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Finney LJ, Fenwick P, Kemp SV, Singanayagam A, Edwards MR, Belchamber KBR, Kebadze T, Regis E, Donaldson GD, Mallia P, Donnelly LE, Johnston SL, Wedzicha JA. Impaired antiviral immunity in frequent exacerbators of chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol 2025; 328:L120-L133. [PMID: 39560620 DOI: 10.1152/ajplung.00118.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 11/20/2024] Open
Abstract
Respiratory viruses cause chronic obstructive pulmonary disease (COPD) exacerbations. Rhinoviruses (RVs) are the most frequently detected. Some patients with COPD experience frequent exacerbations (≥2 exacerbations/yr). The relationship between exacerbation frequency and antiviral immunity remains poorly understood. The objective of this study was to investigate the relationship between exacerbation frequency and antiviral immunity in COPD. Alveolar macrophages and bronchial epithelial cells (BECs) were obtained from patients with COPD and healthy participants. Alveolar macrophages were infected with RV-A16 multiplicity of infection (MOI) 5 and BECs infected with RV-A16 MOI 1 for 24. Interferons (IFNs) and proinflammatory cytokines IL-1β, IL-6, C-X-C motif chemokine ligand (CXCL)-8, and TNF were measured in cell supernatants using a mesoscale discovery platform. Viral load and interferon-stimulated genes were measured in cell lysates using quantitative PCR. Spontaneous and RV-induced IFN-β, IFN-γ, and CXCL-11 release were significantly reduced in alveolar macrophages from patients with COPD compared with healthy subjects. IFN-β was further impaired in uninfected alveolar macrophages from patients with COPD with frequent exacerbations 82.0 pg/mL versus infrequent exacerbators 234.7 pg/mL, P = 0.008 and RV-infected alveolar macrophages from frequent exacerbators 158.1 pg/mL versus infrequent exacerbators 279.5 pg/mL, P = 0.022. Release of proinflammatory cytokines CXCL-8, IL-6, TNF, and IL-1β was higher in uninfected BECs from patients with COPD compared with healthy subjects but there was no difference in proinflammatory response to RV between groups. IFN responses to RV were impaired in alveolar macrophages from patients with COPD and further reduced in patients with frequent exacerbations.NEW & NOTEWORTHY COPD exacerbations are commonly triggered by viral infections. Some patients with COPD have frequent exacerbations leading to rapid lung function decline and increased mortality. In this study, antiviral responses (interferons) from bronchial epithelial cells and alveolar macrophages were reduced in patients with COPD compared with healthy participants and further reduced in patients with COPD with frequent exacerbations. Impaired antiviral immunity may lead to frequent COPD exacerbations. Targeted vaccinations and antiviral therapy may reduce exacerbations in COPD.
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Affiliation(s)
- Lydia J Finney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter Fenwick
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Samuel V Kemp
- Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Aran Singanayagam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Michael R Edwards
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kylie B R Belchamber
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tatiana Kebadze
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Eteri Regis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gavin D Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Louise E Donnelly
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Jones P, Alzaabi A, Casas Herrera A, Polatli M, Rabahi MF, Cortes Telles A, Aggarwal B, Acharya S, Hasnaoui AE, Compton C. Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review. COPD 2024; 21:2316594. [PMID: 38421013 DOI: 10.1080/15412555.2024.2316594] [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: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.
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Affiliation(s)
- Paul Jones
- Global Medical, Regulatory and Quality, GSK plc, Brentford, UK
| | - Ashraf Alzaabi
- Internal Medicine Department, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
- Respirology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Alejandro Casas Herrera
- AIREPOC (Integrated care and rehabilitation program of COPD), Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Mehmet Polatli
- School of Medicine, Chest Disease Department, Aydin Adnan Menderes University, Aydin, Turkey
| | | | - Arturo Cortes Telles
- Clínica de Enfermedades Respiratorias Hospital Regional de Alta Especialidad de la Península de Yucatán, Yucatán, México
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Vogelmeier CF, Friedrich FW, Timpel P, Kossack N, Diesing J, Pignot M, Abram M, Halbach M. Impact of COPD on mortality: An 8-year observational retrospective healthcare claims database cohort study. Respir Med 2024; 222:107506. [PMID: 38151176 DOI: 10.1016/j.rmed.2023.107506] [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: 10/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Here we present a large observational study on the association of COPD and exacerbations with mortality (AvoidEx Mortality). METHODS A real-world, observational cohort study with longitudinal analyses of German healthcare claims data in patients ≥40 years of age with a COPD diagnosis from 2011 to 2018 (n = 250,723) was conducted. Patients entered the cohort (index date) upon the first COPD diagnosis. To assess the impact of COPD on all-cause death, a propensity score-matched control group of non-COPD patients was constructed. The number and severity of exacerbations during a 12-month pre-index period were used to form subgroups. For each exacerbation subgroup the exacerbations during 12 months prior to death were analysed. RESULTS COPD increases the all-cause mortality risk by almost 60% (HR 1.57 (95% CI 1.55-1.59)) in comparison to matched non-COPD controls, when controlling for other baseline covariates. The cumulative risk of death after 8 years was highest in patients with a history of more than one moderate or severe exacerbation. Among all deceased COPD patients, 17.2% had experienced a severe, and 34.8% a moderate exacerbation, within 3 months preceding death. Despite increasing exacerbation rates towards death, more than the half of patients were not receiving any recommended pharmacological COPD therapy in the year before death. CONCLUSION Our study illustrates the impact of COPD on mortality risk and highlights the need for consequent COPD management comprising exacerbation assessment and treatment.
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Affiliation(s)
- Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Baldingerstraße, 35033, Marburg, Hessen, Germany
| | | | - Patrick Timpel
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Nils Kossack
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Joanna Diesing
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Marc Pignot
- ZEG - Center for Epidemiology and Health Research Berlin GmbH, Invalidenstraße 115, 10115, Berlin, Germany
| | - Melanie Abram
- AstraZeneca GmbH, Friesenweg 26, 22763, Hamburg, Germany
| | - Marija Halbach
- AstraZeneca GmbH, Friesenweg 26, 22763, Hamburg, Germany.
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4
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Puccetti M, Gomes Dos Reis L, Pariano M, Costantini C, Renga G, Ricci M, Traini D, Giovagnoli S. Development and in vitro-in vivo performances of an inhalable indole-3-carboxaldehyde dry powder to target pulmonary inflammation and infection. Int J Pharm 2021; 607:121004. [PMID: 34391857 DOI: 10.1016/j.ijpharm.2021.121004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023]
Abstract
A tryptophan metabolite of microbial origin, indole-3-carboxaldehyde (3-IAld), has been recently identified as a Janus molecule that, acting at the host-pathogen interface and activating the aryl hydrocarbon receptor, can result as a potential candidate to treat infections as well as diseases with an inflammatory and/or immune component. In this work, an inhaled dry powder of 3-IAld was developed and evaluated for its efficacy, compared to oral and intranasal administration using an aspergillosis model of infection and inflammation. The obtained inhalable dry powder was shown to: i) be suitable to be delivered for pulmonary administration, ii) possess good toxicological safety, and iii) be superior to other administration modalities (oral and intranasal) in reducing disease scores by acting on infection and inflammation. This study supports the use of 3-IAld inhalable dry powders as a potential novel therapeutic tool to target inflammation and infection in pulmonary diseases.
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Affiliation(s)
- Matteo Puccetti
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, 06123 Perugia, Italy
| | - Larissa Gomes Dos Reis
- Respiratory Technology Group, The Woolcock Institute of Medical Research, Glebe, Sydney, Australia
| | - Marilena Pariano
- Department of Experimental Medicine, University of Perugia, via Gambuli 1, 06132 Perugia, Italy
| | - Claudio Costantini
- Department of Experimental Medicine, University of Perugia, via Gambuli 1, 06132 Perugia, Italy
| | - Giorgia Renga
- Department of Experimental Medicine, University of Perugia, via Gambuli 1, 06132 Perugia, Italy
| | - Maurizio Ricci
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, 06123 Perugia, Italy
| | - Daniela Traini
- Respiratory Technology Group, The Woolcock Institute of Medical Research, Glebe, Sydney, Australia; Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
| | - Stefano Giovagnoli
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, 06123 Perugia, Italy.
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Sun W, Luo Z, Jin J, Cao Z, Ma Y. The Neutrophil/Lymphocyte Ratio Could Predict Noninvasive Mechanical Ventilation Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2267-2277. [PMID: 34385816 PMCID: PMC8353100 DOI: 10.2147/copd.s320529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine the effectiveness of neutrophil/lymphocyte ratio (NLR), compared to traditional inflammatory markers, for predicting noninvasive mechanical ventilation (NIMV) failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Patients and Methods We conducted this retrospective observational study including 212 AECOPD patients who required NIMV during hospitalization from January 2015 to December 2020 in the department of respiratory and critical care medicine of Beijing Chao-Yang Hospital (west campus). We reviewed the medical record to determine if NIMV succeeded or failed for each patient, and compared NLR with traditional markers (leukocyte, C-reactive protein [CRP] and procalcitonin [PCT]) between NIMV failure and NIMV success group. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analysis were used to assess the accuracy of these markers for predicting NIMV failure. Results A total of 38 (17.9%) patients experienced NIMV failure. NLR was a more sensitive biomarker to predict NIMV failure (AUC, 0.858; 95% CI 0.785-0.931) than leukocyte counts (AUC, 0.723; 95% CI 0.623-0.823), CRP (AUC, 0.670; 95% CI 0.567-0.773) and PCT (AUC, 0.719; 95% CI 0.615-0.823). There was statistically positive correlation between NLR and leukocytes count (r=0.35, p<0.001), between NLR and CRP (r=0.258, p<0.001), between NLR and PCT (r=0.306, p<0.001). The cutoff value of NLR to predict NIMV failure was 8.9 with sensitivity 0.688, specificity 0.886 and diagnostic accuracy 0.868. NLR>8.9 (odds ratio, 10.783; 95% CI, 2.069-56.194; P=0.05) was an independent predictor of NIMV failure in the multivariate logistic regression model. Conclusion NLR may be an effective marker for predicting NIMV failure in AECOPD patients, and the patients with NLR>8.9 should be handled with caution since they are at higher risk of NIMV failure and require intubation. Further study with a larger sample size and with more data is necessary to confirm our study.
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Affiliation(s)
- Wei Sun
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiawei Jin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
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6
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Rao Y, Le Y, Xiong J, Pei Y, Sun Y. NK Cells in the Pathogenesis of Chronic Obstructive Pulmonary Disease. Front Immunol 2021; 12:666045. [PMID: 34017339 PMCID: PMC8130558 DOI: 10.3389/fimmu.2021.666045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 01/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a prevalent chronic airway disease with varied frequencies of acute exacerbations, which are the main cause of morbidity and mortality of the disease. It is, therefore, urgent to develop novel therapies for COPD and its exacerbations, which rely heavily on understanding of the pathogenesis and investigation for potential targets. Current evidence indicates that natural killer (NK) cells play important roles in the pathological processes of COPD. Although novel data are revealing the significance of NK cells in maintaining immune system homeostasis and their involvement in pathogenesis of COPD, the specific mechanisms are largely unknown. Specific and in-depth studies elucidating the underlying mechanisms are therefore needed. In this review, we provided a brief overview of the biology of NK cells, from its development to receptors and functions, and outlined their subsets in peripheral blood and lungs. Then we reviewed published findings highlighting the important roles played by NK cells in COPD and its exacerbations, with a view of providing the current state of knowledge in this area to facilitate related in-depth research.
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Affiliation(s)
- Yafei Rao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yanqing Le
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Jing Xiong
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yuqiang Pei
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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7
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Csoma B, Bikov A, Tóth F, Losonczy G, Müller V, Lázár Z. Blood eosinophils on hospital admission for COPD exacerbation do not predict the recurrence of moderate and severe relapses. ERJ Open Res 2021; 7:00543-2020. [PMID: 33585654 PMCID: PMC7869597 DOI: 10.1183/23120541.00543-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background and objective The relationship between hospitalisation with an eosinophilic acute exacerbation of COPD (AE-COPD) and future relapses is unclear. We aimed to explore this association by following 152 patients for 12 months after hospital discharge or until their first moderate or severe flare-up. Methods Patients hospitalised with AE-COPD were divided into eosinophilic and non-eosinophilic groups based on full blood count results on admission. All patients were treated with a course of systemic corticosteroid. The Cox proportional hazards model was used to study the association with the time to first re-exacerbation; a generalised linear regression model was applied to identify clinical variables related to the recurrence of relapses. Results We did not find a difference in the time to the next moderate or severe exacerbation between the eosinophilic (≥2% of total leukocytes and/or ≥200 eosinophils·µL−1, n=51, median (interquartile range): 21 (10–36) weeks) and non-eosinophilic groups (n=101, 17 (9–36) weeks, log-rank test: p=0.63). No association was found when other cut-off values (≥3% of total leukocytes and/or ≥300 eosinophils·µL−1) were used for the eosinophilic phenotype. However, the higher number of past severe exacerbations, a lower forced expiratory volume in 1 s (FEV1) at discharge and higher pack-years were related to shorter exacerbation-free time. According to a subgroup analysis (n=73), 48.1% of patients with initial eosinophilic exacerbations had non-eosinophilic relapses on readmission. Conclusions Our data do not support an increased risk of earlier recurring moderate or severe relapses in patients hospitalised with eosinophilic exacerbations of COPD. Eosinophilic severe exacerbations present a variable phenotype. Shorter time to the next relapse after severe COPD exacerbation is related to the number of prior hospitalisations, smoking history and more severe airflow limitation. Blood eosinophils are not predictive of the recurrence of moderate or severe relapses.https://bit.ly/2VkbBNC
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Affiliation(s)
- Balázs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.,Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - György Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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8
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Thalla S, Yerubandi A, Hafeezunnisa S, Jareena S, Makkapati S. A prospective observational study on acute exacerbation of chronic obstructive pulmonary disease in pulmonology department of tertiary care hospital. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. Acute exacerbation in COPD (AECOPD) is frequent in the course of the illness and is the most common reason for medical visits, hospital admissions, and mortality among these patients. Exacerbations of COPD are associated with increased morbidity and mortality. To assess the exposure and severity of acute exacerbations of COPD with COPD Assessment Test (CAT Scale) and mMRC (modified Medical Research Council) Dyspnea scale. Study design was a hospital-based prospective observational study. Study site was conducted at Pulmonology Department of Government General Hospital, Vijayawada.
Results
The total patients were 197. Out of which, 119 were from In-patient Department (IPD) and 78 were from Out-patient Department (OPD). In this study, males were 167 (85%), among which, IPD were 97 (49%), OPD were 70 (36%), and females were 30 (15%), among which, IPD were 22 (11%), OPD were 8 (4%).
Conclusion
The morbidity and mortality of COPD have been increased in recent years. This study concludes that there is a relation between risk of acute exacerbations in COPD with habitual history and occupational history. Increase in exposure to occupational hazards, smoking habit leads to an increase in risk of acute exacerbations in COPD patients. The level of severity was more in smokers and the patients who had biomass, organic dust, and mineral exposure. When severity was observed, group D severity is more observed in population according to CAT scale and mMRC dyspnea scale.
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9
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Cafferkey J, Coultas JA, Mallia P. Human rhinovirus infection and COPD: role in exacerbations and potential for therapeutic targets. Expert Rev Respir Med 2020; 14:777-789. [PMID: 32498634 DOI: 10.1080/17476348.2020.1764354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Respiratory virus infections (predominantly rhinoviruses) are the commonly identified in COPD exacerbations but debate about their role as a trigger of exacerbations continues. Experimental infection studies have provided significant new evidence establishing a causal relationship between virus infection and COPD exacerbations and contributed to a better understanding of the mechanisms of virus-induced exacerbations. However as yet no anti-viral treatments have undergone clinical trials in COPD patients. AREAS COVERED This review discusses the evidence for and against respiratory viruses being the main trigger of COPD exacerbations from both epidemiological studies and experimental infection studies. The host immune response to rhinovirus infection and how abnormalities in host immunity may underlie increased susceptibility to virus infection in COPD are discussed and the role of dual viral-bacterial infection in COPD exacerbations. Finally the current state of anti-viral therapy is discussed and how these may be used in the future treatment of COPD exacerbations. EXPERT OPINION Respiratory virus infections are the trigger of a substantial proportion of COPD exacerbations and rhinoviruses are the most common virus type. Clinical trials of anti-viral agents are needed in COPD patients to determine whether they are effective in virus-induced COPD exacerbations.
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Affiliation(s)
- John Cafferkey
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust , London, UK
| | | | - Patrick Mallia
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust , London, UK.,National Heart and Lung Institute, Imperial College London , London, UK
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10
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Rodriguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Álvarez Sala-Walther JL, Calle Rubio M. Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15699. [PMID: 32191213 PMCID: PMC7118552 DOI: 10.2196/15699] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background In recent years, mobile health (mHealth)–related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8%) of which were reported exacerbations and 163 (62.2%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition.
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Affiliation(s)
- Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Luis Puente Maestu
- Pulmonology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Medical Department, School of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Departament of Preventive Medicine, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Luis Álvarez Sala-Walther
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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11
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Ubags ND, Baker J, Boots A, Costa R, El-Merhie N, Fabre A, Faiz A, Heijink IH, Hiemstra PS, Lehmann M, Meiners S, Rolandsson Enes S, Bartel S. ERS International Congress, Madrid, 2019: highlights from the Basic and Translational Science Assembly. ERJ Open Res 2020; 6:00350-2019. [PMID: 32154289 PMCID: PMC7049707 DOI: 10.1183/23120541.00350-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/26/2020] [Indexed: 11/15/2022] Open
Abstract
In this review, the Basic and Translational Sciences Assembly of the European Respiratory Society (ERS) provides an overview of the 2019 ERS International Congress highlights. In particular, we discuss how the novel and very promising technology of single cell sequencing has led to the development of a comprehensive map of the human lung, the lung cell atlas, including the discovery of novel cell types and new insights into cellular trajectories in lung health and disease. Further, we summarise recent insights in the field of respiratory infections, which can aid in a better understanding of the molecular mechanisms underlying these infections in order to develop novel vaccines and improved treatment options. Novel concepts delineating the early origins of lung disease are focused on the effects of pre- and post-natal exposures on neonatal lung development and long-term lung health. Moreover, we discuss how these early life exposures can affect the lung microbiome and respiratory infections. In addition, the importance of metabolomics and mitochondrial function analysis to subphenotype chronic lung disease patients according to their metabolic program is described. Finally, basic and translational respiratory science is rapidly moving forward and this will be beneficial for an advanced molecular understanding of the mechanisms underlying a variety of lung diseases. In the long-term this will aid in the development of novel therapeutic targeting strategies in the field of respiratory medicine. Highlights of basic and translational science presented at #ERSCongress 2019 summarising latest research on the lung cell atlas, lung infections, early origins of lung disease and the importance of metabolic alterations in the lunghttp://bit.ly/2UbdBs4
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Affiliation(s)
- Niki D Ubags
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Lausanne, Switzerland
| | - Jonathan Baker
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Agnes Boots
- Dept of Pharmacology and Toxicology, Maastricht University, Maastricht, the Netherlands
| | - Rita Costa
- Lung Repair and Regeneration Unit, Helmholtz-Zentrum Munich, Ludwig-Maximilians-University, University Hospital Grosshadern, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Natalia El-Merhie
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, Member of the DZL and the Airway Research Center North (ARCN), Borstel, Germany
| | - Aurélie Fabre
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin School of Medicine, Dublin, Ireland
| | - Alen Faiz
- University of Technology Sydney, Respiratory Bioinformatics and Molecular Biology (RBMB), School of Life Sciences, Sydney, Australia
| | - Irene H Heijink
- University of Groningen, University Medical Center Groningen, Depts of Pathology & Medical Biology and Pulmonology, Groningen, The Netherlands
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mareike Lehmann
- Lung Repair and Regeneration Unit, Helmholtz-Zentrum Munich, Ludwig-Maximilians-University, University Hospital Grosshadern, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Silke Meiners
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the DZL, Munich, Germany
| | - Sara Rolandsson Enes
- University of Vermont, Dept of Medicine, Larner College of Medicine, Burlington, VT, USA.,Lund University, Dept of Experimental Medical Science, Lund, Sweden
| | - Sabine Bartel
- University of Groningen, University Medical Center Groningen, Depts of Pathology & Medical Biology and Pulmonology, Groningen, The Netherlands
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Artaraz A, Crichton ML, Finch S, Abo-Leyah H, Goeminne P, Aliberti S, Fardon T, Chalmers JD. Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST). Respir Res 2020; 21:18. [PMID: 31931782 PMCID: PMC6958700 DOI: 10.1186/s12931-019-1272-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/29/2019] [Indexed: 12/25/2022] Open
Abstract
Background Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and to an increased mortality. Improved detection of exacerbations has been accomplished in chronic obstructive pulmonary disease through the use of patient completed diaries. These tools may enhance exacerbation reporting and identification. The aim of this study was to develop a novel symptom diary for bronchiectasis symptom burden and detection of exacerbations, named the BEST diary. Methods Prospective observational study of patients with bronchiectasis conducted at Ninewells Hospital, Dundee. We included patients with confirmed bronchiectasis by computed tomography, who were symptomatic and had at least 1 documented exacerbation of bronchiectasis in the previous 12 months to participate. Symptoms were recorded daily in a diary incorporating cough, sputum volume, sputum colour, dyspnoea, fatigue and systemic disturbance scored from 0 to 26. Results Twenty-one patients were included in the study. We identified 29 reported (treated exacerbations) and 23 unreported (untreated) exacerbations over 6-month follow-up. The BEST diary score showed a good correlation with the established and validated questionnaires and measures of health status (COPD Assessment Test, r = 0.61, p = 0.0037, Leicester Cough Questionnaire, r = − 0.52,p = 0.0015, St Georges Respiratory Questionnaire, r = 0.61,p < 0.0001 and 6 min walk test, r = − 0.46,p = 0.037). The mean BEST score at baseline was 7.1 points (SD 2.2). The peak symptom score during exacerbation was a mean of 16.4 (3.1), and the change from baseline to exacerbation was a mean of 9.1 points (SD 2.5). Mean duration of exacerbations based on time for a return to baseline symptoms was 15.3 days (SD 5.7). A minimum clinically important difference of 4 points is proposed. Conclusions The BEST symptom diary has shown concurrent validity with current health questionnaires and is responsive at onset and recovery from exacerbation. The BEST diary may be useful to detect and characterise exacerbations in bronchiectasis clinical trials.
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Affiliation(s)
- Amaia Artaraz
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Megan L Crichton
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Division of Molecular and Clinical Medicine, University of Dundee, DD1 9SY, Dundee, Scotland
| | - Simon Finch
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Division of Molecular and Clinical Medicine, University of Dundee, DD1 9SY, Dundee, Scotland
| | - Hani Abo-Leyah
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Division of Molecular and Clinical Medicine, University of Dundee, DD1 9SY, Dundee, Scotland
| | | | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Thomas Fardon
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Division of Molecular and Clinical Medicine, University of Dundee, DD1 9SY, Dundee, Scotland
| | - James D Chalmers
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, Division of Molecular and Clinical Medicine, University of Dundee, DD1 9SY, Dundee, Scotland.
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