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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic bronchitis and emphysema (chronic obstructive pulmonary disease [COPD]) represent a major health problem in this country. Corticosteroids have provided an important advance in the management of bronchial asthma, but the role of these drugs in the therapy for COPD has not been defined clearly. To gain further insight into this problem, an overview of the pharmacologic properties and mechanisms of action of corticosteroids on the cellular systems of the lung and a critical analysis of the 17 studies evaluating the efficacy of therapy with corticosteroids in COPD were done. There are several theoretic reasons why corticosteroids might be useful in treating COPD; however the majority of studies have not demonstrated a positive effect, yet individual patients have attained marked improvement. An objectively monitored, finite trial of therapy with corticosteroids in the patient with COPD who has worsening symptoms is warranted, as the benefit is high in responsive individuals and the risk is low in nonresponders.
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PMID:Corticosteroids in chronic bronchitis and pulmonary emphysema. 34 9

Emphysema is classified by macroscopic examination of inflated lung sections as proximal acinar, panacinar, distal acinar, and/or paracicatricial. Alveolar fenestrations, the earliest morphologic expression of alveolar wall damage, may be defined with the aid of a dissecting or scanning electron microscope. In bronchial obstructive disease, lesions of both the large and small airways contribute to respiratory impairment. The structural changes of chronic bronchitis are, for practical purposes, always associated with severe emphysematous disease. Thus, it is mandatory for the morphologist who evaluates lung specimens for COPD to pay detailed attention to the acinar pattern of destruction of inflated emphysematous lungs as well as to the gross and microscopic pathology of large and small airways. These structural changes should then be correlated with clinical parameters relative to age, sex, air pollutants, cigarette smoking allergy, and hereditary deficiencies of antiproteolytic enzymes.
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PMID:Structural abnormalities in COPD. 87 95

Air pollution referable to increased ambient levels of sulfur dioxide and suspended particulates is associated with increased episodes of acute bronchitis and is also causally related to some cases of chronic bronchitis. Oxidant air pollution is associated with abnormalities of pulmonary function in children and is a major contributory factor in COP, especially bronchitis, in some areas of the United States. The relationship of nitrogen dioxide atmospheric contamination to COPD is still controversial. In our opinion, the epidemiologic studies conducted to date have been inadequate and further elucidation is indicated. Cadmium fumes and compounds have been found to be instrumental in the development of some cases of chronic bronchitis and emphysema in Sweden. This association is unproved in the United States and warrants a thorough clinical and epidemiologic evaluation.
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PMID:Air pollution and COPD. 87 96

The term "COPD" covers a spectrum of diseases with a common denominator, obstruction to airflow on expiration. Chronic asthma, chronic bronchitis, and pulmonary emphysema are the most prevalent conditions. The signs and symptoms of COPD are similar in all entities. Differential diagnosis may be difficult. Early detection of COPD is important, and tests are available for this purpose. For therapeutic and prognostic reasons it is also important to differentiate, wherever possible, which disease entity is predominant in a particular person. This can be done to a high degree by correlating clinical, radiologic, and physiologic findings. The radiologic manifestations of COPD are multiple, varied, and in many instances nonspecific. The primary radiologic feature in COPD is lung hyperinflation. In advanced disease, radiologic changes are diagnostic and correlate well with physiologic and clinical findings. Frequently, however, the chest film is normal even when clinical and physiologic manifestations indicate advanced disease.
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PMID:Definition, differentiation, and classification of COPD. 87 8

The effects of 1.0 per cent end-tidal halothane-oxygen anesthesia on spontaneous ventilation, ventilatory deadspace, functional residual capacity (FRC), and alveolar-arterial oxygen difference (A-aD-O-2) were measured in patients with chronic obstructive pulmonary disease and in normal patients of similar age. results obtained were compared with values obtained preoperatively from the same patients. The following were measured: 1) ventilation and ventilatory deadspace, breathing room air and breathing 100 per cent oxygen; 2) functional residual capacity (FRC) and alveolar-arterial oxygen tension difference (A-aD-O-2); 3) forced expiratory volume in 1 second (FEV1.0); 4) ventilatory response to exogenous carbon dioxide. Findings indicated that ventilation is depressed more during halothane anesthesia in patients with emphysema than in normal patients and that the extent of depression is best related to a preoperative measurement of FEV1.0 (P less than 0.001, r = 0.86). The depression in alveolar ventilation results primarily from a reduction in tidal volume. A-aD-O-2 and ventilatory deadspace-to-tidal volume ratio are increaded and FRC decreased with anesthesia in patients with COPD, but the changes are no greater than those found in normal patients.
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PMID:Anesthetic effects on ventilation in patients with chronic obstructive pulmonary disease. 111 64

We prospectively elucidated the effect of home oxygen therapy (HOT) on the prognosis of patients with chronic pulmonary disease associated with pulmonary hypertension. One hundred and twenty-seven patients with pulmonary hypertension (mean pulmonary arterial pressure > or = 20 Torr) participated in this study. Fifty-four patients had chronic pulmonary emphysema, 5 chronic bronchitis, 19 diffuse panbronchiolitis, 29 old tuberculosis, 8 pulmonary fibrosis, and 12 other diseases. Fifty-one patients died of respiratory failure. The survival curve of patients who received HOT was not different from that of patients who did not receive HOT, although FEV1 and PaO2, both prognostic factors, were significantly worse in the patients who received HOT than in the patients who did not receive HOT. In the patients with COPD, the survival rate of patients who received HOT was significantly higher than that of those who did not receive HOT. The mean survival time of the patients who received HOT was significantly longer than that of the patients who did not received HOT (1971 +/- 217 SEM days and 978 +/- 156 days, respectively). From these data, we conclude that HOT improves the survival of patients with chronic pulmonary disease, especially COPD, associated with pulmonary hypertension.
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PMID:[Effect of home oxygen therapy on prognosis of patients with chronic pulmonary disease associated with pulmonary hypertension]. 130 22

There were 34 episodes of pneumothorax out of 400 episodes of COPD (i.e. 8.5% of the total) among patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986; the episodes of pneumothorax occurred among 22 males and one female, with the average age on admission being 64.0 +/- 8.5 years. All patients had a long history of smoking (average 40 years) with a history of recurrent pneumothorax (47.8%) and two episodes of pneumothorax per patient. Since only about one third of our patients had chest pain or positive signs of pneumothorax on physical examination, the possibility of pneumothorax should be considered in every patient who develops sudden and increasing shortness of breath, especially during mechanical ventilation, or even in association with other obvious precipitating factors, e.g. URI. With regard to complications, there were eight, four, two, two and five episodes of severe respiratory failure requiring assisted ventilation, tension pneumothorax, bilateral simultaneous pneumothorax, pneumomediastinum with subcutaneous emphysema, and plural effusion, respectively. The death rate was 23.5 per cent. Patients who had a pneumothorax requiring assisted ventilation or who developed a pneumothorax during assisted ventilation had a grave prognosis because of multiple complications from mechanical ventilation. Two episodes with minimal pneumothoraxes achieved re-expansion after conservative treatment. The treatment required 3.3 days for the lung to fully expand, 9.6 days when the air-leak stopped and the duration of tube drainage was 10.8 days. Our study indicates that the longer the duration of lung collapse the longer the time required for re-expansion of the lung.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spontaneous pneumothorax in chronic obstructive pulmonary disease. 140 43

The incidence of mediastinal emphysema (ME) and pneumothorax (PTX) was analyzed to determine the roentgenographic patterns and risk factors for the development of barotrauma in a population of mechanically ventilated patients. The roentgenograms of 139 intubated patients admitted to our medical intensive care unit over a ten-month period were evaluated for the presence of ME and PTX. Barotrauma was diagnosed in 34 of these patients, and ME was the initial manifestation in 24 patients. Of these patients with initial ME, ten subsequently developed PTX, a positive predictive value of 42 percent. The adult respiratory distress syndrome (ARDS) patient population was at highest risk for barotrauma, with an intermediate risk seen in those admitted with COPD or pneumonia. Values of peak inspiratory pressure, positive end-expiratory pressure level, respiratory rate, tidal volume, and minute ventilation were significantly elevated in patients who developed barotrauma as compared with patients who did not develop barotrauma. However, these elevations in part reflect the high incidence of barotrauma in the ARDS population, a patient group in which all of the above parameters were elevated.
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PMID:Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. 836 43

A 76-year-old man, whose carotid bodies had been resected for treatment of bronchial asthma 40 years previously was admitted for evaluation of abnormal arterial blood gases and exertional dyspnea. The case was diagnosed clinically as chronic pulmonary emphysema. His peripheral chemoreceptor function, estimated by hypoxic ventilatory and P0.1 response tests and withdrawal test was non-functioning. His PaCO2 value tended to rise over 50 Torr either after light exercise or during airway infection, though it was normal at rest. In addition his dyspnea had continued for 40 years in spite of carotid body resection. It was concluded that the effect of carotid body resection lasts more than 40 years and it does not have a good effect on COPD.
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PMID:[A case of chronic pulmonary emphysema with a past history of bilateral carotid body resection]. 175 14

We report a patient with COPD and bullous emphysema treated with narcotic antagonists (naloxone and naltrexone) for severe respiratory failure, with hypoxemia and hypercapnia, non responding to traditional medical therapy. According to previous reports, this treatment was started while waiting for lung transplantation, and it improved clinical pattern and arterial blood gas levels. Though the patient died for left ventricular failure fifteen days after the beginning of therapy, we think that narcotic antagonists can be successfully administered in some patients with advanced stage COPD.
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PMID:[Naloxone and naltrexone in the therapy of advanced COPD]. 185 43


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