Chronic pulmonary, pathophysiologic

There is epidemiologic evidence to suggest an increased prevalence of duodenal ulcers in patients with certain chronic diseases, but the pathophysiologic mechanisms of these associations are uncertain. A strong association exists in patients with systemic mastocytosis, multiple endocrine neoplasia type 1, chronic pulmonary diseases, chronic renal failure, kidney stones, hepatic cirrhosis, and ai-antitrypsin deficiency. An association may exist in patients with cystic fibrosis, chronic pancreatitis, Crohn s disease, coronary artery disease, polycythemia vera, and hyperparathyroidism. 

Due to the current limitations in nosology and the paucity of research in the field, 1 will discuss potential mechanisms associated with LTMV based on principles of pulmonary pathophysiology recorded in patients requiring mechanical ventilation for variable periods of time, including those in the acute care setting. Whether it is valid to extrapolate pathophysiological data recorded in the acute care setting to the chronic one is, however, unknown. 

Describe the pathophysiology of chronic obstructive pulmonary disease (COPD). 

Until now we have been discussing natural product HDAC inhibitors and their benefits for pathophysiological conditions. However, recent research shows that for treatment of a few diseased conditions, it is beneficial to increase HDAC activity. One such example is chronic obstructive pulmonary disease (COPD). 

MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease, part 2. Am J Respir Crit Care Med 1994 150 1158-1168. 

Pathophysiologic Derat ements in the Chronic Obstructive Pulmonary Diseases and Pharmacolc ic Regulation of Airway Function... 

Controlled human exposure studies are essential to establish the health consequences of PM exposures. These studies are typically designed to study inhalation of size-defined PM under highly controlled conditions that will allow the characterization of exposure-response relationships. Since humans are exposed to the pollutant of interest, specifically size-fractionated PM, causahty can be established easily and the confounding effects of other pollutants can be minimized (Devlin et al. 2005). Another advantage of such clinical studies is the abihty to select subjects with a known clinical status (i.e., healthy vs. a specific disease, typically cardiovascular or pulmonary disease) and observe the pathophysiological responses of interest. However, controlled human exposures have some limitations (Utell and Frampton 2000). For both practical and ethical reasons, clinical studies are restricted to exposure concentrations and durations that will only ehcit transient responses in human subjects. These studies involve a small number of sample subjects, which excludes susceptible populations at higher risk. Chronic exposure or high PM concentration related health effects are not attainable by the clinical studies. These experiments are also very costly to perform. 

J.C. Hogg, Pathophysiology of airflow limitation in chronic obstructive pulmonary disease, Dancet (Dondon, England) 364 (9435) (2004 Aug 21-27) 709—721. 

Bronchial asthma is characterized by an increased responsiveness of the trachea and bronchi to various stimuli and is manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (91). Chronic bronchitis is defined as a condition with chronic or recurrent bronchial hypersecretion, cough and expectoration during at least 3 months for at least 2 successive years (92). Chronic bronchitis is often associated with chronic airways obstruction with minimal reversibility it is then called chronic obstructive pulmonary disease (COPD). Chronic airways obstruction in COPD is believed to be caused by either emphysema or irreversible obstructive changes in the peripheral airways, or both. There is an overlap between asthma and COPD, and many patients may have features of both diseases (93). Asthma is considered an important risk factor for the development of COPD. Bronchial hyperresponsiveness is a hallmark of asthma, whereas its importance in COPD is more obscure. Airway inflammation is a key factor for the development of bronchial hyperresponsiveness (94). Table 4 shows the main pathophysiological features of airways obstruction in asthma, chronic bronchitis, and emphysema. 

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... 

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