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Cui Y, Ma Y, Dai Z, Long Y, Chen Y. Does the 2017 global initiative for chronic obstructive lung disease revision really improve the assessment of Chinese chronic obstructive pulmonary disease patients? A multicenter prospective study for more than 5 years. Chin Med J (Engl) 2023; 136:2587-2595. [PMID: 37367695 PMCID: PMC10617920 DOI: 10.1097/cm9.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 proposed a new classification that reclassified many chronic obstructive pulmonary disease (COPD) patients from group D to B. However, there is a paucity of data related to the comparison between reclassified and non-reclassified COPD patients in terms of long-term prognosis. This study aimed to investigate long-term outcomes of them and determine whether the GOLD 2017 revision improved the assessment of COPD patients. METHODS This observational, multicenter, prospective study recruited outpatients at 12 tertiary hospitals in China from November 2016 to February 2018 and followed them up until February 2022. All enrolled patients were classified into groups A to D based on GOLD 2017, and the subjects in group B included patients reclassified from group D to B (group DB) and those remaining in group B (group BB). Incidence rates and hazard ratios (HRs) were calculated for the exacerbation of COPD and hospitalization in each group. RESULTS We included and followed up 845 patients. During the first year of follow-up, the GOLD 2017 classification had a better discrimination ability for different risks of COPD exacerbation and hospitalization than GOLD 2013. Group DB was associated with a higher risk of moderate-to-severe exacerbation (HR = 1.88, 95% confidence interval [CI] = 1.37-2.59, P <0.001) and hospitalization for COPD exacerbation (HR = 2.23, 95% CI = 1.29-3.85, P = 0.004) than group BB. However, during the last year of follow-up, the differences in the risks of frequent exacerbations and hospitalizations between group DB and BB were not statistically significant (frequent exacerbations: HR = 1.02, 95% CI = 0.51-2.03, P = 0.955; frequent hospitalizations: HR = 1.66, 95% CI = 0.58-4.78, P = 0.348). The mortality rates of the two groups were both approximately 9.0% during the entire follow-up period. CONCLUSIONS The long-term prognosis of patients reclassified into group B and of those remaining in group B was similar, although patients reclassified from group D to group B had worse short-term outcomes. The GOLD 2017 revision could improve the assessment of Chinese COPD patients in terms of long-term prognosis.
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Affiliation(s)
- Yanan Cui
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Zhongshang Dai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yingjiao Long
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
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Cheng W, Zhou A, Zeng Y, Lin L, Song Q, Liu C, Zhou Z, Peng Y, Yang M, Yang L, Chen Y, Cai S, Chen P. Prediction of Hospitalization and Mortality in Patients with Chronic Obstructive Pulmonary Disease with the New Global Initiative for Chronic Obstructive Lung Disease 2023 Group Classification: A Prospective Cohort and a Retrospective Analysis. Int J Chron Obstruct Pulmon Dis 2023; 18:2341-2352. [PMID: 37908629 PMCID: PMC10615105 DOI: 10.2147/copd.s429104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Background The revised Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 group ABE classification has undergone major modifications, which can simplify clinical assessment and optimize treatment recommendations for Chronic Obstructive Pulmonary Disease (COPD). However, the predictive value of the new grouping classification for prognosis is worth further exploration. We aimed to compare the prediction of hospitalization and mortality between this new GOLD group 2023 ABE classification and the earlier 2017 ABCD classification in a Chinese COPD cohort. Methods Data from 2,499 outpatients with COPD, who first registered in the RealDTC study of Second Xiangya Hospital from December 2016 to December 2019, were collected prospectively and assessed retrospectively. Patients were followed up on all-cause mortality until October 2022 or death. Results Of the 2,499 patients with COPD, the risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The mortality was higher in group E than in groups A and B, and group B was higher than group A. No differences were seen in the area under the curve (AUC) of 2017 vs 2023 GOLD grouping to predict hospitalization. The time-dependent AUC and concordance index for predicting mortality is slightly higher in the GOLD 2017 ABCD than in the 2023 ABE groups. The new GOLD 12-subgroup (1A-4E) classification combining the GOLD 1-4 staging and grouping performed similarly discriminate predictive power for mortality to the GOLD 2017 16-subgroup (A1-4D) classification. Conclusion The risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The all-cause mortality increased gradually from GOLD group A to E. The GOLD 2023 classification based on ABE groups did not predict mortality better than the earlier 2017 ABCD classifications.
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Affiliation(s)
- Wei Cheng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Aiyuan Zhou
- Department of Pulmonary and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
| | - Yuqin Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Ling Lin
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Qing Song
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Cong Liu
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Zijing Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Min Yang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Lizhen Yang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
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Czira A, Purushotham S, Iheanacho I, Rothnie KJ, Compton C, Ismaila AS. Burden of Disease in Patients with Mild or Mild-to-Moderate Chronic Obstructive Pulmonary Disease (Global Initiative for Chronic Obstructive Lung Disease Group A or B): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis 2023; 18:719-731. [PMID: 37151760 PMCID: PMC10155715 DOI: 10.2147/copd.s394325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Background Patients with mild or mild-to-moderate chronic obstructive pulmonary disease (COPD), defined as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A/B, are regarded as having a lower risk of experiencing multiple or severe exacerbations compared with patients classified as GOLD group C/D. Current guidelines suggest that patients in GOLD A/B should commence treatment with a bronchodilator; however, some patients within this population who have a higher disease burden may benefit from earlier introduction of dual bronchodilator or inhaled corticosteroid-containing therapies. This study aimed to provide research-based insights into the burden of disease experienced by patients classified as GOLD A/B, and to identify characteristics associated with poorer outcomes. Methods A systematic literature review (SLR) was conducted to identify evidence (burden of disease and prevalence data) relating to the population of interest (patients with COPD classified as GOLD A/B). Results A total of 79 full-text publications and four conference abstracts were included. In general, the rates of moderate and severe exacerbations were higher among patients in GOLD group B than among those in group A. Among patients classified as GOLD A/B, the risk of exacerbation was higher in those with more symptoms (modified Medical Research Council or COPD Assessment Test scales) and more severe airflow limitation (forced expiratory volume in 1 second % predicted). Conclusion Data from this SLR provide clear evidence of a heavier burden of disease for patients in GOLD B, compared with those in GOLD A, and highlight factors associated with worse outcomes for patients in GOLD A/B.
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Affiliation(s)
- Alexandrosz Czira
- Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, UK
- Correspondence: Alexandrosz Czira, Value Evidence and Outcomes, R&D Global Medical, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK, Tel +44 7788 351610, Email
| | | | | | - Kieran J Rothnie
- Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, UK
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Meng Q, Wang J, Cui J, Li B, Wu S, Yun J, Aschner M, Wang C, Zhang L, Li X, Chen R. Prediction of COPD acute exacerbation in response to air pollution using exosomal circRNA profile and Machine learning. ENVIRONMENT INTERNATIONAL 2022; 168:107469. [PMID: 36041244 PMCID: PMC9939562 DOI: 10.1016/j.envint.2022.107469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 05/11/2023]
Abstract
Ambient fine particulate matter (PM2.5) is linked to an increased risk of chronic obstructive pulmonary disease (COPD) exacerbations, which significantly increase the risk of mortality in COPD patients. Identifying the subtype of COPD patients who are sensitive to environmental aggressions is necessary. Using in vitro and in vivo PM2.5 exposure models, we demonstrate that exosomal hsa_circ_0005045 is upregulated by PM2.5 and binds to the protein cargo peroxiredoxin2, which functionally aggravates hallmarks of COPD by recruiting neutrophil elastase and triggering in situ release of tumor necrosis factor (TNF)-α by inflammatory cells. The biological function of hsa_circ_0005045 associated with aggravation of COPD is validated using exosome-transplantation and conditional circRNA-knockdown murine models. By sorting the major components of PM2.5, we find that PM2.5-bound heavy metals, which are distinguishable from the components of cigarette smoke, trigger the elevation of exosomal hsa_circ_0005045. Finally, using machine learning models in a cohort with 327 COPD patients, the PM2.5 exposure-sensitive COPD patients are characterized by relatively high hsa_circ_0005045 expression, non-smoking, and group C (mMRC 0-1 (or CAT < 10) and ≥ 2 exacerbations (or ≥ 1 exacerbation leading to hospital admission) in the past year). Thus, our results suggest that environmental reduction in PM2.5 emission provides a targeted approach to protecting non-smoking COPD patients against air pollution-related disease exacerbation.
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Affiliation(s)
- Qingtao Meng
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China
| | - Jiajia Wang
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China
| | - Jian Cui
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, 87, Ding Jia Qiao Road, Nanjing 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Bin Li
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China
| | - Shenshen Wu
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China
| | - Jun Yun
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100730, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Luo Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, 100005, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing China; Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing 100005, China.
| | - Xiaobo Li
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Rui Chen
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, PR China; School of Public Health, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, PR China; Institute for Chemical Carcinogenesis, Guangzhou Medical University, Guangzhou 511436, PR China.
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Shin SH, Kim DK, Kim SH, Shin TR, Jung KS, Yoo KH, Hwang KE, Park HY, Jo YS. Lack of Association between Inhaled Corticosteroid Use and the Risk of Future Exacerbation in Patients with GOLD Group A Chronic Obstructive Pulmonary Disease. J Pers Med 2022; 12:jpm12060916. [PMID: 35743701 PMCID: PMC9224662 DOI: 10.3390/jpm12060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: As most clinical trials have been performed in more symptomatic and higher-risk patients, evidence regarding treatment in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A chronic obstructive pulmonary disease (COPD) is limited. We assessed the distribution of inhaler treatment and sought to investigate the association between inhaled corticosteroid (ICS) use and future exacerbation in GOLD group A COPD patients. Methods: Patients with GOLD group A COPD who received maintenance inhalers were identified from a multicentre, prospective cohort in South Korea. Patients were categorized as group A when they had fewer symptoms and did not experience severe exacerbation in the previous year. Development of moderate or severe exacerbation during the 1-year follow-up was analysed according to baseline inhaler treatment. Results: In 286 patients with GOLD group A COPD, mono-bronchodilator (37.8%), dual-bronchodilator (29.0%), triple therapy (17.5%), and ICS/long-acting beta-2 agonist (15.4%) were used. Compared to patients without ICS-containing inhalers (N = 191), those using ICS (N = 95) were more dyspnoeic, and more likely to have asthma history, lower lung function, and bronchodilator response. During the 1-year follow-up, moderate or severe exacerbations occurred in 66 of 286 (23.1%) patients. In the multivariable logistic regression analysis, ICS-containing inhaler use was not associated with the development of exacerbation, even in the subgroup with a high probability of asthma–COPD overlap. Conclusion: Although about one-third of patients with GOLD group A COPD were using ICS-containing inhalers, use of ICS was not associated with a reduction in the future development of exacerbation.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea;
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Tae Rim Shin
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea
| | - Ki-Suck Jung
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan 54538, Korea;
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
| | - Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
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Chin PQ, Sheu CC, Tsai JR, Chang HL, Lee LY, Chen CY. Establishing Quality of Life in Southern Taiwan COPD Patients Using Long-Acting Bronchodilator. Patient Prefer Adherence 2022; 16:875-886. [PMID: 35411135 PMCID: PMC8994661 DOI: 10.2147/ppa.s355023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To assess the health-related quality of life (HRQoL) of Taiwan patients with different stages of chronic obstructive pulmonary disease (COPD) and using different combination therapies and to explore the factors affecting HRQoL in these patients. METHODS This cross-sectional study included outpatient participants aged 35 years old and older who were receiving long-acting bronchodilator treatment in one of two hospitals in Southern Taiwan. Participants were categorized according to their Global Initiative for Obstructive Lung Disease (GOLD) classification as either their COPD group, based on symptoms and exacerbation risk, or their COPD stage, based on spirometry results. Patients' HRQoL was assessed using the St. George's Respiratory Questionnaire score (SGRQ), World Health Organization Quality of Life Quality of Life-BREF (WHOQOL-BREF), and EQ-5D-5L. The total scores of the SGRQ, WHOQOL-BREF, EQ-5D utility index, and EQ-VAS were presented as mean ± standard deviation (SD) among different combination treatments. Univariate and multivariate analyses were used to explore the association of patients' baseline characteristics and environmental factors with HRQoL. RESULTS A total of 218 patients were enrolled in the study. The distribution of patients using GOLD group classification were as follows: 73.39% in group A, 20.19% group B, 1.83% group C and 4.59% group D. Triple therapy patients mostly showed a lower quality of life than other combination therapies, regardless of the GOLD classification system. However, only the SGRQ scores of GOLD groups A and B were significantly different when using different drug combinations (p-value = 0.0072 and 0.0430, respectively). The COPD assessment test (CAT) score, a questionnaire to assess impact of COPD on health status, was found to be associated with all the questionnaires. CONCLUSION The HRQoL is impaired in patients with COPD, and it deteriorates with an increase of severity. The CAT was the strongest predictor of HRQoL.
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Affiliation(s)
- Pik-Qi Chin
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Rung Tsai
- Division of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung, Taiwan
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Yao Lee
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Correspondence: Chung-Yu Chen, Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan, Tel +886-7-3121101 ext 2375, Fax +886-7-3210683, Email
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Sansbury LB, Rothnie KJ, Bains C, Compton C, Anley G, Ismaila AS. Healthcare, Medication Utilization and Outcomes of Patients with COPD by GOLD Classification in England. Int J Chron Obstruct Pulmon Dis 2021; 16:2591-2604. [PMID: 34552325 PMCID: PMC8450675 DOI: 10.2147/copd.s318969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Available data on the relationship between COPD symptoms, disease outcomes, and mortality are currently limited. This study investigated the clinical characteristics, outcomes, healthcare utilization, and prescribing practices across GOLD 2017 groups (A, B, C, and D) in a large-scale, population-based cohort of COPD patients managed in an English primary care setting. Patients and Methods This retrospective analysis included patients aged ≥35 years, with a confirmed diagnosis of COPD and ≥1 record of pulmonary function testing in their medical history. Medical Research Council dyspnea score and exacerbation history were used to define patients’ GOLD 2017 classification. Patients were identified using the UK Clinical Practice Research Database and were followed for 12 months. Results Eligible COPD patients’ (N=42,331; mean [SD] age, 69.5 [10.7] years; 54% males), GOLD 2017 categorizations were: Group A: 49.1%, Group B: 30.5%, Group C: 8.2%, Group D: 12.1%. Overall, 37.7% of patients experienced ≥1 moderate COPD exacerbation. The rate of moderate exacerbations per person per year (PPPY) was highest in GOLD group D (0.72), followed by C (0.53), B (0.22), and A (0.15), while the rate of exacerbations leading to hospitalization PPPY was much higher in D (0.27) than in B (0.10), C (0.08), or A (0.03). Overall, 56.4% of patients visited their general practitioner ≥5 times in the 12 months of follow-up. Time-to-event analysis suggested that breathlessness contributed to exacerbation severity and frequency. One-year mortality was highest in GOLD groups D and B. The most frequent prescribed maintenance therapies were inhaled corticosteroids with long-acting β2-agonists, multiple-inhaler triple therapy, or long-acting muscarinic antagonist, irrespective of GOLD classification. Conclusion The burden of COPD remains substantial in England. Stratification of this large primary care population according to GOLD criteria predicted the risk of COPD exacerbations. Understanding populations of patients with COPD may enable the optimization of patient care.
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Affiliation(s)
- Leah B Sansbury
- Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
| | | | - Chanchal Bains
- Real World Evidence and Epidemiology, GlaxoSmithKline, Uxbridge, UK
| | - Chris Compton
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, UK
| | - Glenn Anley
- Value and Evidence Outcomes, GlaxoSmithKline, Uxbridge, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA.,Department of Health Research Methods, McMaster University, Hamilton, ON, Canada
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Athlin Å, Giezeman M, Hasselgren M, Montgomery S, Lisspers K, Ställberg B, Janson C, Sundh J. Prediction of Mortality Using Different COPD Risk Assessments - A 12-Year Follow-Up. Int J Chron Obstruct Pulmon Dis 2021; 16:665-675. [PMID: 33758503 PMCID: PMC7981171 DOI: 10.2147/copd.s282694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/01/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. Patients and Methods A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality. Results By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3–4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75–0.83) for all-cause mortality and 0.80 (95% CI 0.75–0.85) for respiratory mortality. The AUC values for stages 1–4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality. Conclusion All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.
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Affiliation(s)
- Åsa Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maaike Giezeman
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Centre for Clinical Research, Region Värmland, Karlstad, Sweden
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, S-701 82, Sweden.,Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College, London, UK
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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9
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McAuley H, Hadley K, Elneima O, Brightling CE, Evans RA, Steiner MC, Greening NJ. COPD in the time of COVID-19: an analysis of acute exacerbations and reported behavioural changes in patients with COPD. ERJ Open Res 2021; 7:00718-2020. [PMID: 33527075 PMCID: PMC7607968 DOI: 10.1183/23120541.00718-2020] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and associated “lockdown” measures on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first 6 weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and wellbeing. Methods In this observational study in Leicestershire, UK, patients with COPD under a secondary care clinic were recruited. Exacerbation frequency in the first 6 weeks of COVID-19 lockdown was compared with the same period in 2019 using electronic health records. A telephone survey was used to assess changes in anxiety, inhaler adherence, physical activity and behaviour during the pre-lockdown and lockdown periods compared with normal. Results 160 participants were recruited (mean±sd age 67.3±8.1 years, 88 (55%) males, mean±sd forced expiratory volume in 1 s 34±13% pred). 140 (88%) reported at least one AECOPD in the previous year. Significantly more community managed exacerbations were observed in 2020 compared with 2019 (126 versus 99; p=0.026). The increase was a result of multiple courses of treatment, with a similar proportion of patients receiving at least one course (34.4% versus 33.8%). Discussion During lockdown participants reported significantly increased anxiety, adherence to their preventative inhalers and good adherence to shielding advice (all p<0.001). A significant reduction in self-reported physical activity and visitors was reported (both p<0.001). Conclusions Treatment for AECOPD events increased during the first 6 weeks of the SARS-CoV-2 pandemic in the UK compared with 2019. This was associated with increased symptoms of anxiety and significant behavioural change. The #COVID19 pandemic has changed healthcare provision and access. This study shows a 38% increase in the number of community treated #AECOPD in 2020 compared with 2019, alongside increased anxiety and inhaler adherence with reduced physical activity.https://bit.ly/3lV17Q6
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Affiliation(s)
- Hamish McAuley
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Kate Hadley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Omer Elneima
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Christopher E Brightling
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachael A Evans
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Michael C Steiner
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Neil J Greening
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK.,Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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10
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Fukuzaki S, Righetti RF, Santos TMD, Camargo LDN, Aristóteles LRCRB, Souza FCR, Garrido AC, Saraiva-Romanholo BM, Leick EA, Prado CM, Martins MDA, Tibério IDFLC. Preventive and therapeutic effect of anti-IL-17 in an experimental model of elastase-induced lung injury in C57Bl6 mice. Am J Physiol Cell Physiol 2020; 320:C341-C354. [PMID: 33326311 DOI: 10.1152/ajpcell.00017.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an important health care issue, and IL-17 can modulate inflammatory responses. We evaluated preventive and therapeutic effect of anti-interleukin (IL)-17 in a model of lung injury induced by elastase, using 32 male C57Bl6 mice, divided into 4 groups: SAL, ELASTASE CONTROL (EC), ELASTASE + PREVENTIVE ANTI-IL-17 (EP), and ELASTASE + THERAPEUTIC ANTI-IL-17 (ET). On the 29th day, animals were anesthetized with thiopental, tracheotomized, and placed on a ventilator to evaluate lung mechanical, exhaled nitric oxide (eNO), and total cells of bronchoalveolar lavage fluid was collected. We performed histological techniques, and linear mean intercept (Lm) was analyzed. Both treatments with anti-IL-17 decreased respiratory resistance and elastance, airway resistance, elastance of pulmonary parenchyma, eNO, and Lm compared with EC. There was reduction in total cells and macrophages in ET compared with EC. Both treatments decreased nuclear factor-кB, inducible nitric oxide synthase, matrix metalloproteinase (MMP)-9, MMP-12, transforming growth factor-β, tumor necrosis factor-α, neutrophils, IL-1β, isoprostane, and IL-17 in airways and alveolar septa; collagen fibers, decorin and lumican in airways; and elastic fibers and fibronectin in alveolar septa compared with EC. There was reduction of collagen fibers in alveolar septa and biglycan in airways in EP and a reduction of eNO synthase in airways in ET. In conclusion, both treatments with anti-IL-17 contributed to improve most of parameters evaluated in inflammation and extracellular matrix remodeling in this model of lung injury.
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Affiliation(s)
- Silvia Fukuzaki
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Renato Fraga Righetti
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | - Tabata Maruyama Dos Santos
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | - Leandro do Nascimento Camargo
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Flavia C R Souza
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Aurelio C Garrido
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Beatriz Mangueira Saraiva-Romanholo
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.,Department of Medicine (LIM 20), Hospital Public Employee of São Paulo (Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo), University City of São Paulo, São Paulo, Brazil
| | - Edna Aparecida Leick
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Carla Máximo Prado
- School of Medicine-Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.,Department of Bioscience, Federal University of São Paulo, Santos, São Paulo, Brazil
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11
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Greulich T, Töpfer V, Hennig M, Orehounig CC, Ams K, Mohrlang CD, Killian PH, Kardos P. COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice. Pneumologie 2020; 75:344-352. [PMID: 33307557 PMCID: PMC8093015 DOI: 10.1055/a-1266-6602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists. METHODS A questionnaire evaluating doctors' opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures. RESULTS Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor's questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients' medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %. CONCLUSIONS In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians' increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.
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Affiliation(s)
- T Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, Member of the German Centre for Lung Research (DZL) Marburg, Germany
| | - V Töpfer
- Pneumological Group Practice, Pulmonary Centre Ulm, Ulm, Germany
| | - M Hennig
- GlaxoSmithKline GmbH & Co. KG, Munich, Germany
| | | | - K Ams
- GlaxoSmithKline GmbH & Co. KG, Munich, Germany
| | | | - P H Killian
- GlaxoSmithKline GmbH & Co. KG, Munich, Germany
| | - P Kardos
- Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt am Main, Germany
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12
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García Castillo E, Alonso Pérez T, Ancochea J, Pastor Sanz MT, Almagro P, Martínez-Camblor P, Miravitlles M, Rodríguez-Carballeira M, Navarro A, Lamprecht B, Ramírez-García Luna AS, Kaiser B, Alfageme I, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Celli BR, Marín JM, Ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Anto JM, Turner AM, Han MK, Langhammer A, Vikjord SAA, Sternberg A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosío BG, Echazarreta A, Roche N, Burgel PR, Sin DD, Puhan MA, López-Campos JL, Carrasco L, Soriano JB. Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data. ERJ Open Res 2020; 6:00253-2020. [PMID: 33263033 PMCID: PMC7682666 DOI: 10.1183/23120541.00253-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/31/2020] [Indexed: 01/24/2023] Open
Abstract
In 2019, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) modified the grading system for patients with COPD, creating 16 subgroups (1A–4D). As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aim to compare the mortality prediction of the 2015 and 2019 COPD GOLD staging systems. We studied 17 139 COPD patients from the 3CIA study, selecting those with complete data. Patients were classified by the 2015 and 2019 GOLD ABCD systems, and we compared the predictive ability for 5-year mortality of both classifications. In total, 17 139 patients with COPD were enrolled in 22 cohorts from 11 countries between 2003 and 2017; 8823 of them had complete data and were analysed. Mean±sd age was 63.9±9.8 years and 62.9% were male. GOLD 2019 classified the patients in milder degrees of COPD. For both classifications, group D had higher mortality. 5-year mortality did not differ between groups B and C in GOLD 2015; in GOLD 2019, mortality was greater for group B than C. Patients classified as group A and B had better sensitivity and positive predictive value with the GOLD 2019 classification than GOLD 2015. GOLD 2015 had better sensitivity for group C and D than GOLD 2019. The area under the curve values for 5-year mortality were only 0.67 (95% CI 0.66–0.68) for GOLD 2015 and 0.65 (95% CI 0.63–0.66) for GOLD 2019. The new GOLD 2019 classification does not predict mortality better than the previous GOLD 2015 system. GOLD 2019 staging system created 16 subgroups. GOLD 2015 and GOLD 2019 are not strong predictors of mortality, and do not have sufficient discriminatory power to be used as a tool for risk classification of mortality in patients with COPD.https://bit.ly/3idBuaN
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Affiliation(s)
- Elena García Castillo
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,These authors contributed equally
| | - Tamara Alonso Pérez
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,These authors contributed equally
| | - Julio Ancochea
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Teresa Pastor Sanz
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Barcelona, Spain
| | | | - Marc Miravitlles
- Pneumology Dept, Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Annie Navarro
- Pneumology Service, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Bernd Lamprecht
- Dept of Pulmonary Medicine, Kepler-University-Hospital, Faculty of Medicine, Johannes-Kepler-University Linz, Linz, Austria
| | | | - Bernhard Kaiser
- Dept of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Inmaculada Alfageme
- Departamento de Medicina, Universidad de Sevilla, HU Virgen de Valme, Seville, Spain
| | - Ciro Casanova
- Pulmonary Department, Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna, Tenerife, Spain
| | - Cristóbal Esteban
- Pulmonary Department, Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna, Tenerife, Spain
| | | | - Juan P de-Torres
- Clinica Universidad de Navarra, Pamplona, Spain.,Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
| | - Bartolomé R Celli
- Pulmonary and Critical Care Medicine, Harvard University, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose M Marín
- Hospital Universitario Miguel Servet, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Dept of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Peter Lange
- Section of Social Medicine, Dept of Public Health, Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Josep M Anto
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - MeiLan K Han
- Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Arnulf Langhammer
- Dept of Public Health and Nursing, NTNU (Norwegian University of Science and Technology), Trondheim, Norway.,Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Alice Sternberg
- Dept of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromso, Norway
| | - Per Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Toru Oga
- Dept of Respiratory Care and Sleep Control Medicine, Kyoto University, Kyoto, Japan
| | - Borja G Cosío
- Hospital Universitario Son Espases-IdISPa, Mallorca, Spain
| | - Andrés Echazarreta
- Servicio de Neumonología, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Nicolás Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | - Pierre-Régis Burgel
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, Vancouver, BC, Canada.,Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jose Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Laura Carrasco
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Joan B Soriano
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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13
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Giller Dmitry B, Giller Boris D, Severova Lyudmila P, Berezovsky Yuri S, Martel Ivan I. Surgical treatment of giant bullae on the background of cystic lesion and vascular malformation. Case report. Respir Med Case Rep 2020; 31:101198. [PMID: 32963956 PMCID: PMC7490556 DOI: 10.1016/j.rmcr.2020.101198] [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: 05/16/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Abstract
Bullae formation on a cystic background is still not described thoroughly. This clinical case aims to improve this situation and describes the combination of multiple cysts with vascular malformation, giant bullae (2/3 of the left hemithorax and 1/2 of the right hemithorax) with suppuration in a 50-year-old smoker. Before surgery, treatment for chronic obstructive lung disease (COPD) was administered without a positive outcome. Bullectomy was subsequently conducted and histopathological data revealed vascular malformation causing microinfarctions in pulmonary parenchyma, cystic degeneration and tuberculosis. Although it became possible to establish a final diagnosis due to histology, the need for surgical treatment was clear from clinical and x-ray evidence. Such instances as the one presented in this case report should assist with improving our knowledge about bullae in combination with cysts in the lungs because they provide additional context in a clinical setting.
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Affiliation(s)
- B. Giller Dmitry
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, 4 Dostoevsky Street, Building 2, 127473, Russia
| | - D. Giller Boris
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, 4 Dostoevsky Street, Building 2, 127473, Russia
| | - P. Severova Lyudmila
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, 4 Dostoevsky Street, Building 2, 127473, Russia
| | - S. Berezovsky Yuri
- Central Scientific Research Institute for Tuberculosis, Ministry of Education and Science of the Russian Federation, Moscow, 2 Yauzskaya Alley Str., 107564, Russia
| | - I. Martel Ivan
- M.I. Perelman Department of Phthisiopulmonology and Thoracic Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, 4 Dostoevsky Street, Building 2, 127473, Russia
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14
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Carlsten C, Salvi S, Wong GWK, Chung KF. Personal strategies to minimise effects of air pollution on respiratory health: advice for providers, patients and the public. Eur Respir J 2020; 55:1902056. [PMID: 32241830 PMCID: PMC7270362 DOI: 10.1183/13993003.02056-2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/24/2020] [Indexed: 11/11/2022]
Abstract
As global awareness of air pollution rises, so does the imperative to provide evidence-based recommendations for strategies to mitigate its impact. While public policy has a central role in reducing air pollution, exposure can also be reduced by personal choices. Qualified evidence supports limiting physical exertion outdoors on high air pollution days and near air pollution sources, reducing near-roadway exposure while commuting, utilising air quality alert systems to plan activities, and wearing facemasks in prescribed circumstances. Other strategies include avoiding cooking with solid fuels, ventilating and isolating cooking areas, and using portable air cleaners fitted with high-efficiency particulate air filters. We detail recommendations to assist providers and public health officials when advising patients and the public regarding personal-level strategies to mitigate risk imposed by air pollution, while recognising that well-designed prospective studies are urgently needed to better establish and validate interventions that benefit respiratory health in this context.
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Affiliation(s)
- Christopher Carlsten
- Air Pollution Exposure Laboratory, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Gary W K Wong
- Dept of Pediatrics and School of Public Health, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kian Fan Chung
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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15
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Zhao K, Dong R, Yu Y, Tu C, Li Y, Cui Y, Bao L, Ling C. Cigarette smoke-induced lung inflammation in COPD mediated via CCR1/JAK/STAT /NF-κB pathway. Aging (Albany NY) 2020; 12:9125-9138. [PMID: 32463796 PMCID: PMC7288948 DOI: 10.18632/aging.103180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/16/2020] [Indexed: 01/24/2023]
Abstract
Inflammation is an important cause of chronic obstructive pulmonary disease (COPD) and its acute exacerbation. However, the critical role of C-C chemokine receptor (CCR)1 in progression of cigarette smoke-induced chronic inflammation remains unclear. We studied CCR1 expression using immunohistochemistry, immunofluorescence, and real-time polymerase chain reaction (RT-PCR) in COPD patients and controls. Cytokine levels in peripheral blood were measured by enzyme-linked immunosorbent assay (ELISA). In vitro, we investigated Janus kinase/signal transducers and activators of transcription (JAK/STAT)/nuclear factor-κB (NF-κB) signaling in cigarette smoke extract-induced or CCR1 deficiency/overexpressed mouse macrophage cell line MH-S by RT-PCR and western blot, and measured the cytokine levels in the supernatant with ELISA. We found that CCR1 expression was upregulated in COPD patients and there was a negative correlation between CCR1 mRNA levels and predicted % forced expiratory volume in 1 min. Inflammatory cytokine levels in the peripheral blood were higher in COPD patients than controls, and these were positively correlated with CCR1 levels. CCR1 was shown to play a critical role in regulating smoke-induced inflammation via JAK/STAT3/NF-κB signaling in vitro. CCR1 may play a critical role in airway inflammation in COPD. Additionally, understanding the molecular mechanism may help develop novel methods for the treatment of COPD.
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Affiliation(s)
- Kaishun Zhao
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Jiangsu 215000, China
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
| | - Ran Dong
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Yanfang Yu
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
| | - Chunlin Tu
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
| | - Ying Li
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
| | - YuJuan Cui
- Department of Respiratory Medicine, Jiading Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 201800, China
| | - Lei Bao
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Jiangsu 215000, China
| | - Chunhua Ling
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Jiangsu 215000, China
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16
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Keller T, Spece LJ, Donovan LM, Udris E, Coggeshall SS, Griffith M, Bryant AD, Casaburi R, Cooper JA, Criner GJ, Diaz PT, Fuhlbrigge AL, Gay SE, Kanner RE, Martinez FJ, Panos RJ, Shade D, Sternberg A, Stibolt T, Stoller JK, Tonascia J, Wise R, Yusen RD, Au DH, Feemster LC. Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life: A Secondary Analysis of the Long-Term Oxygen Treatment Trial. Chest 2020; 158:529-538. [PMID: 32278779 DOI: 10.1016/j.chest.2020.02.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/04/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although inhaled therapy reduces exacerbations among patients with COPD, the effectiveness of providing inhaled treatment per risk stratification models remains unclear. RESEARCH QUESTION Are inhaled regimens that align with the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy associated with clinically important outcomes? STUDY DESIGN AND METHODS We conducted secondary analyses of Long-term Oxygen Treatment Trial (LOTT) data. The trial enrolled patients with COPD with moderate resting or exertional hypoxemia between 2009 and 2015. Our exposure was the patient-reported inhaled regimen at enrollment, categorized as either aligning with, undertreating, or potentially overtreating per the 2017 GOLD strategy. Our primary composite outcome was time to death or first hospitalization for COPD. Additional outcomes included individual components of the composite outcome and time to first exacerbation. We generated multivariable Cox proportional hazard models across strata of GOLD-predicted exacerbation risk (high vs low) to estimate between-group hazard ratios for time to event outcomes. We adjusted models a priori for potential confounders, clustered by site. RESULTS The trial enrolled 738 patients (73.4% men; mean age, 68.8 years). Of the patients, 571 (77.4%) were low risk for future exacerbations. Of the patients, 233 (31.6%) reported regimens aligning with GOLD recommendations; most regimens (54.1%) potentially overtreated. During a 2.3-year median follow-up, 332 patients (44.9%) experienced the composite outcome. We found no difference in time to composite outcome or death among patients reporting regimens aligning with recommendations compared with undertreated patients. Among patients at low risk, potential overtreatment was associated with higher exacerbation risk (hazard ratio, 1.42; 95% CI, 1.09-1.87), whereas inhaled corticosteroid treatment was associated with 64% higher risk of pneumonia (incidence rate ratio, 1.64; 95% CI, 1.01-2.66). INTERPRETATION Among patients with COPD with moderate hypoxemia, we found no difference in clinical outcomes between inhaled regimens aligning with the 2017 GOLD strategy compared with those that were undertreated. These findings suggest the need to reevaluate the effectiveness of risk stratification model-based inhaled treatment strategies.
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Affiliation(s)
- Thomas Keller
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Edmunds Udris
- Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Scott S Coggeshall
- Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Matthew Griffith
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Alexander D Bryant
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA
| | - J Allen Cooper
- Birmingham VA Medical Center and the Lung Health Center, University of Alabama Birmingham, Birmingham, AL
| | | | - Philip T Diaz
- 201 Heart Lung Institute, Ohio State University School of Medicine, Columbus, OH
| | | | - Steven E Gay
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | | | - Ralph J Panos
- Cincinnati VA Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Shade
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Alice Sternberg
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Thomas Stibolt
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - James Tonascia
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Robert Wise
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger D Yusen
- Washington University School of Medicine, Saint Louis, MO
| | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA; Health Services Research & Development Center of Innovation for Veteran-centered and Value-driven Care, VA Puget Sound Healthcare System, Seattle, WA
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17
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LaFon DC, Bhatt SP, Labaki WW, Rahaghi FN, Moll M, Bowler RP, Regan EA, Make BJ, Crapo JD, San Jose Estepar R, Diaz AA, Silverman EK, Han MK, Hobbs B, Cho MH, Washko GR, Dransfield MT, Wells JM. Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene. Eur Respir J 2020; 55:13993003.01812-2019. [PMID: 31772001 DOI: 10.1183/13993003.01812-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,UAB Lung Imaging Core, Birmingham, AL, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ P Bowler
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Division of Rheumatology, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hobbs
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
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18
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Bhatta L, Leivseth L, Mai XM, Henriksen AH, Carslake D, Chen Y, Langhammer A, Brumpton BM. GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study. Int J Chron Obstruct Pulmon Dis 2020; 15:225-233. [PMID: 32099347 PMCID: PMC6999582 DOI: 10.2147/copd.s228958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995-1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (ptrend=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.
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Affiliation(s)
- Laxmi Bhatta
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - David Carslake
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yue Chen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Ben Michael Brumpton
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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19
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Marchioni A, Tonelli R, Fantini R, Tabbì L, Castaniere I, Livrieri F, Bedogni S, Ruggieri V, Pisani L, Nava S, Clini E. Respiratory Mechanics and Diaphragmatic Dysfunction in COPD Patients Who Failed Non-Invasive Mechanical Ventilation. Int J Chron Obstruct Pulmon Dis 2019; 14:2575-2585. [PMID: 31819395 PMCID: PMC6879385 DOI: 10.2147/copd.s219125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Although non-invasive mechanical ventilation (NIV) is the gold standard treatment for patients with acute exacerbation of COPD (AECOPD) developing respiratory acidosis, failure rates still range from 5% to 40%. Recent studies have shown that the onset of severe diaphragmatic dysfunction (DD) during AECOPD increases risk of NIV failure and mortality in this subset of patients. Although the imbalance between the load and the contractile capacity of inspiratory muscles seems the main cause of AECOPD-induced hypercapnic respiratory failure, data regarding the influence of mechanical derangement on DD in this acute phase are lacking. With this study, we investigate the impact of respiratory mechanics on diaphragm function in AECOPD patients experiencing NIV failure. Methods Twelve AECOPD patients with respiratory acidosis admitted to the Respiratory ICU of the University Hospital of Modena from 2017 to 2018 undergoing mechanical ventilation (MV) due to NIV failure were enrolled. Static respiratory mechanics and end-expiratory lung volume (EELV) were measured after 30 mins of volume control mode MV. Subsequently, transdiaphragmatic pressure (Pdi) was calculated by means of a sniff maneuver (Pdisniff) after 30 mins of spontaneous breathing trial. Linear regression analysis and Pearson’s correlation coefficient served to assess associations. Results Average Pdisniff was 23.3 cmH2O (standard deviation 29 cmH2O) with 3 patients presenting bilateral diaphragm palsy. Pdisniff was directly correlated with static lung elastance (r=0.69, p=0.001) while inverse correlation was found with dynamic intrinsic PEEP (r=−0.73, p=0.007). No significant correlation was found with static intrinsic PEEP (r=−0.55, p=0.06), EELV (r=−0.4, p=0.3), airway resistance (r=−0.2, p=0.54), chest wall, and total elastance (r=−0-01, p=0.96 and r=0.3, p=0.36, respectively). Significant linear inverse correlation was found between Pdisniff and the ratio between Pdi assessed at tidal volume and Pdi sniff (r=−0.82, p=0.02). Conclusion The causes of extreme DD in AECOPD patients who experienced NIV failure might be predominantly mechanical, driven by a severe dynamic hyperinflation that overlaps on an elastic lung substrate favoring volume overload.
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Affiliation(s)
- Alessandro Marchioni
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.,PhD Course in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Fantini
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Tabbì
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.,PhD Course in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Livrieri
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Respiratory Disease Unit, Hospital Carlo Poma, Mantova, Italy
| | - Sabrina Bedogni
- School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Ruggieri
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Pisani
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Enrico Clini
- University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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20
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Lundblad LKA, Miletic R, Piitulainen E, Wollmer P. Oscillometry in Chronic Obstructive Lung Disease: In vitro and in vivo evaluation of the impulse oscillometry and tremoflo devices. Sci Rep 2019; 9:11618. [PMID: 31406190 PMCID: PMC6690921 DOI: 10.1038/s41598-019-48039-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022] Open
Abstract
Impedance, or oscillometry, measurements of the respiratory system can generate information about the function of the respiratory system not possible with traditional spirometry. There are currently several instruments on the market using different perturbations. We have compared a new respiratory oscillometry instrument, the tremoflo, with Impulse Oscillometry (IOS). Patients with a physician's diagnosis of chronic obstructive lung disease (COPD) and healthy subjects were recruited. They underwent assessment of respiratory function with oscillometry using the IOS and tremoflo devices and the resulting impedance data from the two methods were compared. The two devices were also tested against a reference respiratory phantom with variable resistances. Whereas both devices detected impairments in the patients' lung function commensurate with small airways pathology, the tremoflo appeared to be more sensitive than the IOS. We found systematic differences between the two instruments especially for reactance measurements where the area over the reactance curve (AX) was significantly lower with the IOS compared with the tremoflo (p < 0.001). Moreover, the agreement between the two devices was reduced with increasing severity of the disease as determined with a Bland-Altman test. Testing both instruments against a respiratory phantom unit confirmed that the resistance measured by the tremoflo compares closely with the known resistance of test loads, whereas the IOS' resistance correlated with a test load of 0.19, kPa.s.L-1 at higher loads it deviated significantly from the known resistance (p < 0.0028). We conclude that the absolute values measured with the two devices may not be directly comparable and suggest that differences in the calibration procedures might account for the differences.
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Affiliation(s)
- Lennart K A Lundblad
- Meakins-Christie Laboratories, McGill University, Montréal, QC, Canada. .,Thorasys Thoracic Medical Equipment Inc., Montréal, QC, Canada.
| | - Ruzica Miletic
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Eeva Piitulainen
- Department of Respiratory Medicine and Allergology, Lund University, Malmö, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
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21
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Bari E, Ferrarotti I, Torre ML, Corsico AG, Perteghella S. Mesenchymal stem/stromal cell secretome for lung regeneration: The long way through "pharmaceuticalization" for the best formulation. J Control Release 2019; 309:11-24. [PMID: 31326462 DOI: 10.1016/j.jconrel.2019.07.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Pulmonary acute and chronic diseases, such as chronic obstructive pulmonary disease, pulmonary fibrosis and pulmonary hypertension, are considered to be major health issues worldwide. Cellular therapies with Mesenchymal Stem Cells (MSCs) offer a new therapeutic approach for chronic and acute lung diseases related to their anti-inflammatory, immunomodulatory, regenerative, pro-angiogenic and anti-fibrotic properties. Such therapeutic effects can be attributed to MSC-secretome, made of free soluble proteins and extracellular vesicles (EVs). This review summarizes the recent findings related to the efficacy and safety of MSC-derived products in pre-clinical models of lung diseases, pointing out the biologically active substances contained into MSC-secretome and their mechanisms involved in tissue regeneration. A perspective view is then provided about the missing steps required for the secretome "pharmaceuticalization" into a high quality, safe and effective medicinal product, as well as the formulation strategies required for EV non-invasive route of administration, such as inhalation.
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Affiliation(s)
- Elia Bari
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, Pavia, Italy
| | - Ilaria Ferrarotti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Dept of Internal Medicine and Therapeutics, Pneumology Unit IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Maria Luisa Torre
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, Pavia, Italy; PharmaExceed srl, 27100 Pavia, Italy.
| | - Angelo Guido Corsico
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Dept of Internal Medicine and Therapeutics, Pneumology Unit IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy; PharmaExceed srl, 27100 Pavia, Italy
| | - Sara Perteghella
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, Pavia, Italy; PharmaExceed srl, 27100 Pavia, Italy
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