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Lapi F, Marconi E, Lombardo FP, Cricelli I, Ansaldo E, Gorini M, Micheletto C, Di Marco F, Cricelli C. Development and validation of a prediction score to assess the risk of incurring in COPD-related exacerbations: a population-based study in primary care. Respir Med 2024; 227:107634. [PMID: 38621547 DOI: 10.1016/j.rmed.2024.107634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the fourth most important cause of death in high-income countries. Inappropriate use of COPD inhaled therapy, including the low adherence (only 10 %-40 % of patients reporting an adequate compliance) may shrink or even nullify the proven benefits of these medications. As such, an accurate prediction algorithm to assess at national level the risk of COPD exacerbation might be relevant for general practictioners (GPs) to improve patient's therapy. METHODS We formed a cohort of patients aged 45 years or older being diagnosed with COPD in the period between January 2013 to December 2021. Each patient was followed until occurrence of COPD exacerbation up to the end of 2021. Sixteen determinants were adopted to assemble the CopdEX(CEX)-Health Search(HS)core, which was therefore developed and validated through the related two sub-cohorts. RESULTS We idenfied 63763 patients aged 45 years or older being diagnosed with COPD (mean age: 67.8 (SD:11.7); 57.7 % males).When the risk of COPD exacerbation was estimated via CEX-HScore, its predicted value was equal to 14.22 % over a 6-month event horizon. Discrimination accuracy and explained variation were equal to 66 % (95 % CI: 65-67 %) and 10 % (95 % CI: 9-11 %), respectively. The calibration slope did not significantly differ from the unit (p = 0.514). CONCLUSIONS The CEX-HScore was featured by fair accuracy for prediction of COPD-related exacerbations over a 6-month follow-up. Such a tool might therefore support GPs to enhance COPD patients' care, and improve their outcomes by facilitating personalized approaches through a score-based decision support system.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | | | | | | | | | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Scurek M, Brat K. A narrative review of theophylline: is there still a place for an old friend? J Thorac Dis 2024; 16:3450-3460. [PMID: 38883616 PMCID: PMC11170423 DOI: 10.21037/jtd-23-1781] [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: 11/19/2023] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective Theophylline has been used for decades in human medicine for its psychostimulant, anti-inflammatory, and bronchodilator effects. Historically, in pulmonary medicine, theophylline has been used in the treatment of obstructive pulmonary diseases such as bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD). This review aims to determine whether theophylline still has its place in the therapy of obstructive pulmonary diseases or whether we can even extend its use to other diagnoses such as atropine-resistant cardiac arrests, apnea of prematurity, or others. Moreover, we also aim to determine if there is a rationale for using low-dose theophylline due to its immunomodulatory and anti-inflammatory effect, or if the future of methylxanthines lies in newly synthesized derivates of theophylline such as bamifylline, or doxofylline. Methods The narrative review is based on a literature search of the articles indexed in the PubMed database in 2023. We searched the database since the year 2009 using the MeSH terms "theophylline", "aminophylline", and "methylxanthines" and we included original articles in the English language. Key Content and Findings Theophylline has a number of adverse drug reactions (ADRs), the most serious of which is its effect on the cardiovascular system. It can cause severe arrhythmias or even cardiac arrest when overdosed. On the other hand, there is still a substantial amount of its applications in current clinical practice. Conclusions There is considerable controversy associated with its use in current medicine, which can be attributed both to its narrow therapeutic range and its mentioned cardiotoxic effect. Herein, we summarize the current state-of-art of theophylline and its use in human medicine.
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Affiliation(s)
- Martin Scurek
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
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Rodrigues Sousa S, Nunes Caldeira J, Rodrigues C. COPD phenotypes by computed tomography and ventilatory response to exercise. Pulmonology 2024; 30:222-229. [PMID: 35120868 DOI: 10.1016/j.pulmoe.2022.01.002] [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: 10/17/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Computed tomographic (CT) phenotypic patterns of chronic obstructive pulmonary disease (COPD) identify different clinical features of disease. The impact of these variables on the physiological response to exercise has been the focus of a great deal of research as it allows more individualized clinical approaches. The aim of our study was to evaluate the relationships between CT phenotyping of subjects with COPD and the ventilatory response during cardiopulmonary exercise testing (CPET). METHODS Subjects with COPD were classified into four phenotypes based on CT metrics of emphysema (low attenuation area less than a threshold of -950 Hounsfield [%LAA-950]) and airwall thickness (bronchial wall area percentage [%WA]). RESULTS Eighty COPD patients (78.8% males, median age 65±11.3 years) were enrolled in the study. Based on CT phenotype, 25 (31.3%) patients were classified as normal, 27 (33.8%) air dominant, 17 (21.3%) emphysema dominant and 11 (13.8%) mixed type. The emphysema and mixed phenotypes showed the highest ventilatory equivalent for carbon dioxide (VE/VCO2) and VE/VCO2 slope (p<0,05). In all phenotypes, %LAA was positive correlated with VE/VCO2 and VE/VCO2 slope (r = 0.437, p = 0.006 and r = 0.503, p<0.001, respectively). %WA also showed a positive correlation with VE/VCO2 and VE/VCO2 slope (r = 0.541, p<0.001 and r = 0.299, p = 0.033, respectively). In multivariate regression models, after adjustment for age, BMI, sex and FEV1, %LAA was the only independent predictor of VE/VCO2 and VE/VCO2 slope (β 0.343, SE 0.147, 95% CI 0.009/0.610, p = 0.044 and β 0.496, SE 0.081, 95% CI 0.130/0.455, p = 0.001, respectively). CONCLUSION Emphysema (%LAA) and airways metrics (%WA) had strong relationships with the different characteristics of ventilatory response to exercise in subjects with mild to moderate COPD. In particular, %LAA seemed to play an important role as an independent predictor of VE/VCO2 and VE/VCO2 slope. These results suggested that CT phenotyping may help predicting ventilatory response to exercise in subjects with COPD.
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Affiliation(s)
- S Rodrigues Sousa
- Pulmonology Department, Coimbra University Hospital, Coimbra, Portugal.
| | - J Nunes Caldeira
- Pulmonology Department, Coimbra University Hospital, Coimbra, Portugal
| | - C Rodrigues
- Pulmonology Department, Coimbra University Hospital, Coimbra, Portugal
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Brockway K, Ahmed S. Beyond breathing: Systematic review of global chronic obstructive pulmonary disease guidelines for pain management. Respir Med 2024; 224:107553. [PMID: 38350512 DOI: 10.1016/j.rmed.2024.107553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Patients with chronic obstructive pulmonary disease (COPD) experience pain as both symptom and comorbidity. There has been no evaluation of the recommendations for pain management in updated clinical practice guidelines (CPGs). OBJECTIVES Update the evidence on pain management, determine alignment of pain management recommendations with best-practice, and advocate for optimal pain management in patients with COPD. METHODS PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, Institute of Medicine, grey literature, national websites, and bibliographies were searched. CPGs available online for stable COPD produced by organizations representing reputable knowledge of COPD management were included. CPGs unavailable online, not translatable into English, or not including techniques within the defined scope were excluded. Researchers performed frequency counts for the verbatim terms "pain," "physical activity," "exercise," "rehabilitation," "physical therap(ist)/(y), "physiotherap(ist)/(y)," recorded context, and collected recommendations for pain management/treatment when present. RESULTS Of 32 CPGs, 24 included "pain" verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs referred to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing. CONCLUSIONS Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden is necessary. Pain management should include referrals to providers who can maximize benefit of their services.
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Affiliation(s)
- Kaelee Brockway
- University of St. Augustine for Health Sciences, 901 W. Walnut Hill Ln, Ste 210, Irving, TX, USA.
| | - Shakeel Ahmed
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
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Kim BS, Park SH, Jung SS, Kim HJ, Woo SD, Lee MM. Validity Study for Clinical Use of Hand-Held Spirometer in Patients with Chronic Obstructive Pulmonary Disease. Healthcare (Basel) 2024; 12:507. [PMID: 38470618 PMCID: PMC10930597 DOI: 10.3390/healthcare12050507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
A spirometer is a medical device frequently used clinically for the diagnosis and prediction of lung disease. This study aimed to investigate the clinical usefulness of a hand-held spirometer (The Spirokit), compared with conventional spirometry in patients with chronic obstructive pulmonary disease (COPD). This study was conducted from February 2022 to October 2022. Measurements from 80 patients with COPD (male: 53, female: 27) were obtained using The Spirokit and PC-based pulmonary function test equipment, and the resulting values were compared and analyzed. For the concurrent validity comparison of The Spirokit, the intra-class correlation (ICC 2, 1), coefficients of variation (CVME), 95% limits of agreement (95% LOA), and Cohen's Kappa Index were analyzed. The Spirokit showed high agreement (ICC: 0.929-0.989; 95% LOA: -0.525 to 2.559; and CVME: 0.05-0.08) with the PC-based pulmonary function tester. Using the Cohen's kappa coefficients, the device showed high sensitivity, specificity, and accuracy scores of Pa: 0.90, Pc: 0.52, and K: 0.79, respectively, indicating considerable agreement. The Spirokit, a portable pulmonary function test device, is a piece of equipment with high validity and portability, with high potential for replacing PC-based pulmonary function test equipment.
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Affiliation(s)
- Byeong-Soo Kim
- Department of Physical Therapy, Daejeon University, Daejeon 34520, Republic of Korea; (B.-S.K.); (S.-H.P.)
| | - Sam-Ho Park
- Department of Physical Therapy, Daejeon University, Daejeon 34520, Republic of Korea; (B.-S.K.); (S.-H.P.)
| | - Sung-Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.-S.J.); (S.-D.W.)
| | - Hong-Jun Kim
- Department of Computer Engineering, Daejeon University, Daejeon 34520, Republic of Korea;
| | - Seong-Dae Woo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (S.-S.J.); (S.-D.W.)
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon 34520, Republic of Korea; (B.-S.K.); (S.-H.P.)
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6
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Waeijen-Smit K, Crutsen M, Keene S, Miravitlles M, Crisafulli E, Torres A, Mueller C, Schuetz P, Ringbæk TJ, Fabbian F, Mekov E, Harries TH, Lun CT, Ergan B, Esteban C, Quintana Lopez JM, López-Campos JL, Chang CL, Hancox RJ, Shafuddin E, Ellis H, Janson C, Suppli Ulrik C, Gudmundsson G, Epstein D, Dominguez J, Lacoma A, Osadnik C, Alia I, Spannella F, Karakurt Z, Mehravaran H, Utens C, de Kruif MD, Ko FWS, Trethewey SP, Turner AM, Bumbacea D, Murphy PB, Vermeersch K, Zilberman-Itskovich S, Steer J, Echevarria C, Bourke SC, Lane N, de Batlle J, Sprooten RTM, Russell R, Faverio P, Cross JL, Prins HJ, Spruit MA, Simons SO, Houben-Wilke S, Franssen FME. Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients. ERJ Open Res 2024; 10:00838-2023. [PMID: 38410700 PMCID: PMC10895439 DOI: 10.1183/23120541.00838-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 02/28/2024] Open
Abstract
Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event. Conclusions This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.
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Affiliation(s)
- Kiki Waeijen-Smit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Mieke Crutsen
- Pulmonary Function and Exercise Testing Laboratory, MUMC+, Maastricht, the Netherlands
| | - Spencer Keene
- Department of Research and Development, Ciro, Horn, the Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Pharmacy and Toxicology, MUMC+, Maastricht, the Netherlands
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona and University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Institución Catalana de Investigación y Estudios Avanzados, CIBERES, Barcelona, Spain
| | - Christian Mueller
- Cardiovascular Research Institute Base, Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Thomas J Ringbæk
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Fabio Fabbian
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Evgeni Mekov
- Department of Occupational Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Timothy H Harries
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Chung-Tat Lun
- Department of Medicine and ICU, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Begum Ergan
- Dokuz Eylul University, Faculty of Medicine, Department of Pulmonary and Critical Care, Division of Critical Care, Izmir, Turkey
| | - Cristóbal Esteban
- Respiratory Department, Hospital Galdakao, Galdakao, Spain
- Instituto BioCruces-Bizkaia, Barakaldo, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
| | - Jose M Quintana Lopez
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Catherina L Chang
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Hollie Ellis
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Gunnar Gudmundsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - José Dominguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | - Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | | | - Inmaculada Alia
- Intensive Care Units, Hospital Universitario de Getafe, CIBERES, Getafe, Spain
| | - Francesco Spannella
- Internal Medicine and Geriatrics, Hypertension Excellence Centre of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica delle Marche, Ancona, Italy
| | - Zuhal Karakurt
- Respiratory Critical Care Unit, University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hossein Mehravaran
- Pulmonary and Critical Care Division, Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Cecile Utens
- Libra, Rehabilitation and Audiology, Eindhoven, the Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel P Trethewey
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- University of Exeter, Exeter, UK
| | - Alice M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dragos Bumbacea
- Department of Pneumology and Acute Respiratory Care, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Patrick B Murphy
- Lane Fox Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College, London, UK
| | - Kristina Vermeersch
- Department of Chronic Diseases, Metabolism and Ageing, Research Group BREATHE, KU Leuven, Leuven, Belgium
| | - Shani Zilberman-Itskovich
- Nephrology Division, Assaf-Harofeh (Shamir) Medical Center, Be'er Ya'akov, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - John Steer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Carlos Echevarria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen C Bourke
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Nicholas Lane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (Fundació Dr Pifarré), Lleida, Spain
- CIBERES, Madrid, Spain
| | - Roy T M Sprooten
- Department of Respiratory Medicine, MUMC+, Maastricht, The Netherlands
| | - Richard Russell
- School of Immunology and Microbial Sciences, Guy's Campus, Kings College, London, UK
| | - Paola Faverio
- School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Jane L Cross
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Hendrik J Prins
- Department of PMR, Libra, Rehabilitation and Audiology, Eindhoven, The Netherlands
- Department of PMR, Anna Hospital, Geldrop, The Netherlands
- Department of PMR, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | | | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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van Nijnatten J, Faiz A, Timens W, Guryev V, Slebos DJ, Klooster K, Hartman JE, Kole T, Choy DF, Chakrabarti A, Grimbaldeston M, Rosenberger CM, Kerstjens H, Brandsma CA, van den Berge M. A bronchial gene signature specific for severe COPD that is retained in the nose. ERJ Open Res 2023; 9:00354-2023. [PMID: 38020574 PMCID: PMC10680034 DOI: 10.1183/23120541.00354-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction A subset of COPD patients develops advanced disease with severe airflow obstruction, hyperinflation and extensive emphysema. We propose that the pathogenesis in these patients differs from mild-moderate COPD and is reflected by bronchial gene expression. The aim of the present study was to identify a unique bronchial epithelial gene signature for severe COPD patients. Methods We obtained RNA sequencing data from bronchial brushes from 123 ex-smokers with severe COPD, 23 with mild-moderate COPD and 23 non-COPD controls. We identified genes specific to severe COPD by comparing severe COPD to non-COPD controls, followed by removing genes that were also differentially expressed between mild-moderate COPD and non-COPD controls. Next, we performed a pathway analysis on these genes and evaluated whether this signature is retained in matched nasal brushings. Results We identified 219 genes uniquely differentially expressed in severe COPD. Interaction network analysis identified VEGFA and FN1 as the key genes with the most interactions. Genes were involved in extracellular matrix regulation, collagen binding and the immune response. Of interest were 10 genes (VEGFA, DCN, SPARC, COL6A2, MGP, CYR61, ANXA6, LGALS1, C1QA and C1QB) directly connected to fibronectin 1 (FN1). Most of these genes were lower expressed in severe COPD and showed the same effect in nasal brushings. Conclusions We found a unique severe COPD bronchial gene signature with key roles for VEGFA and FN1, which was retained in the upper airways. This supports the hypothesis that severe COPD, at least partly, comprises a different pathology and supports the potential for biomarker development based on nasal brushes in COPD.
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Affiliation(s)
- Jos van Nijnatten
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Technology Sydney, Respiratory Bioinformatics and Molecular Biology, Sydney, NSW, Australia
| | - Alen Faiz
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Technology Sydney, Respiratory Bioinformatics and Molecular Biology, Sydney, NSW, Australia
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Wim Timens
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Victor Guryev
- University of Groningen University Medical Center Groningen, European Research Institute for the Biology of Ageing, Groningen, the Netherlands
| | - Dirk-Jan Slebos
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Karin Klooster
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Jorine E. Hartman
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Tessa Kole
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | | | | | | | | | - Huib Kerstjens
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- These authors contributed equally
| | - Maarten van den Berge
- University of Groningen University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- University of Groningen University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
- These authors contributed equally
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8
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Woo H, Numano N, Fujisawa R, Kobayashi M, Kawamura K, Tomita K. Influence of upright exercise with external thoracic and pelvic compression on thoracic expansion and respiratory function in healthy young adults: A pilot study. J Bodyw Mov Ther 2023; 36:357-363. [PMID: 37949584 DOI: 10.1016/j.jbmt.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Hyunjae Woo
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan.
| | - Narumi Numano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Ryota Fujisawa
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Masaaki Kobayashi
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Kenta Kawamura
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan; Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
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9
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Kocks J, Ferreira AJ, Bakke P, van Schayck OCP, Ekroos H, Tzanakis N, Soulard S, Haaksma-Herczegh M, Mestres-Simon M, Águila-Fuentes M, Cataldo D. Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study. NPJ Prim Care Respir Med 2023; 33:18. [PMID: 37137900 PMCID: PMC10154184 DOI: 10.1038/s41533-023-00334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/20/2023] [Indexed: 05/05/2023] Open
Abstract
This study aims to understand healthcare professionals' thoughts and motivations about optimal management and treatment of patients with chronic obstructive pulmonary disease (COPD). We conducted a DELPHI survey through an online questionnaire distributed to 220 panellists from six European countries and a discrete choice experiment to describe the relationship between selected clinical criteria and the initial COPD treatment of choice. One hundred twenty-seven panellists (general practitioners [GPs] and pulmonologists) completed the survey. Despite the familiarity and use (89.8%) of the GOLD classification for initial treatment selection, a frequent use of LAMA/LABA/ICS was noted. In fact, panellists agreed that inhaled corticosteroids (ICS) are over-prescribed in the primary care setting. Our study showed that GPs felt less confident than pulmonologists with ICS withdrawal. This mismatch observed between best practice and behaviour indicates the need to increase awareness and efforts to improve the adherence to guidelines in clinical practice.
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Affiliation(s)
- Janwillem Kocks
- General Practitioners Research Institute, Groningen, The Netherlands.
- Observational and Pragmatic Research Institute, Singapore, Singapore.
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - António Jorge Ferreira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Pulmonology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Onno C P van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Heikki Ekroos
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | | | | | | | | | - Didier Cataldo
- Department of Respiratory Medicine, Centre Hospitalier Universitaire de Liège (CHU) and University of Liège, Liège, Belgium
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10
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Yin C, Udrescu M, Gupta G, Cheng M, Lihu A, Udrescu L, Bogdan P, Mannino DM, Mihaicuta S. Fractional Dynamics Foster Deep Learning of COPD Stage Prediction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2203485. [PMID: 36808826 PMCID: PMC10131808 DOI: 10.1002/advs.202203485] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/03/2023] [Indexed: 05/28/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Current COPD diagnosis (i.e., spirometry) could be unreliable because the test depends on an adequate effort from the tester and testee. Moreover, the early diagnosis of COPD is challenging. The authors address COPD detection by constructing two novel physiological signals datasets (4432 records from 54 patients in the WestRo COPD dataset and 13824 medical records from 534 patients in the WestRo Porti COPD dataset). The authors demonstrate their complex coupled fractal dynamical characteristics and perform a fractional-order dynamics deep learning analysis to diagnose COPD. The authors found that the fractional-order dynamical modeling can extract distinguishing signatures from the physiological signals across patients with all COPD stages-from stage 0 (healthy) to stage 4 (very severe). They use the fractional signatures to develop and train a deep neural network that predicts COPD stages based on the input features (such as thorax breathing effort, respiratory rate, or oxygen saturation). The authors show that the fractional dynamic deep learning model (FDDLM) achieves a COPD prediction accuracy of 98.66% and can serve as a robust alternative to spirometry. The FDDLM also has high accuracy when validated on a dataset with different physiological signals.
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Affiliation(s)
- Chenzhong Yin
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Mihai Udrescu
- Department of Computer and Information TechnologyPolitehnica University of Timisoara2 Vasile Parvan Blvd.Timişoara300223Romania
| | - Gaurav Gupta
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Mingxi Cheng
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Andrei Lihu
- Department of Computer and Information TechnologyPolitehnica University of Timisoara2 Vasile Parvan Blvd.Timişoara300223Romania
| | - Lucretia Udrescu
- Department I – Drug Analysis“Victor Babeş”University of Medicine and Pharmacy Timişoara2 Eftimie Murgu Sq.Timişoara300041Romania
| | - Paul Bogdan
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Stefan Mihaicuta
- Department of PulmonologyCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy2 Eftimie Murgu Sq.Timişoara300041Romania
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11
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Ma R, Su H, Jiao K, Liu J. Role of Th17 cells, Treg cells, and Th17/Treg imbalance in immune homeostasis disorders in patients with chronic obstructive pulmonary disease. Immun Inflamm Dis 2023; 11:e784. [PMID: 36840492 PMCID: PMC9950879 DOI: 10.1002/iid3.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, following strokes and cardiovascular diseases. Chronic lung inflammation is believed to play a role in the development of COPD. In addition, accumulating evidence shows that the immune system plays a crucial role in the pathogenesis of COPD. Significant advancements have been made in research on the pathogenesis of immune diseases and chronic inflammation in recent years, and T helper 17 (Th17) cells and regulatory T (Treg) cells have been found to play a crucial role in the autoimmune response. Th17 cells are a proinflammatory subpopulation that causes autoimmune disease and tissue damage. Treg cells, on the other hand, have a negative effect but can contribute to the occurrence of the same disease when their antagonism fails. This review mainly summarizes the biological characteristics of Th17 cells and Treg cells, their roles in chronic inflammatory diseases of COPD, and the role of the Th17/Treg ratio in the onset, development, and outcome of inflammatory disorders, as well as recent advancements in immunomodulatory treatment targeting Th17/Treg cells in COPD.
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Affiliation(s)
- Ru Ma
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Hongling Su
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Keping Jiao
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Jian Liu
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina
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12
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Calle Rubio M, López-Campos JL, Miravitlles M, Soler Cataluña JJ, Alcázar Navarrete B, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variations in Chronic Obstructive Pulmonary Disease Outpatient Care in Respiratory Clinics: Results From the 2021 EPOCONSUL Audit. Arch Bronconeumol 2023; 59:295-304. [PMID: 36858911 DOI: 10.1016/j.arbres.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION The aim of our work has been to describe the results of the clinical audit carried out in 2021 and to compare the results with 2015 EPOCONSUL audit. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in respiratory clinics in Spain with prospective recruitment between April 15, 2021, and January 31, 2022. RESULTS A total of 45 hospitals participated in the 2021 audit and 4.225 clinical records of patients were evaluated. Clinical phenotype according to the Spanish National Guidelines for COPD care (GesEPOC) was reported in 63.1% of the audited patients, and the COPD type assessment for the Global initiative for chronic Obstructive Lung Disease (GOLD) was present in 38.3%. There was an improved compliance with clinical practice guideline (CPG) recommendations in the 2021 audit with respect to the 2015 audit. There was an increase in the proportion of cases with alfa-1-antitrypsin serum level testing available (audit 1: 18.9%; audit 2: 38.7%, p<0.001) and 6-min walk test carried out (audit 1: 24%; audit 2: 45.2%, p<0.001). However, these significant variations adherence to CPG recommendations were not reached for the clinical evaluation and therapeutic intervention category when adjusting for patient and resource variables. CONCLUSIONS The 2021 EPOCONSUL audit showed increased adherence to recommendations although they seem to be related to the availability of resources for care. These results should be taken into account in order to establish improvements in resources to achieve a better quality of care.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- Pulmonology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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13
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Alter P, Kahnert K, Trudzinski FC, Bals R, Watz H, Speicher T, Söhler S, Welte T, Rabe KF, Wouters EFM, Vogelmeier CF, Jörres RA. Clinical factors linked to the type of respiratory medication in COPD: results from the COSYCONET cohort. Ther Adv Respir Dis 2023; 17:17534666231208584. [PMID: 37936408 PMCID: PMC10631320 DOI: 10.1177/17534666231208584] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The use of maintenance medication in patients with chronic obstructive pulmonary disease (COPD) in real life is known to deviate from recommendations in guidelines, which are largely based on randomized controlled trials and selected populations. OBJECTIVES We used the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort to analyze factors linked to the use of COPD drugs under non-interventional circumstances. DESIGN COSYCONET is an ongoing, multi-center, non-interventional cohort of patients with COPD. METHODS Patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 0-4 participating in visits 1-5 were included. Data covered the period from 2010 to 2018. Generalized linear models were used to examine the relation of COPD characteristics to different types of respiratory medication. RESULTS A total of 1043 patients were included. The duration of observation was 4.5 years. Use of respiratory medication depended on GOLD grades 0-4 and groups A-D. Long-acting muscarinic antagonist therapy increased over time, and was associated with low carbon monoxide (CO) diffusing capacity, while inhaled corticosteroid (ICS) use decreased. Active smoking was associated with less maintenance therapy in general, and female sex with less ICS use. From the eight items of the COPD Assessment Test, only hill and stair climbing were consistently linked to treatment. CONCLUSION Using data from a large, close to real-life observational cohort, we identified factors linked to the use of various types of respiratory COPD medication. Overall, use was consistent with GOLD recommendations. Beyond this, we identified other correlates of medication use that may help us to understand and improve therapy decisions in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT01245933.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Baldingerstrasse 1, Marburg 35033, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Franziska C. Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Center for Lung Research (DZL), Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts University, Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany
- German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
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14
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Incalzi RA, Blasi F, Canonica GW, Foschino MP, Prediletto R, Simoni L, Ori A, Giovannetti C, Barsanti S, Scichilone N. The Prescribing Practice for COPD: Relationship to Circadian Rhythm, Disease Severity, and Clinical Phenotype in the STORICO Observational Study. Adv Ther 2022; 39:5582-5589. [PMID: 36219388 DOI: 10.1007/s12325-022-02331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/22/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION While selected clinical and laboratory findings are taken into account to find the best therapeutic strategies for chronic obstructive pulmonary disease (COPD), it is unknown whether the circadian rhythm of respiratory symptoms, a distinctive feature of COPD, affects the prescription pattern of pharmacological therapy. The main aim of this study was to verify whether the circadian rhythm of symptoms correlates with bronchodilating therapy prescribed to COPD patients as per clinical practice. A secondary objective was to assess the relationship between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and circadian rhythm of symptoms and health status. METHODS Five hundred sixty-six COPD patients were enrolled in the Italian multicenter STORICO study. Patients underwent a multidimensional assessment, and correlates of prescribed therapy were assessed through a multivariate multilevel model. RESULTS As expected, patients in GOLD D stage were more likely to receive triple inhaled therapy than GOLD A-C patients, but the circadian rhythm of symptoms, assessed by the nighttime, morning, and daytime symptoms of the COPD questionnaire, was unrelated to the prescription pattern. The multivariate model showed that emphysematous (EM) patients had a 50% increased risk compared with patients affected by chronic bronchitis (CB) of being prescribed long-acting β2-agonists (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combination (FDC) instead of triple therapy [relative risk (RR) EM versus CB 1.50, 95% CI 1.11, 2.03]. Symptoms, mainly in the early morning and daytime, were highly prevalent, even in GOLD B stage (76%). CONCLUSION Even if we cannot infer about causality of the symptoms-therapy relationship, based on the structured recording of circadian symptoms clearly shows that symptoms are poorly controlled as the circadian rhythm of symptoms does not correlate with the prescription pattern, and many patients are symptomatic both at daytime and by nighttime. Thus, therapy should be better tailored to the individual needs, with special attention to control nocturnal symptoms. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03105999.
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Affiliation(s)
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy Clinic, Humanitas University Humanitas Research Hospital Rozzano (Milan), Via Manzoni, 56, 20089, Rozzano (Milan), Italy
| | - Maria Pia Foschino
- MAR4 Univ., D'Avanzo Hospital, Viale degli Aviatori, 1, 71122, Foggia, Italy
| | - Renato Prediletto
- Pneumology, Institute of Clinical Physiology, National Research Council of Italy and Toscana G. Monasterio Foundation, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Lucia Simoni
- Medineos Observational Research, Viale Virgilio 54/U, 41123, Modena, Italy
| | - Alessandra Ori
- Medineos Observational Research, Viale Virgilio 54/U, 41123, Modena, Italy
| | | | | | - Nicola Scichilone
- DIBIMIS, University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
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15
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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16
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Pace E, Cerveri I, Lacedonia D, Paone G, Sanduzzi Zamparelli A, Sorbo R, Allegretti M, Lanata L, Scaglione F. Clinical Efficacy of Carbocysteine in COPD: Beyond the Mucolytic Action. Pharmaceutics 2022; 14:pharmaceutics14061261. [PMID: 35745833 PMCID: PMC9227620 DOI: 10.3390/pharmaceutics14061261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with a versatile and complicated profile, being the fourth most common single cause of death worldwide. Several research groups have been trying to identify possible therapeutic approaches to treat COPD, such as the use of mucoactive drugs, which include carbocysteine. However, their role in the treatment of patients suffering from COPD remains controversial due to COPD's multifaceted profile. In the present review, 72 articles, published in peer-reviewed journals with high impact factors, are analyzed in order to provide significant insight and increase the knowledge about COPD considering the important contribution of carbocysteine in reducing exacerbations via multiple mechanisms. Carbocysteine is in fact able to modulate mucins and ciliary functions, and to counteract viral and bacterial infections as well as oxidative stress, offering cytoprotective effects. Furthermore, carbocysteine improves steroid responsiveness and exerts anti-inflammatory activity. This analysis demonstrates that the use of carbocysteine in COPD patients represents a well-tolerated treatment with a favorable safety profile, and might contribute to a better quality of life for patients suffering from this serious illness.
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Affiliation(s)
- Elisabetta Pace
- Institute of Translational Pharmacology (IFT), National Research Council, Via Ugo la Malfa, 153, 90146 Palermo, Italy;
| | - Isa Cerveri
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy;
| | - Donato Lacedonia
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Gregorino Paone
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandro Sanduzzi Zamparelli
- UOC Pneumotisiologia, Scuola di Specializzazione in Malattie Respiratorie, Università degli Studi di Napoli Federico II A.O.R.N. Monaldi-Cotugno-CTO Piazzale Ettore Ruggieri, 80138 Napoli, Italy;
| | - Rossella Sorbo
- Dompé Farmaceutici SpA, 20122 Milan, Italy; (R.S.); (M.A.); (L.L.)
| | | | - Luigi Lanata
- Dompé Farmaceutici SpA, 20122 Milan, Italy; (R.S.); (M.A.); (L.L.)
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy
- Correspondence:
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17
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Wright A, Vioix H, de Silva S, Langham S, Cook J, Capstick T, Quint JK. Cost-consequence analysis of COPD treatment according to NICE and GOLD recommendations compared with current clinical practice in the UK. BMJ Open 2022; 12:e059158. [PMID: 36691251 PMCID: PMC9171279 DOI: 10.1136/bmjopen-2021-059158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The objective of this study was to model the clinical and economic impact of adapting current clinical practice in the management of patients with chronic obstructive pulmonary disease (COPD) to treatment according to national and international guideline recommendations. DESIGN Treatment mapping was undertaken to hypothetically redistribute patients from current clinical practice, representing actual prescribing patterns in the UK, to an alternative recommendation-based treatment scenario, representing prescribing in accordance with either National Institute for Health and Care Excellence (NICE) guidance [NG115] or Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 strategy. SETTING Primary care practices in the UK (1-year time horizon). PARTICIPANTS Adults with COPD undergoing long-acting inhaler maintenance therapy in the UK (N=1 067,531). INTERVENTIONS Inhaler maintenance therapy. OUTCOME MEASURES Costs and clinical outcomes (type of treatment, rates of moderate and/or severe exacerbations, and mild-to-moderate and/or severe pneumonia events) were modelled for the two alternative pathways. RESULTS Compared with current clinical practice, treating patients according to NICE guidance resulted in an estimated annual reduction in expenditure of £46.9 million, and an estimated annual reduction in expenditure of over £43.7 million when patients were treated according to GOLD 2020 strategy. Total cost savings of up to 8% annually could be achieved by treatment of patients according to either of these recommendations. Cost savings arose from a reduction in the rates of pneumonia, with an associated decrease in costs associated with antibiotic use and hospitalisation. Savings were achieved overall despite a small increase in the rate of exacerbations due to the redistribution of certain patients currently undergoing triple inhaled therapy to therapies not containing inhaled corticosteroids. CONCLUSION Redistribution of patients with COPD from current clinical practice to treatment according to published recommendations would provide substantial cost savings over the first year.
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Affiliation(s)
| | - Helene Vioix
- Former employees of, Boehringer Ingelheim Ltd, Bracknell, UK
| | | | | | - Jennifer Cook
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Bruin MM, Deijkers RLM, Bus MPA, van Elzakker EPM, Bazuin R, Nelissen RG, Pijls BG. Inhaled Corticosteroids, Vitamin K Antagonists and Amlodipine Were Associated with an Increased Risk of Acute Periprosthetic Joint Infection in Patients with Total Hip Arthroplasty: A Retrospective Case–Cohort Study. J Clin Med 2022; 11:jcm11071842. [PMID: 35407449 PMCID: PMC8999352 DOI: 10.3390/jcm11071842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/03/2023] Open
Abstract
The perioperative use of certain medication may influence the risk of developing a periprosthetic joint infection (PJI). Inhaled corticosteroids (ICSs) and cardiovascular drugs are widely used against pulmonary and cardiovascular diseases. While oral corticosteroids and anticoagulants have been shown to increase the risk of developing PJI, this is not clear for ICSs. In contrast, some cardiovascular drugs, such as amlodipine, nifedipine and statins, have been documented to show an antimicrobial effect, suggesting a synergistic effect with antibiotics in the treatment of (multi-resistant) microorganisms. We performed a case–cohort study to assess the association between the occurrence of PJI after THA and the use of inhaled corticosteroids, anticoagulants, or previously mentioned cardiovascular agents. In a cohort of 5512 primary THAs, we identified 75 patients with a PJI (1.4%), and randomly selected 302 controls. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders (age, sex, smoking, and cardiovascular/pulmonary disease). We found ICS use (HR 2.6 [95% CI 1.1–5.9]), vitamin K antagonist use (HR 5.3 [95% CI 2.5–11]), and amlodipine use (HR 3.1 [95% CI 1.4–6.9]) to be associated with an increased risk of developing PJI after THA. The effect remained after correction for the mentioned possible confounders. The underlying diseases for which the medications are prescribed could also play a role in the mentioned association; we believe, however, that the usages of ICSs, vitamin K antagonists and amlodipine appear to be potential modifiable risk factors for PJI, and therefore have to be questioned during preoperative screening and consultation.
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Affiliation(s)
- Maarten M. Bruin
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | - Ruud L. M. Deijkers
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
| | - Michaël P. A. Bus
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | | | - Roos Bazuin
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
| | - Rob G. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | - Bart G. Pijls
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
- Correspondence:
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19
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Chmiel FP, Burns DK, Pickering JB, Blythin A, Wilkinson TM, Boniface MJ. Prediction of Chronic Obstructive Pulmonary Disease Exacerbation Events by Using Patient Self-reported Data in a Digital Health App: Statistical Evaluation and Machine Learning Approach. JMIR Med Inform 2022; 10:e26499. [PMID: 35311685 PMCID: PMC8981014 DOI: 10.2196/26499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/04/2021] [Accepted: 12/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background Self-reporting digital apps provide a way of remotely monitoring and managing patients with chronic conditions in the community. Leveraging the data collected by these apps in prognostic models could provide increased personalization of care and reduce the burden of care for people who live with chronic conditions. This study evaluated the predictive ability of prognostic models for the prediction of acute exacerbation events in people with chronic obstructive pulmonary disease by using data self-reported to a digital health app. Objective The aim of this study was to evaluate if data self-reported to a digital health app can be used to predict acute exacerbation events in the near future. Methods This is a retrospective study evaluating the use of symptom and chronic obstructive pulmonary disease assessment test data self-reported to a digital health app (myCOPD) in predicting acute exacerbation events. We include data from 2374 patients who made 68,139 self-reports. We evaluated the degree to which the different variables self-reported to the app are predictive of exacerbation events and developed both heuristic and machine learning models to predict whether the patient will report an exacerbation event within 3 days of self-reporting to the app. The model’s predictive ability was evaluated based on self-reports from an independent set of patients. Results Users self-reported symptoms, and standard chronic obstructive pulmonary disease assessment tests displayed correlation with future exacerbation events. Both a baseline model (area under the receiver operating characteristic curve [AUROC] 0.655, 95% CI 0.689-0.676) and a machine learning model (AUROC 0.727, 95% CI 0.720-0.735) showed moderate ability in predicting exacerbation events, occurring within 3 days of a given self-report. Although the baseline model obtained a fixed sensitivity and specificity of 0.551 (95% CI 0.508-0.596) and 0.759 (95% CI 0.752-0.767) respectively, the sensitivity and specificity of the machine learning model can be tuned by dichotomizing the continuous predictions it provides with different thresholds. Conclusions Data self-reported to health care apps designed to remotely monitor patients with chronic obstructive pulmonary disease can be used to predict acute exacerbation events with moderate performance. This could increase personalization of care by allowing preemptive action to be taken to mitigate the risk of future exacerbation events.
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Affiliation(s)
- Francis P Chmiel
- School of Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Dan K Burns
- School of Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - John Brian Pickering
- School of Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | | | - Thomas Ma Wilkinson
- my mHealth Limited, Bournemouth, United Kingdom.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom.,Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael J Boniface
- School of Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
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Development of primary care quality indicators for chronic obstructive pulmonary disease using a Delphi-derived method. NPJ Prim Care Respir Med 2022; 32:12. [PMID: 35304476 PMCID: PMC8933430 DOI: 10.1038/s41533-022-00276-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/17/2022] [Indexed: 11/08/2022] Open
Abstract
High-quality care for patients with COPD is necessary. To achieve quality improvement in primary care, the general practitioner and the electronic health record (EHR) play an important role. The aim of this study was to develop a set of evidence-based and EHR extractable quality indicators (QIs) to measure and improve the quality of COPD primary care. We composed a multidisciplinary expert panel of 12 members, including patients, and used a RAND-modified Delphi method. The SMART principle was applied to select recommendations and QIs from international guidelines as well as existing sets of QIs, and these recommendations and QIs were added to an individual written questionnaire. Based on the median score, prioritization and degree of agreement, the recommendations and QIs were rated as having a high, uncertain or low potential to measure the quality of COPD primary care and were then discussed in an online consensus meeting for inclusion or exclusion. After a final validation, a core set of recommendations was translated into QIs. From 37 recommendations, obtained out of 10 international guidelines, and 5 existing indicators, a core set of 18 recommendations and 2 QIs was derived after the rating procedure. The expert panel added one new recommendation. Together, the recommendations and QIs were translated and merged into a final set of 21 QIs. Our study developed a set of 21 evidence-based and EHR-extractable QIs for COPD in primary care. These indicators can be used in an automated quality assessment to measure and improve the quality of COPD primary care.
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21
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van Riet S, van Schadewijk A, Khedoe PPSJ, Limpens RWAL, Bárcena M, Stolk J, Hiemstra PS, van der Does AM. Organoid-based Expansion of Patient-Derived Primary Alveolar Type-2 Cells for Establishment of Alveolus Epithelial Lung-Chip Cultures. Am J Physiol Lung Cell Mol Physiol 2022; 322:L526-L538. [PMID: 35137633 PMCID: PMC8957343 DOI: 10.1152/ajplung.00153.2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Development of effective treatment strategies for lung tissue destruction as seen in emphysema would greatly benefit from representative human in vitro models of the alveolar compartment. Studying how cellular cross-talk and/or (altered) biomechanical cues affect alveolar epithelial function could provide new insight for tissue repair strategies. Preclinical models of the alveolus ideally combine human primary patient-derived lung cells with advanced cell culture applications such as breathing-related stretch, to reliably represent the alveolar microenvironment. To test the feasibility of such a model, we isolated primary alveolar type-2 cells (AEC2) from patient-derived lung tissues including those from patients with severe emphysema, using magnetic bead-based selection of cells expressing the AEC2 marker HTII-280. We obtained pure alveolar feeder-free organoid cultures using a minimally modified commercial medium. This was confirmed by known AEC2 markers as well as by detection of lamellar bodies using electron microscopy. Following (organoid-based) expansion, cells were seeded on both cell culture inserts and the Chip-S1® Organ-Chip that has a flexible PDMS membrane enabling the application of dynamic stretch. AEC2 cultured for 7 days on inserts or the chip maintained expression of HTII-280, pro-surfactant protein C (SP-C), SP-A and SP-B and zonula occludens-1 (ZO-1) also in the presence of stretch. AEC2 cultured on the chip showed lower expression levels of epithelial-mesenchymal transition-related vimentin expression compared to static cultures on inserts. The combination of a straightforward culture method of patient-derived AEC2 and their application in microfluidic chip cultures, supports successful development of more representative human preclinical models of the (diseased) alveolar compartment.
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Affiliation(s)
- Sander van Riet
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - P Padmini S J Khedoe
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ronald W A L Limpens
- Section Electron Microscopy, Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Montserrat Bárcena
- Section Electron Microscopy, Department of Cell and Chemical Biology, Leiden University Medical Center, the Netherlands
| | - Jan Stolk
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M van der Does
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
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22
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Valipour A, Aisanov Z, Avdeev S, Koblizek V, Kocan I, Kopitovic I, Lupkovics G, Man M, Bukovskis M, Tudoric N, Vukoja M, Naumnik W, Yanev N. Recommendations for COPD management in Central and Eastern Europe. Expert Rev Respir Med 2022; 16:221-234. [PMID: 35001780 DOI: 10.1080/17476348.2021.2023498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease-time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for COPD patients can vary widely, even in geographically close and economically similar countries. AREAS COVERED Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking GOLD 2020 recommendations into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. EXPERT OPINION Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Vienna, Austria
| | - Zaurbek Aisanov
- Department of Pulmonology, Pirogov Russian State National Research Medical University, Moscow, Russia
| | - Sergey Avdeev
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Ivan Kocan
- University Hospital Martin, Jessenius Faculty of Medicine, Commenius University, Martin, Slovakia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Gergely Lupkovics
- Adult Pulmonary Department, Institute for Pulmonary Diseases, Törökbálint, Hungary
| | - Milena Man
- Pulmonology Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maris Bukovskis
- Department of Internal Diseases, Faculty Medicine, University of Latvia, Riga, Latvia
| | - Neven Tudoric
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Wojciech Naumnik
- First Department of Lung Diseases and Chemotherapy of Respiratory Neoplasms, Medical University of Bialystok, Bialystok, Poland
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Medical University of Sofia, Sofia, Bulgaria
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Luis Izquierdo J, Casanova C, Celli B, Santos S, Sibila O, Sobradillo P, Agusti A. The 7 cardinal sins of COPD in Spain. Arch Bronconeumol 2022; 58:498-503. [DOI: 10.1016/j.arbres.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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Miravitlles M, Roman-Rodríguez M, Ribera X, Ritz J, Izquierdo JL. Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain. Int J Chron Obstruct Pulmon Dis 2022; 17:245-258. [PMID: 35115771 PMCID: PMC8800566 DOI: 10.2147/copd.s342220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain. Patients and Methods This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use. Results A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67–7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81–3.49), followed by higher mMRC and higher CAT score. Conclusion Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Correspondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, P. Vall d’Hebron 119-129, Barcelona, ES–08035, Spain, Email
| | - Miguel Roman-Rodríguez
- Centro de Salud Dra. Teresa Pique, Mallorca, Spain
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain
| | - Xavier Ribera
- Boehringer Ingelheim España, Sant Cugat del Vallés, Barcelona, Spain
| | - John Ritz
- Syneos Health - Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain
- Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Zeng X, Yang H, Yang Y, Gu X, Ma X, Zhu T. Associations of Clinical Characteristics and Intestinal Flora Imbalance in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients and the Construction of an Early Warning Model. Int J Chron Obstruct Pulmon Dis 2021; 16:3417-3428. [PMID: 34955637 PMCID: PMC8694711 DOI: 10.2147/copd.s330976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Establish a simple predictive model and scoring rule that is suitable for clinical medical staff in respiratory departments to assess intestinal flora imbalance occurrence in stable chronic obstructive pulmonary disease (COPD) patients. Methods From January 1, 2019, to December 31, 2020, COPD patients (195 cases) – who attended the Outpatient Department, Respiratory and Critical Care, Yixing Hospital, Jiangsu University – were enrolled in a cross-sectional study. Based on stool examination results, patients were divided into experimental (41 cases) and control (154 cases) groups. Single-factor and logistic regression analyses were performed with the baseline data of the two groups to obtain a new predictive model, which was further simplified. Results Five predictive factors composed the model: body mass index (BMI), serum albumin (ALB), Charlson’s Comorbidity Index (CCI), gastrointestinal symptom score (GSRs), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The model to predict intestinal flora imbalance in stable COPD patients had an area under the ROC curve (AUC) of 0.953 [95% CI (0.924, 0.982)]. After simplifying the scoring rules, the AUC was 0.767 [95% CI (0.676, 0.858)]. Conclusion In the current study, we obtained a model that could effectively predict intestinal flora imbalance risk in stable COPD patients, being suitable for implementation in early treatments to improve the prognosis. Moreover, all indicators can be easily and simply obtained.
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Affiliation(s)
- Xuetao Zeng
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Hongfeng Yang
- Department of Critical Medicine,The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
| | - Yan Yang
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Xinnan Gu
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Xiuqin Ma
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
| | - Taofeng Zhu
- Department of Respiratory and Critical Medicine, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China
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Payedimarri AB, Ratti M, Rescinito R, Vasile A, Seys D, Dumas H, Vanhaecht K, Panella M. Development of a Model Care Pathway for Myasthenia Gravis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11591. [PMID: 34770107 PMCID: PMC8582978 DOI: 10.3390/ijerph182111591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/21/2022]
Abstract
Myasthenia Gravis (MG) is a chronic, life-lasting condition that requires high coordination among different professionals and disciplines. The diagnosis of MG is often delayed and sometimes misdiagnosed. The goal of the care pathway (CP) is to add value to healthcare reducing unnecessary variations. The quality of the care received by patients affected with MG could benefit from the use of CP. We conducted a study aimed to define an inclusive, comprehensive, and multidisciplinary CP for the diagnosis, treatment, and care of MG. The development of the model CP, key interventions, and process indicators is based on the literature review and 85 international MG experts were involved in their evaluation, expressing a judgment of relevance through the Delphi study. 60 activities are included in the model CP and evaluated by the MG experts were valid and feasible. The 60 activities were then translated into 14 key interventions and 24 process indicators. We believe that the developed model CP will help for MG patients to have a timely diagnosis and high-quality, accessible, and cost-effective treatments and care. We also believe that the development of model CPs for other rare diseases is feasible and could aid in the integration of evidence-based knowledge into clinical practice.
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Affiliation(s)
- Anil babu Payedimarri
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, 28100 Novara, Italy; (M.R.); (R.R.); (A.V.); (M.P.)
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
| | - Matteo Ratti
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, 28100 Novara, Italy; (M.R.); (R.R.); (A.V.); (M.P.)
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
| | - Riccardo Rescinito
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, 28100 Novara, Italy; (M.R.); (R.R.); (A.V.); (M.P.)
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
| | - Alessandra Vasile
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, 28100 Novara, Italy; (M.R.); (R.R.); (A.V.); (M.P.)
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
| | - Deborah Seys
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, 3000 Leuven, Belgium
| | | | - Kris Vanhaecht
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, 3000 Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, University of Leuven, 3000 Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, 28100 Novara, Italy; (M.R.); (R.R.); (A.V.); (M.P.)
- European Pathway Association, 3000 Leuven, Belgium; (D.S.); (K.V.)
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Hourmant B, Gobert CG, Plumet R, Lott MC, Zabbé C, Tromeur C, Leroyer C, Couturaud F. Screening for COPD in primary care, involving dentists, pharmacists, physiotherapists, nurses and general practitioners (the UNANIME pilot study). Respir Med Res 2021; 80:100853. [PMID: 34385099 DOI: 10.1016/j.resmer.2021.100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND COPD is underdiagnosed and is projected to be the third cause of death in 2030. However, recent reviews do not recommend screening for COPD in the general population. METHODS We conducted a prospective study to assess the feasibility of implementing COPD screening in a high-risk COPD population, with the help of various healthcare professionals (General practitioners, pharmacists, dentists, physiotherapists, and nurses). Participants filled out a questionnaire, performed a spirometry (COPD6™) and counselling was performed, including smoking cessation and chest physician referral. Participants were contacted at two months to evaluate the effect of the intervention. RESULTS Between April 7th, 2017 and July 30th, 2018, 157 participants filled out the questionnaires, performed spirometry and were contacted at two months. Thirty-five out of 157 (22% [95% CI, 15.8-28.8]) participants were detected with an airflow obstruction (FEV1/FEV6 < 0.7), using COPD6™ device. At the two-month-contact, 68 participants (43%, [95%CI 35.5-51.1]) were engaged in a smoking cessation program and 22 (14% [95 % CI, 8.6-19.4]) reported having quit smoking. CONCLUSION This pilot study suggested that a predefined screening of COPD by different healthcare professionals could be implemented in primary care and might be part of counselling for smoking cessation (NCT03104348 on ClinicalTrials.gov).
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Affiliation(s)
- Baptiste Hourmant
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France
| | - Christophe Gut Gobert
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France
| | - Régis Plumet
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France
| | | | - Claude Zabbé
- URPS Bretagne, 25 rue Saint-Hélier, Rennes 35000, France
| | - Cécile Tromeur
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France; Centre d'Investigation Clinique, INSERM, Brest 1412, France
| | - Christophe Leroyer
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France; Centre d'Investigation Clinique, INSERM, Brest 1412, France.
| | - Francis Couturaud
- Département de Médecine Vasculaire, Interne et Pneumologie, Groupe D'Etude de la Thrombose de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest EA3878, France; Centre d'Investigation Clinique, INSERM, Brest 1412, France
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Spielmanns M, Tamm M, Schildge S, Valipour A. Swiss Experience in Therapy With Dual Bronchodilation in Chronic Obstructive Pulmonary Disease in Relation to Self-Reported Physical Functionality. J Clin Med Res 2021; 13:392-402. [PMID: 34394782 PMCID: PMC8336944 DOI: 10.14740/jocmr4542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background Medical therapy in chronic obstructive pulmonary disease (COPD) usually includes inhaled dual bronchodilation leading not only to an improvement in symptoms but also to an increase in physical performance. However, it remains unknown whether responder rates to dual bronchodilation differ between the Swiss subgroup in comparison to participants of other European countries. Methods The non-interventional OTIVACTO trial investigated changes in self-reported physical functioning in COPD patients treated with tiotropium/olodaterol 5/5 µg fixed dose combination for 6 weeks. The cut-off between responder and non-responder was defined as a minimum increase of 10 points using the 10-question physical functioning questionnaire (PF-10) score. We searched for patterns of the responder patient group and compared the results of the whole dataset with the subgroup of Swiss participants. Results Compared to the total cohort (n = 7,608), the Swiss participants (n = 94) were predominantly > 65 years of age and had significantly more comorbidities. There were no significant differences according to COPD stage, smoking status, exacerbation rate in the last 12 months and modified Medical Research Council questionnaire (mMRC) score between the total cohort and the Swiss collective. There were no significant differences between the Swiss subgroup and the total cohort with regard to response to the medication in the PF-10 score. In the intragroup comparison, patients with high mMRC score showed significantly higher values in the PF-10 in both groups. The number of exacerbations had no influence on the PF-10 score in the Swiss subgroup but in the total cohort. Conclusion In terms of age and number of comorbidities, significant differences were found between the overall patient population and the Swiss participants, having no influence on the success of the medication. The patients suffering from increased dyspnea benefited most from tiotropium/olodaterol treatment (Clinical Trials Registry NCT02720757).
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Affiliation(s)
- Marc Spielmanns
- Pulmonary Medicine, Zuercher RehaZentren Klinik Wald, Switzerland.,Faculty of Health, Department of Pneumology, University of Witten/Herdecke, Germany
| | - Michael Tamm
- Lung Centre/Pneumology Department, University Hospital Basel, Basel, Switzerland
| | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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29
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Candemir I. The narrative review of chronic obstructive pulmonary disease management in Turkey: medical treatment, pulmonary rehabilitation and endobronchial volume reduction. J Thorac Dis 2021; 13:3907-3917. [PMID: 34277080 PMCID: PMC8264693 DOI: 10.21037/jtd-20-2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. In Turkey, the prevalence of COPD has been shown at rates of 9.1% to 19.1%, and COPD was found to be the third leading cause of mortality and eighth leading cause of disability. In several national multicentral studies, a high rate of non-adherence to pharmacologic treatment according to GOLD was found to be high, and the most commonly prescribed treatment was the triple regimen. The most important non-pharmacologic treatment of COPD is pulmonary rehabilitation (PR), which is also highly recommended in Turkey, but it is also underutilized, like in other countries. Awareness of healthcare professionals and patients should increase in Turkey. The recommendations in content and modality of programs are similar to international guidelines. Another non-pharmacologic treatment is endobronchial volume reduction (EBVR). Although there is limited number of studies about EBVR, in national reports, the importance of patient selection, method, close follow-up after intervention, and applications in experienced centers are emphasized to decrease the economic burden of this expensive treatment. There is still great need for further randomized studies about pharmacologic and non-pharmacologic treatment and additionally, a close collaboration between healthcare professionals, physicians, professional societies of pulmonology, planners of reimbursement system, patients, patient advocacy groups and the general public should be established.
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Affiliation(s)
- Ipek Candemir
- Ataturk Chest Disease and Chest Surgery Education and Research Hospital, Ankara, Turkey
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30
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Brat K, Svoboda M, Zatloukal J, Plutinsky M, Volakova E, Popelkova P, Novotna B, Dvorak T, Koblizek V. The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients - A Prospective Multicenter Study. Int J Chron Obstruct Pulmon Dis 2021; 16:1171-1182. [PMID: 33953554 PMCID: PMC8089082 DOI: 10.2147/copd.s297087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: “Czech“ COPD phenotypes and their most frequent combinations, ”Spanish” phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk. Methods Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary “Czech” phenotypes and their most frequent and relevant combinations, “Spanish” phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test. Results The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV1 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the “Spanish” phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV1% pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort. Conclusion Certain phenotypes (“Czech” or “Spanish”) of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.
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Affiliation(s)
- Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Jaromir Zatloukal
- Pulmonary Department, University Hospital Olomouc, Olomouc, Czech Republic.,Faculty of Medicine, Palacky University, Olomouc, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Volakova
- Pulmonary Department, University Hospital Olomouc, Olomouc, Czech Republic.,Faculty of Medicine, Palacky University, Olomouc, Czech Republic
| | - Patrice Popelkova
- Pulmonary Department, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Barbora Novotna
- Pulmonary Department, Bulovka Hospital, Prague, Czech Republic
| | - Tomas Dvorak
- Pulmonary Department, Mlada Boleslav Hospital, Mlada Boleslav, Czech Republic
| | - Vladimir Koblizek
- Pulmonary Department, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
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Abstract
Pharmacological treatment for chronic obstructive pulmonary disease (COPD) aims to alleviate symptoms and reduce the future risk of events such as exacerbations, disease progression and death. The heterogeneity of COPD results in variable responses to pharmacological interventions. COPD treatment has evolved towards a precision medicine approach, integrating clinical and biomarker information in order to optimize treatment decisions for each individual. The evidence supporting the use of blood eosinophil counts to predict responses to inhaled corticosteroids (ICS) in COPD patients has led to the adoption of this biomarker for use in clinical practice. The development of novel double and triple inhaled combination treatments containing long-acting bronchodilators with or without ICS has involved some landmark randomized controlled trials in COPD patients. These studies have provided valuable evidence to direct the use of different classes of combination treatments. However, there are still some unresolved questions and debates. This review article describes the advances in the pharmacological treatment of COPD, particularly the personalization of treatment. The evidence base for current recommendations is discussed, and controversial issues are dissected.
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Affiliation(s)
- Dave Singh
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Hospital Trust, Manchester, UK
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32
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Hallit S, Zeidan RK, Saade S, Hajj A, Hallit R, Akel M, Yahchouchy C, Kheir N, Iskandar K, Sacre H, Salameh P. Knowledge, Attitude and Practice of Lebanese Community Pharmacists toward Chronic Obstructive Pulmonary Disease. J Epidemiol Glob Health 2021; 10:86-95. [PMID: 32175715 PMCID: PMC7310810 DOI: 10.2991/jegh.k.191215.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Inclusion of a pharmacist showed that pharmacy-led patient education can positively impact treatment outcome, chronic obstructive pulmonary disease (COPD) knowledge, medication adherence, quality of life, significant reduction in hospital admission rates, and emergency department visits. The objectives were to assess the degree of COPD knowledge in Lebanese community pharmacists as well as their attitudes and practice toward disease management. Between January and May 2018, a cross-sectional survey enrolled 709 Lebanese community pharmacists. A committee was created to build up the questionnaire; it was composed of two physicians (one infectious disease specialist and one pulmonologist) and eight pharmacists, with long expertise in community and hospital pharmacy. It comprised 12 questions assessing knowledge, 12 questions for attitude, and 13 questions for practice. Higher attitude (β = 0.56) and higher practice (β = 0.41) were associated with higher knowledge score. Higher knowledge (β = 0.10) and practice (β = 0.16) scores as well as female gender (β = 0.60) were significantly associated with higher attitude scores. Higher knowledge (β = 0.13) and higher attitude (β = 0.19) showed significant association with higher practice scores. Female gender (β = −0.94), however, was significantly associated with decreased practice score. Our study highlights the importance of assessing the capabilities of pharmacists of achieving their support role in COPD patients. In order to improve community pharmacists’ knowledge of COPD, ultimately improving patient outcomes, further education is crucial.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut, Lebanon
| | - Rouba Karen Zeidan
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut, Lebanon.,Faculty of Public Health 2, Lebanese University, Fanar, Lebanon
| | - Sylvia Saade
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Aline Hajj
- Laboratoire de Pharmacologie, Pharmacie clinique et Contrôle de Qualité des médicaments, Pôle Technologie-Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | | | | | - Nelly Kheir
- Faculty of Pedagogy, Holy Family University, 5534 Batroun, Lebanon
| | | | - Hala Sacre
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Pascale Salameh
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
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33
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Tabyshova A, Hurst JR, Soriano JB, Checkley W, Wan-Chun Huang E, Trofor AC, Flores-Flores O, Alupo P, Gianella G, Ferdous T, Meharg D, Alison J, Correia de Sousa J, Postma MJ, Chavannes NH, van Boven JFM. Gaps in COPD Guidelines of Low- and Middle-Income Countries: A Systematic Scoping Review. Chest 2021; 159:575-584. [PMID: 33038390 PMCID: PMC7856534 DOI: 10.1016/j.chest.2020.09.260] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Guidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required. RESEARCH QUESTION We systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context, and quality gaps that may hamper effective implementation. STUDY DESIGN AND METHODS Scoping review of national COPD management guidelines. We assessed: (1) global guideline coverage; (2) guideline information (authors, target audience, dissemination plans); (3) content (prevention, diagnosis, treatments); (4) ethical, legal, and socio-economic aspects; and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared with those from high-income countries (HICs). RESULTS Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer health-care professional groups and less often addressed case finding and co-morbidities. More than 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards, compared with 5.29 (66%) in HICs (P < .05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations, and funding transparency (all, P < .05). INTERPRETATION Several development, content, context, and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk factors, case findings, and co-morbidity management, preferably tailored to available financial and staff resources.
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Affiliation(s)
- Aizhamal Tabyshova
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pulmonary Diseases, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - John R Hurst
- UCL Respiratory, University College London, United Kingdom
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD
| | - Erick Wan-Chun Huang
- Woolcock Institute of Medical Research, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi (UMF Iasi), Iasi, Romania
| | - Oscar Flores-Flores
- Biomedical Research Unit, A.B. PRISMA, Lima, Peru; Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru; and the Universidad Cientifica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - Patricia Alupo
- Department of Medicine, Makerere Lung Institute, Kampala, Uganda
| | - Gonzalo Gianella
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - David Meharg
- University of Sydney, Faculty of Medicine and Health, Australia
| | - Jennifer Alison
- University of Sydney, Faculty of Medicine and Health, Australia
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maarten J Postma
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Unit of Global Health, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands.
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Bourdin A, Criner G, Devouassoux G, Dransfield M, Halpin DM, Han MK, Jones CE, Kalhan R, Lange P, Lettis S, Lipson DA, Lomas DA, Echave-Sustaeta María-Tomé JM, Martin N, Martinez FJ, Quasny H, Sail L, Siler TM, Singh D, Thomashow B, Watz H, Hanania NA. InforMing the PAthway of COPD Treatment (IMPACT Trial) Single-Inhaler Triple Therapy (Fluticasone Furoate/Umeclidinium/Vilanterol) Versus Fluticasone Furoate/Vilanterol and Umeclidinium/Vilanterol in Patients With COPD: Analysis of the Western Europe and North America Regions. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:76-90. [PMID: 33156982 PMCID: PMC8047616 DOI: 10.15326/jcopdf.2020.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The InforMing the Pathway of COPD Treatment (IMPACT) trial demonstrated lower moderate/severe exacerbation rates with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI or UMEC/VI in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. Since IMPACT was a global study, post-hoc analyses were conducted by geographic region to investigate potential differences in overall findings. METHODS IMPACT was a 52-week, randomized, double-blind trial. Patients with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomized 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25µg, FF/VI 100/25µg, or UMEC/VI 62.5/25µg. Endpoints assessed in the overall, Western Europe and North America populations included on-treatment moderate/severe exacerbation (rates and time-to-first), trough forced expiratory volume in 1 second and St George's Respiratory Questionnaire (SGRQ) total score. Safety was assessed. RESULTS Overall, 10,355 patients were enrolled, 3164 from Western Europe, 2639 from North America. FF/UMEC/VI significantly reduced on-treatment moderate/severe exacerbation rates versus FF/VI and UMEC/VI in Western Europe (rate ratios 0.82 [95%CI 0.74-0.91], P<.001 and 0.76 [0.67-0.87], P<.001) and in North America (0.87 [0.77-0.97], P=.014 and 0.69 [0.60-0.80], P<.001). FF/UMEC/VI reduced time-to-first moderate/severe exacerbation and improved lung function versus FF/VI and UMEC/VI in both regions, and improved SGRQ total score in Western Europe, but not North America. Safety profiles were generally similar between treatment groups/regions; the inhaled corticosteroid class effect of increased pneumonia incidence was seen in North America but not Western Europe. CONCLUSION Consistent with intent-to-treat results, FF/UMEC/VI reduced moderate/severe exacerbation rate and risk and improved lung function in Western Europe and North America; however, between-regions differences were seen for SGRQ total score and pneumonia incidence. CLINICAL TRIAL REGISTRATION NCT02164513.
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Affiliation(s)
- Arnaud Bourdin
- Department of Pneumology and Addictology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Gerard Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Gilles Devouassoux
- Univ. Lyon, Université Claude-Bernard Lyon 1, Lyon, France
- Hôpital de la Croix-Rousse, Service de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Alabama, United States
| | - David M.G. Halpin
- College of Medicine and Health, University of Exeter Medical School, Exeter, United Kingdom
| | - MeiLan K. Han
- Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States
| | - C. Elaine Jones
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Peter Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical Department, Herlev University Hospital, Herlev, Denmark
| | - Sally Lettis
- Department of Pneumology and Addictology, University of Montpellier, CHU Montpellier, Montpellier, France
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - David A. Lipson
- GlaxoSmithKline, Collegeville, Pennsylvania, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David A. Lomas
- UCL Respiratory, University College London, London, United Kingdom
| | | | - Neil Martin
- GlaxoSmithKline, Brentford, Middlesex, United Kingdom
- University of Leicester, Leicester, United Kingdom
| | | | - Holly Quasny
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States
| | | | - Thomas M. Siler
- Midwest Chest Consultants, PC, St. Charles, Missouri, United States
| | - Dave Singh
- The University of Manchester, Manchester University National Health Service Foundation Trust, United Kingdom
| | - Byron Thomashow
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Medical Center, New York, New York, United States
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, Airways Clinical Research Center, Baylor College of Medicine, Houston, Texas, United States
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Abstract
Chronic obstructive pulmonary disease (COPD) has a profound impact on people living with the disease and has a high global economic and social burden. Often, people with COPD are undiagnosed, while those diagnosed are undertreated and undereducated on different aspects of COPD care. Although there are many published evidence-based treatment guidelines from different expert groups and societies, they are frequently not adhered to, which results in significant gaps in care. In particular, 'flare-ups' (known as exacerbations of COPD), which accelerate disease progression, are often under-reported, despite guidelines recommending an escalation of maintenance treatment to prevent subsequent flare-ups. Management of COPD should be proactive to prevent worsening of symptoms and to reduce the risk of future flare-ups and premature death, rather than a secondary reaction to a worsening health status. Key to this is patient access to accurate diagnosis, effective treatment and specialist care, which can vary widely due to socioeconomic differences, geographical locations and poor guideline implementation. In addition, the stigma associated with COPD can act as a barrier, which can result in people being reluctant to access treatment or clinicians being nihilistic. As global patient advocates, we have co-developed this patient charter to set a standard of care that people living with COPD should expect, raising awareness and understanding of the causes and consequences of COPD as well as the potential to improve patient care. Patients with COPD should be empowered to live the highest quality of life possible with the least number of flare-ups. We set out six principles in line with current COPD guideline recommendations, that should be implemented by governments, healthcare providers, policymakers, lung health industry partners and patients/caregivers to drive meaningful change in COPD care.
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Zatloukal J, Brat K, Neumannova K, Volakova E, Hejduk K, Kocova E, Kudela O, Kopecky M, Plutinsky M, Koblizek V. Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:325-356. [PMID: 33325455 DOI: 10.5507/bp.2020.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.
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Affiliation(s)
- Jaromir Zatloukal
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Neumannova
- Department of Physiotherapy, Faculty of Physical Culture, Palacky University Olomouc, Czech Republic
| | - Eva Volakova
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Eva Kocova
- Department of Radiology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ondrej Kudela
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Michal Kopecky
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Koblizek
- Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Pelaia C, Procopio G, Deodato MR, Florio O, Maglio A, Sciacqua A, Vatrella A, Pelaia G. Real-Life Clinical and Functional Effects of Fluticasone Furoate/Umeclidinium/Vilanterol-Combined Triple Therapy in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2020; 100:127-134. [PMID: 33302284 DOI: 10.1159/000512064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Triple therapy consisting of a drug association including an inhaled corticosteroid, a long-acting muscarinic receptor antagonist and a long-acting β2-adrenergic agonist, delivered via a single device, can be a valuable treatment for chronic obstructive pulmonary disease (COPD) patients experiencing frequent disease exacerbations. OBJECTIVES The aim of this real-life, single-center, observational study was to evaluate, in 44 COPD patients with recurrent exacerbations, the effects of the triple inhaled therapy combining fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI). METHODS Within such a therapeutic context, several clinical and lung functional parameters were considered at baseline and after 24 weeks of treatment with combined inhaled triple therapy. RESULTS With respect to baseline, after 24 weeks of treatment with FF/UMEC/VI, significant changes were recorded with regard to Modified British Medical Research Council (p < 0.0001) and COPD Assessment Test (p < 0.0001) scores, COPD exacerbations (p < 0.001), forced expiratory volume in the first second (p < 0.001), residual volume (p < 0.01), forced mid-expiratory flow between 25 and 75% of FVC (p < 0.0001), inspiratory capacity (p < 0.01), forced vital capacity (p < 0.05), and peak expiratory flow (p < 0.0001). Moreover, in a subgroup of 28 patients, a significant increase of diffusion lung capacity (p < 0.01) was also detected. CONCLUSIONS In conclusion, our real-life results suggest that triple inhaled therapy with FF/UMEC/VI, when given to COPD patients with frequent exacerbations, is able to positively impact on dyspnea and global health status as well as to significantly decrease COPD exacerbations and improve airflow limitation and lung hyperinflation.
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Affiliation(s)
- Corrado Pelaia
- Respiratory Medicine Unit, University "Magna Græcia" of Catanzaro, Catanzaro, Italy,
| | - Giada Procopio
- Respiratory Medicine Unit, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | | | - Olivia Florio
- Respiratory Medicine Unit, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
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Medical Electronic Prescription for Home Respiratory Care Services (PEM-CRD) at a Portuguese University Tertiary Care Centre (2014–2018): A Case Study. SUSTAINABILITY 2020. [DOI: 10.3390/su12239859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Home respiratory care (HRC) is the provision of healthcare services at the place of residence of patients or their families, with the aim of meeting needs mainly resulting from chronic respiratory conditions, permanent disability, or terminal illness. In 2016, an innovative electronic prescription system, PEM-CRD, was fully implemented for HRC services in Portugal. To date, no study has addressed the impact of the execution of this digital innovation. For this purpose, we carried out an analysis of the prevalence and number of prescriptions for people with chronic respiratory diseases receiving HRC in the Lisbon metropolitan area, during 2014–2018, using the information obtained from the PEM-CRD database. The data analysis shows that while the number of patients receiving HRC treatment with a prescription has remained stable over the last four years, the number of prescriptions has significantly dropped since 2016 (2016–2018), with consequent paper and processes efficiency. The implementation of the digital Medical Electronic Prescription for Home Respiratory Care tool (PEM-CRD) and consequent dematerialization of these processes has increased the efficiency of prescribing in HRC. Additionally, the possibility of obtaining data through the PEM-CRD allows the monitoring of the evolving prevalence of therapies, improving the health services optimization and allowing reporting on data other than medicines.
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Marotta N, Demeco A, Moggio L, Marinaro C, Pino I, Barletta M, Petraroli A, Pepe D, Lavano F, Ammendolia A. Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease. Complement Ther Clin Pract 2020; 41:101260. [PMID: 33221632 DOI: 10.1016/j.ctcp.2020.101260] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE This study aims to determine the best choice of breathing exercises (BE) for patients with chronic obstructive pulmonary disease (COPD) via a network meta-analysis. METHODS We searched randomized controlled trials (RCTs) of adults with COPD investigating any BEs in MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases. The effects of comparative treatment on the St. George Respiratory Questionnaire as the outcome were analysed and ranked according to a surface under the cumulative classification curve (SUCRA) analysis. RESULTS The network meta-analysis included six RCTs involving 280 patients with four intervention groups, comprising control, diaphragmatic breathing training (DBT), yoga, and singing course. Performing SUCRA, we reported that yoga is 75% likely to be the best treatment available as DBT with 66%, instead of 35% for singing and 21% for control. CONCLUSION DBT and yoga seem to be the best choices for breathing exercises in people with COPD.
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Affiliation(s)
- Nicola Marotta
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy.
| | - Andrea Demeco
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Lucrezia Moggio
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Cinzia Marinaro
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Ilaria Pino
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Marianna Barletta
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Annalisa Petraroli
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Davide Pepe
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Francesco Lavano
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
| | - Antonio Ammendolia
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Italy
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Papi A, Avdeev S, Calverley PMA, Cordeiro CR, Jesenak M, Koblížek V, Petkova D, Rogliani P, Tarraf H, Tzanakis N, Ulmeanu R, Uzaslan E, Adir Y. Use of mucolytics in COPD: A Delphi consensus study. Respir Med 2020; 175:106190. [PMID: 33217537 DOI: 10.1016/j.rmed.2020.106190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND International guidelines recommend mucolytic agents as add-on therapy in selected patients with COPD because they may reduce exacerbations and improve health status. As the evidence varies among mucolytic agents, we used the Delphi method to assess consensus amongst an international panel of COPD experts on mucolytics use in COPD. METHODS 53 COPD experts from 12 countries were asked to complete an online questionnaire and rate their agreement with 15 statements using a 5-point scale. The mucolytic agents evaluated were carbocysteine, erdosteine and N-acetylcysteine (NAC). Data were collected anonymously and consensus presented using descriptive statistics. RESULTS The 47 respondents reached consensus on the statements. They agreed that regular treatment with mucolytic agents effectively reduces the frequency of exacerbations, reduces the duration of mild-to-moderate exacerbations, and can increase the time to first exacerbation and symptom-free time in COPD patients. Consensus was consistently highest for erdosteine. The experts agreed that all three mucolytics display antioxidant and anti-inflammatory activity. Erdosteine and NAC were thought to improve the efficacy of some classes of antibacterial drugs. All three mucolytics were considered effective for the short-term treatment of symptoms of acute exacerbations when added to other drugs. The panel agreed that approved doses of mucolytic agents have favorable side-effect profiles and can be recommended for regular use in patients with a bronchitic phenotype. CONCLUSIONS Consensus findings support the wider use of mucolytic agents as add-on therapy for COPD. However, the differences in pharmacological actions and clinical effectiveness must be considered when deciding which mucolytic to use.
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Affiliation(s)
- Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy.
| | - Sergey Avdeev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Peter M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Milos Jesenak
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia
| | - Vladimir Koblížek
- Pneumology Dept., University Hospital Hradec Králové, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Diana Petkova
- Medical University Varna, Bulgaria; University Hospital St. Marina, Varna, Bulgaria
| | - Paola Rogliani
- Respiratory Medicine Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Hesham Tarraf
- Faculty of Medicine, University Medical School, Cairo, Egypt
| | | | | | - Esra Uzaslan
- Faculty of Medicine, Pulmonology Dept., Uludağ University, Bursa, Turkey
| | - Yochai Adir
- Pulmonary Division, Lady Davis-Carmel Medical Center, Haifa, Israel
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Quint JK, O'Leary C, Venerus A, Myland M, Holmgren U, Varghese P, Richter H, Bizouard G, Cabrera C. Prescribing Pathways to Triple Therapy: A Multi-Country, Retrospective Observational Study of Adult Patients with Chronic Obstructive Pulmonary Disease. Pulm Ther 2020; 6:333-350. [PMID: 33064273 PMCID: PMC7672143 DOI: 10.1007/s41030-020-00132-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Maintenance treatment strategies in COPD recommend inhaled corticosteroid (ICS) + long-acting muscarinic antagonist (LAMA) + long-acting β2-agonist (LABA) triple therapy after initial dual therapy. Little is known about how treatment pathways to triple therapy vary across countries in clinical practice. Methods This multi-country, retrospective cohort study (conducted 1 January 2005–1 May 2016) included patients with a COPD diagnosis, and (UK only) evidence of smoking history, or (France, Italy, Germany, and Australia) an indicator confirming COPD diagnosis, a first instance of triple therapy recorded during the study period and ≥ 12 months of data prior to this date. Treatment pathways to triple therapy were analyzed in patients whose first instance of triple therapy was on or after the initial COPD diagnosis. The proportion of patients who initiated triple therapy prior to initial COPD diagnosis was also estimated. Meta-analyses of the main results were performed. Results In 130,729 patients across all countries, mean age (standard deviation) ranged from 63.4 (10.4) years (Germany) to 69.8 (9.9) years (Italy), and median time (interquartile range) from initial COPD diagnosis to first prescription of triple therapy ranged from 16.9 (5.7–36.2) months (Australia) to 42.5 (13.9–87.4) months (UK). ICS + LABA was the most common treatment pathway prior to triple therapy in the UK, Germany, and Italy (27.3%–31.6%); no previous maintenance therapy prior to triple therapy was the most common pathway in France and Australia (32.5% and 37.9%, respectively). Meta-analyses provided a pooled estimate of 20.4% (95% confidence interval: 13.8%–29.1%) for the proportion of patients initiating triple therapy at or before initial COPD diagnosis. Conclusions In this retrospective cohort study, treatment pathways to triple therapy were diverse within and between countries. The differing impact of treatments may affect quality of life and disease control in patients with COPD. Further analyses should investigate factors influencing pathways to triple therapy.
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Affiliation(s)
| | | | | | | | - Ulf Holmgren
- BioPharmaceuticals Medical, Real World Science and Digital, AstraZeneca, Gothenburg, Sweden
| | - Precil Varghese
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Claudia Cabrera
- BioPharmaceuticals Medical, Real World Science and Digital, AstraZeneca, Gothenburg, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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Boixeda R. Guías de práctica clínica: seguirlas o no seguirlas. Rev Clin Esp 2020; 220:442-443. [DOI: 10.1016/j.rce.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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Boixeda R. Clinical practice guidelines: To follow them or not. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Saba M, Davoodabadi A, Ghaffari A, Gilasi H, Haghpanah B. Combination adjunctive nebulized furosemide and salbutamol versus single agent therapy in COPD patients: A randomized controlled trial. Ann Med Surg (Lond) 2020; 57:85-90. [PMID: 32728436 PMCID: PMC7381425 DOI: 10.1016/j.amsu.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/02/2022] Open
Abstract
Background COPD patients often require multiple therapies to enhance their lung function and reduce their symptoms in exacerbations. This study aimed to investigate the relative effects of combination adjunctive nebulized furosemide and salbutamol therapy versus single agent treatment in COPD patients. Methods Sixty-nine COPD patients were randomly divided into two groups. The first group (G1, 34 cases) received salbutamol in their first episode. The second group (G2, 35 cases) received furosemide in their first episode. Spirometry indices (FEV1, FVC, and FEV1/FVC), mMRC and BORG (COPD assessment) were assessed and recorded for all patients.To study the efficacy of combination adjunctive therapy, in 2nd episodes, the nebulized furosemide was added to nebulized salbutamol in the G1, and nebulized salbutamol was added to nebulized furosemide in G2. The aforementioned indices were then re-assessed. Results The mean age was (64.92 ± 11.71 years, 55% males. The use of nebulized furosemide and salbutamol as single agents slightly improved the spirometeric parameters, but it was not noteworthy compared to the significant improvement of the FEV1, FVC, FEV1/FVC, mMRC, and Borg parameters with combination therapy (p-value< 0.001). In the first episode, there was no difference in spirometeric indices, between groups (p-value > 0.1), so furosemide is considered as effective as nebulized salbutamol. Also, the results of sequential drugs administration, in the two groups was similar. Conclusion Conjunction of nebulized furosemide and salbutamol is more effective than single therapy and can be considered as preferred drug regimen without any reported side effect in the treatment of COPD.
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Affiliation(s)
| | | | - Azin Ghaffari
- Internal Medicine, Shahid Beheshti Hospital, Kashan, Iran
| | - Hamidreza Gilasi
- Departments of Epidemiology & Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Haghpanah
- Orthopedic Surgery, Kashan University of Medical Sciences, Kashan, Iran
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Tommola M, Won HK, Ilmarinen P, Jung H, Tuomisto LE, Lehtimäki L, Niemelä O, Kim TB, Kankaanranta H. Relationship between age and bronchodilator response at diagnosis in adult-onset asthma. Respir Res 2020; 21:179. [PMID: 32660470 PMCID: PMC7359254 DOI: 10.1186/s12931-020-01441-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Possible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO). METHODS A total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40-59.9, and ≥ 60 years. The cohorts were analyzed separately. RESULTS BDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar. CONCLUSION By using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached. TRIAL REGISTRATION Seinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016 .
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Affiliation(s)
- Minna Tommola
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Ha-Kyeong Won
- Department of Internal Medicine, VHS Medical Center, Seoul, South Korea
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Heewon Jung
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Mostafavi-Pour-Manshadi SMY, Naderi N, Mancino P, Li PZ, Tan W, Bourbeau J. Fractional Exhaled Nitric Oxide as an Inflammatory Biomarker in Chronic Obstructive Pulmonary Disease (COPD) with or without Concurrent Diagnosis of Asthma: The Canadian Cohort Obstructive Lung Disease (CanCOLD). COPD 2020; 17:355-365. [PMID: 32584165 DOI: 10.1080/15412555.2020.1779681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We studied whether fractional exhaled nitric oxide (F ENO) can differentiate chronic obstructive pulmonary disease (COPD) with concurrent diagnosis of asthma from COPD-only as well as its ability to predict disease severity and progression. This study was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Subjects of ≥40 years old completed F ENO measurements were subdivided into four groups, including COPD (N = 86 [COPD-only (N = 35) and COPD with concurrent diagnosis of asthma (N = 51)], healthy (N = 72), and at risk (N = 151). Three of the most common clinical definitions were used for characterizing COPD with concurrent diagnosis of asthma: 1) atopy and self-reported physician diagnosis of asthma, 2) ≥12% and ≥200 ml post-bronchodilator FEV1; 3) self-reported physician diagnosis of asthma. F ENO values were classified using quartiles and the American Thoracic Society (ATS) guideline 2011. Compared to COPD-only, more COPD with concurrent diagnosis of asthma had a significant F ENO50 level of [Formula: see text] 33.5 ppb (fourth quartile) than COPD-only (p = 0.045, 0.011, and 0.006, for definition 1, 2, and 3, respectively). Considering the ATS guideline 2011, fewer COPD with concurrent diagnosis of asthma had F ENO50 < 25 than COPD-only, which was statistically significant with definition 1 and 3 (p = 0.038 and 0.026, respectively). F ENO as a biomarker has the potential to be used as a complementary value for differentiating COPD with concurrent diagnosis of asthma from COPD-only. Further studies should be conducted on validated definitions of COPD with concurrent diagnosis of asthma, which may include a reference to the type of airway inflammation in addition to the clinical definition.
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Affiliation(s)
| | - Nafiseh Naderi
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada
| | - Palmina Mancino
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada
| | - Pei Zhi Li
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada
| | - Wan Tan
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada.,Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Canada
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Helvaci A, Izgu N, Ozdemir L. Relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease. J Clin Nurs 2020; 29:2388-2396. [PMID: 32221991 DOI: 10.1111/jocn.15251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/29/2020] [Accepted: 03/14/2020] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence and spiritual well-being in patients with COPD has not been explored. DESIGN A descriptive correlational study design was adopted. METHODS A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale-7 (ARMS-7) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The data were analysed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used. RESULTS The CAT score was significantly higher in patients on long-term oxygen therapy and those who had more than three comorbid conditions (p < .05). The mean score of ARMS-7 was significantly associated with age (p < .05). Current smokers had higher ARMS-7 and lower FACIT-Sp scores (p < .001). The FACIT-Sp score was negatively and moderately associated with the CAT and ARMS-7 scores (p < .001). CONCLUSION This study concluded that individuals with higher spiritual well-being had lower symptom burden and higher medication adherence. The need for long-term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well-being and medication adherence. RELEVANCE TO CLINICAL PRACTICE Spiritual well-being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well-being and medication adherence in different populations are warranted.
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Affiliation(s)
- Aylin Helvaci
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Nur Izgu
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Leyla Ozdemir
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
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Marushchak M, Maksiv K, Krynytska I, Dutchak O, Behosh N. The Severity of Oxidative Stress in Comorbid Chronic Obstructive Pulmonary Disease (COPD) and Hypertension: Does it Depend On ACE and AGT Gene Polymorphisms? J Med Life 2020; 12:426-434. [PMID: 32025262 PMCID: PMC6993293 DOI: 10.25122/jml-2019-0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is an increasing number of studies suggesting the role of genetic factors in the development and progression of chronic obstructive pulmonary disease and hypertension. Therefore, our study aimed to establish the role of ACE and AGT gene polymorphisms in the mechanisms behind the development of oxidative stress in patients with concomitant chronic obstructive pulmonary disease and hypertension. The study group consisted of 96 patients: Group 1 (individuals with a chronic obstructive pulmonary disease), Group 2 (individuals with arterial hypertension), Group 3 (individuals with a chronic obstructive pulmonary disease and arterial hypertension). The control group consisted of 20 healthy subjects. ACE and AGT gene polymorphisms were determined by polymerase chain reaction amplification. Detection of intracellular reactive oxygen species levels was performed by EPICS XL cytometer (Beckman Coulter, USA) with dichlorodihydrofluorescein diacetate and dihydroethidium. Serum levels of 8-isoprostane were assayed with ELISA, Cayman Chemicals (USA). No significant correlations between ACE and AGT gene polymorphisms and parameters of oxidative stress in a setting of comorbid chronic obstructive pulmonary disease and hypertension were observed. However, the increase in oxidative stress parameters was observed to be the most significant in patients with chronic obstructive pulmonary disease + hypertension and with I/I genotype of the ACE gene, which was due to their lowest values in virtually healthy individuals. This suggests that I/I genotype may be associated with lower levels of reactive oxygen species production compared with other genotypes.
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Affiliation(s)
- Mariya Marushchak
- Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Khrystyna Maksiv
- Department of Medical Rehabilitation, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Inna Krynytska
- Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Olha Dutchak
- Department of Pediatrics, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University,Ternopil, Ukraine
| | - Nina Behosh
- Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Rehman AU, Hassali MAA, Muhammad SA, Harun SN, Shah S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:181-194. [PMID: 31564007 DOI: 10.1007/s10198-019-01119-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 09/13/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To find the economic burden of COPD and to identify the key cost drivers in the management of COPD patients across different European countries. BACKGROUND COPD is a major cause of mortality and morbidity and is associated with considerable economic burden on the individual and society. It limits the daily activities and working ability of the patients. METHODOLOGY We conducted a systematic search of PUBMED, SCIENCE DIRECT, Cochrane CENTRAL, SCOPUS, Google Scholar and SAGE Premier Databases to find scientific research articles evaluating the cost of COPD management from patient and societal perspective. RESULTS Estimated per patient per year direct cost in Norway, Denmark, Germany, Italy, Sweden, Greece, Belgium, and Serbia was €10,701, €9580, €7847, €7448, €7045, €2896, €1963, and €2047, respectively. Annual per patient cost of work productivity loss was highest in Germany as €5735 and lowest in Greece as €998. It was estimated as €4824, €2033 and €1298 in Bulgaria, Denmark and Sweden, respectively. Several factors found associated with increasing cost of COPD management that include but not limited to late diagnosis, severity of disease, frequency of exacerbation, hospital readmissions, non-adherence to the therapy and exposure to COPD risk factors. CONCLUSION Minimizing the COPD exacerbations and controlling the worsening of symptoms may potentially reduce the cost of COPD management at any stage.
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Affiliation(s)
- Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
- Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, Pakistan.
| | - Mohamed Azmi Ahmad Hassali
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | | | - Sabariah Noor Harun
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Sameen Abbas
- Department of Pharmacy, Quaid e Azam University Islamabad, Islamabad, Pakistan
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Corlateanu A, Mendez Y, Wang Y, Garnica RDJA, Botnaru V, Siafakas N. "Chronic obstructive pulmonary disease and phenotypes: a state-of-the-art.". Pulmonology 2020; 26:95-100. [PMID: 31740261 DOI: 10.1016/j.pulmoe.2019.10.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 02/08/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous and multisystemic disease with progressive increasing morbidity and mortality. COPD is now widely accepted as a heterogeneous condition with multiple phenotypes and endotypes. This review will discuss the old and new concepts for the different types of COPD phenotypes, as well as the inclusion of them in current guidelines. Phenotypical approach to COPD is having huge impact on everyday practice and changed nonpharmacological and pharmacological management of COPD in last decade. However, phenotypical approach is small step to precision medicine in COPD management in the absence of big, specific and well-designed COPD trials with exact identification of phenotypes for more personalization of the treatment of COPD.
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Affiliation(s)
- Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Moldova.
| | - Yamely Mendez
- Research Physician at Faculty of Medicine "Dr. Alberto Romo Caballero", Universidad Autonoma de Tamaulipas. Research Assistant II at Baylor College of Medicine, Houston, Texas. USA
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan 430071, China.
| | | | - Victor Botnaru
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Moldova
| | - Nikolaos Siafakas
- Professor of Thoracic Medicine, Department of Thoracic Medicine, University General Hospital, Heraklion, Greece
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