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Rothnie KJ, Numbere B, Gelwicks S, Lu Y, Sharma R, Compton C, Ismaila AS, Quint JK. Risk Factors Associated with a First Exacerbation Among Patients with COPD Classified as GOLD A and B in Routine Clinical Practice in the UK. Int J Chron Obstruct Pulmon Dis 2023; 18:2673-2685. [PMID: 38022832 PMCID: PMC10676117 DOI: 10.2147/copd.s413947] [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: 04/14/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) have been previously characterized for patients with more severe cases of COPD. It is unclear how the risk of first exacerbation may best be identified in patients with less severe disease. This study investigated risk factors for first exacerbation among English patients with COPD classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A or B. Patients and Methods A retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD) AURUM linked to Hospital Episode Statistics. Patients with COPD aged ≥35 years and classified as GOLD group A or B (2020 criteria) from January 2013-December 2019 were eligible. Patients were required to have 24 months history in CPRD (baseline). Two cohorts were defined: cohort 1 included patients with no severe exacerbations during baseline; cohort 2 included patients with no moderate or severe exacerbations during baseline. Risk factors associated with severe, or combined moderate and severe exacerbation were examined for up to 5 years of follow-up. Results Overall, 194,948 patients were included in cohort 1 (mean age 66.2 years; 55.2% male), and 148,396 patients in cohort 2 (mean age 66.1 years; 56.6% male). Identified risk factors for exacerbation (and associated 1-year absolute risk of severe, or combined moderate and severe exacerbation, respectively) included: Medical Research Council dyspnea scale score (15.9%/28.4%); COPD Assessment Test score (9.6%/25.3%); GOLD grade of airflow limitation (forced expiratory volume in 1 second % predicted; 13.6%/27.5%); and lung cancer (8.1%/23.6%). After adjustment for risk factors, these factors remained independently associated with severe exacerbation at 1, 3, and 5 years of follow-up. Conclusion The identified risk factors may aid physicians in the early recognition of patients with COPD classified as GOLD group A or B at risk of first exacerbation.
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Affiliation(s)
- Kieran J Rothnie
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
| | - Beade Numbere
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
| | - Steven Gelwicks
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
| | - Yifei Lu
- Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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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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Lin SJ, Liao XM, Chen NY, Chang YC, Cheng CL. Beta-blockers reduce severe exacerbation in patients with mild chronic obstructive pulmonary disease with atrial fibrillation: a population-based cohort study. BMJ Open Respir Res 2023; 10:e001854. [PMID: 37989489 PMCID: PMC10660430 DOI: 10.1136/bmjresp-2023-001854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Beta-blockers (BBs) decrease mortality and acute exacerbation (AE) rates in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease; however, information on their effects in patients with COPD and atrial fibrillation (AF) is limited. We aimed to assess the AE risk in patients with different severities of COPD and AF receiving BBs compared with that in patients receiving calcium channel blockers (CCBs). METHODS This retrospective cohort study used data from the Taiwan National Health Insurance Database from 2009 to 2018. Outcomes included AE-related emergency room visits and hospitalisation. HRs and 95% CIs were estimated using the Cox proportional hazards model. COPD severity was classified as mild or severe based on exacerbation history. Sensitivity analyses included treatment and subgroup analyses, and competing risk adjustment. RESULTS After propensity score matching, 4486 pairs of BB and CCB users from 13 462 eligible patients were included. The exacerbation risk for BB users was lower (HR 0.80; 95% CI 0.72 to 0.89) than that of CCB users. After stratification, BB benefits persisted in the mild COPD group (HR 0.75; 95% CI 0.66 to 0.85), unlike the severe COPD group (HR 0.95; 95% CI 0.75 to 1.20). The results of the subgroup analysis showed consistent protective effects even in patients without heart failure or myocardial infarction (adjusted HR 0.82; 95% CI 0.71 to 0.94). CONCLUSION We found that BB use in patients with mild COPD and AF was associated with a lower exacerbation risk than CCB use, and that close monitoring of BB use in patients with severe COPD and AF is warranted.
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Affiliation(s)
- Shan-Ju Lin
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Xin-Min Liao
- Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of clinical medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Yu Chen
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Ching Chang
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
- Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Lan Cheng
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
- Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chang EM, Chen LS, Li YT, Chen CT. Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD. Respir Care 2023; 68:511-519. [PMID: 36854468 PMCID: PMC10173111 DOI: 10.4187/respcare.10416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD. METHODS A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience. RESULTS Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (β = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (β = 0.461, P < .001). CONCLUSIONS This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.
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Affiliation(s)
- En-Ming Chang
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan
| | - Li-Sheng Chen
- Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| | - Yang-Tzu Li
- Department of Long-Term Care, National Taipei University of Nursing and Health Science, Taipei City, Taiwan
| | - Chi-Tsung Chen
- Department of Respiratory Care, Shin Kong Wu Ho Su Memorial Hospital, Taipei City, Taiwan.
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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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6
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Chalupsky MR, Craddock KM, Schivo M, Kuhn BT. Remote patient monitoring in the management of chronic obstructive pulmonary disease. J Investig Med 2022; 70:1681-1689. [PMID: 35710143 DOI: 10.1136/jim-2022-002430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Remote patient monitoring allows monitoring high-risk patients through implementation of an expanding number of technologies in coordination with a healthcare team to augment care, with the potential to provide early detection of exacerbation, prompt access to therapy and clinical services, and ultimately improved patient outcomes and decreased healthcare utilization.In this review, we describe the application of remote patient monitoring in chronic obstructive pulmonary disease including the potential benefits and possible barriers to implementation both for the individual and the healthcare system.
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Affiliation(s)
- Megan R Chalupsky
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Krystal M Craddock
- Department of Respiratory Care, University of California Davis Health System, Sacramento, California, USA
| | - Michael Schivo
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Brooks T Kuhn
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA .,VA Northern California Health Care System, Mather, California, USA
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7
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Rothnie KJ, Joksaite S, Sansbury LB, Compton C, Di Boscio V, Ismaila AS. Characteristics of New Users of Single- and Multiple-Inhaler Triple Therapy for COPD in Primary Care in England. Int J Chron Obstruct Pulmon Dis 2022; 17:1455-1466. [PMID: 35769225 PMCID: PMC9234193 DOI: 10.2147/copd.s338436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Kieran J Rothnie
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK
- Correspondence: Kieran J Rothnie, Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK, Tel +44 208 990 3439, Email
| | - Sandra Joksaite
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK
| | - Leah B Sansbury
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Chris Compton
- Global Medical Affairs, GlaxoSmithKline, Middlesex, UK
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Collegeville, PA, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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8
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Chang YP, Chen YM, Chang YC, Liu SF, Fang WF, Chao TY, Wu CC, Chang HC, Lin MC, Chen YC. Association of baseline parameters with year 0 and year 1 acute exacerbations in male patients with chronic obstructive pulmonary disease. Int J Immunopathol Pharmacol 2022; 36:3946320221099073. [PMID: 35594865 PMCID: PMC9251822 DOI: 10.1177/03946320221099073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) can
affect health status, hospitalization and readmission rates, and disease
progression. This study aimed to identify independent markers associated
with COPD AEs. Methods This study included male patients with COPD and collected data regarding
their AEs and baseline clinical parameters. Results We included 149 male patients. Among them, 58 were included in the year 0
high-AE group and 91 in the low-AE group. Multivariate analysis revealed
that the high-AE group had higher white blood cell count, lower serum
albumin level, and post-bronchodilator (BD) forced expiratory volume in one
second (FEV1) (%) with a combined receiver operating
characteristic curve (ROC) of 0.721 (p < 0.001).
Additionally, 34 patients were included in the year 1 high-AE group and 70
in the low-AE group (p < 0.001). Multivariate analysis
revealed that the high-AE group had higher platelet count, positive asthma
history, and lower pre-BD FEV1 (%) with a combined ROC of 0.782
(p < 0.001). Conclusion In male patients with COPD, baseline white blood cell count, albumin level,
and post-BD FEV1 (%) were correlated with year 0 AE; on the other
hand, baseline platelet count, positive asthma history, and pre-BD
FEV1 (%) were associated with year 1 AE.
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Affiliation(s)
- Yu-Ping Chang
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Yu-Mu Chen
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Ya-Chun Chang
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Shih-Feng Liu
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan.,Department of Respiratory Therapy, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Feng Fang
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan
| | - Tung-Ying Chao
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Chao-Chien Wu
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Huang-Chih Chang
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan.,Department of Respiratory Therapy, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Che Chen
- Department of Internal Medicine, 63328Chang Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan.,Department of Respiratory Therapy, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Paraoxonase 1 and Chronic Obstructive Pulmonary Disease: A Meta-Analysis. Antioxidants (Basel) 2021; 10:antiox10121891. [PMID: 34942993 PMCID: PMC8750165 DOI: 10.3390/antiox10121891] [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: 10/26/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/26/2022] Open
Abstract
Oxidative stress is a driving factor in the pathophysiology of chronic obstructive pulmonary disease (COPD). While paraoxonase 1 (PON1) is an antioxidant enzyme and a potential biomarker of this disease, data regarding the status of PON-1 in COPD are inconclusive. In this regard, to shed light on this issue, we performed a meta-analysis of data on PON1 activity in COPD. Electronic databases (MEDLINE, Embase and CENTRAL) were searched for available studies on PON1 activity in patients with stable COPD published before October 2021. A meta-analysis was performed using random-effects models. Twelve studies (12 studies on paraoxonase and three on arylesterase) were identified. Patients with COPD had lower levels of paraoxonase activity (standard mean difference [SMD] -0.77, 95% confidence interval [CI] -1.35 to -0.18) and arylesterase activity (SMD -1.15, 95% CI -1.95 to -0.36) in comparison to healthy controls. In subgroup analyses, paraoxonase activity was lower in patients of studies as consisted of mainly non-severe COPD (SMD -1.42, 95% CI -2.04 to -0.79) and, by contrast, slightly higher in patients of studies including severe COPD (SMD 0.33, 95% CI 0.02 to 0.64) in comparison to healthy controls. Arylesterase activity showed a similar trend. Overall, PON1 activity was lower in patients with COPD, suggesting that PON1-related antioxidant defense is impaired in COPD. Future studies are warranted.
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