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Hou B, Lin Y, Zhang W, Lin Q, Wang S, Meng F, Dai W, Wang G. Association of nutritional status and comorbidity with long-term survival among community-dwelling older males. BMC Geriatr 2023; 23:697. [PMID: 37891480 PMCID: PMC10605511 DOI: 10.1186/s12877-023-04413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Estimates of survival in the older can be of benefit in various facets, particularly in medical and individual decision-making. We aim to validate the value of a combination of nutrition status evaluation and comorbidity assessment in predicting long-term survival among community-dwelling older. METHODS The Charlson Comorbidity Index (CCI) was applied for comprehensive evaluation of comorbidities. Participants were classified into CCI score ≤ 2 and ≥ 3 subgroups. Nutritional status was assessed by using Mini Nutritional Assessment-Short Form (MNA-SF) and Geriatric Nutritional Risk Index (GNRI) evaluations. Mortality rates and survival curves over a 5-year period were compared among subgroups classified by CCI and/or MNA-SF/GNRI evaluations. RESULTS A total of 1033 elderly male participants were enrolled in this study, with an average age of 79.44 ± 8.61 years. 108 deceased participants (10.5%) were identified during a follow-up of 5 years. Cox proportional hazards regression analysis showed that age, CCI, MNA-SF and GNRI were independent predictors of 5-year all-cause death in this cohort. Compared to those with normal nutrition status and CCI ≤ 2, the subgroup at risk of malnutrition and CCI ≥ 3 had a significantly higher 5-year all-cause mortality rate (HR = 4.671; 95% CI:2.613-8.351 for MNA-SF and HR = 7.268; 95% CI:3.401-15.530 for GNRI; P < 0.001 for both). Receiver operating characteristic curve analysis demonstrated that a combination of either MNA-SF or GNRI with CCI had significantly better performance than CCI, MNA-SF or GNRI alone in predicting all-cause death. CONCLUSION The combination of nutritional assessment (MNA-SF or GNRI) with CCI can significantly improve the predictive accuracy of long-term mortality outcomes among community-dwelling older males.
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Affiliation(s)
- Baicun Hou
- Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China
- Health Service Department of the Guard Bureau of the Joint Staff Department, 100017, Beijing, China
| | - Yunjuan Lin
- Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China
| | | | - Qiqi Lin
- Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, 100853, Beijing, China
| | - Fansen Meng
- Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China
| | - Wei Dai
- Office of Information Management, The Second Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Gangshi Wang
- Department of Gastroenterology, The Second Medical Center, National Clinical Research Center for Geriatrics Diseases, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, 100853, Beijing, China.
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Kim NH, Choi BY, Kim ES, Kim SJ, Hong JY, Heo SH, Jeong JY, Kim K, Yoo HJ, Sul WJ, Lee SW. Systemic antibiotics cause deterioration of emphysema associated with exaggerated inflammation and autophagy. Exp Mol Med 2023; 55:2260-2268. [PMID: 37779147 PMCID: PMC10618248 DOI: 10.1038/s12276-023-01099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 10/03/2023] Open
Abstract
The interaction between the microbial environment and the host is important for immune homeostasis. Recent research suggests that microbiota dysbiosis can be involved in respiratory diseases. Emphysema is a chronic inflammatory disease, but it is unclear whether dysbiosis caused by antibiotics can affect disease progression. Here, we tried to elucidate the effect of systemic antibiotics on smoking-exposed emphysema models. In this study, the antibiotic mixture caused more alveolar destruction and airspace expansion in the smoking group than in the smoking only or control groups. This emphysema aggravation as a result of antibiotic exposure was associated with increased levels of inflammatory cells, IL-6, IFNγ and protein concentrations in bronchoalveolar lavage fluid. Proteomics analysis indicated that autophagy could be involved in antibiotic-associated emphysema aggravation, and increased protein levels of LC3B, atg3, and atg7 were identified by Western blotting. In microbiome and metabolome analyses, the composition of the gut microbiota was different with smoking and antibiotic exposure, and the levels of short-chain fatty acids (SCFAs), including acetate and propionate, were reduced by antibiotic exposure. SCFA administration restored emphysema development with reduced inflammatory cells, IL-6, and IFNγ and decreased LC3B, atg3, and atg7 levels. In conclusion, antibiotics can aggravate emphysema, and inflammation and autophagy may be associated with this aggravation. This study provides important insight into the systemic impact of microbial dysbiosis and the therapeutic potential of utilizing the gut microbiota in emphysema.
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Affiliation(s)
- Na Hyun Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bo-Yun Choi
- Department of Systems Biotechnology, Chung-Ang University, Anseong, Gyeonggi-do, Republic of Korea
| | - Eun Sil Kim
- Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center and Department of Microbiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Jung Kim
- Department of Convergence Medicine, Asan Medical Center, Department of Digital Medicine, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Hong
- Department of Convergence Medicine, Asan Medical Center, Department of Digital Medicine, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Heo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Yong Jeong
- Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center and Department of Microbiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyunggon Kim
- Department of Convergence Medicine, Asan Medical Center, Department of Digital Medicine, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Yoo
- Department of Convergence Medicine, Asan Institute for Life Sciences, Asan Medical Center and Department of Microbiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jun Sul
- Department of Systems Biotechnology, Chung-Ang University, Anseong, Gyeonggi-do, Republic of Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Azarbakhsh H, Abdipour M, Moftakhar L. Years of life lost due to chronic obstructive pulmonary disease in Khuzestan province during 2011-2019: A population-based study. Lung India 2023; 40:37-41. [PMID: 36695257 PMCID: PMC9894273 DOI: 10.4103/lungindia.lungindia_371_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality and a major public health problem all over the world. Therefore, this study aimed to investigate the years of life lost (YLLs) due to COPD between 2011 and 2019 in Khuzestan province, southern Iran. Methods This cross-sectional study evaluated a total of 715 COPD-related deaths during 2011-2019 in Khuzestan, Southern Iran. Required information comprised of age, gender, and number of deaths were collected. First, crude and age-standardized mortality rates were calculated, and then the joinpoint regression was used to evaluate the trend of YLLs. Results The highest number of deaths during the study period was observed in males (65%) and in the age group of over 70 years (52.6%). There was also a decreasing trend in crude and age age-standardized mortality rates in both genders. The total number of YLLs in both genders was 8650, 5747 in men and 2903 in women. Based on the results of joinpoint regression, the percentage of annual YII changes was -1.5% in men, -10.7% in women, and -6.6% in both genders. Conclusion Estimating the trend of YLLs due to COPD can effectively help and lead the way of health policymakers and provide useful information to estimate the economic burden of the disease and assess health needs and priorities of a population.
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Affiliation(s)
- Habibollah Azarbakhsh
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Abdipour
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Moftakhar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang X, Chen H, Gu K, Jiang X. Association of Body Mass Index and Abdominal Obesity with the Risk of Airflow Obstruction: National Health and Nutrition Examination Survey (NHANES) 2007-2012. COPD 2022; 19:99-108. [PMID: 35385365 DOI: 10.1080/15412555.2022.2032627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to explore the relationship between body mass index (BMI) and abdominal obesity and the risk of airflow obstruction, based on the data from the 2007-2012 National Health and Nutrition Survey (NHANES). Logistic regression was applied to assess the relationships between BMI or abdominal obesity and the risk of airflow obstruction by the fixed ratio method and the lower limit of normal (LLN) method. We further used the restricted cubic splines with 3 knots located at the 5th, 50th, and 95th percentiles of the distribution to evaluate the dose-response relationship. A total of 12,865 individuals aged 20-80 years old were included. In the fixed ratio method, underweight was positively correlated with the risk of airflow obstruction, and overweight and obesity were negatively correlated with the risk of airflow obstruction. In the LLN method, the results were consistent with the fixed ratio method. Abdominal obesity was positively associated with the risk of airflow obstruction only in the fixed ratio method (OR: 1.41, 95% CI: 1.04-1.90). There was an additive interaction between underweight and smoking on airflow obstruction in both methods. Abdominal obesity and smoking had additive interactions in the LLN method. Dose-response analysis indicated that there was a non-linear trend between BMI and the risk of airflow obstruction (Pfor nonlinearity < 0.01). Our study suggested that underweight and abdominal obesity were associated with the increased risk of airflow obstruction, and overweight and general obesity were associated with the decreased risk of airflow obstruction.
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Affiliation(s)
- Xiaofei Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Hongru Chen
- Department of Epidemiology and Health Statistics, The School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Kunfang Gu
- Weifang Center for Disease Control and Prevention, Weifang, Shandong, China
| | - Xiubo Jiang
- Department of Epidemiology and Health Statistics, The School of Public Health, Qingdao University, Qingdao, Shandong, China
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Pereira TG, Lima J, Silva FM. Undernutrition is associated with mortality, exacerbation and poorer quality of life in COPD patients: a systematic review with meta‐analysis of observational studies. JPEN J Parenter Enteral Nutr 2022; 46:977-996. [DOI: 10.1002/jpen.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Thainá Gattermann Pereira
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Júlia Lima
- Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
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Eraslan Doganay G, Ulger G. The Relationship of Nutritional Treatments Applied to Patients in a Nutritional Clinic and Mortality. Cureus 2022; 14:e21579. [PMID: 35233299 PMCID: PMC8880877 DOI: 10.7759/cureus.21579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
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Tseng CC, Tu CY, Chen CH, Wang YT, Chen WC, Fu PK, Chen CM, Lai CC, Kuo LK, Ku SC, Fang WF. Significance of the Modified NUTRIC Score for Predicting Clinical Outcomes in Patients with Severe Community-Acquired Pneumonia. Nutrients 2021; 14:198. [PMID: 35011073 DOI: 10.3390/nu14010198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional status could affect clinical outcomes in critical patients. We aimed to determine the prognostic accuracy of the modified Nutrition Risk in Critically Ill (mNUTRIC) score for hospital mortality and treatment outcomes in patients with severe community-acquired pneumonia (SCAP) compared to other clinical prediction rules. We enrolled SCAP patients in a multi-center setting retrospectively. The mNUTRIC score and clinical prediction rules for pneumonia, as well as clinical factors, were calculated and recorded. Clinical outcomes, including mortality status and treatment outcome, were assessed after the patient was discharged. We used the receiver operating characteristic (ROC) curve method and multivariate logistic regression analysis to determine the prognostic accuracy of the mNUTRIC score for predicting clinical outcomes compared to clinical prediction rules, while 815 SCAP patients were enrolled. ROC curve analysis showed that the mNUTRIC score was the most effective at predicting each clinical outcome and had the highest area under the ROC curve value. The cut-off value for predicting clinical outcomes was 5.5. By multivariate logistic regression analysis, the mNUTRIC score was also an independent predictor of both clinical outcomes in SCAP patients. We concluded that the mNUTRIC score is a better prognostic factor for predicting clinical outcomes in SCAP patients compared to other clinical prediction rules.
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Mekal D, Czerw A, Deptala A. Dietary Behaviour and Nutrition in Patients with COPD Treated with Long-Term Oxygen Therapy. Int J Environ Res Public Health 2021; 18:12793. [PMID: 34886519 PMCID: PMC8657430 DOI: 10.3390/ijerph182312793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is the first study in Poland and one of the first in the world to assess the nutrition of patients with chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy (LTOT). METHODS The study group consisted of 110 COPD patients treated with LTOT. Anthropometric measurements and spirometry were performed. The diet of patients was assessed using a 3-day nutrition diary. RESULTS When assessing the degree of airflow obstruction (FEV1% N) depending on the BMI in patients treated with LTOT, a statistically significant correlation was demonstrated between the BMI and the value of the FEV% N parameter (p = 0.0093). Patients with COPD with a BMI >30 had statistically significantly higher values of FEV1% N than patients with a BMI in the range of 20-24.9 (p = 0.0278). Intake of calcium, vitamins A, C, D, E and folates was lower than the recommended daily intake in more than 95% of COPD patients. CONCLUSIONS The diet of COPD patients treated with long-term oxygen therapy was improperly balanced, with deficiencies of important nutrients. Airflow obstruction in the respiratory tract was significantly smaller in obese patients, and greater in patients with diagnosed malnutrition.
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Affiliation(s)
- Dominika Mekal
- Department of Cancer Prevention, Medical University of Warsaw, ul. Zwirki i Wigury 81, 02-291 Warszawa, Poland;
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, ul. Zwirki i Wigury 81, 02-291 Warszawa, Poland;
| | - Andrzej Deptala
- Department of Cancer Prevention, Medical University of Warsaw, ul. Zwirki i Wigury 81, 02-291 Warszawa, Poland;
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García García MDC, Hernández Borge J, García García GM, Márquez Pérez FL. Supervivencia en pacientes con EPOC en tratamiento con oxigenoterapia continua domiciliaria. Open Respiratory Archives 2021. [PMID: 37496844 PMCID: PMC10369520 DOI: 10.1016/j.opresp.2021.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction Continuous home oxygen therapy (CHOT), along with smoking cessation, is the first treatment that has been shown to increase the survival of patients with chronic obstructive pulmonary disease (COPD) and chronic hypoxemia. Objective To determine survival in a cohort of COPD patients receiving CHOT and to analyze the main causes and risk factors associated with their mortality. Methods Prospective study of a cohort of COPD patients receiving CHOT. Numerous variables, including survival and cause of death at the end of follow-up, were collected. Results A total of 409 COPD patients receiving CHOT were included (85.6% men; mean age: 71.27 ± 9.74 years). Mean time of CHOT follow-up was 5.86 ± 3.24 years and median survival was 6 years (95% CI: 5.47-6.53). Mortality at the end of follow-up was 75.8%, the leading cause of death being respiratory (36.9%). Longer survival was significantly associated with lower age, correct CHOT compliance, absence of exacerbations in the previous year, use of long-acting anticholinergics (LAMA), less severe COPD, presence of sleep apnea-hypopnea syndrome/obesity hypoventilation syndrome (SAHS/SHO), absence of malignant disease, heart disease, cerebrovascular disease, and kidney disease. Conclusions The survival of COPD patients receiving CHOT was very long. The main causes of mortality were respiratory (36.9%). Independent predictors of mortality were age, presence of exacerbations in the previous year, previous diagnosis of cancer, and presence of cerebrovascular and renal disease.
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Kandathil A, Mills RA, Hanna M, Merchant AM, Wehrmann LE, Minhajuddin A, Abbara S, Fox AA. Abdominal adiposity assessed using CT angiography associates with acute kidney injury after trans-catheter aortic valve replacement. Clin Radiol 2020; 75:921-926. [PMID: 32782129 DOI: 10.1016/j.crad.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM To determine if there is an association between area-based visceral abdominal adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), and abdominal circumference measured on computed tomography (CT) angiography before trans-catheter aortic valve replacement (TAVR) and post-TAVR acute kidney injury (AKI). MATERIALS AND METHODS In this retrospective cohort study of 106 TAVR patients, SAT and VAT areas and abdominal circumference was measured on a single CT section at L4 vertebral level. Univariate comparisons between patients who did and did not develop AKI were undertaken for radiological measurements. Multivariable logistic regression was used to assess association between CT measurements and the development of post-TAVR AKI. RESULTS Post-TAVR AKI occurred in 20 of 106 patients (19%). In univariate comparisons, body mass index (BMI) did not differ significantly between patients who did and did not develop AKI (p=0.14); however, VAT+SAT (443.2±163.7 versus 351±168.7 cm2; p=0.03), VAT (213.9±110.6 versus 153.9±96.1 cm2; p=0.03), and outer abdominal circumference (100.2±14.4 cm versus 91.8±13.3 cm; p=0.02) were significantly higher in the patients who did not develop post-TAVR AKI. These three measures on pre-TAVR CT angiogram remained significantly associated with reduced post-TAVR AKI with a lower incidence of post-TAVR AKI after multivariable adjustment for pre-TAVR estimated glomerular filtration rate and patient height (p<0.05). CONCLUSION This study found that increased abdominal obesity as assessed by measures on pre-TAVR CT angiogram is associated with a significantly lower incidence of AKI.
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Affiliation(s)
- A Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - R A Mills
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - M Hanna
- Department of Radiology, UT Health Science Center, Houston, TX, 77030, USA
| | - A M Merchant
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - L E Wehrmann
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - A Minhajuddin
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - S Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - A A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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Nasir SA, Singh S, Fotedar M, Chaudhari SK, Sethi KK. Echocardiographic Evaluation of Right Ventricular Function and its Role in the Prognosis of Chronic Obstructive Pulmonary Disease. J Cardiovasc Echogr 2020; 30:125-130. [PMID: 33447502 PMCID: PMC7799065 DOI: 10.4103/jcecho.jcecho_10_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with structural and mechanical changes in the pulmonary vascular bed that increase right ventricular (RV) afterload and subsequently right heart failure. OBJECTIVES The aim of the study was to elucidate RV dysfunction at rest by echocardiography in a cohort of COPD patients and to study its impact on prognosis. METHODS 84 patients of COPD and 40 matching healthy controls were evaluated at baseline. Evaluation included clinical examination, pulmonary function tests; 6 minutes walk test and echocardiography. Patient with COPD were again evaluated after 6 months. RESULTS All echocardiographic parameters of RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (P = 0.018). All the six patients who died had three or more abnormal RV systolic function parameters. CONCLUSIONS RV myocardial performance index and basal strain showed largest difference between controls and COPD cases. Clinical deterioration was more common in patients with abnormal RV function parameters and pulmonary hypertension.
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Affiliation(s)
- Syed Aijaz Nasir
- Department of Cardiology, Delhi Heart and Lung Institute, New Delhi, India
| | - Sukhvinder Singh
- Department of Cardiology, Delhi Heart and Lung Institute, New Delhi, India
| | - Madhulata Fotedar
- Department of Cardiology, Delhi Heart and Lung Institute, New Delhi, India
| | - Sai Kiran Chaudhari
- Department of Pulmonary Medicine, Delhi Heart and Lung Institute, New Delhi, India
| | - Kamal Kumar Sethi
- Department of Cardiology, Delhi Heart and Lung Institute, New Delhi, India
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Jang YO, Lee SH, Choi JJ, Kim DH, Choi JM, Kang MJ, Oh YM, Park YJ, Shin Y, Lee SW. Fecal microbial transplantation and a high fiber diet attenuates emphysema development by suppressing inflammation and apoptosis. Exp Mol Med 2020; 52:1128-1139. [PMID: 32681029 PMCID: PMC8080776 DOI: 10.1038/s12276-020-0469-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Recent work has suggested a microbial dysbiosis association between the lung and gut in respiratory diseases. Here, we demonstrated that gut microbiome modulation attenuated emphysema development. To modulate the gut microbiome, fecal microbiota transplantation (FMT) and diet modification were adopted in mice exposed to smoking and poly I:C for the emphysema model. We analyzed the severity of emphysema by the mean linear intercept (MLI) and apoptosis by the fluorescent TUNEL assay. Microbiome analysis was also performed in feces and fecal extracellular vesicles (EVs). The MLI was significantly increased with smoking exposure. FMT or a high-fiber diet (HFD) attenuated the increase. Weight loss, combined with smoking exposure, was not noted in mice with FMT. HFD significantly decreased macrophages and lymphocytes in bronchoalveolar lavage fluid. Furthermore, IL-6 and IFN-γ were decreased in the bronchoalveolar lavage fluid and serum. The TUNEL score was significantly lower in mice with FMT or HFD, suggesting decreased cell apoptosis. In the microbiome analysis, Bacteroidaceae and Lachnospiraceae, which are alleged to metabolize fiber into short-chain fatty acids (SCFAs), increased at the family level with FMT and HFD. FMT and HFD attenuated emphysema development via local and systemic inhibition of inflammation and changes in gut microbiota composition, which could provide a new paradigm in COPD treatment.
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Affiliation(s)
- Yoon Ok Jang
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Se Hee Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, 13496, Republic of Korea
| | - Jong Jin Choi
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Do-Hyun Kim
- Department of Life Science, College of Natural Sciences, Research Institute for Natural Sciences, Research Institute for Convergence of Basic Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Je-Min Choi
- Department of Life Science, College of Natural Sciences, Research Institute for Natural Sciences, Research Institute for Convergence of Basic Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Min-Jong Kang
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, 06520-8057, Connecticut, USA
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Young-Jun Park
- Environmental Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea
| | - Yong Shin
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
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Naz I, Sahin H, Varol Y, Kömürcüoğlu B. The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients. Chron Respir Dis 2020; 16:1479972318809472. [PMID: 30428708 PMCID: PMC6301838 DOI: 10.1177/1479972318809472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CLINICAL TRIAL NUMBER NCT03319108.
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Affiliation(s)
- Ilknur Naz
- 1 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Hulya Sahin
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yelda Varol
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Berna Kömürcüoğlu
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Hanson C, Bowser EK, Frankenfield DC, Piemonte TA. Chronic Obstructive Pulmonary Disease: A 2019 Evidence Analysis Center Evidence-Based Practice Guideline. J Acad Nutr Diet 2020; 121:139-165.e15. [PMID: 32081589 DOI: 10.1016/j.jand.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 02/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline. This publication outlines the Academy's Evidence Analysis Library methods used to complete the systematic review and guideline and examines the recommendations and supporting evidence. A total of 14 recommendations were developed based on evidence from eight conclusions. Using the Nutrition Care Process as a framework for practice, recommendations rated as strong included assessing and monitoring and evaluating body weight and medical nutrition therapy by a registered dietitian nutritionist. Weak recommendations included predicting resting and total energy expenditure. All other recommendations were rated as fair. These included individualizing the calorie prescription and macronutrient composition of the diet; assessing and monitoring and evaluating energy intake, serum 25-hydroxyvitamin D levels, and frequency of exacerbations; and determining need for vitamin D supplementation. Fewer than one-third of the systematic review's conclusions could be used to support the recommendations due to conflicting results or limited or no evidence available. The Evidence Analysis Library 2019 COPD Evidence-Based Nutrition Practice Guideline is a valuable resource for registered dietitian nutritionists and other health care professionals caring for those with COPD.
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Affiliation(s)
| | - Ellen K Bowser
- (2)Pediatric Pulmonary Division, University of Florida, Gainesville, FL
| | - David C Frankenfield
- (3)Department of Clinical Nutrition, Penn State Health Milton S. Hersey Medical Center, Hershey, PA
| | - Tami A Piemonte
- (4)Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Centre, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, Democritus University of Thrace School of Health Sciences, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London, Royal Free Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
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Burgos R, Joaquín C, Blay C, Vaqué C. Disease-related malnutrition in hospitalized chronic patients with complex needs. Clin Nutr 2020; 39:1447-53. [PMID: 31256806 DOI: 10.1016/j.clnu.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Disease-related malnutrition is a prevalent condition that can be associated with multimorbidity. The purposes of this study were to assess the prevalence of disease-related malnutrition in a cohort of chronic patients with complex needs (CPCN) admitted to two University hospitals, and to evaluate the impact of malnutrition in their hospitalization outcomes. METHODS All CPCN admitted on a previously agreed day in non-critical services of two University hospitals in Catalonia were included. Nutritional risk was evaluated with Mini-Nutritional Assessment Tool and Nutritional Risk Screening 2002. Hospitalization outcome data were evaluated, including length of the hospital stay, mortality during admission and placement when discharged. After five months, a new evaluation was performed to assess mortality and readmissions. RESULTS A total of 101 patients were included, 83% of which were at nutritional risk when screened with NRS-2002; when using MNA, 86% of them were found to be either at nutritional risk or malnourished. Malnourished patients had a greater need for home care/intermediate care hospital at discharge (41.8% vs 22.9%, p < 0.01), and a higher mortality rate during admission (16.7% vs 1.6%, p < 0.01). Mortality at 5 months was also higher in the malnourished group (30.5% vs 9.8%, p < 0.01). Factors associated with malnutrition were BMI and gender (malnutrition was more prevalent in women). In our cohort, malnutrition was the sole independent predictor of mortality at 5 months. CONCLUSIONS The prevalence of both malnutrition and risk of malnutrition is very high in hospital-admitted CPCN, and has a profound impact on placement at discharge and mortality. This high prevalence is not explained by the multimorbidity pattern. Other factors need to be evaluated in this group of high-need, high-cost patients.
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Eroglu SA, Gunen H, Yakar HI, Yildiz E, Kavas M, Duman D. Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients. J Thorac Dis 2019; 11:1379-1386. [PMID: 31179080 DOI: 10.21037/jtd.2019.03.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity around the world, with comorbidities in COPD being common and having a negative effect on survival. We investigate the effects of comorbidities on long-term survival of COPD patients. Methods The study included patients with COPD who were hospitalized with an exacerbation. The demographic characteristics, hematological and biochemical parameters, pulmonary function test parameters and comorbidities of the patients were obtained from the hospital database and patient records, and the mortality of the patients was assessed at two years. The parameters considered to be related to mortality were analyzed using the Cox regression method. Results A total of 826 patients with COPD were included in the study, and the rate of patients with at least one comorbidity was 84.5%. The most common comorbidities were hypertension (n=394, 47.7%), heart failure (n=244, 29.5%) and DM (n=173, 20.9%). In a Cox regression analysis, the Charlson Comorbidity Index was strongly associated with mortality (P=0.000). In Kaplan-Meier analysis, a significant association was noted between the increasing number of comorbidities and long-term mortality, when compared to the patients without comorbidity (comorbidity numbers 1, 2 and ≥3; HR: 1.37, P=0.032, HR: 1.40, P=0.028 and HR: 1.65, P=0.000, respectively). Conclusions Increasing number of comorbidities in COPD patients with severe exacerbation were found to negatively affect long-term survival. We consider both the evaluation and treatment of comorbidities to be important in the reduction of long-term mortality in patients with COPD.
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Affiliation(s)
- Selma Aydogan Eroglu
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Hakan Gunen
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Halil Ibrahim Yakar
- Department of Pulmonary Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ethem Yildiz
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Murat Kavas
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
| | - Dildar Duman
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Istanbul, Turkey
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Mukhopadhyay A, Kowitlawakul Y, Henry J, Ong V, Leong CSF, Tai BC. Higher BMI is associated with reduced mortality but longer hospital stays following ICU discharge in critically ill Asian patients. Clin Nutr ESPEN 2018; 28:165-170. [PMID: 30390876 DOI: 10.1016/j.clnesp.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied. METHODS We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014. Demographics, BMI, MV, comorbidities, ICU scores (Acute Physiology And Chronic Health Evaluation (APACHE) II and sequential organ failure assessment (SOFA)), use of vasopressor, renal replacement therapy and calorie supplementation were collected from the ICU database. BMI was categorized into four groups according to the World Health Organization's Asian BMI recommendation. Post-ICU LOS (days) was calculated from ICU discharge to hospital discharge in hospital survivors. We used multivariable logistic regression to identify factors associated with 28-day mortality and post-ICU LOS of more than 7 days. RESULTS In a cohort of 273 patients (male 62%, mean age 58.4 ± 17 years), the prevalence of overweight/obesity was 53%. In the bivariate analysis, 28-day mortality was lower (p = 0.014) and post-ICU LOS longer (p = 0.01) in the overweight/obese groups. In the multivariable logistic regression analysis, APACHE II (Odds ratio, OR 1.10, CI 1.05-1.16), SOFA (OR 1.17, CI 1.05-1.31), duration of MV (days, OR 1.14, CI 1.05-1.25) were associated with increased and higher BMI groups (p < 0.001) with decreased 28-day mortality. Further analysis of 196 hospital survivors showed age (OR 1.04, CI 1.02-1.06), duration of MV (days, OR 1.14, CI 1.02-1.27) and higher Asian BMI (p = 0.042) were associated with longer post-ICU LOS. The odds of longer post-ICU LOS amongst overweight and obese patients were 1.27 (CI 0.59-2.73) and 1.62 (CI 0.69-3.81) times that of those with normal BMI respectively. CONCLUSION In multiethnic critically ill Asian patients, the prevalence of overweight/obesity was high. Although higher BMI was associated with reduced risk of 28-day mortality, obese patients stayed significantly longer in the hospital following ICU discharge.
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Affiliation(s)
- Amartya Mukhopadhyay
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System and National University of Singapore, Singapore.
| | - Yanika Kowitlawakul
- Alice Lee Centre for Nursing Studies, National University Health System and National University of Singapore, Singapore
| | - Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore
| | - Venetia Ong
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System and National University of Singapore, Singapore
| | - Claudia Shu-Fen Leong
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Sayed MA, El-Sherif RM, Mohamed AR, El-Sherif AA. Low-level laser therapy in chronic obstructive lung disease. Egypt J Bronchol 2018. [DOI: 10.4103/ejb.ejb_110_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Abebaw Mengistu Yohannes
- School of Behavioral and Applied Sciences, Dept of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
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Storgaard LH, Hockey HU, Laursen BS, Weinreich UM. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis 2018; 13:1195-1205. [PMID: 29713153 PMCID: PMC5909797 DOI: 10.2147/copd.s159666] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). PATIENTS AND METHODS A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George's Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV1), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO2) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV1, FEV1%, PaCO2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device. RESULTS The average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p<0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively (p<0.001). The HFNC group had improved mMRC scores from 3 months onward (p<0.001) and improved SGRQ at 6 and 12 months (p=0.002, p=0.033) and PaCO2 (p=0.005) and 6MWT (p=0.005) at 12 months. There was no difference in all-cause mortality. CONCLUSION HFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.
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Affiliation(s)
- Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Birgitte Schantz Laursen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Baba S, Takashima T, Hirota M, Kawashima M, Horikawa E. Relationship between pulmonary function and elevated glycated hemoglobin levels in health checkups: A cross-sectional observational study in Japanese participants. J Epidemiol 2017; 27:511-515. [PMID: 28142050 PMCID: PMC5608596 DOI: 10.1016/j.je.2016.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 10/18/2016] [Indexed: 12/14/2022] Open
Abstract
Background Insulin resistance has been associated with cytokines, including interleukin-6 and tumor necrosis factor alpha soluble receptor, both of which are elevated in chronic obstructive pulmonary disease (COPD). Few studies have investigated the relationship between pulmonary function tests using spirometry (PFT) and fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) levels in Japanese participants. The purpose of this study was to clarify the relationship between PFT in Japanese people who had health checkups and their FPG or HbA1c levels. In the context of preventative medicine, we intend to connect early detection of COPD to an index of blood sugar. Methods From August 2013 through March 2014, 1019 participants underwent health checkups. PFT, FPG, and HbA1c measurements were conducted. HbA1c levels were measured according to National Glycohemoglobin Standardization Program guidelines. Results Participants with FPG ≥100 mg/dL and HbA1c ≥5.6% showed a significantly lower forced expiratory volume in 1 s:forced vital capacity ratio (FEV1/FVC) compared to participants with lower FPG and Hb1Ac levels. Prevalence of FEV1/FVC values <70% in PFT differed significantly depending on sex, age, body mass index, FPG, HbA1c, and smoking habits. Age (≥60 years), HbA1c (≥5.6%), and current or former smoking were associated with FEV1/FVC values <70%. Conclusion In Japan, HbA1c levels were higher in participants with FEV1/FVC values <70% in PFT than in those with FEV1/FVC ≥70%. In preventive medicine, PFT by spirometry should be performed in elderly participants with elevated HbA1c levels who are current or former smokers. Participants with FEV1/FVC values <70% had significantly elevated HbA1c levels. Age, HbA1c, and current or former smoking were associated with FEV1/FVC values <70%. Elderly ever smokers with elevated HbA1c should undergo screened for COPD.
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Affiliation(s)
- Saigo Baba
- International University of Health and Welfare, Department of Nursing, Fukuoka, Japan.
| | - Toru Takashima
- International University of Health and Welfare, Department of Nursing, Fukuoka, Japan
| | - Miki Hirota
- Japan Community Health Care Organization (JCHO), Saga Central Hospital Health Administration Center, Saga, Japan
| | - Michihiro Kawashima
- Japan Community Health Care Organization (JCHO), Saga Central Hospital, Saga, Japan
| | - Etsuo Horikawa
- Mobility Research Laboratory, Center for Comprehensive and Community Medicine, Graduate School of Medicine, Saga University, Saga, Japan
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Gaddam S, Gunukula SK, Lohr JW, Arora P. Prevalence of chronic kidney disease in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMC Pulm Med 2016; 16:158. [PMID: 27881110 PMCID: PMC5122151 DOI: 10.1186/s12890-016-0315-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/07/2016] [Indexed: 01/18/2023] Open
Abstract
Background The incidence and prevalence of chronic kidney disease (CKD) continue to rise worldwide. Increasing age, diabetes, hypertension, and cigarette smoking are well-recognized risk factors for CKD. Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation leading to airway obstruction and parenchymal lung destruction. Due to some of the common pathogenic mechanisms, COPD has been associated with increased prevalence of CKD. Methods Systematic review of medical literature reporting the incidence and prevalence of CKD in patients with COPD using the Cochrane Collaboration Methodology, and conduct meta-analysis to study the cumulative effect of the eligible studies. We searched Medline via Ovid, PubMed, EMBASE and ISI Web of Science databases from 1950 through May, 2016. We included prospective and retrospective observational studies that reported the prevalence of CKD in patients with COPD. Results Our search resulted in 19 eligible studies of which 9 have been included in the meta-analysis. The definition of CKD was uniform across all the studies included in analysis. COPD was found to be associated with CKD in the included epidemiological studies conducted in many countries. Our meta-analysis showed that COPD was found to be associated with a significantly increased prevalence of CKD (Odds Ratio [OR] = 2.20; 95% Confidence Interval [CI] 1.83, 2.65). Study limitations: Studies included are observational studies. However, given the nature of our research question there is no possibility to perform a randomized control trial. Conclusions Patients with COPD have increased odds of developing CKD. Future research should investigate the pathophysiological mechanism behind this association, which may lead to better outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0315-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Swarna Gaddam
- Division of Nephrology at VAMC, Buffalo, NY, USA. .,Department of Medicine, SUNY, Buffalo, NY, USA.
| | | | - James W Lohr
- Division of Nephrology at VAMC, Buffalo, NY, USA.,Department of Medicine, SUNY, Buffalo, NY, USA
| | - Pradeep Arora
- Division of Nephrology at VAMC, Richmond, VA, USA.,Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Rizzi M, Airoldi A, Cristiano A, Frassanito F, Macaluso C, Vanni S, Legnani D. Oxygen therapy in COPD patients with isolated nocturnal hypoxemia; comparison of quality of life and sleep between bronchitis and emphysema phenotype: A prospective observational study. Eur J Intern Med 2016; 34:78-84. [PMID: 27614376 DOI: 10.1016/j.ejim.2016.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND COPD is a heterogeneous disease composed by two main phenotypes: bronchitis (COPDb) and emphysema (COPDe) with different clinical presentation, physiology, imaging, response to therapy and decline in lung function. The aim of this study is to evaluate whether nocturnal hypoxemic COPDb and COPDe have a different behaviour during sleep and the effect of nocturnal oxygen supplementation (nO2LT). MATERIALS AND METHODS 75 COPDb and 120 COPDe were enrolled. All patients performed polysomnography, Pittsburgh and Maugeri Foundation Respiratory Failure questionnaire, and pulmonary function before and after six months of nO2LT. RESULTS At baseline, compared to COPDb, COPDe have decreased sleep efficiency (SE) (67.5±6% vs. 76.9±3% p<0.05) and higher arousals (A/I) (18.1±3 event/h vs. 8.7±1 event/h p<0.05). Oxygen desaturation index (ODI) was increased during REM (7.1±1 event/h vs. 2.3±0.5 event/h p<0.05). nO2LT in COPDe improves SE (77±4% vs. 67.5±6% p<0.05) and decreases A/I (9±5 event/h vs. 18.1±3 event/h p<0.05). ODI during REM (3.5±2 event/h vs. 7.1±1 p<0.05) decreases and quality of life (QoL) improves (MFR-28 total 56±22 vs 45±20 p<0.05), due to an improvement in cognitive abilities (45±30 vs 33±31 p<0.05) and daily activities (61±29 vs 53±21 p>0.05). In COPDb nO2LT reduces ST90 (15±6% vs. 43±8% p<0.05) less than in COPDe (15±6% vs. 8±4% p<0.05); improves A/I (10±2 event/h vs. 8.7±1 p<0.05) and there is no evidence of an improvement in QoL. CONCLUSIONS Six months of nO2LT improve quality of life in COPDe, not in COPDb. We found a difference in sleep quality between COPDe and COPDb.
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Affiliation(s)
- Maurizio Rizzi
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Andrea Airoldi
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Andrea Cristiano
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | | | - Claudio Macaluso
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Silvia Vanni
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Delfino Legnani
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
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Tannus-Silva DGS, Masson-Silva JB, Ribeiro LS, Conde MB, Rabahi MF. Myocardial performance index correlates with the BODE index and affects quality of life in COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11:2261-2268. [PMID: 27695314 PMCID: PMC5033620 DOI: 10.2147/copd.s110779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective COPD, a systemic illness associated with the impairment of different organs, affects patient prognosis and quality of life. The aim of this study was to evaluate the association between right ventricle (RV) function, the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (a multifunctional scale for the assessment of mortality risk), and quality of life in patients with COPD. Methods A cross-sectional study was carried out in 107 outpatients presenting with stable COPD who underwent clinical assessment, spirometry, arterial blood gas analyses, a 6-minute walk test, electrocardiography, and echocardiogram and who responded to the Saint George’s Respiratory Questionnaire (SGRQ). Results Among the study subjects, 53% (57/107) were males, and the mean age was 65.26±8.81 years. A positive correlation was observed between RV dysfunction measured by the myocardial performance index using tissue Doppler (MPIt) and the BODE index, even after adjustment for age and partial pressure of oxygen (r2=0.47; P<0.01). Patients with alterations in the MPIt had worse quality of life, and a statistically significant difference was found for different domains of the SGRQ. Patients with a normal MPIt had a mean total score of 46.2±18.6, whereas for those with MPIt alterations, the mean total score was 61.6±14.2 (P=0.005). These patients had a 1.49-fold increased risk of exhibiting SGRQ total score above the upper limit of the 95% CI (P=0.01). Conclusion The findings of this study suggest that RV dysfunction as measured by the MPIt was associated with impairment in quality of life and a worse BODE index in COPD patients, irrespective of age and hypoxemia status.
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Affiliation(s)
| | | | | | - Marcus Barreto Conde
- Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro; Faculdade de Medicina de Petrópolis, Petrópolis, Rio de Janeiro, Brazil
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Tokgoz Akyil F, Gunen H, Agca M, Gungor S, Yalcinsoy M, Sucu P, Akyil M, Sevim T. Supervivencia en exacerbaciones de la enfermedad pulmonar obstructiva crónica que requirieron ventilación no invasiva en planta. Arch Bronconeumol 2016; 52:470-6. [DOI: 10.1016/j.arbres.2016.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 01/07/2023]
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Abstract
The aim of this study is to summarize the evidence on the dose-response relationship between body mass index (BMI) and mortality in patients with chronic obstructive pulmonary disease (COPD).We performed a systemic literature search in PubMed, Embase, and Web of Science for relevant studies that were published until June 2015. A random effects meta-analysis was used to estimate the pooled relative risks (RRs) of all-cause mortality in COPD patients with normal weight compared with those who were underweight, overweight, or obese. In addition, a dose-response meta-analysis was conducted to explore the dose-response relationship between BMI and all-cause mortality in COPD patients.A total of 17 observational studies involving 30,182 COPD patients among 285,960 participants were included. Compared with the reference category, the RRs of underweight, overweight, and obese individuals were 1.40 (95% confidence interval (CI), 1.20-1.63), 0.80 (95% CI, 0.67-0.96), and 0.77 (95% CI, 0.62-0.95), respectively. A significant nonlinear relationship between BMI and mortality of COPD patients was found by using a random effects model. COPD patients with BMI of <21.75 kg/m had a higher risk of death. Moreover, an increase in the BMI resulted in a decrease in the risk of death. The risk of death was lowest when BMI was 30 kg/m (RR = 0.69; 95% CI, 0.53-0.89). The BMI was not associated with all-cause mortality when BMI was >32 kg/m.Our findings indicate that overweight is associated with a lower risk of all-cause mortality among patients with COPD whereas underweight is associated with a higher risk of all-cause mortality in these patients. However, there is limited evidence to support the association between obesity and the risk of all-cause mortality in patients with COPD.
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Affiliation(s)
| | | | - Zhiyong Wang
- Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Qin Xu
- Department of Health Statistics
| | - Wei Guo
- Department of Health Statistics
| | | | - Jia He
- Department of Health Statistics
- Correspondence: Jia He and Cheng Wu, Department of Health Statistics, Second Military Medical University, Shanghai, China (e-mail: and )
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Thibault R, Samaras N, Samaras D, Chambellan A, Pichard C. Réhabilitation respiratoire dans la broncho-pneumopathie chronique obstructive (BPCO) : l’androgénothérapie, pourquoi ? Pour qui ? Comment ? NUTR CLIN METAB 2016; 30:74-82. [DOI: 10.1016/j.nupar.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kanao K, Shiraishi M, Higashimoto Y, Maeda K, Sugiya R, Okajima S, Chiba Y, Yamagata T, Terada K, Fukuda K, Tohda Y. Factors associated with the effect of pulmonary rehabilitation on physical activity in patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2015; 17:17-23. [PMID: 26634413 DOI: 10.1111/ggi.12656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Abstract
AIM Although the effects of pulmonary rehabilitation (PR) have been well defined for chronic obstructive pulmonary disease (COPD), it remains controversial whether PR improves physical activity (PA). The purpose of the present study was to identify factors associated with the effect of PR on PA. METHODS This was a prospective study of 29 patients with COPD. They underwent pulmonary rehabilitation twice weekly for 12 weeks, and were assessed using the hospital anxiety and depression score, 6-min walk distance (6MWD), and the St. George Respiratory Questionnaire (SGRQ) before and after they underwent PR. The PA of patients was measured by a three-axis accelerometer. Physical activity level (PAL) was calculated by dividing each patient's total energy expenditure by basal metabolic rate. Correlations between changes in PAL after PR and 6MWD, St. George Respiratory Questionnaire, and hospital anxiety and depression score scores, and clinical parameters, including forced expiratory volume in 1 s were determined. RESULTS 6MWD was significantly increased, but PAL was unchanged after PR. PAL was positively correlated with 6MWD, but not with percent predicted forced expiratory volume in 1 s nor St. George Respiratory Questionnaire scores before PR. The increase in PAL was negatively correlated with changes in hospital anxiety and depression score anxiety and depression scores, but was not correlated with the change in 6MWD. CONCLUSIONS A PR program for COPD patients improved results of the 6MWD, but not PAL. Increased PAL was associated with improvements in anxiety and depression, but not with increased exercise capacity. Treating the depression and anxiety of patients with COPD might not only reduce emotional distress, but also improve their PAL. Geriatr Gerontol Int 2017; 17: 17-23.
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Affiliation(s)
- Kenro Kanao
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Japan.,Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka, Osaka, Japan
| | - Masashi Shiraishi
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Yuji Higashimoto
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Kazushige Maeda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Ryuji Sugiya
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Satoshi Okajima
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Toshiyuki Yamagata
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Katsuhiko Terada
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Japan
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Higashimoto Y, Yamagata T, Maeda K, Honda N, Sano A, Nishiyama O, Sano H, Iwanaga T, Chiba Y, Fukuda K, Tohda Y. Influence of comorbidities on the efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2015; 16:934-41. [PMID: 26246006 DOI: 10.1111/ggi.12575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the influence of comorbidities and aging on pulmonary rehabilitation (PR) efficacy in patients with chronic obstructive pulmonary disease (COPD). METHODS This was a retrospective cohort study of patients with COPD attending an outpatient PR program. Comorbidity information was collected with the Charlson Index, BODE index and COPD-specific comorbidity test, and also included other common conditions not included in these indexes. The efficacy of PR was defined as a 54-m increase in 6-min walk distance or a four-point decrease in St. George's Respiratory Questionnaire score. Patients were divided into two age groups according to the median age of 72 years. RESULTS A total of 21 of 52 patients (40%) showed a clinically significant benefit by the 6-min walk distance, and 29 patients (55.8%) by the St. George's Respiratory Questionnaire score. PR efficacy was not different between the elderly group and the younger group by either parameter. A total of 98% of the patients had at least one chronic comorbidity. Hypertension was the most frequently reported comorbidity (28.5%). Higher body mass index, Hospital Anxiety and Depression Scale anxiety score and St. George's Respiratory Questionnaire total score were associated with a good response to PR by the 6-min walk distance. None of the individual comorbidities or indexes were correlated with the efficacy of PR. Multiple logistic regression analysis showed that body mass index was independently associated with the response to PR. CONCLUSIONS PR is equally effective in elderly and younger patients with COPD, with efficacy influenced by body mass index and anxiety. Geriatr Gerontol Int 2016; 16: 934-941.
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Affiliation(s)
- Yuji Higashimoto
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Toshiyuki Yamagata
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kazushige Maeda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Noritsugu Honda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Akiko Sano
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kinki University, Faculty of Medicine, Osakasayama, Osaka, Japan
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Putcha N, Drummond MB, Wise RA, Hansel NN. Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management. Semin Respir Crit Care Med 2015; 36:575-91. [PMID: 26238643 DOI: 10.1055/s-0035-1556063] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities impact a large proportion of patients with chronic obstructive pulmonary disease (COPD), with over 80% of patients with COPD estimated to have at least one comorbid chronic condition. Guidelines for the treatment of COPD are just now incorporating comorbidities to their management recommendations of COPD, and it is becoming increasingly clear that multimorbidity as well as specific comorbidities have strong associations with mortality and clinical outcomes in COPD, including dyspnea, exercise capacity, quality of life, healthcare utilization, and exacerbation risk. Appropriately, there has been an increased focus upon describing the burden of comorbidity in the COPD population and incorporating this information into existing efforts to better understand the clinical and phenotypic heterogeneity of this group. In this article, we summarize existing knowledge about comorbidity burden and specific comorbidities in COPD, focusing on prevalence estimates, association with outcomes, and existing knowledge about treatment strategies.
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Affiliation(s)
- Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Rayner JJ, Neubauer S, Rider OJ. The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy. Obes Rev 2015; 16:679-90. [PMID: 26096833 DOI: 10.1111/obr.12292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the 'obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.
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Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Davis SD, Ferkol TW, Rosenfeld M, Lee HS, Dell SD, Sagel SD, Milla C, Zariwala MA, Pittman JE, Shapiro AJ, Carson JL, Krischer JP, Hazucha MJ, Cooper ML, Knowles MR, Leigh MW. Clinical features of childhood primary ciliary dyskinesia by genotype and ultrastructural phenotype. Am J Respir Crit Care Med 2015; 191:316-24. [PMID: 25493340 DOI: 10.1164/rccm.201409-1672oc] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE The relationship between clinical phenotype of childhood primary ciliary dyskinesia (PCD) and ultrastructural defects and genotype is poorly defined. OBJECTIVES To delineate clinical features of childhood PCD and their associations with ultrastructural defects and genotype. METHODS A total of 118 participants younger than 19 years old with PCD were evaluated prospectively at six centers in North America using standardized procedures for diagnostic testing, spirometry, chest computed tomography, respiratory cultures, and clinical phenotyping. MEASUREMENTS AND MAIN RESULTS Clinical features included neonatal respiratory distress (82%), chronic cough (99%), and chronic nasal congestion (97%). There were no differences in clinical features or respiratory pathogens in subjects with outer dynein arm (ODA) defects (ODA alone; n = 54) and ODA plus inner dynein arm (IDA) defects (ODA + IDA; n = 18) versus subjects with IDA and central apparatus defects with microtubular disorganization (IDA/CA/MTD; n = 40). Median FEV1 was worse in the IDA/CA/MTD group (72% predicted) versus the combined ODA groups (92% predicted; P = 0.003). Median body mass index was lower in the IDA/CA/MTD group (46th percentile) versus the ODA groups (70th percentile; P = 0.003). For all 118 subjects, median number of lobes with bronchiectasis was three and alveolar consolidation was two. However, the 5- to 11-year-old IDA/CA/MTD group had more lobes of bronchiectasis (median, 5; P = 0.0008) and consolidation (median, 3; P = 0.0001) compared with the ODA groups (median, 3 and 2, respectively). Similar findings were observed when limited to participants with biallelic mutations. CONCLUSIONS Lung disease was heterogeneous across all ultrastructural and genotype groups, but worse in those with IDA/CA/MTD ultrastructural defects, most of whom had biallelic mutations in CCDC39 or CCDC40.
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Pizarro C, Schueler R, Hammerstingl C, Tuleta I, Nickenig G, Skowasch D. Impact of endoscopic lung volume reduction on right ventricular myocardial function. PLoS One 2015; 10:e0121377. [PMID: 25856379 PMCID: PMC4391861 DOI: 10.1371/journal.pone.0121377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/31/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Endoscopic lung volume reduction (ELVR) provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV) function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis. Methods We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc.), comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval. Results Patients were predominantly of late middle-age (65.8±8.7yrs), male (62.5%) and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively). After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96±7.02% vs. -13.35±11.48%, p=0.04), whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p=0.03). However, clinical non-responders did not exhibit any RtV functional improvement. Discussion ELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.
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Affiliation(s)
- Carmen Pizarro
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
- * E-mail:
| | - Robert Schueler
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - Christoph Hammerstingl
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - Izabela Tuleta
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - Georg Nickenig
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - Dirk Skowasch
- University Hospital Bonn, Department of Internal Medicine II, Cardiology, Pneumology and Angiology, Bonn, Germany
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Steiner J, Wu WC, Jankowich M, Maron BA, Sharma S, Choudhary G. Echocardiographic predictors of mortality in patients with pulmonary hypertension and cardiopulmonary comorbidities. PLoS One 2015; 10:e0119277. [PMID: 25774911 PMCID: PMC4361665 DOI: 10.1371/journal.pone.0119277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to identify the echocardiographic measures associated with survival in a patient population with a high prevalence of co-morbid cardiovascular and pulmonary disease that have significantly elevated estimated pulmonary artery systolic pressures (ePASP). BACKGROUND Pulmonary hypertension (PH) is a clinical feature of several cardiopulmonary diseases that are prevalent among elderly. While certain echocardiographic parameters have been shown to be important in the prognosis in specific PH groups, the prognostic relevance of echocardiographic characteristics in a cohort with multiple cardiopulmonary comorbidities is unclear. METHODS We retrospectively identified 152 patients with ePASP > 60 mmHg by echocardiography over a five year period (6/2006-11/2011) and followed until 4/2013. Candidate clinical and echocardiographic characteristics suggestive of PH severity were compared between deceased and surviving subpopulations. Cox proportional hazard modeling was used to identify echocardiographic predictors of death adjusted for age and clinical characteristics. RESULTS This was a predominantly elderly (age 78.8 ± 10.2 years), male (98.7%) cohort with several cardiopulmonary comorbidities. Overall mortality was high (69.7%, median survival 129 days). After adjusting for age and clinical characteristics, decreased right ventricular (RV) systolic function assessed by tricuspid annular plane systolic excursion (HR 0.56, 95% CI 0.33-0.96, p = 0.034) and increased RV thickness (HR: 4.34, 95% CI: 1.49-12.59, p = 0.007) were independently associated with mortality. In contrast, left ventricular systolic function, left ventricular diastolic parameters, ePASP, or echo-derived pulmonary vascular resistance (PVR) were not associated with increased mortality. CONCLUSION In a cohort of patients with PH and high prevalence of cardio-pulmonary comorbidities, RV systolic function and hypertrophy are associated with mortality and may be the most relevant echocardiographic markers for prognosis.
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Affiliation(s)
- Johannes Steiner
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Matthew Jankowich
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Bradley A. Maron
- Veterans Affairs Boston Healthcare System, Department of Cardiology, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital and Harvard Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, Boston, Massachusetts, United States of America
| | - Satish Sharma
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Gaurav Choudhary
- Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Ho TW, Tsai YJ, Ruan SY, Huang CT, Lai F, Yu CJ. In-hospital and one-year mortality and their predictors in patients hospitalized for first-ever chronic obstructive pulmonary disease exacerbations: a nationwide population-based study. PLoS One 2014; 9:e114866. [PMID: 25490399 PMCID: PMC4260959 DOI: 10.1371/journal.pone.0114866] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/14/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction Natural history of chronic obstructive pulmonary disease (COPD) is punctuated by exacerbations; however, little is known about prognosis of the first-ever COPD exacerbation and variables predicting its outcomes. Materials and Methods A population-based cohort study among COPD patients with their first-ever exacerbations requiring hospitalizations was conducted. Main outcomes were in-hospital mortality and one-year mortality after discharge. Demographics, comorbidities, medications and in-hospital events were obtained to explore outcome predictors. Results The cohort comprised 4204 hospitalized COPD patients, of whom 175 (4%) died during the hospitalization. In-hospital mortality was related to higher age (odds ratio [OR]: 1.05 per year; 95% confidence interval [CI]: 1.03–1.06) and Charlson comorbidity index score (OR: 1.08 per point; 95% CI: 1.01–1.15); angiotensin II receptor blockers (OR: 0.61; 95% CI: 0.38–0.98) and β blockers (OR: 0.63; 95% CI: 0.41–0.95) conferred a survival benefit. At one year after discharge, 22% (871/4029) of hospital survivors were dead. On multivariate Cox regression analysis, age and Charlson comorbidity index remained independent predictors of one-year mortality. Longer hospital stay (hazard ratio [HR] 1.01 per day; 95% CI: 1.01–1.01) and ICU admission (HR: 1.33; 95% CI: 1.03–1.73) during the hospitalization were associated with higher mortality risks. Prescription of β blockers (HR: 0.79; 95% CI: 0.67–0.93) and statins (HR: 0.66; 95% CI: 0.47–0.91) on hospital discharge were protective against one-year mortality. Conclusions Even the first-ever severe COPD exacerbation signifies poor prognosis in COPD patients. Comorbidities play a crucial role in determining outcomes and should be carefully assessed. Angiotensin II receptor blockers, β blockers and statins may, in theory, have dual cardiopulmonary protective properties and probably alter prognosis of COPD patients. Nevertheless, the limitations inherent to a claims database study, such as the diagnostic accuracy of COPD and its exacerbation, should be born in mind.
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Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yi-Ju Tsai
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Maglione M, Bush A, Nielsen KG, Hogg C, Montella S, Marthin JK, Di Giorgio A, Santamaria F. Multicenter analysis of body mass index, lung function, and sputum microbiology in primary ciliary dyskinesia. Pediatr Pulmonol 2014; 49:1243-50. [PMID: 24420929 DOI: 10.1002/ppul.22984] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 11/30/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND No studies longitudinally, simultaneously assessed body mass index (BMI) and spirometry in primary ciliary dyskinesia (PCD). METHODS We determined BMI and spirometry in 158 PCD children and adolescents from London, UK (n = 75), Naples, Italy (n = 23) and Copenhagen, Denmark (n = 60) at first presentation and during follow-up. Annual BMI and spirometry were prospectively collected and analyzed over blocks of 2, 4, and 6 consecutive years. Sputum pathogens were recorded. RESULTS Age at first spirometry was 8.7 years (range, 4.2-17.4). Mean Z scores of first measured BMI, FEV1, FVC, and FEF(25-75) were 0.01, -1.37, -0.84, and -1.68, respectively. First spirometry was not more frequently impaired in patients referred at age ≥6 years than in those referred at preschool age (P = 0.13). There were no differences in slopes for BMI, FEV1, FVC, or FEF(25-75) over any time block. H. influenzae was the most common pathogen, isolated at least once in 65% of patients. P. aeruginosa was found in 58 subjects (37%) of whom 8 (5%) were chronically infected. Neither pathogens was associated with spirometry changes. CONCLUSIONS Preschool referral to a PCD center was not associated with better spirometry or BMI. PCD children and adolescents receiving centralized care show steady BMI and spirometry during medium term follow-up. There was a high prevalence of Pseudomonas aeruginosa infection, but the evolution of spirometry or BMI was not affected by this microorganism in medium term. Despite our longitudinal analysis showed no differences between the three centers, the assessment of spirometry and BMI over time represents a quality improvement tool. Future studies are needed to highlight the role of spirometry and BMI in long term PCD management and identify subgroups of patients with a higher risk of early lung failure or nutritional problems.
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Affiliation(s)
- Marco Maglione
- Department of Pediatrics, Federico II University, Naples, Italy
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Echave-Sustaeta JM, Comeche Casanova L, Cosio BG, Soler-Cataluña JJ, Garcia-Lujan R, Ribera X. Comorbidity in chronic obstructive pulmonary disease. Related to disease severity? Int J Chron Obstruct Pulmon Dis 2014; 9:1307-14. [PMID: 25429213 PMCID: PMC4242132 DOI: 10.2147/copd.s71849] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. PATIENTS AND METHODS In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. RESULTS Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. CONCLUSION COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity.
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Affiliation(s)
| | | | - Borja G Cosio
- Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Xavier Ribera
- Medical Deparment, Boehringer Ingelheim, Barcelona, Spain
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Hassel E, Berre AM, Skjulsvik AJ, Steinshamn S. Effects of exercise training on pulmonary vessel muscularization and right ventricular function in an animal model of COPD. Respir Res 2014; 15:117. [PMID: 25261051 DOI: 10.1186/s12931-014-0117-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/17/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Right ventricular dysfunction in COPD is common, even in the absence of pulmonary hypertension. The aim of the present study was to examine the effects of high intensity interval training (HIIT) on right ventricular (RV) function, as well as pulmonary blood vessel remodeling in a mouse model of COPD. METHODS 42 female A/JOlaHsd mice were randomized to exposure to either cigarette smoke or air for 6 hours/day, 5 days/week for 14 weeks. Mice from both groups were further randomized to sedentariness or HIIT for 4 weeks. Cardiac function was evaluated by echocardiography and muscularization of pulmonary vessel walls by immunohistochemistry. RESULTS Smoke exposure induced RV systolic dysfunction demonstrated by reduced tricuspid annular plane systolic excursion. HIIT in smoke-exposed mice reversed RV dysfunction. There were no significant effects on the left ventricle of neither smoke exposure nor HIIT. Muscularization of the pulmonary vessels was reduced after exercise intervention, but no significant effects on muscularization were observed from smoke exposure. CONCLUSIONS RV function was reduced in mice exposed to cigarette smoke. No Increase in pulmonary vessel muscularization was observed in these mice, implying that other mechanisms caused the RV dysfunction. HIIT attenuated the RV dysfunction in the smoke exposed mice. Reduced muscularization of the pulmonary vessels due to HIIT suggests that exercise training not only affects the heart muscle, but also has important effects on the pulmonary vasculature.
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Cheng Y, Borrego ME, Frost FJ, Petersen H, Raisch DW. Predictors for mortality in hospitalized patients with chronic obstructive pulmonary disease. Springerplus 2014; 3:359. [PMID: 25061552 PMCID: PMC4108717 DOI: 10.1186/2193-1801-3-359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been the only leading cause of death associated with a continuously increasing trend in the US over the past 30 years. OBJECTIVES The aim of this research was to identify predictors for all-cause in-hospital mortality for COPD patients. METHODS We conducted a cross-sectional study of patients with the discharge diagnosis of COPD, utilizing the 2007 Premier Perspective database. Inpatients aged 40 years and above were selected if they had a discharge with a primary diagnosis of COPD between January 1, 2007 and December 31, 2007. All data analyses were based on individual level. If a patient had multiple discharges, only the last discharge was included for mortality analysis. Predictors for mortality were identified by multiple logistic regressions. Bonferroni correction for multiple logistic regression models was adapted to control for family-wise errors. RESULTS The total of 57,224 patients was selected for data analysis in the study. All-cause in-hospital mortality for patients with COPD was 2.4%. Older age, insurance coverage, elective admission, intensive care unit admission, prolonged length of stay, increased Deyo-adapted Charlson Index (DCI) score and Elixhauser comorbidities of renal failure, metastatic cancer, solid tumor without metastasis, and weight loss were identified as independent predictors for all-cause in-hospital mortality. Antibiotics and β-blockers were predictors of lower all-cause in-hospital mortality risk after adjusting for other factors. CONCLUSIONS The nationwide discharge database provides useful information to identify predictors for all-cause in-hospital mortality of patients with COPD.
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Affiliation(s)
- Yan Cheng
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah USA
| | - Matthew E Borrego
- Pharmacoeconomics, Epidemiology, Public Policy and Outcome Research, College of Pharmacy, University of New Mexico, Albuquerque, NM USA
| | - Floyd J Frost
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Hans Petersen
- Lovelace Respiratory Research Institute, Albuquerque, NM USA
| | - Dennis W Raisch
- Pharmacoeconomics, Epidemiology, Public Policy and Outcome Research, College of Pharmacy, University of New Mexico, Albuquerque, NM USA
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Takir HB, Karakurt Z, Salturk C, Kargin F, Balci M, Yalcinsoy M, Ozmen İ, Yazicioglu OM, Gungor G, Burunsuzoğlu B, Adiguzel N. Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort. COPD 2014; 11:627-38. [DOI: 10.3109/15412555.2014.898041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maters GA, de Voogd JN, Sanderman R, Wempe JB. Predictors of all-cause mortality in patients with stable COPD: medical co-morbid conditions or high depressive symptoms. COPD 2014; 11:468-74. [PMID: 24831411 DOI: 10.3109/15412555.2014.898026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Co-morbid conditions are frequently found in patients with COPD. We evaluate the association of co-morbidities with mortality, in stable COPD. 224 patients, mean age 61.2 (± 10.00), 48.2% female, mean FEV1 1.1 (± 0.5) liters, median follow-up time 4.2 years, participated. Medical co-morbidities were scored according to the Charlson Co-morbidity Index (CCI). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist-90 (SCL-90). The Cox proportional hazard model was used for survival analyses. In our sample, 70% of all patients have a co-morbid medical condition or high depressive symptoms. During follow-up 51% of all patients died, and those with heart failure have the highest mortality rate (75%). Age, fat-free mass and exercise capacity were predictive factors, contrary to CCI-scores and high depressive symptoms. An unadjusted association between heart failure and survival was found. Although the presence of co-morbidities, using the CCI-score, is not related to survival, heart failure seems to have a detrimental effect on survival. Higher age and lower exercise capacity or fat-free mass predict mortality.
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Affiliation(s)
- Gemma A Maters
- 1Department of Health Sciences, Health Psychology Section, University of Groningen, University Medical Center, Groningen , The Netherlands
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Khan JH, Lababidi HMS, Al-Moamary MS, Zeitouni MO, Al-Jahdali HH, Al-Amoudi OS, Wali SO, Idrees MM, Al-Shimemri AA, Al Ghobain MO, Alorainy HS, Al-Hajjaj MS. The Saudi Guidelines for the Diagnosis and Management of COPD. Ann Thorac Med 2014; 9:55-76. [PMID: 24791168 PMCID: PMC4005164 DOI: 10.4103/1817-1737.128843] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 12/26/2022] Open
Abstract
The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.
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Affiliation(s)
- Javed H Khan
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Hani M S Lababidi
- Department of Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed S Al-Moamary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed O Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Hamdan H Al-Jahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Omar S Al-Amoudi
- College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Siraj O Wali
- College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Majdy M Idrees
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A Al-Shimemri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed O Al Ghobain
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hassan S Alorainy
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Samaras N, Samaras D, Chambellan A, Pichard C, Thibault R. Pulmonary rehabilitation: the reference therapy for undernourished patients with chronic obstructive pulmonary disease. Biomed Res Int 2014; 2014:248420. [PMID: 24701566 DOI: 10.1155/2014/248420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.
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Poortvliet RK, Blom JW, de Craen AJ, Mooijaart SP, Westendorp RG, Assendelft WJ, Gussekloo J, de Ruijter W. Low blood pressure predicts increased mortality in very old age even without heart failure: the Leiden 85-plus Study. Eur J Heart Fail 2014; 15:528-33. [DOI: 10.1093/eurjhf/hfs203] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosalinde K.E. Poortvliet
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Anton J.M. de Craen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
- Institute for Evidence-Based Medicine in Old Age; Leiden The Netherlands
| | - Rudi G.J. Westendorp
- Department of Gerontology and Geriatrics; Leiden University Medical Center; Leiden The Netherlands
- Netherlands Consortium for Healthy Ageing; Leiden The Netherlands
| | - Willem J.J. Assendelft
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary Care; Leiden University Medical Center; PO Box 9600 2300 RC Leiden The Netherlands
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Abstract
BACKGROUND COPD is a multi-component disease that is not sufficiently reflected by FEV1 alone. We studied in patients with very severe COPD, which dimensions of the disease, including co-morbidities, dominate prognosis. METHODS In patients with FEV1 < 30% predicted, anthropometric, laboratory, spirometric and body plethysmographic data, smoking status, alcohol consumption, the level of dyspnoea and exercise performance were assessed. Co-morbidities were categorized by the Charlson-index and the COPD-specific co-morbidity test (COTE). The prognostic value of multiple dimensions was explored using uni- and multivariate survival analyses regarding death from any or respiratory cause. RESULTS Among 209 patients included (58/151 female/male; FEV1 25.0 (22.0-26.9)%predicted), arterial hypertension (54.1%), hyperlipidemia (38.3%) and diabetes (19.6%) were most common, 57.9% showing a COTE-index of ≥ 1 point. During follow-up (28 (14-45) months), 121 patients had died, mostly (56.2%) due to respiratory causes. Age, BMI, the ratio of residual volume to total lung capacity (RV/TLC), co-morbidities in terms of the COTE- and Charlson-index, but not FEV1, were significantly associated with all-cause and respiratory mortality. The association of the median values of the Charlson- (HR 1.911 [95%-CI 1.338-2.730]) and COTE-index (HR 1.852 [95%-CI 1.297-2.644], p < 0.001 each) with mortality was similar and stronger when combined with age. In multivariate analyses, only RV/TLC and co-morbidities were independent risk factors of all-cause mortality (p < 0.05 each). CONCLUSION In very severe COPD, resting hyperinflation and co-morbidities provide the major prognostic information, whereas the association of the recently introduced COTE-index with mortality was similar to that of the established Charlson-index and even stronger when including age.
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Affiliation(s)
- Stephan Budweiser
- 1Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre , Rosenheim , Germany
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Hilde JM, Skjørten I, Grøtta OJ, Hansteen V, Melsom MN, Hisdal J, Humerfelt S, Steine K. Right Ventricular Dysfunction and Remodeling in Chronic Obstructive Pulmonary Disease Without Pulmonary Hypertension. J Am Coll Cardiol 2013; 62:1103-1111. [DOI: 10.1016/j.jacc.2013.04.091] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/23/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
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Abstract
Chronic obstructive pulmonary disease (COPD) is the third most common cause of death in the USA. In 2010, the cost of COPD in the USA was projected to be approximately US$50 billion, which includes $20 billion in indirect costs and $30 billion in direct health care expenditures. These costs can be expected to continue to rise with this progressive disease. Costs increase with increasing severity of disease, and hospital stays account for the majority of these costs. Patients are diagnosed with COPD following a multifactorial assessment that includes spirometry, clinical presentation, symptomatology, and risk factors. Smoking cessation interventions are the most influential factor in COPD management. The primary goal of chronic COPD management is stabilization of chronic disease and prevention of acute exacerbations. Bronchodilators are the mainstay of COPD therapy. Patients with few symptoms and low exacerbation risk should be treated with a short-acting bronchodilator as needed for breathlessness. Progression of symptoms, as well as possible decline in forced expiratory volume in the first second of expiration (FEV1), warrant the use of long-acting bronchodilators. For patients with frequent exacerbations with or without consistent symptoms, inhaled corticosteroids should be considered in addition to a long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) and may even consist of "triple therapy" with all three agents with more severe disease. Phosphodiesterase-4 inhibitors may be an option in patients with frequent exacerbations and symptoms of chronic bronchitis. In addition to a variety of novel ultra-LABAs, LAMAs and combination bronchodilator and inhaled corticosteroid (ICS) therapies, other bronchodilators with a variety of mechanisms are also being considered, to expand therapeutic options for the treatment of COPD. With more than 50 new medications in the pipeline for the treatment of COPD, optimal management will continue to evolve and grow more complex as benefits of therapy are balanced with the limitations and needs of each patient.
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Affiliation(s)
| | - Shauntá M Ray
- University of Tennessee College of Pharmacy, Knoxville, USA
| | - Christopher K Finch
- University of Tennessee College of Pharmacy, Memphis, TN, USA
- Methodist University Hospital, Memphis, TN, USA
| | - Timothy H Self
- University of Tennessee College of Pharmacy, Memphis, TN, USA
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Zapatero A, Barba R, Ruiz J, Losa JE, Plaza S, Canora J, Marco J. Malnutrition and obesity: influence in mortality and readmissions in chronic obstructive pulmonary disease patients. J Hum Nutr Diet 2013; 26 Suppl 1:16-22. [DOI: 10.1111/jhn.12088] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A. Zapatero
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - R. Barba
- Servicio de Medicina Interna; Hospital Rey Juan Carlos; Madrid Spain
| | - J. Ruiz
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - J. E. Losa
- Servicio de Medicina Interna; Hospital Universitario Fundación Alcorcón; Madrid Spain
| | - S. Plaza
- Servicio de Medicina Interna; Hospital Severo Ochoa; Madrid Spain
| | - J. Canora
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - J. Marco
- Servicio de Medicina Interna; Hospital Clínico de San Carlos; Madrid Spain
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Thoonsen B, Engels Y, van Rijswijk E, Verhagen S, van Weel C, Groot M, Vissers K. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC). Br J Gen Pract 2012; 62:e625-31. [PMID: 22947583 DOI: 10.3399/bjgp12X654597] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined. AIM The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care. DESIGN A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs. METHOD The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care. RESULTS Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour. CONCLUSION The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice.
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