Obesity and respiratory disease:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa.
Saunders
2009
|
| Schriftenreihe: | Clinics in chest medicine
30,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIII S., S. 415 - 620 Ill., graph. Darst. |
| ISBN: | 9781437712018 1437712010 |
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| 245 | 1 | 0 | |a Obesity and respiratory disease |c guest ed. Charles S. Dela Cruz ... |
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| 490 | 1 | |a Clinics in chest medicine |v 30,3 | |
| 650 | 4 | |a Obesity | |
| 650 | 4 | |a Obesity |x Complications | |
| 650 | 4 | |a Overweight persons |x Diseases | |
| 650 | 4 | |a Respiratory Tract Diseases | |
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Datensatz im Suchindex
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| adam_text | Titel: Obesity and respiratory disease
Autor: Dela Cruz, Charles S.
Jahr: 2009
Obesity and Respiratory Disease
Contents
Preface xiii
Charles S. Dela Cruz, David A. Beuther, and Richard A. Matthay
The Obesity Epidemic 415
Victoria A. Catenacci, James O. Hill, and Holly R.Wyatt
Obesity has reached epidemic proportions in the United States, with 35.1 % of adults
being classified as obese. Obesity affects every segment of the US population and
continues to increase steadily, especially in children. Obesity increases the risk for
many other chronic diseases, including diabetes mellitus, cardiovascular disease,
and nonalcoholic fatty liver disease, and decreases overall quality of life. The current
US generation may have a shorter life expectancy than their parents if the obesity
epidemic is not controlled, and there is no indication that the prevalence of obesity
is decreasing. Because of the complexity of obesity, it is likely to be one of the most
difficult public health issues our society has faced.
Altered Resting and Exercise Respiratory Physiology in Obesity 445
Akshay Sood
Obesity, particularly severe obesity, affects resting and exercise-related respiratory
physiology. Severe obesity classically produces a restrictive ventilatory abnormality
characterized by reduced expiratory reserve volume. Obstructive ventilatory abnor¬
mality may also be associated with abdominal obesity. Decreased peak work rates
are usually seen among obese subjects in a setting of normal or decreased ventila¬
tory reserve and normal cardiovascular response to exercise. Weight loss may re¬
verse many adverse physiologic consequences of severe obesity on the
respiratory system.
The Relationship of Obesity and Obstructive Sleep Apnea 455
Neomi Shah and Francoise Roux
Obstructive sleep apnea is a common disorder, and obesity is a known risk factor for
its development. The prevalence of obesity is increasing worldwide, and a corre¬
sponding increase in the prevalence of obstructive sleep apnea and its cardiovas¬
cular and noncardiovascular consequences is likely. This article reviews the
established evidence supporting obesity as a risk factor for obstructive sleep apnea
and discusses the evidence suggesting that obesity is also a consequence of ob¬
structive sleep apnea. There is evidence that treating obesity reduces the severity
of obstructive sleep apnea and that treating obstructive sleep apnea decreases obe¬
sity. However, the evidence does not support a sustained correlation between
weight loss and improvement in sleep-disordered breathing.
The Pickwickian Syndrome—Obesity Hypoventilation Syndrome 467
Stephen W. Littleton and Babak Mokhlesi
Obesity-hypoventilation syndrome (OHS), also historically described as the Pick¬
wickian syndrome, consists of the triad of obesity, sleep disordered breathing,
and chronic hypercapnia during wakefulness in the absence of other known causes
of hypercapnia. Its exact prevalence is unknown, but it has been estimated that
Contents
10% to 20% of obese patients with obstructive sleep apnea have hypercapnia.
OHS often remains undiagnosed until late in the course of the disease. Early recog¬
nition is important because these patients have significant morbidity and mortality.
Effective treatment can lead to significant improvement in patient outcomes, under¬
scoring the importance of early diagnosis. The authors review the definition and
epidemiology of OHS, in addition to the current multifaceted understanding of the
pathophysiology, and provide useful clinical approaches to diagnosis and
treatment.
Obesity and Asthma 479
David A. Beuther
Population-based studies have defined a significant, bidirectional, dose-dependent
association between obesity and asthma. Obesity does not cause airflow obstruc¬
tion, but can result in pulmonary restriction and a reduction in airway diameter,
and that could contribute to airway hyper-responsiveness. Mouse models of asthma
have demonstrated that obesity and adipokines can enhance airway hyper-respon¬
siveness, airway inflammation, and allergic responses, but it is unclear whether obe¬
sity-associated inflammatory mechanisms are relevant in human asthma. Shared
environmental and genetic factors are incompletely understood, but very likely to
be relevant. Obese asthma appears to be a distinct and novel phenotype of asthma,
associated with a reduction in lung volumes, lack of eosinophilic inflammation,
altered response to asthma controller therapy, glucocorticoid resistance, and poor
asthma control.
Obesity and Thromboembolic Disease 489
Paul D. Stein and Jose Goldman
Various abnormalities of hemostasis have been described in obesity, mainly con¬
cerning increased levels of plasminogen activator inhibitor-1, but other abnormal¬
ities of coagulation and platelet activation have been reported as well.
Circulating microparticles have also been observed in obese patients. These sug¬
gest that obesity would be a risk factor for venous thromboembolism (VTE). Anal¬
ysis of the database of the National Hospital Discharge Survey showed compelling
evidence that obesity is, in fact, a risk factor for VTE. Obesity is also a risk factor for
recurrent VTE. A synergistic effect of oral contraceptives with obesity has been
shown.
Obesity and Acute Lung Injury 495
Jennifer W. McCallister, Eric J. Adkins, and James M. O Brien, Jr
Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are
common indications for ICU admission and mechanical ventilation. ALI/ARDS
also consumes significant health care resources and is a common cause of death
in ICU patients. Obesity produces changes in respiratory system physiology that
could affect outcomes for ALI/ARDS patients and their response to treatment. Ad¬
ditionally, the biochemical alterations seen in obese patients, such as increased
inflammation and altered metabolism, could affect the risk of developing ALI/
ARDS in patients with another risk factor (eg, sepsis). The few studies that have
examined the influence of obesity on the outcomes from ALI/ARDS are inconclu¬
sive. Furthermore, observed results could be biased by disparities in provided
care.
Contents
Role of Obesity in Cardiomyopathy and Pulmonary Hypertension 509
Charles S. Dela Cruz and Richard A. Matthay
Obesity is becoming a worldwide problem of epidemic proportions, and its effect on
the heart is increasingly being recognized. Obesity is often associated with an
increased risk for heart failure. In this article, the authors review the evidence for
obesity-related cardiomyopathy. The importance of metabolic disturbances in the
development of cardiomyopathy in obese patients is highlighted. The authors also
briefly explore whether obesity plays a role in the development of pulmonary hyper¬
tension. Better recognition and understanding of both obesity cardiomyopathy and
pulmonary hypertension are needed in the obese patient population.
Medications for Obesity: Mechanisms and Applications 525
George A. Bray
Medications can significantly increase weight loss compared with placebo in most
trials. In general, patients can expect a weight loss of 8% to 10% from baseline pro¬
vided they adhere to the weight-loss program and take medications regularly. All
medications have side effects that need to be considered before initiating treatment,
however. For sibutramine, there is an increase in blood pressure and heart rate that
may require discontinuation of the drug in a small percentage of patients. For orlistat,
the principal side effect is gastrointestinal in origin resulting from the increased ac¬
tivity of the lower bowel. Cannabinoid receptor antagonists, once a promising target,
are no longer under study. Other medications are in clinical trials and on their way.
Obesity and Bariatric Surgery 539
Basil M.Yurcisin, Moataz M. Gaddor, and Eric J. DeMaria
Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric band¬
ing are the most commonly performed weight reduction operations in the United
States. Preoperative assessment and selection should be performed by a multidisci-
plinary team to obtain optimal results. The most devastating complication of bariatric
surgery is leak, which can carry a high risk of mortality if not detected and treated ex¬
pediently. New nationwide databases have been developed to monitor outcomes and
facilitate better understanding of the mechanisms of bariatric surgery. New horizons
for the advancement of bariatric surgery are in the realm of surgery in adolescent and
geriatric populations, the use of weight-loss surgery in lower body mass index ( 35
kg/m2) populations, and the use of surgery to cure the comorbidities of obesity.
Airway Management in the Obese Patient 555
Ali A. El Solh
Airway management is a major factor underlying morbidity and mortality in the obese
population. The validity of anthropomorphic prediction model in assessing a difficult
airway is less accurate compared with lean subjects. Preoperative evaluation and
anticipation of potential complications are critical for safe and successful intubation.
Application of noninvasive positive airway pressure can prevent atelectasis and im-
; prove oxygenation during the anesthetic induction as well during the postoperative
I period and after liberation from mechanical ventilation. When performed by trained
! operators, bedside percutaneous dilatation tracheostomy in obese patients has
I a safety profile comparable to surgical tracheostomy but provides advantages in¬
cluding ease of performance and lesser cost, and obviates transporting a critically
ill patient outside the intensive care unit.
Contents
Anesthetic Management of Patients with Obesity with and Without Sleep Apnea 569
Anthony N. Passannante and Michael Tielborg
The global obesity epidemic presents anesthesia providers with unique and com¬
plex challenges as an increasing number of patients with elevated body mass index
present for medical care. Pharmacokinetics, respiratory and cardiac physiology, po¬
sitioning, regional anesthetic techniques, monitoring, and postoperative care are all
profoundly affected by increased body mass. In recent years, the occult impact of
undiagnosed obstructive sleep apnea on perioperative morbidity and mortality has
marshaled increased attention from both patients and practitioners. A summary
and discussion of the Practice Guidelines developed by the American Society of An¬
esthesiologists regarding the care of patients with obstructive sleep apnea is
provided.
Obesity in the Intensive Care Unit 581
Shyoko Honiden and John R. McArdle
The exact prevalence of obesity among critically ill patients is not known, but some
evidence suggests that in the United States one in four patients in the intensive care
unit is obese. The authors review the physiologic alterations in obesity that are rel¬
evant in critical illness and highlight some common diseases associated with obe¬
sity. Various practical challenges in the care of the critically ill obese patient,
including drug dosing, are also reviewed.
Obesity and Respiratory Diseases in Childhood 601
Elizabeth K. Fiorino and Lee J. Brooks
The prevalence of childhood obesity has more than tripled over the past five de¬
cades. Obesity results in low lung volumes, likely through increased loading of the
chest wall and abdomen. The prevalence of asthma in children has paralleled the
rise in obesity; obesity may increase the severity of asthma, but a direct link has
been difficult to establish. Obesity is a risk factor for obstructive sleep apnea
(OSA) in children as well as adults. Obese children may be at increased risk for per¬
sistent OSA following adenotonsillectomy treatment for OSA. Severe obesity and
OSA may lead to the obesity-hypoventilation syndrome, with hypoxia, hypercapnia,
and reduced ventilatory drive. Obesity can increase a child s risk for complications
of anesthesia and recovery from surgery.
Obesity and Aging 609
John Harrington and Teof ilo Lee-Chiong
In this article, the combined effects of aging and obesity on the respiratory system
are examined. Following a concise epidemiologic overview of the prevalence of
obesity among older adults, the occurrence of prospective, often variable, health
consequences related to this trend are considered as well as the observed effects
of the association of both aging and obesity on respiratory anatomy, physiology,
and diseases. Last, findings of research related to weight loss on respiratory function
in obese older adults are summarized.
Index 615
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| spelling | Obesity and respiratory disease guest ed. Charles S. Dela Cruz ... Philadelphia, Pa. Saunders 2009 XIII S., S. 415 - 620 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 30,3 Obesity Obesity Complications Overweight persons Diseases Respiratory Tract Diseases Respiratory organs Diseases Dela Cruz, Charles S. edt Clinics in chest medicine 30,3 (DE-604)BV000001084 30,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=018638195&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Obesity and respiratory disease Clinics in chest medicine Obesity Obesity Complications Overweight persons Diseases Respiratory Tract Diseases Respiratory organs Diseases |
| title | Obesity and respiratory disease |
| title_auth | Obesity and respiratory disease |
| title_exact_search | Obesity and respiratory disease |
| title_full | Obesity and respiratory disease guest ed. Charles S. Dela Cruz ... |
| title_fullStr | Obesity and respiratory disease guest ed. Charles S. Dela Cruz ... |
| title_full_unstemmed | Obesity and respiratory disease guest ed. Charles S. Dela Cruz ... |
| title_short | Obesity and respiratory disease |
| title_sort | obesity and respiratory disease |
| topic | Obesity Obesity Complications Overweight persons Diseases Respiratory Tract Diseases Respiratory organs Diseases |
| topic_facet | Obesity Obesity Complications Overweight persons Diseases Respiratory Tract Diseases Respiratory organs Diseases |
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