RESUMO
The aim of this review is to update and synthesize the molecular mechanisms that lead to the heterogeneous effect on tissue remodeling observed in the two most important clinical phenotypes of chronic obstructive pulmonary disease (COPD), pulmonary emphysema (PE) and chronic bronchitis (CB). Clinical and experimental evidence suggests that this heterogeneous response to promote PE, CB, or both, is related to differentiated genetic, epigenetic, and molecular conditions. Specifically, a tendency toward PE could be related to a variant in the DSP gene, SIRT1 downregulation, macrophage polarization to M1, as well as the involvement of the noncanonical Wnt5A signaling pathway, among other alterations. Additionally, in advanced stages of COPD, PE development is potentiated by dysregulations in autophagy, which promotes senescence and subsequently cell apoptosis, through exacerbated inflammasome activation and release of caspases. On the other hand, CB or the pro-fibrotic phenotype could be potentiated by the downregulated activity of HDAC2, the activation of the TGF-ß/Smad or Wnt/ß-catenin signaling pathways, macrophage polarization to M2, upregulation of TIMP-1, and/or the presence of the epithelial-mesenchymal transition (EMT) mechanism. Interestingly, the upregulated activity of MMPs, especially MMP-9, is widely involved in the development of both phenotypes. Furthermore, MMP-9 and MMP-12 enhance the severity, perpetuation, and exacerbation of COPD, as well as the development of autoimmunity in this disease.
Assuntos
Bronquite Crônica , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Humanos , Enfisema Pulmonar/patologia , Enfisema Pulmonar/metabolismo , Enfisema Pulmonar/genética , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/genética , Bronquite Crônica/metabolismo , Bronquite Crônica/patologia , Bronquite Crônica/genética , Animais , Transdução de SinaisRESUMO
OBJECTIVE: To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS: A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS: A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION: The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.
Assuntos
Bronquite Crônica , Enfisema , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Adulto , Humanos , Bronquite Crônica/tratamento farmacológico , Bronquite Crônica/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Enfisema Pulmonar/epidemiologia , Oxigênio , PrevalênciaRESUMO
BACKGROUND Patients with multiple comorbidities who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a higher risk of mortality. However, treatment with mepolizumab may be a key factor in counteracting the risk of these comorbidities. We present a patient who had an uneventful recovery from coronavirus disease 2019 (COVID-19), despite having 5 independent risk factors for severe disease and increased mortality. CASE REPORT A 75-year-old man with a long-standing history of asthma, chronic bronchitis, coronary artery disease, and hypertension presented to the Emergency Department in November 2020 with a 4-day history of fever, chills, shortness of breath, cough, and fatigue. Six months prior to this presentation, the patient was hospitalized for severe chronic bronchitis and acute exacerbation of asthma. His medications included mepolizumab, aclidinium, ramipril, diltiazem, aspirin, albuterol sulfate, and micronized budesonide/micronized formoterol fumarate dihydrate. Physical examination was unremarkable, except for cardiopulmonary distress. Laboratory tests showed leucocytosis. His chest X-ray revealed infiltrates and interstitial edema in the lower lung fields. A PCR test for SARS-CoV-2 was positive. COVID-19 pneumonia was diagnosed, and the patient was admitted to the hospital, where he was treated with acetaminophen, amoxicillin, dexamethasone, and supplemental oxygen. The patient remained stable and was discharged from the hospital the following day. He was free of all symptoms after 21 days. CONCLUSIONS This case of a 75-year-old man who presented with mild COVID-19 supports the findings from other reports of improvement in clinical outcomes for some patients with asthma who received treatment with mepolizumab.
Assuntos
Asma , Bronquite Crônica , COVID-19 , Masculino , Humanos , Idoso , SARS-CoV-2 , Fatores de Proteção , Fatores de Risco , Asma/tratamento farmacológicoRESUMO
ABSTRACT OBJECTIVE To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.
RESUMO OBJETIVO Estimar a prevalência dos tratamentos utilizados para o manejo da doença pulmonar obstrutiva crônica (DPOC) na população adulta brasileira. MÉTODOS Estudo transversal de base populacional com dados oriundos da Pesquisa Nacional de Saúde de 2013, incluindo indivíduos com 40 anos ou mais, com diagnóstico médico autorreferido de DPOC, bronquite crônica e/ou enfisema, os quais foram questionados sobre tratamentos utilizados para o manejo da doença. RESULTADOS Foram entrevistados 60.202 adultos, dos quais 636 tinham 40 ou mais anos de idade e haviam referido diagnóstico médico de DPOC, enfisema ou bronquite crônica. Menos da metade (49,4%) da população diagnosticada relatou utilizar algum tipo de tratamento, havendo diferenças quanto à macrorregião do país (Sul 53,8% - Nordeste 41,2%, p = 0,007). O tratamento medicamentoso foi o mais referido e portadores de enfisema apresentaram a maior proporção de mais de um tipo de tratamento utilizado. Entre os indivíduos que declararam ter apenas bronquite crônica, 55,1% (IC95% 48,7-61,4) usavam medicamento, 4,7% (IC95% 2,6-8,3) realizavam fisioterapia e 6,0% (IC95% 3,6-9,9) oxigenoterapia. Por outro lado, entre os enfisematosos, 44,1% (IC95% 36,8-51,7) realizavam tratamento medicamentoso, 8,8% (IC95% 5,4-14,2) fisioterapia e 10,0% (IC95% 6,3-15,6) oxigenoterapia. CONCLUSÕES As prevalências de tratamentos para o manejo da DPOC estavam aquém do ideal em 2013. O medicamentoso foi o principal tipo de tratamento, seguido de oxigenoterapia e fisioterapia.
Assuntos
Humanos , Masculino , Feminino , Adulto , Enfisema Pulmonar , Inquéritos Epidemiológicos , Gerenciamento Clínico , Bronquite Crônica , Doença Pulmonar Obstrutiva Crônica/epidemiologiaRESUMO
INTRODUCCIÓN. La exposición a plaguicidas de trabajadores agrícolas y productores ha sido causal de aparición de síntomas respiratorios teniendo el Ecuador el 62% de población rural dedicada a esta actividad. OBJETIVO. Identificar y evaluar las condiciones de trabajo asociadas a síntomas respiratorios por exposición a residuos de plaguicidas. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 140 y muestra de 102 trabajadores de la empresa Condimensa. Los datos fueron recolectados mediante el cuestionario de salud respiratoria de la European Comunity Respiratory Health Survey en Latinoamérica segunda versión, en septiembre de 2020. RESULTADOS. Se encontró una relación estadísticamente significativa entre flema crónica y sexo con unA Prueba Exacta de Fisher (p=0,015), la manipulación de sustancias nocivas o toxicas (p=0,001), y la condición de exposición química (p=0,0006). Mediante análisis de regresión logística se determinó que la manipulación de sustancias nocivas o tóxicas (Odds Ratio 5.50, Intervalo de Confianza 95% 1.58 19.17), y estar expuesto a químicos (Odds Ratio 7.00, Intervalo de Confianza 95% 2.11 23.22), fueron factores de riesgo para el desarrollo de síntomas respiratorios: flema crónica, tos crónica, sibilancia, opresión en el pecho, disnea crónica, bronquitis crónica. CONCLUSIÓN. Se registró y evaluó las condiciones de trabajo asociadas a síntomas respiratorios por exposición a residuos; y, la evidencia fue fuerte para la exposición residual a plaguicidas.
INTRODUCTION.Worldwide Exposure to pesticides in agricultural workers and producers has been the cause of the appearance of respiratory symptoms. Ecuador having 62% of the rural population dedicated to this activity. OBJETIVE. Identify and evaluate the working conditions associated with respiratory symptoms due to exposure to pesticide residues. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 140 and sample of 102 workers of the Condimensa company. The data were collected using the respiratory health questionnaire of the European Community Respiratory Health Survey in Latin America, second version, in september 2020. RESULTS. A statistically significant relationship between chronic phlegm and sex type was found with a Fisher exact (p=0,015), the handling of harmful or toxic substances Fisher exact (p = 0.001), and the condition of chemical exposure a Fisher Exact Test (p=0,0006). Through logistic regression analysis, it was determined that the handling of harmful or toxic substances (Odds Ratio 5.50, Confidence Interval 95% 1.58 - 19.17), and being exposed to chemicals (Odds Ratio 7.00, Confidence Interval 95% 2.11 - 23.22), were risk factors for the development of respiratory symptoms: chronic phlegm, chronic cough, wheezing, chest tightness, chronic dyspnea, chronic bronchitis. CONCLUSION. The working conditions associated with respiratory symptoms due to exposure to residues associated with chronic phlegm were recorded and evaluated; and the evidence was strong for residual pesticide exposure.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Doenças Respiratórias , Uso de Praguicidas , Exposição Ocupacional , Absorção pelo Trato Respiratório , Sistema Respiratório , Dor no Peito , Sons Respiratórios , Indicadores Básicos de Saúde , Exposição a Produtos Químicos , Exposição a Praguicidas , Tosse , Bronquite Crônica , Doenças dos Trabalhadores Agrícolas , Fungicidas IndustriaisRESUMO
OBJECTIVES: In the US, chronic bronchitis (CB) is common and is associated with substantial morbidity and mortality. Data on CB in the Hispanic/Latino population-a large, diverse US minority-are scarce. We aimed to test whether the prevalence of CB varies across Hispanic/Latino heritages and to identify CB risk factors, including occupational exposures, in this population. METHODS: We analysed data from the Hispanic Community Health Study/Study of Latinos, a US population-based probability sample of participants aged 18-74 years (n=16 415) including those with Mexican, Puerto Rican, Dominican, Cuban, Central American and South American heritages. Participants who had a completed respiratory questionnaire and valid spirometric data were included in the analysis (n=13 259). CB, place of birth, heritage, occupational exposures and other risk factors were based on standardised questionnaires. The prevalence of CB was estimated using survey logistic regression-conditional marginal analysis. RESULTS: The estimated (mean (95% CI)) overall adjusted prevalence of CB was 12.1% (9.3 to 15.6), with a large variation across heritages. Dominican heritage had a fivefold higher prevalence than South American heritage. US-born participants had a higher adjusted prevalence than their non-US-born counterparts (16.8% (12.5 to 22.1) vs 11.0% (8.5 to 14.10); p=0.022). Compared with non-exposed participants, those exposed to cleaning or disinfecting solutions had a higher adjusted prevalence of CB (12.6% (9.1 to 17.1) vs 11.8% (9.2 to 15.1); p=0.024). CONCLUSIONS: The prevalence of CB was higher among Dominicans than other Hispanic/Latino heritages. CB was more prevalent among US-born participants and those exposed to cleaning and disinfecting solutions.
Assuntos
Bronquite Crônica/epidemiologia , Bronquite Crônica/etiologia , Hispânico ou Latino/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Emigrantes e Imigrantes , Feminino , Humanos , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , América do Sul/etnologia , Espirometria , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The objective of the article was to establish the prevalence, underdiagnosis, and risk factors of chronic bronchitis (CB) in a general population in five Colombian cities. Cross-sectional study using a probabilistic sampling technique in five Colombian cities was adopted. The CB definition was "cough and expectoration for three or more months per year for at least two consecutive years." Underdiagnosis was considered in subjects with clinical definition without previous medical diagnosis. Univariate χ2 or Student's t-test and logistic regression analysis were used. The study included 5539 subjects. The prevalence was 5.5%, the underdiagnosis 50.3%, and 33.7% of the cases were in nonsmokers (53.6% in women vs. 16.9% in men, p < 0.001). The adjusted risk factors were living in Bogota, current smoking, male, age ≥ 64 years, low education, indoor wood smoke exposure, and occupational exposure to vapors, gases, dust, and fumes. CB is a common disease among adults in Colombia. The underdiagnosis was high and there were a large proportion of cases in nonsmokers, particularly in women. Our findings support the association of CB with indoor wood smoke and occupational exposures.
Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Bronquite Crônica/epidemiologia , não Fumantes/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Bronquite Crônica/complicações , Bronquite Crônica/diagnóstico , Cidades/epidemiologia , Colômbia/epidemiologia , Tosse/etiologia , Estudos Transversais , Poeira , Escolaridade , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumaça , Fumar/epidemiologiaRESUMO
Introducción. La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una patología no transmisible, caracterizada por una limitación de flujo de aire en las vías respiratorias debido a una respuesta inmunológica anormal frente a partículas. Objetivo. Conocer la eficacia que tiene la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar en personas mayores de 40 años con Enfermedad Pulmonar Obstructiva Crónica. Materiales y métodos. Se realizó una revisión sistemática de documentos producidos entre el año 2000 y 2018 en distintas bases de datos, donde se incluyeron ensayos clínicos. Se identificaron cuatro artículos para el análisis final. Resultados. Durante la evaluación comparativa de budesonida con formoterol, los artículos muestran un total de 709 personas evaluadas, con un promedio de edad de 53,5 años. El 65,4 % eran varones, el 21 % manifestaba no haber consumido tabaco, todos con diagnóstico de Enfermedad Pulmonar Obstructiva Crónica moderada-severa, según la escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Los estudios determinaron que al administrar budesonida/formoterol de 400/12 mcg y 320/9 mcg, los pacientes tuvieron una leve mejoría en el Volumen Espiratorio Forzado del primer segundo (VEF1). Solo dos pacientes presentaron efectos adversos. No obstante, para los resultados mencionados anteriormente no se encontró diferencias significativas. Conclusiones. El uso de budesonida/formoterol es eficaz al mejorar la capacidad ventilatoria pulmonar, disminuye el número de exacerbaciones anuales y genera un adecuado control de los síntomas, sin embargo, es igual de efectivo a la fluticasona/salmeterol.
Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a not transmissible disease, characterized by a limitation of airflow in the respiratory tract, due to an abnormal immune response to particles. Objective. This article aims to show that the application of budesonide / formoterol improves lung capacity in people over 40 years with Chronic Obstructive Pulmonary Disease. Materials and methods. A systematic review was conducted in the period between 2000 and 2018 in different databases where clinical trials were included. Four articles were identified for the final analysis. Results. During the comparative evaluation of budesonide with formoterol, a total of 709 people were evaluated, with an average age of 53.5 years, 65.4% were male, 21% reported not having used tobacco, all with a diagnosis of moderate-severe Chronic Obstructive Pulmonary Disease according to the GOLD scale (Global Initiative For Chronic Obstrutive Lung Disease). The studies determined that when budesonide / formoterol of 400/12 mcg and 320/9 mcg was administered, the patients had a slight improvement in the Forced Expiratory Volume of the first second (FEV1). Only two patients presented adverse effects. However, for the results mentioned above no significant differences were found. Conclusions. The use of budesonide / formoterol is effective in improving pulmonary ventilatory capacity, decreases the number of annual exacerbations and generates adequate control of symptoms, however, it is equally effective in fluticasone / salmeterol.
Introdução. A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia não transmissível, caraterizada por uma limitação do fluxo de ar nas vias aéreas devido a uma resposta imune anormal contra partículas. Objetivo. Conhecer a eficiência que apresenta a budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar em pessoas com mais de 40 anos com Doença Pulmonar Obstrutiva Crônica. Materiais e métodos. Foi realizada uma revisão sistemática dos documentos produzidos entre 2000 e 2018 em diferentes bancos de dados, onde foram incluídos ensaios clínicos. Quatro artigos foram identificados para a análise final. Resultados. Durante a avaliação comparativa de budesonida com formoterol, os artículos mostram um total de 709 pessoas avaliadas, com uma idade média de 53,5 anos. O 65,4 % eram do sexo masculino, o 21 % disseram que não usavam tabaco, todos diagnosticados com Doença Pulmonar Obstrutiva Crônica moderada a grave, de acordo com a escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Os estudos determinaram que administrar budesonida/formoterol de 400/12 mcg e 320/9 mcg, os pacientes apresentaram uma leve melhora no Volume Expiratório Forçado no primeiro segundo (VEF1). Apenas dois pacientes tiveram efeitos adversos. No entanto, não foram encontradas diferenças significativas para os resultados mencionados acima. Conclusões. O uso de budesonida/formoterol é eficaz na melhora da capacidade ventilatória pulmonar, diminui o numero de exacerbações anuais e gera controle adequado dos sintomas, no entanto, é igualmente eficaz para a fluticasona/salmeterol.