1
|
Vogelmeier CF, Friedrich FW, Timpel P, Kossack N, Diesing J, Pignot M, Abram M, Halbach M. Impact of COPD on mortality: An 8-year observational retrospective healthcare claims database cohort study. Respir Med 2024; 222:107506. [PMID: 38151176 DOI: 10.1016/j.rmed.2023.107506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Here we present a large observational study on the association of COPD and exacerbations with mortality (AvoidEx Mortality). METHODS A real-world, observational cohort study with longitudinal analyses of German healthcare claims data in patients ≥40 years of age with a COPD diagnosis from 2011 to 2018 (n = 250,723) was conducted. Patients entered the cohort (index date) upon the first COPD diagnosis. To assess the impact of COPD on all-cause death, a propensity score-matched control group of non-COPD patients was constructed. The number and severity of exacerbations during a 12-month pre-index period were used to form subgroups. For each exacerbation subgroup the exacerbations during 12 months prior to death were analysed. RESULTS COPD increases the all-cause mortality risk by almost 60% (HR 1.57 (95% CI 1.55-1.59)) in comparison to matched non-COPD controls, when controlling for other baseline covariates. The cumulative risk of death after 8 years was highest in patients with a history of more than one moderate or severe exacerbation. Among all deceased COPD patients, 17.2% had experienced a severe, and 34.8% a moderate exacerbation, within 3 months preceding death. Despite increasing exacerbation rates towards death, more than the half of patients were not receiving any recommended pharmacological COPD therapy in the year before death. CONCLUSION Our study illustrates the impact of COPD on mortality risk and highlights the need for consequent COPD management comprising exacerbation assessment and treatment.
Collapse
Affiliation(s)
- Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, German Center for Lung Research (DZL), Baldingerstraße, 35033, Marburg, Hessen, Germany
| | | | - Patrick Timpel
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Nils Kossack
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Joanna Diesing
- WIG2 GmbH Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Sachsen, Germany
| | - Marc Pignot
- ZEG - Center for Epidemiology and Health Research Berlin GmbH, Invalidenstraße 115, 10115, Berlin, Germany
| | - Melanie Abram
- AstraZeneca GmbH, Friesenweg 26, 22763, Hamburg, Germany
| | - Marija Halbach
- AstraZeneca GmbH, Friesenweg 26, 22763, Hamburg, Germany.
| |
Collapse
|
2
|
Ding Q, Li J, Xu S, Gao Y, Guo Y, Xie B, Li H, Wei X. Different Smoking Statuses on Survival and Emphysema in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:505-515. [PMID: 35281478 PMCID: PMC8906824 DOI: 10.2147/copd.s346456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/21/2022] [Indexed: 12/31/2022] Open
Affiliation(s)
- Qi Ding
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Jie Li
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Shudi Xu
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Yanzhong Gao
- Department of Radiology, The Ninth Hospital of Xi’an affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi
| | - Baozhu Xie
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
- The Medical School of Yan’an University, Yan’an, Shaanxi
| | - Hua Li
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
- The Medical School of Yan’an University, Yan’an, Shaanxi
| | - Xia Wei
- Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an Affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi
- Correspondence: Xia Wei, Department of Pulmonary and Critical Care Medicine, The Ninth Hospital of Xi’an affiliated with Xi’an Jiaotong University, Xi’an, Shaanxi, Tel +18891991910, Email
| |
Collapse
|
3
|
Wu M, Xu B. Bone Marrow Mesenchymal Stem Cell Transplantation in Combination with Nasal Continuous Positive Airway Pressure Improves Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We aimed to explore the efficacy of bone marrow mesenchymal stem cell (BMSC) transplantation combined with nasal continuous positive airway pressure (nCPAP) for treating severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD). SD rat AECOPD model was established
by injecting endotoxin and Staphylococcus aureus and then treated with nCPAP, BMSCs, or nCPAP combined with BMSCs (n = 20) and their conditions were evaluated with BBB score at 1 d, 3 d, 7 d, 14 d, 28 d after treatment along with analysis of apoptosis and BrdU-positive cells
as well as NF200 expression by TUNEL kit staining and levels of Th1, Th7 and Th12 before and after treatment. As revealed by BBB score and HE staining, all treatments significantly alleviated the symptom of severe APEOPD (p < 0.05), while compared with nCPAP, the combined treatment
exhibited higher efficacy. Besides, upon treatment, apoptosis and level of Th1, Th7 and Th12 was reduced but N200 absorbance value was elevated, with significant difference in combination group (p < 0.05). In conclusion, BMSC transplantation in combination with nCPAP alleviates severe
AECOPD by reducing cell apoptosis, repairing cell damage, and regulating T-cell subsets.
Collapse
Affiliation(s)
- Minna Wu
- Department of Emergency Medicine, Hangshi Central Hospital, Edong Healthcare, Huangshi, Hubei, 435000, China
| | - Bo Xu
- Department of Emergency Medicine, Hangshi Central Hospital, Edong Healthcare, Huangshi, Hubei, 435000, China
| |
Collapse
|
4
|
Shin SH, Shin JS, Kim EK, Kim HS. Capillary partial pressure of carbon dioxide for predicting rehospitalization in preterm infants under noninvasive respiratory support with severe bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3863-3869. [PMID: 34547833 DOI: 10.1002/ppul.25672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The severity of bronchopulmonary dysplasia (BPD) is an important predictor of prognosis in preterm infants. However, the severity of BPD was determined mainly by the degree of oxygen supplementation and mode of respiratory support. OBJECTIVES This retrospective study aimed to examine the role of partial pressure of carbon dioxide (pCO2 ) in predicting rehospitalization among preterm infants with severe BPD without invasive ventilation at 36 weeks' postmenstrual age (PMA). METHODS We assessed preterm infants aged <32 gestational weeks with severe BPD who were receiving noninvasive respiratory support at 36 weeks' PMA. Patients were compared after stratifying them according to the history of rehospitalization owing to respiratory infection before a corrected age (CA) of 1 year and pCO2 measured by capillary blood gas analysis at 36 weeks' PMA. RESULTS Among 54 infants who had severe BPD with noninvasive respiratory support at 36 weeks' PMA, 16 (29.6%) experienced rehospitalization due to respiratory problems. At 36 weeks' PMA, the amount of oxygen supplementation (0.30 vs. 0.28, p = 0.021) and pCO2 (62.1 vs. 53.6 mmHg, p = 0.006) were higher in the rehospitalization group than in the no rehospitalization group. Multivariate logistic analysis findings indicated that pCO2 ≥ 57.4 mmHg was the only factor associated with rehospitalization (adjusted odds ratio: 8.017, 95% confidence interval 1.239-51.859). CONCLUSION High pCO2 during noninvasive respiratory support at 36 weeks' PMA in severe BPD was associated with rehospitalization. Consideration of the degree of impairment in ventilatory capacity may improve the prediction of later respiratory outcomes in infants with BPD.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Jae-Suk Shin
- Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University, Children's Hospital, Seoul, Republic of Korea
| |
Collapse
|
5
|
Zhou D, Ye Y, Kong Y, Li Z, Shi G, Zhou J. The effect of mild hypercapnia on hospital mortality after cardiac arrest may be modified by chronic obstructive pulmonary disease. Am J Emerg Med 2021; 44:78-84. [PMID: 33582612 DOI: 10.1016/j.ajem.2021.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/09/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The main objective was to evaluate the effect of carbon dioxide on hospital mortality in chronic obstructive pulmonary disease (COPD) and non-COPD patients with out-of-hospital cardiac arrest (OHCA). METHODS We conducted a retrospective observational study in OHCA patients from the eICU database (eicu-crd.mit.edu). The main exposure was the partial pressure of arterial carbon dioxide (PaCO2). The proportion of time spent (PTS) within four predefined PaCO2 ranges (hypocapnia: <35 mmHg, normocapnia: 35-45 mmHg, mild hypercapnia: 46-55 mmHg, and severe hypercapnia: >55 mmHg) were calculated respectively. The primary outcome was hospital mortality. Multivariable logistic regression models were performed to assess the independent relationship between PTS within PaCO2 range and hospital mortality, and the interaction between PTS within PaCO2 range and COPD was explored. RESULTS A total of 1721 OHCA patients were included, of which 272 (15.8%) had COPD. After adjusted for the confounders, the PTS within mild hypercapnia was associated with lower odds ratio for hospital mortality in COPD patients (OR 0.923; 95% CI 0.857-0.992; P = 0.036); however, it was associated with higher odds ratio for hospital mortality in non-COPD patients (OR 1.053; 95% CI 1.012-1.097; P = 0.012; Pinteraction = 0.008). The PTS within normocapnia was not associated with hospital mortality in COPD patients (OR 0.987; 95% CI 0.914-1.067; P = 0.739); however, it was associated with lower odds ratio for hospital mortality in non-COPD patients (OR 0.944; 95% CI 0.916-0.973; P < 0.001; Pinteraction = 0.113). CONCLUSIONS The effect of carbon dioxide on hospital mortality differed between COPD and non-COPD patients. Mild hypercapnia was associated with increased hospital mortality for non-COPD patients but reduced hospital mortality for COPD patients. It would be reasonable to adjust PaCO2 targets in OHCA patients with COPD.
Collapse
Affiliation(s)
- Dawei Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Ye
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yueyue Kong
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhimin Li
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guangzhi Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
6
|
Jiang Z, Huang Y, Jiang H, Wang P, Zhang L, Ren L, Han P. Albuterol combined with tiotropium bromide to improve the conditions and pulmonary functions of patients with acute exacerbation of chronic obstructive pulmonary disease. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1846084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Zhendong Jiang
- Department of Respiratory Medicine, Wuhu First People’s Hospital, Wuhu, People’s Republic of China
| | - Youming Huang
- Department of Respiratory Medicine, the Second Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Hui Jiang
- the Sencond Department of Respiratory Medicine, General Hospital of Wanbei Coal and Power Group, Suzhou, People’s Republic of China
| | - Ping Wang
- Department of Respiratory Medicine, Wuhu First People’s Hospital, Wuhu, People’s Republic of China
| | - Lei Zhang
- Department of Respiratory Medicine, Wuhu First People’s Hospital, Wuhu, People’s Republic of China
| | - Li Ren
- Wuhu First People’s Hospital, Wuhu, People’s Republic of China
| | - Ping Han
- Department of Respiratory and Critical Medicine, Linyi People’s Hospital, Linyi, People’s Republic of China
| |
Collapse
|