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Palleschi A, Mattioni G, LoMauro A, Privitera E, Musso V, Morlacchi L, Vergari M, Velardo D, Grasselli G. Diaphragm and Lung Transplantation. Transpl Int 2024; 37:12897. [PMID: 38979122 PMCID: PMC11228173 DOI: 10.3389/ti.2024.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024]
Abstract
Mutual interactions between the diaphragm and lung transplantation (LTx) are known to exist. Before LTx, many factors can exert notable impact on the diaphragmatic function, such as the underlying respiratory disease, the comorbidities, and the chronic treatments of the patient. In the post-LTx setting, even the surgical procedure itself can cause a stressful trauma to the diaphragm, potentially leading to morphological and functional alterations. Conversely, the diaphragm can significantly influence various aspects of the LTx process, ranging from graft-to-chest cavity size matching to the long-term postoperative respiratory performance of the recipient. Despite this, there are still no standard criteria for evaluating, defining, and managing diaphragmatic dysfunction in the context of LTx to date. This deficiency hampers the accurate assessment of those factors which affect the diaphragm and its reciprocal influence on LTx outcomes. The objective of this narrative review is to delve into the complex role the diaphragm plays in the different stages of LTx and into the modifications of this muscle following surgery.
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Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanni Mattioni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- School of Thoracic Surgery, University of Milan, Milan, Italy
| | - Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Emilia Privitera
- Department of Healthcare Professions, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Musso
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Morlacchi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Pneumology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vergari
- Neuropathophysiology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Velardo
- Neuromuscular and Rare Diseases Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergencies, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Maldonado-Franco A, Giraldo-Cadavid LF, Tuta-Quintero E, Cagy M, Bastidas Goyes AR, Botero-Rosas DA. Curve-Modelling and Machine Learning for a Better COPD Diagnosis. Int J Chron Obstruct Pulmon Dis 2024; 19:1333-1343. [PMID: 38895045 PMCID: PMC11182754 DOI: 10.2147/copd.s456390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Background Development of new tools in artificial intelligence has an outstanding performance in the recognition of multidimensional patterns, which is why they have proven to be useful in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Methods This was an observational analytical single-centre study in patients with spirometry performed in outpatient medical care. The segment that goes from the peak expiratory flow to the forced vital capacity was modelled with quadratic polynomials, the coefficients obtained were used to train and test neural networks in the task of classifying patients with COPD. Results A total of 695 patient records were included in the analysis. The COPD group was significantly older than the No COPD group. The pre-bronchodilator (Pre BD) and post-bronchodilator (Post BD) spirometric curves were modelled with a quadratic polynomial, and the coefficients obtained were used to feed three neural networks (Pre BD, Post BD and all coefficients). The best neural network was the one that used the post-bronchodilator coefficients, which has an input layer of 3 neurons and three hidden layers with sigmoid activation function and two neurons in the output layer with softmax activation function. This system had an accuracy of 92.9% accuracy, a sensitivity of 88.2% and a specificity of 94.3% when assessed using expert judgment as the reference test. It also showed better performance than the current gold standard, especially in specificity and negative predictive value. Conclusion Artificial Neural Networks fed with coefficients obtained from quadratic and cubic polynomials have interesting potential of emulating the clinical diagnostic process and can become an important aid in primary care to help diagnose COPD in an early stage.
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Affiliation(s)
| | - Luis F Giraldo-Cadavid
- School of Medicine, Universidad de La Sabana, Chía, Colombia
- Interventional Pulmonology Service, Fundación Neumológica Colombiana, Bogotá, DC, Colombia
| | | | - Mauricio Cagy
- Biomedical Engineering Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Kilaru SC, Bansal AG, Naik VS, Lopez M, Gogtay JA. A review of the efficacy and safety of fluticasone propionate/formoterol fixed-dose combination. Expert Rev Respir Med 2022; 16:529-540. [PMID: 35727177 DOI: 10.1080/17476348.2022.2089117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Fluticasone propionate/formoterol fumarate (FP/FORM) is one of the newer combinations among inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA) combination formulations currently available. To evaluate the efficacy and safety of this FP/FORM combination, it is important to review all the available evidence and take a comprehensive look at the current and relevant data in the patient population suffering from asthma and chronic obstructive pulmonary disease (COPD). AREAS COVERED In this focused review, we summarize the available literature published until January 2021 using the PubMed/Medline and Cochrane Controlled Trials Register databases on the efficacy and safety of FP/FORM with its mono-components; concurrent administration of FP+FORM; and with other ICS/LABA combinations in asthma and COPD patients. EXPERT OPINION FP/FORM combination therapy is a strong alternative in the treatment of persistent asthma and moderate-severe COPD. Extensive study of several trials has established the superior efficacy of FP/FORM combination therapy over FP or FORM monotherapy, comparable efficacy with FP+FORM and non-inferiority to other ICS/LABA fixed-dose combinations. The safety profile of FP/FORM has also been found to be comparable with respect to its mono-components and their concurrent use, and also other ICS/LABA combinations such as formoterol/budesonide and fluticasone/salmeterol.
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Affiliation(s)
- Satish Chandra Kilaru
- Department of Respiratory Medicine, Prathima Institute of Medical Sciences, Telangana, India
| | - Avya Gopal Bansal
- Department of Chest Medicine, Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | - Meena Lopez
- Department of Medical Affairs, Cipla Ltd., Mumbai, India
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Solooki M, Mahjoob MP, Mousavi-roknabadi RS, Sedaghat M, Rezaeisadrabadi M, Fazlzadeh A, Absalan A. Comparison of High-Sensitive CRP, RDW, PLR and NLR between Patients
with Chronic Obstructive Pulmonary Disease and Chronic Heart
Failure. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210823143235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is a chronic systemic inflammation,
which has similar signs and symptoms to chronic heart failure (CHF).
Objective:
To compare high-sensitive C-reactive protein (hsCRP) level and selected blood indices
in patients with COPD and CHF.
Methods:
This prospective cross-sectional study (July 2019-July 2020) was conducted on patients
aged 40-70 years old with a previous diagnosis of COPD, CHF, and cor pulmonale. They were divided
into four groups: 1) patients with COPD, who were hospitalized due to exacerbation of dyspnea,
2) patients with CHF without a history of COPD, 3) patients with CHF and history of COPD
(COPD+CHF), and finally 4) patients who had concomitant COPD and cor pulmonale condition.
Spirometry, echocardiography, and six-minute walking test were performed. The hsCRP level was
assessed at the beginning and end of hospital admission. Finally, RDW, neutrophil, lymphocyte,
platelet counts, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were
measured. Data were analyzed by SPSS software (α = 0.05).
Results:
In total, 140 patients were enrolled. The highest hsCRP level was observed in patients in
the COPD+CHF group, and the lowest level was found in patients with CHF. Overall, a significant
difference was observed in the hsCRP level at the beginning and the end of admission (P =0.0001).
HsCRP had a positive correlation with the duration of hospital stay and a negative correlation with
the results of the six-minute walking test. The lymphocyte counts and PLR had significant positive
correlations with the six-minute walking test (R =0.38, P =0.0001 vs. R =0.325, P =0.001, respectively),
and significant negative correlations with duration of hospital stay (R =-0.317, P =0.0001
vs. R =-0.380, P =0.001, respectively). At the admission, a significant difference in hsCRP was only
observed comparing the COPD and cor pulmonale groups (OR =1.097, P =0.002). There were
significant differences in the six-minute walking test comparing the COPD group with either of
CHF or COPD+CHF groups. Significant differences were noted in the hospital stay duration comparing
the COPD group with all other groups.
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Affiliation(s)
- Mehrdad Solooki
- Department of Internal Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsa Mahjoob
- Cardiocascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Razieh Sadat Mousavi-roknabadi
- Department of
Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Emergency Medicine
Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meghdad Sedaghat
- Department of Internal Medicine, Faculty of
Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rezaeisadrabadi
- Resident of Gastroenterology and Liver Disease
Subspecialty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aylar Fazlzadeh
- Internal Medicine Specialist, Department of
Internal Medicine, Sahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdorrahim Absalan
- Department of Medical Laboratory
sciences, Khomein University of Medical Sciences, Khomein, Markazi Province, Iran
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Mapel DW, Roberts MH, Davis J. Budesonide/formoterol therapy: effective and appropriate use in asthma and chronic obstructive pulmonary disease. J Comp Eff Res 2020; 9:231-251. [PMID: 31983228 DOI: 10.2217/cer-2019-0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Quality, real-world comparative effectiveness (CE) studies of asthma and chronic obstructive pulmonary disease therapy efficacy are scarce. We identified and evaluated peer-reviewed CE and appropriate-use evaluations of budesonide/formoterol combination (BFC) maintenance therapy. Materials & methods: Analyses were limited to retrospective, real-world utilization studies of BFC delivered by pressurized metered-dose inhalers. Results: In a CE study of BFC versus fluticasone/salmeterol combinations (FSC) in asthma, BFC users had fewer total exacerbations. In appropriate-use studies of asthma treatment, BFC patients were consistently more likely to meet treatment escalation recommendations. BFC comparisons with FSC or tiotropium for chronic obstructive pulmonary disease found differences in exacerbation rates and rescue inhaler use. Conclusion: We found available, good quality BFC CE and appropriate-use articles; however, all had limitations.
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Affiliation(s)
- Douglas W Mapel
- University of New Mexico College of Pharmacy, MSC09 5360, University of New Mexico, Albuquerque, NM 87131, USA.,LCF Research, 2309 Renard Place SE Ste 103, Albuquerque, NM 87106, USA
| | - Melissa H Roberts
- University of New Mexico College of Pharmacy, MSC09 5360, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jill Davis
- AstraZeneca LP, 1800 Concord Pike, Wilmington, DE 19897, USA
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Kerget B, Afşin DE, Kerget F, Aşkın S, Akgün M. Is Metrnl an Adipokine İnvolved in the Anti-inflammatory Response to Acute Exacerbations of COPD? Lung 2020; 198:307-314. [PMID: 31960164 DOI: 10.1007/s00408-020-00327-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation and systemic inflammation. Recently, there has been growing interest in adipose tissue-mediated inflammation in the pathogenesis of COPD. The aim of our study was to determine the relationships between a new adipocytokine, meteorin-like protein (Metrnl), and acute exacerbations of COPD, smoking, and comorbidities. MATERIALS AND METHODS The study included 313 patients aged 40-65 years in four groups: Group 1: ex-smokers (≥ 20 pack-years) with COPD hospitalized for COPD exacerbation (n = 133), Group 2: current-smokers (≥ 20 pack-years) without COPD (n = 60), Group 3: ex-smokers (≥ 20 pack-years) without COPD (n = 60), and Group 4: never-smokers without COPD (n = 60). Peripheral venous blood samples (5 cc) were collected from all participants. Plasma Metrnl levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kit. RESULTS Mean Metrnl levels were 28.45 ± 11.27 ng/ml in Group 1, 24.34 ± 4.38 ng/ml in Group 2, 18.84 ± 3.8 ng/ml in Group 3, and 19.44 ± 3.92 ng/ml in Group 4. Group 1 had significantly higher mean Metrnl level compared to the other groups (p = 0.006, p = 0.001, p = 0.001). Metrnl level was also significantly higher in Group 2 when compared with Groups 3 and 4 (p = 0.001, p = 0.005). Group 1 patients with diabetes mellitus and coronary artery disease showed significantly lower Metrnl levels compared to other patients in the group (p = 0.001, p = 0.001). CONCLUSION The high Metrnl level in COPD exacerbations and active smoking may be important in balancing the inflammatory response. However, plasma Metrnl levels were found to be lower in COPD patients with comorbidities.
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Affiliation(s)
- Buğra Kerget
- Depertmant of Pulmonary Diseases, Health Sciences University Erzurum Regional Education and Research Hospital, 25240, Yakutiye, Erzurum, Turkey.
| | | | - Ferhan Kerget
- Depertmant of Infection Diseases and Clinical Microbiology, Health Sciences University Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Seda Aşkın
- Department of Biochemistry, Ataturk University School of Medicine, 25240, Erzurum, Turkey
| | - Metin Akgün
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey
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7
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Andell P, James S, Östlund O, Yndigegn T, Sparv D, Pernow J, Jernberg T, Lindahl B, Herlitz J, Erlinge D, Hofmann R. Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:984-992. [PMID: 31081342 DOI: 10.1177/2048872619848978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction. METHODS AND RESULTS A total of 6629 patients with suspected acute myocardial infarction were randomly assigned in the DETO2X-AMI trial to oxygen or ambient air. In the oxygen group (n=3311) and the ambient air group (n=3318), 155 and 141 patients, respectively, had chronic obstructive pulmonary disease (prevalence of 4.5%). Patients with chronic obstructive pulmonary disease were older, had more comorbid conditions and experienced a twofold higher risk of death at one year (chronic obstructive pulmonary disease: 32/296 (10.8%) vs. non-chronic obstructive pulmonary disease: 302/6333 (4.8%)). Oxygen therapy compared to ambient air was not associated with improved outcomes at 365 days (chronic obstructive pulmonary disease: all-cause mortality hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.50-1.99, Pinteraction=0.96); cardiovascular death HR 0.80, 95% CI 0.32-2.04, Pinteraction=0.59); rehospitalisation with acute myocardial infarction or death HR 1.27, 95% CI 0.71-2.28, Pinteraction=0.46); hospitalisation for heart failure or death HR 1.08, 95% CI 0.61-1.91, Pinteraction=0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions. CONCLUSIONS Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings. CLINICAL TRIALS REGISTRATION NCT02290080.
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Affiliation(s)
- Pontus Andell
- Unit of Cardiology, Karolinska Institutet, Sweden
- Department of Cardiology, Lund University, Sweden
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Sweden
- Department of Medical Sciences, Uppsala University, Sweden
| | - Ollie Östlund
- Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - David Sparv
- Department of Cardiology, Lund University, Sweden
| | - John Pernow
- Unit of Cardiology, Karolinska Institutet, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Johan Herlitz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
- Department of Health Sciences, University of Borås, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
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8
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de Groot LES, van der Veen TA, Martinez FO, Hamann J, Lutter R, Melgert BN. Oxidative stress and macrophages: driving forces behind exacerbations of asthma and chronic obstructive pulmonary disease? Am J Physiol Lung Cell Mol Physiol 2018; 316:L369-L384. [PMID: 30520687 DOI: 10.1152/ajplung.00456.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Oxidative stress is a common feature of obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD). Lung macrophages are key innate immune cells that can generate oxidants and are known to display aberrant polarization patterns and defective phagocytic responses in these diseases. Whether these characteristics are linked in one way or another and whether they contribute to the onset and severity of exacerbations in asthma and COPD remain poorly understood. Insight into oxidative stress, macrophages, and their interactions may be important in fully understanding acute worsening of lung disease. This review therefore highlights the current state of the art regarding the role of oxidative stress and macrophages in exacerbations of asthma and COPD. It shows that oxidative stress can attenuate macrophage function, which may result in impaired responses toward exacerbating triggers and may contribute to exaggerated inflammation in the airways.
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Affiliation(s)
- Linsey E S de Groot
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands.,Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - T Anienke van der Veen
- Department of Pharmacokinetics, Toxicology, and Targeting, Groningen Research Institute for Pharmacy, University of Groningen , Groningen , The Netherlands.,Groningen Research Institute for Asthma and Chronic Obstructive Pulmonary Disease, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Fernando O Martinez
- Department of Biochemical Sciences, University of Surrey , Guildford , United Kingdom
| | - Jörg Hamann
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - René Lutter
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands.,Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam , Amsterdam , The Netherlands
| | - Barbro N Melgert
- Department of Pharmacokinetics, Toxicology, and Targeting, Groningen Research Institute for Pharmacy, University of Groningen , Groningen , The Netherlands.,Groningen Research Institute for Asthma and Chronic Obstructive Pulmonary Disease, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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9
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Ho JKM, Yau WH. Nurse-Initiated Albuterol Metered-Dose Inhaler for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in an Emergency Department: A Randomised Controlled Trial. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective A randomised controlled trial (RCT) to assess the effectiveness of nurse-initiated use of albuterol metered-dose inhaler (MDI) to patients for relieving the signs and symptoms of acute exacerbations of chronic obstructive pulmonary disease (COPD) prior to consultation in an emergency department (ED). Design A single-centre unblinded RCT. Methods Known COPD Chinese patients who aged at least 18 years old, previous use of albuterol MDI, competent to blow the peak flow meter and complained of dyspnoea. The anticipated time between nurse-initiated use of albuterol MDI and consultation was over five minutes. The subjects were recruited from the ED of a hospital in Hong Kong and were allocated to the albuterol or control group by block randomisation. Six albuterol puffs were administered via a MDI to the albuterol group but not the control group. Peak flow rate, blood oxygen saturation, respiratory rate, adverse effects, ED length of stay and admission rate were assessed before nursed-initiated use of albuterol MDI and prior to consultation. Results 110 subjects were recruited and randomly allocated into the albuterol (n=55) or control (n=55) group. The PFR increased 2.4 L/minute (p<0.001) in the albuterol group but not in the control group. The oxygen saturation and symptom of dyspnoea also improved in the albuterol group but not in the control group. Conclusions Nurse-initiated use of albuterol MDI can improve PFR prior to consultation so that it should be recommended as a standard practice in EDs to reduce the suffering of patients with acute exacerbations of COPD.
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Affiliation(s)
| | - WH Yau
- Queen Elizabeth Hospital, Accident and Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong
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10
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Du J, Chi Y, Song Z, Di Q, Mai Z, Shi J, Li M. Crocin reduces Aspergillus fumigatus-induced airway inflammation and NF-κB signal activation. J Cell Biochem 2017; 119:1746-1754. [PMID: 28786504 DOI: 10.1002/jcb.26335] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammation and its exacerbation is often accompanied by Aspergillus fumigatus (A. fumigatus) infection. Increasing evidences demonstrated the potent antioxidant and -inflammatory effects of crocin. However, the role of crocin in A. fumigatus-induced inflammation is still unknown. We aimed to evaluate the role of crocin in inflammation response induced by A. fumigatus in human bronchial epithelial cells and the possible mechanisms. BEAS-2B and NHBE cells were pretreated with crocin for 24 h, and then A. fumigatus conidia were added for 24 h. A. fumigatus treatment exhibited a significant higher TNF-α, IL-8, IL-6, and IL-1β level (P < 0.05), whereas crocin pretreatment significantly inhibited A. fumigatus induced the pro-inflammatory cytokines (P < 0.05). NF-κB inhibitor PDTC inhibited pro-inflammatory cytokines release triggered by A. fumigatus (P < 0.05). Furthermore, crocin suppressed A. fumigatus induced NF-κB p65 nuclear translocation, the phosphorylation of IKKα and IκBα, the degradation of IκBα and NF-κB reporter activity. Crocin pretreatment also resulted in an inhibition of A.fumigatus-induced ROS production (P < 0.05). Taken together, these results indicate that crocin may prevent A. fumigatus-induced inflammation through suppressing NF-κB signal pathway.
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Affiliation(s)
- Junfeng Du
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Yumin Chi
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Zhan Song
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Qingguo Di
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Zhitao Mai
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Jian Shi
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
| | - Min Li
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei, P. R. China
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Abstract
Current guidelines recommend inhaled pharmacologic therapy as the preferred route of administration for treating COPD. Bronchodilators (β2-agonists and antimuscarinics) are the mainstay of pharmacologic therapy in patients with COPD, with long-acting agents recommended for patients with moderate to severe symptoms or those who are at a higher risk for COPD exacerbations. Dry powder inhalers and pressurized metered dose inhalers are the most commonly used drug delivery devices, but they may be inadequate in various clinical scenarios (eg, the elderly, the cognitively impaired, and hospitalized patients). As more drugs become available in solution formulations, patients with COPD and their caregivers are becoming increasingly satisfied with nebulized drug delivery, which provides benefits similar to drugs delivered by handheld inhalers in both symptom relief and improved quality of life. This article reviews recent innovations in nebulized drug delivery and the important role of nebulized therapy in the treatment of COPD.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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12
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Utiyama DMO, Yoshida CT, Goto DM, de Santana Carvalho T, de Paula Santos U, Koczulla AR, Saldiva PHN, Nakagawa NK. The effects of smoking and smoking cessation on nasal mucociliary clearance, mucus properties and inflammation. Clinics (Sao Paulo) 2016; 71:344-50. [PMID: 27438569 PMCID: PMC4930664 DOI: 10.6061/clinics/2016(06)10] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters). METHOD A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550. RESULTS Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations. CONCLUSION This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.
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Affiliation(s)
- Daniela Mitiyo Odagiri Utiyama
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | - Carolina Tieko Yoshida
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | | | - Tômas de Santana Carvalho
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | - Ubiratan de Paula Santos
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Smoking Cessation Group, São Paulo/SP, Brazil
| | | | | | - Naomi Kondo Nakagawa
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
- E-mail:
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Effectiveness of Teamwork in an Integrated Care Setting for Patients with COPD: Development and Testing of a Self-Evaluation Instrument for Interprofessional Teams. Int J Integr Care 2016; 16:9. [PMID: 27616953 PMCID: PMC5015529 DOI: 10.5334/ijic.2454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Teamwork between healthcare providers is conditional
for the delivery of integrated care. This study aimed to assess the usefulness
of the conceptual framework Integrated Team Effectiveness Model for developing
and testing of the Integrated Team Effectiveness Instrument. Theory and methods: Focus groups with healthcare providers in an
integrated care setting for people with chronic obstructive pulmonary disease
(COPD) were conducted to examine the recognisability of the conceptual framework
and to explore critical success factors for collaborative COPD practice out of
this framework. The resulting items were transposed into a pilot instrument.
This was reviewed by expert opinion and completed 153 times by healthcare
providers. The underlying structure and internal consistency of the instrument
were verified by factor analysis and Cronbach’s alpha. Results: The conceptual framework turned out to be comprehensible
for discussing teamwork effectiveness. The pilot instrument measures 25 relevant
aspects of teamwork in integrated COPD care. Factor analysis suggested three
reliable components: teamwork effectiveness, team processes and team
psychosocial traits (Cronbach’s alpha between 0.76 and 0.81). Conclusions and discussion: The conceptual framework Integrated Team
Effectiveness Model is relevant in developing a practical full-spectrum
instrument to facilitate discussing teamwork effectiveness. The Integrated Team
Effectiveness Instrument provides a well-founded basis to self-evaluate teamwork
effectiveness in integrated COPD care by healthcare providers. Recommendations
are provided for the improvement of the instrument.
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Gouda E, Zidan M, Gharraf H, Younan DN, Mohamed S. Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Li H, Wu Q, Xu L, Li X, Duan J, Zhan J, Feng J, Sun X, Chen H. Increased oxidative stress and disrupted small intestinal tight junctions in cigarette smoke-exposed rats. Mol Med Rep 2015; 11:4639-44. [PMID: 25606848 DOI: 10.3892/mmr.2015.3234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 01/07/2015] [Indexed: 02/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem, and cigarette smoke (CS) is the primary risk factor. The pathology is often observed in the lung, but COPD is also associated with intestinal barrier disruption, although the underlying mechanisms are poorly understood. To address this, a CS‑exposed rat model was evaluated in the present study by analyzing small intestinal gene expression using reverse transcription‑quantitative polymerase chain reaction. CS exposure caused upregulation of the nicotinamide adenine dinucleotide phosphate‑oxidase subunits nox2 and p22phox in the small intestine, while the antioxidative enzyme superoxide dismutase was downregulated. CS exposure also increased bax expression and decreased bcl‑2 expression. This was associated with an elevation of hypoxia‑inducible factor (HIF)‑1α. Claudin‑1 was decreased and claudin‑2 increased, indicating a loosening of small intestinal tight junctions (TJs). These data suggest that during the development of COPD, HIF‑1α expression is altered in the small intestine, which may be associated with the increased oxidative stress and apoptosis, eventually resulting in disruption of the intestinal TJs.
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Affiliation(s)
- Hongwei Li
- Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Qi Wu
- Department of Basic Medicine Laboratory, Tianjin Institute of Respiratory Diseases, Haihe Hospital, Tianjin 300350, P.R. China
| | - Long Xu
- Department of Basic Medicine Laboratory, Tianjin Institute of Respiratory Diseases, Haihe Hospital, Tianjin 300350, P.R. China
| | - Xue Li
- Department of Basic Medicine Laboratory, Tianjin Institute of Respiratory Diseases, Haihe Hospital, Tianjin 300350, P.R. China
| | - Jianmin Duan
- Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Jingyan Zhan
- Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Jing Feng
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xin Sun
- Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Respiratory Department, Tianjin Institute of Respiratory Diseases, Haihe Hospital, Tianjin 300350, P.R. China
| | - Huaiyong Chen
- Department of Basic Medicine Laboratory, Tianjin Institute of Respiratory Diseases, Haihe Hospital, Tianjin 300350, P.R. China
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Liu L, Li X, Yuan R, Zhang H, Qiang L, Shen J, Jin S. Associations of ABHD2 genetic variations with risks for chronic obstructive pulmonary disease in a Chinese Han population. PLoS One 2015; 10:e0123929. [PMID: 25880496 PMCID: PMC4399978 DOI: 10.1371/journal.pone.0123929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022] Open
Abstract
The human α/β hydrolase domain-containing protein 2 gene (ABHD2) plays a critical role in pulmonary emphysema, a major subset of the clinical entity known as chronic obstructive pulmonary disease (COPD). Here, we evaluated genetic variation in the ABHD2 gene in a Chinese Han population of 286 COPD patients and 326 control subjects. The rs12442260 CT/CC genotype was associated with COPD (P < 0.001) under a dominant model. In the former-smoker group, the rs12442260 TT genotype was associated with a decreased risk of developing COPD after adjusting for age, gender and pack-years (P = 0.012). Rs12442260 was also associated with pre-FEV1 (the predicted bronchodilator forced expiratory volume in the first second) in controls (P = 0.027), but with FEV1/ forced vital capacity (FVC) ratios only in COPD patients (P = 0.012) under a dominant model. Results from the current study suggest that ABHD2 gene polymorphisms contribute to COPD susceptibility in the Chinese Han population.
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Affiliation(s)
- Li Liu
- Department of Histology and Embryology, Harbin Medical University, Harbin, Heilongjiang Province, 150018, China
| | - Xiangshun Li
- Division of Respiratory Disease, The Fourth Hospital of Harbin Medical University, Harbin, Harbin, Heilongjiang Province, 150001, China
| | - Rui Yuan
- Department of Histology and Embryology, Harbin Medical University, Harbin, Heilongjiang Province, 150018, China
| | - Honghong Zhang
- Department of Histology and Embryology, Harbin Medical University, Harbin, Heilongjiang Province, 150018, China
| | - Lixia Qiang
- Division of Respiratory Disease, The Fourth Hospital of Harbin Medical University, Harbin, Harbin, Heilongjiang Province, 150001, China
| | - Jingling Shen
- Department of Histology and Embryology, Harbin Medical University, Harbin, Heilongjiang Province, 150018, China
- * E-mail: (SJ); (JS)
| | - Shoude Jin
- Division of Respiratory Disease, The Fourth Hospital of Harbin Medical University, Harbin, Harbin, Heilongjiang Province, 150001, China
- * E-mail: (SJ); (JS)
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Durmaz D, Göksu E, Kılıç T, Özbudak Ö, Eray O. The Role of Nitric Oxide In Predicting Revisit of Patients With Exacerbated Chronic Obstructive Pulmonary Disease. J Emerg Med 2015; 48:247-53. [DOI: 10.1016/j.jemermed.2014.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/24/2014] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
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Eberhardt R, Gerovasili V, Kontogianni K, Gompelmann D, Ehlken N, Herth FJF, Grünig E, Nagel C. Endoscopic lung volume reduction with endobronchial valves in patients with severe emphysema and established pulmonary hypertension. ACTA ACUST UNITED AC 2014; 89:41-8. [PMID: 25502235 DOI: 10.1159/000368369] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND One of the most common forms of pulmonary hypertension (PH) is that associated with chronic obstructive pulmonary disease (COPD). So far, patients with severe emphysema and established PH have been excluded from endoscopic lung volume reduction (ELVR) therapy due to the risk of right heart decompensation. OBJECTIVE The aim of this pilot study was to evaluate the feasibility and efficacy of ELVR using one-way endobronchial valves (EBV) in this specific group of patients. METHODS We prospectively included 6 patients with COPD, severe heterogeneous emphysema, and established PH who underwent right heart catheterization and clinical assessments before and 90 days after ELVR with unilateral EBV placement. RESULTS This study was not powered to measure any statistical differences in endpoints. Ninety days after ELVR, the symptoms, lung function, and hemodynamics improved in 5 out of 6 patients (1 patient normalized and 1 slightly worsened). The mean hemodynamics improved from baseline to 90 days after ELVR as follows: mean pulmonary artery pressure, -2.5 ± 3.5 mm Hg; pulmonary arterial wedge pressure, -4.3 ± 8.3 mm Hg; cardiac index, +0.3 ± 0.6 l/min/m(2), and 6-min walk distance, +59 ± 99 m. ELVR was performed without PH-related complications in all patients. CONCLUSION To our knowledge, this is the first prospective, single-center pilot study to evaluate the feasibility and efficacy of ELVR in patients with established PH. ELVR was feasible and resulted in an improvement of clinical and hemodynamic parameters in 5 out of 6 patients. These results have to be further confirmed in larger-scale controlled studies.
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Affiliation(s)
- Ralf Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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Schwellnus MP, Patel DN, Nossel C, Dreyer M, Whitesman S, Derman EW. Healthy lifestyle interventions in general practice. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2008.10873771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Lisspers K, Johansson G, Jansson C, Larsson K, Stratelis G, Hedegaard M, Ställberg B. Improvement in COPD management by access to asthma/COPD clinics in primary care: data from the observational PATHOS study. Respir Med 2014; 108:1345-54. [PMID: 25002194 DOI: 10.1016/j.rmed.2014.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) guidelines emphasize the importance of patient education to improve quality of life and avoid exacerbations. Longitudinal evaluations of structured management of COPD in primary care are lacking. AIM To evaluate the impact of primary care asthma/COPD clinics on exacerbations, hospitalizations, and associated costs in COPD. METHODS This population-based, retrospective, observational study, linking primary care medical records data to mandatory Swedish national registries, included patients with COPD from 76 primary healthcare centers (1999-2009). A questionnaire on access to an asthma/COPD clinic was retrospectively answered. Propensity score matching was performed at index (COPD diagnosis) by center type (with and without an asthma/COPD clinic). Poisson regression was used to compare the yearly rate of exacerbations (hospitalization, emergency visits, or prescription for oral steroids or antibiotics) and COPD-related prescriptions at the centers. An economic analysis was performed from the Swedish healthcare perspective using 2011 unit costs and the incremental cost-effectiveness ratio was calculated. RESULTS The study included 21,361 patients (mean age, 68.0 years; 53% female). Access to asthma/COPD clinics increased from 34% to 85% during the study period. Patients at primary healthcare centers with asthma/COPD clinics had 27% fewer exacerbations (0.71 vs. 0.98) and 37% fewer hospitalizations annually (0.36 vs. 0.58) (p < 0.0001). Asthma/COPD clinics reduced the annual cost of medication and healthcare contacts by 37% (SEK 52,892 [€5858] to SEK 33,410 [€3700] per patient). CONCLUSIONS Patients at primary healthcare centers with asthma/COPD clinics experienced fewer COPD exacerbations and hospitalizations, and overall treatment costs were substantially reduced. ClinicalTrials.gov identifier: NCT01146392.
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Affiliation(s)
- Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden.
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden
| | - Christer Jansson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Kjell Larsson
- Unit of Lung and Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | | | - Morten Hedegaard
- Formerly AstraZeneca Nordic-Baltic, DK-2300 Copenhagen S, Denmark
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden
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Donesky D, Nguyen HQ, Paul SM, Carrieri-Kohlman V. The affective dimension of dyspnea improves in a dyspnea self-management program with exercise training. J Pain Symptom Manage 2014; 47:757-71. [PMID: 23954497 DOI: 10.1016/j.jpainsymman.2013.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT The perception of dyspnea includes both sensory and affective dimensions that are shaped by emotions and psychological, social, and environmental experiences. Previous investigators have studied either measurement or strategies to decrease the affective dimension with laboratory-induced dyspnea. Few have reported the effect of a therapeutic clinical intervention on the affective dimension of dyspnea. OBJECTIVES (1) To evaluate the effects of three different versions of a dyspnea self-management program (DM) on the affective dimension of dyspnea, measured by dyspnea-related anxiety (DA) and dyspnea-related distress (DD); and (2) to determine the stability of DA and DD over two baseline incremental treadmill tests (ITTs). METHODS Participants with chronic obstructive pulmonary disease were randomly assigned to three 12 month DMs with varying doses of supervised exercise (DM, DM-Exposure, and DM-Training). The measurements of the affective dimension, DA and DD, were rated during ITTs on two baseline days and at two, six, and 12 months. Changes over time in DA and DD were analyzed using linear mixed-effects models. RESULTS Participants in the DM-Training group who received 24 nurse-coached exercise sessions had significantly greater reductions in DA and DD compared with those who had four exercise sessions (DM-Exposure) or only received a home-walking program (DM). Reductions in DA and DD in the DM-Training group were only maintained through six months. There were no significant differences in ratings of DA and DD at end between the two baseline ITTs. CONCLUSION These findings provide initial support for the positive impact of a self-management program with nurse-coached exercise on the affective dimension of dyspnea. Further investigation of interventions that target the affective dimension in addition to the sensory dimension of dyspnea should be encouraged.
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Affiliation(s)
- Doranne Donesky
- University of California, San Francisco, San Francisco, California, USA.
| | - Huong Q Nguyen
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Steven M Paul
- University of California, San Francisco, San Francisco, California, USA
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Kahraman H, Orhan FO, Sucakli MH, Ozer A, Koksal N, Sen B. Temperament and character profiles of male COPD patients. J Thorac Dis 2013; 5:406-13. [PMID: 23991295 DOI: 10.3978/j.issn.2072-1439.2013.07.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/03/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and is characterized by persistent airflow obstruction. These patients are exposed to severe physical limitations and substantial psychosocial trouble. The aims of this study were to determine the temperament and character profiles of personality in patients with COPD and to compare the results with those of healthy controls. METHODS Thirty-nine male COPD patients and 67 age- and gender-matched healthy controls completed the self-administered 240-item temperament and character inventory (TCI) and 14-item hospital anxiety and depression scale. The relationships between temperament and character personality profiles and clinical factors such as severity of COPD, anxiety, and depression were evaluated. RESULTS COPD patients had significantly higher mean scores of Harm avoidance and lower mean score of Self-directedness than those of healthy controls. In the COPD patients, the anxiety score was significantly higher (P=0.03) and the depression score was found to be insignificantly higher than that of control group. The TCI profiles were not correlated with the severity of COPD. In COPD patients, Self-directedness and Cooperativeness traits of TCI character negatively correlated with anxiety, but any of traits did not correlate with depression. CONCLUSIONS The present study defined the Harm avoidance score was higher and Self-directedness was lower in COPD patients and the COPD severity did not correlate with any of the personality trait. We suggest that during evaluation of COPD patients for treatment, personality trait should also be considered in clinical practice.
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Affiliation(s)
- Hasan Kahraman
- Department of Chest Diseases, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras 46050, Turkey
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Bollu V, Ejzykowicz F, Rajagopalan K, Karafilidis J, Hay JW. Risk of all-cause hospitalization in COPD patients initiating long-acting or short-acting beta agonist therapy. J Med Econ 2013; 16:1082-8. [PMID: 23777224 DOI: 10.3111/13696998.2013.815625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This retrospective claims study investigated the rates of all-cause hospitalization among chronic obstructive pulmonary disease (COPD) patients initiating treatment with short-acting beta agonists (SABA) or long-acting beta agonists (LABA). METHODS Data from the 5% national sample of Medicare enrollees for 2006-2008 were used. Patients initiating COPD therapy were identified as those with no COPD therapy for ≥ 6-months prior to initiating SABA or LABA (administered via dry-powder inhalers, metered-dose inhalers, or nebulizer) treatment. All patients were continuously eligible for Medicare Parts A, B, and D for 18 months. Those enrolled in Medicare Advantage, who had asthma, or were < 65 years old were excluded. Differences in the rates of all-cause hospitalizations and time to all-cause hospitalization during the 6-month follow-up period were examined, while adjusting for demographics, clinical indicators, and health service use. RESULTS Among 3017 COPD patients who met the inclusion criteria, 883 (30%) were LABA users and 2134 (70%) were SABA users. Overall, 21% of patients (16% [144/883] of LABA and 23% [492/2134] of SABA) had a hospitalization during the follow-up period. Mean time to hospitalization was 86 days for LABA vs 64 days for SABA patients (p < 0.05). The adjusted hazard ratio for hospitalization in a Cox proportional hazards model was 0.74 (95% CI = 0.62-0.90) for patients treated with LABA vs. SABA. LIMITATIONS The analysis was adjusted for multiple background characteristics, but important measures of severity in COPD, such as measures of lung functioning, were not available and may have differed between patients treated with LABA or SABA. CONCLUSIONS The results of this analysis indicate COPD patients initiating LABA treatment had a longer time to all-cause hospitalization and a 26% lower risk of hospitalization during the 6-months follow-up period compared to those initiating SABA therapy.
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Affiliation(s)
- Vamsi Bollu
- Sunovion Pharmaceuticals, Inc., Marlborough, MA 01752, USA.
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Ennis S, Alison J, McKeough Z. The effects of arm endurance and strength training on arm exercise capacity in people with chronic obstructive pulmonary disease. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331909x12488667116970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Koblizek V, Chlumsky J, Zindr V, Neumannova K, Zatloukal J, Zak J, Sedlak V, Kocianova J, Zatloukal J, Hejduk K, Pracharova S. Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:189-201. [PMID: 23733084 DOI: 10.5507/bp.2013.039] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 05/20/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world. METHODS The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version. DIAGNOSIS The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype. TREATMENT Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care. CONCLUSION Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.
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Affiliation(s)
- Vladimir Koblizek
- Pulmonary Department, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic.
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Zhang X, Zhang J, Li Q, Wu X, Wang T, Wang Y. SELDI-TOF-MS in chronic obstructive pulmonary disease. CHINESE SCIENCE BULLETIN-CHINESE 2013. [DOI: 10.1007/s11434-012-5460-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Whittaker C. Chronic obstructive pulmonary disease. S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Deslee G, Barbe C, Bourdin A, Durand-Zaleski I, Dutau H, Jolly D, Jounieaux V, Kessler R, Mal H, Pison C, Thiberville L, Vergnon JM, Marquette CH. [Cost-effectiveness of lung volume reduction coil treatment in emphysema. STIC REVOLENS]. Rev Mal Respir 2012. [PMID: 23200592 DOI: 10.1016/j.rmr.2012.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical therapeutic options for the treatment of emphysema remain limited. Lung volume reduction surgery is infrequently used because of its high morbi-mortality. Endobronchial lung volume reduction coil (LVRC(®), PneumRx, Mountain View, CA) treatment has been recently developed and has been shown to be feasible and associated with an acceptable safety profile, while resulting in improvements in dyspnea, exercise capacity and lung function. The objective of this study is to analyze the cost effectiveness of LVRC treatment in severe emphysema. METHODS This prospective, multicenter study, randomized with a 1:1 ratio (LVRC vs conventional treatment) will include 100 patients who will be followed up for 1year. The primary outcome measure is the 6-month improvement of the 6-minute walk test: the percentage of patients showing an improvement of at least 54m will be compared between groups. A cost-effectiveness study will estimate the cost of LVRC treatment, the global cost of this therapeutic option and will compare the cost between patients treated by LVRC and by medical treatment alone. EXPECTED RESULTS This study should allow validating the clinical efficacy of LVRC in severe emphysema. The cost-effectiveness study will assess the medical-economic impact of the LVRC therapeutic option.
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Affiliation(s)
- G Deslee
- Service de pneumologie, hôpital Maison-Blanche, CHU de Reims, 45 rue Cognacq-Jay, Reims, France.
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Nilsson JLG, Haupt D, Krigsman K, Moen J. Asthma/COPD drugs reflecting disease prevalence, patient adherence and persistence. Expert Rev Respir Med 2012; 3:93-101. [PMID: 20477285 DOI: 10.1586/17476348.3.1.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this review is to discuss the methodological issues involved in using pharmacy-record databases of drug sales in pharmacoepidemiology and to illustrate the usefulness of such data in estimating disease prevalence, patient adherence and persistence to therapy. Recent studies show that asthma/chronic obstructive pulmonary disease (COPD) prevalence increases with age. The volume of acquired asthma/COPD drugs per patient also increases with age and was approximately 2.5-times higher for patients aged 60-69 years compared with patients aged 20-29 years. Despite this, there is a comparatively low interest in asthma/COPD research involving elderly individuals. Published asthma/COPD-prevalence data and drug-treatment-prevalence data correspond reasonably well. Short- as well as long-term studies on drug acquisition indicate that approximately a third of patients have drugs available to cover at least 80% of the prescribed treatment time. Only approximately a tenth of the patients acquired steroids or steroid combinations, corresponding to one daily defined dose per day over a 5-year treatment period. It is probable that asthma/COPD is undertreated in all age groups.
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Eberhardt R, Gompelmann D, Schuhmann M, Reinhardt H, Ernst A, Heussel CP, Herth FJ. Complete Unilateral vs Partial Bilateral Endoscopic Lung Volume Reduction in Patients With Bilateral Lung Emphysema. Chest 2012; 142:900-908. [DOI: 10.1378/chest.11-2886] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kathiresan G, Jeyaraman SK, Jaganathan J. Effect of upper extremity exercise in people with COPD. J Thorac Dis 2012; 2:223-36. [PMID: 22263051 DOI: 10.3978/j.issn.2072-1439.2010.11.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 11/11/2010] [Indexed: 11/14/2022]
Abstract
BACKGROUND Exercise for people with COPD has focused on leg training, such as walking and cycling. The role and effectiveness of arm training has not been investigated in detail. This review was undertaken to examine the literature for the effectiveness of upper extremity exercise on arm exercise capacity and arm strength in people with COPD. METHODS Trials relating to arm endurance and strength training in COPD were located by searching electronic databases and screening the reference lists of pertinent articles. Where possible, effect sizes and 95% CI were determined and meta-analysis used. RESULTS The search strategy yielded 24 articles. Unsupported arm training improved arm endurance capacity (standard mean difference [SMD] =1.25; 95% CI=0.16 to 2.66) and was the optimal mode of arm endurance training. Combined unsupported and supported arm training was also found to have a large positive effect on peak arm exercise capacity (SMD=1.27; 95% CI=0.59 to 1.94). In addition arm strength training produced moderate improvements in arm strength (SMD=0.46; 95% CI=0.10 to 0.81). CONCLUSION This review suggests that in the short term, arm endurance training improves arm exercise capacity and arm strength training improves arm strength. Further research is required, in people with COPD, to investigate the long-term effects of arm training.
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Affiliation(s)
- Ganesan Kathiresan
- School of Therapeutic sciences, Masterskill University College, Malaysia
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Corlateanu A, Siafakas N, Botnaru V. Defining COPD: from simplistic approach to multilateral assessment of COPD. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0023-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Practical management problems of stable chronic obstructive pulmonary disease in the elderly. Curr Opin Pulm Med 2012; 17 Suppl 1:S43-8. [PMID: 22209930 DOI: 10.1097/01.mcp.0000410747.20958.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. RECENT FINDINGS In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. SUMMARY The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines.
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Hughes AD, McNamara A, Steinfeld T. Multivalent dual pharmacology muscarinic antagonist and β₂ agonist (MABA) molecules for the treatment of COPD. PROGRESS IN MEDICINAL CHEMISTRY 2012; 51:71-95. [PMID: 22520472 DOI: 10.1016/b978-0-12-396493-9.00003-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Adam D Hughes
- Department of Medicinal Chemistry, Theravance, Inc., South San Francisco, CA, USA
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Mapel DW, Dalal AA, Blanchette CM, Petersen H, Ferguson GT. Severity of COPD at initial spirometry-confirmed diagnosis: data from medical charts and administrative claims. Int J Chron Obstruct Pulmon Dis 2011; 6:573-81. [PMID: 22135490 PMCID: PMC3224652 DOI: 10.2147/copd.s16975] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was conducted to determine COPD severity at the time of diagnosis as confirmed by spirometry in patients treated in a US managed care setting. Patients and methods All patients with one or more inpatient stays, one or more emergency department visits, or two or more outpatient visits with diagnosis codes for COPD during 1994–2006 were identified from the Lovelace Patient Database. From this group, a subset of continuously enrolled patients with evidence in claims of a first available pulmonary function test or pulmonary clinic visit and a confirmatory claim for a COPD diagnosis was selected. Medical chart abstraction was undertaken for this subset to gather information for diagnosis and severity staging of each patient based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD. Results Of the 12,491 patients with a primary or secondary COPD diagnosis between 1994 and 2006, there were 1520 continuously enrolled patients who comprised the study cohort. Among the 648 eligible records from patients with evidence of a pulmonary function test, 366 were identified by spirometry as having COPD of GOLD stage I or higher (average percentage of predicted forced expiratory volume in 1 second: 60%): 19% were diagnosed at the stage of mild disease (GOLD stage I); 50% at moderate disease (GOLD stage II); and 31% at severe or very severe disease (GOLD stage III or IV, respectively). The majority of patients in these groups were not receiving maintenance treatment. Conclusion The results demonstrate a very low incidence of early-stage diagnosis, confirmed by a pulmonary function test, of COPD in a large US sample and support calls for increased screening for COPD and treatment upon diagnosis.
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Lahu G, Nassr N, Hünnemeyer A. Pharmacokinetic evaluation of roflumilast. Expert Opin Drug Metab Toxicol 2011; 7:1577-91. [DOI: 10.1517/17425255.2011.632409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The Asthma-COPD Overlap Syndrome: A Common Clinical Problem in the Elderly. J Allergy (Cairo) 2011; 2011:861926. [PMID: 22121384 PMCID: PMC3205664 DOI: 10.1155/2011/861926] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/30/2011] [Accepted: 07/31/2011] [Indexed: 12/25/2022] Open
Abstract
Many patients with breathlessness and chronic obstructive lung disease are diagnosed with either asthma, COPD, or—frequently—mixed disease. More commonly, patients with uncharacterized breathlessness are treated with therapies that target asthma and COPD rather than one of these diseases. This common practice represents the difficulty in distinguishing these disorders clinically, particularly in patients with a history that does not easily differentiate asthma from COPD. A common clinical scenario is an older former smoker with partially reversible or fixed airflow obstruction and evidence of atopy, demonstrating “overlap” features of asthma and COPD. We stress that asthma-COPD overlap syndrome becomes more prevalent with advancing age as patients respond less favorably to guideline-recommended drug therapy. We review the similarities and differences in clinical characteristics between these disorders, and their physiologic and inflammatory profiles within the context of the aging patient. We underscore the difficulties in differentiating asthma from COPD in current or former smokers, share our institutional experience with overlap syndrome, and highlight the need for new research to better characterize and investigate this important clinical phenotype.
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Delage A, Marquette CH. Bronchoscopic treatments for emphysema. Rev Mal Respir 2011; 28:e108-14. [DOI: 10.1016/j.rmr.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 09/07/2009] [Indexed: 11/27/2022]
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Effectiveness of discharge-coordinator intervention in patients with chronic obstructive pulmonary disease: study protocol of a randomized controlled clinical trial. Respir Med 2011; 105 Suppl 1:S26-30. [DOI: 10.1016/s0954-6111(11)70007-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hanania NA. Safety of chronic obstructive pulmonary disease medications: a primary care perspective. Postgrad Med 2011; 123:72-9. [PMID: 21566417 DOI: 10.3810/pgm.2011.05.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), which affects > 210 million individuals worldwide, places primary care practitioners at the forefront of diagnosing and managing COPD, and preventing adverse drug reactions (ADRs) associated with COPD medications. Therefore, it is essential that practitioners understand the safety profiles of these medications. They should also be aware of the host factors and any preexisting comorbidities in their patients that may impact the safety and efficacy of the prescribed therapy. Drug safety information obtained from randomized controlled trials, observational studies, and meta-analyses should be analyzed to assess the risk-benefit to a patient, since the majority of ADRs associated with COPD medications are predictable, and are avoidable with judicious use of these drugs. This article discusses the different medications available for COPD management and the factors affecting their safety based on current evidence.
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Affiliation(s)
- Nicola A Hanania
- Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, TX 77030, USA.
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Nagelmann A, Tonnov Ä, Laks T, Sepper R, Prikk K. Lung dysfunction of chronic smokers with no signs of COPD. COPD 2011; 8:189-95. [PMID: 21513442 DOI: 10.3109/15412555.2011.565090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cigarette smoking causes airflow limitation with lung hyperinflation being the primary causes of COPD. Fifty chronic smokers (CSs) with no signs of GOLD-adjusted COPD with smoking habit at least ≥10 pack-years (p/yrs) were divided into CS-mild (n = 24) with smoking history from ≥10 to ≤20 p/yrs and CS-heavy groups (n = 26) with smoking history ≥21 p/yrs. Spirometry, plethysmography and diffusing capacity were measured and lung computed tomography (CT) was performed. Residual volume (RV) (L) and RV/TLC (total lung capacity) ratio were significantly increased in CS-heavy when compared to CS-mild (p = 0.001, p = 0.03). A significant reduction of forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) ratio and airway specific conductance was shown in CS-heavy (p = 0.02, p = 0.03). Lung emphysema signs at CTs were revealed in 17 CSs and ten of them had declined diffusing capacity below 70% of predicted. The percentage of emphysematous lesions inversely and significantly correlated with measured diffusing capacity (p = 0.0009, r = --0.72). Study groups' smoking intensity inversely correlated the declined airway specific conductance (p = 0.004, r = --0.39) and increase of the RV (L) (p = 0.0004, r = 0.46). Multiple regression analysis determined that smoking intensity regardless of the subjects' age was significant factor for decline of airway specific conductance and increase of RV (L). Here we conclude that lung function deviation and lung structural changes are present in CSs before the clinical signs of airway obstruction reveal. Body plethysmography and diffusing capacity measurement with routine spirometry can provide valuable information for detection of changes reflecting to the early onset of COPD in CSs.
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Affiliation(s)
- Ave Nagelmann
- Institute of Clinical Medicine, Tallinn University of Technology, Estonia
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42
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Albuquerque SC, Carvalho ER, Lopes RS, Marques HS, Macêdo DS, Pereira ED, Hyphantis TN, Carvalho AF. Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity. Qual Life Res 2011; 20:1401-10. [DOI: 10.1007/s11136-011-9884-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2011] [Indexed: 11/28/2022]
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Abstract
Diagnosis of chronic obstructive pulmonary disease (COPD) in primary care is complex, as many clinical symptoms are similar to asthma and heart disease, which may lead to misdiagnosis and suboptimal disease management. Spirometry is the best method for diagnosing COPD and distinguishing between COPD, asthma, and cardiovascular diseases. Airway obstruction is fully reversible in asthma, but not in COPD, and can be confirmed when the postbronchodilator ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is <0.7. Knowledge of COPD treatment guidelines and a proactive attitude toward disease management by primary care physicians are key to improving symptom control and patients' quality of life. Identification of the appropriate drug/inhaler combination, patient education, training on inhaler use followed by regular monitoring, and pulmonary rehabilitation are also vital to successful COPD management. This review outlines steps to aid physicians in devising and implementing an optimal management plan for COPD patients.
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Ulrik CS, Løkke A, Dahl R, Dollerup J, Hansen G, Cording PH, Andersen KK. Early detection of COPD in general practice. Int J Chron Obstruct Pulmon Dis 2011; 6:123-7. [PMID: 21407825 PMCID: PMC3048088 DOI: 10.2147/copd.s16929] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIM Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detection of COPD. The aim, therefore, was to provide evidence for the feasibility and impact of doing spirometry in this target population. METHODS Participating general practitioners (GPs) (n = 335; 10% of the Danish GPs) recruited consecutively, subjects with >35 years exposure, no previous diagnosis of obstructive lung disease, and at least 1 of the following symptoms: cough, dyspnea, wheezing, sputum, or recurrent respiratory infection. Data on age, smoking status, pack-years, body mass index (BMI), dyspnea score (Medical Research Council, MRC), and pre-bronchodilator spirometry (FEV(1), FEV(1)% predicted, FEV(1)/FVC) were obtained. RESULTS A total of 3.095 (51% females) subjects was included: mean age 58 years, BMI 26.3, and 31.5 pack-years. The majority of subjects (88%) reported MRC score 1 or 2. FEV(1)/FVC-ratio ≤ 0.7 was found in 34.8% of the subjects; the prevalence of airway obstruction increased with age and decreased with increasing BMI, and was higher in men and current smokers. According to the level of FEV(1), 79% of the subjects with airway obstruction had mild to moderate COPD. CONCLUSIONS More than one-third of the recruited subjects had airway obstruction (FEV(1)/ FVC < 0.7). Early detection of COPD appears to be feasible through offering spirometry to adults with tobacco/occupational exposure and at least 1 respiratory symptom.
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Donohue JF, Jones PW. Changing patterns in long-acting bronchodilator trials in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011; 6:35-45. [PMID: 21311692 PMCID: PMC3034288 DOI: 10.2147/copd.s14680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Developments in the understanding of COPD have led to standard guidelines for diagnosis, treatment, and spirometry assessments, which have in turn influenced trial designs and inclusion criteria. Substantial clinical evidence has been gained from clinical trials and supports a positive approach to COPD management. However, there appear to be changing trends in recent trials. Large bronchodilator studies have reported lower improvements in trough forced expiratory volume in 1 second (FEV(1)) values versus placebo than were observed in earlier studies, while the rate of FEV(1) decline seems to be lower in more recent trials. In addition, recent evidence has called into question the usefulness of bronchodilator reversibility testing as a trial inclusion criterion. Baseline patient populations and use of concomitant medications have also changed over recent years due to increased treatment options. The impact of these many variables on clinical trial results is explored, with a particular focus on changes in inclusion criteria and patient baseline demographics.
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Affiliation(s)
- James F Donohue
- Division of Pulmonary Disease and Critical Care Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Diaz-Guzman E, Mannino DM. Airway obstructive diseases in older adults: from detection to treatment. J Allergy Clin Immunol 2010; 126:702-9. [PMID: 20920760 DOI: 10.1016/j.jaci.2010.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/07/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
Abstract
Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adults. Smoking, air pollution, and bronchial hyperresponsiveness are the main risk factors. The treatment of these diseases in older adults does not differ from the available guidelines but may be complicated by the presence of comorbidities. Smoking cessation is essential for smokers, and pulmonary rehabilitation must be considered regardless of the age of the patient.
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Affiliation(s)
- Enrique Diaz-Guzman
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Kentucky, Lexington, KY, USA
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Gooneratne NS, Patel NP, Corcoran A. Chronic obstructive pulmonary disease diagnosis and management in older adults. J Am Geriatr Soc 2010; 58:1153-62. [PMID: 20936735 DOI: 10.1111/j.1532-5415.2010.02875.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short-and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients.
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Affiliation(s)
- Nalaka S Gooneratne
- Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kostikas K, Bouros D. "Show me the money": a fair criticism of economic studies on inhaled bronchodilators for COPD. BMC Pulm Med 2010; 10:48. [PMID: 20843312 PMCID: PMC2946282 DOI: 10.1186/1471-2466-10-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 09/15/2010] [Indexed: 11/10/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) represents a significant burden for healthcare systems that is expected to grow further in the future. Inhaled long-acting bronchodilators, including tiotropium, represent the cornerstone of management of COPD patients. Economic studies evaluating the cost-effectiveness ratio of inhaled bronchodilators have to take into account several parameters, including the reduction of COPD exacerbations and related hospitalizations, as well as disease modification and improvement in quality of life and mortality. At an era when the healthcare resources are unlikely to grow as quickly as demand, economic analyses remain the cornerstone for the justification of the broad use of medication with an acceptable cost-effectiveness ratio. The greatest importance of such studies in COPD is the identification of subgroups of patients that will have the most benefit with an acceptable cost-effectiveness ratio for the healthcare providers. The development of models that will incorporate a global evaluation of the different aspects of this multi-component disease, in order to provide the best available care to each individual patient is urgently needed.
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Affiliation(s)
- Konstantinos Kostikas
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Influence of Body Mass Index on Changes in Disease-Specific Quality of Life of Veterans Completing Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2010; 30:334-9. [DOI: 10.1097/hcr.0b013e3181e17607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berton DC, Reis M, Siqueira ACB, Barroco AC, Takara LS, Bravo DM, Andreoni S, Neder JA. Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD. Respir Med 2010; 104:1288-96. [DOI: 10.1016/j.rmed.2010.05.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 05/21/2010] [Accepted: 05/24/2010] [Indexed: 11/25/2022]
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