Managing patients with recurrent acute exacerbations of chronic bronchitis: a common clinical problem
acute exacerbation; acute otitis media; airway inflammation; antimicrobial resistance; chronic bronchitis; chronic obstructive; community-acquired pneumonia; disease; empiric therapy; General & Internal Medicine; haemophilus-influenzae; moraxella-catarrhalis; obstructive-pulmonary-disease; pneumococcal; pneumonia; pulmonary; Research & Experimental Medicine; resistance; resistant streptococcus-pneumoniae; surveillance program
Chronic obstructive pulmonary disease (COPD) affects 15 million people and is the fourth leading cause of death in the United States. It places a considerable burden on the healthcare system, with exacerbations contributing to a significant proportion of this burden. Patients with recurrent exacerbation, who experience more than 2 exacerbations per year, are especially difficult to manage. Several potential host, pathogen, and treatment factors can be identified that contribute to recurrent exacerbation. Patients with recurrent exacerbations are often exposed to frequent courses of antimicrobials. Therefore, antimicrobial resistance among common bacterial pathogens is likely to be prevalent in this group of patients, and further complicates therapy in this already difficult-to-treat patient population. In the management of patients with recurrent exacerbation, one goal should be to decrease the frequency of exacerbations, for which several strategies are suggested. In this article, we will review available literature identified through an extensive search of Medline and PubMed on the characteristics and approach to management of these difficult-to-treat patients. There is a substantial need for more research to understand the etiology and identify efficacious interventions to reduce the frequency of exacerbations of COPD.
Sethi S; File T M
Current Medical Research and Opinion
2004
2004-10
Journal Article
<a href="http://doi.org/10.1185/030079904x3096" target="_blank" rel="noreferrer noopener">10.1185/030079904x3096</a>
Association of pulse pressure, pulse pressure index, and ambulatory arterial stiffness index with kidney function in a cross-sectional pediatric chronic kidney disease cohort from the CKiD study.
inflammation; risk; children; blood-pressure; progression; ckd; AASI; chronic kidney disease; pulse pressure; pulse pressure index; aasi; albuminuria; dialysis patients; left-ventricular hypertrophy
The morbidity and mortality of adult and pediatric chronic kidney disease (CKD) and end-stage renal disease (ESRD) populations are mainly driven by cardiovascular disease (CVD). Improving CVD outcomes focuses on risk assessment of factors including diastolic blood pressure (DBP), systolic blood pressure (SBP), left ventricular mass index (LVMI), pulse pressure (PP), and pulse pressure index (PPi), which is calculated as PP/SBP. These markers are also proven predictors of CKD progression; however, their role in children has not been established. This study aims to evaluate the relationship between PP, PPi, ambulatory arterial stiffness index (AASI), and proteinuria with kidney function in pediatric CKD patients; it is a retrospective analysis of 620 patients (1-16 years) from the NIDDK Chronic Kidney Disease in Children (CKiD) registry. The authors analyzed data for three separate cohorts: an overall CKD as well as immunological versus non-immunological cause for CKD groups. An inverse relationship was found between SBP, DBP, and PP with iGFR and LVMI in the overall CKD group. Our immunological CKD subgroup showed significantly higher serum creatinine, SBP, DBP, and PP values with significantly lower serum albumin levels compared to the non-immunological group. There were no significant differences with iohexol-based glomerular filtration rate (iGFR), LVMI, PPi, or high-sensitivity C-reactive protein (hs-CRP) between the two groups. A subgroup analysis demonstrated that SBP, DBP, and PP all correlated significantly with LVMI in the immunological CKD patients but not the non-immunological subgroup. Additionally, AASI data in the overall CKD population were significantly correlated with PP, PPi, and DBP. This study is one of the first to correlate noninvasive measurements of vascular compliance including PP, PPi, and AASI with iGFR and LVMI in a pediatric CKD cohort. Improving our understanding of surrogate markers for early CVD is integral to improving the care of pediatric CKD population as these patients have yet to develop the hard end points of ESRD, heart failure, myocardial infarction, or stroke.
Raina R; Polaconda S; Nair N; Chakraborty R; Sethi S; Krishnappa V; Kapur G; Mhanna M; Kusumi K
Journal of Clinical Hypertension
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/jch.13905" target="_blank" rel="noreferrer noopener">10.1111/jch.13905</a>