Artikel Epidemiology of chronic obstructive pulmonary disease and LC Chronic obstructive pulmonary disease COPD is a chronic condition that narrows the inflamed aerial pathways and destroys the alveoli.
It is the leading cause of morbidity and mortality worldwide, and it is estimated that it will be the third cause of death untilhelba din recenzii prostatita ischaemic heart disease and cerebrovascular diseases.
Other possible risk factors may be abnormal sensitivity or an exaggerated response to several stimuli such as inhaled substances or other types of exposure—passive smoking, use of solid fuels, exposure to environmental dust, workplace organic materials, or air pollution 2. Urina de reflux cu prostatita developed countries, the prevalence is between 7. Exposure to cigarette smoke induces a further increase in the risk of developing COPD when other risk factors are present 4.
The incidence of COPD was higher in rural areas inand males were more frequently affected 5. Smoking continues to be alongside other prostate cancer statistics uk 2020 factors the leading cause for the presence of COPD in Romania too. Also, in our country, the consumption of electronic cigarettes has led to the increase of COPD cases over the last two years.
Long-term epidemiological studies should be conducted to discover the effects of other substances found in these cigarettes as well as the impact that these heated substances have on the lungs and other organs.
Both in COPD and lung cancer LCexposure to cigarette smoke and other emissions represents the main risk factor for the onset of the two diseases.
Chronic inflammation and oxidative stress, caused by various emissions in the lung tissue, precede the development of dysplasia that can evolve prostate cancer statistics uk 2020 carcinoma in situ and LC. Active and passive smoking cessation and discontinuation of exposure to the pollutants is necessary at any time in life to prevent their harmful effect on the respiratory epithelium. The prevalence of LC is ~2. Incidence and mortality through LC typically show a rapid expansion around the world.
The LC incidence varies proportionally with tobacco consumption and air quality in the population. The explanation is elaborate, and it reflects both the age of the population and the continuous ageing process.
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Regarding LC, some of the changes in prevalence and risk factor distribution are associated with socioeconomic development. Men all over the world are more affected by Prostate cancer statistics uk 2020 7. In the last century, LC has become one of the most common neoplasms for both genders and the most common cause of oncological death around the world.
Because of the growing number of new LC cases, from 22 cases published into in and up to 1. LC is the second most common malignant disease in the world after prostate cancer in men and breast cancer in women 9. The LC incidence in Romania is included in the incidences of the South Eastern area of Europe and calculated by extrapolation based on the values obtained from the surrounding areas.
Globally, there are only a few states that have cancer registers.
Only one in four countries reports accurate data regarding incidence and mortality by cancer For the rest of the country, indices are calculated according to neighbouring countries and isolated studies published by health specialists. The existence of an LC register would bring more benefits. First, the possession of accurate data on LC would lead to the development of prevention strategies, early diagnosis methods, and treatment options that would lead to a decrease in incidence and mortality benefits for both patient and health system by generating lower costs in supporting these patients.
Diagnosis of LC and COPD COPD should be considered as a possible diagnosis in any patient at risk for the disease smokers, patients with exposure to air pollutants, or biomass such as solid fuelswith chronic productive cough and dyspnoea.
It combines the severity of symptoms, the risk of exacerbations, and the patient's comorbidities. LC may be one of the comorbidities of COPD, and therefore, we must actively seek it in these patients.
Usually, patients with LC present respiratory symptoms, general symptoms, or symptoms that are the expression of other organ damage and may thus indicate the extension of the disease.
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The most common symptoms are cough, chest pain, dyspnoea, haemoptysis, dysphonia, and weight loss. A meta-analysis published in reveals that the symptoms encountered with the highest frequency in studies, with significant value for the diagnosis of LC, are haemoptysis and dyspnoea, followed by cough, chest pain, and weight loss Unfortunately, many patients with LC are still diagnosed in advanced stages of the disease, when palliative treatment remains the only therapeutic option.
The importance of a multidisciplinary team gets more and more recognised in diagnostic centres. All physicians have a role in establishing the diagnosis and providing treatment as quickly as possible. The goal is to improve both the patient's quality of life and their survival. The general practitioner has the first contact with the patient; the pulmonologist initiates investigations, the radiologist assists with diagnosis and staging, the bronchologist and pathologist make staging and histopathologic diagnosis possible, and the surgeon and oncologist contribute to diagnosis and treatment; thus, all practitioners have an essential impact.
The first investigation that raises concern for the diagnosis of LC remains the thoracic chest X-ray. Chest CT with intravenous IV contrast completed with cerebral, cervical, abdominal, and pelvic examinations for a complete staging represents the essential imaging technique used for the diagnosis of LC.
AF uses a blue light source and can highlight dysplastic or minimally invasive lesions. NBI shows the pathologic thickness of the mucosa and indicates which is the best region for performing the biopsy. The sensitivity of these techniques prostate cancer statistics uk 2020 when used together.
AF and NBI are also used to asses edges after surgical resections In the case of a suspected pleural tumour, liquid and pleural biopsy have an essential role in establishing the diagnosis and confirming the neoplastic aetiology. Accurate staging is crucial when choosing the proper treatment.
Surgical techniques proved to be useful in patients in which less invasive investigations are not an option. The most common histological types of LC are also the most studied. Adenocarcinoma and squamous carcinoma occupy the first place, followed by large cell carcinoma, which is rarer than the first two. In recent years, biomarker testing and genetic profiling used to determine immunotherapy sensitivity have developed In reference centres for LC diagnosis, appropriate resources are available for this kind of analysis.
In selected cases, targetted therapy and immunotherapy are recommended. A heavy smoker patient or a patient with exposure to noxious will delay the medical consult because most of the symptoms are identical with the ones in chronic bronchitis caused by exposure to polluting agents.
The appearance of other symptoms, such as haemoptysis, chest pain, weight loss, or fatigue, increases the chances of presentation. In this situation, conducting a chest X-ray can bring new elements for diagnosis and guide further on the investigation plan.
If COPD is the diagnosis, then appropriate bronchodilator treatment according to the stage of the disease. Periodic revaluation by clinic exam, spirometry, and chest X-ray is mandatory. Plante pentru tratamentul prostatitei the symptomatology prostate cancer statistics uk 2020 or other symptoms appear, early presentation for further investigations is vital for immediate diagnosis and treatment of LC, with increased chances of survival and preservation of the quality of life.
There are situations when CT images are highly suggestive for a tumour, although there is no endobronchial expression. These cases require EBUS or surgical biopsy techniques. Multiple previous studies have determined that the severity of the airflow obstruction in COPD is an independent risk factor for LC.
The presence of chronic bronchitis in early prostate cancer statistics uk 2020 carcinogenicity was demonstrated by studies, with prostate cancer statistics uk 2020 latency period of ~ 15 years between the diagnosis of chronic bronchitis and the development of LC In some studies, LC appears to be more common in patients with a recently diagnosed COPD than in those with longstanding obstructive airway disease, and it may be 2—3 times more common in patients with a mild-to-moderate obstruction than in those with more advanced disease More mechanisms would seem to explain the relation between COPD and LC: genetic susceptibility, DNA damage and abnormal repair, chronic inflammation, and a favourable milieu.
In essence, only a minority of smokers develop any of these diseases, while at the same time, most are spared, and also susceptibility has a hereditary component That is why when diagnosing LC in a patient, COPD must be ruled out, and inquiring about exposure becomes essential for epidemiological reasons.
To non-smokers, chronic inflammation secondary to other exposures or other pulmonary pathologies e. All patients with LC need special attention because of the oncological and surgical complications that may appear.
Smoking cessation and the removal of environmental risk factors are useful therapeutic approaches. Prevention helps in slowing lung function degradation; the patient needs to approach a healthy lifestyle and accept bronchodilator treatment.
Infection prophylaxis includes annual influenza vaccination, anti-haemophilus, and anti-pneumococcal vaccinations once in a lifetime. Respiratory rehabilitation and oxygen therapy, as needed, are useful in selected patients.
Bronchodilator treatment offers more control over symptoms, the frequency, and severity of exacerbations. It also improves effort tolerance. There are two major classes of nu a tratat prostatita mult timp bronchodilators:β2-agonists and anticholinergics. Depending on the stage of the disease according to GOLD recommendationstherapeutical options vary.
In less severe cases, a single bronchodilator can be sufficient, while in more severe ones, a combination of two bronchodilators from different classes may be necessary.
Availability, price, compliance, tolerance, and adverse effects are also important in choosing the right medication. Corticosteroids can be associated in the advanced stages of the disease, by systemic route for a short period during exacerbations or by inhalation, in combination with one or two bronchodilators.
Methylxanthines are a class with almost historical value very rarely used because of the adverse effects and interactions with other drugs. The patient with COPD is generally aware of his illness, knows what causes the disease, and is careful about his condition of health.
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In such cases, avoiding factors that can lead to an exacerbation must be a priority. Some studies prove that offering permanent advice at each visit regarding the use of medical devices and rehabilitation exercises adapted to the stage of the disease improved the patient's perception of the disease and treatment adhesion The patients with very severe obstruction are highly symptomatic, partly due to COPD but also due to other comorbidities, psychological stress, and social isolation.
Studies still show a reduced addressability to palliative therapies in these patients Such patients can present emphysema located in the upper pulmonary territories. In contrast, the reduction of pulmonary volume by bronchoscopic route valve implant is especially used in patients waiting for lung transplantation as a last therapeutic option Surgical treatment in LC is an option in the early stages of the disease maximum IIIAafter a careful evaluation of the risks that it involves.
Decisions are usually made after conferring with a multidisciplinary team, especially when treating borderline cases.
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From an atypical pulmonary resection to a pneumonectomy, all interventions depend on operability and resectability. A multidisciplinary team formed of a pulmonologist, a pathologist, a thoracic surgeon, a bronchologist, an anaesthesiologist, an oncologist, and a radiotherapist will decide whether surgical treatment is an option As the LC prevalence is more than two times higher in COPD patients, the combination of the two diseases can be a challenge for both physician and patient, especially when the diseases are diagnosed at advanced stages.
In patients who meet the resectability and operability criteria, bronchodilator treatment is necessary for improving the pulmonary function and for assuring a rapid recovery after surgery. If the patient does not meet resectability criteria above stage IIIBand surgery is necessary for a histopathological diagnosis, recovering the pulmonary reserve becomes crucial to initiate oncological treatment and increase the quality of life.
The most common conditions associated with LC, besides COPD, are ischaemic heart disease, heart failure, and renal failure Associated cardiovascular diseases and COPD are independent risk factors for increased chemotherapy toxicity, thus influencing the evolution of the oncological treatment. New oncological treatments, like immunotherapy, are currently being used for LC in advanced stages. In particular, they prove to be safe due to the limited number of adverse reactions The presence of pleural effusions, no matter the aetiology, aggravates the patient's status.
After determining its aetiology, specific treatment is mandatory. The presence of secondary determinations cerebral and prostate cancer statistics uk 2020 metastasis are the most frequent requires special attention because it associates invalidating symptoms.
Palliative radiation therapy prescribed for lowering the tumour's volume and obtaining local decompression brings essential improvements in selected cases. In these cases, the increased risk of relapse influences long-term survival rates The same study demonstrated that although the risk of mortality is high in patients with LC and emphysema, it is lower than in patients with LC and COPD. Complications Pulmonary resections are considered the most useful interventions in LC, especially in the early stages.
These occur, especially in smokers, patients with COPD, obese, male gender, and those aged over 50 years The most important elements associated with a decrease of foreseeable complications were cessation of smoking, improvement of preoperative physical condition, adequate pain control, control of cardiac affections, and secretion drainage Disabling complications After thoracic LC surgery, the most important complications are the infectious ones.
In patients with LC and COPD, there is a high risk of introducerea în uretră pentru prostatită infectious complications through the retention of endobronchial secretions and at the drain level. Either after surgery or after intrapleural installations, the risk of infection is increased.
By performing these manoeuvers, the pleural cavity remains accessible.
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When not reversed, the procedure produces disability, and it determines an increase in healthcare costs The primary complication of mediastino-pulmonary tumours with tracheal and oesophageal invasion is the tracheoesophageal fistula, which can occur before, but especially after radiotherapy. Besides chemo and radiotherapy, auxiliary procedures might be necessary, one of the treatment options being to insert prosthetic material in the trachea and oesophagus.
Complication of tracheal prosthesis, such as bleeding, neoformation tissue at the ends of the prosthesis, or prosthesis migration, fuel the vicious circle of complications making the patient dependent on repeated endobronchial evaluations and interventions Another serious complication that can even become life-threatening is the pulmonary torsion, which can occur after a lobectomy.
Without prompt intervention, it becomes a functional pneumonectomy, and in a patient with a limited functional lung reserve due to COPD association can become invalidating Fortunately, severe and invalidating complications are rare, thanks to the multidisciplinary team's preoperative assessments. COPD, cigarette smoke, and other emissions determine chronic inflammation and subsequent preneoplastic or malignant changes in the mucous membrane of the respiratory tract.
Patients with COPD need careful monitoring using bronchoscopy combined with modern biopsy techniques, and CT scans to increase the chances of discovering pulmonary lesions with oncological risk. The existence of a national register for patients with LC would bring important data regarding epidemiology and prostate cancer statistics uk 2020, thereby helping to create sustainable prevention policies.
Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis.