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Nam J, Sljivic S, Matthews R, Pak J, Agala CB, Nizamani R, King B, Williams FN. Outcomes of COPD Patients with Flame Burn and Inhalation Injuries at a Single Institution. J Burn Care Res 2023; 44:35-41. [PMID: 36181677 DOI: 10.1093/jbcr/irac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 01/11/2023]
Abstract
The presence of any comorbid condition may lead to worse outcomes after burn injury. Chronic obstructive pulmonary disease (COPD) is a condition with significant morbidity and mortality. In 2018, about 16 million adults in the United States reported a diagnosis of COPD based on data from the American Lung Association. The objective of this study was to explore the outcomes of patients with COPD admitted to our Burn Center with flame burns and/or inhalation injury. Patients were identified using our Institutional Burn Center registry and linked to the clinical and administrative data. All adult flame-injured and/or inhalation injury-only patients admitted to our burn center between July 1, 2011 and June 30, 2020 were included. Demographics, length of stay, burn, and patient characteristics and outcomes, including mortality, were evaluated. Four thousand three hundred ninety-seven patients were included in the study. Patients were divided into two populations, those with COPD (n = 515) and those without a diagnosis of COPD (n = 3882). Patients with COPD were older, more likely to be white and male, and had smaller sized burns, p < .001. Patients with COPD were more likely to be smokers and have comorbid conditions. There was no statistically significant difference between the incidence of inhalation injury, lengths of stay, or number of ventilator days. Burn size and inhalation injury increased mortality risk regardless of COPD severity, as did age among those not on home oxygen. More studies are needed to determine the genomic or proteomic changes in patients with COPD that lead to worse outcomes after flame injury, and/or inhalation injury alone.
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Affiliation(s)
- Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina
| | - Sanja Sljivic
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Robert Matthews
- Department of Anesthesiology, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina 27599
| | - Chris B Agala
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina 27599
| | - Rabia Nizamani
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Booker King
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
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Freire APCF, Ferreira AD, Santos CP, Araújo ICD, Uzeloto JS, Silva BSDA, Ramos D, Ramos EMC. Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study. CLINICAL RESPIRATORY JOURNAL 2020; 14:1182-1190. [PMID: 32790933 DOI: 10.1111/crj.13259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/26/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD. OBJECTIVES To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects. MATERIALS AND METHODS 109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance). RESULTS BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14). CONCLUSION In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.
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Affiliation(s)
| | | | | | | | | | | | - Dionei Ramos
- Physiotherapy Department, São Paulo State University (UNESP), São Paulo, Brazil
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3
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Mansoor S, Obaida Z, Ballowe L, Campbell AR, Patrie JT, Byrum TD, Shim YM. Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:33-42. [PMID: 32021142 PMCID: PMC6955613 DOI: 10.2147/copd.s225156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD. Methods A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM. Results Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57-70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1-3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up. Conclusion Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.
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Affiliation(s)
- Sahar Mansoor
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zaid Obaida
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lorna Ballowe
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amanda R Campbell
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Timothy D Byrum
- Rheumatology Associate of North Alabama, Huntsville, AL, USA
- The Joint Commission, Oakbrook Terrace, IL, USA
| | - Yun M Shim
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
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Kayyali R, Hassan Y, Hesso I, Siva R. Co-Morbidities as Predictors of Airflow Limitation among Smokers in England. PHARMACY 2018; 6:pharmacy6020045. [PMID: 29789461 PMCID: PMC6025281 DOI: 10.3390/pharmacy6020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/16/2022] Open
Abstract
The prevalence of co-morbidities among patients with Chronic Obstructive Pulmonary Disease (COPD) is well documented in the literature. Therefore, this pilot study aimed to identify whether co-morbidities screening would enhance COPD case-finding. Smoking patients were approached at Croydon University Hospital and two local community pharmacies (CPs). Their co-morbidities, respiratory symptoms, smoking pack-years and exercise capacity were collected. Airflow limitation was determined using handheld spirometry (COPD-6) device. The prevalence of airflow limitation was 42% (n = 21/50). The main identified predictors of airflow limitation were: co-morbidities (OR = 9, CI: 1.04–77.81, p = 0.025), respiratory symptoms (OR = 33.54, CI: 1.06–11.77, p = 0.039) and smoking history of ≥20 pack-years (OR = 3.94, CI: 1.13–13.64, p = 0.029). CPs were the main location for case-finding. This study demonstrated the need to screen for co-morbidities for COPD case-finding within CPs.
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Affiliation(s)
- Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston Upon Thames KT1 2EE, UK.
| | - Yusur Hassan
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston Upon Thames KT1 2EE, UK.
| | - Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston Upon Thames KT1 2EE, UK.
| | - Roshan Siva
- Croydon Health Services NHS Trust, Lennard Road, Croydon CR7 7YE, UK.
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Prunera-Pardell MJ, Padín-López S, Domenech-Del Rio A, Godoy-Ramírez A. Effectiveness of a respiratory rehabilitation programme in patients with chronic obstructive pulmonary disease. ENFERMERIA CLINICA 2017; 28:5-12. [PMID: 29287828 DOI: 10.1016/j.enfcli.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 10/06/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the multidisciplinary respiratory rehabilitation (RR) programme in patients with severe or very severe chronic obstructive pulmonary disease pre the RR programme, at the end of the programme and one year after the RR, measuring changes in ability to exercise (walking test), effort tolerance(forced expiratory volume (FEV1)) and health-related quality of life. METHOD Quasi-experimental single group design. We included patients diagnosed with severe or very severe chronic obstructive pulmonary disease (stages III and IV of the GOLD classification) who entered the rehabilitation programme for the years 2011 and 2012. Demographic data, questionnaires on general health-related quality of life (SF-36) and specific to respiratory patients (St George's Respiratory Questionnaire), FEV1% and exercise capacity test (running test 6minutes) were collected. Data were collected before the RR programme, at the end of the RR programme and a year after completing the program. RESULTS No significant differences in FEV1% values were observed. Regarding exercise capacity, an increase in distance walked in the walking test was noted, which changed significantly after training, 377±59.7 to 415±79 m after one year (P<.01). A statistically significant improvement in mean scores of HRQoL was observed, except for the emotional role dimension of the SF-36 questionnaire. CONCLUSION A pulmonary rehabilitation programme for 8 weeks improved the exercise capacity, dyspnoea and quality of life of patients with severe and very severe chronic obstructive pulmonary disease.
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Affiliation(s)
- María Jesús Prunera-Pardell
- Unidad de Gestión Clínica de enfermedades respiratorias y Cirugía Torácica, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Susana Padín-López
- Unidad de Gestión Clínica de Endocrinología y Nutrición. Hospital Regional Universitario de Málaga, Málaga, España
| | - Adolfo Domenech-Del Rio
- Unidad de Gestión Clínica de enfermedades respiratorias y Cirugía Torácica, Hospital Regional Universitario de Málaga, Málaga, España
| | - Ana Godoy-Ramírez
- Unidad de Gestión Clínica de Rehabilitación, Hospital Regional Universitario de Málaga, Málaga, España
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Bajc M, Chen Y, Wang J, Li XY, Shen WM, Wang CZ, Huang H, Lindqvist A, He XY. Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1579-1587. [PMID: 28603413 PMCID: PMC5457181 DOI: 10.2147/copd.s131847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. Methods 94 COPD patients (aged 43–86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I–IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry. Results Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages (r=0.63 and −0.60, respectively, P<0.0001). V/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases. Conclusion V/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.
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Affiliation(s)
- M Bajc
- Department of Clinical Science Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Y Chen
- Respiratory Department, Changzheng Hospital, Shanghai
| | - J Wang
- Respiratory Department, Xinqiao Hospital, Chongqing
| | - X Y Li
- Respiratory Department, Huadong Hospital, Shanghai, China
| | - W M Shen
- Respiratory Department, Huadong Hospital, Shanghai, China
| | - C Z Wang
- Respiratory Department, Xinqiao Hospital, Chongqing
| | - H Huang
- Respiratory Department, Changzheng Hospital, Shanghai
| | - A Lindqvist
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - X Y He
- Suzhou University Affiliated Tumor Hospital, Wuxi, China
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Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the "stroke of the lungs"? Int J Chron Obstruct Pulmon Dis 2016; 11:1579-86. [PMID: 27471380 PMCID: PMC4948693 DOI: 10.2147/copd.s106160] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the top five major causes of morbidity and mortality worldwide. Despite worldwide health care efforts, costs, and medical research, COPD figures demonstrate a continuously increasing tendency in mortality. This is contrary to other top causes of death, such as neoplasm, accidents, and cardiovascular disease. A major factor affecting COPD-related mortality is the acute exacerbation of COPD (AECOPD). Exacerbations and comorbidities contribute to the overall severity in individual patients. Despite the underestimation by the physicians and the patients themselves, AECOPD is a really devastating event during the course of the disease, similar to acute myocardial infarction in patients suffering from coronary heart disease. In this review, we focus on the evidence that supports the claim that AECOPD is the “stroke of the lungs”. AECOPD can be viewed as: a Semicolon or disease’s full-stop period, Triggering a catastrophic cascade, usually a Relapsing and Overwhelming event, acting as a Killer, needing Emergent treatment.
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Affiliation(s)
- Georgios Hillas
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens
| | - Fotis Perlikos
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
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Tashkin DP. The safety of anticholinergic bronchodilators for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Saf 2015; 14:1759-72. [PMID: 26401729 DOI: 10.1517/14740338.2015.1093621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Poorly absorbable quaternary ammonium-inhaled muscarinic antagonists both as the short-acting ipratropium and as long-acting (12 - 24 h) agents (tiotropium, glycopyrronium, aclidinium and umeclidinium) have all demonstrated statistically and clinically significant efficacy in chronic obstructive pulmonary disease compared with placebo. However, controversy has arisen concerning the safety of this class of agents principally regarding their association with both fatal and nonfatal cardiovascular toxicity. AREAS COVERED The safety of both ipratropium and the long-acting muscarinic antagonists is reviewed with a major emphasis on potential cardiovascular toxicity, based on published clinical trials data and results of analyses of pooled data, meta-analyses, and observational studies. Since glycopyrronium, aclidinium, and umeclidinium have become available only relatively recently, more emphasis will be placed on the more extensive literature concerning the safety of the older anticholinergic compounds, the short-acting ipratropium, and the long-acting tiotropium in its dry powder formulation, as well as its newer soft mist inhaler delivery device. EXPERT OPINION Pooled analyses and meta-analyses of randomized controlled trials (RCTs) of tiotropium in both its dry powder and soft mist formulations, as well as some observational studies, have implicated this agent as increasing the risk of nonfatal and fatal cardiovascular events. However, the most robust evidence based on large-scale randomized controlled trials (RCTs) of relatively long duration specifically designed to evaluate the cardiovascular safety of tiotropium have not confirmed these safety concerns. Because of the relatively limited amount of safety data for the newer long-acting muscarinic antagonists compared to the far more extensive experience with tiotropium, it will be important to accumulate additional safety information from post-marketing pharmacovigilance for these newer agents.
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Affiliation(s)
- D P Tashkin
- a Professor of Medicine, University of California-Los Angeles - Medicine, David Geffen School of Medicine at UCLA , 10833 Le Conte Ave, Los Angeles, California 90095, USA +1 31 08 25 31 63 ; +1 31 02 06 50 88 ;
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Bajc M, Markstad H, Jarenbäck L, Tufvesson E, Bjermer L, Jögi J. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers. Ann Nucl Med 2014; 29:91-9. [PMID: 25315109 PMCID: PMC4284371 DOI: 10.1007/s12149-014-0913-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 01/08/2023]
Abstract
UNLABELLED The severity of chronic obstructive lung disease (COPD) is defined by the degree of flow limitation measured as forced expiratory volume in 1 s, which mainly reflects impairment of large and intermediate airways. However, COPD is primarily a small airways disease. Therefore, better diagnostic tools are needed. Ventilation-Perfusion (V/P) SPECT is a sensitive method to detect obstructive lung changes but criteria for staging airway obstruction are missing. PURPOSE To define and validate criteria to stage COPD using V/P SPECT. METHOD 74 subjects (healthy non-smokers, healthy smokers or with stable COPD) were included. All were examined with V/P SPECT in a hybrid SPECT/CT system. Spirometry was performed and patients were evaluated with the clinical COPD questionnaire (CCQ). V/P SPECT was interpreted independently. Preserved lung function (%) was evaluated. The degree of airway obstruction on V/P SPECT was graded according to newly-developed grading criteria. The degree of airway obstruction was graded from normal (0) to severe (3). The airway obstructivity-grade and degree of preserved lung function were compared to GOLD, CCQ and LDCT emphysema extent. RESULTS Obstructivity-grade (r = 0.66, P < 0.001) and the degree of preserved lung function (r = -0.70, P < 0.001) both correlated to GOLD. Total preserved lung function decreased in relation to higher GOLD stage. There was a significant difference between healthy controls and apparently healthy long time smokers both regarding obstructivity-grade (P = 0.001) and preserved lung function (P < 0.001). Long-time smokers did not differ significantly from GOLD 1 COPD patients (P = 0.14 and P = 0.55 for obstructivity-grade and preserved lung function, respectively). However, patients in GOLD 1 differed in obstructivity-grade from non-smoking controls (P = 0.02). CONCLUSION Functional imaging with V/P SPECT enables standardized grading of airway obstruction as well as reduced lung function, both of which correlate with GOLD stage. V/P SPECT shows that long-term smokers in most cases have signs of ventilatory impairment and airway obstruction not shown by spirometry.
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Affiliation(s)
- Marika Bajc
- Department of Clinical Physiology and Nuclear Medicine, Department of Imaging and Physiology, Skåne University Hospital and Lund University, 22185, Lund, Sweden,
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Andell P, Koul S, Martinsson A, Sundström J, Jernberg T, Smith JG, James S, Lindahl B, Erlinge D. Impact of chronic obstructive pulmonary disease on morbidity and mortality after myocardial infarction. Open Heart 2014; 1:e000002. [PMID: 25332773 PMCID: PMC4189340 DOI: 10.1136/openhrt-2013-000002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022] Open
Abstract
AIM To gain a better understanding of the impact of chronic obstructive pulmonary disease (COPD) on long-term mortality in patients with myocardial infarction (MI) and identify areas where the clinical care for these patients may be improved. METHODS Patients hospitalised for MI between 2005 and 2010 were identified from the nationwide Swedish SWEDEHEART registry. Patients with MI and a prior COPD hospital discharge diagnosis were compared to patients with MI without a prior COPD hospital discharge diagnosis for the primary endpoint of all-cause mortality at 1 year after MI. Secondary endpoints included rates of reinfarction, new-onset stroke, new-onset bleeding and new-onset heart failure at 1 year. RESULTS A total of 81 191 MI patients were included, of which 4867 (6%) had a COPD hospital discharge diagnosis at baseline. Patients with COPD showed a significantly higher unadjusted 1-year mortality (24.6 vs 13.8%) as well as a higher rate of reinfarction, new-onset bleeding and new-onset heart failure post-MI. After adjustment for potential confounders, including comorbidities and treatment, the patients with COPD still showed a significantly higher 1-year mortality (HR 1.14, 95% CI 1.07 to 1.21) as well as a higher rate of new-onset heart failure (HR 1.35, 95% CI 1.24 to 1.47), whereas no significant association between COPD and myocardial reinfarction or new-onset bleeding remained. CONCLUSIONS In this nationwide contemporary study, patients with COPD frequently had an atypical presentation, less often underwent revascularisation and less often received guideline-recommended secondary preventive medications of established benefit. Prior COPD was associated with a higher 1-year mortality and a higher risk of subsequent new-onset heart failure after MI. The association seems to be mainly explained by differences in background characteristics, comorbidities and treatment, although a minor part might be explained by COPD in itself. Improved in-hospital MI treatment and post-MI secondary prevention according to the guidelines may lower the mortality in this high-risk population.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Lund University, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Lund, Sweden
| | | | - Johan Sundström
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Stefan James
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
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Small BG, McColl BW, Allmendinger R, Pahle J, López-Castejón G, Rothwell NJ, Knowles J, Mendes P, Brough D, Kell DB. Efficient discovery of anti-inflammatory small-molecule combinations using evolutionary computing. Nat Chem Biol 2011; 7:902-8. [PMID: 22020553 PMCID: PMC3223407 DOI: 10.1038/nchembio.689] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Indexed: 12/19/2022]
Abstract
The control of biochemical fluxes is distributed, and to perturb complex intracellular networks effectively it is often necessary to modulate several steps simultaneously. However, the number of possible permutations leads to a combinatorial explosion in the number of experiments that would have to be performed in a complete analysis. We used a multiobjective evolutionary algorithm to optimize reagent combinations from a dynamic chemical library of 33 compounds with established or predicted targets in the regulatory network controlling IL-1β expression. The evolutionary algorithm converged on excellent solutions within 11 generations, during which we studied just 550 combinations out of the potential search space of ~9 billion. The top five reagents with the greatest contribution to combinatorial effects throughout the evolutionary algorithm were then optimized pairwise. A p38 MAPK inhibitor together with either an inhibitor of IκB kinase or a chelator of poorly liganded iron yielded synergistic inhibition of macrophage IL-1β expression. Evolutionary searches provide a powerful and general approach to the discovery of new combinations of pharmacological agents with therapeutic indices potentially greater than those of single drugs.
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Affiliation(s)
- Ben G Small
- Doctoral Training Centre, Integrative Systems Biology Molecules to Life, University of Manchester, 131 Princess Street, Manchester, M1 7DN, United Kingdom
- School of Chemical Engineering and Analytical Science, University of Manchester, 131 Princess St, Manchester M1 7DN, United Kingdom
| | - Barry W McColl
- The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, United Kingdom
| | - Richard Allmendinger
- School of Computer Science, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Jürgen Pahle
- School of Computer Science, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Gloria López-Castejón
- NeuroSystems, Faculty of Life Sciences, AV Hill Building, University of Manchester, Oxford Road, Manchester, M13 9PT, United Kingdom
| | - Nancy J Rothwell
- NeuroSystems, Faculty of Life Sciences, AV Hill Building, University of Manchester, Oxford Road, Manchester, M13 9PT, United Kingdom
| | - Joshua Knowles
- School of Computer Science, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Pedro Mendes
- Manchester Centre for Integrative Systems Biology, Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, Manchester, M1 7DN, United Kingdom
- School of Computer Science, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Washington Street, MC0477, Blacksburg, Virginia, United States, 24061-0477
| | - David Brough
- NeuroSystems, Faculty of Life Sciences, AV Hill Building, University of Manchester, Oxford Road, Manchester, M13 9PT, United Kingdom
| | - Douglas B Kell
- Manchester Centre for Integrative Systems Biology, Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, Manchester, M1 7DN, United Kingdom
- School of Chemistry, University of Manchester, 131 Princess St, Manchester M1 7DN, United Kingdom
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Linneberg A, Rasmussen M, Buch TF, Wester A, Malm L, Fannikke G, Vest S. A randomised study of the effects of supplemental exercise sessions after a 7-week chronic obstructive pulmonary disease rehabilitation program. CLINICAL RESPIRATORY JOURNAL 2011; 6:112-9. [DOI: 10.1111/j.1752-699x.2011.00256.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vest S, Moll L, Petersen M, Buch TF, Bruun DM, Rask M, Wester A, Linneberg A. Results of an outpatient multidisciplinary COPD rehabilitation programme obtained in two settings: primary and secondary health care. CLINICAL RESPIRATORY JOURNAL 2011; 5:84-91. [DOI: 10.1111/j.1752-699x.2010.00203.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anderwald C, Ankersmit HJ, Badaoui A, Beneduce L, Buko VU, Calo LA, Carrero JJ, Chang CY, Chang KC, Chen YJ, Cnotliwy M, Costelli P, Crujeiras AB, Cuocolo A, Davis PA, De Boer OJ, Ebenbichler CF, Erridge C, Fassina G, Felix SB, García-Gómez MC, Guerrero-Romero F, Haider DG, Heinemann A, Herda LR, Hoogeveen EK, Hörl WH, Iglseder B, Huang KC, Kaser S, Kastrati A, Kuzniatsova N, Latella G, Lichtenauer M, Lin YK, Lip GYH, Lu NH, Lukivskaya O, Luschnig P, Maniscalco M, Martinez JA, Müller-Krebs S, Ndrepepa G, Nicolaou G, Peck-Radosavljevic M, Penna F, Pintó X, Reiberger T, Rodriguez-Moran M, Schmidt A, Schwenger V, Spinelli L, Starkel P, Stehouwer CDA, Stenvinkel P, Strasser P, Suzuki H, Tschoner A, Van Der Wal AC, Vesely DL, Wen CJ, Wiernicki I, Zanninelli G, Zhu Y. Research update for articles published in EJCI in 2008. Eur J Clin Invest 2010. [DOI: 10.1111/j.1365-2362.2010.02351.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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