1
|
Xu J, Zeng Q, Li S, Su Q, Fan H. Inflammation mechanism and research progress of COPD. Front Immunol 2024; 15:1404615. [PMID: 39185405 PMCID: PMC11341368 DOI: 10.3389/fimmu.2024.1404615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by irreversible progressive airflow limitation, often manifested by persistent cough, sputum production and other respiratory symptoms that pose a serious threat to human health and affect the quality of life of patients. The disease is associated with chronic inflammation, which is associated with the onset and progression of COPD, but anti-inflammatory therapy is not first-line treatment. Inflammation has multiple manifestations and phenotypes, and this heterogeneity reveals different patterns of inflammation, making treatment difficult. This paper aims to explore the direction of more effective anti-inflammatory treatment by analyzing the nature of inflammation and the molecular mechanism of disease occurrence and development in COPD patients, and to provide new ideas for the treatment of COPD patients.
Collapse
Affiliation(s)
- Jiao Xu
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyue Zeng
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shuangqing Li
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaoli Su
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Xiang Y, Luo X. Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2024; 19:567-578. [PMID: 38476124 PMCID: PMC10927883 DOI: 10.2147/copd.s447739] [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: 11/01/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Most patients with chronic obstructive pulmonary disease (COPD) suffer from at least one additional, clinically relevant chronic disease. To a degree, the high global prevalence and mortality rate of COPD is closely related to its extrapulmonary effects. Moreover, the various of comorbidities of COPD and itself interact with each other, resulting in diverse clinical manifestations and individual differences, and thus further influencing the prognosis as well as healthcare burden of COPD patients. This is closely related to the common risk factors of chronic diseases (aging, smoking, inactivity, etc.). Additionally, some pathophysiological mechanisms caused by COPD, including the systemic inflammatory response, hypoxia, oxidative stress, and others, also have an impact on other systems. But comprehensive management and medical interventions have not yet been established. The clinicians should improve their knowledge and skills in diagnosing as well as treating the comorbidities of COPD, and then aim to develop more individualized, efficient diagnostic and therapeutic strategies for different patients to achieve greater clinical benefits. In this article, we will review the risk factors, mechanisms, and treatment strategies for extrapulmonary comorbidities in chronic obstructive pulmonary disease, including cardiovascular diseases, diabetes, anemia, osteoporosis, emotional disorders, and gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Yurong Xiang
- School of Medical and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Xiaobin Luo
- Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan, 629000, People’s Republic of China
| |
Collapse
|
3
|
Mariniello DF, D’Agnano V, Cennamo D, Conte S, Quarcio G, Notizia L, Pagliaro R, Schiattarella A, Salvi R, Bianco A, Perrotta F. Comorbidities in COPD: Current and Future Treatment Challenges. J Clin Med 2024; 13:743. [PMID: 38337438 PMCID: PMC10856710 DOI: 10.3390/jcm13030743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, primarily characterized by the presence of a limited airflow, due to abnormalities of the airways and/or alveoli, that often coexists with other chronic diseases such as lung cancer, cardiovascular diseases, and metabolic disorders. Comorbidities are known to pose a challenge in the assessment and effective management of COPD and are also acknowledged to have an important health and economic burden. Local and systemic inflammation have been proposed as having a potential role in explaining the association between COPD and these comorbidities. Considering that the number of patients with COPD is expected to rise, understanding the mechanisms linking COPD with its comorbidities may help to identify new targets for therapeutic purposes based on multi-dimensional assessments.
Collapse
Affiliation(s)
- Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Donatella Cennamo
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Stefano Conte
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Gianluca Quarcio
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Luca Notizia
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Raffaella Pagliaro
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Angela Schiattarella
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Rosario Salvi
- U.O.C. Chirurgia Toracica, Azienda Ospedaliera “S.G. Moscati”, 83100 Avellino, Italy;
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (D.F.M.); (V.D.); (D.C.); (S.C.); (G.Q.); (L.N.); (R.P.); (A.S.); (A.B.)
| |
Collapse
|
4
|
Xia J, Hu C, Wang L, Zhang Y. Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. Eur J Med Res 2023; 28:572. [PMID: 38062497 PMCID: PMC10704755 DOI: 10.1186/s40001-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Delirium occurs frequently in patients with chronic obstructive pulmonary disease in the intensive care unit. Effective prevention and treatment strategies for delirium remain limited. We aimed to assess delirium and 30-day mortality in patients with chronic obstructive pulmonary disease who were statin and non-statin users. METHODS In this retrospective study, patients with chronic obstructive pulmonary disease were identified from the Medical Information Mart for Intensive Care database (MIMIC-IV). The primary exposure variable was the use of statins 3 days after entering the intensive care unit and the primary outcome measure was the presence of delirium. The secondary outcome measure was 30-day mortality. Since the cohort study was retrospective, we used an inverse probability weighting derived from the propensity score matching to balance different variables. RESULTS Among a cohort of 2725 patients, 1484 (54.5%) were statin users. Before propensity score matching, the prevalence of delirium was 16% and the 30-day mortality was 18% in patients with chronic obstructive pulmonary disease. Statin use was significantly negatively correlated with delirium, with an odds ratio of 0.69 (95% CI 0.56-0.85, p < 0.001) in the inverse probability weighted cohort and 30-day mortality of 0.7 (95% CI 0.57-0.85, p < 0.001). CONCLUSIONS Statin use is associated with a lower incidence of delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit.
Collapse
Affiliation(s)
- Jiangling Xia
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China
| | - Chunhuan Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang, China
| | - Leilei Wang
- School of Architecture and Engineering, Zibo Vocational Institute, Zibo, Shandong, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo, Shandong, China.
| |
Collapse
|
5
|
Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
Collapse
Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| |
Collapse
|
6
|
Zysman M, Mahay G, Guibert N, Barnig C, Leroy S, Guilleminault L. Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients. Respir Med Res 2023; 84:101035. [PMID: 37651981 DOI: 10.1016/j.resmer.2023.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. METHODS We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. RESULTS Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. CONCLUSION Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
Collapse
Affiliation(s)
- Maeva Zysman
- Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France
| | - Guillaume Mahay
- Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
| | - Cindy Barnig
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France; Service de Pneumologie, Oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France
| | - Sylvie Leroy
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, CNRS UMR 7275 - FHU OncoAge, Service de Pneumologie Oncologie Thoracique et Soins Intensifs Respiratoires, CHU de Nice, Hôpital Pasteur, Nice, France
| | - Laurent Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, CRISALIS F-CRIN, Toulouse, France.
| |
Collapse
|
7
|
Fabbri LM, Celli BR, Agustí A, Criner GJ, Dransfield MT, Divo M, Krishnan JK, Lahousse L, Montes de Oca M, Salvi SS, Stolz D, Vanfleteren LEGW, Vogelmeier CF. COPD and multimorbidity: recognising and addressing a syndemic occurrence. THE LANCET. RESPIRATORY MEDICINE 2023; 11:1020-1034. [PMID: 37696283 DOI: 10.1016/s2213-2600(23)00261-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 09/13/2023]
Abstract
Most patients with chronic obstructive pulmonary disease (COPD) have at least one additional, clinically relevant chronic disease. Those with the most severe airflow obstruction will die from respiratory failure, but most patients with COPD die from non-respiratory disorders, particularly cardiovascular diseases and cancer. As many chronic diseases have shared risk factors (eg, ageing, smoking, pollution, inactivity, and poverty), we argue that a shift from the current paradigm in which COPD is considered as a single disease with comorbidities, to one in which COPD is considered as part of a multimorbid state-with co-occurring diseases potentially sharing pathobiological mechanisms-is needed to advance disease prevention, diagnosis, and management. The term syndemics is used to describe the co-occurrence of diseases with shared mechanisms and risk factors, a novel concept that we propose helps to explain the clustering of certain morbidities in patients diagnosed with COPD. A syndemics approach to understanding COPD could have important clinical implications, in which the complex disease presentations in these patients are addressed through proactive diagnosis, assessment of severity, and integrated management of the COPD multimorbid state, with a patient-centred rather than a single-disease approach.
Collapse
Affiliation(s)
- Leonardo M Fabbri
- Section of Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alvar Agustí
- Cátedra Salud Respiratoria, Universitat de Barcelona, Barcelona, Spain; Institut Respiratori, Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédicas August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Spain
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Miguel Divo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Maria Montes de Oca
- School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; Hospital Centro Medico de Caracas, Caracas, Venezuela
| | - Sundeep S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India; School of Health Sciences, Symbiosis International Deemed University, Pune, India
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University of Marburg, Member of the German Centre for Lung Research, Marburg, Germany.
| |
Collapse
|
8
|
Papaporfyriou A, Bartziokas K, Gompelmann D, Idzko M, Fouka E, Zaneli S, Bakakos P, Loukides S, Papaioannou AI. Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy. Life (Basel) 2023; 13:1299. [PMID: 37374082 DOI: 10.3390/life13061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is considered one of the leading causes of mortality. Cardiovascular comorbidities are diagnosed often in COPD patients, not only because of the common risk factors these two diseases share, but also because of the systemic inflammation which characterizes COPD and has deleterious effects in the cardiovascular system. The comorbid cardiovascular diseases in COPD result in several difficulties in the holistic treatment of these patients and affect outcomes such as morbidity and mortality. Several studies have reported that mortality from cardiovascular causes is common among COPD patients, while the risk for acute cardiovascular events increases during COPD exacerbations and remains high for a long time even after recovery. In this review, we focus on the prevalence of cardiovascular comorbidities in COPD patients, presenting the evidence regarding the interaction of the pathophysiological pathways which characterize each disease. Furthermore, we summarize information regarding the effects of cardiovascular treatment on COPD outcomes and vice versa. Finally, we present the current evidence regarding the impact of cardiovascular comorbidities on exacerbations, quality of life and survival of COPD patients.
Collapse
Affiliation(s)
- Anastasia Papaporfyriou
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Evangelia Fouka
- General Hospital G. Papanikolaou, Pulmonary Department of Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stavrina Zaneli
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Bakakos
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Andriana I Papaioannou
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
9
|
Matsubayashi S, Ito S, Araya J, Kuwano K. Drugs against metabolic diseases as potential senotherapeutics for aging-related respiratory diseases. Front Endocrinol (Lausanne) 2023; 14:1079626. [PMID: 37077349 PMCID: PMC10106576 DOI: 10.3389/fendo.2023.1079626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Recent advances in aging research have provided novel insights for the development of senotherapy, which utilizes cellular senescence as a therapeutic target. Cellular senescence is involved in the pathogenesis of various chronic diseases, including metabolic and respiratory diseases. Senotherapy is a potential therapeutic strategy for aging-related pathologies. Senotherapy can be classified into senolytics (induce cell death in senescent cells) and senomorphics (ameliorate the adverse effects of senescent cells represented by the senescence-associated secretory phenotype). Although the precise mechanism has not been elucidated, various drugs against metabolic diseases may function as senotherapeutics, which has piqued the interest of the scientific community. Cellular senescence is involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), which are aging-related respiratory diseases. Large-scale observational studies have reported that several drugs, such as metformin and statins, may ameliorate the progression of COPD and IPF. Recent studies have reported that drugs against metabolic diseases may exert a pharmacological effect on aging-related respiratory diseases that can be different from their original effect on metabolic diseases. However, high non-physiological concentrations are needed to determine the efficacy of these drugs under experimental conditions. Inhalation therapy may increase the local concentration of drugs in the lungs without exerting systemic adverse effects. Thus, the clinical application of drugs against metabolic diseases, especially through an inhalation treatment modality, can be a novel therapeutic approach for aging-related respiratory diseases. This review summarizes and discusses accumulating evidence on the mechanisms of aging, as well as on cellular senescence and senotherapeutics, including drugs against metabolic diseases. We propose a developmental strategy for a senotherapeutic approach for aging-related respiratory diseases with a special focus on COPD and IPF.
Collapse
|
10
|
Smirnova MI, Gorbunov VM, Kurekhyan AS, Andreeva GF, Koshelyaevskaya YN, Deev АD. Results of the prospective observation in routine practice of hypertensive patients with concomitant chronic respiratory diseases. Part II. Predictors of adverse events. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim. To study the predictors of adverse events in hypertensive (HTN) patients, including those with chronic respiratory diseases (CRDs).Material and methods. Regression analysis evaluated clinical and anamnestic data and blood pressure (BP) in outpatients with stage II-III HTN (n=156): 49 patients had asthma, 20 — chronic obstructive pulmonary disease; age — 63,4±8,8 years, women — 72,4%, followup duration 29,3±8,0 months. The outcomes included in the composite primary endpoint (EP) were registered in 32 patients (death, major cardiovascular events and complications), while the secondary EPs were registered in 57 patients (hospitalizations, emergency calls, temporary disability due to cardiovascular disease/CRD, hypertensive crisis, exacerbation of CRD, pneumonia, respiratory failure), and tertiary EP — in 76 (other significant diseases/conditions, including increased blood pressure without hypertensive crisis, requiring correction of regular therapy).Results. Predictors of primary EPs were the decrease level of nocturnal diastolic BP (DBP) (β=-5,335, p=0,026), nocturnal DBP variability (β=1,796, p=0,007), blood leukocyte level (β=0,241, p=0,039); secondary EPs — systolic blood pressure ≥170 mm Hg in history (β=1,305-1,641, p=0,037-0,017), statin use (β=-0,997, p=0,037), CRD (β=0,734, p=0,023), blood platelet level (β=-0,008, p=0,022); tertiary EPs — only CRD (β=1,082, p<0,0001).Conclusion. Patients with HTN need complex multifactorial prevention. It is necessary to improve the control of office and ambulatory blood pressure, blood lipids, especially in the presence of CRD, to improve the control of CRDs themselves. The method of 24-hour blood pressure monitoring should be used more often in routine practice, including assessing the degree of nocturnal blood pressure reduction and its variability.
Collapse
Affiliation(s)
- M. I. Smirnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. S. Kurekhyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. F. Andreeva
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - А. D. Deev
- National Medical Research Center for Therapy and Preventive Medicine
| |
Collapse
|
11
|
Interpretation of the Key Issues of Expert Consensus on Immunomodulatory Therapies for Chronic Obstructive Pulmonary Disease. J Transl Int Med 2023; 10:277-280. [PMID: 36860626 PMCID: PMC9969563 DOI: 10.2478/jtim-2022-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
12
|
Li XF, Wan CQ, Mao YM. Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease. Front Med (Lausanne) 2022; 9:979959. [PMID: 36405582 PMCID: PMC9672343 DOI: 10.3389/fmed.2022.979959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/05/2022] [Indexed: 09/19/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent airflow limitation, and is associated with abnormal inflammatory responses in the lungs to cigarette smoke and toxic and harmful gases. Due to the existence of common risk factors, COPD is prone to multiple complications, among which cardiovascular disease (CVD) is the most common. It is currently established that cardiovascular comorbidities increase the risk of exacerbations and mortality from COPD. COPD is also an independent risk factor for CVD, and its specific mechanism is still unclear, which may be related to chronic systemic inflammation, oxidative stress, and vascular dysfunction. There is evidence that chronic inflammation of the airways can lead to destruction of the lung parenchyma and decreased lung function. Inflammatory cells in the airways also generate reactive oxygen species in the lungs, and reactive oxygen species further promote lung inflammation through signal transduction and other pathways. Inflammatory mediators circulate from the lungs to the whole body, causing intravascular dysfunction, promoting the formation and rupture of atherosclerotic plaques, and ultimately leading to the occurrence and development of CVD. This article reviews the pathophysiological mechanisms of COPD complicated by CVD and the effects of common cardiovascular drugs on COPD.
Collapse
Affiliation(s)
- Xiao-Fang Li
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
| | - Cheng-Quan Wan
- Department of Neonatology, Luoyang Maternal and Child Health Hospital,, Luoyang, Henan, China
| | - Yi-Min Mao
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
| |
Collapse
|
13
|
Kotlyarov S. High-Density Lipoproteins: A Role in Inflammation in COPD. Int J Mol Sci 2022; 23:8128. [PMID: 35897703 PMCID: PMC9331387 DOI: 10.3390/ijms23158128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a widespread disease associated with high rates of disability and mortality. COPD is characterized by chronic inflammation in the bronchi as well as systemic inflammation, which contributes significantly to the clinically heterogeneous course of the disease. Lipid metabolism disorders are common in COPD, being a part of its pathogenesis. High-density lipoproteins (HDLs) are not only involved in lipid metabolism, but are also part of the organism's immune and antioxidant defense. In addition, HDL is a versatile transport system for endogenous regulatory agents and is also involved in the removal of exogenous substances such as lipopolysaccharide. These functions, as well as information about lipoprotein metabolism disorders in COPD, allow a broader assessment of their role in the pathogenesis of heterogeneous and comorbid course of the disease.
Collapse
Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
| |
Collapse
|
14
|
Chronic obstructive pulmonary disease and atherosclerosis: common mechanisms and novel therapeutics. Clin Sci (Lond) 2022; 136:405-423. [PMID: 35319068 PMCID: PMC8968302 DOI: 10.1042/cs20210835] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and atherosclerosis are chronic irreversible diseases, that share a number of common causative factors including cigarette smoking. Atherosclerosis drastically impairs blood flow and oxygen availability to tissues, leading to life-threatening outcomes including myocardial infarction (MI) and stroke. Patients with COPD are most likely to die as a result of a cardiovascular event, with 30% of all COPD-related deaths being attributed to cardiovascular disease (CVD). Both atherosclerosis and COPD involve significant local (i.e. lung, vasculature) and systemic inflammation and oxidative stress, of which current pharmacological treatments have limited efficacy, hence the urgency for the development of novel life-saving therapeutics. Currently these diseases must be treated individually, with no therapies available that can effectively reduce the likelihood of comorbid CVD other than cessation of cigarette smoking. In this review, the important mechanisms that drive atherosclerosis and CVD in people with COPD are explained and we propose that modulation of both the oxidative stress and the inflammatory burden will provide a novel therapeutic strategy to treat both the pulmonary and systemic manifestations related to these diseases.
Collapse
|
15
|
Kim JH, Choi HG, Kwon MJ, Kim JH, Park JY, Hwang YI, Jang SH, Jung KS. The Influence of Prior Statin Use on the Prevalence and Exacerbation of Chronic Obstructive Pulmonary Disease in an Adult Population. Front Med (Lausanne) 2022; 9:842948. [PMID: 35402450 PMCID: PMC8987534 DOI: 10.3389/fmed.2022.842948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStatins have anti-inflammatory and antioxidant properties, and previous studies have reported the positive effects of statins on chronic obstructive pulmonary disease (COPD) outcomes. However, the effects of statins on the development and acute exacerbations of COPD remain unclear. Therefore, this study aimed to assess the relation between statin use and COPD occurrence in all participants and the link between statin use and COPD acute exacerbations in participants with COPD.MethodsThis case-control study comprised 26,875 COPD participants and 107,500 control participants who were 1:4 matched from the Korean National Health Insurance Service-Health Screening Cohort. Conditional logistic regression was used to evaluate the probability of COPD occurrence associated with previous statin use. In addition, unconditional logistic regression was employed to assess the risk of exacerbations related to statin use among COPD participants. These relations were estimated in subgroup analysis according to statin type (lipophilic vs. hydrophilic).ResultsThe association between previous statin use and the occurrence of COPD did not reach statistical significance in the overall population (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI] = 0.93–1.00, P = 0.059). However, statin use decreased the probability of exacerbations in participants with COPD (aOR = 0.79, 95% CI = 0.74–0.85, P < 0.001). Lipophilic statins decreased the probability of exacerbations, whereas hydrophilic statins were not associated with a decreased likelihood of exacerbations (aOR = 0.78, 95% CI = 0.72–0.84, P < 0.001 for lipophilic statins; aOR = 0.89, 95% CI = 0.78–1.02, P = 0.102 for hydrophilic statins).DiscussionStatin use was not associated with the occurrence of COPD in the adult population. However, statin use was associated with a reduced probability of exacerbations in participants with COPD, with a greater risk reduction with lipophilic statin use.
Collapse
Affiliation(s)
- Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- *Correspondence: Hyo Geun Cho, ;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji-Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| |
Collapse
|
16
|
Smith MC, Ashdown HF, Sheppard JP, Butler CC, Bankhead C. Statin prescription in patients with chronic obstructive pulmonary disease and risk of exacerbations: a retrospective cohort study in the Clinical Practice Research Datalink. BMJ Open 2021; 11:e050757. [PMID: 34876426 PMCID: PMC8655534 DOI: 10.1136/bmjopen-2021-050757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/08/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Observational studies have suggested a beneficial effect of taking statins on frequency of chronic obstructive pulmonary disease (COPD) exacerbations. However, clinical trials of statins in people with COPD did not confirm those results. This study aimed to investigate this association using a methodological approach, which reduces the biases associated with some previous observational study designs. DESIGN Retrospective cohort study comparing new-users of statins with non-users. SETTING General practices in England contributing to the Clinical Practice Research Datalink in 2007-2017, with linkage to data on Hospital Episode Statistics inpatient episodes. PARTICIPANTS 48 124 people with COPD, aged over 40 years, who had not been prescribed statin in the previous year. EXPOSURE Participants became new-users of statins at their first prescription for a statin during follow-up. They were then assumed to remain statin users. Statin users were compared with non-users. OUTCOMES Primary outcomes were COPD exacerbation, or severe exacerbation requiring hospitalisation. Secondary outcomes were death from any cause (for comparison with other studies) and urinary tract infection (negative-control). Maximum follow-up was 3 years. Adjusted HR were calculated using time-dependent Cox regression. The Andersen-Gill model was used for recurrent exacerbations. Covariates included demographic variables, variables related to COPD severity, cardiovascular comorbidities as time-dependent variables, and other comorbidities at baseline. RESULTS 7266 participants became new-users of statins over an average 2.5 years of follow-up. In total, 30 961 people developed an exacerbation, 8110 severe exacerbation, 3650 urinary tract infection and 5355 died. Adjusted HR (95% CI) in statin users compared with non-users were first exacerbation 1.01 (0.96-1.06), severe exacerbation 0.92 (0.84-0.99), number of exacerbations 1.00 (0.97-1.04), urinary tract infection 1.10 (0.98-1.23) and death 0.63 (0.57-0.70). CONCLUSIONS In this study of health records from a Primary Care database, statin use in people with COPD was not associated with a lower risk of COPD exacerbation.
Collapse
Affiliation(s)
- Margaret C Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Helen Frances Ashdown
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Peter Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
17
|
Sun SH, Chang CH, Zhan ZW, Chang WH, Chen YA, Dong YH. Risk of COPD Exacerbations Associated with Statins versus Fibrates: A New User, Active Comparison, and High-Dimensional Propensity Score Matched Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2721-2733. [PMID: 34621122 PMCID: PMC8491865 DOI: 10.2147/copd.s323391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several observational studies have found that statins may materially decrease the risk of chronic obstructive pulmonary disease (COPD) exacerbations. However, most of these studies used a prevalent user, non-user comparison approach, which may lead to overestimation of the clinical benefits of statins. We aimed to explore the risk of COPD exacerbations associated with statins with a new user, active comparison approach to address potential methodological concerns. We selected fibrates, another class of lipid-lowering agents, as the reference group because no evidence suggests that fibrates have an effect on COPD exacerbations. METHODS We identified patients with COPD who initiated statins or fibrates from a nationwide Taiwanese database. Patients were followed from cohort entry to the earliest of the following: hospitalization for COPD exacerbations, death, end of the data, or 180 days after cohort entry. Stratified Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of COPD exacerbations comparing statins with fibrates after variable-ratio propensity score (PS) matching and high-dimensional PS (hd-PS) matching, respectively. RESULTS We identified a total of 134,909 eligible patients (110,726 initiated statins; 24,183 initiated fibrates); 1979 experienced COPD exacerbations during follow-up. The HRs were 1.10 (95% CI, 0.96 to 1.26) after PS matching and 1.08 (95% CI, 0.94 to 1.24) after hd-PS matching. The results did not differ materially by type of statins and patient characteristic and did not change with longer follow-up durations. CONCLUSION This large-scale, population-based cohort study did not show that use of statins was associated with a reduced risk of acute exacerbations in patients with COPD using state-of-the-art pharmacoepidemiologic approaches. The findings emphasize the importance of applying appropriate methodology in exploring statin effectiveness in real-world settings.
Collapse
Affiliation(s)
- Shu-Hui Sun
- Department of Pharmacy, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Zhe-Wei Zhan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Hsuan Chang
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-An Chen
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yaa-Hui Dong
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
18
|
Young RP, Scott RJ. Statins as adjunct therapy in COPD: is it time to target innate immunity and cardiovascular risk? Eur Respir J 2021; 58:58/1/2100342. [PMID: 34326175 DOI: 10.1183/13993003.00342-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Robert P Young
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Raewyn J Scott
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Kotlyarov S, Kotlyarova A. Molecular Mechanisms of Lipid Metabolism Disorders in Infectious Exacerbations of Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2021; 22:7634. [PMID: 34299266 PMCID: PMC8308003 DOI: 10.3390/ijms22147634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Exacerbations largely determine the character of the progression and prognosis of chronic obstructive pulmonary disease (COPD). Exacerbations are connected with changes in the microbiological landscape in the bronchi due to a violation of their immune homeostasis. Many metabolic and immune processes involved in COPD progression are associated with bacterial colonization of the bronchi. The objective of this review is the analysis of the molecular mechanisms of lipid metabolism and immune response disorders in the lungs in COPD exacerbations. The complex role of lipid metabolism disorders in the pathogenesis of some infections is only beginning to be understood, however, there are already fewer and fewer doubts even now about its significance both in the pathogenesis of infectious exacerbations of COPD and in general in the progression of the disease. It is shown that the lipid rafts of the plasma membranes of cells are involved in many processes related to the detection of pathogens, signal transduction, the penetration of pathogens into the cell. Smoking disrupts the normally proceeded processes of lipid metabolism in the lungs, which is a part of the COPD pathogenesis.
Collapse
Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
| | - Anna Kotlyarova
- Department of Pharmacology and Pharmacy, Ryazan State Medical University, 390026 Ryazan, Russia;
| |
Collapse
|
20
|
Yayan J, Bald M, Franke KJ. No Independent Influence of Statins on the Chronic Obstructive Pulmonary Disease Exacerbation Rate: A Cohort Observation Study Over 10 Years. Int J Gen Med 2021; 14:2883-2892. [PMID: 34234518 PMCID: PMC8254092 DOI: 10.2147/ijgm.s309647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Some previously published primarily retrospective studies have shown that statins could reduce the rate and severity of exacerbations, the length of hospital stays, and mortality in patients with chronic obstructive pulmonary disease (COPD), but retrospective data needs to be reviewed regarding this connection since statins are cholesterol-lowering drugs. Therefore, the aim of this study was to investigate the independent influence of statins on the exacerbation rate in COPD patients. Methods An observational retrospective study was conducted to assess the independent influence of statins on the COPD exacerbation rate at the Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Witten/Herdecke University from January 1, 2010 to December 31, 2020. This study enrolled patients with COPD in 2010 and documented their exacerbation rate over a further 10 years. The number of exacerbations in COPD patients was compared between statin users and non-users. Results Of the total of 295 [176 male (59.7%)] COPD patients, 105 (35.6%, CI 30.3–41.2%) patients with COPD were treated with statins, and 190 (64.4%, CI 58.8–69.7%) were treated without statins. The mean exacerbation rate in the COPD patients who received statin did not differ from that in the COPD patients who did not receive statin (p = 0.175). Also, the mortality rates did not differ between the statin-treated and non-statin-treated COPD patients (p = 0.271). Conclusion Statins have no effect on the exacerbation rate or mortality in COPD patients.
Collapse
Affiliation(s)
- Josef Yayan
- Witten/Herdecke University, Witten, Germany.,Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Lüdenscheid, Germany
| | - Markus Bald
- Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Lüdenscheid, Germany
| | - Karl-Josef Franke
- Witten/Herdecke University, Witten, Germany.,Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Lüdenscheid, Germany
| |
Collapse
|
21
|
Matera MG, Calzetta L, Annibale R, Russo F, Cazzola M. Classes of drugs that target the cellular components of inflammation under clinical development for COPD. Expert Rev Clin Pharmacol 2021; 14:1015-1027. [PMID: 33957839 DOI: 10.1080/17512433.2021.1925537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The persistent inflammation that characterizes COPD and affects its natural course also impacting on symptoms has prompted research to find molecules that can regulate the inflammatory process but still available anti-inflammatory therapies provide little or no benefit in COPD patients. Consequently, numerous anti-inflammatory molecules that are effective in animal models of COPD have been or are being evaluated in humans. AREAS COVERED In this article we describe several classes of drugs that target the cellular components of inflammation under clinical development for COPD. EXPERT OPINION Although the results of many clinical trials with new molecules have often been disappointing, several studies are underway to investigate whether some of these molecules may be effective in treating specific subgroups of COPD patients. Indeed, the current perspective is to apply a more personalized treatment to the patient. This means being able to better define the patient's inflammatory state and treat it in a targeted manner. Unfortunately, the difficulty in translating encouraging experimental data into human clinical trials, the redundancy in the effects induced by signal-transmitting substances and the nonspecific effects of many classes that are undergoing clinical trials, do not yet allow specific inflammatory cell types to be targeted.
Collapse
Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosa Annibale
- Pharmacy Unit, "Luigi Vanvitelli" University Hospital, Naples, Italy
| | - Francesco Russo
- Pharmacy Unit, "Luigi Vanvitelli" University Hospital, Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| |
Collapse
|
22
|
Damkjær M, Håkansson K, Kallemose T, Ulrik CS, Godtfredsen N. Statins in High-Risk Chronic Obstructive Pulmonary Disease Outpatients: No Impact on Time to First Exacerbation and All-Cause Mortality - The STATUETTE Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:579-589. [PMID: 33707941 PMCID: PMC7943323 DOI: 10.2147/copd.s296472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Statins have, due to their anti-inflammatory properties, been suggested to potentially improve chronic obstructive pulmonary disease (COPD) outcomes. We aimed to investigate the effect of statins on time to first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods All outpatients with COPD seen at the Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Denmark in 2016 were identified and followed for 3.5 years in this retrospective, registry-based cohort study of time to first acute exacerbation of COPD (AECOPD) or death. AECOPD was defined as a rescue course of oral corticosteroid and/or hospital admission. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression. Results The cohort comprised 950 COPD outpatients, mean (SD) age 71 (11) years, and FEV1 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (1.68) and 211 patients (22%) had a history of hospital admission for AECOPD in the 12 months prior to index date. Three hundred and ninety-three patients (41.4%) were defined as statin users, with 131 (33.3%) having filled the first prescription for statin after index date. Statin use was not associated with reduced risk of AECOPD. When stratifying for moderate and severe exacerbations in a sub-analysis in the same model, statin use did not have an increased HR for exacerbation of either severity (HR = 1.02 (95% CI 0.85to 1.24; p = 0.811) and HR = 1.07 (95% CI 0.89 to 1.29; p = 0.492) respectively). Statin use was not associated with all-cause mortality (HR 1.05 (95% CI, 0.75 to 1.47, p = 0.777)). Conclusion We did not find any association between statin use and risk of AECOPD or all-cause mortality. The result adds to the evidence that an aggressive approach with statin treatment upfront is not beneficial in COPD, unless prescribed according to current guidelines for cardiovascular diseases.
Collapse
Affiliation(s)
- Mathias Damkjær
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Kjell Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
23
|
Huang YJ, Kao S, Kao LT, Chian CF, Chung CH, Chien WC, Wang KY. Association Between Statin Use and Exacerbation of Chronic Obstructive Pulmonary Disease Among Patients Receiving Corticosteroids. Int J Chron Obstruct Pulmon Dis 2021; 16:591-602. [PMID: 33716501 PMCID: PMC7944644 DOI: 10.2147/copd.s292026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose The role of statins as anti-inflammatory drugs in chronic obstructive pulmonary disease (COPD) is controversial. This study aimed to determine the efficacy of statins used with or without corticosteroids in COPD patients. Patients and Methods This was a retrospective cohort study and used the two million outpatients and inpatients in Taiwan’s Longitudinal Health Insurance Database covering 2000 to 2015. A total of 92,460 patients were identified in this study. We divided COPD patients into four groups by auditing each patient’s medication (statins used or not; corticosteroids used or not) and used Cox regression to analyze and compare the effects of statins in COPD patients with or without corticosteroids. Results In terms of all COPD patients, our findings were consistent with previous studies showing that statins decreased COPD-related hospitalization and mortality rates. However, the beneficial effects were only observed in younger patients or those not taking corticosteroids in further analysis. Statins significantly decreased hospitalization and mortality rates in the non-corticosteroids groups. The hazard ratios increased with age and were not statistically significant for patients > 70 years old. Statins did not significantly decrease ED visits, hospitalization, and mortality in corticosteroids groups. Conclusion Statins decreased hospitalization and mortality rates in COPD patients not taking corticosteroids but were not efficacious in patients on corticosteroids therapy. Furthermore, the beneficial effects of statins gradually decreased with patient age. Based on the findings, statins used in COPD patients may need to consider the patient age and corticosteroids used or not.
Collapse
Affiliation(s)
- Yi-Jen Huang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, University of Kang Ning, Taipei, Taiwan
| | - Senyeong Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kwua-Yun Wang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
24
|
Schenk P, Spiel AO, Hüttinger F, Gmeiner M, Fugger J, Pichler M, Pichler G, Schmeikal S, Janistyn W, Schügerl S, Sajdik C, Herkner H. Can simvastatin reduce COPD exacerbations? A randomised double-blind controlled study. Eur Respir J 2021; 58:13993003.01798-2020. [DOI: 10.1183/13993003.01798-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022]
Abstract
BackgroundSeveral studies have shown that statins have beneficial effects in COPD regarding lung function decline, rates and severity of exacerbation, hospitalisation and need for mechanical ventilation.MethodsWe performed a randomised double-blind placebo-controlled single-centre trial of simvastatin at a daily dose of 40 mg versus placebo in patients with Global Initiative for Chronic Obstructive Lung Disease criteria grades 2–4 at a tertiary care pulmonology department in Austria. Scheduled treatment duration was 12 months and the main outcome parameter was time to first exacerbation.ResultsOverall, 209 patients were enrolled. In the 105 patients taking simvastatin, time to first exacerbation was significantly longer compared to the 104 patients taking placebo: median 341 versus 140 days (log-rank test p<0.001). Hazard ratio for risk of first exacerbation for the simvastatin group was 0.51 (95% CI 0.34–0.75; p=0.001). Rate of exacerbations was significantly lower with simvastatin: 103 (41%) versus 147 (59%) (p=0.003). The annualised exacerbation rate was 1.45 events per patient-year in the simvastatin group and 1.9 events per patient-year in the placebo group (incidence rate ratio 0.77, 95% CI 0.60–0.99). We found no effect on quality of life, lung function, 6-min walk test and high-sensitivity C-reactive protein. More patients dropped out in the simvastatin group compared to the placebo group (39 versus 29).ConclusionIn our single-centre RCT, simvastatin at a dose of 40 mg daily significantly prolonged time to first COPD exacerbation and reduced exacerbation rate.
Collapse
|
25
|
Kohlbrenner D, Clarenbach CF, Thiel S, Roeder M, Kohler M, Sievi NA. A few more steps lead to improvements in endothelial function in severe and very severe COPD. Respir Med 2020; 176:106246. [PMID: 33248361 DOI: 10.1016/j.rmed.2020.106246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiovascular disease is among the most prevalent concomitant chronic diseases in COPD. Physical activity (PA) modifies endothelial function and is commonly impaired in COPD. However, studies directly investigating the effects of increased PA on endothelial function in COPD are lacking. We investigated the effect of changes in PA on endothelial function in patients with severe to very severe COPD. Furthermore, we determined which variables modify this effect. MATERIALS AND METHODS This is a secondary outcome analysis from a randomised controlled trial investigating the effects of combined PA counselling and pedometer-based feedback in COPD. We analysed the change in PA based on three visits during one year. We measured PA using a validated triaxial accelerometer, and endothelial function using flow-mediated dilation. RESULTS Data was analysed from 54 patients, which provided 101 change scores. Multiple regression modelling, including adjustment for baseline step count, showed strong evidence for an association between changes in flow-mediated dilation and changes in PA (p < 0.001). The analysis of several effect modificators showed no evidence of any influence on the interaction between PA and endothelial function: smoking status (p = 0.766), severity of airflow obstruction (p = 0.838), exacerbation frequency (p = 0.227), lung diffusion capacity of carbon monoxide % pred. (p = 0.735). CONCLUSION We found strong evidence that increasing steps per day ameliorates the heavily impaired endothelial function in patients with severe and very severe COPD. Further studies should examine which factors influence this relationship in a positive or negative manner.
Collapse
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
26
|
Vestbo J, Janson C, Nuevo J, Price D. Observational studies assessing the pharmacological treatment of obstructive lung disease: strengths, challenges and considerations for study design. ERJ Open Res 2020; 6:00044-2020. [PMID: 33083435 PMCID: PMC7553106 DOI: 10.1183/23120541.00044-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022] Open
Abstract
Randomised controlled trials (RCTs) are the gold standard for evaluating treatment efficacy in patients with obstructive lung disease. However, due to strict inclusion criteria and the conditions required for ascertaining statistical significance, the patients included typically represent as little as 5% of the general obstructive lung disease population. Thus, studies in broader patient populations are becoming increasingly important. These can be randomised effectiveness trials or observational studies providing data on real-world treatment effectiveness and safety data that complement efficacy RCTs. In this review we describe the features associated with the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the real-world clinical practice setting. We also discuss how RCTs and observational studies have reported opposing outcomes with several treatments and inhaler devices due to differences in study design and the variations in patients recruited by different study types. Whilst observational studies are not without weaknesses, we outline recently developed tools for defining markers of quality of observational studies. We also examine how observational studies are capable of providing valuable insights into disease mechanisms and management and how they are a vital component of research into obstructive lung disease. As we move into an era of personalised medicine, recent observational studies, such as the NOVEL observational longiTudinal studY (NOVELTY), have the capacity to provide a greater understanding of the value of a personalised healthcare approach in patients in clinical practice by focussing on standardised outcome measures of patient-reported outcomes, physician assessments, airway physiology, and blood and airway biomarkers across both primary and specialist care.
Collapse
Affiliation(s)
- Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Christer Janson
- Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
27
|
He P, Gelissen IC, Ammit AJ. Regulation of ATP binding cassette transporter A1 (ABCA1) expression: cholesterol-dependent and - independent signaling pathways with relevance to inflammatory lung disease. Respir Res 2020; 21:250. [PMID: 32977800 PMCID: PMC7519545 DOI: 10.1186/s12931-020-01515-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022] Open
Abstract
The role of the ATP binding cassette transporter A1 (ABCA1) in maintaining cellular lipid homeostasis in cardiovascular disease is well established. More recently, the important beneficial role played by ABCA1 in modulating pathogenic disease mechanisms, such as inflammation, in a broad range of chronic conditions has been realised. These studies position ABCA1 as a potential therapeutic target in a diverse range of diseases where inflammation is an underlying cause. Chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are driven by inflammation, and as such, there is now a growing recognition that we need a greater understanding of the signaling pathways responsible for regulation of ABCA1 expression in this clinical context. While the signaling pathways responsible for cholesterol-mediated ABCA1 expression have been clearly delineated through decades of studies in the atherosclerosis field, and thus far appear to be translatable to the respiratory field, less is known about the cholesterol-independent signaling pathways that can modulate ABCA1 expression in inflammatory lung disease. This review will identify the various signaling pathways and ligands that are associated with the regulation of ABCA1 expression and may be exploited in future as therapeutic targets in the setting of chronic inflammatory lung diseases.
Collapse
Affiliation(s)
- Patrick He
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Ingrid C Gelissen
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Alaina J Ammit
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.
| |
Collapse
|
28
|
Saad AB, Loued L, Joobeur S, Migaou A, Mhamed SC, Rouatbi N, Fahem N. [Influence of co-morbidities on the progression and prognosis of patients with chronic obstructive pulmonary disease in a Tunisian Hospital]. Pan Afr Med J 2020; 36:76. [PMID: 32774635 PMCID: PMC7386274 DOI: 10.11604/pamj.2020.36.76.21511] [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: 01/12/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction la broncho-pneumopathie chronique obstructive (BPCO) s’associe fréquemment avec des comorbidités. L’objectif de notre travail est d'étudier l'impact des comorbidités sur l’évolution et le pronostic de la BPCO. Méthodes il s’agit d’une étude rétrospective incluant des patients porteurs de BPCO hospitalisés et/ou suivis à la consultation de Pneumologie au Centre Hospitalo-Universitaire Fattouma Bourguiba de Monastir entre Janvier 2000 jusqu’à Décembre 2017. Les patients ont été répartis initialement en deux groupes, le groupe G0: BPCO isolée et le groupe G1: au moins une comorbidité. Nous avons divisé les patients du groupe G1 en deux sous-groupes: Groupe A: patients ayant 1-2 comorbidités et Groupe B: ≥ 3 comorbidités associées. Nous avons comparé les différents paramètres de sévérité de la BPCO entre les différents groupes. Résultats en tout 1152 patients BPCO ont été inclus. Soixante-dix-neuf pourcent des patients avaient au moins une pathologie chronique associée à leur BPCO. La présence d’au moins une comorbidité était associée à l'augmentation du nombre des exacerbations sévères (p = 0,004), avec plus de recours à l’oxygène longue durée (p = 0,006) et à une survie réduite (p = 0,001). De même, un nombre de comorbidités plus important (≥ 3 comorbidités) était associé à une inflammation systémique plus importante, à un recours plus fréquent à la ventilation mécanique ou la ventilation non invasive (p = 0,04) et à une survie réduite (p = 0,05). Conclusion la présence de comorbidités au cours de la BPCO s’associe à une sévérité plus importante et un pronostic plus sombre de la maladie. Abstract
Collapse
Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Lobna Loued
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| |
Collapse
|
29
|
Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
Collapse
Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain
- CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
| |
Collapse
|
30
|
The bidirectional relationship between chronic obstructive pulmonary disease and coronary artery disease. Herz 2020; 45:110-117. [DOI: 10.1007/s00059-020-04893-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
31
|
Lin CM, Yang TM, Yang YH, Tsai YH, Lee CP, Chen PC, Chen WC, Hsieh MJ. Statin Use and the Risk of Subsequent Hospitalized Exacerbations in COPD Patients with Frequent Exacerbations. Int J Chron Obstruct Pulmon Dis 2020; 15:289-299. [PMID: 32103928 PMCID: PMC7020922 DOI: 10.2147/copd.s229047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Rationale The potential benefits of statins for the prevention of exacerbations in patients with COPD remains controversial. No previous studies have investigated the impact of statins on clinical outcomes in COPD patients with frequent exacerbations. Objective This study aimed to evaluate the association between the use of statins and the risk of subsequent hospitalized exacerbations in COPD frequent exacerbators. Materials and Methods We conducted a population-based cohort study using the Taiwan National Health Insurance Research Database. 139,223 COPD patients with a first hospitalized exacerbation between 2004 and 2012 were analyzed. Among them, 35,482 had a second hospitalized exacerbation within a year after the first exacerbation, and were defined as frequent exacerbators. 1:4 propensity score matching was used to create matched samples of statin users and non-users. The competing risk regression analysis model was used to evaluate the association between statin use and exacerbation risk. Results The use of statins was associated with a significantly reduced risk in subsequent hospitalized exacerbations in COPD patients after their first hospitalized exacerbation (adjusted subdistribution hazard ration [SHR], 0.89; 95% CI, 0.85-0.93, P<0.001). In frequent exacerbators, the SHR for subsequent hospitalized exacerbations in statins users was 0.88 (95% CI, 0.81-0.94, P=0.001). Subgroup analysis among frequent exacerbators demonstrated that the use of statins only provided a protective effect against subsequent hospitalized exacerbations in male patients aged 75 years and older, with coexisting diabetes mellitus, hypertension or cardiovascular disease, and no protective effect was observed in those with lung cancer or depression. Current use of statins was associated with a greater protective effect for reducing subsequent hospitalized exacerbation. Conclusion The use of statins was associated with a significant reduction in the risk of hospitalized exacerbations in COPD patients after a first hospitalized exacerbation and in specified COPD frequent exacerbators.
Collapse
Affiliation(s)
- Chieh-Mo Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taoyuan, Taiwan.,Department of Respiratory Therapy, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Office of Occupational Safety and Health, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan.,Department of Respiratory Therapy, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
32
|
Walsh A, Perrem L, Khashan AS, Henry MT, Ni Chroinin M. Statins versus placebo for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 7:CD011959. [PMID: 31425628 PMCID: PMC6699658 DOI: 10.1002/14651858.cd011959.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable respiratory disease. COPD exacerbations are associated with worse quality of life, increased hospitalisations, and increased mortality. Currently available pharmacological interventions have variable impact on exacerbation frequency. The anti-inflammatory effects of statins may lead to decreased pulmonary and systemic inflammation, resulting in fewer exacerbations of COPD. Several observational studies have shown potential benefits of statins for patients with COPD. OBJECTIVES This review aims to evaluate available evidence on benefits and harms associated with statin therapy compared with placebo as adjunct therapy for patients with COPD. Primary objectives include the following.• To determine whether statins reduce mortality rates in COPD.• To determine whether statins reduce exacerbation frequency, improve quality of life, or improve lung function in COPD.• To determine whether statins are associated with adverse effects. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent search on 20 May 2019. SELECTION CRITERIA Parallel, randomised controlled trials recruiting adults with COPD. DATA COLLECTION AND ANALYSIS We used standard methods as expected by Cochrane. Prespecified primary outcomes were number of exacerbations, all-cause mortality, and COPD-specific mortality. MAIN RESULTS Eight studies including 1323 participants with COPD were included in the review. Participants had a mean age of 61.4 to 72 years, and most were male (median 73.4%). Mean baseline forced expiratory volume in one second (FEV₁) ranged from 41% to 90% predicted. All studies compared moderate- or high-intensity statin therapy versus placebo. The duration of treatment ranged from 12 weeks to 36 months.We found no statistically significant difference between statins and placebo in our primary outcome of number of exacerbations per person-year (mean difference (MD) -0.03, 95% confidence interval (CI) -0.25 to 0.19, 1 trial, 877 participants), including number of exacerbations requiring hospitalisation per person-year (MD 0.00, 95% CI -0.10 to 0.10, 1 trial, 877 exacerbations). This evidence was of moderate quality after downgrading for unclear risk of bias. Our primary outcomes of all-cause mortality (odds ratio (OR) 1.03, 95% CI 0.61 to 1.74, 2 trials, 952 participants) and COPD-specific mortality (OR 1.25, 95% CI 0.38 to 4.13, 1 trial, 877 participants) showed no significant difference between statins and placebo, with wide confidence intervals suggesting uncertainty about the precision of the results. This evidence was of low quality after downgrading for unclear risk of bias and imprecision.Results of the secondary outcomes analysis showed no clear differences between statins and placebo for FEV₁ (% predicted) (MD 1.18, 95% CI -2.6 to 4.97, 6 trials, 325 participants) but did show a statistically significant improvement in FEV₁/forced vital capacity (FVC) (MD 2.66, 95% CI 0.12 to 5.2; P = 0.04; 6 trials, 325 participants). A sensitivity analysis excluding two trials at high risk of bias showed no statistically significant difference in FEV₁/FVC (MD 2.05, 95% CI -0.87 to -4.97; P = 0.17; 4 trials, 255 participants). We also found no significant differences between the two groups in functional capacity measured by six-minute walk distance in metres (MD 1.79, 95% CI -52.51 to 56.09, 3 trials, 71 participants), with wide confidence intervals suggesting uncertainty about the precision of the results. Results show no clear difference in quality of life, which was reported in three trials, and a slight reduction in C-reactive protein (CRP) in the intervention group, which was statistically significant (MD -1.03, 95% CI -1.95 to -0.11; I² = 0%, P = 0.03; 3 trials, 142 participants). We noted a significant reduction in interleukin (IL)-6 in the intervention group (MD -2.11, 95% CI -2.65 to -1.56; I² = 0%, P ≤ 0.00001; 2 trials, 125 participants). All trials mentioned adverse events and indicated that statins were generally well tolerated. One study reported adverse events in detail and indicated that rates of all non-fatal adverse events (the number of serious adverse events per person-year) were similar in both groups (0.63 ± 1.56 events (intervention group) and 0.62 ± 1.48 events (control group); P > 0.20) for all comparisons, except for non-fatal serious adverse events involving the gastrointestinal tract, which were more frequent in the intervention group (in 30 patients (0.05 events per person-year) vs 17 patients (0.02 events per person-year); P = 0.02). Another trial lists the total numbers and percentages of adverse events in the intervention group (12 (26%)) and in the control group (21 (43%)) and of serious adverse events in the intervention group (4 (9%)) and in the control group (3 (6%)).The other trials stated that researchers found no significant adverse effects of statins but did not report adverse events in detail. AUTHORS' CONCLUSIONS A small number of trials providing low- or moderate-quality evidence were suitable for inclusion in this review. They showed that use of statins resulted in a reduction in CRP and IL-6, but that this did not translate into clear clinical benefit for people with COPD. Further randomised controlled trials are needed to explore this topic.
Collapse
Affiliation(s)
- Aisling Walsh
- Cork University HospitalDepartment of PaediatricsCorkIreland
| | - Lucy Perrem
- The Hospital for Sick Children (SickKids)TorontoCanada
| | - Ali S Khashan
- University College CorkSchool of Public HealthCorkIreland
- University College CorkIrish Centre for Fetal and Neonatal Translational Research (INFANT)CorkIreland
| | | | | | | |
Collapse
|
33
|
Hopkins RJ, Young RP. Mevalonate signaling, COPD and cancer: the statins and beyond. J Investig Med 2019; 67:711-714. [PMID: 30787037 DOI: 10.1136/jim-2018-000829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 01/12/2023]
Abstract
Evidence suggests that smoking confers a persistent and/or exaggerated inflammatory response in the lungs that, with underlying genetic susceptibility, may result in lung remodeling and impaired repair. The innate immune response to smoking described above, which is modified by the mevalonate pathway, provides a plausible pathogenic link between the development of chronic obstructive pulmonary disease and lung cancer. The mevalonate pathway modifies innate responsiveness through important intracellular signaling molecules called guanine phosphate transferases (GTPases) such as Rho-A. Smoke exposure activates cell surface proteins which, through the mediating influence of GTPases, then modifies the activation of nuclear factor kappa -light-chain-enhancer of activated B cells (NFĸB) its downstream effects on genes underlying innate immunity, neutrophilic inflammation and carcinogenesis. The mevalonate pathway is modifiable through the enzyme 3-hydroxy-3-methyl-glutaryl-Coenzyme A (HMGCo-A) reductase. This enzyme controls the rate limiting step of the mevalonate pathway and is subject to inhibition by statin drugs (HMGCo-A reductase inhibitors) and small chain fatty acids derived from high dietary fiber intake. Ths, inhibitory effect dampens the innate immune response to smoking and may modify pulmonary inflammation and lung remodeling. This article is a symposia summary outlining the preclinical and clinical data suggesting that statins and a high-fiber diet may have a chemopreventive effect on lung cancer.
Collapse
Affiliation(s)
- Raewyn J Hopkins
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert P Young
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
34
|
Lu Y, Chang R, Yao J, Xu X, Teng Y, Cheng N. Effectiveness of long-term using statins in COPD - a network meta-analysis. Respir Res 2019; 20:17. [PMID: 30674312 PMCID: PMC6343315 DOI: 10.1186/s12931-019-0984-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/13/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of long-term treatment of statins for chronic obstructive pulmonary disease (COPD), and to answer which one is better. METHODS General meta-analysis was performed to produce polled estimates of the effect of mortality, inflammatory factors, and lung function index in COPD patients by the search of PubMed, Web of Science, Embase, and China National Knowledge Infrastructure for eligible studies. A network meta-analysis was performed to synthetically compare the effectiveness of using different statins in COPD patients. RESULTS General meta-analysis showed that using statins reduced the risk of all-cause mortality, heart disease-related mortality and COPD acute exacerbation (AECOPD) in COPD patients, the RR (95% CI) were 0.72 (0.63,0.84), 0.72 (0.53,0.98) and 0.84 (0.79,0.89), respectively. And using statins reduced C-reactive protein (CRP) and pulmonary hypertension (PH) in COPD patients, the SMD (95% CI) were - 0.62 (- 0.52,-0.72) and - 0.71 (- 0.85,-0.57), respectively. Network meta-analysis showed that Fluvastatin (97.7%), Atorvastatin (68.0%) and Rosuvastatin (49.3%) had higher cumulative probability than other statins in reducing CRP in COPD patients. Fluvastatin (76.0%) and Atorvastatin (75.4%) had higher cumulative probability than other satins in reducing PH in COPD patients. CONCLUSIONS Using statins can reduce the risk of mortality, the level of CRP and PH in COPD patients. In addition, Fluvastatin and Atorvastatin are more effective in reducing CRP and PH in COPD patients.
Collapse
Affiliation(s)
- Yongbin Lu
- The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Ruixia Chang
- Lanzhou Maternal and Child Health Care Hospital, Lanzhou, Gansu, 730000, People's Republic of China.
| | - Jia Yao
- The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xinni Xu
- The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Yongjun Teng
- The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Ning Cheng
- Lanzhou University, Basic Medical College, Lanzhou, Gansu, 730000, People's Republic of China.
| |
Collapse
|
35
|
Pose E, Trebicka J, Mookerjee RP, Angeli P, Ginès P. Statins: Old drugs as new therapy for liver diseases? J Hepatol 2019; 70:194-202. [PMID: 30075229 DOI: 10.1016/j.jhep.2018.07.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Abstract
In addition to lowering cholesterol levels, statins have pleiotropic effects, particularly anti-inflammatory, antiangiogenic, and antifibrotic, that may be beneficial in some chronic inflammatory conditions. Statins have only recently been investigated as a potential treatment option in chronic liver diseases because of concerns related to their safety in patients with impaired liver function. A number of experimental studies in animal models of liver diseases have shown that statins decrease hepatic inflammation, fibrogenesis and portal pressure. In addition, retrospective cohort studies in large populations of patients with cirrhosis and pre-cirrhotic conditions have shown that treatment with statins, with the purpose of decreasing high cholesterol levels, was associated with a reduced risk of disease progression, hepatic decompensation, hepatocellular carcinoma development, and death. These beneficial effects persisted after adjustment for disease severity and other potential confounders. Finally, a few randomised controlled trials have shown that treatment with simvastatin decreases portal pressure (two studies) and mortality (one study). Statin treatment was generally well tolerated but a few patients developed severe side effects, particularly rhabdomyolysis. Despite these promising beneficial effects, further randomised controlled trials in large series of patients with hard clinical endpoints should be performed before statins can be recommended for use in clinical practice.
Collapse
Affiliation(s)
- Elisa Pose
- Liver Unit, Hospital Clinic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Institute for Bioengineering of Catalonia, Barcelona, Spain
| | | | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Pere Ginès
- Liver Unit, Hospital Clinic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigaciones Biomédicas en Red Enfermedades Hepáticas y Digestivas, Catalonia, Spain.
| |
Collapse
|
36
|
Adherence of Elderly Patients with Cardiovascular Disease to Statins and the Risk of Exacerbation of Chronic Obstructive Pulmonary Disease: Evidence from an Italian Real-World Investigation. Drugs Aging 2018; 35:1099-1108. [DOI: 10.1007/s40266-018-0600-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
37
|
Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev 2018; 27:27/149/180057. [PMID: 30282634 DOI: 10.1183/16000617.0057-2018] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. Pathophysiological links between COPD and CVD include lung hyperinflation, systemic inflammation and COPD exacerbations. COPD treatments may produce beneficial cardiovascular (CV) effects, such as long-acting bronchodilators, which are associated with improvements in arterial stiffness, pulmonary vasoconstriction, and cardiac function. However, data are limited regarding whether these translate into benefits in CV outcomes. Some studies have suggested that treatment with long-acting β2-agonists and long-acting muscarinic antagonists leads to an increase in the risk of CV events, particularly at treatment initiation, although the safety profile of these agents with prolonged use appears reassuring. Some CV medications may have a beneficial impact on COPD outcomes, but there have been concerns about β-blocker use leading to bronchospasm in COPD, which may result in patients not receiving guideline-recommended treatment. However, there are few data suggesting harm with these agents and patients should not be denied β-blockers if required. Clearer recommendations are necessary regarding the identification and management of comorbid CVD in patients with COPD in order to facilitate early intervention and appropriate treatment.
Collapse
Affiliation(s)
- Klaus F Rabe
- Dept of Medicine, University of Kiel, Kiel, Germany .,Lung Clinic Großhansdorf, Airway Research Center North (ARCN), Groβhansdorf, Germany
| | - John R Hurst
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Dept of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| |
Collapse
|
38
|
Zhang W, Zhang Y, Li CW, Jones P, Wang C, Fan Y. Effect of Statins on COPD. Chest 2017; 152:1159-1168. [DOI: 10.1016/j.chest.2017.08.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022] Open
|
39
|
Castiglia D, Battaglia S, Benfante A, Sorino C, Scichilone N. Pharmacological Management of Elderly Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: Room for Speculation? Drugs Aging 2017; 33:375-85. [PMID: 27138954 DOI: 10.1007/s40266-016-0368-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are two distinct diseases that share a condition of chronic inflammation of the airways and bronchial obstruction. In clinical settings, it is not rare to come across patients who present with clinical and functional features of both diseases, posing a diagnostic dilemma. The overlap condition has been termed asthma-COPD overlap syndrome (ACOS), and mainly occurs in individuals with long-standing asthma, especially if they are also current or former smokers. Patients with ACOS have poorer health-related quality of life and a higher exacerbation rate than subjects with asthma or COPD alone. Whether ACOS is a distinct nosological entity with genetic variants or rather a condition of concomitant diseases that overlap is still a matter of debate. However, there is no doubt that extended life expectancy has increased the prevalence of asthma and COPD in older ages, and thus the probability that overlap conditions occur in clinical settings. In addition, age-associated changes of the lung create the basis for the two entities to converge on the same subject. ACOS patients may benefit from a stepwise treatment similar to that of asthma and COPD; however, the proposed therapeutic algorithms are only speculative and extrapolated from studies that are not representative of the ACOS population. Inhaled corticosteroids are the mainstay of therapy, and always in conjunction with long-acting bronchodilators. The potential heterogeneity of the overlap syndrome in terms of inflammatory features (T helper-1 vs. T helper-2 pathways) may be responsible for the different responses to treatments. The interaction between respiratory drugs and concomitant diseases should be carefully evaluated. Similarly, the effect of non-respiratory drugs, such as aspirin, statins, and β-blockers, on lung function needs to be properly assessed.
Collapse
Affiliation(s)
- Daniela Castiglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, via Trabucco 180, 90146, Palermo, Italy
| | - Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, via Trabucco 180, 90146, Palermo, Italy
| | - Alida Benfante
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, via Trabucco 180, 90146, Palermo, Italy
| | | | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, via Trabucco 180, 90146, Palermo, Italy. .,Istituto Euro-Mediterraneo di Scienza e Tecnologia, Palermo, Italy.
| |
Collapse
|
40
|
Li WF, Huang YQ, Huang C, Feng YQ. Statins reduce all-cause mortality in chronic obstructive pulmonary disease: an updated systematic review and meta-analysis of observational studies. Oncotarget 2017; 8:73000-73008. [PMID: 29069843 PMCID: PMC5641186 DOI: 10.18632/oncotarget.20304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/04/2017] [Indexed: 01/29/2023] Open
Abstract
Recently, a number of observational studies have suggested that use of statins reduces mortality in patients suffering from chronic obstructive pulmonary disease (COPD). To obtain a more valid assessment, we update the meta-analysis of the effect of statins on COPD exacerbation and mortality. We searched for eligible articles using PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, Cochrane Databases and Web of Science between January 2006 and February 2017, with no restrictions. The hazard ratio (HR) with 95% confidence interval (CI) was estimated. Publication bias was evaluated by funnel plot and Begg's test. Sensitivity analyses were also conducted. Twenty studies with a total of 303,981 patients were included. Thirteen articles provided data on all-cause mortality (165,221 participants), and the pooled hazard ratio of 0.65 (95% CI: 0.57–0.74, P < 0.001). Nine cohorts involving 155,435 patients reported data for COPD exacerbation with or without hospitalization, and they gave a HR of 0.58(95%CI: 0.48–0.72, P < 0.001). Our systematic review of exclusively observational studies showed a clear benefit of statins for patients suffering from COPD.
Collapse
Affiliation(s)
- Wen-Feng Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Cheng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| |
Collapse
|
41
|
Vanasse A, Courteau J, Couillard S, Beauchesne MF, Larivée P. Predicting One-year Mortality After a "First" Hospitalization for Chronic Obstructive Pulmonary Disease: An Eight-Variable Assessment Score Tool. COPD 2017; 14:490-497. [PMID: 28745528 DOI: 10.1080/15412555.2017.1343814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several authors have studied predictors of outcomes following a hospitalization for chronic obstructive pulmonary disease (COPD); however, few have reported outcomes following a first hospitalization for COPD. The objective is to develop a predictive mortality risk model in patients surviving a first hospitalization for COPD. This is a retrospective cohort study using linked administrative and clinical data. The cohort included 1129 patients of 40-84 years, discharged alive from a hospitalization for COPD in a regional hospital (Sherbrooke, Canada) between 04/2006 and 03/2013 and to whom were prescribed at least two COPD drugs during their hospitalization. One-year mortality was analysed using logistic regression on a derivation sample and validated on a testing sample. In total, 141 (12.5%) patients died within one year from discharge of their first hospitalization for COPD. Predictors were: older age (OR (95% CI): 1.055 (1.026-1.085)), male sex (OR (95% CI): 1.474 (0.921-2.358)), having a severe COPD exacerbation (OR (95% CI): 2.548 (1.571-4.132)), higher hospital length of stay (OR (95% CI): 1.024 (0.996-1.053)), higher Charlson co-morbidity index (OR (95% CI): 1.262 (1.099-1.449)), being diagnosed of cancer (OR (95% CI): 2.928 (1.456-5.885)), the number of prior all-cause hospitalizations (OR (95% CI): 1.323 (1.097-1.595)), and a COPD duration exceeding 3 years (OR (95% CI): 1.710 (1.058-2.763)). A simple clinical prognosis tool is proposed and shows good discrimination in both the derivation and validation cohorts (c-statistic >0.78). One over eight patients discharged alive from a first COPD hospitalization will die the following year. It is thus important to identify higher-risk patients in order to plan and manage appropriate treatment.
Collapse
Affiliation(s)
- Alain Vanasse
- a Département de médecine de famille et de médecine d'urgence , Université de Sherbrooke , Sherbrooke , Canada.,b PRIMUS Group, Centre de recherche du CHUS , Université de Sherbrooke , Sherbrooke , Canada
| | - Josiane Courteau
- b PRIMUS Group, Centre de recherche du CHUS , Université de Sherbrooke , Sherbrooke , Canada
| | - Simon Couillard
- c Service de pneumologie du Département de Médecine, Faculté de médecine et des sciences de la santé , Université de Sherbrooke , Sherbrooke , Canada
| | - Marie-France Beauchesne
- d Faculté de Pharmacie , Université de Montréal , Montréal , Canada.,e Département de Pharmacie , Centre Hospitalier Universitaire de Sherbrooke , Sherbrooke , Canada
| | - Pierre Larivée
- c Service de pneumologie du Département de Médecine, Faculté de médecine et des sciences de la santé , Université de Sherbrooke , Sherbrooke , Canada
| |
Collapse
|
42
|
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195:557-582. [PMID: 28128970 DOI: 10.1164/rccm.201701-0218pp] [Citation(s) in RCA: 2083] [Impact Index Per Article: 297.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.
Collapse
Affiliation(s)
- Claus F Vogelmeier
- 1 University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- 3 New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- 4 University of Texas Health Science Center, San Antonio, Texas.,5 South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- 7 McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- 9 State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- 12 Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- 16 Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- 18 St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- 19 University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- 19 University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agustí
- 21 Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain
| |
Collapse
|
43
|
Chogtu B, Kuriachan S, Magazine R, Shetty KR, Kamath A, George MM, Tripathy A, Kumar DM. A prospective, randomized study: Evaluation of the effect of rosuvastatin in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Indian J Pharmacol 2017; 48:503-508. [PMID: 27721534 PMCID: PMC5051242 DOI: 10.4103/0253-7613.190721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Statins by their anti-inflammatory and endothelial stabilizing effect can be beneficial in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). The present study was done to evaluate the effect of rosuvastatin on pulmonary functions and quality of life (QOL) in patients with concomitant COPD and PH. Materials and Methods: It was a prospective, randomized, double-blind, placebo-controlled, study conducted in patients with COPD and PH. A total of sixty patients were assigned to receive either rosuvastatin 10 mg or placebo once a day in addition to their conventional treatment for 12 weeks. Routine blood investigations, pulmonary functions, echocardiogram, exercise capacity, and QOL using a questionnaire were assessed at the baseline and after 12 weeks. Results: In patients of rosuvastatin group, there was a statistically significant increase in peak expiratory flow rate (PEFR) (P = 0.04) but no significant change in other pulmonary functions: Forced vital capacity (FVC), forced expiratory volume at 1 s (FVC, FEV1, FEV1/FVC), and echocardiogram parameters. There was a significant increase in 6-min walk test (6-min walk distance) (P = 0.03) at the end of 12 weeks. On comparing with placebo, rosuvastatin showed a significant reduction (P = 0.045) in COPD exacerbations while adverse effects did not differ. Conclusion: Statins have a favorable effect on patients with COPD and PH regarding the improvement in PEFR, COPD exacerbations, and exercise capacity. Such effects can be beneficial in these patients and more so in patients with concomitant coronary artery disease or hyperlipidemia where long-term benefits of statins have been established.
Collapse
Affiliation(s)
- Bharti Chogtu
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sanitha Kuriachan
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - K Ranjan Shetty
- Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Manu Mathew George
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Amruta Tripathy
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - D Mahesh Kumar
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
44
|
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Respirology 2017; 22:575-601. [PMID: 28150362 DOI: 10.1111/resp.13012] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.
Collapse
Affiliation(s)
- Claus F Vogelmeier
- University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- Lewis Katz School of Medicine at, Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- University of Texas Health Science Center, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agusti
- Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomé dica en Red de Enfermedade Respiratorias, Barcelona, Spain
| |
Collapse
|
45
|
Vogelmeier CF, Criner GJ, Martínez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodríguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Arch Bronconeumol 2017; 53:128-149. [PMID: 28274597 DOI: 10.1016/j.arbres.2017.02.001] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
Collapse
Affiliation(s)
- Claus F Vogelmeier
- Universidad de Marburg, Marburg, Alemania, Miembro del Centro Alemán para Investigación Pulmonar (DZL).
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Filadelfia, Pensilvania, EE. UU
| | - Fernando J Martínez
- New York-Presbyterian Hospital, Weil Cornell Medical Center, Nueva York, Nueva York, EE. UU
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, Texas, EE. UU
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, Londres, Reino Unido
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canadá
| | | | - Rongchang Chen
- Laboratorio Central Estatal para Enfermedades Respiratorias, Instituto de Enfermedades Respiratorias de Guangzhou, Primer Hospital Afiliado de la Universidad de Medicina de Guangzhou, Guangzhou, República Popular de China
| | | | | | - Peter Frith
- Flinders University Faculty of Medicine, Bedford Park, South Australia Australia
| | | | | | | | - Nicolás Roche
- Hôpital Cochin (APHP), Universidad Paris Descartes, París, Francia
| | | | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canadá
| | - Dave Singh
- University of Manchester, Manchester, Reino Unido
| | | | | | | | - Alvar Agustí
- Hospital Clínic, Universitat de Barcelona, Ciberes, Barcelona, España
| |
Collapse
|
46
|
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
47
|
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J 2017; 49:1700214. [PMID: 28182564 DOI: 10.1183/13993003.00214-2017] [Citation(s) in RCA: 480] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/05/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
Collapse
Affiliation(s)
- Claus F Vogelmeier
- University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
- These authors contributed equally to the manuscript
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
- These authors contributed equally to the manuscript
| | - Fernando J Martinez
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
- These authors contributed equally to the manuscript
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Rongchang Chen
- State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- Flinders University Faculty of Medicine, Bedford Park, Australia
| | | | | | | | - Nicolas Roche
- Hôpital Cochin (APHP), University Paris Descartes, Paris, France
| | | | - Don D Sin
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Alvar Agusti
- Hospital Clínic, Universitat de Barcelona, Ciberes, Barcelona, Spain
| |
Collapse
|
48
|
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is more prevalent in HIV-infected individuals and is associated with persistent inflammation. Therapies unique to HIV are lacking. We performed a pilot study of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor rosuvastatin to determine effects on lung function. DESIGN Randomized, placebo-controlled, triple-blinded trial. METHODS HIV-infected individuals with abnormal lung function were recruited from an ongoing lung function study. Participants were randomized to 24 weeks of placebo (n = 11) or rosuvastatin (n = 11) using an adaptive randomization based on change in peripheral C-reactive protein levels at 30 days of treatment. Forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLco)%-predicted were compared to baseline at 24 weeks in the two groups using a Wilcoxon rank-sum test. The %-predicted change at 24 weeks in pulmonary function variables was compared between groups using simulated randomization tests. RESULTS The placebo group experienced a significant decline in FEV1%-predicted (P = 0.027), and no change in DLco%-predicted over 24 weeks. In contrast, FEV1%-predicted remained stable in the rosuvastatin group, and DLco%-predicted increased significantly (P = 0.027). There was no significant difference in absolute change in either measure between placebo and rosuvastatin groups. CONCLUSION In a pilot study, the use of rosuvastatin for 24 weeks appeared to slow worsening of airflow obstruction and to improve DLco in HIV-infected individuals with abnormal lung function, although comparison of absolute changes between the groups did not reach significance. This study is the first to test a therapy for COPD in an HIV-infected population, and large-scale clinical trials are needed.
Collapse
|
49
|
Westerik JAM, Metting EI, van Boven JFM, Tiersma W, Kocks JWH, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res 2017; 18:31. [PMID: 28166777 PMCID: PMC5294875 DOI: 10.1186/s12931-017-0512-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients. METHOD Retrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions. RESULTS Fourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from ≥1 comorbidities, 3263 (22%) from ≥5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., ≥2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38-2.14), blindness & low vision (OR 1.46; 1.21-1.75), pulmonary cancer (OR 1.85; 1.28-2.67), depression 1.48; 1.14-1.91), prostate disorders (OR 1.50; 1.13-1.98), asthma (OR 1.36; 1.11-1.70), osteoporosis (OR 1.41; 1.11-1.80), diabetes (OR 0.80; 0.66-0.97), dyspepsia (OR 1.25; 1.03-1.50), and peripheral vascular disease (OR 1.20; 1.00-1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17-1.36). CONCLUSION Chronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk.
Collapse
Affiliation(s)
- Janine A M Westerik
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands
| | - Esther I Metting
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Waling Tiersma
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands
| | - Janwillem W H Kocks
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Tjard R Schermer
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands.
| |
Collapse
|
50
|
Zuo L, Chuang CC, Clark AD, Garrison DE, Kuhlman JL, Sypert DC. Reactive Oxygen Species in COPD-Related Vascular Remodeling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 967:399-411. [PMID: 29047102 DOI: 10.1007/978-3-319-63245-2_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The pathogenesis of chronic obstructive pulmonary disease (COPD) is a multifaceted process involving the alteration of pulmonary vasculature. Such vascular remodeling can be associated with inflammation, shear stress, and hypoxia-conditions commonly seen in patients with lung diseases. Particularly, the overproduction of reactive oxygen species (ROS) in the diseased lungs contributes greatly to pulmonary vascular remodeling. ROS play an important role in vascular homeostasis, yet excessive ROS can alter pulmonary vasculature and impair lung function, as implicated in COPD at all stages. Increased inflammatory cell infiltration and endothelial dysfunction both correspond to the severity of COPD. As a byproduct of vascular remodeling, pulmonary hypertension negatively affects the long-term survival rate of COPD patients. While there is currently no cure for COPD, several treatment options have focused on alleviating COPD symptoms. Interventions such as long-term oxygen therapy, endothelium-targeted treatment, and pharmacological therapies show promising results in improving the life span of COPD patients and attenuating the progression of pulmonary hypertension. In this chapter, we aim to discuss the contributing factors of pulmonary vascular remodeling in COPD with an emphasis on the ROS, as well as potential redox treatments for COPD-related vascular remodeling.
Collapse
Affiliation(s)
- Li Zuo
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Chia-Chen Chuang
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Alexander D Clark
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Davis E Garrison
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Jamie L Kuhlman
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - David C Sypert
- Molecular Physiology and Rehabilitation Research Laboratory, Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| |
Collapse
|