Xanthine oxidase is involved in exercise-induced oxidative stress in chronic obstructive pulmonary disease

In the present study, we hypothesized that exhaustive exercise in patients with chronic obstructive pulmonary disease (COPD) results in glutathione oxidation and lipid peroxidation and that xanthine oxidase (XO) contributes to free radical generation during exercise. COPD patients performed incremental cycle ergometry until exhaustion with (n=8) or without (n=8) prior treatment with allopurinol, an XO inhibitor. Reduced (GSH) and oxidized glutathione (GSSG) and lipid peroxides [malondialdehyde (MDA)] were measured in arterial blood. In nontreated COPD patients, maximal exercise (~75 W) resulted in a significant increase in the GSSG-to-GSH ratio (4.6 ± 0.9% at rest vs. 9.3 ± 1.7% after exercise). In nontreated patients, MDA- increased from 0.68 ± 0.08 nmol/ml at rest up to 1.32 ± 0.13 nmol/ml 60 min after cessation of exercise. In contrast, in patients treated with allopurinol, GSSG-to-GSH ratio did not increase in response to exercise (5.0 ± 1.2% preexercise vs. 4.6 ± 1.1% after exercise). Plasma lipid peroxide formation was also inhibited by allopurinol pretreatment (0.72 ± 0.15 nmol/ml preexercise vs. 0.64 ± 0.09 nmol/m160 min after exercise). We conclude that strenuous exercise in COPD patients results in blood glutathione oxidation and lipid peroxidation. This can be inhibited by treatment with allopurinol, indicating that XO is an important source for free radical generation during exercise in COPD

Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines

Inhaled medication is important in the treatment of chronic obstructive pulmonary disease (COPD). In this paper a comparison of the long-term efficacy of three instruction-modes is presented. A total of 152 COPD-patients were randomized into one of four groups: Personal-, video-, group-instruction and a control group. Inhalation technique was assessed by means of checklists, on which essential inhalation manoeuvres were identified. Up to 9 months later, 148 patients returned for follow-up assessment. Prior to instruction 61% of patients in the control group had a perfect score on essential actions, compared to 62, 65 and 53% for those receiving group-, personal- and video-instruction respectively. At follow-up these percentages were 49, 97, 75 and 76%. For group-(35%) and video-instruction (24%) the increase from baseline was significant. Examining the different inhalers under investigation, it is striking, that only 24% of all patients with a Metered Dose Inhaler (MDI) performed all essential checklist items correctly, versus 96% for those using a Diskhaler. The fact that for the MDI this percentage improved to 90% post-instruction, shows that time spent on instruction, is time well spent. We conclude that group instruction seems superior to personal counselling, and equally effective or even better than video instruction. Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well

Behavioural effect of self-treatment guidelines in a self-management program for adults with asthma.

Item does not contain fulltextTo assess the efficacy of self-management programs it is important to know what behavioural changes take place. This paper assesses whether including self-treatment guidelines (action plans) in a self-management program for adult asthmatics, leads to greater behavioural changes than a program without these guidelines. Patients were randomised into a self-treatment group (n=123) or an active control group (n=122). All subjects received self-management training. Discussed topics included the pathophysiology of asthma, medication and side-effects, triggers, symptoms, smoking, physical exercise, and compliance. The only difference was that the self-treatment group received instructions about self-treatment of exacerbations and the control group did not. At 1 year of follow-up asthma-specific self-efficacy expectancies, outcome expectancies, and asthma-specific knowledge improved significantly in all patients. Only self-treatment group patients demonstrated favourable changes in generalised self-efficacy, social support, and self-treatment and self-management behaviour, in case of a hypothetical scenario of a slow-onset exacerbation. We conclude that our self-management program is effective in changing the behavioural variables, and including self-treatment guidelines (action plans) has added benefit

The effect of a minimal contact smoking cessation programme in out-patients with chronic obstructive pulmonary disease: a pre–post-test study

This study assessed the efficacy of an individual, minimal contact, smoking cessation programme in chronic obstructive pulmonary disease (COPD) patients, using a pre–post-test design. The study was part of a large ongoing investigation into the efficacy of self-management in patients with COPD (the COPE-study). In total, the participants received three 15–30 min home-based counselling sessions. Additionally, patients were provided with a written self-help manual. On the patient’s request, the chest physician prescribed bupropion or nicotine replacement therapy (NRT). Cessation rates after nine months were based on self-report, and afterwards confirmed by salivary cotinine analysis. Patients were biochemically classified as smoker if their cotinine levels exceeded 20 ng/ml. At baseline, one third of the 269 patients in the COPE-study were active smokers (according to self-report). Almost 70% (n=64) of these patients were willing to participate in the smoking cessation program. After nine months follow-up, 23 (36.5%) patients self-reported abstinence. However, the cotinine validated abstinence rate was much lower: 12.7% (n=8), implying that the actual abstinence rate is severely overestimated by self-report in this study. The results suggest that the (validated) effectiveness of this intervention is probably in line with that of comparable programmes for “healthy” persons. However, considering the urgent need for quitting in COPD patients, a more intensive programme resulting in higher quit rates, seems to be required for this high-risk population

Sustained protection against distilled water by a single dose of salmeterol in patients with asthma.

Item does not contain fulltex

Clinical predictors of bacterial involvement in exacerbations of chronic obstructive pulmonary disease.

Contains fulltext : 57556.pdf (publisher's version ) (Open Access)BACKGROUND: The wide use of antibiotics for treatment of exacerbations of chronic obstructive pulmonary disease (COPD) lacks evidence. The efficacy is debatable, and bacterial involvement in exacerbation is difficult to verify. The aim of this prospective study was to identify factors that can help to estimate the probability that a microorganism is involved in exacerbation of COPD and, therefore, predict the success of antibiotic treatment. METHODS: Clinical data and sputum samples were obtained from 116 patients during exacerbation of COPD. Bacterial infection was defined by the abundant presence of >or=1 potential pathological microorganism in relation to the normal flora in sputum. RESULTS: Of 116 exacerbations, 22 (19%) had bacterial involvement. The combination of a negative result of a sputum Gram stain, a relevant nonclinical decrease in lung function (compared with baseline measurements), and occurrence of <2 exacerbations in the previous year were 100% predictive of a nonbacterial origin of the exacerbation. The presence of all 3 of these clinical characteristics yielded a positive predictive value of 67% for a bacterial exacerbation. CONCLUSIONS: Patients presenting with an exacerbation who have a negative result of a sputum Gram stain, do not have a clinically relevant decrease in lung function, and who have not experienced <2 exacerbations of COPD in the previous year do not require antibiotic treatment. A treatment protocol taking into account these variables might lead to a 5%-24% reduction in unnecessary treatment with antibiotics, depending on actual prescription rates

Anabolic steroids in part reverse glucocorticoid-induced alterations in rat diaphragm

Item does not contain fulltex