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Muñoz Montiel A, Ruiz-Esteban P, Doménech Del Río A, Valdivielso P, Sánchez Chaparro MÁ, Olveira C. The effect of pulmonary rehabilitation on cardiovascular risk, oxidative stress and systemic inflammation in patients with COPD. Respir Med 2024; 232:107740. [PMID: 39009098 DOI: 10.1016/j.rmed.2024.107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients. PATIENTS AND METHODS This was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70 % and FEV1 <80 % predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-min walking test [6MWT]). CVR was assessed using different risk prediction models. RESULTS A total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72 %; arterial hypertension: 70 %, dyslipidemia: 30 %, diabetes: 20 %; CV disease (CVD): 24 %. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p < 0.001); patients with ≥30-m increase on the 6MWT showed statistically significant lower levels of glucose (p = 0.004), HbA1c (p = 0.004) and BODE index score (p = 0.026) compared to patients with <30-m increase. CONCLUSIONS PR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.
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Affiliation(s)
- Ana Muñoz Montiel
- Pulmonology Service/Unit, Monographic COPD Consultation. Regional University Hospital of Malaga, Malaga, Spain
| | - Pedro Ruiz-Esteban
- Nephrology Department, Regional University Hospital of Malaga, University of Malaga, The Biomedical Research Institute of Malaga (IBIMA), RICORS2040 (RD21/0005/0012), Malaga, Spain.
| | - Adolfo Doménech Del Río
- Pulmonology Service/Unit, Monographic COPD Consultation. Regional University Hospital of Malaga, Malaga, Spain
| | - Pedro Valdivielso
- Laboratory of Lipids and Atherosclerosis, Medico-Sanitarias Research Center (IBIMA), University of Malaga, Malaga, Spain; Internal Medicine, University Hospital Virgen de la Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine, University Hospital Virgen de la Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
| | - Casilda Olveira
- Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand. University of Malaga, Malaga, Spain
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Yin Y, Xu J, Cai S, Chen Y, Chen Y, Li M, Zhang Z, Kang J. Development and Validation of a Multivariable Prediction Model to Identify Acute Exacerbation of COPD and Its Severity for COPD Management in China (DETECT Study): A Multicenter, Observational, Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2093-2106. [PMID: 36092968 PMCID: PMC9462440 DOI: 10.2147/copd.s363935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose There is an unmet clinical need for an accurate and objective diagnostic tool for early detection of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DETECT (NCT03556475) was a multicenter, observational, cross-sectional study aiming to develop and validate multivariable prediction models for AECOPD occurrence and severity in patients with chronic obstructive pulmonary disease (COPD) in China. Patients and Methods Patients aged ≥40 years with moderate/severe COPD, AECOPD, or no COPD were consecutively enrolled between April 22, 2020, and January 18, 2021, across seven study sites in China. Multivariable prediction models were constructed to identify AECOPD occurrence (primary outcome) and AECOPD severity (secondary outcome). Candidate variables were selected using a stepwise procedure, and the bootstrap method was used for internal model validation. Results Among 299 patients enrolled, 246 were included in the final analysis, of whom 30.1%, 40.7%, and 29.3% had COPD, AECOPD, or no COPD, respectively. Mean age was 64.1 years. Variables significantly associated with AECOPD occurrence (P<0.05) and severity (P<0.05) in the final models included COPD disease-related characteristics, as well as signs and symptoms. Based on cut-off values of 0.374 and 0.405 for primary and secondary models, respectively, the performance of the primary model constructed to identify AECOPD occurrence (AUC: 0.86; sensitivity: 0.84; specificity: 0.77), and of the secondary model for AECOPD severity (AUC: 0.81; sensitivity: 0.90; specificity: 0.73) indicated high diagnostic accuracy and clinical applicability. Conclusion By leveraging easy-to-collect patient and disease data, we developed identification tools that can be used for timely detection of AECOPD and its severity. These tools may help physicians diagnose AECOPD in a timely manner, before further disease progression and possible hospitalizations.
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Affiliation(s)
- Yan Yin
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Institute of Respiratory Medicine, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shaoxi Cai
- Department of Pulmonary and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Manxiang Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhiqiang Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People's Republic of China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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Camac ER, Stumpf NA, Voelker HK, Criner GJ. Short-Term Impact of the Frequency of COPD Exacerbations on Quality of Life. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:298-308. [PMID: 35397199 PMCID: PMC9448005 DOI: 10.15326/jcopdf.2021.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients in the Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD (STATCOPE) and Azithromycin for Prevention of Exacerbations of COPD (MACRO) trials provide an opportunity to prospectively study the short-term effect of acute exacerbations of COPD (AECOPDs). RESEARCH QUESTION We hypothesized that those patients with frequent exacerbations (≥2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St George's Respiratory Questionnaire (SGRQ). STUDY DESIGN AND METHODS A total of 1934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to azithromycin in MACRO or were followed less than 180 days were excluded. A total of 1219 patients were included. Patients were divided into 2 groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (≥2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups. RESULTS Of the patients studied, 871 were in the infrequent exacerbators group. A total of 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators. INTERPRETATION Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.
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Affiliation(s)
- Erin R. Camac
- College of Medicine, the University of Kentucky, Lexington, Kentucky, United States
| | - Natalie A. Stumpf
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | | | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
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Herer B, Ghergan A. Mixed results of pulmonary rehabilitation in hyperventilation syndrome: a case series of six patients. Respir Med Res 2022; 83:100935. [PMID: 37037057 DOI: 10.1016/j.resmer.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/09/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Bertrand Herer
- Respiratory Rehabilitation Unit, Centre Hospitalier De Bligny, Briis sous Forges 91640, France.
| | - Adelina Ghergan
- Respiratory Rehabilitation Unit, Centre Hospitalier De Bligny, Briis sous Forges 91640, France
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Anlló H, Herer B, Delignières A, Ghergan A, Bocahu Y, Segundo I, Moulin C, Larue F. Hypnosis for the Management of COPD-related anxiety and dyspnea in Pulmonary Rehabilitation - rationale and design for a cluster-randomised, active-control trial [HYPNOBPCO_2]. ERJ Open Res 2022; 8:00565-2021. [PMID: 35141317 PMCID: PMC8819244 DOI: 10.1183/23120541.00565-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Complementary psychological care is recommended for COPD, as it significantly reduces anxiety and boosts the pulmonary rehabilitation efficacy. In a precedent trial (HYPNOBPCO_1, ISRCTN10029862), administering a single hypnosis session was linked to reduced anxiety and improved breathing mechanics in intermediate and advanced COPD patients. However, whether hypnosis could improve self-management of anxiety and dyspnoea in COPD during pulmonary rehabilitation is yet to be investigated. This is the protocol for HYPNOBPCO_2, a 2-arm, cluster-randomised, statistician-blinded superiority monocentre trial (NCT04868357). Its aim is to assess the efficacy of hypnosis as a tool to manage anxiety and dyspnoea during a pulmonary rehabilitation programme (PRP). Clusters of COPD patients eligible for the conventional hospital-based PRP at the Centre Hospitalier de Bligny (CHB) will be randomised and evenly allocated into two parallel arms: “Hypnosis” (treatment) and “Relaxation” (active control). “Hypnosis” will consist of the CHB's conventional 4-week group PRP, supplemented by two educational sessions for teaching self-hypnosis. “Relaxation” will be identical, except standard relaxation exercises will be taught instead. Primary end-point will consist of assessing weekly changes in anxiety throughout the PRP, additional to total anxiety change after treatment completion. Anxiety will be determined by the six-item version of the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes will include change in the 6-min walk test and the COPD assessment test (CAT). Further follow-up outcomes will include CAT and STAI-6 retests, re-hospitalisation rate, action plan use and persistence in self-hypnosis use, throughout the 12 weeks ensuing PRP completion. Rationale for HYPNOBPCO_2 (NCT04868357), a trial investigating whether self-hypnosis (fast, low-cost, effortless) reliably improves breathlessness-related anxiety and breathing mechanics, during and after pulmonary rehabilitation in COPDhttps://bit.ly/3JF2vCW
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Skeletal muscle is associated with exercise tolerance evaluated by cardiopulmonary exercise testing in Japanese patients with chronic obstructive pulmonary disease. Sci Rep 2021; 11:15862. [PMID: 34354171 PMCID: PMC8342424 DOI: 10.1038/s41598-021-95413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
Decreasing exercise tolerance is one of the key features related to a poor prognosis in patients with chronic obstructive pulmonary disease (COPD). Cardiopulmonary exercise testing (CPET) is useful for evaluating exercise tolerance. The present study was performed to clarify the correlation between exercise tolerance and clinical parameters, focusing especially on the cross-sectional area (CSA) of skeletal muscle. The present study investigated 69 patients with COPD who underwent CPET. The correlations between oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$${{\dot{\text{V}} \text{O}}}_{2}$$\end{document}V˙O2) at peak exercise and clinical parameters of COPD, including skeletal muscle area measured using single-section axial computed tomography (CT), were evaluated. The COPD assessment test score (ρ = − 0.35, p = 0.02) was weakly correlated with \documentclass[12pt]{minimal}
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\begin{document}$${{\dot{\text{V}} \text{O}}}_{2}$$\end{document}V˙O2 at peak exercise. In addition, forced expiratory volume in one second (FEV1) (ρ = 0.39, p = 0.0009), FEV1/forced vital capacity (ρ = 0.33, p = 0.006), and the CSA of the pectoralis muscles (PMs) (ρ = 0.36, p = 0.007) and erector spinae muscles (ECMs) (ρ = 0.39, p = 0.003) were correlated with \documentclass[12pt]{minimal}
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\begin{document}$${{\dot{\text{V}} \text{O}}}_{2}$$\end{document}V˙O2 at peak exercise. Multivariate analysis adjusted by age and FEV1 indicated that PMCSA was weakly correlated after adjustment (β value [95% confidence interval] 0.175 [0.03–0.319], p = 0.02). In addition, ECMCSA tended to be correlated, but not significantly after adjustment (0.192 [− 0.001–0.385] p = 0.052). The COPD assessment test, FEV1, FEV1/FVC, PMCSA, and ECMCSA were significantly correlated with \documentclass[12pt]{minimal}
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\begin{document}$${{\dot{\text{V}} \text{O}}}_{2}$$\end{document}V˙O2 at peak exercise.
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Horne BD, Ali R, Midwinter D, Scott-Wilson C, Crim C, Miller BE, Rubin DB. Validation of the Summit Lab Score in Predicting Exacerbations of Chronic Obstructive Pulmonary Disease Among Individuals with High Arterial Stiffness. Int J Chron Obstruct Pulmon Dis 2021; 16:41-51. [PMID: 33447025 PMCID: PMC7802087 DOI: 10.2147/copd.s279645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The presence of cardiovascular (CV) risk factors and CV disease in patients with chronic obstructive pulmonary disease (COPD) leads to worse outcomes. A number of tools are currently available to stratify the risk of adverse outcomes in these patients with COPD. This post hoc analysis evaluated the Summit Lab Score for validation as a predictor of the first episode of moderate-to-severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and other outcomes, in patients with COPD and high arterial pulse wave velocity (aPWV). METHODS Data from a multicenter, randomized, placebo-controlled, double-blind study were retrospectively analyzed to evaluate treatment effects of once-daily fluticasone furoate/vilanterol 100/25 μg in patients with COPD and an elevated CV risk (aPWV≥11m/s) over 24 weeks. The previously derived Summit Lab Score and, secondarily, the Intermountain Risk Score (IMRS) were computed for each patient, with patients then stratified into tertiles for each score. Risk of moderate-to-severe AECOPD was analyzed across tertiles using Kaplan-Meier survival curve and Cox regression analyses. RESULTS In 430 patients with COPD, Kaplan-Meier probabilities of no moderate-to-severe AECOPD for Summit Lab Score tertiles 1, 2, and 3 were 92.3%, 95.5%, and 85.1%, respectively (P trend = 0.015), over 24 weeks. Grouped by IMRS tertiles, the respective probabilities were 92.9%, 91.2%, and 88.3%, respectively (P trend = 0.141). Length of stay in the hospital (P = 0.034) and the hospital ward (P = 0.042) were also significantly different between Summit Lab Score tertiles but not for intensive care (P = 0.191). CONCLUSION The Summit Lab Score was associated with the 24-week risk of moderate-to-severe AECOPD in COPD patients with elevated CV risk. Secondarily, IMRS showed a trend towards differences in the risk of AECOPD, which was not statistically significant.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | | | - Courtney Crim
- GlaxoSmithKline Plc., Research Triangle Park, Raleigh, NC, USA
| | | | - David B Rubin
- GlaxoSmithKline Plc., Research Triangle Park, Raleigh, NC, USA
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Wageck B, Cox NS, McDonald CF, Burge AT, Mahal A, Hill CJ, Lee AL, Moore R, Nicolson C, O’Halloran P, Lahham A, Gillies R, Holland AE. The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:3423-3431. [PMID: 33408472 PMCID: PMC7781036 DOI: 10.2147/copd.s271094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months. Methods This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA). Results A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV1) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV1%predicted (0.98, 95% CI 0.96 to 0.99). Conclusion Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.
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Affiliation(s)
| | - Narelle S Cox
- La Trobe University, Melbourne, Australia
- Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Angela T Burge
- La Trobe University, Melbourne, Australia
- Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Ajay Mahal
- The Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Caroline Nicolson
- Department of Pulmonary Hypertension, Alfred Health, Melbourne, Australia
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Paul O’Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahham
- La Trobe University, Melbourne, Australia
- Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Rebecca Gillies
- La Trobe University, Melbourne, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Anne E Holland
- La Trobe University, Melbourne, Australia
- Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
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Bellou V, Belbasis L, Konstantinidis AK, Tzoulaki I, Evangelou E. Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal. BMJ 2019; 367:l5358. [PMID: 31585960 PMCID: PMC6776831 DOI: 10.1136/bmj.l5358] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD). DESIGN Systematic review. DATA SOURCES PubMed until November 2018 and hand searched references from eligible articles. ELIGIBILITY CRITERIA FOR STUDY SELECTION Studies developing, validating, or updating a prediction model in COPD patients and focusing on any potential clinical outcome. RESULTS The systematic search yielded 228 eligible articles, describing the development of 408 prognostic models, the external validation of 38 models, and the validation of 20 prognostic models derived for diseases other than COPD. The 408 prognostic models were developed in three clinical settings: outpatients (n=239; 59%), patients admitted to hospital (n=155; 38%), and patients attending the emergency department (n=14; 3%). Among the 408 prognostic models, the most prevalent endpoints were mortality (n=209; 51%), risk for acute exacerbation of COPD (n=42; 10%), and risk for readmission after the index hospital admission (n=36; 9%). Overall, the most commonly used predictors were age (n=166; 41%), forced expiratory volume in one second (n=85; 21%), sex (n=74; 18%), body mass index (n=66; 16%), and smoking (n=65; 16%). Of the 408 prognostic models, 100 (25%) were internally validated and 91 (23%) examined the calibration of the developed model. For 286 (70%) models a model presentation was not available, and only 56 (14%) models were presented through the full equation. Model discrimination using the C statistic was available for 311 (76%) models. 38 models were externally validated, but in only 12 of these was the validation performed by a fully independent team. Only seven prognostic models with an overall low risk of bias according to PROBAST were identified. These models were ADO, B-AE-D, B-AE-D-C, extended ADO, updated ADO, updated BODE, and a model developed by Bertens et al. A meta-analysis of C statistics was performed for 12 prognostic models, and the summary estimates ranged from 0.611 to 0.769. CONCLUSIONS This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients. The findings indicate several methodological pitfalls in their development and a low rate of external validation. Future research should focus on the improvement of existing models through update and external validation, as well as the assessment of the safety, clinical effectiveness, and cost effectiveness of the application of these prognostic models in clinical practice through impact studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017069247.
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Affiliation(s)
- Vanesa Bellou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Respiratory Medicine, University Hospital of Ioannina, University of Ioannina Medical School, Ioannina, Greece
| | - Lazaros Belbasis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Athanasios K Konstantinidis
- Department of Respiratory Medicine, University Hospital of Ioannina, University of Ioannina Medical School, Ioannina, Greece
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC-PHE Center for Environment, School of Public Health, Imperial College London, London, UK
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Cômes J, Prieur G, Combret Y, Gravier FE, Bonnevie T, Medrinal C. Changes in cycle-ergometer performance during pulmonary rehabilitation predict COPD exacerbation. COPD 2019; 16:308. [PMID: 31514554 DOI: 10.1080/15412555.2019.1663498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonas Cômes
- School of Physiotherapy, Rouen University Hospital , Rouen , France
| | - Guillaume Prieur
- Normandie Univ, UNIROUEN, EA3830-GRHV , Rouen , France.,Institute for Research and Innovation in Biomedicine (IRIB) , Rouen , France.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain , Brussels , Belgium.,Pulmonology Department and Pulmonary Rehabilitation Department, Groupe Hospitalier du Havre , Montivilliers , France
| | - Yann Combret
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain , Brussels , Belgium.,Physiotherapy Department, Groupe Hospitalier du Havre , Montivilliers , France
| | - Francis-Edouard Gravier
- Normandie Univ, UNIROUEN, EA3830-GRHV , Rouen , France.,Institute for Research and Innovation in Biomedicine (IRIB) , Rouen , France
| | - Tristan Bonnevie
- Normandie Univ, UNIROUEN, EA3830-GRHV , Rouen , France.,Institute for Research and Innovation in Biomedicine (IRIB) , Rouen , France.,ADIR Association, Rouen University Hospital , Rouen , France
| | - Clement Medrinal
- Normandie Univ, UNIROUEN, EA3830-GRHV , Rouen , France.,Institute for Research and Innovation in Biomedicine (IRIB) , Rouen , France.,Pulmonology Department, Groupe Hospitalier du Havre , Montivilliers , France
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Comes J, Prieur G, Combret Y, Gravier FE, Gouel B, Quieffin J, Lamia B, Bonnevie T, Medrinal C. Changes in Cycle-Ergometer Performance during Pulmonary Rehabilitation Predict COPD Exacerbation. COPD 2019; 16:261-265. [DOI: 10.1080/15412555.2019.1645106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Guillaume Prieur
- UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), UPRESS EA 3830, GRHV, Rouen, France
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels 1200, Belgium
- Groupe Hospitalier du Havre, Pulmonology/Intensive Care Unit department, Avenue Pierre Mendes France, Montivilliers, France
| | - Yann Combret
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels 1200, Belgium
- Groupe Hospitalier du Havre, Pulmonology/Intensive Care Unit department, Avenue Pierre Mendes France, Montivilliers, France
| | - Francis Edouard Gravier
- UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), UPRESS EA 3830, GRHV, Rouen, France
- ADIR Association, Bois Guillaume, France
| | | | - Jean Quieffin
- Groupe Hospitalier du Havre, Pulmonology/Intensive Care Unit department, Avenue Pierre Mendes France, Montivilliers, France
| | - Bouchra Lamia
- UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), UPRESS EA 3830, GRHV, Rouen, France
- Groupe Hospitalier du Havre, Pulmonology/Intensive Care Unit department, Avenue Pierre Mendes France, Montivilliers, France
| | - Tristan Bonnevie
- UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), UPRESS EA 3830, GRHV, Rouen, France
- ADIR Association, Bois Guillaume, France
| | - Clément Medrinal
- UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), UPRESS EA 3830, GRHV, Rouen, France
- Groupe Hospitalier du Havre, Pulmonology/Intensive Care Unit department, Avenue Pierre Mendes France, Montivilliers, France
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Herer B, Bergelin E, Cancan S, Commaille N, Germain E, Segundo I, Tondeur I. Étude de faisabilité d’un programme institutionnel court de réhabilitation respiratoire un an après un séjour conventionnel. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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