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Bucci T, Wat D, Sibley S, Wootton D, Green D, Pignatelli P, Lip GYH, Frost F. Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease. Intern Emerg Med 2024:10.1007/s11739-024-03653-0. [PMID: 38819711 DOI: 10.1007/s11739-024-03653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. To investigate the risk of adverse events after COPD exacerbations in patients with atrial fibrillation (AF) treated with azithromycin prophylaxis. Retrospective cohort study within the TriNetX Platform, including AF patients with COPD exacerbations. Risks of primary and secondary outcomes were recorded up to 30 days post-COPD exacerbations and compared between azithromycin users and azithromycin non-users. The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Dennis Wat
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Knowsley Community Respiratory Service, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Sarah Sibley
- Knowsley Community Respiratory Service, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dan Wootton
- Respiratory Department, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David Green
- Knowsley Community Respiratory Service, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Freddy Frost
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Knowsley Community Respiratory Service, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
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Ancel J, Chen E, Pavot A, Regard L, Le Rouzic O, Guecamburu M, Zysman M, Rapin A, Martin C, Soumagne T, Patout M, Roche N, Deslee G. [Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]. Rev Mal Respir 2024; 41:331-342. [PMID: 38609767 DOI: 10.1016/j.rmr.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023. STATE OF THE ART Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation. PERSPECTIVES The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options. CONCLUSIONS As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.
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Affiliation(s)
- J Ancel
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France
| | - E Chen
- Service de pneumologie, Hôpital universitaire Avicenne, Bobigny, France
| | - A Pavot
- Centre de recherche cardio-thoracique de Bordeaux, université de Bordeaux, Inserm U1045, Bordeaux, France
| | - L Regard
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - O Le Rouzic
- Institut Pasteur de Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, CHU de Lille, CNRS, Inserm, University Lille, pneumologie et immuno-allergologie, 59000 Lille, France
| | - M Guecamburu
- Service des maladies respiratoires, CHU de Bordeaux, centre François-Magendie, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac, France
| | - M Zysman
- Service de pneumologie, CHU de Haut-Lévèque, Bordeaux, France; Centre de recherche cardio-thoracique, University Bordeaux, Inserm U1045, CIC 1401, Pessac, France
| | - A Rapin
- Département de médecine physique et de réadaptation, centre hospitalo-universitaire de Reims, hôpital Sébastopol, CHU de Reims, 51092 Reims, France; Faculté de médecine, VieFra, EA3797, 51097, université de Reims Champagne-Ardenne, Reims, France
| | - C Martin
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - T Soumagne
- Service de pneumologie et Soins intensifs respiratoires, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, Paris, France
| | - M Patout
- Service des pathologies du sommeil (département R3S), groupe hospitalier universitaire AP-HP - Sorbonne université, site Pitié-Salpêtrière, 75013 Paris, France; UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, Inserm, 75005 Paris, France
| | - N Roche
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - G Deslee
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France.
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Idigo AJ, Wells JM, Brown ML, Wiener HW, Griffin RL, Cutter G, Shrestha S, Lee RA. Socio-demographic and comorbid risk factors for poor prognosis in patients hospitalized with community-acquired bacterial pneumonia in southeastern US. Heart Lung 2024; 65:31-39. [PMID: 38382142 DOI: 10.1016/j.hrtlng.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND How socio-demographic characteristics and comorbidities affect bacterial community-acquired pneumonia (CAP) prognosis during/after hospitalization is important in disease management. OBJECTIVES To identify predictors of medical intensive care unit (MICU) admission, length of hospital stay (LOS), in-hospital mortality, and bacterial CAP readmission in patients hospitalized with bacterial CAP. METHODS ICD-9/10 codes were used to query electronic medical records to identify a cohort of patients hospitalized for bacterial CAP at a tertiary hospital in Southeastern US between 01/01/2013-12/31/2019. Adjusted accelerated failure time and modified Poisson regression models were used to examine predictors of MICU admission, LOS, in-hospital mortality, and 1-year readmission. RESULTS There were 1956 adults hospitalized with bacterial CAP. Median (interquartile range) LOS was 11 days (6-23), and there were 26 % (513) MICU admission, 14 % (266) in-hospital mortality, and 6 % (117) 1-year readmission with recurrent CAP. MICU admission was associated with heart failure (RR 1.38; 95 % CI 1.17-1.62) and obesity (RR 1.26; 95 % CI 1.04-1.52). Longer LOS was associated with heart failure (adjusted time ratio[TR] 1.27;95 %CI 1.12-1.43), stroke (TR 1.90;95 %CI 1.54,2.35), type 2 diabetes (TR 1.20;95 %CI 1.07-1.36), obesity (TR 1.50;95 %CI 1.31-1.72), Black race (TR 1.17;95 %CI 1.04-1.31), and males (TR 1.24;95 %CI 1.10-1.39). In-hospital mortality was associated with stroke (RR 1.45;95 %CI 1.03-2.04) and age ≥65 years (RR 1.34;95 %CI 1.06-1.68). 1-year readmission was associated with COPD (RR 1.55;95 %CI 1.05-2.27) and underweight BMI (RR 1.74;95 %CI 1.04-2.90). CONCLUSIONS Comorbidities and socio-demographic characteristics have varying impacts on bacterial CAP in-hospital prognosis and readmission. More studies are warranted to confirm these findings to develop comprehensive care plans and inform public health interventions.
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Affiliation(s)
- Adeniyi J Idigo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States.
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, United States; UAB Lung Health Center, United States; Birmingham VA Medical Center, United States
| | | | - Howard W Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Russell L Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Gary Cutter
- Department of Biostatistics, School of Public Health, UAB, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Rachael A Lee
- Birmingham VA Medical Center, United States; Department of Medicine, Division of Infectious Diseases, UAB School of Medicine, Alabama, United States
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De Rubis G, Paudel KR, Corrie L, Mehndiratta S, Patel VK, Kumbhar PS, Manjappa AS, Disouza J, Patravale V, Gupta G, Manandhar B, Rajput R, Robinson AK, Reyes RJ, Chakraborty A, Chellappan DK, Singh SK, Oliver BGG, Hansbro PM, Dua K. Applications and advancements of nanoparticle-based drug delivery in alleviating lung cancer and chronic obstructive pulmonary disease. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2793-2833. [PMID: 37991539 DOI: 10.1007/s00210-023-02830-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) are among the leading causes of mortality worldwide. Cigarette smoking is among the main aetiologic factors for both ailments. These diseases share common pathogenetic mechanisms including inflammation, oxidative stress, and tissue remodelling. Current therapeutic approaches are limited by low efficacy and adverse effects. Consequentially, LC has a 5-year survival of < 20%, while COPD is incurable, underlining the necessity for innovative treatment strategies. Two promising emerging classes of therapy against these diseases include plant-derived molecules (phytoceuticals) and nucleic acid-based therapies. The clinical application of both is limited by issues including poor solubility, poor permeability, and, in the case of nucleic acids, susceptibility to enzymatic degradation, large size, and electrostatic charge density. Nanoparticle-based advanced drug delivery systems are currently being explored as flexible systems allowing to overcome these limitations. In this review, an updated summary of the most recent studies using nanoparticle-based advanced drug delivery systems to improve the delivery of nucleic acids and phytoceuticals for the treatment of LC and COPD is provided. This review highlights the enormous relevance of these delivery systems as tools that are set to facilitate the clinical application of novel categories of therapeutics with poor pharmacokinetic properties.
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Affiliation(s)
- Gabriele De Rubis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Keshav Raj Paudel
- Centre of Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, NSW, 2007, Australia
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Samir Mehndiratta
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Vyoma K Patel
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Popat S Kumbhar
- Department of Pharmaceutics, Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala, Dist: Kolhapur, Maharashtra, 416113, India
| | - Arehalli Sidramappa Manjappa
- Department of Pharmaceutics, Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala, Dist: Kolhapur, Maharashtra, 416113, India
- Department of Pharmaceutics, Vasantidevi Patil Institute of Pharmacy, Kodoli, Kolkapur, Maharashtra, 416114, India
| | - John Disouza
- Department of Pharmaceutics, Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala, Dist: Kolhapur, Maharashtra, 416113, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga, Mumbai, 400019, Maharashtra, India
| | - Gaurav Gupta
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, India, Chennai, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, 248007, India
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Mahal Road, Jaipur, 302017, India
| | - Bikash Manandhar
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Rashi Rajput
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Alexandra Kailie Robinson
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Ruby-Jean Reyes
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Amlan Chakraborty
- Division of Immunology, Immunity to Infection and Respiratory Medicine (DIIIRM), School of Biological Sciences I Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dinesh Kumar Chellappan
- School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Sachin Kumar Singh
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Brian Gregory George Oliver
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW, 2007, Australia
- Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Philip Michael Hansbro
- Centre of Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Sydney, NSW, 2007, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia.
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
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Rahi MS, Mudgal M, Asokar BK, Yella PR, Gunasekaran K. Management of Refractory Chronic Obstructive Pulmonary Disease: A Review. Life (Basel) 2024; 14:542. [PMID: 38792564 PMCID: PMC11122447 DOI: 10.3390/life14050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common condition with an estimated prevalence of 12% in adults over the age of 30 years worldwide. COPD is a leading cause of morbidity and mortality globally, with a substantial economic and social burden. There are an estimated 3 million deaths annually due to COPD. However, most of the patients with COPD respond to routine interventions like bronchodilator therapy, assessing supplemental oxygen needs, smoking cessation, vaccinations, and pulmonary rehabilitation. There is a significant number of patients who unfortunately progress to have persistent symptoms despite these interventions. Refractory COPD is not yet formally defined. Patients with severe persistent symptoms or exacerbations despite appropriate care can be considered to have refractory COPD. Managing refractory COPD needs a multidimensional approach. In this review article, we will discuss essential interventions like ensuring adequate inhaler techniques, exploring the need for non-invasive ventilatory support, use of chronic antibiotics and phosphodiesterase inhibitors to advanced therapies like bronchoscopic lung volume reduction surgery, and the upcoming role of anti-IL5 agents in managing patients with refractory COPD. We will also discuss non-pharmacologic interventions like psycho-social support and nutritional support. We will conclude by discussing the palliative care aspect of managing patients with refractory COPD. Through this review article, we aim to better the approach to managing patients with refractory COPD and discuss new upcoming therapies.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Lawrence and Memorial Hospital, New London, CT 06320, USA
| | - Mayuri Mudgal
- Department of Internal Medicine, Camden Clark Medical Center, Parkersburg, WV 26101, USA;
| | - Bharat Kumar Asokar
- Division of Medical Sciences, The Tamilnadu Dr. MGR University, Chennai 600032, Tamilnadu, India;
| | | | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yuma Regional Medical Center, Yuma, AZ 85364, USA;
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Dong S, Liu Z, Chen H, Ma S, Wang F, Shen H, Li H, Zhang B. A synergistic mechanism of Liquiritin and Licochalcone B from Glycyrrhiza uralensis against COPD. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 132:155664. [PMID: 38870751 DOI: 10.1016/j.phymed.2024.155664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a refractory respiratory disease mainly attributed to multiple pathological factors such as oxidative stress, infectious inflammation, and idiopathic fibrosis for decades. The medicinal plant Glycyrrhiza uralensis extract (ULE) was widely used to control respiratory diseases in China. However, the regulatory mechanism of scientific evidence to support the therapeutic benefits of ULE in the management of COPD is greatly limited. PURPOSE This study aims to discover the potential protection mechanism of ULE on COPD via a muti-targets strategy. STUDY DESIGN AND METHODS The present study set out to determine the potential protective effects of ULE on COPD through a multi-target strategy. In vivo and in vitro models of COPD were established using cigarette smoke and lipopolysaccharide to assess the protective effects of ULE. It was evaluated by measuring inflammatory cytokines and assessing pulmonary pathological changes. HPLC was used to verify the active compounds of the potential compounds that were collected and screened using HERB, works of literature, and ADME tools. The mechanisms of ULE in the treatment of COPD were explored using transcriptomics, connectivity-map, and network pharmacology approaches. The relevant targets were further investigated using RT-PCR, western blot, and immunohistochemistry. The HCK inhibitor (iHCK-37) was used to evaluate the potential mechanism of ULE's active compounds in the prevention of COPD. RESULTS ULE effectively protected the lungs of COPD mice from oxidative stress, inflammation, and fibrosis damage. After screening and verification using ADME properties and HPLC, 4 active compounds were identified in ULE: liquiritin (LQ), licochalcone B (LCB), licochalcone A (LCA), and echinatin (ET). Network pharmacology integrated with transcriptomics analysis showed that ULE mitigated oxidative stress, inflammation, and fibrosis in COPD by suppressing HCK. The combination of LCB and LQ was optimized for anti-inflammation, antioxidation, and anti-fibrosis activities. The iHCK-37 further validated the preventive treatment of LCB and LQ on COPD by inhibiting HCK to exert antioxidant, anti-inflammatory, and anti-fibrotic effects. The combination of LCB and LQ, in a 1:1 ratio, exerted synergistic antioxidative, anti-inflammatory, and anti-fibrotic effects in the treatment of COPD by downregulating HCK. CONCLUSION The combination of LCB and LQ performed a significant anti-COPD effect via downregulating HCK.
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Affiliation(s)
- Shi Dong
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, Chengdu, 610106, PR China; Key Laboratory of Xinjiang Phytomedicine Resource and Utilization of Ministry of Education, College of Life Sciences, Shihezi University, Shihezi, 832003, PR China
| | - Zijing Liu
- Key Laboratory of Xinjiang Phytomedicine Resources and Utilization, Ministry of Education, School of Pharmacy, Shihezi University, Shihezi, 832002, PR China
| | - Hongmei Chen
- Key Laboratory of Xinjiang Phytomedicine Resources and Utilization, Ministry of Education, School of Pharmacy, Shihezi University, Shihezi, 832002, PR China
| | - Shaozhuang Ma
- Key Laboratory of Xinjiang Phytomedicine Resources and Utilization, Ministry of Education, School of Pharmacy, Shihezi University, Shihezi, 832002, PR China
| | - Fei Wang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization of Ministry of Education, College of Life Sciences, Shihezi University, Shihezi, 832003, PR China
| | - Haitao Shen
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization of Ministry of Education, College of Life Sciences, Shihezi University, Shihezi, 832003, PR China
| | - Hongbin Li
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization of Ministry of Education, College of Life Sciences, Shihezi University, Shihezi, 832003, PR China.
| | - Bo Zhang
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, Chengdu, 610106, PR China; Key Laboratory of Xinjiang Phytomedicine Resource and Utilization of Ministry of Education, College of Life Sciences, Shihezi University, Shihezi, 832003, PR China.
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7
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Avdeev SN, Leshchenko IV, Aisanov ZR, Arkhipov VV, Belevskiy AS, Ovcharenko SI, Emelyanov AV, Sinopalnikov AI, Shmelev EI, Chuchalin AG. [New clinical guidelines for COPD - a paradigm shift: A review]. TERAPEVT ARKH 2024; 96:292-297. [PMID: 38713046 DOI: 10.26442/00403660.2024.03.202646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
Chronic obstructive pulmonary disease is now one of the most common noncommunicable diseases and the main causes of morbidity, disability and mortality in the world. In recent years, new approaches to epidemiology, diagnosis, classification (categorization), evaluation of phenotypes, as well as characterization and assessment of the severity of сhronic obstructive pulmonary disease exacerbations have emerged. Modern approaches to starting and subsequent drug therapy have changed significantly. This is largely due to the results of recently conducted major clinical trials, demonstrated high efficacy of triple fixed combinations, including inhaled glucocorticosteroids, long-acting beta-agonists and long-acting anticholinergic drugs. The use of non-medication methods (smoking cessation, physical activity and respiratory rehabilitation) and modern approaches to the treatment of respiratory failure and antibiotic therapy remain important. In terms of their significance, all these updates have a significant impact on real clinical practice and can be considered as a novel paradigm of the approaches to the diagnosis and management of this disease.
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Affiliation(s)
- S N Avdeev
- Sechenov First Moscow State Medical University (Sechenov University)
- Research Institute of Pulmonology
| | - I V Leshchenko
- Ural State Medical University
- Ural Research Institute of Phthisiopulmonology - branch of the National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - Z R Aisanov
- Pirogov Russian National Research Medical University
| | - V V Arkhipov
- Russian Medical Academy of Continuous Professional Education
| | - A S Belevskiy
- Pirogov Russian National Research Medical University
| | - S I Ovcharenko
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | - A G Chuchalin
- Pirogov Russian National Research Medical University
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Bruner MM, Bazan C, Liu B, Cheng C, Chad M, Sievert C, Edwards L, Solomon GM. Effects of High Frequency Chest Wall Oscillation (HFCWO) on Clinical Symptoms in COPD. RESEARCH SQUARE 2024:rs.3.rs-4165729. [PMID: 38659871 PMCID: PMC11042428 DOI: 10.21203/rs.3.rs-4165729/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Mucociliary clearance plays a critical role in pulmonary host defense. Abnormal mucociliary clearance contributes to the pathogenesis of pulmonary disorders, including COPD. In bronchiectasis, treatments targeting mucus obstruction in the airways include the use of high frequency chest wall oscillation (HFCWO) therapy. This prospective outcome based study was designed to investigate the changes in symptoms and quality of life (QOL) to measure the effect of adjunctive HFCWO therapy to standard of care therapy for patients with COPD. Research Question When HFCWO is indicated and used as intended, will the quality of life for those patients with COPD improve and sustain improvement. Study Design and Methods We conducted a prospective, openl-label, observational study in COPD patients without concomitant bronchiectasis. Participants had assessments of QOL at baseline (day 0) and then at 30 and 90 days after initiation of HFCWO therapy. The St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) was employed and longitudinally followed at each timepoint. Paired t-tests were used to compare means between each time points adjusted for multiple comparisons. A linear mixed model for the analysis of longitudinal data was then constructed to determine the simultaneous contribution of race, gender, ethnicity, time, and selected interactions in the primary outcome of change in SGRQ-C across 0, 30, and 90 days. Results The cohort of patients (n=102) demonstrated a significant reduction in the SGRQ-C at 30 and sustained at 90 days compared to baseline. In addition, two component scores of the SGRQ-C questionnaire ("Symptoms" and Impacts") were significantly reduced at 30 and 90 days. Interpretation This prospective, observational study demonstrates statistically significant and clinically favorable responses to HFCWO as an adjunctive therapy for patients with a primary diagnosis of COPD without concomitant bronchiectasis. Results of this study inform the design of additional additional studies of HFCWO to prove efficacy inCOPD patients.
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Affiliation(s)
| | | | - Bo Liu
- University of Alabama at Birmingham
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9
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Luo L, Tang J, Du X, Li N. Chronic obstructive pulmonary disease and the airway microbiome: A review for clinicians. Respir Med 2024; 225:107586. [PMID: 38460708 DOI: 10.1016/j.rmed.2024.107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/30/2023] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous disease characterized by progressive airflow limitation and chronic inflammation. The progressive development and long-term repeated acute exacerbation of COPD make many patients still unable to control the deterioration of the disease after active treatment, and even eventually lead to death. An increasing number of studies have shown that the occurrence and development of COPD are closely related to the composition and changes of airway microbiome. This article reviews the interaction between COPD and airway microbiome, the potential mechanisms of interaction, and the treatment methods related to microbiome. We elaborated the internal correlation between airway microbiome and different stages of COPD, inflammatory endotypes, glucocorticoid and antibiotic treatment, analyze the pathophysiological mechanisms such as the "vicious cycle" hypothesis, abnormal inflammation-immune response of the host and the "natural selection" of COPD to airway microbiome, introduce the treatment of COPD related to microbiome and emphasize the predictive value of airway microbiome for the progression, exacerbation and prognosis of COPD, as well as the guiding role for clinical management of patients, in order to provide a new perspective for exploring the pathogenesis of COPD, and also provide clues and guidance for finding new treatment targets.
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Affiliation(s)
- Lingxin Luo
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China
| | - Junli Tang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China
| | - Xianzhi Du
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China
| | - Na Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, PR China.
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10
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Rose L, Messer B. Prolonged Mechanical Ventilation, Weaning, and the Role of Tracheostomy. Crit Care Clin 2024; 40:409-427. [PMID: 38432703 DOI: 10.1016/j.ccc.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are worse than those ventilated for a shorter duration. Outcomes are affected by patient characteristics before critical illness and its severity but also by organizational characteristics and care models. Definitive trials of interventions to inform care activities, such as ventilator weaning, upper airway management, rehabilitation, and nutrition specific to the prolonged mechanical ventilation patient population, are lacking. A structured and individualized approach developed by the multiprofessional team in discussion with the patient and their family is warranted.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, UK; Department of Critical Care and Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, King's College London, 57 Waterloo Road, London SE1 8WA, UK.
| | - Ben Messer
- Royal Victoria Infirmary, Newcastle-Upon-Tyne NHS Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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11
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Dallal Bashi YH, Ali A, Al Ayoub Y, Assi KH, Mairs R, McCarthy HO, Tunney MM, Kett VL. Inhaled dry powder liposomal azithromycin for treatment of chronic lower respiratory tract infection. Int J Pharm 2024; 653:123841. [PMID: 38266939 DOI: 10.1016/j.ijpharm.2024.123841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
A dry powder inhaled liposomal azithromycin formulation was developed for the treatment of chronic respiratory diseases such as cystic fibrosis and bronchiectasis. Key properties including liposome size, charge and encapsulation efficiency powder size, shape, glass transition temperature (Tg), water content and in vitro respiratory deposition were determined. Antimicrobial activity against cystic fibrosis (CF) respiratory pathogens was determined by MIC, MBC and biofilm assays. Cytotoxicity and cellular uptake studies were performed using A549 cells. The average liposome size was 105 nm, charge was 55 mV and encapsulation efficiency was 75 %. The mean powder particle size d[v,50] of 4.54 µm and Mass Median Aerodynamic Diameter (MMAD) was 5.23 µm with a mean Tg of 76˚C and water content of 2.1 %. These excellent physicochemical characteristics were maintained over one year. Liposomal loaded azithromycin demonstrated enhanced activity against P. aeruginosa clinical isolates grown in biofilm. The formulation was rapidly delivered into bacterial cells with > 75 % uptake in 1 h. Rapid uptake into A549 cells via a cholesterol-dependent endocytosis pathway with no cytotoxic effects apparent. These data demonstrate that this formulation could offer benefits over current treatment regimens for people with chronic respiratory infection.
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Affiliation(s)
| | - Ahlam Ali
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Yuosef Al Ayoub
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK; School of Pharmacy, University of Bradford, UK
| | - Khaled H Assi
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK; School of Pharmacy, University of Bradford, UK
| | - Rachel Mairs
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Michael M Tunney
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Vicky L Kett
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK.
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12
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Huang L, Yang S, Xu G, Luo Q, Yang C, Tian H, Liu Y, Zhou Z, Huang F, Gong S, Li Q, Yu X, Chen M, Huang D, Liu Y, Tang J, Zhang R, Sun X, Lu G, Zeng C, Ai S, Li B, Chen JQ, Luo Q, Xiong C, Zou Z, Hu Q, Luo X, Li L, Sun M, Zeng F, Liang F. Efficacy of acupuncture as an adjunctive treatment to patients with stable COPD: a multicenter, randomized, sham-controlled trial protocol. BMC Complement Med Ther 2024; 24:114. [PMID: 38454410 PMCID: PMC10918953 DOI: 10.1186/s12906-024-04412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common respiratory disease and the third leading cause of death worldwide. Previous evidence has shown that acupuncture may be an effective complementary alternative therapy for stable COPD. However, large-sample, rigorously designed long-term follow-up studies still need to be completed. Notably, the relationship between the frequency of acupuncture and clinical efficacy in studies on acupuncture for stable COPD still needs further validation. This study aims to evaluate the efficacy and safety of acupuncture for stable COPD and further investigate the dose-effect relationship of acupuncture. METHODS/DESIGN This is a multicenter, randomized, controlled trial that uses central randomization to randomly allocate 550 participants in a 1:1:1:1:1 ratio to once a week acupuncture group, twice a week acupuncture group, three times a week acupuncture group, sham acupuncture group and waiting-list control group. The sham acupuncture group will receive placebo acupuncture treatments three times per week, and the waiting-list control group will not receive any form of acupuncture intervention. The study consists of a 2-week baseline, 12-week of treatment, and 52-week of follow-up. Patients with COPD between 40 to 80 years old who have received stable Western medication within the previous 3 months and have had at least 1 moderate or severe acute exacerbation within the past 1 year will be included in the study. Basic treatment will remain the same for all participants. The primary outcome is the proportion of responders at week 12. Secondary outcomes include the proportion of responders at week 64, change in the St. George's Respiratory Questionnaire (SGRQ) Scale, change in the Modified-Medical Research Council (mMRC) Scale, change in the COPD Assessment Test (CAT) Scale, change in the Lung Function Screening Indicators (LFSI), change in the 6-min walk distance (6-MWD), change in Short-Form 36 Health Survey (SF-36) Scale, the number of moderate and severe acute exacerbations and adverse event rate during the follow-up period. DISCUSSION This study will provide robust evidence on whether acupuncture is safe and effective for treating stable COPD. Meanwhile, comparing the differences in efficacy between different acupuncture frequencies will further promote the optimization of acupuncture for stable COPD. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2200058757), on April 16, 2022.
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Affiliation(s)
- Liuyang Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Sha Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Guixing Xu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Qin Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Chunyan Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Hao Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Yilin Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Zhuo Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Fengyuan Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Siyao Gong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Qian Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
- School of Health and Wellness, Panzhihua University, No. 10, North Section of Sanxian Avenue, East District, Panzhihua, 617000, Sichuan, China
| | - Xin Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Ming Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Dan Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Yunyu Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Juan Tang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Ruixin Zhang
- Department of Acupuncture and Tuina Medicine, Guangyuan Hospital of Traditional Chinese Medicine, No.133 Jianshe Road, Lizhou District, Guangyuan, 628099, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Guangbing Lu
- Department of Respiratory Medicine, Chinese Traditional Medicine Hospital of Meishan, No. 9, North Section of Mindong Avenue, Dongpo District, Meishan, 620010, Sichuan, China
| | - Chunfang Zeng
- Department of Respiratory Medicine, Deyang People's Hospital, No.173, Section 1, Taishan North Road, Jingyang District, Deyang, 618009, Sichuan, China
| | - Shuangchun Ai
- Department of Acupuncture and Tuina Medicine, Mianyang Hospital of TCM, No.14, Fucheng Road, Fucheng District, Mianyan, 621053, Sichuan, China
| | - Bin Li
- Department of Respiratory Medicine, Guangyuan Hospital of Traditional Chinese Medicine, No.133 Jianshe Road, Lizhou District, Guangyuan, 628099, Sichuan, China
| | - Jian Qin Chen
- Department of Respiratory Medicine, Hospital of Chengdu University of TCM, No. 39, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Quan Luo
- Department of Traditional Chinese Medicine, Chengdu Second People's Hospital, No.10 Qingyun South Street, Jinjiang District, Chengdu, 610021, Sichuan, China
| | - Chan Xiong
- Department of Respiratory Medicine, Chengdu TCM Hospital of Pidu District, No.169, Sec.1, Zhongxin Avenue, Pidu District, Chengdu, 611730, Sichuan, China
| | - Zhi Zou
- Department of Respiratory Medicine, Meishan People's Hospital, No. 288, South Section 4Dongpo Avenue, Dongpo District, Meishan, 620020, Sichuan, China
| | - Qiang Hu
- Department of Respiratory Medicine, Panzhihua Integrated TCM and Western Medicine Hospital, No. 27, Taoyuan Street, Bingcaogang, East District, Panzhihua, 617099, Sichuan, China
| | - Xiaochao Luo
- Department of Acupuncture and Tuina Medicine, Guangyuan Hospital of Traditional Chinese Medicine, No.133 Jianshe Road, Lizhou District, Guangyuan, 628099, Sichuan, China
| | - Ling Li
- Department of Acupuncture and Tuina Medicine, Guangyuan Hospital of Traditional Chinese Medicine, No.133 Jianshe Road, Lizhou District, Guangyuan, 628099, Sichuan, China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
| | - Fang Zeng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37, Shi'er Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
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13
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Paróczai D, Burian K, Bikov A. Bacterial Vaccinations in Patients with Chronic Obstructive Pulmonary Disease. Vaccines (Basel) 2024; 12:213. [PMID: 38400196 PMCID: PMC10893474 DOI: 10.3390/vaccines12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent, often progressive, chronic disease of the lungs. Patients with COPD often have impaired immunity; therefore, they are prone to chest infections, such as pneumonia or bronchitis. Acute exacerbations of COPD are major events that accelerate disease progression, contributing to its symptoms' burden, morbidity, and mortality. Both pneumonia and acute exacerbations in COPD are caused by bacteria against which there are effective vaccinations. Although the number of randomised controlled studies on bacterial vaccinations in COPD is limited, national and international guidelines endorse specific vaccinations in patients with COPD. This review will summarise the different types of vaccinations that prevent pneumonia and COPD exacerbations. We also discuss the results of early phase studies. We will mainly focus on Streptococcus pneumoniae, as this bacterium was predominantly investigated in COPD. However, we also review studies investigating vaccinations against Haemophilus influenzae, Moraxella catarrhalis, and Bordetella pertussis.
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Affiliation(s)
- Dóra Paróczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary; (D.P.); (K.B.)
- Albert Szent-Györgyi Health Center, Department of Pulmonology, University of Szeged, H-6720 Szeged, Hungary
| | - Katalin Burian
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary; (D.P.); (K.B.)
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
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14
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Pandya CD, Vekaria HJ, Zamorano M, Trout AL, Ritzel RM, Guzman GU, Bolden C, Sullivan PG, Gensel JC, Miller BA. Azithromycin reduces hemoglobin-induced innate neuroimmune activation. Exp Neurol 2024; 372:114574. [PMID: 37852468 DOI: 10.1016/j.expneurol.2023.114574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
Neonatal intraventricular hemorrhage (IVH) releases blood products into the lateral ventricles and brain parenchyma. There are currently no medical treatments for IVH and surgery is used to treat a delayed effect of IVH, post-hemorrhagic hydrocephalus. However, surgery is not a cure for intrinsic brain injury from IVH, and is performed in a subacute time frame. Like many neurological diseases and injuries, innate immune activation is implicated in the pathogenesis of IVH. Innate immune activation is a pharmaceutically targetable mechanism to reduce brain injury and post-hemorrhagic hydrocephalus after IVH. Here, we tested the macrolide antibiotic azithromycin, which has immunomodulatory properties, to reduce innate immune activation in an in vitro model of microglial activation using the blood product hemoglobin (Hgb). We then utilized azithromycin in our in vivo model of IVH, using intraventricular blood injection into the lateral ventricle of post-natal day 5 rat pups. In both models, azithromycin modulated innate immune activation by several outcome measures including mitochondrial bioenergetic analysis, cytokine expression and flow cytometric analysis. This suggests that azithromycin, which is safe for neonates, could hold promise for modulating innate immune activation after IVH.
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Affiliation(s)
- Chirayu D Pandya
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Hemendra J Vekaria
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Miriam Zamorano
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Amanda L Trout
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Rodney M Ritzel
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Gary U Guzman
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Christopher Bolden
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Patrick G Sullivan
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America; Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - John C Gensel
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Physiology, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Brandon A Miller
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America.
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15
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Waitayangkoon P, Moon SJ, Tirupur Ponnusamy JJ, Zeng L, Driban J, McAlindon T. Long-Term Safety Profiles of Macrolides and Tetracyclines: A Systematic Review and Meta-Analysis. J Clin Pharmacol 2024; 64:164-177. [PMID: 37751595 DOI: 10.1002/jcph.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023]
Abstract
Macrolides and tetracyclines are antibiotics that have a range of anti-inflammatory properties beyond their microbial capabilities. Although these antibiotics have been in widespread use, the long-term safety profiles are limited. We performed a systematic review and meta-analysis of randomized clinical trials that compared macrolides or tetracyclines with placeboes to provide long-term safety information. We searched Medline and EMBASE from inception to October 2022 and identified studies that reported study drug-related death, serious adverse events (SAEs), or withdrawal rates, and common adverse effects of each drug. Relative risk (RR) and number needed to harm were calculated. Of the 52 randomized clinical trials included, there are 3151 participants on doxycycline, 2519 participants on minocycline, 3049 participants on azithromycin, 763 participants on clarithromycin, 262 participants on erythromycin, and 100 participants on roxithromycin. There was no death related to any study drugs and rates of SAE were not significantly different from placebo in any drug. Overall withdrawal rates were slightly higher than placebo in doxycycline (RR, 1.30; 95% CI, 1.12-1.52) and minocycline (RR, 1.29; 95% CI, 1.15-1.46). Withdrawal rates due to adverse events were higher in doxycycline (RR, 2.82; 95% CI, 1.88-4.22), minocycline (RR, 1.48; 95% CI, 1.09-1.98), and azithromycin (RR, 1.53; 95% CI, 1.13-2.08). Gastrointestinal disturbances are the most common tolerable adverse effects for every drug. Photosensitivity and rash are the second most common adverse effects for doxycycline and minocycline. We found no evidence that long-term use up to 2 years of macrolides or tetracyclines was associated with increased risk of SAEs.
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Affiliation(s)
- Palapun Waitayangkoon
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
| | - Soo Jin Moon
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
| | | | - Li Zeng
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Jeffrey Driban
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Boston, MA, USA
| | - Timothy McAlindon
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Boston, MA, USA
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16
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Holtzman MJ, Zhang Y, Wu K, Romero AG. Mitogen-activated protein kinase-guided drug discovery for post-viral and related types of lung disease. Eur Respir Rev 2024; 33:230220. [PMID: 38417971 PMCID: PMC10900067 DOI: 10.1183/16000617.0220-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/18/2024] [Indexed: 03/01/2024] Open
Abstract
Respiratory viral infections are a major public health problem, with much of their morbidity and mortality due to post-viral lung diseases that progress and persist after the active infection is cleared. This paradigm is implicated in the most common forms of chronic lung disease, such as asthma and COPD, as well as other virus-linked diseases including progressive and long-term coronavirus disease 2019. Despite the impact of these diseases, there is a lack of small-molecule drugs available that can precisely modify this type of disease process. Here we will review current progress in understanding the pathogenesis of post-viral and related lung disease with characteristic remodelling phenotypes. We will also develop how this data leads to mitogen-activated protein kinase (MAPK) in general and MAPK13 in particular as key druggable targets in this pathway. We will also explore recent advances and predict the future breakthroughs in structure-based drug design that will provide new MAPK inhibitors as drug candidates for clinical applications. Each of these developments point to a more effective approach to treating the distinct epithelial and immune cell based mechanisms, which better account for the morbidity and mortality of post-viral and related types of lung disease. This progress is vital given the growing prevalence of respiratory viruses and other inhaled agents that trigger stereotyped progression to acute illness and chronic disease.
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Affiliation(s)
- Michael J Holtzman
- Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
- NuPeak Therapeutics Inc., St. Louis, MO, USA
| | - Yong Zhang
- Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kangyun Wu
- Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Arthur G Romero
- Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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17
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Moll M, Silverman EK. Precision Approaches to Chronic Obstructive Pulmonary Disease Management. Annu Rev Med 2024; 75:247-262. [PMID: 37827193 DOI: 10.1146/annurev-med-060622-101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD heterogeneity has hampered progress in developing pharmacotherapies that affect disease progression. This issue can be addressed by precision medicine approaches, which focus on understanding an individual's disease risk, and tailoring management based on pathobiology, environmental exposures, and psychosocial issues. There is an urgent need to identify COPD patients at high risk for poor outcomes and to understand at a mechanistic level why certain individuals are at high risk. Genetics, omics, and network analytic techniques have started to dissect COPD heterogeneity and identify patients with specific pathobiology. Drug repurposing approaches based on biomarkers of specific inflammatory processes (i.e., type 2 inflammation) are promising. As larger data sets, additional omics, and new analytical approaches become available, there will be enormous opportunities to identify high-risk individuals and treat COPD patients based on their specific pathophysiological derangements. These approaches show great promise for risk stratification, early intervention, drug repurposing, and developing novel therapeutic approaches for COPD.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; ,
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; ,
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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18
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Hamid A, Mäser P, Mahmoud AB. Drug Repurposing in the Chemotherapy of Infectious Diseases. Molecules 2024; 29:635. [PMID: 38338378 PMCID: PMC10856722 DOI: 10.3390/molecules29030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Repurposing is a universal mechanism for innovation, from the evolution of feathers to the invention of Velcro tape. Repurposing is particularly attractive for drug development, given that it costs more than a billion dollars and takes longer than ten years to make a new drug from scratch. The COVID-19 pandemic has triggered a large number of drug repurposing activities. At the same time, it has highlighted potential pitfalls, in particular when concessions are made to the target product profile. Here, we discuss the pros and cons of drug repurposing for infectious diseases and analyze different ways of repurposing. We distinguish between opportunistic and rational approaches, i.e., just saving time and money by screening compounds that are already approved versus repurposing based on a particular target that is common to different pathogens. The latter can be further distinguished into divergent and convergent: points of attack that are divergent share common ancestry (e.g., prokaryotic targets in the apicoplast of malaria parasites), whereas those that are convergent arise from a shared lifestyle (e.g., the susceptibility of bacteria, parasites, and tumor cells to antifolates due to their high rate of DNA synthesis). We illustrate how such different scenarios can be capitalized on by using examples of drugs that have been repurposed to, from, or within the field of anti-infective chemotherapy.
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Affiliation(s)
- Amal Hamid
- Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan;
| | - Pascal Mäser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, 4123 Basel, Switzerland
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
| | - Abdelhalim Babiker Mahmoud
- Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan;
- Department of Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland, 66123 Saarbruecken, Germany
- Department of Microbial Drugs, Helmholtz Centre for Infection Research (HZI), 38124 Braunschweig, Germany
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19
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Li R, Li J, Zhou X. Lung microbiome: new insights into the pathogenesis of respiratory diseases. Signal Transduct Target Ther 2024; 9:19. [PMID: 38228603 DOI: 10.1038/s41392-023-01722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/25/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024] Open
Abstract
The lungs were long thought to be sterile until technical advances uncovered the presence of the lung microbial community. The microbiome of healthy lungs is mainly derived from the upper respiratory tract (URT) microbiome but also has its own characteristic flora. The selection mechanisms in the lung, including clearance by coughing, pulmonary macrophages, the oscillation of respiratory cilia, and bacterial inhibition by alveolar surfactant, keep the microbiome transient and mobile, which is different from the microbiome in other organs. The pulmonary bacteriome has been intensively studied recently, but relatively little research has focused on the mycobiome and virome. This up-to-date review retrospectively summarizes the lung microbiome's history, composition, and function. We focus on the interaction of the lung microbiome with the oropharynx and gut microbiome and emphasize the role it plays in the innate and adaptive immune responses. More importantly, we focus on multiple respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), fibrosis, bronchiectasis, and pneumonia. The impact of the lung microbiome on coronavirus disease 2019 (COVID-19) and lung cancer has also been comprehensively studied. Furthermore, by summarizing the therapeutic potential of the lung microbiome in lung diseases and examining the shortcomings of the field, we propose an outlook of the direction of lung microbiome research.
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Affiliation(s)
- Ruomeng Li
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Xikun Zhou
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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20
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Hua JL, Yang ZF, Cheng QJ, Han YP, Li ZT, Dai RR, He BF, Wu YX, Zhang J. Prevention of exacerbation in patients with moderate-to-very severe COPD with the intent to modulate respiratory microbiome: a pilot prospective, multi-center, randomized controlled trial. Front Med (Lausanne) 2024; 10:1265544. [PMID: 38249987 PMCID: PMC10797043 DOI: 10.3389/fmed.2023.1265544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Considering the role of bacteria in the onset of acute exacerbation of COPD (AECOPD), we hypothesized that the use of influenza-Streptococcus pneumoniae vaccination, oral probiotics or inhaled amikacin could prevent AECOPD. Methods In this pilot prospective, muti-central, randomized trial, moderate-to-very severe COPD subjects with a history of moderate-to-severe exacerbations in the previous year were enrolled and assigned in a ratio of 1:1:1:1 into 4 groups. All participants were managed based on the conventional treatment recommended by GOLD 2019 report for 3 months, with three groups receiving additional treatment of inhaled amikacin (0.4 g twice daily, 5-7 days monthly for 3 months), oral probiotic Lactobacillus rhamnosus GG (1 tablet daily for 3 months), or influenza-S. pneumoniae vaccination. The primary endpoint was time to the next onset of moderate-to-severe AECOPD from enrollment. Secondary endpoints included CAT score, mMRC score, adverse events, and survival in 12 months. Results Among all 112 analyzed subjects (101 males, 96 smokers or ex-smokers, mean ± SD age 67.19 ± 7.39 years, FEV1 41.06 ± 16.09% predicted), those who were given dual vaccination (239.7 vs. 198.2 days, p = 0.044, 95%CI [0.85, 82.13]) and oral probiotics (248.8 vs. 198.2 days, p = 0.017, 95%CI [7.49, 93.59]) had significantly delayed onset of next moderate-to-severe AECOPD than those received conventional treatment only. For subjects with high symptom burden, the exacerbations were significantly delayed in inhaled amikacin group as compared to the conventional treatment group (237.3 vs. 179.1 days, p = 0.009, 95%CI [12.40,104.04]). The three interventions seemed to be safe and well tolerated for patient with stable COPD. Conclusion The influenza-S. pneumoniae vaccine and long-term oral probiotic LGG can significantly delay the next moderate-to-severe AECOPD. Periodically amikacin inhalation seems to work in symptomatic patients. The findings in the current study warrants validation in future studies with microbiome investigation.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03449459.
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Affiliation(s)
- Jian-lan Hua
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zi-feng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qi-jian Cheng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao-pin Han
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zheng-tu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ran-ran Dai
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin-feng He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-xing Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China
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21
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Shim SR, Lee Y, In SM, Lee KI, Kim I, Jeong H, Shin J, Kim JY. Increased risk of hearing loss associated with macrolide use: a systematic review and meta-analysis. Sci Rep 2024; 14:183. [PMID: 38167873 PMCID: PMC10762137 DOI: 10.1038/s41598-023-50774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
The increased risk of hearing loss with macrolides remains controversial. We aimed to systematically review and meta-analyze data on the clinical risk of hearing loss, tinnitus, and ototoxicity following macrolide use. A systematic search was conducted across PubMed, MEDLINE, Cochrane, and Embase databases from database inception to May 2023. Medical Subject Heading (MeSH) terms and text keywords were utilized, without any language restrictions. In addition to the electronic databases, two authors manually and independently searched for relevant studies in the US and European clinical trial registries and Google Scholar. Studies that involved (1) patients who had hearing loss, tinnitus, or ototoxicity after macrolide use, (2) intervention of use of macrolides such as azithromycin, clarithromycin, erythromycin, fidaxomicin, roxithromycin, spiramycin, and/or telithromycin, (3) comparisons with specified placebos or other antibiotics, (4) outcomes measured as odds ratio (OR), relative risk (RR), hazard ratio (HR), and mean difference for ototoxicity symptoms using randomized control trial (RCT)s and observational studies (case-control, cross-section, and cohort studies) were included. Data extraction was performed independently by two extractors, and a crosscheck was performed to identify any errors. ORs along with their corresponding 95% confidence intervals (CIs) were estimated using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines for RCTs and Meta-Analysis of Observational Studies in Epidemiology guidelines for observational studies were followed. We assessed the hearing loss risk after macrolide use versus controls (placebos and other antibiotics). Based on data from 13 studies including 1,142,021 patients (n = 267,546 for macrolide and n = 875,089 for controls), the overall pooled OR was 1.25 (95% CI 1.07-1.47). In subgroup analysis by study design, the ORs were 1.37 (95% CI 1.08-1.73) for RCTs and 1.33 (95% CI 1.24-1.43) for case-control studies, indicating that RCT and case-control study designs showed a statistically significant higher risk of hearing loss. The group with underlying diseases such as multiple infectious etiologies (OR, 1.16 [95% CI 0.96-1.41]) had a statistically significant lower risk than the group without (OR, 1.53 [95% CI 1.38-1.70] P = .013). The findings from this systematic review and meta-analysis suggest that macrolide antibiotics increase the risk of hearing loss and that healthcare professionals should carefully consider this factor while prescribing macrolides.
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Affiliation(s)
- Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea
| | - YungJin Lee
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea
- Department of Rehabilitation Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Seung Min In
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Ki-Il Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Ikhee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Hyoyeon Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jieun Shin
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea.
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea.
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea.
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea.
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea.
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22
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Weir DL, Bai YQ, Thavorn K, Guilcher S, Kanji S, Mulpuru S, Wodchis W. Non-adherence to COPD medications and its association with adverse events: A longitudinal population based cohort study of older adults. Ann Epidemiol 2023:S1047-2797(23)00228-4. [PMID: 38141744 DOI: 10.1016/j.annepidem.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To determine the association between non-adherence to long term chronic obstructive pulmonary disease (COPD) medications and COPD related emergency department (ED) visits and hospitalizations in patients with incident COPD, utilizing time varying measures of adherence as well as accounting for time-varying confounding impacted by prior adherence. STUDY DESIGN AND SETTING We conducted a population-based retrospective cohort study between 2007-2017 among individuals aged 66 years and older with incident COPD using multiple linked administrative health databases from the province of Ontario, Canada. Adherence to COPD medications was measured using time varying proportion of days covered based on insurance claims for medications dispensed at community pharmacies. The parametric g-formula was used to assess the association between time-varying adherence (in the last 90-days) to COPD medications and risk of COPD related hospitalizations and ED visits while accounting for time varying confounding by COPD severity. RESULTS Overall, 60,251 individuals with incident COPD were included; mean age was 76 (SD 7) and 59% were male. Mean adherence over the entire follow-up was 23% (SD 0.3). There were 7248 (12%) COPD related ED visits (2.8 events per 100 person years [PY]) and 9188 (15%) COPD related hospitalizations (3.5 events per 100 PY). Compared to those with 0% 90-day adherence, those with adherence between 1-33% had a 19% decreased risk of COPD related ED visits (adjusted risk ratio[aRR]:0.81, 95% confidence interval [CI]:0.78-0.83), those with adherence between 34%-67% had a 18% decreased risk (aRR: 0.82, 95% CI: 0.77-0.85) while those with 68%-100% 90-day adherence had a 63% increased risk of COPD related ED visits (aRR: 1.63, 95% CI: 1.47-1.78). Nearly identical results were obtained for COPD specific hospitalizations. CONCLUSION After accounting for time varying confounding by COPD severity, the highest time varying 90-days adherence was associated with an increased risk of both COPD related ED visits and hospitalizations compared to the lowest adherence categories. Differences in COPD severity between adherence categories, perception of need for medication management in the higher adherence categories, and potential residual confounding makes it difficult to disentangle the independent effects of adherence from the severity of the condition itself.
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Affiliation(s)
- Daniala L Weir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Utrecht Institute of Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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23
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Sawka A, Burke A. Medications and Monitoring in Treatment of Nontuberculous Mycobacterial Pulmonary Disease. Clin Chest Med 2023; 44:815-828. [PMID: 37890918 DOI: 10.1016/j.ccm.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
In the treatment of nontuberculous mycobacteria (NTM) lung disease, clinicians must consider potential toxicities that may occur as a result of prolonged exposure to a multidrug antibiotic regimen. Frequent clinical and microbiological monitoring is required to assess response and guide treatment duration. This article summarizes toxicity profiles of the antibiotics that are most frequently prescribed for the treatment of NTM lung disease. The role of therapeutic drug monitoring during use of amikacin and linezolid is discussed. The available evidence to guide frequency and extent of medication monitoring during NTM treatment is provided.
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Affiliation(s)
- Alice Sawka
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Burke
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
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24
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Ahmadian S, Johnson KM, Ho JK, Sin DD, Lynd LD, Harrison M, Sadatsafavi M. A Cost-Effectiveness Analysis of Azithromycin for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1735-1742. [PMID: 37703432 DOI: 10.1513/annalsats.202304-301oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023] Open
Abstract
Rationale: Daily oral azithromycin therapy can reduce the risk of acute exacerbations of chronic obstructive pulmonary disease (COPD). However, given its adverse events and additional costs, it is not known whether adding long-term azithromycin as an adjunct therapy to inhaled pharmacotherapy is cost effective. Objectives: The objective of this study was to evaluate the cost-effectiveness of add-on azithromycin therapy in COPD as recommended by contemporary COPD management guidelines. Methods: We extended a previously validated Canadian COPD policy model to include azithromycin-related inputs and outcomes. The cost-effectiveness of azithromycin was evaluated over a 20-year time horizon in patients who continue to exacerbate despite receiving maximal inhaled therapies. The benefit of azithromycin was modeled as a reduction in exacerbation rates. Adverse events included cardiovascular death, hearing loss, gastrointestinal symptoms, and antimicrobial resistance. The incremental cost-effectiveness ratio (ICER) was calculated with costs in 2020 Canadian dollars ($) and quality-adjusted life-years (QALYs) discounted at 1.5% per year. The analysis was stratified among patient subgroups based on exacerbation histories. Results: In patients with a positive exacerbation history (one or more events in the previous 12 mo), azithromycin was associated with $49,732 costs, 7.65 QALYs, and 10.95 exacerbations per patient over 20 years. The corresponding values were $48,436, 7.62, and 11.86 for the reference group, resulting in an ICER of $43,200 per QALY gained. In patients defined as frequent exacerbators (two or more moderate or one or more severe events in the past 12 mo), the ICER was reduced to $8,862 per QALY gained. In patients with no history of exacerbation, azithromycin had lower QALYs and higher costs than the reference group. Conclusions: Add-on azithromycin is cost effective in patients with a recent history of exacerbations at commonly accepted willingness-to-pay thresholds of $50,000-$100,000/QALY. Guidelines should consider recommending add-on azithromycin for patients who had at least one moderate or severe exacerbation in the past year, albeit more information about treatment efficacy would strengthen this recommendation.
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Affiliation(s)
- Safa Ahmadian
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Joseph Khoa Ho
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Don D Sin
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
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25
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Taylor B, Chiang S, Taylor S. The Price Is Right: Cost-Effectiveness of Long-Term Azithromycin for Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1707-1708. [PMID: 38038601 PMCID: PMC10704227 DOI: 10.1513/annalsats.202308-745ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Brice Taylor
- Division of Pulmonary and Critical Care Medicine
| | | | - Stephanie Taylor
- Division of Hospital Medicine, and
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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26
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van Beveren GJ, Said H, van Houten MA, Bogaert D. The respiratory microbiome in childhood asthma. J Allergy Clin Immunol 2023; 152:1352-1367. [PMID: 37838221 DOI: 10.1016/j.jaci.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
Asthma is the most prevalent noncommunicable disease in childhood, characterized by reversible airway constriction and inflammation of the lower airways. The respiratory tract consists of the upper and lower airways, which are lined with a diverse community of microbes. The composition and density of the respiratory microbiome differs across the respiratory tract, with microbes adapting to the gradually changing physiology of the environment. Over the past decade, both the upper and lower respiratory microbiomes have been implicated in the etiology and disease course of asthma, as well as in its severity and phenotype. We have reviewed the literature on the role of the respiratory microbiome in asthma, making a careful distinction between the relationship of the microbiome with development of childhood asthma and its relationship with the disease course, while accounting for age and the microbial niches studied. Furthermore, we have assessed the literature regarding the underlying asthma endotypes and the impact of the microbiome on the host immune response. We have identified distinct microbial signatures across the respiratory tract associated with asthma development, stability, and severity. These data suggest that the respiratory microbiome may be important for asthma development and severity and may therefore be a potential target for future microbiome-based preventive and treatment strategies.
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Affiliation(s)
- Gina J van Beveren
- Spaarne Gasthuis Academy, Hoofddorp and Haarlem, Hoofddorp, The Netherlands; Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hager Said
- Department of Pediatrics, Spaarne Gasthuis Haarlem
| | - Marlies A van Houten
- Spaarne Gasthuis Academy, Hoofddorp and Haarlem, Hoofddorp, The Netherlands; Department of Pediatrics, Spaarne Gasthuis Haarlem
| | - Debby Bogaert
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
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27
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Hardman SJ, Shackley FM, Ugonna K, Darton TC, Rigby AS, Bogaert D, Binkowska JM, Condliffe AM. Seasonal Azithromycin Use in Paediatric Protracted Bacterial Bronchitis Does Not Promote Antimicrobial Resistance but Does Modulate the Nasopharyngeal Microbiome. Int J Mol Sci 2023; 24:16053. [PMID: 38003242 PMCID: PMC10671346 DOI: 10.3390/ijms242216053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Protracted bacterial bronchitis (PBB) causes chronic wet cough for which seasonal azithromycin is increasingly used to reduce exacerbations. We investigated the impact of seasonal azithromycin on antimicrobial resistance and the nasopharyngeal microbiome. In an observational cohort study, 50 children with PBB were enrolled over two consecutive winters; 25/50 at study entry were designated on clinical grounds to take azithromycin over the winter months and 25/50 were not. Serial nasopharyngeal swabs were collected during the study period (12-20 months) and cultured bacterial isolates were assessed for antimicrobial susceptibility. 16S rRNA-based sequencing was performed on a subset of samples. Irrespective of azithromycin usage, high levels of azithromycin resistance were found; 73% of bacteria from swabs in the azithromycin group vs. 69% in the comparison group. Resistance was predominantly driven by azithromycin-resistant S. pneumoniae, yet these isolates were mostly erythromycin susceptible. Analysis of 16S rRNA-based sequencing revealed a reduction in within-sample diversity in response to azithromycin, but only in samples of children actively taking azithromycin at the time of swab collection. Actively taking azithromycin at the time of swab collection significantly contributed to dissimilarity in bacterial community composition. The discrepancy between laboratory detection of azithromycin and erythromycin resistance in the S. pneumoniae isolates requires further investigation. Seasonal azithromycin for PBB did not promote antimicrobial resistance over the study period, but did perturb the microbiome.
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Affiliation(s)
- Simon J. Hardman
- Department of General Paediatrics, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield S44 5BL, UK
| | - Fiona M. Shackley
- Department of Paediatric Immunology, Allergy and Infectious Diseases, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield S10 2TH, UK;
| | - Kelechi Ugonna
- Department of Paediatric Respiratory Medicine, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield S10 2TH, UK;
| | - Thomas C. Darton
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield S10 2RX, UK; (T.C.D.); (A.M.C.)
| | - Alan S. Rigby
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK;
| | - Debby Bogaert
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital and University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Justyna M. Binkowska
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Alison M. Condliffe
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield S10 2RX, UK; (T.C.D.); (A.M.C.)
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Zysman M, Mahay G, Guibert N, Barnig C, Leroy S, Guilleminault L. Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients. Respir Med Res 2023; 84:101035. [PMID: 37651981 DOI: 10.1016/j.resmer.2023.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. METHODS We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. RESULTS Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. CONCLUSION Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
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Affiliation(s)
- Maeva Zysman
- Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France
| | - Guillaume Mahay
- Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
| | - Cindy Barnig
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France; Service de Pneumologie, Oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France
| | - Sylvie Leroy
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, CNRS UMR 7275 - FHU OncoAge, Service de Pneumologie Oncologie Thoracique et Soins Intensifs Respiratoires, CHU de Nice, Hôpital Pasteur, Nice, France
| | - Laurent Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, CRISALIS F-CRIN, Toulouse, France.
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Ansari AW, Ahmad F, Raheed T, Jochebeth A, Mateo JMP, Abdulrahman N, Joy EF, Alam MA, Buddenkotte J, Hamoudi RA, Steinhoff M. Azithromycin downregulates ICOS (CD278) and OX40 (CD134) expression and mTOR activity of TCR-activated T cells to inhibit proliferation. Int Immunopharmacol 2023; 124:110831. [PMID: 37633240 DOI: 10.1016/j.intimp.2023.110831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
The precise mechanism of macrolide antibiotic azithromycin (AZM) mediated CD4+ T cell suppression is not fully understood. Given the crucial role of co-stimulatory signaling in T-lymphocyte function, we tested in vitro effects of AZM on two of the most extensively investigated costimulatory molecules, ICOS and OX40 in context to CD4+ T cell proliferation. Using multi-color flow cytometry approach on TCR-activated healthy donor peripheral blood mononuclear cells, we observed a marked reduction in the frequencies and surface expression of ICOS and OX40 receptors following AZM treatment. Functionally, in contrast to ICOS- and OX40- CD3+ CD4+ T cells, AZM treated ICOS+ and OX40+ displayed profound reduction in cell proliferation. Furthermore, AZM treated T cells displaying reduced levels of ICOS and OX40 found to be associated with suppressed mTOR activity as detected by phosphorylation levels of S6 ribosomal protein. This study provides new insights on potential mechanism of AZM mediated inhibition of T cell proliferation by targeting costimulatory pathways.
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Affiliation(s)
- Abdul Wahid Ansari
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar.
| | - Fareed Ahmad
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Thesni Raheed
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Anh Jochebeth
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Jericha Miles Pamiloza Mateo
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Nabeel Abdulrahman
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Elizabeth Febu Joy
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Majid Ali Alam
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Joerg Buddenkotte
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Akram Hamoudi
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Martin Steinhoff
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Medicine, Weill Cornell University, New York, NY, USA
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Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne MF, Kermelly SB, D'Urzo A, Lal A, Maltais F, Marciniuk JD, Mulpuru S, Penz E, Sin DD, Van Dam A, Wald J, Walker BL, Marciniuk DD. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD. Chest 2023; 164:1159-1183. [PMID: 37690008 DOI: 10.1016/j.chest.2023.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
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Affiliation(s)
- Jean Bourbeau
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shawn D Aaron
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Sophie B Kermelly
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Anthony D'Urzo
- Primary Care Lung Clinic, University of Toronto, Toronto, ON, Canada
| | - Avtar Lal
- Canadian Thoracic Society, Ottawa, ON, Canada
| | - François Maltais
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jeffrey D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erika Penz
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Don D Sin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brandie L Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
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Nakamura K, Fujita Y, Chen H, Somekawa K, Kashizaki F, Koizumi H, Takahashi K, Horita N, Hara Y, Muro S, Kaneko T. The Effectiveness and Safety of Long-Term Macrolide Therapy for COPD in Stable Status: A Systematic Review and Meta-Analysis. Diseases 2023; 11:152. [PMID: 37987263 PMCID: PMC10660475 DOI: 10.3390/diseases11040152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition with fewer treatments available as the severity increases. Previous systematic reviews have demonstrated the benefits of long-term macrolide use. However, the therapeutic differences between different macrolides and the optimal duration of use remain unclear. Methods: A systematic review and meta-analysis were conducted to assess the effectiveness of long-term macrolide use in reducing COPD exacerbations, compare the therapeutic differences among macrolides, and determine the appropriate treatment duration. Four databases (PubMed, Cochrane Library, Web of Science, and ICHU-SHI) were searched until 20 March 2023, and a random-effects model was used to calculate the pooled effect. Results: The meta-analysis included nine randomized controlled trials involving 1965 patients. The analysis revealed an odds ratio (OR) of 0.34 (95% confidence interval [CI] 0.19, 0.59, p < 0.001) for the reduction in exacerbation frequency. Notably, only azithromycin or erythromycin showed suppression of COPD exacerbations. The ORs for reducing exacerbation frequency per year and preventing hospitalizations were -0.50 (95% CI: -0.81, -0.19; p = 0.001) and 0.60 (95% CI: 0.3, 0.97; p = 0.04), respectively. Statistical analyses showed no significant differences between three- and six-month macrolide prescriptions. However, studies involving a twelve-month prescription showed an OR of 0.27 (95% CI: 0.11, 0.68; p = 0.005; I2 = 81%). Although a significant improvement in St George's Respiratory Questionnaire (SGRQ) total scores was observed with a mean difference of -4.42 (95% CI: -9.0, 0.16; p = 0.06; I2 = 94%), the minimal clinically important difference was not reached. While no adverse effects were observed between the two groups, several studies have reported an increase in bacterial resistance. Conclusions: Long-term use of azithromycin or erythromycin suppresses COPD exacerbations, and previous studies have supported the advantages of a 12-month macrolide prescription over a placebo.
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Affiliation(s)
- Kazunori Nakamura
- Department of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto 861-4193, Japan;
| | - Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, Nara 634-8522, Japan; (Y.F.); (S.M.)
| | - Hao Chen
- Department of Pulmonology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (K.S.); (Y.H.); (T.K.)
- Department of Respiratory Medicine, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan; (F.K.); (H.K.); (K.T.)
| | - Kohei Somekawa
- Department of Pulmonology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (K.S.); (Y.H.); (T.K.)
| | - Fumihiro Kashizaki
- Department of Respiratory Medicine, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan; (F.K.); (H.K.); (K.T.)
| | - Harumi Koizumi
- Department of Respiratory Medicine, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan; (F.K.); (H.K.); (K.T.)
| | - Kenichi Takahashi
- Department of Respiratory Medicine, Yokohama Minami Kyousai Hospital, Yokohama 236-0037, Japan; (F.K.); (H.K.); (K.T.)
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama 236-0004, Japan;
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (K.S.); (Y.H.); (T.K.)
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara 634-8522, Japan; (Y.F.); (S.M.)
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Hospital, Yokohama 236-0004, Japan; (K.S.); (Y.H.); (T.K.)
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32
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Baker JG, Shaw DE. Asthma and COPD: A Focus on β-Agonists - Past, Present and Future. Handb Exp Pharmacol 2023. [PMID: 37709918 DOI: 10.1007/164_2023_679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Asthma has been recognised as a respiratory disorder for millennia and the focus of targeted drug development for the last 120 years. Asthma is one of the most common chronic non-communicable diseases worldwide. Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide, is caused by exposure to tobacco smoke and other noxious particles and exerts a substantial economic and social burden. This chapter reviews the development of the treatments of asthma and COPD particularly focussing on the β-agonists, from the isolation of adrenaline, through the development of generations of short- and long-acting β-agonists. It reviews asthma death epidemics, considers the intrinsic efficacy of clinical compounds, and charts the improvement in selectivity and duration of action that has led to our current medications. Important β2-agonist compounds no longer used are considered, including some with additional properties, and how the different pharmacological properties of current β2-agonists underpin their different places in treatment guidelines. Finally, it concludes with a look forward to future developments that could improve the β-agonists still further, including extending their availability to areas of the world with less readily accessible healthcare.
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Affiliation(s)
- Jillian G Baker
- Department of Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Cell Signalling, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Allinson JP, Vlies BH, Brill SE, Law M, Burnside G, Finney LJ, Alves-Moreira L, Donaldson GC, Calverley PMA, Walker PP, Wedzicha JA. A Double-Blind, Randomized, Placebo-controlled Trial of Long-Term Doxycycline Therapy on Exacerbation Rate in Patients with Stable Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:549-558. [PMID: 37450935 PMCID: PMC10492249 DOI: 10.1164/rccm.202212-2287oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) exacerbations are a major cause of morbidity and mortality, and preventing them is a key treatment target. Long-term macrolide treatment is effective at reducing exacerbations, but there is a paucity of evidence for other antibiotic classes. Objectives: To assess whether 12-month use of doxycycline reduces the exacerbation rate in people with COPD. Methods: People with moderate to very severe COPD and an exacerbation history were recruited from three UK centers and randomized to 12 months of doxycycline 100 mg once daily or placebo. The primary study outcome was the exacerbation rate per person-year. Results: A total of 222 people were randomized. Baseline mean FEV1 was 1.35 L (SD, 0.35 L), 52.5% predicted (SD, 15.9% predicted). The median number of treated exacerbations in the year before the study was 2 (SD, 1-4). A total of 71% of patients reported two or more exacerbations, and 81% were already prescribed inhaled corticosteroids at baseline. The COPD exacerbation rate did not differ between the groups (doxycycline/placebo rate ratio [RR], 0.86; 95% confidence interval [CI], 0.67-1.10; P = 0.23). No difference was seen if only treated exacerbations or hospitalizations were considered. In preplanned subgroup analysis, doxycycline appeared to better reduce the exacerbation rate among people with severe COPD (RR, 0.36; 95% CI, 0.15-0.85; P = 0.019) and in those with an eosinophil count <300 cells/μl (RR, 0.50; 95% CI, 0.29-0.84; P = 0.01). Health status measured by St. George's Respiratory Questionnaire was 5.2 points worse in the doxycycline group at 12 months (P < 0.007). Conclusions: Doxycycline did not significantly reduce the exacerbation rate, over 12 months, in participants with COPD who exacerbated regularly, but it may have benefitted those with more severe COPD or blood eosinophil counts <300 cells/μl. Clinical trial registered with www.clinicaltrials.gov (NCT02305940).
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Affiliation(s)
- James P. Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | | | - Simon E. Brill
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Martin Law
- Hub for Trials Methodology Research, Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom; and
| | - Lydia J. Finney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Luana Alves-Moreira
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gavin C. Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Peng H, Zhou Q, Liu J, Wang Y, Mu K, Zhang L. Endoplasmic reticulum stress: a vital process and potential therapeutic target in chronic obstructive pulmonary disease. Inflamm Res 2023; 72:1761-1772. [PMID: 37695356 DOI: 10.1007/s00011-023-01786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD), a chronic and progressive disease characterized by persistent respiratory symptoms and progressive airflow obstruction, has attracted extensive attention due to its high morbidity and mortality. Although the understanding of the pathogenesis of COPD has gradually increased because of increasing evidence, many questions regarding the mechanisms involved in COPD progression and its deleterious effects remain unanswered. Recent advances have shown the potential functions of endoplasmic reticulum (ER) stress in causing airway inflammation, emphasizing the vital role of unfolded protein response (UPR) pathways in the development of COPD. METHODS A comprehensive search of major databases including PubMed, Scopus, and Web of Science was conducted to retrieve original research articles and reviews related to ER stress, UPR, and COPD. RESULTS The common causes of COPD, namely cigarette smoke (CS) and air pollutants, induce ER stress through the generation of reactive oxygen species (ROS). UPR promotes mucus secretion and further plays a dual role in the cell apoptosis-autophagy axis in the development of COPD. Existing drug research has indicated the potential of UPR as a therapeutic target for COPD. CONCLUSIONS ER stress and UPR activation play significant roles in the etiology, pathogenesis, and treatment of COPD and discuss whether related genes can be used as biomarkers and therapeutic targets.
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Affiliation(s)
- Hao Peng
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Qing Zhou
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Jing Liu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Yi Wang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China
| | - Ketao Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China.
| | - Lei Zhang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China.
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Adrish M, Hanania NA. Revisiting the Use of Antibiotics to Prevent COPD Exacerbation: Is Doxycycline the Answer? Am J Respir Crit Care Med 2023; 208:509-511. [PMID: 37531185 PMCID: PMC10492254 DOI: 10.1164/rccm.202307-1302ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Muhammad Adrish
- Section of Pulmonary, Critical Care and Sleep Medicine Baylor College of Medicine Houston, Texas
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine Baylor College of Medicine Houston, Texas
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36
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Celli B, Vestbo J. Simplifying pharmacotherapy for patients with COPD: a viewpoint. Eur Respir J 2023; 62:2300115. [PMID: 37591551 DOI: 10.1183/13993003.00115-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/07/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Bartolome Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and the North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Agustí A, Sisó-Almirall A, Roman M, Vogelmeier CF. Gold 2023: Highlights for primary care. NPJ Prim Care Respir Med 2023; 33:28. [PMID: 37524724 PMCID: PMC10390461 DOI: 10.1038/s41533-023-00349-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Cátedra Salud Respiratoria, Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain.
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE). Grup de Recerca Transversal en Atenció Primària (IDIBAPS). Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Roman
- Univ. Islas Baleares, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), centro de salud Son Pisa Palma de Mallorca, Palma de Mallorca, Spain
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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Cuevas E, Huertas D, Montón C, Marin A, Carrera-Salinas A, Pomares X, García-Nuñez M, Martí S, Santos S. Systemic and functional effects of continuous azithromycin treatment in patients with severe chronic obstructive pulmonary disease and frequent exacerbations. Front Med (Lausanne) 2023; 10:1229463. [PMID: 37554497 PMCID: PMC10406447 DOI: 10.3389/fmed.2023.1229463] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Continuous treatment with azithromycin may lead to fewer acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but little is known of its impact on systemic and functional outcomes in real-life settings. METHODS This was a multicenter prospective observational study of patients with severe COPD who started treatment with azithromycin. Tests were compared at baseline and after 3 and 12 months of treatment. These included lung function tests, a 6-min walking test (6MWT), and enzyme-linked immunosorbent assays of serum and sputum markers, such as interleukins (IL-6, IL-8, IL-13, IL-5), tumor necrosis factor receptor 2 (TNFR2), and inflammatory markers. Incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) are reported. RESULTS Of the 478 eligible patients, the 42 who started azithromycin experienced reductions in AECOPDs (IRR, 0.34; 95% CI, 0.26-0.45) and hospitalizations (IRR, 0.39; 95% CI, 0.28-0.49). Treatment was also associated with significant improvement in the partial arterial pressure of oxygen (9.2 mmHg, 95% CI 1.4-16.9) at 12 months. While TNFR2 was reduced significantly in both serum and sputum samples, IL-13 and IL-6 were only significantly reduced in serum samples. Moreover, an elevated serum and sputum IL-8 level significantly predicted good clinical response to treatment. CONCLUSION Continuous azithromycin treatment in a cohort of patients with severe COPD and frequent exacerbations can significantly reduce the number and severity of exacerbations and improve gas exchange. Treatment changes the pattern of microorganism isolates and decreases the inflammatory response. Of note, IL-8 may have utility as a predictor of clinical response to azithromycin treatment.
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Affiliation(s)
- Ester Cuevas
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d’Investigacio Biomedica de Bellvitge – IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Huertas
- Department of Respiratory Medicine, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
| | - Concepción Montón
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - Alicia Marin
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
- Department of Respiratory Medicine, Hospital Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol – IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Carrera-Salinas
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Pomares
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - Marian García-Nuñez
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
| | - Sara Martí
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Salud Santos
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d’Investigacio Biomedica de Bellvitge – IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
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Pistenmaa CL, Washko GR. Chest Imaging of COPD: Bridging the COPD Research Gap With Stop, Look, and Listen. Chest 2023; 164:8-10. [PMID: 37423699 DOI: 10.1016/j.chest.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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40
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Carlin BW. Exacerbations of COPD. Respir Care 2023; 68:961-972. [PMID: 37353338 PMCID: PMC10289624 DOI: 10.4187/respcare.10782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD exacerbations are associated with significant morbidity, mortality, and increased health care expenditures. The recently published Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations have further refined the definition of an exacerbation. A better understanding of the risk factors associated with the development of an exacerbation exists, and improvements are being made in earlier detection approaches. Pharmacologic treatment strategies have been the cornerstone of effective therapy. In addition, both pharmacologic and non-pharmacologic strategies have been proven successful in the prevention of future exacerbations. Newer technologies, including the use of artificial intelligence and wearable monitoring devices, are now being used to help in the earlier detection of exacerbations. Such preventive and earlier detection strategies can help to develop a more personalized care model and improve outcomes for patients with COPD.
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Affiliation(s)
- Brian W Carlin
- Sleep Medicine and Lung Health Consultants, Ingomar, Pennsylvania.
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41
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Kreniske JS, Kaner RJ, Glesby MJ. Pathogenesis and management of emphysema in people with HIV. Expert Rev Respir Med 2023; 17:873-887. [PMID: 37848398 PMCID: PMC10872640 DOI: 10.1080/17476348.2023.2272702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Since early in the HIV epidemic, emphysema has been identified among people with HIV (PWH) and has been associated with increased mortality. Smoking cessation is key to risk reduction. Health maintenance for PWH and emphysema should ensure appropriate vaccination and lung cancer screening. Treatment should adhere to inhaler guidelines for the general population, but inhaled corticosteroid (ICS) should be used with caution. Frontiers in treatment include targeted therapeutics. Major knowledge gaps exist in the epidemiology of and optimal care for PWH and emphysema, particularly in low and middle-income countries (LMIC). AREAS COVERED Topics addressed include risk factors, pathogenesis, current treatment and prevention strategies, and frontiers in research. EXPERT OPINION There are limited data on the epidemiology of emphysema in LMIC, where more than 90% of deaths from COPD occur and where the morbidity of HIV is most heavily concentrated. The population of PWH is aging, and age-related co-morbidities such as emphysema will only increase in salience. Over the next 5 years, the authors anticipate novel trials of targeted therapy for emphysema specific to PWH, and we anticipate a growing body of evidence to inform optimal clinical care for lung health among PWH in LMIC.
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Affiliation(s)
- Jonah S. Kreniske
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
- Department of Genetic Medicine, Weill Cornell Medical College, USA
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, USA
- Department of Population Health Sciences, Weill Cornell Medical College, USA
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42
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Schleich F, Bougard N, Moermans C, Sabbe M, Louis R. Cytokine-targeted therapies for asthma and COPD. Eur Respir Rev 2023; 32:32/168/220193. [PMID: 37076177 PMCID: PMC10113955 DOI: 10.1183/16000617.0193-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/23/2023] [Indexed: 04/21/2023] Open
Abstract
Asthma affects over 300 million people worldwide and its prevalence is increasing. COPD is the third leading cause of death globally. Asthma and COPD are complex inflammatory diseases of the airways in which impaired host defences lead to increased susceptibility to pathogens, pollutants and allergens. There is a constant interplay between host and the environment. Environmental exposures can alter the lung microbiome and influence the development of sensitisation by disrupting normal immunoregulation. The underlying airway inflammation in severe asthma is heterogeneous, with upregulation of type 2 cytokines in most cases but increased neutrophilic inflammation and activated T-helper 17 mediated immunity in others. COPD may also comprise several different phentoypes that are driven by different molecular mechanisms or endotypes. This disease heterogeneity is affected by comorbidities, treatments and environmental exposures. Recent intervention trials have shed light on the pathways beyond type 2 inflammation that can lead to beneficial outcomes versus potentially deleterious effects. We have made a great deal of progress over the last 10 years in terms of immunology and the pathophysiology of asthma and this has led to the development of novel treatments and major improvements in severe asthma outcomes. In COPD, however, no targeted treatments have demonstrated great improvements. This article reviews the mechanism of action and efficacy of the available biologics in asthma and COPD.
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Affiliation(s)
- Florence Schleich
- Respiratory Medicine, CHU of Liege, Belgium
- GIGA I3, University of Liege, Belgium
| | | | | | - Mare Sabbe
- Respiratory Medicine, CHU of Liege, Belgium
| | - Renaud Louis
- Respiratory Medicine, CHU of Liege, Belgium
- GIGA I3, University of Liege, Belgium
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43
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Calzetta L, Pistocchini E, Chetta A, Rogliani P, Cazzola M. Experimental drugs in clinical trials for COPD: Artificial Intelligence via Machine Learning approach to predict the successful advance from early-stage development to approval. Expert Opin Investig Drugs 2023. [PMID: 37364225 DOI: 10.1080/13543784.2023.2230138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Therapeutic advances in drug therapy of chronic obstructive pulmonary disease (COPD) really effective in suppressing the pathological processes underlying the disease deterioration are still needed. Artificial Intelligence (AI) via Machine Learning (ML) may represent an effective tool to predict clinical development of investigational agents. AREAL COVERED Experimental drugs in Phase I and II development for COPD from early 2014 to late 2022 were identified in the ClinicalTrials.gov database. Different ML models, trained from prior knowledge on clinical trial success, were used to predict the probability that experimental drugs will successfully advance toward approval in COPD, according to Bayesian inference as follows: ≤25% low probability, >25% and ≤ 50% moderate probability, >50% and ≤ 75% high probability, and > 75% very high probability. EXPERT OPINION The Artificial Neural Network and Random Forest ML models indicated that, among the current experimental drugs in clinical trials for COPD, only the bifunctional muscarinic antagonist - β2-adrenoceptor agonists (MABA) navafenterol and batefenterol, the inhaled corticosteroid (ICS)/MABA fluticasone furoate/batefenterol, and the bifunctional phosphodiesterase (PDE) 3/4 inhibitor ensifentrine resulted to have a moderate to very high probability of being approved in the next future, however not before 2025.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Pistocchini
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Hayat Syed MK, Bruck O, Kumar A, Surani S. Acute exacerbation of interstitial lung disease in the intensive care unit: Principles of diagnostic evaluation and management. World J Crit Care Med 2023; 12:153-164. [PMID: 37397591 PMCID: PMC10308341 DOI: 10.5492/wjccm.v12.i3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
Interstitial lung disease (ILD) is typically managed on an outpatient basis. Critical care physicians manage patients with ILD in the setting of an acute exacerbation (ILD flare) causing severe hypoxia. The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis, etc. Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation, while almost all patients will benefit from early palliative care. This review focused on the types of ILD, diagnosis, and management pathways for this challenging condition.
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Affiliation(s)
- Muhammad K Hayat Syed
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Or Bruck
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Anupam Kumar
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Salim Surani
- Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, United States
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45
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LaFon DC, Woo H, Fedarko N, Azar A, Hill H, Tebo AE, Martins TB, Han MK, Krishnan JA, Ortega VE, Barjaktarevic I, Kaner RJ, Hastie A, O'Neal WK, Couper D, Woodruff PG, Curtis JL, Hansel NN, Nahm MH, Dransfield MT, Putcha N. Reduced quantity and function of pneumococcal antibodies are associated with exacerbations of COPD in SPIROMICS. Clin Immunol 2023; 250:109324. [PMID: 37030524 PMCID: PMC10171244 DOI: 10.1016/j.clim.2023.109324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/10/2023]
Abstract
While hypogammaglobulinemia is associated with COPD exacerbations, it is unknown whether frequent exacerbators have specific defects in antibody production/function. We hypothesized that reduced quantity/function of serum pneumococcal antibodies correlate with exacerbation risk in the SPIROMICS cohort. We measured total pneumococcal IgG in n = 764 previously vaccinated participants with COPD. In a propensity-matched subset of n = 200 with vaccination within five years (n = 50 without exacerbations in the previous year; n = 75 with one, n = 75 with ≥2), we measured pneumococcal IgG for 23 individual serotypes, and pneumococcal antibody function for 4 serotypes. Higher total pneumococcal IgG, serotype-specific IgG (17/23 serotypes), and antibody function (3/4 serotypes) were independently associated with fewer prior exacerbations. Higher pneumococcal IgG (5/23 serotypes) predicted lower exacerbation risk in the following year. Pneumococcal antibodies are inversely associated with exacerbations, supporting the presence of immune defects in frequent exacerbators. With further study, pneumococcal antibodies may be useful biomarkers for immune dysfunction in COPD.
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Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States.
| | - Han Woo
- Johns Hopkins University, Baltimore, MD, United States
| | - Neal Fedarko
- Johns Hopkins University, Baltimore, MD, United States
| | - Antoine Azar
- Johns Hopkins University, Baltimore, MD, United States
| | - Harry Hill
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - Anne E Tebo
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Thomas B Martins
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - MeiLan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Igor Barjaktarevic
- Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Annette Hastie
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Wanda K O'Neal
- Marisco Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - David Couper
- University of North Carolina Department of Biostatistics, Chapel Hill, NC, United States
| | | | - Jeffrey L Curtis
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | | | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; Department of Microbiology, University of Alabama at Birmingham, United States
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States; Birmingham VA Medical Center, Birmingham, AL, United States
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46
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Mesfin N, Sangani R, Shankar DA, Reardon C. New Frontiers in Therapeutics for Interstitial Lung Diseases. Am J Respir Crit Care Med 2023; 207:1089-1091. [PMID: 36735934 PMCID: PMC10112432 DOI: 10.1164/rccm.202206-1035rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Nathan Mesfin
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ruchika Sangani
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Divya A Shankar
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Christine Reardon
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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47
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Rofael SAD, Brown J, Lipman MCI, Lowe DM, Spratt D, Quaderi S, Hurst JR, McHugh TD. Impact of prophylactic and 'rescue pack' antibiotics on the airway microbiome in chronic lung disease. BMJ Open Respir Res 2023; 10:10/1/e001335. [PMID: 37085283 PMCID: PMC10124267 DOI: 10.1136/bmjresp-2022-001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/23/2023] Open
Abstract
The management of many chronic lung diseases involves multiple antibiotic prescriptions either to treat acute exacerbations or as prophylactic therapy to reduce the frequency of exacerbations and improve patients' quality of life. AIM To investigate the effects of antibiotics on the homeostasis of bacterial communities in the airways, and how this may contribute to antimicrobial resistance (AMR) among respiratory pathogens and microbiota. METHODS Within an observational cohort study, sputum was collected from 84 patients with chronic obstructive pulmonary disease and/or bronchiectasis at stable state: 47 were receiving antibiotic prophylaxis therapy. V3-V4 16S-rRNA sequencing on Illumina MiSeq, quantitative PCR for typical respiratory pathogens, bacteriology cultures and antimicrobial susceptibility testing of sputum isolates, resistome analysis on a subset of 17 sputum samples using MinION metagenomics sequencing were performed. FINDING The phylogenetic α-diversity and the total bacterial density in sputum were significantly lower in patients receiving prophylactic antibiotics (p=0.014 and 0.029, respectively). Antibiotic prophylaxis was associated with significantly lower relative abundance of respiratory pathogens such as Pseudomonas aeruginosa, Moraxella catarrhalis and members of family Enterobacteriaceae in the airway microbiome, but not Haemophilus influenzae and Streptococcus pneumoniae. No major definite directional shifts in the microbiota composition were identified with prophylactic antibiotic use at the cohort level. Surveillance of AMR and resistome analysis revealed a high frequency of resistance to macrolide and tetracycline in the cohort. AMR expressed by pathogenic bacterial isolates was associated with antibiotics prescribed as 'rescue packs' for prompt initiation of self-treatment of exacerbations (Spearman's rho=0.408, p=0.02). CONCLUSIONS Antibiotic prophylactic therapy suppresses recognised pathogenic bacteria in the sputum of patients with chronic lung disease. The use of antibiotic rescue packs may be driving AMR in this cohort rather than prophylactic antibiotics.
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Affiliation(s)
- Sylvia A D Rofael
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - James Brown
- UCL Respiratory, Divison of Medicine, University College London, London, UK
- Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK
| | - Marc C I Lipman
- UCL Respiratory, Divison of Medicine, University College London, London, UK
- Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK
| | - David M Lowe
- Institute for Immunity and Transplantation, Divison of Infection and Immunity, University College London, London, UK
| | - David Spratt
- Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - Shumonta Quaderi
- UCL Respiratory, Divison of Medicine, University College London, London, UK
- Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK
| | - John R Hurst
- UCL Respiratory, Divison of Medicine, University College London, London, UK
- Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
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48
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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49
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Parnham MJ, Norris V, Kricker JA, Gudjonsson T, Page CP. Prospects for macrolide therapy of asthma and COPD. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 98:83-110. [PMID: 37524493 DOI: 10.1016/bs.apha.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Macrolide compounds, many of which are derived from natural sources, all share a lactone ring structure, but of varying sizes. Their biological activities differ with structure and size but tend to overlap. Marketed macrolide drugs include immunosuppressives and antibiotics. Some of the latter have been shown to exert anti-inflammatory activities, due to direct effects on inflammatory cells and processes when used for respiratory infections. Consequently, azithromycin is included in clinical guidelines for COPD and asthma treatment, though it has the disadvantage, as an antibiotic, of increasing bacterial resistance. COPD and asthma, however, like several chronic inflammatory diseases involving other organs, are driven to a large extent by epithelial barrier dysfunction. Recently, azithromycin was shown to directly enhance epithelial barrier function and a new class of derivatives, barriolides, is under development with the lead indication COPD. It is thus likely that by circumventing antibiosis and acting on a crucial etiological disease process, this type of agent will open up a new, safer approach to COPD and asthma therapy with macrolides.
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Affiliation(s)
- Michael J Parnham
- EpiEndo Pharmaceuticals ehf, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany.
| | | | - Jennifer A Kricker
- EpiEndo Pharmaceuticals ehf, Reykjavik, Iceland; Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gudjonsson
- EpiEndo Pharmaceuticals ehf, Reykjavik, Iceland; Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland; Department of Laboratory Hematology, Landspitali-University Hospital, Reykjavik, Iceland
| | - Clive P Page
- EpiEndo Pharmaceuticals ehf, Reykjavik, Iceland; Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom
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Song Y, Fu W, Zhang Y, Huang D, Wu J, Tong S, Zhong M, Cao H, Wang B. Azithromycin ameliorated cigarette smoke-induced airway epithelial barrier dysfunction by activating Nrf2/GCL/GSH signaling pathway. Respir Res 2023; 24:69. [PMID: 36879222 PMCID: PMC9990325 DOI: 10.1186/s12931-023-02375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Airway epithelium is the first barrier against environmental insults, and epithelial barrier dysfunction caused by cigarette smoke (CS) is particularly relevant to chronic obstructive pulmonary disease (COPD) progression. Our study was to determine whether Azithromycin (AZI) ameliorates CS-induced airway epithelial barrier dysfunction and the underlying mechanisms. METHODS Primary bronchial epithelial cells (PBECs), human bronchial epithelial cells (HBECs), Sprague Dawley rats and nuclear factor erythroid 2-related factor 2 (Nrf2)-/- mice were pretreated with AZI and subsequently exposed to CS. Transepithelial electronic resistance (TEER), junction proteins as well as pro-inflammatory cytokines and apoptosis markers were examined to assess epithelial barrier dysfunction. Metabolomics study was applied to explore the underlying mechanism of AZI. RESULTS CS-induced TEER decline and intercellular junction destruction, accompanied with inflammatory response and cell apoptosis in PBECs were restored by AZI dose-dependently, which were also observed in CS-exposed rats. Mechanistically, GSH metabolism pathway was identified as the top differentially impacted pathway and AZI treatment upregulated the activities of glutamate cysteine ligase (GCL) and the contents of metabolites in GSH metabolic pathway. Furthermore, AZI apparently reversed CS-induced Nrf2 suppression, and similar effects on airway epithelial barrier dysfunction were also found for Nrf2 agonist tert-butylhydroquinone and vitamin C. Finally, deletion of Nrf2 in both HBECs and C57BL/6N mice aggravated CS-induced GSH metabolism imbalance to disrupt airway epithelial barrier and partially deprived the effects of AZI. CONCLUSION These findings suggest that the clinical benefits of AZI for COPD management are related with the protection of CS-induced airway epithelial barrier dysfunction via activating Nrf2/GCL/GSH pathway, providing potential therapeutic strategies for COPD.
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Affiliation(s)
- Yun Song
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenhuan Fu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Youzhi Zhang
- Department of Respiration, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Doudou Huang
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jian Wu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Shuangmei Tong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Mingkang Zhong
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Huifang Cao
- Department of Respiratory and Critical Medicine, Jing'an District Centre Hospital of Shanghai (Huashan Hospital Fudan University Jing'an Branch), Shanghai, 200040, China.
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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