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Lee JH, Rhee CK, Kim K, Kim JA, Kim SH, Yoo KH, Kim WJ, Park YB, Park HY, Jung KS. Identification of subtypes in subjects with mild-to-moderate airflow limitation and its clinical and socioeconomic implications. Int J Chron Obstruct Pulmon Dis 2017; 12:1135-1144. [PMID: 28442900 PMCID: PMC5396836 DOI: 10.2147/copd.s130140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purpose of this study was to identify subtypes in patients with mild-to-moderate airflow limitation and to appreciate their clinical and socioeconomic implications. METHODS Subjects who were aged ≥20 years and had forced expiratory volume in 1 second (FEV1) ≥60% predicted and FEV1/forced vital capacity <0.7 were selected from the fourth Korea National Health and Nutrition Examination Survey (KNHANES) in 2007-2012. The data were merged to the National Health Insurance reimbursement database during the same period. k-Means clustering was performed to explore subtypes. For clustering analysis, six key input variables - age, body mass index (BMI), FEV1% predicted, the presence or absence of self-reported wheezing, smoking status, and pack-years of smoking - were selected. RESULTS Among a total of 2,140 subjects, five groups were identified through k-means clustering, namely putative "near-normal (n=232)," "asthmatic (n=392)," "chronic obstructive pulmonary disease (COPD) (n=37)," "asthmatic-overlap (n=893)," and "COPD-overlap (n=586)" subtypes. Near-normal group showed the oldest mean age (72±7 years) and highest FEV1 (102%±8% predicted), and asthmatic group was the youngest (46±9 years). COPD and COPD-overlap groups were male predominant and all current or ex-smokers. While asthmatic group had the lowest prescription rate despite the highest proportion of self-reported wheezing, COPD, asthmatic-overlap, and COPD-overlap groups showed high prescription rate of respiratory medicine. Although COPD group formed only 1.7% of total subjects, they showed the highest mean medical cost and health care utilization, comprising 5.3% of the total medical cost. When calculating a ratio of total medical expense to household income, the mean ratio was highest in the COPD group. CONCLUSION Clinical and epidemiological heterogeneities of subjects with mild-to-moderate airflow limitation and a different level of health care utilization by each subtype are shown. Identification of a subtype with high health care demand could be a priority for effective utilization of limited resources.
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Affiliation(s)
- Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, EwhaWomans University
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul
| | - Kyungjoo Kim
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul
| | - Jee-Ae Kim
- Pharmaceutical Policy Evaluation Research Team, Research Institution, Health Insurance Review and Assessment Service
| | - Sang Hyun Kim
- Big Data Division, Health Insurance Review and Assessment Service, Wonju
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Chuncheon
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, South Korea
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Fouda MA, Alhamad EH, Al-Hajjaj MS, Shaik SA, Alboukai AA, Al-Kassimi FA. A study of chronic obstructive pulmonary disease-specific causes of osteoporosis with emphasis on the emphysema phenotype. Ann Thorac Med 2017; 12:101-106. [PMID: 28469720 PMCID: PMC5399683 DOI: 10.4103/atm.atm_357_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/20/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Osteoporosis, the most common extra-pulmonary complication of chronic obstructive pulmonary disease (COPD), may be related to general causes or COPD-specific causes such as low forced expiratory volume in 1 s (FEV1) and hypoxia. A few studies reported that emphysema is an independent risk factor for osteoporosis. However, other workers considered the association to be confounded by low FEV1 and low body mass index (BMI) which cluster with emphysema. AIMS To study the association between osteoporosis and emphysema in a model that includes these potentially confounding factors. METHODS We studied prospectively 52 COPD patients with both high resolution computed tomography and carbon monoxide diffusion coefficient as diagnostic markers of emphysema. Dual-energy X-ray absorptiometry was used to measure the bone mass density (BMD) of lumbar vertebrae and neck of the femur. Vertebral fractures were evaluated using the Genant semiquantitative score. Multiple linear regression analysis was used to identify the following independent variables: age, BMI, FEV1% predicted, PaO2, emphysema score, C-reactive protein (CRP), and dyspnea score as related to BMD. P ≤ 0.05 was considered statistically significant. RESULTS There was no significant difference in the serum Vitamin D levels, vertebral fracture score, or BMD between the emphysematous and nonemphysematous patients. Multivariate analysis showed that (in a model including age, BMI, FEV1, PaO2, emphysema score, CRP, and dyspnea score) only reduced BMI, FEV1, and PaO2 were independent risk factors for low BMD. CONCLUSIONS The emphysematous phenotype is not a risk factor for osteoporosis independently of BMI, FEV1, and PaO2.
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Affiliation(s)
- Mona Ali Fouda
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Shaffi Ahmed Shaik
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
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Jonker R, Deutz NE, Erbland ML, Anderson PJ, Engelen MP. Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults. Metabolism 2017; 69:120-129. [PMID: 28285641 PMCID: PMC5351771 DOI: 10.1016/j.metabol.2016.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/22/2016] [Accepted: 12/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The development of effective nutritional strategies in support of muscle growth for patients with chronic obstructive pulmonary disease (COPD) remains challenging. Dietary essential amino acids (EAAs) are the main driver of postprandial net protein anabolism. In agreement, EAA supplements in healthy older adults are more effective than supplements with the composition of complete proteins. In patients with COPD it is still unknown whether complete protein supplements can be substituted with only EAAs, and whether they are as effective as in healthy older adults. METHODS According to a double-blind randomized crossover design, we examined in 23 patients with moderate to very severe COPD (age: 65±2 years, FEV1: 40±2% of predicted) and 19 healthy age-matched subjects (age: 64±2 years), whether a free EAA mixture with a high proportion (40%) of leucine (EAA mixture) stimulated whole body net protein gain more than a similar mixture of balanced free EAAs and non-EAAs as present in whey protein (TAA mixture). Whole body net protein gain and splanchnic extraction of phenylalanine (PHE) were assessed by continuous IV infusion of L-[ring-2H5]-PHE and L-[ring-2H2]-tyrosine, and enteral intake of L-[15N]-PHE (added to the mixtures). RESULTS Besides an excellent positive linear relationship between PHE intake and net protein gain in both groups (r=0.84-0.91, P<0.001), net protein gain was 42% higher in healthy controls and 49% higher in COPD patients after intake of the EAA mixture compared to the TAA mixture (P<0.0001). These findings could not be attributed to the high LEU content, as in both groups net protein gain per gram EAA intake was lower for the EAA mixture (P<0.0001). Net protein gain was higher in COPD patients for both mixtures due to a 40% lower splanchnic extraction (P<0.0001), but was similarly related to dietary PHE (i.e. EAA) plasma appearance. CONCLUSIONS In COPD patients, similarly to healthy older adults, free EAA supplements stimulate whole body protein anabolism more than free amino acid supplements with the composition of complete proteins. Therefore, free EAA supplements may aid in the prevention and treatment of muscle wasting in this patient population.
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Affiliation(s)
- Renate Jonker
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A..
| | - Nicolaas Ep Deutz
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Marcia L Erbland
- Dept. of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Paula J Anderson
- Dept. of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Mariëlle Pkj Engelen
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
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Magnetic resonance apparent diffusion coefficient values of the brain in COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nishiyama O, Yamazaki R, Sano H, Iwanaga T, Higashimoto Y, Kume H, Tohda Y. Fat-free mass index predicts survival in patients with idiopathic pulmonary fibrosis. Respirology 2017; 22:480-485. [PMID: 27868303 DOI: 10.1111/resp.12941] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/15/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Detailed body composition, such as fat-free mass, has not been examined in idiopathic pulmonary fibrosis (IPF). We investigated whether the fat-free mass index (FFMI), an index of lean body mass, predicted survival. METHODS Forty-four patients with IPF were enrolled in the study. Their body composition was assessed using direct segmental multi-frequency bioelectrical impedance analysis. The degree of correlation between variables of body composition and other variables such as forced vital capacity (FVC) and survival was examined. RESULTS There was a significant positive correlation between FFMI and FVC, diffusion capacity of the lung for carbon monoxide (DLCO ) and 6-min walk distance, and a significant negative correlation with age. However, there was no significant correlation between FFMI and percentage predicted FVC or DLCO , with the degree of correlation being similar to that observed for BMI. The mean observation period in the survival analysis was 837.5 ± 407.5 days. A univariate Cox proportional hazard model showed that several variables, but not BMI, were associated significantly with survival. FFMI (hazard ratio (HR): 0.64, 95% CI: 0.43-0.94, P = 0.02) and percentage predicted FVC (HR: 0.96, 95% CI: 0.93-0.99, P=0.008) were significant factors in a multivariate model. CONCLUSION We conclude that FFMI is a significant independent predictor of survival in patients with IPF.
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Affiliation(s)
- Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yuji Higashimoto
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hiroaki Kume
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
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Maximum inspiratory pressure as a clinically meaningful trial endpoint for neuromuscular diseases: a comprehensive review of the literature. Orphanet J Rare Dis 2017; 12:52. [PMID: 28302142 PMCID: PMC5353799 DOI: 10.1186/s13023-017-0598-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/23/2017] [Indexed: 12/14/2022] Open
Abstract
Respiratory muscle strength is a proven predictor of long-term outcome of neuromuscular disease (NMD), including amyotrophic lateral sclerosis, Duchenne muscular dystrophy, and spinal muscular atrophy. Maximal inspiratory pressure (MIP), a sensitive measure of respiratory muscle strength, one of several useful tests of respiratory muscle strength, is gaining interest as a therapeutic clinical trial endpoint for NMD. In this comprehensive review we investigate the use of MIP as a measure of respiratory muscle strength in clinical trials of therapeutics targeting respiratory muscle, examine the correlation of MIP with survival, quality of life, and other measures of pulmonary function, and outline the role of MIP as a clinically significantly meaningful outcome measure. Our analysis supports the utility of MIP for the early evaluation of respiratory muscle strength, especially of the diaphragm, in patients with NMD and as a surrogate endpoint in clinical trials of therapies for NMD.
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107
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Chronic obstructive pulmonary disease and malnutrition in developing countries. Curr Opin Pulm Med 2017; 23:139-148. [DOI: 10.1097/mcp.0000000000000356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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108
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Interstitial Lung Disease, Body Mass Index, Energy Expenditure and Malnutrition—a Review. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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109
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Abstract
This article looks at the role of the community nurse in assessing the nutritional status of patients with COPD and in integrating nutrition into the COPD care pathway.
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Affiliation(s)
- Matthew Hodson
- Chair, Association of Respiratory Nurse Specialists; Honorary Respiratory Nurse Consultant, Homerton University Hospital, London
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110
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Sloots JM, Barton CA, Buckman J, Bassett KL, van der Palen J, Frith PA, Effing TW. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients. Chron Respir Dis 2017; 14:72-84. [PMID: 28238276 PMCID: PMC5720215 DOI: 10.1177/1479972316687099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations ( p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00-1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30-12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87-10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared 'protective' (OR: 0.17; 95% CI: 0.05-0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). 'Previous respiratory-related hospitalizations' was the strongest factor in this equation.
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Affiliation(s)
- Joanne M Sloots
- Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Christopher A Barton
- School of Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Julie Buckman
- Department of Respiratory Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Katherine L Bassett
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Job van der Palen
- Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, The Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Peter A Frith
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Tanja W Effing
- Department of Respiratory Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
- Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia
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Ozawa C, Horiguchi M, Akita T, Oiso Y, Abe K, Motomura T, Yamashita C. Pulmonary Administration of GW0742, a High-Affinity Peroxisome Proliferator-Activated Receptor Agonist, Repairs Collapsed Alveoli in an Elastase-Induced Mouse Model of Emphysema. Biol Pharm Bull 2017; 39:778-85. [PMID: 27150147 DOI: 10.1248/bpb.b15-00909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary emphysema is a disease in which lung alveoli are irreversibly damaged, thus compromising lung function. Our previous study revealed that all-trans-retinoic acid (ATRA) induces the differentiation of human lung alveolar epithelial type 2 progenitor cells and repairs the alveoli of emphysema model mice. ATRA also reportedly has the ability to activate peroxisome proliferator-activated receptor (PPAR) β/δ. A selective PPARβ/δ ligand has been reported to induce the differentiation of human keratinocytes during wound repair. Here, we demonstrate that treatment using a high-affinity PPARβ/δ agonist, GW0742, reverses the lung tissue damage induced by elastase in emphysema-model mice and improves respiratory function. Mice treated with elastase, which collapsed their alveoli, were then treated with either 10% dimethyl sulfoxide (DMSO) in saline (control group) or GW0742 (1.0 mg/kg twice a week) by pulmonary administration. Treatment with GW0742 for 2 weeks increased the in vivo expression of surfactant proteins A and D, which are known alveolar type II epithelial cell markers. GW0742 treatment also shortened the average distance between alveolar walls in the lungs of emphysema model mice, compared with a control group treated with 10% DMSO in saline. Treatment with GW0742 for 3 weeks also improved tissue elastance (cm H2O/mL), as well as the ratio of the forced expiratory volume in the first 0.05 s to the forced vital capacity (FEV 0.05/FVC). In each of these experiments, GW0742 treatment reversed the damage caused by elastase. In conclusion, PPARβ/δ agonists are potential therapeutic agents for pulmonary emphysema.
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Affiliation(s)
- Chihiro Ozawa
- Department of Pharmaceutics and Drug Delivery, Faculty of Pharmaceutical Sciences, Tokyo University of Science
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112
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Ju S, Lee SJ, Park MJ, Cho YJ, Jeong YY, Jeon KN, Bae K, Lee JD, Kim HC. Clinical importance of cross-sectional area of intercostal muscles in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:939-947. [PMID: 28054460 DOI: 10.1111/crj.12609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Limb muscle wasting is one of main systemic manifestation of chronic obstructive pulmonary disease (COPD). However, the change of respiratory muscle is unclear. OBJECTIVES This study assessed the cross-sectional area (CSA) of the intercostal muscles (ICMs) in patients with COPD, using chest computed tomography (CT) and determined its association with the clinical characteristics of COPD. METHODS They retrospectively reviewed 60 patients with stable COPD and compared them with 30 controls. CSA (mm2 ) of the ICM on chest CT was measured at the midline level of the lateral arch of the bilateral first rib with a 3-mm slice thickness by using CT histogram software. The association with the clinical characteristics of COPD and with the control groups was assessed. RESULTS CSA of the ICM and the CSA/body mass index (BMI) were lower in the COPD group than in the control group. Patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 4 had a significantly lower CSA of the ICM than patients with stage 1, 2, and 3. CSA of the ICM was positively associated with FEV1 , %FEV1 predicted, FEV1 /FVC ratio, and BMI and negatively associated with age. However, there were no associations with PaO2 , PaCO2 , smoking status, 6-minute walk test, frequency of acute exacerbation of COPD, and serum C-reactive protein level. CONCLUSION Intercostal muscle atrophy occurs in COPD patients and is associated with severity of airway obstruction, BMI, and increasing age.
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Affiliation(s)
- Sunmi Ju
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Jun Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Mi Jung Park
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung Nyeo Jeon
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyungsoo Bae
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Deog Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho Cheol Kim
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
BACKGROUND Influence of tuberculosis (TB) on the natural course of COPD has not been well known. This study was designed to investigate the effects of history of TB on the long-term course of COPD. METHODS Patients hospitalized with COPD exacerbation were consecutively included (n=598). Cases were classified into two categories: those with TB history and those without. Clinical, demographic, and radiological features were meticulously recorded, and patients were followed up for hospitalizations due to exacerbation and for overall mortality. RESULTS A total of 93 patients (15%) had a history of TB. On average, patients with past TB history were 4 years younger than the rest of the patients (P=0.002). Our study revealed that patients with past TB were diagnosed with COPD 4 years earlier and died 5 years earlier as compared to the patients without TB. In addition, in the past TB group, rate of hospital admissions per year was higher compared to the group that lacked TB history (2.46±0.26 vs 1.56±0.88; P=0.001). Past TB group had higher arterial carbon dioxide tension (PaCO2) and lower forced expiratory volume in 1 second (FEV1; P=0.008 and P=0.069, respectively). Median survival was 24 months for patients who had past TB and 36 months for those who had not. Kaplan-Meier analysis revealed that although 3-year survival rate was lower in patients with past TB, it was not statistically significant (P=0.08). Cox regression analysis showed that while factors such as age, PaCO2, hematocrit, body mass index (BMI) and Charlson index affected mortality rates in COPD patients (P<0.05), prior history of TB did not. CONCLUSION Our results showed that a history of TB caused more hospitalizations, reduced respiratory functions and increased PaCO2. It was found that, despite similarity of the overall mortality, COPD diagnosis and death occurred 5 years earlier in patients with past TB. We conclude that history of TB has an important role in the natural course of COPD.
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Affiliation(s)
- Halil Ibrahim Yakar
- Department of Pulmonology, Faculty of Medicine, Istanbul Medeniyet University
| | - Hakan Gunen
- Department of Pulmonology, Sureyyapasa Training and Research Center for Chest Disease and Thoracic Surgery, Istanbul
| | - Erkan Pehlivan
- Department of Public Health, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Selma Aydogan
- Department of Pulmonology, Sureyyapasa Training and Research Center for Chest Disease and Thoracic Surgery, Istanbul
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Graf CE, Herrmann FR, Spoerri A, Makhlouf AM, Sørensen TI, Ho S, Karsegard VL, Genton L. Impact of body composition changes on risk of all-cause mortality in older adults. Clin Nutr 2016; 35:1499-1505. [DOI: 10.1016/j.clnu.2016.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/16/2016] [Accepted: 04/01/2016] [Indexed: 12/26/2022]
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115
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Chi F, Canada T. Effects of ω-3 Polyunsaturated Fatty Acids on Inflammatory Markers in Chronic Obstructive Pulmonary Disease. Nutr Clin Pract 2016. [DOI: 10.1177/0115426506021005533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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116
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Gea J, Casadevall C, Pascual S, Orozco-Levi M, Barreiro E. Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction. J Thorac Dis 2016; 8:3379-3400. [PMID: 28066619 DOI: 10.21037/jtd.2016.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Carme Casadevall
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Sergi Pascual
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Mauricio Orozco-Levi
- Department of Respiratory, Cardiovascular Foundation from Colombia Floridablanca, Santander, Colombia, CIBERES, ISC III, Barcelona, Catalonia, Spain
| | - Esther Barreiro
- Servei de Pneumologia, Hospital del Mar - IMIM, Experimental Sciences and Health Department (DCEXS), Universitat Pompeu Fabra, CIBERES, ISC III, Barcelona, Catalonia, Spain
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Camillo CA, Langer D, Osadnik CR, Pancini L, Demeyer H, Burtin C, Gosselink R, Decramer M, Janssens W, Troosters T. Survival after pulmonary rehabilitation in patients with COPD: impact of functional exercise capacity and its changes. Int J Chron Obstruct Pulmon Dis 2016; 11:2671-2679. [PMID: 27822029 PMCID: PMC5087703 DOI: 10.2147/copd.s113450] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan–Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30–0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51–0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92–2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28–2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02–5.33]; P<0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.
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Affiliation(s)
- Carlos A Camillo
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Daniel Langer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Christian R Osadnik
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Monash University, Department of Physiotherapy, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia; Monash Health, Monash Lung and Sleep, Melbourne, VIC, Australia
| | - Lisa Pancini
- University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Chris Burtin
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Rik Gosselink
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Marc Decramer
- University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Wim Janssens
- University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
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118
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Sand JMB, Leeming DJ, Byrjalsen I, Bihlet AR, Lange P, Tal-Singer R, Miller BE, Karsdal MA, Vestbo J. High levels of biomarkers of collagen remodeling are associated with increased mortality in COPD - results from the ECLIPSE study. Respir Res 2016; 17:125. [PMID: 27716343 PMCID: PMC5050854 DOI: 10.1186/s12931-016-0440-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background There is a need to identify individuals with COPD at risk for disease progression and mortality. Lung tissue remodeling is associated with the release of extracellular matrix (ECM) fragments into the peripheral circulation. We hypothesized that ECM remodeling was associated with mortality in COPD and measured neo-epitopes originating from ECM proteins associated with lung tissue remodeling. Methods Biomarkers of ECM remodeling were assessed in a subpopulation (n = 1000) of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort. Validated immunoassays measuring serological neo-epitopes produced by proteolytic cleavage associated with degradation of collagen type I, III, IV, and VI, elastin, and biglycan, and formation of collagen type VI as well as fibrinogen and C-reactive protein were used. Multivariate models were used to assess the prognostic value of these biomarkers. Results Thirty subjects (3.0 %) died during follow-up. Non-survivors were older, had reduced exercise capacity, increased dyspnea score, and included fewer current smokers. All collagen biomarkers were significantly elevated in non-survivors compared to survivors. Mortality risk was significantly increased for subjects with collagen remodeling biomarkers in the upper quartile, especially for the degradation fragment of collagen type IV C6M (hazard ratio 6.6 [95 % confidence interval 2.9-15.2], P < 0.0001) after adjusting for relevant confounders. Conclusions Serological biomarkers of collagen remodeling were strongly associated with mortality in subjects with COPD indicating that assessment of tissue turnover in the parenchyma and small airways may be useful in the prognosis of COPD. Trial registration NCT00292552, GSK Study No. SCO104960. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0440-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jannie M B Sand
- Nordic Bioscience, Herlev, Denmark. .,Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | - Peter Lange
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Section of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Ruth Tal-Singer
- Respiratory Therapy Area Unit, GSK Research and Development, King of Prussia, PA, USA
| | - Bruce E Miller
- Respiratory Therapy Area Unit, GSK Research and Development, King of Prussia, PA, USA
| | | | - Jørgen Vestbo
- Centre for Respiratory Medicine and Allergy, Manchester Academic Science Centre, The University of Manchester and University Hospital South Manchester NHS Foundation Trust, Manchester, UK
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119
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McKeough ZJ, Alison JA, Bye PTP. Reduction in resting energy expenditure following lung volume reduction surgery in subjects with chronic obstructive pulmonary disease. Chron Respir Dis 2016; 1:197-202. [PMID: 16281646 DOI: 10.1191/1479972304cd043xx] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Study objectives: Some subjects with COPD have an elevated resting energy expenditure (REE)which may be related to an increased work of breathing at rest. The purpose of this study was to examine the effect of lung volume reduction surgery (LVRS) on REE and body weight. Design: Ten subjects with COPD were recruited (mean age + SD = 61.4 + 6.1 years). At baseline (which was following preoperative pulmonary rehabilitation) and four months following LVRS (combined with postoperative pulmonary rehabilitation), each subject had tests of lung function, REE via indirect calorimetry using a canopy system, six minute walk distance (6MWD) and quality of life (QoL) using the St George's Hospital Respiratory Questionnaire (SGRQ). Measurements: The FEV, (% predicted) increased from 27.7 + 5.8% (mean + SD) at baseline to 33.9 + 7.8% following LVRS (P < 0.05). REE (% predicted) was 110 + 9.8% at baseline and decreased to 106 + 6.7% following LVRS (P = 0.04). Body mass index (BMI) following LVRS was unchanged (P = 0.67). No correlation between the change in BMI and change in REE was shown (r2 = 0.3, P = 0.1). Therewas a significant improvement in QoL following LVRS (P < 0.001). 6MWD also significantly increased from 354 + 83 m to 412 + 82 m following LVRS (P = 0.001). Conclusion: Whilst there was an increase in lung function and a reduction in REE following LVRS, there was no corresponding change to body weight. The improvement in REE following LVRS may be related to an improvement in work of breathing.
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Affiliation(s)
- Z J McKeough
- School of Physiotherapy, Faculty of Health Sciences, Sydney University, Australia.
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120
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Hoogendoorn M, Feenstra TL, Asukai Y, Briggs AH, Borg S, Dal Negro RW, Hansen RN, Jansson SA, Leidl R, Risebrough N, Samyshkin Y, Wacker ME, Rutten-van Mölken MPMH. Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease: Are Current Models Suitable to Evaluate Personalized Medicine? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:800-810. [PMID: 27712708 DOI: 10.1016/j.jval.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/18/2016] [Accepted: 04/03/2016] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess how suitable current chronic obstructive pulmonary disease (COPD) cost-effectiveness models are to evaluate personalized treatment options for COPD by exploring the type of heterogeneity included in current models and by validating outcomes for subgroups of patients. METHODS A consortium of COPD modeling groups completed three tasks. First, they reported all patient characteristics included in the model and provided the level of detail in which the input parameters were specified. Second, groups simulated disease progression, mortality, quality-adjusted life-years (QALYs), and costs for hypothetical subgroups of patients that differed in terms of sex, age, smoking status, and lung function (forced expiratory volume in 1 second [FEV1] % predicted). Finally, model outcomes for exacerbations and mortality for subgroups of patients were validated against published subgroup results of two large COPD trials. RESULTS Nine COPD modeling groups participated. Most models included sex (seven), age (nine), smoking status (six), and FEV1% predicted (nine), mainly to specify disease progression and mortality. Trial results showed higher exacerbation rates for women (found in one model), higher mortality rates for men (two models), lower mortality for younger patients (four models), and higher exacerbation and mortality rates in patients with severe COPD (four models). CONCLUSIONS Most currently available COPD cost-effectiveness models are able to evaluate the cost-effectiveness of personalized treatment on the basis of sex, age, smoking, and FEV1% predicted. Treatment in COPD is, however, more likely to be personalized on the basis of clinical parameters. Two models include several clinical patient characteristics and are therefore most suitable to evaluate personalized treatment, although some important clinical parameters are still missing.
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Affiliation(s)
- Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Talitha L Feenstra
- Department for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yumi Asukai
- IMS Health, Health Economics and Outcomes Research and Real-World Evidence Solutions, London, UK
| | - Andrew H Briggs
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sixten Borg
- The Swedish Institute for Health Economics, Lund, Sweden; Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden; Evidera, London, UK
| | - Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy
| | - Ryan N Hansen
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany
| | | | - Yevgeniy Samyshkin
- IMS Health, Health Economics and Outcomes Research and Real-World Evidence Solutions, London, UK
| | - Margarethe E Wacker
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich, Neuherberg, Germany
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Molecular modeling of Gly80 and Ser80 variants of human group IID phospholipase A2 and their receptor complexes: potential basis for weight loss in chronic obstructive pulmonary disease. J Mol Model 2016; 22:232. [PMID: 27585677 DOI: 10.1007/s00894-016-3095-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
Weight loss is a well known systemic manifestation of chronic obstructive pulmonary disease (COPD). A Gly80Ser mutation on human group IID secretory phospholipase A2 (sPLA2) enhances expression of the cytokines that are responsible for weight loss. In this study, we seek to establish a structural correlation of wild type sPLA2 and the Gly80Ser mutation with function. sPLA2 with glycine and serine at the 80th positions and the M-type receptor were modelled. The enzymes were docked to the receptor and molecular dynamics was carried out to 70 ns. Structural analysis revealed the enzymes to comprise three helices (H1-H3), two short helices (SH1 and SH2), and five loops including a calcium binding loop (L1-L5), and to be stabilized by seven disulfide bonds. The overall backbone folds of the two models are very similar, with main chain RMSD of less than 1 Å. The active site within the substrate binding channel shows a catalytic triad of water-His67-Asp112, showing a hydrogen bonded network. Major structural differences between wild type and mutant enzymes were observed locally at the site of the mutation and in their global conformations. These differences include: (1) loop-L3 between H2 and H3, which bears residue Gly80 in the wild type, is in a closed conformation with respect to the channel opening, while in the mutant enzyme it adopts a relatively open conformation; (2) the mutant enzyme is less compact and has higher solvent accessible surface area; and (3) interfacial binding contact surface area is greater, and the quality of interactions with the receptor is better in the mutant enzyme as compared to the wild type. Therefore, the structural differences delineated in this study are potential biophysical factors that could determine the increased potency of the mutant enzyme with macrophage receptor for cytokine secreting function, resulting in exacerbation of cachexia in COPD.
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122
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Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD. Chest 2016; 151:68-77. [PMID: 27568229 DOI: 10.1016/j.chest.2016.08.1432] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/01/2016] [Accepted: 08/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. METHODS We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2). RESULTS Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations. CONCLUSIONS Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.
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123
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Law S, Kumar P, Woods S, Sriram KB. Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes. Hosp Pract (1995) 2016; 44:207-212. [PMID: 27560297 DOI: 10.1080/21548331.2016.1224007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES There is a paucity of information on the prevalence and clinical implications of malnutrition in patients hospitalised for management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to fill this gap in knowledge. METHODS We performed a retrospective observational cohort study of 100 hospitalised AECOPD patients. The Malnutrition Screening Tool (MST) was used to identify patients at risk of malnutrition (MST ≥2). Patient characteristics, length of stay, readmission rate, 12-month survival and overall survival were collected using a proforma. RESULTS MST scores were available in 90 patients, of whom 22% of patients had a MST score of ≥2. There were no significant differences in COPD severity, treatment received and biochemical parameters between the groups of patients 'at risk of malnutrition' and those 'not at risk of malnutrition'. Length of stay in hospital was longer in patients 'at risk of malnutrition' (median (IQR): 3.5 (2-7.5) vs. 3.0 (1-5), p = 0.048). Overall survival was significantly reduced in patients with 'at risk of malnutrition' compared to those patients 'not at risk of malnutrition' (337 ± 245 vs. 670 ± 292, p < 0.001). CONCLUSIONS Using the MST we found that one-fifths of our hospitalised AECOPD patients are at 'at risk of malnutrition'. Moreover, this cohort of patients had worse outcomes both during and extending beyond hospitalisation compared to patients 'not at risk of malnutrition'. Our study illustrates the need for routine malnutrition screening for hospitalised AECOPD patients because it has implications for potentially reducing morbidity and mortality in COPD.
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Affiliation(s)
- Stephanie Law
- a School of Medicine, Parklands Drive , Griffith University , Southport , Australia
| | - Praneel Kumar
- a School of Medicine, Parklands Drive , Griffith University , Southport , Australia
| | - Sharon Woods
- b Nutrition and Food Services , Gold Coast University Hospital , Southport , Australia
| | - Krishna B Sriram
- a School of Medicine, Parklands Drive , Griffith University , Southport , Australia.,c Department of Respiratory Medicine , Gold Coast University Hospital , Southport , Australia
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124
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Undernutrition state in patients with chronic obstructive pulmonary disease. A critical appraisal on diagnostics and treatment. Respir Med 2016; 117:81-91. [DOI: 10.1016/j.rmed.2016.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 12/19/2022]
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Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung condition, affecting ∼10% of adults over the age of 40 years in the western world. Research over the past 10 years has shown that COPD is more than just a lung disorder; it affects other end-organs including the cardiovascular and the musculoskeletal systems, making it a multi-component, multi-system disease. COPD increases the risk for ischemic heart disease, stroke, osteoporosis, cachexia, and muscle weakness by two to threefold, independent of other factors such as smoking and age. The mechanisms by which COPD affects these end-organs, however, are unclear. In this paper, we review some of the common and serious extra-pulmonary manifestations of COPD and the potential mechanisms by which they can be linked with COPD.
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Affiliation(s)
- Ján Tkáč
- The University of British Columbia (Respiratory Division), Vancouver, BC
| | - S. F. Paul Man
- The University of British Columbia (Respiratory Division), Vancouver, BC
| | - Don D. Sin
- The University of British Columbia (Respiratory Division), Vancouver, BC,
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126
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Hogan D, Lan LTT, Diep DTN, Gallegos D, Collins PF. Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease. J Hum Nutr Diet 2016; 30:83-89. [DOI: 10.1111/jhn.12402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- D. Hogan
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
| | - L. T. T. Lan
- Respiratory Care Center; University of Medicine and Pharmacy; Ho Chi Minh City Vietnam
| | | | - D. Gallegos
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
| | - P. F. Collins
- Nutrition and Dietetics; School of Exercise and Nutrition Sciences; Faculty of Health; Queensland University of Technology; Kelvin Grove QLD Australia
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Woolloongabba QLD Australia
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127
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The Isosteroid Alkaloid Imperialine from Bulbs of Fritillaria cirrhosa Mitigates Pulmonary Functional and Structural Impairment and Suppresses Inflammatory Response in a COPD-Like Rat Model. Mediators Inflamm 2016; 2016:4192483. [PMID: 27524867 PMCID: PMC4971319 DOI: 10.1155/2016/4192483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Present therapies for COPD have limited effect on reducing the progression of COPD and suppressing the inflammatory response in the lung. Bulbs of Fritillaria cirrhosa D. Don (BFC) have been used in many Asian countries for a long time to treat pulmonary diseases, such as cough, expectoration, and asthma. Steroidal alkaloids are the major biological active constituents in BFC, whereby imperialine is one of the important steroidal alkaloids. So far, there are no studies reporting the effect of imperialine on COPD. In this study, we investigated the effect of imperialine on pulmonary function and structure and inflammation in a COPD-like rat model which was induced by the combination of exposure to CS and intratracheal administration of LPS. Our data show that imperialine mitigates pulmonary functional and structural impairment and suppressed inflammatory response in a COPD-like rat model by mediating expression of related cytokines in lung tissues of the COPD-like rats, such as IL-1β, IL-6, IL-8, TNF-α, NF-κB, TGF-β1, MMP-9, and TIMP-1.
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128
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Hoong JM, Ferguson M, Hukins C, Collins PF. Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease. Clin Nutr 2016; 36:1105-1109. [PMID: 27496063 DOI: 10.1016/j.clnu.2016.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/14/2016] [Accepted: 07/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore its association with all-cause mortality, emergency hospitalisation and subsequently healthcare costs. METHODS A prospective cohort observational pilot study was carried out in outpatients with COPD that attended routine respiratory clinics at a large tertiary Australian hospital during 2011. Electronic hospital records and hospital coding was used to determine nutritional status and whether a patient was coded as nourished or malnourished and information on healthcare use and 1-year mortality was recorded. RESULTS Eight hundred and thirty four patients with COPD attended clinics during 2011, of those 286 went on to be hospitalised during the 12 month follow-up period. Malnourished patients had a significantly higher 1-year mortality (27.7% vs. 12.1%; p = 0.001) and were hospitalised more frequently (1.11 SD 1.24 vs. 1.51 SD 1.43; p = 0.051). Only malnutrition (OR 0.36 95% CI 0.14-0.91; p = 0.032) and emergency hospitalisation rate (OR 1.58 95% CI 1.2-2.1; p = 0.001) were independently associated with 1-year mortality. Length of hospital stay was almost twice the duration in those coded for malnutrition (11.57 SD 10.93 days vs. 6.67 SD 10.2 days; p = 0.003) and at almost double the cost (AUD $23,652 SD $26,472 vs. $12,362 SD $21,865; p = 0.002) than those who were well-nourished. CONCLUSION Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden.
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Affiliation(s)
- Jian Ming Hoong
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia; Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Jurong Health Services, 609606, Singapore
| | - Maree Ferguson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia
| | - Craig Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia
| | - Peter F Collins
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia.
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129
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Stoll P, Foerster S, Virchow JC, Lommatzsch M. Overweight is a predictor of long-term survival in hospitalised patients with exacerbations of COPD. Respir Med 2016; 116:59-62. [DOI: 10.1016/j.rmed.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 04/17/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
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130
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Barbaro MF, Carpagnano G, Spanevello A, Cagnazzo M, Barnes P. Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease. Int J Immunopathol Pharmacol 2016; 20:753-63. [DOI: 10.1177/039463200702000411] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary diseases (COPD) is a pulmonary disease characterized by systemic abnormalities. The aim of this study is to investigate inflammation and systemic effects in mild COPD. Twenty-seven mild stable smoking related COPD patients and 15 age-matched healthy subjects were enrolled in the study. IL-6, TNF-α and IL-4 in plasma, sputum and exhaled breath condensate were measured. We also measured exhaled nitric oxide (NO) and pH in sputum and in breath condensate. Moreover, fat-free mass, body mass index (BMI), respiratory muscle strength, plasma oxidative stress and C-reactive protein (CRP) were measured. Higher concentrations were found of CRP, of diacron reactive oxygen metabolites (DROMs) and of IL-6, TNF-α and IL-4 either in plasma or in supernatant of induced sputum or in exhaled breath condensate of COPD subjects compared to healthy controls. Furthermore, higher concentrations were observed of exhaled NO and lower exhaled pH in breath condensate of COPD when compared with healthy subjects. In the group of COPD patients, the subjects with airway reversibility showed an increase of sputum eosinophils and exhaled NO, whereas the subjects without airway obstruction reversibility showed an increase in sputum neutrophils, TNF-α and IL-6. We also found a trend towards a decrease in fat-free mass and respiratory muscle strength in COPD compared to healthy subjects and a negative correlation between these systemic indices (fat-free mass, maximal inspiratory pressure, maximal expiratory pressure) and TNF-α concentrations in the blood, sputum and breath condensate. We conclude that mild COPD subjects present an increase in inflammatory markers in blood and in airways of similar pattern and furthermore, the neutrophilic pattern of airway inflammation observed in the group of COPD subjects without an airway obstruction reversibility makes it more likely that systemic features are present.
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Affiliation(s)
- M.P. Foschino Barbaro
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia
| | - G.E. Carpagnano
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia
| | - A. Spanevello
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia
- Fondazione Salvatore Maugeri, Care and Research Institute, Cassano delle Murge, Bari, Italy
| | - M.G. Cagnazzo
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia
| | - P.J. Barnes
- Dept. of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK
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131
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Edelman JD, Kotloff RM. Critical Care of the Lung Volume Reduction Surgery Patient. J Intensive Care Med 2016. [DOI: 10.1177/088506660001500402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung volume reduction surgery (LVRS) offers the potential to improve lung function, exercise tolerance, and quality of life for patients with advanced emphysema. At present, the specific role of this procedure in the treatment of advanced emphysema is a subject of ongoing investigation. LVRS is most commonly performed bilaterally via either median sternotomy or video thoracoscopic approach with resection of the most severely affected lung tissue to reduce the overall lung volume by 20–30%. This results in improvements in lung elastic recoil, airway conductance, chest wall, and diaphragmatic function leading to greater inspiratory and expiratory airflow, decreased hyperinflation, and improved exercise tolerance. The greatest improvement after LVRS occurs within 3–6 months after surgery. In the perioperative period, however, lung function may be compromised by surgical incisions, pain, chest tubes, retained secretions, pneumonia, and parenchymal injury associated with resection. The risks of LVRS are not insignificant, with reported mortality prior to hospital discharge ranging from 2.5 to 14%. Pulmonary complications may include respiratory failure, persistent air leaks, pneumonia, tracheobronchitis, retained secretions, atelectasis, pneumothorax, bleeding, and sternal wound infections or dehiscence. Cardiac and gastrointestinal complications are the most common extrathoracic causes of perioperative morbidity after LVRS. Although many patients have an uneventful postoperative course, patients who experience complications frequently require prolonged mechanical ventilation and intensive care. Critical care practitioners must therefore be familiar with LVRS, its potential complications, and the ICU management of LVRS patients.
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Affiliation(s)
- Jeffrey D. Edelman
- From the Pulmonary and Critical Care Division, Oregon Health Sciences University, Portland, OR
| | - Robert M. Kotloff
- From the Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, PA
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132
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Vanfleteren LEGW, Spruit MA, Wouters EFM, Franssen FME. Management of chronic obstructive pulmonary disease beyond the lungs. THE LANCET RESPIRATORY MEDICINE 2016; 4:911-924. [PMID: 27264777 DOI: 10.1016/s2213-2600(16)00097-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 01/26/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is an umbrella term that covers many clinical subtypes with clearly different pulmonary and extra-pulmonary characteristics, but with persistent airflow limitation in common. This insight has led to the development of a more personalised approach in bronchodilator therapy, prevention of exacerbations, and advanced treatments (such as non-invasive ventilation and lung volume reduction techniques). However, systemic manifestations and comorbidities of COPD also contribute to different clinical phenotypes and warrant an individualised approach as part of integrated disease management. Alterations in bodyweight and composition, from cachexia to obesity, demand specific management. Psychological symptoms are highly prevalent, and thorough diagnosis and treatment are necessary. Moreover, prevention of exacerbations requires interventions beyond the lungs, including treatment of gastro-oesophageal reflux disease, reduction of cardiovascular risks, and management of dyspnoea and anxiety. In this Review, we discuss the management of COPD beyond the respiratory system and propose treatment strategies on the basis of the latest research and best practices.
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Affiliation(s)
- Lowie E G W Vanfleteren
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
| | | | - Emiel F M Wouters
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
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133
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Kostikas K, Clemens A, Patalano F. Prediction and prevention of exacerbations and mortality in patients with COPD. Expert Rev Respir Med 2016; 10:739-53. [DOI: 10.1080/17476348.2016.1185371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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134
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Predictors for mortality from respiratory failure in a general population. Sci Rep 2016; 6:26053. [PMID: 27180927 PMCID: PMC4867438 DOI: 10.1038/srep26053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 02/07/2023] Open
Abstract
Risk factors for death from respiratory failure in the general population are not established. The aim of this study was to determine the characteristics of individuals who die of respiratory failure in a Japanese general population. In total, 3253 adults aged 40 years or older participated in annual health check in Takahata, Yamagata, Japan from 2004 to 2006. Subject deaths through the end of 2010 were reviewed; 27 subjects died of respiratory failure (pneumonia, n = 22; COPD, n = 1; pulmonary fibrosis, n = 3; and bronchial asthma, n = 1). Cox proportional hazard analysis revealed that male sex; higher age, high levels of D-dimer and fibrinogen; lower body mass index (BMI) and total cholesterol; and history of stroke and gastric ulcer were independent risk factors for respiratory death. On analysis with C-statistics, net reclassification improvement, and integrated discrimination improvement, addition of the disease history and laboratory data significantly improved the model prediction for respiratory death using age and BMI. In conclusion, we identified risk factors for mortality from respiratory failure in a prospective cohort of a Japanese general population. Men who were older, underweight, hypocholesterolemic, hypercoagulo-fibrinolytic, and had a history of stroke or gastric ulcer had a higher risk of mortality due to respiratory failure.
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135
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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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Boeck L, Soriano JB, Brusse-Keizer M, Blasi F, Kostikas K, Boersma W, Milenkovic B, Louis R, Lacoma A, Djamin R, Aerts J, Torres A, Rohde G, Welte T, Martinez-Camblor P, Rakic J, Scherr A, Koller M, van der Palen J, Marin JM, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Tamm M, Stolz D. Prognostic assessment in COPD without lung function: the B-AE-D indices. Eur Respir J 2016; 47:1635-44. [PMID: 27103389 PMCID: PMC5394475 DOI: 10.1183/13993003.01485-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/18/2016] [Indexed: 02/02/2023]
Abstract
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05).The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk.
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Affiliation(s)
- Lucas Boeck
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
| | | | - Wim Boersma
- Dept of Pneumology, Medisch Centrum, Alkmaar, The Netherlands
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Renaud Louis
- Dept of Pneumology, University of Liege, Liege, Belgium
| | - Alicia Lacoma
- Dept of Microbiology, Hospital Universitari Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Remco Djamin
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Joachim Aerts
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Antoni Torres
- Dept of Pneumology, Hospital Clinic, Barcelona, Spain
| | - Gernot Rohde
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tobias Welte
- Dept of Pneumology, Medizinische Hochschule, Hannover, Germany
| | | | - Janko Rakic
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Andreas Scherr
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Michael Koller
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jose M Marin
- Respiratory Dept, Hospital Universitario Miguel Servet, Zaragoza, CIBER Enfermedades Respiratoria, Madrid, Spain
| | | | - Pere Almagro
- Internal Medicine Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Ciro Casanova
- Respiratory Dept, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Juan P de-Torres
- Respiratory Dept, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bartolome R Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Michael Tamm
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
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Body mass index and its relation to GOLD stage in chronic obstructive pulmonary disease patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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138
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Abstract
OBJECTIVES The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status. DESIGN Retrospective observational study. SETTING Single academic medical center. PATIENTS Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition. CONCLUSION In a large population of critically ill adults, an association exists between nutrition status and mortality.
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Dal Negro RW, Celli BR. The BODECOST Index (BCI): a composite index for assessing the impact of COPD in real life. Multidiscip Respir Med 2016; 11:10. [PMID: 26941954 PMCID: PMC4776418 DOI: 10.1186/s40248-016-0045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/13/2016] [Indexed: 02/02/2023] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition which is characterized by a dramatic socio-economic impact. Several indices were extensively investigated in order to asses the mortality risk in COPD, but the utilization of health care resources was never included in calculations. The aim of this study was to assess the predictive value of annual cost of care on COPD mortality at three years, and to develop a comprehensive index for easy calculation of mortality risk in real life. Methods COPD patients were anonymously and automatically selected from the local institutional Data Base. Selection criteria were: COPD diagnosis; both genders; age ≥ 40 years; availability of at least one complete clinical record/year, including history; clinical signs; complete lung function, therapeutic strategy, health BODE index; Charlson Comorbidity Index, and outcomes, collected at the first visit, and over the following 3-years. At the first visit, the health annual cost of care was calculated in each patient for the previous 12 months, and the survival rate was also measured over the following 3 years. The hospitalization and the exacerbation rate were implemented to the BODE index and the novel index thus obtained was called BODECOST index (BCI), ranging from 0 to 10 points. The mean cost for each BCI step was calculated and then compared to the corresponding patients’ survival duration. Parametrical, non parametrical tests, and linear regression were used; p < 0.05 was accepted as the lower limit of significance. Results At the first visit, the selected 275 patients were well matched for all variables by gender. The overall mortality over the 3 year survey was 40.4 % (n = 111/275). When compared to that of BODE index (r = 0.22), the total annual cost of care and the number of exacerbations showed the highest regression value vs the survival time (r = 0.58 and r = 0.44, respectively). BCI score proved strictly proportional to both the cost of care and the survival time in our sample of COPD patients. Discussion BCI takes origin from the implementation of the BODE index with the two main components of the annual cost of care, such as the number of hospitalizations and of exacerbations occurring yearly in COPD patients, and their corresponding economic impact. In other words, higher the BCI score, shorter the survival and higher the cost, these trends being strictly linked. Conclusions BCI is a novel composite index which helps in predicting the impact of COPD at 3 years in real life, both in terms of patients’ survival and of COPD economic burden.
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Affiliation(s)
- Roberto W Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy
| | - Bartolome R Celli
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
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140
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Réhabilitation respiratoire dans la broncho-pneumopathie chronique obstructive (BPCO) : l’androgénothérapie, pourquoi ? Pour qui ? Comment ? NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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141
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Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, Hegazi RA, Tappenden KA, Ziegler TR. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr 2016; 35:18-26. [PMID: 26797412 DOI: 10.1016/j.clnu.2015.12.010] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/13/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hospitalized, malnourished older adults have a high risk of readmission and mortality. OBJECTIVE Evaluation of a high-protein oral nutritional supplement (HP-HMB) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished, hospitalized older adults. DESIGN Multicenter, randomized, placebo-controlled, double-blind trial. SETTING Inpatient and posthospital discharge. PATIENTS Older (≥65 years), malnourished (Subjective Global Assessment [SGA] class B or C) adults hospitalized for congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. INTERVENTIONS Standard-of-care plus HP-HMB (n = 328) or a placebo supplement (n = 324), 2 servings/day. MEASUREMENTS Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission. Other endpoints included 30- and 60-day postdischarge incidence of death or readmission, length of stay (LOS), SGA class, body weight, and activities of daily living (ADL). RESULTS The primary composite endpoint was similar between HP-HMB (26.8%) and placebo (31.1%). No between-group differences were observed for 90-day readmission rate, but 90-day mortality was significantly lower with HP-HMB relative to placebo (4.8% vs. 9.7%; relative risk 0.49, 95% confidence interval [CI], 0.27 to 0.90; p = 0.018). The number-needed-to-treat to prevent 1 death was 20.3 (95% CI: 10.9, 121.4). Compared with placebo, HP-HMB resulted in improved odds of better nutritional status (SGA class, OR, 2.04, 95% CI: 1.28, 3.25, p = 0.009) at day 90, and an increase in body weight at day 30 (p = 0.035). LOS and ADL were similar between treatments. LIMITATIONS Limited generalizability; patients represent a selected hospitalized population. CONCLUSIONS Although no effects were observed for the primary composite endpoint, compared with placebo HP-HMB decreased mortality and improved indices of nutritional status during the 90-day observation period. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.govNCT01626742.
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Affiliation(s)
- Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, 1700 Research Parkway, College Station, TX 77845, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, 5 Charleston Center Dr, Charleston, SC, USA.
| | - Laura E Matarese
- Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, USA.
| | - Menghua Luo
- Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA.
| | - Geraldine E Baggs
- Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA.
| | - Jeffrey L Nelson
- Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA.
| | - Refaat A Hegazi
- Abbott Nutrition, Research and Development, 3300 Stelzer Rd, Columbus, OH, USA; Faculty of Medicine, Mansoura University, Egypt.
| | - Kelly A Tappenden
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S. Goodwin Ave, Urbana, IL, USA.
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, USA.
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Vanfleteren LE, Lamprecht B, Studnicka M, Kaiser B, Gnatiuc L, Burney P, Wouters EF, Franssen FM. Body mass index and chronic airflow limitation in a worldwide population-based study. Chron Respir Dis 2016; 13:90-101. [PMID: 26768010 DOI: 10.1177/1479972315626012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nutritional status has been associated with clinical outcome in chronic airflow limitation (CAL), but epidemiological studies are scarce. We aimed to assess the relationship between body mass index (BMI) and CAL, taking into account confounding factors. 18,606 participants (49% male, 21% smokers, mean age: 55.8 ± 11.2 years, mean BMI: 26.7 ± 5.5 kg/m(2)) of the BOLD initiative from 26 sites in 23 countries were included. CAL was defined as post-bronchodilator forced expiratory volume in the first second/forced vital capacity < lower limit of normal. Low and obese BMI were defined as <21 kg/m(2) and ≥30 kg/m(2), respectively. Multivariate logistic regression analysis controlled for confounders age, sex and smoking, and meta-analysis of between-site heterogeneity and clustering. Prevalence of low and obese BMI, smoking history and prevalence of CAL were highly variable between sites. After adjustment for confounders, the meta-analysis of all sites showed that compared to subjects without CAL, low BMI was more frequent, (adjusted odds ratio (OR): 2.23 (95% confidence interval: 1.75, 2.85)) and conversely, obesity was less frequent in subjects with CAL (adjusted OR: 0.78 (0.65, 0.94)). In a worldwide population sample, CAL was associated with lower BMI, even after adjusting for confounding factors age, gender, smoking and between-site heterogeneity. These results indicate a CAL-specific association with body composition.
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Affiliation(s)
- Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Louisa Gnatiuc
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Emiel Fm Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Frits Me Franssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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143
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Dubé BP, Guerder A, Morelot-Panzini C, Laveneziana P. The clinical relevance of the emphysema-hyperinflated phenotype in COPD. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40749-015-0017-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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144
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Wedzicha JA, Calverley PM, Rabe KF. Roflumilast: a review of its use in the treatment of COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:81-90. [PMID: 26792988 PMCID: PMC4708192 DOI: 10.2147/copd.s89849] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
COPD is a progressive condition involving chronic inflammation and parenchymal destruction with resulting airflow limitation. COPD is associated with worsening airflow limitation over time and increased frequency of COPD exacerbations, leading to increased mortality and morbidity. The effects of COPD extend beyond the lungs, as multiple comorbidities may occur with COPD, including cardiovascular disease, diabetes mellitus, osteoporosis, depression, and pneumonia. COPD exacerbations are associated with a rapid worsening of baseline symptoms that requires prompt management and may necessitate hospitalization in the case of a severe episode. Patients with COPD exacerbations require urgent management of symptoms to prevent further worsening, and preventative steps may be taken to help reduce the number and frequency of future exacerbations. Roflumilast is a potent and selective inhibitor of the enzyme phosphodiesterase-4 that targets the systemic inflammation associated with COPD. Roflumilast has a variety of anti-inflammatory effects including decreasing inflammatory mediators and the expression of cell surface markers and inhibition of apoptosis. Several clinical trials evaluating roflumilast in the treatment of COPD have demonstrated significant improvements from baseline versus placebo in lung function, including increases in mean pre- and postbronchodilator forced expiratory volume in 1 second and forced vital capacity. Data suggest that roflumilast reduces moderate to severe exacerbations with the benefit most well established in patients with severe disease. Given this evidence, roflumilast, as part of a combination regimen with long-acting bronchodilators, appears to be a reasonable treatment option for patients with severe to very severe COPD associated with chronic bronchitis and a history of exacerbations.
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Affiliation(s)
- Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Ma Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Klaus F Rabe
- Department of Internal Medicine, Christian-Albrechts University, Kiel, Germany; Department of Pulmonary Medicine and Medical Director, LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
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145
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Gea J, Pascual S, Casadevall C, Orozco-Levi M, Barreiro E. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. J Thorac Dis 2015; 7:E418-38. [PMID: 26623119 DOI: 10.3978/j.issn.2072-1439.2015.08.04] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Respiratory and/or limb muscle dysfunction, which are frequently observed in chronic obstructive pulmonary disease (COPD) patients, contribute to their disease prognosis irrespective of the lung function. Muscle dysfunction is caused by the interaction of local and systemic factors. The key deleterious etiologic factors are pulmonary hyperinflation for the respiratory muscles and deconditioning secondary to reduced physical activity for limb muscles. Nonetheless, cigarette smoke, systemic inflammation, nutritional abnormalities, exercise, exacerbations, anabolic insufficiency, drugs and comorbidities also seem to play a relevant role. All these factors modify the phenotype of the muscles, through the induction of several biological phenomena in patients with COPD. While respiratory muscles improve their aerobic phenotype (percentage of oxidative fibers, capillarization, mitochondrial density, enzyme activity in the aerobic pathways, etc.), limb muscles exhibit the opposite phenotype. In addition, both muscle groups show oxidative stress, signs of damage and epigenetic changes. However, fiber atrophy, increased number of inflammatory cells, altered regenerative capacity; signs of apoptosis and autophagy, and an imbalance between protein synthesis and breakdown are rather characteristic features of the limb muscles, mostly in patients with reduced body weight. Despite that significant progress has been achieved in the last decades, full elucidation of the specific roles of the target biological mechanisms involved in COPD muscle dysfunction is still required. Such an achievement will be crucial to adequately tackle with this relevant clinical problem of COPD patients in the near-future.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Sergi Pascual
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Carme Casadevall
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Mauricio Orozco-Levi
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Esther Barreiro
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
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146
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Outcomes for COPD pharmacological trials: From lung function to biomarkers. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 14:579-83. [PMID: 25967077 DOI: 10.1016/s0873-2159(15)30266-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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147
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Prognostic Value of the Six-Second Spirometry in Patients with Chronic Obstructive Pulmonary Disease: A Cohort Study. PLoS One 2015; 10:e0140855. [PMID: 26489023 PMCID: PMC4619273 DOI: 10.1371/journal.pone.0140855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/01/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The six-second spirometry has been proposed as an alternative to diagnose airflow limitation, although its prognostic value in patients with chronic obstructive pulmonary disease (COPD) remains unknown. The purpose of this study was to determine the prognostic value of the postbronchodilator forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio and FEV6 in COPD patients. METHODS AND FINDINGS The study population consisted of 2,614 consecutive stable patients with COPD. The patients were monitored for an average period of 4.3 years regarding mortality, hospitalizations by COPD exacerbations, diagnosis of lung cancer, and annual lung function decline. The overall rate of death was 10.7 (95%CI: 8.7-12.7) per 1000 person-years. In addition to male gender, age and comorbidity, FEV6 (hazard ratio [HR]: 0.981, 95%CI: 0.968-0.003) and FEV1/FEV6 quartiles (lowest quartile (<74% pred.): HR 3.558, 95%CI: 1.752-7.224; and second quartile (74-84% pred.): HR 2.599, 95%CI: 1.215-5.561; versus best quartile (>0.89% pred.)) were independently associated with mortality, whereas FEV1 was not retained in the model. 809 patients (30.9%) had at least one hospital admission due to COPD exacerbation. In addition to sex, age, smoking and comorbidity, FEV1 and FEV1/FEV6 quartiles were independent risk factors of hospitalization. FEV6 was the only spirometric parameter independently related with lung function annual decline, while the FEV6 and FEV1/FEV6 quartiles were independent risk factors for lung cancer. CONCLUSIONS In a general COPD outpatient population, airflow obstruction assessed by the FEV1/FEV6 is an independent risk factor for both death and hospitalization.
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148
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Exuzides A, Colby C, Briggs AH, Lomas DA, Rutten-van Mölken MPMH, Tabberer M, Chambers M, Muellerova H, Locantore N, Risebrough NA, Ismaila AS, Gonzalez-McQuire S. Statistical Modeling of Disease Progression for Chronic Obstructive Pulmonary Disease Using Data from the ECLIPSE Study. Med Decis Making 2015; 37:453-468. [PMID: 26449490 DOI: 10.1177/0272989x15610781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To develop statistical models predicting disease progression and outcomes in chronic obstructive pulmonary disease (COPD), using data from ECLIPSE, a large, observational study of current and former smokers with COPD. METHODS Based on a conceptual model of COPD disease progression and data from 2164 patients, associations were made between baseline characteristics, COPD disease progression attributes (exacerbations, lung function, exercise capacity, and symptoms), health-related quality of life (HRQoL), and survival. Linear and nonlinear functional forms of random intercept models were used to characterize these relationships. Endogeneity was addressed by time-lagging variables in the regression models. RESULTS At the 5% significance level, an exacerbation history in the year before baseline was associated with increased risk of future exacerbations (moderate: +125.8%; severe: +89.2%) and decline in lung function (forced expiratory volume in 1 second [FEV1]) (-94.20 mL per year). Each 1% increase in FEV1 % predicted was associated with decreased risk of exacerbations (moderate: -1.1%; severe: -3.0%) and increased 6-minute walk test distance (6MWD) (+1.5 m). Increases in baseline exercise capacity (6MWD, per meter) were associated with slightly increased risk of moderate exacerbations (+0.04%) and increased FEV1 (+0.62 mL). Symptoms (dyspnea, cough, and/or sputum) were associated with an increased risk of moderate exacerbations (+13.4% to +31.1%), and baseline dyspnea (modified Medical Research Council score ≥2 v. <2) was associated with lower FEV1 (-112.3 mL). CONCLUSIONS A series of linked statistical regression equations have been developed to express associations between indicators of COPD disease severity and HRQoL and survival. These can be used to represent disease progression, for example, in new economic models of COPD.
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Affiliation(s)
| | | | - Andrew H Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK (AHB).,ICON Health Economics, Morristown, NJ, USA (AHB)
| | - David A Lomas
- Wolfson Institute for Biomedical Research, University College London, London, UK (DAL)
| | | | - Maggie Tabberer
- Value Evidence and Outcomes, GSK R&D, Uxbridge, UK (MT, SG-M)
| | - Mike Chambers
- Global Market Access and Healthcare Solutions, GSK, Brentford, UK (MC)
| | | | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK R&D, Research Triangle Park, NC, USA (ASI).,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (ASI)
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149
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El-Shafey BI, El-Deib AE. Effect of weight reduction on obese patients with COPD and bronchial asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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150
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Schols AMWJ. The 2014 ESPEN Arvid Wretlind Lecture: Metabolism & nutrition: Shifting paradigms in COPD management. Clin Nutr 2015; 34:1074-9. [PMID: 26474814 DOI: 10.1016/j.clnu.2015.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/10/2015] [Indexed: 01/09/2023]
Abstract
COPD is a chronic disease of the lungs, but heterogeneous with respect to clinical manifestations and disease progression. This has consequences for health risk assessment, stratification and management. Heterogeneity can be driven by pulmonary events but also by systemic consequences (e.g. cachexia and muscle weakness) and co-morbidity (e.g. osteoporosis, diabetes and cardiovascular disease). This paper shows how a metabolic perspective on COPD has contributed significantly to understanding clinical heterogeneity and the need for a paradigm shift from reactive medicine towards predictive, preventive, personalized and participatory medicine. These insights have also lead to a paradigm shift in nutritional therapy for COPD from initial ignorance or focusing on putative adverse effects of carbohydrate overload on the ventilatory system to beneficial effects of nutritional intervention on body composition and physical functioning as integral part of disease management. The wider implications beyond COPD as disease have been as clinical model for translational cachexia research.
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Affiliation(s)
- Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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