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Epidemiology, radiology, and genetics of nicotine dependence in COPD

This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers.

Methods: Current smokers with COPD (GOLD stage >= 2) or normal spirometry were analyzed from the COPDGene Study, a prospective observational study. Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND). Volumetric CT acquisitions measuring the percent of emphysema on inspiratory CT (% of lung < -950 HU) and gas trapping on expiratory CT (% of lung < -856 HU) were obtained. Genotypes for two SNPs in the CHRNA3/5 region (rs8034191, rs1051730) previously associated with nicotine dependence and COPD were analyzed for association to COPD and nicotine dependence phenotypes.

Results: Among 842 c...

Determinants of elevated healthcare utilization in patients with COPD

Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system.

Methods: Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients.

Results: Healthcare utilization was 3.4-fold higher among COPD patients compared with controls ...

Self-reported Familiarity With Acute Respiratory Infection Guidelines and Antibiotic Prescribing in Primary Care

What impact does a physician's knowledge of clinical guidelines have on primary care and prescribing practices? International Journal for Quality in Health Care

The influence of crying and breathing pattern on inhalatory drug deposition in children

CONCLUSIONS: Crying and breathing patterns influence the inhalation therapy. The presence of cry significantly reduces the amount of drug deposition in the airways. There is insufficient evidence about the possible mechanisms that explain potential changes of inhalatory drugs deposition in children, despite its relevance to the management of pediatric pulmonary disorders.

Management of Pleural Effusion in the Cancer Patient

The differential diagnosis of a pleural effusion is expanded in the cancer patient. A cancer patient may have a malignant pleural effusion, a pleural effusion indirectly caused by the cancer or its treatment, or a pleural effusion unrelated to the cancer.

The approach to the cancer patient with a pleural effusion must take into account the impact of the pleural effusion on quality of life, type and stage of the underlying cancer, impact of biopsy procedures on cancer staging, availability of treatment of the underlying cancer, performance status, and patient preferences. Minimally invasive palliative treatment options for the management of symptomatic malignant pleural effusion, such as chronic indwelling pleura...

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