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European Respiratory Review : An... Sep 2023Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the... (Meta-Analysis)
Meta-Analysis Review
Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.
Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the evidence from individual clinical trials on the effect of continuous positive airway pressure (CPAP) treatment on glycaemic control in patients with co-existing obstructive sleep apnoea and type 2 diabetes remains controversial. A systematic review of randomised controlled trials assessing the effect of CPAP on glycaemic control in patients with obstructive sleep apnoea and type 2 diabetes was conducted using the databases MEDLINE, Embase, Cochrane and Scopus up to December 2022. Meta-analysis using a random-effect model was performed for outcomes that were reported in at least two randomised controlled trials. From 3031 records screened, 11 RCTs with a total of 964 patients were included for analysis. CPAP treatment led to a significant reduction in haemoglobin A1c (HbA1c) (mean difference -0.24%, 95% CI -0.43- -0.06%, p=0.001) compared to inactive control groups. Meta-regression showed a significant association between reduction in HbA1c and hours of nightly CPAP usage. CPAP therapy seems to significantly improve HbA1c and thus long-term glycaemic control in patients with type 2 diabetes and obstructive sleep apnoea. The amount of improvement is dependent on the hours of usage of CPAP and thus optimal adherence to CPAP should be a primary goal in these patients.
Topics: Humans; Continuous Positive Airway Pressure; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Sleep Apnea, Obstructive; Glucose
PubMed: 37673425
DOI: 10.1183/16000617.0083-2023 -
International Journal of Chronic... 2022COPD has a profound impact on the lives of patients and their partners, but the influence on physical, psychological and social aspects of sexual health has not been... (Meta-Analysis)
Meta-Analysis Review
COPD has a profound impact on the lives of patients and their partners, but the influence on physical, psychological and social aspects of sexual health has not been reviewed systematically. Searches for studies of the impact of COPD on sexual health were conducted independently by two authors in the databases of PubMed, PsycINFO, Embases, CINAHL, Web of Science, Scopus and The Cochrane Library. English-language quantitative and qualitative studies assessing one or more aspects of sexual health in patients diagnosed with COPD were narratively reviewed and, when possible, subjected to meta-analytic evaluation. A total of 31 studies, including 4 qualitative, were included. Twelve studies assessing erectile dysfunction with the International Index of Erectile Function were subjected to meta-analysis. The pooled prevalence of erectile dysfunction was 74% (95% CI: 68-80%) in a total of 1187 patients with COPD, compared with 56% (37-73%) in 224 age-matched, non-COPD controls. The sexual health outcomes assessed in the remaining studies varied considerably, compromising the comparability of the results. None of the qualitative studies had sexual health as their primary focus. Compared with non-COPD individuals, erectile dysfunction appears to be more prevalent among patients with COPD, but more studies including non-COPD controls are needed to confirm this finding. In addition, the impact of COPD on other physical, psychological and social aspects of sexual health remains unclear due to the lack of comparable assessment methods and study designs.
Topics: Humans; Male; Prevalence; Pulmonary Disease, Chronic Obstructive; Qualitative Research; Sexual Health
PubMed: 35173430
DOI: 10.2147/COPD.S347578 -
Therapeutic Advances in Respiratory... 2023Upper limb (UL) muscle dysfunction is a common extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD). UL muscle dysfunction is associated with... (Meta-Analysis)
Meta-Analysis Review
The effects of upper limb exercise training on upper limb muscle strength in people with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Upper limb (UL) muscle dysfunction is a common extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD). UL muscle dysfunction is associated with muscle weakness, dyspnea, and exercise intolerance. Although upper limb exercise training (ULET) is typically incorporated in pulmonary rehabilitation programs, its effects on UL muscle strength remains unclear.
OBJECTIVES
The purpose of this systematic review was to investigate the effectiveness of ULET, in UL muscle strength of people with COPD.
DESIGN
This is systematic review and meta-analysis study.
DATA SOURCES AND METHODS
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2020 guidelines were used for this study. PubMed, Cochrane, CINAHL Plus and SPORTDiscus and clinicaltrials.gov registry were searched from inception to July 2022. Included studies were randomized controlled trials, assessing the effectiveness in muscle strength of ULET, compared with other types of upper or lower limb exercise or no exercise. The quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and certainty of evidence with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Treatment effects of ULET were calculated using standardized mean differences and 95% confidence intervals.
RESULTS
Twenty-four studies, with a total sample of 882 patients, were included. Most studies were of moderate quality and high risk of bias. Very low to low certainty evidence indicates a significant difference in UL muscle strength in favor of resistance ULET, compared with lower limb exercise alone or no exercise. No significant differences were found in different types of ULET comparisons.
CONCLUSION
The results of this review showed that resistance ULET could improve UL muscle strength in people with COPD. Most studies, however, were of moderate quality and high risk of bias. Further studies with larger sample sizes, better methodological quality, and standardized training protocols are needed to confirm these findings.
Topics: Humans; Quality of Life; Randomized Controlled Trials as Topic; Pulmonary Disease, Chronic Obstructive; Exercise; Physical Therapy Modalities; Upper Extremity; Muscle Strength
PubMed: 37165688
DOI: 10.1177/17534666231170813 -
International Journal of Chronic... 2021Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, causing substantial economic and social burden. (Review)
Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, causing substantial economic and social burden.
OBJECTIVE
This review assessed the patient-reported humanistic burden associated with moderate to very severe COPD, specifically the impact on health-related quality of life (HRQoL), symptoms, limitations in daily life, and emotional implications, through the use of HRQoL instruments.
METHODS
A systematic review was conducted to retrieve relevant clinical data from published literature using a representative sample of countries where healthcare systems provide wide availability of COPD medications and/or universal coverage includes respiratory medicines (Australia, Canada, China, France, Germany, Italy, Spain, the UK, and the USA). The primary inclusion criteria were patients with moderate to very severe COPD. HRQoL was quantified with non-disease-specific and disease-specific questionnaires.
RESULTS
In total, 82 studies from 95 publications presented HRQoL data from patients with moderate to very severe COPD. Patient-reported HRQoL declined with worsening airflow limitation, advancing GOLD group, and increasing exacerbation frequency. Both increasing frequency of hospitalization for COPD exacerbations and recurrent hospitalization adversely impacted HRQoL. Comorbidity incidence was higher in patients with increased airflow limitation. It was associated with a further decline in HRQoL and increased depression and anxiety, particularly as disease-associated pain worsened. Physical activity improved HRQoL over time.
CONCLUSION
This review highlighted the impact of exacerbations and associated hospitalizations on the humanistic burden of COPD. These findings underline the importance of managing COPD actively, including prompt and appropriate use of pharmacological and non-pharmacological therapies that can improve symptoms and reduce the risk of exacerbations, thereby lessening the humanistic burden. Future reviews could consider a broader range of countries and publications to further assess the humanistic impact of COPD in low- and middle-income economies.
Topics: Australia; Canada; China; France; Germany; Humans; Italy; Pulmonary Disease, Chronic Obstructive; Quality of Life; Spain
PubMed: 34007170
DOI: 10.2147/COPD.S296696 -
Archives of Medical Science : AMS 2020Preoperative biliary drainage has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method is more effective:... (Review)
Review
INTRODUCTION
Preoperative biliary drainage has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method is more effective: internal drainage or external drainage. Thus, we carried out a meta-analysis to compare the safety and efficacy of the two drainage methods in treatment of malignant biliary obstruction in terms of preoperative and postoperative complications.
MATERIAL AND METHODS
We conducted a literature search of Medline, EMBASE, PubMed, Ovid journals and the Cochrane Library, and compared internal drainage and external drainage in malignant biliary obstruction patients. The pre- and postoperative complications, stent dysfunction rate and mortality were analyzed.
RESULTS
Ten published studies ( = 1464 patients) were included in this meta-analysis. We found that patients with malignant biliary obstruction who received external drainage showed reductions in the preoperative cholangitis rate (OR = 0.33, 95% CI: 0.24-0.44, < 0.00001), the incidence of stent dysfunction (OR = 0.41, 95% CI: 0.30-0.57, < 0.00001), and total morbidity (OR = 0.34, 95% CI: 0.23-0.50, < 0.00001) compared with patients who received internal drainage.
CONCLUSIONS
The current meta-analysis indicates that external drainage is better than internal drainage for malignant biliary obstruction in terms of the preoperative cholangitis rate, the incidence of stent dysfunction and total morbidity, etc. However, the findings need to be confirmed by randomized controlled trials.
PubMed: 32542075
DOI: 10.5114/aoms.2020.94160 -
Drug Design, Development and Therapy 2018Asthma-COPD overlap (ACO) is a type of incomplete obstructive airway disease that has a high incidence and mortality. Nevertheless, there is currently no clear... (Review)
Review
Asthma-COPD overlap (ACO) is a type of incomplete obstructive airway disease that has a high incidence and mortality. Nevertheless, there is currently no clear definition of ACO and no effective intervention. The newly discovered phosphodiesterase-4 inhibitor, roflumilast, has shown initial efficacy for treating asthma, COPD, and ACO. The mechanism of roflumilast, however, remains unclear, and there has been no interpretation through systematic review to date. The determination of a definite mechanism of roflumilast will guide the clinician's decisions regarding medication use, standardized diagnosis, and treatment guidelines. For this reason, we have systematically reviewed the therapeutic mechanism of roflumilast for ACO and provided reference for the clinical application of roflumilast in ACO.
Topics: Airway Remodeling; Aminopyridines; Asthma; Benzamides; Cyclopropanes; Forced Expiratory Volume; Humans; Interleukin-17; Phosphodiesterase 4 Inhibitors; Pulmonary Disease, Chronic Obstructive
PubMed: 30122895
DOI: 10.2147/DDDT.S165161 -
International Journal of Chronic... 2016COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking... (Review)
Review
BACKGROUND
COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers.
OBJECTIVE
This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers.
METHODS
PubMed and Google Scholar were utilized to search for articles related to our study's focus. Search terms included "COPD exacerbation", "air pollution", "air quality guidelines", "air quality standards", "COPD morbidity and mortality", "chronic bronchitis", and "air pollution control" separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles.
RESULTS
Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females.
CONCLUSION
There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries' socioeconomic conditions to reduce the air pollution exposure and COPD burden.
Topics: Air Pollution; Guidelines as Topic; Humans; Pulmonary Disease, Chronic Obstructive
PubMed: 27143874
DOI: 10.2147/COPD.S49378 -
International Journal of Chronic... 2023NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD.
METHODS
The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients.
RESULTS
A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; =0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; =0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; =0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; =0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; <0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; <0.0001] showed higher NT-proBNP level.
CONCLUSION
NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.
Topics: Adult; Humans; Pulmonary Disease, Chronic Obstructive; Lung; Peptide Fragments; Natriuretic Peptide, Brain; Biomarkers
PubMed: 37197601
DOI: 10.2147/COPD.S396663 -
International Journal of Chronic... 2016Short-term exposure to major air pollutants (O, CO, NO, SO, PM, and PM) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Short-term exposure to major air pollutants (O, CO, NO, SO, PM, and PM) has been associated with respiratory risk. However, evidence on the risk of chronic obstructive pulmonary disease (COPD) exacerbations is still limited. The present study aimed at evaluating the associations between short-term exposure to major air pollutants and the risk of COPD exacerbations.
METHODS
After a systematic search up until March 30, 2016, in both English and Chinese electronic databases such as PubMed, EMBASE, and CNKI, the pooled relative risks and 95% confidence intervals were estimated by using the random-effects model. In addition, the population-attributable fractions (PAFs) were also calculated, and a subgroup analysis was conducted. Heterogeneity was assessed by .
RESULTS
In total, 59 studies were included. In the single-pollutant model, the risks of COPD were calculated by each 10 μg/m increase in pollutant concentrations, with the exception of CO (100 μg/m). There was a significant association between short-term exposure and COPD exacerbation risk for all the gaseous and particulate pollutants. The associations were strongest at lag0 and lag3 for gaseous and particulate air pollutants, respectively. The subgroup analysis not only further confirmed the overall adverse effects but also reduced the heterogeneities obviously. When 100% exposure was assumed, PAFs ranged from 0.60% to 4.31%, depending on the pollutants. The adverse health effects of SO and NO exposure were more significant in low-/middle-income countries than in high-income countries: SO, relative risk: 1.012 (95% confidence interval: 1.001, 1.023); and NO, relative risk: 1.019 (95% confidence interval: 1.014, 1.024).
CONCLUSION
Short-term exposure to air pollutants increases the burden of risk of COPD acute exacerbations significantly. Controlling ambient air pollution would provide benefits to COPD patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Air Pollutants; Child; Child, Preschool; Disease Progression; Female; Humans; Infant; Infant, Newborn; Inhalation Exposure; Lung; Male; Middle Aged; Odds Ratio; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Risk Factors; Time Factors; Young Adult
PubMed: 28003742
DOI: 10.2147/COPD.S122282 -
Brazilian Journal of Otorhinolaryngology 2022Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications... (Review)
Review
OBJECTIVE
Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing.
METHODS
We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review.
RESULTS
We found 10 smartphone apps that met the inclusion criteria.
CONCLUSIONS
The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable.
Topics: Humans; Mobile Applications; Reproducibility of Results; Sleep Apnea, Obstructive; Smartphone; Sleep Apnea Syndromes
PubMed: 35210182
DOI: 10.1016/j.bjorl.2022.01.004