Browsing by Author "Moita, J"
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- COPD control: Can a consensus be found?Publication . Guimarães, M; Bugalho, A; Oliveira, AS; Moita, J; Marques, AThere are currently no reliable instruments for assessing the onset and progression of chronic obstructive pulmonary disease (COPD) or predicting its prognosis. Currently, a comprehensive assessment of COPD including several objective and subjective parameters is recommended. However, the lack of biomarkers precludes a correct assessment of COPD severity, which consequently hampers adequate therapeutic approaches and COPD control. In the absence of a definition of "well-controlled disease", a consensus regarding COPD control will be difficult to reach. However, COPD patient assessment should be multidimensional, and anchored in five points: control of symptoms, decline of pulmonary function, levels of physical activity, exacerbations, and Quality of Life. Several non-pharmacological and pharmacological measures are currently available to achieve disease control. Smoking cessation, vaccination, exercise training programs and pulmonary rehabilitation are recognized as important non-pharmacological measures but bronchodilators are the pivotal therapy in the control of COPD. This paper discusses several objective and subjective parameters that may bridge the gap between disease assessment and disease control. The authors conclude that, at present, it is not possible to reach a consensus regarding COPD control, essentially due to the lack of objective instruments to measure it. Some recommendations are set forth, but true COPD control awaits further objective assessments.
- Titration with automatic continuous positive airway pressure in obstructive sleep apneaPublication . Dias, C; Sousa, L; Batata, L; Reis, R; Teixeira, F; Moita, J; Moutinho Dos Santos, JBackground and objective Autotitrating positive airway pressure (APAP) is an accepted titration method to determine the optimal positive airway pressure (PAP), for the treatment of obstructive sleep apnea (OSA). The required duration of APAP monitoring to determine a fixed continuous positive airway pressure level still remains to be established. We aimed to evaluate the variation in PAP level, delivered by APAP devices, at different periods of treatment, to determine the APAP treatment duration required to reach an effective and stable PAP level. Methods A cross-sectional study of 62 patients newly diagnosed with OSA were evaluated after 3 months of APAP therapy. APAP data corresponding to the first day (D1), first week (W1), seventh week (W7) and twelfth week (W12) under APAP therapy was collected. For the analysis of the pressure behaviour, the difference of P95th pressure level between W12 and W7 (P W12–W7), W12 and W1 (P W12–W1) and W12 and D1 (P W12–D1) was calculated. Results There was a high correlation in P95th pressure level between D1 and W12 (r = 0.771; p > 0.0001), W1 and W12 (r = 0.817; p > 0.0001), and W7 and W12 (r = 0.926; p > 0.0001). This correlation progressively increased with APAP use. A significance difference was found in concordance between P W12–W7 and P W12–D1 (p = 0.046) within the pressure range ±2 cmH2O. However there was no significant difference in concordance between P W12–W7 and P W12–W1. Conclusions One week of APAP therapy seems sufficient to determine an effective and stable PAP level, within the pressure range ±2 cmH2O.