Geert Celis

Modification of COPD Presentation During the Last 25 Years

ABSTRACT During the last decades progress has been made in the treatment of Chronic Obstructive Pulmonary Disease (COPD). We compared a random sample of patients admitted for an exacerbation in the period 2001–2005 (n = 101), with a random sample of patients hospitalized for the same reason in the period 1980–1984 (n = 51). Patients of the 2001–2005 cohort had a lower FEV1 (48 ± 3 vs. 41 ± 2% predicted, p = 0.01) for similar mean age, gender and body- mass index when compared to the historical sample. Co-morbidities, according to the Charlsons index, were more prevalent in the 2001–2005 cohort compared to the 1980–1984 cohort, with a reduction of hemoglobin (13.9 ± 0.2 gr/dl vs. 14.9 ± 0.2, p < 0.01) and higher prevalence of anemia in the most recent cohort. We found an increase in the use of cardiovascular drugs and respiratory medications over time with exception for the long-term use of oxygen. Despite lower FEV1 and more prevalent co-morbidities, no difference in length of hospitalization (13.6 ± 1.4 days vs. 12.7 ± 0.7 days, p = 0.52) and 30 months survival post-exacerbation was noted (66.6% vs. 69.3%, p = 0.85). Over the course of 20 years, the presentation of COPD patients admitted for an exacerbation seems to be changed towards a more severe phenotype with lower FEV1 and more co-morbidities. As the length of hospitalization and the overall survival were not different between the two samples, a currently improved management of COPD can be hypothesized.

Non-linear parameters of specific resistance loops to characterise obstructive airways diseases

BackgroundSpecific resistance loops appear in different shapes influenced by different resistive properties of the airways, yet their descriptive ability is compressed to a single parameter - its slope. We aimed to develop new parameters reflecting the various shapes of the loop and to explore their potential in the characterisation of obstructive airways diseases.MethodsOur study included 134 subjects: Healthy controls (N = 22), Asthma with non-obstructive lung function (N = 22) and COPD of all disease stages (N = 90). Different shapes were described by geometrical and second-order transfer function parameters.ResultsOur parameters demonstrated no difference between asthma and healthy controls groups, but were significantly different (p < 0.0001) from the patients with COPD. Grouping mild COPD subjects by an open or not-open shape of the resistance loop revealed significant differences of loop parameters and classical lung function parameters. Multiple logistic regression indicated RV/TLC as the only predictor of loop opening with OR = 1.157, 95% CI (1.064–1.267), p-value = 0.0006 and R2 = 0.35. Inducing airway narrowing in asthma gave equal shape measures as in COPD non-openers, but with a decreased slope (p < 0.0001).ConclusionThis study introduces new parameters calculated from the resistance loops which may correlate with different phenotypes of obstructive airways diseases.

Is repeated education about small volume nebulizer aerosol, by an expert respiratory nurse to colleagues, needful?

Aim: To investigate the improvement of knowledge after recurrent education in nebulization guidelines for correct use, in university hospital nurses. Materials and methods: In 2010, without special attention to previous aerosol education, an unannounced individual questionnaire about correct use of nebulizers was randomized distributed among nurses on different wards in the hospital. In 2014, after education on voluntary basis, we performed the same randomized survey over different wards. In 2015 we organized a compulsory education about correct use of nebulizers. After two months the same questionnaire was unannounced randomized distributed on different wards in the hospital. Questions about nebulization were: What is the preferred system for correct use: a mask or mouthpiece? What is the flow and duration of nebulizing? What is your advice to patients about their breathing pattern? Results: There were n=238 responders in 2010 (group A), n=219 in 2014 (group B) and n=173 in 2015 (Group C). Conclusion: The existing procedure for nebulization protocols was poorly applied in 2010 but improved significant in 2014. In 2015 the results were even better and again significant different. We conclude that recurrent education by an expert, improves the knowledge to nebulisation guidelines in university hospital nurses and it is useful to give education on a regular base.