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Biomedical subjects

Kozui Kida

Publications and source records attributed to Kozui Kida.

11 recordsLinked to original sources
PubMed2006

Screening for suspected chronic obstructive pulmonary disease with an eleven-item pre-interview questionnaire (11-Q).

OBJECTIVE: Early diagnosis is central to the management of chronic obstructive pulmonary disease (COPD). In time-constrained clinical situations, a pre-interview questionnaire can be a useful method for alerting both clinicians and patients with COPD, particularly for elderly patients. To screen subjects who might have COPD, we have developed an efficient pre-interview questionnaire. METHODS: In study I, we developed an 11-item questionnaire (11-Q) to alert primary care providers to the possibility of COPD, and the validity of this questionnaire was investigated. In study II, a randomized and prospective cross-sectional study was performed on a total of 245 subjects with or without respiratory symptoms. RESULTS: Good test-retest reliability and validity were shown in study I; the internal consistency of 11-Q was highly preserved (Cronbach alpha value of 0.867), with a high reproducibility of responses by inter- and intra examinees. Study II showed that the 11-Q in COPD patients with more than moderate severity was significantly higher than that in bronchial asthma or non-cardiopulmonary subjects (both, p<0.0001). Among the COPD patients, the total score significantly distinguished the severity of COPD as mild or more than moderate. CONCLUSION: The pre-interview questionnaire, 11-Q, was found to be a useful tool to alert primary care providers to subjects with COPD and could also be used to distinguish COPD with a more than moderate severity from bronchial asthma. The 11-Q can be used as a simple and inexpensive method of predicting COPD, thus being a useful tool to alert primary care providers to patients with suspected COPD, particularly among the elderly.

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PubMed2006

The treatment of refractory pneumothorax in diffuse panbronchiolitis by intravenous administration of coagulation factor XIII concentrate.

This case report presents a patient with advanced diffuse panbronchiolitis accompanied by chronic respiratory failure, marked cachexia, and refractory spontaneous pneumothorax. Because instillation of a pleurodesis agent and thoracoscopy were considered highly risky and invasive, we instead treated the patient with intravenous administration of a coagulation factor XIII concentrate, and the pneumothorax resolved. This case suggests refractory pneumothorax in a restrictive ventilatory disorder can be effectively treated with noninvasive intravenous administration of coagulation factor XIII concentrate.

Bronchiolitis↗
PubMed2006

[Cost analysis for inpatient therapy for patients with acute exacerbations of chronic obstructive pulmonary disease].

Acute exacerbation of COPD (AE-COPD) is a major problem influencing patient outcome, increasing both economic burden and mortality. We investigated: 1) the direct medical cost for inpatients with AE-COPD, and 2) factors that contribute to the higher cost of AE-COPD. A total of 131 episodes in 99 patients (mean age: 77.9 yr) with AE-COPD (79 men and 20 women) were investigated. Mean FEV1 and FEV1% pred were 0.97L and 42.7%, respectively. Mean length of stay (LOS) was 23.9 days and longer LOS was correlated with poorer basic activities of daily living (ADL). Mortality during admission and one month after discharge was 4.8%, however, it reached 20.2% one year later. The mean total cost for each admission was 690,000 yen (median 613,000 yen). Univariate analysis indicated that advanced age, hypoxemia, hypercapnea, systemic steroid use and reduction of ADL significantly correlated with increased total cost over the median cost. Multivariate analysis showed that factors significantly correlated with high medical cost over the median cost were observed in patients with a reduction of ADL (p < 0.001), hypoxemia OR 4.13 (95% CI: 1.54-11.05), systemic steroid use OR 3.14 (95% CI: 1.07-9.26), and reduced ADL OR 2.76 (95% CI: 1.04-7.30). However, neither advanced age nor severity of COPD, body mass index, or comorbidity significantly correlated with the total cost. We concluded that reduction of ADL in elderly COPD patients closely correlated with increased cost due to acute exacerbation. Therefore, pulmonary rehabilitation should be implemented from the perspective of reducing economic health burden.

Activities of Daily Living↗
PubMed2005

The impact of dyspnoea and leg fatigue during exercise on health-related quality of life in patients with COPD.

OBJECTIVE: COPD patients frequently complain of symptoms such as dyspnoea and leg fatigue during exercise. However, the impact of these symptoms on the health-related quality of life (HRQoL) is not known. This study tested whether dyspnoea and leg fatigue during exercise affects the HRQoL of patients with COPD. METHODS: In a cross-sectional study, 90 patients with stable COPD (mean age, 76.0+/-0.7 years; FEV(1), 1.11+/-0.04 L) completed the St. George's Respiratory Questionnaire (SGRQ), pulmonary function testing, arterial blood gas analysis, and a 6-min walking distance test (6MWD). Dyspnoea and leg fatigue during exercise were quantitated into 12 grades using the Borg scale (0--10). Correlations between the SGRQ and various variables were determined. In a longitudinal study, 22 patients with COPD (mean age, 71.5+/-1.1 years; FEV(1), 1.31+/-0.08 L) completed a pulmonary rehabilitation program, for which correlations between changes in the SGRQ as well as changes in both dyspnoea and leg fatigue, during the 6MWD before and 3 months after pulmonary rehabilitation, were examined. RESULTS: For the cross-sectional study, the total SGRQ score correlated significantly with the walking distance, dyspnoea and leg fatigue during the 6MWD and FEV(1), respectively. Stepwise multiple regression analysis showed that dyspnoea and leg fatigue during the 6MWD were independent variables for HRQoL measured by the SGRQ. For the longitudinal study, changes in the SGRQ correlated significantly with changes in dyspnoea and leg fatigue, before and 3 months after, pulmonary rehabilitation. CONCLUSIONS: Symptoms, such as the degree of dyspnoea and leg fatigue during exercise, are significant variables which influence the HRQoL of patients with COPD. In addition, the improvement in HRQoL following pulmonary rehabilitation may be due to improvements in dyspnoea and leg fatigue in patients with COPD.

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PubMed2004

Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD.

This study evaluated the effects of body weight on both generic and disease-specific health-related quality of life (HRQoL) of patients with COPD. A total of 83 patients with stable COPD were enrolled (mean age: 74.6 yr, mean FEV1: 1.29 L). Patients were divided into two groups according to body mass index (BMI) (UW group: BMI < or = 20, NW group: 20 < BMI < or = 26). The degree of dyspnea and both disease-specific and generic HRQoL were compared between the two groups. An oxygen cost diagram (OCD) was used to assess the degree of dyspnea and St. George's Respiratory Questionnaire (SGRQ) and Medical Outcomes Study Short Form 36-item Questionnaire (SF-36) were used for HRQoL evaluation. The OCD was significantly lower in the UW group. Compared with the NW group, the UW group showed significant deterioration in the total score and three subscales of SGRQ. SF-36 also showed significantly worse scores for the parameters of physical functioning, role emotional, bodily pain, and general health. The results of stepwise multiple regression analysis showed that OCD, FEV1, %pred. BMI were independent variables in the total score on SGRQ. The results of stepwise multiple regression analysis also showed that OCD was an independent variable for four of eight components of SF-36, while BMI was three of eight components of SF-36. In conclusion, low body weight in patients with COPD is related to a worsening of dyspnea and deterioration of both generic and disease-specific HRQoL. The present results also indicate that nutritional intervention may be important for improving dyspnea and HRQoL in patients with COPD.

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PubMed2004

Long-term effectiveness of an inpatient pulmonary rehabilitation program for elderly COPD patients: comparison between young-elderly and old-elderly groups.

OBJECTIVE: To evaluate the long-term effects of pulmonary rehabilitation in elderly COPD patients, we monitored patients for 1 year after they completed a 2-week inpatient pulmonary rehabilitation program. We also compared the effects of pulmonary rehabilitation on young-elderly (age 65-74 years) and old-elderly (age 75 years or over) COPD patients. METHODOLOGY: Fifty-nine elderly COPD patients (mean age 72.8 years) were studied. They underwent a comprehensive 2-week inpatient pulmonary rehabilitation program incorporating 10 exercise sessions, each of which included endurance training of the lower extremities, peripheral muscle conditioning training of the upper and lower extremities, and stretching, along with various education sessions. The effects of pulmonary rehabilitation were evaluated at 3, 6, and 12 months after completion of the program. RESULTS: Overall, patient health-related quality of life (HRQoL) as assessed by a QoL scale, and dyspnoea as assessed by an oxygen cost diagram, improved significantly over the 12-month period. Exercise capacity assessed by a 6-min walking distance test (6MWD) was similarly significantly improved. However, there was some fall-off in terms of the distance walked 12 months after pulmonary rehabilitation. The improvements in exercise capacity, dyspnoea, and HRQoL did not differ between the two groups, with the exception that the 6MWD (P < 0.01) and the QoL scale (P < 0.05) at 3 months post-pulmonary rehabilitation were significantly higher in the old-elderly group. CONCLUSIONS: Pulmonary rehabilitation is an effective treatment in terms of improving dyspnoea, exercise capacity and HRQoL in elderly COPD patients, and the benefits are almost comparable for young-elderly and old-elderly patients.

Age Factors↗
PubMed2003

Usefulness of a linear analog scale questionnaire to measure health-related quality of life in elderly patients with chronic obstructive pulmonary disease.

OBJECTIVES: To examine the validity, discriminatory ability, and responsiveness of health-related quality-of-life (HRQoL) questionnaires using a linear analog scale (Quality of Life (QOL) scale) for chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional and longitudinal. SETTING: Outpatient. PARTICIPANTS: One hundred two elderly subjects with mild to severe COPD. MEASUREMENTS: Scores on the QOL scale, the St. George's Respiratory Questionnaire (SGRQ), and the 36-item Short-Form Health Survey questionnaire (SF-36) and various clinical parameters were recorded. The correlations between these QOL questionnaires and various clinical parameters were then examined. The responses of 31 elderly COPD patients to the QOL scale and the SGRQ before and 3 months after the completion of a comprehensive pulmonary rehabilitation program were compared longitudinally. RESULTS: On cross-sectional study, the QOL scale showed a significant correlation with the total score and three components of the SGRQ. The QOL scale correlated significantly with all components of the SF-36, but the total SGRQ score correlated with only six components of the SF-36, excluding vitality and the mental health index. Both the QOL scale and the total score of the SGRQ correlated significantly with the oxygen cost diagram (OCD), Morale scale, 6-minute walking distance (6MWD), forced expiratory volume in 1 second, and instrumental activities of daily living (IADL) score. When subjects were divided into three groups according to disease severity (mild, moderate, severe) using American Thoracic Society guidelines, the total SGRQ score discriminated between the three groups. The QOL scale could not discriminate between mild and moderate or moderate and severe. On longitudinal study, 3 months after finishing the comprehensive pulmonary rehabilitation program, the QOL scale, the SGRQ, 6MWD, and OCD all showed significant improvement. The difference in the QOL scale after the comprehensive pulmonary rehabilitation program showed a significant correlation with changes in the SGRQ total score and the OCD but not with the 6MWD. CONCLUSION: The QOL scale is similar to more-complex questionnaires such as the SGRQ in terms of validity and responsiveness for evaluating disease-specific HRQoL in elderly COPD patients. In clinical settings, the QOL scale, as a simple questionnaire, may be useful for disease-specific HRQoL assessments in elderly COPD patients.

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PubMed2003

A clinical study of idiopathic pulmonary fibrosis based on autopsy studies in elderly patients.

OBJECTIVES: The prevalence of idiopathic pulmonary fibrosis (IPF) tends to be greater in the elderly although the precise outcome is not known. The present study investigated the outcome of IPF in elderly patients whose pathological diagnosis corresponded to usual interstitial pneumonia (UIP) on autopsy findings. METHODS: In a consecutive autopsy series, (n = 4,554 cases), complete information was obtained in 86 cases in which the clinical and pathological diagnosis was IPF and UIP, respectively. RESULTS: Mean subject age was 80.5 years and there were 52 males and 34 females. Median survival time (MST) was 3.5 years overall. Dyspnea ranking by the MRC dyspnea scale (DR) on admission was closely related to the outcome. When MST was compared between DR0 and DR1, or DR2 and DR3, the former patient group survived significantly longer than the latter (p < 0.05). Twenty percent of patients died of severe respiratory failure. Other causes of death were disease progression of IPF (10.5%), bacterial pneumonia (23.3%) and lung cancer (17.4%). The patients in the young-elderly group (age < 75) survived for a significantly longer period than those in the old-elderly group (age > or = 75) (MST; 5.5 vs 2.0 years; p < 0.001). Both lung cancer and pneumonia were significantly more prevalent among IPF patients than among non-IPF patients; these IPF with lung cancer profoundly reflected the smoking history of IPF patients. CONCLUSIONS: The poor outcome in IPF in elderly patients was characterized by more severe dyspnea, advanced age and co-morbidity.

Age Distribution↗
PubMed2002

A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma.

BACKGROUND: A recent study has shown that osteoporosis and vertebral fractures are quite common in patients with advanced COPD and showed a significant relationship to the mortality of these patients. These results suggested that management of osteoporosis in advanced COPD is an important intervention. But whether patients with COPD who had never received chronic systemic corticosteroids have a high incidence of osteoporosis and whether these patients require treatment strategies to decrease osteoporotic fracture is not yet known. Furthermore, it is unclear whether there are differences in terms of the degree of osteoporosis between patients with COPD and patients with bronchial asthma. OBJECTIVES: To compare the degree of osteoporosis and bone metabolism markers between elderly women with COPD and those with bronchial asthma who had never received chronic systemic corticosteroids, and to determine the factors influencing bone metabolism in these patients. DESIGN: Cross-sectional medical survey. PATIENTS: A total of 44 elderly female patients with COPD (n = 20) or bronchial asthma (n = 24) who had not received chronic systemic corticosteroids were enrolled (mean +/- SEM age, 74.6 +/- 1.0 years). MEASUREMENTS: Total body and lumbar bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry, and the data were compared between the two groups. In addition, the association between bone mass and clinical variables was determined. RESULTS: When lumbar BMD was expressed as a Z score, the Z scores of patients with COPD were significantly lower than those of patients with bronchial asthma (p < 0.01). The prevalence of osteoporosis was also significantly higher in patients with COPD (50% vs 21%, p < 0.05). In patients with COPD, body mass index was positively correlated with BMD in the lumbar spine (r = 0.55, p = 0.02) and total body (r = 0.49, p = 0.03). Other clinical, biochemical, and anthropometric variables were not correlated with BMD. CONCLUSIONS: In elderly female patients, osteoporosis is more common in cases of COPD than in bronchial asthma, even if these patients had not received long-term systemic corticosteroids. The explanation for the higher prevalence of osteoporosis in COPD is still not known, but preventive strategies to decrease osteoporotic fractures should be added to the management of elderly patients with COPD.

Absorptiometry, Photon↗
PubMed2002

[A case of infected bulla caused by Mycobacterium gordonae].

A 65-year-old man was admitted to Tokyo Metropolitan Geriatric Medical Center because of dyspnea on effort, loss of appetite and general fatigue. Chest radiography on admission showed niveau formation in, and infiltration around, the bulla. Percutaneous drainage of the intrabullous fluid was performed and Mycobacterium gordonae was repeatedly cultured from it. The patient was treated with RFP, INH and CAM and the intrabullous fluid and infiltration around the bulla was markedly improved. Seven cases of pulmonary infection by M. gordonae have been reported in Japan, but this is the first case of bulla infected by this organism.

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