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Ellis P, Parekh G, Duvoix A, Watson L, Sharp A, Mobeen F, Pye A, Stockley R, Turner A. Characteristics of alpha-1 antitrypsin deficiency related lung disease exacerbations using a daily symptom diary and urinary biomarkers. PLoS One 2024; 19:e0297125. [PMID: 38306339 PMCID: PMC10836691 DOI: 10.1371/journal.pone.0297125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Pulmonary exacerbations in alpha-1 antitrypsin deficiency (AATD) related lung disease are a significant contributor to disease burden, as with usual COPD. Separating the early stages of an exacerbation from the day-to-day variation in stable COPD is central to the concerns of both clinicians and patients and has been identified as a research priority by NIHR. Clinical tools that distinguish baseline symptoms from those of an exacerbation could allow early and appropriate treatment of AECOPD to reduce the impact and potentially may slow disease progression thereby improving survival and quality of life. Candidate tools include symptom diaries and biomarkers of infection and acute inflammation. Urinary biomarkers of AECOPD have yet to be explored in AATD related COPD. METHODS 55 patients with AATD related lung disease with a history of 2 or more AECOPD in the preceding year were prospectively followed for 18 months. Each patient recorded symptom scores daily via an electronic symptom diary (eDiary) based on Bronkotest. Urinary biomarkers for AAT, NE, CRP, TIMP1 and desmosine were measured weekly using a home urinary lateral flow device. During self-reported AECOPD patients were asked to perform urine analysis on the first 7 consecutive days. RESULTS Type I Anthonisen exacerbations and episodes occurring in autumn/winter lasted longer than Type II/III exacerbations and spring/summer episodes respectively. Median urinary CRP concentration across all study participants increased during Type I AECOPD. eDiary adherence was 68% over a median of 17.8 months (IQR 15.7 to 18.5). CONCLUSIONS Use of an eDiary and urinary biomarkers to detect and characterise AECOPD remotely in AATD related lung disease is feasible over a prolonged period and paves the way for precision detection of exacerbations.
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Affiliation(s)
- Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Gita Parekh
- Mologic Ltd, Thurleigh, Bedford, United Kingdom
| | | | | | - Alex Sharp
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Farah Mobeen
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Robert Stockley
- Institute of Inflammation and Aging, University of Birmingham, Birmingham, United Kingdom
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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2
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Hering T, Krinner A, Bulenda D. [Validation study of MEP questionnaire for simplified detection of exacerbation of chronic obstructive pulmonary disease]. Pneumologie 2022; 76:671-678. [PMID: 36257306 PMCID: PMC9578762 DOI: 10.1055/a-1925-7281] [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] [Indexed: 11/25/2022]
Abstract
The Questionnaire "Monitoring of Exacerbation Probability" (MEP) provides a novel simple tool to assist detection and semiquantitative numerical documentation of exacerbation (ECOPD) in daily routine. In a prospective multi-center trial involving 3751 visits of 810 patients in 21 centers, MEP was evaluated and compared to the application of the EXACT-Pro questionnaire under real world conditions. The population of COPD patients included in this study is a typical COPD population demographically and clinically. Defining a MEP score of one or more as a positive test result, we found a sensitivity of 91% and a specificity of 66%. Additionally, MEP results correlated clearly with EXACT-Pro results. This qualifies the MEP questionnaire as a valid tool for the detection of ECOPD and longitudinal characterization of COPD patients.
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Affiliation(s)
- Thomas Hering
- Pneumologie, Lungenarztpraxis Tegel, Berlin, Deutschland,Korrespondenzadresse Thomas Hering Lungenarztpraxis Tegel, PneumologieSchloßstraße 513507 BerlinDeutschland
| | - Axel Krinner
- Statistik, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung WIG2 GmbH, Leipzig, Deutschland
| | - Dietmar Bulenda
- Medizin, med wiss Gesellschaft für Versorgungsforschung in der Medizin mbH, Günzburg, Deutschland
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3
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Celli BR, Fabbri LM, Aaron SD, Agusti A, Brook R, Criner GJ, Franssen FME, Humbert M, Hurst JR, O'Donnell D, Pantoni L, Papi A, Rodriguez-Roisin R, Sethi S, Torres A, Vogelmeier CF, Wedzicha JA. An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal. Am J Respir Crit Care Med 2021; 204:1251-1258. [PMID: 34570991 DOI: 10.1164/rccm.202108-1819pp] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leonardo M Fabbri
- Section of Respiratory Medicine, Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alvar Agusti
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | | | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Université Paris-Saclay and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 999, Le Kremlin-Bicêtre, France
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Denis O'Donnell
- Respiratory Investigation Unit, Queens University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Alberto Papi
- Section of Respiratory Medicine, University of Ferrara, Ferrara, Italy.,Emergency Department, St. Anna University Hospital, Ferrara, Italy
| | - Roberto Rodriguez-Roisin
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sanjay Sethi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Antoni Torres
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats Acadèmia, Centre d'Investigació Biomèdica en Xarxa de Malalties Respiratòries, Barcelona, Spain
| | - Claus F Vogelmeier
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Center of Giessen and Marburg, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany; and
| | - Jadwiga A Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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4
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Halıcı A, Hür İ, Abatay K, Çetin E, Halıcı F, Özkan S. The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia. Biomark Med 2019; 14:31-41. [PMID: 31701761 DOI: 10.2217/bmm-2019-0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Patients & methods: Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Results: Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Conclusion: Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.
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Affiliation(s)
- Ali Halıcı
- Department of Emergency Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training & Research Hospital, 06145, Ankara, Turkey
| | - İzzettin Hür
- Department of Emergency Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training & Research Hospital, 06145, Ankara, Turkey
| | - Kerim Abatay
- Department of Emergency Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training & Research Hospital, 06145, Ankara, Turkey
| | - Esra Çetin
- Department of Biochemistry, University of Health Sciences, Diskapi Yildirim Beyazit Training & Research Hospital, 06145, Ankara, Turkey
| | - Filiz Halıcı
- Department of Family Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training & Research Hospital, 06145, Ankara, Turkey
| | - Seda Özkan
- Department of Emergency Medicine, University of Istanbul-Cerrahpasa, Faculty of Medical, 34098, Istanbul, Turkey
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Liu F, Zou Y, Huang Q, Zheng L, Wang W. Electronic health records and improved nursing management of chronic obstructive pulmonary disease. Patient Prefer Adherence 2015; 9:495-500. [PMID: 25848228 PMCID: PMC4376268 DOI: 10.2147/ppa.s76562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper identifies evolving trends in the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), and recommends the integration of nursing strategies in COPD management via widespread implementation of electronic health records. COPD is a complex lung disease with diverse origins, both physical and behavioral, manifested in a wide range of symptoms that further increase the patient's risk for comorbidities. Early diagnosis and effective management of COPD require monitoring of a dizzying array of COPD symptoms over extended periods of time, and nurses are especially well positioned to manage potential progressions of COPD, as frontline health care providers who obtain, record, and organize patient data. Developments in medical technology greatly aid nursing management of COPD, from the deployment of spirometry as a diagnostic tool at the family practice level to newly approved treatment options, including non-nicotine pharmacotherapies that reduce the cravings associated with tobacco withdrawal. Among new medical technologies, electronic health records have proven particularly advantageous in the management of COPD, enabling providers to gather, maintain, and reference more patient data than has ever been possible before. Thus, consistent and widespread implementation of electronic health records facilitates the coordination of diverse treatment strategies, resulting in increased positive health outcomes for patients with COPD.
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Affiliation(s)
- Fengping Liu
- Yancheng Medical College, Yancheng, Jiangsu Province, People’s Republic of China
| | - Yeqing Zou
- Yancheng Medical College, Yancheng, Jiangsu Province, People’s Republic of China
| | - Qingmei Huang
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Li Zheng
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Wei Wang
- The First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
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Kocks JWH, van den Berg JWK, Kerstjens HAM, Uil SM, Vonk JM, de Jong YP, Tsiligianni IG, van der Molen T. Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:273-86. [PMID: 23766644 PMCID: PMC3678711 DOI: 10.2147/copd.s43992] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes. Methods Data from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George’s Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study. Results All patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar. Conclusion Daily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD.
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Affiliation(s)
- Jan Willem H Kocks
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Agustí A, Barnes PJ. Update in chronic obstructive pulmonary disease 2011. Am J Respir Crit Care Med 2012; 185:1171-6. [PMID: 22661523 DOI: 10.1164/rccm.201203-0505up] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alvar Agustí
- Institut del Torax, Hospital Clinic, Villarroel 170, Barcelona, Spain.
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