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Xu J, Xu W, Qiu Y, Gong D, Man C, Fan Y. Association of Prefrailty and Frailty With All-Cause Mortality, Acute Exacerbation, and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis. J Am Med Dir Assoc 2023; 24:937-944.e3. [PMID: 37150209 DOI: 10.1016/j.jamda.2023.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD). DESIGN Meta-analysis. SETTING AND PARTICIPANTS Two authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022,to identify studies that reported the predictive value of prefrailty and frailty in COPD patients. MEASUREMENTS All-cause mortality, acute exacerbation, and all-cause hospitalization. RESULTS Ten studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses. CONCLUSIONS AND IMPLICATIONS Frailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.
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Affiliation(s)
- Juan Xu
- Department of Oncology, Ganyu District People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Wei Xu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yue Qiu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Changfeng Man
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China.
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Meeraus WH, DeBarmore BM, Mullerova H, Fahy WA, Benson VS. Terms and Definitions Used to Describe Recurrence, Treatment Failure and Recovery of Acute Exacerbations of COPD: A Systematic Review of Observational Studies. Int J Chron Obstruct Pulmon Dis 2022; 16:3487-3502. [PMID: 34992357 PMCID: PMC8713707 DOI: 10.2147/copd.s335742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are important clinical events, with many patients experiencing multiple AECOPDs annually. The terms used in the literature to define recurring AECOPD events are inconsistent and may impact the ability to describe the true burden of these events. We undertook a systematic review to identify and summarize terms and definitions used in observational studies to describe AECOPD-related events occurring after an initial AECOPD (hereafter “subsequent AECOPD”). Methods PubMed was searched (2000–2019) for observational studies on subsequent AECOPD events using broad search strings for “COPD”, “exacerbation”, and “subsequent exacerbation events”. Only English-language studies were included. Small studies (n<50) and studies focusing on hospital re-admission only were excluded. Extracted data were analyzed descriptively to generate a narrative summary, using a thematic approach to group studies utilizing similar terms for subsequent AECOPD. Results Forty-seven studies were included. No single, distinct terms or definitions were used to define and identify multiple occurrences of AECOPDs, though most (46) studies used one or more of four clustered terms and definitions: reapse (n = 13), recurrence/re-exacerbation (n = 11), treatment failure (n = 12) and non-recovery/time to recovery (n = 16). Heterogeneity was observed within and between the four clusters with respect to study setting, starting point for observing subsequent AECOPDs, time frame to identify a subsequent AECOPD (except for studies using “time to recovery”), and basis for identifying a subsequent exacerbation. Conclusion Our review demonstrates that subsequent AECOPDs (including events such as relapse, recurrence/re-exacerbation, treatment failure, non-recovery/time to recovery) are ill-defined in the observational study literature, emphasizing the need to reach consensus on precise and objective definitions (for example, when one AECOPD ends and another begins). Use of standardized terminology and definitions may aid comparability between, and synthesis of, studies, thus improving the understanding of the natural history and burden of exacerbations in COPD patients.
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Affiliation(s)
- Wilhelmine H Meeraus
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
| | - Bailey M DeBarmore
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Raleigh, NC, USA
| | - Hana Mullerova
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
| | - William A Fahy
- Discovery Medicine, Research and Development, GlaxoSmithKline, Stevenage, UK
| | - Victoria S Benson
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
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3
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Zhu J, Mallia P, Footitt J, Qiu Y, Message SD, Kebadze T, Aniscenko J, Barnes PJ, Adcock IM, Kon OM, Johnson M, Contoli M, Stanciu LA, Papi A, Jeffery PK, Johnston SL. Bronchial mucosal inflammation and illness severity in response to experimental rhinovirus infection in COPD. J Allergy Clin Immunol 2020; 146:840-850.e7. [PMID: 32283204 PMCID: PMC7173046 DOI: 10.1016/j.jaci.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/06/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023]
Abstract
Background Respiratory viral infection causes chronic obstructive pulmonary disease (COPD) exacerbations. We previously reported increased bronchial mucosa eosinophil and neutrophil inflammation in patients with COPD experiencing naturally occurring exacerbations. But it is unclear whether virus per se induces bronchial mucosal inflammation, nor whether this relates to exacerbation severity. Objectives We sought to determine the extent and nature of bronchial mucosal inflammation following experimental rhinovirus (RV)-16–induced COPD exacerbations and its relationship to disease severity. Methods Bronchial mucosal inflammatory cell phenotypes were determined at preinfection baseline and following experimental RV infection in 17 Global Initiative for Chronic Obstructive Lung Disease stage II subjects with COPD and as controls 20 smokers and 11 nonsmokers with normal lung function. No subject had a history of asthma/allergic rhinitis: all had negative results for aeroallergen skin prick tests. Results RV infection increased the numbers of bronchial mucosal eosinophils and neutrophils only in COPD and CD8+ T lymphocytes in patients with COPD and nonsmokers. Monocytes/macrophages, CD4+ T lymphocytes, and CD20+ B lymphocytes were increased in all subjects. At baseline, compared with nonsmokers, subjects with COPD and smokers had increased numbers of bronchial mucosal monocytes/macrophages and CD8+ T lymphocytes but fewer numbers of CD4+ T lymphocytes and CD20+ B lymphocytes. The virus-induced inflammatory cells in patients with COPD were positively associated with virus load, illness severity, and reductions in lung function. Conclusions Experimental RV infection induces bronchial mucosal eosinophilia and neutrophilia only in patients with COPD and monocytes/macrophages and lymphocytes in both patients with COPD and control subjects. The virus-induced inflammatory cell phenotypes observed in COPD positively related to virus load and illness severity. Antiviral/anti-inflammatory therapies could attenuate bronchial inflammation and ameliorate virus-induced COPD exacerbations.
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Affiliation(s)
- Jie Zhu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Footitt
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yusheng Qiu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Simon D Message
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tatiana Kebadze
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Julia Aniscenko
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Onn M Kon
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Marco Contoli
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Luminita A Stanciu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alberto Papi
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Peter K Jeffery
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sebastian L Johnston
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
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4
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Wedzicha JA, Zhong N, Ichinose M, Humphries M, Fogel R, Thach C, Patalano F, Banerji D. Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study. Int J Chron Obstruct Pulmon Dis 2017; 12:339-349. [PMID: 28176893 PMCID: PMC5261570 DOI: 10.2147/copd.s125058] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The FLAME study demonstrated that indacaterol/glycopyrronium (IND/GLY), the fixed-dose combination of a long-acting β2-agonist (LABA, IND) and a long-acting muscarinic antagonist (LAMA, GLY), was superior to salmeterol/fluticasone combination (SFC) in preventing exacerbations in COPD patients with a high risk of exacerbations. In this study, we report a prespecified analysis of the efficacy and safety of IND/GLY versus SFC in Asian patients from the FLAME study. Patients and methods Patients from Asian centers with moderate-to-very severe COPD and ≥1 exacerbation in the previous year from the 52-week, randomized FLAME study were included. IND/GLY was compared versus SFC for effects on exacerbations, lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), health status (St George’s Respiratory Questionnaire [SGRQ]), rescue medication use, and safety. Results A total of 510 Asian patients (IND/GLY, n=250 or SFC, n=260) were included. Compared to the overall FLAME population, the Asian cohort had more males, a shorter duration of COPD, fewer patients using inhaled corticosteroid (ICS) at screening, fewer current smokers, and more patients with very severe COPD. IND/GLY significantly reduced the rate of moderate/severe exacerbations (rate ratio: 0.75; 95% confidence interval: 0.58–0.97; P=0.027) and prolonged time to first moderate/severe exacerbation versus SFC (hazard ratio: 0.77; 95% confidence interval: 0.59–1.01; P=0.055). Predose trough FEV1 and FVC significantly improved in Asian patients (P<0.001). IND/GLY improved SGRQ for COPD (SGRQ-C score; P=0.006) and reduced rescue medication use (P=0.058) at week 52. Pneumonia incidence was 3.6% with IND/GLY and 7.7% with SFC (P=0.046). Conclusion In exacerbating Asian COPD patients, IND/GLY was more effective than SFC.
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Affiliation(s)
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michael Humphries
- Beijing Novartis Pharma Co. Ltd., Shanghai, People's Republic of China
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Chau Thach
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Donald Banerji
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Milewska A, Rysiak E, Zareba I, Holownia A, Mroz RM. Costs of Treatment of Chronic Obstructive Pulmonary Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 885:67-75. [PMID: 26801145 DOI: 10.1007/5584_2015_199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim of this study was to analyze direct costs of COPD therapy in relation with clinical course and stage of the disease. Sixty patients with moderate to severe COPD were included into the study. The average cost was taken from institutional data file and was also assessed from a social perspective. Results were presented as average costs per patient per year. Forty two percent of patients was classified as GOLD D category, while categories A, B, and C accounted for 8 %, 27 %, and 23 %, respectively. Approximately 65 % of patients had 2-3 degrees of dyspnea according to the Modified Medical Research Council Dyspnea Scale. About 60 % of patients underwent two or three exacerbations per year and those patients had one or two co-morbidities diagnosed. Treatment costs almost doubled with disease progression, mainly due to exacerbations. In patients in Group C and Group D with exacerbations the direct costs were several times higher than in group A or B and the difference increased with progression of the disease. In Groups A and B, the costs of treatment of stable disease or with exacerbation were comparable. We conclude that costs of treatment of COPD patients were highest in advanced disease and were strongly related to COPD exacerbations.
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Affiliation(s)
- A Milewska
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland
| | - E Rysiak
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - I Zareba
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - A Holownia
- Department of Clinical Pharmacology, Bialystok Medical University, 15a Waszyngtona St., Bialystok, Poland
| | - R M Mroz
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland. .,Department of Lung Diseases and Tuberculosis, Bialystok Medical University, 14 Zurawia St., 15-540, Bialystok, Poland.
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6
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Impact of renal dysfunction on in-hospital mortality of patients with severe chronic obstructive pulmonary disease: a single-center Italian study. Int Urol Nephrol 2016; 48:1121-7. [PMID: 27020445 DOI: 10.1007/s11255-016-1272-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/13/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND We conducted a study, based on discharge hospital sheets [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)], in order to evaluate the relationship between chronic kidney disease (CKD), acute kidney injury (AKI), multi-morbidity, and in-hospital mortality (IHM). METHODS This study included all hospital admissions for chronic obstructive pulmonary disease (COPD) exacerbations between January 1, 2000, and December 31, 2013, recorded in the database of the University Hospital St. Anna of Ferrara. Age, sex, and diagnosis of CKD and AKI were collected, and Charlson comorbidity index (CCI) was calculated by ICD-9-CM codes. IHM was our main outcome. RESULTS We analyzed 7073 subjects with COPD exacerbation; they were more frequently male (56.9 vs 43.1 %), and mean age was 76.7 ± 9.8 years. Diagnosis of CKD was present in 771 patients (10.9 %), while AKI was diagnosed in 354 cases (5 %). A total of 554 patients (7.8 %) died during hospitalization, and LOS was 10.3 ± 11.2 days (median 8 days); the CCI corrected for CKD was 2.30 ± 1.65. Univariate analysis showed that IHM group had higher age (81.2 ± 7.9 vs 76.3 ± 9.9 years, p < 0.001), CCI (2.61 ± 2.21 vs 2.28 ± 1.62, p = 0.001), and LOS (11.1 ± 15.1 vs 10.3 ± 10.8 days, p = 0.001) and developed AKI more frequently (16.6 vs 4 %, p < 0.001) than survivors. Multivariate logistic regression analysis showed an independent association of IHM with age (OR 1.063; 95 % CI 1.050-1.075, p < 0.001), male sex (OR 1.229; 95 % CI 1.016-1.486, p = 0.033), logCCI (OR 2.051; 95 % CI 1.419-2.964, p < 0.001), and AKI (OR 3.849; 95 % CI 2.874-5.155, p < 0.001). CONCLUSIONS Acute kidney injury (AKI) represents a very important predictive factor of IHM in male older adult with multi-morbidity admitted because of COPD exacerbations.
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Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, Bashshur N, Brown EM, Coye MJ, Doarn CR, Ferguson S, Grigsby J, Krupinski EA, Kvedar JC, Linkous J, Merrell RC, Nesbitt T, Poropatich R, Rheuban KS, Sanders JH, Watson AR, Weinstein RS, Yellowlees P. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health 2014; 20:769-800. [PMID: 24968105 PMCID: PMC4148063 DOI: 10.1089/tmj.2014.9981] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 01/18/2023] Open
Abstract
The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.
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Affiliation(s)
- Rashid L. Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Brian R. Smith
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | | | - Noura Bashshur
- E-Health Center, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Molly J. Coye
- University of California at Los Angeles, Los Angeles, California
| | - Charles R. Doarn
- Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Jim Grigsby
- University of Colorado Denver, Denver, Colorado
| | | | - Joseph C. Kvedar
- Partners Health Care, Harvard University, Cambridge, Massachusetts
| | | | | | | | | | | | | | - Andrew R. Watson
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Caramori G, Adcock IM, Di Stefano A, Chung KF. Cytokine inhibition in the treatment of COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:397-412. [PMID: 24812504 PMCID: PMC4010626 DOI: 10.2147/copd.s42544] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cytokines play an important part in many pathobiological processes of chronic obstructive pulmonary disease (COPD), including the chronic inflammatory process, emphysema, and altered innate immune response. Proinflammatory cytokines of potential importance include tumor necrosis factor (TNF)-α, interferon-γ, interleukin (IL)-1β, IL-6, IL-17, IL-18, IL-32, and thymic stromal lymphopoietin (TSLP), and growth factors such as transforming growth factor-β. The current objectives of COPD treatment are to reduce symptoms, and to prevent and reduce the number of exacerbations. While current treatments achieve these goals to a certain extent, preventing the decline in lung function is not currently achievable. In addition, reversal of corticosteroid insensitivity and control of the fibrotic process while reducing the emphysematous process could also be controlled by specific cytokines. The abnormal pathobiological process of COPD may contribute to these fundamental characteristics of COPD, and therefore targeting cytokines involved may be a fruitful endeavor. Although there has been much work that has implicated various cytokines as potentially playing an important role in COPD, there have been very few studies that have examined the effect of specific cytokine blockade in COPD. The two largest studies that have been reported in the literature involve the use of blocking antibody to TNFα and CXCL8 (IL-8), and neither has provided benefit. Blocking the actions of CXCL8 through its CXCR2 receptor blockade was not successful either. Studies of antibodies against IL-17, IL-18, IL-1β, and TSLP are currently either being undertaken or planned. There is a need to carefully phenotype COPD and discover good biomarkers of drug efficacy for each specific target. Specific groups of COPD patients should be targeted with specific anticytokine therapy if there is evidence of high expression of that cytokine and there are features of the clinical expression of COPD that will respond.
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Affiliation(s)
- Gaetano Caramori
- Dipartimento di Scienze Mediche, Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF; formerly Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy
| | - Ian M Adcock
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, UK
- Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Antonino Di Stefano
- Divisione di Pneumologia e Laboratorio di Citoimmunopatologia dell’Apparato Cardio-Respiratorio, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy
| | - Kian Fan Chung
- Airway Diseases Section, National Heart and Lung Institute, Imperial College London, UK
- Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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9
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Beekman E, Mesters I, Hendriks EJM, Muris JWM, Wesseling G, Evers SMAA, Asijee GM, Fastenau A, Hoffenkamp HN, Gosselink R, van Schayck OCP, de Bie RA. Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial. BMC Pulm Med 2014; 14:71. [PMID: 24767519 PMCID: PMC4108017 DOI: 10.1186/1471-2466-14-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/10/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Physical exercise training aims at reducing disease-specific impairments and improving quality of life in patients with chronic obstructive pulmonary disease (COPD). COPD exacerbations in particular negatively impact COPD progression. Physical therapy intervention seems indicated to influence exacerbations and their consequences. However, information on the effect of physical therapy on exacerbation occurrence is scarce. This study aims to investigate the potential of a protocol-directed physical therapy programme as a means to prevent or postpone exacerbations, to shorten the duration or to decrease the severity of exacerbations in patients with COPD who have recently experienced an exacerbation. Besides, this study focuses on the effect of protocol-directed physical therapy on health status and quality of life and on cost-effectiveness and cost-utility in patients with COPD who have recently experienced an exacerbation. METHODS/DESIGN A prospective cohort of 300 COPD patients in all GOLD stages will be constructed. Patients will receive usual multidisciplinary COPD care including guideline-directed physical therapy. Patients in this cohort who have GOLD stage 2 to 4 (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80% of predicted), who receive reimbursement by health insurance companies for physical therapy (post-bronchodilator Tiffeneau-index < 0.6) and who experience a COPD exacerbation will be asked within 56 days to participate in a cohort-nested prospective randomised controlled trial (RCT). In this RCT, the intervention group will receive a strict physical therapy programme for patients with COPD. This protocol-directed physical therapy (pdPT) will be compared to a control group that will receive sham-treatment, meaning no or very low-intensity exercise training (ST). An economic evaluation will be embedded in the RCT. Anthropometric measurements, comorbidities, smoking, functional exercise capacity, peripheral muscle strength, physical activity level, health related quality of life, patients' perceived benefit, physical therapy compliance, motivation level, level of effective mucus clearance, exacerbation symptoms and health care contacts due to COPD will be recorded. Follow-up measurements are scheduled at 3 and 6 weeks, 3, 6, 12 and 24 months after inclusion. DISCUSSION Ways to minimise potential problems regarding the execution of this study will be discussed. TRIAL REGISTRATION The Netherlands National Trial Register NTR1972.
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Affiliation(s)
- Emmylou Beekman
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
- Physical therapy practice in multidisciplinary centre, ParaMedisch Centrum Sittard Zuid, Sittard, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
| | - Erik JM Hendriks
- Physical therapy practice, Fysiotherapie Maasstaete, Druten, The Netherlands
| | - Jean WM Muris
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silvia MAA Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Guus M Asijee
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Boehringer Ingelheim, Alkmaar, The Netherlands
| | - Annemieke Fastenau
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Hannah N Hoffenkamp
- International Victimology Institute Tilburg, Tilburg University, Tilburg, The Netherlands
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Onno CP van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
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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]
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Aisanov Z, Bai C, Bauerle O, Colodenco FD, Feldman C, Hashimoto S, Jardim J, Lai CKW, Laniado-Laborin R, Nadeau G, Sayiner A, Shim JJ, Tsai YH, Walters RD, Waterer G. Primary care physician perceptions on the diagnosis and management of chronic obstructive pulmonary disease in diverse regions of the world. Int J Chron Obstruct Pulmon Dis 2012; 7:271-82. [PMID: 22563246 PMCID: PMC3340113 DOI: 10.2147/copd.s28059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a multicomponent disorder that leads to substantial disability, impaired quality of life, and increased mortality. Although the majority of COPD patients are first diagnosed and treated in primary care practices, there is comparatively little information on the management of COPD patients in primary care. A web-based pilot survey was conducted to evaluate the primary care physician’s, or general practitioner’s (GP’s), knowledge, understanding, and management of COPD in twelve territories across the Asia-Pacific region, Africa, eastern Europe, and Latin America, using a 10-minute questionnaire comprising 20 questions and translated into the native language of each participating territory. The questionnaire was administered to a total of 600 GPs (50 from each territory) involved in the management of COPD patients and all data were collated and analyzed by an independent health care research consultant. This survey demonstrated that the GPs’ understanding of COPD was variable across the territories, with large numbers of GPs having very limited knowledge of COPD and its management. A consistent finding across all territories was the underutilization of spirometry (median 26%; range 10%–48%) and reliance on X-rays (median 14%; range 5%–22%) for COPD diagnosis, whereas overuse of blood tests (unspecified) was particularly high in Russia and South Africa. Similarly, there was considerable underrecognition of the importance of exacerbation history as an important factor of COPD and its initial management in most territories (median 4%; range 0%–22%). Management of COPD was well below guideline-recommended levels in most of the regions investigated. The findings of this survey suggest there is a need for more ongoing education and information, specifically directed towards GPs outside of Europe and North America, and that global COPD guidelines appear to have limited reach and application in most of the areas studied.
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Effect of budesonide/formoterol pMDI on COPD exacerbations: A double-blind, randomized study. Respir Med 2012; 106:257-68. [DOI: 10.1016/j.rmed.2011.07.020] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/22/2011] [Accepted: 07/25/2011] [Indexed: 11/19/2022]
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Mohktar MS, Basilakis J, Redmond SJ, Lovell NH. A guideline-based decision support system for generating referral recommendations from routinely recorded home telehealth measurement data. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:6166-9. [PMID: 21097150 DOI: 10.1109/iembs.2010.5627766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objectives of this paper are to present a guideline-based decision support system (GBDSS) design for supporting patient telehealth management of chronic disease and to test its performance in correctly making referral recommendations using routinely recorded measurement data from home telehealth recordings. The GBDSS has been developed to manage lung disease patients in a home telehealth environment. The system operates by checking the availability of home telehealth measurement data on a daily basis, interprets these data using a rule-based decision tree classification, and ultimately generates referral recommendations based on these measured data. The system has demonstrated discriminative power when applied in the analysis of retrospective telehealth data, as a surrogate for realtime referral generation. To this end a telehealth dataset comprising 16 chronic obstructive pulmonary disease (COPD) patients monitored over a 12 month period was used. It was shown that GBDSS referral recommendations could help reduce the number of cases that required a carer's urgent attention by 72.1%, with 81.9% accuracy, 80.8% specificity and 90.4% sensitivity.
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Affiliation(s)
- Mas S Mohktar
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
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Dalal AA, Christensen L, Liu F, Riedel AA. Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis 2010; 5:341-9. [PMID: 21037958 PMCID: PMC2962300 DOI: 10.2147/copd.s13771] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US. Methods In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient- level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated. Results Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD) annual COPD-related health care costs (2008 US$) increased across the cohorts (P < 0.001), ranging from $2003 ($3238) to $43,461 ($76,159) per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD) episode-level costs were $305 ($310) for an outpatient visit, $274 ($336) for an urgent outpatient visit, $327 ($65) for an ED visit, $9745 ($2968) for a standard admission, and $33,440 for an ICU stay. Conclusion Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs.
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Affiliation(s)
- Anand A Dalal
- US Health Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC 27709, USA.
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Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis. J Am Geriatr Soc 2010; 58:570-9. [PMID: 20398122 PMCID: PMC7166863 DOI: 10.1111/j.1532-5415.2010.02741.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components—emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more‐common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less‐common nonenteric, gram‐negative organisms including Pseudomonas aeruginosa, gram‐positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk‐stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk‐stratification approach for elderly patients, first‐line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more‐limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second‐line antibiotics (e.g., amoxicillin/clavulanic acid, second‐ or third‐generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment.
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Affiliation(s)
- Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine University of California at Davis, Sacramento, California, USA.
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