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Nagase H, Oka H, Uchimura H, Arita Y, Hirai T, Makita N, Tashiro N, Matsunaga K. Changes in disease burden and treatment reality in patients with severe asthma. Respir Investig 2024; 62:431-437. [PMID: 38492333 DOI: 10.1016/j.resinv.2024.02.007] [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: 09/04/2023] [Revised: 11/29/2023] [Accepted: 02/11/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Biologics are clinically available for patients with severe asthma, but changes in asthma control over time are unknown. We examined changes in disease burden and treatment in severe asthma patients. METHODS This retrospective study used a Japanese health insurance database (Cross Fact) and included patients aged ≥16 years treated continuously with an inhaled corticosteroid (ICS) for a diagnosis of asthma in each calendar year from 2015 to 2019. Severe asthma was defined as annual use of high-dose ICS plus one or more asthma controller medications four or more times, oral corticosteroids for ≥183 days, or biologics for ≥16 weeks. Changes in asthma exacerbations, prescriptions, and laboratory testing were examined. RESULTS Demographic characteristics were similar throughout the study. The number and proportion of patients with severe asthma among those with asthma increased (2724; 15.3% in 2015 vs 4485; 19.0% in 2019). The proportion of severe asthma patients with two or more asthma exacerbations decreased from 24.4% to 21.5%. Odds ratios (95% confidence interval) of ≥2 asthma exacerbations in each year compared with 2015 were 0.96 (0.85-1.08) in 2016 and 0.86 (0.76-0.97) in 2017, with significant reductions observed in subsequent years. Short-acting beta agonists and oral corticosteroid prescriptions for asthma exacerbations decreased and long-acting muscarinic antagonist and biologic prescriptions for maintenance treatment increased. CONCLUSIONS This study showed improvements in disease burden and treatment in severe asthma patients. There remains an unmet medical need for patients with severe asthma, given the proportion who continue to have asthma exacerbations.
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Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Hayato Oka
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Hitomi Uchimura
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Yoshifumi Arita
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Takehiro Hirai
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Naoyuki Makita
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Naoki Tashiro
- AstraZeneca K. K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
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Kendra M, Mansukhani R, Rudawsky N, Landry L, Reyes N, Chiu S, Daley B, Markley D, Fetherman B, Dimitry EA Jr, Cerrone F, Shah CV. Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle. Lung 2022. [PMID: 35796786 DOI: 10.1007/s00408-022-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.
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Secher PH, Hangaard S, Kronborg T, Hæsum LKE, Udsen FW, Hejlesen O, Bender C. Clinical implementation of an algorithm for predicting exacerbations in patients with COPD in telemonitoring: a study protocol for a single-blinded randomized controlled trial. Trials 2022; 23:356. [PMID: 35473589 PMCID: PMC9040210 DOI: 10.1186/s13063-022-06292-y] [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: 09/27/2021] [Accepted: 04/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute exacerbations have a significant impact on patients with COPD by accelerating the decline in lung function leading to decreased health-related quality of life and survival time. In telehealth, health care professionals exercise clinical judgment over a physical distance. Telehealth has been implemented as a way to monitor patients more closely in daily life with an intention to intervene earlier when physical measurements indicate that health deteriorates. Several studies call for research investigating the ability of telehealth to automatically flag risk of exacerbations by applying the physical measurements that are collected as part of the monitoring routines to support health care professionals. However, more research is needed to further develop, test, and validate prediction algorithms to ensure that these algorithms improve outcomes before they are widely implemented in practice. Method This trial tests a COPD prediction algorithm that is integrated into an existing telehealth system, which has been developed from the previous Danish large-scale trial, TeleCare North (NCT: 01984840). The COPD prediction algorithm aims to support clinical decisions by predicting the risk of exacerbations for patients with COPD based on selected physiological parameters. A prospective, parallel two-armed randomized controlled trial with approximately 200 participants with COPD will be conducted. The participants live in Aalborg municipality, which is located in the North Denmark Region. All participants are familiar with the telehealth system in advance. In addition to the participants’ usual weekly monitored measurements, they are asked to measure their oxygen saturation two more times a week during the trial period. The primary outcome is the number of exacerbations defined as an acute hospitalization from baseline to follow-up. Secondary outcomes include changes in health-related quality of life measured by both the 12-Item Short Form Survey version 2 and EuroQol-5 Dimension Questionnaire as well as the incremental cost-effectiveness ratio. Discussion This trial seeks to explore whether the COPD prediction algorithm has the potential to support early detection of exacerbations in a telehealth setting. The COPD prediction algorithm may initiate timely treatment, which may decrease the number of hospitalizations. Trial registration NCT05218525 (pending at clinicaltrials.gov) (date, month, year)
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Affiliation(s)
- Pernille Heyckendorff Secher
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark.
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark
| | - Lisa Korsbakke Emtekær Hæsum
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark.,Department of Nursing, University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark
| | - Clara Bender
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7C, 9220, Aalborg East, Denmark
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4
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Nelke C, Stascheit F, Eckert C, Pawlitzki M, Schroeter CB, Huntemann N, Mergenthaler P, Arat E, Öztürk M, Foell D, Schreiber S, Vielhaber S, Gassa A, Stetefeld H, Schroeter M, Berger B, Totzeck A, Hagenacker T, Meuth SG, Meisel A, Wiendl H, Ruck T. Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients. J Neuroinflammation 2022; 19:89. [PMID: 35413850 PMCID: PMC9005160 DOI: 10.1186/s12974-022-02448-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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] [Received: 12/06/2021] [Accepted: 03/29/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Myasthenic crisis (MC) and disease exacerbation in myasthenia gravis (MG) are associated with significant lethality and continue to impose a high disease burden on affected patients. Therefore, we sought to determine potential predictors for MC and exacerbation as well as to identify factors affecting outcome. METHODS We examined a retrospective, observational cohort study of patients diagnosed with MG between 2000 and 2021 with a mean follow-up of 62.6 months after diagnosis from eight tertiary hospitals in Germany. A multivariate Cox regression model with follow-up duration as the time variable was used to determine independent risk factors for MC and disease exacerbation. RESULTS 815 patients diagnosed with MG according to national guidelines were included. Disease severity at diagnosis (quantitative MG score or Myasthenia Gravis Foundation of America class), the presence of thymoma and anti-muscle specific tyrosine kinase-antibodies were independent predictors of MC or disease exacerbation. Patients with minimal manifestation status 12 months after diagnosis had a lower risk of MC and disease exacerbation than those without. The timespan between diagnosis and the start of immunosuppressive therapy did not affect risk. Patients with a worse outcome of MC were older, had higher MGFA class before MC and at admission, and had lower vital capacity before and at admission. The number of comorbidities, requirement for intubation, prolonged mechanical ventilation, and MC triggered by infection were associated with worse outcome. No differences between outcomes were observed comparing treatments with IVIG (intravenous immunoglobulin) vs. plasma exchange vs. IVIG together with plasma exchange. CONCLUSIONS MC and disease exacerbations inflict a substantial burden of disease on MG patients. Disease severity at diagnosis and antibody status predicted the occurrence of MC and disease exacerbation. Intensified monitoring with emphasis on the prevention of infectious complications could be of value to prevent uncontrolled disease in MG patients.
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Affiliation(s)
- Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.,Department of Neurology with Institute of Translational Neurology, University and University Hospital Münster, Munster, Germany
| | - Frauke Stascheit
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Department of Neurology With Experimental Neurology, Humboldt-Universität zu Berlin, Berlin, Germany.,Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, NeuroCure Clinical Research Center, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carmen Eckert
- Department of Neurology with Institute of Translational Neurology, University and University Hospital Münster, Munster, Germany
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Münster, Munster, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Philipp Mergenthaler
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Department of Neurology With Experimental Neurology, Humboldt-Universität zu Berlin, Berlin, Germany.,Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, NeuroCure Clinical Research Center, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ercan Arat
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Menekse Öztürk
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Dirk Foell
- Department for Pediatric Rheumatology and Immunology, University of Münster, Munster, Germany
| | - Stefanie Schreiber
- Department of Neurology, University of Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, University of Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Asmae Gassa
- Department of Cardiothoracic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Henning Stetefeld
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Schroeter
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Benjamin Berger
- Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Totzeck
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Andreas Meisel
- Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Department of Neurology With Experimental Neurology, Humboldt-Universität zu Berlin, Berlin, Germany.,Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, NeuroCure Clinical Research Center, Humboldt-Universität zu Berlin, Berlin, Germany.,Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Center for Stroke Research Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,German Myasthenia Gravis Society, Berlin, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University and University Hospital Münster, Munster, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. .,Department of Neurology with Institute of Translational Neurology, University and University Hospital Münster, Munster, Germany.
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5
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Macdonald DM, Palzer EF, Abbasi A, Baldomero AK, Bhatt SP, Casaburi R, Connett JE, Dransfield MT, Gaeckle NT, Mkorombindo T, Rossiter HB, Stringer WW, Tiller NB, Wendt CH, Zhao D, Kunisaki KM. Chronotropic index during 6-minute walk and acute respiratory events in COPDGene. Respir Med 2022; 194:106775. [PMID: 35203009 PMCID: PMC8932051 DOI: 10.1016/j.rmed.2022.106775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lower heart rate (HR) increases during exercise and slower HR recovery (HRR) after exercise are markers of worse autonomic function that may be associated with risk of acute respiratory events (ARE). METHODS Data from 6-min walk testing (6MWT) in COPDGene were used to calculate the chronotropic index (CI) [(HR immediately post 6MWT - resting HR)/((220 - age) - resting HR)] and HRR at 1 min after 6MWT completion. We used zero-inflated negative binomial regression to test associations of CI and HRR with rates of any ARE (requiring steroids and/or antibiotics) and severe ARE (requiring emergency department visit or hospitalization), among all participants and in spirometry subgroups (normal, chronic obstructive pulmonary disease [COPD], and preserved ratio with impaired spirometry). RESULTS Among 4,484 participants, mean follow-up time was 4.1 years, and 1,966 had COPD. Among all participants, CI-6MWT was not associated with rate of any ARE [adjusted incidence rate ratio (aIRR) 0.98 (0.95-1.01)], but higher CI-6MWT was associated with lower rate of severe ARE [0.95 (0.92-0.99)]. Higher HRR was associated with a lower rate of both any ARE [0.97 (0.95-0.99)] and severe ARE [0.95 (0.92-0.98)]. Results were similar in the COPD spirometry subgroup. CONCLUSION Heart rate measures derived from 6MWT tests may have utility in predicting risk of acute respiratory events and COPD exacerbations.
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Affiliation(s)
- David M Macdonald
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA.
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Asghar Abbasi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Arianne K Baldomero
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Surya P Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Casaburi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John E Connett
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | | | - Harry B Rossiter
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - William W Stringer
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicholas B Tiller
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chris H Wendt
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China
| | - Ken M Kunisaki
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
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6
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Charokopos A, Moua T, Ryu JH, Smischney NJ. Acute exacerbation of interstitial lung disease in the intensive care unit. World J Crit Care Med 2022; 11:22-32. [PMID: 35433309 PMCID: PMC8788209 DOI: 10.5492/wjccm.v11.i1.22] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/04/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Acute exacerbations of interstitial lung disease (AE-ILD) represent an acute, frequent and often highly morbid event in the disease course of ILD patients. Admission in the intensive care unit (ICU) is very common and the need for mechanical ventilation arises early. While non-invasive ventilation has shown promise in staving off intubation in selected patients, it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation. Risk stratification using clinical and radiographic findings, and early palliative care involvement, are important in ICU care. In this review, we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD. We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.
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Affiliation(s)
- Antonios Charokopos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Teng Moua
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Jay H Ryu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Nathan J Smischney
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
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7
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Yokoyama A, Okazaki H, Makita N, Fukui A, Piao Y, Arita Y, Itoh Y, Tashiro N. Regional differences in the incidence of asthma exacerbations in Japan: A heat map analysis of healthcare insurance claims data. Allergol Int 2022; 71:47-54. [PMID: 34493447 DOI: 10.1016/j.alit.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/04/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In Japan, regional differences in asthma mortality have been reported; however, regional differences in asthma exacerbations have not been studied extensively. Therefore, using a health insurance claims database, we investigated the regional differences in the incidence of asthma exacerbations in Japan. METHODS This study used data from Medi-Scope (Japan Medical Information Research Institute Inc., Japan)-a nationwide health insurance claims database. Patients with asthma at the index date (the latest date of an asthma-related prescription with an asthma diagnosis before October 1, 2018) were included in the analysis. The pre-index period was defined as 1 year before the index date, and the follow-up period as 1 year after the index date. The incidence of asthma exacerbation events was analyzed for each region. RESULTS The primary analysis population comprised 24,883 patients who were continuously prescribed ICS or ICS/LABA at least four times during the pre-index period. The incidence rate of asthma exacerbations with hospitalization was the highest in Chugoku (2.95/100 person-years [95% CI, 1.97-4.43]) and the lowest in Kanto (1.52/100 person-years [95% CI, 1.26-1.83]). The incidence rate of asthma exacerbations for the composite outcome of hospitalization, injectable corticosteroid prescription, and oral corticosteroid burst was the highest in Fukui (105.00/100 person-years [95% CI, 64.53-170.85]) and the lowest in Nagasaki (15.69/100 person-years [95% CI, 10.84-22.72]). CONCLUSIONS Regional differences in the incidence of asthma exacerbations as well as their treatments were observed in Japan.
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Affiliation(s)
- Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan.
| | | | | | | | - Yi Piao
- AstraZeneca K.K., Osaka, Japan
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8
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Demoly P, Bos C, Vidal C. Worsening of chronic house-dust-mite-induced respiratory allergies: An observational survey in three European countries. World Allergy Organ J 2021; 14:100563. [PMID: 34306302 PMCID: PMC8271175 DOI: 10.1016/j.waojou.2021.100563] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022] Open
Abstract
Background Although respiratory allergies to house dust mites (HDMs) can often be controlled with symptomatic medications, some patients do not achieve satisfactory disease control. Objective To assess fortnightly fluctuations (notably worsening and/or exacerbations) in disease parameters among patients taking only symptomatic medications for HDM allergy. Methods In a 13-month, observational, multicenter survey of adults with a self-reported history of poorly controlled, moderate-to-severe, physician-diagnosed HDM respiratory allergy in France, Italy, and Spain, fortnightly telephone interviews were used to gather information on medication use, symptoms, the disease burden, and medical consultations from late May 2012 to early July 2013. Results A total of 313 patients completed the study (n = 114 in Italy, 92 in France, and 107 in Spain). Although most participants reported improvements in symptoms, a substantial minority (ranging from 12% to 44% per fortnightly telephone interview in 2012 and from 16% to 37% in 2013) complained of worsening. A few study participants did not improve at any time in the study: 4% overall, and 2%, 2%, and 7% in Italy, France and Spain, respectively. A change in the weather and/or contact with other allergens were the most frequent self-reported reasons for worsening, although the answer “I don't know” was also prominent. Conclusion In a 13-month survey of patients with HDM allergy in Italy, France, and Spain, the participants’ symptom status fluctuated significantly — illustrating the complexity of this condition. Although most participants reported improvements, the “never-improver” profile warrants further investigation. More prominence could be given to symptom control and a low exacerbation risk as treatment goals in allergic rhinitis.
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Affiliation(s)
- Pascal Demoly
- Allergy Division, Pulmonology Department, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,Sorbonne Université, UMR-S 1136 INSERM, IPLESP, Equipe EPAR, Paris, France
| | | | - Carmen Vidal
- Allergy Service, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
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9
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Olschewski H, Buhl R, Funk GC, Valipour A, Vogelmeier CF. [Chronic obstructive pulmonary disease: the right treatment for the right patient]. Internist (Berl) 2021; 62:679-85. [PMID: 33860810 DOI: 10.1007/s00108-021-01021-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
In den vergangenen Jahren wurden auf dem Gebiet der chronisch-obstruktiven Lungenerkrankung (COPD) große Therapiestudien publiziert, die 2020 um mehrere Post-hoc-Analysen ergänzt wurden. Die neuen Erkenntnisse flossen in das Update des Global-Initiative-for-Chronic-Obstructive-Lung-Disease(GOLD)-Report 2021 ein. Im vorliegenden Beitrag werden die aktualisierten Grundlagen und Empfehlungen zur Therapie der COPD beschrieben. Dabei wird auf die Indikationen von inhalativen Kortikosteroiden (ICS), lang wirksamen Muskarinantagonisten (LAMA) und/oder lang wirksamen β‑Mimetika (LABA) eingegangen. Die Therapie der COPD wird der des Asthma bronchiale gegenübergestellt. Diskutiert wird auch, wie sich eine gleichzeitig bestehende Asthmakomponente auf die Behandlungsstrategie bei COPD auswirkt. Ein Schwerpunkt des Beitrags liegt auf der Triple-Therapie mit LAMA, LABA und ICS. In diesem Zusammenhang werden die Studienlage und die Indikationen beschrieben. Die Bronchodilatation bleibt weiterhin die Grundlage der COPD-Therapie. Für Patienten mit gehäuften Exazerbationen bedeutet eine Triple-Therapie mit LAMA + LABA + ICS einen Mortalitätsvorteil. Weitere Analysen oder Studien sollen klären, ob dieser Effekt für spezifische Subgruppen stärker ausgeprägt ist.
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Fan Y, Wang X, Jun Zhang, Mo D, Xiao X. The Risk Factors for the Exacerbation of COVID-19 Disease: A Case-control Study. J Clin Nurs 2020; 30:725-731. [PMID: 33331072 DOI: 10.1111/jocn.15601] [Citation(s) in RCA: 4] [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] [Received: 07/29/2020] [Revised: 11/11/2020] [Accepted: 12/04/2020] [Indexed: 01/20/2023]
Abstract
AIMS AND OBJECTIVES To investigate the factors associated with the exacerbations of COVID-19. BACKGROUND At present, COVID-19 is prevalent in the world, seriously endangering the property and life safety of people around the world. Currently, there are many reports on the clinical features, complications and risk factors of death of COVID-19, but there are few reports on the factors associated with the exacerbation of COVID-19. DESIGN Case-control Study. METHODS Patients with COVID-19 were recruited from four designated hospitals for novel coronavirus pneumonia in Xiangyang City, Hubei Province from January to April 2020. The patients were divided into disease exacerbation group (n = 53) and disease stabilisation group (n = 265) according to the disease progression during hospitalisation. Univariate analysis and multivariate logistic regression were used to identify the factors associated with the exacerbation of COVID-19. The research was reported according to STROBE statement. RESULTS Univariate analysis showed there were significant differences in gender, age, hypertension, heart disease, kidney disease, white blood cell count, percentage of neutrophil, percentage of lymphocyte, C-reactive protein, lactate dehydrogenase, total protein, albumin, creatinine, calcium ion, rate of erythrocyte sedimentation, cough, expectoration, chest tightness, gastrointestinal discomfort and dyspnoea between the two groups. The variables with p < 0.05 in the aforementioned difference analysis were included in binary logistic regression analysis, which showed that age, hypertension history, chest tightness, percentage of neutrophil, percentage of lymphocyte, lactate dehydrogenase and creatinine were independent factors associated with COVID-19 disease exacerbation. CONCLUSION Clinicians may warn the exacerbation of COVID-19 facing above risk factors and associated characteristics, and adjust the diagnosis and treatment plan to delay the disease progression, reduce complications and mortality and improve the prognosis of patients. RELEVANCE TO CLINICAL PRACTICE Patients with certain risk factors associated with COVID-19 diseases exacerbation should be observed and targeted by using effective early interventions.
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Affiliation(s)
- Ying Fan
- Wuhan University School of Health Sciences, Xiangzhou District People's Hospital in Hubei Province, Xiangyang, China
| | - Xuefei Wang
- Xiangyang Central Hospital in Hubei Province, Xiangyang, China
| | - Jun Zhang
- Wuhan University School of Health Sciences, Wuhan University, Wuhan, China
| | - Daorong Mo
- Xiangzhou District People's Hospital, Xiangyang, Hubei, China
| | - Xuexia Xiao
- Xiangyang Hospital of Traditional Chinese Medicine in Hubei Province, Xiangyang, China
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Wang C, Yang T, Kang J, Chen R, Zhao L, He H, Assam PN, Su R, Bourne E, Ballal S, DeAngelis K, Dorinsky P. Efficacy and Safety of Budesonide/Glycopyrrolate/Formoterol Fumarate Metered Dose Inhaler in Chinese Patients with COPD: A Subgroup Analysis of KRONOS. Adv Ther 2020; 37:1591-1607. [PMID: 32152869 PMCID: PMC7140742 DOI: 10.1007/s12325-020-01266-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 11/21/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This pre-specified subgroup analysis evaluated the efficacy and safety of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler (BGF MDI) triple therapy versus corresponding dual therapies in the China subgroup of the phase III, double-blind KRONOS study in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). METHODS Patients were randomized 2:2:1:1 to BGF MDI 320/18/9.6 μg, glycopyrrolate/formoterol fumarate (GFF) MDI 18/9.6 μg, budesonide/formoterol fumarate (BFF) MDI 320/9.6 μg, or budesonide/formoterol fumarate dry powder inhaler (BUD/FORM DPI) 400/12 μg twice daily for 24 weeks. The primary endpoint was change from baseline in morning pre-dose trough forced expiratory volume in 1 s (FEV1) over weeks 12-24. Secondary endpoints included symptoms, health-related quality of life, and safety. Rate of moderate/severe COPD exacerbations was an additional efficacy endpoint. RESULTS In the China subgroup (n = 432; 22.7% of the KRONOS population), BGF MDI demonstrated nominally significant improvements in the primary endpoint versus BFF MDI (least squares mean (LSM) difference 68 mL; P = 0.0035) and BUD/FORM DPI (LSM difference 78 mL; P = 0.0010) but not GFF MDI (LSM difference - 4 mL; P = 0.8316). BGF MDI demonstrated at least numerical improvements versus comparators in secondary lung function and symptom endpoints. BGF MDI reduced the rate of moderate/severe COPD exacerbations versus GFF MDI (rate ratio 0.41; P = 0.0030), with numerical benefits versus BFF MDI and BUD/FORM DPI. All treatments were well tolerated. CONCLUSIONS Results demonstrated that BGF MDI showed benefits on lung function (vs inhaled corticosteroid/long-acting β2-agonist), as well as symptoms and exacerbations relative to dual therapies. Findings support BGF MDI use in Chinese patients with moderate to very severe COPD. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02497001.
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Affiliation(s)
- Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No. 2, East Yinghua Street, Chaoyang District, Beijing, 100029, China.
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- National Clinical Research Center for Respiratory Diseases, Beijing, China.
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No. 2, East Yinghua Street, Chaoyang District, Beijing, 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Jian Kang
- The First Hospital of China Medical University, Shenyang, China
| | - Rongchang Chen
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Zhao
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Huijie He
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
| | | | - Rong Su
- AstraZeneca, Shanghai, China
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Langham S, Lewis J, Pooley N, Embleton N, Langham J, Han MK, Chalmers JD. Single-inhaler triple therapy in patients with chronic obstructive pulmonary disease: a systematic review. Respir Res 2019; 20:242. [PMID: 31684965 DOI: 10.1186/s12931-019-1213-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/21/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Guidelines recommend that treatment with a long-acting β2 agonist (LABA), a long-acting muscarinic antagonist (LAMA), and inhaled corticosteroids (ICS), i.e. triple therapy, is reserved for a select group of symptomatic patients with chronic obstructive pulmonary disease (COPD) who continue to exacerbate despite treatment with dual therapy (LABA/LAMA). A number of single-inhaler triple therapies are now available and important clinical questions remain over their role in the patient pathway. We compared the efficacy and safety of single-inhaler triple therapy to assess the magnitude of benefit and to identify patients with the best risk-benefit profile for treatment. We also evaluated and compared study designs and population characteristics to assess the strength of the evidence base. Methods We conducted a systematic search, from inception to December 2018, of randomised controlled trials (RCTs) of single-inhaler triple therapy in patients with COPD. The primary outcome was the annual rate of moderate and severe exacerbations. Results We identified 523 records, of which 15 reports/abstracts from six RCTs were included. Triple therapy resulted in the reduction of the annual rate of moderate or severe exacerbations in the range of 15–52% compared with LAMA/LABA, 15–35% compared to LABA/ICS and 20% compared to LAMA. The patient-based number needed to treat for the moderate or severe exacerbation outcome ranged between approximately 25–50 (preventing one patient from having an event) and the event-based number needed to treat of around 3–11 (preventing one event). The absolute benefit appeared to be greater in patients with higher eosinophil counts or historical frequency of exacerbations and ex-smokers. In the largest study, there was a significantly higher incidence of pneumonia in the triple therapy arm. There were important differences in study designs and populations impacting the interpretation of the results and indicating there would be significant heterogeneity in cross-trial comparisons. Conclusion The decision to prescribe triple therapy should consider patient phenotype, magnitude of benefit and increased risk of adverse events. Future research on specific patient phenotype thresholds that can support treatment and funding decisions is now required from well-designed, robust, clinical trials. Trial registration PROSPERO #CRD42018102125.
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Raeisi S, Fakharian A, Ghorbani F, Jamaati HR, Mirenayat MS. Value and Safety of High Flow Oxygenation in the Treatment of Inpatient Asthma: A Randomized, Double-blind, Pilot Study. Iran J Allergy Asthma Immunol 2019; 18:615-623. [PMID: 32245305 DOI: 10.18502/ijaai.v18i6.2174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
Abstract
This study was aimed to compare the value and safety of high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) in patients with asthma exacerbation. In this randomized double-blind study, forthy patients with moderate-to-severe asthma exacerbations, aged 18 years or older were enrolled. Patients were randomly assigned to receive either HFNC or COT for 24 hours. Dyspnea scale, O2 saturation, spirometer indexes, respiratory and heart rate, and arterial blood gas (ABG) were compared within 2 and 24 hours of intervention. Dyspnea scale decreased significantly from 7.58±1.04 to 6.45±0.51 (p=0.000), and from 7.84±1.7 to 6.89±0.9 (p=0.049) within 2 hours in HFNC and COT groups, respectively. In the HFNC group, forced expiratory volume in one second (FEV1) was 1.48 ±0.94 L at the time of admission and increased to 1.61±0.66 L (p=0.19) and 1.82±0.92 L (p=0.003) after 2 and 24 hours of experience, respectively. In addition, in the COT group, FEV1 increased from 1.43±0.65 L to 1.46±0.53 L and 1.64±0.6 L in the respective time-points, (p=0.071, 0.079). PaO2 and O2 saturation increased significantly in both groups during the first 2 hours. Two patients in the HFNC group had the complaint of nasal irritation and the device-produced heat; while one patient in the COT group needed more respiratory care. HFNC could be a therapeutic option for asthma exacerbation among adult patients after considering the patient's selection.
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Affiliation(s)
- Sharare Raeisi
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Ghorbani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Reza Jamaati
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Sadaat Mirenayat
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
BACKGROUND Grip strength measurement is a widely used method for clinical as well as scientific purposes. In hand surgery, it is an essential component in the diagnosis of disease, treatment sequences and assessment. In epidemiological studies, it is a good predictor of healthy ageing or disease progression. PROBLEM Measurement results and their interpretation can be influenced by many factors. The historical development of dynamometry, measurement technology and the standard values in various population groups are presented. Comparisons with standard values should only be made using current tables because the grip strength has changed in recent decades. Assessment of the voluntarily submaximal grip strength remains problematic. Proposals are made for how to assess grip strength during the evaluation.
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Crooks MG, den Brinker A, Hayman Y, Williamson JD, Innes A, Wright CE, Hill P, Morice AH. Continuous Cough Monitoring Using Ambient Sound Recording During Convalescence from a COPD Exacerbation. Lung 2017; 195:289-294. [PMID: 28353117 PMCID: PMC5437191 DOI: 10.1007/s00408-017-9996-2] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/10/2017] [Indexed: 11/29/2022]
Abstract
Purpose Cough is common in chronic obstructive pulmonary disease (COPD) and is associated with frequent exacerbations and increased mortality. Cough increases during acute exacerbations (AE-COPD), representing a possible metric of clinical deterioration. Conventional cough monitors accurately report cough counts over short time periods. We describe a novel monitoring system which we used to record cough continuously for up to 45 days during AE-COPD convalescence. Methods This is a longitudinal, observational study of cough monitoring in AE-COPD patients discharged from a single teaching hospital. Ambient sound was recorded from two sites in the domestic environment and analysed using novel cough classifier software. For comparison, the validated hybrid HACC/LCM cough monitoring system was used on days 1, 5, 20 and 45. Patients were asked to record symptoms daily using diaries. Results Cough monitoring data were available for 16 subjects with a total of 568 monitored days. Daily cough count fell significantly from mean ± SEM 272.7 ± 54.5 on day 1 to 110.9 ± 26.3 on day 9 (p < 0.01) before plateauing. The absolute cough count detected by the continuous monitoring system was significantly lower than detected by the hybrid HACC/LCM system but normalised counts strongly correlated (r = 0.88, p < 0.01) demonstrating an ability to detect trends. Objective cough count and subjective cough scores modestly correlated (r = 0.46). Conclusions Cough frequency declines significantly following AE-COPD and the reducing trend can be detected using continuous ambient sound recording and novel cough classifier software. Objective measurement of cough frequency has the potential to enhance our ability to monitor the clinical state in patients with COPD.
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Affiliation(s)
- Michael G Crooks
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK.
| | | | - Yvette Hayman
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
| | - James D Williamson
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
| | - Andrew Innes
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
| | - Caroline E Wright
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
| | - Peter Hill
- Philips Respironics, Pittsburgh, PA, USA
| | - Alyn H Morice
- Department of Academic Respiratory Medicine, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
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Tadokoro S, Nonomura N, Kanahara N, Hashimoto K, Iyo M. Reduction of Severity of Recurrent Psychotic Episode by Sustained Treatment with Aripiprazole in a Schizophrenic Patient with Dopamine Supersensitivity: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:79-81. [PMID: 28138118 PMCID: PMC5290712 DOI: 10.9758/cpn.2017.15.1.79] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 01/08/2023]
Abstract
Dopamine supersensitivity psychosis (DSP) is a type of acute exacerbation of recurrent psychosis caused by long-term treatment with antipsychotics in schizophrenic patients. Although DSP is exceedingly troublesome for clinicians, effective treatment has not yet been established. Based on clinical research and our animal study, we hypothesize that aripiprazole, an atypical anti-psychotic, may reduce the exacerbation of recurrent psychotic episodes. We report the case of a 46-year-old female who suffered from schizophrenia with DSP. In this case, sustained treatment with a high dose of aripiprazole gradually reduced the severity of her recurrent psychotic episodes. In conclusion, sustained treatment with aripiprazole may reduce the exacerbation of recurrent psychotic episodes in schizophrenic patients with DSP, and may be an effective treatment of DSP.
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Affiliation(s)
- Shigenori Tadokoro
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Health Administration Center, Muroran Institute of Technology, Hokkaido, Japan
| | - Naho Nonomura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Biomedical Ethics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Ciet P, Serra G, Andrinopoulou ER, Bertolo S, Ros M, Catalano C, Colagrande S, Tiddens HAWM, Morana G. Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging. Eur Radiol 2016; 26:3830-3839. [PMID: 26873494 DOI: 10.1007/s00330-016-4248-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/02/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots. RESULTS Thirty-three CF patients were enrolled (mean 21 years, range 6-51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-score correlated (all p < 0.0001) positively to CF-CTBE (r = 0.757), CF-CTmucus (r = 0.759) and CF-CTtotal-score (r = 0.79); and negatively to FEV1 (r = 0.688). FEV1 was significantly higher (p < 0.0001) in patients without DWI-hotspots. CONCLUSIONS DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients. KEY POINTS • DWI hotspots only partly overlapped structural abnormalities on morphological imaging • DWI strongly correlated with radiological and clinical indicators of CF-disease severity • Patients with more DWI hotspots had lower lung function values • Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.,Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Goffredo Serra
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | | | - Silvia Bertolo
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy
| | - Harm A W M Tiddens
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
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Pulido Herrero E, García Gutiérrez S, Antón Ladislao A, Piñera Salmerón P, Quintana López JM, Gallardo Rebollal MS, Sánchez Fernández M, Ortega Marcos ME, Amigo Angulo JM. [Quality of life in exacerbated chronic obstructive pulmonary disease emergencies: influence on the decision to admit patients and relation to poor outcome at 2 months]. Emergencias 2016; 28:387-395. [PMID: 29106083] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study the influence of quality of life on the decision to admit patients attended for exacerbated chronic obstructive pulmonary disease (COPD) in a hospital emergency department (ED) and to explore the association with poor outcome at 2 months. MATERIAL AND METHODS Prospective study of a cohort of patients with exacerbated COPD attended in an ED between November 2011 and September 2012. We collected sociodemographic and clinical data as well as scores on the COPD Assessment Test (CAT), the modified scale of the Medical Research Council, and the Borg scale for Perceived Dyspnea at the following times: baseline (clinically stable) (t0), on exacerbation (emergency) (t1), 15 days later or on discharge (t2), and 2 months after the emergency (t3). The outcome measures were hospital admission, revisits to the ED, and readmission within 2 months of the exacerbation. RESULTS A total of 191 patients treated for exacerbated COPD were included. The mean (SD) age was 74.9 (10.2) years; 173 (90.6%) were men. The exacerbations were mild in 97 cases (56.4%). The median (interquartile range) CAT scores were 14.5 (9-21), 20 (15-28), 16 (10-22), and 14.5 (10-21) at t0, t1, t2 and t3, respectively. One hundred twenty-three patients (64.4%) were admitted, 68 (35.6%) revisited the ED, and 39 (20.4%) were readmitted within 2 months. A high level of disease impact on quality of life at t1 (vs low impact) was independently associated with hospital admission (adjusted odds ratio [OR], 3.7; 95% CI, 1.0-13.2; P=.043). Impact on t2 was associated with a revisit within 2 months (adjusted OR, 3.6; 95% CI, 1.1-11.7; P=.031). Minimal change between the t1 and t2 CAT scores was independently associated with an ED revisit within 2 months (adjusted OR, 2.9; 95% CI, 1.2-7.4; P=.023). When the data for patients discharged from the ED were analyzed separately from those for admitted patients, the differences were statistically significant only for those who had been hospitalized. CONCLUSION The CAT score could be useful for predicting hospital admissions and revisiting within 2 months, especially in patients admitted for exacerbated COPD.
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Affiliation(s)
| | | | - Ane Antón Ladislao
- Unidad de Investigación, OSI Barrualde-Galdakao, Galdakao, Bizkaia, España
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Lopes PO, Alfaro TM, Lopes P, Cunha RA, Cordeiro CR. Caffeine consumption and exacerbations of chronic obstructive pulmonary disease: retrospective study. Rev Port Pneumol (2006) 2015; 21:271-5. [PMID: 26070452 DOI: 10.1016/j.rppnen.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/24/2015] [Revised: 04/27/2015] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The modulation of adenosine receptors has been proposed as new therapeutic target for chronic obstructive pulmonary disease, but studies in humans were negative. Caffeine is widely consumed and acts by non-selective modulation of these receptors, allowing for a non-interventional evaluation of the purinergic effects on COPD. We evaluated the effects of chronic caffeine consumption on the risk for COPD exacerbations. METHODS Retrospective study including patients with COPD. The total number of exacerbations during a three-year period and the mean daily caffeine consumption in the last twenty years were evaluated. A univariate and multiple regression analysis were performed for evaluation of the significant predictors of exacerbations. RESULTS A total of 90 patients were included. Most were males (82.2%) and had a mean forced expiratory volume in the first second (FEV1) of 57.0±17.1% predicted. The mean daily caffeine consumption was 149.7±140.9mg. There was no correlation between the mean caffeine consumption and exacerbations (p>0.05). DISCUSSION Our results suggest that caffeine has no significant effect on the frequency of COPD exacerbations. These conclusions are limited by the sample size and the retrospective nature of the study.
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Affiliation(s)
- P O Lopes
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Portugal.
| | - T M Alfaro
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Portugal; Unit of Pneumology, Centro Hospitalar e Universitário de Coimbra, Portugal; CNC - Center for Neurosciences and Cell Biology, University of Coimbra, Portugal.
| | - P Lopes
- Unit of Pneumology, Centro Hospitalar e Universitário de Coimbra, Portugal.
| | - R A Cunha
- Unit of Pneumology, Centro Hospitalar e Universitário de Coimbra, Portugal; FMUC - Faculty of Medicine, University of Coimbra, Portugal.
| | - C Robalo Cordeiro
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Portugal; Unit of Pneumology, Centro Hospitalar e Universitário de Coimbra, Portugal.
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Abstract
[Holland AE (2014) Physiotherapy management of acute exacerbations of chronic obstructive pulmonary disease.Journal of Physiotherapy60: 181-188].
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Affiliation(s)
- Anne E Holland
- La Trobe University, Alfred Health and Institute for Breathing and Sleep, Melbourne, Australia
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