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Biomedical subjects

Peter Lange

Publications and source records attributed to Peter Lange.

44 records · Page 3Linked to original sources
PubMed2003

[Tiotropium. A new anti-cholinergic agent for treatment of chronic obstructive pulmonary disease].

Tiotropium is a new anti-cholinergic drug with a long duration of action designed for maintenance treatment of chronic obstructive pulmonary disease (COPD). Tiotropium is the first drug specifically developed for the treatment of COPD, but it is also amongst the most expensive drugs used for this condition. The clinical pharmacology of tiotropium and results from published controlled clinical trials are reviewed. It is concluded that tiotropium seems suitable as a symptomatic treatment for patients with moderate to severe COPD (typically a forced expiratorical volume FEV1 < 50% of the predicted volume), who despite optimal use of short acting bronchodilators still suffer from severe symptoms.

Cholinergic Antagonists↗
PubMed2003

Chronic bronchitis in an elderly population.

BACKGROUND: in order to describe the prevalence and prognostic implications of chronic bronchitis in individuals 65 years or older we analysed data from The Copenhagen City Heart Study. METHODS: the population was studied in 1976-1978 resurveyed in 1981-1983 and 1991-1994 and followed with regard to survival for up to 12 years. Approximately 3,700 elderly participants with a mean age of 76 years were available for analyses. RESULTS: the prevalence of chronic bronchitis was 13.0% in women and 18.6% in men. Multiple logistic regression yielded the following predictors for chronic bronchitis: male gender (odds ratio with 95% confidence interval = 1.1 (0.9-1.3)), previous smoking odds ratio = 1.7 (1.2-2.2), present smoking odds ratio = 2.1 (2.1-3.8), previous exposure to dusts and fumes (odds ratio = 2.2 (1.7-2.7)), chest infections in childhood (odds ratio = 2.1 (1.6-2.9)), more than 6 chest infections in previous 10 years (odds ratio = 6.2 (4.1-9.2)) and alcohol consumption of more than 3 drinks a day (odds ratio = 1.8 (1.3-2.3)). Chronic bronchitis was a significant predictor of both subsequent respiratory infections and survival. After adjustment for age, smoking and lung function, a Cox regression showed that chronic bronchitis was significantly related to mortality from all causes with a hazard ratio with 95% confidence interval = 1.3 (1.1-1.4), all benign respiratory diseases (hazard ratio = 2.0 (1.6-2.7)), obstructive lung disease (hazard ratio = 2.5 (1.7-3.6)) and lung cancer (hazard ratio = 2.0 (1.4-2.9)). CONCLUSIONS: in an elderly population, chronic bronchitis is a prevalent condition with important prognostic implications.

Aged↗
PubMed2002

[Teenagers with asthma. A qualitative survey among teenagers with asthma of their expectations and attitudes when it comes to offered health care services].

INTRODUCTION: We wanted to examine the factors that were of importance for the hospital outpatient treatment of teenagers with asthma. MATERIAL AND METHODS: A total of 89 teenagers received a postal questionnaire and an invitation to participate in a focus group interview on outpatient asthma follow-up. RESULTS: Only 16 answered the questionnaire and 7 participated in the interview. The importance of personal contact was stressed and the teenagers expected much from the personnel aiming to help them. In a questionnaire follow-up of initial non-responders, 82% still had asthma and 75% of these received asthma medication. DISCUSSION: The low participation rate and the high expectations explain why teenagers with asthma constitute a group of patients with less than optimal results of treatment.

Adolescent↗
PubMed2002

Can GOLD Stage 0 provide information of prognostic value in chronic obstructive pulmonary disease?

In the recently published guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for chronic obstructive pulmonary disease (COPD), the staging system included a Stage 0 for subjects without airways obstruction but with respiratory symptoms, denoting these subjects "at risk" for COPD. Our aim was to validate this staging approach using data from three surveys in The Copenhagen City Heart Study, in which a sample of the general population was examined at baseline and in which, after 5 and 15 years, spirometry was performed at all surveys. Criteria for GOLD Stage 0 was fulfilled by 5.8% of the total adult population and 7.2% of smokers. After 5 and 15 years, 13.2 and 20.5%, respectively, of smokers with GOLD Stage 0 had developed COPD fulfilling criteria for GOLD Stage 1 or worse. This was the case for 11.6 and 18.5%, respectively, of smokers without respiratory symptoms. Further analyses using multivariate logistic regression analysis confirmed that GOLD Stage 0 was not identifying subsequent airways obstruction. When analyzing FEV(1) decline, Stage 0 carried a risk of excess decline. GOLD Stage 0 was not a stable feature, which may explain the lack of predictive value. In the Western world, smoking is still in itself the most important indicator of risk of COPD, and alternative markers of susceptibility in the population must be investigated.

Adult↗
PubMed2002

Change in lung function and morbidity from chronic obstructive pulmonary disease in alpha1-antitrypsin MZ heterozygotes: A longitudinal study of the general population.

BACKGROUND: A deteriorating effect of severe alpha(1)-antitrypsin deficiency (ZZ genotype) on lung function is well known, whereas the role of intermediate deficiency (MZ genotype) remains uncertain. OBJECTIVE: To test the hypothesis that MZ intermediate alpha(1)-antitrypsin deficiency affects pulmonary function and disease. DESIGN: Population-based cohort study with 21-year follow-up. SETTING: Copenhagen, Denmark. PARTICIPANTS: 9187 adults randomly selected from the Danish general population. MEASUREMENTS: Plasma alpha(1)-antitrypsin levels, annual decrease in FEV(1), airway obstruction, and hospitalization and mortality from chronic obstructive pulmonary disease (COPD). RESULTS: 451 participants (4.9%) carried the MZ genotype. Plasma alpha(1)-antitrypsin levels were 31% lower in MZ heterozygotes than in persons with the MM genotype (Student t -test, P < 0.001). Annual decrease in FEV(1) was 25 mL in MZ heterozygotes and 21 mL in persons with the MM genotype (t -test, P = 0.048). Airway obstruction was found in 19% of MZ heterozygotes compared with 15% of MM carriers (chi-square test, P = 0.023); in a logistic regression analysis adjusted for age, sex, and tobacco consumption, the corresponding odds ratio was 1.3 (CI, 1.0 to 1.7). The incidence of hospitalization and mortality from COPD was 32 cases per 10 000 person-years in persons with the MZ genotype and 22 cases per 10 000 person-years in those with the MM genotype (log-rank test, P = 0.063). In a Cox regression model adjusted for age, sex, tobacco use, and FEV(1) at study entry, relative risk for COPD outcomes in persons with the MZ genotype versus persons with the MM genotype was 1.5 (CI, 1.0 to 2.3). All these results were independent of the S and E alleles in this gene and were not affected by cystic fibrosis Delta F508 heterozygosity. CONCLUSIONS: MZ heterozygotes had a slightly greater rate of decrease in FEV(1) and were modestly over-represented among persons with airway obstruction and COPD. In the population at large, MZ heterozygosity may account for a fraction of COPD cases---on the order of 2%, similar to the percentage of persons with COPD who have the severe but rare ZZ genotype.

Adult↗
PubMed2002

[Smoking and asthma].

Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients with asthma. Substantial evidence suggests that smoking affects asthma adversely. Exposure to environmental tobacco smoke, especially maternal smoking in children, may be a significant risk factor for asthma. Such exposure in patients with established asthma is not only associated with more severe symptoms, but also with a poorer quality of life, reduced lung function, and increased utilisation of health care including hospital admissions. Active smoking does not appear to be a significant risk factor for asthma, but is associated with a worse outcome with regard to both longitudinal changes in lung function and asthma-related mortality. Based on current knowledge, it is therefore of utmost importance to encourage patients with asthma not to smoke, and accordingly these patients should be given full support in their right to a smoke-free environment.

Asthma↗
PubMedDate not supplied

Transfusion-free cardiac surgery with cardiopulmonary bypass in a 2.2-kg neonate.

Particularly in neonates, complex cardiac surgery employing cardiopulmonary bypass normally requires the transfusion of autologous blood components. This is predominately caused by the relatively high priming volume of the circuit with subsequent extreme hemodilution. We report on a synoptic approach to avoiding transfusions in a 2.2 kg neonate with scheduled for correction of an intracardiac total anomalous pulmonary venous connection to the coronary sinus and a persistent foramen ovale. In this patient with a preoperative hemoglobin value of 16.5 g/dL, minimization of the cardiopulmonary bypass circuit, adjustment of the perfusion technique and strict reduction of blood sampling resulted in complete avoidance of transfusions during the entire course of the operation while maintaining safe hemoglobin levels, which never fell below a concentration of 8 g/mL.

Blood Transfusion, Autologous↗