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Kirby M, van Beek EJR, Seo JB, Biederer J, Nakano Y, Coxson HO, Parraga G. Management of COPD: Is there a role for quantitative imaging? Eur J Radiol 2016; 86:335-342. [PMID: 27592252 DOI: 10.1016/j.ejrad.2016.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/26/2016] [Indexed: 11/19/2022]
Abstract
While the recent development of quantitative imaging methods have led to their increased use in the diagnosis and management of many chronic diseases, medical imaging still plays a limited role in the management of chronic obstructive pulmonary disease (COPD). In this review we highlight three pulmonary imaging modalities: computed tomography (CT), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) imaging and the COPD biomarkers that may be helpful for managing COPD patients. We discussed the current role imaging plays in COPD management as well as the potential role quantitative imaging will play by identifying imaging phenotypes to enable more effective COPD management and improved outcomes.
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Affiliation(s)
- Miranda Kirby
- Department of Radiology, University of British Columbia, Vancouver, Canada; UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joon Beom Seo
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Juergen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Germany; Radiologie Darmstadt, Gross-Gerau County Hospital, Germany
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, Canada; UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada
| | - Grace Parraga
- Robarts Research Institute, The University of Western Ontario, London, Canada; Department of Medical Biophysics, The University of Western Ontario, London, Canada.
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52
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Quality of life changes over time in patients with chronic obstructive pulmonary disease. Curr Opin Pulm Med 2016; 22:125-9. [PMID: 26814143 DOI: 10.1097/mcp.0000000000000242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is often considered to be a disease in which an inevitable decline in lung function results in increasing dyspnea and deteriorating quality of life. This review summarizes recent data that calls this classic paradigm into question. Studies evaluating the effects of chronic sputum production, physical activity, and inhaled medications on quality of life and prognosis are also discussed. RECENT FINDINGS Chronic sputum production and level of dyspnea contribute at least as much to impairment of quality of life and prognosis as does abnormal lung function. An accelerated decline in FEV1 occurs in only half of the patients who develop COPD. Current pharmacotherapy has been shown to moderate disease progression and quality of life, although the effects are lost when inhaled corticosteroids are discontinued. Declining physical activity begins early in the course of COPD, but increasing activity levels result in improved quality of life and a slower decline in lung function. SUMMARY Symptoms and activity levels are as important as measuring FEV1 in determining disease severity, quality of life, and prognosis of COPD. Therapies exist that moderate the course of the disease, and small sustained increases in physical activity may slow physical deterioration and improve health-related quality of life.
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Vieira R, Fonseca JA, Lopes F, Freitas A. Trends in hospital admissions for obstructive lung disease from 2000 to 2010 in Portugal. Respir Med 2016; 116:63-9. [PMID: 27296823 DOI: 10.1016/j.rmed.2016.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
The burden of hospitalisations for obstructive lung diseases (OLD) has not been sufficiently studied. We aimed to characterise the hospitalisations for OLD from 2000 to 2010 in all Portuguese public hospitals. We analysed hospital discharges with a diagnosis of OLD regarding the patients' gender, age, residence and comorbidities. Of the 120 399 hospital admissions with a principal diagnosis of OLD, COPD (ICD-9-CM 491.x, 492.x, 496) was responsible for 81%. The change in patients discharged with OLD as a principal diagnosis was only 1% from 2000 to 2010 and did not change for COPD. Hospital admissions and deaths for COPD and other OLD increased with age and were more common in men than women. In-hospital mortality for COPD decreased 34.1% from 2000 to 2010, while the median length of stay was fairly constant at 8 days. Respiratory failure, insufficiency and/or arrest, and pneumonia, are the principal diagnoses often associated with COPD. When both pneumonia and COPD were diagnosed there was an increasing trend to classify pneumonia as the principal diagnosis (64.4%-72.9%), a sign that may lead to underestimation of COPD hospitalisations. In summary, a considerable decrease in in-hospital COPD mortality was observed while hospital admissions and the length of stay did not change substantially. These results suggest that better healthcare or other factors may be counteracting the expected increase of the burden of COPD.
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Affiliation(s)
- Rafael Vieira
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal.
| | - João Almeida Fonseca
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Fernando Lopes
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
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54
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Laucho-Contreras ME, Polverino F, Tesfaigzi Y, Pilon A, Celli BR, Owen CA. Club Cell Protein 16 (CC16) Augmentation: A Potential Disease-modifying Approach for Chronic Obstructive Pulmonary Disease (COPD). Expert Opin Ther Targets 2016; 20:869-83. [PMID: 26781659 DOI: 10.1517/14728222.2016.1139084] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Club cell protein 16 (CC16) is the most abundant protein in bronchoalveolar lavage fluid. CC16 has anti-inflammatory properties in smoke-exposed lungs, and chronic obstructive pulmonary disease (COPD) is associated with CC16 deficiency. Herein, we explored whether CC16 is a therapeutic target for COPD. AREAS COVERED We reviewed the literature on the factors that regulate airway CC16 expression, its biologic functions and its protective activities in smoke-exposed lungs using PUBMED searches. We generated hypotheses on the mechanisms by which CC16 limits COPD development, and discuss its potential as a new therapeutic approach for COPD. EXPERT OPINION CC16 plasma and lung levels are reduced in smokers without airflow obstruction and COPD patients. In COPD patients, airway CC16 expression is inversely correlated with severity of airflow obstruction. CC16 deficiency increases smoke-induced lung pathologies in mice by its effects on epithelial cells, leukocytes, and fibroblasts. Experimental augmentation of CC16 levels using recombinant CC16 in cell culture systems, plasmid and adenoviral-mediated over-expression of CC16 in epithelial cells or smoke-exposed murine airways reduces inflammation and cellular injury. Additional studies are necessary to assess the efficacy of therapies aimed at restoring airway CC16 levels as a new disease-modifying therapy for COPD patients.
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Affiliation(s)
- Maria E Laucho-Contreras
- a Division of Pulmonary and Critical Care Medicine , Brigham and Women's Hospital/Harvard Medical School , Boston , MA , USA
| | - Francesca Polverino
- a Division of Pulmonary and Critical Care Medicine , Brigham and Women's Hospital/Harvard Medical School , Boston , MA , USA.,b COPD Program , Lovelace Respiratory Research Institute , Albuquerque , NM , USA.,c Department of Medicine , University of Parma , Parma , Italy
| | - Yohannes Tesfaigzi
- b COPD Program , Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Aprile Pilon
- d Therabron Therapeutics Inc. , Rockville , MD , USA
| | - Bartolome R Celli
- a Division of Pulmonary and Critical Care Medicine , Brigham and Women's Hospital/Harvard Medical School , Boston , MA , USA.,b COPD Program , Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Caroline A Owen
- a Division of Pulmonary and Critical Care Medicine , Brigham and Women's Hospital/Harvard Medical School , Boston , MA , USA.,b COPD Program , Lovelace Respiratory Research Institute , Albuquerque , NM , USA
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Shiue I. Increased health service use for asthma, but decreased for COPD: Northumbrian hospital episodes, 2013-2014. Eur J Clin Microbiol Infect Dis 2016; 35:311-24. [PMID: 26780693 PMCID: PMC4724373 DOI: 10.1007/s10096-015-2547-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/07/2015] [Indexed: 12/04/2022]
Abstract
The burden of respiratory disease has persisted over the years, for both men and women. The aim of the present study was to investigate the hospital episode rates in respiratory disease and to understand whether and how the use of the health service for respiratory disease might have changed in recent years in the North-East of England. Hospital episode data covering two full calendar years (in 2013–2014) was extracted from the Northumbria Healthcare NHS Foundation Trust, which serves a population of nearly half a million. Hospital episode rates were calculated from admissions divided by annual and small area-specific population size by sex and across age groups, presented with per 100,000 person-years. The use of the health service for influenza and pneumonia, acute lower respiratory infections and chronic obstructive pulmonary disease (COPD) increased with an advancing age, except for acute upper respiratory infections and asthma. Overall, the use of the health service for common respiratory diseases has seemed to be unchanged, except for asthma. There were large increases in young adults aged 20–50 for both men and women and the very old aged 90+ in women. Of note, there were large increases in acute lower respiratory infections for both men and women aged 90+, whereas there was also a large decrease in COPD in women aged 80–90. This is the first study to examine health service use for respiratory diseases by calculating the detailed population size as denominator. Re-diverting funding to improve population health on a yearly basis may serve the changing need in local areas.
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Affiliation(s)
- I Shiue
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK. .,Department of Healthcare, Northumbria University, Newcastle upon Tyne, NE1 8ST, England, UK.
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57
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Wells JM, Morrison JB, Bhatt SP, Nath H, Dransfield MT. Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD. Chest 2016; 149:1197-204. [PMID: 26501747 DOI: 10.1378/chest.15-1504] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/27/2015] [Accepted: 10/01/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Relative pulmonary arterial enlargement, defined by a pulmonary artery to aorta (PA/A) ratio > 1 on CT scanning, predicts hospitalization for acute exacerbations of COPD (AECOPD). However, it is unclear how AECOPD affect the PA/A ratio. We hypothesized that the PA/A ratio would increase at the time of AECOPD and that a ratio > 1 would be associated with worse clinical outcomes. METHODS Patients discharged with an International Classification of Diseases, Ninth Revision, diagnosis of AECOPD from a single center over a 5-year period were identified. Patients were included who had a CT scan performed during the stable period prior to the index AECOPD episode as well as a CT scan at the time of hospitalization. A subset of patients also underwent postexacerbation CT scans. The pulmonary arterial diameter, ascending aortic diameter, and the PA/A ratio were measured on CT scans. Demographic data, comorbidities, troponin level, and hospital outcome data were analyzed. RESULTS A total of 134 patients were included in the study. They had a mean age of 65 ± 10 years, 47% were male, and 69% were white; overall, patients had a mean FEV1 of 47% ± 19%. The PA/A ratio increased from baseline at the time of exacerbation (0.97 ± 0.15 from 0.91 ± 0.17; P < .001). Younger age and known pulmonary hypertension were independently associated with an exacerbation PA/A ratio > 1. Patients with PA/A ratio > 1 had higher troponin values. Those with a PA/A ratio > 1 and troponin levels > 0.01 ng/mL had increased acute respiratory failure, ICU admission, or inpatient mortality compared with those without both factors (P = .0028). The PA/A ratio returned to baseline values following AECOPD. CONCLUSIONS The PA/A ratio increased at the time of severe AECOPD and a ratio > 1 predicted cardiac injury and a more severe hospital course.
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Affiliation(s)
- J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL.
| | - Joshua B Morrison
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL
| | - Hrudaya Nath
- Division of Cardiothoracic Imaging, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL
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