1
|
Vanfleteren LEGW, Spruit MA, Franssen FME. Tailoring the approach to multimorbidity in adults with respiratory disease: the NICE guideline. Eur Respir J 2017; 49:49/2/1601696. [PMID: 28179440 DOI: 10.1183/13993003.01696-2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/08/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Lowie E G W Vanfleteren
- Dept of Research and Education, CIRO+, Horn, The Netherlands .,Dept of Respiratory Medicine, Maastricht University Medical Hospital, Maastricht, The Netherlands
| | - Martijn A Spruit
- Dept of Research and Education, CIRO+, Horn, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits M E Franssen
- Dept of Research and Education, CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Hospital, Maastricht, The Netherlands
| |
Collapse
|
2
|
Acharyya A, Shahjahan MD, Mesbah FB, Dey SK, Ali L. Association of metabolic syndrome with chronic obstructive pulmonary disease in an Indian population. Lung India 2016; 33:385-90. [PMID: 27578930 PMCID: PMC4948225 DOI: 10.4103/0970-2113.184871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Chronic obstructive pulmonary disease (COPD) is thought to have increased association with metabolic syndrome (MS) which represents a cluster of factors that increase the risk of cardiovascular diseases and diabetes mellitus. However, the extent of association of COPD with MS and its individual components are still an unsettled issue, and it is likely to vary from population to population. Under the above context, this study was undertaken to investigate the association of MS and its components with COPD. Materials and Methods: With a cross-sectional analytic design, 77 COPD and an equal number of non-COPD (apparently healthy) participants were studied purposively. The two groups were found to be matched by age, sex, and monthly income groups. The data of COPD patients and non-COPD participants were collected from a tertiary level hospital in Kolkata and a locality of Greater Kolkata, respectively. They were interviewed, and the frequencies of MS were assessed using 3 criteria (National Cholesterol Education Program-Third Adult Treatment Panel [NCEP ATP III], modified NCEP ATP III, and International Diabetic Federation [IDF]). Anthropometric measurements were taken, and fasting blood sample was collected to test the fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein (HDL) of respondents. Logistic regression was applied to estimate the odds ratio (OR). Results: Among the COPD subjects, 44%, 46%, and 31% had coexisting MS as defined by NCEP ATP III, modified NCEP ATP III, and IDF criteria, respectively. The corresponding percentages in the non-COPD groups were 31%, 38%, and 32%. On multivariate analysis, a significant association of MS (P < 0.015) with COPD was found only when the NCEP ATP III criteria were used. The (mean ± standard deviation) FBG concentration among COPD and non-COPD groups was 130 ± 65 mg/dl and 97 ± 26 mg/dl, which was significantly different (P < 0.001). The difference in systolic blood pressure (SBP) (P < 0.063) and HDL level (P < 0.058) lied just outside the statistical significance among COPD and non-COPD groups. Gender, exercise habit, family history of hypertension, and smoking habits were important confounders for the association of COPD with individual MS components. Using NCEP ATP III criteria, female gender (OR = 3.48), COPD groups (OR = 3.05), and family history of hypertension (OR = 3.31) were found as determinants (P < 0.05) of MS. Using modified NCEP ATP III criteria, female (OR = 3.66) and family history of hypertension (OR = 3.84) were found as determinants (P < 0.05) of MS. Conclusions: COPD is associated with MS only when the NCEP ATP III is used for the diagnosis of MS. No association can be revealed on using the IDF criteria for MS. Body mass index (BMI), and waist circumference does not seem to be appropriate measures for assessing the presence of MS among COPD patients. Among the components of MS BMI, SBP, FBG, TG, and HDL are significantly associated with COPD.
Collapse
Affiliation(s)
- Amitava Acharyya
- Department of Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
| | - M D Shahjahan
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Fahmida Binte Mesbah
- Department of Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
| | - Subir Kumar Dey
- Department of Pulmonary Medicine, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Liaquat Ali
- Department of Biochemistry and Cell Biology, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh
| |
Collapse
|
3
|
Serafino-Agrusa L, Scichilone N, Spatafora M, Battaglia S. Blood eosinophils and treatment response in hospitalized exacerbations of chronic obstructive pulmonary disease: A case-control study. Pulm Pharmacol Ther 2016; 37:89-94. [PMID: 26996272 DOI: 10.1016/j.pupt.2016.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In outpatients with chronic obstructive pulmonary disease (COPD), blood eosinophilia is considered as a biomarker of response to systemic corticosteroid therapy. However, little is known on whether blood eosinophilia is also predictive of positive clinical outcome in severe acute exacerbations of COPD requiring hospitalization. We hypothesized that blood eosinophil-positive severe acute exacerbations of COPD differ from eosinophil-negative ones in terms of response to therapy and clinical outcomes. METHODS To test our experimental hypothesis, we retrospectively analyzed medical records of patients with COPD admitted to our ward because of severe exacerbation, over a two-year period of observation. After evaluation of inclusion and exclusion criteria, 132 patients were selected and divided in cases (blood eosinophilia ≥2% at admission; n = 20) and controls (blood eosinophilia <2% at admission; n = 112). RESULTS Cases had a shorter hospital stay than controls (geometric mean = 8.9 ± 1.5 versus 11.3 ± 1.5 days; p = 0.028). In addition, cases had a significantly lower consumption of systemic corticosteroids (geometric mean = 19.2 ± 4.0 versus 35.7 ± 2.5 mg per day of hospitalization; p = 0.012). CONCLUSIONS In severe acute exacerbations of COPD requiring hospitalization, blood eosinophilia identifies a subgroup of subjects characterized by a prompt response to treatment with shorter hospital stay.
Collapse
Affiliation(s)
- Laura Serafino-Agrusa
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, University of Palermo, Palermo, Italy.
| | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, University of Palermo, Palermo, Italy.
| | - Mario Spatafora
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, University of Palermo, Palermo, Italy.
| | - Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, University of Palermo, Palermo, Italy.
| |
Collapse
|
4
|
Mackie SL, Koduri G, Hill CL, Wakefield RJ, Hutchings A, Loy C, Dasgupta B, Wyatt JC. Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review. RMD Open 2015; 1:e000100. [PMID: 26535139 PMCID: PMC4623371 DOI: 10.1136/rmdopen-2015-000100] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/18/2015] [Accepted: 05/31/2015] [Indexed: 01/13/2023] Open
Abstract
Objectives To review the evidence for accuracy of imaging for diagnosis of polymyalgia rheumatica (PMR). Methods Searches included MEDLINE, EMBASE and PubMed. Evaluations of diagnostic accuracy of imaging tests for PMR were eligible, excluding reports with <10 PMR cases. Two authors independently extracted study data and three authors assessed methodological quality using modified QUADAS-2 criteria. Results 26 studies of 2370 patients were evaluated: 10 ultrasound scanning studies; 6 MRI studies; 1 USS and MRI study; 7 18-fluorodeoxyglucose-positron emission tomography (PET) studies; 1 plain radiography and 1 technetium scintigraphy study. In four ultrasound studies, subacromial-subdeltoid bursitis had sensitivity 80% (95% CI 55% to 93%) and specificity 68% (95% CI 60% to 75%), whereas bilateral subacromial-subdeltoid bursitis had sensitivity 66% (95% CI 43% to 87%) and specificity 89% (95% CI 66% to 97%). Sensitivity for ultrasound detection of trochanteric bursitis ranged from 21% to 100%. In four ultrasound studies reporting both subacromial-subdeltoid bursitis and glenohumeral synovitis, detection of subacromial-subdeltoid bursitis was more accurate than that of glenohumeral synovitis (p=0.004). MRI and PET/CT revealed additional areas of inflammation in the spine and pelvis, including focal areas between the vertebrae and anterior to the hip joint, but the number of controls with inflammatory disease was inadequate for precise specificity estimates. Conclusions Subacromial-subdeltoid bursitis appears to be the most helpful ultrasound feature for PMR diagnosis, but interpretation is limited by study heterogeneity and methodological issues, including variability in blinding and potential bias due to case–control study designs. Recent MRI and PET/CT case–control studies, with blinded readers, yielded promising data requiring validation within a diagnostic cohort study.
Collapse
Affiliation(s)
- Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds , UK and NIHR Leeds Musculoskeletal Biomedical Research Unit, UK ; Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Gouri Koduri
- Harrogate and District NHS Foundation Trust , Harrogate , UK ; York Teaching Hospital NHS Foundation Trust , UK
| | - Catherine L Hill
- University of Adelaide, The Queen Elizabeth Hospital , Adelaide , Australia
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds , UK and NIHR Leeds Musculoskeletal Biomedical Research Unit, UK ; Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Clement Loy
- University of Sydney , Sydney , Australia ; Huntington Disease Service , Westmead Hospital , Sydney , Australia
| | | | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds , UK
| |
Collapse
|
5
|
Ouanes I, Hammouda Z, Ben Abdallah S, Dachraoui F, Ouanes-Besbes L, Abroug F. Corticothérapie systémique et antibiothérapie lors des exacerbations aiguës d’une bronchopneumopathie chronique obstructive nécessitant une assistance ventilatoire. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0732-5] [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]
|
6
|
Marwick JA, Chung KF. Glucocorticoid insensitivity as a future target of therapy for chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2010; 5:297-309. [PMID: 20856829 PMCID: PMC2939685 DOI: 10.2147/copd.s7390] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by an abnormal and chronic inflammatory response in the lung that underlies the chronic airflow obstruction of the small airways, the inexorable decline of lung function, and the severity of the disease. The control of this inflammation remains a key strategy for treating the disease; however, there are no current anti-inflammatory treatments that are effective. Although glucocorticoids (GCs) effectively control inflammation in many diseases such as asthma, they are less effective in COPD. The molecular mechanisms that contribute to the development of this relative GC-insensitive inflammation in the lung of patients with COPD remain unclear. However, recent studies have indicated novel mechanisms and possible therapeutic strategies. One of the major mechanisms proposed is an oxidant-mediated alteration in the signaling pathways in the inflammatory cells in the lung, which may result in the impairment of repressor proteins used by the GC receptor to inhibit the transcription of proinflammatory genes. Although these studies have described mechanisms and targets by which GC function can be restored in cells from patients with COPD, more work is needed to completely elucidate these and other pathways that may be involved in order to allow for more confident therapeutic targeting. Given the relative GC-insensitive nature of the inflammation in COPD, a combination of therapies in addition to a restoration of GC function, including effective alternative anti-inflammatory targets, antioxidants, and proresolving therapeutic strategies, is likely to provide better targeting and improvement in the management of the disease.
Collapse
Affiliation(s)
- John A Marwick
- Medical Research Council Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh Medical School, Edinburgh, UK.
| | | |
Collapse
|
7
|
Pant S, Walters EH, Griffiths A, Wood-Baker R, Johns DP, Reid DW. Airway inflammation and anti-protease defences rapidly improve during treatment of an acute exacerbation of COPD. Respirology 2009; 14:495-503. [PMID: 19645868 PMCID: PMC7190194 DOI: 10.1111/j.1440-1843.2009.01517.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and objective: There are few data on the short‐term natural history of airway inflammation during severe episodes of acute exacerbation of COPD (AECOPD). An observational study was performed to determine how rapidly conventional treatment improves airway inflammation in patients admitted to hospital with AECOPD. Methods: Twenty‐four consecutive patients with AECOPD were recruited and changes in sputum inflammatory indices were assessed after 2 and 4 days of treatment. The primary end‐points included presence of bacteria and viruses, changes in sputum total cell counts (TCC) and polymorphonuclear leukocyte (PMN) differential counts, and levels of secretory leukocyte protease inhibitor (SLPI), IL‐8 and TNF‐α. Results: All patients received oral corticosteroids and 17 (71%) were also treated with oral antibiotics. A bacterial or viral pathogen was isolated from 12 patients (50%), and Aspergillus fumigatus was isolated from one. A positive bacterial culture was associated with increased sputum TCC and PMN count (P < 0.05), as well as higher levels of IL‐8 and TNF‐α (P < 0.05), and a trend towards lower sputum SLPI levels (P = 0.06). Sputum PMN numbers fell by 70% within the first 48 h of admission (P < 0.05), accompanied by an increase in sputum SLPI (P < 0.001) and reductions in the levels of TNF‐α (P < 0.005) and IL‐8 (P = 0.06), with no further significant change at 4 days. Conclusions: Conventional treatment for severe AECOPD is associated with rapid reduction of neutrophilic inflammation and improvement in anti‐protease defences.
Collapse
Affiliation(s)
- Sushil Pant
- Cardio-Respiratory Research Group, Menzies Research Institute, University of Tasmania, Australia
| | | | | | | | | | | |
Collapse
|
8
|
McDougall D, Bhibhatbhan A, Toth C. Adverse effects of corticosteroid therapy in neuromuscular diseased patients are common and receive insufficient prophylaxis. Acta Neurol Scand 2009; 120:364-7. [PMID: 19832774 DOI: 10.1111/j.1600-0404.2009.01190.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corticosteroid therapy is known to have long-term adverse effects and complications, but our knowledge of the adverse effects of corticosteroids within a neuromuscular patient population is limited. AIMS OF THE STUDY We sought to determine the prevalence and impact of corticosteroid use in a population of patients with neuromuscular diseases, as well as possible clinical associations for presence of adverse effects. METHODS A retrospective chart review from a comprehensive database from a tertiary care neuromuscular clinic spanning 1988-2007 was performed. RESULTS Corticosteroids led to adverse effects in 74% of exposed patients, without proper prophylaxis considered in about 50% of cases. There were no associations determined to have impact upon adverse effect occurrence, including the exposure to cumulative corticosteroid dosing or diagnosis. CONCLUSION Corticosteroid therapy is frequently associated with adverse effects, although prediction of their occurrence is not clear. Prophylaxis of their occurrence is underperformed in our tertiary care clinic patient population.
Collapse
Affiliation(s)
- D McDougall
- Department of Clinical Neurosciences and the University of Calgary, Calgary, AB, Canada
| | | | | |
Collapse
|
9
|
|
10
|
Primary care of the patient with chronic obstructive pulmonary disease-part 2: pharmacologic treatment across all stages of disease. Am J Med 2008; 121:S13-24. [PMID: 18558103 DOI: 10.1016/j.amjmed.2008.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
National guidelines for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD) can be clarified for busy primary care practitioners who must deal with dozens of such treatment algorithms. MEDLINE searches and reviews of national evidence-based guidelines identified clinical trials and meta-analyses with relevant information on the stage-by-stage pharmacologic treatment of COPD. After formal presentations to a panel of pulmonary specialists and primary care physicians, key messages to assist in the implementation of guideline-based care in the primary care setting were identified and integrated into this article, the second in a 4-part mini-symposium. Main points of the roundtable consensus were as follows: (1) Spirometry is required for the diagnosis and staging of patients with COPD before treatment initiation; (2) all patients with COPD should be counseled to stop smoking, encouraged to start regular physical activity, and given a yearly influenza vaccination; (3) severity-based drug treatment of mild or moderate COPD, which accounts for 95% of all COPD cases, generally involves long-acting > or =1 bronchodilator because of their effectiveness and convenience; (4) patient response in terms of dyspnea, exercise ability, and side effects should be the primary guide for monitoring therapy; and (5) proper treatment of COPD can relieve patient symptoms, boost exercise capacity, reduce the number and severity of exacerbations, and improve the overall quality of life. We conclude that implementation of a relatively simple evidence-based treatment algorithm can be applied to that vast majority of the COPD population seen only in primary care.
Collapse
|
11
|
Rammaert B, Ader F, Nseir S. Pneumonies acquises sous ventilation mécanique invasive et bronchopneumopathie chronique obstructive. Rev Mal Respir 2007; 24:1285-98. [DOI: 10.1016/s0761-8425(07)78507-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|