RESUMEN

BACKGROUND: The prognosis of Japanese patients with COPD who suffer repeated exacerbations is unclear, although Westerners with such episodes have a poor prognosis. MATERIALS AND METHODS: We conducted a 1-year prospective observational trial involving 90 Japanese patients with COPD: 58 nonexacerbators, 12 infrequent exacerbators, and 20 frequent exacerbators classified on the basis of exacerbation frequency (zero, one, and two or more exacerbations/year), respectively, during the previous year were observed prospectively for 1 year. The characteristics of frequent exacerbators, the frequency of exacerbation, and the period until the first event were then compared among the groups. RESULTS: A total of 78 patients completed the study. Frequent exacerbators had a significantly higher risk of frequent exacerbation in the following year than the case for nonexacerbators (odds ratio [95% confidence interval] 2.94 [1.21-7.17], P=0.0340), but not in comparison with infrequent exacerbators (1.51 [0.49-4.63], P>0.05). The mean annual frequency of exacerbations in the following year was significantly (P=0.0020) higher in the frequent exacerbators (1.4 exacerbations/year) than in the nonexacerbators (0.4), but not in the infrequent exacerbators (0.9, P>0.05). The mean period until the first exacerbation was significantly shorter in the frequent exacerbators than in the infrequent or nonexacerbators (P=0.0012). Independent risk factors for future frequent exacerbation included the presence of gastroesophageal reflux disease, more severe airflow obstruction, and use of inhaled corticosteroids. CONCLUSION: Our present results indicate that Japanese COPD patients suffering frequent exacerbation have a poor prognosis. The characteristics of Japanese and Western COPD patients suffering frequent exacerbation are similar.

Asunto(s)

Enfermedad Pulmonar Obstructiva Crónica , Anciano , Progresión de la Enfermedad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Fenotipo , Pronóstico , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Pruebas de Función Respiratoria/métodos , Factores de Riesgo , Brote de los Síntomas

RESUMEN

BACKGROUND: We aimed to develop the Japanese version of the COPD Assessment Test (TM) (CAT), which was recently developed in overseas countries, to measure the health status of patients with chronic obstructive pulmonary disease (COPD) and to validate its psychometric properties. METHODS: The original CAT was translated to Japanese through linguistic validation. Then, an Internet-based survey was conducted by including 301 Japanese patients with COPD who were over 40 years of age and had a history of smoking, to assess the reliability and validity of the translated CAT. RESULTS: The Japanese CAT was shown to have high internal consistency (Cronbach's α coefficient: 0.891). The assessment using the Japanese CAT was highly correlated with assessment using the COPD-specific St. George's Respiratory Questionnaire (r = 0.820). The assessment also showed correlation between the Japanese CAT and a generic health-related quality of life (QOL) questionnaire (SF-12v2). CONCLUSION: The Japanese version of the CAT has high reliability and validity, and can be expected to serve as a short and simple questionnaire for precise assessment of the health status of Japanese patients with COPD.

Asunto(s)

Autoevaluación Diagnóstica , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/psicología , Calidad de Vida , Encuestas y Cuestionarios , Pueblo Asiatico , Estado de Salud , Humanos , Japón , Lenguaje , Reproducibilidad de los Resultados , Fumar

RESUMEN

Background and Objectives. Many cases of pleural effusion can remain undiagnosed following thoracentesis. We evaluated our own technique for performing thoracoscopy under local anesthesia using a 32 Fr chest tube and a flexible fiberoptic bronchoscope without a rigid thoracoscope for the diagnosis, inspection, and management of patients with pleurisy. Methods. Seven patients with pleural effusion who underwent thoracoscopy under local anesthesia using a 32 Fr chest tube and a flexible fiberoptic bronchoscope were retrospectively studied. Results. Thoracoscopy was safely performed in the diagnosis and management of pleural effusion in all cases. The visualization of the pleura, diaphragm, and lung using this instrumentation was excellent in comparison to that normally obtained during surgical thoracoscopy. A forceps biopsy of the pleura or diaphragm could therefore be easily and effectively performed. Conclusion. This technique is considered to have clinical utility as a diagnostic tool for pleurisy; furthermore, this method is safe, effective and inexpensive, not only for surgeons but also for physicians.