Molecular diagnosis of respiratory tract infection in acute exacerbations of chronic obstructive pulmonary disease.

Clin Infect Dis. 2011 May;52 Suppl 4:S290-5

Authors: Sethi S

Acute exacerbations are significant events in the course of chronic obstructive pulmonary disease. Modern diagnostic techniques have revealed an infectious cause for the majority of exacerbations. Common respiratory viruses contribute to 25%-50% of exacerbations. Detection of viral nucleic acids in nasopharyngeal swab or sputum samples has become the preferred method to study viral exacerbations instead of viral cultures and serologic examination. Clinical application of such molecular detection requires additional studies to clarify interpretation of a positive result. Bacteria account for 25%-50% of exacerbations. Studies comparing molecular detection of bacteria in sputum with conventional culture techniques have shown that a substantial proportion of bacteria are not detected by the latter method. However, as with molecular viral detection, clinical application of molecular bacterial diagnosis requires additional studies. Although still faced with several challenges and requiring additional development, it is quite likely that molecular methods will become the preferred methods for determining the etiology of exacerbations of chronic obstructive pulmonary disease.

PMID: 21460287 [PubMed - indexed for MEDLINE]

Effect of inhaled corticosteroid therapy on CT scan-estimated airway dimensions in a patient with chronic bronchitis related to ulcerative colitis.

Chest. 2011 Apr;139(4):930-2

Authors: Hamada S, Ito Y, Imai S, Oguma T, Niimi A, Mishima M

CT scanning allows assessment of airway-wall thickness and is useful for diagnosing and assessing various lung diseases, including asthma and COPD. Several studies have reported that CT scan-estimated dimensions are positively correlated with pulmonary function test results and a positive response to treatment. However, to our knowledge, airway disease complicated by inflammatory bowel disease has not yet been assessed using CT scan-estimated dimensions. A 61-year-old woman with ulcerative colitis (UC) complained of cough, sputum, and fever 4 months after undergoing a total colectomy and rectal mucosectomy. Examination of bronchial biopsy samples demonstrated lymphocytic and plasma cell infiltration of the epithelium and submucosa. CT scan-estimated dimensions indicated thickening of the airways. Chronic bronchitis complicated with UC was diagnosed, and high-dose inhaled corticosteroid therapy was prescribed. Three months later, the CT scan-estimated dimensions of the patient's airways, her symptoms, and pulmonary function test results were dramatically improved.

PMID: 21467060 [PubMed - indexed for MEDLINE]

Developing criteria to assist in the palliative phase of COPD.

Br J Nurs. 2011 Mar 24-Apr 14;20(6):364-5, 367-9

Authors: Trueman J, Trueman I

For people with chronic obstructive pulmonary disease (COPD), hospital admission can be associated with a poor prognosis. Consequently, the end-stage of the illness needs to be recognized for timely palliative care to be initiated. Tools to enhance the palliative phase, such as the Gold Standards Framework and the Liverpool Care Pathway, rely on the recognition of the final phase of a person's life. The illness trajectory of cancer makes this recognition far easier than for COPD, and as a result, many patients and their families manage at home with limited support. The Lincolnshire Respiratory Network has developed criteria to help recognize the end stage of COPD, which correlate well with recommendations from the Consultation on a Strategy for Services for COPD in England (Department of Health, 2010). However, there needs to be appropriate training to assist practitioners in their confidence to refer patients with end-stage COPD to palliative care providers.

PMID: 21471893 [PubMed - indexed for MEDLINE]

Diagnosis and treatment of patients with chronic obstructive pulmonary disease in the primary care setting: focus on the role of spirometry and bronchodilator reversibility.

J Fam Pract. 2011 Apr;60(4 Suppl Diagnosis):S9-16

Authors: Stoloff SW

PMID: 21472146 [PubMed - indexed for MEDLINE]