RESUMEN
OBJECTIVE: Although pulmonary involvement is common in Wegener's granulomatosis (WG), little is known about the pulmonary outcome. We evaluated the relationship between clinical disease characteristics and pulmonary function and high-resolution computed tomography (HRCT) findings after disease duration of 5 years. METHODS: A pulmonary function test (PFT) and pulmonary HRCT were performed in 41 patients from a population-based register of WG. Clinical predictors for abnormal PFT and HRCT were tested by logistic regression. RESULTS: Previous WG-related lung involvement (PLI) had occurred in 80% of patients, but only 24% of patients still reported pulmonary symptoms at the research visit. One-third of patients had abnormal PFT findings, with reduced alveolar diffusion by KCO (transfer coefficient) being most common (24%). The number of PLI episodes was associated with reduced KCO and reduced FEV1% (forced expiratory volume in 1 s as a percentage of forced vital capacity) (overall presence 10%). Reduced KCO was also associated with disease duration. Reduced total lung capacity (TLC) (overall presence 8%) was only related to prior WG-related lung nodules. Pulmonary HRCT was abnormal in 80%, but with more severe abnormalities in only 30%. Pleural thickening and parenchymal bands were associated with PLI. None of the treatment variables was associated with the PFT or HRCT findings. CONCLUSION: Five years after disease onset a quarter of the WG patients reported pulmonary symptoms, had severe abnormalities on HRCT, and abnormal PFT. The correlation between these abnormalities was poor, but the number of pulmonary involvements was a risk factor for reduced gas diffusion, obstructive lung disease, parenchymal bands, and pleural thickening. Treatment variables had no discernible negative pulmonary effects.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/fisiopatología , Pulmón/fisiopatología , Sistema de Registros , Capacidad Pulmonar Total , Adolescente , Adulto , Edad de Inicio , Anciano , Niño , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Granulomatosis con Poliangitis/epidemiología , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Vigilancia de la Población , Factores de Tiempo , Tomografía Computarizada por Rayos X , Capacidad Pulmonar Total/fisiologíaRESUMEN
The aim of this study was to assess the effect of a low-dose testosterone on body composition and pulmonary function, as well as on quality of life, sexuality, and psychological symptoms in patients with chronic obstructive pulmonary disease (COPD). Twenty-nine men with moderate to severe COPD were allocated to receive either 250 mg of testosterone or placebo intra-muscularly, every fourth week, during the 26 weeks study period. Fat-free mass increased in the treatment group (P<0.05), and a significant difference between the treatment and the control group was seen after 26 weeks (P<0.05). Fat mass decreased in the treatment group (P<0.05), and there was a significant difference between the treatment and the control group after 12 weeks (P<0.01). A significantly better erectile function was reported in the treatment group at the final visit (P<0.05), and the overall sexual quality of life was significantly better in the treatment group after 12 weeks (P<0.05). No improvement in pulmonary function was found. In conclusion, administration of a low-dose testosterone to men with COPD for 26 weeks was associated with improvement of body composition, better erectile function and sexual quality of life. Furthermore, there were no clinical or biochemical side effects.
Asunto(s)
Composición Corporal/efectos de los fármacos , Erección Peniana/efectos de los fármacos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Testosterona/administración & dosificación , Absorciometría de Fotón/métodos , Tejido Adiposo/efectos de los fármacos , Anciano , Esquema de Medicación , Humanos , Inyecciones Intramusculares , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Erección Peniana/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Calidad de Vida , Pruebas de Función Respiratoria , Encuestas y Cuestionarios , Testosterona/análisisRESUMEN
The present study is concerned with plasma beta-endorphin and glucose tolerance in patients with chronic obstructive pulmonary disease (COPD). Plasma beta-endorphin, glucagon and insulin concentrations were measured during an oral glucose tolerance test in 20 COPD patients and in 18 age-matched healthy controls (mean age 62 years). Seven patients had a moderate COPD (group I) and seven a severe COPD (group II). The remaining six severe COPD patients received long-term oxygen therapy (group III). We found that fasting levels of beta-endorphin were significantly increased in all patient groups compared to healthy controls (p < 0.01, 0.05 and 0.005, respectively). Six of the 13 severely diseased COPD patients had impaired glucose tolerance. Plasma beta-endorphin levels decreased significantly during OGTT in the COPD patients (p < 0.05). Fasting beta-endorphin levels were higher in patients with impaired glucose tolerance than in those patients with normal OGTT (42.0 pmol/L +/- 11.4 SD versus 34.8 +/- 10.2). However, this difference was not statistically significant. In conclusion, this study showed that beta-endorphin concentrations are increased in COPD patients whether or not they receive oxygen therapy.
Asunto(s)
Enfermedades Pulmonares Obstructivas/sangre , betaendorfina/sangre , Glucemia/análisis , Estudios de Casos y Controles , Femenino , Glucagón/sangre , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To investigate the survival of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT). DESIGN: Retrospective study of 124 patients (76 males and 48 females, mean age 68 years) using LTOT from 1990 to 1996, studied with lifetable analyses. Seventy-six patients with PaO2 < or = 7.3 kPa, and 48 patients with PaO2 > or = 7.4 kPa were allocated to Groups I and II, respectively. RESULTS: The groups had similar FEV1 and FVC levels. The 2- and 5-year survival rates were 73% and 50%, respectively, in Group I, and 78% and 40% in Group II. PaCO2 and FVC were predictors of survival in Group II. Women lived significantly longer than men (Group I: P < 0.01, relative risk [RR] 0.341) but had better FEV1 (P < 0.01). Survival was significantly poorer for patients in the general hospital (P < 0.05, RR 2.096) compared with those at a university hospital. CONCLUSION: Survival during LTOT was similar in patients with and without severe hypoxaemia at the same level of loss of lung function. Survival was poorer when LTOT was not prescribed and followed in a department of respiratory medicine.
Asunto(s)
Tablas de Vida , Enfermedades Pulmonares Obstructivas/mortalidad , Terapia por Inhalación de Oxígeno , Anciano , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/terapia , Masculino , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Factores de TiempoRESUMEN
The aim of this study was to assess effect of long-term oxygen therapy (LTOT) on the function of central and autonomic nervous system in patients with hypoxaemic chronic obstructive pulmonary disease (COPD). A battery of neuropsychological tests was used together with the Short Test of Mental Status in addition to transcranial Doppler ultrasonography, and five cardiovascular tests as well as a questionnaire on autonomic function. Ten COPD patients, 4 males and 6 females, with a mean age of 65.9 +/- 7.3 (SD) years, were studied at the beginning and after 3 months of LTOT. At start PaO2 was 6.7 +/- 1.1 kPa without oxygen and 9.9 +/- 1.5 kPa after 3 months with oxygen. Our results demonstrate that neuropsychological function, cerebral blood flow velocity and autonomic function were positively influenced after 3 months of LTOT although the changes did not reach statistical significance. The COPD patients were cognitively impaired as compared to age-matched healthy controls. Our findings were consistent with the previous notion of improvement of hypoxic cognitive dysfunction by LTOT.
Asunto(s)
Cognición/fisiología , Enfermedades Pulmonares Obstructivas/terapia , Pruebas Neuropsicológicas , Terapia por Inhalación de Oxígeno , Anciano , Sistema Nervioso Autónomo/fisiopatología , Encéfalo/irrigación sanguínea , Femenino , Humanos , Hipoxia/etiología , Enfermedades Pulmonares Obstructivas/fisiopatología , Enfermedades Pulmonares Obstructivas/psicología , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Estudios Prospectivos , Valores de Referencia , Flujo Sanguíneo Regional , Ultrasonografía Doppler TranscranealRESUMEN
The responses of serum testosterone, sex hormone-binding globulin (SHBG) and luteinizing hormone (LH) to an oral glucose tolerance test (OGTT) were investigated in 16 healthy subjects as well as in 11 normoxaemic and 10 hypoxaemic chronic obstructive pulmonary disease (COPD) patients. The latter group were investigated on two occasions, with and without oxygen therapy. Testosterone and apparent free testosterone concentration (AFTC) fell significantly in the healthy subjects as well as in the hypoxaemic patients on oxygen therapy (p < 0.01), whereas LH increased in all groups during the OGTT (p < 0.05). There were significantly higher SHBG levels (p < 0.01), and lower AFTC levels (p < 0.05) in the hypoxaemic group compared to the healthy subjects. In the hypoxaemic group short-term oxygen therapy increased basal AFTC significantly (p < 0.05). With oxygen therapy, the 120-min glucose levels fell significantly from 9.1 +/- 3.2 to 7.6 +/- 2.7 mmol l-1 (mean +/- SD) in the hypoxaemic group (p < 0.05). In conclusion, we have found the serum testosterone and AFTC levels to decrease after an oral glucose load in healthy subjects, together with a compensatory increase in LH. The same pattern is seen in COPD patients. The hypoxaemic patients have a reduced AFTC which is partly reversed by oxygen therapy.
Asunto(s)
Prueba de Tolerancia a la Glucosa , Enfermedades Pulmonares Obstructivas/sangre , Hormona Luteinizante/sangre , Globulina de Unión a Hormona Sexual/metabolismo , Testosterona/sangre , Anciano , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/uso terapéuticoRESUMEN
The aim of this study was to investigate autonomic neuropathy, with and without oxygen therapy, in patients with chronic obstructive pulmonary disease (COPD). Four cardiovascular tests for autonomic function were used, and in addition, basal pancreatic polypeptide (PP) was measured. The following COPD patients were studied: 10 normoxemic (mean PaO2 10.9 +/- SD 1.1 kPa), 10 hypoxemic (PaO2 7.6 +/- 0.7 kPa before, and 10.6 +/- 1.4 kPa after 24 h oxygen therapy), and 6 hypoxemic on long-term oxygen therapy (LTOT) (PaO2 10.3 +/- 1.3 kPa before, and 7.0 +/- 0.8 kPa after 4 h of low dose or oxygen free interval). Twenty healthy age-matched subjects served as controls. In the individual tests the hypoxemic and the LTOT groups had a significantly decreased heart rate response to the Valsalva manoeuvre (ratio 1.23 +/- 0.17 and 1.12 +/- 0.07 versus control's 1.45 +/- 0.26 (p < 0.01 and 0.005, respectively) and versus the normoxemic group 1.46 +/- 0.30 (p < 0.05)) and the hypoxemic as well as the LTOT group had a significantly decreased heart rate response to standing up (ratio 0.97 +/- 0.04 and 0.97 +/- 0.07, respectively, versus the controls 1.06 +/- 0.09 (p < 0.005 and 0.05)). The blood pressure response to standing up and to sustained handgrip did not differ significantly between the groups. In spite of apparent autonomic dysfunction, PP levels in the LTOT group were significantly higher than in the controls (p < 0.01-0.001) and the normoxemic group (p < 0.05-0.01). Twenty-four hours of oxygen treatment in the hypoxemic group or four hours of oxygen withdrawal in the LTOT group did not change the results significantly. In conclusion, our findings are consistent with the previous notion of neurological dysfunction from hypoxemia, but this may not be corrected by the use of short term oxygen treatment. This contrasts to previous findings in which longer term oxygen did correct some of these problems.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Sistema Cardiovascular/inervación , Enfermedades Pulmonares Obstructivas/fisiopatología , Terapia por Inhalación de Oxígeno , Adulto , Anciano , Enfermedades del Sistema Nervioso Autónomo/complicaciones , Enfermedades del Sistema Nervioso Autónomo/tratamiento farmacológico , Análisis de los Gases de la Sangre , Presión Sanguínea , Fenómenos Fisiológicos Cardiovasculares , Interpretación Estadística de Datos , Femenino , Volumen Espiratorio Forzado , Fuerza de la Mano , Frecuencia Cardíaca , Humanos , Hipoxia/fisiopatología , Enfermedades Pulmonares Obstructivas/complicaciones , Enfermedades Pulmonares Obstructivas/terapia , Masculino , Persona de Mediana Edad , Polipéptido Pancreático/sangre , Postura , Prednisolona/administración & dosificación , Encuestas y Cuestionarios , Maniobra de ValsalvaRESUMEN
This study investigated glucose metabolism and glucose-mediated hormone responses in patients with chronic respiratory hypoxaemia. Glucose as well as insulin, glucagon, adrenaline, cortisol and growth hormone (GH) were measured before and at 30, 60 and 120 min during an oral glucose-tolerance test. The following chronic obstructive pulmonary disease (COPD) patients were studied: 10 normoxaemic (mean paO2 10.9 +/- 0.4 kPa), 10 hypoxaemic (mean paO2 7.6 +/- 0.2 kPa before, and 10.6 +/- 0.4 after 24-h oxygentherapy, and 6 hypoxaemic patients on long-term oxygen therapy (LTOT) (mean paO2 10.9 +/- 0.7 kPa before, and 7.1 +/- 0.3 after 4 h with less than 0.5 litre oxygen per minute). The hypoxaemic patients were tested both with and without (or reduced) oxygen therapy. Twenty healthy sex- and age-matched subjects served as controls. Plasma glucose at 120 min was significantly higher in LTOT patients than in controls (p < 0.01), normoxaemic patients (p < 0.01) or hypoxaemic patients (p < 0.01). The areas under the curve for plasma glucose and insulin were significantly higher in both the LTOT and hypoxaemic groups compared to controls (p < 0.01 and 0.05, respectively). Glucose values for normoxaemic COPD patients were similar to those for controls. Glucagon, adrenaline, cortisol and GH levels did not differ significantly between the groups. A 4-h low-dose or oxygen-free interval in the LTOT group or 24 h of oxygen supplementation in the hypoxaemic group did not affect glucose and hormone levels significantly. It is concluded that severely hypoxaemic COPD patients have altered glucose metabolism which cannot be readily explained by changes in gluco-regulatory hormones or short-term alterations in oxygenation.
Asunto(s)
Intolerancia a la Glucosa/fisiopatología , Hipoxia/tratamiento farmacológico , Enfermedades Pulmonares/tratamiento farmacológico , Oxígeno/uso terapéutico , Anciano , Glucemia/metabolismo , Femenino , Humanos , Hipoxia/fisiopatología , Insulina/sangre , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
Pulmonary function was studied 3 and 12 months after pulmonary resection for lung cancer in 37 patients, ten of whom had undergone pneumonectomy, 17 lobectomy and eight bilobectomy. The resection was right-sided in 25 cases and left-sided in 12. Tumour site and diameter were registered, arterial blood gases measured and spirometry performed Three months after all types resection there was significant decrease in forced vital capacity (FVC), and forced expiratory volume/1 second (FEV1), but not in FEV1/FVC%. At 12 months pneumonectomy had reduced FVC to 58% of predicted values, FEV1 to 50% and FEV1/FVC% to 70%. After lobectomy the corresponding figures were 86%, 73% and 67% and after bilobectomy they were 88%, 78% and 70%. Between 3 and 12 months postoperatively, FVC increased in all groups, significantly in those with lobectomy or bilobectomy (p<0.01 and 0.05, respectively).