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C Verkindre

Publications and source records attributed to C Verkindre.

8 recordsLinked to original sources
PubMed2005

The effect of tiotropium on hyperinflation and exercise capacity in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, which results in the progressive development of dyspnea and exercise limitation. OBJECTIVE AND METHODS: To compare the effect of tiotropium with placebo on forced vital capacity (FVC) in patients with moderate-to-severe COPD and lung hyperinflation, using exercise endurance, dyspnea and health-related quality of life (HRQoL) as secondary endpoints. One hundred patients were randomized to receive either tiotropium 18 mug once daily or placebo for 12 weeks. RESULTS: Trough (predose) FVC was significantly improved with tiotropium compared to placebo on day 42 (0.27 +/- 0.08 liters) and 84 (0.20 +/- 0.08 liters; p < 0.05 for both). Trough inspiratory capacity (IC) was also significantly improved with tiotropium compared to placebo on day 42 (0.16 +/- 0.07 liters) and 84 (0.15 +/- 0.07 liters; p < 0.05 for both). Tiotropium increased the mean distance walked during the shuttle walking test by 33 +/- 12 (day 42) and 36 +/- 14 m (day 84) compared to placebo (p < 0.05 for both). On day 84, 59% of the patients in the tiotropium group and 35% of the patients in the placebo group had significant and clinically meaningful improvements in the St. George's Respiratory Questionnaire total score (p < 0.05). Numerical decreases in the focal score in the Transition Dyspnea Index in patients receiving tiotropium versus placebo suggest that tiotropium also improved dyspnea during activities of daily living. CONCLUSION: Tiotropium 18 mug once daily reduced hyperinflation with consequent improvements in walking distance and HRQoL in patients with COPD and lung hyperinflation.

Adult↗
PubMed2004

[Asthma in the elderly].

INTRODUCTION: Asthma in the elderly is a growing clinical problem. It affects 6 to 7% of this age-group, but making the distinction between asthma and chronic obstructive pulmonary disease is more difficult as patients get older. STATE OF THE ART: This difficulty is due to a number of factors: the confounding role of smoking, and also the physiological effects of ageing on the airways which renders airway obstruction more resistant to bronchodilation. Elderly asthmatics can be divided on clinical grounds into two arbitrary groups: "ageing asthmatics" who have had asthma since childhood or adolescence and "late-onset asthmatics" who may present following an infective episode. Certain features of asthma in the elderly include: poor perception of breathlessness, technical difficulties in making reliable pulmonary function measurements and the extrapulmonary manifestations (impact on quality of life). PERSPECTIVES: The therapeutic strategy is much the same as for younger asthmatics but certain aspects take on greater importance: concerns about osteoporosis with long-term corticosteroid therapy (both oral and inhaled), the risk of arrhythmias with beta-2 adrenergic drugs and the significant side-effects of theophylline justifies, in difficult cases, consideration of anticholinergic and/or anti-leukotriene therapy. CONCLUSION: Most importantly, for elderly asthmatics it is a treatment regimen that is as simple as possible and is backed up by a written self-management plan that will improve outcomes.

Aged↗
PubMed2003

[Asthma in the elderly].

INTRODUCTION: Asthma in the elderly is a growing clinical problem. It affects 6 to 7% of this age-group, but making the distinction between asthma and chronic obstructive pulmonary disease is more difficult as patients get older. STATE OF THE ART: This difficulty is due to a number of factors: the confounding role of smoking, and also the physiological effects of ageing on the airways which renders airway obstruction more resistant to bronchodilation. Elderly asthmatics can be divided on clinical grounds into two arbitrary groups: "ageing asthmatics" who have had asthma since childhood or adolescence and "late-onset asthmatics" who may present following an infective episode. Certain features of asthma in the elderly include: poor perception of breathlessness, technical difficulties in making reliable pulmonary function measurements and the extra-pulmonary manifestations (impact on quality of life). PERSPECTIVES: The therapeutic strategy is much the same as for younger asthmatics but certain aspects take on greater importance: concerns about osteoporosis with long-term corticosteroid therapy (both oral and inhaled), the risk of arrhythmias with beta-2 adrenergic drugs and the significant side-effects of theophylline justifies, in difficult cases, consideration of anti-cholinergic and/or anti-leukotriene therapy. CONCLUSION: Most importantly, for elderly asthmatics it is a treatment regimen that is as simple as possible and is backed up by a written self-management plan that will improve outcomes.

Adolescent↗
PubMed1999

Multidisciplinary approach to management of postintubation tracheal stenoses.

The optimal management of postintubation tracheal stenosis is not well defined. A therapeutic algorithm was designed by thoracic surgeons, ear, nose and throat (ENT) surgeons, anaesthetists and pulmonologists. Rigid bronchoscopy with neodymium-yttrium aluminium garnet (Nd-YAG) laser resection or stent implantation (removable stent) was proposed as first-line treatment, depending on the type of stenosis (web-like versus complex stenosis). In patients with web-like stenoses, sleeve resection was proposed when laser treatment (up to three sessions) failed. In patients with complex stenoses, operability was assessed 6 months after stent implantation. If the patient was judged operable, the stent was removed and the patient underwent surgery if the stenosis recurred. This algorithm was validated prospectively in a series of 32 consecutive patients. Three patients died from severe coexistent illness shortly after the first bronchoscopy. Of the 15 patients with web-like stenosis, laser resection was curative in 10 (66%). Among the 17 patients with complex stenoses, three remained symptom-free after stent removal. Bronchoscopy alone was thus curative in more than one-third of the patients. Six patients underwent surgery, two after failure of laser resection and four after failure of temporary stenting. Surgery was always performed with the patient in good operative condition. Palliative stenting was the definitive treatment in nine cases. Tracheostomy was the definitive solution in two cases. This approach, including an initial conservative treatment, depending on the type of the stenosis, appears to be applicable to almost all patients and allows secondary surgery to be performed with the patient in good condition.

Algorithms↗
PubMed1999

Morphological changes induced by extensive endobronchial electrocautery.

Due to recent improvements of safety conditions for therapeutic devices, electrocautery is being considered with renewed interest in the field of therapeutic bronchoscopy. The efficiency of this technique for destructing intraluminal tumours is well documented and makes it an attractive alternative to Yttrium aluminium garnet (YAG) laser photo-coagulation. Little is known, however, about the morphologic changes induced by electrocautery within the bronchial wall structures. This information is, however, important since electrocautery has been proposed as an alternative to other techniques to treat superficial tumours of the bronchial wall. Soft coagulation, with autostop, using two different power setting (40 and 120 W), produced by a new generation of high frequency voltage regulated generators was applied circumferentially to the trachea or left main bronchus, in a series of 52 piglets. Early (48 h) and late effects (6 weeks) were assessed through gross examination (bronchoscopy and autopsy) and light microscopy. Early effects of electrocautery included coagulation necrosis of the mucosa only and intense acute inflammation extending deep into the bronchial structure. The inflammatory phase progressively resolved while extensive transmural fibrosis and deterioration of the cartilage plates developed. The nature and extent of these lesions did not depend upon the energy delivered (40 W versus 120 W). Retractile scar formation and loss of cartilaginous support then produced iatrogenic secondary stenoses. These results do not question the use of electrocautery to palliate endoluminal tumours but should make operators careful when treating extensive infiltration of the bronchial wall.

Animals↗
PubMed1999

[Post-intubation tracheal stenosis].

Post intubation tracheal stenosis (STPI) is a rare but serious complication of tracheal intubation and/or tracheotomy. The epidemiology has changed over the last twenty years. The diagnosis is sometimes difficult to establish on clinical grounds alone. Flexible bronchoscopy is often necessary to confirm the diagnosis and to influence treatment. The ideal curative treatment is surgical resection of the stenosis with end-to-end tracheal anastomosis. In patients presenting with definitive or transitory contraindications to this treatment there is a place for interventional endoscopy. Rigid bronchoscopy enables mechanical dilatation of the STPI which can be associated with Nd-Yag laser ortracheal endoprostheses. In certain cases interventional bronchoscopy may be curative. However in all cases the management of such lesions remains multi-disciplinary involving pulmonologists, thoracic surgeons, otolaryngologists and anaesthetists.

Algorithms↗