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K L Fraser

Publications and source records attributed to K L Fraser.

6 recordsLinked to original sources
PubMed2000

Chronic obstructive pulmonary disease. Prevention, early detection, and aggressive treatment can make a difference.

COPD is common, and certainly its impact on healthcare systems is significant. It is imperative to diagnose COPD early in patients with or without respiratory symptoms. This requires office spirometry performed periodically in persons at risk, such as long-time cigarette smokers over 40 years of age. Once airflow obstruction has been identified, smoking cessation is the priority to prevent further deterioration. Our increased understanding of the underlying physiology of COPD and recent developments in medical and surgical treatments have resulted in many new therapeutic options. Many of these treatments have the potential to alleviate symptoms, reduce healthcare utilization, improve quality of life, and extend survival.

Algorithms↗
PubMed1999

Pulmonary hypertension and cardiac function in adult cystic fibrosis: role of hypoxemia.

STUDY OBJECTIVES: To determine (1) the prevalence of pulmonary hypertension and cardiac dysfunction in adult cystic fibrosis (CF) patients with severe lung disease, (2) the relationship between these cardiovascular abnormalities and hypoxemia, and (3) the impact of subclinical pulmonary hypertension on survival. DESIGN: Single-blind, cross-sectional study. SETTING: Ambulatory clinic of the Adult CF program at a tertiary-level hospital. PATIENTS: Clinically stable patients with severe lung disease (FEV1 < 40% of predicted normal value) who were not receiving supplemental oxygen. A second cohort of patients in stable condition with less severe lung disease (FEV1 40 to 65% predicted) was also recruited to enable multivariate analysis for the determinants of pulmonary hypertension. MEASUREMENTS AND RESULTS: Eighteen patients with severe lung disease (FEV1 28 +/- 7% of predicted normal value) were initially studied. Each patient had overnight polysomnography, pulmonary function tests, and Doppler echocardiography. Arterial oxygen saturation (SaO2) was reduced during wakefulness (87.1 +/- 6.1%) and fell during sleep (84.0 +/- 6.6%) while transcutaneous PCO2 was normal during wakefulness (41.1 +/- 6.9 mm Hg) and increased during sleep (46.6 +/- 4.7 mm Hg). Left ventricular size, systolic function, and diastolic function were normal except in one patient who had had a previous silent myocardial infarction due to coronary artery disease. Qualitative assessment of right ventricular function was normal in all patients. Pulmonary artery systolic pressure (PASP) was increased (> 35 mm Hg) in seven patients without clinical evidence of cor pulmonale. Regression analysis was performed by combining these data with data from an additional 15 CF patients with moderately severe lung disease (FEV1 56.3 +/- 8.9% predicted normal) who were recruited to a modified study protocol that included overnight oximetry, pulmonary function tests, and Doppler echocardiography. None of these patients had evidence of hypoxemia and only three had mild elevation of PASP (36, 37, and 39 mm Hg). Linear regression analysis revealed that PASP was significantly correlated with FEV1 (r = -0.44; p = 0.013), and SaO2 during wakefulness (r =-0.60; p = 0.0003), during sleep (r = -0.56; p = 0.0008), and after 6 min of exercise (r = -0.75; p < 0.0001). Multivariate analysis revealed that awake SaO2 was a significantly better predictor of PASP than FEV1 (p = 0.0104). Clinical follow-up of the original cohort for up to 5 years revealed that mortality was significantly higher in those with pulmonary hypertension than those without pulmonary hypertension (p = 0.0129). CONCLUSIONS: In adult CF patients with severe stable lung disease, left and right ventricular function is well maintained in the absence of significant coronary artery disease; pulmonary hypertension develops in a significant proportion of patients and is strongly correlated with oxygen status, independent of lung function; and subclinical pulmonary hypertension is associated with an increased mortality.

Adult↗
PubMed1998

What new antibiotics to offer in the outpatient setting.

The treatment of community-acquired pneumonia is empiric. Guidelines have been developed to assist the clinician in selecting antibiotics to cover the likely pathogens. Given the difficulty of predicting an etiologic agent from patient characteristics, radiologic findings, and laboratory studies, initial regimens recommend broad-spectrum coverage. In some circumstances, two antibiotics may be required. The prevalence of resistant organisms is increasing and must be considered when prescribing treatment. Patient compliance is essential for successful therapy but diminishes with inconvenient dosing schedules and with poorly tolerated medicines. A number of novel antimicrobials have either been just launched or are in the late stages of development. Most have been developed in an attempt to address the above concerns. This article focuses on the new oral cephalosporins, macrolides, and fluoroquinolones, and discusses the place of each in the therapy of community-acquired pneumonia.

Ambulatory Care↗