1
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Adamson AJ, Kallis C, Douglas I, Quint JK. Accuracy of the recording of pneumonia events in English electronic healthcare record data in patients with chronic obstructive pulmonary disease. Pneumonia (Nathan) 2024; 16:8. [PMID: 38704560 PMCID: PMC11070075 DOI: 10.1186/s41479-024-00130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/06/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND In primary care, identifying pneumonia events in people with chronic obstructive pulmonary disease (COPD) may be challenging due to similarities in symptoms with COPD exacerbations and lack of diagnostic testing. This study explored the accuracy of pneumonia diagnosis coded in primary care by comparing diagnosis in primary care with diagnosis in hospital. METHODS A study population of people with COPD in England was created using the Clinical Practice Research Datalink Aurum database linked with Hospital Episode Statistics inpatient data. Pneumonia codes only, and pneumonia code with associated clinical and/or treatment codes (chest x-ray, symptoms, antibiotics, sputum and blood culture) were used to determine pneumonia events in primary care. Events that were followed by hospitalisation within 7 days were used to estimate the positive predictive value (PPV) of pneumonia coding in primary care, using primary diagnosis of pneumonia in secondary care as the gold standard. The PPV of primary care recording of hospitalised pneumonia was also calculated. RESULTS Two hundred seventy-four thousand one hundred fifty-six COPD patients were eligible for inclusion, of whom 7,560 had an eligible pneumonia event in primary care diagnosed between 2015-2019 which was not 'hospital-acquired' and was diagnosed and entered on the same day. Of the 2,094 events which were followed by hospitalisation within 7 days, 1,208 had a primary diagnosis of pneumonia in hospital, representing a PPV of pneumonia coding in primary care of 57.7% (95% CI 55.6%-59.8%). Another 284 (13.6%) were diagnosed as a COPD exacerbation and 114 (5.4%) were diagnosed as another respiratory disease. Use of additional pneumonia clinical and treatment codes had a modest effect on the PPV but substantially lowered the number of events. Of the 33,603 eligible pneumonia events identified in secondary care, only 11,445 were recorded in primary care within 42 days, representing a sensitivity of 34.1% (95% CI 33.6%-34.6%). CONCLUSIONS Use of primary care pneumonia codes and associated clinical and treatment codes to determine pneumonia is not recommended due to significant levels of misdiagnosis and many hospitalised events failing to be recorded in primary care.
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Affiliation(s)
| | | | - Ian Douglas
- London School of Hygiene and Tropical Medicine, London, UK
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2
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Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC, Sin DD, Wedzicha JA, Martinez FJ. Phenotypes, Etiotypes, and Endotypes of Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1026-1041. [PMID: 37560988 PMCID: PMC10867924 DOI: 10.1164/rccm.202209-1748so] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.
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Affiliation(s)
- Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alvar Agusti
- Institut Respiratori (Clinic Barcelona), Càtedra Salut Respiratoria (Universitat de Barcelona), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-Barcelona), Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), España
| | - Mona Bafadhel
- Faculty of Life Sciences and Medicine, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gavin C. Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Don D. Sin
- Centre for Heart Lung Innovation and
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- St. Paul’s Hospital, Vancouver, British Columbia, Canada; and
| | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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3
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Prediletto I, Giancotti G, Nava S. COPD Exacerbation: Why It Is Important to Avoid ICU Admission. J Clin Med 2023; 12:jcm12103369. [PMID: 37240474 DOI: 10.3390/jcm12103369] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide. Hospitalization due to acute exacerbations of COPD (AECOPD) is a relevant health problem both for its impact on disease outcomes and on health system resources. Severe AECOPD causing acute respiratory failure (ARF) often requires admission to an intensive care unit (ICU) with endotracheal intubation and invasive mechanical ventilation. AECOPD also acts as comorbidity in critically ill patients; this condition is associated with poorer prognoses. The prevalence reported in the literature on ICU admission rates ranges from 2 to 19% for AECOPD requiring hospitalization, with an in-hospital mortality rate of 20-40% and a re-hospitalization rate for a new severe event being 18% of the AECOPD cases admitted to ICUs. The prevalence of AECOPD in ICUs is not properly known due to an underestimation of COPD diagnoses and COPD misclassifications in administrative data. Non-invasive ventilation in acute and chronic respiratory failure may prevent AECOPD, reducing ICU admissions and disease mortality, especially when associated with a life-threating episode of hypercapnic ARF. In this review, we report on up to date evidence from the literature, showing how improving the knowledge and management of AECOPD is still a current research issue and clinical need.
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Affiliation(s)
- Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gilda Giancotti
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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4
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The establishment of COPD organoids to study host-pathogen interaction reveals enhanced viral fitness of SARS-CoV-2 in bronchi. Nat Commun 2022; 13:7635. [PMID: 36496442 PMCID: PMC9735280 DOI: 10.1038/s41467-022-35253-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation and infective exacerbations, however, in-vitro model systems for the study of host-pathogen interaction at the individual level are lacking. Here, we describe the establishment of nasopharyngeal and bronchial organoids from healthy individuals and COPD that recapitulate disease at the individual level. In contrast to healthy organoids, goblet cell hyperplasia and reduced ciliary beat frequency were observed in COPD organoids, hallmark features of the disease. Single-cell transcriptomics uncovered evidence for altered cellular differentiation trajectories in COPD organoids. SARS-CoV-2 infection of COPD organoids revealed more productive replication in bronchi, the key site of infection in severe COVID-19. Viral and bacterial exposure of organoids induced greater pro-inflammatory responses in COPD organoids. In summary, we present an organoid model that recapitulates the in vivo physiological lung microenvironment at the individual level and is amenable to the study of host-pathogen interaction and emerging infectious disease.
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5
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Li H, Chen J, Hu P. Diagnostic value of pulmonary ultrasound in acute exacerbation of chronic obstructive pulmonary disease: A pilot study. Med Clin (Barc) 2022; 159:509-514. [PMID: 35331547 DOI: 10.1016/j.medcli.2022.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the value of the pulmonary ultrasound for the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency departments (EDs). MATERIALS AND METHODS Between January 2018 and December 2019, patients admitted to the ED of Shanxi Provincial People's Hospital for suspected AECOPD were prospectively included in this study. Pulmonary ultrasound was performed using a linear transducer. The pulmonary ultrasound findings were evaluated for further discrimination for patients with AECOPD. Then, the diagnostic performance of pulmonary ultrasound was estimated and calculated. The clinical characteristics between groups with and without pneumonia were compared. RESULTS A total of 53 patients with AECOPD were included in the final analysis. For diagnosis of AECOPD due to pneumonia, ultrasound findings, such as consolidation, slightly rough pleural line, or irregular and interrupted pleural line had a sensitivity of 92.3% and a specificity of 86.7%. For diagnosis of AECOPD complicating pulmonary fibrosis, fringed pleural line had a sensitivity of 100% and a specificity of 97.5%. In addition, patients with pleural effusion (n=19) or pneumothorax (n=1) were correctly identified and wavy or bulging pleural lines were common in patients with AECOPD (58.5%, 31/53). CONCLUSION Ultrasound findings could offer further discrimination for AECOPD complications and other pathological conditions, such as pneumonia, pulmonary fibrosis, pleural effusion, and pneumothorax in EDs.
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Affiliation(s)
- Hong Li
- Department of Ultrasound, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Shenzhen 518033, China
| | - Jian Chen
- Department of Ultrasound, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen 518033, China
| | - Pingxiang Hu
- Department of Ultrasound, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine (Shenzhen Traditional Chinese Medicine Hospital), Shenzhen 518033, China.
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6
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Mitzel H, Brown D, Thomas M, Curl B, Wild M, Kelsch A, Muskrat J, Hossain A, Ryan K, Babalola O, Burgard M, Mehedi M. Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:254. [PMID: 35208578 PMCID: PMC8878082 DOI: 10.3390/medicina58020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD-an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Masfique Mehedi
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (H.M.); (D.B.); (M.T.); (B.C.); (M.W.); (A.K.); (J.M.); (A.H.); (K.R.); (O.B.); (M.B.)
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7
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Spielmanns M, Schildge S, Diedrich JP, Valipour A. Therapeutic Success in Swiss COPD Patients Receiving Dual Bronchodilation Therapy as COPD Maintenance Treatment. Clin Pract 2022; 12:46-56. [PMID: 35076494 PMCID: PMC8788262 DOI: 10.3390/clinpract12010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Health-related quality of life (HRQoL) in patients with moderate to severe chronic obstructive pulmonary disease (COPD) is often reduced by high symptom burden and frequent exacerbations. So far, data on therapeutic success in Swiss COPD patients receiving dual bronchodilation therapy as COPD maintenance treatment are limited. Data from a recently published, non-interventional study on clinical benefit after the start of combined tiotropium-olodaterol treatment were analyzed focusing on Swiss patients compared to the overall cohort including patients from various European countries. Demographic data on the changes in Clinical COPD Questionnaire (CCQ) for the assessment of HRQoL in correlation to symptoms and the number of exacerbations, as well as physician's global assessment (PGE), were evaluated 6 weeks after treatment start. In Switzerland (n = 61), significantly more patients had comorbidities and exacerbations but showed less symptoms compared to the overall cohort (n = 4639). HRQoL improved in both cohorts, with a negative correlation to symptom burden and number of exacerbations in the overall cohort. PGE scores improved after 6 weeks with a better general condition at baseline in Swiss patients (PGE score 4/5: 68.9% [Swiss cohort] vs. 49.0% [overall cohort]. Despite significant differences regarding the presence of symptoms and exacerbations, therapeutic success was similar in both patient groups. Highly symptomatic patients benefited mostly from tiotropium-olodaterol treatment.
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Affiliation(s)
- Marc Spielmanns
- Pulmonary Medicine, Zuercher RehaZentren Klinik Wald, 8636 Wald, Switzerland
- Department of Pneumology, Faculty of Health, University of Witten/Herdecke, 58455 Witten, Germany
| | - Sebastian Schildge
- Medical Affairs, Boehringer Ingelheim, 4002 Basel, Switzerland; (S.S.); (J.P.D.)
| | - Jens Peter Diedrich
- Medical Affairs, Boehringer Ingelheim, 4002 Basel, Switzerland; (S.S.); (J.P.D.)
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria;
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8
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Thu PNT, Huong MNT, Thi NT, Thanh HN, Minh KP. Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial. BMC Infect Dis 2021; 21:1019. [PMID: 34587911 PMCID: PMC8480084 DOI: 10.1186/s12879-021-06687-3] [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: 08/17/2021] [Accepted: 09/13/2021] [Indexed: 01/21/2023] Open
Abstract
Background The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD. Methods We enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated.
Results Clinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05). Conclusions Concomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.
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Affiliation(s)
- Phuong Nguyen Thi Thu
- Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Haiphong, Vietnam.,Haiphong International Hospital, 124 Nguyen Duc Canh, Le Chan, Haiphong, Vietnam
| | | | - Ngan Tran Thi
- Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Haiphong, Vietnam.,Haiphong International Hospital, 124 Nguyen Duc Canh, Le Chan, Haiphong, Vietnam
| | - Hoi Nguyen Thanh
- Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Haiphong, Vietnam.,Haiphong International Hospital, 124 Nguyen Duc Canh, Le Chan, Haiphong, Vietnam
| | - Khue Pham Minh
- Haiphong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Haiphong, Vietnam.
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9
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Cai Y, Liu R, Lu X, Zhang Q, Wang X, Lian H, Wang H. Correlation in gene expression between the aggravation of chronic obstructive pulmonary disease and the occurrence of complications. Bioengineered 2020; 11:1245-1257. [PMID: 33108241 PMCID: PMC8291885 DOI: 10.1080/21655979.2020.1839216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aggravation of the chronic obstructive pulmonary disease (COPD) often leads to a slew of complications, but the correlation between COPD aggravation and the complications on the basis of molecular level remains unclear. In this study, gene expression profiles of COPD in patients at early and aggravation stages were collected and differentially-expressed genes were selected. Meanwhile, gene expression data implicated in COPD complications were analyzed to establish a regulatory network of COPD aggravation and COPD related complications. In addition, the gene enrichment function of DAVID6.7 was utilized to evaluate the similarities between COPD aggravation and COPD complications in term of biological process. By analyzing the genes of COPD aggravation and the COPD complications, we found 18 genes highly related to COPD aggravation, among which haptoglobin (HP) was correlated with 14 complications, followed by ADRB2, LCK and CA1, which were related to 13, 11 and 11 complications, respectively. As far as the complications concerned, obesity was regulated by 17 of the 18 genes, which indicated that there was a close correlation between COPD aggravation and obesity. Meanwhile, lung cancer, diabetes and heart failure were regulated by 15, 15 and 14 genes, respectively, among the 18 selected genes. This study suggested the driver genes of COPD aggravation were capable of extensively regulating COPD complications, which would provide a theoretical basis for development of cures for COPD and its complications.
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Affiliation(s)
- Yuchen Cai
- Department of Mathematics, School of Science, Hainan University , Haikou, Hainan Province, China
| | - Runhan Liu
- Department of Mathematics, School of Science, Hainan University , Haikou, Hainan Province, China
| | - Xinhe Lu
- School of Life and Pharmaceutical Science , Haikou, Hainan Province, China
| | - Qiming Zhang
- School of Electrical and Information Engineering, Anhui University of Science and Technology , Huainan, Anhui Province, China
| | - Xinwei Wang
- College of Information Science and Engineering, Ocean University of China , Qingdao, Shandong Province, China
| | - Huijing Lian
- School of Economics, Hainan University , Haikou, Hainan Province, China
| | - Haohua Wang
- Department of Mathematics, School of Science, Hainan University , Haikou, Hainan Province, China
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10
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Vahedian-Azimi A, Bashar FR, Boushra MN, Quinn JW, Miller AC. Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients. Int J Crit Illn Inj Sci 2020; 10:99-104. [PMID: 32904565 PMCID: PMC7456290 DOI: 10.4103/ijciis.ijciis_37_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives: The negative inspiratory force (NIF) has been used to help clinicians predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH
2O may not be appropriate for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients. Methods: A prospective-observational multi-center study was conducted in intensive care units of six academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive, and negative predictive value (PPV, NPV), positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy recorded. Results: A total of 90 patients with COPD (39 males and 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation (P = 0.654). The threshold value of ≤−25 cmH2O offered the optimal performance in COPD patients: area under the receiver operating characteristic (ROC) curves ROC curves 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, and NPV 95.6%., LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%. Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH2O was a moderate-to-good predictor for successful ventilator liberation, and outperforms the traditional threshold of ≤−30 cmH2O.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid R Bashar
- Department of Anesthesia and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marina N Boushra
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Joseph W Quinn
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Andrew C Miller
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
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11
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Alobaidi NY, Stockley JA, Stockley RA, Sapey E. An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management? Ann Thorac Med 2020; 15:54-63. [PMID: 32489439 PMCID: PMC7259399 DOI: 10.4103/atm.atm_323_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.
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Affiliation(s)
- Nowaf Y Alobaidi
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - James A Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Robert A Stockley
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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12
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Sun Z, Zhu Q, Shen Y, Yan T, Zhou X. Dynamic changes of gut and lung microorganisms during chronic obstructive pulmonary disease exacerbations. Kaohsiung J Med Sci 2019; 36:107-113. [PMID: 31782610 DOI: 10.1002/kjm2.12147] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Zhe Sun
- Department of Respiration MedicineShanghai General Hospital of Nanjing Medical University Shanghai China
- Department of RespiratoryShanghai General Hospital, Shanghai Jiao Tong University Shanghai China
| | - Qiu‐Li Zhu
- Department of RespiratoryShanghai General Hospital, Shanghai Jiao Tong University Shanghai China
| | - Yun Shen
- Department of RespiratoryShanghai General Hospital, Shanghai Jiao Tong University Shanghai China
| | - Tao Yan
- Department of RespiratoryShanghai General Hospital, Shanghai Jiao Tong University Shanghai China
| | - Xin Zhou
- Department of Respiration MedicineShanghai General Hospital of Nanjing Medical University Shanghai China
- Department of RespiratoryShanghai General Hospital, Shanghai Jiao Tong University Shanghai China
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13
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Zhao D, Feng JF. Efficacy of low molecular weight heparin for chronic obstructive pulmonary disease and respiratory failure: A protocol of systematic review of randomized controlled trials. Medicine (Baltimore) 2019; 98:e18051. [PMID: 31770219 PMCID: PMC6890332 DOI: 10.1097/md.0000000000018051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Evaluating the efficacy and safety of low molecular weight heparin (LMWH) for patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF) is a major purpose of this study. METHODS The following electronic databases will be comprehensively retrieved from the inception to July 1, 2019: Cochrane Library, PUBMED, EMBASE, Google Scholar, Web of Science, Allied and Complementary Medicine Database, WANGFANG, and China National Knowledge Infrastructure without language restrictions. All randomized controlled trials related to LMWH for COPD and RF will be included. Two authors will carry out study selection, data collection, and risk of bias assessment independently. RESULTS This study will systematically explore the efficacy and safety of LMWH for COPD and RF. The primary outcome is lung function. The secondary outcomes are severity of dyspnea on exertion, quality of life, body mass index, airflow obstruction; and any expected and unexpected adverse events. CONCLUSION The findings of this study will provide evidence to judge whether LMWH is an effective treatment for patients with COPD and RF. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019 139631.
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Affiliation(s)
- Dejun Zhao
- Department of Respiratory Medicine, People's Hospital of Fuyang, Hangzhou
| | - Jun-Fei Feng
- Department of Respiratory Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, China
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Toraldo DM, Conte L. Influence of the Lung Microbiota Dysbiosis in Chronic Obstructive Pulmonary Disease Exacerbations: The Controversial Use of Corticosteroid and Antibiotic Treatments and the Role of Eosinophils as a Disease Marker. J Clin Med Res 2019; 11:667-675. [PMID: 31636780 PMCID: PMC6785281 DOI: 10.14740/jocmr3875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/16/2019] [Indexed: 12/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease associated with loss of lung function, poorer quality of life, co-morbidities, significant mortality, and higher health care costs. Frequent acute exacerbations of COPD are sudden worsening of symptoms, the nature of which is associated with bacterial or viral infections. However, one-third of exacerbations remain of undetermined origin. Although it is largely discussed and controversial, current guidelines recommend treatment of exacerbations with bronchodilators, antibiotics, and systemic corticosteroids; this is despite being associated with limited benefits in term of reducing mortality, side effects and without paying attention to the heterogeneity of these exacerbations. Increasing evidence suggests that the lung microbiota plays an important role in COPD and numerous studies have reported differences in the microbiota between healthy and disease states, as well as between exacerbations and stable COPD, leading to the hypothesis that frequent acute exacerbation is more likely to experience significant changes in lung microbiota composition. These findings will need further examination to explain the causes of lung dysbiosis, namely microbial composition, the host response, including the recruitment of eosinophils, lifestyle, diet, cigarette smoking and the use of antibiotics and corticosteroids. It is now important to assess: 1) Whether alterations in the lung microbiota contribute to disease pathogenesis, especially in exacerbations of unknown origin; 2) The role of eosinophils; and 3) Whether the microbiota of the lung can be manipulated therapeutically to improve COPD exacerbation event and disease progression. In summary, we hypothesize that the alterations of the lung microbiota may explain the undetermined origins of exacerbations and that there is an urgent need to facilitate the design of intervention studies that aim at conserving the lung microbial flora.
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Affiliation(s)
- Domenico Maurizio Toraldo
- Department of Rehabilitation, Respiratory Care Unit, ASL/Lecce, Italy
- Both authors contributed equally to this manuscript
| | - Luana Conte
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics “E. De Giorgi”, University of Salento, Lecce, Italy
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, “V. Fazzi” Hospital, Lecce, Italy
- Both authors contributed equally to this manuscript
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Varon F, Torres-Caro C, Herrera-Diaz C, Ali A, Hernández-Parra A, Aguirre-Franco C, Uribe-Hernández AM. Microbiological characterization of severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD) in patients admitted to the ICU with or without associated pneumonia: A retrospective cross-sectional study. INFECTIO 2019. [DOI: 10.22354/in.v23i4.803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Wang Z, Maschera B, Lea S, Kolsum U, Michalovich D, Van Horn S, Traini C, Brown JR, Hessel EM, Singh D. Airway host-microbiome interactions in chronic obstructive pulmonary disease. Respir Res 2019; 20:113. [PMID: 31170986 PMCID: PMC6555748 DOI: 10.1186/s12931-019-1085-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/28/2019] [Indexed: 12/31/2022] Open
Abstract
Background Little is known about the interactions between the lung microbiome and host response in chronic obstructive pulmonary disease (COPD). Methods We performed a longitudinal 16S ribosomal RNA gene-based microbiome survey on 101 sputum samples from 16 healthy subjects and 43 COPD patients, along with characterization of host sputum transcriptome and proteome in COPD patients. Results Dysbiosis of sputum microbiome was observed with significantly increased relative abundance of Moraxella in COPD versus healthy subjects and during COPD exacerbations, and Haemophilus in COPD ex-smokers versus current smokers. Multivariate modeling on sputum microbiome, host transcriptome and proteome profiles revealed that significant associations between Moraxella and Haemophilus, host interferon and pro-inflammatory signaling pathways and neutrophilic inflammation predominated among airway host-microbiome interactions in COPD. While neutrophilia was positively correlated with Haemophilus, interferon signaling was more strongly linked to Moraxella. Moreover, while Haemophilus was significantly associated with host factors both in stable state and during exacerbations, Moraxella-associated host responses were primarily related to exacerbations. Conclusions Our study highlights a significant airway host-microbiome interplay associated with COPD inflammation and exacerbations. These findings indicate that Haemophilus and Moraxella influence different components of host immune response in COPD, and that novel therapeutic strategies should consider targeting these bacteria and their associated host pathways in COPD. Electronic supplementary material The online version of this article (10.1186/s12931-019-1085-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhang Wang
- Computational Biology, Human Genetics, Research and Development (R&D), GlaxoSmithKline (GSK), 1250 S. Collegeville Road, Collegeville, PA, 19426-0989, USA.,Present Address: School of Life Sciences, South China Normal University, Guangzhou, 510631, People's Republic of China
| | - Barbara Maschera
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, R&D, GSK, Stevenage, SG1 2NY, UK
| | - Simon Lea
- University of Manchester and University Hospital of South Manchester, Manchester, M23 9QZ, UK
| | - Umme Kolsum
- University of Manchester and University Hospital of South Manchester, Manchester, M23 9QZ, UK
| | - David Michalovich
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, R&D, GSK, Stevenage, SG1 2NY, UK
| | - Stephanie Van Horn
- Functional Genomics, Medicinal Science and Technology, R&D, GSK, Collegeville, PA, 19426, USA
| | - Christopher Traini
- Functional Genomics, Medicinal Science and Technology, R&D, GSK, Collegeville, PA, 19426, USA
| | - James R Brown
- Computational Biology, Human Genetics, Research and Development (R&D), GlaxoSmithKline (GSK), 1250 S. Collegeville Road, Collegeville, PA, 19426-0989, USA.
| | - Edith M Hessel
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, R&D, GSK, Stevenage, SG1 2NY, UK
| | - Dave Singh
- University of Manchester and University Hospital of South Manchester, Manchester, M23 9QZ, UK
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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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Messous S, Grissa MH, Beltaief K, Boukef R, Nouira S, Mastouri M. [Bacteriology of acute exacerbations of chronic obstructive pulmonary disease in Tunisia]. Rev Mal Respir 2018; 35:36-47. [PMID: 29395563 DOI: 10.1016/j.rmr.2017.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The role of bacteria, including atypical organisms, in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been assessed in various ways in Tunisia. METHODS This was a descriptive and analytical study of patients with a mean age of 68.3±10.5 years hospitalized for AECOPD. Bacteriological examination included a cytological sputum exam and serology for atypical organisms including Mycoplasma pneumoniae, Coxiella burnetii, Chlamydophila pneumoniae and Legionella pneumophila using standard techniques. RESULTS Of the 240 patients enrolled, 175 sputum cultures (73%) were considered significant. Twenty-nine cultures were positive (16.5%) and 31 microorganisms were isolated of which the most frequent were P. aeruginosa (25.8%), K. pneumoniae (16.2%), H. influenzae (13%) and S. pneumoniae (9.7%). The prevalence of C. pneumoniae, M. pneumoniae and C. burnetii was 8.4%, 9% and 6.6%, respectively. No L. pneumophila infection was found. The Anthonisen criteria were associated with a positive culture (P=0.04). Almost half (40.9%) of the isolates were resistant to conventional first line antibiotics (43.7% to amoxicillin-clavulanic acid). CONCLUSIONS Awareness of the low positivity of quantitative sputum bacteriology and the large percentage of resistant strains with a predominance of exclusively multi-resistant Pseudomonas should help in the management of patients with AECOPD.
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Affiliation(s)
- S Messous
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie.
| | - M H Grissa
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - K Beltaief
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - R Boukef
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Sahloul de Sousse, Sousse, Tunisie
| | - S Nouira
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - M Mastouri
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
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Wang Z, Singh R, Miller BE, Tal-Singer R, Van Horn S, Tomsho L, Mackay A, Allinson JP, Webb AJ, Brookes AJ, George LM, Barker B, Kolsum U, Donnelly LE, Belchamber K, Barnes PJ, Singh D, Brightling CE, Donaldson GC, Wedzicha JA, Brown JR. Sputum microbiome temporal variability and dysbiosis in chronic obstructive pulmonary disease exacerbations: an analysis of the COPDMAP study. Thorax 2017; 73:331-338. [DOI: 10.1136/thoraxjnl-2017-210741] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/02/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022]
Abstract
BackgroundRecent studies suggest that lung microbiome dysbiosis, the disease associated disruption of the lung microbial community, might play a key role in chronic obstructive pulmonary disease (COPD) exacerbations. However, characterising temporal variability of the microbiome from large longitudinal COPD cohorts is needed to better understand this phenomenon.MethodsWe performed a 16S ribosomal RNA survey of microbiome on 716 sputum samples collected longitudinally at baseline and exacerbations from 281 subjects with COPD at three UK clinical centres as part of the COPDMAP consortium.ResultsThe microbiome composition was similar among centres and between stable and exacerbations except for a small significant decrease of Veillonella at exacerbations. The abundance of Moraxella was negatively associated with bacterial alpha diversity. Microbiomes were distinct between exacerbations associated with bacteria versus eosinophilic airway inflammation. Dysbiosis at exacerbations, measured as significant within subject deviation of microbial composition relative to baseline, was present in 41% of exacerbations. Dysbiosis was associated with increased exacerbation severity indicated by a greater fall in forced expiratory volume in one second, forced vital capacity and a greater increase in CAT score, particularly in exacerbations with concurrent eosinophilic inflammation. There was a significant difference of temporal variability of microbial alpha and beta diversity among centres. The variation of beta diversity significantly decreased in those subjects with frequent historical exacerbations.ConclusionsMicrobial dysbiosis is a feature of some exacerbations and its presence, especially in concert with eosinophilic inflammation, is associated with more severe exacerbations indicated by a greater fall in lung function.Trial registration numberResults, NCT01620645.
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Miravitlles M, D'Urzo A, Singh D, Koblizek V. Pharmacological strategies to reduce exacerbation risk in COPD: a narrative review. Respir Res 2016; 17:112. [PMID: 27613392 PMCID: PMC5018159 DOI: 10.1186/s12931-016-0425-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/20/2016] [Indexed: 01/17/2023] Open
Abstract
Identifying patients at risk of exacerbations and managing them appropriately to reduce this risk represents an important clinical challenge. Numerous treatments have been assessed for the prevention of exacerbations and their efficacy may differ by patient phenotype. Given their centrality in the treatment of COPD, there is strong rationale for maximizing bronchodilation as an initial strategy to reduce exacerbation risk irrespective of patient phenotype. Therefore, in patients assessed as frequent exacerbators (>1 exacerbation/year) we propose initial bronchodilator treatment with a long-acting muscarinic antagonist (LAMA)/ long-acting β2-agonist (LABA). For those patients who continue to experience >1 exacerbation/year despite maximal bronchodilation, we advocate treating according to patient phenotype. Based on currently available data on adding inhaled corticosteroids (ICS) to a LABA, ICS might be added to a LABA/LAMA combination in exacerbating patients who have an asthma-COPD overlap syndrome or high blood eosinophil counts, while in exacerbators with chronic bronchitis, consideration should be given to treating with a phosphodiesterase (PDE)-4 inhibitor (roflumilast) or high-dose mucolytic agents. For those patients who experience frequent bacterial exacerbations and/or bronchiectasis, addition of mucolytic agents or a macrolide antibiotic (e.g. azithromycin) should be considered. In all patients at risk of exacerbations, pulmonary rehabilitation should be included as part of a comprehensive management plan.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital General Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anthony D'Urzo
- Department of Family and Community Medicine, University of Toronto, 1670 Dufferin Street, Suite 107, Toronto, ON, M6H 3M2, Canada
| | - Dave Singh
- University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Southmoor Road, Manchester, M23 9QZ, UK
| | - Vladimir Koblizek
- Department of Pneumology, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Simkova 870, Hradec Kralove 1, 500 38, Czech Republic
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Wang Z, Bafadhel M, Haldar K, Spivak A, Mayhew D, Miller BE, Tal-Singer R, Johnston SL, Ramsheh MY, Barer MR, Brightling CE, Brown JR. Lung microbiome dynamics in COPD exacerbations. Eur Respir J 2016; 47:1082-92. [PMID: 26917613 DOI: 10.1183/13993003.01406-2015] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/06/2015] [Indexed: 02/06/2023]
Abstract
Increasing evidence suggests that the lung microbiome plays an important role in chronic obstructive pulmonary disease (COPD) severity. However, the dynamics of the lung microbiome during COPD exacerbations and its potential role in disease aetiology remain poorly understood.We completed a longitudinal 16S ribosomal RNA survey of the lung microbiome on 476 sputum samples collected from 87 subjects with COPD at four visits defined as stable state, exacerbation, 2 weeks post-therapy and 6 weeks recovery.Our analysis revealed a dynamic lung microbiota where changes appeared to be associated with exacerbation events and indicative of specific exacerbation phenotypes. Antibiotic and steroid treatments appear to have differential effects on the lung microbiome. We depict a microbial interaction network for the lung microbiome and suggest that perturbation of a few bacterial operational taxonomic units, in particular Haemophilus spp., could greatly impact the overall microbial community structure. Furthermore, several serum and sputum biomarkers, in particular sputum interleukin-8, appear to be highly correlated with the structure and diversity of the microbiome.Our study furthers the understanding of lung microbiome dynamics in COPD patients and highlights its potential as a biomarker, and possibly a target, for future respiratory therapeutics.
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Affiliation(s)
- Zhang Wang
- Computational Biology, Target Sciences, GSK R&D, Collegeville, PA, USA These authors contributed equally
| | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK These authors contributed equally
| | - Koirobi Haldar
- Institute for Lung Health, National Institute for Health Research Respiratory Biomedical Research Unit, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK Dept of Health Sciences, University of Leicester, Leicester, UK
| | - Aaron Spivak
- Computational Biology, Target Sciences, GSK R&D, Collegeville, PA, USA
| | - David Mayhew
- Computational Biology, Target Sciences, GSK R&D, Collegeville, PA, USA
| | - Bruce E Miller
- Respiratory Therapy Area Unit, GSK R&D, King of Prussia, PA, USA
| | - Ruth Tal-Singer
- Respiratory Therapy Area Unit, GSK R&D, King of Prussia, PA, USA
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mohammadali Yavari Ramsheh
- Institute for Lung Health, National Institute for Health Research Respiratory Biomedical Research Unit, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Michael R Barer
- Institute for Lung Health, National Institute for Health Research Respiratory Biomedical Research Unit, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Institute for Lung Health, National Institute for Health Research Respiratory Biomedical Research Unit, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK Dept of Health Sciences, University of Leicester, Leicester, UK Both authors contributed equally
| | - James R Brown
- Computational Biology, Target Sciences, GSK R&D, Collegeville, PA, USA Both authors contributed equally
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Bhavsar NV, Dave BD, Brahmbhatt NA, Parekh R. Periodontal status and oral health behavior in hospitalized patients with chronic obstructive pulmonary disease. J Nat Sci Biol Med 2015; 6:S93-7. [PMID: 26604629 PMCID: PMC4630773 DOI: 10.4103/0976-9668.166097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM We evaluated the periodontal health status and oral health behavior among hospitalized patients with chronic obstructive pulmonary disease (COPD) to assess the association of COPD with dental health. MATERIALS AND METHODS A group of 100 hospitalized patients with COPD and a group of 100 age, sex, and race-matched control patients were included in this study. Detailed case histories along with standardized measures of oral health including gingival index, plaque index (PI), and simplified oral hygiene index (OHI) were estimated and compared. Probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth. C-reactive protein (CRP) levels in saliva and serum were also measured. RESULTS The study subjects had similar demographics and distribution in either group. Patients with COPD had significantly lower brushing frequency, poor periodontal health (OHI and PI), greater gingival inflammation, and deeper pockets/CALs compared to controls. Further COPD patients had significantly higher serum and salivary CRP levels compared to control groups. CONCLUSIONS Lower brushing frequency, poor oral health, and presence of destructive periodontal disease were observed among patients with COPD, which warrants promoting dental care and oral health knowledge as an integrated approach to treating COPD patients.
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Affiliation(s)
- Neeta Vijay Bhavsar
- Department of Periodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Bela Dilip Dave
- Department of Periodontia, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | | | - Rishikesh Parekh
- Department of Periodontia, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Marcus BS, McAvay G, Gill TM, Vaz Fragoso CA. Respiratory symptoms, spirometric respiratory impairment, and respiratory disease in middle-aged and older persons. J Am Geriatr Soc 2015; 63:251-7. [PMID: 25643966 PMCID: PMC4333080 DOI: 10.1111/jgs.13242] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate whether a novel definition of spirometric respiratory impairment from the Global Lung Initiative (GLI) is strongly associated with respiratory symptoms and, in turn, frequently establishes symptomatic respiratory disease. DESIGN Cross-sectional. SETTING Third National Health and Nutrition Examination Survey. PARTICIPANTS Community-dwelling individuals aged 40 to 80 (N = 7,115). MEASUREMENTS GLI-defined spirometric respiratory impairment (airflow obstruction and restrictive pattern), dyspnea on exertion (DOE), chronic bronchitis (CB), and wheezing. RESULTS Prevalence rates were 12.7% for airflow obstruction, 6.2% for restrictive pattern, 28.6% for DOE, 12.6% for CB, and 12.9% for wheezing. Airflow obstruction was associated with DOE (adjusted odds ratio (aOR) = 1.69, 95% confidence interval (CI) = 1.42-2.02), CB (aOR = 1.92, 95% CI = 1.62-2.29), and wheezing (aOR = 2.50, 95% CI = 2.08-3.00), and restrictive pattern was associated with DOE (aOR = 1.75, 95% CI = 1.36-2.25), CB (aOR = 1.39, 95% CI = 1.08-1.78), and wheezing (aOR = 1.53, 95% CI = 1.15-2.04). Nonetheless, among participants who had airflow obstruction and restrictive pattern, only a minority had DOE (38.6% and 45.5%), CB (23.3% and 15.9%), and wheezing (24.4% and 19.1%), yielding a positive predictive value (PPV) of only 53% for any respiratory symptom in the setting of any spirometric respiratory impairment. In addition, most participants who had DOE (73.0%), CB (67.8%), and wheezing (66.8%) did not have airflow obstruction or restrictive pattern, yielding a PPV of only 26% for any spirometric respiratory impairment in the setting of any respiratory symptom. The results differed only modestly when stratified according to age (40-64 vs 65-80). CONCLUSION GLI-defined spirometric respiratory impairment increased the likelihood of respiratory symptoms but was nonetheless a poor predictor of respiratory symptoms. Similarly, respiratory symptoms were poor predictors of GLI-defined spirometric respiratory impairment. Hence, a comprehensive assessment is needed when evaluating respiratory symptoms, even in the presence of spirometric respiratory impairment.
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Affiliation(s)
| | | | | | - Carlos A. Vaz Fragoso
- Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT, USA
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Rutebemberwa A, Stevens MJ, Perez MJ, Smith LP, Sanders L, Cosgrove G, Robertson CE, Tuder RM, Harris JK. Novosphingobium and its potential role in chronic obstructive pulmonary diseases: insights from microbiome studies. PLoS One 2014; 9:e111150. [PMID: 25340840 PMCID: PMC4207766 DOI: 10.1371/journal.pone.0111150] [Citation(s) in RCA: 13] [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: 12/10/2013] [Accepted: 09/29/2014] [Indexed: 02/03/2023] Open
Abstract
Bacterial infection of lung airways underlies some of the main complications of COPD, significantly impacting disease progression and outcome. Colonization by bacteria may further synergize, amplify, or trigger pathways of tissue damage started by cigarette smoke, contributing to the characteristic airway inflammation and alveolar destruction of COPD. We sought to elucidate the presence and types of lung bacterial populations in different stages of COPD, aimed at revealing important insights into the pathobiology of the disease. Sequencing of the bacterial small subunit ribosomal RNA gene in 55 well-characterized clinical lung samples, revealed the presence of Novosphingobium spp. (>2% abundance) in lungs of patients with GOLD 3-GOLD 4 COPD, cystic fibrosis and a subset of control individuals. Novosphingobium-specific quantitative PCR was concordant with the sequence data and high levels of Novosphingobium spp. were quantifiable in advanced COPD, but not from other disease stages. Using a mouse model of subacute lung injury due to inhalation of cigarette smoke, bronchoalveolar lavage neutrophil and macrophage counts were significantly higher in mice challenged intratracheally with N. panipatense compared to control mice (p<0.01). Frequencies of neutrophils and macrophages in lung tissue were increased in mice challenged with N. panipatense at room air compared to controls. However, we did not observe an interaction between N. panipatense and subacute cigarette smoke exposure in the mouse. In conclusion, Novosphingobium spp. are present in more severe COPD disease, and increase inflammation in a mouse model of smoke exposure.
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Affiliation(s)
- Alleluiah Rutebemberwa
- University of Colorado School of Medicine, Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Mark J. Stevens
- University of Colorado - School of Medicine, Department of Pediatrics, Pulmonary Medicine, Mucosal and Vaccine Research Colorado, Microbiome Research Colorado, Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Mario J. Perez
- University of Colorado School of Medicine, Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lynelle P. Smith
- University of Colorado School of Medicine, Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Linda Sanders
- University of Colorado School of Medicine, Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Gregory Cosgrove
- National Jewish Health, Department of Medicine and University of Colorado School of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Charles E. Robertson
- Department of Molecular, Cellular and Developmental Biology, University of Colorado, Boulder, Colorado, United States of America
| | - Rubin M. Tuder
- University of Colorado School of Medicine, Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail: (JKH); (RMT)
| | - J. Kirk Harris
- University of Colorado - School of Medicine, Department of Pediatrics, Pulmonary Medicine, Mucosal and Vaccine Research Colorado, Microbiome Research Colorado, Children’s Hospital Colorado, Aurora, Colorado, United States of America
- * E-mail: (JKH); (RMT)
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Morsi TS, Degady AAE. Value of copeptin and C-reactive protein in acute exacerbation of chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Minov J, Karadzinska-Bislimovska J, Petrova T, Vasilevska K, Stoleski S, Mijakoski D, Risteska-Kuc S. Efficacy and Tolerability of Eight Antimicrobial Regimens in the Outpatient Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Bacterial infections are considered as the most important cause of exacerbations in patients with chronic obstructive pulmonary disease.AIM: To compare the efficacy and tolerability of eight antibiotics empirically administered for outpatient treatment of exacerbations of COPD.METHODS: We performed an observational study including 343 COPD patients with probable bacterial exacerbation (Group A and Group B COPD patients) managed in an outpatient setting. Eight antibiotic regimens each used 10 days were evaluated: amoxicillin/clavulonic acid, doxycycline, cefuroxime, cefixime, clarithromycin, roxithromycin, ciprofloxacin, and moxifloxacin. All patients were followed up for 30 days, with an intermediate visits at 5, 7 and 10 days at which the duration of symptoms and the side-effects of the drug were evaluated.RESULTS: The clinical success rate varied from 69.8% with doxycycline to 80.9% with moxifloxacin. The mean time to relief of symptoms varied from 5.6 days with moxifloxacin to 6.3 days with amoxicillin/clavulonic acid. Significant increase of the post-treatment FEV1value was registered in all treatment groups. Relapse within the first 20 days was registered in the group receiving doxycycline, clarithromycin, and ciprofloxacin. The prevalence of the adverse events was low varying from 6.7% with cefuroxime to 11.3% with ciprofloxacin.CONCLUSION: Our findings suggest high clinical success rate and high safety of all studied regimens.
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ElKorashy R, El-Sherif R. Gram negative organisms as a cause of acute exacerbation of COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Biscevic-Tokic J, Tokic N, Musanovic A. Pneumonia as the most common lower respiratory tract infection. Med Arch 2013; 67:442-5. [PMID: 25568518 PMCID: PMC4272454 DOI: 10.5455/medarh.2013.67.442-445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/25/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction: Pneumonia is the most serious inflammatory disease of the respiratory system and also the most common infectious disease. Even now, in the 21st century, pneumonia occupies a prominent place in clinical medicine and public health. We are confronted daily with the increased number of patients, as well as the constant increase in annual mortality due to this infectious disease. Goal: The goal was to investigate the prevalence and pneumonia characteristics as the most serious lower respiratory tract infection, the incidence of typical and atypical pneumonia, hospitalization duration of the patients at the Clinic of Infectious Diseases, Clinical Center of Sarajevo University CCUS. Patients and Methods: From January 2011 until December 2012 the study involved 100 hospitalized patients with infections of the lower respiratory tract at the Clinic of Infectious Diseases CCUS. Results: Among the most common infections the pneumonia is highly represented. Lung X-Ray in two planes, by all protocols, demonstrated with the auscultatory finding has the highest value in the diagnosis of clinical pneumonieae. A statistically significant difference among our hospitalized patients, compared to typical and atypical pneumonia, is in favor of the first–typical bacterial pneumonia. Hospitalization duration ranges between 7-14 days. Conclusion: We believe that the introduction of the pneumococcal vaccine (PCV) should reduce the number of pneumonia caused by this bacterium. Recommendations for its use also come from the WHO. Until December 2012, WHO added 86 states in the PCV immunization as a part of their national immunization programs. Pneumococcal conjugate vaccine (PCV) is safe and effective for the reduction in number of patients suffering from pneumonia caused by St. pneumoniae. In particular, the vaccine is a significant protection for children, who due to age and severity of the disease must remain under medical supervision. In elderly vaccine is important and useful as preventive measure, due to their biological characteristics and life circumstances which mark this group as vulnerable population, like the youngest, and can be fatal for them.
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Affiliation(s)
| | - Nedim Tokic
- Clinic of Urgent Medicine, Clinical Center, University of Sarajevo, Bosnia and Herzegovina
| | - Adnan Musanovic
- Clinic of Urgent Medicine, Clinical Center, University of Sarajevo, Bosnia and Herzegovina
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Zhou Y, Kang MJ, Jha BK, Silverman RH, Lee CG, Elias JA. Role of ribonuclease L in viral pathogen-associated molecular pattern/influenza virus and cigarette smoke-induced inflammation and remodeling. THE JOURNAL OF IMMUNOLOGY 2013; 191:2637-46. [PMID: 23913960 DOI: 10.4049/jimmunol.1300082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interactions between cigarette smoke (CS) exposure and viral infection play an important role(s) in the pathogenesis of chronic obstructive pulmonary disease and a variety of other disorders. A variety of lines of evidence suggest that this interaction induces exaggerated inflammatory, cytokine, and tissue remodeling responses. We hypothesized that the 2'-5' oligoadenylate synthetase (OAS)/RNase L system, an innate immune antiviral pathway, plays an important role in the pathogenesis of these exaggerated responses. To test this hypothesis, we characterize the activation of 2'-5' OAS in lungs from mice exposed to CS and viral pathogen-associated molecular patterns (PAMPs)/live virus, alone and in combination. We also evaluated the inflammatory and remodeling responses induced by CS and virus/viral PAMPs in lungs from RNase L null and wild-type mice. These studies demonstrate that CS and viral PAMPs/live virus interact in a synergistic manner to stimulate the production of select OAS moieties. They also demonstrate that RNase L plays a critical role in the pathogenesis of the exaggerated inflammatory, fibrotic, emphysematous, apoptotic, TGF-β1, and type I IFN responses induced by CS plus virus/viral PAMP in combination. These studies demonstrate that CS is an important regulator of antiviral innate immunity, highlight novel roles of RNase L in CS plus virus induced inflammation, tissue remodeling, apoptosis, and cytokine elaboration and highlight pathways that may be operative in chronic obstructive pulmonary disease and mechanistically related disorders.
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Affiliation(s)
- Yang Zhou
- Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
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Harte BJ, Wesorick D, Odden A. Chronic Obstructive Pulmonary Disease: Inpatient Management. HOSPITAL MEDICINE CLINICS 2013; 2:e169-e191. [PMID: 32288997 PMCID: PMC7104036 DOI: 10.1016/j.ehmc.2012.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
This article outlines the management of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), which are common in the course of chronic COPD and are associated with substantial morbidity. There are numerous guidelines, but literature suggests that there is substantial variation in care in patients with acute exacerbations of COPD. Key components of acute therapy for most patients include oral steroids, antibiotics, nebulizers, oxygen, and early consideration of noninvasive ventilation. Adjuvant components of care include venous thromboembolism prophylaxis, appropriate immunizations, counseling for smoking cessation, and consideration of pulmonary rehabilitation.
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Affiliation(s)
- Brian J Harte
- Department of Hospital Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western University, 2000 Harvard Road, Warrensville Heights, Cleveland, OH 44122, USA
| | - David Wesorick
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew Odden
- Department of Internal Medicine, Ann Arbor Veterans Affairs Healthcare System, University of Michigan Medical School, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Shafiek HA, Abd-Elwahab NH, Baddour MM, El-Hoffy MM, Degady AAE, Khalil YM. Assessment of some inflammatory biomarkers as predictors of outcome of acute respiratory failure on top of chronic obstructive pulmonary disease and evaluation of the role of bacteria. ISRN MICROBIOLOGY 2012; 2012:240841. [PMID: 23724320 PMCID: PMC3658585 DOI: 10.5402/2012/240841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/18/2012] [Indexed: 11/23/2022]
Abstract
Objective. To study the value of the inflammatory markers (interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP)) in predicting the outcome of noninvasive ventilation (NIV) in the management of acute respiratory failure (ARF) on top of chronic obstructive pulmonary disease (COPD) and the role of bacteria in the systemic inflammation. Methods. Thirty three patients were subjected to standard treatment plus NIV, and accordingly, they were classified into responders and nonresponders. Serum samples were collected for IL-6, IL-8, and CRP analysis. Sputum samples were taken for microbiological evaluation. Results. A wide spectrum of bacteria was revealed; Gram-negative and atypical bacteria were the most common (31% and 28% resp.; single or copathogen). IL-8 and dyspnea grade was significantly higher in the non-responder group (P = 0.01 and 0.023 resp.). IL-6 correlated positivity with the presence of infection and type of pathogen (P = 0.038 and 0.034 resp.). Gram-negative bacteria were associated with higher significant IL-6 in comparison between others (196.4 ± 239.1 pg/dL; P = 0.011) but insignificantly affected NIV outcome (P > 0.05). Conclusions. High systemic inflammation could predict failure of NIV. G-ve bacteria correlated with high IL-6 but did not affect the response to NIV.
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Hashibe M, Hunt J, Wei M, Buys S, Gren L, Lee YCA. Tobacco, alcohol, body mass index, physical activity, and the risk of head and neck cancer in the prostate, lung, colorectal, and ovarian (PLCO) cohort. Head Neck 2012; 35:914-22. [PMID: 22711227 DOI: 10.1002/hed.23052] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Estimation of attributable fractions for tobacco and alcohol, and investigation of the association between body mass index (BMI) and head and neck cancer risk have largely been in case-control studies. These aspects and physical activity need to be assessed as possible head and neck cancer risk/protective factors in a cohort study. METHODS In the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial, of the 101,182 study subjects, 177 individuals developed head and neck cancer. RESULTS The proportion of head and neck cancer cases attributed to tobacco and/or alcohol was 66% (50.5% tobacco alone, 14.7% alcohol alone, 0.9% tobacco and alcohol combined). BMI was not associated with head and neck cancer risk, but increasing hours of physical activity per week was associated with a reduced head and neck cancer risk (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.35-0.96). CONCLUSIONS Cigarette smoking is clearly the most important head and neck cancer risk factor in this population. The reduced cancer risk due to physical activity was consistent with results from a pooled analysis of case-control studies.
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Affiliation(s)
- Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA.
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Roberts M, Mapel D, Petersen H, Blanchette C, Ramachandran S. Comparative effectiveness of budesonide/formoterol and fluticasone/salmeterol for COPD management. J Med Econ 2011; 14:769-76. [PMID: 21942463 DOI: 10.3111/13696998.2011.622817] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the effectiveness of budesonide/formoterol fumarate dihydrate (BFC) and fluticasone propionate/salmeterol (FSC), two combination inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) products approved for the treatment of chronic obstructive pulmonary disease (COPD) in the US with respect to cost, therapy adherence, and related healthcare utilization. The effectiveness of these two treatments has not previously been compared in a US COPD population. METHODS A retrospective cohort study assessed COPD-related outcomes using administrative claims data among ICS/LABA-naïve patients. Patients initiating BFC were propensity matched to FSC patients. Cost and effectiveness were measured as total healthcare expenditures, exacerbation events (hospitalizations, emergency department visits, or outpatient visits associated with oral corticosteroid or antibiotic prescription fills), and treatment medication adherence. Differences in COPD symptom control were assessed via proxy measure through claims for rescue medications and outpatient encounters. RESULTS Of the 6770 patients (3385 BFC and 3385 FSC), fewer BFC patients had claims for short-acting beta agonists (SABA) (34.7% vs 39.5%; p<0.001) and ipratropium (7.8% vs 9.8%, p<0.005) than FSC patients, but no substantial differences were seen in other clinical outcomes including tiotropium or nebulized SABA claims, COPD-related outpatient visits, or exacerbation events. There were no significant differences in total COPD-related medical costs in the 6-month period after initiation of combination therapy. LIMITATIONS This was a retrospective observational study using claims data and accuracy of COPD diagnoses could not be verified, nor was information available on severity of disease. The results and conclusions of this study are limited to the population observed and the operational definitions of the study variables. CONCLUSIONS For most outcomes of interest, BFC and FSC showed comparable real-world effectiveness.
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Park SW. Respiratory Vaccination. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.6.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sang-Won Park
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Gotfried MH, Grossman RF. Short-course fluoroquinolones in acute exacerbations of chronic bronchitis. Expert Rev Respir Med 2010; 4:661-72. [PMID: 20923343 DOI: 10.1586/ers.10.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is estimated that 50-70% of acute exacerbations of chronic bronchitis (AECB) are caused by bacterial infections. Appropriate selection of antimicrobials may lead to better outcomes and reduced healthcare costs. Respiratory fluoroquinolones (moxifloxacin, levofloxacin and gemifloxacin) have a broad spectrum of activity against most AECB-causing pathogens and are used as first-line treatment in patients with comorbidity, severe airway obstruction or recurrent exacerbations. We review studies, identified through a MEDLINE search, that compared clinical efficacy and speed of recovery for short-course (≤ 5 days) fluoroquinolone therapy with commonly prescribed standard therapy (≥ 7 days). Among 177 studies reporting the use of fluoroquinolones for AECB treatment, 23 used a short-course regimen, shown to be at least as effective as standard therapy of 7 or more days duration. Furthermore, evidence suggests that short-course therapy offers faster resolution of symptoms, faster rate of recovery, fewer relapses, fewer and shorter hospitalizations, and longer time between recurrences.
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Affiliation(s)
- Mark H Gotfried
- College of Medicine, University of Arizona, 1112 East McDowell Road, Phoenix, AZ 85006, USA.
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Ndiaye AG, Edwige H, Guèye FB, Boye CSB. Trend in Antibiotic Resistance of Streptococcus Pneumoniae and Haemophilus Influenzae Strains Isolated from Community Acquired Respiratory Tract Infections in Dakar, Senegal between 2005 and 2008. Microbiol Insights 2010. [DOI: 10.4137/mbi.s3819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Development of antibiotic resistance among common respiratory pathogens is a major cause of concern worldwide. Streptococcus pneumoniae and Haemophilus influenzae are among the most common respiratory pathogens. In this study, representative samples obtained from 3 different medical centers in Dakar, Senegal were subjected to antibiotic susceptibility testing. The samples were collected from 2005 to 2008 and the data obtained was compared to establish resistance patterns between the two years (i.e. 2005–2006 to 2007–2008). S. pneumoniae exhibited a significant increase in the resistance to azithromycin and the intermediate susceptibility to penicillin G and cotrimoxazole. H. influenzae also exhibited a significant increase in resistance to azithromycin and intermediate susceptibility to chloramphenicol. None of H. influenzae samples were resistant to amoxicillin/clavulanic acid, cephalosporin and fluroquinolones and most of the S. pneumoniae isolates demonstrated high susceptibility to the antibiotics tested. Results from this study will provide greater insights to antibiotic therapy during respiratory tract infections in Dakar, Senegal. This study also establishes the importance of continuous monitoring of antibiotic susceptibility patterns that are often region-specific.
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Affiliation(s)
- A. Guèye Ndiaye
- Bacteriology and Virology Laboratory, Dantec teaching Hospital, Dakar, Senegal
| | - Hounkponou Edwige
- Bacteriology and Virology Laboratory, Dantec teaching Hospital, Dakar, Senegal
| | - Fatou Bintou Guèye
- Bacteriology and Virology Laboratory, Dantec teaching Hospital, Dakar, Senegal
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Ramaswamy M, Groskreutz DJ, Look DC. Recognizing the importance of respiratory syncytial virus in chronic obstructive pulmonary disease. COPD 2009; 6:64-75. [PMID: 19229710 DOI: 10.1080/15412550902724024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (COPD) are responsible for a large proportion of the health care dollar expenditure, morbidity, and mortality related to COPD. Respiratory infections are the most common cause of acute exacerbations, but recent evidence indicates that the importance of respiratory syncytial virus (RSV) infection in COPD is under-appreciated. Improved detection of RSV using techniques based on the polymerase chain reaction accounts for much of the increased recognition of the importance of this virus in COPD patients. Furthermore, COPD patients may be more susceptible to RSV infection, possibly due to RSV-or immune response-induced pulmonary effects that are altered by age, environmental exposures, genetics, COPD itself, or a combination of these. However, although RSV infection occurs throughout life, viral and host factors that place COPD patients at increased risk are unclear. The complexities of RSV effects in COPD present opportunities for research with the goal of developing approaches to selectively modify damaging viral effects (e.g., altered airway function), while retaining beneficial immunity (e.g., clearance of virus) in COPD patients. This review explores the role RSV plays in acute exacerbations of COPD, the potential for RSV disease in chronic stable COPD, and newer concepts in RSV diagnosis, epidemiology, and host defense.
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Affiliation(s)
- Murali Ramaswamy
- VA San Diego Healthcare System, University of California at San Diego, San Diego, CA, USA.
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Borrell E, Rodríguez M, Torán P, Muñoz L, Pera G, Montellà N, Monteagudo M, Urrea M, Puigfel Y, Negrete A, Mezquiriz X, Domènech C, Lacasta A, García ML, Maneus S, Tintoré G. Incidence and risk factors of exacerbations among COPD patients in primary health care: APMPOC study. BMC Public Health 2009; 9:8. [PMID: 19134205 PMCID: PMC2633267 DOI: 10.1186/1471-2458-9-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 01/09/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care. METHODS AND DESIGN A prospective, observational, 3-phase, multicentre study will be performed involving: baseline evaluation, follow up and final evaluation. A total of 685 smokers or ex-smokers from 40 to 80 years of age with COPD, without acute respiratory disease or any other long-term respiratory disease will be randomly selected among the population assigned to 21 primary care centres. The diagnosis of COPD and its severity will be confirmed by spirometry. Information regarding the baseline situation, quality of life and exposure to contaminants or other factors potentially related to exacerbations will be collected. A group of 354 patients with confirmed COPD of varying severity will be followed for one year through monthly telephone calls and daily reporting of symptoms with the aim of detecting all the exacerbations which occur. These patients will be evaluated again at the end of the study and the incidence of exacerbations and associated relative risks will be estimated by negative binomial regression. DISCUSSION The results will be relevant to provide knowledge about natural history of the initial phases of the COPD and the impact and incidence of the exacerbations on the patients with mild-moderate forms of the disease. These data may be important to know the milder forms of exacerbation which are often silent or very little expressed clinically.
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Affiliation(s)
- Eulàlia Borrell
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Mar Rodríguez
- Primary Healtcare Centre Canet de Mar, Catalan Health Institute, Costa de l'Hospital s/n, 08640 Canet de Mar, Spain
| | - Pere Torán
- Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3planta), 08303 Mataró, Spain
- Primary Healthcare Centre Gatassa, Catalan Health Institute, Camí del Mig 36 (4planta), 08303 Mataró, Spain
| | - Laura Muñoz
- Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3planta), 08303 Mataró, Spain
| | - Guillem Pera
- Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3planta), 08303 Mataró, Spain
| | - Núria Montellà
- Primary Healthcare Methodology, Quality and Evaluation Unit Badalona i Sant Adrià de Besòs, Catalan Health Institute, Plaça de la Medicina, s/n, 08911 Badalona, Spain
| | - Mònica Monteagudo
- Primary Healthcare Research Support, IDIAP Jordi Gol. Avda, Gran Via de les Corts Catalanes 487, 08007 Barcelona, Spain
| | - Magalí Urrea
- Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3planta), 08303 Mataró, Spain
| | - Yolanda Puigfel
- Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3planta), 08303 Mataró, Spain
| | - Antonio Negrete
- Primary Healthcare Centre Gatassa, Catalan Health Institute, Camí del Mig 36 (4planta), 08303 Mataró, Spain
| | - Xavier Mezquiriz
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Cristina Domènech
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Anna Lacasta
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Ma Llum García
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Sandra Maneus
- Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain
| | - Glòria Tintoré
- Primary Healthcare Centre Llefià, Catalan Health Institute, Carretera Antiga de València s/n, 08913 Badalona, Spain
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Tratamiento empírico de las infecciones en el adulto. FMC : FORMACION MEDICA CONTINUADA EN ATENCION PRIMARIA 2009; 14:7-58. [PMID: 32288493 PMCID: PMC7144493 DOI: 10.1016/s1134-2072(07)71960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Erkan L, Uzun O, Findik S, Katar D, Sanic A, Atici AG. Role of bacteria in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2009; 3:463-7. [PMID: 18990975 PMCID: PMC2629984 DOI: 10.2147/copd.s2776] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND STUDY OBJECTIVE Infections are major causes of acute exacerbations of chronic obstructive pulmonary disease (COPD) which result in significant mortality and morbidity. The primary aim of the study was to determine the microbiological spectrum including atypical agents in acute exacerbations. The secondary aim was to evaluate resistance patterns in the microorganisms. METHODS The sputum culture of 75 patients admitted to our clinic from January 1, 1999 to December 31, 2002 was evaluated prospectively, for aerobic Gram-positive and Gram-negative bacteria, and serologically for Chlamydophila pneumoniae and Mycoplasma pneumoniae. Sensitivity patterns in potentially pathogenic microorganisms (PPMs) were also investigated. RESULTS An infectious agent was identified in 46 patients, either serologically or with sputum culture. Pathogens most commonly demonstrated were: Haemophilus influenzae (30%), Chlamydophila pneumoniae (17%), and Mycoplasma pneumoniae (9%). Mixed infections were diagnosed in 9 patients. PPMs showed a high resistance rate to commonly used antibiotics. CONCLUSION We have shown that microorganisms causing acute exacerbations of COPD are not only typical bacteria (46%) but also atypical pathogens (26%), with unpredictable high rates. Typical agents showed a high resistance to commonly used antibiotics.
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Affiliation(s)
- Levent Erkan
- Ondokuz Mayis University, Faculty of Medicine, Department of Pulmonary Medicine, Samsun, Turkey
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Targeting the NF-kappaB pathway in asthma and chronic obstructive pulmonary disease. Pharmacol Ther 2008; 121:1-13. [PMID: 18950657 PMCID: PMC7172981 DOI: 10.1016/j.pharmthera.2008.09.003] [Citation(s) in RCA: 286] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 09/09/2008] [Indexed: 11/23/2022]
Abstract
Asthma and chronic obstructive pulmonary disease are inflammatory lung disorders responsible for significant morbidity and mortality worldwide. While the importance of allergic responses in asthma is well known, respiratory viral and bacterial infections and pollutants especially cigarette smoke are important factors in the pathogenesis of both diseases. Corticosteroid treatment remains the first preference of treatment in either disease, however these therapies are not always completely effective, and are associated with side effects and steroid resistance. Due to such limitations, development of new treatments represents a major goal for both the pharmaceutical industry and academic researchers. There are now excellent reasons to promote NF-kappaB signalling intermediates and Rel family proteins as potential therapeutic targets for both asthma and chronic obstructive pulmonary disease. This notion is supported by the fact that much of the underlying inflammation of both diseases independent of stimuli, is mediated at least in part, by NF-kappaB mediated signalling events in several cell types. Also, a range of inhibitors of NF-kappaB signalling intermediates are now available, including DNA oligonucleotides and DNA-peptide molecules that act as NF-kappaB decoy sequences, small molecule inhibitors such as IKK-beta inhibitors, and proteasome inhibitors affecting NF-kappaB signalling, that have either shown promise in animal models or have begun clinical trials in other disorders. This review will focus on the role of NF-kappaB in both diseases, will discuss its suitability as a target, and will highlight recent key studies that support the potential of NF-kappaB as a therapeutic target in these two important inflammatory lung diseases.
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Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Ann Am Thorac Soc 2008; 5:530-5. [PMID: 18453367 DOI: 10.1513/pats.200707-088et] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) describe the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. These exacerbations can range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. The average patient with COPD experiences two such episodes annually, and they account for significant consumption of health care resources. Although bacterial infections are the most common causes of AECOPD, viral infections and environmental stresses are also implicated. AECOPD episodes can be triggered or complicated by other comorbidities, such as heart disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. Pharmacologic management includes bronchodilators, corticosteroids, and antibiotics in most patients. Oxygen, physical therapy, mucolytics, and airway clearance devices may be useful in selected patients. In hypercapneic respiratory failure, noninvasive positive pressure ventilation may allow time for other therapies to work and thus avoid endotracheal intubation. If the patient requires invasive mechanical ventilation, the focus should be on avoiding ventilator-induced lung injury and minimizing intrinsic positive end-expiratory pressure. These may require limiting ventilation and "permissive hypercapnia." Although mild episodes of AECOPD are generally reversible, more severe forms of respiratory failure are associated with a substantial mortality and a prolonged period of disability in survivors.
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Braido F, Bellotti M, De Maria A, Cazzola M, Canonica GW. The role of Pneumococcal vaccine. Pulm Pharmacol Ther 2008; 21:608-15. [DOI: 10.1016/j.pupt.2008.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/14/2008] [Accepted: 04/16/2008] [Indexed: 11/25/2022]
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Jenkins SG, Brown SD, Farrell DJ. Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1-4. Ann Clin Microbiol Antimicrob 2008; 7:1. [PMID: 18190701 PMCID: PMC2262084 DOI: 10.1186/1476-0711-7-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 01/11/2008] [Indexed: 11/29/2022] Open
Abstract
Background The increasing prevalence of resistance to established antibiotics among key bacterial respiratory tract pathogens, such as Streptococcus pneumoniae, is a major healthcare problem in the USA. The PROTEKT US study is a longitudinal surveillance study designed to monitor the susceptibility of key respiratory tract pathogens in the USA to a range of commonly used antimicrobials. Here, we assess the geographic and temporal trends in antibacterial resistance of S. pneumoniae isolates from patients with community-acquired respiratory tract infections collected between Year 1 (2000–2001) and Year 4 (2003–2004) of PROTEKT US. Methods Antibacterial minimum inhibitory concentrations were determined centrally using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method; susceptibility was defined according to CLSI interpretive criteria. Macrolide resistance genotypes were determined by polymerase chain reaction. Results A total of 39,495 S. pneumoniae isolates were collected during 2000–2004. The percentage of isolates resistant to erythromycin, penicillin, levofloxacin, and telithromycin were 29.3%, 21.2%, 0.9%, and 0.02%, respectively, over the 4 years, with marked regional variability. The proportion of isolates exhibiting multidrug resistance (includes isolates known as penicillin-resistant S. pneumoniae and isolates resistant to ≥ 2 of the following antibiotics: penicillin; second-generation cephalosporins, e.g. cefuroxime; macrolides; tetracyclines; and trimethoprim-sulfamethoxazole) remained stable at ~30% over the study period. Overall mef(A) was the most common macrolide resistance mechanism. The proportion of mef(A) isolates decreased from 68.8% to 62.3% between Year 1 and Year 4, while the percentage of isolates carrying both erm(B) and mef(A) increased from 9.7% to 18.4%. Over 99% of the erm(B)+mef(A)-positive isolates collected over Years 1–4 exhibited multidrug resistance. Higher than previously reported levels of macrolide resistance were found for mef(A)-positive isolates. Conclusion Over the first 4 years of PROTEKT US, penicillin and erythromycin resistance among pneumococcal isolates has remained high. Although macrolide resistance rates have stabilized, the prevalence of clonal isolates, with a combined erm(B) and mef(A) genotype together with high-level macrolide and multidrug resistance, is increasing, and their spread may have serious health implications. Telithromycin and levofloxacin both showed potent in vitro activity against S. pneumoniae isolates irrespective of macrolide resistance genotype.
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Affiliation(s)
- Stephen G Jenkins
- Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
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Martinez FJ. Pathogen-directed therapy in acute exacerbations of chronic obstructive pulmonary disease. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2007; 4:647-58. [PMID: 18073397 PMCID: PMC2647652 DOI: 10.1513/pats.200707-097th] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 08/22/2007] [Indexed: 12/15/2022]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this chronic lung disorder. These events can be caused by a large number of infectious and noninfectious agents and are associated with an increased local and systemic inflammatory response. Their frequency and severity have been linked to progressive deterioration in lung function and health status. Infectious pathogens ranging from viral to atypical and typical bacteria have been implicated in the majority of episodes. Most therapeutic regimens to date have emphasized broad, nonspecific approaches to bronchoconstriction and pulmonary inflammation. Increasingly, therapy that targets specific etiologic pathogens has been advocated. These include clinical and laboratory-based methods to identify bacterial infections. Further additional investigation has suggested specific pathogens within this broad class. As specific antiviral therapies become available, better diagnostic approaches to identify specific pathogens will be required. Furthermore, prophylactic therapy for at-risk individuals during high-risk times may become a standard therapeutic approach. As such, the future will likely include aggressive diagnostic algorithms based on the combination of clinical syndromes and rapid laboratory modalities to identify specific causative bacteria or viruses.
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Affiliation(s)
- Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109-5360, USA.
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Blasi F, Cazzola M, Tarsia P, Aliberti S, Baldessari C, Valenti V. Telithromycin in lower respiratory tract infections. Future Microbiol 2007; 1:7-16. [PMID: 17661681 DOI: 10.2217/17460913.1.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Telithromycin is a ketolide, a semisynthetic derivative of the 14-membered ring macrolide antibiotics, with an expanded spectrum of activity relative to macrolides. Its good tissue pharmacokinetic characteristics allows once-daily administration, and it has been successfully employed in lower respiratory tract infections. Recent data indicate that telithromycin may exert anti-inflammatory/immunomodulatory effects that may be of use in the treatment of both acute and chronic airway diseases. This review examines the role of telithromycin in lower respiratory tract infections, analyzing published data on exacerbations of chronic bronchitis, community-acquired pneumonia and asthma in adults. In addition, pharmacokinetic and pharmacodynamic properties of the drug are considered.
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Affiliation(s)
- F Blasi
- University of Milan, Institute of Respiratory Diseases, IRCCS Ospedale Maggiore Milano, Milan, Italy.
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Felmingham D, Cantón R, Jenkins SG. Regional trends in β-lactam, macrolide, fluoroquinolone and telithromycin resistance among Streptococcus pneumoniae isolates 2001–2004. J Infect 2007; 55:111-8. [PMID: 17568680 DOI: 10.1016/j.jinf.2007.04.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 04/13/2007] [Accepted: 04/17/2007] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine global antibacterial resistance rates among community-acquired isolates of Streptococcus pneumoniae. METHODS Between 2001 and 2004, 20,142 S. pneumoniae isolates from 151 centres in 40 countries were collected and tested for susceptibility to common antibacterials in the PROTEKT surveillance study. RESULTS The prevalence of beta-lactam and macrolide resistance did not change, but there was marked geographic variability. The most common macrolide resistance mechanism was ribosomal methylation mediated by erm(B), except in Canada, Greece and the USA where drug efflux mediated by mef(A) was predominant. The erythromycin minimum inhibitory concentration for mef(A) isolates increased significantly (P<0.001; chi2 test). The global prevalence of macrolide-resistant isolates positive for both erm(B) and mef(A) was 12.0% in 2003-2004; erm(B)+mef(A) strains were particularly common in South Korea (40.8%), South Africa (46.4%) and the USA (29.6%). Telithromycin was the most active antibacterial tested. Over the studied period, > or = 99.7% of all isolates and > 99% of erythromycin-resistant isolates, irrespective of genotype, were susceptible to telithromycin. CONCLUSIONS These results confirm the high worldwide prevalence of resistance to commonly used antibacterial agents and multiple resistance phenotypes among clinical isolates of S. pneumoniae and suggest that high-level macrolide resistance is continuing to increase in most countries.
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Banerjee D, Honeybourne D. The role of quinolones in chronic obstructive pulmonary disease. Curr Opin Infect Dis 2007; 12:543-7. [PMID: 17035819 DOI: 10.1097/00001432-199912000-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic obstructive pulmonary disease is a disease state characterized by the presence of airflow obstruction due to chronic bronchitis and/or emphysema. The airflow obstruction is generally progressive. In the past asthma was often confused with chronic obstructive pulmonary disease but as the cellular inflammatory mechanisms are quite different to chronic bronchitis and emphysema it is prudent to separate this condition of airway hyper-responsiveness. Exacerbation of chronic obstructive pulmonary disease is a considerable burden on health service resources in terms of morbidity and mortality. Approximately one half of exacerbations can be attributed to bacterial pathogens, the major pathogens being Haemophilus influenzae, Streptococcus pnemoniae and Moraxella catarrhalis. Resistance to common first-line treatment antibiotics such as the beta-lactams can be variable. Newer fluoroquinolones such as grepafloxacin, levofloxacin, sparfloxacin, clinafloxacin, moxifloxacin, gatifloxacin and gemifloxacin are characterized by improved activity against Gram positive bacteria as well as their Gram negative properties. However, more randomized controlled trials need to be accomplished before the true role of quinolones in exacerbation of chronic obstructive pulmonary disease is clearly ascertained.
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Affiliation(s)
- D Banerjee
- Department of Respiratory Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
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Granizo JJ, Giménez MJ, Barberán J, Coronel P, Gimeno M, Aguilar L. The efficacy of cefditoren pivoxil in the treatment of lower respiratory tract infections, with a focus on the per-pathogen bacteriologic response in infections caused by Streptococcus pneumoniae and Haemophilus influenzae: a pooled analysis of seven clinical trials. Clin Ther 2007; 28:2061-9. [PMID: 17296462 DOI: 10.1016/j.clinthera.2006.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are frequently caused by Streptococcus pneumoniae, Haemopbilus influenzae, and Moraxella catarrbalis; thus, these are the target pathogens for antibiotic treatment. OBJECTIVES This pooled analysis was performed to evaluate the efficacy of cefditoren pivoxil (CDN) in patients with lower respiratory tract infections (CAP or AECB). A particular focus was the per-pathogen bacteriologic response rate among the most common causative pathogens, S pneumoniae, H influenzae, and M catarrbalis. METHODS The final reports of all clinical trials of CDN in the treatment of community-acquired lower respiratory tract infection were reviewed. Microbiologic outcome data for CDN 200 and 400 mg and comparator treatments were pooled from 4 CAP studies (3 randomized and 1 noncomparative) and 3 AECB studies. The comparators were the standard oral treatments clarithromycin 500 mg BID, cefuroxime 250 mg BID, cefpodoxime 200 mg BID, and amoxicillin/clavulanate 500/125 mg TID or 875/125 mg BID. Microbiologic response was defined as eradication of the initial pathogen or presumed eradication (absence of sputum for culture in a patient with a clinical response). RESULTS The bacteriologically evaluable population contained 654 patients in the CDN 200-mg group, 592 in the CDN 400-mg group, and 664 in the comparator group. A total of 1223 target pathogens were isolated before treatment: 406 isolates of S pneumoniae (including 56 penicillin-nonsusceptible [intermediate + resistant] strains), 595 isolates of H influenzae, and 222 isolates of M catarrbalis. The microbiologic response ranged from 84.1% to 88.8% in the CAP studies and from 75.1% to 77.1% in the AECB studies, with no differences between the CDN 200-mg, CDN 400-mg, and comparator groups. In the analysis of per-pathogen bacteriologic response, similar response rates were found for S pneumoniae (range, 88.5%-92.0%), H influenzae (range, 82.7%-86.6%), and M catarrbalis (range, 84.1%-95.2%), with no significant differences between groups. Focusing on penicillin-nonsusceptible (MIC >or=0.12 microg/mL) strains of S pneumoniae, CDN (both doses pooled) was associated with a response rate of 92.3% (36/39 isolates); all nonresponders were in the CDN 200-mg group. When only penicillin-resistant (MIC >or=2 microg/mL) strains were considered, there was only 1 nonresponder, again in the CDN 200-mg group. Thus, the overall response rate to CDN (both doses pooled) was 94.4% (17/18 isolates). CONCLUSIONS In this pooled analysis, CDN was associated with high rates of per-pathogen bacteriologic response among the main causative pathogens in lower respiratory tract infection. The rates of response were approximately 85% against H influenzae and approximately 90% against S pneumoniae, including penicillin-intermediate and penicillin-resistant strains.
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Affiliation(s)
- Juan José Granizo
- Clinical Epidemiology Department, Fundación Jiménez Díaz, Madrid, Spain
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