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Whittaker HR, Torkpour A, Quint J. Eligibility of patients with chronic obstructive pulmonary disease for inclusion in randomised control trials investigating triple therapy: a study using routinely collected data. Respir Res 2024; 25:43. [PMID: 38238769 PMCID: PMC10797743 DOI: 10.1186/s12931-024-02672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Randomised control trials (RCTs) with strict eligibility criteria can lead to trial populations not commonly seen in clinical practice. We described the proportion of people with chronic obstructive pulmonary disease (COPD) in England eligible for RCTs investigating treatment with triple therapy. METHODS MEDLINE and Clinicaltrials.gov were searched for RCTs investigating triple therapy and eligibility criteria for each trial were extracted. Using routinely collected primary care data from Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics, we defined a population of COPD patients registered at a general practice in England, who were ≥ 40 years old, and had a history of smoking. Inclusion date was January 1, 2020. Patients who died earlier or left the general practice were excluded. Eligibility criteria for each RCT was applied to the population of COPD patients and the proportion of patients meeting each trial eligibility criteria were described. RESULTS 26 RCTs investigating triple therapy were identified from the literature. The most common eligibility criteria were post-bronchodilator FEV1% predicted 30-80%, ≥ 2 moderate/≥ 1 severe exacerbations 12-months prior, no moderate exacerbations one-month prior and no severe exacerbations three-months prior, and the use of maintenance therapy or ICS use prior to inclusion. After applying each RCT eligibility criteria to our population of 79,810 COPD patients, a median of 11.2% [interquartile range (IQR) 1.8-17.4] of patients met eligibility criteria. The most discriminatory criteria included the presence exacerbations of COPD and previous COPD related medication use with a median of 67.6% (IQR 8.5-73.4) and 63% (IQR 69.3-38.4) of COPD patients not meeting these criteria, respectively. CONCLUSION Data from these RCTs may not be generalisable to the wider population of people with COPD seen in everyday clinical practice and real-world evidence studies are needed to supplement trials to understand effectiveness in all people with COPD.
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Affiliation(s)
| | - Aria Torkpour
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Jennifer Quint
- School of Public Health, Imperial College London, London, UK
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2
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Hughes R, Rapsomaniki E, Bansal AT, Vestbo J, Price D, Agustí A, Beasley R, Fageras M, Alacqua M, Papi A, Müllerová H, Reddel HK. Cluster Analyses From the Real-World NOVELTY Study: Six Clusters Across the Asthma-COPD Spectrum. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2803-2811. [PMID: 37230383 DOI: 10.1016/j.jaip.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are complex diseases, the definitions of which overlap. OBJECTIVE To investigate clustering of clinical/physiological features and readily available biomarkers in patients with physician-assigned diagnoses of asthma and/or COPD in the NOVEL observational longiTudinal studY (NOVELTY; NCT02760329). METHODS Two approaches were taken to variable selection using baseline data: approach A was data-driven, hypothesis-free and used the Pearson dissimilarity matrix; approach B used an unsupervised Random Forest guided by clinical input. Cluster analyses were conducted across 100 random resamples using partitioning around medoids, followed by consensus clustering. RESULTS Approach A included 3796 individuals (mean age, 59.5 years; 54% female); approach B included 2934 patients (mean age, 60.7 years; 53% female). Each identified 6 mathematically stable clusters, which had overlapping characteristics. Overall, 67% to 75% of patients with asthma were in 3 clusters, and approximately 90% of patients with COPD were in 3 clusters. Although traditional features such as allergies and current/ex-smoking (respectively) were higher in these clusters, there were differences between clusters and approaches in features such as sex, ethnicity, breathlessness, frequent productive cough, and blood cell counts. The strongest predictors of the approach A cluster membership were age, weight, childhood onset, prebronchodilator FEV1, duration of dust/fume exposure, and number of daily medications. CONCLUSIONS Cluster analyses in patients from NOVELTY with asthma and/or COPD yielded identifiable clusters, with several discriminatory features that differed from conventional diagnostic characteristics. The overlap between clusters suggests that they do not reflect discrete underlying mechanisms and points to the need for identification of molecular endotypes and potential treatment targets across asthma and/or COPD.
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Affiliation(s)
- Rod Hughes
- Early Clinical Development, AstraZeneca, Cambridge, United Kingdom.
| | | | | | - Jørgen Vestbo
- University of Manchester, Manchester, United Kingdom
| | - David Price
- Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Alvar Agustí
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Malin Fageras
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Marianna Alacqua
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Alberto Papi
- Respiratory Medicine Unit, Department of Translational Medicine, Università di Ferrara, Ferrara, Italy
| | - Hana Müllerová
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Helen K Reddel
- The Woolcock Institute of Medical Research and the University of Sydney, Sydney, Australia.
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study. ERJ Open Res 2023; 9:00098-2023. [PMID: 37609600 PMCID: PMC10440648 DOI: 10.1183/23120541.00098-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Abstract
Background Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. Method We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Results Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86-6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69-6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Conclusions Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maria R. Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David P. Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Guy B. Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Helen K. Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Brett G. Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
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4
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Regard L, Burgel PR, Roche N. Inhaled therapy, cardiovascular risk and benefit-risk considerations in COPD: innocent until proven guilty, or vice versa? Eur Respir J 2023; 61:61/2/2202135. [PMID: 36758999 DOI: 10.1183/13993003.02135-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/06/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Lucile Regard
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
- Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
| | - Pierre-Régis Burgel
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
- Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
| | - Nicolas Roche
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
- Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
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5
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Zysman M, Baptista BR, Soumagne T, da Silva VM, Martin C, de Menonville CT, Boyer L, Degano B, Burgel PR, Perez T, Bourdin A, Raherison C, Pégliasco H, Piperno D, Zanetti C, Morel H, Delclaux B, Delafosse C, Lorenzo A, Housset B, Morélot-Panzini C, Chabot F, Devillier P, Deslée G, Roche N. Position paper of the French Society of Respiratory Diseases regarding pharmacological treatment optimization for stable COPD in 2021. Respir Med Res 2022; 81:100889. [PMID: 35219225 DOI: 10.1016/j.resmer.2022.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Maeva Zysman
- Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33604 Pessac, France; Service des Maladies Respiratoires, CHU Bordeaux, Bordeaux, France.
| | - Bruno Ribeiro Baptista
- Université Paris-Est, UMR S955, UPEC, F-94000, Créteil, France; Département de Pneumologie-CHRU Nancy-Université de Lorraine, Vandœuvre-lès-Nancy, Inserm, U1116; Université de Lorraine, Nancy, France
| | - Thibaud Soumagne
- Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, France
| | | | - Clémence Martin
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
| | | | - Laurent Boyer
- Université Paris-Est, UMR S955, UPEC, F-94000, Créteil, France; Département de physiologie-explorations fonctionnelles, AP-HP Hôpital Henri-Mondor, Créteil, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, France; Université Grenoble Alpes, Grenoble, France
| | - Pierre-Régis Burgel
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
| | - Thierry Perez
- Service de Pneumologie, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France
| | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France; Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Chantal Raherison
- Service des Maladies Respiratoires, CHU Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, Univ. Bordeaux, INSERM, Team EPICENE, UMR 1219, Bordeaux, France
| | | | | | | | - Hughes Morel
- Service de pneumologie d'allergologie et d'oncologie thoracique, CHR d'Orléans, 45067 Orléans, France
| | - Bertrand Delclaux
- Service de pneumologie, centre hospitalier de Troyes, 10003 Troyes, France
| | | | - Alain Lorenzo
- Médecine Sorbonne Université, Département de médecine générale, Paris, France
| | - Bruno Housset
- Pulmonary Department, CHI de Créteil, University Paris Est Créteil, Créteil, France
| | | | - François Chabot
- Département de Pneumologie-CHRU Nancy-Université de Lorraine, Vandœuvre-lès-Nancy, Inserm, U1116; Université de Lorraine, Nancy, France
| | - Philippe Devillier
- Department of Airway Diseases, UPRES EA 220, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Gaëtan Deslée
- Service de Pneumologie, INSERM U1250, CHU Reims, Université Reims Champagne Ardenne, Reims, France
| | - Nicolas Roche
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
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6
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Concepts of advanced therapeutic delivery systems for the management of remodeling and inflammation in airway diseases. Future Med Chem 2022; 14:271-288. [PMID: 35019757 PMCID: PMC8890134 DOI: 10.4155/fmc-2021-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic respiratory disorders affect millions of people worldwide. Pathophysiological changes to the normal airway wall structure, including changes in the composition and organization of its cellular and molecular constituents, are referred to as airway remodeling. The inadequacy of effective treatment strategies and scarcity of novel therapies available for the treatment and management of chronic respiratory diseases have given rise to a serious impediment in the clinical management of such diseases. The progress made in advanced drug delivery, has offered additional advantages to fight against the emerging complications of airway remodeling. This review aims to address the gaps in current knowledge about airway remodeling, the relationships between remodeling, inflammation, clinical phenotypes and the significance of using novel drug delivery methods.
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7
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Fally M, Nagavci B, Tonia T, van den Berge M, Bush A, Brightling C, Roche N. Real-life evidence in ERS clinical practice guidelines: from foes to friends. Eur Respir J 2021; 58:58/2/2101718. [PMID: 34353865 DOI: 10.1183/13993003.01718-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Markus Fally
- Dept of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,European Respiratory Society Guidelines Working Group, Switzerland
| | - Blin Nagavci
- European Respiratory Society Guidelines Working Group, Switzerland.,Institute for Evidence in Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Thomy Tonia
- European Respiratory Society Guidelines Working Group, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Maarten van den Berge
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrew Bush
- European Respiratory Society Guidelines Working Group, Switzerland.,Dept of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | | | - Nicolas Roche
- European Respiratory Society Guidelines Working Group, Switzerland.,Dept of Pulmonology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University of Paris, Paris, France
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8
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Gershon AS, Lindenauer PK, Wilson KC, Rose L, Walkey AJ, Sadatsafavi M, Anstrom KJ, Au DH, Bender BG, Brookhart MA, Dweik RA, Han MK, Joo MJ, Lavergne V, Mehta AB, Miravitlles M, Mularski RA, Roche N, Oren E, Riekert KA, Schoenberg NC, Stukel TA, Weiss CH, Wunsch H, Africk JJ, Krishnan JA. Informing Healthcare Decisions with Observational Research Assessing Causal Effect. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 203:14-23. [PMID: 33385220 PMCID: PMC7781125 DOI: 10.1164/rccm.202010-3943st] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy. Objectives: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement to clarify the role of observational studies—alongside randomized controlled trials (RCTs)—in informing clinical decisions in pulmonary, critical care, and sleep medicine. Methods: The committee examined the strengths of observational studies assessing causal effects, how they complement RCTs, factors that impact observational study quality, perceptions of observational research, and, finally, the practicalities of incorporating observational research into ATS clinical practice guidelines. Measurements and Main Results: There are strengths and weakness of observational studies as well as RCTs. Observational studies can provide evidence in representative and diverse patient populations. Quality observational studies should be sought in the development of ATS clinical practice guidelines, and medical decision-making in general, when 1) no RCTs are identified or RCTs are appraised as being of low- or very low-quality (replacement); 2) RCTs are of moderate quality because of indirectness, imprecision, or inconsistency, and observational studies mitigate the reason that RCT evidence was downgraded (complementary); or 3) RCTs do not provide evidence for outcomes that a guideline committee considers essential for decision-making (e.g., rare or long-term outcomes; “sequential”). Conclusions: Observational studies should be considered in developing clinical practice guidelines and in making clinical decisions.
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9
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Singer D, Bengtson LGS, Elliott C, Buikema AR, Franchino-Elder J. Healthcare Resource Utilization, Exacerbations, and Readmissions Among Medicare Patients with Chronic Obstructive Pulmonary Disease After Long-Acting Muscarinic Antagonist Therapy Initiation with Soft Mist versus Dry Powder Inhalers. Int J Chron Obstruct Pulmon Dis 2020; 15:3239-3250. [PMID: 33324047 PMCID: PMC7732756 DOI: 10.2147/copd.s284678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is often managed with inhaled long-acting muscarinic antagonists (LAMAs), yet real-world data on healthcare resource utilization (HRU) by inhaler type are lacking. This study compared HRU after LAMA initiation with a soft mist inhaler (SMI) versus a dry powder inhaler (DPI). Patients and Methods Inclusion criteria were COPD diagnosis, age ≥40 years, LAMA initiation (index date = first LAMA SMI or DPI claim 9/1/14—6/30/18), and Medicare Advantage enrollment 1 year pre-index (baseline) to ≥30 days post-index (follow-up). Patients were followed to the earliest of discontinuation, switch, disenrollment, 1 year, or study end (7/31/18). Exclusion criteria were asthma, cystic fibrosis, or lung cancer diagnoses, unavailable demographics, multiple index LAMAs, or baseline LAMA use. Cohorts (SMI or DPI) were balanced on baseline characteristics using inverse probability of treatment weighting. Outcomes included per patient per month (PPPM) COPD-related HRU encounters, and exacerbations (defined as moderate [ambulatory visit with corticosteroid or antibiotic within ±7 days] or severe [emergency visit or inpatient admission]); and 30-day readmissions following COPD-related hospitalizations. Results After weighting, cohorts (SMI [n=5360] and DPI [n=22,880]) were similar in age (72 and 73 years, respectively), gender (both 52% female), and COPD severity score (31.3 and 31.5, respectively). Cohorts had similar counts of follow-up HRU encounters. However, the SMI cohort had fewer (mean ± standard deviation) COPD-related exacerbations (0.054±0.082 vs DPI cohort 0.059±0.088 PPPM, p<0.001) overall. Moreover, the SMI cohort had fewer severe exacerbations (0.030±0.058 vs DPI: 0.034±0.065 PPPM, p<0.001). Hospitalizations among SMI patients had a lower adjusted odds of readmission versus hospitalizations among DPI patients (odds ratio: 0.656, 95% confidence interval= 0.460, 0.937; p=0.020). Conclusion SMI initiators had significantly fewer COPD-related exacerbations than DPI initiators. In addition, lower odds of readmissions were observed following COPD-related hospitalizations among the SMI cohort, as compared with the DPI cohort.
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Affiliation(s)
- David Singer
- Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | | | - Caitlin Elliott
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Ami R Buikema
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Jessica Franchino-Elder
- Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
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10
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Whittaker HR, Pimenta JM, Jarvis D, Kiddle SJ, Quint JK. Characteristics Associated with Accelerated Lung Function Decline in a Primary Care Population with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:3079-3091. [PMID: 33268984 PMCID: PMC7701160 DOI: 10.2147/copd.s278981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Estimates for lung function decline in chronic obstructive pulmonary disease (COPD) have differed by study setting and have not been described in a UK primary care population. Purpose To describe rates of FEV1 and FVC decline in COPD and investigate characteristics associated with accelerated decline. Patients and Methods Current/ex-smoking COPD patients (35 years+) who had at least 2 FEV1 or FVC measurements ≥6 months apart were included using Clinical Practice Research Datalink. Patients were followed up for a maximum of 13 years. Accelerated rate of lung function decline was defined as the fastest quartile of decline using mixed linear regression, and association with baseline characteristics was investigated using logistic regression. Results A total of 72,683 and 50,649 COPD patients had at least 2 FEV1 or FVC measurements, respectively. Median rates of FEV1 and FVC changes or decline were -18.1mL/year (IQR: -31.6 to -6.0) and -22.7mL/year (IQR: -39.9 to -6.7), respectively. Older age, high socioeconomic status, being underweight, high mMRC dyspnoea and frequent AECOPD or severe AECOPD were associated with an accelerated rate of FEV1 and FVC decline. Current smoking, mild airflow obstruction and inhaled corticosteroid treatment were additionally associated with accelerated FEV1 decline whilst women, sputum production and severe airflow obstruction were associated with accelerated FVC decline. Conclusion Rate of FEV1 and FVC decline was similar and showed similar heterogeneity. Whilst FEV1 and FVC shared associations with baseline characteristics, a few differences highlighted the importance of both lung function measures in COPD progression. We identified important characteristics that should be monitored for disease progression.
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Affiliation(s)
- Hannah R Whittaker
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jeanne M Pimenta
- Epidemiology (Value Evidence and Outcomes), GlaxoSmithKline, R&D, Uxbridge, UK
| | - Deborah Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Steven J Kiddle
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
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11
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Samanta D, Chakraborty T. VectorEntry. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2020. [DOI: 10.1145/3406537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mobile phones are now touch-enabled, which allows the use of on-screen keyboards for text entry. Text entry tasks are among the most frequently occurring tasks performed by mobile phone users. However, people with visual impairments find it difficult to use on-screen keyboards, and this affects their digital literacy. In this article, a text entry mechanism is proposed to solve this problem using directional movement gestures suitable for people with visual impairments. Two forms of directional movement gestures, guided and unguided movements, are first studied, and the analysis reveals that unguided directional movement gestures are more suitable for a text entry mechanism for individuals who are visually impaired. Based on this insight, a text entry mechanism called
VectorEntry
is developed. It uses eight unguided directional movement gestures to select characters on the keyboard of a touch-enabled mobile phone. The keyboard is designed in accordance with the traditional
4×3
telephone keypad. The results of experiments show that the average text entry rate of
VectorEntry
was 3.3 wpm, 83.3% higher than the state-of-the-art
No-Look Notes
used for similar tasks. Its average rate of error in text entry was only 0.19% per character.
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Affiliation(s)
- Debasis Samanta
- Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Tuhin Chakraborty
- Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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12
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Lopez-Campos JL, Carrasco-Hernandez L, Quintana-Gallego E, Calero-Acuña C, Márquez-Martín E, Ortega-Ruiz F, Soriano JB. Triple therapy for COPD: a crude analysis from a systematic review of the evidence. Ther Adv Respir Dis 2020; 13:1753466619885522. [PMID: 31694491 PMCID: PMC7000908 DOI: 10.1177/1753466619885522] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We systematically reviewed the current knowledge on fixed-dose triple therapies
for the treatment of chronic obstructive pulmonary disease (COPD), with a
specific focus on its efficacy versus single bronchodilation,
double fixed dose combinations, and open triple therapies. Articles were
retrieved from PubMed, Embase, and Scopus up to 3 August 2018. We selected
articles with randomized controlled or crossover design conducted in patients
with COPD and published as full-length articles or scientific letters,
evaluating triple therapy combinations in a single or different inhaler, and
with efficacy data versus monocomponents, double combinations,
or open triple therapies. Our systematic search reported 108 articles, of which
24 trials were finally selected for the analysis. A total of 7 studies with
fixed dose triple therapy combinations, and 17 studies with open triple
therapies combinations. Triple therapy showed improvements in lung function
[trough forced expiratory volume (FEV1) ranging from not significant
(NS) to 147 ml], health status using the St. George’s Respiratory Questionnaire
[(SGRQ) from NS to 8.8 points], and exacerbations [risk ratio (RR) from NS to
0.59 for all exacerbations] versus single or double therapies
with a variability in the response, depending the specific combination, and the
comparison group. The proportion of adverse effects was similar between study
groups, the exception being the increase in pneumonia for some inhaled
corticosteroid (ICS) containing groups. The reviews of this paper are available via the supplementary material
section.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Instituto de Biomedicina de Sevilla (IBiS), Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Avda. Manuel Siurot, s/n., Seville, 41013, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Carrasco-Hernandez
- IBiS, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Quintana-Gallego
- IBiS, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Calero-Acuña
- IBiS, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Márquez-Martín
- IBiS, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Ortega-Ruiz
- IBiS, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan B Soriano
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, España
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13
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Rogliani P, Ritondo BL, Zerillo B, Cazzola M, Matera MG, Calzetta L. Adding a Second Bronchodilator in COPD: A Meta-Analysis on the Risk of Specific Cardiovascular Serious Adverse Events of Tiotropium/Olodaterol Fixed-Dose Combination. COPD 2020; 17:215-223. [PMID: 32252547 DOI: 10.1080/15412555.2020.1749252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Dual bronchodilation therapy represents the cornerstone for the treatment of COPD. A large retrospective study reports that adding a second long-acting bronchodilator in patients with COPD significantly increases the risk of heart failure. Nevertheless, retrospective studies are characterized by limitations including misdiagnosis and inaccuracy of recordkeeping. This study aimed to ascertain whether tiotropium/olodaterol (T/O) 5/5 μg fixed-dose combination (FDC) may modulate the risk of main cardiovascular outcomes in COPD patients enrolled in randomized controlled trials (RCTs). A meta-analysis (CRD42017070100) was performed by selecting RCTs reporting raw data from the ClinicalTrials.gov database concerning the impact of T/O 5/5 µg FDC vs. monocomponents on the occurrence of specific cardiovascular serious adverse events: arrhythmia, heart failure, myocardial infarction, and stroke. Data were reported as relative risk and 95% Confidence Interval, and the risk of publication bias assessed via Egger's test. Eighty six full text articles were identified, and 10 RCTs published in 7 studies between 2015 and 2018 were included into the analysis. Data obtained from 12,690 COPD patients (44.47% T/O FDC, 55.53% monocomponents) were extracted. T/O 5/5 μg FDCs did not significantly modulate (p-value > 0.05) the risk of arrhythmia (1.02, 0.55 - 1.92), heart failure (0.88, 0.41 - 1.92), myocardial infarction (1.15, 0.70 - 1.87), and stroke (0.98, 0.44 - 2.16) vs. monocomponents. No significant publication bias affected the effect estimates of this meta-analysis. The results of this quantitative synthesis indicate that dual bronchodilation with T/O 5/5 μg FDC is characterized by an acceptable cardiovascular safety profile in COPD patients.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Division of Respiratory Medicine, University Hospital "Policlinico Tor Vergata", Rome, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Bartolomeo Zerillo
- Division of Respiratory Medicine, University Hospital "Policlinico Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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14
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Calzetta L, Ritondo BL, Matera MG, Cazzola M, Rogliani P. Evaluation of fluticasone propionate/salmeterol for the treatment of COPD: a systematic review. Expert Rev Respir Med 2020; 14:621-635. [PMID: 32168461 DOI: 10.1080/17476348.2020.1743180] [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: 12/30/2022]
Abstract
Introduction: Recently, the generic formulation of FP/SAL FDC has been approved in COPD. Although FP/SAL FDC has been the first long-acting FDC approved in COPD, no systematic review assessed the effect of this combination for the treatment of COPD by considering specifically Phase IV studies. The aim of this review was to systematically assess the effect of FP/SAL FDC in COPD patients enrolled in Phase IV studies.Areas covered: The question of this systematic review was to examine the evidence regarding the impact of FP/SAL FDC for the treatment of COPD by searching for Phase IV studies in the ClinicalTrials.gov database.Expert opinion: Generic drugs represent an effective cost-saving step for health-care budgets in the treatment of COPD and should be used in agreement with current recommendations and prescription accuracy. FP/SAL FDC is recommended for the initiation therapy just in a small percentage of symptomatic patients that are at high risk of exacerbation with blood eosinophil counts ≥300 cells per μl. At follow-up, FP/SAL FDC can be escalated to triple ICS/LABA/LAMA combination or switched to LABA/LAMA combination by considering symptoms, exacerbations, lack of response to ICS, inappropriate original indication, and ICS-related adverse events such as pneumonia.
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Affiliation(s)
- Luigino Calzetta
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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