Læknablaðið - 01.07.2015, Blaðsíða 21

Y F i R l i T S G R E i n
Önnur meðferð en lyfjameðferð
Reykleysisráðgjöf og reykbindindi er það inngrip sem mestan þátt
getur átt í að hægja á versnun lungnastarfsemi hjá sjúklingum með
LLT. Ef vel er að slíku staðið má fá allt að 25% langtíma reykleys-
isáhrif.54 Reykbindindi fækkar BVLLT og áhættuminnkunin er í
beinu hlutfalli við lengd reykleysisins hjá LLT-sjúklingnum.55
Lungnaendurhæfing er mikilvæg fyrir alla sjúklinga með lang-
vinna lungnateppu.2 Ekki hefur verið sýnt fram á að lungnaendur-
hæfing fljótt eftir sjúkrahúslegu flýti fyrir bata eða fækki versn-
unum.56 Þannig getur verið betra að láta nokkurn tíma líða áður en
sjúklingur byrjar í lungnaendurhæfingu eftir sjúkrahúsinnlögn.
Hins vegar hefur líkamsþjálfun í sjúkrahúslegu vegna BVLLT sýnt
sig að flýta fyrir bata og lungnaendurhæfing eftir að sjúklingur
hefur náð sér eftir bráða versnun fækkar sjúkrahúsinnlögnum og
lækkar dánartíðni.2,57
Það er aukin dánartíðni við lækkaðan líkamsþyngdarstuðul og
vannæring er mikilvægur áhættuþáttur fyrir slæmar horfur hjá
LLT-sjúklingum.58,59
Eftirlit
Rannsóknir hafa sýnt fram á að minni líkur eru á endurinnlögn ef
sjúklingur hittir lækni innan 30 daga frá útskrift.60 Eftirlit hjúkr-
unarfræðinga fljótt eftir útskrift getur einnig verið hjálplegt. Mis-
vísandi niðurstöður hafa fengist við rannsóknir á sjálfshjálparúr-
ræðum fyrir sjúklinga eftir útskrift og beðið er frekari rannsókna
til að skera úr um virkni þeirra.2,3
Lokaorð
Langvinn lungnateppa er algengur sjúkdómur með mikilli
sjúkdómsbyrði og hárri dánartíðni. Þar skipta bráðar versnanir
höfuðmáli. Markviss meðferð þeirra er mikilvæg og ekki er síður
mikilvægt að reyna með öllum ráðum að fyrirbyggja endurteknar
versnanir því þær skerða mjög lífsgæði sjúklinga og auka dánar-
tíðni. Þessir sjúklingar koma víða við í heilbrigðisþjónustunni og
því nauðsynlegt fyrir íslenska lækna að þekkja vel til þessa vanda-
máls. Þá er rökvíst val sýklalyfja mikilvægt til að minnka líkur á
sýklalyfjaónæmi með tilheyrandi þjáningum og kostnaði fyrir ís-
lenska þjóð.
Heimildir
1. Anzueto A, Sethi S, Martinez F. Exacerbations of chronic
obstructive pulmonary disease. Proc Am Thorac Soc 2007
4: 554–64.
2. GOLD (2015) Global Strategy for the Diagnosis,
Management, and Prevention of Chronic Obstructive
Pulmonary Disease. March. goldcopd.org – mars 2015.
3. Qureshi H, Sharafkhaneh A, Hanania NA. Chronic obst-
ructive pulmonary disease exacerbations: latest evidence
and clinical implications. Ther Adv Chronic Dis 2014 ;5:
212-27.
4. Donaldson G, Seemungal T, Bhowmik A, Wedzicha,
J. Relationship between exacerbation frequency and
lung function decline in chronic obstructive pulmonary
disease. Thorax 2002; 57: 847-52.
5. Seemungal T, Donaldson G, Bhowmik A, Jeffries D,
Wedzicha J. Time course and recovery of exacerbations in
patients with chronic obstructive pulmonary disease. Am
J Respir Crit Care Med 2000 161: 1608-13.
6. Seemungal T, Donaldson G, Paul E, Bestall J, Jeffries D,
Wedzicha J. Effect of exacerbation on quality of life in
patients with chronic obstructive pulmonary disease. Am
J Respir Crit Care Med 1998 151: 1418-22.
7. Vestbo, J, Lisa, D., Scanlon, P., Yates, J., Agusti, A., Bakke,
P. et al. Changes in forced expiratory volume in 1 second
overtime in COPD. N Engl J Med 2011; 365: 1184–1192.
8. Hurst J, Vestbo J. Evaluation of COPD Longitudinally
to Identify Predictive Surrogate Endpoints (ECLIPSE)
investigators. Susceptibility to exacerbation in chronic
obstructive pulmonary disease. N Engl J Med 2010; 363:
1128-38
9. Husebø GR, Bakke PS, Aanerud M, Hardie JA, Ueland T,
Grønseth R, et al. Predictors of exacerbations in chronic
obstructive pulmonary disease--results from the Bergen
COPD cohort study. PLoS One 2014; 9: e109721.
10. Rennard SI, Locantore N, Delafont B, Tal-Singer
R, Silverman EK, Vestbo J, et al. Evaluation of
COPD Longitudinally to Identify Predictive Surrogate
Endpoints. Identification of Five Chronic Obstructive
Pulmonary Disease Subgroups with Different Prognoses
in the ECLIPSE Cohort Using Cluster Analysis. Ann Am
Thorac Soc 2015; 12: 303-12.
11. Beghé B, Verduri A, Roca M, Fabbri, L. Exacerbation
of respiratory symptoms in COPD patients may not be
exacerbations of COPD. Eur Respir J 2013; 41: 993-5.
12. Clini E, Beghé B, Fabbri L. Chronic obstructive pulmonary
disease is just one component of the complex multimor-
bidities in patients with COPD. Am J Respir Crit Care Med
2013; 187: 668-71.
13. Smith MC, Wrobel JP. Epidemiology and clinical impact
of major comorbidities in patients with COPD.Int J Chron
Obstruct Pulmon Dis 2014; 9: 871-88.
14. Sapey E, Stockley, R. COPD exacerbations.2: Aetiology.
Thorax 2006; 61: 250-8.
15. Sethi S, Murphy T. Infection in the pathogenesis and
course of chronic obstructive pulmonary disease. N Engl J
Med 2008; 59: 2355-65.
16. Song Q, Christiani DC, XiaorongWang, Ren J. The global
contribution of outdoor air pollution to the incidence,
prevalence, mortality and hospital admission for chronic
obstructive pulmonary disease: a systematic review and
meta-analysis. Int J Environ Res Public Health 2014; 11:
11822-32.
17. Carlsen HK, Forsberg B, Meister K, Gíslason T, Oudin A.
Ozone is associated with cardiopulmonary and stroke
emergency hospital visits in Reykjavík, Iceland 2003-2009.
Environ Health 2013; 12: 28.
18. Carlsen HK, Zoëga H, Valdimarsdóttir U, Gíslason T,
Hrafnkelsson B. Hydrogen sulfide and particle matter
levels associated with increased dispensing of anti-asthma
drugs in Iceland's capital. Environ Res 2012; 113: 33-9.
19. Rizkallah J, Man S, Sin D. Prevalence of pulmonary
embolism in acute exacerbations of COPD: a systematic
review and metaanalysis. Chest 2009; 135: 786-93.
20. Yetgin GO, Aydin SA, Koksal O, Ozdemir F, Mert DK,
Torun G. Clinical probability and risk analysis of patients
with suspected pulmonary embolism. World J Emerg Med
2014; 5: 264-9.
21. Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y,
Jones PW. Changes in plasma levels of B-type natriuretic
peptide with acute exacerbations of chronic obstructive
pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014;
9: 155-62.
22. Price, L., Lowe, D., Hosker, H., Anstey, K., Pearson, M.
and Roberts, C. UK National COPD Audit 2003: impact of
hospital resources and organization of care on patient out-
come following admission for acute COPD exacerbation.
Thorax 2006; 61: 837-42.
23. Malolepszy, J, Boszormenyi N, Selroos O. Safety of form-
oterol Turbuhaler at cumulative dose of 90 microg in
patients with acute bronchialobstruction. Eur Respir J
2001; 18: 928-34.
24. Abroug F, Ouanes I, Abroug S, Dachraoui F, Abdallah
SB, Hammouda Z, Ouanes-Besbes L. Systemic corticos-
teroids in acute exacerbation of COPD: a meta-analysis
of controlled studies with emphasis on ICU patients. Ann
Intensive Care 2014; 4: 32.
25. De Coster DA, Jones M. Tailoring of corticosteroids in
COPD management. Curr Respir Care Rep 2014; 3: 121-32.
26. Walters JA, Tan DJ, White CJ, Wood-Baker R. Different
durations of corticosteroid therapy for exacerbations
of chronic obstructive pulmonary disease. Cochrane
Database Syst Rev 2014; 12: CD006897.
27. Niewoehner D, Erbland M, Deupree R, Collins D, Gross
N, Light R, et al. Effect of systemic glucocorticoids on
exacerbations of chronic obstructive pulmonary disease.
N Engl J Med 1999; 340: 1941-7.
28. Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M,
Drescher T, et al. Short-term vs conventional glucocortico-
id therapy in acute exacerbations of chronic obstructive
pulmonary disease: the REDUCE randomized clinical
trial. JAMA 2013; 309: 2223-31.
29. Sýklalyfjanæmi 2013. landspitali.is/library/Sameigin-
legar-skrar/Gagnasafn/Kl inisk-svid-og-dei ldir /
Rannsoknarsvid/Syklafraedidei ld/Naemisprof /
Sýklalyfjanæmi%202013.pdf - mars 2015.
30. Anthonisen NR, Manfreda J, Warren CP, Hershfield
ES, Harding GK, Nelson NA. Antibiotic therapy in
exacerbations of chronic obstructive pulmonary disease.
Ann Intern Med 1987; 106: 196-204.
31. Rohde GG, Koch A, Welte T, ABACOPD study group.
Randomized double blind placebo-controlled study to
demonstrate that antibiotics are not needed in moderate
acute exacerbations of COPD--the ABACOPD study. BMC
Pulm Med 2015; 15: 5.
32. Tse HN, Tseng CZ. Update on the pathological processes,
molecular biology, and clinical utility of N-acetylcysteine
in chronic obstructive pulmonary disease. Int J Chron
Obstruct Pulmon Dis 2014; 9: 825-36.
33. Brill SE, Wedzicha JA. Oxygen therapy in acute exacerba-
tions of chronic obstructive pulmonary disease. Int J
Chron Obstruct Pulmon Dis 2014; 9: 1241-52.
34. Quintana JM, Esteban C, Unzurrunzaga A, et al; IRYSS-
COPD group. Predictive score for mortality in patients
with COPD exacerbations attending hospital emergency
departments. BMC Med. 2014; 12: 66.
35. Roberts CM, Stone RA, Buckingham RJ, Pursey NA, Lowe
D; National Chronic Obstructive Pulmonary Disease
Resources and Outcomes Project Implementation Group.
Acidosis, non-invasive ventilation and mortality in
hospitalised COPD exacerbations. Thorax 2011; 66: 43-8.
36. O’Driscoll BR, Howard LS, Davison AG; British Thoracic
Society. BTS guideline for emergency oxygen use in adult
patients. Thorax.- 2008; 63 Suppl 6: vi1–vi68.
37. Mas A, Masip J. Noninvasive ventilation in acute respira-
tory failure. Int J Chron Obstruct Pulmon Dis 2014; 9: 837-
52.
38. Gudmundsson G, Gislason T, Janson C, Hallin R,
Lindberg E, Suppli Ulrik C, et al. Risk factors for reho-
spitalization in COPD: role of health status, anxiety and
depression. Eur Resp J 2005; 26: 414-9.
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