0.001) and a lower prevalence of idiopathic bronchiectasis (p=0.029) in severe patients.
CONCLUSIONS: Physicians should not be guided by disease severity in suspecting specific etiologies in patients with bronchiectasis, although idiopathic bronchiectasis appears to be less common in the most severe patients.

PMID: 26431397 [PubMed - as supplied by publisher]

Role of oxidative stress and serum lipid levels in stable chronic obstructive pulmonary disease.

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Chronic obstructive pulmonary disease (COPD) has been associated with increased oxidative stress or reduced antioxidant resources. The main goal of this study was to evaluate the levels of serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL), total oxidant status (TOS), and total antioxidant status in patients with stable COPD, compared with a control group.

METHODS: This study was performed on 51 patients with stable COPD (42 men and 9 women; mean age 56.92 ± 3.0 years) and 45 healthy control participants (32 men and 13 women; 54.8 ± 3.8 years). The levels of serum lipids, IMA, total antioxidant status, TOS, and ox-LDL were measured in all participants.

RESULTS: The levels of serum IMA, ox-LDL, and TOS were significantly higher in patients with COPD than those in control individuals. There was no difference between the levels of serum total antioxidant status, triglycerides, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) of patients with COPD and those of control individuals. Serum high-density lipoprotein cholesterol levels were significantly lower in patients with COPD than in control individuals.

CONCLUSION: Our study indicated that serum IMA, ox-LDL, and TOS may be increased as a result of chronic hypoxia, inflammation, and oxidative stress in patients with severe and very severe stable COPD. Our findings also revealed that IMA is higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stages II, III, and IV, while TOS and ox-LDL are higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stage IV. Measurements of serum IMA, TOS, and ox-LDL levels may be useful markers in the evaluation of stable COPD.

Extracorporeal CO2 removal: Technical and physiological fundaments and principal indications.

In recent years, technological improvements have reduced the complexity of extracorporeal membrane oxygenation devices. This have enabled the development of specific devices for the extracorporeal removal of CO2. These devices have a simpler configuration than extracorporeal membrane oxygenation devices and uses lower blood flows which could reduce the potential complications. Experimental studies have demonstrated the feasibility, efficacy and safety of extracorporeal removal of CO2 and some of its effects in humans.

This technique was initially conceived as an adjunct therapy in patients with severe acute respiratory distress syndrome, as a tool to optimize protective ventilation. More recently, the use of this technique has allowed the emergence of a relatively new concept called "tra-protective ventilation"whose effects are still to be determined. In addition, the extracorporeal removal of CO2 has been used in patients with exacerbated hypercapnic respiratory failure with promising results.

In this review we will describe the physiological and technical fundamentals of this therapy and its variants as well as an overview of the available clinical evidence, focused on its current potential.

The 2015 guidelines for idiopathic pulmonary fibrosis: an important chapter in the evolution of the management of patients with IPF.

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Eur Respir J. 2015 Oct;46(4):883-6
Authors: Wilson KC, Raghu G

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