Sunday, September 15, 2013

0 Acute rhinosinusitis: New guidelines for diagnosis and treatment




Journal of the American Academy of Physician Assistants:


doi: 10.1097/01.JAA.0000431519.28443.5e

Special Topics in Otolaryngology






Acute rhinosinusitis: New guidelines for diagnosis and treatment



Teeters, Jennifer ATC; Boles, Michelle; Ethier, Julie; Jenkins, Ambria; Curtis, L. Gail PA-C, MPAS




Free Access





Article Outline


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Author Information





Jennifer Teeters, Michelle Boles, Julie Ethier, and Ambria Jenkins are graduates of the PA program at Wake Forest School of Medicine, Winston-Salem, North Carolina. L. Gail Curtis is an associate professor and vice chair of the department of physician assistant studies at Wake Forest School of Medicine. The authors have indicated no relationships to disclose relating to the content of this article.

Roy A. Borchardt, PA-C, PhD, department editor.




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Abstract





ABSTRACT: New treatment guidelines for acute rhinosinusitis outline when antibiotic therapy is appropriate, as well as describe evidence-based treatment to relieve symptoms, prevent complications, and prevent chronic disease.


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Open Access


Research


The role of uPAR in epithelial-mesenchymal transition in small airway epithelium of patients with chronic obstructive pulmonary disease



Qin Wang, Yunshan Wang, Yi Zhang, Yuke Zhang and Wei Xiao










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Respiratory Research 2013, 14:67 doi:10.1186/1465-9921-14-67

Published: 28 June 2013





Abstract (provisional)


Background


Epithelial-mesenchymal transition (EMT) plays a crucial role in small airway fibrosis of patients with chronic obstructive pulmonary disease (COPD). Increasing evidence suggests that the urokinase plasminogen activator receptor (uPAR) is involved in the pathogenesis of COPD. Increased uPAR expression has been implicated in the promotion of EMT in numerous cancers; however the role of uPAR in EMT in small airway epithelial cells of patients with COPD remains unclear. In this study, we investigated the degree of EMT and uPAR expression in lung epithelium of COPD patients, and verified the effect of uPAR on cigarette smoke extract (CSE)-induced EMT in vitro.

Methods


The expression of EMT biomarkers and uPAR was assessed in lung epithelium specimens from non-smokers (n = 25), smokers (n = 25) and non-smokers with COPD (n = 10) and smokers with COPD (n = 18). The role of uPAR on CSE-induced EMT in human small airway epithelial cells (HSAEpiCs) was assessed by silencing uPAR expression in vitro.

Results


Markers of active EMT and uPAR expression were significantly increased in the small airway epithelium of patients with COPD compared with controls. We also observed a significant correlation between uPAR and vimentin expression in the small airway epithelium. In vitro, CSE-induced EMT in HSAEpiCs was associated with high expression of uPAR, and targeted silencing of uPAR using shRNA inhibited CSE-induced EMT. Finally, we demonstrate that the PI3K/Akt signaling pathway is required for uPAR-mediated EMT in HSAEpiCs.

Conclusions


A uPAR-dependent signaling pathway is required for CSE-induced EMT, which contributes to small airway fibrosis in COPD. We propose that increased uPAR expression in the small airway epithelium of patients with COPD participates in an active EMT process.






The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.










The association between COPD and heart failure risk: a review




Article has an altmetric score of 1




Review


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Authors: de Miguel Díez J, Chancafe Morgan J, Jiménez García R


Published Date June 2013 Volume 2013:8 Pages 305 – 312
DOI: http://dx.doi.org/10.2147/COPD.S31236















Received:28 February 2013
Accepted:12 April 2013
Published:28 June 2013

Javier de Miguel Díez,1 Jorge Chancafe Morgan,1 Rodrigo Jiménez García2


1Pulmonology Department, Gregorio Maranon University Hospital, Complutense University of Madrid, Madrid, Spain; 2Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Rey Juan Carlos University, Madrid, Spain


Abstract: Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure (HF) in clinical practice since they share the same pathogenic mechanism. Both conditions incur significant morbidity and mortality. Therefore, the prognosis of COPD and HF combined is poorer than for either disease alone. Nevertheless, usually only one of them is diagnosed. An active search for each condition using clinical examination and additional tests including plasma natriuretic peptides, lung function testing, and echocardiography should be obtained. The combination of COPD and HF presents many therapeutic challenges. The beneficial effects of selective ß1-blockers should not be denied in stable patients who have HF and coexisting COPD. Additionally, statins, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers may reduce the morbidity and mortality of COPD patients. Moreover, caution is advised with use of inhaled ß2-agonists for the treatment of COPD in patients with HF. Finally, noninvasive ventilation, added to conventional therapy, improves the outcome of patients with acute respiratory failure due to hypercapnic exacerbation of COPD or HF in situations of acute pulmonary edema. The establishment of a combined and integrated approach to managing these comorbidities would seem an appropriate strategy. Additional studies providing new data on the pathogenesis and management of patients with COPD and HF are needed, with the purpose of trying to improve quality of life as well as survival of these patients.


Keywords: chronic obstructive pulmonary disease, heart failure



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BMJ Open. 2013; 3(6): e003177.

Published online 2013 June 19. doi:  10.1136/bmjopen-2013-003177




PMCID: PMC3693416





The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol



Simon L Bacon,1,2,3 Kim L Lavoie,1,3,4 Jean Bourbeau,5 Pierre Ernst,5,6 Karim Maghni,3 Denyse Gautrin,3,7 Manon Labrecque,3,7 Veronique Pepin,1,2,3 and Bente Klarlund Pedersen8



Author information ► Article notes ► Copyright and License information ►







Abstract




Objective


Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles.



Design


A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50–75% of heart rate reserve for weeks 1–4, then 70–85% for weeks 5–12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques.



Ethics and dissemination


The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time.



Results


The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public.



Registration Details ClinicalTrials.gov Identifier


NCT00953342



Keywords: Exercise, Quality of life, Inflammation





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Open Access


Research


Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea



Tsai-Yu Wang1†, Yu-Lun Lo1†, Kang-Yun Lee1, Wen-Te Liu2,3, Shu-Min Lin1, Ting-Yu Lin1,Yung-Lun Ni4, Chao-Yung Wang5, Shu-Chuan Ho1,3 and Han-Pin Kuo1*






Author Affiliations


1Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan

2Division of Pulmonary, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan

3School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

4Department of Chest Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan

5Department of Cardiology Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan


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Respiratory Research 2013, 14:66 doi:10.1186/1465-9921-14-66



The electronic version of this article is the complete one and can be found online at:http://respiratory-research.com/content/14/1/66

















Received:11 February 2013
Accepted:17 June 2013
Published:19 June 2013


© 2013 Wang et al.; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.







Abstract



Background


Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea.

Methods


Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment.

Results


After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564).

Conclusion


Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome.

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Keywords: 

Chronic obstructive pulmonary disease; Obstructive sleep apnoea; Walking capacity; Autonomic dysfunction; Continuous positive airway pressure










Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis




Article has an altmetric score of 1




Original Research


(419) Total Article Views





Authors: Yawn BP, Li YF, Tian HJ, Zhang J, Arcona S, Kahler KH


Published Date June 2013 Volume 2013:8 Pages 295 – 304
DOI: http://dx.doi.org/10.2147/COPD.S42366















Received:05 January 2013
Accepted:22 March 2013
Published:27 June 2013

Barbara P Yawn,1 Yunfeng Li,2 Haijun Tian,2 Jie Zhang,2 Steve Arcona,2 Kristijan H Kahler2


1Department of Research, Olmsted Medical Center, Rochester, MN, USA; 2Department of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA


Background: The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses.
Objective: Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia.
Patients and methods: This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006–2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 µg–499 µg, 500 µg–999 µg, and ≥1000 µg fluticasone equivalents daily) and was modeled as a time-dependent variable.
Results: Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27–1.49) for low-dose users, 1.69 (1.52–1.88) for medium-dose users, and 2.57 (1.98–3.33) for high-dose users (P - 0.01 versus no use and between doses).
Conclusion: The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia.


Keywords: COPD, ICS, LABA, pneumonia



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Thorax 68:658-663 doi:10.1136/thoraxjnl-2012-203109




  • Epidemiology



  • Original article



Effectiveness of influenza vaccination in working-age adults with diabetes: a population-based cohort study


Open Access









  1. Jeffrey A Johnson1


+Author Affiliations




  1. 1Department of Public Health Sciences, University of Alberta, Edmonton, Canada




  2. 2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada




  3. 3Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada





  1. Correspondence toDr Jeffrey A Johnson, 2-040G Li Ka Shing Center for Health Research Innovation, 8602 112 Street, Department of Public Health Sciences, University of Alberta, Edmonton, Canada, AB T6G 2E1; jeff.johnson@ualberta.ca




  • Received 7 December 2012


  • Revised 7 February 2013


  • Accepted 2 March 2013


  • Published Online First 27 March 2013




Abstract




Background Guidelines recommend influenza vaccinations in all diabetic adults, but there is limited evidence to support vaccinating working-age adults ( – 65 years) with diabetes. We examined the effectiveness of influenza vaccine in this subgroup, compared with elderly adults (+ 65 years) for whom vaccination recommendations are well accepted.








Methods We identified all adults with diabetes, along with a sample of age-matched and sex-matched comparison subjects without diabetes, from 2000 to 2008, using administrative data from Manitoba, Canada. With multivariable Poisson regression, we estimated vaccine effectiveness (VE) on influenza-like illnesses (ILIs), pneumonia and influenza (PI) hospitalisations and all-cause (ALL) hospitalisations during periods of known circulating influenza. Analyses were replicated outside of influenza season to rule out residual confounding.



Results We included 543 367 person-years of follow-up, during which 223 920 ILI, 5422 PI and 94 988 ALL occurred. The majority (58%) of adults with diabetes were working age. In this group, influenza vaccination was associated with relative reductions in PI (43%, 95% CI 28% to 54%) and ALL (28%, 95% CI 24% to 32%) but not ILI (−1%, 95% CI −3% to 1%). VE was similar in elderly adults for ALL (33–34%) and PI (45–55%), although not ILI (12–13%). However, similar estimates of effectiveness were also observed for all three groups during non-influenza control periods.



Conclusions Working-age adults with diabetes experience similar benefits from vaccination as elderly adults, supporting current diabetes-specific recommendations. However, these benefits were also manifest outside of influenza season, suggesting residual bias. Vaccination recommendations in all high-risk adults would benefit from randomised trial evidence.




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    1. thoraxjnl-2012-203109v1


    2. 68/7/658 most recent






This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ andhttp://creativecommons.org/licenses/by-nc/3.0/legalcode








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