Chronic obstructive pulmonary disease cystic fibrosis

Advances in the chemokine field have serendipitously had an impact on other fields of investigation such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, and acute respiratory distress syndrome. 

Long-term oxygen-therapy is indicated for all patients with a stable chronic lung disease (such as chronic obstructive pulmonary disease, cystic fibrosis etc.), who have an arterial PO2 (oxygen partial pressure) consistently less than or equal to 55 mm Hg when breathing air, at rest and awake [10.2]. These patients need a... 

One should consider infiuenza- and pneumococcal-vaccination in patients with increased risk for lower RTI including patients with chronic obstructive pulmonary disease like chronic bronchitis or emphysema and cystic fibrosis patients. It should be considered for the elderly population in general. There is no role for prophylactic antibiotic therapy in patients with frequent RTI. Attempts should be made to have those patients that smoke stop doing so. 

Table 10.1 Drags administered by inhalation for local action in the airways. COPD=chronic obstructive pulmonary disease CF=cystic fibrosis...

Saprophytic colonization is found with increased incidence in patients with underlying pulmonary diseases, such as in advanced stages of chronic obstructive pulmonary disease, chronic asthma requiring administration of adrenal corticosteroids, primary ciliary dyskinesia syndrome and cystic fibrosis [4-7]. A.fumigatus is the predominant species cultured from the respiratory tract although other Aspergillus species may also be found occasionally. 

Nebulizers are generally used to treat acute exacerbations of asthma or chronic obstructive pulmonary disease. Other indications include long-term bronchodilator treatment of chronic airflow obstruction prophylactic treatment for asthma antimicrobial drugs for cystic fibrosis, bronchiectasis, and HIV/AIDS and symptomatic relief in palliative care. 

This discussion includes two topics (1) delivery of bronchodilators and glucocorticoids to patients with asthma and chronic obstructive pulmonary diseases (COPD) and (2) aerosols for the treatment of cystic fibrosis (CF). 

Clubbing does not occur with clients diagnosed with asthma. It occurs in clients with chronic hypoxia such as occurs with chronic obstructive pulmonary disease (COPD) or cystic fibrosis (CF). 

Pulmonary administration of medicines currently has the primary objective to achieve local effects in the respiratory tract of patients with chronic diseases like asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). For half a century, inhalation therapy has been the cornerstone in the management of these diseases and the often life-time therapies aim to suppress inflammatory processes and bacterial infection in order to reduce hospitalisations and to improve the patient s quality of life. They also give relief to the patient in moments of bronchoconstriction. The advantages of pulmonary administration of medicines for local treatment are well known. The active substances are delivered directly to the site of action which leads to a faster response than via the systemic route. It may also result in higher local active substance concentrations and this could reduce the total dose by as much as a factor 10 compared to oral or intravenous administration. This has the advantage that systemic side effects are reduced and in combination with being a non-invasive method of administration, inhalation therapy may lead to better patient compliance. 

Airway diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) have been identified as the fifth cause of mortality worldwide (1.4 million deaths annually), and it is expected a growing trend for the coming years [2]. The data provided by the World Health Organization estimate that currently hundreds of millions of people suffer from chronic respiratory diseases 300 million for asthma 80 million with COPD, and millions more suffer the consequences of mild COPD allergic rhinitis and other chronic respiratory diseases. 

Multislice CT is the method of choice for the morphological visualization of the airways and the associated diseases. High isotropic resolution and high contrast are the ideal prerequisites to generate MPRs in order to demonstrate the typical findings of airway disease, such as dilation, ectasis, wall thickening, increased collapsibility, and stenosis as well as visibility of small airways in bronchiolitis. The major diseases of the airways that can be adequately studied by multislice CT are tracheobronchomalacia, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). 

S. Onoue, et al. New treatments for chronic obstructive pulmonary disease and viable for-mulation/device options for inhalation therapy. Expert Opin DrugDeliv 6,793-811,2009. B.M. Ibrahim, et al. Challenges and advances in the development of inhalable drug formulations for cystic fibrosis lung disease. Expert Opin DrugDeliv 8, 451-466, 2011. 

Chronic obstructive pulmonary disease Bronchiectasis and cystic fibrosis... 

Pryor JA, Webber BA, Hodson BA, et al. Evaluation of the forced expiration technique as an adjunet to postural drainage in treatment of cystic fibrosis. BMJ 1979 2(6187) 417-418. American ThOTacic Society. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1995 152(5 pt 2) S77-S121. Clarke SW, Pavia D. Lung mucus jnoduction and mucociliary clearance methods of assessment. Br J Clin Pharmacol 1980 9(6) 537-546. 

Chronic ventilatory support is currently a well-accepted therapy in patients with chronic respiratory failure due to thoracic cage abnormalities or in patients with neuromuscular disease. In contrast, the evidence to use chronic ventilatory support in patients with obstructive lung disease is less clear. Most of studies in this area have been in patients with chronic obstructive pulmonary disease (COPD) and only a few in patients wiA cystic fibrosis (CF) and bronchiectasis. In this chapter, we will focus primarily on COPD, discussing first the rationale of noninvasive positive pressure ventilation (NIPPV) in these patients and second all randomized controlled studies. Thereafter, we will elaborate on different issues that might be important in making NIPPV more effective in patients with COPD. Finally, we will discuss the effeets of ehronie ventilatory support in patients with CF and bronchiectasis. 

Figure 3 Percentage of users in each disease category by country. The symbol represents lung/ airways (COPD, cystic fibrosis, bronchiectasis, pulmonary fibrosis, and pediatric diseases) , chest wall deformities (kyphoscoliosis, old TB, OHS, surgical resection) and , neuromuscular disorders (muscular dystrophy, motor neuron disease, post-polio kyphoscoliosis, central hypoventilation, spinal cord damage, and phrenic nerve palsy). Abbreviations COPD, chronic obstructive pulmonary disease TB, tuberculosis OHS, obesity hypoventilation syndrome. Source From Ref. 15.

In 1983 the Toronto Lung Transplant Group (1986) performed the first single-lung transplantations for patients with end-stage chronic obstructive pulmonary disease and advanced pulmonary fibrosis. Their technique was later expanded to bilateral sequential single-lung transplantation for patients with bronchiectasis and cystic fibrosis. 

Particle clearance by cough supports mucociliary clearance, especially under pathophysiological conditions of diseased lungs (60), such as chronic obstructive pulmonary disease (COPD), immotile cilia syndrome (ICS), and cystic fibrosis (CF). An increased secretion in the airways seems to be necessary. During cough, mucus is propelled toward the larynx by the very fast exhalation, with linear air... 

Girod S, Galabert C, Lecuire A, Zahm J-M, Puchelle E. Phospholipid composition and surface-active properties of tracheobronchial secretions from patients with cystic fibrosis and chronic obstructive pulmonary disease. Pedeatr Pulmonal 1992 13 22-27. 

Mucolytic Adjuvant therapy for abnormal, viscid, or inspissated mucus secretions in chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis, primary amyloidosis of lung) acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis) pulmonary complications of cystic fibrosis tracheostomy care pulmonary complications associated with surgery use during anesthesia posttraumatic chest conditions atelectasis due to mucus obstruction diagnostic bronchial studies (bronchograms, bronchospirometry, bronchial wedge catheterization). 

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