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Qureshi MA, Vernooij RWM, La Rosa GRM, Polosa R, O'Leary R. Respiratory health effects of e-cigarette substitution for tobacco cigarettes: a systematic review. Harm Reduct J 2023; 20:143. [PMID: 37794458 PMCID: PMC10552385 DOI: 10.1186/s12954-023-00877-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND E-cigarettes (electronic nicotine delivery system, ENDS) have been presented as a harm reduction strategy for people who smoke tobacco cigarettes but who cannot achieve abstinence, or for those who wish to continue to enjoy nicotine and the habit of smoking. What are the health effects of the substitution of ENDS for tobacco cigarettes? This systematic review evaluates the evidence of human clinical tests on the respiratory effects of ENDS use in participants who smoke tobacco cigarettes. METHODS A registered and published protocol was developed conforming to PRISMA 2020 and AMSTAR2 standards. The literature search was conducted in PubMed, Scopus, and the CENTRAL Cochrane Library and updated to May 2022. Three supplementary searches and a grey literature search were performed. Studies were evaluated with the JBI quality tools and the Oxford Catalogue of Bias. Due to the heterogeneity (diversity) of the studies, a narrative data synthesis was performed on the test findings plus three sub-group analyses. RESULTS The review consists of sixteen studies and twenty publications. Spirometry tests comprised the majority of the data. In total, 66 respiratory test measurements were reported, out of which 43 (65%) were not significant. Statistically significant findings were mixed, with 9 tests showing improvements and 14 measuring declines, none of which was clinically relevant. Ten studies were rated at a high risk of bias, and six had some concerns primarily due to inadequate research designs and the conduct of the studies. Reporting bias was documented in thirteen studies. CONCLUSIONS Most of the studies showed no difference in respiratory parameters. This indicates that ENDS substitution for smoking likely does not result in additional harm to respiratory health. Due to the low quality of the studies, confidence in the conclusions is rated as low. Robust studies with a longer duration and sufficient power are required to validate any potential benefits or possible harms of ENDS substitution. Registration PROSPERO #CRD42021239094, International Registered Report Identifier (IRRID): DERR1-10.2196/29084.
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Affiliation(s)
- Maria Ahmed Qureshi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht and Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | | | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy
| | - Renee O'Leary
- Centre of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, 89 Torre Biologica 11 Piano, 95123, Catania, Italy.
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2
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Mahler DA, Halpin DMG. Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1389-1396. [PMID: 37499210 PMCID: PMC10559134 DOI: 10.1513/annalsats.202304-384cme] [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: 04/27/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
It can be challenging for healthcare professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) because of the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on the selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s). Although numerous recommendations and algorithms have been proposed to guide the selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using handheld inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. On the basis of these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication delivery system as a unit and to match appropriate medication(s) with the unique features of the delivery system to individual patient factors. Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.
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Affiliation(s)
- Donald A. Mahler
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
- Valley Regional Hospital, Claremont, New Hampshire; and
| | - David M. G. Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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3
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Quiroga TN, Bachar N, Voigt W, Danino N, Shafran I, Shtrichman R, Shuster G, Lambrecht N, Eisenmann S. Changes in tidal breathing biomarkers as indicators of treatment response in AECOPD patients in an acute care setting. Adv Med Sci 2023; 68:176-185. [PMID: 37146372 DOI: 10.1016/j.advms.2023.04.001] [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: 12/02/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a complication of COPD that typically necessitates intensified treatment and hospitalization. It is linked to higher morbidity, mortality and healthcare spending. Assessment of therapy response for AECOPD is difficult due to the variability of symptoms and limitations in current measures. Hence, there is a need for new biomarkers to aid in the management of AECOPD in acute care settings. MATERIALS AND METHODS Fifteen hospitalized AECOPD patients (GOLD 3-4) were enrolled in this study. Treatment response was assessed daily through clinical evaluations and by monitoring tidal breathing biomarkers (respiratory rate [RR], expiratory time [Tex], inspiratory time [Tin], expiratory pause [Trst], total breath time [Ttot]), using a novel, wearable nanosensor-based device (SenseGuard™). RESULTS Patients who showed significant clinical improvement had substantial changes in ΔTex/Ttot (+14%), ΔTrst/Ttot (-18%), and ΔTin/Tex (+0.09), whereas patients who showed mild or no clinical improvement had smaller changes (+5%, +3%, and -0.03, respectively). Linear regression between change in physician's assessment score and the median change in tidal breathing parameters was significant for Tin/Tex (R2 = 0.449, ∗p = 0.017), Tex/Ttot (R2 = 0.556, ∗p = 0.005) and Trst/Ttot (R2 = 0.446, ∗p = 0.018), while no significant regression was observed for RR, Tin/(Trst + Tex) and Tin/Ttot. CONCLUSIONS Our study demonstrates the potential of the SenseGuard™ to monitor treatment response in AECOPD patients by measuring changes in tidal breathing biomarkers, which were shown to be associated with significant changes in the patients' respiratory condition as evaluated by physicians. However, further large-scale clinical studies are needed to confirm these findings.
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Affiliation(s)
- Tess Nuñez Quiroga
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | | | - Wieland Voigt
- NanoVation-GS LTD, Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
| | | | | | | | | | - Nina Lambrecht
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
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4
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Kurian V, Ghadipasha N, Gee M, Chalant A, Hamill T, Okossi A, Chen L, Yu B, Ogunnaike BA, Beris AN. Systems Engineering Approach to Modeling and Analysis of Chronic Obstructive Pulmonary Disease. ACS OMEGA 2023; 8:20524-20535. [PMID: 37332794 PMCID: PMC10268641 DOI: 10.1021/acsomega.3c00854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation. This study develops a systems engineering framework for representing important mechanistic details of COPD in a model of the cardiorespiratory system. In this model, we present the cardiorespiratory system as an integrated biological control system responsible for regulating breathing. Four engineering control system components are considered: sensor, controller, actuator, and the process itself. Knowledge of human anatomy and physiology is used to develop appropriate mechanistic mathematical models for each component. Following a systematic analysis of the computational model, we identify three physiological parameters associated with reproducing clinical manifestations of COPD: changes in the forced expiratory volume, lung volumes, and pulmonary hypertension. We quantify the changes in these parameters (airway resistance, lung elastance, and pulmonary resistance) as the ones that result in a systemic response that is diagnostic of COPD. A multivariate analysis of the simulation results reveals that the changes in airway resistance have a broad impact on the human cardiorespiratory system and that the pulmonary circuit is stressed beyond normal under hypoxic environments in most COPD patients.
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Affiliation(s)
- Varghese Kurian
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Navid Ghadipasha
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Michelle Gee
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
- Daniel
Baugh Institute of Functional Genomics/Computational Biology, Department
of Pathology and Genomic Medicine, Thomas
Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Anais Chalant
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Teresa Hamill
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Alphonse Okossi
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Lucy Chen
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Bin Yu
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Babatunde A. Ogunnaike
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Antony N. Beris
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
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5
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Topole E, Biondaro S, Montagna I, Corre S, Corradi M, Stanojevic S, Graham B, Das N, Ray K, Topalovic M. Artificial intelligence based software facilitates spirometry quality control in asthma and COPD clinical trials. ERJ Open Res 2023; 9:00292-2022. [PMID: 36776483 PMCID: PMC9907146 DOI: 10.1183/23120541.00292-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Rationale Acquiring high-quality spirometry data in clinical trials is important, particularly when using forced expiratory volume in 1 s or forced vital capacity as primary end-points. In addition to quantitative criteria, the American Thoracic Society (ATS)/European Respiratory Society (ERS) standards include subjective evaluation which introduces inter-rater variability and potential mistakes. We explored the value of artificial intelligence (AI)-based software (ArtiQ.QC) to assess spirometry quality and compared it to traditional over-reading control. Methods A random sample of 2000 sessions (8258 curves) was selected from Chiesi COPD and asthma trials (n=1000 per disease). Acceptability using the 2005 ATS/ERS standards was determined by over-reader review and by ArtiQ.QC. Additionally, three respiratory physicians jointly reviewed a subset of curves (n=150). Results The majority of curves (n=7267, 88%) were of good quality. The AI agreed with over-readers in 91% of cases, with 97% sensitivity and 93% positive predictive value. Performance was significantly better in the asthma group. In the revised subset, n=50 curves were repeated to assess intra-rater reliability (κ=0.83, 0.86 and 0.80 for each of the three reviewers). All reviewers agreed on 63% of 100 unique tests (κ=0.5). When reviewers set the consensus (gold standard), individual agreement with it was 88%, 94% and 70%. The agreement between AI and "gold-standard" was 73%; over-reader agreement was 46%. Conclusion AI-based software can be used to measure spirometry data quality with comparable accuracy as experts. The assessment is a subjective exercise, with intra- and inter-rater variability even when the criteria are defined very precisely and objectively. By providing consistent results and immediate feedback to the sites, AI may benefit clinical trial conduct and variability reduction.
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Affiliation(s)
- Eva Topole
- Global Clinical Development, Chiesi Farmaceutici, S.p.A., Parma, Italy
| | - Sonia Biondaro
- Global Clinical Development, Chiesi Farmaceutici, S.p.A., Parma, Italy
| | - Isabella Montagna
- Global Clinical Development, Chiesi Farmaceutici, S.p.A., Parma, Italy
| | - Sandrine Corre
- Global Clinical Development, Chiesi Farmaceutici, S.p.A., Parma, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Brian Graham
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nilakash Das
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,ArtiQ NV, Leuven, Belgium
| | | | - Marko Topalovic
- ArtiQ NV, Leuven, Belgium,Corresponding author: Marko Topalovic ()
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Wingood M, Jones SMW, Gell NM, Brach JS, Peters DM. The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation. THE GERONTOLOGIST 2021; 62:e555-e563. [PMID: 34794173 PMCID: PMC9710241 DOI: 10.1093/geront/gnab165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity. RESEARCH DESIGN AND METHODS Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity. RESULTS The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001). DISCUSSION AND IMPLICATIONS The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.
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Affiliation(s)
- Mariana Wingood
- Address correspondence to: Mariana Wingood, PhD, Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Drive, Rowell Building, Burlington, VT 05405, USA. E-mail:
| | - Salene M W Jones
- Public Health Science Division, Fred Hutch, Seattle, Washington, USA
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
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7
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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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8
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Webber SC, Tittlemier BJ, Loewen HJ. Apparent Discordance Between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review. Phys Ther 2021; 101:6307339. [PMID: 34160029 PMCID: PMC8420624 DOI: 10.1093/ptj/pzab155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many survivors of COVID-19 experience ongoing signs and symptoms affecting multiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages. METHODS MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. Select questions from the Appraisal of Guidelines for Research and Evaluation instrument were used to evaluate the quality of consensus guidelines. RESULTS Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, activities of daily living and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation. CONCLUSION There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self-management and access to rehabilitation specialists in multidisciplinary teams. IMPACT Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.
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Affiliation(s)
| | - Brenda J Tittlemier
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
| | - Hal J Loewen
- Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
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Corchon S, Rodriguez-Blazquez C, Carvajal-Carrascal G, Fuentes-Ramirez A, Ruiz de Ocenda MI, Caparros N, Timonet-Andreu E, Navarta-Sanchez MV, Ambrosio L. International psychometric validation of the Living with Chronic Illness Scale in Spanish-speaking patients with chronic obstructive pulmonary disease. BMJ Open 2021; 11:e039973. [PMID: 33712522 PMCID: PMC7959234 DOI: 10.1136/bmjopen-2020-039973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/30/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To validate the Living with Chronic Illness (LW-CI) Scale in patients with chronic obstructive pulmonary disease (COPD). DESIGN Observational, cross-sectional validation study with retest. Acceptability, reliability, precision and construct validity were tested. SETTING The study took place in primary and secondary specialised units of public and private hospitals of Spain and Colombia. PARTICIPANTS The study included 612 patients with COPD assessed from May 2018 to May 2019. A consecutive cases sampling was done. Inclusion criteria included: (A) patients with a diagnosis of COPD; (B) native Spanish speaking; (C) able to read and understand questionnaires; and (D) able to provide informed consent. Exclusion criteria included: (A) cognitive deterioration and (B) pharmacological effect or disorder that could disrupt the assessment. RESULTS The LW-CI-COPD presented satisfactory data quality, with no missing data or floor/ceiling effects, showing high internal consistency for all the domains (Cronbach's alpha for the total score 0.92). Test-retest reliability was satisfactory (intraclass correlation coefficient=0.92). The LW-CI-COPD correlated 0.52-0.64 with quality of life and social support measures. The scale demonstrated satisfactory known-groups validity, yielding significantly different scores in patients grouped according to COPD severity levels. CONCLUSIONS This has been the first validation study of the LW-CI-COPD. It is a feasible, reliable, valid and precise self-reported scale to measure living with COPD in the Spanish-speaking population. Therefore, it could be recommended for research and clinical practice to measure this concept and evaluate the impact of centred-care interdisciplinary interventions based on the patients' perspective, focused on providing holistic and comprehensive care to patients with COPD.
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Affiliation(s)
- Silvia Corchon
- Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
| | - Carmen Rodriguez-Blazquez
- National Centre of Epidemiology and Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas/CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | | | | | | | - Neus Caparros
- Faculty of Legal and Social Science, University of La Rioja, La Rioja, Spain
| | | | | | - Leire Ambrosio
- School of Health Sciences, NIHR ARC Wessex, University of Southampton, Southampton, UK
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10
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Camus-García E, González-González AI, Heijmans M, Niño de Guzmán E, Valli C, Beltran J, Pardo-Hernández H, Ninov L, Strammiello V, Immonen K, Mavridis D, Ballester M, Suñol R, Orrego C. Self-management interventions for adults living with Chronic Obstructive Pulmonary Disease (COPD): The development of a Core Outcome Set for COMPAR-EU project. PLoS One 2021; 16:e0247522. [PMID: 33647039 PMCID: PMC7920347 DOI: 10.1371/journal.pone.0247522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care. METHODS We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers' perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS. RESULTS From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness. CONCLUSION The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients' preferences regarding COPD outcomes are more systematically included.
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Affiliation(s)
- Estela Camus-García
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ana Isabel González-González
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Institute of General Practice, Goethe University, Frankfurt, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre Barcelona, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Atónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernández
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau) - CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | | | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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11
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Elghafari A, Finkelstein J. Automated Identification of Common Disease-Specific Outcomes for Comparative Effectiveness Research Using ClinicalTrials.gov: Algorithm Development and Validation Study. JMIR Med Inform 2021; 9:e18298. [PMID: 33460388 PMCID: PMC7899806 DOI: 10.2196/18298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/30/2020] [Accepted: 01/17/2021] [Indexed: 01/02/2023] Open
Abstract
Background Common disease-specific outcomes are vital for ensuring comparability of clinical trial data and enabling meta analyses and interstudy comparisons. Traditionally, the process of deciding which outcomes should be recommended as common for a particular disease relied on assembling and surveying panels of subject-matter experts. This is usually a time-consuming and laborious process. Objective The objectives of this work were to develop and evaluate a generalized pipeline that can automatically identify common outcomes specific to any given disease by finding, downloading, and analyzing data of previous clinical trials relevant to that disease. Methods An automated pipeline to interface with ClinicalTrials.gov’s application programming interface and download the relevant trials for the input condition was designed. The primary and secondary outcomes of those trials were parsed and grouped based on text similarity and ranked based on frequency. The quality and usefulness of the pipeline’s output were assessed by comparing the top outcomes identified by it for chronic obstructive pulmonary disease (COPD) to a list of 80 outcomes manually abstracted from the most frequently cited and comprehensive reviews delineating clinical outcomes for COPD. Results The common disease-specific outcome pipeline successfully downloaded and processed 3876 studies related to COPD. Manual verification indicated that the pipeline was downloading and processing the same number of trials as were obtained from the self-service ClinicalTrials.gov portal. Evaluating the automatically identified outcomes against the manually abstracted ones showed that the pipeline achieved a recall of 92% and precision of 79%. The precision number indicated that the pipeline was identifying many outcomes that were not covered in the literature reviews. Assessment of those outcomes indicated that they are relevant to COPD and could be considered in future research. Conclusions An automated evidence-based pipeline can identify common clinical trial outcomes of comparable breadth and quality as the outcomes identified in comprehensive literature reviews. Moreover, such an approach can highlight relevant outcomes for further consideration.
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Affiliation(s)
- Anas Elghafari
- Center for Biomedical and Population Health Informatics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Finkelstein
- Center for Biomedical and Population Health Informatics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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Effects of Tiotropium/Olodaterol on Activity-Related Breathlessness, Exercise Endurance and Physical Activity in Patients with COPD: Narrative Review with Meta-/Pooled Analyses. Adv Ther 2021; 38:835-853. [PMID: 33306188 PMCID: PMC7889690 DOI: 10.1007/s12325-020-01557-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/29/2020] [Indexed: 01/17/2023]
Abstract
Abstract One of the most debilitating symptoms of chronic obstructive pulmonary disease (COPD) is breathlessness, which leads to avoidance of physical activities in daily living and hastens clinical deterioration. Treatment of patients with COPD with inhaled long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination therapy improves airflow limitation, reduces breathlessness compared with LAMA or LABA monotherapies, and improves health status and quality of life. A large clinical trial programme focusing on the effects of tiotropium/olodaterol combination therapy demonstrated that this LAMA/LABA combination improves lung function and reduces hyperinflation (assessed by serial inspiratory capacity measurements) compared with either tiotropium alone or placebo in patients with COPD. Tiotropium/olodaterol also increases exercise endurance capacity and improves patient perception of the intensity of breathlessness compared with placebo. In this narrative review, we focus on the relationship between improving symptoms during activity, the ability to remain active in daily life and how this may impact quality of life. We consider the benefits of therapy optimisation by means of dual bronchodilation with tiotropium/olodaterol, and present new data from meta-analyses/pooled analyses showing that tiotropium/olodaterol improves inspiratory capacity compared with placebo and tiotropium and improves exercise endurance time compared with placebo after 6 weeks of treatment. We also discuss the importance of taking a holistic approach to improving physical activity, including pulmonary rehabilitation and exercise programmes in parallel with bronchodilator therapy and psychological programmes to support behaviour change. Graphic Abstract ![]()
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13
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Exhaled Breath Condensate and Dyspnea in COPD. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:339-344. [DOI: 10.1007/978-3-030-78771-4_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Cheng WC, Wu BR, Liao WC, Chen CY, Chen WC, Hsia TC, Tu CY, Chen CH, Hsu WH. When to Use Initial Triple Therapy in COPD: Adding a LAMA to ICS/LABA by Clinically Important Deterioration Assessment. Int J Chron Obstruct Pulmon Dis 2020; 15:3375-3384. [PMID: 33376318 PMCID: PMC7764554 DOI: 10.2147/copd.s279482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Triple therapy versus dual therapy for chronic pulmonary obstructive disease (COPD) can reduce symptoms, limit the risk of acute exacerbations (AEs) as well as improve lung function. Currently, studies that feature clinically important deterioration (CID) as a composite endpoint to assess the need for treatment intensification for patients maintained on dual therapy remained to be scarce. Patients and Methods This study is a retrospective analysis (January 2014 to January 2018) of COPD patients that presented with moderate to severe AEs during the previous year with blood eosinophil counts ≥ 100 cells/μL. The first line of therapy included a combination of inhaled corticosteroid (ICS) and a long-acting β2 agonist (LABA). Composite CID was used in assessing the response to treatment after 24 weeks of therapy. Results This study included 110 patients, of which 49 patients reportedly experienced CID. The most common events of CID include a decline in forced expiratory volume in 1 second (FEV1) ≥ 100 mL from baseline (25/49, 51%) and an increase in COPD Assessment Test (CAT) scores ≥ 2 (13/49, 26.5%); many of these patients respond to the addition of a long-acting muscarinic antagonist (LAMA). Seven patients (7/110, 6.3%) experienced moderate to severe exacerbations while undergoing treatment with ICS/LABA. Univariate and multivariate analyses have identified low baseline FEV1 (OR = 0.81, p = 0.004), high CAT score (OR = 1.89, p = 0.004), and the frequency of AE (OR = 19.86, p = 0.021) as independent predictors of CID. A baseline FEV1 of ≤42%, an initial CAT score ≥ 18, and AE ≥ 2 last year were considered the optimal cut-off values, which were identified via receiver operating characteristics (ROC) curve analysis. Conclusion Triple therapy (ICS/LABAs/LAMAs) may be considered as first-line treatment in patients experiencing more than 2 times moderate to severe AEs of COPD in the previous year and who have blood eosinophil counts ≥100 cells/μL, reduced lung function (FEV1 ≤ 42%), and more symptoms (CAT score ≥ 18).
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Affiliation(s)
- Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Life Science, National Chung Hsing University, Taichung, Taiwan.,Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University Hospital, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Biing-Ru Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Life Science, National Chung Hsing University, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chih-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chun Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Life Science, National Chung Hsing University, Taichung, Taiwan.,Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University Hospital, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, China Medical University Hospital, Taichung, Taiwan.,Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Life Science, National Chung Hsing University, Taichung, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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15
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Abstract
Evaluating symptoms is a central part of the chronic obstructive pulmonary disease (COPD) assessment system as suggested by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Considering the pros and cons of all currently available tests, GOLD suggests using primarily the modified Medical Research Council dyspnea scale or the COPD Assessment Test. Based on the test results, patients are categorized as having a low or high level of symptoms. This level then becomes one of the 2 dimensions of the ABCD grading system, which was designed to match the best initial treatment option to the individual patient's needs.
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16
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Dhamodharan P, Arumugam M. Multiple Gene Expression Dataset Analysis Reveals Toll-Like Receptor Signaling Pathway is Strongly Associated With Chronic Obstructive Pulmonary Disease Pathogenesis. COPD 2020; 17:684-698. [PMID: 32757672 DOI: 10.1080/15412555.2020.1793314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease is a complex pulmonary disease that causes airflow obstruction in humans. To identify the core genes in COPD pathogenesis, seven diverse microarray datasets (GSE475, GSE1122, GSE1650, GSE3212, GSE8823, GSE37768, and GSE22148) were downloaded from the gene expression omnibus database. All the datasets were analyzed independently with the R/Bioconductor package to screen the differentially expressed genes (DEGs). The gene ontology and pathway enrichment analysis were performed for the acquired DEGs using DAVID (Database for Annotation, Visualization, and Integrated Discovery). Further protein-protein interaction network was constructed for the DEGs and their potential hub genes and sub-networks were identified using Cytoscape software. From the selected seven datasets, 188 overlapped DEGs were perceived eventually based on considering the repetitive genes between at-least one dataset. Gene Ontology analysis reveals that most of the DEGs were significantly enriched in immune response, inflammatory response, extracellular region, lipid binding, cytokine, and chemokine activity. Moreover, genes from the sub-network analysis were again submitted to the DAVID server to validate the results which uncover the Toll-like receptor signaling pathway was significantly enriched and all the genes present in this pathway were likewise detected as hub genes from Cytoscape software. CXCL9, CXCL10, CXCL11, CCL4, TLR7, and SPP1 hub genes in the toll-like receptor signaling pathway were explored in this study as potential biomarker genes associated with COPD pathogenesis.
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Affiliation(s)
- Pavithra Dhamodharan
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Mohanapriya Arumugam
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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17
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Suehs CM, Zysman M, Chenivesse C, Burgel PR, Couturaud F, Deslee G, Berger P, Raherison C, Devouassoux G, Brousse C, Roche N, Molimard M, Chinet T, Devillier P, Chanez P, Kessler R, Didier A, Martinat Y, Le Rouzic O, Bourdin A. Prioritising outcomes for evaluating eosinophil-guided corticosteroid therapy among patients with acute COPD exacerbations requiring hospitalisation: a Delphi consensus study. BMJ Open 2020; 10:e035811. [PMID: 32611741 PMCID: PMC7332193 DOI: 10.1136/bmjopen-2019-035811] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Presently, those outcomes that should be prioritised for chronic obstructive pulmonary disease (COPD) exacerbation studies remain unclear. In order to coordinate multicentre studies on eosinophilia-driven corticosteroid therapy for patients hospitalised for acute exacerbation of COPD (AECOPD), we aimed to find consensus among experts in the domain regarding the prioritisation of outcomes. DESIGN A modified Delphi study was proposed to recognised COPD experts. Two brainstorming questionnaires were used to collect potential outcomes. Four subsequent rounds of questionnaires were used to rank items according to a six-point Likert scale for their importance in the protocol, as well as for being the primary outcome. Priority outcome criteria were predefined as those for which ≥70% of experts indicated that the outcome was essential for interpreting study results. SETTING COPD exacerbation management in France. PARTICIPANTS 34 experts recommended by the French Language Pulmonology Society were invited to participate. Of the latter, 21 experts participated in brainstorming, and 19 participated in all four ranking rounds. RESULTS 105 outcomes were ranked. Two achieved consensus as candidate primary outcomes: (1) treatment failure defined as death from any cause or the need for intubation and mechanical ventilation, readmission because of COPD or intensification of pharmacologic therapy, and (2) the time required to meet predefined discharge criteria. The 10 secondary priority outcomes included survival, time with no sign of improvement, episodes of hospitalisation, exacerbation, pneumonia, mechanical or non-invasive ventilation and oxygen use, as well as comorbidities during the initial hospitalisation. CONCLUSIONS This Delphi consensus project generated and prioritised a great many outcomes, documenting current expert views concerning a diversity of COPD endpoints. Among the latter, 12 reached consensus as priority outcomes for evaluating the efficacy of eosinophil-driven corticosteroid therapy in AECOPD inpatients. STUDY REGISTRATION The eo-Delphi project/protocol was registered on 23 January 2018 at https://osf.io/4ahqw/.
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Affiliation(s)
| | - Maéva Zysman
- Maladies Respiratoires, Pôle Cardiothoracique, CHU Haut-Lévèque, Bordeaux, France
- Centre de Recherche Cardio-thoracique de Bordeaux, INSERM U1045, Univ. Bordeaux, Bordeaux, France
| | - Cécile Chenivesse
- Pneumologie et Immuno-Allergologie, CHU Lille, Univ. Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Pierre-Régis Burgel
- Respiratory Medicine, Cochin Hospital (APHP), University Paris Descartes (INSERM U1016 Institut Cochin), Université de Paris, Paris, France
| | - F Couturaud
- Internal Medicine and Chest Diseases, EA3878, CIC-INSERM1412, Brest University Hospital Centre, Brest University, Brest, France
| | - Gaëtan Deslee
- Pulmonary Medicine, INSERM U1250, University Hospital of Reims, Reims, France
| | - Patrick Berger
- Centre de Recherche Cardio-thoracique de Bordeaux, INSERM U1045, Univ. Bordeaux, Bordeaux, France
- Exploration Fonctionnelle Respiratoire, CIC 1401, CHU Bordeaux, Bordeaux, France
| | - Chantal Raherison
- Bordeaux Population Health Research Center, U1219 BPH - Inserm - Université de Bordeaux, Bordeaux, France
| | - Gilles Devouassoux
- Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon et Université Claude Bernard Lyon 1, EA7426, Lyon, France
| | | | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital (APHP), University Paris Descartes (INSERM U1016 Institut Cochin), Université de Paris, Paris, France
| | | | - Thierry Chinet
- Pneumologie et Oncologie Thoracique, CHU Ambroise Paré, AP-HP, Université de Versailles SQY, Saint-Quentin-en-Yvelines, France
| | - Philippe Devillier
- Airway Diseases, UPRES EA 220, Foch hospital, University Paris-Saclay, Suresnes, France
| | - Pascal Chanez
- Respiratory Diseases, AP-HM, INSERM, INRA, C2VN Aix Marseille Université, Marseille, France
| | - Romain Kessler
- Pneumologie, Fédération de médecine translationnelle, Université de Strasbourg, Strasbourg, France
| | - Alain Didier
- Pôle des Voies Respiratoires, Hôpital Larrey, CHU de Toulouse et Université Paul Sabatier, Toulouse, France
| | | | - Olivier Le Rouzic
- Pneumologie et Immuno-Allergologie, CHU Lille, Univ. Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - A Bourdin
- Maladies Respiratoires, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
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18
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Singh D, Criner GJ, Naya I, Jones PW, Tombs L, Lipson DA, Han MK. Measuring disease activity in COPD: is clinically important deterioration the answer? Respir Res 2020; 21:134. [PMID: 32487202 PMCID: PMC7265253 DOI: 10.1186/s12931-020-01387-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
Given the heterogeneity of chronic obstructive pulmonary disease (COPD), personalized clinical management is key to optimizing patient outcomes. Important treatment goals include minimizing disease activity and preventing disease progression; however, quantification of these components remains a challenge. Growing evidence suggests that decline over time in forced expiratory volume in 1 s (FEV1), traditionally the key marker of disease progression, may not be sufficient to fully determine deterioration across COPD populations. In addition, there is a lack of evidence showing that currently available multidimensional COPD indexes improve clinical decision-making, treatment, or patient outcomes. The composite clinically important deterioration (CID) endpoint was developed to assess disease worsening by detecting early deteriorations in lung function (measured by FEV1), health status (assessed by the St George’s Respiratory Questionnaire), and the presence of exacerbations. Post hoc and prospective analyses of clinical trial data have confirmed that the multidimensional composite CID endpoint better predicts poorer medium-term outcomes compared with any single CID component alone, and that it can demonstrate differences in treatment efficacy in short-term trials. Given the widely acknowledged need for an individualized holistic approach to COPD management, monitoring short-term CID has the potential to facilitate early identification of suboptimal treatment responses and patients at risk of increased disease progression. CID monitoring may lead to better-informed clinical management decisions and potentially improved prognosis.
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Affiliation(s)
- Dave Singh
- University of Manchester, Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Gerard J Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Ian Naya
- GSK, Respiratory Medicines Development Centre, Stockley Park, Middlesex, UK.,RAMAX Ltd, Bramhall, Cheshire, UK
| | - Paul W Jones
- GSK, Respiratory Medicines Development Centre, Stockley Park, Middlesex, UK
| | | | - David A Lipson
- GSK, Respiratory Clinical Sciences, Collegeville, PA, USA.,Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
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19
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Shen T, Bimali M, Faramawi M, Orloff MS. Consumption of Vitamin K and Vitamin A Are Associated With Reduced Risk of Developing Emphysema: NHANES 2007-2016. Front Nutr 2020; 7:47. [PMID: 32391372 PMCID: PMC7192023 DOI: 10.3389/fnut.2020.00047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) comprising of emphysema and chronic bronchitis are the most common chronic respiratory diseases that impart a huge economic and clinical burden. Factors other than smoking and air pollutants can cause inflammation and emphysematous changes in the lung airspaces or alveoli have been understudied. Using a cross-sectional study design, we assessed the association of dark green vegetables, vitamin K and Vitamin A with emphysema status among adults at U.S. These nutrients have a role in lung biology. A complete case NHANES data (n = 17,681) was used. After adjusting for modifiable and non-modifiable confounders, consumption of recommended amounts of vitamin K was associated with 39% decrease in odds (Odds Ratio: 0.61; 95% CI: 0.40–0.92, P-val: 0.02) of emphysema. Similarly consumption of recommended amounts vitamin A dose was associated with 33% decrease in odds (Odds Ratio: 0.67; 95% CI: 0.44–1.00, P-val: 0.05) of emphysema. Vitamin K shows an inverse association suggesting that it may be important in slowing the emphysematous process. Vitamin A is important in maintaining the anti-inflammatory process. Together vitamin K and vitamin A are important in the lung health.
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Affiliation(s)
- Tianjiao Shen
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Milan Bimali
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohammed Faramawi
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohammed S Orloff
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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20
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Vogelmeier CF, Román-Rodríguez M, Singh D, Han MK, Rodríguez-Roisin R, Ferguson GT. Goals of COPD treatment: Focus on symptoms and exacerbations. Respir Med 2020; 166:105938. [PMID: 32250871 DOI: 10.1016/j.rmed.2020.105938] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/18/2020] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is currently a leading cause of death worldwide, and its burden is expected to rise in the coming years. Common COPD symptoms include dyspnea, cough and/or sputum production. Some patients may experience acute worsening of symptoms (known as an exacerbation), and therefore require additional therapy. Exacerbations are mainly triggered by respiratory infections and environmental factors. Healthcare professionals face many challenges in COPD management, including the heterogeneity of the disease and under-reporting of symptoms. The authors review these challenges and provide recommendations for the best methods to assess COPD. The goals of COPD treatment include recognising the impact that both symptoms and exacerbations have on patients' lives when considering optimal patient-focused management. The review discusses the need for COPD management strategies to include both pharmacologic and non-pharmacologic approaches and provides recommendations for monitoring treatment outcomes and adjusting management strategies accordingly. Novel treatment strategies including precision medicine and point-of-care testing are also discussed.
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Affiliation(s)
- Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany.
| | - Miguel Román-Rodríguez
- Son Pisà Primary Health Care Centre, Instituto de Investigación Sanitaria de Las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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21
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Singh D, Martinez FJ, Watz H, Bengtsson T, Maurer BT. A dose-ranging study of the inhaled dual phosphodiesterase 3 and 4 inhibitor ensifentrine in COPD. Respir Res 2020; 21:47. [PMID: 32041601 PMCID: PMC7011474 DOI: 10.1186/s12931-020-1307-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many patients with chronic obstructive pulmonary disease (COPD) still experience daily symptoms, exacerbations, and accelerated lung function decline, even when receiving maximal combined treatment with inhaled long-acting bronchodilators and corticosteroids. Novel treatment options are needed for these patients. Phosphodiesterases (PDEs) are enzymes that impact a range of cellular functions by modulating levels of cyclic nucleotides, and there is evidence to suggest that combined inhibition of PDE3 and PDE4 can have additive (or perhaps synergistic) effects. This study investigated the efficacy and safety of ensifentrine, a first-in-class dual inhibitor of PDE 3 and 4, in patients with COPD. METHODS This randomised, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with COPD, post-bronchodilator forced expiratory volume in 1 s (FEV1) 40-80% predicted and FEV1/forced vital capacity ratio ≤ 0.7. Patients were randomised equally to inhale nebulised ensifentrine 0.75, 1.5, 3 or 6 mg or placebo, all twice daily. PRIMARY OUTCOME placebo-adjusted difference in peak FEV1 (assessed over 3 h) at Week 4. RESULTS The study took place between July 2017 and February 2018. Of 405 patients randomly assigned to medication, 375 (92.6%) completed the study. For peak FEV1 at Week 4, all four ensifentrine doses were superior to placebo (p ≤ 0.0001) with least squares mean differences of 146 (95% CI 75-216), 153 (83-222), 200 (131-270) and 139 (69-210) mL for ensifentrine 0.75, 1.5, 3 and 6 mg, respectively. Respiratory symptoms (assessed using the Evaluating Respiratory Symptoms questionnaire) were also significantly improved with all ensifentrine doses at Week 4. Adverse events were reported by 33.3, 44.4, 35.4 and 36.3% patients with ensifentrine 0.75, 1.5, 3 and 6 mg, respectively, and 39.2% with placebo. CONCLUSIONS In this four-week Phase IIb study, all four ensifentrine doses significantly improved bronchodilation and symptoms, with a dose-ranging effect from 0.75 to 3 mg twice daily, and all doses well tolerated. The study supports the continuing development of ensifentrine in COPD. TRIAL REGISTRATION EudraCT 2016-005205-40, registered 30 May 2017.
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, University of Manchester & Manchester University NHS Foundation Trust, Manchester, UK.
| | - Fernando J Martinez
- Weill Cornell Medical College, New York, New York, and University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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Coquart JB, Heutte N, Terce G, Grosbois JM. Convergent Validity and Minimal Clinically Important Difference of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the Chronic Obstructive Pulmonary Disease-Specific Health-Related Quality of Life questionnaire (VQ11). Int J Chron Obstruct Pulmon Dis 2019; 14:2895-2903. [PMID: 31853177 PMCID: PMC6916677 DOI: 10.2147/copd.s222165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients. Patients and methods Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30–45 mins/week for 8 weeks, including a weekly session supervised by a team member). Results PR improved all measured variables (p < 0.0001). The correlations were significant (p < 0.0001) between VSRQ and MRF-28 (r = −0.685 at baseline and r = −0.686 after the PR program), and between VSRQ and VQ11 (r = −0.691 at baseline and r = −0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated (p < 0.0001) to changes in score of MRF-28 (r = −0.372) and VQ11 (r = −0.423). Last, we calculated MCID of −5.2 and −2.0 units for MRF-28 and VQ11, respectively. Conclusion The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of −5.2 and −2.0, respectively.
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Affiliation(s)
- Jérémy B Coquart
- Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, France
| | - Natacha Heutte
- Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, France
| | - Gaelle Terce
- Centre Hospitalier de Béthune, Service de Pneumologie et de Réhabilitation Respiratoire, Beuvry F-62660, France
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Xiong C, Hanafy S, Chan V, Hu ZJ, Sutton M, Escobar M, Colantonio A, Mollayeva T. Comorbidity in adults with traumatic brain injury and all-cause mortality: a systematic review. BMJ Open 2019; 9:e029072. [PMID: 31699721 PMCID: PMC6858248 DOI: 10.1136/bmjopen-2019-029072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Comorbidity in traumatic brain injury (TBI) has been recognised to alter the clinical course of patients and influence short-term and long-term outcomes. We synthesised the evidence on the effects of different comorbid conditions on early and late mortality post-TBI in order to (1) examine the relationship between comorbid condition(s) and all-cause mortality in TBI and (2) determine the influence of sociodemographic and clinical characteristics of patients with a TBI at baseline on all-cause mortality. DESIGN Systematic review. DATA SOURCES Medline, Central, Embase, PsycINFO and bibliographies of identified articles were searched from May 1997 to January 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included studies met the following criteria: (1) focused on comorbidity as it related to our outcome of interest in adults (ie, ≥18 years of age) diagnosed with a TBI; (2) comorbidity was detected by any means excluding self-report; (3) reported the proportion of participants without comorbidity and (4) followed participants for any period of time. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted the data and assessed risk of bias using the Quality in Prognosis Studies tool. Data were synthesised through tabulation and qualitative description. RESULTS A total of 27 cohort studies were included. Among the wide range of individual comorbid conditions studied, only low blood pressure was a consistent predictors of post-TBI mortality. Other consistent predictors were traditional sociodemographic risk factors. Higher comorbidity scale, scores and the number of comorbid conditions were not consistently associated with post-TBI mortality. CONCLUSIONS Given the high number of comorbid conditions that were examined by the single studies, research is required to further substantiate the evidence and address conflicting findings. Finally, an enhanced set of comorbidity measures that are suited for the TBI population will allow for better risk stratification to guide TBI management and treatment. PROSPERO REGISTRATION NUMBER CRD42017070033.
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Affiliation(s)
- Chen Xiong
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
| | - Sara Hanafy
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
| | - Vincy Chan
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
| | - Zheng Jing Hu
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Sutton
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tatyana Mollayeva
- KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
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Yount SE, Atwood C, Donohue J, Hays RD, Irwin D, Leidy NK, Liu H, Spritzer KL, DeWalt DA. Responsiveness of PROMIS® to change in chronic obstructive pulmonary disease. J Patient Rep Outcomes 2019; 3:65. [PMID: 31664536 PMCID: PMC6820639 DOI: 10.1186/s41687-019-0155-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by airflow obstruction that leads to shortness of breath and substantial negative impacts on health-related quality of life (HRQL). The course of COPD includes periodic acute exacerbations that require changes in treatment and/or hospitalizations. This study was designed to examine the responsiveness of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures to changes associated with COPD exacerbation recovery. Methods A longitudinal analysis using mixed-effects models was conducted of people who were enrolled while stable (n = 100) and those who experienced an acute exacerbation (n = 85). PROMIS (physical function, pain interference, pain behavior, fatigue, anxiety, depression, anger, social roles, discretionary social activities, Global Health, dyspnea severity and dyspnea functional limitations) and COPD-targeted HRQL measures were completed at baseline and at 12 weeks. Results We administered PROMIS measures using computer adaptive testing (CAT), followed by administration of any remaining short form (SF) items that had not yet been administered by CAT. Examination of the difference between group differences from baseline to 12 weeks in the stable and exacerbation groups revealed that the exacerbation group changed (improved) significantly more than the stable group in anxiety (p < .001 to p < .01; f2 effect size [ES] = 0.023/0.021), fatigue (p < .0001; ES = 0.036/0.047) and social roles (p < .001 to p < .05; ES = 0.035/0.024). All effect sizes were small in magnitude and smaller than hypothesized. Depression was also statistically significant (p < .05, SF only) but the ES was trivial. For all other PROMIS domains, the differences were not significant and ES were trivial. Conclusions This longitudinal study provides some support for the validity of the PROMIS fatigue, anxiety, and social roles domains in COPD, but further evaluation of responsiveness is warranted.
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Affiliation(s)
- Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th floor, Chicago, IL, 60611, USA.
| | - Charles Atwood
- Pulmonary Section, VA Pittsburgh Healthcare System and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Donohue
- Division of Pulmonary Medicine, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ron D Hays
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debra Irwin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Honghu Liu
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Karen L Spritzer
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Darren A DeWalt
- Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina School of Medicine - Chapel Hill, Chapel Hill, NC, USA
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25
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Hao W, Li M, Zhang Y, Zhang C, Wang P. Comparative Study of Cytokine Levels in Different Respiratory Samples in Mild-to-Moderate AECOPD Patients. Lung 2019; 197:565-572. [PMID: 31451927 DOI: 10.1007/s00408-019-00263-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Matrix metalloproteinase-12 (MMP-12) and Tissue inhibitor of metalloproteinase-4 (TIMP-4) play important roles in the pathophysiology of chronic obstructive pulmonary disease (COPD). Subjects of many previous studies were patients with severe and very severe COPD. However, there are comparatively few studies on patients with mild-to-moderate COPD. Our aim was to measure MMP-12 and TIMP-4 levels and to compare its levels in various materials in patients with mild-to-moderate acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We also compared which of the two materials of these biomarkers was better correlated with disease severity and DODE index. METHODS A total of 39 patients with AECOPD and 25 control subjects were enrolled in our study. MMP-12 and TIMP-4 in different respiratory samples were detected by ELISA. RESULTS Expression levels of MMP-12 in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) and TIMP-4 in BALF were significantly higher in AECOPD patients than that in healthy subjects (P < 0.001). However, there was no significant difference in TIMP-4 level in EBC of AECOPD patients compared to healthy subjects (P = 0.0527). The levels of MMP-12 in BALF and EBC and TIMP-4 in BAFL of AECOPD patients were significantly correlated with FEV1% predicted (P < 0.001). However, in AECOPD patients, there was no significant correlation between TIMP-4 levels in EBC and BODE index (r = 0.4175, P = 0.0559). CONCLUSION During mild-to-moderate AECOPD, the levels of MMP-12 and TIMP-4 in BALF were better correlated with FEV1% predicted and BODE index than that in EBC, indicating that they may be new target interventions for pharmacology to prevent and/or treat AECOPD.
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Affiliation(s)
- Wendong Hao
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yunqing Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
| | - Cailian Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
| | - Ping Wang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
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26
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Fernández-Jané C, Vilaró J, Fei Y, Wang C, Liu J, Huang N, Xia R, Tian X, Hu R, Yu M, Gómara-Toldrà N, Solà-Madurell M, Sitjà-Rabert M. Filiform needle acupuncture for copd: A systematic review and meta-analysis. Complement Ther Med 2019; 47:102182. [PMID: 31780020 DOI: 10.1016/j.ctim.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND This is the first part of a larger spectrum systematic review which aims to identify and evaluates the effectiveness of all different non-pharmacological acupuncture techniques used for COPD. In this first publication, we describe the results of filiform needle acupuncture METHODS: Randomised controlled trials up to May 2019 were searched in 11 databases. Data extraction and risk of bias assessment was conducted in pairs independently. RevMan 5.3 was used for the meta-analysis. RESULTS 28 trials using filiform needle alone or in combination of other techniques were included. Compared with no acupuncture, no difference was seen for dyspnoea, but statistical benefits were found on quality of life (Std. MD: -0.62, 95%CI: -0.90, -0.34), exercise capacity (stable subgroup) (6MWT MD: 33.05 m, 95%CI: 19.11, 46.99) and lung function (FEV1% MD: 1.58, 95%CI: 0.51, 2.66). Compared with sham, statistical benefits were found on dyspnoea (Std. MD: -1.07, 95%CI: -1.58, -0.56), quality of life (Std. MD: -0.81, 95%CI: -1.12, -0.49), exercise capacity (6MWT MD: 76.68 m, 95% CI: 39.93, 113.43) and lung function (FEV1% MD: 5.40, 95%CI: 2.90, 7.91; FEV1/FVC MD: 6.64, 95%CI: 3.44, 9.83). CONCLUSIONS Results show that filiform needle acupuncture might be beneficial for COPD, but due to the low quality of the studies this should be confirmed by future well-designed trials. PROTOCOL REGISTRATION PROSPERO (identifier: CRD42014015074).
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Affiliation(s)
- Carles Fernández-Jané
- School of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain; Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Barcelona, Spain.
| | - Jordi Vilaró
- School of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain; Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Barcelona, Spain.
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Congcong Wang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Na Huang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Ruyu Xia
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Xia Tian
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Ruixue Hu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Mingkun Yu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Natàlia Gómara-Toldrà
- School of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain; Faculty of Health Science and Welfare, University of Vic, Vic, Spain.
| | | | - Mercè Sitjà-Rabert
- School of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain; Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Barcelona, Spain.
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27
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New therapeutic targets for the prevention of infectious acute exacerbations of COPD: role of epithelial adhesion molecules and inflammatory pathways. Clin Sci (Lond) 2019; 133:1663-1703. [PMID: 31346069 DOI: 10.1042/cs20181009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/15/2022]
Abstract
Chronic respiratory diseases are among the leading causes of mortality worldwide, with the major contributor, chronic obstructive pulmonary disease (COPD) accounting for approximately 3 million deaths annually. Frequent acute exacerbations (AEs) of COPD (AECOPD) drive clinical and functional decline in COPD and are associated with accelerated loss of lung function, increased mortality, decreased health-related quality of life and significant economic costs. Infections with a small subgroup of pathogens precipitate the majority of AEs and consequently constitute a significant comorbidity in COPD. However, current pharmacological interventions are ineffective in preventing infectious exacerbations and their treatment is compromised by the rapid development of antibiotic resistance. Thus, alternative preventative therapies need to be considered. Pathogen adherence to the pulmonary epithelium through host receptors is the prerequisite step for invasion and subsequent infection of surrounding structures. Thus, disruption of bacterial-host cell interactions with receptor antagonists or modulation of the ensuing inflammatory profile present attractive avenues for therapeutic development. This review explores key mediators of pathogen-host interactions that may offer new therapeutic targets with the potential to prevent viral/bacterial-mediated AECOPD. There are several conceptual and methodological hurdles hampering the development of new therapies that require further research and resolution.
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28
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Xiao Y, Wang H, Zhang T, Ren X. Psychosocial predictors of physical activity and health-related quality of life among Shanghai working adults. Health Qual Life Outcomes 2019; 17:72. [PMID: 31023310 PMCID: PMC6485148 DOI: 10.1186/s12955-019-1145-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participating in regular physical activity contributes to significant improvements of quality of life (QOL) in adults. Understanding psychosocial factors that influence physical activity and QOL in working adults may have important implications for future interventions aimed at improving their health. The major purpose of this study was to investigate the psychosocial predictors of physical activity and QOL among Shanghai working adults. METHODS Participants were 238 working adults (M age = 51.6 ± 5.6) living in Shanghai communities, China. They completed previously validated questionnaires assessing their perceptions of stress, social support from friends, self-efficacy, physical activity, and QOL. Pearson correlations were computed to assess the associations among physical activity, QOL, and psychosocial variables. Path analysis was used to test the predictive strengths of psychosocial factors on physical activity and QOL among Shanghai working adults. RESULTS The results indicated that stress had directly negative relationships on self-efficacy and QOL. Social support had directly positive relationships on self-efficacy, physical activity, and QOL. Physical activity had directly positive relationship on QOL. Self-efficacy and physical activity mediated the influences of stress and social support on QOL. CONCLUSIONS Stress and social support from friends were two important sources of self-efficacy, all of which facilitated more physical activity participation. Lower stress, higher social support, and more physical activity may directly increase QOL among Shanghai working adults. The mediating roles of self-efficacy and physical activity should be taken into account in managing stress and social support in order to promote QOL among Shanghai working adults.
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Affiliation(s)
- Yi Xiao
- Shanghai University of Sport, NO. 399, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China.
| | - Hongying Wang
- Shanghai University of Sport, NO. 399, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Tao Zhang
- University of North Texas, Denton, USA
| | - Xiaoling Ren
- Shanghai University of Sport, NO. 399, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China
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Current Controversies in Chronic Obstructive Pulmonary Disease. A Report from the Global Initiative for Chronic Obstructive Lung Disease Scientific Committee. Ann Am Thorac Soc 2019; 16:29-39. [DOI: 10.1513/annalsats.201808-557ps] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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30
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Oh DK, Baek S, Lee SW, Lee JS, Lee SD, Oh YM. Comparison of the fixed ratio and the Z-score of FEV 1/FVC in the elderly population: a long-term mortality analysis from the Third National Health and Nutritional Examination Survey. Int J Chron Obstruct Pulmon Dis 2018; 13:903-915. [PMID: 29559774 PMCID: PMC5857155 DOI: 10.2147/copd.s148421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and objective Despite the ongoing intense debate on the definition of airflow limitation by spirometry in the elderly population, there have only been few studies comparing the fixed ratio and the Z-score of forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) in terms of long-term mortalities. In this study, we aimed to identify the proper method for accurately defining the airflow limitation in terms of long-term mortality prediction in the elderly population. Methods Data were collected from the Third National Health and Nutrition Examination Survey in the US. Non-Hispanic Caucasians aged 65–80 years were included. The receiver operating characteristic (ROC) curves of both methods were plotted and compared for 10-year all-cause, respiratory, and COPD mortalities. Results Of 1,331 subjects, the mean age was 71.7 years and 805 (60.5%) were males. For the 10-year all-cause mortality, the area under the curve (AUC) of the fixed ratio was significantly greater than that of the Z-score of FEV1/FVC, but both showed poor prediction performance (0.633 vs 0.616, p<0.001). For the 10-year respiratory and COPD mortalities, both the fixed ratio and the Z-score of FEV1/FVC showed comparable prediction performance with greater AUCs (0.784 vs 0.778, p=0.160, and 0.896 vs 0.896, p=0.971, respectively). Interestingly, the conventional cutoff of 0.7 in the fixed ratio was consistently higher than the optimal for the 10-year all-cause, respiratory, and COPD mortalities (0.70 vs 0.69, 0.62, and 0.61, respectively), whereas that of −1.64 in the Z-score of FEV1/FVC was consistently lower than the optimal cutoff (−1.64 vs −1.31, −1.47, and −1.41, respectively). Conclusion In the elderly population, both the fixed ratio and the Z-score of FEV1/FVC showed comparable prediction performance for the 10-year respiratory and COPD mortalities. However, the conventional cutoff of neither 0.70 in the fixed ratio nor −1.64 in the Z-score of FEV1/FVC was optimal for predicting the long-term mortalities.
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Affiliation(s)
- Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kessler R, Casan-Clara P, Koehler D, Tognella S, Viejo JL, Dal Negro RW, Díaz-Lobato S, Reissig K, Rodríguez González-Moro JM, Devouassoux G, Chavaillon JM, Botrus P, Arnal JM, Ancochea J, Bergeron-Lafaurie A, De Abajo C, Randerath WJ, Bastian A, Cornelissen CG, Nilius G, Texereau JB, Bourbeau J. COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD. Eur Respir J 2018; 51:51/1/1701612. [DOI: 10.1183/13993003.01612-2017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/13/2017] [Indexed: 11/05/2022]
Abstract
The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference −5.3, 95% CI −13.7 to −3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.
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Lee AL, Dolmage TE, Rhim M, Goldstein RS, Brooks D. The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD. Chest 2017; 153:1134-1141. [PMID: 29253555 DOI: 10.1016/j.chest.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/23/2017] [Accepted: 12/01/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In people with COPD, dyspnea is the primary symptom limiting exercise tolerance. One approach to reducing dyspnea during exercise is through music listening. A constant speed endurance test reflects a high-intensity aerobic exercise training session, but whether listening to music affects endurance time is unknown. This study aimed to determine the effects of listening to music during a constant speed endurance test in COPD. METHODS Participants with COPD completed two endurance walk tests, one with and one without listening to self-selected music throughout the test. The primary outcome was the difference in endurance time between the two conditions. Heart rate, percutaneous oxygen saturation, dyspnea, and rate of perceived exertion were measured before and after each test. RESULTS Nineteen participants (mean [SD]: age, 71 [8] years; FEV1, 47 [19] % predicted) completed the study. Endurance time was greater (1.10 [95% CI, 0.41-1.78] min) while listening to music (7.0 [3.1] min) than without (5.9 [2.6] min), and reduced end-test dyspnea (1.0 [95% CI, -2.80 to -1.80] units) (with music, 4.6 [1.7] units; vs without music, 5.6 [1.4] units, respectively). There was not a significant difference in heart rate, percutaneous oxygen saturation, or leg fatigue. There were no adverse events under either condition. CONCLUSIONS In COPD, dyspnea was less while listening to music and was accompanied by an increased tolerance of high-intensity exercise demonstrated by greater endurance time. Practically, the effect was modest but may represent an aid for exercise training of these patients. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; No. ACTRN12617001217392.
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Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - Thomas E Dolmage
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - Matthew Rhim
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Sion KYJ, Huisman EL, Punekar YS, Naya I, Ismaila AS. A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β 2-Agonist (LABA) Combinations in COPD. Pulm Ther 2017; 3:297-316. [PMID: 32026346 PMCID: PMC6964204 DOI: 10.1007/s41030-017-0048-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Comparative data on the efficacies of long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) combinations for the treatment of moderate-to-very-severe chronic obstructive pulmonary disease (COPD) are limited. The aim of this Bayesian network meta-analysis (NMA) is to assess the relative efficacies of available open combinations (delivered via separate inhalers) and fixed-dose combinations (FDCs, delivered via a single inhaler). METHODS We conducted a systematic literature review with the aim of identifying randomized controlled trials (RCTs) of ≥8-week duration in adults aged ≥40 years with COPD that compared LAMA + LABA combinations with each other, with tiotropium (TIO), or with placebo. Data on changes from baseline in trough forced expiratory volume in 1 s (FEV1) and on St George's Respiratory Questionnaire (SGRQ) total score, the Transition Dyspnea Index (TDI) focal score, and rescue medication use at 12 and 24 weeks were extracted from these RCTs and analyzed using a NMA in a Bayesian framework. RESULTS Data from 44 RCTs were included in the NMA. All FDCs showed improvements relative to placebo in terms of trough FEV1, SGRQ total score, and TDI focal score above clinically relevant thresholds, with the exception of TIO/olodaterol and aclidinium/formoterol, both of which failed to show clinically relevant improvements in SGRQ score at 24 weeks. All FDCs demonstrated reduced rescue medication use versus placebo. Open combinations demonstrated improved efficacy in all outcomes versus placebo, but these improvements did not consistently exceed clinically relevant thresholds for SGRQ and TDI scores. All once-daily FDCs showed improved efficacy versus TIO, but improvements were less consistently observed versus TIO with open dual combinations and combinations containing formoterol or salmeterol administered twice daily. Relative probabilities of improvement between FDCs highlighted potential between-class differences for trough FEV1 but suggested little potential for differences in patient-reported outcomes. CONCLUSION LAMA + LABA combinations generally showed improved outcomes versus placebo and TIO. FDCs appeared to perform better than open dual combinations. A potential effectiveness gradient was observed between FDCs for objectively assessed functional outcomes, although further prospective trials are required to confirm these findings. FUNDING GSK.
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Affiliation(s)
- Katya Y J Sion
- Real World Strategy and Analytics, Mapi Group, Houten, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eline L Huisman
- Real World Strategy and Analytics, Mapi Group, Houten, The Netherlands
- Novo Nordisk, Alphen aan den Rijn, The Netherlands
| | - Yogesh S Punekar
- ViiV Healthcare, GlaxoSmithKline, Brentford, Hounslow, Middlesex, UK
| | - Ian Naya
- Respiratory Medicine Development Centre, GlaxoSmithKline, Brentford, Hounslow, Middlesex, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline, 5 Moore Drive, PO Box 13398, Research Triangle Park, NC, 27709-3398, USA.
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
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Clinical and Physiological Effects of Rollators in Individuals With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2017; 38:366-373. [PMID: 29120969 DOI: 10.1097/hcr.0000000000000280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the effects of using a rollator in people with chronic obstructive pulmonary disease (COPD). METHODS Studies were systematically identified from literature searches of MEDLINE, CINAHL, PEDro, PubMed, EMBASE, and the Cochrane Library databases and the reference lists of included studies. Two reviewers independently selected randomized controlled or crossover studies examining the effects of rollator usage compared with no aid in individuals with COPD. Methodologic quality was assessed by 2 reviewers independently using the Cochrane Risk of Bias tool. Two reviewers also used a customized form to extract characteristics of and outcomes for subjects related to exercise capacity, symptoms, health-related quality of life (HRQOL), physiological, and gait parameters. Weighted mean differences (WMD) with 95% CI were calculated using a fixed-effects model. RESULTS A total of 7 studies (126 participants) were included. Use of a rollator during a 6-Minute Walk Test (6MWT) improved distance walked (WMD = 13 m; 95% CI, 5-22) and lowered end-6MWT dyspnea rating (WMD = 0.97; 95% CI, 0.63-1.32). Longer-term use did not appear to impact exercise capacity or HRQOL, although this may be related to the frequency of use. CONCLUSIONS When used in the short-term, rollators resulted in a small increase in 6MWT and a reduction in dyspnea. Details on patient adherence are required to accurately evaluate the longer-term effects of rollator usage.
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Reychler G, Boucard E, Peran L, Pichon R, Le Ber-Moy C, Ouksel H, Liistro G, Chambellan A, Beaumont M. One minute sit-to-stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients. CLINICAL RESPIRATORY JOURNAL 2017. [DOI: 10.1111/crj.12658] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; 1200 Brussels, Belgique
- Service de Pneumologie, Cliniques universitaires Saint-Luc; 1200 Brussels, Belgique
- Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc; 1200 Brussels, Belgique
| | - Eliott Boucard
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; 1200 Brussels, Belgique
| | - Loïc Peran
- Pulmonary rehabilitation unit, Morlaix Hospital Centre; France
| | - Romain Pichon
- Pulmonary rehabilitation unit, Morlaix Hospital Centre; France
| | | | | | - Giuseppe Liistro
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; 1200 Brussels, Belgique
- Service de Pneumologie, Cliniques universitaires Saint-Luc; 1200 Brussels, Belgique
| | - Arnaud Chambellan
- Explorations fonctionnelles et Réhabilitation Respiratoire, l'institut du thorax, CHU de Nantes, FR. Faculté de Médecine, Université de Nantes; France
| | - Marc Beaumont
- Pulmonary rehabilitation unit, Morlaix Hospital Centre; France
- European University of Occidental Brittany; EA3878, France
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D'Ruiz CD, O'Connell G, Graff DW, Yan XS. Measurement of cardiovascular and pulmonary function endpoints and other physiological effects following partial or complete substitution of cigarettes with electronic cigarettes in adult smokers. Regul Toxicol Pharmacol 2017; 87:36-53. [PMID: 28476553 DOI: 10.1016/j.yrtph.2017.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/31/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
Acute changes in select physiological parameters associated with cardiovascular physiology (systolic and diastolic blood pressure (BP) and heart rate (HR)), pulmonary function (FVC, FEV1, and exhaled CO and NO) and adverse events were measured in 105 clinically confined subjects who were randomized into groups that either completely or partially switched from conventional cigarettes to e-cigarettes or completely discontinued using tobacco and nicotine products altogether. Use of the e-cigarettes for five days under the various study conditions did not lead to higher BP or HR values, negative respiratory health outcomes or serious adverse health events. Reductions in BP and HR vital signs were observed in most of the participants that either ceased tobacco and nicotine products use altogether or switched completely to using e-cigarettes. Pulmonary function tests showed small but non-statistically significant improvements in FVC and FEV1 measurements in most use groups. Statistically significant (p < 0.05) benefits associated with smoking reduction were also noted in exhaled CO and NO levels. All study products were well tolerated. The study findings suggest that there are potential cardiovascular and pulmonary function benefits when smokers switch to using e-cigarette products. This further reinforces the potential that e-cigarettes offer smokers seeking an alternative to conventional tobacco products.
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Affiliation(s)
- Carl D D'Ruiz
- Clinical Study Consultant, Fontem Ventures, Greensboro, NC, USA.
| | - Grant O'Connell
- Fontem Ventures, Scientific and Regulatory Affairs, Amsterdam, The Netherlands.
| | | | - X Sherwin Yan
- Lorillard Tobacco Company (formerly), Greensboro, NC, USA.
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Sciriha A, Lungaro-Mifsud S, Scerri J, Magro R, Camilleri L, Montefort S. Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ. Chron Respir Dis 2017; 14:352-359. [PMID: 29081264 PMCID: PMC5729730 DOI: 10.1177/1479972317694622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The St. George’s Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1–2) and severe to very severe (mMRC 3–4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3–4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3–4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3–4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.
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Affiliation(s)
- Anabel Sciriha
- 1 Department of Physiotherapy, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Stephen Lungaro-Mifsud
- 1 Department of Physiotherapy, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Josianne Scerri
- 2 Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Rosalie Magro
- 3 Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Liberato Camilleri
- 4 Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Stephen Montefort
- 5 Department of Medicine, Faculty of Medicine and Surgery; University of Malta, Msida, Malta
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Safka KA, Wald J, Wang H, McIvor L, McIvor A. GOLD Stage and Treatment in COPD: A 500 Patient Point Prevalence Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 4:45-55. [PMID: 28848910 DOI: 10.15326/jcopdf.4.1.2016.0126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background and Objective: The Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines recommend using a combination of spirometry, symptoms and exacerbation history to classify patients into 4 categories (A, B, C, D) to guide treatment decisions along with a stepwise increase in therapy. Our objectives were to identify the GOLD stage of patients in respiratory outpatient clinics and assess how treatment compares to guideline recommendations. Methods: This was a point prevalence study using a convenience sample of 500 patients with chronic obstructive pulmonary disease (COPD) from a single tertiary care outpatient respiratory clinic. Results: Patients' GOLD classification was determined based on symptoms (modified Medical Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT]), spirometry and self-reported exacerbation history. A total of 8.2% of patients were in the GOLD group A, 28.3% in group B, 4.2% in group C and 59.2% in group D. Conclusions: In this 500 patient point prevalence study we report a low proportion of patients in GOLD group C and a high level of inhaled corticosteroids (ICS)/ long-acting beta2-agonist (LABA) and triple therapy use throughout all GOLD categories. Clinical Implications: The GOLD guidelines have attempted to provide direction to practitioners by grouping patients into 4 groups based on symptoms and exacerbations however, the low prevalence of GOLD group C may indicate that not all of these groupings are clinically relevant. Future research is needed to better identify clinically relevant phenotypes that predict benefit from ICS and methods to promote guideline concordant management in COPD.
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Affiliation(s)
- Katherine A Safka
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Wald
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Hongyu Wang
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Luke McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
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Espantoso-Romero M, Román Rodríguez M, Duarte-Pérez A, Gonzálvez-Rey J, Callejas-Cabanillas PA, Lazic DK, Anta-Agudo B, Torán Monserrat P, Magallon-Botaya R, Gerasimovska Kitanovska B, Lingner H, Assenova RS, Iftode C, Gude-Sampedro F, Clavería A. External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort). BMC Pulm Med 2016; 16:143. [PMID: 27835945 PMCID: PMC5106777 DOI: 10.1186/s12890-016-0305-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient's lifestyle, social network and adherence to treatment. METHODS Design: External validation of scales, open and prospective cohort study in primary care. SETTING 36 health centres in 6 European high, medium and low income countries. SUBJECTS 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse. PREDICTORS Detailed patient history, exacerbations, lung function test and questionnaires at baseline. OUTCOMES Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment. ANALYSIS Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis. DISCUSSION The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients. TRIAL REGISTRATION ISRCTN52402811 . Date: 15/01/2015. Prospectively registered.
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Affiliation(s)
| | | | - Ana Duarte-Pérez
- Cangas Health Centre, Xerencia de Xestión Integrada, Vigo, Spain
| | | | | | - Durdica Kasuba Lazic
- Department of Family Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Pere Torán Monserrat
- Family Medicine, Jordi Gol Institute for Primary Care Research, Santa Coloma de Gramenet, Spain
| | - Rosa Magallon-Botaya
- Arrabal Health Centre, Zaragoza, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | | | - Heidrun Lingner
- Hannover Medical School, Centre for Public Health and Healthcare, Hannover, Germany
| | - Radost S. Assenova
- Department General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Claudia Iftode
- Cabinet Medical De Medicina Familiei, Timisoara, Romania
| | - Francisco Gude-Sampedro
- Epidemiology Department, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Santiago de Compostela, Spain
| | - Ana Clavería
- Primary Care, Instituto Investigación Sanitaria Galicia Sur, Xerencia de Xestión Integrada, Vigo, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Vigo, Spain
| | - On behalf of the PROEPOC/COPD study group
- Teis Health Centre, Xerencia de Xestión Integrada, Vigo, Spain
- Son Pisà Health Centre, IB-Salut Balears, Palma de Mallorca, Spain
- Cangas Health Centre, Xerencia de Xestión Integrada, Vigo, Spain
- Matamá Health Centre, Xerencia de Xestión Integrada, Vigo, Spain
- Department of Family Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
- Barrio La Salud Health Centre, Santa Cruz de Tenerife, Spain
- Family Medicine, Jordi Gol Institute for Primary Care Research, Santa Coloma de Gramenet, Spain
- Arrabal Health Centre, Zaragoza, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
- Department of Family Medicine, University of Sts. Cyril and Methodius, Skopje, Macedonia
- Hannover Medical School, Centre for Public Health and Healthcare, Hannover, Germany
- Department General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
- Cabinet Medical De Medicina Familiei, Timisoara, Romania
- Epidemiology Department, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Santiago de Compostela, Spain
- Primary Care, Instituto Investigación Sanitaria Galicia Sur, Xerencia de Xestión Integrada, Vigo, Spain
- Preventative Activities and Health Promotion Network (REDIAPP), Vigo, Spain
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Albarrati AM, Gale NS, Enright S, Munnery MM, Cockcroft JR, Shale DJ. A simple and rapid test of physical performance inchronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:1785-91. [PMID: 27536090 PMCID: PMC4976811 DOI: 10.2147/copd.s106151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Impaired physical performance is common in chronic obstructive pulmonary disease (COPD), but its assessment can be difficult in routine clinical practice. We compared the timed up and go (TUG) test and other easily applied assessments of physical performance with the 6-minute walk distance (6MWD). In a longitudinal study of comorbidities in COPD, submaximal physical performance was determined in 520 patients and 150 controls using the TUG test and 6MWD. Spirometry, body composition, handgrip strength, the COPD assessment test, St George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council dyspnoea scale were also determined. Patients and controls were similar in age, body mass index, and sex proportions. The TUG in the patients was greater than that in the control group, P=0.001, and was inversely related to 6MWD (r=−0.71, P<0.001) and forced expiratory volume in one second predicted (r=−0.19, P<0.01) and was directly related to the SGRQ activity (r=0.39, P<0.001), SGRQ total (r=0.37, P<0.001), and total COPD assessment test scores (r=0.37, P<0.001). The TUG identified the difference in physical performance between patients and controls. The TUG test and validated questionnaires provide a measure of physical performance, which is rapid and could be used in clinical practice.
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Affiliation(s)
- Ali Mufraih Albarrati
- Physiotherapy Department, School of Healthcare Sciences, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Nichola S Gale
- Physiotherapy Department, School of Healthcare Sciences, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Stephanie Enright
- Physiotherapy Department, School of Healthcare Sciences, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Margaret M Munnery
- Cardiorespiratory Medicine Department, Cardio-Respiratory Medicine, Wales Heart Research Institute, Cardiff University, University Hospital of Wales, Cardiff, UK
| | - John R Cockcroft
- Cardiorespiratory Medicine Department, Cardio-Respiratory Medicine, Wales Heart Research Institute, Cardiff University, University Hospital of Wales, Cardiff, UK
| | - Dennis J Shale
- Cardiorespiratory Medicine Department, Cardio-Respiratory Medicine, Wales Heart Research Institute, Cardiff University, University Hospital of Wales, Cardiff, UK
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Mak S, Soicher JE, Mayo NE, Wood-Dauphinee S, Bourbeau J. Cross-Cultural Adaptation of the CHAMPS Questionnaire in French Canadians with COPD. Can Respir J 2016; 2016:9304505. [PMID: 27445570 PMCID: PMC4906179 DOI: 10.1155/2016/9304505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
Abstract
Physical activity is difficult to measure in individuals with COPD. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire demonstrated strong clinometric properties when used with the elderly and with those affected by chronic disease. Study objectives were to translate, culturally adapt the CHAMPS into French, and reexamine its test-retest reliability and construct validity in French and English Canadians with COPD. This paper presents the cross-cultural adaptation of the CHAMPS; results of its clinometric testing will be described in another article. The CHAMPS examines the degree of physical activity performed in a typical week through two summary scales, caloric expenditure and activity frequency. The CHAMPS was only in English; thus, a cross-cultural adaptation was needed to translate the CHAMPS into French for use in French Canadians with COPD. Cross-cultural adaptation consisted of forward and back translation, with expert review at each stage of translation: minor inconsistencies were uncovered and rectified. Five French participants with COPD completed the finalized Canadian French CHAMPS and participated in cognitive debriefing; no problematic items were identified. A structured and stepwise, cross-cultural adaptation process produced the Canadian French CHAMPS, with items of equivalent meaning to the English version, for use in French Canadians with COPD.
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Affiliation(s)
- Susanne Mak
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada H3G 1Y5
| | - Judith E. Soicher
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada H3G 1Y5
- Respiratory Epidemiology & Clinical Research Unit, McGill University, Montreal, QC, Canada H3H 2R9
| | - Nancy E. Mayo
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada H3G 1Y5
| | - Sharon Wood-Dauphinee
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada H3G 1Y5
| | - Jean Bourbeau
- Respiratory Epidemiology & Clinical Research Unit, McGill University, Montreal, QC, Canada H3H 2R9
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Abstract
Alpha-1 antitrypsin deficiency (AATD) is associated with premature onset of emphysema resulting from low serum A1-PI levels. The only available pharmacological treatment affecting the underlying cause of AATD is A1-PI therapy. AATD-related emphysema is considered a good model to study disease-modifying effects of treatment as the causative process has been identified. Disease modification is a sustained improvement in disease state following therapeutic intervention that persists when therapy is discontinued. Appropriate trial design and the use of valid study endpoints are key to illustrating disease modification, particularly in clinical trials of rare diseases where it can be difficult to recruit sufficient numbers of patients. Delayed-start trials are advantageous ethically as all patients ultimately receive active treatment and imaging techniques have proven promising as valid study endpoints. Specifically, computed tomography (CT) measured lung density has been used to monitor emphysema and is considered a more sensitive outcome than pulmonary function tests to monitor disease progression. This review will discuss the importance of clinical endpoints and trial design to determine disease modification and will review the evidence for disease modification in AATD-related emphysema. Until recently, clinical studies have not shown a significant effect of A1-PI therapy, possibly due to insufficient numbers of patients, short duration of clinical trials and lack of appropriate trial design. A recently completed randomised trial and open-label extension study followed a larger study population for a longer duration and incorporated a delayed-start design. The results demonstrated clinical efficacy of A1-PI therapy and indicate that treatment is disease-modifying.
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Affiliation(s)
- Joanna Chorostowska-Wynimko
- a Department of Genetics and Clinical Immunology , National Institute of Tuberculosis and Lung Diseases , Warsaw , Poland
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Sauer R, Hänsel M, Buhl R, Rubin RA, Frey M, Glaab T. Impact of tiotropium + olodaterol on physical functioning in COPD: results of an open-label observational study. Int J Chron Obstruct Pulmon Dis 2016; 11:891-8. [PMID: 27217742 PMCID: PMC4853152 DOI: 10.2147/copd.s103023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Maintaining and improving physical functioning is key to mitigating the cycle of deconditioning associated with chronic obstructive pulmonary disease (COPD). We evaluated the impact of free combination of the long-acting anticholinergic tiotropium plus the long-acting β2-agonist olodaterol on physical functioning in a real-world clinical setting. Methods In this open-label noninterventional study, Global initiative for chronic Obstructive Lung Disease (GOLD) B–D patients with COPD aged ≥40 years were treated for 4–6 weeks with either tiotropium 5 μg + olodaterol 5 μg (both via Respimat® inhaler) or tiotropium 18 μg (HandiHaler®) + olodaterol 5 μg (Respimat®) once daily. Physical functioning was assessed by the self-reported 10-item Physical Functioning Questionnaire (PF-10). The primary end point was the percentage of patients achieving therapeutic success, defined as a 10-point increase in the PF-10 between baseline (visit 1) and weeks 4–6 (visit 2). Secondary end points included absolute PF-10 scores, Physicians’ Global Evaluation, satisfaction with Respimat® and adverse events. Results A total of 1,858 patients were treated: 1,298 (69.9%) with tiotropium 5 μg + olodaterol 5 μg and 560 (30.1%) with tiotropium 18 μg + olodaterol 5 μg. At study end, 1,683 (92.6%) and 1,556 patients (85.6%) continued using tiotropium and olodaterol, respectively; 48.9% (95% confidence interval: 46.5, 51.3) achieved the primary end point. Therapeutic success rates were significantly higher for maintenance-naïve patients compared to those who had received prior therapy (59.1% vs 44.5%; P<0.0001), largely driven by maintenance-treatment-naïve GOLD B (59.8%) and C (63.0%) patients. Absolute physical functioning scores increased from an average baseline of 44.0 (standard deviation: 25.2) to 54.2 (standard deviation: 26.9) at visit 2. Patients’ general condition improved from baseline to visit 2, and patients were largely satisfied with the Respimat® inhaler. Adverse events were reported by 7.5% of patients; the most common were respiratory in nature. Conclusion Tiotropium + olodaterol improved physical functioning within 4–6 weeks in patients with moderate-to-very severe COPD. GOLD B and C patients with no prior maintenance treatment demonstrated the greatest benefit.
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Affiliation(s)
| | - Michaela Hänsel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | | | - Thomas Glaab
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; Pulmonary Department, Mainz University Hospital, Mainz, Germany
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Kerwin E, Siler TM, Korenblat P, White A, Eckert JH, Henley M, Patalano F, D'Andrea P. Efficacy and Safety of Twice-Daily Glycopyrrolate Versus Placebo in Patients With COPD: The GEM2 Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 3:549-559. [PMID: 28848879 DOI: 10.15326/jcopdf.3.2.2015.0157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Long-acting bronchodilators including muscarinic antagonists are central to the management of patients with COPD. The Glycopyrrolate Effect on syMptoms and lung function (GEM2) study assessed the efficacy and safety of twice-daily glycopyrrolate 15.6 μg in patients with moderate-to-severe airflow limitation. This 12-week multicenter, double-blind study randomized (1:1) patients to glycopyrrolate 15.6 μg twice daily (b.i.d.) or placebo both delivered via the NeohalerTM device. The primary objective was superiority of glycopyrrolate compared with placebo for forced expiratory volume in 1 second (FEV1) standardized area under curve (AUC) between 0 and 12 hours post dosing (FEV1 AUC0-12h)at week 12. Other outcomes included additional spirometry parameters, health status using St George's Respiratory Questionnaire (SGRQ), dyspnea via Transition Dyspnea Index (TDI), rescue medication use and COPD symptoms reported by patients via the electronic diary. Safety was also assessed. Of the 432 patients randomized (glycopyrrolate, n=216; placebo, n=216), 96% completed the planned treatment phase. The study met its primary objective (superiority of glycopyrrolate compared with placebo for FEV1 AUC0-12h).Compared with placebo, glycopyrrolate showed significant improvements in lung function parameters (p<0.001). Health status (SGRQ total score and COPD assessment test), rescue medication use and daily total COPD symptom scores were significantly improved with glycopyrrolate versus placebo over 12 weeks. Improvements in dyspnea were observed with glycopyrrolate and placebo although the treatment difference was not statistically significant. Overall, differences in the incidences of adverse events and serious adverse events between the groups were not considered clinically meaningful. No deaths were reported. Twice-daily glycopyrrolate 15.6 μg showed statistically significant and clinically meaningful improvements compared with placebo in lung function, COPD symptoms, health status, and rescue medication usage in COPD patients with moderate-to-severe airflow limitation. CLINICAL TRIAL REGISTRATION NCT01715298.
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Affiliation(s)
- Edward Kerwin
- Clinical Research Institute of Southern Oregon, Medford
| | | | | | | | | | - Michelle Henley
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Peter D'Andrea
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
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Leitão Filho FS, Hang Chen H, Ngan DA, Tam A, Kirby M, Sin DD. Current methods to diagnose small airway disease in patients with COPD. Expert Rev Respir Med 2016; 10:417-429. [PMID: 26890226 DOI: 10.1586/17476348.2016.1155455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The small airways are characterized by an internal diameter < 2 mm and absence of cartilage. Approximately 10-25% of total airway resistance in healthy lungs is due to the small airways, with their contribution to total airway resistance increasing substantially in chronic obstructive pulmonary disease (COPD). As the small airways are located in the lung periphery, they are not easily evaluable, which can potentially interfere with the diagnosis (especially at early stages), monitoring, detection of responses to clinical interventions, and prognostic evaluation in COPD. Here, we will discuss the currently available methods in clinical practice to evaluate small airway disease in COPD, focusing on the concept, advantages, and disadvantages of each method.
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Affiliation(s)
- Fernando Sergio Leitão Filho
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Hao Hang Chen
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - David A Ngan
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Anthony Tam
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Miranda Kirby
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Don D Sin
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
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van den Akker EFMM, van 't Hul AJ, Chavannes NH, Braunstahl GJ, van Bruggen A, Rutten-van Mölken MPMH, In 't Veen JCCM. Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study. Int J Chron Obstruct Pulmon Dis 2015; 10:2413-22. [PMID: 26609228 PMCID: PMC4644182 DOI: 10.2147/copd.s90680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traditional assessment of patients with obstructive lung diseases (asthma and chronic obstructive pulmonary disease; COPD) relies on physiological tests. The COPD and Asthma Rotterdam Integrated Care Approach (CORONA) study aims to develop a diagnostic pathway with a more comprehensive approach to the assessment of patients with asthma and COPD in secondary care. METHODS An eight-step method was used to develop and implement the pathway for patients with asthma or COPD referred to an outpatient hospital setting. RESULTS The diagnostic pathway consists of an evidence-based set of measurements prioritized by a Delphi procedure. The pathway incorporates three innovative diagnostics: the metronome-paced hyperventilation test to measure dynamic hyperinflation, an activity monitor to objectively evaluate physical activity in daily life, and the Nijmegen Clinical Screening Instrument as a comprehensive assessment tool to acquire detailed insight into symptoms, functional limitations, and quality of life. CONCLUSION An innovative diagnostic pathway was developed and implemented for patients with obstructive lung diseases referred to secondary care. As this pathway aims to provide a comprehensive analysis of health status, it focuses on biomedical aspects and also reviews behavioral aspects that further elucidate the patient's health status. The added value of the diagnostic pathway needs to be determined from both an organizational perspective and from the individual patient's viewpoint.
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Affiliation(s)
- Edmée F M M van den Akker
- Department of Pulmonary Diseases, STZ Center of Excellence for Asthma & COPD, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Alex J van 't Hul
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonary Diseases, STZ Center of Excellence for Asthma & COPD, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Alie van Bruggen
- Department of Pulmonary Diseases, STZ Center of Excellence for Asthma & COPD, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Maureen P M H Rutten-van Mölken
- Department of Health Care Policy and Management, Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Johannes C C M In 't Veen
- Department of Pulmonary Diseases, STZ Center of Excellence for Asthma & COPD, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
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Rossi A, Zanardi E, Poletti V, Cazzola M. Clinical role of dual bronchodilation with an indacaterol-glycopyrronium combination in the management of COPD: its impact on patient-related outcomes and quality of life. Int J Chron Obstruct Pulmon Dis 2015; 10:1383-92. [PMID: 26229457 PMCID: PMC4516211 DOI: 10.2147/copd.s55488] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the result of persistent and progressive pathologic abnormalities in the small airways, most often associated with alveolar loss. Smoking cessation is the most effective intervention to slow down the progression of COPD. Long-acting inhaled bronchodilators are prescribed for the symptomatic relief at any stage of disease severity. For patients whose COPD cannot be not sufficiently controlled with long-acting bronchodilator monotherapy, international guidelines suggest the possibility of associating a long-acting beta2 agonist (LABA) with a long-acting muscarinic antagonist (LAMA), ie, dual bronchodilation. This is not a new concept as the combination of short-acting agents has been popular in the past. In recent years, several fixed-dose combinations containing a LAMA and a LABA in a single inhaler have been approved by regulatory authorities in several countries. Among the new LAMA/LABA combinations, the fixed-dose combination of indacaterol 110 µg/glycopyrronium 50 µg (QVA149) has been shown in a series of clinical trials to be as safe as the single components and placebo, and more effective than placebo and the single components with regard to lung function, symptoms, and patient-oriented outcomes. Furthermore, QVA149 achieved better bronchodilation than salmeterol 50 µg/fluticasone 500 µg twice daily. Compared with tiotropium, a well-recognized treatment for COPD, the percentage of patients that exceed the minimal clinical important difference for dyspnea and health-related quality of life measurements was superior with QVA149. Other patient-oriented outcomes, such as daily symptoms, night-time awakening, and use of rescue medication consistently favored QVA149. Finally, QVA149 was significantly superior to LAMAs for reducing all types of exacerbation. In conclusion, several years after introduction of dual bronchodilation, the fixed-dose combination of indacaterol 110 µg/glycopyrronium 50 µg in a single inhaler for once-daily administration via the Breezhaler® device (QVA149) has been demonstrated to be a safe and effective treatment for COPD patients.
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Affiliation(s)
- Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | - Erika Zanardi
- Department of Respiratory and General Rehabilitation, ULSS 20, Verona, Italy
| | | | - Mario Cazzola
- Pulmonary Unit, University of Rome, Tor Vergata, Italy
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French A, Balfe D, Mirocha JM, Falk JA, Mosenifar Z. The inspiratory capacity/total lung capacity ratio as a predictor of survival in an emphysematous phenotype of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1305-12. [PMID: 26203237 PMCID: PMC4506024 DOI: 10.2147/copd.s76739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV1) grades severity of COPD and predicts survival. We hypothesize that the inspiratory capacity/total lung capacity (IC/TLC) ratio, a sensitive measure of static lung hyperinflation, may have a significant association with survival in an emphysematous phenotype of COPD. OBJECTIVES To access the association between IC/TLC and survival in an emphysematous phenotype of COPD. METHODS We performed a retrospective analysis of a large pulmonary function (PF) database with 39,050 entries, from April 1978 to October 2009. Emphysematous COPD was defined as reduced FEV1/forced vital capacity (FVC), increased TLC, and reduced diffusing capacity of the lungs for carbon monoxide (DLCO; beyond 95% confidence intervals [CIs]). We evaluated the association between survival in emphysematous COPD patients and the IC/TLC ratio evaluated both as dichotomous (≤25% vs >25%) and continuous predictors. Five hundred and ninety-six patients had reported death dates. RESULTS Univariate analysis revealed that IC/TLC ≤25% was a significant predictor of death (hazard ratio [HR]: 2.39, P<0.0001). Median survivals were respectively 4.3 (95% CI: 3.8-4.9) and 11.9 years (95% CI: 10.3-13.2). Multivariable analysis revealed age (HR: 1.19, 95% CI: 1.14-1.24), female sex (HR: 0.69, 95% CI: 0.60-0.83), and IC/TLC ≤25% (HR: 1.69, 95% CI: 1.34-2.13) were related to the risk of death. Univariate analysis showed that continuous IC/TLC was associated with death, with an HR of 1.66 (95% CI: 1.52-1.81) for a 10% decrease in IC/TLC. CONCLUSION Adjusting for age and sex, IC/TLC ≤25% is related to increased risk of death, and IC/TLC as a continuum, is a significant predictor of mortality in emphysematous COPD patients.
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Affiliation(s)
- Aimee French
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - David Balfe
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - James M Mirocha
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - Jeremy A Falk
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - Zab Mosenifar
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
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Cazzola M, Hanania NA, MacNee W, Rüdell K, Hackford C, Tamimi N. A review of the most common patient-reported outcomes in COPD--revisiting current knowledge and estimating future challenges. Int J Chron Obstruct Pulmon Dis 2015; 10:725-38. [PMID: 25897216 PMCID: PMC4396518 DOI: 10.2147/copd.s77368] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patient-reported outcome (PRO) measures that quantify disease impact have become important measures of outcome in COPD research and treatment. The objective of this literature review was to comprehensively evaluate psychometric properties of available PRO instruments and the ability of each of them to characterize pharmaceutical treatment effects from published clinical trial evidence. Identified in this study were several PRO measures, both those that have been used extensively in COPD clinical trials (St George’s Respiratory Questionnaire and Chronic Respiratory Questionnaire) and new instruments whose full value is still to be determined. This suggests a great need for more information about the patient experience of treatment benefit, but this also may pose challenges to researchers, clinicians, and other important stakeholders (eg, regulatory agencies, pharmaceutical companies) who develop new treatment entities and payers (including but not limited to health technology assessment agencies such as the National Institute for Health and Care Excellence and the Canadian Agency for Drugs and Technologies in Health). The purpose of this review is to enable researchers and clinicians to gain a broad overview of PRO measures in COPD by summarizing the value and purpose of these measures and by providing sufficient detail for interested audiences to determine which instrument may be the most suitable for evaluating a particular research purpose.
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Affiliation(s)
- Mario Cazzola
- University of Rome 'Tor Vergata', Department of Medicine of Systems, Unit of Respiratory Clinical Pharmacology, Rome, Italy
| | - Nicola Alexander Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - William MacNee
- University of Edinburgh/MRC Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Katja Rüdell
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
| | - Claire Hackford
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
| | - Nihad Tamimi
- Patient Reported Outcome Center of Excellence, Global Market Access, Primary Care Business Unit, Pfizer, Tadworth, United Kingdom
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Abstract
Research has validated the desire of patients and families for ongoing prognostic information; however, few conversations occur before patients reach the advanced stages of their disease trajectory. Physician hesitance and delay in discussing unfavorable prognoses deny patients and families optimal time to prepare for critical decision making. Advanced practice registered nurses can play a crucial, complementary role with the critical care interdisciplinary team to implement strategies to improve communication about prognosis and end of life with patients and families. Clinicians should discuss deterioration in disease-specific characteristics and changes (decline) in functional status. Functional status can serve as an accurate guide for forecasting prognosis, particularly in patients with heart failure, stroke, chronic lung disease, and end-stage renal disease. This article provides an overview of effective intensive care unit prognostic systems and discusses barriers and opportunities for nurses to use evidence-based knowledge related to disease trajectory and prognosis to improve communication and the quality of palliative and end-of-life care for patients.
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Affiliation(s)
- Peggy Kalowes
- Peggy Kalowes is Director, Nursing Research, Innovation and Evidence Based Practice, Long Beach Memorial, Miller Children’s and Women’s Hospital, 2801 Atlantic Ave, Long Beach, CA 90806
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