Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several meetings of chest specialists were held in order to update basic knowledge on Chronic Obstructive Pulmonary Disease (COPD) and to establish guidelines regarding its prevention and treatment. This Consensus was prompted by the important morbidity and mortality due to COPD. Pulmonary emphysema, chronic bronchitis and asthma may evolve into COPD when developing chronic, persistent, non reversible airflow obstruction. Its pathologic features, physiopathology, pulmonary function derangements and clinico-radiological picture are summarized. Early detection and prevention accomplished through smoking cessation are essential to stop health damage due to this condition. Strategies directed to smoking cessation are described. Once COPD is established, inhaled bronchodilators (IB)--anticholinergics, beta-2 agonists or both--might be useful. Teophylline is indicated additionally when no improvement is obtained with IB. Inhaled steroids (IE) may stop progression of airways obstruction; they are recommended in patients who remain symttomatic and/or with severe airflow obstruction (FEV1 less than 50% predicted) despite treatment with beta-2 adrenergics and teophylline. Vaccination against influenza and pneumococcal pneumonia is suggested. Other medications (antibiotics, psychoactive drugs, alpha-1 antitrypsine, respiratory stimulants) or surgical interventions, including lung transplantation, might be of help in certain circumstances. In patients with physiotherapy, supplementary nutrition, muscle retraining, prolonged oxygen therapy and, eventually, noninvasive mechanical ventilation might improve survival and quality of life. Acute decompensations leading to respiratory failure should be promptly detected and treated with oxygen, IB, teophylline, corticosteroids, antibiotics and, eventually, mechanical ventilation. The main role of public education in disease prevention is emphasized. Moreover, patient and family education is essential for adequate treatment of COPD.
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PMID:[Chronic obstructive pulmonary disease]. 872 81

The objectives of this study were to determine the risk for coughing as an adverse reaction to angiotensin converting enzyme (ACE) inhibitors under everyday circumstances in a large population and to study whether this adverse effect is more common in women. A population-based case-control study was used. The study was set in the practices of 161 Dutch general practitioners (GPs), in which all consultations, morbidity, mortality, medical interventions and prescriptions were registered during 4 consecutive 3-month periods in 4 consecutive groups of 40-41 GPs. The subjects were 2436 patients with incident coughing and up to 3 controls per case were obtained (total group: 7348 controls), matched for GP and a contemporary consultation in the same 3 months. All cases and controls were 20 years or older and had no notification of respiratory infections, influenza, tuberculosis, asthma, chronic bronchitis, emphysema, congestive heart failure, sinusitis, laryngitis, haemoptysis or respiratory neoplasms during the 3-month period. The results showed that cases were 3.6 times as likely as controls to have been exposed to ACE inhibitors (95% CI: 2.4-5.5) but after adjustment for potential confounders the odds ratio was 2.5 (95% CI: 1.6-3.9). The crude odds ratio for males was 2.7 (95% CI: 1.4-5.1) and for females 4.2 (95% CI: 2.4-7.5). The adjusted odds ratio for males was 1.8 (95% CI: 0.9-3.5) and for females 2.7 (95% CI: 1.5-4.8).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Angiotensin converting enzyme inhibitor associated cough: a population-based case-control study. 776 16

Isolated pathogenic bacteria from sputum of the patients with pulmonary emphysema who were admitted in our hospital from 1984 to 1994 were examined to elucidate the relationship between isolated bacteria from sputum and pulmonary functions including vital capacity (VC), forced expiratory volume (FEV1.0), PaO2 and PaCO2. VC of the patients from whom MSSA (methicillin-sensitive Staphylococcus aureus) or Enterococcus faecalis (E. faecalis) were isolated was significantly lower than that of the patients from whom Streptococcus pneumoniae (S. pneumoniae), Branhamella catarrhalis (B. catarrhalis) or Haemophilus influenza (H. influenza) were isolated. FEV1.0 had a similar tendency as VC in terms of isolated organisms from the patients with emphysema. Similarly, PO2 of the patients from whom MSSA or E. cloacae were isolated was significantly lower than that of the patients from whom S. pneumoniae, B. catarrhalis or H. influenzae were isolated, and PCO2 of the patients from whom S. pneumoniae, B. catarrhalis or H. influenza were isolated. There was also impaired respiratory function in the patients from whom MSSA, Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), Xanthomonas maltophilia (X. maltophilia) or Enterobacter cloacae (E. cloacae) were isolated, compared with those in the patients from whom S. pneumonia, B. catarrhalis or H. influenzae were isolated. These results suggest that isolated pathogenic bacteria are shifted from S. pneumoniae, B. catarrhalis or H. influenza to MSSA, E. coli, P. aeruginosa, X. maltophilia or E. cloacae in the course of impairment of respiratory function in pulmonary emphysema. The treatment and prophylaxis for acute exacerbation in pulmonary emphysema should be based on these results.
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PMID:[Pathogenic bacteria isolated from the sputum of the patients with pulmonary emphysema]. 870 5

The effectiveness of influenza vaccine in reducing hospital admissions for pneumonia, influenza, bronchitis, or emphysema was assessed by a case-control study of people aged 16 years and older who were admitted to 10 Leicestershire hospitals between 1 December 1989 and 31 January 1990. Hospital and general practitioners' records for 156 admissions (the cases) and 289 controls matched for age and sex were reviewed. Information was collected on demography, the usual place of residence (institutional or non-institutional), the existence of chronic illness, and vaccination during the 5 years before admission. The odds ratio for hospital admission among vaccinees was 0.67 (95% CI 0.39-1.12) giving an estimate of vaccine effectiveness in this setting of 33% (95% CI 0-61). However, multivariate logistic regression, adjusting for the effects of institutional care and chronic illness, revealed that influenza vaccination reduced hospital admissions by 63% (95% CI 17-84%). There was a strong trend towards improved vaccine effectiveness when used in institutional settings. Influenza vaccine is effective in reducing hospital admissions for influenza, pneumonia, bronchitis and emphysema, and effectiveness is comparable to that observed for influenza and pneumonia admissions in North America.
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PMID:Effectiveness of influenza vaccine in reducing hospital admissions during the 1989-90 epidemic. 904 32

The expansion of our knowledge regarding the pathogenesis of asthma has now made clear that it is an inflammatory disease. Although the treatment of bronchospasm associated with asthma is essential, it is important to consider the inflammatory aspect of the disease. The first therapeutic approach is to control environmental hazards (allergen, air pollution, tobacco smoke). It should always be remembered that patient education is of critical importance. Patients with only occasional asthma symptoms (2-4 times a week) should receive inhaled short-acting beta-2 agonists as needed. Treatment with inhaled corticosteroids is instituted in all asthmatics except the mildest cases. Long-acting beta-2 agonists are an additional therapy for patients with unsatisfactory symptom control despite an optimal dose of inhaled steroids, particularly when there are nocturnal symptoms. Chronic obstructive pulmonary disease is defined as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. Although the airflow obstruction is generally progressive, comprehensive therapeutic management benefits all patients including those with severe disease: stopping smoking, vaccination against influenza and pneumococcus, pharmacologic therapy. The judicious use of bronchodilators increases airflow and reduces dyspnea. Ipratropium and beta-2 agonists are equally efficacious and may work synergistically. The use of corticosteroids is controversial. Thus a closely monitored steroid trial of therapy should be considered in patients who have continuing symptoms or severe airflow limitation despite maximal therapy with other agents. Broad spectrum antibiotics are beneficial in severe exacerbations.
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PMID:[New aspects in the treatment of bronchial asthma and chronic obstructive lung diseases]. 928 15

Respiratory infectious diseases such as bacterial pneumonia and bronchitis are common and costly, especially in institutionalized and elderly inpatients. Respiratory infection is thought to rely in part on the aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defense mechanisms to eliminate the contaminating bacteria, which then multiply to cause infection. It has been suggested that dental plaque may act as a reservoir of respiratory pathogens, especially in patients with periodontal disease. However, the impact of poor oral health on oral respiratory pathogen colonization and lung infection is uncertain, especially in ambulatory, non-institutionalized populations. To begin to assess potential associations between respiratory diseases and oral health, data from the National Health and Nutrition Examination Survey I (NHANES I) were analyzed. This database contains information on the general health status of 23,808 individual Of these, 386 individuals reported a suspected respiratory condition that was further assessed by a physician. These subjects were categorized as having a confirmed chronic respiratory disease (chronic bronchitis or emphysema) or an acute respiratory disease (influenza, pneumonia, acute bronchitis). They were compared to those not having a respiratory disease. Initial non-parametric analysis noted that individuals with a confirmed chronic respiratory disease (n = 41) had significantly greater oral hygiene index scores than subjects without respiratory disease (n = 193; P = 0.0441). Logistic regression analysis of data from these subjects, which considered age, race, gender, smoking status, and simplified oral hygiene index (OHI), suggested that subjects having the median OHI value were 1.3 times more likely to have a chronic respiratory disease relative to those with and OHI of O. Similarly, subjects with the maximum OHI value were 4.5 times more likely to have a chronic respiratory disease than those with an OHI of O. No evidence was found to support an association between the periodontal index and any respiratory disease. These results suggest OHI to have a residual effect on chronic respiratory disease of both practical and statistical significance.
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PMID:Associations between oral conditions and respiratory disease in a national sample survey population. 972 8

Asthma is common, affecting 5% to 10% of adults; asthma is progressive, leading to irreversible obstruction in 80% of elderly patients; and asthma is complex, often complicated by coexisting lung diseases. This loss of lung function results from 4 independent pathologic conditions: (1) airway remodeling, especially in the small airways, from the lymphocytic-eosinophilic inflammation that characterizes asthma; (2) bronchiectasis; (3) postinfectious pulmonary fibrosis; and (4) emphysema and chronic bronchitis from tobacco smoke. Deterioration in lung function develops faster in nonallergic patients with intrinsic asthma during the period shortly after onset of asthma and in older patients. About 4% of patients die of asthma, and most are elderly. Death most often results from complications of irreversible obstruction or cardiotoxicity of bronchodilator therapy. More research is needed to improve therapy for preventing remodeling of small airways, to confirm the frequency of bronchiectasis and postinfectious fibrosis and to determine their causes, and to develop diagnostic criteria to identify these complications. Meanwhile, clinicians treating adult asthmatic patients need to be aggressive in preventing the damage from cigarette smoke; in immunizing for influenza and pneumococcus infection and identifying and treating respiratory infections, particularly at times of acute exacerbations; in diagnosing and managing bronchiectasis; and in objectively confirming the efficacy of asthma therapy to prevent illness from overtreatment with glucocorticoids and bronchodilators.
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PMID:The natural history of asthma in adults: the problem of irreversibility. 1019 98

The cost burden associated with chronic bronchitis and emphysema, collectively known as chronic obstructive pulmonary disease (COPD), is large. The disease impacts not only on patients but caregivers and society as well. An estimated 16 million people in the US are currently diagnosed with COPD, the majority having chronic bronchitis. Mortality associated with this disease is on the upswing, as is its prevalence in the female population and the elderly. It is currently the fourth most common cause of death both in the US and worldwide. To date, the only proven cost-effective therapies for the disease are the cessation or prevention of smoking, which is the single most common cause of COPD, and vaccination to prevent influenza and pneumococcal infection. Hospitalisation and associated costs represent the greatest healthcare expenditures for people with the disease. Long-term oxygen therapy is also among the most costly interventions in terms of total money spent on direct medical costs for COPD treatment, although it is probably cost-effective because of its positive impact on rates of mortality. In fact, oxygen therapy is the only intervention to date that has been shown to decrease death rates due to COPD. Appropriate treatment with medication has the potential to decrease resource utilisation but does not appear to affect death rates. Similarly, pulmonary rehabilitation programs appear to benefit patients in terms of quality of life; however, long-term cost-effectiveness and effects on mortality have yet to be elucidated. Indirect costs also contribute a substantial part of the economic burden of the disease but are significantly harder to quantify.
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PMID:The economic impact of chronic obstructive pulmonary disease. 1186 72

Surfactant protein D (SP-D) and serum conglutinin are closely related members of the collectin family of host defense lectins. Although normally synthesized at different anatomic sites, both proteins participate in the innate immune response to microbial challenge. To discern the roles of specific domains in the function of SP-D in vivo, a fusion protein (SP-D/Cong(neck+CRD)) consisting of the NH(2)-terminal and collagenous domains of rat SP-D (rSP-D) and the neck and carbohydrate recognition domains (CRDs) of bovine conglutinin (Cong) was expressed in the respiratory epithelium of SP-D gene-targeted (SP-D(-/-)) mice. While SP-D/Cong(neck+CRD) fusion protein did not affect lung morphology and surfactant phospholipid levels in the lungs of wild type mice, the chimeric protein substantially corrected the increased lung phospholipids in SP-D(-/-) mice. The SP-D/Cong(neck+CRD) fusion protein also completely corrected defects in influenza A clearance and inhibited the exaggerated inflammatory response that occurs following viral infection. However, the chimeric protein did not ameliorate the ongoing lung inflammation, enhanced metalloproteinase expression, and alveolar destruction that characterize this model of SP-D deficiency. By contrast, a single arm mutant (RrSP-D(Ser15,20)) partially restored antiviral activity but otherwise failed to rescue the deficient phenotype. Our findings directly implicate the CRDs of both SP-D and conglutinin in host defense in vivo. Our findings also strongly suggest that the molecular mechanisms underlying impaired pulmonary host defense and abnormal lipid metabolism are distinct from those that promote ongoing inflammation and the development of emphysema.
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PMID:Complementation of pulmonary abnormalities in SP-D(-/-) mice with an SP-D/conglutinin fusion protein. 1195 9

Due to the increase in morbidity and mortality from Chronic Obstructive Pulmonary Disease (COPD), a group of chest physicians updates the basic knowledge on COPD since the last Consensus in 1994 in order to prepare guidelines for its diagnosis, prevention and treatment. The authors review the definition of COPD together with the most recent information on its pathophysiology. The clinical presentation is summarized together with functional evaluation and imaging. Early diagnosis by means of functional testing (i.e., spirometry) is stressed, emphasizing smoking cessation as the only measure that has been shown to alter the outcome of the disease. Smoking cessation strategies are described as well as pharmacological and non-pharmacological treatment. In the pharmacological section, the use of inhaled bronchodilators (anticholinergic, beta 2 adrenergic agonists or both) is considered the first option for treatment. Long acting bronchodilators improve patient compliance and treatment effectiveness. Inhaled corticosteroids are indicated for patients with severe airways obstruction and known response to corticosteroids. These agents can diminish the number of exacerbations. Annual influenza vaccination is recommended in all patients. In the non-pharmacological section, surgery for emphysema is suggested in particular cases. Rehabilitation, including exercise training, kinesitherapy and nutrition, is a useful tool for patients who are physically disabled. Long-term oxygen therapy at home improves survival in patients with severe chronic hypoxemia. Other therapeutic interventions such as non-invasive home ventilation have specific indications. Acute exacerbations must be aggressively treated with oxygen, corticosteroids, antibiotics, combination of bronchodilators, and eventually respiratory support. The role of public education of the patients and their families is essential in the prevention and treatment of the disease.
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PMID:[Updated Argentine consensus on chronic obstructive pulmonary disease]. 1462 55


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