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Ancel J, Chen E, Pavot A, Regard L, Le Rouzic O, Guecamburu M, Zysman M, Rapin A, Martin C, Soumagne T, Patout M, Roche N, Deslee G. [Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]. Rev Mal Respir 2024; 41:331-342. [PMID: 38609767 DOI: 10.1016/j.rmr.2024.03.008] [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] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023. STATE OF THE ART Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation. PERSPECTIVES The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options. CONCLUSIONS As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.
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Affiliation(s)
- J Ancel
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France
| | - E Chen
- Service de pneumologie, Hôpital universitaire Avicenne, Bobigny, France
| | - A Pavot
- Centre de recherche cardio-thoracique de Bordeaux, université de Bordeaux, Inserm U1045, Bordeaux, France
| | - L Regard
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - O Le Rouzic
- Institut Pasteur de Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, CHU de Lille, CNRS, Inserm, University Lille, pneumologie et immuno-allergologie, 59000 Lille, France
| | - M Guecamburu
- Service des maladies respiratoires, CHU de Bordeaux, centre François-Magendie, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac, France
| | - M Zysman
- Service de pneumologie, CHU de Haut-Lévèque, Bordeaux, France; Centre de recherche cardio-thoracique, University Bordeaux, Inserm U1045, CIC 1401, Pessac, France
| | - A Rapin
- Département de médecine physique et de réadaptation, centre hospitalo-universitaire de Reims, hôpital Sébastopol, CHU de Reims, 51092 Reims, France; Faculté de médecine, VieFra, EA3797, 51097, université de Reims Champagne-Ardenne, Reims, France
| | - C Martin
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - T Soumagne
- Service de pneumologie et Soins intensifs respiratoires, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, Paris, France
| | - M Patout
- Service des pathologies du sommeil (département R3S), groupe hospitalier universitaire AP-HP - Sorbonne université, site Pitié-Salpêtrière, 75013 Paris, France; UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, Inserm, 75005 Paris, France
| | - N Roche
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - G Deslee
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France.
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Cometa M, Ursitti A, Lombardo LP, Rana R, Gardani A, Contoli M, Papi A. Can the Rome classification of chronic obstructive pulmonary disease exacerbation severity be applied in the hospital setting? Respir Med 2024; 222:107509. [PMID: 38145723 DOI: 10.1016/j.rmed.2023.107509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) exacerbations (ECOPDs) are crucial events in the natural history of the disease. The recent Rome proposal defines exacerbations and their grade of severity using objective parameters derived from published data. AIMS A) To evaluate the applicability of the Rome proposal in current clinical practice in different hospitals settings, B) to compare the resulting degree of severity with the conventional non-objective classification, C) to evaluate the relationship between ECOPD severity and mortality and D) the outputs in different hospital specialist wards. METHODS Observational retrospective study in patients admitted to the University Hospital of Ferrara (Italy) with a primary diagnosis of ECOPD in the year 2021. The items of severity of the Rome proposal at admission were acquired from clinical records. A clinical-based score surrogated the missing VAS data on dyspnoea. RESULTS Data were collected at admission form 320 patients. The data collected allowed the classification of severity based on the Rome proposal in 88.5 % of eligible cases. 18.5 %, 50.5 % and 31 % of ECOPD admissions were categorised as mild, moderate or severe ECOPDs respectively. In-hospital mortality increased with the ECOPD severity and mortality at 12 months was 27 % and 53.2 % in patients who have had a mild vs severe ECOPD, respectively (p = 0.059). Severe ECOPDs were more frequent and mortality rate was lower in patients admitted to Respiratory as compared to Internal Medicine wards. CONCLUSION The Rome classification is ready to use in hospitalised ECOPD. It could allow for a better identification of the hospital setting most appropriate for ECOPD management.
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Affiliation(s)
- Marianna Cometa
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy
| | - Antonio Ursitti
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Pasquale Lombardo
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy
| | - Roberto Rana
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy
| | | | - Marco Contoli
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy
| | - Alberto Papi
- Department of Translational Medicine, University of Ferrara Medical School, University of Ferrara, Sant'Anna University Hospital, Ferrara, Italy.
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Zeng J, Zhou C, Yi Q, Luo Y, Wei H, Ge H, Liu H, Zhang J, Li X, Pan P, Yi M, Cheng L, Liu L, Zhang J, Peng L, Pu J, Zhou H. Validation of the Rome Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter Cohort Study. Int J Chron Obstruct Pulmon Dis 2024; 19:193-204. [PMID: 38249828 PMCID: PMC10800102 DOI: 10.2147/copd.s442382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Background The Rome severity classification is an objective assessment tool for the severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on readily measurable variables but has not been widely validated. The aim of this study is to evaluate the validity of the Rome classification in distinguishing the severity of AECOPD based on short-term mortality and other adverse outcomes. Methods The Rome severity classification was applied to a large multicenter cohort of inpatients with AECOPD. Differences in clinical features, in-hospital and 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) and invasive mechanical ventilation (IMV) usage were compared among the mild, moderate and severe AECOPD according to the Rome proposal. Moreover, univariate logistic analysis and Kaplan Meier survival analysis were also performed to find the association between the Rome severity classification and those adverse outcomes. Results A total of 7712 patients hospitalized for AECOPD were included and classified into mild (41.88%), moderate (40.33%), or severe (17.79%) group according to the Rome proposal. The rate of ICU admission (6.4% vs 12.0% vs 14.9%, P <0.001), MV (11.7% vs 33.7% vs 45.3%, P <0.001) and IMV (1.4% vs 6.8% vs 8.9%, P <0.001) increased significantly with the increase of severity classification from mild to moderate to severe AECOPD. The 60-day mortality was higher in the moderate or severe group than in the mild group (3.5% vs 1.9%, 4.3% vs 1.9%, respectively, P <0.05) but showed no difference between the moderate and severe groups (2.6% vs 2.5%, P >0.05), results for in-hospital mortality showed the same trends. Similar findings were observed by univariate logistic analysis and survival analysis. Conclusion Rome severity classification demonstrated excellent performance in predicting ICU admission and the need for MV or IMV, but how it performs in differentiating short-term mortality still needs to be confirmed.
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Affiliation(s)
- Jiaxin Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Chen Zhou
- Center of Infectious Diseases, Division of Infectious Diseases in State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, Sichuan Province, People’s Republic of China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Mengqiu Yi
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
| | - Lina Cheng
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - On behalf of the MAGNET AECOPD Registry Investigators
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Center of Infectious Diseases, Division of Infectious Diseases in State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, Sichuan Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, People’s Republic of China
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Agusti A, Vogelmeier CF. GOLD 2024: a brief overview of key changes. J Bras Pneumol 2023; 49:e20230369. [PMID: 38126685 PMCID: PMC10760434 DOI: 10.36416/1806-3756/e20230369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Alvar Agusti
- . Respiratory Institute, Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERES, Spain
| | - Claus F Vogelmeier
- . Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, German Center for Lung Research (DZL), Marburg, Germany
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Quadflieg K, Machado A, de Lima FF, Dederen A, Daenen M, Ruttens D, Thomeer M, Spruit MA, Burtin C. Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events. Respir Med 2023; 220:107437. [PMID: 37918543 DOI: 10.1016/j.rmed.2023.107437] [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: 08/23/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients' risk for future events. METHODS This observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected. RESULTS Forty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1. CONCLUSION Patients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge.
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Affiliation(s)
- Kirsten Quadflieg
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ana Machado
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Fabiano Francisco de Lima
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Department of Physical Therapy, SãoPaulo State University (UNESP), Presidente Prudente, Brazil
| | - Anand Dederen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Marc Daenen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Ruttens
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Michiel Thomeer
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Martijn A Spruit
- CIRO, Center of Expertise for Chronic Organ Failure, Department of Research and Education, 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, Maastricht, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
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Ryu MH, Hersh CP. The Road From Rome: Applying a New COPD Exacerbation Classification to a Real-World Cohort. Chest 2023; 164:1339-1340. [PMID: 38070951 DOI: 10.1016/j.chest.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Min Hyung Ryu
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
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Jacobson PK, Lind L, Persson HL. Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter? Int J Chron Obstruct Pulmon Dis 2023; 18:2055-2064. [PMID: 37744733 PMCID: PMC10517701 DOI: 10.2147/copd.s425592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Chronic heart failure (CHF) is a common comorbidity among patients with chronic obstructive pulmonary disease (COPD). Both exacerbations of COPD (ECOPDs) and exacerbations of CHF (ECHFs) display worsening of breathlessness at rest (BaR) and breathlessness at physical activity (BaPA). Comorbid CHF may have an impact on the vital signs assessed, when the Rome proposal (adopted by GOLD 2023) is applied on ECOPDs. Thus, the aim of the present study was to investigate the impact of comorbid CHF on ECOPDs severity, particularly focusing on the influence of comorbid CHF on BaR and BaPA. Methods We analysed data on COPD symptoms collected from the telehealth study The eHealth Diary. Patients with COPD (n = 43) and patients with CHF (n = 41) were asked to daily monitor BaR and BaPA, employing a digital pen and scales for BaR and BaPA (from 0 to 10). Twenty-eight patients of the COPD patients presented with comorbid CHF. Totally, 125 exacerbations were analysed. Results Exacerbations in the group with COPD patients and comorbid CHF were compared to the group with COPD patients without comorbid CHF and the group with CHF patients. Compared with GOLD 2022, the GOLD 2023 (the Rome proposal) significantly downgraded the ECOPD severity. Comorbid CHF did not interfere significantly on the observed difference. Comorbid CHF did not worsen BaR scores, assessed at inclusion and at the symptom peak of the exacerbations. Conclusion In the present study, we find no evidence that comorbid CHF would interfere significantly with the parameters included in the Rome proposal (GOLD 2023). We conclude that the Rome proposal can be safely applied even on COPD patients with very advanced comorbid CHF.
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Affiliation(s)
- Petra Kristina Jacobson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Linköping, Sweden
- Digital Systems Division, Unit Digital Health, RISE Research Institutes of Sweden, Linköping, Sweden
| | - Hans L Persson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
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