The association of dietary intake and supplementation of specific polyunsaturated fatty acids with inflammation and functional capacity in chronic obstructive pulmonary disease : a systematic review

Objective: This systematic review sought to identify the association of dietary intake and supplementation of specific polyunsaturated fatty acids with inflammation and function in people with chronic obstructive pulmonary disease (COPD). Data sources: We searched electronic databases including PubMed, CINAHL, MEDLINE, EMBASE, The Cochrane Library, ProQuest Dissertations and Theses, Scopus, Google Scholar, Trove, and WHO International Clinical Trials Registry Platform and reference lists of retrieved articles published prior to August 2014. Inclusion criteria: We considered observational studies that evaluated dietary intake of omega-3 (eicosapentaenoic acid, docosahexaenoic acid or α-linolenic acid) and/or omega-6 fatty acids (γ-linoleic acid or arachidonic acid), and experimental studies that evaluated omega-3 fatty acid supplementation (containing predominantly one or more omega-3 fatty acids) on airway and systemic inflammatory markers and/or functional capacity outcomes in people with COPD-related diagnoses. Data synthesis: Since statistical pooling was not possible, the findings were presented in narrative form including tables and figures to aid in data presentation when appropriate. Results: One 8-week randomized controlled trial conducted in 80 COPD patients in the Netherlands showed polyunsaturated fatty acid supplementation significantly improved exercise capacity compared with the control condition [between-group difference in mean peak workload was 9.7 W (2.5-17.0; P = 0.009); and mean duration was 4.3 min (0.6-7.9; P = 0.023)]. One cross-sectional study conducted in 250 COPD patients in Spain found associations of specific dietary omega-3 fatty acids with inflammation were inconsistent. Conclusions: Limited evidence provides weak support for the use of omega-3 fatty acid supplementation for reducing chronic inflammation and some support for improving functional capacity in COPD patients. There is no consistent evidence showing that low dietary intake of specific omega-3 fatty acids worsens inflammation and/or function. More evidence is required before routinely incorporating this therapy within COPD management plans

The association of dietary intake and supplementation of specific polyunsaturated fatty acids with inflammation and functional capacity outcomes in chronic obstructive pulmonary disease : a systematic review protocol

Chronic obstructive pulmonary disease is currently ranked the fifth leading cause of global disability (health loss).1 The BOLD (Burden of Obstructive Lung Disease) study estimates that the prevalence of COPD, defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as stage 2 or higher, was 7.5% among Australian people aged 40 years or older in 2006-10.2 The prevalence of COPD was highest among people aged 75 years or older.2 A recent report by Access Economics estimates that COPD cost the Australian economy about $98 billion in 2008.3 Since Australia’s population is ageing, the projected rise in the health burden of COPD will undoubtedly cause significant stress on the national healthcare system. Effective treatments to slow the progression of COPD and/or prevent exacerbations will likely result in significant health and economic benefits

Psychiatric disorders and COPD : response

Related letter(s): Psychiatric Disorders and COPDPsychiatric Disorders and COPD: Still Stronger Evidence for Convincing Policymakers? (Chest. 2013;144(3):1084.) This letter concerns the article(s): Bidirectional Associations Between Clinically Relevant Depression or Anxiety and COPDCOPD Prognosis with Depression or Anxiety: A Systematic Review and Meta-analysis (Chest. 2013;144(3):766-777.) To the Editor: We thank Dr Moullec and colleagues for their interest in, and supportive comments on, our study in this issue of CHEST.1 Generally speaking, we agree with the principle that careful consideration is needed when pooling results from individual studies included in a systematic review. However, the selection of studies is also determined by the research question(s), and our study may have had a wider focus than theirs.2 Our responses to their specific points are as follows

Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease : the impact of bronchodilator treatment

Chronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side-effects. Despite the theory behind increased pro-arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short-acting 'relief' bronchodilators and non-respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short-acting beta-agonists with short-acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk

Investigating the adverse respiratory effects of beta-blocker treatment : six years of prospective longitudinal data in a cohort with cardiac disease

Background: Globally, cardiovascular disease (CVD) is the leading cause of death. Beta-blocker medications have well-established survival benefit for myocardial infarction and heart failure. However, CVD frequently coexists with chronic obstructive airways disease (COPD), a disease in which beta-blockers are traditionally avoided. Aim: We sought to investigate the adverse respiratory effects associated with long-term beta-blocker treatment in patients with cardiac disease, and presumed high risk of COPD. Methods: In this prospective cohort study, patients admitted with acute cardiac disease were recruited from the cardiology unit of a tertiary referral hospital. The treating cardiologist determined beta-blocker treatment, independent of the study. Repeated measures of spirometry and respiratory symptom scores were assessed over 12months. Respiratory exacerbations, cardiac events and survival were recorded over 6years. Outcomes were compared according to beta-blocker exposure. Results: Sixty-four subjects participated, 30 of whom received beta-blockers. Beta-blockers did not adversely affect spirometry, respiratory symptoms or survival. However, considering two categories of respiratory exacerbations (symptom-based vs treated), subjects taking beta-blockers accumulated increased annual risk (relative risk (RR) 1.30, 95% confidence interval (CI) 1.11-1.53, P= 0.001 and RR 1.37, 95% CI 1.09-1.72, P= 0.008) and concluded with overall increased risk (RR 3.67, 95% CI 1.65-8.18, P= 0.001 and RR 4.03, 95% CI 1.26-12.9, P= 0.019), when compared with the group not taking beta-blockers. Conclusion: Long-term beta-blocker treatment did not adversely affect lung function, respiratory symptom scores or survival, but was associated with increased risk of respiratory exacerbations

The Oxygen project: a prospective study to assess the effectiveness of a targeted intervention to improve oxygen management in hospitalised patients

Background: Oxygen is commonly used in the acute care setting. However, used inappropriately, oxygen therapy can result in adverse consequences, including progressive respiratory failure and death. Aim: To investigate the effectiveness of a targeted intervention to improve prescribing practice and therapeutic application of supplemental oxygen. Methods: Respiratory, Oncology and Surgery wards were targeted for the intervention. Nursing and junior medical staff from these wards undertook an education pro-gramme about safe use of oxygen. Cross-sectional data about oxygen prescribing, administration and monitoring were collected on inpatients in these wards at baseline, and at 3 and 6 months post-intervention, using a modified version of the British Thoracic Society Oxygen Audit Tool. Results: At baseline, there was a written prescription for oxygen in 56% of patients (n= 43) using oxygen and this increased to 75% (n = 44) at 3 months, and remained at65% (n = 48) at 6 months. However, the increased prescription rates were not statistically significant when compared to baseline (χ2= 3.54, df = 1, P = 0.06 and χ2= 0.73, df = 1, P = 0.40, respectively). The observed increase in oxygen prescriptions was driven by the medical wards: Oncology ward at 3 months (χ2= 8.24, df = 1, P = 0.004); and Respiratory ward at 3 months (χ2= 3.31, df = 1, P = 0.069) and 6 months (χ2= 4.98,df = 1, P = 0.026). Conclusion: The education programme intervention to improve oxygen prescription showed promise in the medical wards but did not impact outcomes in the surgical ward setting, where different strategies may be needed

The Oxygen project : a prospective study to assess the effectiveness of a targeted intervention to improve oxygen management in hospitalised patients

Background: Oxygen is commonly used in the acute care setting. However, used inappropriately, oxygen therapy can result in adverse consequences, including progressive respiratory failure and death. Aim: To investigate the effectiveness of a targeted intervention to improve prescribing practice and therapeutic application of supplemental oxygen. Methods: Respiratory, Oncology and Surgery wards were targeted for the intervention. Nursing and junior medical staff from these wards undertook an education pro-gramme about safe use of oxygen. Cross-sectional data about oxygen prescribing, administration and monitoring were collected on inpatients in these wards at baseline, and at 3 and 6 months post-intervention, using a modified version of the British Thoracic Society Oxygen Audit Tool. Results: At baseline, there was a written prescription for oxygen in 56% of patients (n= 43) using oxygen and this increased to 75% (n = 44) at 3 months, and remained at65% (n = 48) at 6 months. However, the increased prescription rates were not statistically significant when compared to baseline (χ2= 3.54, df = 1, P = 0.06 and χ2= 0.73, df = 1, P = 0.40, respectively). The observed increase in oxygen prescriptions was driven by the medical wards: Oncology ward at 3 months (χ2= 8.24, df = 1, P = 0.004); and Respiratory ward at 3 months (χ2= 3.31, df = 1, P = 0.069) and 6 months (χ2= 4.98,df = 1, P = 0.026). Conclusion: The education programme intervention to improve oxygen prescription showed promise in the medical wards but did not impact outcomes in the surgical ward setting, where different strategies may be needed

[unknown]

原著和名: [記載なし]科名: キク科 = Compositae採集地: 茨城県 筑波郡 谷田部町 薬用植物園 (常陸 谷田部町 薬用植物園)採集日: 1982/6/25採集者: 萩庭丈壽整理番号: JH025262国立科学博物館整理番号: TNS-VS-97526

Bidirectional associations between clinically relevant depression or anxiety and COPD

Background: The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice. Methods: We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verified using fixed-effects models. Heterogeneity was explored with subgroup and metaregression analyses. Results: Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96). Conclusions: Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention

Treatable traits can be identified in a severe asthma registry and predict future exacerbations

Background and objective: A new taxonomic and management approach, termed treatable traits, has been proposed for airway diseases including severe asthma. This study examined whether treatable traits could be identified using registry data and whether particular treatable traits were associated with future exacerbation risk. Methods: The Australasian Severe Asthma Web-Based Database (SAWD) enrolled 434 participants with severe asthma and a comparison group of 102 participants with non-severe asthma. Published treatable traits were mapped to registry data fields and their prevalence was described. Participants were characterized at baseline and every 6 months for 24 months. Results: In SAWD, 24 treatable traits were identified in three domains: pulmonary, extrapulmonary and behavioural/risk factors. Patients with severe asthma expressed more pulmonary and extrapulmonary treatable traits than non-severe asthma. Allergic sensitization, upper-airway disease, airflow limitation, eosinophilic inflammation and frequent exacerbations were common in severe asthma. Ten traits predicted exacerbation risk; among the strongest were being prone to exacerbations, depression, inhaler device polypharmacy, vocal cord dysfunction and obstructive sleep apnoea. Conclusion: Treatable traits can be assessed using a severe asthma registry. In severe asthma, patients express more treatable traits than non-severe asthma. Traits may be associated with future asthma exacerbation risk demonstrating the clinical utility of assessing treatable traits