ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cigarette smoking is the main risk factor for the development of chronic obstructive pulmonary disease (COPD). An accelerated rate of lung function decline that causes clinically significant COPD, however, is present in only a minority of smokers. In addition to the cumulative amount of cigarettes smoked, other environmental and genetic properties contribute to this variable physiological response. This article reviews the role of airway hyperresponsiveness, mucus hypersecretion, infection, and proteases in the development of COPD.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The outpatient management of chronic obstructive pulmonary disease (COPD) is designed to limit the decline in respiratory function over time, to relieve the symptoms and improve the patient’s functional status, and to manage complications when they arise. Factors that predispose to airway inflammation, including cigarette smoking and respiratory infections, are prevented by behavioral modification programs, measures such as exercise and nutrition to improve general health, and regular vaccination. Symptoms are relieved by bronchodilator and anti-inflammatory therapy, based upon the specific needs of the patient. Hypoxemia and acute infections are treated with oxygen administration and the use of antibiotics when necessary. The management of acute exacerbations of COPD is addressed elsewhere in this symposium (ie, choice of antibiotics is not discussed here). Also, certain aspects of management, such as surgical procedures, chest physical therapy, and other aspects of pulmonary rehabilitation, are also subjects of subsequent articles in this series. Although none of these modalities, except for smoking cessation and oxygen administration, have been shown to alter the course of COPD, the careful choice of the therapeutic measures discussed here can lead to significant relief of symptoms in the patient with chronic airway obstruction.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Acute exacerbations of chronic bronchitis (AECB) result in increased morbidity and mortality. The role of bacteria in AECB, the importance of antimicrobial therapy, and the choice of antimicrobial agents have been debated for decades. Fortunately, within the past few years, a number of studies and one consensus statement have been reported that have increased the understanding of the role of bacteria in AECB and suggest approaches in selecting antimicrobial therapy. This article will review these studies and present an empiric approach in treating AECB based upon the patient’s presenting findings, related risk factors, and potential antimicrobial resistance patterns that may be encountered.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Over the past several decades, a number of surgical techniques have been developed for the treatment of chronic obstructive pulmonary disease. Many of these procedures have been abandoned because of lack of efficacy and/or high morbidity and mortality. At the present time, lung transplantation, reduction pneumoplasty for giant bullous emphysema, and lung volume reduction surgery are being performed in a number of centers. Data concerning the effectiveness of these procedures is accumulating and will ultimately need careful analysis to determine long-term outcomes in this group of patients.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Alternative therapies for chronic bronchitis are therapies in which clinical efficacy is not well established. These can be broadly divided into expectorants, mucolytics, mucokinetics, antiproteases, antioxidants, and immunostimulants. Data supporting these therapies may be present in disorders clinically similar to chronic bronchitis, such as cystic fibrosis. Alternatively, these therapies may be based on clinical observations or in vitro studies that suggest a potential therapeutic benefit. Establishment of these therapies is likely to require more extensive investigation before their use is routinely recommended. Until such data is available, the clinician can only use his or her clinical judgement regarding the likely risk-benefit ratio.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Pulmonary rehabilitation measures acquired a poor reputation when early studies failed to demonstrate improvements in traditional pulmonary function tests. However, current evidence now indicates that such measures benefit patients with severe chronic obstructive pulmonary disease (COPD). Alleviation of symptoms, improved quality of life, improved nutrition, and decreased health care costs are some of the benefits seen in patients who successfully complete a rehabilitation program. This article reviews the role of a comprehensive rehabilitation program in the continuing care of the patient with severe COPD, the components of such a program, and specific measures to be considered.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Chronic obstructive pulmonary disease (COPD) continues to increase in incidence as the population of developed countries ages. Much time has been devoted to studying the natural course of this disorder and to searching for risk factors for a decline in respiratory function. The major risk factor for a decline in 1-second forced expiratory volume (FEV1) is cigarette smoking, and smoking cessation is a major part of its prevention. Other risk factors for development of COPD include passive exposure to cigarette smoke, age, and genetic factors including airway hyperreactivity, eosinophilia, and a history of atopy. This discussion presents a review of the current literature regarding the natural course and prognosis of COPD. The approach to patients with end-stage disease and the use of advance directives is considered.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Platelet secretion plays an important role in the aggregation of platelets. However, the quantitative relationship between platelet aggregation and secretion of ATP during pregnancy and in preeclampsia has yet to be clarified. This study is designed to determine whether platelet count, volume, aggregation, and the amount of secreted ATP change in healthy, nonpregnant women, nonpreeclamptic pregnant women, and preeclamptic pregnant women and whether &bgr;-thromboglobulin (BTG) and platelet factor 4 (PF-4) concentrations alter in nonpreeclamptic and preeclamptic women.Methods:Peripheral blood was collected from 114 women. Nonpreeclamptic pregnant women were divided into four groups (gestational weeks 10, 20, 30, and 35). Platelet aggregation and ATP secretion were investigated with the use of a lumi-aggregometer. BTG and PF-4 concentrations in peripheral blood were determined in 12 pregnant and 11 preeclamptic women.Results:The amount of secreted ATP upon induction by 5 &mgr;M ADP increased significantly (P< 0.05–0.01) with gestational age. On the other hand, the amount of secreted ATP induced by 5 &mgr;g/mL collagen reached the maximal value from gestational weeks 20 to 35 in nonpreeclamptic women. Significantly more platelet aggregation was induced by the ADP and collagen in nonpreeclamptic women in gestational weeks 20 and 30 than in the gestational weeks 10 or 35 (P< 0.05–0.005). The amount of secreted ATP and platelet count were significantly lower (P< 0.05) in preeclampsia than in normal pregnancy. The BTG and PF-4 concentrations were significantly higher (P< 0.05) in preeclampsia than in normal pregnancy.Conclusions:The sensitivity of platelets for ATP secretion may intensify with progression of pregnancy. In normal pregnancy, around gestational week 35, the platelets may exhibit weaker ability to aggregate but maintain the capacity to secrete ATP. In preeclampsia, secreted ATP decreased because platelets may be stimulated to undergo a partial secretion.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID