COPD

Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. Systematic thematic synthesis. Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to...

Modern  guidelines for the treatment  of asthma and COPD emphasize the use of inhalational    therapy.    Administration of drug directly to the airway offers several advantages  to both patients and their physicians.    Most  evident to patients with asthma  is  the  speed of response when  using inhaled  bronchodilating  agents  as compared  to  oral  agents.    Bronchodilitation  occurs  within  minutes  rather  than hours  so that  bronchodilators may be used  on an intermittent  as-needed  basis. Moreover,  drugs delivered  directly to the airway  can produce  much of their effect directly  with  fewer  associated  systemic side-effects.    Orally  administered  betas agonists,  for  example, produce  considerably more  tremor  and  tachycardia  than inhaled beta, agonists at equipotent bronchodilating doses.    The reduced  systemic toxicity  of inhaled  agents is pivotal  in  our current use of corticosteroids  for  the management  of  asthma.    Control  of airway  irritability  with  oral  steroids  is associated with considerable risk of systemic toxicity including immunosuppression, osteoporosis and cataract formation.    The same effect may be achieved with  little or no risk by using inhaled, topically-active corticosteroids.    This combination of advantages. has lead to flexible patient self-management schemes.    Physicians can gauge the  severity of disease by quantifying the patients need for inhaled bronchodilator  therapy.    A variety of delivery systems is  available ranging  from the  traditional  metered-dose  inhaler  to  breath-actuated  dry  powder  inhalers. Holding chambers may be used to augment the delivery of drug via metered-dose inhaler.    this flexibility requires that physicians become familiar with a variety of delivery systems so that they may properly instruct their patients.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease of the lungs characterized by persistent airflow obstruction resulting from inflammation and remodeling of the airways, and may include development of emphysema. 1 Inflammatory activation in COPD induces a hypermetabolic state, characterized by catabolic and anabolic imbalance, which results in weight loss, 2 commonly seen in patients with COPD. Weight loss and low body weight are independent risk factors of morbidity and mortality in such patients. 3 One possible reason for weight loss in patients with COPD is altered taste sensitivity. Because patients with COPD may need to consume additional energy to maintain or gain weight, the taste sensory quality of meals becomes important. Pulmonary rehabilitation is known to lead to improved exercise performance in patients with COPD. However, the relationship between pulmonary rehabilitation and taste sensitivity has not been evaluated. Therefore, we compared taste sensitivity before and after pulmonary rehabilitation in patients with COPD. 4 The six-min walk distance (6MWD), COPD assessment test, and taste test were conducted before and after 4-week comprehensive pulmonary rehabilitation. Taste sensitivity was evaluated using the filter-paper disc method for 4 taste stimuli. Taste stimuli were salty, sweet, sour, and bitter tastes. Three taste thresholds (salty, sweet and bitter) were significantly lower at the end of the PR program than at the beginning. 4 Each patient with COPD took part in the PR program, which consisted of a 20-min class one or more times a day. The exercise training consisted of walking on a treadmill, stair climbing, and ergometer cycling. Frequency of the training program was 5 times a week for 4 weeks. The intensity of the training program was 60-70% of peak work rate. 5 Following pulmonary rehabilitation, the 6MWD, COPD assessment test, salty recognition threshold, sweet recognition threshold and bitter recognition threshold improved significantly, whereas there were no significant improvements in body mass index or sour recognition threshold. 4 Pulmonary rehabilitation may improve taste sensitivity in patients with COPD. 4 In any wasting condition, the aim of nutritional intervention is not only to treat an-orexia or balance elevated energy requirements, but also to facilitate muscle protein synthesis. In the COPD field, Engelen et al. 6 was the first to show elevated whole body protein turnover in COPD and identified abnormalities in amino acids profiles in wasted COPD patients as puta-tive therapeutic target. 7 In 2012 Cochrane meta-analysis concluded that nutritional intervention is indeed effective to improve weight, body composition and exercise performance in mal-nourished COPD patients. 8,9 Therefore, nutritional supplementation is an important therapeutic intervention, particularly for severely ill COPD patients with malnutrition. Difficulties may be experienced by these COPD patients, who are struggling to breathe and eliminate CO 2 from the lungs, resulting in dyspnea, hypercapnia, hypoxia, and respiratory acidosis, which exacerbates muscle loss through oxidative stress and inflammatory responses. 10 To overcome these problems, nutritional supplements should aim to reduce metabolic CO 2 production, lower respiratory quotient, and improve lung function. Several studies have shown that high-fat supplements produce less CO 2 and have lower respiratory quotient value than high-carbohydrate supplements. In addition, high-fat supplements may be the most efficient means of providing a low-volume, calorie-dense supplement to COPD patients, and may be

Aspergillus infections are among the most feared opportunistic infections in humans because they are capable of causing several distinct pulmonary diseases. The aim of this study was to determine the prevalence of Aspergillus species in patients with pulmonary pneumonia and susceptibility testing to the most commonly used antifungal agents.
A total of 311 specimens were collected from patients presented with the pulmonary complaint. Out of which, 139 (44.6%) yielded Aspergillus growth. Aspergillus isolates were obtained from Bronchoalveolar lavage and sputum. Ten species of Aspergillus were identified, A. flavus, A. niger, and A. terreus were the most frequently isolated species. Antifungal susceptibility of 10 different Aspergillus spp. isolates were performed using E-test. Voriconazole and caspofungin were having full inhibitory activity (100%) against tested Aspergillus spp., while some resistance was observed against itraconazole and posaconazole (50% and 75% respectively). Aspergillus was found to be the predominant fungal pathogen isolated from patients with pulmonary diseases, notably from patients with COPD and pulmonary TB.

Conclusion: Even in patients with stable chronic obstructive pulmonary disease, the serum troponin T concentration was controlled by at least three major factors, ie, systemic inflammation, advancing age, and right cardiac overload.

Read this original research and sign up to receive International Journal of Chronic Obstructive Pulmonary Disease here: http://www.dovepress.com/articles.php?article_id=20380

A limitação ao exercício com desenvolvimento precoce de dispneia e fadiga é comum entre os pacientes com DPOC. Além disso, o agravamento da doença acaba interferindo em suas atividades profissionais, sociais e da vida diária. A presente revisão teve como objetivo comparar os protocolos utilizados por programas nacionais de reabilitação pulmonar e confrontá-los às recomendações do II Consenso Brasileiro Sobre Doença Pulmonar Obstrutiva Crônica (2004). Realizou-se uma revisão narrativa da literatura, nas bases de dados virtuais LILACS, MEDLINE, SciELO, PubMed, Google Acadêmico, PAHO, Biblioteca Cochrane e IBECS, utilizando-se os descritores “Reabilitação”, “Doença Pulmonar Obstrutiva Crônica” e sua sinonímia “DPOC”, sem restrição de datas ou períodos para os resultados. Os estudos deveriam envolver pacientes com DPOC submetidos em qualquer momento da pesquisa a um programa de reabilitação pulmonar. Dessa forma, 12 trabalhos se mostraram adequados, perfazendo-se um total de 416 sujeitos envolvidos. A composição da equipe interdisciplinar, instrumentos de avaliação e a metodologia empregada nas intervenções tiveram ampla variação entre os programas de reabilitação analisados. Concluiu-se que é importante que os protocolos de reabilitação sejam orientados por diretrizes específicas, objetivando-se maior uniformidade de ações e o fomento à comparação de resultados entre os programas nacionais de reabilitação pulmonar de pacientes com essa doença.

COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in patients. It has become one of the leading causes of fatality worldwide. The ACBT corrects breathing pattern and it strengthen respiratory muscles with airway clearance, these all in a combination improves respiratory functions in COPD patients. Autogenic drainage is found to less likely cause oxygen desaturation than postural drainage and percussion. Aim: To evaluate the immediate effect of Conventional Physiotherapy versus ACBT with Autogenic Drainage (AD) on dyspnoea and cough in patient with COPD. Procedure: An experimental comparative study design which included 20 patients with COPD aged between 40-70 years. Patients were randomly allocated in 2 groups, either Conventional Physiotherapy (Control) or ACBT with AD (Experimental) group. The patients in control group received Deep Breathing Exercises followed by Active Range of Motion of both upper extremities and Huffing and Coughing. Whereas the experimental group received the activities were Active cycle breathing technique, Autogenic drainage and Active Range of Motion for both upper extremities. To evaluate immediate effect of therapies on dyspnoea Modified Borg Dyspnoea (RPE) Scale was used and cough was taken in a container to measure prior and after the treatment protocols. Paired sample t-test was used to compare pre and post treatment data in both the groups and independent sample t-test was used to compare the variables between the groups Results: Both the groups showed significant improvement in reducing the dyspnoea, whereas only ACBT with AD shown better effects on production of Cough. No significant difference was found between the groups in reducing the breathlessness Conclusion: Finally, it can be concluded that ACBT and AD were individually more effective technique than conventional physiotherapy in improving cough production and dyspnoea. Whereas there is no significant difference found in comparing both the groups.

Varón de 58 anos, exfumador desde hacia 4 años de 60 paquetes-año. El paciente consultó a su médico de familia en 2012 por disnea como único síntoma respiratorio, con una puntuación de 2 en la escala modificada de la Medical Research Council (mMRC). No había tenido agudizaciones los años anteriores.

Varón de 65 años natural de Portugal. Alérgico a la penicilina y el metamizol (exantema cutáneo), ex fumador desde hace 19 años con un factor de expo- sición de 50 paquetes/año. Historia de paludismo a los 33 años y dermatitis seborreica.

Paciente de 58 años, de profesión adminis- trativo, que acude por primera vez en los úl- timos 5 años al medico de familia consultan- do por dolor en el tobillo en la deambulación a raíz de una caída hace 1 semana. Bebedor moderado. Vida sedentaria. Fumador des- de la juventud, con un índice acumulado de 42 paquetes/año.

Varón de 61 años, diagnosticado de EPOC. Ex fumador de 70 paquetes/año.
Antecedentes personales
• Hipertensión arterial y dislipemia.
• Cardiopatía isquémica (portador de triple
stent coronario).
• Aneurisma de aorta abdominal.
• Nefrectomía izquierda por hipernefroma.
Tratamiento actual
En el año 2009 se pautó tratamiento con la combinación fluticasona/salmeterol 50/ 500 μg y tiotropio.

Hombre de 64 años, sin aler- gias medicamentosas conocidas. No presenta hábi- to enólico y es exfumador desde hace 7 años con un índice tabáquico de 45 paquetes-año. Como antecedentes patológicos destacan: hipertensión esencial tratada con enalapril 20 mg/24 h e hiper- colesterolemia en tratamiento con simvastatina 20 mg/24 h.

The purpose of the article is to provide guidelines for the physiotherapy management of patients with chronic obstructive pulmonary disease (COPD). The various publications on the same topic were brought together with input from several textbooks in the field of cardiorespiratory physiotherapy and translated into clinical practice. This article briefs with definition, risk factors, prevalence, clinical features, investigations, differential diagnosis, and management of COPD patient. Then, information on physiotherapy management during acute exacerbation phase and during stable phase is detailed. The article provides specific details on the rationale of why and especially how to implement exercise training in patients with COPD.

Synopsis of the Hawks Nest Disaster which at its peak had employed a number of oscillatory migrants from across the US during the period of the Great Depression. Many of these men were directly involved in constructing a viaduct through a particularly high grade of sandstone which would go on to make many very sick and have a high mortality rate amongst the construction workers directly involved in the project.

Many of the tens of thousands of men went on to develop acute silicosis due to extremely poor working conditions. Shrouded in controversy many men died both at the time of the construction or a short time thereafter. The controversy over the tunnels construction would go on to be considered one of the worst industrial disasters in the US history.

Abstract COPD [Chronic Obstructive Lung Disease] is one of several chronic diseases that are becoming increasingly problematic worldwide nowadays. Low- and middle-income countries already have much of the burden of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have identified the goals of treatment for patients with COPD, these include the patients’ goals of improved breathing pattern [exercise tolerance] and emotional function (health-related quality of life), clinical goals such as prevention of disease progression and minimization of symptoms . Nurses care for patients with COPD across the spectrum of care, from outpatient and home care to emergency department, critical care and hospice settings. Many reviews shown the commonest techniques to reduce dyspnea that are being applied to patients with Chronic Obstructive Lung Disease (COPD) subjected to a pulmonary rehabilitation program (PRP) are breathing retraining strategies. The Pursed lip breathing (PLB) and diaphragmatic breathing (DB) are breathing retraining strategies employed by COPD patients in order to relieve and control dyspnea. Through breathing retraining we can improve their breathing pattern along with routine medical care. Patient & family teaching is an important nursing intervention to enhance self-management in patients with COPD. Keywords: breathing retraining, COPD, chronic diseases

Varón de 56 años, ex fumador desde hace 6 de 30 paquetes/año, con antecedentes laborales de haber trabajado en un bar durante 15 años. Antecedentes familiares de interés: madre que presenta asma desde hace unos 30 años. El paciente está diagnosticado de EPOC desde hace mucho tiempo y acude a la consulta cada 6 meses para control clínico y funcional.

The clinical manifestations of chronic obstructive pulmonary disease symptoms variably affect the health of the patients, requiring them to visit specialized doctors in medical units. Diagnosis is by a specialized and complete medical examination accompanied by laboratory investigation. The interpretation of the results has the aim of establishing an appropriate therapeutic conduct according to the stage of the disease. The selected medical methods, aimed at improving the symptomatology of the disease, are undertake to ensure the life quality of patients diagnosed with chronic obstructive pulmonary disease. Among the laboratory tests that are required in order to evaluate the respiratory function of patients is spirometry. To consider this a study was performed in the second quarter of 2014 on a population segment, selected from the medical specialized service. The study collected statistical data on the testing of the respiratory function. This provided a comprehensive picture of patients investigated by this functional exploration method.

A continuación presentamos 6 casos clínicos en situaciones de la práctica clínica habitual de pacientes diagnosticados con EPOC de fe- notipos distintos. Planteamos los casos con su metodología diagnóstica, su tratamiento y evolución clínica según las normativas de las guías, junto a comentarios y una discusión práctica. Estos casos pretenden ser procesos asistenciales clínicos de situaciones que nos encontramos con frecuencia, mostrándolo que un grupo de expertos hacen en el manejo de estos pacientes.

Glyphosate, a synthetic amino acid and analogue of glycine, is the most widely used biocide
on the planet. Its presence in food for human consumption and animal feed is ubiquitous.
Epidemiological studies have revealed a strong correlation between the increasing incidence
in the United States of a large number of chronic diseases and the increased use of
glyphosate herbicide on corn, soy and wheat crops. Glyphosate, acting as a glycine
analogue, may be mistakenly incorporated into peptides during protein synthesis. A deep
search of the research literature has revealed a number of protein classes that depend on
conserved glycine residues for proper function. Glycine, the smallest amino acid, has unique
properties that support flexibility and the ability to anchor to the plasma membrane or the
cytoskeleton. Glyphosate substitution for conserved glycines can easily explain a link with
diabetes, obesity, asthma, chronic obstructive pulmonary disease (COPD), pulmonary
edema, adrenal insufficiency, hypothyroidism, Alzheimer’s disease, amyotrophic lateral
sclerosis (ALS), Parkinson’s disease, prion diseases, lupus, mitochondrial disease, non-
Hodgkin’s lymphoma, neural tube defects, infertility, hypertension, glaucoma, osteoporosis,
fatty liver disease and kidney failure. The correlation data together with the direct biological
evidence make a compelling case for glyphosate action as a glycine analogue to account for
much of glyphosate’s toxicity. Glufosinate, an analogue of glutamate, likely exhibits an
analogous toxicity mechanism. There is an urgent need to find an effective and economical
way to grow crops without the use of glyphosate and glufosinate as herbicides.

El tratamiento del paciente con enfermedad pul- monar obstructiva crónica (EPOC) en fase estable está sufriendo un cambio de paradigma en los últi- mos tiempos. Las nuevas evidencias demostradas respecto a la superioridad de la broncodilatación dual en combinación fija (LABA: long acting beta2 agonist/LAMA: long acting muscarinic antagonist) comparada con la de LABA/CI en determinados grupos de pacientes ha desplazado el uso de corti- coides inhalados (CI) a fenotipos concretos.

Aspergillus infections are among the most feared opportunistic infections in humans because they are capable of causing several distinct pulmonary diseases .The aim of this study detection the aspergillosis occurrences with patients undergo pulmonary infection and Susceptibility testing of some antifungals by MIC and E-test. The results showed that 139 (44.6%) out of 311 patients were presented with pulmonary complain. of which yielded Aspergillus growth while 49 (15.7%) yielded no growth. Six patients (4.31%) were presented with tuberculosis. All of the patients have had a history of chronic bronchitis, pneumonia, cancer, suffering from Chronic Obstructive Pulmonary Disease (COPD) or have other form of pulmonary disease.Aspergillus isolates were obtained from two types of specimens, of which 47 isolates (33.8%) were obtained from Broncheoalveolar lavage (BAL) and the remaining 92 isolates (66.1%) were obtained from sputum. Aspergillus spp. were the predominant microorganism among the pathogenic fungi obtained by culture. 10 species of Aspergillus were identified, A. niger 71 (48.9%), A. flavus 71 (51%), A. fumigatus 16 (11.5%), A. terreus 40 (28.7%), A. oryzae 1 (0.71%), A. tumorous 4 (2.8%), A. candidus 9 (6.4%), A. tamari 3 (2.15%), A. parasiticus 3 (2.15%) and one isolate A. versicolor (2.15%). A. flavus, A. niger and A. terreus were the most frequent isolated species followed by A. fumigatus in the fourth place .Antibiotic susceptibility (MIC test) of 10 different Aspergillus isolates were performed using Epsilometer (E-test) technique. The following antifungal agents were used in the test: Caspofungin (CAS),Itraconazole (ITC), Posaconazole (POS) and Voriconazole (VO). The study results showed VO and CAS were having full inhibitory activity (100%) against the tested Aspergillus spp., while in case of ITC and POS some resistance were observed, (50% and 75% respectively).

La enfermedad pulmonar obstructiva crónica
(EPOC) puede cursar con exacerbaciones que se
asocian a un rápido deterioro de la función pul-
monar, una reducción de la actividad física, un
empeoramiento de la calidad de vida, un aumen-
to de la mortalidad y un incremento de costes1.
En el estudio ECLIPSE, que incluyó 2138 pacien-
tes con seguimiento durante 3 años, el 22 % de
enfermos en estadio 2 de GOLD, el 33 % en esta-
dio 3 y el 47 % en estadio 4 tenían al menos dos
episodios de exacerbación al año2. La utilización
de antibióticos en la EPOC estable de forma con- positivos, preferentemente neumococo, microor- tinua se ha llevado a cabo empíricamente desde la ganismos atípicos, y posiblemente Haemophilus década de 1960 en lo que se llamaba profilaxis anti- influenzae....

Infradiagnostico y sobrediagnostico de la enfermedad pulmonar obstructiva cronica.
Tanto el infradiagnostico como el sobrediagnostico y el diagnostico erróneo o impreciso de la EPOC son problemas de gran trascendencia en la práctica clínica que conllevan importantes consecuencias para el paciente y el sistema sanitario, lo que constituye un importante punto de ineficiencia. La falta de concienciación general existente sobre estas situaciones, así como la inespecificidad de la definición de la EPOC, la escasa generalización de la adecuada frecuencia y calidad de los estudios espirométricos, la banalización de los riesgos de la inadecuación del tratamiento con fármacos broncodilatadores o antiinflamatorios inhalados y los limitados conocimientos de los profe- sionales sanitarios y de los propios pacientes sobre la enfermedad son, con una intensidad algo diferente en función del problema, las claves sobre las que se debe actuar para poder avanzar en la mejora de la calidad de vida y pronóstico de los pacientes con EPOC y en la eficiencia de las actuaciones sanitarias que se llevan a cabo para ello.

Errors with the use of pressurized metered-dose inhalers (pMDIs) reduces lung deposition and increases the local and systemic side effects. The use of a spacer reduces these errors. The studies aimed to assess the usability, confidence, preference and satisfaction with the use of three spacers (Zerostat, Zerostat V and Zerostat VT) in three different, identically designed studies. The three studies were open-labelled, prospective and multicentric in subjects with mild obstructive disease like asthma and COPD. In these two visit studies, the subjects were trained to use the device at visit 1 and again at visit 2, and the average time taken for three consecutive correct attempts was reported (primary endpoint). The secondary endpoints included number and type of errors (critical and non-critical), and scores on usability, confidence, preference, and satisfaction questionnaires. A total of 90 participants (30 participants per study, 1:1 healthy volunteers: subjects with asthma/COPD) completed these studies. The average time taken for three consecutive correct attempts in subjects with asthma/COPD in the three studies decreased at visit 2 (2.99, 4.65 and 1.91 minutes) from visit 1 (3.58, 4.99 and 2.23 minutes), respectively. The critical and non-critical errors also decreased at visit 2 from visit 1. Overall reduction in the scores at visit 2 was also observed on the usability, confidence, preference and satisfaction questionnaires. The results from the three studies demonstrated that Zerostat, Zerostat V and Zerostat VT spacers are easy to learn, understand and operate. This highlights the fact that the spacer devices can be recommended for all patients using a pMDI.

Keywords: spacers, inhalation spacers, valved holding chamber, aerosol holding chamber, patient preference, patient satisfaction, asthma, metered dose inhaler