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Kanwal H, Khan S, Eldesoky GE, Mushtaq S, Khan A. Management of COPD and Comorbidities in COPD patients by Dispensing Pharmaceutical Care following Global Initiative for chronic Obstructive Lung Disease-Guidelines (GOLD guidelines 2020): A study protocol for a Prospective Randomized Clinical Trial. Heliyon 2023; 9:e21539. [PMID: 37942165 PMCID: PMC10628705 DOI: 10.1016/j.heliyon.2023.e21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.
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Affiliation(s)
- Hafsa Kanwal
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shahzeb Khan
- Centre for Pharmaceutical Engineering, Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, West Yorkshire, BD7, 1DP, UK
| | - Gaber E. Eldesoky
- Department of Chemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Noor NM, Mustaffa Z, Nizam A, Mohd Zim MA, Ng LWC, Mirza FT. Protocol for a systematic review of the associations between inflammatory markers and lung function, muscle force and exercise capacity in people with COPD. BMJ Open 2023; 13:e068776. [PMID: 37463801 PMCID: PMC10357637 DOI: 10.1136/bmjopen-2022-068776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The prevalence of chronic obstructive pulmonary disease (COPD) has been on the rise, with acute exacerbation of COPD associated with the highest burden and multiple pulmonary and systemic consequences. People with COPD have been found to have an abnormal response of systemic inflammation. To date, although limited, there are studies that suggest negative associations between inflammatory markers and important clinical outcomes such as exercise capacity and muscle force. This protocol aims to systematically review the evidence for (i) the associations between inflammatory markers and lung function, muscle force and exercise capacity and (ii) the influence of other factors (eg, hospitalisation, exercise programme) on the level of inflammatory markers in people with COPD. METHODS AND ANALYSIS Scopus, PubMed, Cochrane, Web of Science and ProQuest will be searched from database inception to February 2023 using PEO search strategy (Population: adults with COPD; Exposure: inflammatory markers; Outcomes: lung function, muscle force and exercise capacity). Four reviewers working in pairs will independently screen articles for eligibility and extract data that fulfilled the inclusion criteria. Depending on the design of the included studies, either Cochrane risk-of-bias version 2 or the Newcastle-Ottawa Scale tools will be used to rate the methodological quality of the included studies. Effect sizes reported in each individual study will be standardised to Cohen's d and a random effects model will be used to calculate the pooled effect size for the association. ETHICS AND DISSEMINATION Ethical approval is unnecessary as this study will only use publicly available data. The findings will be disseminated through publication in peer-reviewed journals and conferences. PROSPERO REGISTRATION NUMBER CRD42022284446.
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Affiliation(s)
- Nadhirah Mohd Noor
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
| | - Zawani Mustaffa
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
- Rehabilitation Department, KPJ Bandar Dato' Onn Specialist Hospital, Bandar Dato' Onn, Malaysia
| | - Alia Nizam
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
- Department of Physiotherapy, Sunway Medical Centre, Bandar Sunway, Malaysia
| | - Mohd Arif Mohd Zim
- Respiratory Medicine, Internal Medicine, KPJ Damansara Specialist Hospital 2, Kuala Lumpur, Malaysia
| | - Li Whye Cindy Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Fatim Tahirah Mirza
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
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Zhang T, Wang G, Li Q, Yan P, Sun J, Jin Y. Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications. Technol Health Care 2023; 31:2047-2058. [PMID: 37694327 PMCID: PMC10741335 DOI: 10.3233/thc-230665] [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: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society. OBJECTIVE The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management. METHODS From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression. RESULTS Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P< 0.05). Interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were significantly higher in the COPD with depression group than in the group without depression (P< 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6 months was noticeably higher in the COPD with depression group than in the group without depression. CONCLUSION Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD.
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Affiliation(s)
- Teng Zhang
- Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Guodong Wang
- Department of Geriatrics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiang Li
- Department of Geriatrics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Pan Yan
- Department of Molecular Laboratory, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Jijun Sun
- Department of Psychiatry, Hangzhou Seventh People’s Hospital, Hangzhou, Zhejiang, China
| | - Yun Jin
- Department of Geriatrics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Romero D, Blanco-Almazán D, Groenendaal W, Lijnen L, Smeets C, Ruttens D, Catthoor F, Jané R. Predicting 6-minute walking test outcomes in patients with chronic obstructive pulmonary disease without physical performance measures. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107020. [PMID: 35905697 DOI: 10.1016/j.cmpb.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/20/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) requires a multifactorial assessment, evaluating the airflow limitation and symptoms of the patients. The 6-min walk test (6MWT) is commonly used to evaluate the functional exercise capacity in these patients. This study aims to propose a novel predictive model of the major 6MWT outcomes for COPD assessment, without physical performance measurements. METHODS Cardiopulmonary and clinical parameters were obtained from fifty COPD patients. These parameters were used as inputs of a Bayesian network (BN), which integrated three multivariate models including the 6-min walking distance (6MWD), the maximum HR (HRmax) after the walking, and the HR decay 3 min after (HRR3). The use of BN allows the assessment of the patients' status by predicting the 6MWT outcomes, but also inferring disease severity parameters based on actual patient's 6MWT outcomes. RESULTS Firstly, the correlation obtained between the estimated and actual 6MWT measures was strong (R = 0.84, MAPE = 8.10% for HRmax) and moderate (R = 0.58, MAPE = 15.43% for 6MWD and R = 0.58, MAPE = 32.49% for HRR3), improving the classical methods to estimate 6MWD. Secondly, the classification of disease severity showed an accuracy of 78.3% using three severity groups, which increased up to 84.4% for two defined severity groups. CONCLUSIONS We propose a powerful two-way assessment tool for COPD patients, capable of predicting 6MWT outcomes without the need for an actual walking exercise. This model-based tool opens the way to implement a continuous monitoring system for COPD patients at home and to provide more personalized care.
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Affiliation(s)
- Daniel Romero
- Universitat Politecnica de Catalunya · BarcelonaTech (UPC), Barcelona 08019, Spain; Institute for Bioengineering of Catalonia (IBEC-BIST), Barcelona 08019, Spain; Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid 28029, Spain.
| | - Dolores Blanco-Almazán
- Universitat Politecnica de Catalunya · BarcelonaTech (UPC), Barcelona 08019, Spain; Institute for Bioengineering of Catalonia (IBEC-BIST), Barcelona 08019, Spain; Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid 28029, Spain
| | | | | | | | | | | | - Raimon Jané
- Universitat Politecnica de Catalunya · BarcelonaTech (UPC), Barcelona 08019, Spain; Institute for Bioengineering of Catalonia (IBEC-BIST), Barcelona 08019, Spain; Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid 28029, Spain
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Olofson J, Bake B, Bergman B, Vanfleteren LEGW, Svärdsudd K. Prediction of COPD by the single-breath nitrogen test and various respiratory symptoms. ERJ Open Res 2021; 7:00383-2021. [PMID: 34589539 PMCID: PMC8473809 DOI: 10.1183/23120541.00383-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
Early identification of subjects running an increased risk of contracting COPD enables focus on individual preventive measures. The slope of the alveolar plateau of the single-breath nitrogen washout test (N2-slope) is a sensitive measure of small-airway dysfunction. However, its role remains unexplored in predicting hospital admission or death related to COPD, i.e. incident COPD events, in relation to the presence of various respiratory symptoms. A random population sample of 625 men, aged 50 (n=218) or 60 years (n=407), was followed for 38 years for incident COPD events. At baseline, a questionnaire on respiratory symptoms and smoking habits was collected, spirometry and the single-breath nitrogen test were performed, and the N2-slope was determined. Proportional hazard regression (Cox regression) analysis was used for the prediction model. The N2-slope improved the prediction of COPD events significantly beyond that of respiratory symptoms weighted all together and other covariates (hazard ratio 1.63, 95% CI 1.20–2.22; p<0.005), a prediction applicable to subjects without (p=0.001) and with (p<0.05) airway obstruction. Dyspnoea and wheezing were the most predictive symptoms. The combination of the N2-slope and number of respiratory symptoms notably resulted in an effective prediction of incident COPD events even in nonobstructive subjects, as evidenced by a predicted incidence of ∼70% and ∼90% for a very steep N2-slope combined with many respiratory symptoms in subject without and with airway obstruction, respectively. The alveolar N2-slope should be considered in the critical need for further research on early diagnosis of COPD. The N2 slope of the single-breath nitrogen test predicts incident COPD events as well as or better than respiratory symptoms among subjects without and with airway obstruction. Combining N2 slope and symptoms results in effective prediction.https://bit.ly/3dYJdu1
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Affiliation(s)
- Jan Olofson
- Unit of Respiratory Medicine and Allergology, Dept of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Unit of Respiratory Medicine and Allergology, Dept of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Bergman
- Unit of Respiratory Medicine and Allergology, Dept of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kurt Svärdsudd
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
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The Impact of Air Pollutants and Meteorological Factors on Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Study. Ann Am Thorac Soc 2021; 19:214-226. [PMID: 34499589 DOI: 10.1513/annalsats.202103-298oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Chronic obstructive lung disease (COPD) is a chronic progressive disease. Although smoking is the most important risk factor, 30% of COPD patients are never smokers, and environmental agents are also influential. The effects of air pollutants and meteorological factors on COPD exacerbations have not been studied extensively. OBJECTIVE We aimed to investigate the air pollutants and meteorological factors that impact the incidence of COPD exacerbations. METHODS We obtained clinical data of COPD exacerbation cases from The National Health Insurance Service (NHIS) and merged it with 24-hour average values of air pollutants and meteorological factors from national databases. Patients who reside in eight metropolitan cities, where observatory stations are densely located, were selected for analysis. RESULTS In 1,404,505 COPD patients between 2013 and 2018, 15,282 COPD exacerbations leading to hospitalization or emergency room visits were identified. Among the various air pollutants and meteorological factors, particulate matter (PM)2.5, PM10, NO2, SO2, CO, O3, average temperature and diurnal temperature range (DTR) were associated with COPD exacerbations. GAM model analysis with cubic splines showed an inverted U-shaped relationship with PM2.5, PM10, CO, NO2, SO2, O3, DTR and humidity, while it displayed a U-shaped pattern with the average temperature. Distinct patterns were found from 2015-2016 to 2017-2018. CONCLUSIONS PM2.5, PM10, CO, NO2, O3, SO2, average temperature, humidity, and DTR affected the incidence of COPD exacerbations in various patterns, up to 10 lag days.
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Halpin DMG, Worsley S, Ismaila AS, Beeh KM, Midwinter D, Kocks JWH, Irving E, Marin JM, Martin N, Tabberer M, Snowise NG, Compton C. INTREPID: single- versus multiple-inhaler triple therapy for COPD in usual clinical practice. ERJ Open Res 2021; 7:00950-2020. [PMID: 34109236 PMCID: PMC8181617 DOI: 10.1183/23120541.00950-2020] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/23/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Real-world trial data comparing single- with multiple-inhaler triple therapy (MITT) in COPD patients are currently lacking. The effectiveness of once-daily single-inhaler fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) and MITT were compared in usual clinical care. Methods INTREPID was a multicentre, randomised, open-label, phase IV effectiveness study comparing FF/UMEC/VI 100/62.5/25 µg via the ELLIPTA inhaler with a clinician's choice of any approved non-ELLIPTA MITT in usual COPD clinical practice in five European countries. Primary end-point was proportion of COPD Assessment Test (CAT) responders (≥2-unit decrease in CAT score from baseline) at week 24. Secondary end-points in a subpopulation included change from baseline in forced expiratory volume in 1 s (FEV1) and percentage of patients making at least one critical error in inhalation technique at week 24. Safety was also assessed. Results 3092 patients were included (FF/UMEC/VI n=1545; MITT n=1547). The proportion of CAT responders at week 24 was significantly greater with FF/UMEC/VI versus non-ELLIPTA MITT (OR 1.31, 95% CI 1.13–1.51; p<0.001) and mean change from baseline in FEV1 was significantly greater with FF/UMEC/VI (77 mL versus 28 mL; treatment difference 50 mL, 95% CI 26–73 mL; p<0.001). The percentage of patients with at least one critical error in inhalation technique was low in both groups (FF/UMEC/VI 6%; non-ELLIPTA MITT 3%). Safety profiles, including incidence of pneumonia serious adverse events, were similar between treatments. Conclusions In a usual clinical care setting, treatment with once-daily single-inhaler FF/UMEC/VI resulted in significantly more patients gaining health status improvement and greater lung function improvement versus non-ELLIPTA MITT. Once-daily single-inhaler treatment with FF/UMEC/VI results in greater improvements in health status and lung function compared with non-ELLIPTA multiple-inhaler triple therapy in patients with COPD in a usual clinical practice settinghttps://bit.ly/2PHXNwU
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.,Dept of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.,Observational and Pragmatic Research Institute, Singapore
| | | | - Jose M Marin
- University Hospital Miguel Servet, IIS Aragón and CIBERES, Zaragoza, Spain.,CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Neil Martin
- Global Medical Affairs, GSK, Brentford, UK.,Institute for Lung Health, University of Leicester, Leicester, UK
| | | | - Neil G Snowise
- Global Medical Affairs, GSK, Brentford, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
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Saad AB, Adhieb A, Migaou A, Mhamed SC, Fahem N, Rouatbi N, Joobeur S. [Effect of intensity of smoking intoxication on severity parameters of acute exacerbations of chronic obstructive pulmonary disease treated in a hospital milieu]. Pan Afr Med J 2021; 38:91. [PMID: 33889257 PMCID: PMC8035682 DOI: 10.11604/pamj.2021.38.91.21512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction le tabagisme constitue le principal facteur de risque de la broncho-pneumopathie chronique obstructive (BPCO). Le cours évolutif de cette maladie est caractérisé par la survenue des exacerbations aiguës (EA). L'objectif de notre travail est d'évaluer l´impact de l´intensité de l´intoxication tabagique (en paquets-années (PA)) sur les différents paramètres de sévérité des EA des patients BPCO non sevrés hospitalisés. Méthodes c´est une étude rétrospective, monocentrique, portant sur 685 patients porteurs de BPCO, tabagiques non sevrés ayant été hospitalisés au moins une fois pour une EA entre 1990 et 2017. Nous avons défini 2 groupes de patients (G1: < 30PA, et G2: ≥ 30PA). Nous avons comparé les différents paramètres de sévérité des EA BPCO entre les deux groupes. Résultats l´âge moyen de nos patients était de 66 ans. Il n'y avait pas de différence significative entre les deux groupes concernant l´importance du syndrome inflammatoire biologique, la durée de l´hospitalisation et celle de l´antibiothérapie. Le G2 était caractérisé par une PaO2 plus basse au cours des EA (G1: 63,5, G2: 59,3, p: 0,007), avec plus d'hospitalisation en réanimation (p < 0,001), plus de recours à la ventilation non invasive (p: < 0.001) et à la ventilation invasive (p: 0,008). Le G2 avait plus d'EA/an (G1: 2,06, G2: 2,72/patient/an, p: 0,001) avec un délai moyen de survenue d'EA sévère plus court (p: 0,038). Conclusion l´intensité de l´intoxication tabagique a un impact négatif sur plusieurs paramètres de sévérité des EA sévères de BPCO. D´où l´intérêt de sevrage tabagique pour prévenir la maladie et ses complications.
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Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Ali Adhieb
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Tunisie
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Montaño M, Pérez-Bautista O, Velasco-Torres Y, González-Ávila G, Ramos C. Women with COPD from biomass smoke have reduced serum levels of biomarkers of angiogenesis and cancer, with EGFR predominating, compared to women with COPD from smoking. Chron Respir Dis 2021; 18:14799731211005023. [PMID: 33787367 PMCID: PMC8020220 DOI: 10.1177/14799731211005023] [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] [Indexed: 12/23/2022] Open
Abstract
The main causes of COPD are smoking (COPD-TS) and exposure to biomass smoke (COPD-BS), considered as different phenotypes. The association of COPD-TS with lung cancer (LC) is well established, but not in COPD-BS. Thus, we studied the serum concentration of cytokines that participate in inflammation, angiogenesis, and tumor progression, used frequently as LC biomarkers, in women with COPD-BS compared with COPD-TS (n = 70). Clinical and physiological characteristics and the serum concentration (multiplex immunoassay) of 16 cytokines were evaluated. The analysis revealed that women with COPD-BS were shorter and older, and had lower concentrations of 12 serum cytokines: 6 proinflammatory and angiogenic IL-6Rα, PECAM-1, leptin, osteopontin, prolactin, and follistatin; and 6 that participate in angiogenesis and in tumor progression FGF-2, HGF, sVEGFR-2, sHER2/neu, sTIE-2, G-CSF, and SCF. Notably, there was a significant increase in sEGFR in women with COPD-BS compared to women with COPD-TS. PDGF-AA/BB and sTIE-2 did not change. These findings suggest that women with COPD-BS have markedly decreased proinflammatory, angiogenic, and tumor progression potential, compared to women with COPD-TS, with sEGFR as the predominant mediator, which might reflect a differential pattern of inflammation in women exposed to BS, favoring the development of chronic bronchitis.
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Affiliation(s)
- Martha Montaño
- Laboratorio de Biología Celular, Departamento de Investigación en Fibrosis Pulmonar, 42635Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México, México
| | - Oliver Pérez-Bautista
- Departamento de Investigación en Tabaquismo y EPOC, 42635Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, (INER), Ciudad de México, México
| | - Yadira Velasco-Torres
- Laboratorio de Biología Celular, Departamento de Investigación en Fibrosis Pulmonar, 42635Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México, México
| | - Georgina González-Ávila
- Laboratoro de Oncología Biomédica, 42635Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México, México
| | - Carlos Ramos
- Laboratorio de Biología Celular, Departamento de Investigación en Fibrosis Pulmonar, 42635Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México, México
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Pierucci P, Santomasi C, Ambrosino N, Portacci A, Diaferia F, Hansen K, Odemyr M, Jones S, Carpagnano GE. Patient's treatment burden related to care coordination in the field of respiratory diseases. Breathe (Sheff) 2021; 17:210006. [PMID: 34295410 PMCID: PMC8291948 DOI: 10.1183/20734735.0006-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Carla Santomasi
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Andrea Portacci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Fabrizio Diaferia
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Kjeld Hansen
- European Lung Foundation Chair, Sheffield, UK
- Dept of Technology, Kristiana University College Oslo, Norway
| | - Mikaela Odemyr
- European Lung Foundation Council Member and Patient Advisory Committee Chair, Sheffield, UK
| | - Steve Jones
- European Lung Foundation Council Member, Sheffield, UK
- Action for Pulmonary Fibrosis, Peterborough, UK
- EU IPFF, Brussels, Belgium
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
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11
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Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve. ACTA ACUST UNITED AC 2020; 56:medicina56090422. [PMID: 32825456 PMCID: PMC7558424 DOI: 10.3390/medicina56090422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 01/09/2023]
Abstract
Background and objectives: Data about pulmonologist adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines showed a great variability and cannot be extrapolated. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence. Materials and methods: This retrospective study took place between 1 February and 30 April 2018 in Pneumophtysiology Clinical Hospital Cluj-Napoca. We included 348 stable COPD outpatients classified according to the 2017 GOLD strategy in the ABCD risk groups. Pulmonologist adherence was defined as appropriate if the recommended pharmacological therapy was the first- or alternative-choice drug according to the guidelines, and inappropriate (overtreatment, undertreatment) if it was not in line with these recommendations. Results: The most prescribed treatment was the combination long-acting beta agonist (LABA) + long-acting antimuscarinic agent (LAMA) (34.77%), followed by LAMA + LABA + inhaled corticosteroid (ICS). Overall, pneumologist adherence was 79.02%. The most inappropriate therapies were in Group B (33.57%), followed by 33.33% in Group A. Compared to Groups C and D (analyzed together), Groups A and B had a 4.65 times higher chance (p = 0.0000001) of receiving an inappropriate therapy. Patients with cardiovascular comorbidities had a 1.89 times higher risk of receiving an inappropriate therapy (p = 0.021). ICS overprescription was the most common type of inappropriateness (17.81%). Groups C and D had a 3.12 times higher chance of being prescribed ICS compared to Groups A and B (p = 0.0000004). Conclusions: Pulmonologist adherence to the GOLD guidelines is not optimal and needs to be improved. Among the factors that influence the inappropriateness of COPD treatments, cardiovascular comorbidities and low-risk Groups A and B are important. ICS represent the most prescribed overtreatment. Further multicentric studies are needed to evaluate all factors that might influence the adherence rate.
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Halpin DMG, Singh D, Hadfield RM. Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective. Eur Respir J 2020; 55:2001009. [PMID: 32341100 PMCID: PMC7236828 DOI: 10.1183/13993003.01009-2020] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/05/2022]
Abstract
The current coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, raises important questions as to whether pre-morbid use or continued administration of inhaled corticosteroids (ICS) affects the outcomes of acute respiratory infections due to coronavirus. Many physicians are concerned about whether individuals positive for SARS-CoV-2 and taking ICS should continue them or stop them, given that ICS are often regarded as immunosuppressive. A number of key questions arise. Are people with asthma or COPD at increased risk of developing COVID-19? Do ICS modify this risk, either increasing or decreasing it? Do ICS influence the clinical course of COVID-19? (figure 1). Whether ICS modify the risk of developing COVID-19 or the clinical course of COVID-19 in people who do not have lung disease should also be considered (figure 1). There is no evidence on benefits or harms of inhaled steroids in COVID-19. It is essential that epidemiological studies of COVID-19 include detailed information on comorbidities and prior medication to help answer this question. https://bit.ly/2XVwIsa
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Affiliation(s)
- David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
- Global Initiative for Chronic Obstructive Lung Disease (GOLD)
| | - Dave Singh
- Global Initiative for Chronic Obstructive Lung Disease (GOLD)
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ruth M Hadfield
- Global Initiative for Chronic Obstructive Lung Disease (GOLD)
- Macquarie University, Sydney, Australia
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