The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials.

Although inhaled corticosteroids are commonly used to treat patients with chronic obstructive pulmonary disease (COPD), their effect on clinical outcomes such as exacerbation and mortality is unknown. This systematic review was conducted to determine whether inhaled corticosteroids improve clinical outcomes for patients with stable COPD. All placebo-controlled randomized trials of inhaled corticosteroids given for at least 6 months for stable COPD were identified by searching MEDLINE (1966-2000), EMBASE (1980-2001), CINAHL (1982-2000), SIGLE (1980-2000), the Cochrane Controlled Trial Registry, and the bibliographies of published studies.

Obesity is a risk factor for dyspnea but not for airflow obstruction.

Background: Previous research suggests that obesity is an important risk factor for asthma. However, since obesity can cause dyspnea through mechanisms other than airflow obstruction, diagnostic misclassification of asthma could partially account for this association.

Objective: To determine whether there is a relationship between obesity and airflow obstruction.

Measurement of carbonaceous aerosols: validation and comparison of a solvent extraction-gas chromatographic method and a thermal optical transmittance method.

A solvent extraction-gas chromatographic method was developed for the measurement of four classes of solvent-extractable organic compounds (SEOC), viz., aliphatic hydrocarbons, polynuclear aromatic hydrocarbons, fatty acids and alkanols, in ambient carbonaceous aerosols. The selectivity and recovery of the method using different solvents commonly used in the analysis of SEOC was evaluated.

Asthma and COPD among aboriginals in Alberta, Canada.

Background: Aboriginals in Canada bear a disproportionately higher burden of some chronic illnesses than nonaboriginals. Although there is a greater prevalence of smoking, poor housing, and overcrowding in aboriginal than nonaboriginal communities, the rates of office and emergency visits for asthma and COPD among aboriginals are not well known.

Study Objective: To determine whether aboriginals require higher rates of asthma and COPD emergency and office visits than nonaboriginals.

A study of polychlorinated dibenzo-p-dioxins and dibenzofurans in the atmosphere of Hong Kong.

A total of 27 ambient air samples of were collected from six locations in Hong kong during the period of January-August, 2000 and analysed for polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs). In all sampling locations, higher concentrations of PCDDs/PCDFs, ranging from 0.03 to 0.

The impact of chronic obstructive pulmonary disease on work loss in the United States.

Chronic obstructive pulmonary disease (COPD) is a rapidly growing public health problem in the United States and elsewhere. Although direct costs of COPD are well documented, the impact of COPD and its severity on labor force participation is not well known. Using population-based data from the Third National Health and Nutrition Examination Survey (NHANES III), we determined the adjusted relationship between COPD (and its severity) and labor force participation in the U.

The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: a population-based study.

Purpose: To examine the relation between follow-up office visits after emergency discharge and the risk of emergency readmissions in patients with asthma or chronic obstructive pulmonary disease (COPD).

Subjects And Methods: We used population-based data to identify all patients in Alberta, Canada, who had at least one emergency visit for asthma or COPD between April 1, 1996, and March 31, 1997 (N = 25 256). A Cox proportional hazards model was used to estimate the adjusted relative risk (RR) of a repeat visit to an emergency department within 90 days of an initial emergency visit in patients who did or did not have an office follow-up within the first 30 days.

Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study.

Study Objectives: To determine long-term compliance rates to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea enrolled in a comprehensive CPAP program in the community.

Design: Prospective cohort longitudinal study.

Setting: University sleep disorders center.

Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease.

There is considerable controversy concerning the utility of inhaled corticosteroids for the long-term treatment of patients with COPD. Recent studies have suggested that although inhaled corticosteroids do not alter the rate of decline in lung function, they may reduce airway hyperresponsiveness, decrease the frequency of exacerbations, and slow the rate of decline in the patients' health status. The relationship between inhaled corticosteroids and subsequent risk of hospitalization or mortality remains unknown.

Do area-based markers of poverty accurately measure personal poverty?

Area-based markers of deprivation (e.g., postal codes) are commonly used to identify groups of people with low socioeconomic status (SES); the validity of this approach, however, remains unknown.

Inhaled corticosteroid therapy reduces the risk of rehospitalization and all-cause mortality in elderly asthmatics.

Elderly patients with asthma have relatively high rates of hospitalization and mortality. Although inhaled corticosteroids have been shown to improve outcomes among younger patients with asthma, their usefulness in elderly patients has not been established. Therefore, a population-based study of patients 65 yrs of age or older, who have been hospitalized at least once with asthma in Ontario, Canada was conducted to determine the impact of inhaled corticosteroids on rehospitalization for asthma and all-cause mortality rates.

Development of an analytical technique and stability evaluation of 143 C3-C12 volatile organic compounds in Summa canisters by gas chromatography-mass spectrometry.

A technique using Summa canisters with cryogenic preconcentration and gas chromatographic-mass spectrometric (GC-MS) detection was developed to determine 143 C3-C12 volatile organic compounds (VOCs) including alkanes, alkenes, aromatics and halohydrocarbons in ambient and indoor air. The method detection limits and practical quantification limits were sensitive at 0.02 and 0.

Underuse of inhaled steroid therapy in elderly patients with asthma.

Study Objectives: Despite their proven efficacy, inhaled steroids may be underused in the elderly asthmatic population. The objectives of this study were to determine if inhaled steroids are underused in the elderly asthmatic population, who are at a high risk for rehospitalization and mortality, and to identify certain risk factors that predict lower use of inhaled steroids in this group of patients.

Design: Population-based, retrospective, cohort study using linked data from hospital discharge and outpatient drug databases.

Outpatient antibiotic therapy and short term mortality in elderly patients with chronic obstructive pulmonary disease.

Objective: To determine the association between outpatient use of oral antibiotics and 30-day all-cause mortality following hospitalization in a group of elderly chronic obstructive pulmonary disease (COPD) patients.

Design: A population-based retrospective cohort study.

Setting: Ontario, Canada.

Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration.

Background: Continuous positive airway pressure (CPAP) improves cardiac function in patients with congestive heart failure (CHF) who also have Cheyne-Stokes respiration and central sleep apnea (CSR-CSA). However, the effects of CPAP in CHF patients without CSR-CSA have not been tested, and the long-term effects of this treatment on clinical cardiovascular outcomes are unknown.

Methods And Results: We conducted a randomized, controlled trial in which 66 patients with CHF (29 with and 37 without CSR-CSA) were randomized to either a group that received CPAP nightly or to a control group.

Are elderly patients with obstructive airway disease being prematurely discharged?

Despite the temporal trend toward decreasing length of hospital stay for all medical conditions in North America, the effect of different lengths of hospitalization on short-term outcomes such as readmission or mortality has not been well studied. However, there is growing concern that very short stays in hospital may result in premature discharges, which may lead to worse outcomes for patients. We conducted a population-based study of elderly patients with obstructive airway disease in Ontario, Canada to test the hypothesis that very short initial hospital stays increase the short-term risk for readmission and mortality.

Lack of association between ipratropium bromide and mortality in elderly patients with chronic obstructive airway disease.

Background: Ipratropium is commonly used for the management of elderly patients with obstructive airway disease. However, a recent report suggested that its use might be associated with a significant increase in mortality. A study was therefore conducted to compare all-cause mortality rates between users and non-users of ipratropium in elderly patients with either asthma or chronic obstructive pulmonary disease (COPD).

Hypercapnic ventilatory response in patients with and without obstructive sleep apnea: do age, gender, obesity, and daytime PaCO(2) matter?

Study Objective: To evaluate the relationship between obstructive sleep apnea (OSA) and ventilatory responsiveness to carbon dioxide in both men and women.

Design: An analysis of 219 patients referred to an university-based sleep center between 1989 to 1994 was conducted (104 with OSA and 115 without OSA; 43 women and 176 men). These patients had spirometry and a daytime hypercapnic ventilatory response (HCVR) test that was corrected to the patient's ability to attain maximal ventilation.

Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure.

In previous analyses of the occurrence of central (CSA) and obstructive sleep apnea (OSA) in patients with congestive heart failure (CHF), only men were studied and risk factors for these disorders were not well characterized. We therefore analyzed risk factors for CSA and OSA in 450 consecutive patients with CHF (382 male, 68 female) referred to our sleep laboratory. Risk factors for CSA were male gender (odds ratio [OR] 3.

Dapsone- and primaquine-induced methemoglobinemia in HIV-infected individuals.

Clinically significant methemoglobinemia can develop as a result of medications. Although dapsone and primaquine are known to produce methemoglobinemia in susceptible individuals, methemoglobinemia has been reported only rarely in the human immunodeficiency virus (HIV) population. We describe five cases of methemoglobinemia caused by either primaquine or dapsone alone or in combination.

Urethral caruncle occurring in a young girl--a case report.

Urethral caruncles are the most common benign tumors in the female urethra, and are usually found in the posterior lip of the urethral meatus of post-menopausal women. It is very rare in young girls. Its etiology is unknown.