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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied treatment for respiratory emergencies over the past 11 years at our hospital, a tertiary emergency center. We supply intermediate management services to a general hospital. A total of 13,667 patients received tertiary emergency medical care (annual mean: 1243). Of these, 1592 had severe respiratory disturbances (11.5% of the total; 971 males, 621 females; annual mean: 143). The most frequently seen conditions were COPD, respiratory failure due to old pulmonary tuberculosis) 35.2%, mortality failure due to old pulmonary tuberculosis (35.2%, mortality rate: 29.7%), bronchial asthma (26.0%, mortality rate 9.6%), pneumonia (19.0%, mortality rate 20.4%), and pneumothorax (10.3%). Very few of the patients with bronchial asthma who arrived in cardiopulmonary arrest survived. Patients with interstitial pneumonia, paraquat lung, pulmonary obstruction, adult respiratory distress syndrome, and near-drowning all had poor prognoses, as did victims of attempted suicide by hanging and attempted murder by strangulation. About 25% of the patients required mechanical ventilation, and about half of those patients died. Changes in prehospital care and in care given after critical care is no longer needed are important in improving the prognoses for patients with respiratory emergencies.
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PMID:[Respiratory disease in the tertiary emergency hospital]. 760 42

The objective of this study was to describe the health problems of a group dementia patients on admission and during residence in a Dutch nursing home and to compare these with figures of patients of 75 years and over from general practice. In 890 nursing home patients suffering from dementia prevalence of health problems on admission and the incidence during the residence were classified by means of the ICHPPC-2-defined. The differences between men and women were studied as was the influence of the season on the incidence during the stay. Results were compared with figures of patients of seventy five year and over from the continuous morbidity registration (CMR) from 'Nijmegen'. The most frequently occurring health problems on admission were: varicose veins of legs, acquired deformation of the spine, presbyacusis, hypertension, arthrosis, COPD, cerebrovascular disorders, heart murmur, cataract and chronic ischemic heart disease. During the residence the following health problems were frequently diagnosed: urinary tract infection, side effect of medicine, constipation, pneumonia, pressure sore, feeding problem, contusion, heart failure, cold and conjunctivitis. There were clear differences between men and women. Especially the incidence of intercurrent diseases showed great differences from the patterns in general practice. Prevalence of health problems on admission to the nursing home home agreed mor with figures from general practice. Respiratory tract infections frequently occurred in winter and urinary tract infections, pressure sores and conjunctivitis seemed to occur more in the summer. Nursing home patients with dementia have a lot of chronic and intercurrent health problems. They differ clearly from patients in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Incidence and prevalence of health problems in a group of nursing home patients with dementia. A comparison with family practice]. 780 16

The aim of this prospective study was to analyse the contribution of the measurement of alveolar arterial gradients of CO2 during forced expiration in the diagnosis of pulmonary emboli occurring in chronic airflow obstruction (COPD) as a result of smoking. The study was carried out on 178 patients: Group 1: 54 subjects without emboli (14 controls, 33 COPD and 7 patients with chest pain); Group 2: 72 patients with proved emboli (49 non COPD, 23 COPD); Group 3: 52 patients COPD presenting with varied non-embolic broncho-pulmonary pathology (pneumonia, bronchospasm, pulmonary oedema, bronchial neoplasm). The diagnosis of pulmonary emboli was confirmed by scintigraphy in patients with non COPD or angiography (in patients with COPD). The maximal fraction of CO2 was measured using a capnologue during a forced expiration which was long and prolonged until residual volume was achieved. The PaCO2 was measured simultaneously by an analysis of arterial blood gases. The D index was calculated according to the formula [(PaCO2-PEM CO2)/PaCO2] x 100. The D index was significantly lower in Group 1 (3.42 +/- 3.8% p < 0.0001) than in Group 2 (20.8 +/- 10%) and Group 3 (17.6 +/- 11.7%) (not significant between Groups 2 and 3). In patients with COPD the specificity and sensitivity and the predicted positive and negative value were 100% for a D limit of 7%. In COPD patients these values were respectively 82, 95, 75 and 96% for a D limit of 7%; on the other hand for a D below 5% the values were 60, 100, 64 and 100% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The significance of maximal expiratory concentrations of CO2 (MEC CO2) in the negative diagnosis of acute pulmonary embolism in chronic obstructive bronchopneumopathies]. 789 65

Several studies in recent years have suggested that exposure to airborne particles and to ozone are associated with increases in respiratory hospital admissions. Few of those studies have used inhalable particles as their measure of exposure, and the studies did not always examine both particle and ozone exposure. This study examined the association between both PM10 and ozone and respiratory hospital admissions for persons 65 yr of age and older in the Detroit, Michigan, metropolitan area during the years 1986 to 1989. After controlling for seasonal and other long-term temporal trends, temperature, and dew point temperature, both PM10 (RR = 1.012, 95% CI = 1.019-1.004) and 24-h ozone concentrations (RR = 1.026, 95% CI = 1.040-1.013) were associated with daily admissions for pneumonia. The relative risks are for a 10-microgram/m3 increase in PM10 and a 5-ppb increase in 24-h ozone concentration and from models including both pollutants. Admissions for COPD other than asthma were associated with PM10 (RR = 1.020, 95% CI = 1.032-1.009) and ozone (RR = 1.028, 95% CI = 1.049-1.007) as well. Asthma admissions were not associated with either pollutant. Controlling for one pollutant did not effect the magnitude of the association with the other pollutant. The magnitude of these relative risks are very similar to those recently reported in Birmingham, Alabama, Ontario, and New York State. This suggests that the associations with both pollutants are likely to be causal.
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PMID:Air pollution and hospital admissions for the elderly in Detroit, Michigan. 808 33

This study related respiratory illness documented in the first 2 yr of life to the lung function of 618 men and women with a mean age of 70 yr living in Derbyshire, England. Pneumonia before 2 yr of age was associated with a lower mean FEV1, adjusted for age and height. In men, the difference was -0.65L (95% CI: -1.02, -0.29; p = 0.0005). This estimate did not diminish after adjustment for smoking and asthma. In women, the reduction in mean FEV1 associated with pneumonia before 2 yr of age was smaller and nonsignificant. Bronchitis, measles, and whooping cough before 2 yr of age were not associated with diminished adult lung function in either sex. The findings in men support a causal relationship between pneumonia in early childhood and COPD in late adult life.
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PMID:The relationship between pneumonia in early childhood and impaired lung function in late adult life. 811 27

A prospective study of 132 patients with severe community-acquired pneumonia (CAP) treated in the ICU was carried out to determine the causative agents, the value of the clinical, biological, and radiologic features in predicting the etiology, and to define prognostic factors. The study group included 98 men and 34 women (mean age: 58 +/- 18 years). The most frequent underlying condition was COPD (51 patients, 39 percent). On admission, 35 patients were in shock, 71 were mentally confused, and 81 (61 percent) required mechanical ventilation during their hospitalization. The clinical, laboratory, and radiologic parameters were of little value for predicting the etiology in patients with severe CAP. An etiologic diagnosis was made in 95 (72 percent) patients. The most frequent pathogens were Streptococcus pneumoniae (43 cases [45 percent]), Gram-negative bacilli (14 cases [15 percent]), and Haemophilus influenzae (14 cases [15 percent]) Mortality was 24 percent. It was significantly associated with a age more than 60 years, septic shock, impairment of alertness, mechanical ventilation requirement, bacteremic pneumonia, and S pneumoniae or Enterobacteriaceae as the causes of the pneumonia. Recommendations for antibiotic chemotherapy in patients with severe CAP admitted to the ICU are included.
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PMID:Severe community-acquired pneumonia. Etiology, epidemiology, and prognosis factors. French Study Group for Community-Acquired Pneumonia in the Intensive Care Unit. 770 43

Among 182 episodes with ARF (PaCO2 > 50 torr) in 400 episodes of COPD patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986, despite conservative treatment, 66 developed severe acute respiratory failure requiring assisted ventilation. Patients with a history of chronic cough, pneumonia as a precipitating factor and more severe ARF on admission, as indicated by palpitation, headache, cyanosis, alteration of consciousness, cor-pulmonale and decompensated acidosis (pH < 7.30), were likely to require mechanical ventilation. Indications for mechanical ventilation were carbon dioxide narcosis (43 episodes), severe hypoxemia despite on a high FIO2 (one episode), various combination parameters of respiratory muscle fatigue, cardiovascular instability (22 episodes). The major complications of mechanical ventilation were pneumonia, sepsis, pneumothorax, UGI bleeding of 16, 8, 5 and 9 episodes, respectively. The average duration of assisted ventilation and hospitalization were 15.8 and 19.02 days, respectively. The mortality rate was 50 per cent in the mechanical ventilation group compared with 9.8 per cent in the non-mechanical ventilation group. Increased mortality rate was found in those with pneumonia as the precipitating factor (68.4 vs 14.3%, respectively, in comparing the two groups). Complications of mechanical ventilation, which included pneumonia, sepsis, fluid overload, hyponatremia and persistent acidosis, were high-risk factors for the non-surviving group.
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PMID:Mechanical and non-mechanical ventilation of respiratory failure in chronic obstructive pulmonary disease. 822 88

The air pollution disasters in London in 1952, the Meuse valley in 1930, and in Donoroa, Pennsylvania, in 1948 made it clear that extremely high levels of particulate-based smog could produce large increases in the daily mortality rate. Recent studies of fluctuations in daily air pollution and daily mortality have reported associations at much lower concentrations in London during the 1960s and in Philadelphia, Steubenville, Santa Clara, St. Louis, Utah valley, Detroit, and eastern Tennessee in the 1970s and 1980s. Whether these associations are causal or not is a matter of considerable public health concern. If the detailed pattern of the deaths at these lower concentrations appeared similar to the pattern in London, this would strengthen the argument for causality. To examine this issue, the death certificates from Philadelphia were examined on the 5% of the days with the highest particulate air pollution and the 5% of the days with the lowest particulate air pollution during the years 1973-1980. There was little difference in weather between the high and low pollution days, but total suspended particulate matter concentrations averaged 141 micrograms/m3 on the high pollution days versus 47 micrograms/m3 on the low pollution days. The relative risk of dying on the high pollution days was 1.08 P < 0.0001. The relative increase was higher for COPD (1.25) and pneumonia (1.13). Deaths were also elevated for heart disease and stroke; however, there was a substantial increase in the reports of respiratory factors as contributing causes for those underlying causes of death. Dead-on-arrival deaths and deaths outside of hospitals and clinics were also disproportionately increased. This paralleled the pattern seen in London in 1952. The age pattern of the relative risk of death was also similar. This adds to the evidence that the association is causal.
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PMID:What are people dying of on high air pollution days? 828 40

To assess awareness and understanding of obstructive airway diseases by primary-care physicians, the authors surveyed a randomly selected population of 75 primary care practitioners. During one-on-one interviews, physicians were presented with a standardized case scenario and a subsequent series of open-ended questions concerning asthma and COPD. Each respondent was presented in randomized fashion with one of two versions of a case description of a hypothetical 52-year-old male smoker with a recent upper respiratory tract infection and persistent productive cough. The only difference between case descriptions was that one included explicit reference to an earlier tentative diagnosis of chronic bronchitis (CB version); the other description made no specific mention of this diagnostic term (NCB version). Chest radiographs were requested by 80 percent of physicians and sputum cultures by 50 percent, these percentages not differing significantly between CB and NCB groups. Spirometry was requested less often than either of the foregoing tests (21 percent). The CB group requested spirometry significantly more often than the NCB group (38 percent vs 5 percent, p < 0.05). The most frequently mentioned primary diagnosis was bronchitis/pneumonia (33 percent), followed by bronchitis (28 percent) and chronic bronchitis (16 percent), all of which were similar in both groups. However, the diagnostic term "COPD" was the primary diagnosis in 16 percent of the CB group, compared with 8 percent in the NCB group (p > 0.05). Oral antibiotics were the most frequently chosen first-line drug therapy (63 percent). In subsequent questions concerning the management of obstructive airway diseases, primary practitioners distinguished COPD from asthma conceptually, but their prescribed therapy for the two disorders was less distinct. beta 2-agonists were selected most frequently and similarly as initial therapy for both disorders (53 percent). Minor differences between first-line therapeutic choices included nonsignificant trends toward the more frequent mention of anticholinergic bronchodilators for COPD than for asthma (10 percent vs 0 percent) and the more frequent selection of inhaled corticosteroids for asthma (12 percent vs 5 percent). The authors conclude that to the extent that questionnaire responses reflect actual practice, primary care practitioners (1) have a low index of suspicion for obstructive airway disease, (2) markedly underutilized spirometry as a screening tool, (3) consider beta 2-agonists first-line therapy for COPD and asthma, and (4) despite considering COPD and asthma different disease processes, choose similar medications for each disorder.
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PMID:Physician perceptions and management of COPD. 832 79

In recent years aerosol therapy has become increasingly important for the management of asthma and COPD as well as for the treatment of airway and parenchymal infections in bronchiectasis and in AIDS patients with pneumocystis carinii pneumonia. In the management of asthma inhaled steroids have become the mainstay of therapy in adults and children while bronchodilators have been relegated to a secondary role. While there has long been considerable controversy about the best way to generate and deliver aerosols, it has become evident that metered dose inhalers (MDI) and their increasingly sophisticated valved accessory devices are the most efficient, versatile and cost effective aerosol systems for the majority of patients in the adult and paediatric age group. By contrast, nebulizers are inefficient and costly and powder inhalers, while providing aerosol on inhalation, have major limitations in the paediatric age group, in less cooperative or handicapped patients and in those in emergency departments or on assisted ventilation. Recent studies have demonstrated that even in life-threatening asthma, MDI generated aerosols delivered by means of valved holding chambers are better suited to managing the acute episode because of the improved speed of administration and lower cost. Developments in aerosol therapy are likely to remain in the forefront of the management of a variety of airway and pulmonary parenchymal diseases as new and improved pharmaceutical agents and aerosol delivery systems are developed.
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PMID:[Aerosol generation and delivery systems for pulmonary drug administration: theory and practice]. 837 17


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