Endurance shuttle walking test: responsiveness to salmeterol in COPD.

Few studies have shown that the endurance shuttle walking test (ESWT) is responsive to treatment in patients with chronic obstructive pulmonary disease (COPD). This exercise test needs to be further investigated because of its relevance for activity of daily living. The aim of the present study was to evaluate, in patients with COPD, the responsiveness of the ESWT in detecting improvement in walking performance after a single dose of salmeterol.

Self-administered prescriptions of oral steroids and antibiotics in chronic obstructive pulmonary disease: are we doing more harm than good?

Patients with chronic obstructive pulmonary disease (COPD) are often given a prescription for a short course of oral steroids and antibiotics for self-administration during an acute exacerbation. The main objective of this study was to determine the impact of such prescriptions on medical care utilization, and steroids and antibiotics intake. This retrospective cohort study included patients with moderate to severe COPD participating in a self-management programme.

Symposium on obesity and asthma - November 2, 2006.

Asthma and obesity are frequently associated, and obesity has been considered a factor contributing to both an increase in severity of asthma and to its development. The present document summarizes the proceedings of a symposium held in Montreal, Quebec, on November 2, 2006, under the auspices of the Réseau en santé respiratoire du Fonds de la recherche en santé du Québec in collaboration with the McGill University - Strauss Severe Asthma Program, Université Laval (Quebec City) and Université de Montréal. It includes an overview of the various aspects of the relationships between asthma and obesity with regard to animal models; genetic, hormonal and physiological determinants; influence of comorbidities (eg, sleep apnea syndrome); epidemiology; clinical and psychological features; and management of asthma in the obese population.

Surgical anatomy of the bronchial tree and pulmonary artery.

Sleeve lobectomy is an excellent procedure in the surgical management of non-small-cell lung cancer located in proximal lobal bronchi. The surgeon undertaking these procedures has, however, the responsibility of understanding the particular anatomy applicable to the technique. Good knowledge of the topographic anatomy of the tracheobronchial tree and of its blood supply is necessary to reduce the operative morbidity, whereas that of the oncological anatomy of lung cancer forms the theoretical basis for the operation and improves the potential for better long-term results.

Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease.

Background: The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported. The current literature suggests that the 6 min walking test (6MWT) is less responsive to bronchodilation than the endurance shuttle walk.

Aim: To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk.

Hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP) is a pulmonary disease with symptoms of dyspnea and cough resulting from the inhalation of an antigen to which the subject has been previously sensitized. The incidence of HP is unknown. A population-based study estimated the annual incidence of interstitial lung diseases as 30:100,000 and HP accounted for less than 2% of these cases.

Algae-induced occupational asthma in a thalassotherapist.

Background: Algae powders have been increasingly used in therapeutic preparations. Their potential as inducers of occupational asthma (OA), however, remains to be demonstrated.

Methods: A 33-year-old woman developed asthma following exposure to algae powder used for thalassotherapy.

Meta-analysis of silicosis and lung cancer.

Objectives: This study examined the association between silicosis and lung cancer in a systematic review (and meta-analysis) of the epidemiologic literature, with special reference to the methodological quality of observational studies.

Methods: We searched Medline, Toxline, BIOSIS and Embase (1966-May 2004) for original articles published in any language and systematically reviewed the bibliographies of the retrieved articles. Observational studies (cohort and case-control studies) were selected if they reported a measure of association [standardized mortality ratio (SMR), relative risk or odds ratio] relating lung cancer to silicosis.

Bleeding "downhill" varices: a rare complication of intrathoracic goiter.

We report a case of a 68-year-old woman with a 16-year history of a benign goiter. The patient presented with hematemesis and a clinically evident superior vena cava syndrome. Preoperative evaluation demonstrated upper esophageal varices and large posterior mediastinal goiter.

The validity of diagnosing chronic obstructive pulmonary disease from a large administrative database.

Background: Health authorities create and maintain administrative databases. Despite the potential advantages of these databases, the validity of the information they include must be considered.

Objective: To examine the validity of diagnosing chronic obstructive pulmonary disease (COPD) from a large administrative database.

Modulation of airway inflammation and resistance in mice by a nicotinic receptor agonist.

Nicotinic agonists, including 1,1-dimethyl-4-phenylpiperazinium (DMPP), have anti-inflammatory properties and in some instances smooth muscle relaxing effects. Since inflammation and airway smooth muscle contraction are two major components of asthma, the present authors investigated the effects of DMPP on airway inflammation and airway resistance in a mouse model of asthma. Mice were sensitised and challenged with ovalbumin (OVA) and treated either intraperitoneally or intranasally with DMPP.

Randomised trial of ambulatory oxygen in oxygen-dependent COPD.

Long-term oxygen therapy may limit a patient's ability to remain active and may be detrimental to the rehabilitation process. This study aimed to determine the effect of ambulatory oxygen on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease fulfilling the usual criteria of long-term oxygen therapy. In a 1-yr, randomised, three-period, crossover trial, 24 patients (mean age 68 yrs; mean arterial partial pressure of oxygen at rest 7.

Prospective evaluation of nocturnal oximetry for detection of sleep-related breathing disturbances in patients with chronic heart failure.

Background: Because patients with chronic heart failure (CHF) can benefit from specific treatment for coexisting obstructive and central sleep apnea (CSA), there is a need to develop accurate screening tools to identify or exclude these sleep-related breathing disturbances (SRBDs) in patients with CHF.

Objectives: To evaluate, prospectively, the diagnostic value of nocturnal home oximetry in identifying SRBD in CHF patients and in distinguishing central events from obstructive events.

Design: Blinded comparison of hospital and home oximetry, and polysomnographic nocturnal recordings

Setting: Cardiac heart failure and sleep clinics in three tertiary referral centers.

Randomized trial of paroxetine in end-stage COPD.

Background: Although the underlying pathology is initially confined to the lungs, the associated emotional responses to chronic obstructive pulmonary disease (COPD) contribute greatly to the resulting morbidity. The objective of this study was to examine the effect of an antidepressant drug on disease-specific quality of life in patients with end-stage COPD who present significant depressive symptoms.

Methods: We conducted a 12-week, randomized double-blind placebo-controlled trial of Paroxetine in which quality of life measured by the Chronic Respiratory Questionnaire (CRQ), an evaluative COPD-specific quality-of-life questionnaire, was the primary outcome.

Chronic inflammation induced by organic dust and related metabolic cardiovascular disease risk factors.

Objective: Chronic inflammation is now considered a risk factor for cardiovascular diseases. Exposure to organic dust induces an inflammatory response. This study was done to verify whether inflammation caused by exposure to organic dust increases the metabolic risk factors for cardiovascular diseases.

[Pulmonary gas exchange during exercise in healthy subjects].

Introduction: The modifications of gas exchange on exercise reflect the consequences of the control and limits of adaptation of the respiratory apparatus to the mechanical loads imposed on the muscles and the oxygen requirements of the organism. In the majority of cases, even if the thoraco-pulmonary apparatus is perfectly adapted to the increase in these requirements, the balance between the metabolic demands of the tissues and the pulmonary supply appears difficult to satisfy beyond certain limits without hypoxaemia, particularly in those subjects with a low ventilatory response to exercise. Based on the populations reported in the literature the functional limits of the control of the thoraco-pulmonary system and the possible modifications of the structures of the lung are discussed for each of these mechanisms.

Pulmonary rehabilitation: an integral part of the long-term management of COPD.

Pulmonary rehabilitation comprises a variety of interventions grouped into three main categories: exercise training, education, and psychological support. Typically, patients participate in a programme of exercise rehabilitation 2-3 times a week for 6-12 weeks, at the same time being encouraged to incorporate breathing and stretching exercises as part of their daily routine. The physiological rationale for pulmonary rehabilitation in COPD is primarily based on its effect on peripheral muscle dysfunction.

Adaptation of the diaphragm and the vastus lateralis in mild-to-moderate COPD.

The chronology of diaphragm and vastus lateralis adaptation in chronic obstructive pulmonary disease (COPD) has not been studied. The hypothesis of this study was that muscle changes would occur earlier in the diaphragm than in the vastus lateralis in COPD, a finding that would suggest that local factors would be more important than systemic factors in determining the muscle phenotypic expression, at least in mild-to-moderate disease. The adaptation of the vastus lateralis and diaphragm muscles was evaluated in patients with mild-to-moderate COPD and in subjects with normal pulmonary function.

Evaluation of a program aimed at increasing referrals for asthma education of patients consulting at the emergency department for acute asthma.

Background: Emergency department (ED) visits for asthma may reflect poor asthma control, often due to insufficient asthma education and medical follow-up. However, few patients consulting an ED for asthma are referred for education.

Aims: To describe a model for automatic referral to educational interventions targeting patients consulting at the ED for acute asthma, to demonstrate how this model can be integrated into current care, and to increase referrals for asthma education.

Sleeve pneumonectomy.

Lung cancer involving the carina can be treated by surgery, but patients must be carefully selected before the operation. Because pneumonectomy is required in addition to carinal resection, patients must be able to withstand the procedure, and they must be told that the operative mortality is 2 to 4 times higher than what is expected after standard pneumonectomy. Patients who have mediastinal nodal disease documented preoperatively by mediastinoscopy should not have this operation.

A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea.

Background: A short, standardised, self-administered quality of life questionnaire would be a useful addition to the outcome measures in obstructive sleep apnoea (OSA) research. A study was therefore undertaken to validate a new OSA specific self-administered questionnaire (the Quebec Sleep Questionnaire, QSQ) for use in clinical trials.

Methods: This study followed a description of health related quality of life in patients with OSA.