Nasal intermittent positive pressure ventilation (NIPPV) is being increasingly recognized as an effective means of ventilatory support for patients with respiratory failure due to neuromuscular disease or chest wall deformity [1]. Although physiological benefits such as a reduction in the workload on the respiratory muscles have been demonstrated with NIPPV in cases of severe chronic obstructive pulmonary disease (COPD) [2], little is known about the impact of NIPPV on these patients' survival, quality of life, or lung function [3,4]. Several studies have reported varying degrees of improvement in lung function [5][6][7] and quality of life [6,7] with NIPPV. Additional investigations have thus been recommended to determine the potential value of NIPPV in hypercapnic COPD patients [3]. This prospective study assessed the effect of NIPPV plus long-term oxygen therapy (LTOT) on lung function and quality of life in patients with stable hypercapnic respiratory failure due to COPD, using two validated health questionnaires. Follow-up was continued for 6 months.
Subjects and methods
PatientsFourteen COPD patients (eight male, six female), mean age 65 yrs (range 47-79), with severe airflow limitation were enrolled. Patient characteristics are listed in tables 1 and 2. Five patients had been established on LTOT for over 1 yr prior to recruitment; their mean±SD blood gas levels in room air on entry to the study were arterial carbon dioxide tension (Pa,CO 2 ) 7.2±0.3 kPa, arterial oxygen tension (Pa,O 2 ) 7±0.8 kPa, and pH was 7.39±0.008. The other nine patients had been hospitalized in our department 2-3 months before inclusion in the study for acute respiratory decompensation; six of these nine patients had required intubation/assisted ventilation. Following this episode of acute exacerbation, oxygen therapy was continued at home because of nocturnal or exertional aggravation of hypoxaemia. At the time of initiation of mechanical ventilation by nasal mask, all patients were clinically stable, as confirmed by a variation of less than 10% in arterial blood gas tensions and forced expiratory volume in one second (FEV1), at the beginning and at the end of a 4 week run-in period. All patients were hypoxaemic and hypercapnic at the time of recruitment (pH 7.38±0.01; Pa,CO 2 7.8±0.8 kPa; Pa,O 2 7.8±0.7 kPa; arterial oxygen saturation (Sa,O 2 ) 89.2±2.9 %).
Study designThe patients entered in this prospective study first completed a 4 week run-in period of standard care (including Fourteen hypercapnic COPD patients in a stable clinical condition were evaluated in a prospective study of domiciliary NIPPV plus long-term oxygen therapy. Baseline data obtained during a 4 week run-in period were compared with measurements at the end of the 6 month study period. Spirometric parameters, arterial blood gas tensions, and quality of life were assessed. Quality of life was measured using the St George's Respiratory Questionnaire (SGRQ) and the French version of the Nottingham Health Profile (FVNHP).All patients completed 6 months of domici...
BackgroundThe contribution of occupational exposures to COPD and their interaction with cigarette smoking on clinical pattern of COPD remain underappreciated. The aim of this study was to explore the contribution of occupational exposures on clinical pattern of COPD.MethodsCross-sectional data from a multicenter tertiary care cohort of 591 smokers or ex-smokers with COPD (median FEV1 49%) were analyzed. Self-reported exposure to vapor, dust, gas or fumes (VDGF) at any time during the entire career was recorded.ResultsVDGF exposure was reported in 209 (35%) subjects aged 31 to 88 years. Several features were significantly associated with VDGF exposure: age (median 68 versus 64 years, p < 0.001), male gender (90% vs 76%; p < 0.0001), reported work-related respiratory disability (86% vs 7%, p < 0.001), current wheezing (71% vs 61%, p = 0.03) and hay fever (15.5% vs 8.5%, p < 0.01). In contrast, current and cumulative smoking was less (p = 0.01) despite similar severity of airflow obstruction.ConclusionIn this patient series of COPD patients, subjects exposed to VDGF were older male patients who reported more work-related respiratory disability, more asthma-like symptoms and atopy, suggesting that, even in smokers or ex-smokers with COPD, occupational exposures are associated with distinct patients characteristics.
Parallel variations in plasma and urine variations of endogenous urea and creatinine level in the rat during 4 consecutive 6-h-long periods permit to evidence urea and creatinine clearance diurnal variations with very significant increase in the 2 nightly periods. The signification of this very large nightly glomerular filtration increase is discussed.
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