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Maniscalco M, Calzetta L, Rogliani P, Cazzola M. Reducing the risk of death - a possible outcome in COPD patients. Expert Rev Clin Pharmacol 2024:1-9. [PMID: 39313486 DOI: 10.1080/17512433.2024.2408272] [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: 07/01/2024] [Revised: 09/09/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION COPD is a leading cause of global mortality, particularly under-recognized and under-diagnosed. In 2020, it was the sixth leading cause of death in the US and has contributed to 4.72% of all-cause mortality (ACM) according to the Global Burden of Disease Study 2017. Factors influencing COPD-related mortality include smoking, aging populations, comorbidities, sarcopenia, physical capacity, and lack of effective treatments. AREAS COVERED This review discusses various factors influencing COPD-related mortality and analyzes observational studies and pivotal RCTs evaluating the impact of different therapies on ACM. EXPERT OPINION COPD significantly impacts ACM, necessitating effective management strategies. Smoking cessation is crucial in reducing mortality risk. Exacerbation management and comorbidity treatment are essential to improve patient outcomes. Various therapeutic interventions, such as smoking cessation, vaccination, long-term oxygen therapy, and lung volume reduction surgery, have shown benefits in reducing mortality. Pharmacotherapies might reduce the risk of mortality, although the current scientific evidences remain inconclusive. Advances in pharmacological interventions, tailored treatment plans, and physical activity programs are vital. More robust and long-term studies, focusing on real-world data and addressing biases in treatment allocation, are needed to conclusively determine the efficacy of different therapies in reducing ACM in COPD patients.
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Affiliation(s)
- Mauro Maniscalco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Saifan AR, Elshatarat RA, Sawalha MA, Khraim F, Ibrahim AM, Zaghamir DE, Saleh ZT, Hamdan KM, AbuRuz ME, Al-Bashaireh AM. Assessing the impact of a respiratory care bundle on health status and quality of life of chronic obstructive pulmonary disease patients in Jordan: A quasi-experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:191. [PMID: 39268425 PMCID: PMC11392283 DOI: 10.4103/jehp.jehp_1110_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/03/2023] [Indexed: 09/15/2024]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of a respiratory care bundle, including deep breathing exercises, incentive spirometry, and airway clearance techniques, on the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients in Jordan. MATERIALS AND METHODS A quasi-experimental study design and convenience sampling method was used to recruit 120 COPD patients, with 54 in the intervention group and 66 in the control group. The intervention group received additional respiratory care bundle training, while the control group received only discharge instructions and an education program. The St. George's Respiratory Questionnaire (SGRQ-C) was used to assess participants' QoL before and after the intervention. Independent t-tests, paired t-tests, and analysis of covariance (ANCOVA) analysis were used to analyze the data. RESULTS The study found no significant differences between patients' characteristics, health status, and SGRQ-C scores between the two groups at baseline. After the intervention, there were statistically significant differences in all SGRQ-C subscales, which were lower in the intervention group compared to the control group. The paired t-test showed significant reductions in all SGRQ-C symptoms components (t = 7.62, P < .001), activity component (t = 7.58, P < .001), impact component (t = 7.56, P < .001), and total scores post-intervention (t = 7.52, P < .001) for the intervention group. The ANCOVA analysis showed significant differences in scores of SGRQ-C components and total scores (f = 11.3, P < .001) post-intervention between the two groups. CONCLUSION The study's findings suggest that providing additional respiratory care bundle training for COPD patients can significantly improve their QoL, as measured by the SGRQ-C scores. The respiratory care bundle intervention was effective in reducing COPD symptoms and improving the QoL of COPD patients. Healthcare providers should consider implementing respiratory care bundles as part of COPD management to improve patients' outcomes.
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Affiliation(s)
- Ahmad R Saifan
- Department of Nursing, Applied Science Private University, Amman, Jordan
| | - Rami A Elshatarat
- Department of Medical and Surgical Nursing, College of Nursing, Taibah University, Madinah, Saudi Arabia
| | - Murad A Sawalha
- Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Fadi Khraim
- College of Nursing, Qatar University, Doha, Qatar
| | - Ateya M Ibrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
- Family and Community Health Nursing, Faculty of Nursing, Port Said University, Egypt
| | - Donia E Zaghamir
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
- Pediatric Nursing, Faculty of Nursing, Port Said University, Egypt
| | - Zyad T Saleh
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | | | - Mohannad E AbuRuz
- Department of Medical and Surgical Nursing, College of Nursing, Taibah University, Madinah, Saudi Arabia
| | - Ahmad M Al-Bashaireh
- Faculty of Health Science, Higher Colleges of Technologies, Fujairah, United Arab Emirates
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Wang X, Aga EB, Tse WM, Tse KWG, Ye B. Protective Effect of the Total Alkaloid Extract from Bulbus Fritillariae pallidiflorae in a Mouse Model of Cigarette Smoke-Induced Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:1273-1289. [PMID: 38881716 PMCID: PMC11178083 DOI: 10.2147/copd.s459166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose In recent years, the incidence of chronic obstructive pulmonary disease (COPD) has been increasing year by year, but therapeutic drugs has no breakthrough. The total alkaloid extract from Bulbus Fritillariae pallidiflorae (BFP-TA) is widely used in treating lung diseases. Therefore, this study aimed to investigate the protective effect and mechanism of BFP-TA in COPD mice. Methods BFP-TA was prepared by macroporous adsorbent resin, and the material basis of BFP-TA was analyzed by HPLC-ELSD and UHPLC-MS/MS. Then, the COPD mouse model was induced by cigarette smoke (CS) for 12 weeks, administered at weeks 9-12. Subsequently, the body weight, lung-body ratio, pulmonary function, histopathology, and the levels of pro-inflammatory cytokines, matrix metalloproteinases (MMPs) and oxidative stress markers in the serum of mice were determined. The expressions of related protein of EMT and MAPK signaling pathways in the lung tissues of mice were detected by Western blot. Results The alkaloid relative content of BFP-TA is 64.28%, and nine alkaloids in BFP-TA were identified and quantified by UHPLC-MS/MS. Subsequently, the animal experiment showed that BFP-TA could improve pulmonary function, and alleviate inflammatory cell infiltration, pulmonary emphysema, and collagen fiber deposition in the lung of COPD mice. Furthermore, BFP-TA could decrease the levels of pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β), MMPs (MMP-9 and MMP-12) and MDA, while increase the levels of TIMP-1 and SOD. Moreover, BFP-TA could decrease the protein expressions of collagen I, vimentin, α-SMA, MMP-9, MMP-9/TIMP-1, Bax, p-JNK/JNK, p-P38/P38, and p-ERK/ERK, while increase the level of E-cadherin. Conclusion This study is the first to demonstrate the protective effect of BFP-TA in CS-induced COPD mouse model. Furthermore, BFP-TA may improve airway remodeling by inhibiting the EMT process and potentially exert anti-inflammatory effect by inhibiting the MAPK signaling pathway.
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Affiliation(s)
- Xiaoyu Wang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Er-Bu Aga
- Medical College of Tibet University, Lasa, Tibet, 850002, People's Republic of China
| | - Wai Ming Tse
- Nin Jiom Medicine Manufactory (H.K.) Limited, Hong Kong, 999077, People's Republic of China
| | - Kathy Wai Gaun Tse
- Nin Jiom Medicine Manufactory (H.K.) Limited, Hong Kong, 999077, People's Republic of China
| | - Bengui Ye
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Medical College of Tibet University, Lasa, Tibet, 850002, People's Republic of China
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4
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Pang X, Liu X. Immune Dysregulation in Chronic Obstructive Pulmonary Disease. Immunol Invest 2024; 53:652-694. [PMID: 38573590 DOI: 10.1080/08820139.2024.2334296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease whose incidence increase with age and is characterised by chronic inflammation and significant immune dysregulation. Inhalation of toxic substances cause oxidative stress in the lung tissue as well as airway inflammation, under the recruitment of chemokines, immune cells gathered and are activated to play a defensive role. However, persistent inflammation damages the immune system and leads to immune dysregulation, which is mainly manifested in the reduction of the body's immune response to antigens, and immune cells function are impaired, further destroy the respiratory defensive system, leading to recurrent lower respiratory infections and progressive exacerbation of the disease, thus immune dysregulation play an important role in the pathogenesis of COPD. This review summarizes the changes of innate and adaptive immune-related cells during the pathogenesis of COPD, aiming to control COPD airway inflammation and improve lung tissue remodelling by regulating immune dysregulation, for further reducing the risk of COPD progression and opening new avenues of therapeutic intervention in COPD.
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Affiliation(s)
- Xichen Pang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoju Liu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
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Jahn D, Knapstein PR, Otto E, Köhli P, Sevecke J, Graef F, Graffmann C, Fuchs M, Jiang S, Rickert M, Erdmann C, Appelt J, Revend L, Küttner Q, Witte J, Rahmani A, Duda G, Xie W, Donat A, Schinke T, Ivanov A, Tchouto MN, Beule D, Frosch KH, Baranowsky A, Tsitsilonis S, Keller J. Increased β 2-adrenergic signaling promotes fracture healing through callus neovascularization in mice. Sci Transl Med 2024; 16:eadk9129. [PMID: 38630849 DOI: 10.1126/scitranslmed.adk9129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
Traumatic brain injury (TBI) leads to skeletal changes, including bone loss in the unfractured skeleton, and paradoxically accelerates healing of bone fractures; however, the mechanisms remain unclear. TBI is associated with a hyperadrenergic state characterized by increased norepinephrine release. Here, we identified the β2-adrenergic receptor (ADRB2) as a mediator of skeletal changes in response to increased norepinephrine. In a murine model of femoral osteotomy combined with cortical impact brain injury, TBI was associated with ADRB2-dependent enhanced fracture healing compared with osteotomy alone. In the unfractured 12-week-old mouse skeleton, ADRB2 was required for TBI-induced decrease in bone formation and increased bone resorption. Adult 30-week-old mice had higher bone concentrations of norepinephrine, and ADRB2 expression was associated with decreased bone volume in the unfractured skeleton and better fracture healing in the injured skeleton. Norepinephrine stimulated expression of vascular endothelial growth factor A and calcitonin gene-related peptide-α (αCGRP) in periosteal cells through ADRB2, promoting formation of osteogenic type-H vessels in the fracture callus. Both ADRB2 and αCGRP were required for the beneficial effect of TBI on bone repair. Adult mice deficient in ADRB2 without TBI developed fracture nonunion despite high bone formation in uninjured bone. Blocking ADRB2 with propranolol impaired fracture healing in mice, whereas the ADRB2 agonist formoterol promoted fracture healing by regulating callus neovascularization. A retrospective cohort analysis of 72 patients with long bone fractures indicated improved callus formation in 36 patients treated with intravenous norepinephrine. These findings suggest that ADRB2 is a potential therapeutic target for promoting bone healing.
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Affiliation(s)
- Denise Jahn
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Paul Richard Knapstein
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Ellen Otto
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Paul Köhli
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, 13353 Berlin, Germany
| | - Jan Sevecke
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Frank Graef
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, 13353 Berlin, Germany
| | - Christine Graffmann
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Melanie Fuchs
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Shan Jiang
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Mayla Rickert
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Cordula Erdmann
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Jessika Appelt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Lawik Revend
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
| | - Quin Küttner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
| | - Jason Witte
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Adibeh Rahmani
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Georg Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Weixin Xie
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Antonia Donat
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Thorsten Schinke
- University Medical Center Hamburg-Eppendorf, Department of Osteology and Biomechanics, 20251 Hamburg, Germany
| | - Andranik Ivanov
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Unit Bioinformatics, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine, 13125 Berlin, Germany
| | - Mireille Ngokingha Tchouto
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Unit Bioinformatics, 10117 Berlin, Germany
| | - Dieter Beule
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Unit Bioinformatics, 10117 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine, 13125 Berlin, Germany
| | - Karl-Heinz Frosch
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Anke Baranowsky
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
| | - Serafeim Tsitsilonis
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, 13353 Berlin, Germany
| | - Johannes Keller
- University Medical Center Hamburg-Eppendorf, Department of Trauma and Orthopedic Surgery, 20251 Hamburg, Germany
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Zuliani G, Zuin M, Romagnoli T, Polastri M, Cervellati C, Brombo G. Acetyl-cholinesterase-inhibitors reconsidered. A narrative review of post-marketing studies on Alzheimer's disease. Aging Clin Exp Res 2024; 36:23. [PMID: 38321321 PMCID: PMC10847178 DOI: 10.1007/s40520-023-02675-6] [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: 08/29/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
The real efficacy of Acetyl-cholinesterase-inhibitors (AChEI) has been questioned. In this narrative review we evaluated their effect on cognitive decline, measured by Mini Mental State Examination (MMSE), and on total mortality rates in patients with Alzheimer's disease (AD) recruited into post-marketing open/non-randomized/retrospective studies. In AD patients treated with AChEI, the mean MMSE loss ranged from 0.2 to 1.37 points/years, compared with 1.07-3.4 points/years in non-treated patients. Six studies also reported data about survival; a reduction in total mortality relative risk between 27% and 42% was observed, over a period of 2-8 years. The type of studies and the use of MMSE to assess cognitive decline, may have introduced several biases. However, the clinical effects of AChEI seem to be of the same order of magnitude as the drugs currently used in most common chronic disorders, as regards progression of the disease and total mortality. In the absence of long-term randomized trials on "standard" unselected AD outpatients, open/retrospective studies and health databases represent the best available evidence on the possible effect of AChEI in the real-word setting. Our data support the clinical benefit of AChEI in older patients affected by AD.
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Affiliation(s)
- Giovanni Zuliani
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Marco Zuin
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Tommaso Romagnoli
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Michele Polastri
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Carlo Cervellati
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.
| | - Gloria Brombo
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Zhang S, Wang J, Li X, Zhang H. Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews. Ther Adv Respir Dis 2024; 18:17534666241259634. [PMID: 38877687 PMCID: PMC11179455 DOI: 10.1177/17534666241259634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/07/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Some systematic reviews (SRs) on triple therapy (consisting of long-acting β2-agonist, long-acting muscarinic antagonist, and inhaled corticosteroid, LABA/LAMA/ICS) for chronic obstructive pulmonary disease (COPD) have reported conflicting results. As the number of syntheses increases, the task of identifying and interpreting evidence becomes increasingly complex and demanding. OBJECTIVES To provide a comprehensive overview of the efficacy and safety of triple therapy for COPD. DESIGN Overview of SRs. METHODS Two independent reviewers conducted comprehensive searches in PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant SRs that compared triple therapy with any non-triple therapy for COPD, from the inception of these databases until 1 June 2023. The AMSTAR 2 and GRADE tools were utilized to assess the quality of the included studies and the evidence for each outcome. RESULTS Eighteen SRs encompassing 30 original studies and involving 47,340 participants were analyzed. The overall AMSTAR 2 rating revealed that 3 SRs were of low quality, 13 SRs were of critically low quality, and 2 SRs were of high quality. No high-certainty evidence revealed a significant advantage of triple therapy in improving lung function or reducing acute exacerbations. However, all evidence, including one high certainty, supported the benefits of improving quality of life. Regarding all-cause mortality, no significant difference was found when compared to LAMA or ICS/LABA; however, high-certainty evidence confirmed its effectiveness when compared with LABA/LAMA. Notably, high-certainty evidence indicated that triple therapy was associated with a significant increase in the risk of pneumonia compared to LABA/LAMA. CONCLUSION Triple therapy demonstrated notable benefits in improving lung function, reducing exacerbations, improving quality of life, and reducing all-cause mortality. However, it is important to note that it may also significantly increase the risk of pneumonia. TRIAL REGISTRATION This overview protocol was prospectively registered with PROSPERO (No. CRD42023431548).
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Affiliation(s)
- Shujuan Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Jinshui District, Zhengzhou, Henan, People's Republic of China
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Jun Wang
- Department of Respiratory Diseases, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Xuanlin Li
- College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Hailong Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Jinshui District, Zhengzhou, Henan 450046, People's Republic of China
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-Constructed by Henan Province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
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Hu HS, Wang Z, Jian LY, Zhao LM, Liu XD. Optimizing inhaled corticosteroid use in patients with chronic obstructive pulmonary disease: assessing blood eosinophils, neutrophil-to-lymphocyte ratio, and mortality outcomes in US adults. Front Immunol 2023; 14:1230766. [PMID: 38035096 PMCID: PMC10684949 DOI: 10.3389/fimmu.2023.1230766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Accurate biomarkers for evaluating mortality rates in patients with chronic obstructive pulmonary disease (COPD) remain scarce. This study aimed to explore the relationships between mortality rates in patients with COPD and blood eosinophil counts, neutrophil counts, and lymphocyte counts, along with the neutrophil-to-lymphocyte ratio (NLR). Additionally, we sought to identify the optimal response values for these biomarkers when utilizing inhaled corticosteroids (ICS). Methods Utilizing a nationally representative, multistage cross-sectional design and mortality correlation study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 involving US adults aged 40 years or older with COPD. The primary endpoint was all-cause mortality, with Kaplan-Meier survival curves and restricted cubic splines applied to illustrate the relationship between leukocyte-based inflammatory markers and mortality. The analysis was conducted in 2023. Results Our analysis included 1,715 COPD participants, representing 6,976,232 non-institutionalized US residents [weighted mean age (SE), 62.09 (0.28) years; range, 40-85 years]. Among the participants, men constituted 50.8% of the population, and the weighted mean follow-up duration was 84.9 months. In the ICS use group, the weighted proportion of participants over 70 years old was significantly higher compared with the non-ICS use group (31.39% vs 25.52%, p < 0.0001). The adjusted hazard ratios for all-cause mortality related to neutrophil counts, lymphocyte counts, and NLR were 1.10 [95% confidence interval (CI), 1.04-1.16, p < 0.001], 0.83 (95% CI, 0.71-0.98; p = 0.03), and 1.10 (95% CI, 1.05-1.15; p < 0.0001), respectively. Optimal ICS response was linked with higher levels of eosinophil count (≥240 cells/μL), neutrophil count (≥3,800 cells/μL), NLR (≥4.79), and lower levels of lymphocyte count (<2,400 cells/μL). Conclusion Adjusted baseline neutrophil, lymphocyte counts, and NLR serve as independent risk factors for all-cause mortality in patients with COPD. Further, ICS application appears to mitigate mortality risk, particularly when NLR levels reach 4.79 or higher, underlining the importance of ICS in COPD management.
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Affiliation(s)
- Han-Shuo Hu
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Zhuo Wang
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Ling-Yan Jian
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Li-Mei Zhao
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
| | - Xiao-Dong Liu
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
- Department of The Second Clinical Pharmacy, School of Pharmacy, China Medical University, Shenyang, China
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Aldabayan YS. Perceptions of the effectiveness of non-pharmacological management of respiratory disorders among CRD patients. Medicine (Baltimore) 2023; 102:e35474. [PMID: 37832130 PMCID: PMC10578682 DOI: 10.1097/md.0000000000035474] [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] [Received: 06/24/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Chronic respiratory diseases (CRDs) are among the leading cause of mortality worldwide. While pharmacological approaches are commonly used to manage symptoms, non-pharmacological management of CRDs is considered crucial in preventing disease progression and improving patient self-efficacy. To describe the perceived effectiveness of non-pharmacological management of CRDs among CRD patients and determine whether the CRD patients perceptions of the effectiveness of non-pharmacological management are associated with their demographic characteristics. An analytic cross-sectional study design was utilized. The non-pharmacological management practices of CRD patients and their perception of the effectiveness of these therapeutic measures were assessed using a researcher-developed questionnaire. Data collection took place in primary healthcare centers in Al Ahsa, Saudi Arabia from October 2021 to March 2022. The proportion of CRD patients who perceived that non-pharmacological interventions were effective was computed. Binary logistic regression was performed to determine the association between the demographic characteristics of the respondents and their perception of the effectiveness of non-pharmacological management. Among the 390 respondents, 42% perceived that non-pharmacological measures were effective. Half of the respondents believed that smoking cessation, influenza vaccination, improving physical activity, and nutrition support helped alleviate CRD symptoms, while less than half of the respondents considered pulmonary rehabilitation, educational programs, and oxygen therapy effective measures to control symptoms. Women were found to be 3.24 times more likely to perceive non-pharmacological interventions as effective (P < .0000) compared to men. Those with university-level education were 66.6% less likely to consider non-pharmacological interventions to be effective (P < .0000) than those who completed preuniversity-level education. Age and marital status did not significantly influence perceptions of effectiveness. Differences in the perceptions of the effectiveness of various non-pharmacological measures to alleviate CRD symptoms existed among the CRD patients of Al Ahsa. The perception of effectiveness was significantly associated with the patient's gender and educational attainment.
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Affiliation(s)
- Yousef S. Aldabayan
- Department of Respiratory Care, King Faisal University, AL Ahsa, Saudi Arabia
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Jahn D, Knapstein PR, Otto E, Köhli P, Sevecke J, Graef F, Graffmann C, Fuchs M, Jiang S, Rickert M, Erdmann C, Appelt J, Revend L, Küttner Q, Witte J, Rahmani A, Duda G, Xie W, Donat A, Schinke T, Ivanov A, Tchouto MN, Beule D, Frosch KH, Baranowsky A, Tsitsilonis S, Keller J. Increased beta2-adrenergic signaling is a targetable stimulus essential for bone healing by promoting callus neovascularization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.14.548550. [PMID: 37502964 PMCID: PMC10369985 DOI: 10.1101/2023.07.14.548550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Traumatic brain injury (TBI) is associated with a hyperadrenergic state and paradoxically causes systemic bone loss while accelerating fracture healing. Here, we identify the beta2-adrenergic receptor (Adrb2) as a central mediator of these skeletal manifestations. While the negative effects of TBI on the unfractured skeleton can be explained by the established impact of Adrb2 signaling on bone formation, Adrb2 promotes neovascularization of the fracture callus under conditions of high sympathetic tone, including TBI and advanced age. Mechanistically, norepinephrine stimulates the expression of Vegfa and Cgrp primarily in periosteal cells via Adrb2, both of which synergistically promote the formation of osteogenic type-H vessels in the fracture callus. Accordingly, the beneficial effect of TBI on bone repair is abolished in mice lacking Adrb2 or Cgrp, and aged Adrb2-deficient mice without TBI develop fracture nonunions despite high bone formation in uninjured bone. Pharmacologically, the Adrb2 antagonist propranolol impairs, and the agonist formoterol promotes fracture healing in aged mice by regulating callus neovascularization. Clinically, intravenous beta-adrenergic sympathomimetics are associated with improved callus formation in trauma patients with long bone fractures. Thus, Adrb2 is a novel target for promoting bone healing, and widely used beta-blockers may cause fracture nonunion under conditions of increased sympathetic tone. Abstract Figure
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PLGA-Based Micro/Nanoparticles: An Overview of Their Applications in Respiratory Diseases. Int J Mol Sci 2023; 24:ijms24054333. [PMID: 36901762 PMCID: PMC10002081 DOI: 10.3390/ijms24054333] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are critical areas of medical research, as millions of people are affected worldwide. In fact, more than 9 million deaths worldwide were associated with respiratory diseases in 2016, equivalent to 15% of global deaths, and the prevalence is increasing every year as the population ages. Due to inadequate treatment options, the treatments for many respiratory diseases are limited to relieving symptoms rather than curing the disease. Therefore, new therapeutic strategies for respiratory diseases are urgently needed. Poly (lactic-co-glycolic acid) micro/nanoparticles (PLGA M/NPs) have good biocompatibility, biodegradability and unique physical and chemical properties, making them one of the most popular and effective drug delivery polymers. In this review, we summarized the synthesis and modification methods of PLGA M/NPs and their applications in the treatment of respiratory diseases (asthma, COPD, cystic fibrosis (CF), etc.) and also discussed the research progress and current research status of PLGA M/NPs in respiratory diseases. It was concluded that PLGA M/NPs are the promising drug delivery vehicles for the treatment of respiratory diseases due to their advantages of low toxicity, high bioavailability, high drug loading capacity, plasticity and modifiability. And at the end, we presented an outlook on future research directions, aiming to provide some new ideas for future research directions and hopefully to promote their widespread application in clinical treatment.
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