1
|
Hoang T, Tran Thi Anh T. Comparison of Comorbidities in Relation to Critical Conditions among Coronavirus Disease 2019 Patients: A Network Meta-Analysis. Infect Chemother 2021; 53:13-28. [PMID: 34409779 PMCID: PMC8032911 DOI: 10.3947/ic.2020.0136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Severe illness and poor outcome are mainly associated with aging or certain medical comorbidities, especially chronic diseases. However, factors for unfavorable prognosis have not been well described owing to relatively small sample sizes and single-center reports. Therefore, this study aimed to compare the contribution of comorbidities in the development of critical conditions in coronavirus disease 2019 (COVID-19) patients. Pooled estimates of relative risks (RRs) and their 95% confidence intervals (CIs) were calculated by conducting a meta-analysis and network meta-analysis of 18 studies. Chronic obstructive pulmonary disease (COPD) was most strongly associated with the overall critical condition (RR = 4.22, 95% CI = 3.12 - 5.69), followed by cardiovascular disease (CVD) (RR = 3.00, 95% CI = 2.41 - 3.73), malignancy (RR = 2.91, 95% CI = 2.16 - 3.91), cerebrovascular accident (CVA) (RR = 2.86, 95% CI = 1.95 - 4.19), diabetes (RR = 2.10, 95% CI = 2.16 - 3.91), hypertension (RR = 2.02, 95% CI = 1.82 - 2.23), and chronic kidney disease (RR = 2.00, 95% CI = 1.36 - 2.94). The presence of comorbidities except for chronic liver disease and chronic kidney disease significantly increased the risk of severe infection, intensive care unit (ICU) admission, and cardiac injury in the subgroup analysis by types of critical conditions. Preexisting hypertension and diabetes additionally increased the risk of acute respiratory distress syndrome (ARDS). Among comorbidities, COPD had the highest probability of leading to severe COVID-19, ICU admission, and liver injury, while malignancy was most likely to cause ARDS and cardiac injury. In summary, preexisting COPD, CVD, CVA, hypertension, diabetes, and malignancy are more likely to worsen the progression of COVID-19, with severe infection, ICU admission requirement, and cardiac injury development.
Collapse
Affiliation(s)
- Tung Hoang
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.
| | - Tho Tran Thi Anh
- Department of Gastroenterology and Hepatology, Nghe An Oncology Hospital, Nghe An, Vietnam
| |
Collapse
|
2
|
Recio Iglesias J, López García F, Almagro P, Varela Aguilar JM, Boixeda Viu R. Spanish clinical practice consensus in internal medicine on chronic obstructive pulmonary disease patients with comorbidities (miEPOC). Curr Med Res Opin 2020; 36:1033-1042. [PMID: 32228115 DOI: 10.1080/03007995.2020.1749995] [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] [Indexed: 10/24/2022]
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is one of the diseases that leads to a higher number of hospitalizations in internal medicine departments. These patients are usually older and have greater multimorbidity than COPD patients hospitalized in other departments, which hinders the implementation of clinical guidelines necessarily focused on the management of a single disease.Aims: To ascertain the opinion of Spanish internists on the management of COPD in scenarios in which the available evidence is sparse and to produce a consensus document designed to assist in decision-making in COPD patients with comorbidities treated in internal medicine services.Methods: After identifying the clinical areas of greatest uncertainty by consensus, a survey was designed with 89 questions on the epidemiology and diagnosis of COPD, its management both in stable phase and during decompensation, and the treatment of the associated comorbidities in outpatients and inpatients. The consensus process was carried out using the Delphi method in an anonymized two-round process.Results: The survey was completed by 67 internists experienced in the clinical management of COPD. Of all the questions posed, a consensus was reached for 51 (57.3%) in the first round and for 67 (75.3%) in the second round. The result of the process is a series of 67 suggestions that may assist in the care of these patients.Conclusions: Our study allows us to ascertain the views of a large number of internists experienced in the management of COPD and to learn how the recommendations for guidelines are applied in clinical practice.
Collapse
Affiliation(s)
| | | | - Pere Almagro
- Department of Internal Medicine, Hospital Mutua de Terrassa, Barcelona, Spain
| | - José Manuel Varela Aguilar
- Department of Internal Medicine, CIBER de Epidemiología y Salud Pública, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ramón Boixeda Viu
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| |
Collapse
|
3
|
Challenges to the Application of Integrated, Personalized Care for Patients with COPD-A Vision for the Role of Clinical Information. J Clin Med 2020; 9:jcm9051311. [PMID: 32370150 PMCID: PMC7290491 DOI: 10.3390/jcm9051311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/10/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex disease defined by airflow limitation and characterized by a spectrum of treatable and untreatable pulmonary and extra-pulmonary disease characteristics. Nonpharmacological management related to physical activity, physical capacity, body composition, breathing and energy-saving techniques, coping strategies, and self-management is as important as its pharmacological management. Most patients with COPD carry other chronic diagnoses and this poses a key challenge, as it lowers the quality of life, increases mortality, and impacts healthcare consumption. A personalized, multi-, and interprofessional approach is key. Today, healthcare is poorly organized to meet this complexity with the isolation between care levels, logic silos of the different healthcare professions, and lack of continuity of care along the patient’s journey with the healthcare system. In order to meet the criteria for integrated, personalized care for COPD, the structural capabilities of healthcare to support a comprehensive approach and continuity of care needs improvement. COPD is preeminently a disease that requires a transition from a reactive single-specialty approach to a proactive interprofessional approach. In this study, we discuss the issues that need to be addressed when moving from current health care practice to a person-centered model where the care processes and information are aligned to the individual personal needs of the patient.
Collapse
|
4
|
Jullian-Desayes I, Trzepizur W, Boursier J, Joyeux-Faure M, Bailly S, Benmerad M, Le Vaillant M, Jaffre S, Pigeanne T, Bizieux-Thaminy A, Humeau MP, Alizon C, Goupil F, Costentin C, Gaucher J, Tamisier R, Gagnadoux F, Pépin JL. Obstructive sleep apnea, chronic obstructive pulmonary disease and NAFLD: an individual participant data meta-analysis. Sleep Med 2020; 77:357-364. [PMID: 32843301 DOI: 10.1016/j.sleep.2020.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE Chronic intermittent hypoxia occurring in obstructive sleep apnea (OSA) is independently associated with nonalcoholic fatty liver disease (NAFLD). Chronic obstructive pulmonary disease (COPD) has also been suggested to be linked with liver disease. OBJECTIVE In this individual participant data meta-analysis, we investigated the association between liver damage and OSA and COPD severity. METHODS AND MEASUREMENTS Patients suspected of OSA underwent polysomnography (PSG) or home sleep apnea testing (HSAT). Non-invasive tests were used to evaluate liver steatosis (Hepatic Steatosis Index) and fibrosis (Fibrotest or FibroMeter). An individual participant data meta-analysis approach was used to determine if the severity of OSA/COPD affects the type and severity of liver disease. Results were confirmed by multivariate and causal mediation analysis. Sub-group analyses were performed to investigate specific populations. MAIN RESULTS Among 2120 patients, 1584 had steatosis (75%). In multivariable analysis, risk factors for steatosis were an apnea-hypopnea index (AHI) > 5/h, body mass index (BMI) > 26 kg/m2, age, type 2 diabetes (all p-values <0.01) and male gender (p = 0.02). Concerning fibrosis, among 2218 patients 397 had fibrosis (18%). Risk factors associated with fibrosis were BMI>26 kg/m2, age, male gender, and type 2 diabetes (all p-values <0.01). AHI severity was not associated with fibrosis. A combination of AHI >30/h and COPD stage 1 was associated with an increased risk of steatosis. CONCLUSION This meta-analysis confirms the strong association between steatosis and the severity of OSA. The relation between OSA and fibrosis is mainly due to BMI as shown by causal mediation analysis.
Collapse
Affiliation(s)
- Ingrid Jullian-Desayes
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Wojciech Trzepizur
- Department of Respiratory Diseases, Angers University Hospital, Angers, France; INSERM U1063, SOPAM, Angers University, F-49045, Angers, France
| | - Jérôme Boursier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Marc Le Vaillant
- Institut Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - Sandrine Jaffre
- Institut du Thorax, Department of Respiratory Diseases, Nantes University Hospital, Nantes, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle Santé des Olonnes, Olonne sur Mer, France
| | | | - Marie-Pierre Humeau
- Department of Respiratory Diseases, Nouvelles Cliniques Nantaises, Nantes, France
| | - Claire Alizon
- Department of Respiratory Diseases, General Hospital, Cholet, France
| | - François Goupil
- Department of Respiratory Diseases, General Hospital, Le Mans, France
| | - Charlotte Costentin
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France; INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Jonathan Gaucher
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Frédéric Gagnadoux
- Department of Respiratory Diseases, Angers University Hospital, Angers, France; INSERM U1063, SOPAM, Angers University, F-49045, Angers, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France.
| |
Collapse
|
5
|
Aldibbiat AM, Al-Sharefi A. Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus? Int J Chron Obstruct Pulmon Dis 2020; 15:567-574. [PMID: 32214806 PMCID: PMC7084124 DOI: 10.2147/copd.s236305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/21/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are chronic health conditions with significant impacts on quality and extent of life. People with COPD and DM appear to have worse outcomes in each of the comorbid conditions. Treatment with corticosteroids in acute exacerbation of COPD (AECOPD) has been shown to reduce treatment failure and exacerbation relapse, and to shorten length of hospital stay, but not to affect the inexorable gradual worsening of lung function. Treatment with corticosteroids can lead to a wide spectrum of side effects and complications, including worsening hyperglycemia and deterioration of diabetes control in those with pre-existing DM. The relationship between COPD and DM is rather complex and accumulating evidence indicates a distinct phenotype of the comorbid state. Several randomized controlled trials on corticosteroid treatment in AECOPD excluded people with DM or did not report on outcomes in this subgroup. As such, the perceived benefits of corticosteroids in AECOPD in people with DM have not been validated. In people with COPD and DM, the detrimental side effects of corticosteroids are guaranteed, while the benefits are not confirmed and only presumed based on extrapolation from the general COPD population. Therefore, the potential for harm when prescribing corticosteroids for AECOPD in people with DM cannot be excluded.
Collapse
Affiliation(s)
- Ali M Aldibbiat
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Ahmed Al-Sharefi
- Metabolic and Diabetes Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| |
Collapse
|
6
|
Schuler M, Murauer K, Stangl S, Grau A, Gabriel K, Podger L, Heuschmann PU, Faller H. Pre-post changes in main outcomes of medical rehabilitation in Germany: protocol of a systematic review and meta-analysis of individual participant and aggregated data. BMJ Open 2019; 9:e023826. [PMID: 31154291 PMCID: PMC6549744 DOI: 10.1136/bmjopen-2018-023826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Multidisciplinary, complex rehabilitation interventions are an important part of the treatment of chronic diseases. However, little is known about the effectiveness of routine rehabilitation interventions within the German healthcare system. Due to the nature of the social insurance system in Germany, randomised controlled trials examining the effects of rehabilitation interventions are challenging to implement and scarcely accessible. Consequently, alternative pre-post designs can be employed to assess pre-post effects of medical rehabilitation programmes. We present a protocol of systematic review and meta-analysis methods to assess the pre-post effects of rehabilitation interventions in Germany. METHODS AND ANALYSIS The respective study will be conducted within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic literature review will be conducted to identify studies reporting the pre-post effects (start of intervention vs end of intervention or later) in German healthcare. Studies investigating the following disease groups will be included: orthopaedics, rheumatology, oncology, pulmonology, cardiology, endocrinology, gastroenterology and psychosomatics. The primary outcomes of interest are physical/mental quality of life, physical functioning and social participation for all disease groups as well as pain (orthopaedic and rheumatologic patients only), blood pressure (cardiac patients only), asthma control (patients with asthma only), dyspnoea (patients with chronic obstructive pulmonary disease only) and depression/anxiety (psychosomatic patients only). We will invite the principal investigators of the identified studies to provide additional individual patient data. We aim to perform the meta-analyses using individual patient data as well as aggregate data. We will examine the effects of both study-level and patient-level moderators by using a meta-regression method. ETHICS AND DISSEMINATION Only studies that have received institutional approval from an ethics committee and present anonymised individual patient data will be included in the meta-analysis. The results will be presented in a peer-reviewed publication and at research conferences. A declaration of no objection by the ethics committee of the University of Würzburg is available (number 20180411 01). TRIAL REGISTRATION NUMBER CRD42018080316.
Collapse
Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Kathrin Murauer
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Stephanie Stangl
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Anna Grau
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Katharina Gabriel
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | | | - Peter U Heuschmann
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Comprehensive Heart Failure Center Würzburg, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| |
Collapse
|
7
|
Houben-Wilke S, Triest FJJ, Franssen FME, Janssen DJA, Wouters EFM, Vanfleteren LEGW. Revealing Methodological Challenges in Chronic Obstructive Pulmonary Disease Studies Assessing Comorbidities: A Narrative Review. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:166-177. [PMID: 30974051 DOI: 10.15326/jcopdf.6.2.2018.0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Beyond respiratory impairment, patients with chronic obstructive pulmonary disease (COPD) often suffer from comorbidities which are associated with worse health status, higher health care costs and worse prognosis. Reported prevalences of comorbidities largely differ between studies which might be explained by different assessment methods (objective assessment, self-reported assessment, or assessment by medical records), heterogeneous study populations, inappropriate control groups, incomparable methodologies, etc. This narrative review demonstrates and further evaluates the variability in prevalence of several comorbidities in patients with COPD and control individuals and discusses several shortcomings and pitfalls which need to be considered when interpreting comorbidity data. Like in other chronic organ diseases, the accurate diagnosis and integrated management of comorbidities is a key for outcome in COPD. This review highlights that there is a need to move from the starting point of an established index disease towards the concept of the development of multimorbidity in the elderly including COPD as an important and highly prevalent pulmonary component.
Collapse
Affiliation(s)
- Sarah Houben-Wilke
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Filip J J Triest
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M E Franssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy J A Janssen
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emiel F M Wouters
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lowie E G W Vanfleteren
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,COPD Center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
8
|
Viglino D, Plazanet A, Bailly S, Benmerad M, Jullian-Desayes I, Tamisier R, Leroy V, Zarski JP, Maignan M, Joyeux-Faure M, Pépin JL. Impact of Non-alcoholic Fatty Liver Disease on long-term cardiovascular events and death in Chronic Obstructive Pulmonary Disease. Sci Rep 2018; 8:16559. [PMID: 30410123 PMCID: PMC6224555 DOI: 10.1038/s41598-018-34988-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcoholic Fatty Liver Disease (NAFLD) both independently increase cardiovascular risk. We hypothesized that NAFLD might increase the incidence of cardiovascular disease and death in COPD patients. The relationship between NAFLD, incident cardiovascular events, and death was assessed in a prospective cohort of COPD patients with 5-year follow-up. Noninvasive algorithms combining biological parameters (FibroMax®) were used to evaluate steatosis, non-alcoholic steatohepatitis (NASH) and liver fibrosis. Univariate and multivariate Cox regression models were used to assess the hazard for composite outcome at the endpoint (death or cardiovascular event) for each liver pathology. In 111 COPD patients, 75% exhibited liver damage with a prevalence of steatosis, NASH and fibrosis of 41%, 37% and 61%, respectively. During 5-year follow-up, 31 experienced at least one cardiovascular event and 7 died. In univariate analysis, patients with liver fibrosis had more cardiovascular events and higher mortality (Hazard ratio [95% CI]: 2.75 [1.26; 6.03]) than those with no fibrosis; this remained significant in multivariate analysis (Hazard ratio [95% CI]: 2.94 [1.18; 7.33]). We also found that steatosis and NASH were not associated with increased cardiovascular events or mortality. To conclude, early assessment of liver damage might participate to improve cardiovascular outcomes in COPD patients.
Collapse
Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Anais Plazanet
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Sebastien Bailly
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Meriem Benmerad
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Vincent Leroy
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Jean-Pierre Zarski
- Hepatogastroenterology Department, Grenoble Alpes University Hospital, Grenoble, France
- INSERM U823, IAPC Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France
| | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, Grenoble, France
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
- EFCR Laboratory, Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France.
| |
Collapse
|
9
|
Kahn N, Vanfleteren LEGW, Kaltsakas G, Andrianopoulos V, Gompelmann D, de Jong C, Herth FJF. Preview of highlighted presentations from the European Respiratory Society' clinical assembly. J Thorac Dis 2018; 10:S3034-S3042. [PMID: 30310696 PMCID: PMC6174136 DOI: 10.21037/jtd.2018.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Nicolas Kahn
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Gompelmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Corina de Jong
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| |
Collapse
|
10
|
Divo MJ, Celli BR, Poblador-Plou B, Calderón-Larrañaga A, de-Torres JP, Gimeno-Feliu LA, Bertó J, Zulueta JJ, Casanova C, Pinto-Plata VM, Cabrera-Lopez C, Polverino F, Carmona Píréz J, Prados-Torres A, Marin JM. Chronic Obstructive Pulmonary Disease (COPD) as a disease of early aging: Evidence from the EpiChron Cohort. PLoS One 2018; 13:e0193143. [PMID: 29470502 PMCID: PMC5823454 DOI: 10.1371/journal.pone.0193143] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aging is an important risk factor for most chronic diseases. Patients with COPD develop more comorbidities than non-COPD subjects. We hypothesized that the development of comorbidities characteristically affecting the elderly occur at an earlier age in subjects with the diagnosis of COPD. METHODS AND FINDINGS We included all subjects carrying the diagnosis of COPD (n = 27,617), and a similar number of age and sex matched individuals without the diagnosis, extracted from the 727,241 records of individuals 40 years and older included in the EpiChron Cohort (Aragon, Spain). We compared the cumulative number of comorbidities, their prevalence and the mortality risk between both groups. Using network analysis, we explored the connectivity between comorbidities and the most influential comorbidities in both groups. We divided the groups into 5 incremental age categories and compared their comorbidity networks. We then selected those comorbidities known to affect primarily the elderly and compared their prevalence across the 5 age groups. In addition, we replicated the analysis in the smokers' subgroup to correct for the confounding effect of cigarette smoking. Subjects with COPD had more comorbidities and died at a younger age compared to controls. Comparison of both cohorts across 5 incremental age groups showed that the number of comorbidities, the prevalence of diseases characteristic of aging and network's density for the COPD group aged 56-65 were similar to those of non-COPD 15 to 20 years older. The findings persisted after adjusting for smoking. CONCLUSION Multimorbidity increases with age but in patients carrying the diagnosis of COPD, these comorbidities are seen at an earlier age.
Collapse
Affiliation(s)
- Miguel J. Divo
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Instituto Investigación Sanitaria Aragón (IISAragón), REDISSEC (ISCIII), Hospital Universitario Miguel Servet University Hospital, Zaragoza, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Instituto Investigación Sanitaria Aragón (IISAragón), REDISSEC (ISCIII), Hospital Universitario Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Luis A. Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Instituto Investigación Sanitaria Aragón (IISAragón), REDISSEC (ISCIII), Hospital Universitario Miguel Servet University Hospital, Zaragoza, Spain
| | - Juan Bertó
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Carretera del Rosario, Santa Cruz de Tenerife, Spain
| | - Victor M. Pinto-Plata
- Pulmonary and Critical Care Division, Baystate Medical Center, Springfield, Massachusetts, United States of America
| | - Carlos Cabrera-Lopez
- Pulmonary Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canarias, Spain
| | - Francesca Polverino
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jonás Carmona Píréz
- EpiChron Research Group on Chronic Diseases, Instituto Investigación Sanitaria Aragón (IISAragón), REDISSEC (ISCIII), Hospital Universitario Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Instituto Investigación Sanitaria Aragón (IISAragón), REDISSEC (ISCIII), Hospital Universitario Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose M. Marin
- Pulmonary Department, Hospital Universitario Miguel Servet, IISAragón & CIBERES, Zaragoza, Spain
| | | |
Collapse
|
11
|
Shindi R, Almehairi A, Negm OH, Kalsheker N, Gale NS, Shale DJ, Harrison TW, Bolton CE, John M, Todd I, Tighe PJ, Fairclough LC. Autoantibodies of IgM and IgG classes show differences in recognition of multiple autoantigens in chronic obstructive pulmonary disease. Clin Immunol 2017; 183:344-353. [DOI: 10.1016/j.clim.2017.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/10/2017] [Accepted: 09/22/2017] [Indexed: 12/22/2022]
|
12
|
van Boven JFM. Costly comorbidities of COPD: the ignored side of the coin? Eur Respir J 2017; 50:50/1/1700917. [PMID: 28751418 DOI: 10.1183/13993003.00917-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Job F M van Boven
- Dept of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands .,Unit of PharmacoEpidemiology and PharmacoEconomics, Dept of Pharmacy, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
13
|
Viglino D, Jullian-Desayes I, Minoves M, Aron-Wisnewsky J, Leroy V, Zarski JP, Tamisier R, Joyeux-Faure M, Pépin JL. Nonalcoholic fatty liver disease in chronic obstructive pulmonary disease. Eur Respir J 2017; 49:49/6/1601923. [DOI: 10.1183/13993003.01923-2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/23/2017] [Indexed: 12/18/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is independently linked to cardiometabolic morbidity and mortality. Low-grade inflammation, oxidative stress and ectopic fat, common features of chronic obstructive pulmonary disease (COPD), might contribute to the development of NAFLD.We aimed to investigate the prevalence of NAFLD and to evaluate the relationship between various types of liver damage and COPD severity, comorbidities and circulating inflammatory cytokines. Validated noninvasive tests (FibroMax: SteatoTest, NashTest and FibroTest) were used to assess steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Patients underwent an objective assessment of COPD comorbidities, including sleep studies. Biological parameters included a complete lipid profile and inflammatory markers.In COPD patients the prevalence of steatosis, NASH and fibrosis were 41.4%, 36.9% and 61.3%, respectively. In multivariate analysis, SteatoTest and FibroTest were significantly associated with sex, body mass index (BMI), untreated sleep apnoea and insulin resistance, and, in addition, COPD Global Initiative for Chronic Obstructive Lung Disease stage for SteatoTest. Patients with steatosis had higher tumour necrosis factor-α levels and those with NASH or a combination of liver damage types had raised leptin levels after adjustment for age, sex and BMI.We concluded that NAFLD is highly prevalent in COPD and might contribute to cardiometabolic comorbidities.
Collapse
|
14
|
Koblizek V, Milenkovic B, Barczyk A, Tkacova R, Somfay A, Zykov K, Tudoric N, Kostov K, Zbozinkova Z, Svancara J, Sorli J, Krams A, Miravitlles M, Valipour A. Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study. Eur Respir J 2017; 49:1601446. [PMID: 28495687 PMCID: PMC5460642 DOI: 10.1183/13993003.01446-2016] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/10/2016] [Indexed: 12/16/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma-COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma-COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.
Collapse
Affiliation(s)
- Vladimir Koblizek
- Dept of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Faculty of Medicine, Clinical Centre of Serbia, Belgrade, Serbia
| | - Adam Barczyk
- Dept of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ruzena Tkacova
- Dept of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
| | - Attila Somfay
- Dept of Pulmonology, University of Szeged, Deszk, Hungary
| | - Kirill Zykov
- Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I.Evdokimov, Moscow, Russia
| | - Neven Tudoric
- School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia
| | - Kosta Kostov
- Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Svancara
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jurij Sorli
- Pulmonary Dept, Topolsica Hospital, Topolsica, Slovenia
| | - Alvils Krams
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Arschang Valipour
- Dept of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| |
Collapse
|
15
|
Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? Breathe (Sheff) 2017; 13:e1-e9. [PMID: 29184593 PMCID: PMC5702891 DOI: 10.1183/20734735.001417] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/09/2022] Open
Abstract
Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. EDUCATIONAL AIMS To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction.To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy.To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment.
Collapse
Affiliation(s)
- Vasileios Andrianopoulos
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
| | - Rainer Gloeckl
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ioannis Vogiatzis
- Dept of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Dept of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Klaus Kenn
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
| |
Collapse
|
16
|
Multiple Circulating Cytokines Are Coelevated in Chronic Obstructive Pulmonary Disease. Mediators Inflamm 2016; 2016:3604842. [PMID: 27524865 PMCID: PMC4976159 DOI: 10.1155/2016/3604842] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/23/2016] [Indexed: 01/05/2023] Open
Abstract
Inflammatory biomarkers, including cytokines, are associated with COPD, but the association of particular circulating cytokines with systemic pathology remains equivocal. To investigate this, we developed a protein microarray system to detect multiple cytokines in small volumes of serum. Fourteen cytokines were measured in serum from never-smokers, ex-smokers, current smokers, and COPD patients (GOLD stages 1–3). Certain individual circulating cytokines (particularly TNFα and IL-1β) were significantly elevated in concentration in the serum of particular COPD patients (and some current/ex-smokers without COPD) and may serve as markers of particularly significant systemic inflammation. However, numerous circulating cytokines were raised such that their combined, but not individual, elevation was significantly associated with severity of disease, and these may be further indicators of, and contributors to, the systemic inflammatory manifestations of COPD. The coelevation of numerous circulating cytokines in COPD is consistent with the insidious development, chronic nature, and systemic comorbidities of the disease.
Collapse
|