Long-term oxygen therapy in Japan: history, present status, and current problems

Historically, the progress of long term-oxygen therapy (LTOT) in Japan has been characterized by collaboration among academicgroups, policy makers, and industrial companies. The public health insurance program has covered the cost of LTOT since 1985.Thomas Petty’s group in Denver enthusiastically carried out the public implementation of LTOT and conveyed the concept of pulmonaryrehabilitation for the processing with LTOT. Although the target diseases of LTOT in Japan tended to be chronic obstructivepulmonary disease or sequelae of primary lung tuberculosis, it was soon applied for cardiac diseases as well as other pulmonarydiseases. Together with increasing medical costs for geriatric patients, the political conversion from hospital based care ofa traditional style to home care system has been performed, with two background reasons: the improvement of quality of life ofpatients and the reduction of the medical expense. Presently, LTOT plays a pivotal role in the successful implementation of homerespiratory care for elderly patients. In addition, this promotes comprehensive pulmonary rehabilitation, a team approach, andclose liaisons between primary care and hospitals. Currently, the total number of patients using LTOT exceeds 150,000. In Japan,LTOT resulted in an advancement in the medical care as well as in administrative decision to introduce it as a nationwide systemafter analyzing the results of opinion polls of patients with respiratory failure. However, the recent great earthquake in East Japanrevealed that many unresolved problems remain for these patients, and these issues are of great concern.Historically, the progress of long term-oxygen therapy (LTOT) in Japan has been characterized by collaboration among academicgroups, policy makers, and industrial companies. The public health insurance program has covered the cost of LTOT since 1985.Thomas Petty’s group in Denver enthusiastically carried out the public implementation of LTOT and conveyed the concept of pulmonaryrehabilitation for the processing with LTOT. Although the target diseases of LTOT in Japan tended to be chronic obstructivepulmonary disease or sequelae of primary lung tuberculosis, it was soon applied for cardiac diseases as well as other pulmonarydiseases. Together with increasing medical costs for geriatric patients, the political conversion from hospital based care ofa traditional style to home care system has been performed, with two background reasons: the improvement of quality of life ofpatients and the reduction of the medical expense. Presently, LTOT plays a pivotal role in the successful implementation of homerespiratory care for elderly patients. In addition, this promotes comprehensive pulmonary rehabilitation, a team approach, andclose liaisons between primary care and hospitals. Currently, the total number of patients using LTOT exceeds 150,000. In Japan,LTOT resulted in an advancement in the medical care as well as in administrative decision to introduce it as a nationwide systemafter analyzing the results of opinion polls of patients with respiratory failure. However, the recent great earthquake in East Japanrevealed that many unresolved problems remain for these patients, and these issues are of great concern

Polymorphism of SERPINE2 gene is associated with pulmonary emphysema in consecutive autopsy cases

<p>Abstract</p> <p>Background</p> <p>The <it>SERPINA1</it>, <it>SERPINA3</it>, and <it>SERPINE2 </it>genes, which encode antiproteases, have been proposed to be susceptible genes for of chronic obstructive pulmonary disease (COPD) and related phenotypes. Whether they are associated with emphysema is not known.</p> <p>Methods</p> <p>Twelve previously reported single nucleotide polymorphisms (SNPs) in <it>SERPINA1 </it>(rs8004738, rs17751769, rs709932, rs11832, rs1303, rs28929474, and rs17580), <it>SERPINA3 </it>(rs4934, rs17473, and rs1800463), and <it>SERPINE2 </it>(rs840088 and rs975278) were genotyped in samples obtained from 1,335 consecutive autopsies of elderly Japanese people. The association between these SNPs and the severity of emphysema, as assessed using macroscopic scores, was determined.</p> <p>Results</p> <p>Emphysema of more than moderate degree was detected in 189 subjects (14.1%) and showed a significant gender difference (males, 20.5% and females, 7.0%; p < 0.0001). Among the 12 examined SNPs, only rs975278 in the <it>SERPINE2 </it>gene was positively associated with emphysema. Unlike the major alleles, homozygous minor alleles of rs975278 were associated with emphysema (odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.02-2.30; p = 0.037) and the association was very prominent in smokers (OR = 2.02; 95% CI = 1.29-3.15; p = 0.002).</p> <p>Conclusions</p> <p><it>SERPINE2 </it>may be a risk factor for the development of emphysema and its association with emphysema may be stronger in smokers.</p

Long-Term Oxygen Therapy in Japan: History, Present Status, and Current Problems

Historically, the progress of long term-oxygen therapy (LTOT) in Japan has been characterized by collaboration among academic groups, policy makers, and industrial companies. The public health insurance program has covered the cost of LTOT since 1985. Thomas Petty’s group in Denver enthusiastically carried out the public implementation of LTOT and conveyed the concept of pulmonary rehabilitation for the processing with LTOT. Although the target diseases of LTOT in Japan tended to be chronic obstructive pulmonary disease or sequelae of primary lung tuberculosis, it was soon applied for cardiac diseases as well as other pulmonary diseases. Together with increasing medical costs for geriatric patients, the political conversion from hospital based care of a traditional style to home care system has been performed, with two background reasons: the improvement of quality of life of patients and the reduction of the medical expense. Presently, LTOT plays a pivotal role in the successful implementation of home respiratory care for elderly patients. In addition, this promotes comprehensive pulmonary rehabilitation, a team approach, and close liaisons between primary care and hospitals. Currently, the total number of patients using LTOT exceeds 150,000. In Japan, LTOT resulted in an advancement in the medical care as well as in administrative decision to introduce it as a nationwide system after analyzing the results of opinion polls of patients with respiratory failure. However, the recent great earthquake in East Japan revealed that many unresolved problems remain for these patients, and these issues are of great concern

Gender Differences in Chronic Obstructive Pulmonary Disease Using the Lung Information Needs Questionnaire

Aim: To investigate gender-related information needs in patients with chronic obstructive pulmonary disease (COPD) using the Lung Information Needs Questionnaire (LINQ). Design: Cross-sectional, prospective cohort study. Methods: Patients with COPD receiving standardized self-management education including information regarding disease knowledge, medications, avoidance of exacerbation, smoking cessation, exercise, and nutrition were included. Gender differences were assessed by pulmonary function tests, 6-minute walking test, modified Medical Research Council dyspnea scale, Mini-Mental State Examination, St. George's Respiratory Questionnaire, and LINQ. Results: A total of 122 patients were enrolled. Females displayed significantly higher information needs for total LINQ score ( p  < .001), avoidance of exacerbation ( p  < .03), and nutrition ( p  < .006). Significant correlations were seen between total LINQ score and gender ( p  = .001), forced expiratory volume in 1 second, % predicted ( p  = .003), and Mini-Mental State Examination ( p  = .002) for male patients. In females, modified Medical Research Council dyspnea scale was correlated with the total LINQ score ( p  = .04)