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Pirera E, Di Raimondo D, D'Anna L, Tuttolomondo A. Risk trajectory of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. Eur J Intern Med 2025; 135:74-82. [PMID: 39884921 DOI: 10.1016/j.ejim.2025.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/05/2025] [Accepted: 01/21/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are known to increase the risk of cardiovascular (CV) events and mortality. However, the temporal trend of this risk has not fully elucidated. This systematic review and meta-analysis aims to quantify the risk of CV events after COPD exacerbations over different time periods. OBJECTIVES To assess the temporal association between CV events, including acute coronary syndrome (ACS), heart failure (HF), acute cereberovascular events, arrhythmia and all-cause mortality after the onset of COPD exacerbations in the following timepoints: 1-30 and 31-180 days; 1-7, 8-14, 15-30, 31-180, 181-365 and >365 days. METHODS A comprehensive literature search was conducted in PubMed, Embase, Web of Science and Cochrane databases, identifying observational studies that reported CV outcomes following COPD exacerbations. Studies were included if they enrolled adults diagnosed with COPD and compared CV event rates during exacerbation and non-exacerbation periods (PROSPERO, CRD42024561490). RESULTS Sixteen studies with over 1.8 million participants were included. Our meta-analysis demonstrated a significantly increased risk of ACS, HF, cerebrovascular events and arrhythmia, with the highest magnitude of risk observed in the period 1-30 days following an exacerbation. This increased risk showed a decline in time points 31-180, 181-365 days and remained persistently higher for ACS even one year after an acute exacerbation. Notably, the risk of HF was found to be greater compared to the other CV outcomes. CONCLUSION COPD exacerbations significantly increase the risk of acute CV events, particularly within the first 30 days. Optimal strategies to reduce cardiopulmonary risk are needed.
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Affiliation(s)
- Edoardo Pirera
- Internal Medicine and Stroke Care ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo Italy.
| | - Domenico Di Raimondo
- Internal Medicine and Stroke Care ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo Italy
| | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo Italy
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Zhu H, Lei J, Gao F, Guo Y, Zhao L. Evaluation of comparative efficacy of Umeclidinium/Vilanterol versus other bronchodilators in the management of chronic obstructive pulmonary disease: a systematic review and meta-analysis of RCTs. BMC Pulm Med 2024; 24:609. [PMID: 39696097 DOI: 10.1186/s12890-024-03445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 12/10/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND UMEC/VI administered via a combination inhaler is associated with a clinically significant improvement in lung function and health-related quality of life in patients with mild-to-moderate COPD. However, their efficacy compared to other bronchodilator mono or dual therapies still remains unclear. OBJECTIVE The objective of this research was to evaluate the therapeutic efficacy of UMEC/VI dual and UMEC/VI/FF triple therapies versus alternative bronchodilator regimens in COPD patients. METHODS A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. The odds ratio (OR) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I [2] statistics and the appropriate p-value. The analysis used RevMan 5.4. RESULTS The current meta-analysis includes 31,814 COPD patients from 17 RCTs. The meta-analysis results demonstrate that the combination of LABA and LAMA provides additive bronchodilation and improved lung function in COPD patients. We found that UMEC/VI dual therapy significantly improved FEV1 (OR 1.98 [95% CI 1.70-2.30]), TDI values (OR 1.97 [95% CI 1.72-2.26]), and reduced SGRQ total scores (OR 1.99 [95% CI 1.71-2.32]), with fewer drug-related adverse events (RR 0.58 [95% CI 0.53-0.64]). Similarly, UMEC/VI/FF triple therapy also showed similar benefits, with significant improvements in FEV1 (OR 1.93 [95% CI 1.73-2.15]), TDI values (OR 2.37 [95% CI 2.15-2.61]), and reduced SGRQ total scores (OR 1.83 [95% CI 1.63-2.05]), and fewer drug-related adverse events (RR 0.53 [95% CI 0.49-0.58]). CONCLUSION This systematic review and meta-analysis concludes that UMEC and VI combinations are an efficacious treatment option for symptomatic COPD patients.
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Affiliation(s)
- He Zhu
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Jiahui Lei
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Fan Gao
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yingjie Guo
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Limin Zhao
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China.
- Department of respiratory and critical care medicine, Henan provincial people's hospital, Henan, Zhengzhou, 450003, Jinshui District, China.
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Biener L, Pizarro C, Skowasch D. [Chronic obstructive pulmonary disease (COPD): eosinophilia and novel drug therapies]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:738-745. [PMID: 38831048 DOI: 10.1007/s00108-024-01725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The phenotyping of chronic obstructive pulmonary disease (COPD) has increasingly gained attention in recent years, as it leads to new and individualized therapeutic concepts. OBJECTIVE The aim is to provide an overview of the heterogeneity of COPD and to summarize current drug therapy concepts, particularly in the context of eosinophilic airway inflammation. DATA Several prospective, randomized, placebo-controlled studies have shown a reduction in exacerbations and overall mortality with inhaled triple therapy using an inhaled corticosteroid and dual bronchodilation. The higher the eosinophils in the blood, the greater the expected effect. In addition, a reduction in exacerbations with biologics in COPD with eosinophilia has been demonstrated for dupilumab. Eosinophil-guided therapy for acute exacerbations is the subject of current research. CONCLUSION For COPD without exacerbations, dual bronchodilation forms the basis of inhaled therapy. With exacerbations, inhaled triple therapy is indicated for patients with a blood eosinophil count of ≥ 300/µl. This type of treatment may also be useful when eosinophils are between 100 and 300/µl. Therapy with dupilumab is a possible option for the eosinophilic phenotype in the near future.
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Affiliation(s)
- L Biener
- Medizinische Klinik und Poliklinik II - Kardiologe, Pneumologie, Angiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - C Pizarro
- Medizinische Klinik und Poliklinik II - Kardiologe, Pneumologie, Angiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - D Skowasch
- Medizinische Klinik und Poliklinik II - Kardiologe, Pneumologie, Angiologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Halpin DMG. Mortality of patients with COPD. Expert Rev Respir Med 2024; 18:381-395. [PMID: 39078244 DOI: 10.1080/17476348.2024.2375416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/04/2024] [Accepted: 06/28/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide and 24% of the patients die within 5 years of diagnosis. AREAS COVERED The epidemiology of mortality and the interventions that reduce it are reviewed. The increasing global deaths reflect increases in population sizes, increasing life expectancy and reductions in other causes of death. Strategies to reduce mortality aim to prevent the development of COPD and improve the survival of individuals. Historic changes in mortality give insights: improvements in living conditions and nutrition, and later improvements in air quality led to a large fall in mortality in the early 20th century. The smoking epidemic temporarily reversed this trend.Older age, worse lung function and exacerbations are risk factors for death. Single inhaler triple therapy; smoking cessation; pulmonary rehabilitation; oxygen therapy; noninvasive ventilation; and surgery reduce mortality in selected patients. EXPERT OPINION The importance of addressing the global burden of mortality from COPD must be recognized. Steps must be taken to reduce it, by reducing exposure to risk factors, assessing individual patients' risk of death and using treatments that reduce the risk of death. Mortality rates are falling in countries that have adopted a comprehensive approach to COPD prevention and treatment.
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Affiliation(s)
- David M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
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Polman R, Hurst JR, Uysal OF, Mandal S, Linz D, Simons S. Cardiovascular disease and risk in COPD: a state of the art review. Expert Rev Cardiovasc Ther 2024; 22:177-191. [PMID: 38529639 DOI: 10.1080/14779072.2024.2333786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited. AREAS COVERED 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD. EXPERT OPINION The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2023.
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Affiliation(s)
- Ricardo Polman
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
| | - Dominik Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Sami Simons
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
- Department of Respiratory Medicine, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Sánchez-Salcedo P, Llanos-González AB, Dorado Arenas S, Carrión Collado N, García AR, Sánchez Zaballos M, Alonso Pérez T. [Highlights 56th SEPAR Congress]. OPEN RESPIRATORY ARCHIVES 2023; 5:100265. [PMID: 37720490 PMCID: PMC10502405 DOI: 10.1016/j.opresp.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
The Spanish Society of Pneumology and Thoracic Surgery (SEPAR) has held its 56th congress in Granada from 8 to 10 June 2023. The SEPAR congress has established itself as the leading scientific meeting for specialists in medicine and respiratory care, reaching a record of participation this year with 2600 attendees. Our society thus demonstrates its leadership in the management of respiratory diseases, as well as its growth and progress in order to achieve excellence. In this review, we offer a summary of some notable issues addressed in six selected areas of interest: chronic obstructive pulmonary disease (COPD), asthma, interstitial lung diseases (ILDs), tuberculosis and respiratory infections, pulmonary circulation, and respiratory nursing.
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Affiliation(s)
- Pablo Sánchez-Salcedo
- Servicio de Neumología, Hospital Universitario de Navarra, Pamplona, Navarra, España
| | - Ana Belén Llanos-González
- Servicio de Neumología, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, España
| | - Sandra Dorado Arenas
- Servicio de Neumología, Hospital Universitario de Galdakao (Osakidetza), Galdakao, Bizkaia, España
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, España
| | - Noelia Carrión Collado
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Agustín Roberto García
- Servicio de Neumología, Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)
| | - Marta Sánchez Zaballos
- Enfermería. Área de Gestión Clínica del Pulmón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Tamara Alonso Pérez
- Servicio de Neumología, Hospital Universitario La Princesa. Universidad Autónoma de Madrid, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)
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Klemmer A, Alter P, Vogelmeier CF. [COPD - what has changed in GOLD 2023 and is relevant for clinical practice?]. Dtsch Med Wochenschr 2023; 148:780-787. [PMID: 37257481 DOI: 10.1055/a-1997-1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The annual report of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) is one of the most relevant documents covering prevention, diagnosis and treatment of chronic obstructive pulmonary disease (COPD). The 2023 edition contains a number of changes with impact on clinical practice. For assessment and categorization, a new patient group termed E based on individual exacerbation history has been introduced. The basis of pharmacological management for most patients is the use of combinations containing a long acting β2-agonist (LABA) and a long-acting anticholinergic (LAMA). Combinations of LABA and inhaled corticosteroids (ICS) are no longer recommended. When there is an indication for ICS therapy, a combination of LABA, LAMA and ICS should be used. For these triple combinations, a significant reduction of mortality could be demonstrated in selected patient populations. GOLD proposes a new definition and assessment of COPD exacerbations focussing on objectively assessible parameters and relevant differential diagnoses.
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Affiliation(s)
- Andreas Klemmer
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin, UKGM, Standort Marburg, Deutsches Zentrum für Lungenforschung, Marburg
| | - Peter Alter
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin, UKGM, Standort Marburg, Deutsches Zentrum für Lungenforschung, Marburg
| | - Claus F Vogelmeier
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin, UKGM, Standort Marburg, Deutsches Zentrum für Lungenforschung, Marburg
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