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Tsiligianni I, Kocks JWH. Daytime symptoms of chronic obstructive pulmonary disease: a systematic review. NPJ Prim Care Respir Med 2020; 30:6. [PMID: 32081967 PMCID: PMC7035364 DOI: 10.1038/s41533-020-0163-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023] Open
Abstract
There is no single source of compiled data on symptoms experienced by patients with chronic obstructive pulmonary disease (COPD) when awake and active throughout the day. The aim of this systematic review was to evaluate the prevalence, variability, and burden (i.e., bothersomeness and/or intensity), and the impact of daytime COPD symptoms on other outcomes. The review also evaluated the impact of interventions and the measures/tools used to assess daytime COPD symptoms in patients. A systematic literature search was conducted using the primary search terms "COPD", "symptoms", and "daytime" in EMBASE®, MEDLINE®, MEDLINE® In-Process, and CENTRAL in 2016, followed by an additional search in 2018 to capture any new literature that was published since the last search. Fifty-six articles were included in the review. The accumulated evidence indicated that the symptomatic burden of COPD appears greatest in the morning, particularly upon waking, and that these morning symptoms have a substantial impact on patients' ability to function normally through the day; they also worsen quality of life. A wide variety of tools were used to evaluate symptoms across the studies. The literature also confirmed the importance of pharmacotherapy in the management of daytime COPD symptoms, and in helping normalize daily functioning. More research is needed to better understand how COPD symptoms impact daily functioning and to evaluate COPD symptoms at well-defined periods throughout the day, using validated and uniform measures/tools. This will help clinicians to better define patients' needs and take appropriate action.
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Affiliation(s)
- Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- General Practitioners Research Institute, Groningen, The Netherlands
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Hallowell RW, Schwartzstein R, O'Donnell CR, Sheridan A, Banzett RB. Controlled Delivery of 80 mg Aerosol Furosemide Does Not Achieve Consistent Dyspnea Relief in Patients. Lung 2020; 198:113-120. [PMID: 31728632 PMCID: PMC11001166 DOI: 10.1007/s00408-019-00292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/03/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Aerosol furosemide may be an option to treat refractory dyspnea, though doses, methods of delivery, and outcomes have been variable. We hypothesized that controlled delivery of high dose aerosol furosemide would reduce variability of dyspnea relief in patients with underlying pulmonary disease. METHODS Seventeen patients with chronic exertional dyspnea were recruited. Patients rated recently recalled breathing discomfort on a numerical rating scale (NRS) and the multidimensional dyspnea profile (MDP). They then performed graded exercise using an arm-ergometer. The NRS was completed following each exercise grade, and the MDP was repeated after a pre-defined dyspnea threshold was reached. During separate visits, patients received either aerosol saline or 80 mg of aerosol furosemide in a randomized, double-blind, crossover design. After treatment, graded exercise to the pre-treatment level was repeated, followed by completion of the NRS and MDP. Treatment effect was defined as the difference between pre- and post-treatment NRS at end exercise, expressed in absolute terms as % Full Scale. "Responders" were defined as those showing treatment effect ≥ 20% of full scale. RESULTS Final analysis included 15 patients. Neither treatment produced a statistically significant change in NRS and there was no significant difference between treatments (p = 0.45). There were four "responders" and one patient whose dyspnea worsened with furosemide; two patients were responders with saline, of whom one also responded to furosemide. No adverse events were reported. CONCLUSIONS High dose controlled delivery aerosol furosemide was not statistically different from saline placebo at reducing exercise-induced dyspnea. However, a clinically meaningful improvement was noted in some patients.
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Affiliation(s)
- Robert W Hallowell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Richard Schwartzstein
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Carl R O'Donnell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew Sheridan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Robert B Banzett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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Choate R, Pasquale CB, Parada NA, Prieto-Centurion V, Mularski RA, Yawn BP. The Burden of Cough and Phlegm in People With COPD: A COPD Patient-Powered Research Network Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 7:49-59. [PMID: 31999902 DOI: 10.15326/jcopdf.7.1.2019.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rationale Cough and phlegm are common symptoms of chronic obstructive pulmonary disease (COPD) and may significantly affect quality of life. This study assessed the burden of cough and phlegm on clinical outcomes and quality of life among people with a self-reported physician diagnosis of COPD. Methods Patient-reported data from the COPD Foundation's Patient-Powered Research Network (COPD PPRN) were utilized. Cough and phlegm severity and frequency were assessed by responses to questions on the COPD Assessment Test (CAT) and categorized into none/low, moderate and severe. Quality of life domains were evaluated using the Patient-Reported Outcome Measurement Information System (PROMIS-29). Associations between cough and phlegm levels and PROMIS-29 domains were examined using multivariate analysis of variance (MANOVA). Results The 5286 participants were average age 64.4 years (SD=11.4), 87.9% white, 60.4% female, 51.2% married, and 42.2% with caregivers. Approximately three-fourths of the participants had moderate or severe cough or phlegm levels. Respondents with moderate and high cough or phlegm had significantly worse dyspnea (p<0.0001), more exacerbations in the previous one year (p<0.0001), worse physical and social functioning, and more symptoms of anxiety and depression on PROMIS-29 compared to those with no/low cough and phlegm. Conclusions In this group of people with COPD, higher levels of cough and phlegm are associated with worse clinical and quality of life outcomes.
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Affiliation(s)
- Radmila Choate
- Research, COPD Foundation, Inc., Washington, DC.,University of Kentucky College of Public Health, Lexington
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Rebelo P, Oliveira A, Paixão C, Valente C, Andrade L, Marques A. Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Cough and Sputum in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:201-212. [PMID: 32099345 PMCID: PMC6996113 DOI: 10.2147/copd.s219480] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of minimal clinically important differences (MCIDs). Purpose This study established MCIDs for the Leicester cough questionnaire (LCQ) and the cough and sputum assessment questionnaire (CASA-Q), in patients with COPD after PR. Patients and Methods An observational prospective study was conducted in patients with COPD who participated in a 12-weeks community-based PR program. Anchor- (mean change, receiver operating characteristic curves and linear regression analysis) and distribution-based methods [0.5*standard deviation; standard error of measurement (SEM); 1.96*SEM; minimal detectable change and effect size] were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George's respiratory questionnaire and iv) occurrence of an exacerbation during PR. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 for anchor- and 1/3 for distribution-based methods). Results Forty-nine patients with COPD (81.6% male, 69.8±7.4years, FEV150.4±19.4%predicted) were used in the analysis. The pooled MCIDs were 1.3 for LCQ and for CASA-Q domains were: 10.6 - cough symptoms; 10.1 - cough impact; 9.5 - sputum symptoms and 7.8 - sputum impact. Conclusion The MCIDs found in this study are potential estimates to interpret PR effects on cough and sputum, and may contribute to guide interventions.
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Affiliation(s)
- Patrícia Rebelo
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Cátia Paixão
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Carla Valente
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Lília Andrade
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
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Kokturk N, Abuharbid W, Albanna AS, Gunen H, Gurgun A, Khadadah M, Malvolti E, Soliman M, van Zyl-Smit R, Zidouni N, Alzaabi A. A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa. Int J Chron Obstruct Pulmon Dis 2020; 14:2959-2970. [PMID: 31908444 PMCID: PMC6929940 DOI: 10.2147/copd.s215859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose This study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries. Patients and methods Non-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ). Results A total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p<0.001) in GOLD D than in GOLD C patients at each time during the day. In GOLD D, the mean (±SD) GCSQ score was higher at night (1.6±1.2, p<0.001) and in the morning (1.5±1.0, p<0.001) than in the afternoon (1.3±0.9), suggesting daytime variability of breathlessness and chest tightness. Overall, 60.0% of GOLD D patients (versus 13.6% GOLD C, p<0.0001) had difficulty getting out of bed due to COPD. Patients with symptom variability had significantly more difficulty to get out of bed, especially patients with chest tightness variability (p<0.0001) and wheezing variability (p<0.0001). The CDLM global score was significantly lower (p<0.0001) in GOLD D than in GOLD C patients (3.5±1.1 and 4.6 ± 3.5, respectively). Daily variability in chest tightness and wheezing was also significantly associated with CDLM scores (p<0.0001). Conclusion In MEA countries, patients with severe stable COPD reported significant daily and weekly symptom variability which affects morning activities, particularly in GOLD D patients.
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Affiliation(s)
- Nurdan Kokturk
- Department of Chest Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hakan Gunen
- Clinic of Chest Diseases, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alev Gurgun
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mousa Khadadah
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | - Medhat Soliman
- Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Richard van Zyl-Smit
- University of Cape Town Lung Institute, Department of Medicine and Division of Pulmonology, Groote Schuur Hospital, Cape Town, South Africa
| | - Noureddine Zidouni
- Department of Pulmonology, University Hospital Issad Hassani, Béni Messous, Alger, Algeria
| | - Ashraf Alzaabi
- Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, UAE
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Cukier A, Godoy ID, Costa CHD, Rubin AS, Gregorio MG, Albuquerque Neto AAD, Lima MA, Pereira MC, Tanni SE, Athanazio RA, Bessa EJC, Wehrmeister FC, Lourenco CB, Menezes AMB. Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study. ACTA ACUST UNITED AC 2019; 46:e20190223. [PMID: 31859705 PMCID: PMC7572289 DOI: 10.36416/1806-3756/e20190223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/08/2019] [Indexed: 11/23/2022]
Abstract
Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.
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Affiliation(s)
- Alberto Cukier
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Claudia Henrique da Costa
- . Disciplina de Pneumologia, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | | | - Aldo Agra de Albuquerque Neto
- . Departamento de Pneumologia, Centro de Reabilitação Pulmonar, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | | | - Monica Corso Pereira
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas (SP) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | - Rodrigo Abensur Athanazio
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Hahn B, Stanford RH, Hunter AG, White J, Essoi B, Ray R. Predictors of Symptom Burden in Patients with COPD on LAMA Monotherapy: Multivariable Analysis of a Claims-Linked Survey Study. Pulm Ther 2019; 5:179-190. [PMID: 32026410 PMCID: PMC6967173 DOI: 10.1007/s41030-019-00098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Many patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic. This multivariable analysis of a previously reported claims-linked, cross-sectional survey assessed symptom burden measured by the COPD assessment test (CAT) in patients treated with LAMA monotherapy. METHODS Eligible patients aged ≥ 40 years with COPD (≥ 2 International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] diagnosis codes ≥ 30 days apart during the 12-month baseline period) and ≥ 2 claims for LAMA monotherapy in the latter half of the baseline period were identified using claims data from the Optum Research Database. Patients completed a survey and 7-day daily diary; baseline clinical characteristics and resource utilization were assessed from claims data. Association between symptom burden and baseline characteristics was assessed using generalized linear regression modeling with normal distribution and identity link. RESULTS Overall, 433 patients prescribed LAMA monotherapy with claims-linked survey and diary data were included in the analysis. Most patients (85.5%) had a mean CAT score ≥ 10; 39.0% had scores ≥ 21. Overall, the factors most related to a clinically meaningful increase in CAT score (≥ 2 points) were being diagnosed with COPD for > 5 years and being a current smoker (2.25 points, P = 0.003 and 2.22 points, P = 0.025, respectively). CONCLUSIONS Results demonstrate that many patients with COPD receiving LAMA monotherapy remain symptomatic, especially those diagnosed > 5 years ago or those who continue to smoke. Use of patient-reported outcomes such as the CAT should be considered part of routine visits for patients with COPD. FUNDING GlaxoSmithKline (GSK study number 205862 [HO-16-16642]).
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Affiliation(s)
- Beth Hahn
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA.
| | - Richard H Stanford
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA
| | - Alyssa Goolsby Hunter
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - John White
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Breanna Essoi
- Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Riju Ray
- US Medical Affairs, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA
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Helvaci A, Gok Metin Z, Ozdemir L, Ergun P. The Effects of a Nurse-Led Education and Counseling Program on Dyspnea, Health Status, and Care Dependency in Patients With Chronic Obstructive Pulmonary Disease: A Feasibility Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319850819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this feasibility study was to determine the effects of a nurse-led education and counseling program for chronic obstructive pulmonary disease (COPD-ECP) on dyspnea, health status, and care dependency in patients. A quasi-experimental, pre-posttest research design without a control group was performed on 30 COPD patients. The patients received an 8-week COPD-ECP via home visits during the first 4 weeks and via phone interviews in the subsequent 4 weeks. After completion of COPD-ECP and a 4-week break, a final follow-up was conducted at the end of 12th week. The Dyspnea-12, COPD Assessment Test (CAT), and Care Dependency Scale (CDS) scores were calculated during the first interview, and on the 4th, 8th, and 12th week of the study. The patients completed all sessions of COPD-ECP without side effects. There was a significant decrease in the total Dyspnea-12 scores at the end of the study period. Compared to the baseline assessment, CAT total scores significantly decreased in the 4th, 8th, and 12th week ( p < 0.05), and CDS scores showed a significant reduction at the 12th week ( p < 0.05). In conclusion, COPD-ECP is feasible in regular clinical practice and well accepted by patients, and it seems to improve health status and decrease dyspnea, and care dependency. Future randomized controlled studies are warranted to explore the effects of COPD-ECP on fatigue, cough and sleep problems, and the best innovative strategies to improve the efficiency of COPD-ECP.
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Affiliation(s)
- Aylin Helvaci
- Hacettepe University Faculty of Nursing, Ankara, Turkey
| | | | - Leyla Ozdemir
- Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Pinar Ergun
- Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
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Kim MA, Suh MK, Park J, Kim JH, Kim TH, Kim EK, Oh YM, Lee SD, Lee JH. Impact of symptom variability on clinical outcomes in COPD: analysis of a longitudinal cohort. Int J Chron Obstruct Pulmon Dis 2019; 14:2135-2144. [PMID: 31571850 PMCID: PMC6759953 DOI: 10.2147/copd.s203715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We compared clinical characteristics of COPD patients according to symptom variability and evaluated the effect of symptom variability during the first year of enrollment on clinical outcomes of COPD. Methods We analyzed COPD patients’ data from the Korean Obstructive Lung Disease (KOLD) cohort. Symptom variability was defined based on the value of standard deviation (SD) of mMRC scores obtained every 3 months during the follow-up period of the first year. Patients were divided into 2 groups: the consistent (SD of mMRC scores =0) and variable (SD of mMRC scores >0) groups. Clinical characteristics and outcomes were compared in terms of symptom variability. Results A total of 407 patients were included in the analysis. Patient age was 67.2 years and 97.8% of the subjects were male. Initial mMRC was 1.5 and the SD of mMRC scores during the first year was 0.5. There were 137 subjects (33.7%) in the consistent group and 270 (66.3%) in the variable group. The variable group showed a lower FEV1 (P=0.019) and a higher mMRC score (P=0.001). The annual incidence of acute exacerbation of COPD (AE-COPD) tended to be higher in the variable group (P=0.078) and that of severe AE-COPD was higher in the variable group than in the consistent group (P=0.002). The variable group showed a higher proportion of annual exacerbators (P=0.001) and frequent exacerbators (P=0.017). In multivariate logistic regression analysis, the variable group was significantly associated with annual exacerbators (OR =1.963, P=0.011) and frequent exacerbators (OR =2.090, P=0.055). Conclusion COPD patients with symptom variability may have higher exacerbation risk as well as lower lung function and more severe respiratory symptoms.
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Affiliation(s)
- Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Min-Kang Suh
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jisoo Park
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jung-Hyun Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Tae-Hoon Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eun Kyung Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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60
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Antonelli Incalzi R, Canonica GW, Scichilone N, Rizzoli S, Simoni L, Blasi F. The COPD multi-dimensional phenotype: A new classification from the STORICO Italian observational study. PLoS One 2019; 14:e0221889. [PMID: 31518364 PMCID: PMC6743765 DOI: 10.1371/journal.pone.0221889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background This paper is aimed to (i) develop an innovative classification of COPD, multi-dimensional phenotype, based on a multidimensional assessment; (ii) describe the identified multi-dimensional phenotypes. Methods An exploratory factor analysis to identify the main classificatory variables and, then, a cluster analysis based on these variables were run to classify the COPD-diagnosed 514 patients enrolled in the STORICO (trial registration number: NCT03105999) study into multi-dimensional phenotypes. Results The circadian rhythm of symptoms and health-related quality of life, but neither comorbidity nor respiratory function, qualified as primary classificatory variables. Five multidimensional phenotypes were identified: the MILD COPD characterized by no night-time symptoms and the best health status in terms of quality of life, quality of sleep, level of depression and anxiety, the MILD EMPHYSEMATOUS with prevalent dyspnea in the early-morning and day-time, the SEVERE BRONCHITIC with nocturnal and diurnal cough and phlegm, the SEVERE EMPHYSEMATOUS with nocturnal and diurnal dyspnea and the SEVERE MIXED COPD distinguished by higher frequency of symptoms during 24h and worst quality of life, of sleep and highest levels of depression and anxiety. Conclusions Our results showed that properly collected respiratory symptoms play a primary classificatory role of COPD patients. The longitudinal observation will disclose the discriminative and prognostic potential of the proposed multidimensional phenotype. Trial registration Trial registration number: NCT03105999, date of registration: 10th April 2017.
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Affiliation(s)
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic Humanitas University Humanitas research Hospital, Rozzano, Milan, Italy
| | - Nicola Scichilone
- DIBIMIS, University of Palermo, Piazza delle Cliniche, Palermo, Italy
| | | | | | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Maggiore Hospital, Milan, Italy
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Criner GJ, Celli BR, Brightling CE, Agusti A, Papi A, Singh D, Sin DD, Vogelmeier CF, Sciurba FC, Bafadhel M, Backer V, Kato M, Ramírez-Venegas A, Wei YF, Bjermer L, Shih VH, Jison M, O'Quinn S, Makulova N, Newbold P, Goldman M, Martin UJ. Benralizumab for the Prevention of COPD Exacerbations. N Engl J Med 2019; 381:1023-1034. [PMID: 31112385 DOI: 10.1056/nejmoa1905248] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) are not known. METHODS In the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. <220 per cubic millimeter]) who had frequent exacerbations despite receiving guideline-based inhaled treatment. Patients were randomly assigned to receive benralizumab (30 or 100 mg in GALATHEA; 10, 30, or 100 mg in TERRANOVA) every 8 weeks (every 4 weeks for the first three doses) or placebo. The primary end point was the treatment effect of benralizumab, measured as the annualized COPD exacerbation rate ratio (benralizumab vs. placebo) at week 56 in patients with baseline blood eosinophil counts of 220 per cubic millimeter or greater. Safety was also assessed. RESULTS In GALATHEA, the estimates of the annualized exacerbation rate were 1.19 per year (95% confidence interval [CI], 1.04 to 1.36) in the 30-mg benralizumab group, 1.03 per year (95% CI, 0.90 to 1.19) in the 100-mg benralizumab group, and 1.24 per year (95% CI, 1.08 to 1.42) in the placebo group; the rate ratio as compared with placebo was 0.96 for 30 mg of benralizumab (P = 0.65) and 0.83 for 100 mg of benralizumab (P = 0.05). In TERRANOVA, the estimates of the annualized exacerbation rate for 10 mg, 30 mg, and 100 mg of benralizumab and for placebo were 0.99 per year (95% CI, 0.87 to 1.13), 1.21 per year (95% CI, 1.08 to 1.37), 1.09 per year (95% CI, 0.96 to 1.23), and 1.17 per year (95% CI, 1.04 to 1.32), respectively; the corresponding rate ratios were 0.85 (P = 0.06), 1.04 (P = 0.66), and 0.93 (P = 0.40). At 56 weeks, none of the annualized COPD exacerbation rate ratios for any dose of benralizumab as compared with placebo reached significance in either trial. Types and frequencies of adverse events were similar with benralizumab and placebo. CONCLUSIONS Add-on benralizumab was not associated with a lower annualized rate of COPD exacerbations than placebo among patients with moderate to very severe COPD, a history of frequent moderate or severe exacerbations, and blood eosinophil counts of 220 per cubic millimeter or greater (Funded by AstraZeneca [GALATHEA and TERRANOVA] and Kyowa Hakko Kirin [GALATHEA]; GALATHEA and TERRANOVA ClinicalTrials.gov numbers, NCT02138916 and NCT02155660.).
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MESH Headings
- Aged
- Anti-Asthmatic Agents/administration & dosage
- Anti-Asthmatic Agents/adverse effects
- Anti-Asthmatic Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Double-Blind Method
- Eosinophils/metabolism
- Female
- Humans
- Injections, Subcutaneous
- Leukocyte Count
- Male
- Middle Aged
- Patient Acuity
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/immunology
- Receptors, Interleukin-5/antagonists & inhibitors
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Affiliation(s)
- Gerard J Criner
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Bartolome R Celli
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Christopher E Brightling
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Alvar Agusti
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Alberto Papi
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Dave Singh
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Don D Sin
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Claus F Vogelmeier
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Frank C Sciurba
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Mona Bafadhel
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Vibeke Backer
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Motokazu Kato
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Alejandra Ramírez-Venegas
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Yu-Feng Wei
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Leif Bjermer
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Vivian H Shih
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Maria Jison
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Sean O'Quinn
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Natalya Makulova
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Paul Newbold
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Mitchell Goldman
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
| | - Ubaldo J Martin
- From the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia (G.J.C.); Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston (B.R.C.); the Institute for Lung Health, Leicester National Institute for Health Research Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester (C.E.B.), the University of Manchester, Manchester University NHS Hospital Trust, Manchester (D.S.), and the Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford (M.B.) - all in the United Kingdom; Respiratory Institute, Hospital Clinic, University of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Barcelona (A.A.); the Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.P.); the Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada (D.D.S.); the Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Marburg, Germany (C.F.V.); University of Pittsburgh School of Medicine, Pittsburgh (F.C.S.); the Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen (V.B.); Kishiwada City Hospital, Osaka, Japan (M.K.); the Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosio Villegas, Mexico City (A.R.-V.); the Division of Respiratory and Chest Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan (Y.-F.W.); the Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund University, Lund, Sweden (L.B.); and AstraZeneca, Gaithersburg, MD (V.H.S., M.J., S.O., N.M., P.N., M.G., U.J.M.)
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Nicola S, Raffaele AI, Francesco B, Pietro S, Giuseppina C, Alessandro Z, Alessandra O, Giorgio Walter C. Circadian rhythm of COPD symptoms in clinically based phenotypes. Results from the STORICO Italian observational study. BMC Pulm Med 2019; 19:171. [PMID: 31500607 PMCID: PMC6734215 DOI: 10.1186/s12890-019-0935-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) encompasses various phenotypes that severely limit the applicability of precision respiratory medicine. The present investigation is aimed to assess the circadian rhythm of symptoms in pre-defined clinical COPD phenotypes and its association with health-related quality of life (HR-QoL), the quality of sleep and the level of depression/anxiety in each clinical phenotype. METHODS The STORICO (NCT03105999) Italian observational prospective cohort study enrolled COPD subjects. A clinical diagnosis of either chronic bronchitis (CB), emphysema (EM) or mixed COPD-asthma (MCA) phenotype was made by clinicians at enrollment. Baseline early-morning, day-time and nocturnal symptoms (gathered via the Night-time, Morning and Day-time Symptoms of COPD questionnaire), HR-QoL (via the St. George's Respiratory Questionnaire), anxiety and depression levels (via the Hospital Anxiety and Depression Scale), quality of sleep (via COPD and Asthma Sleep Impact Scale), physical activity (via the International Physical Activity Questionnaire) as well as lung function were recorded. RESULTS 606 COPD subjects (age 71.4 ± 8.2 years, male 75.1%) were studied. 57.9, 35.5 5.3 and 1.3% of the sample belonged to the CB, EM, MCA and EM + CB phenotypes respectively. The vast majority of subjects reported early-morning and day-time symptoms (79.5 and 79.2% in the CB and 75.8 and 77.7% in the EM groups); the proportion suffering from night-time symptoms was higher in the CB than in the EM group (53.6% vs. 39.5%, p = 0.0016). In both CB and EM, indiscriminately, the presence of symptoms during the 24-h day was associated with poorer HR-QoL, worse quality of sleep and higher levels of anxiety/depression. CONCLUSIONS The findings highlight the primary classificatory role of nocturnal symptoms in COPD. TRIAL REGISTRATION Trial registration number: NCT03105999 , date of registration: 10th April 2017.
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Affiliation(s)
- Scichilone Nicola
- DIBIMIS, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | | | - Blasi Francesco
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza, 35, 20122 Milan, Italy
| | - Schino Pietro
- Miulli Hospital, Acquaviva delle FontiStrada Prov. 127 Acquaviva – Santeramo Km. 4, 10070021 Bari, Italy
| | | | - Zullo Alessandro
- Medineos Observational Research, Viale Virgilio 54/U, 41123 Modena, Italy
| | - Ori Alessandra
- Medineos Observational Research, Viale Virgilio 54/U, 41123 Modena, Italy
| | - Canonica Giorgio Walter
- Personalized Medicine Asthma and Allergy Clinic Humanitas University Humanitas research Hospital Rozzano (Milan), via Manzoni, 56, 20089 Rozzano, MI Italy
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Singh D, D'Urzo AD, Donohue JF, Kerwin EM. Weighing the evidence for pharmacological treatment interventions in mild COPD; a narrative perspective. Respir Res 2019; 20:141. [PMID: 31286970 PMCID: PMC6615221 DOI: 10.1186/s12931-019-1108-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
There is increasing focus on understanding the nature of chronic obstructive pulmonary disease (COPD) during the earlier stages. Mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 or the now-withdrawn GOLD stage 0) represents an early stage of COPD that may progress to more severe disease. This review summarises the disease burden of patients with mild COPD and discusses the evidence for treatment intervention in this subgroup. Overall, patients with mild COPD suffer a substantial disease burden that includes persistent or potentially debilitating symptoms, increased risk of exacerbations, increased healthcare utilisation, reduced exercise tolerance and physical activity, and a higher rate of lung function decline versus controls. However, the evidence for treatment efficacy in these patients is limited due to their frequent exclusion from clinical trials. Careful assessment of disease burden and the rate of disease progression in individual patients, rather than a reliance on spirometry data, may identify patients who could benefit from earlier treatment intervention.
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Affiliation(s)
- Dave Singh
- University of Manchester, Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, M23 9QZ, UK.
| | - Anthony D D'Urzo
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James F Donohue
- Division of Pulmonary Diseases & Critical Care Medicine, University of North Carolina Pulmonary Critical Medicine, Chapel Hill, North Carolina, USA
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Mihaltan F, Adir Y, Antczak A, Porpodis K, Radulovic V, Pires N, de Vries GJ, Horner A, De Bontridder S, Chen Y, Shavit A, Alecu S, Adamek L. Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study. Respir Res 2019; 20:89. [PMID: 31088560 PMCID: PMC6518503 DOI: 10.1186/s12931-019-1053-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/16/2019] [Indexed: 03/19/2023] Open
Abstract
Background The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. This study aimed to explore in more depth the 24-h respiratory symptoms, the physical activity level (PAL) and the relationship between these two determinants in stable COPD patients. Methods This was a multinational, multicenter, observational, cross-sectional study conducted in ten European countries and Israel. Dedicated questionnaires for each part of the day (morning, daytime, night) were used to assess respiratory symptoms. PAL was evaluated with self- and interview-reported tools [EVS (exercise as vital sign) and YPAS (Yale Physical Activity Survey)], and physician’s judgement. Patients were stratified in ABCD groups by 2013 and 2017 GOLD editions using the questionnaires currently recommended: modified Medical Research Council dyspnea scale and COPD Assessment Test. Results The study enrolled 2190 patients (mean age: 66.9 years; male: 70.0%; mean % predicted FEV1: 52.6; GOLD groups II-III: 84.5%; any COPD treatment: 98.9%). Most patients (> 90%) reported symptoms in any part of the 24-h day, irrespective of COPD severity. PAL evaluations showed discordant results between patients and physicians: 32.9% of patients considered themselves completely inactive, while physicians judged 11.9% patients as inactive. By YPAS, the overall study population spent an average of 21.0 h/week performing physical activity, and 68.4% of patients were identified as sedentary. In any GOLD ABCD group, the percentage of inactive patients was high. Our study found negative, weak correlations between respiratory symptoms and self-reported PAL (p < 0.001). Conclusions Despite regular treatment, the majority of stable COPD patients with moderate to severe disease experienced daily variable symptoms. Physical activity level was low in this COPD cohort, and yet overestimated by physicians. With evidence indicating the negative consequences of inactivity, its adequate screening, a more active promotion and regular assessment of physical activity are urgently needed in COPD patients for better outcomes. Trial registration NCT03031769, retrospectively registered, 23 Jan 2017. Electronic supplementary material The online version of this article (10.1186/s12931-019-1053-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florin Mihaltan
- Department of Pulmonology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| | - Yochai Adir
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adam Antczak
- Clinical Department of Pulmonology and Allergology, University Hospital, Lodz, Poland
| | | | - Vesna Radulovic
- Municipal Institute for Lung Diseases and Tuberculosis, Belgrade, Serbia
| | - Nuno Pires
- Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Andreas Horner
- Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria
| | | | - Yunqin Chen
- AstraZeneca Global R&D Information, Shanghai, China
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Achury-Beltrán L, Garcia-Peñuela P. Efecto de una actividad grupal educativa en la calidad de vida de la persona con EPOC. ENFERMERÍA UNIVERSITARIA 2019. [DOI: 10.22201/eneo.23958421e.2019.2.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), es un importante problema de salud pública que repercute sobre la calidad de vida. Se requieren intervenciones que reduzcan su impacto. Objetivo: Determinar el efecto de una actividad educativa grupal sobre la calidad de vida de personas con EPOC, que asisten a una institución de cuarto nivel durante septiembre-2017 y junio-2018, en Bogotá, Colombia. Métodos: Diseño cuasi-experimental. La variable independiente fue la actividad educativa grupal y la variable dependiente la calidad de vida, medida con el Cuestionario Respiratorio de Saint George (SGRQ). Los pacientes se aleatorizaron con una tabla generada por computador. El grupo control (n=30) recibió la intervención usual y el grupo experimental (n=30) una actividad educativa grupal diseñada bajo recomendaciones internacionales, impartida por el personal de enfermería. Se excluyeron pacientes con asistencia a actividades grupales durante los últimos dos meses. Resultados: La media de la calidad de vida pos-intervención fue 41% y 32% para el grupo control y experimental, respectivamente, se redujeron dos puntos con respecto a la medición inicial. La dimensión de actividad fue la más comprometida. No se encontraron diferencias estadísticamente significativas en el análisis intragrupal ni intergrupal. Discusión: La leve mejoría pos-intervención en las dimensiones de actividad e impacto, así como las variables sociodemográficas son congruentes con otros estudios. Los resultados pueden guardar relación con la cantidad de actividades desarrolladas. Conclusiones: La actividad grupal no genera mejoría estadísticamente significativa en la calidad de vida de las personas con EPOC. Se identificó una mejoría clínica en las dimensiones de actividad e impacto, así como en la puntuación global.
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Johansson H, Berterö C, Berg K, Jonasson LL. To live a life with COPD - the consequences of symptom burden. Int J Chron Obstruct Pulmon Dis 2019; 14:905-909. [PMID: 31114186 PMCID: PMC6497002 DOI: 10.2147/copd.s192280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a prevalent illness that, due to its symptoms and treatment, entails a significant burden for the affected person, and his/her family, health care and private finances. Today, knowledge and understanding are sparse regarding COPD-affected persons’ own lived experiences and about the symptom burden and its effect on their daily life. Due to this knowledge gap the aim of this study was to identify and describe the symptom burden and its effect on daily life in people with COPD, based on their own lived experiences. Subject and method Eleven males and 14 females in GOLD stages III and IV, in an age range of 58–82 years, were interviewed. An interview guide was used to direct the face-to-face interviews. Data was analyzed with thematic analysis following the six steps according to Braun and Clarke. Results The results highlighted one theme: an altered everyday life. The altered everyday life leads to a need for support to handle everyday life and for different strategies to live as desired. Persons with COPD need to take each day as it comes and their life is not easy to plan since it depends on how they feel from day to day. Life is handled with several strategies such as breathing techniques, and ways to take care of the home and garden as well as the emotions. Support from the next of kin, society and the health care service is important. Conclusion This study provides the insight that persons with COPD in stages III and IV have an altered life caused by the symptom burden. They must struggle with strategies to handle everyday life. There is a need of support from the next of kin and society to facilitate daily living, but this support needs to be well-balanced.
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Affiliation(s)
- Helena Johansson
- Department of Medical Specialist, Linköping University, Motala, Sweden, .,Department of Medical Health Sciences, Linköping University, Linköping, Sweden,
| | - Carina Berterö
- Department of Medical Health Sciences, Linköping University, Linköping, Sweden,
| | - Katarina Berg
- Department of Medical Health Sciences, Linköping University, Linköping, Sweden,
| | - Lise-Lotte Jonasson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Tsiligianni I, Kampouraki M, Ierodiakonou D, Poulonirakis I, Papadokostakis P. COPD patients' characteristics, usual care, and adherence to guidelines: the Greek UNLOCK study. Int J Chron Obstruct Pulmon Dis 2019; 14:547-556. [PMID: 30880944 PMCID: PMC6402614 DOI: 10.2147/copd.s185362] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose GOLD guidelines classify COPD patients into A–D groups based on health status as assessed by COPD Assessment Test (CAT) or mMRC tools and exacerbations and recommend single or dual long-acting bronchodilators as maintenance therapy, with additional inhaled corticosteroids (ICS) if the disease remains uncontrolled. We aimed to classify primary care COPD patients into A–D groups, assess usual treatment and adherence to guidelines, potential mismatches between CAT-and mMRC-based classification and described symptoms within groups. Patients and methods A total of 257 primary care COPD patients were enrolled between 2015 and 2016 in Greece. Physicians used structured interviews to collect cross-sectional data including demographics, symptoms, CAT, mMRC scores, and medications. Patients were classified into A–D groups based on CAT and mMRC, and prevalence of symptoms and medication was estimated within A–D groups. Interviews with physicians were also performed to explore additional issues about treatment and adherence to guidelines. Results Mean (SD) age was 65 (12.3) years with 79% males. The majority of patients reported uncontrolled symptoms (91% and 61% with ≥10 CAT or ≥2 mMRC scores, respectively). Thirty-seven percentage had $2 exacerbations in the past year. Group B was the largest followed by Groups D, A, and C. Patients were classified as more severe by CAT than by mMRC. In all groups, the majority were treated with combined long-acting beta agonist/ICS (> 50%). When patients were asked to report their main symptoms, dyspnea and cough were the most important symptoms mentioned, and there was a great variation between the A–D groups. However, Groups A–C reported mainly morning symptoms, whereas Group D suffered symptoms all day. Physicians reported a significant number of barriers to implementing guidelines, eg, frequent lack of guideline updates, access to diagnostic procedures, and prescription-reimbursement issues. Conclusion Our study confirms poor adherence to guidelines regarding treatment with an overuse of ICS and important barriers to implementation. A mismatch in classification occurs depending on the tool used, which can mislead clinicians in their choice of treatment.
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Affiliation(s)
- Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece,
| | - Maria Kampouraki
- Primary Care Practice, Health Center of Moires, Heraklion, Crete, Greece
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D’Urzo AD, Singh D, Donohue JF, Chapman KR. Aclidinium bromide in fixed-dose combination with formoterol fumarate in the management of COPD: an update on the evidence base. Ther Adv Respir Dis 2019; 13:1753466619850725. [PMID: 31096854 PMCID: PMC6535700 DOI: 10.1177/1753466619850725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
Aclidinium bromide/formoterol fumarate (AB/FF) 400/12 µg is a twice-daily long-acting muscarinic receptor antagonist and long-acting β2 agonist (LAMA/LABA) dual-bronchodilator maintenance therapy used to relieve symptoms and reduce future risk of exacerbations in adults with chronic obstructive pulmonary disease (COPD). To date, there have been several clinical studies and post hoc analyses of AB/FF, assessing treatment outcomes in patients with moderate-to-severe COPD. These studies have looked at a range of outcomes, including lung function parameters, patient-reported symptom scores, quality-of-life measures assessing impaired health and perceived well-being, and the frequency, duration, and severity of exacerbations. In light of the major 2017 revision to the Global initiative for chronic Obstructive Lung Disease (GOLD) recommendations, and the subsequent updates, we present an update on the latest evidence supporting the efficacy and safety of AB/FF. This review discusses the clinical relevance of the improvements in lung function, symptoms, quality of life, and exacerbations in patients with COPD reported in the phase III and IV trials of AB/FF. Given the current concerns over unnecessary inhaled corticosteroid (ICS) use in COPD, we also touch briefly on the use of blood eosinophils as a biomarker for identifying those patients with COPD already using LAMA/LABA therapy for whom the addition of ICS might be of benefit.
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Affiliation(s)
- Anthony D. D’Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON 12354, Canada
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundations Trust, Manchester, UK
| | - James F. Donohue
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina Pulmonary Critical Medicine, Chapel Hill, NC, USA
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Johnson KM, Safari A, Tan WC, Bourbeau J, FitzGerald JM, Sadatsafavi M, Study OBOTCCOOLDC. Heterogeneity in the respiratory symptoms of patients with mild-to-moderate COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3983-3995. [PMID: 30587954 PMCID: PMC6296193 DOI: 10.2147/copd.s184424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The burden of symptoms varies markedly between patients with COPD and is only weakly correlated with lung function impairment. While heterogeneity in lung function decline and exacerbations have been previously studied, the extent of heterogeneity in symptoms and the factors associated with this heterogeneity are not well understood. Methods A sample of the general Canadian population ≥40 years with persistent airflow limitation was followed for up to 3 years. Participants reported whether they experienced chronic coughing, phlegm, wheezing, or dyspnea during visits at 18-month intervals. We used mixed-effect logistic regression models (separately for each symptom) to assess overall heterogeneity in the occurrence of symptoms between individuals, and the proportion of variation in symptom burden explained by lung function vs all other clinical characteristics of participants. Results Four hundred forty-nine participants (53% male, mean age 67 years) contributed 968 visits in total, and 89% of patients reported at least one symptom during follow-up. There was substantial heterogeneity in the individual-specific probabilities for the occurrence of symptoms. This heterogeneity was highest for wheeze and dyspnea (IQR of probabilities: 0.13–0.78 and 0.19–0.81, respectively). FEV1 explained 28% of the variation between individuals in the occurrence of dyspnea, 8% for phlegm, 3% for cough, and 2% for wheeze. All clinical characteristics of participants (including FEV1) explained between 26% of heterogeneity in the occurrence of cough to 49% for dyspnea. Conclusion There is marked heterogeneity in the burden of respiratory symptoms between COPD patients. The ability of lung function and other commonly measured clinical characteristics to explain this heterogeneity differs between symptoms.
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Affiliation(s)
- Kate M Johnson
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada,
| | - Abdollah Safari
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, .,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada,
| | - Wan C Tan
- Centre for Heart Lung Innovation (the James Hogg Research Centre), St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada,
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, .,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada, .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada,
| | - On Behalf Of The Canadian Cohort Of Obstructive Lung Disease CanCOLD Study
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, .,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada, .,Centre for Heart Lung Innovation (the James Hogg Research Centre), St Paul's Hospital, Vancouver, BC, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada,
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Núñez A, Esquinas C, Barrecheguren M, Calle M, Casamor R, Miravitlles M. Evaluating the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire. Int J Chron Obstruct Pulmon Dis 2018; 13:3837-3844. [PMID: 30538445 PMCID: PMC6263249 DOI: 10.2147/copd.s179402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to evaluate the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire and to determine the clinical variables that are related to CDLM scores. Methods This was an observational, cross-sectional, and multicenter study conducted in stable COPD patients. CDLM scores ranged from 0 to 5 and were transformed into a qualitative variable according to tertile values to compare patient characteristics. A multivariate linear regression model was used to identify the clinical variables related to CDLM scores. Results A total of 605 patients were included in the study; the mean age (SD) was 68 years (9.1) and mostly were male (80.8%). The mean post-bronchodilator FEV1% was 53.4% (19.2%), and the mean BODEx (body mass index, airway obstruction, dyspnea, exacerbation) score was 3.2 (2.0). The mean COPD assessment test (CAT) score was 16.6 (8.3), and the mean CDLM score was 4.2 (0.9). First tertile patients, that is, those with a higher impact in the morning, were older, had more respiratory symptoms, more dyspnea, a lower FEV1%, lower CAT and BODEx scores, and more exacerbations. We found a ceiling effect on the CDLM scores: 194 (32%) patients scored 5.00 and no patients scored 0. On multivariate analysis, higher CAT and BODEx scores, a lower FEV1%, and use of long-term oxygen therapy (LTOT) were all independently related to lower CDLM scores. Conclusion Morning respiratory symptoms are associated with more severe airflow obstruction, lower CAT and BODEx scores, and LTOT. The ceiling effect of the CDLM questionnaire does not allow it to discriminate well between low and high impact of morning symptoms.
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Affiliation(s)
- Alexa Núñez
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain,
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain,
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain,
| | - Myriam Calle
- Pneumology Department, Hospital Clínico de San Carlos, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricard Casamor
- Medical Department, Novartis Farmaceutica, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain, .,CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain,
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What have we learned from observational studies and clinical trials of mild to moderate COPD? Respir Res 2018; 19:177. [PMID: 30223834 PMCID: PMC6142698 DOI: 10.1186/s12931-018-0882-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/05/2018] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. It is well established that patients with mild to moderate disease represent the majority of patients with COPD, and patients with mild COPD already have measurable physiological impairment with increased morbidity and a higher risk of mortality compared with healthy non-smoking individuals. However, this subpopulation is both underdiagnosed and undertreated. In addition, most clinical trials include cohorts of patients with worse lung function and quality of life, which are very different from the milder patients usually seen in primary care. Clinical trials have shown that mild-moderate COPD patients present an improvement in lung function after treatment with long-acting bronchodilators (LABD). Inhaled therapy has also shown benefits in terms of symptoms, health-related quality of life (HRQL) and exacerbation prevention in this population. Early intervention might have also a positive effect to prevent functional impairment. Nevertheless, there is scarce evidence from randomised clinical trials and real-life studies about the importance of pharmacological treatment in early stages of COPD to improve long-term outcomes. New concepts such as clinically important deterioration may help to investigate the impact of interventions on the natural history of the disease.
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D'Urzo AD, Cazzola M, Hanania NA, Buhl R, Maleki-Yazdi MR. New developments in optimizing bronchodilator treatment of COPD: a focus on glycopyrrolate/formoterol combination formulated by co-suspension delivery technology. Int J Chron Obstruct Pulmon Dis 2018; 13:2805-2819. [PMID: 30233171 PMCID: PMC6135066 DOI: 10.2147/copd.s113306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COPD causes considerable health and economic burden worldwide, with incidence of the disease expected to continue to rise. Inhaled bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), are central to the maintenance treatment of patients with COPD. Clinical studies have demonstrated that combined LAMA + LABA therapies improve efficacy while retaining a safety profile similar to LAMA or LABA alone. This has led to the development of several LAMA/LABA fixed-dose combination (FDC) therapies, which provide patients with the convenience of two active compounds in a single inhaler. GFF MDI (Bevespi Aerosphere®) is an FDC of glycopyrrolate/formoterol fumarate 18/9.6 µg formulated using innovative co-suspension delivery technology for administration via metered dose inhaler (MDI). GFF MDI was developed to make a treatment option available for patients who have a requirement or preference to use an MDI, rather than a dry powder or soft mist inhaler. Now that several LAMA/LABA FDCs have been approved for use in COPD, we review the impact of dual-bronchodilator treatment on COPD therapy and discuss recent clinical studies that are helping to develop a more comprehensive understanding of how LAMA/LABA FDCs can improve patient outcomes.
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Affiliation(s)
- Anthony D D'Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - M Reza Maleki-Yazdi
- Division of Respiratory Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Basile M, Baiamonte P, Mazzuca E, Principe S, Pennavaria F, Benfante A, Scichilone N. Sleep Disturbances in COPD are Associated with Heterogeneity of Airway Obstruction. COPD 2018; 15:350-354. [PMID: 30188194 DOI: 10.1080/15412555.2018.1504015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with Chronic Obstructive Pulmonary Disease (COPD) experience sleep disturbances due to the impact of respiratory symptoms on sleep quality. We explored whether sleep disturbances in COPD are linked to heterogeneity of airway constriction. The impact of breathing problems on sleep quality was measured in consecutive COPD outpatients with the COPD and Asthma Sleep Impact Scale (CASIS) questionnaire. Impulse oscillometry technique (IOS) was employed to assess heterogeneity of airway constriction. Subjects with a previous or concomitant diagnosis of asthma or obstructive sleep apnea (OSA) were excluded. Fifty COPD subjects (M/F 40/10; age: 71 ± 8 yrs, Body Mass Index (BMI): 26.2 ± 4.7 kg/m2, Forced Expiratory Volume in the first second (FEV1): 65 ± 25% predicted; mean ± SD) were enrolled. The mean CASIS score was 36 ± 3.3, and the R5-R20 value was 0.2 ± 0.15 kPa s L-1. The CASIS score was significantly higher in subjects with increased R5-R20 (>0.07 kPa s L-1) (39 ± 24; p = 0.02) compared to normal R5-R20 (21 ± 17). When subjects were categorized on the basis of lung function in severely versus non severely obstructed (FEV1 ≤ or >50% predicted) or air trappers versus non air trappers (Residual Volume, RV ≥ or <120% predicted) the CASIS score remained unchanged (for FEV1: 37 ± 23 versus 33 ± 25, respectively, p = 0.61; for RV: 30 ± 20 versus 40 ± 23, p = 0.16). Sleep disturbances due to COPD symptoms are associated with heterogeneity of airway constriction, possibly reflecting peripheral airway dysfunction.
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Affiliation(s)
- Marco Basile
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Pierpaolo Baiamonte
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Emilia Mazzuca
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Stefania Principe
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Federica Pennavaria
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Alida Benfante
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
| | - Nicola Scichilone
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS) , University of Palermo . Palermo , Italy
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Svedsater H, Doll HA, Macey J, Miles G, Bradshaw L, Vanya M. Evaluating the Impact and Benefits of Fluticasone Furoate/Vilanterol in Individuals with Asthma or COPD: A Mixed-Methods Analysis of Patient Experiences. Adv Ther 2018; 35:1378-1399. [PMID: 30105658 PMCID: PMC6133131 DOI: 10.1007/s12325-018-0760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Indexed: 12/05/2022]
Abstract
Introduction This study evaluated patients’ experiences with fluticasone furoate/vilanterol (FF/VI) combination therapy in UK patients with asthma or chronic obstructive pulmonary disease (COPD). Methods Participants aged ≥ 18 years, with self-reported, physician-diagnosed asthma or COPD (≥ 1 year) who had been receiving FF/VI (≥ 3 months) were recruited from UK primary care. This two-phase, mixed-methods study consisted of a semi-structured, telephone-interview phase (qualitative) and a self-completed online/paper-survey phase (quantitative). Results The telephone-interview phase included 50 individuals [asthma, n = 25; COPD, n = 25; mean age (SD) 56.7 years (13.3); 50% female]. Of these, 21 with asthma reported that their condition was stable/well controlled and 13 with COPD felt their condition was manageable. Most participants found FF/VI easy to use (asthma, 25; COPD, 23), easy to integrate into their daily routine (asthma, 25; COPD, 24), and able to control symptoms for ≥ 24 h (asthma, 14; COPD, 16). During the survey phase, 199 individuals were recruited [asthma, n = 100; COPD, n = 99; mean age (SD) 63.6 years (15.1); 59.3% female]. Most participants were satisfied/very satisfied with the efficacy of FF/VI in terms of all-day symptom relief (asthma, 84%; COPD, 75%) and found FF/VI easy/very easy to fit into their daily routine (asthma, 99%; COPD, 96%), easy/very easy to use (asthma, 97%; COPD, 92%), and convenient/very convenient to take as instructed (asthma, 95%; COPD, 93%). Significantly more individuals with asthma (87% versus 46%, P < 0.001) and numerically more individuals with COPD (84% versus 76%, P = 0.055) were satisfied/very satisfied with FF/VI compared with their most recent previous maintenance medication. Conclusion The majority of individuals in this study had confidence in FF/VI and were satisfied or very satisfied with various key attributes of the treatment. Electronic supplementary material The online version of this article (10.1007/s12325-018-0760-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henrik Svedsater
- Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK.
| | - Helen A Doll
- ICON, ICON Clinical Outcome Assessments, Abingdon, UK
| | - Jake Macey
- ICON, ICON Clinical Outcome Assessments, Abingdon, UK
| | | | - Lisa Bradshaw
- Centre for Workplace Health, Northern General Hospital, Sheffield, UK
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Crook S, Büsching G, Keusch S, Wieser S, Turk A, Frey M, Puhan MA, Frei A. The association between daily exacerbation symptoms and physical activity in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:2199-2206. [PMID: 30140152 PMCID: PMC6054763 DOI: 10.2147/copd.s156986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Evidence from longitudinal studies on the impact of exacerbation symptoms on physical activity in chronic obstructive pulmonary disease (COPD) is lacking. The aim of this first exploratory study was to assess the association between exacerbation symptoms and physical activity, and to quantify the relative influence of specific symptoms. Methods We recruited COPD patients at high risk for exacerbations from 2 pulmonary rehabilitation clinics and 1 acute care clinic in Switzerland. For 3 months after discharge, patients completed a daily symptom diary on a smartphone application, the EXAcerbations of Chronic pulmonary disease Tool (EXACT), and wore a pedometer to measure daily steps. We used mixed-effects models to determine the association of daily steps with exacerbation symptoms. Results A total of 21 patients (Global Initiative for Chronic Obstructive Lung Disease grades 2-4) were enrolled for a mean of 94.4 days (standard deviation 4.2). The baseline median number of daily steps was 3,264.6 (interquartile range [IQR]: 1,851.3-4,784.1) and EXACT score was 37.0 (IQR: 30.9-41.4). A 12-point increase in EXACT score (indicating the start of an exacerbation) was statistically significantly associated with a decrease in daily steps of 653.3 (95% CI 969.7-336.9). Chest symptoms (tightness, discomfort and congestion) were more strongly associated with change in steps than breathlessness, and cough and sputum (z-value -4.5 vs -2.9 and -3.0). Conclusion This is the first study to show that, in a small cohort of COPD patients, increases in exacerbation symptoms were associated with a statistically and clinically significant reduction in daily physical activity. These results underscore the importance for symptom control and exacerbation prevention in COPD patients.
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Affiliation(s)
- Sarah Crook
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland,
| | - Gilbert Büsching
- Pulmonary Rehabilitation, Klinik Barmelweid, Barmelweid, Switzerland
| | - Stephan Keusch
- Pulmonology, Zürcher RehaZentrum Wald, Wald, Switzerland
| | | | - Alexander Turk
- Pulmonology, Zürcher RehaZentrum Wald, Wald, Switzerland.,Department of Internal Medicine, See-Spital Horgen, Horgen, Switzerland
| | - Martin Frey
- Pulmonary Rehabilitation, Klinik Barmelweid, Barmelweid, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland,
| | - Anja Frei
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland,
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Calabrese C, Costigliola A, Maffei M, Simeon V, Perna F, Tremante E, Merola E, Leone CA, Bianco A. Clinical impact of nasal budesonide treatment on COPD patients with coexistent rhinitis. Int J Chron Obstruct Pulmon Dis 2018; 13:2025-2032. [PMID: 29988687 PMCID: PMC6029594 DOI: 10.2147/copd.s165857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background A high percentage of patients with COPD report chronic nasal symptoms. The study aims to evaluate the clinical impact of a 2-month treatment with inhaled nasal budesonide (100 µg per nostril twice daily) in patients affected by COPD with chronic rhinitis comorbidity. Patients and methods Fifty-three stable COPD patients in therapy according to the Global initiative for chronic Obstructive Lung Disease recommendations were enrolled; 49 completed the study. At enrollment (visit 0), patients underwent skin prick test and rhinoscopy. At visit 0 and after 1 month (visit 1) and 2 months (visit 2) of therapy with nasal budesonide, patients underwent spirometry, and COPD assessment test (CAT), Sinonasal Outcome Test (SNOT 22), and modified Medical Research Council dyspnea scale were administered. Differences in continuous variables, after 2 months of treatment with nasal budesonide, were evaluated using a paired t-test or Wilcoxon matched-pairs signed-ranks test. Results Two months of treatment with nasal budesonide showed a significant statistical improvement in the total scores of CAT, SNOT 22, and modified Medical Research Council (p<0.001). A significant relationship between CAT and SNOT 22 total scores at baseline and after treatment was observed. Conclusion The results of the present study indicate the importance of careful evaluation of the presence of chronic nasal symptoms in all COPD patients and suggest beneficial clinical effect from treatment with nasal budesonide in terms of COPD symptoms and quality of life.
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Affiliation(s)
- Cecilia Calabrese
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Adriano Costigliola
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
| | - Marianna Maffei
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Perna
- Department of Clinical Medicine and Surgery, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Eugenio Tremante
- Ear Nose and Throat Unit and Neck Surgery, Monaldi Hospital, Naples, Italy
| | - Elena Merola
- Bronchoscopic Unit, Public Hospital, Eboli, Italy
| | | | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy,
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78
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Shin SH, Park J, Cho J, Sin DD, Lee H, Park HY. Severity of Airflow Obstruction and Work Loss in a Nationwide Population of Working Age. Sci Rep 2018; 8:9674. [PMID: 29946117 PMCID: PMC6018711 DOI: 10.1038/s41598-018-27999-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/14/2018] [Indexed: 12/17/2022] Open
Abstract
The impact of COPD severity on labor force participation and work loss is not well known. This study aimed to describe the characteristics of occupations and to evaluate the reason for work loss based on the severity of airflow obstruction (AO). We performed a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey V-VI. We identified 9,901 people aged 40 to 60 years who had normal or AO in spirometry test results. AO was defined as a pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity <70%. AO was present in 7.6% of the subjects, and 81.5%, 82.9%, and 71.6% of subjects with mild, moderate, and severe-to-very severe AO were in the labor force, respectively. Multivariable analyses revealed that severe-to-very severe AO subjects were more likely to have precarious job (adjusted OR = 4.71, 95% CI = 1.70-13.06) and cite health-related problem as the reason for not being in the labor force (adjusted OR = 3.38, 95% CI = 1.03-11.02). Overall, AO was not associated with any significant changes in labor force participation. However, subjects with severe-to-very severe disease were more likely to drop out of the labor force owing to their health-related problems.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Don D Sin
- Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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79
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Muñoz A, Small M, Wood R, Ribera A, Nuevo J. The impacts of morning, daytime, and nighttime symptoms on disease burden in real-world patients with COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1557-1568. [PMID: 29805254 PMCID: PMC5960242 DOI: 10.2147/copd.s157874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Respiratory symptoms are increasingly recognized as an important consideration in COPD management. Understanding the links between the time(s) of day symptoms are experienced and overall symptom burden could support personalized management strategies. This real-world study aimed to establish the association between the time of day of symptoms and the burden on patients using validated patient-reported outcomes, health care resource utilization, and physician-perceived impact of COPD on patients’ lives. Materials and methods Analyses used data from four waves (2012, 2013, 2014, and 2016) of the Respiratory Disease Specific Programme: cross-sectional surveys of patients with COPD in Germany, Italy, Spain, and the UK. Patients were classified by their physicians as having symptoms in the morning (M), daytime (D), and/or nighttime (N) in the 4 weeks before entering the Disease Specific Programme. Outcomes included health care resource utilization, work productivity and activity impairment, COPD Assessment Test, EuroQol 5-dimension 3-level questionnaire with visual analog scale, and Jenkins Sleep Evaluation Questionnaire. Results In total, 8,844 patients were included, and 8,185 had evaluable time-of-day symptom data. Physicians reported that in the previous 4 weeks, 25% of patients experienced no symptoms, 16% D only, 17% M/D only, 6% D/N only, 4% M, N, or M/N only, and 32% M/D/N. In general, patients with M/D/N symptoms utilized more health care resources in the previous 12 months, had more prior exacerbations, and reported worse activity impairment, health status, and sleep than other symptom groups, whereas patients with symptoms at any time of the day utilized more resources, experienced more exacerbations, and reported worse health status than patients with no symptoms during the 4 weeks before entering the survey. Conclusion Patients experiencing morning, daytime, and nighttime symptoms experience a greater disease burden than those in other groups. An individualized approach to COPD treatment based on the timing and persistence of symptoms may improve outcomes for these patients.
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Affiliation(s)
- Anna Muñoz
- Formerly of Global Medical Affairs, AstraZeneca PLC, Barcelona, Spain
| | - Mark Small
- Respiratory Research, Adelphi Real World, Macclesfield, UK
| | - Robert Wood
- Real World Evidence and Epidemiology, Adelphi Real World, Macclesfield, UK
| | - Anna Ribera
- Formerly of Global Medical Affairs, AstraZeneca PLC, Barcelona, Spain
| | - Javier Nuevo
- Global Medical Affairs, AstraZeneca PLC, Madrid, Spain
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80
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Chen S, Small M, Lindner L, Xu X. Symptomatic burden of COPD for patients receiving dual or triple therapy. Int J Chron Obstruct Pulmon Dis 2018; 13:1365-1376. [PMID: 29731624 PMCID: PMC5927353 DOI: 10.2147/copd.s163717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background COPD is associated with a large disease burden. The use of dual (two maintenance treatments) and triple (combination of any three treatments) therapy has shown efficacy for symptom relief; however, some patients with COPD remain symptomatic despite these therapies. This study assessed the scope and magnitude of the symptomatic burden for patients with COPD receiving dual or triple therapy. Patients and methods Cross-sectional data from three Adelphi COPD surveys (2013–2016) conducted in the USA, Europe, Japan, and China were analyzed for patients with COPD and forced expiratory volume in 1 second ≤65% receiving dual or triple therapy for ≥3 months. Physicians completed clinical and disease characteristic forms for identified patients. Corresponding patients completed questionnaires that included validated survey instruments to assess adherence and symptom impact. Descriptive statistics are reported. Results Our analysis included 690 patients (mean age 68.2 years; 73.3% male); 41.4% and 58.6% were receiving dual and triple therapy, respectively. Most patients had dyspnea with substantial disability (modified Medical Research Council dyspnea scale rating ≥2, 56.3%; large health status impairment from symptoms, COPD Assessment Test score >20, 64.4%). A large symptom burden was observed, even for patients highly adherent to treatment (Morisky Medication Adherence Scale 8, 30.3% [185/612]), of whom 62.1% still had a COPD Assessment Test score >20. Sensitivity analyses of patients regardless of their forced expiratory volume in 1 second status and of those receiving treatment for >6 months both reported similar results. Conclusion Although patients who consult their physicians more frequently than average may be overrepresented because of the observational design of this study, we report that unmet needs remain for patients with COPD, despite the use of dual or triple therapy. A percentage of patients with COPD reported major symptom burden affecting their daily living and causing a large impairment in the health status, regardless of treatment adherence.
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Affiliation(s)
- Stephanie Chen
- Health Economics and Payer Analytics, AstraZeneca, Gaithersburg, MD, USA
| | - Mark Small
- Respiratory, Adelphi Real World, Bollington, UK
| | - Leandro Lindner
- Global Payer Evidence and Pricing, AstraZeneca, Cambridge, UK
| | - Xiao Xu
- Health Economics and Payer Analytics, AstraZeneca, Gaithersburg, MD, USA.,Global Payer Evidence and Pricing, AstraZeneca, Gaithersburg, MD, USA
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81
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van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Physical activity in the morning and afternoon is lower in patients with chronic obstructive pulmonary disease with morning symptoms. Respir Res 2018; 19:49. [PMID: 29587841 PMCID: PMC5870529 DOI: 10.1186/s12931-018-0749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) experience symptoms that vary over the day. Symptoms at the start of the day might influence physical activity during the rest of the day. Therefore, physical activity during the course of the day was studied in patients with low and high morning symptom scores. Methods This cross-sectional observational study included patients with moderate to very severe COPD. Morning symptoms were evaluated with the PRO-morning COPD Symptoms Questionnaire (range 0–60); the median score was used to create two groups (low and high morning symptom scores). Physical activity was examined with an accelerometer. Activity parameters during the night, morning, afternoon and evening were compared between patients with low and high morning symptom scores using independent t-tests or Mann-Whitney U tests. Results Seventy nine patients were included. Patients were aged (mean ± SD) 65.6 ± 8.8 years with a mean forced expiratory volume in 1 s of 55 ± 17%predicted. Patients with low morning symptom scores (score < 17.0) took more steps in the afternoon (p = 0.015) and morning (p = 0.030). There were no significant differences during the evening and night. Conclusion Patients with high morning symptom scores took significantly fewer steps in the morning and afternoon than those with low morning symptom scores. Prospective studies are needed to prove causality between morning symptoms and physical activity during different parts of the day. Electronic supplementary material The online version of this article (10.1186/s12931-018-0749-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda R van Buul
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.
| | - Marise J Kasteleyn
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, postzone V-0p, Postbus 9600, 2300, RC, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, postzone V-0p, Postbus 9600, 2300, RC, Leiden, The Netherlands
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.,Department of Pulmonary Medicine, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
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82
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Doward L, Svedsater H, Whalley D, Crawford R, Leather D, Lay-Flurrie J, Bosanquet N. Salford Lung Study in chronic obstructive pulmonary disease (SLS COPD): follow-up interviews on patient-centred outcomes. NPJ Prim Care Respir Med 2017; 27:66. [PMID: 29247229 PMCID: PMC5732268 DOI: 10.1038/s41533-017-0066-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 11/08/2022] Open
Abstract
This study investigated patient perceptions, experiences and management of COPD throughout the SLS COPD study. Follow-up interviews were conducted with 400 patients who completed SLS COPD; a mixed-methods approach was used to collect quantitative and qualitative information. Structured interviews using closed-ended questions were conducted with 360 patients, detailing aspects of background/lifestyle information and COPD. Extended interviews containing open-ended questions on perceptions of COPD and quality of life (QoL) in addition to the closed-ended questions were completed by 40 further patients. Participants also completed the Adherence Starts with Knowledge-12 (ASK-12) and the COPD and Asthma Sleep Impact Scale (CASIS) questionnaire. Quantitative data were analysed descriptively; qualitative data were analysed using qualitative description. The participants (n = 400) were reasonably representative of the SLS COPD population; mean age was 66.2 years. Breathlessness was the most commonly recalled symptom of/associated with COPD (88.5% of patients) and was the symptom that changed the most (improved, 26.8%/worsened, 20.9%) throughout the study. Participants' daily functioning and activities were most affected by symptoms of/associated with COPD, followed by relationships and psychological issues. 66.5% of participants experienced exacerbations, 60.5% of whom reported self-management as their first treatment strategy (taking antibiotics, resting and/or corticosteroids). Qualitative analysis revealed COPD symptoms, breathlessness in particular, to have a significant impact on mobility and in turn QoL. In conclusion, breathlessness was cited in these interviews as the COPD symptom with the greatest impact on participants' daily functioning, activities and self-care. The findings provided significant additional knowledge to the SLS COPD study findings.
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Affiliation(s)
| | | | | | | | - David Leather
- Global Respiratory Franchise, GSK, Uxbridge, Middlesex, UK
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83
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Factors affecting self-care behavior in Koreans with COPD. Appl Nurs Res 2017; 38:29-37. [DOI: 10.1016/j.apnr.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
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84
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Miravitlles M, Menezes A, López Varela MV, Casas A, Ugalde L, Ramirez-Venegas A, Mendoza L, López A, Wehrmeister FC, Surmont F, Montes de Oca M. Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study. Respir Med 2017; 134:62-69. [PMID: 29413510 DOI: 10.1016/j.rmed.2017.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD. METHODS Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated. RESULTS 734 patients (59.6% male, mean age 69.5 years, mean FEV1 50% predicted normal) were recruited. The most frequent symptoms during the day were dyspnea (75% of patients, of which 94% mild-moderate) and cough (72.2%, of which 93.4% mild-moderate). Highly symptomatic patients had a greater impairment in FEV1, more exacerbations and worse scores in COPD assessment test (CAT) and Body Mass Index, Obstruction, Dyspnoea and Exacerbations (BODEx) index (all p < 0.001). Morning symptoms were more frequent than night-time symptoms, particularly cough and dyspnoea (morning: 50.1% and 45.7%; night-time: 33.2% and 24.4%, respectively), and mostly rated as mild or moderate. Patients with morning or night-time symptoms presented with worse severity of daytime symptoms. There was a strong correlation between intensity of daytime with morning or night-time symptoms, as well as with CAT score (r = 0.715; p < 0.001), but a weak correlation with FEV1 (r = -0.205; p < 0.001). CONCLUSION Morning symptoms were more frequent than night-time symptoms, and having either morning and/or night-time symptoms was associated with worse severity of daytime symptoms. Increased symptoms were strongly associated with worse quality of life and more frequent exacerbations, but weakly associated with airflow limitation. CLINICAL TRIAL REGISTRATION NCT02789540.
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Affiliation(s)
- Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Ana Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Alejandro Casas
- Fundación Neumológica Colombiana, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Laura Mendoza
- Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Ana López
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | | | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
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Contoli M, Corsico AG, Santus P, Di Marco F, Braido F, Rogliani P, Calzetta L, Scichilone N. Use of ICS in COPD: From Blockbuster Medicine to Precision Medicine. COPD 2017; 14:641-647. [PMID: 29116901 DOI: 10.1080/15412555.2017.1385056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality worldwide, whose burden is expected to increase in the next decades, because of numerous risk factors, including the aging of the population. COPD is both preventable and treatable by an effective management including risk factor reduction, prevention, assessment, and treatment of acute exacerbations and co-morbidities. The available agents approved for COPD treatment are long-acting or ultra-long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) bronchodilators, as well as inhaled corticosteroids (ICS) in combination with LABAs. ICS use has been restricted only to selected COPD patients by the most recent documents, mainly based on the risk of exacerbations. However, several observational studies showed a high rate of prescription of ICS in COPD, irrespective of clinical recommendations, questioning the efficacy of these compounds in unselected patients with COPD and leading to possible increase risk of side effects related to ICS use. After examining the low levels of adherence in primary care and in the clinical settings to national and international recommendations for the treatment of COPD in different countries, the most common drivers of the prevailing use of ICS are critically reviewed here by examining their pros and cons, aimed at identifying evidence-based drivers for a proper selection of patients who may benefit from the proper use of ICS.
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Affiliation(s)
- Marco Contoli
- a Section of Respiratory Internal and Cardio-Respiratory Diseases, Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Angelo G Corsico
- b Division of Respiratory Diseases, Foundation IRCCS Policlinico San Matteo, Department of Internal Medicine and Therapeutics , University of Pavia , Pavia , Italy
| | - Pierachille Santus
- c Department of Biomedical and Clinical Sciences (DIBIC) , University of Milan , Milan , Italy.,d Division of Respiratory Diseases , "Luigi Sacco" University Hospital , Milan , Italy.,e ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Fabiano Di Marco
- f Respiratory Unit, ASST Santi Paolo e Carlo, Ospedale San Paolo , Milan , Italy.,g Department of Health Science , Università degli Studi di Milano , Milan , Italy
| | - Fulvio Braido
- h Respiratory and Allergy Department , University of Genoa, Ospedale Policlinico San Martino , Genoa , Italy
| | - Paola Rogliani
- i Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Luigi Calzetta
- i Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Nicola Scichilone
- j Department of Biomedicine and DIBIMIS , University of Palermo , Palermo , Italy
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86
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van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. The association between objectively measured physical activity and morning symptoms in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2831-2840. [PMID: 29042764 PMCID: PMC5633288 DOI: 10.2147/copd.s143387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The morning is the most bothersome period for COPD patients. Morning symptom severities in different Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages are not well studied. Furthermore, factors that are associated with morning symptoms, especially the associations with objectively measured physical activity, are also not well described. MATERIALS AND METHODS The aim of this cross-sectional observational study was to assess morning symptom severity in GOLD A, B, C and D patients, according to the definitions of the GOLD 2015 statement. Morning symptoms were assessed with the PRO-Morning COPD Symptoms Questionnaire. Differences in morning symptom severity between different COPD stages were assessed with a one-way analysis of variance followed by post hoc analyses. The association between dyspnea severity (assessed with the modified Medical Research Council scale), health status, airflow limitation, lung hyperinflation, anxiety and depression, inflammatory parameters, exacerbations, objectively measured physical activity parameters retrieved from accelerometry and morning symptom severity was evaluated using linear regression analysis. RESULTS Eighty patients were included (aged 65.6±8.7 years, forced expiratory volume in 1 second [FEV1] % predicted 55.1±16.9). Mean (±SD) morning symptom score was 19.7 (±11.7). Morning symptom severity was significantly different between COPD stages: mean (±SD) score in GOLD A was 9.7 (±7.2), in GOLD B 19.8 (±10.7), in GOLD C 8.6 (±9.3) and in GOLD D 23.8 (±11.2) (p<0.001). Lower health status, more symptoms, increased anxiety and depression, less physical activity (all p<0.001) and lower FEV1 (p=0.03) were associated with an increased morning symptom severity. CONCLUSION Patients with overall more symptomatic COPD have significant higher morning symptom scores. Morning symptom severity was associated with important clinical outcomes: lower health status, more symptoms, increased anxiety and depression, fewer steps a day, less time in moderate and vigorous physical activity with bouts of at least 10 minutes and lower FEV1. The data suggest that morning symptoms should be carefully assessed in addition to assessment by general COPD-specific questionnaires, especially in those with more symptomatic COPD. More research is needed on potential therapies to improve morning symptoms; this study shows potential targets for intervention.
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Affiliation(s)
| | - Marise J Kasteleyn
- Department of Pulmonology.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian Taube
- Department of Pulmonology.,Department of Pulmonary Medicine, West German Lung Center, Essen University Hospital, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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87
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Comas M, Gordon CJ, Oliver BG, Stow NW, King G, Sharma P, Ammit AJ, Grunstein RR, Phillips CL. A circadian based inflammatory response – implications for respiratory disease and treatment. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0019-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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88
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Canonica GW, Blasi F, Scichilone N, Simoni L, Zullo A, Giovannetti C, Briguglio C, Barsanti S, Antonelli Incalzi R. Characterization of circadian COPD symptoms by phenotype: Methodology of the STORICO observational study. Eur J Intern Med 2017; 43:62-68. [PMID: 28576398 DOI: 10.1016/j.ejim.2017.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. The symptoms of COPD are troublesome, variable, can occur during all parts of the 24-h day and have a substantial impact on patients' health status, quality of life and healthcare resource utilization. Reducing symptoms, improving health status and increasing physical activity are major goals in the management of stable COPD. In order to provide effective, patient-oriented care, patients should be evaluated on the basis of lung function, frequency of symptoms and patient-perceived impact of symptoms on their lives and treatment decisions made on a case-by-case basis. The identification of COPD phenotypes is an evolving debate and literature data about the circadian variation of COPD symptoms according to phenotypes are nowadays lacking. The ongoing STORICO (STudio Osservazionale sulla caratteRizzazione dei sIntomi delle 24 ore nei pazienti con BPCO) study (NCT03105999) is aimed to describe by clinically defined phenotypes the frequency and 12-month evolution of early-morning, day- and night-time COPD symptoms in a cohort of 600 Italian patients with stable COPD. Secondary objectives include the description of the 12-month variation of outcomes of interest according to phenotypes and of the healthcare resources utilization (overall and by phenotype) during 12-month observation. An exploratory analysis will be conducted aimed to phenotype COPD patients in an alternative researcher-independent way based on circadian pattern of symptoms combined with measures of respiratory function, health-related quality of life and comorbidity. The present paper describes the methodology of the STORICO study.
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Affiliation(s)
- G W Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-Thoracic Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - L Simoni
- Medineos Observational Research, Modena, Italy
| | - A Zullo
- Medineos Observational Research, Modena, Italy
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Reisner C, Gottschlich G, Fakih F, Koser A, Krainson J, Delacruz L, Arora S, Feldman G, Pudi K, Siddiqui S, Orevillo C, Maes A, St. Rose E, Martin U. 24-h bronchodilation and inspiratory capacity improvements with glycopyrrolate/formoterol fumarate via co-suspension delivery technology in COPD. Respir Res 2017; 18:157. [PMID: 28821260 PMCID: PMC5563048 DOI: 10.1186/s12931-017-0636-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of chronic obstructive pulmonary disease may vary throughout the day and it is important that therapeutic approaches provide 24-h symptom control. We report the results of two phase IIIb crossover studies, PT003011 and PT003012, investigating the 24-h lung function profile of GFF MDI (glycopyrrolate/formoterol fumarate 18/9.6 μg delivered using innovative co-suspension delivery technology) administered twice daily. METHODS Patients with moderate-to-very severe chronic obstructive pulmonary disease received 4 weeks' treatment with each of GFF MDI, placebo MDI, and open-label tiotropium (PT003011 only). Lung function was assessed over 24 h on day 29 of each treatment period. The primary outcome was forced expiratory volume in 1 second area under the curve from 0 to 24 h (FEV1AUC0-24). Other outcomes included change from baseline in average daily rescue medication use over the treatment period. In addition, we conducted a post-hoc analysis of data pooled from both studies to further characterize the effect of GFF MDI on inspiratory capacity. RESULTS GFF MDI treatment significantly increased FEV1AUC0-24 versus placebo in studies PT003011 (n = 75) and PT003012 (n = 35) on day 29 (both studies p < 0.0001), with similar improvements in FEV1AUC versus placebo for hours 0-12 and 12-24. In PT003011, improvements with GFF MDI versus tiotropium in FEV1AUC were greater during hours 12-24 compared to 0-12 h. GFF MDI treatment also resulted in a significant reduction in rescue medication use versus placebo (-0.84 [p<0.0001] and -1.11 [p=0.0054] puffs/day in PT003011 and PT003012, respectively), and versus tiotropium in PT003011 (-0.44 [p=0.017] puffs/day). A post-hoc pooled analysis showed patients treated with GFF MDI were more likely to achieve a >15% increase from baseline in inspiratory capacity than patients treated with placebo or tiotropium (72.1%, 19.0% and 47.0% of patients, respectively after the evening dose on day 29). There were no significant safety/tolerability findings. CONCLUSIONS GFF MDI significantly improved 24-h lung function versus placebo in patients with moderate-to-very severe chronic obstructive pulmonary disease, with similar benefits in the second 12-h period compared to the first, supporting twice-daily dosing of GFF MDI. TRIAL REGISTRATION Pearl Therapeutics, Inc.; www.clinicaltrials.gov ; NCT02347072 and NCT02347085 . Registered 21 January 2015.
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Affiliation(s)
- Colin Reisner
- AstraZeneca, Inc., Gaithersburg, MD USA
- Pearl Therapeutics, Inc., 280 Headquarters Plaza, East Tower, Morristown, NJ 07960 USA
| | | | - Faisal Fakih
- Florida Pulmonary Research Institute, Winter Park, FL USA
| | - Andras Koser
- Palmetto Medical Research Associates, Easley, SC USA
| | | | - Luis Delacruz
- Greenville Pharmaceutical Research, Greenville, SC USA
| | | | | | - Krishna Pudi
- Upstate Pharmaceutical Research, Greenville, SC USA
| | | | - Chad Orevillo
- Former employee of Pearl Therapeutics, Inc., Morristown, NJ USA
| | - Andrea Maes
- Pearl Therapeutics, Inc., 280 Headquarters Plaza, East Tower, Morristown, NJ 07960 USA
| | - Earl St. Rose
- Pearl Therapeutics, Inc., 280 Headquarters Plaza, East Tower, Morristown, NJ 07960 USA
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Thomas M, Halpin DMG, Miravitlles M. When is dual bronchodilation indicated in COPD? Int J Chron Obstruct Pulmon Dis 2017; 12:2291-2305. [PMID: 28814857 PMCID: PMC5546730 DOI: 10.2147/copd.s138554] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Inhaled bronchodilator medications are central to the management of COPD and are frequently given on a regular basis to prevent or reduce symptoms. While short-acting bronchodilators are a treatment option for people with relatively few COPD symptoms and at low risk of exacerbations, for the majority of patients with significant breathlessness at the time of diagnosis, long-acting bronchodilators may be required. Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be more effective treatment for some of these patients, with the aim of improving symptoms. This combination may also reduce the rate of exacerbations compared with a bronchodilator-inhaled corticosteroid combination in those with a history of exacerbations. However, there is currently a lack of guidance on clinical indicators suggesting which patients should step up from mono- to dual bronchodilation. In this article, we discuss a number of clinical indicators that could prompt a patient and physician to consider treatment escalation, while being mindful of the need to avoid unnecessary polypharmacy. These indicators include insufficient symptomatic response, a sustained increased requirement for rescue medication, suboptimal 24-hour symptom control, deteriorating symptoms, the occurrence of exacerbations, COPD-related hospitalization, and reductions in lung function. Future research is required to provide a better understanding of the optimal timing and benefits of treatment escalation and to identify the appropriate tools to inform this decision.
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Affiliation(s)
- Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton
| | - David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195:557-582. [PMID: 28128970 DOI: 10.1164/rccm.201701-0218pp] [Citation(s) in RCA: 2071] [Impact Index Per Article: 295.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- 1 University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- 3 New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- 4 University of Texas Health Science Center, San Antonio, Texas.,5 South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- 7 McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- 9 State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- 12 Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- 16 Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- 18 St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- 19 University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- 19 University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agustí
- 21 Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain
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92
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Krönig J, Hildebrandt O, Weissflog A, Cassel W, Gross V, Sohrabi K, Fischer P, Koehler U. Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II-IV. COPD 2017; 14:498-503. [PMID: 28715232 DOI: 10.1080/15412555.2017.1338681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. METHODS In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II-IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. RESULTS In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1-326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. CONCLUSIONS Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.
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Affiliation(s)
- Johannes Krönig
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | - Olaf Hildebrandt
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | | | - Werner Cassel
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
| | - Volker Gross
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Keywan Sohrabi
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Patrick Fischer
- c Faculty of Health Sciences , University of Applied Sciences , Giessen , Germany
| | - Ulrich Koehler
- a Department of Pneumology, Intensive Care and Sleep Medicine , University Hospital of Marburg and Giessen , Marburg , Germany
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Fernandes FLA, Cukier A, Camelier AA, Fritscher CC, da Costa CH, Pereira EDB, Godoy I, Cançado JED, Romaldini JG, Chatkin JM, Jardim JR, Rabahi MF, de Nucci MCNM, Sales MDPU, Castellano MVCDO, Aidé MA, Teixeira PJZ, Maciel R, Corrêa RDA, Stirbulov R, Athanazio RA, Russo R, Minamoto ST, Lundgren FLC. Recommendations for the pharmacological treatment of COPD: questions and answers. J Bras Pneumol 2017; 43:290-301. [PMID: 29365005 PMCID: PMC5687967 DOI: 10.1590/s1806-37562017000000153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.
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Affiliation(s)
- Frederico Leon Arrabal Fernandes
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Alberto Cukier
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Aquiles Assunção Camelier
- . Universidade do Estado da Bahia - UNEB - Salvador (BA) Brasil
- . Escola Bahiana de Medicina e Saúde Pública, Salvador (BA) Brasil
| | - Carlos Cezar Fritscher
- . Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS− Porto Alegre (RS)Brasil
| | | | | | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | - José Gustavo Romaldini
- . Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo,São Paulo (SP) Brasil
| | - Jose Miguel Chatkin
- . Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS− Porto Alegre (RS)Brasil
| | - José Roberto Jardim
- . Faculdade de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | | | | | | | | | - Miguel Abidon Aidé
- . Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Paulo José Zimermann Teixeira
- . Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
- . Universidade FEEVALE, Campus II, Novo Hamburgo (RS) Brasil
| | - Renato Maciel
- . Disciplina de Pneumologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Ricardo de Amorim Corrêa
- . Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Roberto Stirbulov
- . Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo,São Paulo (SP) Brasil
| | - Rodrigo Abensur Athanazio
- . Divisão de Pneumologia, Instituto do Coração - InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rodrigo Russo
- . Departamento de Medicina, Universidade Federal de São João Del Rei - UFSJ − São João Del Rei (MG) Brasil
| | - Suzana Tanni Minamoto
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
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94
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The variability of respiratory symptoms and associated factors in COPD. Respir Med 2017; 129:165-172. [PMID: 28732827 DOI: 10.1016/j.rmed.2017.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022]
Abstract
Few studies have investigated the variability of COPD-related symptoms or factors related to symptom variability. This observational, prospective, multicentre study was conducted to describe the number and intensity of morning and night-time respiratory symptoms and their variability over one week using the Night-time and Early Morning Symptoms of COPD Instruments (NiSCI and EMSCI) to evaluate stable COPD patients. Logistic regression analyses were performed to investigate factors associated with symptom variability. A total of 2669 patients were evaluated (mean age, 67.7 years; 80.9% men; mean FEV1 50.6%). Of these, 48% reported night-time symptoms and 71% reported morning symptoms. Of the 2293 patients who completed the NiSCI and EMSCI, 90% showed variability in either symptom number (89.6%) or symptom intensity (15.8%). More severe dyspnoea, more exacerbations during the previous year and the exacerbator or mixed COPD-asthma phenotypes were associated with variability in symptom number or intensity. Anxiety was significantly associated with variability in symptom number and intensity. Most COPD patients showed symptom variability over a weeklong period, especially in terms of symptom number. Several COPD-related factors, mainly factors related to more severe disease and more frequent exacerbations, were associated with increased symptom variability.
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95
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Beier J, Mroz R, Kirsten AM, Chuecos F, Gil EG. Improvement in 24-hour bronchodilation and symptom control with aclidinium bromide versus tiotropium and placebo in symptomatic patients with COPD: post hoc analysis of a Phase IIIb study. Int J Chron Obstruct Pulmon Dis 2017; 12:1731-1740. [PMID: 28652725 PMCID: PMC5476673 DOI: 10.2147/copd.s121723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A previous Phase IIIb study (NCT01462929) in patients with moderate to severe COPD demonstrated that 6 weeks of treatment with aclidinium led to improvements in 24-hour bronchodilation comparable to those with tiotropium, and improvement of symptoms versus placebo. This post hoc analysis was performed to assess the effect of treatment in the symptomatic patient group participating in the study. METHODS Symptomatic patients (defined as those with Evaluating Respiratory Symptoms [E-RS™] in COPD baseline score ≥10 units) received aclidinium bromide 400 μg twice daily (BID), tiotropium 18 μg once daily (QD), or placebo, for 6 weeks. Lung function, COPD respiratory symptoms, and incidence of adverse events (AEs) were assessed. RESULTS In all, 277 symptomatic patients were included in this post hoc analysis. Aclidinium and tiotropium treatment improved forced expiratory volume in 1 second (FEV1) from baseline to week 6 at all time points over 24 hours versus placebo. In addition, improvements in FEV1 from baseline during the nighttime period were observed for aclidinium versus tiotropium on day 1 (aclidinium 157 mL, tiotropium 67 mL; P<0.001) and week 6 (aclidinium 153 mL, tiotropium 90 mL; P<0.05). Aclidinium improved trough FEV1 from baseline versus placebo and tiotropium at day 1 (aclidinium 136 mL, tiotropium 68 mL; P<0.05) and week 6 (aclidinium 137 mL, tiotropium 71 mL; P<0.05). Aclidinium also improved early-morning and nighttime symptom severity, limitation of early-morning activities, and E-RS Total and domain scores versus tiotropium (except E-RS Chest Symptoms) and placebo over 6 weeks. Tolerability showed similar incidence of AEs in each arm. CONCLUSION In this post hoc analysis of symptomatic patients with moderate to severe COPD, aclidinium 400 μg BID provided additional improvements compared with tiotropium 18 μg QD in: 1) bronchodilation, particularly during the nighttime, 2) daily COPD symptoms (E-RS), 3) early-morning and nighttime symptoms, and 4) early-morning limitation of activity.
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Affiliation(s)
- Jutta Beier
- insaf Respiratory Research Institute, Wiesbaden, Germany
| | - Robert Mroz
- Centrum Medycyny Oddechowej
- Medical University of Białystok, Białystok, Poland
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
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Svedsater H, Roberts J, Patel C, Macey J, Hilton E, Bradshaw L. Life Impact and Treatment Preferences of Individuals with Asthma and Chronic Obstructive Pulmonary Disease: Results from Qualitative Interviews and Focus Groups. Adv Ther 2017; 34:1466-1481. [PMID: 28536998 PMCID: PMC5487856 DOI: 10.1007/s12325-017-0557-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The impact of asthma and chronic obstructive pulmonary disease (COPD) on individuals' lives may be substantial, yet clinical practice often focuses only on symptoms. We aimed to better understand the perspective of asthma or COPD patients and to identify condition-related burden, life impact, priorities, unmet needs, and treatment goals. METHODS Individuals aged at least 18 years with asthma or COPD were identified by a recruitment panel via clinical referrals, support groups, consumer networks, and a patient database. Interviews were carried out individually (by telephone) or in focus groups (with no more than five participants per group). A semi-structured interview guide was used with prespecified topics, informed by a literature review, that were considered impactful in asthma or COPD (symptoms and daily-life impact, satisfaction with current treatment, important aspects of treatment, adherence, and ideal treatment). RESULTS Overall, 72 people participated in focus groups/individual interviews (asthma n = 18/n = 21; COPD n = 15/n = 18). "Shortness of breath" was the most frequently reported symptom; however, participants discussed the life impact of their condition more than symptoms alone. Reported physical impacts included the inability to sleep and socialize, while emotional impacts included "embarrassment, stigma, and/or self-consciousness", "fear and/or panic", and "sadness, anxiety, and/or depression". Coping mechanisms for normal activities included continuing at reduced pace and avoidance. Treatment preferences centered on resolving impacts; improved sleep, "speed of action", and "length of relief" were the most frequently reported ideal treatment factors. CONCLUSION Patients with asthma or COPD experience substantial quality of life limitations and tend to focus on these in their expressions of concern, rather than symptoms per se. Life impacts of these conditions may have implications beyond those commonly appreciated in routine practice; these considerations will be applied to a future discrete choice experiment survey. FUNDING GSK funded study (H0-15-15502/204821).
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97
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Ding B, Small M, Holmgren U. A cross-sectional survey of current treatment and symptom burden of patients with COPD consulting for routine care according to GOLD 2014 classifications. Int J Chron Obstruct Pulmon Dis 2017; 12:1527-1537. [PMID: 28579771 PMCID: PMC5447695 DOI: 10.2147/copd.s133793] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background As part of the Respiratory Disease Specific Program (DSP) conducted to provide observations of clinical practice from a physician and matched patient viewpoint, this study aimed to establish how patients with COPD are treated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system and to quantify the symptom burden. Methods Data were obtained from the Respiratory DSP, a cross-sectional survey of patients with a diagnosis of COPD consulting for routine care in France, Germany, Italy, Spain, the UK, and the USA during the third quarter of 2013. Patients’ exacerbation risk and symptom data were used for classification into GOLD groups A−D based on GOLD 2014 criteria. Prescribing practices were stratified by physician type and time since patient diagnosis. Results A total of 903 physicians participated in the Respiratory DSP, with data from 1,641 patients included in this analysis. Most patients were classified into GOLD groups B (n=742; 45.2%) and D (n=704; 42.9%). Patients in groups A and D were most likely to be treated in line with GOLD recommendations (61.5% and 77.5%, respectively), compared with 40.1% for group B. Patients with a diagnosis within the past 12 months were more likely to be treated according to recommendations. Inhaled corticosteroids (ICSs) in combination with one or more long-acting bronchodilator were prescribed across all GOLD groups. Patterns of treatment were, in general, similar for patients treated by a primary care physician or a pulmonologist. COPD assessment test scores ≥10 indicating a high symptom burden were reported for >80% of patients. Conclusion This analysis confirmed a high symptom burden among patients with COPD and indicates some misalignment of prescribing with GOLD recommendations, particularly regarding the role of ICS/long-acting β2-agonist (LABA) and ICS/LABA + long-acting muscarinic antagonist combinations across the different GOLD groups.
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Affiliation(s)
- Bo Ding
- Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Mark Small
- Real World Research (Respiratory), Adelphi Real World, Bollington, UK
| | - Ulf Holmgren
- Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden
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98
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Wu M, Wang Z, Li M, Li K. Daily Symptom Variability in Patients With Stable COPD: A Narrative Review. West J Nurs Res 2017; 40:1543-1561. [DOI: 10.1177/0193945917705132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Daily symptom variability refers to the fluctuation of chronic obstructive pulmonary disease (COPD) symptoms over the day. Although most clinicians can describe the day-to-day variation in symptoms experienced by patients with COPD, little has been done to quantify the variability. This review aims to synthesize evidence of daily symptom variability among patients with stable COPD. Of the 325 potentially relevant articles that were retrieved, 11 observational articles were finally included in the review. Patients with stable COPD commonly experience daily symptom variability, with morning being the most troublesome time of day, followed by night. Morning symptoms had a significant effect on morning routines or daily activities, and night-time symptoms affected the sleep quality of patients. In comparison with patients without symptom variability, patients with morning/night-time symptoms or symptom variability exhibited poorer health status as well as greater disease severity and incidence of exacerbation.
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Affiliation(s)
| | | | | | - Kun Li
- Jilin University, Changchun, China
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99
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Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res 2017; 18:67. [PMID: 28431503 PMCID: PMC5399825 DOI: 10.1186/s12931-017-0548-3] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERES), P. de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anna Ribera
- AstraZeneca PLC, Avda. Diagonal 615, 08028, Barcelona, Spain
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López-Campos JL, Abad Arranz M, Calero-Acuña C, Romero-Valero F, Ayerbe-García R, Hidalgo-Molina A, Aguilar-Pérez-Grovas RI, García-Gil F, Casas-Maldonado F, Caballero-Ballesteros L, Sánchez-Palop M, Pérez-Tejero D, Segado Soriano A, Calvo-Bonachera J, Hernández-Sierra B, Doménech A, Arroyo-Varela M, González-Vargas F, Cruz-Rueda JJ. Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit. Int J Chron Obstruct Pulmon Dis 2017; 12:785-792. [PMID: 28424549 PMCID: PMC5344429 DOI: 10.2147/copd.s121885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Clinical practice in chronic obstructive pulmonary disease (COPD) can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013-2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons. METHODS The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants) with retrospective data gathering. For the present analysis, astronomical seasons in the Northern Hemisphere were used as reference. Bivariate associations between the different COPD guidelines and the clinical practice changes over the seasons were explored by using binomial multivariate logistic regression analysis with age, sex, Charlson comorbidity index, type of hospital, and COPD severity by forced expiratory volume in 1 second as covariates, and were expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS The Andalusian COPD audit included 621 clinical records from 9 hospitals. After adjusting for covariates, only inhaler device satisfaction evaluation was found to significantly differ according to the seasons with an increase in winter (OR, 3.460; 95% CI, 1.469-8.151), spring (OR, 4.215; 95% CI, 1.814-9.793), and summer (OR, 3.371; 95% CI, 1.391-8.169) compared to that in autumn. The rest of the observed differences were not significant after adjusting for covariates. However, compliance with evaluating inhaler satisfaction was low. CONCLUSION The various aspects of clinical practice for COPD care were found to be quite homogeneous throughout the year for the variables evaluated. Inhaler satisfaction evaluation, however, presented some significant variation during the year. Inhaler device satisfaction should be evaluated during all clinical visits throughout the year for improved COPD management.
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Affiliation(s)
- Jose Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
| | - Maria Abad Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adolfo Doménech
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Málaga
| | | | | | - Juan J Cruz-Rueda
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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