Respiratory Medicine: X最新文献

Background

There are similar risk factors for the development of chronic obstructive pulmonary disease (COPD) and lung cancer. It is recognized that COPD is common in patients with lung cancer. However, the prevalence of lung cancer in the COPD population remains unclear. We performed a systematic review and meta-analysis to determine the prevalence of lung cancer in COPD.

Methods

Four databases (MEDLINE, EMBASE, PubMed, CINAHL) examining the prevalence of lung cancer in COPD were searched for studies published between 1997 and 2018. Meta-analysis with a random effects model was used to calculate pooled prevalence for the included studies. A sub-group analysis was performed for studies of similar population and design. Odds ratios were calculated for case-control studies.

Results

Twenty-one studies that examined the prevalence of lung cancer in a population of 1,682,908 individuals with COPD were included. The pooled prevalence for lung cancer in COPD was 2.79% (95% CI: 1.88–3.88). Results are confounded by significant heterogeneity among studies (Q = 12,622, I² = 100%), particularly related to the large variation in sample size and study design. Seven studies compared lung cancer prevalence in COPD to controls without COPD with an odds ratio of 6.35 (95% CI: 3.98–10.15).

Conclusions

Although the prevalence of lung cancer in individuals with COPD is low, it is greater than the prevalence of lung cancer in the general population. Knowledge of the co-occurrence of lung cancer in COPD will inform the screening of lung cancer for patients who have COPD.

Background

The association of obesity and asthma has been described in children and adults. However, whether a different life course of weight in men and women may explain gender differences in asthma incidence, has not been addressed.

Objectives

Using data from the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults, we investigated the role of overweight/obesity as measured by body silhouettes at different life stages in men and women for asthma incidence.

Methods

Our analysis included 5417 subjects who were asthma free at age 8, followed up to 2011, and had complete covariate information. The main predictor of interest was self-reported body silhouettes at age 8, menarche, 30, 45, menopause, and 60, and additionally changes in body silhouette number across these different time points. Asthma incidence was defined as newly reported doctor-diagnosed asthma after the body silhouette time point. Asthma incidence and its association with body silhouettes was analysed using sex stratified logistic regression, adjusting for age, atopy, urbanity, smoking, parental asthma, education and study area.

Results

Men at age 60 had an increased risk of asthma incidence per unit increase in body silhouette number (OR 1.93, 95% CI 1.13–3.30). This association was stronger in women at age 60 (OR 2.78, 95% CI 1.49–5.18) and observed also at menopause (OR 1.35, 95% CI 1.03–1.78), as well as per unit change in body silhouette number between age 45 – menopause (OR 1.74, 95% CI 1.15–2.63).

Conclusion

In this longitudinal study, the risk of incident asthma increased in men and women with a larger body silhouette in late adulthood. In women, this risk appeared present between age 45 and menopause. At age 60, both men and women were at higher risk of asthma incidence per unit increase in body silhouette, the risk being more pronounced in women. The age-related increase of obesity may underlie gender differences in asthma incidence at higher ages.

Exacerbations, which often lead to emergency department visits and hospitalizations, are the main drivers of morbidity and utilization of health care resources among patients with chronic obstructive pulmonary disease (COPD). Appropriate choice of an effective, long-term pharmacotherapy for reducing exacerbations is key to COPD management. In this review, we summarize the available long-acting, maintenance pharmacotherapeutic options for patients with moderate or severe COPD and discuss practical considerations in the management of these patients. Bronchodilators are the cornerstone of pharmacological treatment for COPD, and long-acting muscarinic antagonists (LAMAs) are recommended as initial treatment for most patients with COPD. Dual bronchodilation with a LAMA and long-acting β₂-agonist (LABA), with their synergistic bronchodilatory actions, is the mainstay of long-term COPD maintenance pharmacotherapy for patients with high symptom burden, persistent symptoms, or exacerbations. Evidence hints that the effects of different LAMA + LABA combinations may not always be similar, suggesting the presence of an efficacy gradient. However, large-scale clinical trials directly comparing different LAMA + LABA combinations are needed to support or refute this observation. Use of an inhaled corticosteroid in addition to LABA or LAMA + LABA as the initial or follow-up pharmacological treatment is now guided by eosinophil count thresholds. In addition to various medication options, different inhalation devices are available to deliver the medications. When making treatment decisions, medication class, inhalation device, patient and disease characteristics, and patient goals and preferences should be considered.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in < Respiratory Medicine: X 1C 100007>, http://dx.doi.org/<10.1016/j.yrmex.2019.100007>. The duplicate article has therefore been withdrawn.

The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Background

Many patients with COPD are ventilatory limited and unable to tolerate effective levels of aerobic training. A scooter could be an enticing training modality if muscle activity is partitioned and distal leg muscle activity is emphasized. The aim of this study was to determine whether scooting might emphasize leg heaviness (desired muscle burden), relative to the breathing heaviness, when compared with walking.

Methods

Participants completed two endurance tests, walking and scooting. The intensity for each targeted similar tolerable exercise times (t_limit) simulating comparable training session exposure. Participants scored (Borg_0-10) leg and breathing heaviness throughout each test and the slope calculated. Electromyography was used to quantify leg muscle activity.

Results

15 participants with COPD (mean[SD]: age = 64[11]y; FEV₁ = 52[17]%predicted; FEV₁/FVC = 50[10]%) completed the study. Successful matching of intensity between modalities was demonstrated by similar t_limit (difference [95%CI] = -0.3[-2.8 to 2.1]min). Scooting resulted in more (60[24 to 95]%) activity of the gastrocnemius in the propulsion and less (−82[-91 to −72]%) in the support leg. Rectus femoris activity was reduced (−68[-95 to −41]%) and increased (117[49 to 184]%) in the propulsion and support leg, respectively. There was no significant difference (0.1[-0.1 to 0.2]) in the relationship between breathing and leg heaviness when scooting was compared to walking.

Conclusions

Scooting is associated with increased activity of the distal muscles of propulsion of the scooting leg. However, this is offset by the increased activity of the support leg as it resists the rotational force of propulsion, such that the relationship between breathing and leg heaviness is not altered.