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MacDonald MI, Polkinghorne KR, MacDonald CJ, Leong P, Hamza K, Kathriachchige G, Osadnik CR, King PT, Bardin PG. Elevated blood lactate in COPD exacerbations associates with adverse clinical outcomes and signals excessive treatment with β 2 -agonists. Respirology 2023; 28:860-868. [PMID: 37400102 DOI: 10.1111/resp.14534] [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: 11/09/2022] [Accepted: 05/31/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Raised blood lactate secondary to high dose β2 -agonist treatment has been reported in asthma exacerbations but has not been investigated during acute exacerbations of COPD (AECOPD). We explored associations of blood lactate measurements with disease outcomes and β2 -agonist treatments during AECOPD. METHODS Retrospective (n = 199) and prospective studies (n = 142) of patients hospitalized with AECOPD were conducted. The retrospective cohort was identified via medical records and the prospective cohort was recruited during hospitalization for AECOPD. Baseline demographics, comorbidities, β2 -agonist treatment, biochemical measurements and clinical outcomes were compared between patients with normal (≤2.0 mmol/L) versus elevated lactate (>2.0 mmol/L). Regression analyses examined associations of lactate measurements with β2 -agonist dosages. RESULTS Demographic data and comorbidities were similar between high versus normal lactate groups in both cohorts. The populations were elderly (mean >70 years), predominantly male (>60%) with reduced FEV1 (%) 48.2 ± 19 (prospective cohort). Lactate was elevated in approximately 50% of patients during AECOPD and not related to evidence of sepsis. In the prospective cohort, patients with high lactate had more tachypnoea, tachycardia, acidosis and hyperglycaemia (p < 0.05) and received more non-invasive ventilation (37% vs. 9.7%, p < 0.001, prospective cohort). There was a trend to longer hospitalization (6 vs. 5 days, p = 0.06, prospective cohort). Higher cumulative β2 -agonist dosages were linked to elevated lactate levels (OR 1.04, p = 0.01). CONCLUSION Elevated lactate during AECOPD was common, unrelated to sepsis and correlated with high cumulative doses of β2 -agonists. Raised lactate may indicate excessive β2 -agonist treatment and should now be investigated as a possible biomarker.
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Affiliation(s)
- Martin I MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Hudson Institute, Melbourne, Victoria, Australia
| | | | | | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Hudson Institute, Melbourne, Victoria, Australia
| | - Kais Hamza
- Department of Mathematical Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Christian Robert Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Hudson Institute, Melbourne, Victoria, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Hudson Institute, Melbourne, Victoria, Australia
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Byron C, Osadnik CR. Physical Activity Profiles among Patients Admitted with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 12:4914. [PMID: 37568317 PMCID: PMC10419862 DOI: 10.3390/jcm12154914] [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: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
People with hospitalised acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exhibit low levels of physical activity (PA) and increased risks of future exacerbations. While methods to objectively measure and express PA are established for people with stable COPD, less clarity exists for people during AECOPD. Further, the relationship between PA during AECOPD and clinically relevant outcomes remains uncertain. The purpose of the study was to evaluate how much PA (step count and intensity) people accumulate during hospitalised AECOPDs, and the effect of accumulated inpatient PA (expressed via differing metrics) on length of stay (LOS), PA recovery, and readmission risk. This study was a secondary analysis of prospective observational cohort data collected with Actigraph wActiSleep-BT devices from patients with AECOPD in a Melbourne hospital from 2016 to 2018. Step counts and PA intensity throughout the hospital admission and at one-month follow-up were collected and analysed. Sixty-eight participants were recruited for inpatient measurement, and 51 were retained for follow-up. There were no significant changes in step count or intensity across the inpatient days, but 33/51 (65%) of participants demonstrated a clinically meaningful improvement in steps per day from 3817.0 to 6173.7 at follow-up. Participants spent most time sedentary and in light PA, with both PA metrics demonstrating significant influences on LOS and follow-up PA intensity, but with generally low explanatory power (R2 value range 7-22%). Those who had LOS < 5 days spent significantly less time sedentary and more time in light PA than those with LOS ≥ 5 days (p < 0.001 for both). Time spent sedentary or in light PA appears to be the most promising metric to associate with clinically relevant outcomes related to recovery following AECOPD. These findings can inform future clinical practice for the evaluation of inpatient PA to better establish its role in the clinical management of patients with AECOPD.
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Affiliation(s)
- Christopher Byron
- Department of Physiotherapy, Monash University, Melbourne 3199, Australia;
| | - Christian R. Osadnik
- Department of Physiotherapy, Monash University, Melbourne 3199, Australia;
- Monash Lung Sleep Allergy Immunology, Monash Health, Melbourne 3168, Australia
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Kaleem Ullah M, Parthasarathi A, Biligere Siddaiah J, Vishwanath P, Upadhyay S, Ganguly K, Anand Mahesh P. Impact of Acute Exacerbation and Its Phenotypes on the Clinical Outcomes of Chronic Obstructive Pulmonary Disease in Hospitalized Patients: A Cross-Sectional Study. TOXICS 2022; 10:toxics10110667. [PMID: 36355958 PMCID: PMC9695923 DOI: 10.3390/toxics10110667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 06/07/2023]
Abstract
Acute exacerbations of COPD (AECOPD) are clinically significant events having therapeutic and prognostic consequences. However, there is a lot of variation in its clinical manifestations described by phenotypes. The phenotypes of AECOPD were categorized in this study based on pathology and exposure. In our cross-sectional study, conducted between 1 January 2016 to 31 December 2020, the patients were categorized into six groups based on pathology: non-bacterial and non-eosinophilic; bacterial; eosinophilic; bacterial infection with eosinophilia; pneumonia; and bronchiectasis. Further, four groups were classified based on exposure to tobacco smoke (TS), biomass smoke (BMS), both, or no exposure. Cox proportional-hazards regression analyses were performed to assess hazard ratios, and Kaplan-Meier analysis was performed to assess survival, which was then compared using the log-rank test. The odds ratio (OR) and independent predictors of ward admission type and length of hospital stay were assessed using binomial logistic regression analyses. Of the 2236 subjects, 2194 were selected. The median age of the cohort was 67.0 (60.0 to 74.0) and 75.2% were males. Mortality rates were higher in females than in males (6.2% vs. 2.3%). AECOPD-B (bacterial infection) subjects [HR 95% CI 6.42 (3.06-13.46)], followed by AECOPD-P (pneumonia) subjects [HR (95% CI: 4.33 (2.01-9.30)], were at higher mortality risk and had a more extended hospital stay (6.0 (4.0 to 9.5) days; 6.0 (4.0 to 10.0). Subjects with TS and BMS-AECOPD [HR 95% CI 7.24 (1.53-34.29)], followed by BMS-AECOPD [HR 95% CI 5.28 (2.46-11.35)], had higher mortality risk. Different phenotypes have different impacts on AECOPD clinical outcomes. A better understanding of AECOPD phenotypes could contribute to developing an algorithm for the precise management of different phenotypes.
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Affiliation(s)
- Mohammed Kaleem Ullah
- Centre for Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSSAHER, Mysore 570015, Karnataka, India
- Global Infectious Diseases Fellow, Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Ashwaghosha Parthasarathi
- Allergy, Asthma, and Chest Centre, Krishnamurthypuram, Mysore 570004, Karnataka, India
- RUTGERS Centre for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ 08901-1293, USA
| | | | - Prashant Vishwanath
- Centre for Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSSAHER, Mysore 570015, Karnataka, India
| | - Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institutet, 17177 Stockholm, Sweden
| | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institutet, 17177 Stockholm, Sweden
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore 570015, Karnataka, India
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Pépin JL, Degano B, Tamisier R, Viglino D. Remote Monitoring for Prediction and Management of Acute Exacerbations in Chronic Obstructive Pulmonary Disease (AECOPD). Life (Basel) 2022; 12:life12040499. [PMID: 35454991 PMCID: PMC9028268 DOI: 10.3390/life12040499] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
Abstract
The progression of chronic obstructive pulmonary disease (COPD) is characterized by episodes of acute exacerbation (AECOPD) of symptoms, decline in respiratory function, and reduction in quality-of-life increasing morbi-mortality and often requiring hospitalization. Exacerbations can be triggered by environmental exposures, changes in lifestyle, and/or physiological and psychological factors to greater or lesser extents depending on the individual’s COPD phenotype. The prediction and early detection of an exacerbation might allow patients and physicians to better manage the acute phase. We summarize the recent scientific data on remote telemonitoring (TM) for the prediction and management of acute exacerbations in COPD patients. We discuss the components of remote monitoring platforms, including the integration of environmental monitoring data; patient reported outcomes collected via interactive Smartphone apps, with data from wearable devices that monitor physical activity, heart rate, etc.; and data from medical devices such as connected non-invasive ventilators. We consider how telemonitoring and the deluge of data it potentially generates could be combined with electronic health records to provide personalized care and multi-disease management for COPD patients.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
- Correspondence:
| | - Bruno Degano
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Damien Viglino
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- Emergency Department, University Hospital of Grenoble Alpes, 38043 Grenoble, France
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Beghé B, Clini E, Fabbri LM. Urgent need of novel biomarkers of acute dyspnea. Intern Emerg Med 2022; 17:491-493. [PMID: 34813008 DOI: 10.1007/s11739-021-02874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Bianca Beghé
- Section of Respiratory Diseases, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Largo del Pozzo 71, 41124, Modena, Italy.
| | - Enrico Clini
- Section of Respiratory Diseases, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Largo del Pozzo 71, 41124, Modena, Italy
| | - Leonardo M Fabbri
- Section of Respiratory Diseases, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Largo del Pozzo 71, 41124, Modena, Italy
- Section of Respiratory Medicine, Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Duszyk K, McLoughlin RF, Gibson PG, McDonald VM. The use of treatable traits to address COPD complexity and heterogeneity and to inform the care. Breathe (Sheff) 2022; 17:210118. [PMID: 35035572 PMCID: PMC8753613 DOI: 10.1183/20734735.0118-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022] Open
Abstract
COPD is complex and heterogeneous with respect to its aetiology, clinical presentation, phenotypes and biological mechanisms. Despite this, COPD is still diagnosed and treated according to simple clinical measures, including airflow limitation, symptoms and exacerbation frequency, leading to failure to recognise the disease's heterogeneity and/or to provide targeted interventions. COPD continues to have a very large burden of disease with suboptimal outcomes for people with the disease, including frequent hospitalisation with exacerbations, rapid lung function decline, multimorbidity and death from respiratory failure. In light of this, there have been increasing calls for a renewed taxonomy with better characterisation of COPD phenotypes and endotypes. This would allow the unravelling of COPD's complexity and heterogeneity, the implementation of targeted interventions and improved patient outcomes. The treatable traits strategy is a proposed vehicle for the implementation of precision medicine in chronic airway diseases. In this review, in addition to summarising the key knowledge on the heterogeneity of COPD, we refer to the existing evidence pertaining to the treatable traits strategy as applied in COPD and discuss implementation in different settings. COPD is a heterogeneous clinical syndrome, which requires deconstruction of its individual components to facilitate targeted treatment and improve individual patient outcomes.
https://bit.ly/2YXWgHN
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Affiliation(s)
- Katarzyna Duszyk
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia
| | - Rebecca F McLoughlin
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Treatable Traits and Priority Research Centre for Healthy Lungs, the University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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7
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Cen LJ, Zhang XX, Guan WJ. Phenotyping acute exacerbation of COPD: what more can we do for hospitalised patients? ERJ Open Res 2021; 7:00362-2021. [PMID: 34350289 PMCID: PMC8326715 DOI: 10.1183/23120541.00362-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
Hospitalised #AECOPD are characterised by multiple facets of aetiology. The clinical interpretation of the composite phenotypes of AECOPD and the robustness of the AECOPD phenotype need to be discussed further. https://bit.ly/3grzQEO.
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Affiliation(s)
- Lai-Jian Cen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors contributed equally
| | - Xiao-Xian Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors contributed equally
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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