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Enríquez-Rodríguez CJ, Pascual-Guardia S, Casadevall C, Caguana-Vélez OA, Rodríguez-Chiaradia D, Barreiro E, Gea J. Proteomic Blood Profiles Obtained by Totally Blind Biological Clustering in Stable and Exacerbated COPD Patients. Cells 2024; 13:866. [PMID: 38786086 PMCID: PMC11119172 DOI: 10.3390/cells13100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Although Chronic Obstructive Pulmonary Disease (COPD) is highly prevalent, it is often underdiagnosed. One of the main characteristics of this heterogeneous disease is the presence of periods of acute clinical impairment (exacerbations). Obtaining blood biomarkers for either COPD as a chronic entity or its exacerbations (AECOPD) will be particularly useful for the clinical management of patients. However, most of the earlier studies have been characterized by potential biases derived from pre-existing hypotheses in one or more of their analysis steps: some studies have only targeted molecules already suggested by pre-existing knowledge, and others had initially carried out a blind search but later compared the detected biomarkers among well-predefined clinical groups. We hypothesized that a clinically blind cluster analysis on the results of a non-hypothesis-driven wide proteomic search would determine an unbiased grouping of patients, potentially reflecting their endotypes and/or clinical characteristics. To check this hypothesis, we included the plasma samples from 24 clinically stable COPD patients, 10 additional patients with AECOPD, and 10 healthy controls. The samples were analyzed through label-free liquid chromatography/tandem mass spectrometry. Subsequently, the Scikit-learn machine learning module and K-means were used for clustering the individuals based solely on their proteomic profiles. The obtained clusters were confronted with clinical groups only at the end of the entire procedure. Although our clusters were unable to differentiate stable COPD patients from healthy individuals, they segregated those patients with AECOPD from the patients in stable conditions (sensitivity 80%, specificity 79%, and global accuracy, 79.4%). Moreover, the proteins involved in the blind grouping process to identify AECOPD were associated with five biological processes: inflammation, humoral immune response, blood coagulation, modulation of lipid metabolism, and complement system pathways. Even though the present results merit an external validation, our results suggest that the present blinded approach may be useful to segregate AECOPD from stability in both the clinical setting and trials, favoring more personalized medicine and clinical research.
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Affiliation(s)
- Cesar Jessé Enríquez-Rodríguez
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Sergi Pascual-Guardia
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Carme Casadevall
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Oswaldo Antonio Caguana-Vélez
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Diego Rodríguez-Chiaradia
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Esther Barreiro
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar—IMIM, 08003 Barcelona, Spain; (C.J.E.-R.); (S.P.-G.); (C.C.); (O.A.C.-V.); (D.R.-C.); (E.B.)
- MELIS Department, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBERES, ISCiii, 08003 Barcelona, Spain
- BRN, 08003 Barcelona, Spain
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Miravitlles M, Kostikas K, Bizymi N, Tzanakis N. Reply to Figueroa-Gonçalves and de Miguel-Díez. Arch Bronconeumol 2024; 60:67-68. [PMID: 38030417 DOI: 10.1016/j.arbres.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | | | - Nikoletta Bizymi
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
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3
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Miravitlles M, Martinez-Garcia MA. Chronic bronchial infection in stable COPD: To treat or not to treat. Pulmonology 2023; 29:449-451. [PMID: 36922260 DOI: 10.1016/j.pulmoe.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/15/2023] Open
Affiliation(s)
- M Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron / Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
| | - M A Martinez-Garcia
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe. Valencia, Spain
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Correa-Gutiérrez CA, Ji Z, Aragón-Espinosa P, Rodrigues-Oliveira S, Zeng L, Meizoso-Pita O, Sevillano-Collantes C, Hernández-Vázquez J, Puente-Maestu L, de Miguel-Díez J. Influence of Diabetes Mellitus and Nutritional Parameters on Clinical and Functional Aspects and Quality of Life in Patients Hospitalized Due to Exacerbation of Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 12:6874. [PMID: 37959339 PMCID: PMC10650144 DOI: 10.3390/jcm12216874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations. During severe exacerbations, nutritional and endocrinological comorbidities can play an important role in the clinical and functional aspects of these patients. The aim of this study was to analyse the influence of the presence of diabetes mellitus (DM) and nutritional parameters on the deterioration of symptoms and quality of life during a severe exacerbation in patients with COPD. An observational study was conducted on COPD patients admitted due to an exacerbation. The COPD Assessment Test (CAT) questionnaire was administered, and clinical and functional parameters were compared based on the presence of nutritional and endocrinological alterations. A total of 50 patients were included, of whom 30 (60%) were male. The mean age was 70.5 years (standard deviation (SD) 9.6). The median CAT score during exacerbation was 25 (interquartile range (IQR) 17.5-30), and the baseline score was 13.5 (IQR 7-19), which represented a statistically significant difference (p < 0.001). Patients with iron deficiencies had a lower total CAT score (p = 0.041), specifically for items related to daily activity (p = 0.009) and energy (p = 0.007). Diabetic patients exhibited a greater decline in pulmonary function during exacerbation (p = 0.016), while patients with high thyroid-stimulating hormone (TSH) levels had a shorter hospital stay (p = 0.016). For COPD patients admitted due to an exacerbation, the metabolic assessment is useful and relevant in the clinical set-up, as endocrinological comorbidities negatively affect clinical and functional aspects of these patients.
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Affiliation(s)
- Cristhian Alonso Correa-Gutiérrez
- Respiratory Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain; (C.A.C.-G.); (L.P.-M.); (J.d.M.-D.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.A.-E.); (S.R.-O.)
| | - Zichen Ji
- Respiratory Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain; (C.A.C.-G.); (L.P.-M.); (J.d.M.-D.)
- Gregorio Marañón Biomedical Research Institute, 28007 Madrid, Spain
| | - Patricia Aragón-Espinosa
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.A.-E.); (S.R.-O.)
| | - Sarah Rodrigues-Oliveira
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.A.-E.); (S.R.-O.)
| | - Luyi Zeng
- Endocrinology and Nutrition Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (L.Z.); (O.M.-P.); (C.S.-C.)
| | - Olalla Meizoso-Pita
- Endocrinology and Nutrition Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (L.Z.); (O.M.-P.); (C.S.-C.)
| | - Cristina Sevillano-Collantes
- Endocrinology and Nutrition Department, Infanta Leonor University Hospital, 28031 Madrid, Spain; (L.Z.); (O.M.-P.); (C.S.-C.)
| | | | - Luis Puente-Maestu
- Respiratory Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain; (C.A.C.-G.); (L.P.-M.); (J.d.M.-D.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.A.-E.); (S.R.-O.)
- Gregorio Marañón Biomedical Research Institute, 28007 Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain; (C.A.C.-G.); (L.P.-M.); (J.d.M.-D.)
- Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.A.-E.); (S.R.-O.)
- Gregorio Marañón Biomedical Research Institute, 28007 Madrid, Spain
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Melani AS, Croce S, Cassai L, Montuori G, Fabbri G, Messina M, Viani M, Bargagli E. Systemic Corticosteroids for Treating Respiratory Diseases: Less Is Better, but… When and How Is It Possible in Real Life? Pulm Ther 2023; 9:329-344. [PMID: 37356085 PMCID: PMC10447722 DOI: 10.1007/s41030-023-00227-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 06/27/2023] Open
Abstract
Systemic corticosteroids (CSs), a keystone in pulmonology, are drugs with strong antiinflammatory activity. They are cheap, easily available, and accessible, but with common and serious side effects. Moreover, the use of exogenous CSs may suppress the hypothalamic-pituitary-adrenal (HPA) axis, predisposing to adrenal insufficiency. Safe CS treatment is a challenge of pharmacological research. This narrative review examined the indications of CSs in some respiratory diseases, analyzing what types, dosages, and length of treatment are required as the dosage and duration of CS treatments need to be minimized. Chronic maintenance treatments with CSs are associated with poor prognosis, but they are still prescribed in patients with severe asthma, Chronic obstructive pulmonary disease (COPD), and interstitial lung diseases. When CS discontinuation is not possible, all efforts should be made to achieve clinically meaningful reductions. Guidelines suggest the use of methylprednisolone at a dose of 20-40 mg/day or equivalent for up to 10 days in subjects with COVID-19 pneumonia (but not other respiratory viral diseases) and respiratory failure, exacerbations of asthma, and COPD. Some guidelines suggest that CS treatment shorter than 10-14 days can be abruptly stopped, strictly monitoring subjects with unexplained symptoms after CS withdrawal, who should promptly be tested for adrenal insufficiency (AI) and eventually treated. CSs are often used in severe community-acquired pneumonia associated with markedly increased serum inflammation markers, in acute respiratory distress syndrome (ARDS), in septic shock unresponsive to hydro-saline replenishment and vasopressors, and acute exacerbations of interstitial lung diseases. As these cases often require higher doses and longer duration of CS treatment, CS tapering should be gradual and, when useful, supported by an evaluation of HPA axis function.
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Affiliation(s)
- Andrea S. Melani
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Sara Croce
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Lucia Cassai
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Giusy Montuori
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Gaia Fabbri
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Maddalena Messina
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Magda Viani
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
| | - Elena Bargagli
- Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100 Siena, Italy
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Amado CA, Martín-Audera P, Agüero J, Lavín BA, Guerra AR, Boucle D, Ferrer-Pargada D, Berja A, Martín F, Casanova C, García-Unzueta M. Circulating levels of mitochondrial oxidative stress-related peptides MOTS-c and Romo1 in stable COPD: A cross-sectional study. Front Med (Lausanne) 2023; 10:1100211. [PMID: 36844198 PMCID: PMC9944395 DOI: 10.3389/fmed.2023.1100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background MOTS-c and Romo1 are mitochondrial peptides that are modulated by oxidative stress. No previous studies have explored circulating levels of MOTS-c in patients with chronic obstructive pulmonary disease (COPD). Methods We enrolled 142 patients with stable COPD and 47 smokers with normal lung function in an observational cross-sectional study. We assessed serum levels of both MOTS-c and Romo1 and associated these findings with clinical characteristics of COPD. Results Compared with smokers with normal lung function, patients with COPD had lower levels of MOTS-c (p = 0.02) and higher levels of Romo1 (p = 0.01). A multivariate logistic regression analysis revealed that above-median MOTS-c levels were positively associated with Romo1 levels (OR 1.075, 95% CI 1.005-1.150, p = 0.036), but no association was found with other COPD characteristics. Below-median levels of circulating MOTS-c were associated with oxygen desaturation (OR 3.25 95% CI 1.456-8.522, p = 0.005) and walking <350 meters (OR 3.246 95% CI 1.229-8.577, p = 0.018) in six-minute walk test. Above-median levels of Romo1 were positively associated with current smoking (OR 2.756, 95% CI 1.133-6.704, p = 0.025) and negatively associated with baseline oxygen saturation (OR 0.776 95% CI 0.641-0.939, p = 0.009). Conclusions Reduced levels of circulating MOTS-c and increased levels of Romo1 were detected in patients diagnosed with COPD. Low levels of MOTS-c were associated with oxygen desaturation and poorer exercise capacity using 6 min walk test. Romo1 was associated with current smoking and baseline oxygen saturation. Trial registration www.clinicaltrials.gov; No.: NCT04449419; URL: www.clinicaltrials.gov. Date of registration: June 26, 2020.
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Affiliation(s)
- Carlos A. Amado
- Department of Pulmonology, Hospital Universitario Marqués de Valdecilla, Santander, Spain,University of Cantabria, Santander, Spain,IDIVAL (Instituto de Investigación Biomédica de Cantabria), Santander, Spain,*Correspondence: Carlos A. Amado ✉
| | - Paula Martín-Audera
- Department of Clinical Biochemistry, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Agüero
- Department of Pulmonology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Bernardo A. Lavín
- Department of Clinical Biochemistry, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Armando R. Guerra
- Department of Clinical Biochemistry, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Diego Ferrer-Pargada
- Department of Pulmonology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ana Berja
- Department of Clinical Biochemistry, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Fernando Martín
- Unidad de Deshabituación Tabáquica (UDESTA), Servicio Cántabro de Salud, Santander, Spain
| | - Ciro Casanova
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario La Candelaria, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Mayte García-Unzueta
- University of Cantabria, Santander, Spain,Department of Clinical Biochemistry, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia. Arch Bronconeumol 2023; 59:90-100. [PMID: 36376121 DOI: 10.1016/j.arbres.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP. METHODS We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population. RESULTS We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7-35.2]), hospitalization in the past 12 months (OR 3.7 [1.5-9.2]), and bronchiectasis (OR 3.2 [1.4-7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%. CONCLUSIONS COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy.
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Darbà J, Ascanio M. Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis. J Med Econ 2023; 26:335-341. [PMID: 36800217 DOI: 10.1080/13696998.2023.2182092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain. METHODS Admission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS 95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI. CONCLUSIONS Patients' condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Ascanio
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
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Miravitlles M, Kawayama T, Dreher M. LABA/LAMA as First-Line Therapy for COPD: A Summary of the Evidence and Guideline Recommendations. J Clin Med 2022; 11:jcm11226623. [PMID: 36431099 PMCID: PMC9692772 DOI: 10.3390/jcm11226623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
Inhaled bronchodilators (alone or in combination) are the cornerstone of treatment for symptomatic patients with COPD, either as initial/first-line treatment or for second-line/treatment escalation in patients who experience persistent symptoms or exacerbations on monotherapy. The Global Initiative for Chronic Obstructive Lung Disease 2022 report recommends initial pharmacological treatment with a long-acting muscarinic antagonist (LAMA) or a long-acting β2-agonist (LABA) as monotherapy for most patients, or dual bronchodilator therapy (LABA/LAMA) in patients with more severe symptoms, regardless of exacerbation history. The recommendations for LABA/LAMA are broader in the American Thoracic Society treatment guidelines, which strongly recommend LABA/LAMA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance. However, despite consistent guideline recommendations, real-world prescribing data indicate that LAMA and/or LABA without an inhaled corticosteroid are not the most widely prescribed therapies in COPD. This article reviews global and regional/national guideline recommendations for the use of LABA/LAMA in COPD, examines the evidence for the effectiveness and safety of LABA/LAMA versus other therapies and offers a practical guide for clinicians to help ensure appropriate use of LABA/LAMA therapy.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d′Hebron, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-(93)-274-6157
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, 52074 Aachen, Germany
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Matera MG, Rinaldi B, Belardo C, Cazzola M. Pharmacotherapy of LAMA/LABA inhaled therapy combinations for chronic obstructive pulmonary disease: a clinical overview. Expert Rev Clin Pharmacol 2022; 15:1269-1281. [DOI: 10.1080/17512433.2022.2134113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Barbara Rinaldi
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carmela Belardo
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
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Martín-Ontiyuelo C, Rodó-Pin A, Echeverría-Esnal D, Admetlló M, Duran-Jordà X, Alvarado M, Gea J, Barreiro E, Rodríguez-Chiaradía DA. Intravenous Iron Replacement Improves Exercise Tolerance in COPD: A Single-Blind Randomized Trial. Arch Bronconeumol 2022; 58:689-698. [PMID: 35312562 DOI: 10.1016/j.arbres.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Iron deficiency affects exercise capacity because of the critical role iron plays in the optimal functioning of skeletal muscle metabolism. We hypothesized that intravenous iron may improve exercise tolerance, quality of life (QoL), and daily physical activity (DPA) in patients with chronic obstructive pulmonary disease (COPD). METHODS This was a placebo-controlled, single-blind, parallel-group, randomized clinical trial. Iron deficiency was defined as a ferritin level<100ng/mL or a ferritin level between 100 and 299ng/mL with a transferrin saturation<20%, with or without mild anaemia. Patients were randomized at a 2:1 ratio to receive intravenous ferric carboxymaltose or placebo. The primary objective was to investigate whether intravenous iron replacement improved endurance time from baseline by at least 33%. The secondary objectives were to evaluate impact on QoL using the COPD Assessment Test (CAT) and on DPA by accelerometry. RESULTS We included 66 patients, 44 (66.7%) in the intervention group and 22 (33.3%) in the placebo group. Among patients receiving ferric carboxymaltose, 23 (52.3%) achieved the primary endpoint compared to 4 (18.2%) in the placebo group [p=0.009; relative risk 3.12, (95% CI, 1.19-8.12)]. CAT score decreased -3 (-6.0-1.3) points from baseline in the intervention group (p=0.007), in contrast to placebo group [-1 (-4.0-2.3) points, p=0.236] with no differences in DPA and adverse events in both groups. CONCLUSIONS Iron replacement improved exercise capacity and QoL in stable COPD patients with iron deficiency. The treatment was well tolerated. CLINICAL TRIAL REGISTRATION EudraCT 2016-001238-89.
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Affiliation(s)
- Clara Martín-Ontiyuelo
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos-III (ISCIII), Barcelona, Spain
| | - Anna Rodó-Pin
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
| | - Daniel Echeverría-Esnal
- Pharmacy Department, Hospital del Mar (Parc de Salut Mar), Barcelona, Spain; Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Mireia Admetlló
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
| | - Xavier Duran-Jordà
- Methodology & Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Mariela Alvarado
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
| | - Joaquim Gea
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos-III (ISCIII), Barcelona, Spain
| | - Esther Barreiro
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos-III (ISCIII), Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos-III (ISCIII), Barcelona, Spain.
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Miravitlles M, Soler-Cataluña JJ, Soriano JB, García-Río F, de Lucas P, Alfageme I, Casanova C, Rodríguez González-Moro JM, Sánchez G, Ancochea J, Cosío BG. Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years. ERJ Open Res 2022; 8:00067-2022. [PMID: 36382234 PMCID: PMC9661281 DOI: 10.1183/23120541.00067-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Few large epidemiological studies have analysed the prevalence of respiratory symptoms and their determinants in the general adult population. We investigated the prevalence and determinants of respiratory symptoms and compared their prevalence with that of two previous studies conducted in 1999 and 2009. Method EPISCAN II was a multicentre, cross-sectional, population-based epidemiological study in individuals older than 40 years. Results A total of 9092 individuals were included. Up to 47.5% reported at least one respiratory symptom, being more frequent in women than in men (49.4% versus 45.5%, p=0.0002) and with wheezing being the most frequent (33.7%) followed by dyspnoea (26.8%). The presence of any symptom was associated with female sex, higher body mass index (BMI), lower forced expiratory volume in 1 s (FEV1 % pred), reduced physical activity, a higher Charlson index and the presence of anxiety and depression. Smoking was also significantly associated with having at least one respiratory symptom in a dose–response fashion (OR: 1.415, 1.916, 2.192 and 2.987 for 0–10, 10–20, 20–30 and >30 pack-years, respectively, all p<0.0001). The prevalence of symptoms remained quite similar over the last 20 years (wheezing 40%, 36% and 33.7% and dyspnoea 10.4%, 9.9% and 13.1% in 1999, 2009 and 2019, respectively). Conclusions Approximately half of the adult Spanish population have respiratory symptoms and this prevalence has remained quite stable over the last 20 years. Smoking remains the main factor associated with respiratory symptoms, but female sex, comorbidities, high BMI and low FEV1 and low physical activity are also significantly associated with respiratory symptoms. Approximately half of the adult Spanish population has some respiratory symptoms and this prevalence has remained quite stable over the last 20 yearshttps://bit.ly/37uGRT7
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Clinical Assessment and Utility of Biomarkers in Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:631-643. [DOI: 10.1016/j.iac.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Golpe R, Figueira-Gonçalves JM, Esteban C, Amado-Diago CA, Aramburu A, García-Talavera I, Veiga I. [Translated article] Relationship Between the GesEPOC 2021 Classification of Risk Levels and Phenotypes and the Incidence of Adverse Events. Arch Bronconeumol 2022. [PMID: 35525714 DOI: 10.1016/j.arbres.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain; Grupo C039 Biodiscovery HULA-USC, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Juan Marco Figueira-Gonçalves
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Cristóbal Esteban
- Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Bizkaia, Spain
| | - Carlos Antonio Amado-Diago
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Universidad de Cantabria, Instituto de Investigación Sanitaria de Cantabria IDIVAL, Santander, Spain
| | - Amaia Aramburu
- Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, Spain
| | - Ignacio García-Talavera
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Iria Veiga
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Roncero C, Pérez J, Molina J, Quintano JA, Campuzano AI, Pérez J, Miravitlles M. Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11092558. [PMID: 35566685 PMCID: PMC9101437 DOI: 10.3390/jcm11092558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771–4.183)), depression score (OR = 1.163 (95% IC = 1.127–1.200)), and Charlson Index (OR 1.228 (95% IC 1.082–1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
- Correspondence: (C.R.); (M.M.)
| | - Joselín Pérez
- Medical Department, Grupo Ferrer, 08029 Barcelona, Spain; (J.P.); (A.I.C.)
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, 28993 Madrid, Spain;
| | | | | | - Javier Pérez
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence: (C.R.); (M.M.)
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Lundh L, Larsson K, Lindén A, Montgomery S, Palmberg L, Sandelowsky H. Biomarkers, Clinical Course, and Individual Needs in COPD Patients in Primary Care: The Study Protocol of the Stockholm COPD Inflammation Cohort (SCOPIC). Int J Chron Obstruct Pulmon Dis 2022; 17:993-1004. [PMID: 35528148 PMCID: PMC9075012 DOI: 10.2147/copd.s358056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/11/2022] [Indexed: 01/09/2023] Open
Abstract
Background To facilitate effective personalized medicine, primary health care needs better methods of assessing and monitoring chronic obstructive pulmonary disease (COPD). Aim This cohort study aims to investigate how biomarkers relate to clinical characteristics and COPD patients' subjective needs over time. Methods Patients (n=750) in different COPD severity according to the GOLD criteria and age- and sex-matched controls (n=750) will be recruited over a period of 5 years from 15 primary health care centers in Region Stockholm, Sweden, and followed for 10 years in the first instance. Data on patients' subjective needs will be collected via telephone/email, data on clinical/physiological variables (eg, symptoms, exacerbations, comorbidities, medications, smoking habits, lung function) from existing databases that are based on medical records, and data on biomarkers via repeated blood sampling. Quantitative and qualitative methods will be used. Initial results are expected after 2 years (feasibility test), and a larger body of evidence after 5 years. Discussion The study is expected to provide definitive and clinically useful scientific evidence about how biomarkers relate to clinical variables and patients' subjective needs. This new evidence will facilitate accurate, and personalized COPD management by the use of valid biomarkers. It will provide useful tools for primary care professionals and may facilitate optimal self-management.
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Affiliation(s)
- Lena Lundh
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Kjell Larsson
- Division of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lindén
- Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology and Public Health, University College London, London, UK
| | - Lena Palmberg
- Division of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Correspondence: Hanna Sandelowsky, Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, Stockholm, SE-171 76, Sweden, Tel +46738902565, Email
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Monteagudo M, Nuñez A, Barrecheguren M, Miravitlles M. Effectiveness of treatment with dual bronchodilation (LABA/LAMA) compared with combination therapy (LABA/ICS) for patients with COPD: A population-based study. Arch Bronconeumol 2022; 58:699-707. [DOI: 10.1016/j.arbres.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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Mekov E, Yanev N, Kurtelova N, Mihalova T, Tsakova A, Yamakova Y, Miravitlles M, Petkov R. Diaphragmatic Movement at Rest and After Exertion: A Non-Invasive and Easy to Obtain Prognostic Marker in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:1041-1050. [PMID: 35547783 PMCID: PMC9084386 DOI: 10.2147/copd.s361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Diaphragmatic dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the prognostic significance of impaired diaphragmatic movement at rest and after exercise. Methods This was a prospective study of patients with stable COPD. Diaphragmatic movements were examined at rest and after a 6-minute walking test (6MWT) with a convex transducer with a frequency of 3.5-5-7.5 MHz. Maximal movement of the diaphragm was measured in both right and left diaphragm, and the side with higher amplitude was selected for further analysis. Measurements obtained were evaluated for their prognostic value for a composite endpoint of moderate and severe COPD exacerbations and death in 1 year time period was assessed. In addition, postbronchodilator spirometry, symptoms, quality of life, and demographic and clinical information were collected. Results A total of 96 patients were analyzed (62.5% male, mean age 65.1 years (standard deviation (SD): 8.1), mean FEV1 (% predicted): 55.8%, SD: 18.3%, mean CAT: 15.6 units, SD: 9.2). Sixty-four patients (67%) presented the composite endpoint. In the multivariate Cox analysis, FVC (HR = 0.944, p = 0.005), CAT score (HR = 1.133, p = 0.011), previous severe exacerbations (HR = 5.446, p = 0.004) and diaphragmatic movement at rest (HR = 0.932, p = 0.033) were found to be predictors of the composite endpoint. This model correctly classified 86.5% (83/96) of the patients. Conclusion Non-invasive assessment of diaphragmatic movement by ultrasound measurement both at rest and after exercise could contribute to the assessment of disease severity and prognosis of COPD.
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Affiliation(s)
- Evgeni Mekov
- Department of Occupational Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Nedelina Kurtelova
- Department of Pulmonary Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Teodora Mihalova
- Department of Pulmonary Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Adelina Tsakova
- Central Clinical Laboratory, Medical University Sofia, Sofia, Bulgaria
| | - Yordanka Yamakova
- Department of Anesthesiology and Intensive Care, Medical University Sofia, Sofia, Bulgaria
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Correspondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d´Hebron, Pg. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Email
| | - Rosen Petkov
- Department of Pulmonary Diseases, Medical University Sofia, Sofia, Bulgaria
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Impact of anxiety and depression on the prognosis of copd exacerbations. BMC Pulm Med 2022; 22:169. [PMID: 35488330 PMCID: PMC9052487 DOI: 10.1186/s12890-022-01934-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 12/20/2022] Open
Abstract
Background Frequent and highly prevalent as comorbidities in Chronic Obstructive Pulmonary Disease (COPD) patients, both depression and anxiety seem to have an impact on COPD prognosis. However, they are underdiagnosed and rarely treated properly.
Aim To establish the prevalence of depression and anxiety in patients admitted for Acute Exacerbation of COPD (AECOPD) and determine their influence on COPD prognosis. Methods Prospective observational study conducted from October 1, 2016 to October 1, 2018 at the following centers in Galicia, Spain: Salnés County Hospital, Arquitecto Marcide, and Clinic Hospital Complex of Santiago de Compostela. Patients admitted for AECOPD who agreed to participate and completed the anxiety and depression scale (HADS) were included in the study. Results 288 patients (46.8%) were included, mean age was 73.7 years (SD 10.9), 84.7% were male. 67.7% patients were diagnosed with probable depression, and depression was established in 41.7%; anxiety was probable in 68.2% and established in 35.4%. 60.4% of all patients showed symptoms of both anxiety and depression. Multivariate analysis relates established depression with a higher risk of late readmission (OR 2.06, 95% CI 1.28; 3.31) and a lower risk of mortality at 18 months (OR 0.57, 95% CI 0.37; 0.90). Conclusion The prevalence of anxiety and depression in COPD patients is high. Depression seems to be an independent factor for AECOPD, so early detection and a multidisciplinary approach could improve the prognosis of both entities. The study was approved by the Ethical Committee of Galicia (code 2016/460).
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Figueira Gonçalves JM, Golpe R, Esteban C, Amado Diago C, García-Talavera I, Ramos-Izquierdo C. [Translated article] Initial Treatment in Chronic Obstructive Pulmonary Disease According to GesEPOC 2021 vs. GesEPOC 2017. Approaching Criteria With GOLD 2021? Arch Bronconeumol 2022. [PMID: 35337690 DOI: 10.1016/j.arbres.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Juan Marco Figueira Gonçalves
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
| | - Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain; Grupo C039 Biodiscovery HULA-USC, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Cristóbal Esteban
- Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Bizkaia, Spain
| | - Carlos Amado Diago
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ignacio García-Talavera
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Ramos-Izquierdo
- Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Fuentes-Alonso M, Jimenez-Garcia R, Lopez-de-Andres A, Zamorano-Leon JJ, Carabantes-Alarcon D, Jimenez-Trujillo I, Sanz-Rojo S, de Miguel-Diez J. Time Trends (2012-2020), Sex Differences and Predictors for Influenza Vaccination Uptake among Individuals with Chronic Obstructive Pulmonary Disease in Spain. J Clin Med 2022; 11:jcm11051423. [PMID: 35268514 PMCID: PMC8910978 DOI: 10.3390/jcm11051423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023] Open
Abstract
(1) Background: To analyze time trends, sex differences, and factors associated with influenza vaccination uptake among individuals with COPD in Spain, 2012−2020. (2) Methods: A cross-sectional study based on data from the European Health Surveys for Spain, 2020 (EHSS2020) and 2014 and from the Spanish National Health Interview Surveys for 2017 and 2012. (3) Results: The study included 65,447 participants. Prevalence of COPD was 5.9% (n = 3855). Overall, the influenza vaccination uptake among COPD patients was 57.8% versus 28.6% for those without COPD (p < 0.001). Men with COPD reported higher uptake than women in all the surveys studied. Neither the crude nor the multivariable analysis showed a significant variation change overtime for people with COPD. However, among those aged <65 years, crude uptake decreased from 2012 to 2020 (39.4% vs. 33.3%; p = 0.039). Over the entire period, men were vaccinated significantly more than women (OR 1.28; 95% CI 1.12−1.47). Among COPD participants, included in the EHSS2020, independent predictors of vaccine uptake included being male, higher age, reporting no current smoking and suffering cancer or heart disease. (4) Conclusions: In COPD patients, the influenza vaccination uptake is below desirable levels and did not improve from 2012 to 2020. Sex differences are found, with consistent and constant lower uptake among women with COPD. The observed lower uptake among COPD women and patients with unhealthy lifestyle requires increased attention.
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Affiliation(s)
- Marta Fuentes-Alonso
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.F.-A.); (J.d.M.-D.)
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain; (A.L.-d.-A.); (J.J.Z.-L.); (D.C.-A.)
- Correspondence: ; Tel.: +34-91-394-1521
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain; (A.L.-d.-A.); (J.J.Z.-L.); (D.C.-A.)
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain; (A.L.-d.-A.); (J.J.Z.-L.); (D.C.-A.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain; (A.L.-d.-A.); (J.J.Z.-L.); (D.C.-A.)
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Sara Sanz-Rojo
- Faculty of Health Science, Universidad Alfonso X El Sabio, Villanueva de la Cañada, 28691 Madrid, Spain;
| | - Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.F.-A.); (J.d.M.-D.)
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Cosío BG, Hernández C, Chiner E, Gimeno-Santos E, Pleguezuelos E, Seijas N, Rigau D, López-Campos JL, Soler-Cataluña JJ, Calle M, Miravitlles M, Casanova C. [Translated article] Spanish COPD Guidelines (GesEPOC 2021): Non-pharmacological Treatment Update. ARCHIVOS DE BRONCONEUMOLOGÍA 2022. [DOI: 10.1016/j.arbres.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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23
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Luis Izquierdo J, Casanova C, Celli B, Santos S, Sibila O, Sobradillo P, Agusti A. The 7 cardinal sins of COPD in Spain. Arch Bronconeumol 2022; 58:498-503. [DOI: 10.1016/j.arbres.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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24
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Golpe R, Figueira-Gonçalves JM, Esteban C, Amado-Diago CA, Aramburu A, García-Talavera I, Veiga I. Relación de la clasificación GesEPOC 2021 de niveles de riesgo y fenotipos con la incidencia de eventos adversos. Arch Bronconeumol 2021; 58:451-453. [DOI: 10.1016/j.arbres.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/11/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
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25
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Shafiek H, Verdú J, Iglesias A, Ramon-Clar L, Toledo-Pons N, Lopez-Causape C, Juan C, Fraile-Ribot P, Oliver A, Cosio BG. Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD. BMJ Open Respir Res 2021; 8:8/1/e001067. [PMID: 34615691 PMCID: PMC8496398 DOI: 10.1136/bmjresp-2021-001067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA). OBJECTIVES To investigate the association between the use of ICS and PsA infection among ExCOPD. METHODS Case-control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality. RESULTS 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3-8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250-1000) vs 400 µg (IQR=200-1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use. CONCLUSIONS ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.
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Affiliation(s)
- Hanaa Shafiek
- Department of Chest Diseases, Alexandria University Faculty of Medicine, Alexandria, Egypt.,Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Javier Verdú
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Amanda Iglesias
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Lluisa Ramon-Clar
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carla Lopez-Causape
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Carlos Juan
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pablo Fraile-Ribot
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Oliver
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.,Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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26
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Aguilar-Shea AL, Gallardo-Mayo C. [COPD inhaled therapy narrative review]. Semergen 2021; 48:214-218. [PMID: 34493458 DOI: 10.1016/j.semerg.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Inhaled therapy with long-acting bronchodilators is the base of pharmacological treatment in COPD. In order to find out those that offer better control, a search was carried out in Medline (Pubmed). Comparative studies of inhaler therapy in COPD patients were analyzed. The comparison between the fixed combination LABA/LAMA versus LABA/CI in non-exacerbating patients, revealed a better control with LABA/LAMA. Within the LABA/CI combinations, budesonide/formoterol combination offered better control. LAMA inhalers revealed no great differences, but when compared to LABA, it offered a better control. Regarding triple therapy in a single device, was superior to double therapy and to triple therapy in two devices, with no relevant differences among the available combinations.
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Affiliation(s)
- A L Aguilar-Shea
- Medicina Familiar y Comunitaria, Centro de Salud Puerta de Madrid, Atención Primaria de Madrid, Madrid, España.
| | - C Gallardo-Mayo
- Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Infanta Leonor, Madrid, España
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