May 31, 2013

Small airways diseases, excluding asthma and COPD: an overview

Small airways diseases, excluding asthma and COPD:

an overview

+Author Affiliations

For a full list of affiliations see the Acknowledgements section

D. Dusser, Service de Pneumologie, Hôpital Cochin, 27 rue du Faubourg St Jacques, 75679 Paris Cedex 14, France. E-mail: daniel.dusser@cch.aphp.fr

Abstract

This review is the summary of a workshop on small airways disease, which took place in Porquerolles, France in November 2011. The purpose of this workshop was to review the evidence on small airways (bronchiolar) involvement under various pathophysiological circumstances, excluding asthma and chronic obstructive pulmonary disease. Histopathological patterns associated with small airways disease were reviewed, including cellular and obliterative bronchiolitis. Many pathophysiological conditions have been associated with small airways disease including airway infections, connective tissue diseases and inflammatory bowel diseases, bone marrow and lung transplantation, common variable immunodeficiency disorders, diffuse panbronchiolitis, and diseases related to environmental exposures to pollutants, allergens and drugs. Pathogenesis, clinical presentation, a computed tomography scan and pulmonary function test findings are reviewed, and therapeutic options are described with the objective of providing an integrative approach to these disorders.

doi:10.1183/09059180.00001313

Eur Respir Rev June 1, 2013 vol. 22 no. 128 131-147

Footnotes

↵We dedicate this manuscript to honour the legacy of our dear co-author and friend Isabelle Tillie-Leblond (1965–2013), for her outstanding contribution to respiratory disease care and research, and her unconditional friendship.
Provenance

Publication of this peer-reviewed article was supported by Chiesi SA, France (article sponsor, European Respiratory Review issue 128).
Statement of Interest

Conflict of interest information can be found alongside the online version of this article at err.ersjournals.com

Received March 12, 2013.
Accepted March 29, 2013.

©ERS 2013

Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study

Research article

Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study

Rachael Boggon, Richard Hubbard, Liam Smeeth, Martin Gulliford, Jackie Cassell, Susan Eaton, Munir Pirmohamed andTjeerd-Pieter van Staa

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BMC Pulmonary Medicine 2013, 13:32 doi:10.1186/1471-2466-13-32

Published: 31 May 2013

Abstract (provisional)

Background

The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations.

Method

A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models.

Results

COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5--2.32]), hazard ratio for mortality 2.14 [95%CI 1.59--2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48--73%). This variation is greater than can be explained by patient characteristics alone.

Conclusions

There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects.

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

Associations of Moderate to Severe Asthma with Obstructive Sleep Apnea

Original Article

Open Access


Yonsei Med J. 2013 Jul;54(4):942-948. English. Published online 2013 May 14. http://dx.doi.org/10.3349/ymj.2013.54.4.942
© Copyright: Yonsei University College of Medicine 2013


Associations of Moderate to Severe Asthma with Obstructive Sleep Apnea
Min Kwang Byun,¹ Seon Cheol Park,² Yoon Soo Chang,¹^,³ Young Sam Kim,²^,³ Se Kyu Kim,²^,³ Hyung Jung Kim,¹^,³ Joon Chang,²^,³ Chul Min Ahn,¹^,³ and Moo Suk Park²^,³
¹Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
²Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
³The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
Corresponding author: Dr. Moo Suk Park, Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-1974, Fax: 82-2-393-6884, Email: pms70@yuhs.ac

Received March 19, 2012; Revised September 10, 2012; Accepted September 11, 2012.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Purpose This study aimed to evaluate the correlation between associating factors of moderate to severe asthma with obstructive sleep apnea (OSA). Materials and Methods One hundred and sixty-seven patients who visited the pulmonary and sleep clinic in Severance Hospital presenting with symptoms of sleep-disordered breathing were evaluated. All subjects were screened with ApneaLink. Thirty-two subjects with a high likelihood of having OSA were assessed with full polysomnography (PSG). Results The mean age was 58.8±12.0 years and 58.7% of subjects were male. The mean ApneaLink apnea-hypopnea index (AHI) was 12.7±13.0/hr. The mean ApneaLink AHI for the 32 selected high risk patients of OSA was 22.3±13.2/hr, which was lower than the sleep laboratory-based PSG AHI of 39.1±20.5/hr. When OSA was defined at an ApneaLink AHI ≥5/hr, the positive correlating factors for OSA were age, male gender, and moderate to severe asthma. Conclusion Moderate to severe asthma showed strong correlation with OSA when defined at an ApneaLink AHI ≥5/hr.


Keywords: Apnea-hypopnea index, ApneaLink, asthma, obstructive sleep apnea, sleep-disordered breathing. Full Text

Increased serum complement C3 and C4 concentrations and their relation to severity of chronic spontaneous urticaria and CRP concentration

Short Report