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Ryu MH, Murphy S, Hinkley M, Carlsten C. COPD Exposed to Air Pollution: A Path to Understand and Protect a Susceptible Population. Chest 2024; 165:836-846. [PMID: 37972689 DOI: 10.1016/j.chest.2023.11.012] [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: 05/18/2023] [Revised: 09/14/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
TOPIC IMPORTANCE Air pollution poses a risk to the respiratory health of individuals with COPD. Long- and short-term exposures to higher levels of particulate-rich air pollution are associated with increased COPD exacerbation, hospitalization, and mortality, collectively implicating air pollution as a cause of adverse COPD-related outcomes. REVIEW FINDINGS This review summarizes the evidence for COPD as a phenotype that confers susceptibility for adverse health outcomes in the face of common air pollution. We highlight how typical contributors to compromised urban air quality, including that from traffic, wildfire smoke, and indoor biomass combustion, adversely affect the COPD patient population. Evidence underscoring the burden of ongoing air pollution exposure on patients with COPD is discussed. We then detail the detrimental impact of that exposure on COPD pathophysiology, which in turn increases the patient's susceptibility. We specifically propose that indoor air is a particularly rational target for increased monitoring and remediation to protect patients with COPD. Because COPD is a heterogeneous disease with several endotypes, future intervention studies need to better include control populations, to highlight COPD-specific risks and identify subpopulations within patients with COPD who will benefit the most from improved indoor air quality. SUMMARY Regulatory efforts must continue to broadly lower emission standards to protect this susceptible population from the negative health impacts of air pollution.
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Affiliation(s)
- Min Hyung Ryu
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Shane Murphy
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Madison Hinkley
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada; Legacy for Airway Health and Centre for Lung Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
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2
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Agusti A, Böhm M, Celli B, Criner GJ, Garcia-Alvarez A, Martinez F, Sin DD, Vogelmeier CF. GOLD COPD DOCUMENT 2023: a brief update for practicing cardiologists. Clin Res Cardiol 2024; 113:195-204. [PMID: 37233751 PMCID: PMC10215047 DOI: 10.1007/s00392-023-02217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
Many patients seen by cardiologists suffer chronic obstructive pulmonary disease (COPD) in addition to their primary cardiovascular problem. Yet, quite often COPD has not been diagnosed and, consequently, patients have not been treated of their pulmonary disease. Recognizing and treating COPD in patients with CVDs is important because optimal treatment of the COPD carries important benefits on cardiovascular outcomes. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) publishes an annual report that serves as a clinical guideline for the diagnosis and management of COPD around the world and has very recently released the 2023 annual report. Here, we provide a summary of the GOLD 2023 recommendations that highlights those aspects of more interest for practicing cardiologists dealing with patients with CVD who may suffer COPD.
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Affiliation(s)
- Alvar Agusti
- Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Michael Böhm
- KardiologieAngiologie und Internistische Intensivmedizin, Universitätsklinikum des SaarlandesKlinik für Innere Medizin III, Saarland University, Homburg/Saar, Germany
| | - Bartolomé Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine, Philadelphia, PA, USA
| | | | | | - Don D Sin
- Centre for Heart Lung Innovation, Department of Medicine (Division of Respirology), St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University of Marburg, Marburg, Germany.
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3
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Agustí A, Hughes R, Rapsomaki E, Make B, del Olmo R, Papi A, Price D, Benton L, Franzen S, Vestbo J, Mullerova H. The many faces of COPD in real life: a longitudinal analysis of the NOVELTY cohort. ERJ Open Res 2024; 10:00895-2023. [PMID: 38348246 PMCID: PMC10860203 DOI: 10.1183/23120541.00895-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024] Open
Abstract
Background The diagnosis of COPD requires the demonstration of non-fully reversible airflow limitation by spirometry in the appropriate clinical context. Yet, there are patients with symptoms and relevant exposures suggestive of COPD with either normal spirometry (pre-COPD) or preserved ratio but impaired spirometry (PRISm). Their prevalence, clinical characteristics and associated outcomes in a real-life setting are unclear. Methods To investigate them, we studied 3183 patients diagnosed with COPD by their attending physician included in the NOVELTY study (clinicaltrials.gov identifier NCT02760329), a global, 3-year, observational, real-life cohort that included patients recruited from both primary and specialist care clinics in 18 countries. Results We found that 1) approximately a quarter of patients diagnosed with (and treated for) COPD in real life did not fulfil the spirometric diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and could be instead categorised as pre-COPD (13%) or PRISm (14%); 2) disease burden (symptoms and exacerbations) was highest in GOLD 3-4 patients (exacerbations per person-year (PPY) 0.82) and lower but similar in those in GOLD 1-2, pre-COPD and PRISm (exacerbations range 0.27-0.43 PPY); 3) lung function decline was highest in pre-COPD and GOLD 1-2, and much less pronounced in PRISm and GOLD 3-4; 4) PRISm and pre-COPD were not stable diagnostic categories and change substantially over time; and 5) all-cause mortality was highest in GOLD 3-4, lowest in pre-COPD, and intermediate and similar in GOLD 1-2 and PRISm. Conclusions Patients diagnosed COPD in a real-life clinical setting present great diversity in symptom burden, progression and survival, warranting medical attention.
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Affiliation(s)
- Alvar Agustí
- University of Barcelona, Respiratory Institute – Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
- These authors contributed equally
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
- These authors contributed equally
| | - Eleni Rapsomaki
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Barry Make
- National Jewish Health and University of Colorado Denver, Denver, CO, USA
| | - Ricardo del Olmo
- Diagnostic and Treatment Department, Hospital de Rehabilitaciόn Respiratoria “Maria Ferrer” and IDIM CR, Buenos Aires, Argentina
| | - Alberto Papi
- University of Ferrara, Department of Translation Medicine, Ferrara, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore and Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Laura Benton
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Stefan Franzen
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Hana Mullerova
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
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Iyer S, Rai SP, Singhania S, Simon C. Role of Screening Lung Function Tests in a Routine Health Checkup. Cureus 2023; 15:e49430. [PMID: 38024041 PMCID: PMC10679964 DOI: 10.7759/cureus.49430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives The lung function test is a gold standard, guideline-recommended test to detect obstructive airway diseases like asthma and COPD. It is of considerable value in detecting the presence and severity of airflow obstruction in patients with respiratory symptoms. However, the role of spirometry in a routine health checkup is controversial. Spirometry, when used in routine health checkup settings as a case-finding tool for all adults with persistent respiratory symptoms or having a history of exposure to risk factors, is likely to label a relatively large proportion of individuals as diseased with airflow obstruction. Conversely, spirometry is normal in a relatively large percentage of adults who report respiratory symptoms including dyspnea, the respiratory symptom having the greatest impact on quality of life. The objective of this study is to determine the utility of spirometry as a screening test to detect airflow obstruction in otherwise healthy subjects undergoing a routine health checkup. Methods This observational study was conducted with 538 health checkup individuals aged 18 and over. A brief history was taken prior to the test. Lung function tests were performed and interpreted as per the Global Initiative for Chronic Obstructive Lung Disease criteria. The anthropometric and spirometric data obtained were compared to other population-based spirometric studies to compare the prevalence of airflow limitation, the risk factors, and smoking history. Results Of the total 538 subjects incorporated in the study, 305 (57%) were males and 233 (43%) were females aged between 18 to 80 years with a mean age of 45 years. The male-to-female ratio was 1.3:1 with a mean BMI of 25.9. The overall yield from lung function tests in detecting airflow obstruction was 63 subjects (11.7%), of which 36 (11.8%) were males and 27 (11.5%) were females. Seventy-three subjects (13.5%) were classified as having a small airway obstruction, of which 34 were males (46.6%), and 39 were females (53.4%). The distribution of airflow obstruction by age was with eight subjects (5.4%) in the 18-35 group, 21 subjects (7.8%) in the 36-55 group, and 34 (25%) in the elderly (>55) age group. Although overall smoking history showed no significant association with developing airflow obstruction, significant association with smoking was found in the elderly (>55) age group. Interpretation and conclusions The results of the study suggest that lung function tests should be included in routine health checkups in the subset of individuals greater than 35 years of age with or without a history of smoking, in all age groups with a family history of asthma, in individuals with respiratory symptoms and in individuals greater than 55 years of age with a moderate history of smoking.
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Affiliation(s)
- Shankar Iyer
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - S P Rai
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Sumeet Singhania
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Caroline Simon
- Respiratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
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Agustí A, Sisó-Almirall A, Roman M, Vogelmeier CF. Gold 2023: Highlights for primary care. NPJ Prim Care Respir Med 2023; 33:28. [PMID: 37524724 PMCID: PMC10390461 DOI: 10.1038/s41533-023-00349-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Cátedra Salud Respiratoria, Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain.
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE). Grup de Recerca Transversal en Atenció Primària (IDIBAPS). Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Roman
- Univ. Islas Baleares, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), centro de salud Son Pisa Palma de Mallorca, Palma de Mallorca, Spain
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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Zhang X, Lei Z, Wu Y, Song Y, Wu X, Yang B, Fan J, Feng S, Wu L, Li L, Dai Q, Zeng Z, Feng M, Zhang T. Prevalence and Risk Factors for COPD in an Urbanizing Rural Area in Western China: A Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2023; 18:459-468. [PMID: 37038543 PMCID: PMC10082583 DOI: 10.2147/copd.s400213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
Purpose To investigate the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) in a rural area in western China with severe air pollution. Patients and Methods 10% of local residents aged 40 years and above were included using a convenience sampling method. This was a cross-sectional study. A self-designed questionnaire was used to collect participants' demographic data. The screening program was comprised of two steps: First, a portable electronic spirometer was used for COPD screening. Those participants with FEV1/FVC ratio <0.7 were then referred to a confirmatory pulmonary function (PF) test. COPD was confirmed according to the 2020 Global Initiative for Chronic Obstructive Lung Disease criteria. Results A total of 4577 participants aged 40 years old or above were included in the final analysis. Examination with a mobile spirometer identified 1159 individuals for confirmatory testing; after that, of the 1159 individuals, 889 were diagnosed with COPD by the confirmatory PF test. The prevalence of COPD among the target group was 19.4%. Older age, male sex (odds ratio [OR] = 1.537, 95% confidence interval [CI] 1.246-1.894), smoking history (OR = 1.338, 95% CI 1.069-1.675), family history of respiratory disease (OR = 1.625, 95% CI 1.350-1.957), education level (OR = 0.735, 95% CI 0.617-0.876), overweight (OR = 0.614, 95% CI 0.517-0.730) and obesity (OR = 0.572, 95% CI 0.449-0.721) were identified as independent factors associated with COPD. The screening program helped earlier detection of COPD in 719 participants. Conclusion COPD was highly prevalent in the rural area studied. Rural residents who were older, current or ever-smokers, male and those who had a lower education level were more vulnerable to developing COPD. The COPD screening program may be helpful for earlier disease detection in rural health-care settings.
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Affiliation(s)
- Xiaolong Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Zhiyin Lei
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Ying Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yuanyuan Song
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Xiaoling Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Department of Nursing, Sanya People’s Hospital/West China (Sanya) Hospital, Sichuan University, Sanya, Hainan Province, People’s Republic of China
| | - Bo Yang
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Jianmei Fan
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Shixu Feng
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Liping Wu
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Lingyan Li
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Qin Dai
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Zhen Zeng
- Department of Respiratory and Critical Care Medicine, Jiajia Central Health Center of Chengdu Eastern New Area, Chengdu Eastern New Area, Sichuan Province, People’s Republic of China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Tingting Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 141] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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Association between antibiotics and rehospitalization in patients with acute exacerbations of chronic obstructive pulmonary disease discharged from the emergency department. CAN J EMERG MED 2022; 24:725-734. [PMID: 36242731 DOI: 10.1007/s43678-022-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/05/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently discharged from the emergency department (ED) and treated with antibiotics. The role of antibiotics in the outpatient management of AECOPD is controversial and has never been studied in the ED setting. METHODS We conducted a secondary analysis of prospectively collected data from the validation study of the Ottawa COPD Risk Scale. We included adult patients with AECOPD who were discharged from six tertiary care EDs in Canada over a two-year period and assessed rates of rehospitalization within 14 days of ED discharge. To examine the association between antibiotic treatment and rehospitalization, we performed multivariable logistic regression and propensity score-matched analyses. RESULTS A total of 774 patients were included in the analysis. The mean age was 69.4 years, 388 patients (50.1%) were female, and 451 patients (58.3%) were discharged with antibiotics. Twenty-nine (6.4%) and 36 (11.1%) patients returned to hospital with admission in the antibiotic and no antibiotic groups, respectively (unadjusted OR 0.55; 95% CI 0.33-0.92); adjustment for prespecified baseline characteristics using logistic regression yielded OR 0.65; 95% CI 0.38-1.08. In the propensity score-matched analysis comprising of 197 matched pairs, 15 (7.6%) and 19 patients (9.6%) in the antibiotic and no antibiotic groups returned with admission, respectively (OR 0.69; 95% CI 0.29-1.62). CONCLUSION For patients with AECOPD discharged from the ED, we did not find an association between outpatient treatment with antibiotics and lower rates of rehospitalization after accounting for differences in baseline patient characteristics. However, the small sample size and low observed rate of the primary outcome created substantial risk of Type II error. Until further evidence is available, clinicians should continue prescribing antibiotics for patients with AECOPD based on clinical judgement and current practice guidelines.
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Gene Expression Trajectories from Normal Nonsmokers to COPD Smokers and Disease Progression Discriminant Modeling in Response to Cigarette Smoking. DISEASE MARKERS 2022; 2022:9354286. [PMID: 36157207 PMCID: PMC9493146 DOI: 10.1155/2022/9354286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022]
Abstract
Background Cigarette smoking (CS) is considered to the predominant risk factor contributing to the etiopathogenesis of chronic obstructive pulmonary disease (COPD); meanwhile, genetic predisposition likely plays a role in determining disease susceptibility. Objectives We aimed to investigate gene expression trajectories from normal nonsmokers to COPD smokers and disease progression discriminant modeling in response to cigarette smoking. Methods Small airway epithelial samples of human with different smoking status using fiberoptic bronchoscopy and corresponding rat lung tissues following 0, 3, and 6 months of CS exposure were obtained. The expression of the significant overlapping genes between human and rats was confirmed in 16HBE cells, rat lung tissues, and human peripheral PBMC using qRT-PCR. Binary logistic regression analysis was carried out to establish discrimination models. Results The integrated bioinformatic analysis of 8 human GEO datasets (293 individuals) and 9 rat transcriptome databases revealed 13 overlapping genes between humans and rats in response to smoking exposure during COPD progression. Of these, 5 genes (AKR1C3/Akr1c3, ERP27/Erp27, AHRR/Ahrr, KCNMB2/Kcnmb2, and MRC1/Mrc1) were consistently identified in both the human and rat and validated by qRT-PCR. Among them, ERP27/Erp27, KCNMB2/Kcnmb2, and MRC1/Mrc1 were newly identified. On the basis of the overlapping gene panel, discriminant models were established with the receiver operating characteristic curve (AUC) of 0.98 (AKR1C3/Akr1c3 + ERP27/Erp27) and 0.99 (AHRR/Ahrr + KCNMB2/Kcnmb2) in differentiating progressive COPD from normal nonsmokers. In addition, we also found that DEG obtained from each expression profile dataset was better than combined analysis as more genes could be identified. Conclusion This study identified 5 DEG candidates of COPD progression in response to smoking and developed effective and convenient discriminant models that can accurately predict the disease progression.
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10
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Wei D, Wang Q, Liu S, Tan X, Chen L, Tu R, Liu Q, Jia Y, Liu S. Influences of Two FEV1 Reference Equations (GLI-2012 and GIRH-2017) on Airflow Limitation Classification Among COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 17:2053-2065. [PMID: 36081764 PMCID: PMC9447406 DOI: 10.2147/copd.s373834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Dafei Wei
- Department of Pediatrics, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Qi Wang
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Shasha Liu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Xiaowu Tan
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Lin Chen
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Rongfang Tu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Qing Liu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Yuanhang Jia
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Sha Liu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
- Correspondence: Sha Liu, Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China, Email
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11
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Guan Q, Tian Y, Zhang Z, Zhang L, Zhao P, Li J. Identification of Potential Key Genes in the Pathogenesis of Chronic Obstructive Pulmonary Disease Through Bioinformatics Analysis. Front Genet 2021; 12:754569. [PMID: 34804123 PMCID: PMC8595135 DOI: 10.3389/fgene.2021.754569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease with high morbidity and mortality. The etiology of COPD is complex, and the pathogenesis mechanisms remain unclear. In this study, we used rat and human COPD gene expression data from our laboratory and the Gene Expression Omnibus (GEO) database to identify differentially expressed genes (DEGs) between individuals with COPD and healthy individuals. Then, protein–protein interaction (PPI) networks were constructed, and hub genes were identified. Cytoscape was used to construct the co-expressed network and competitive endogenous RNA (ceRNA) networks. A total of 198 DEGs were identified, and a PPI network with 144 nodes and 355 edges was constructed. Twelve hub genes were identified by the cytoHubba plugin in Cytoscape. Of these genes, CCR3, CCL2, COL4A2, VWF, IL1RN, IL2RA, and CCL13 were related to inflammation or immunity, or tissue-specific expression in lung tissue, and their messenger RNA (mRNA) levels were validated by qRT-PCR. COL4A2, VWF, and IL1RN were further verified by the GEO dataset GSE76925, and the ceRNA network was constructed with Cytoscape. These three genes were consistent with COPD rat model data compared with control data, and their dysregulation direction was reversed when the COPD rat model was treated with effective-component compatibility of Bufei Yishen formula III. This bioinformatics analysis strategy may be useful for elucidating novel mechanisms underlying COPD. We pinpointed three key genes that may play a role in COPD pathogenesis and therapy, which deserved to be further studied.
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Affiliation(s)
- Qingzhou Guan
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yange Tian
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhenzhen Zhang
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lanxi Zhang
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Peng Zhao
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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12
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Yamada M, Motoike IN, Kojima K, Fuse N, Hozawa A, Kuriyama S, Katsuoka F, Tadaka S, Shirota M, Sakurai M, Nakamura T, Hamanaka Y, Suzuki K, Sugawara J, Ogishima S, Uruno A, Kodama EN, Fujino N, Numakura T, Ichikawa T, Mitsune A, Ohe T, Kinoshita K, Ichinose M, Sugiura H, Yamamoto M. Genetic loci for lung function in Japanese adults with adjustment for exhaled nitric oxide levels as airway inflammation indicator. Commun Biol 2021; 4:1288. [PMID: 34782693 PMCID: PMC8593164 DOI: 10.1038/s42003-021-02813-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/27/2021] [Indexed: 11/08/2022] Open
Abstract
Lung function reflects the ability of the respiratory system and is utilized for the assessment of respiratory diseases. Because type 2 airway inflammation influences lung function, genome wide association studies (GWAS) for lung function would be improved by adjustment with an indicator of the inflammation. Here, we performed a GWAS for lung function with adjustment for exhaled nitric oxide (FeNO) levels in two independent Japanese populations. Our GWAS with genotype imputations revealed that the RNF5/AGER locus including AGER rs2070600 SNP, which introduces a G82S substitution of AGER, was the most significantly associated with FEV1/FVC. Three other rare missense variants of AGER were further identified. We also found genetic loci with three candidate genes (NOS2, SPSB2 and RIPOR2) associated with FeNO levels. Analyses with the BioBank-Japan GWAS resource revealed genetic links of FeNO and asthma-related traits, and existence of common genetic background for allergic diseases and their biomarkers. Our study identified the genetic locus most strongly associated with airway obstruction in the Japanese population and three genetic loci associated with FeNO, an indicator of type 2 airway inflammation in adults.
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Affiliation(s)
- Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ikuko N Motoike
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kaname Kojima
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Nobuo Fuse
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Shinichi Kuriyama
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Fumiki Katsuoka
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Shu Tadaka
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Matsuyuki Shirota
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Miyuki Sakurai
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Tomohiro Nakamura
- Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yohei Hamanaka
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kichiya Suzuki
- Department of Biobank, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Junichi Sugawara
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Soichi Ogishima
- Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, Japan
| | - Akira Uruno
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Eiichi N Kodama
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naoya Fujino
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadahisa Numakura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Ichikawa
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ayumi Mitsune
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Ohe
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kinoshita
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, Japan
- Department of System Bioinformatics, Tohoku University Graduate School of Information Sciences, Sendai, Japan
| | | | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Yamamoto
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
- Department of Medical Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan.
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13
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González-Mejía EA, Uñate-Suárez OC, Bula- Gutiérrez CJ, Patiño-Jiménez YP. Variabilidad de síntomas en pacientes ambulatorios con EPOC y validación del Instrumento colombiano de variabilidad de síntomas en EPOC (CoVaSy). REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n4.79817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Se considera que la variabilidad de los síntomas respiratorios de la enfermedad pulmonar obstructiva crónica (EPOC) es baja o inexistente. Sin embargo, algunos autores afirman que se pueden presentar fluctuaciones.
Objetivos. Describir la variabilidad de síntomas en pacientes con EPOC a lo largo del día y la noche durante cuatro semanas mediante un diario de paciente y validar un cuestionario desarrollado para tal fin (el Instrumento Colombiano Autoadministrado de Variabilidad de Síntomas en EPOC - EPOC-CoVaSy)
Materiales y métodos. Estudio de cohorte realizado en 96 pacientes con EPOC atendidos entre junio y diciembre de 2016 en el Centro de Atención Pulmonar - CAP, en Barranquilla, Colombia, quienes diligenciaron un diario de paciente durante cuatro semanas y, luego de este periodo, el instrumento auto administrado EPOC-CoVaSy. La independencia y comparación de frecuencias de las variables categóricas y continuas se establecieron mediante las pruebas χ² y exacta de Fisher y el coeficiente de correlación de Pearson, respectivamente. Se realizó un MANOVA, utilizando modelos de regresión lineal, para determinar las correlaciones entre los resultados del diario y el instrumento.
Resultados. La edad promedio de los participantes fue 73.3±8.3 años y 71.87% eran hombres. Según el análisis de los diarios, los puntajes promedio (escala visual analógica) para todos los síntomas y desempeño de actividades diarias oscilaron entre 0.5 y 2.5 siendo más altos en la mañana (puntajes promedio entre 1.5 y 2.5) que en la tarde y noche (puntajes promedio entre 0.5 y 1.5), sin embargo esta variabilidad fue mínima, lo que coincidió con los resultados obtenidos en el EPOC-CoVaSy, evidenciándose una alta correlación entre ambos instrumentos, lo que permitió confirmar que la herramienta diseñada es útil para medir dicha variabilidad.
Conclusiones. Con base en los hallazgos del presente estudio, se puede concluir que existe una leve variabilidad en los síntomas de EPOC a lo largo del día, la cual debe considerarse a la hora de establecer esquemas de tratamiento para esta enfermedad. Asimismo, se estableció que el EPOC-CoVaSy es válido para medir dicha variabilidad en la población colombiana con EPOC.
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14
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Yao LP, Tao R. Does Chronic Obstructive Pulmonary Disease Affect Workers' Health? Front Public Health 2021; 9:711629. [PMID: 34291035 PMCID: PMC8287322 DOI: 10.3389/fpubh.2021.711629] [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: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
During recent decades, the elevation of workers' health has become the utmost point of concern since it is considered among the primary indicators of economies. The economies, especially the emerging ones, are primarily focusing on every indicator to uplift their businesses. Along with the other aspects, it is also required to assess the impact of Chronic Obstructive Pulmonary Disease (COPD) on workers' health conditions in small- and medium-scale enterprises (SMEs). With this aim, we are presenting a detailed analysis to reveal useful insights regarding the COPD-workers' health nexus. The sample set of 1,008 workers is working in various SMEs in Beijing and Tianjin from September, 2020. The findings infer that a rise in COPD concerning wages will uplift the worker health problems due to COPD affecting worker health. Whereas, the working condition and tools, smoking years, and health safety training have a statistically adverse effect on workers' health concerning wages. The outcomes in terms of insights would be useful for planning future perspectives.
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Affiliation(s)
- Li-Peng Yao
- Ningbo College of Health Sciences, Ningbo, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Preventation, Qingdao, China
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15
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Tamaki K, Sakihara E, Miyata H, Hirahara N, Kirichek O, Tawara R, Akiyama S, Katsumata M, Haruya M, Ishii T, Simard EP, Miller BE, Tal-Singer R, Kaise T. Utility of Self-Administered Questionnaires for Identifying Individuals at Risk of COPD in Japan: The OCEAN (Okinawa COPD casE finding AssessmeNt) Study. Int J Chron Obstruct Pulmon Dis 2021; 16:1771-1782. [PMID: 34168439 PMCID: PMC8216667 DOI: 10.2147/copd.s302259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed and untreated even though they may have a burden of respiratory symptoms that impact quality of life. The OCEAN study assessed the ability of screening questionnaires to identify individuals with, or at risk of, COPD by comparing questionnaire outcomes with spirometric measures of lung function. Methods This observational study included participants ≥40 years of age presenting for their annual health examination at a single medical center in Okinawa, Japan. Participants completed COPD screening questionnaires (CAPTURE and COPD-Q), the Chronic Airways Assessment Test (CAAT), and general demographic and health-related questionnaires. The performance characteristics of CAPTURE and COPD-Q were compared with spirometry-based airflow limitation by calculating the area under the receiver operating characteristic (ROC-AUC) curve. Results A total of 2518 participants were included in the study; 79% of whom were <60 years of age (mean 52.0 years). A total of 52 (2.1%) participants had airflow limitation defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.7, and 420 (16.7%) participants were classified as Preserved Ratio Impaired Spirometry (PRISm). Among participants with PRISm, 75 (17.9%) had a CAAT total score ≥10. Airflow limitation and PRISm were more prevalent in current smokers versus past smokers. For the CAPTURE questionnaire, ROC-AUC for screening airflow limitation, PRISm, and PRISm with a CAAT total score ≥10 were 0.59, 0.55, and 0.69, respectively; for COPD-Q, these three clinical features were 0.67, 0.58 and 0.68, respectively. Conclusion This study demonstrated that CAPTURE and COPD-Q appear to be effective screening tools for identifying symptomatic individuals with undiagnosed, or at risk of developing COPD in adults ≥40 years of age in Okinawa. Furthermore, early diagnosis and management of PRISm is important to improve future outcomes and the societal burden of disease.
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Affiliation(s)
- Kentaro Tamaki
- Department of Breast Surgery, Nahanishi Clinic, Okinawa, Japan
| | - Eishin Sakihara
- Lifestyle Related Disease Medical Center, Naha Medical Association, Okinawa, Japan
| | - Hiroaki Miyata
- Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Norimichi Hirahara
- Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | | | | | | | | | - Mei Haruya
- Government Affairs and Market Access, GSK, Tokyo, Japan
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16
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Safitri W, Martini S, Artanti KD, Li CY. Smoking from a Younger Age Is the Dominant Factor in the Incidence of Chronic Obstructive Pulmonary Disease: Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116047. [PMID: 34199771 PMCID: PMC8200000 DOI: 10.3390/ijerph18116047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 01/15/2023]
Abstract
Background: Indonesia ranks 7th highest in the world for the number of deaths caused by tobacco use including those caused by Chronic Obstructive Pulmonary Disease (COPD). The purpose of this study was to determine the influence of initial smoking age and habit on the incidence of COPD. Methods: This research was a case-control study. The sampling in this research took a systematic random sampling method. The samples of this study were 56 respondents of a case group and 56 respondents of a control group. This study was conducted at Ngudi Waluyo Hospital, Wlingi, Blitar from October to November 2017. Results: The factors that influenced the incidence of COPD were being male (p = 0.00; OR = 6.333; 95%CI = 2.776–14.450), a smoker (p = 0.00050; OR = 5.1318; 95%CI = 1.9004–13.8958), initially smoking at <15 years old (p = 0.00; OR = 11,769; 95%CI = 4.086–33.903), initially getting into a smoking habit at the age of <15 years old (OR = 12; CI = 1346–106,950), initially getting into a smoking habit at the age of ≥15 years old (OR = 3647; CI = 1625–8183) and having smoked for ≥30 years (OR = 8857; CI = 3298–23,787). Conclusion: There are three factors of smoking behavior that influence COPD: smoking habit, initial smoking age and smoking duration. Of all factors, forming a smoking habit at the age of <15 years old has the biggest risk (OR = 12; CI = 1346–106,950).
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Affiliation(s)
- Winda Safitri
- Faculty of Public Health, Universitas Airlangga, Surabaya 60236, East Java, Indonesia;
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, East Java, Indonesia;
- Correspondence: ; Tel.: +62-81-2326-1228
| | - Kurnia Dwi Artanti
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, East Java, Indonesia;
- Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, East Java, Indonesia
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
- Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
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17
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Wang Y, Li Z, Li FS. Development and Assessment of Prediction Models for the Development of COPD in a Typical Rural Area in Northwest China. Int J Chron Obstruct Pulmon Dis 2021; 16:477-486. [PMID: 33664570 PMCID: PMC7924122 DOI: 10.2147/copd.s297380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to construct and evaluate a clinical predictive model for the development of COPD in northwest China's rural areas. Methods A cross-sectional study of a natural population was performed in rural northwest China. After assessing demographic and disease characteristics, a clinical prediction model was developed. First, we used the least absolute shrinkage and selection operator regression model to screen possible factors influencing COPD. Then construct a logistic regression model and draw a nomogram. The discriminability of the model was further evaluated by the calibration diagram, C-index and ROC curve system. Clinical benefit was analyzed using the decision curve. Finally, the 1000 bootstrap resamples and Harrell's C-index was used for internal verification of the nomogram. Results Among 3249 patients in the local rural natural population, 394 (12.13%) were diagnosed with COPD. The LASSO regression model was used to find the optimal combination of parameters, and the screened influencing factors included age, gender, barbeque, smoking, passive smoking, energy type, ventilation system and Post-Bronchodilator FEV1. These predictors are used to construct a nomogram. C index is 0.81 (95% confidence interval:0.79-0.83). The combination of the calibration curve and ROC curve indicates that the model has high discriminability. The decision curve shows benefits in clinical practice when the threshold probability is >6% and <58%, respectively. The internal verification results using Harrell's C-Index were 0.80 (95% confidence interval: 0.78-0.83). Conclusion Combining information such as age, sex, barbeque, smoking, passive smoking, type of energy, ventilation systems, and Post-Bronchodilator FEV1 can be easily used to predict the risk of COPD in local rural areas.
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Affiliation(s)
- Yide Wang
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Zheng Li
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.,Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
| | - Feng-Sen Li
- Department of Integrated Pulmonology, Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.,Xinjiang National Clinical Research Base of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
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Bourdin A, Criner G, Devouassoux G, Dransfield M, Halpin DM, Han MK, Jones CE, Kalhan R, Lange P, Lettis S, Lipson DA, Lomas DA, Echave-Sustaeta María-Tomé JM, Martin N, Martinez FJ, Quasny H, Sail L, Siler TM, Singh D, Thomashow B, Watz H, Hanania NA. InforMing the PAthway of COPD Treatment (IMPACT Trial) Single-Inhaler Triple Therapy (Fluticasone Furoate/Umeclidinium/Vilanterol) Versus Fluticasone Furoate/Vilanterol and Umeclidinium/Vilanterol in Patients With COPD: Analysis of the Western Europe and North America Regions. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:76-90. [PMID: 33156982 PMCID: PMC8047616 DOI: 10.15326/jcopdf.2020.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The InforMing the Pathway of COPD Treatment (IMPACT) trial demonstrated lower moderate/severe exacerbation rates with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI or UMEC/VI in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. Since IMPACT was a global study, post-hoc analyses were conducted by geographic region to investigate potential differences in overall findings. METHODS IMPACT was a 52-week, randomized, double-blind trial. Patients with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomized 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25µg, FF/VI 100/25µg, or UMEC/VI 62.5/25µg. Endpoints assessed in the overall, Western Europe and North America populations included on-treatment moderate/severe exacerbation (rates and time-to-first), trough forced expiratory volume in 1 second and St George's Respiratory Questionnaire (SGRQ) total score. Safety was assessed. RESULTS Overall, 10,355 patients were enrolled, 3164 from Western Europe, 2639 from North America. FF/UMEC/VI significantly reduced on-treatment moderate/severe exacerbation rates versus FF/VI and UMEC/VI in Western Europe (rate ratios 0.82 [95%CI 0.74-0.91], P<.001 and 0.76 [0.67-0.87], P<.001) and in North America (0.87 [0.77-0.97], P=.014 and 0.69 [0.60-0.80], P<.001). FF/UMEC/VI reduced time-to-first moderate/severe exacerbation and improved lung function versus FF/VI and UMEC/VI in both regions, and improved SGRQ total score in Western Europe, but not North America. Safety profiles were generally similar between treatment groups/regions; the inhaled corticosteroid class effect of increased pneumonia incidence was seen in North America but not Western Europe. CONCLUSION Consistent with intent-to-treat results, FF/UMEC/VI reduced moderate/severe exacerbation rate and risk and improved lung function in Western Europe and North America; however, between-regions differences were seen for SGRQ total score and pneumonia incidence. CLINICAL TRIAL REGISTRATION NCT02164513.
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Affiliation(s)
- Arnaud Bourdin
- Department of Pneumology and Addictology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Gerard Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Gilles Devouassoux
- Univ. Lyon, Université Claude-Bernard Lyon 1, Lyon, France
- Hôpital de la Croix-Rousse, Service de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Alabama, United States
| | - David M.G. Halpin
- College of Medicine and Health, University of Exeter Medical School, Exeter, United Kingdom
| | - MeiLan K. Han
- Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States
| | - C. Elaine Jones
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Peter Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical Department, Herlev University Hospital, Herlev, Denmark
| | - Sally Lettis
- Department of Pneumology and Addictology, University of Montpellier, CHU Montpellier, Montpellier, France
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - David A. Lipson
- GlaxoSmithKline, Collegeville, Pennsylvania, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David A. Lomas
- UCL Respiratory, University College London, London, United Kingdom
| | | | - Neil Martin
- GlaxoSmithKline, Brentford, Middlesex, United Kingdom
- University of Leicester, Leicester, United Kingdom
| | | | - Holly Quasny
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States
| | | | - Thomas M. Siler
- Midwest Chest Consultants, PC, St. Charles, Missouri, United States
| | - Dave Singh
- The University of Manchester, Manchester University National Health Service Foundation Trust, United Kingdom
| | - Byron Thomashow
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Medical Center, New York, New York, United States
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, Airways Clinical Research Center, Baylor College of Medicine, Houston, Texas, United States
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Wang C, Zhou J, Wang J, Li S, Fukunaga A, Yodoi J, Tian H. Progress in the mechanism and targeted drug therapy for COPD. Signal Transduct Target Ther 2020; 5:248. [PMID: 33110061 PMCID: PMC7588592 DOI: 10.1038/s41392-020-00345-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is emphysema and/or chronic bronchitis characterised by long-term breathing problems and poor airflow. The prevalence of COPD has increased over the last decade and the drugs most commonly used to treat it, such as glucocorticoids and bronchodilators, have significant therapeutic effects; however, they also cause side effects, including infection and immunosuppression. Here we reviewed the pathogenesis and progression of COPD and elaborated on the effects and mechanisms of newly developed molecular targeted COPD therapeutic drugs. Among these new drugs, we focussed on thioredoxin (Trx). Trx effectively prevents the progression of COPD by regulating redox status and protease/anti-protease balance, blocking the NF-κB and MAPK signalling pathways, suppressing the activation and migration of inflammatory cells and the production of cytokines, inhibiting the synthesis and the activation of adhesion factors and growth factors, and controlling the cAMP-PKA and PI3K/Akt signalling pathways. The mechanism by which Trx affects COPD is different from glucocorticoid-based mechanisms which regulate the inflammatory reaction in association with suppressing immune responses. In addition, Trx also improves the insensitivity of COPD to steroids by inhibiting the production and internalisation of macrophage migration inhibitory factor (MIF). Taken together, these findings suggest that Trx may be the ideal drug for treating COPD.
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Affiliation(s)
- Cuixue Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, 312000, China
| | - Jiedong Zhou
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, 312000, China
| | - Jinquan Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, 312000, China
| | - Shujing Li
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, 312000, China
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Junji Yodoi
- Laboratory of Infection and Prevention, Department of Biological Response, Institute for Virus Research, Kyoto University, Kyoto, 606-8501, Japan
| | - Hai Tian
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, 312000, China.
- Jiaozhimei Biotechnology (Shaoxing) Co, Ltd, Shaoxing, 312000, China.
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20
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Sajith M, Bargaje MD, Gharat S, Mathew J, Varghese A. Assessment of the effectiveness of a pharmacist approach for improving disease-specific knowledge and treatment in patients with chronic obstructive pulmonary disease. Eur J Hosp Pharm 2020; 28:e97-e101. [PMID: 33051196 DOI: 10.1136/ejhpharm-2020-002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Adequate knowledge is essential for the appropriate management of chronic conditions such as chronic obstructive pulmonary disease (COPD). However, some patients may not be able either to comprehend or obtain adequate information. This study aims to assess the effectiveness of the clinical pharmacist approach to refining disease-specific knowledge in patients with COPD treated in a tertiary care hospital. METHODS A prospective observational longitudinal study was carried out in adult COPD patients for 9 months in the tertiary care hospital of Pune. At the time of enrolment, disease-specific knowledge of patients with COPD was assessed using the Bristol COPD Knowledge Questionnaire (BCKQ). After the assessment, patients were educated, counselled verbally and provided with a validated COPD information leaflet. The patients' knowledge was reassessed 1 month and 3 months after enrolment. Pre and post scores of BCKQ were compared by ANOVA followed by Tukey's post hoc test. The difference in the proportions was calculated using the χ2 test. RESULTS Of 75 patients, the majority were men (53.33%), aged >60 years (72%), employed (62.67%) and had obtained secondary education (37.33%). The mean baseline BCKQ overall score of the patients was 25.87, which increased after education to 42.43 on the first visit (1 month) and to 45.62 on the second visit (3 months) (p<0.0001). At baseline, the topics 'vaccination', 'inhaled steroids' and 'antibiotics' returned the lowest mean scores of 0.37, 0.38 and 0.60, which were increased to 2.30, 2.70 and 2.72, respectively, after follow-up. CONCLUSION The knowledge of patients with COPD about the disease and its treatment was poor at the time of enrolment. Proper counselling and education provided by the clinical pharmacist helped to improve the patients' knowledge about COPD and its treatment.
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Affiliation(s)
- Manjusha Sajith
- Clinical Pharmacy, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Smruti Gharat
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Joelin Mathew
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Amruta Varghese
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
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21
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Prevalence and Economic Burden of Respiratory Diseases in Central Asia and Russia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207483. [PMID: 33066700 PMCID: PMC7602368 DOI: 10.3390/ijerph17207483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/17/2022]
Abstract
Prevalence data of respiratory diseases (RDs) in Central Asia (CA) and Russia are contrasting. To inform future research needs and assist government and clinical policy on RDs, an up-to-date overview is required. We aimed to review the prevalence and economic burden of RDs in CA and Russia. PubMed and EMBASE databases were searched for studies that reported prevalence and/or economic burden of RDs (asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, interstitial lung diseases (ILD), lung cancer, pulmonary hypertension, and tuberculosis (TB)) in CA (Kyrgyzstan, Uzbekistan, Tajikistan, Kazakhstan, and Turkmenistan) and Russia. A total of 25 articles (RD prevalence: 18; economics: 7) were included. The majority (n = 12), mostly from Russia, reported on TB. TB prevalence declined over the last 20 years, to less than 100 per 100,000 across Russia and CA, yet in those, multidrug-resistant tuberculosis (MDR-TB) was alarming high (newly treated: 19–26%, previously treated: 60–70%). COPD, asthma (2–15%) and ILD (0.006%) prevalence was only reported for Russia and Kazakhstan. No studies on cystic fibrosis, lung cancer and pulmonary hypertension were found. TB costs varied between US$400 (Tajikistan) and US$900 (Russia) for drug-susceptible TB to ≥US$10,000 for MDR-TB (Russia). Non-TB data were scarce and inconsistent. Especially in CA, more research into the prevalence and burden of RDs is needed.
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22
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Yan X, Xu L, Shi B, Wang H, Xu X, Xu G. Epidemiology and risk factors of chronic obstructive pulmonary disease in Suzhou: a population-based cross-sectional study. J Thorac Dis 2020; 12:5347-5356. [PMID: 33209368 PMCID: PMC7656423 DOI: 10.21037/jtd-20-1616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The prevalence of chronic obstructive pulmonary disease (COPD) in Suzhou remains still unknown. The aim of this study was to quantify the disease burden and assess the risk factors of COPD. Methods This was a population-based, cross-sectional study of adults aged 40 years and older in Suzhou. A total of 4,864 adults were identified from June 2018 to December 2018 and 4,725 adults were finally recruited. Subjects underwent post-bronchodilator spirometry and were diagnosed according to the 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD). Results The data from 4,725 adults were ultimately included in the final analysis. The overall prevalence of COPD in subjects aged 40 and older was 12.4%, while it was 12.3% in men and 12.5% in women. Risk factors identified by multivariable logistic analysis were age (P<0.05, OR =2.29, 95% CI, 1.83–2.88) and underweight (BMI <18.5 kg/m2) (P<0.05, OR =1.57, 95% CI, 1.01–2.44). COPD patients also displayed weaker grip strength (P<0.001). Approximately half (50.7%) the COPD patients were asymptomatic, and compared with asymptomatic COPD patients, symptomatic COPD patients were older (69.5 vs. 67.2, P<0.05), smoked more frequently (12.1 vs. 7.1 pack year, P<0.05), had a more severe GOLD stage (stage I 27.0% vs. 39.4%, stage II 50.2% vs. 46.8%, stage III 17.0% vs. 11.1%, stage IV 5.8% vs. 2.7%, P<0.05), and a worse lung function index (FEV1, FVC, PEF, FEF25, FEF50, FEF75, FEF2575) (P<0.05). Conclusions COPD was found to be highly prevalent in adults aged 40 years and older in Suzhou. Age and underweight were major risk factors of COPD. Half of the COPD patients were asymptomatic, and displayed decreased lung function upon the onset of respiratory symptoms. Therefore, spirometry screening is essential for the early detection and management of COPD.
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Affiliation(s)
- Xiaopei Yan
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Baoyu Shi
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Hui Wang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiao Xu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Guopeng Xu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
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23
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Müllerová H, Dransfield MT, Thomashow B, Jones PW, Rennard S, Karlsson N, Fageras M, Metzdorf N, Petruzzelli S, Rommes J, Sciurba FC, Tabberer M, Merrill D, Tal-Singer R. Clinical Development and Research Applications of the Chronic Obstructive Pulmonary Disease Assessment Test. Am J Respir Crit Care Med 2020; 201:1058-1067. [PMID: 31815521 DOI: 10.1164/rccm.201907-1369pp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hana Müllerová
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Paul W Jones
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Stephen Rennard
- University of Nebraska, Omaha, Nebraska.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fageras
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Frank C Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maggie Tabberer
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | - Ruth Tal-Singer
- Value Evidence and Outcomes, Medical Innovation, Global Medical R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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24
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Irritable bowel syndrome increases the risk of chronic obstructive pulmonary disease: A retrospective cohort study. Sci Rep 2020; 10:10008. [PMID: 32561774 PMCID: PMC7305148 DOI: 10.1038/s41598-020-66707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Both inflammation and infection are associated with the development of irritable bowel syndrome (IBS) and chronic obstructive pulmonary disease (COPD). The purpose of this study is to further elucidate the association between IBS and COPD through a retrospective cohort study. We enrolled IBS patients diagnosed between 2000 and 2011 with follow-up for at least one year. The non-IBS patients as comparison group were selected with 1:3 matching by propensity score. Statistical analysis was utilized to assess the differences in characteristic distribution, and to compare the cumulative incidence of COPD between the IBS and non-IBS cohorts. We selected 14,021 IBS patients and 42,068 non-IBS patients for comparison. The IBS patients exhibited a significant risk to develop COPD compared with non-IBS patients. Additionally, the cumulative incidence rate of COPD in the IBS cohort increased significantly during the follow-up period of more than ten years, compared to the non-IBS cohort, based on the Kaplan-Meier analysis. The risk of COPD was also significantly decreased in those patients with more than eighteen IBS-related clinical visits. This retrospective cohort study demonstrates the significantly increased risk of COPD in patients with IBS. Therefore, early inspection and prevention of COPD is essential for patients with IBS.
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25
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Axelsson M, Ilmarinen P, Backman H, Ekerljung L, Hedman L, Langhammer A, Lindberg A, Lindqvist A, Nwaru BI, Pallasaho P, Sovijärvi A, Vähätalo I, Kankaanranta H, Hisinger-Mölkänen H, Piirilä P, Rönmark E. Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland - the Nordic EpiLung study. J Asthma 2020; 58:1196-1207. [PMID: 32475292 DOI: 10.1080/02770903.2020.1776727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. METHOD In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. RESULTS The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2% versus 6.3-6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. CONCLUSION The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
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Affiliation(s)
- Malin Axelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Ari Lindqvist
- Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki University and Clinical Research Institute HUCH Ltd, Helsinki, Finland
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | | | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
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26
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Abdulsalim S, Unnikrishnan MK, Manu MK, Alsahali S, Alrasheedy AA, Martin AP, Godman B, Alfadl AA. Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India. PHARMACOECONOMICS - OPEN 2020; 4:331-342. [PMID: 31368087 PMCID: PMC7248138 DOI: 10.1007/s41669-019-0172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs) such as India. Medicine costs are a key issue in LMICs, with typically high patient co-payments. In addition, pharmacists are underutilised in LMICs, including India. However, pharmacist-led educational interventions may improve the care of patients with COPD, as well as reduce medicine costs. Consequently, the objective of this study was to assess the effectiveness of a pharmacist-led intervention in reducing medicine costs. METHODOLOGY We assessed the impact of a pharmacist intervention on direct medicine costs in COPD patients (medicine costs and pharmacist time) in a randomised controlled study involving an intervention and control group, conducted at a tertiary care teaching hospital in India. RESULTS The 6-monthly cost of medicines at baseline increased with disease severity, from a maximum of US$29.46 for those with mild COPD to US$63.28 for those with very severe COPD. Substantial savings in medical costs were achieved with the pharmacist-led programme, to a maximum of US$20.49 over 6 months for very severe patients. This equates to a reduction of 30.6% in medicine costs (p < 0.001), reduced to 26.1% when pharmacists' time (US$3.00/patient) was included. CONCLUSION There could be a key role for pharmacists as educators for COPD patients in LMICs, to improve care and reduce costs, including patient co-payments.
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Affiliation(s)
- Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- MCOPS, Manipal Academy of Higher Education, Manipal, India
| | | | - Mohan K. Manu
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Saud Alsahali
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- HCD Economics, The Innovation Centre, Daresbury, WA4 4FS UK
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM Penang, Malaysia
| | - Abubakr A. Alfadl
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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27
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Ford JA, Liu X, Chu SH, Lu B, Cho MH, Silverman EK, Costenbader KH, Camargo CA, Sparks JA. Asthma, Chronic Obstructive Pulmonary Disease, and Subsequent Risk for Incident Rheumatoid Arthritis Among Women: A Prospective Cohort Study. Arthritis Rheumatol 2020; 72:704-713. [PMID: 32129572 PMCID: PMC7188599 DOI: 10.1002/art.41194] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/19/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Inflamed airways are hypothesized to contribute to rheumatoid arthritis (RA) pathogenesis due to RA-related autoantibody production, and smoking is the strongest environmental RA risk factor. However, the role of chronic airway diseases in RA development is unclear. We undertook this study to investigate whether asthma and chronic obstructive pulmonary disease (COPD) were each associated with RA. METHODS We performed a prospective cohort study of 205,153 women in the Nurses' Health Study (NHS, 1988-2014) and NHSII (1991-2015). Exposures were self-reported physician-diagnosed asthma or COPD confirmed by validated supplemental questionnaires. The primary outcome was incident RA confirmed by medical record review by 2 rheumatologists. Covariates (including smoking pack-years/status) were assessed via biennial questionnaires. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for RA were estimated using Cox regression. RESULTS We identified 15,148 women with confirmed asthma, 3,573 women with confirmed COPD, and 1,060 incident RA cases during 4,384,471 person-years (median 24.0 years/participant) of follow-up in the NHS and NHSII. Asthma was associated with increased RA risk (HR 1.53 [95% CI 1.24-1.88]) compared to no asthma/COPD after adjustment for covariates, including smoking pack-years/status. Asthma remained associated with increased RA risk when analyzing only never-smokers (HR 1.53 [95% CI 1.14-2.05]). COPD was also associated with increased RA risk (HR 1.89 [95% CI 1.31-2.75]). The association of COPD with RA was most pronounced in the subgroup of ever-smokers age >55 years (HR 2.20 [95% CI 1.38-3.51]). CONCLUSION Asthma and COPD were each associated with increased risk of incident RA, independent of smoking status/intensity and other potential confounders. These results provide support for the hypothesis that chronic airway inflammation may be crucial in RA pathogenesis.
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Affiliation(s)
- Julia A. Ford
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Xinyi Liu
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Su H. Chu
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bing Lu
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael H. Cho
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Edwin K. Silverman
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen H. Costenbader
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carlos A. Camargo
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A. Sparks
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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28
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Bergqvist J, Andersson A, Schiöler L, Olin AC, Murgia N, Bove M, Janson C, Abramson MJ, Leynaert B, Nowak D, Franklin KA, Pin I, Storaas T, Schlünssen V, Heinrich J, Hellgren J. Non-infectious rhinitis is more strongly associated with early-rather than late-onset of COPD: data from the European Community Respiratory Health Survey (ECRHS). Eur Arch Otorhinolaryngol 2020; 277:1353-1359. [PMID: 32048027 PMCID: PMC7160078 DOI: 10.1007/s00405-020-05837-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is associated with several co-morbidities and non-infectious rhinitis (NIR) has emerged as a new possible co-morbidity. The primary aim of this study is to confirm a previously reported association between NIR and COPD in a multicentre population over time. The secondary aim is to investigate the course over time of such an association through a comparison between early- and late-onset COPD. METHODS This study is part of the European Community Respiratory Health Survey (ECRHS). A random adult population from 25 centres in Europe and one in Australia was examined with spirometry and answered a respiratory questionnaire in 1998-2002 (ECRHS II) and in 2008-2013 (ECRHS III). Symptoms of non-infectious rhinitis, hay fever and asthma, and smoking habits were reported. Subjects reporting asthma were excluded. COPD was defined as a spirometry ratio of FEV1/FVC < 0.7. A total of 5901 subjects were included. RESULTS Non-infectious rhinitis was significantly more prevalent in subjects with COPD compared with no COPD (48.9% vs 37.1%, p < 0.001) in ECRHS II (mean age 43) but not in ECHRS III (mean age 54). In the multivariable regression model adjusted for COPD, smoking, age, BMI, and gender, non-infectious rhinitis was associated with COPD in both ECRHS II and III. CONCLUSION Non-infectious rhinitis was significantly more common in subjects with COPD at a mean age of 43. Ten years later, the association was weaker. The findings indicate that NIR could be associated with the early onset of COPD.
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Affiliation(s)
- Joel Bergqvist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden.
| | - Anders Andersson
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicola Murgia
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Mogens Bove
- Department of ENT and Oral Maxillofacial Surgery, NU Hospital Group, Trollhättan, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bénédicte Leynaert
- Inserm UMR1152, Pathophysiology and Epidemiology of Respiratory Diseases, University of Paris, Paris, France
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Karl A Franklin
- Department of Surgery and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Isabelle Pin
- Pneumologie Pédiatrique, Antenne Pédiatrique du CIC, Grenoble, France
| | - Torgeir Storaas
- SKS/RAAO-Helse Vest, Haukeland universitetssjukehus, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center (CPC), University Hospital, LMU Munich, Munich, Germany
| | - Johan Hellgren
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 9, 413 45, Gothenburg, Sweden
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Choate R, Pasquale CB, Parada NA, Prieto-Centurion V, Mularski RA, Yawn BP. The Burden of Cough and Phlegm in People With COPD: A COPD Patient-Powered Research Network Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 7:49-59. [PMID: 31999902 DOI: 10.15326/jcopdf.7.1.2019.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rationale Cough and phlegm are common symptoms of chronic obstructive pulmonary disease (COPD) and may significantly affect quality of life. This study assessed the burden of cough and phlegm on clinical outcomes and quality of life among people with a self-reported physician diagnosis of COPD. Methods Patient-reported data from the COPD Foundation's Patient-Powered Research Network (COPD PPRN) were utilized. Cough and phlegm severity and frequency were assessed by responses to questions on the COPD Assessment Test (CAT) and categorized into none/low, moderate and severe. Quality of life domains were evaluated using the Patient-Reported Outcome Measurement Information System (PROMIS-29). Associations between cough and phlegm levels and PROMIS-29 domains were examined using multivariate analysis of variance (MANOVA). Results The 5286 participants were average age 64.4 years (SD=11.4), 87.9% white, 60.4% female, 51.2% married, and 42.2% with caregivers. Approximately three-fourths of the participants had moderate or severe cough or phlegm levels. Respondents with moderate and high cough or phlegm had significantly worse dyspnea (p<0.0001), more exacerbations in the previous one year (p<0.0001), worse physical and social functioning, and more symptoms of anxiety and depression on PROMIS-29 compared to those with no/low cough and phlegm. Conclusions In this group of people with COPD, higher levels of cough and phlegm are associated with worse clinical and quality of life outcomes.
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Affiliation(s)
- Radmila Choate
- Research, COPD Foundation, Inc., Washington, DC.,University of Kentucky College of Public Health, Lexington
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Ichinose M, Fukushima Y, Inoue Y, Hataji O, Ferguson GT, Rabe KF, Hayashi N, Okada H, Takikawa M, Bourne E, Ballal S, DeAngelis K, Aurivillius M, Dorinsky P, Reisner C. Efficacy and Safety of Budesonide/Glycopyrrolate/Formoterol Fumarate Metered Dose Inhaler Formulated Using Co-Suspension Delivery Technology in Japanese Patients with COPD: A Subgroup Analysis of the KRONOS Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2979-2991. [PMID: 31920295 PMCID: PMC6939402 DOI: 10.2147/copd.s220850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022] Open
Abstract
Background KRONOS, a Phase III, multicenter, randomized, double-blind study (NCT02497001) conducted in Canada, China, Japan, and the USA, assessed the efficacy and safety of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler (BGF MDI), a triple fixed-dose combination therapy, relative to dual therapies in patients with moderate-to-very severe COPD. Here we present findings from the Japanese subgroup of KRONOS. Methods Patients received BGF MDI 320/18/9.6μg, glycopyrrolate/formoterol fumarate (GFF) MDI 18/9.6μg, budesonide/formoterol fumarate (BFF) MDI 320/9.6μg, or budesonide/formoterol fumarate dry powder inhaler (BUD/FORM DPI) 400/12μg twice-daily for 24 weeks. The primary endpoint was the change from baseline in morning pre-dose trough forced expiratory volume in 1 s (FEV1) over Weeks 12-24. Symptoms, quality of life, exacerbations, and safety were also assessed. Results In total, 416 Japanese patients (21.9% of the global KRONOS population) were randomized and treated with BGF MDI (n=139), GFF MDI (n=138), BFF MDI (n=70), or BUD/FORM DPI (n=69). Nominally significant improvements in the change from baseline in morning pre-dose trough FEV1 over Weeks 12-24 were observed for BGF MDI vs GFF MDI (least squares mean [LSM] difference 37 mL, 95% confidence interval [CI] 3, 72; P=0.0337) and BFF MDI (67 mL; 95% CI 25, 109; P=0.0020). Treatment with BGF MDI led to a nominally significant reduction in the rate of moderate/severe exacerbations vs GFF MDI (rate ratio 0.40, 95% CI 0.19, 0.83; P=0.0142). Compared with dual therapies, numerical improvements were observed with BGF MDI for Transition Dyspnea Index focal score and the change from baseline in Evaluating Respiratory Symptoms in COPD total score (P≤0.3899). All treatments were generally well tolerated. Conclusion BGF MDI nominally significantly improved lung function and numerically improved symptoms vs GFF MDI and BFF MDI. BGF MDI nominally significantly reduced exacerbations vs GFF MDI in Japanese patients with COPD. Efficacy and safety findings were generally comparable to those in the global KRONOS population.
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Affiliation(s)
- Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Christian-Albrechts University Kiel, Airway Research Center North, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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Kato M, Tomii K, Hashimoto K, Nezu Y, Ishii T, Jones CE, Kilbride S, Gross AS, Clifton CS, Lipson DA. The IMPACT Study - Single Inhaler Triple Therapy (FF/UMEC/VI) Versus FF/VI And UMEC/VI In Patients With COPD: Efficacy And Safety In A Japanese Population. Int J Chron Obstruct Pulmon Dis 2019; 14:2849-2861. [PMID: 31839705 PMCID: PMC6904247 DOI: 10.2147/copd.s226601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/31/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose The Informing the Pathway of COPD Treatment (IMPACT) study demonstrated that single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) reduces moderate/severe exacerbation rates and improves lung function and health status versus FF/VI or UMEC/VI dual therapy in patients with symptomatic COPD and a history of exacerbations. This analysis evaluated the efficacy and safety of FF/UMEC/VI in patients enrolled in Japan. Patients and methods IMPACT was a 52-week, randomized, double-blind, multicenter study comparing FF/UMEC/VI 100/62.5/25 µg with FF/VI 100/25 µg or UMEC/VI 62.5/25 µg in patients ≥40 years with symptomatic COPD and ≥1 moderate/severe exacerbation in the previous year. Endpoints included annual rate of on-treatment moderate/severe exacerbations (primary endpoint), time-to-first on-treatment moderate/severe exacerbation and change from baseline at Week 52 in trough FEV1, post-bronchodilator FEV1, St. George's Respiratory Questionnaire, and COPD Assessment Test score. Safety was also assessed. Results The Japan subgroup accounted for only 4% (378/10,355) of the overall IMPACT intent-to-treat (ITT) population. In the Japan subgroup, FF/UMEC/VI reduced the annual rate of on-treatment moderate/severe exacerbations by 15% (95% CI: -20, 40) versus FF/VI (compared with 15% [10, 20] in the ITT) and 36% (95% CI: 6, 57) versus UMEC/VI (compared with 25% [19, 30] in the ITT). FF/UMEC/VI reduced moderate/severe exacerbation risk (time-to-first), improved lung function and health status at Week 52 versus both dual therapies. These results were in the same direction and of a generally similar magnitude to those seen in the overall ITT population. No new safety signals were identified in the Japan subgroup compared with the ITT population. Pneumonia incidence was higher with FF/UMEC/VI and FF/VI versus UMEC/VI. Conclusion These results highlight the favorable benefit-risk profile of FF/UMEC/VI single-inhaler triple therapy compared with FF/VI or UMEC/VI dual therapy in patients in Japan with symptomatic COPD and ≥1 exacerbation in the prior year.
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Affiliation(s)
- Motokazu Kato
- Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Kishiwada, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Yasuko Nezu
- Evidence Generation Department, GlaxoSmithKline K.K., Tokyo, Japan
| | - Takeo Ishii
- MA Respiratory Department, GlaxoSmithKline K.K., Tokyo, Japan
| | - C Elaine Jones
- Development, R&D, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | - Annette S Gross
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline R&D, Sydney, Australia
| | - Christine S Clifton
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline R&D, Sydney, Australia
| | - David A Lipson
- Clinical Sciences, GlaxoSmithKline, Collegeville, PA, USA
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Akgün KM, Krishnan S, Feder SL, Tate J, Kutner JS, Crothers K. Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. Am J Hosp Palliat Care 2019; 37:278-285. [PMID: 31550901 DOI: 10.1177/1049909119877512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. METHODS Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. RESULTS The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate-severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate-severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate-severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate-severe OR = 1.09 [0.98-1.22]). CONCLUSION Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.
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Affiliation(s)
- Kathleen M Akgün
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Supriya Krishnan
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Janet Tate
- Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristina Crothers
- Department of Medicine, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA, USA
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Nakanishi M, Minakata Y, Tanaka R, Sugiura H, Kuroda H, Yoshida M, Yamamoto N. Simple standard equation for daily step count in Japanese patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1967-1977. [PMID: 31564845 PMCID: PMC6724423 DOI: 10.2147/copd.s218705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose The improvement of physical activity in patients with COPD is an important issue. However, no standard for the recommended number of steps for patients with COPD has been determined. We conducted a retrospective observational study to create a simple standard equation for the daily step count, which makes it easier to determine whether each subject is attaining his/her predicted value or not. Patients and methods Stable outpatients diagnosed with COPD whose physical activities had been measured using a triaxial accelerometer for more than 2 weeks were recruited from 5 institutes in Japan. Factors associated with the step count were detected by multivariate regression analysis. After the data were transformed to a normalized distribution, a multivariate linear regression equation was created using stepwise regression. Results One hundred sixty-two patients aged 72.3 (7.2) years and of FEV1 %pred 59.2 (22.8) % were recruited. Among the parameters, age, mMRC dyspnea scale and inspiratory capacity (IC) were detected by the stepwise method. The created standard equation was “Step count = (−0.079×[age]−1.595×[mMRC]+2.078×[IC]+18.149)3”. The correlations between the calculated values and the measured values were observed, and fixed, and proportional biases between them were also observed. When patients with <6500 steps/day were selected, no systematic bias between them could be detected. Conclusion A simple standard equation for Japanese patients with COPD was created using age, mMRC and IC, and could provide an individual-predicted value, especially for patients with <6500 steps/day.
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Affiliation(s)
- Masanori Nakanishi
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiaki Minakata
- Department of Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama, Japan
| | - Rie Tanaka
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hikaru Kuroda
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Hokkaido, Japan
| | - Makoto Yoshida
- Department of Respiratory Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Lainez S, Court-Fortune I, Vercherin P, Falchero L, Didi T, Beynel P, Piperno D, Frappe E, Froudarakis M, Vergnon J, Devouassoux G. Clinical ACO phenotypes: Description of a heterogeneous entity. Respir Med Case Rep 2019; 28:100929. [PMID: 31516821 PMCID: PMC6733899 DOI: 10.1016/j.rmcr.2019.100929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/25/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Because ACO (Asthma-COPD-Overlap) does not fill out asthma or COPD (Chronic Obstructive Pulmonary Disease) criteria, such patients are poorly evaluated. The aim of this study was to screen asthma and COPD for an alternative diagnosis of ACO, then to determine subgroups of patients, using cluster analysis. MATERIAL AND METHODS Using GINA-GOLD stepwise approach, asthmatics and COPD were screened for ACO. Clusterization was then performed employing Multiple Correspondent Analysis (MCA) model, encompassing 9 variables (age, symptoms onset, sex, BMI (Body Mass Index), smoking, FEV-1, dyspnea, exacerbation, comorbidity). Finally, clusters were compared to determine phenotypes. RESULTS MCA analysis was performed on 172 ACO subjects. To better distinguish clusters, the analysis was then focused on 55 subjects, having at least one cosine squared >0.3. Six clusters were identified, allowing the description of 4 phenotypes. Phenotype A represented overweighed heavy smokers, with an early onset and a severe disease (27% of ACO patients). Phenotype B gathered similar patients, with a late onset (29%). Patients from Phenotypes C-D were slighter smokers, presenting a moderate disease, with early and late onset respectively (respectively 13% and 31%). CONCLUSIONS By providing evidences for clusters within ACO, our study confirms its heterogeneity, allowing the identification of 4 phenotypes. Further prospective studies are mandatory to confirm these data, to determine both specific management requirements and prognostic value.
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Affiliation(s)
- S. Lainez
- Service de Pneumologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - I. Court-Fortune
- Service de Pneumologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - P. Vercherin
- Service de Santé Publique, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - L. Falchero
- Service de Pneumologie, L’Hôpital Nord-Ouest, CH de Villefranche-sur-Saône, Gleizé, France
| | - T. Didi
- Service de Pneumologie, CH Annecy Genevois, Metz-Tessy, France
| | - P. Beynel
- Service de Pneumologie, Hôpital Fleyriat, Bourg-en-Bresse, France
| | | | - E. Frappe
- Service de Pneumologie, Hôpital Du Gier, Saint-Chamond, France
| | - M. Froudarakis
- Service de Pneumologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - J.M. Vergnon
- Service de Pneumologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - G. Devouassoux
- Service de Pneumologie, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, and EA7426, Université Claude Bernard Lyon 1, France
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Chinai B, Hunter K, Roy S. Outpatient Management of Chronic Obstructive Pulmonary Disease: Physician Adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease Guidelines and its Effect on Patient Outcomes. J Clin Med Res 2019; 11:556-562. [PMID: 31413767 PMCID: PMC6681860 DOI: 10.14740/jocmr3888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a common and preventable illness that carries significant economic and social burden. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review of the available literature for the diagnosis and management of COPD. Despite being considered the standard of care, adherence to the GOLD guidelines varies among practitioners. In addition, there is yet to be a clear correlation between misalignment with GOLD practicing guidelines and patient outcomes. We studied the outpatient management of COPD, with special attention paid to whether or not adherence to the 2017 GOLD guidelines affected patient outcomes. Methods This retrospective electronic medical record review study observed the outpatient management of patients with COPD, aged 18 year or older, who presented to the suburban primary care office. Patients who received treatment according to the GOLD guidelines were compared with the patients who did not. Categorical data were analyzed as frequencies with percentages. Frequencies were compared using Chi-square and Fisher's exact tests. A P value < 0.05 was used to determine statistical significance. Results A total of 158 patients were included in this study. Thirty-six percent of the patients were treated according to the GOLD guidelines. There was no significant difference in the mortality, exacerbations or hospitalizations between the patients who were treated according to the GOLD guidelines and those who were not. Comparing prescribing practices for those treated according to the GOLD guidelines versus those who were not, a significant difference in management occurred in regards to long acting beta agonist (P < 0.05) and inhaled corticosteroid therapy (P < 0.001). The differences in the use of other pharmacological and nonpharmacological agents were not significant. Conclusions Adherence to the 2017 GOLD guidelines had no statistically significant difference in patient outcomes. GOLD nonadherent patients received long-acting beta agonist and inhaled corticosteroid therapy at a significantly higher frequency compared to GOLD-adherent patients.
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Affiliation(s)
- Brian Chinai
- Department of Internal Medicine, Cooper University Healthcare, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Healthcare, Camden, NJ, USA.,Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Department of Internal Medicine, Cooper University Healthcare, Camden, NJ, USA.,Cooper Medical School at Rowan University, Camden, NJ, USA
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Kume H, Hojo M, Hashimoto N. Eosinophil Inflammation and Hyperresponsiveness in the Airways as Phenotypes of COPD, and Usefulness of Inhaled Glucocorticosteroids. Front Pharmacol 2019; 10:765. [PMID: 31404293 PMCID: PMC6676333 DOI: 10.3389/fphar.2019.00765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background: The differential diagnosis in persistent airway limitation is sometimes not so clear in older adults. Airway eosinophilia and airway hyperresponsiveness may develop in some cases with chronic obstructive lung disease (COPD), independent of asthma. However, little is known about clinical significance of these phenotypes of COPD in detail. Aims and objectives: This clinical study was designed to examine prevalence of airway eosinophilia and airway hyperresponsiveness in COPD who have no symptom and no past history of asthma, and to examine involvement of these pathophysiological features of asthma in the management and therapy for COPD. Methods: Sputum examination via qualitative and quantitative procedures was performed in stable COPD (GOLD 1-3). When sputum eosinophils were qualitatively (≥+) or quantitatively assessed (≥3%), ciclesonide (inhaled glucocorticosteroids) was added on bronchodilators. In cases with FEV1 ≥ 70% of predicted values, acetylcholine provocation test was examined for assessment of airway hyperresponsiveness. Therapeutic effect was evaluated using spirometry and COPD assessment test (CAT). Results: Sputum eosinophils were observed in 65 (50.4%) of 129 subjects using qualitative analysis; in contrast, lower grade (>0%) and higher grade (≥3%) were observed in 15 (20.3%) and 25 (33.8%) of 74 subjects using quantitative analysis. Airway hyperresponsiveness developed in 46.9% of these subjects with sputum eosinophils. Exacerbations occurred much more frequently in lower-grade airway eosinophilia without ciclesonide than in higher-grade airway eosinophilia with ciclesonide. Airway hyperresponsiveness significantly increased frequency of exacerbations in COPD with both lower and higher grade in airway eosinophilia. Addition of ciclesonide to indacaterol markedly improved lung function (FEV1, IC), CAT score, and reliever use in these subjects with airway eosinophilia determined by qualitative analysis. However, ciclesonide was less effective in improving these values in subjects with airway hyperresponsiveness than in those without airway hyperresponsiveness. Conclusions: Airway eosinophilia and airway hyperresponsiveness are complicated with 25-50% of COPD that have no symptom and history for asthma. These phenotypes of COPD are closely related to symptom stability and reactivity to glucocorticosteroids. These phenotypes may play key roles for advancement of the management and therapy of this disease.
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Affiliation(s)
- Hiroaki Kume
- Department of Respiratory Medicine, Rinku General Medical Center, Izumisano, Japan.,Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Masayuki Hojo
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Rigo A, Paz-Lourido B. ¿Por qué la rehabilitación respiratoria no llega a todos los pacientes de enfermedad pulmonar obstructiva crónica que lo necesitan? Revisión de la literatura. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n2.67252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La rehabilitación respiratoria (RR) es un tratamiento clave en la enfermedad pulmonar obstructiva crónica, pero aun estando disponible, los pacientes no siempre acceden a ella.Objetivo. Identificar los factores que pueden limitar el acceso a la RR y que se relacionan con los pacientes, los médicos y los fisioterapeutas.Materiales y métodos. Se realizó una revisión de artículos publicados en inglés y español entre 2006 y 2018. Se usaron los términos “COPD”, “chronic obstructive pulmonary disease”, “COLD”, “chronic obstructive lung disease”, “physical therapy modalities”, “rehabilitation”, “health services accessibility” y “patient” en las bases de datos PubMed, PEDro, Scielo e IBECS.Resultados. Se seleccionaron 11 publicaciones. Entre las barreras que afectan a los pacientes destacan el transporte, la condición ambiental, las situaciones personales y algunos factores sociales y contextuales. El conocimiento de los profesionales, sus condiciones de trabajo y sus expectativas sobre beneficio de los protocolos de RR también son factores que condicionan el acceso de los pacientes.Conclusiones. La formación interprofesional de médicos y fisioterapeutas, la implantación de protocolos flexibles a las condiciones de los pacientes y las medidas organizativas e intersectoriales del sistema sanitario pueden facilitar la accesibilidad a la RR de los pacientes.
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Ham S, Oh YM, Roh TY. Evaluation and Interpretation of Transcriptome Data Underlying Heterogeneous Chronic Obstructive Pulmonary Disease. Genomics Inform 2019; 17:e2. [PMID: 30929403 PMCID: PMC6459164 DOI: 10.5808/gi.2019.17.1.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 01/23/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease, featured by airflow obstruction. Recently, a comprehensive analysis of the transcriptome in lung tissue of COPD patients was performed, but the heterogeneity of the sample was not seriously considered in characterizing the mechanistic dysregulation of COPD. Here, we established a new transcriptome analysis pipeline using a deconvolution process to reduce the heterogeneity and clearly identified that these transcriptome data originated from the mild or moderate stage of COPD patients. Differentially expressed or co-expressed genes in the protein interaction subnetworks were linked with mitochondrial dysfunction and the immune response, as expected. Computational protein localization prediction revealed that 19 proteins showing changes in subcellular localization were mostly related to mitochondria, suggesting that mislocalization of mitochondria-targeting proteins plays an important role in COPD pathology. Our extensive evaluation of COPD transcriptome data could provide guidelines for analyzing heterogeneous gene expression profiles and classifying potential candidate genes that are responsible for the pathogenesis of COPD.
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Affiliation(s)
- Seokjin Ham
- Department of Life Sciences, POSTECH, Pohang 37674, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Tae-Young Roh
- Department of Life Sciences, POSTECH, Pohang 37674, Korea.,Division of Integrative Biosciences and Biotechnology, POSTECH, Pohang 37674, Korea
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Vashakidze SA, Kempker JA, Jakobia NA, Gogishvili SG, Nikolaishvili KA, Goginashvili LM, Magee MJ, Kempker RR. Pulmonary function and respiratory health after successful treatment of drug-resistant tuberculosis. Int J Infect Dis 2019; 82:66-72. [PMID: 30844519 PMCID: PMC6528816 DOI: 10.1016/j.ijid.2019.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Post-treatment morbidity among subjects with drug-resistant tuberculosis (DR-TB) is unclear. Methods: This was a cross-sectional study of patients from Tbilisi, Georgia with cavitary DR-TB and an outcome of cure. Participants had a chest X-ray (CXR), St. George Respiratory Quality (SGRQ) survey, and pulmonary function tests (PFTs) performed. Correlations between SGRQ and PFT results and factors associated with pulmonary impairment were examined. Results: Among 58 subjects (median age 31 years), 40% used tobacco, 59% had prior TB, and 47% underwent adjunctive surgical resection. The median follow-up time was 41 months. Follow-up CXR revealed fibrosis in 30 subjects (52%) and bronchiectasis in seven (12%). The median forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio was 0.72, with 24 subjects (41%) having a ratio of ≤0.70. Significant correlations existed between PFT measures and overall and component SGRQ scores. In linear regression, age, prior TB, and CXR fibrosis or bronchiectasis were significantly associated with decreased pulmonary function. Adjunctive surgery was significantly associated with a higher percent predicted FEV1 and FVC. Conclusions: A high proportion of DR-TB subjects had residual pulmonary impairment, particularly with recurrent TB and severe radiological disease. The association of surgical resection with improved lung function deserves further study. PFTs and SGRQ may both be useful to evaluate lung health.
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Affiliation(s)
| | - Jordan A Kempker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nino A Jakobia
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | | | - Matthew J Magee
- Georgia State University, School of Public Health, Atlanta, GA, USA
| | - Russell R Kempker
- Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Hanania NA, Sethi S, Koltun A, Ward JK, Spanton J, Ng D. Long-term safety and efficacy of formoterol fumarate inhalation solution in patients with moderate-to-severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 14:117-127. [PMID: 30643398 PMCID: PMC6311322 DOI: 10.2147/copd.s173595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Formoterol fumarate inhalation solution (FFIS; Perforomist®) is a long-acting β2-agonist (LABA) marketed in the US as a nebulized COPD maintenance treatment. Because long-term LABA use was associated with a potential increased risk of exacerbation or death in asthma patients, the US Food and Drug Administration (FDA) requested a postmarketing commitment study to evaluate long-term safety in COPD patients. Methods This was a multicenter, randomized, double-blind, placebo-controlled, noninferiority study. Patients (N=1,071; mean age, 62.6 years; 48.5% male; 89.7% white) with moderate-to-severe COPD on stable COPD therapy received FFIS (20 µg; n=541) or placebo (n=530) twice daily. The primary end point was the combined incidence of respiratory death, first COPD-related ER visit, or first COPD exacerbation-related hospitalization during 1 year post randomization. Noninferiority to placebo was concluded if the two-sided 90% CI of the HR of FFIS to placebo was <1.5. Secondary end points included spirometry. Results The planned 1-year treatment period was completed by 520 patients; 551 discontinued prematurely (FFIS: 45.7%; placebo: 57.4%). The median treatment duration was approximately 10 and 7 months for FFIS and placebo, respectively. Among 1,071 randomized patients, 121 had ≥1 primary event (FFIS: 11.8%; placebo: 10.8%). The estimated HR of a primary event with FFIS vs placebo was 0.965 (90% CI: 0.711, 1.308), demonstrating that FFIS was noninferior to placebo. No respiratory deaths were observed in the FFIS group. Adverse events were similar for FFIS vs placebo (patients with ≥1 treatment-emergent adverse events: 374 [69.1%] vs 369 [69.6%], respectively). Compared with placebo, FFIS demonstrated statistically greater improvements from baseline in trough FEV1, FVC, percent predicted FEV1, and patient-reported outcomes (Transition Dyspnea Index). Conclusions Nebulized FFIS was noninferior to placebo with respect to safety in patients with moderate-to-severe COPD. Additionally, fewer treatment withdrawals and larger lung function improvements were observed with FFIS compared with placebo when added to other maintenance COPD therapies.
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Affiliation(s)
- Nicola A Hanania
- Asthma Clinical Research Center, Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sanjay Sethi
- Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Arkady Koltun
- Global Medical Affairs, Mylan Inc., Canonsburg, PA, USA
| | - Jonathan K Ward
- Mylan Global Respiratory Group, Mylan Pharma UK Ltd., Sandwich, Kent, UK,
| | - Jacqui Spanton
- Mylan Global Respiratory Group, Mylan Pharma UK Ltd., Sandwich, Kent, UK,
| | - Dik Ng
- Mylan Global Respiratory Group, Mylan Pharma UK Ltd., Sandwich, Kent, UK,
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Kc R, Shukla SD, Gautam SS, Hansbro PM, O'Toole RF. The role of environmental exposure to non-cigarette smoke in lung disease. Clin Transl Med 2018; 7:39. [PMID: 30515602 PMCID: PMC6279673 DOI: 10.1186/s40169-018-0217-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 02/03/2023] Open
Abstract
Chronic exposure to household indoor smoke and outdoor air pollution is a major contributor to global morbidity and mortality. The majority of these deaths occur in low and middle-income countries. Children, women, the elderly and people with underlying chronic conditions are most affected. In addition to reduced lung function, children exposed to biomass smoke have an increased risk of developing lower respiratory tract infections and asthma-related symptoms. In adults, chronic exposure to biomass smoke, ambient air pollution, and opportunistic exposure to fumes and dust are associated with an increased risk of developing chronic bronchitis, chronic obstructive pulmonary disease (COPD), lung cancer and respiratory infections, including tuberculosis. Here, we review the evidence of prevalence of COPD in people exposed to non-cigarette smoke. We highlight mechanisms that are likely involved in biomass-smoke exposure-related COPD and other lung diseases. Finally, we summarize the potential preventive and therapeutic strategies for management of COPD induced by non-cigarette smoke exposure.
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Affiliation(s)
- Rajendra Kc
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Sanjay S Gautam
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
- Centenary Institute and University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ronan F O'Toole
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
- Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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42
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Santambrogio L, Tarsia P, Mendogni P, Tosi D. Transplant options for end stage chronic obstructive pulmonary disease in the context of multidisciplinary treatments. J Thorac Dis 2018; 10:S3356-S3365. [PMID: 30450242 DOI: 10.21037/jtd.2018.04.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lung transplantation (LTx) in advanced stage chronic obstructive pulmonary disease (COPD) patients is associated with significant improvement in lung function and exercise capacity. However, demonstration that the procedure also provides a survival benefit has been more elusive compared to other respiratory conditions. Identification of patients with increased risk of mortality is crucial: a low forced expiratory volume in 1 second (FEV1) is perhaps the most common reason for referral to a lung transplant center, but in itself is insufficient to identify which COPD patients will benefit from LTx. Many variables have to be considered in the selection of candidates, time for listing, and choice of procedure: age, patient comorbidities, secondary pulmonary hypertension, the balance between individual and community benefit. This review will discuss patient selection, transplant listing, potential benefits and critical issues of bilateral (BLTx) and single lung (SLTx) procedure, donor-to-recipient organ size-matching; furthermore, it will describe LTx outcomes and its effects on recipient survival and quality of life.
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Affiliation(s)
- Luigi Santambrogio
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Tarsia
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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43
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Lipworth BJ, Collier DJ, Gon Y, Zhong N, Nishi K, Chen R, Arora S, Maes A, Siddiqui S, Reisner C, Martin UJ. Improved lung function and patient-reported outcomes with co-suspension delivery technology glycopyrrolate/formoterol fumarate metered dose inhaler in COPD: a randomized Phase III study conducted in Asia, Europe, and the USA. Int J Chron Obstruct Pulmon Dis 2018; 13:2969-2984. [PMID: 30310273 PMCID: PMC6167125 DOI: 10.2147/copd.s171835] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background COPD is a major global cause of mortality and morbidity. PINNACLE-4 evaluated the efficacy and safety of GFF MDI (glycopyrrolate/formoterol fumarate metered dose inhaler) in patients from Asia, Europe, and the USA with moderate-to-very severe COPD. Methods In this double-blind, placebo-controlled, Phase III study, patients were randomized to treatment with GFF MDI 18/9.6 μg, glycopyrrolate (GP) MDI 18 μg, formoterol fumarate (FF) MDI 9.6 μg, or placebo MDI (all twice daily) for 24 weeks. Lung function, patient-reported outcomes (symptoms and health-related quality of life), and safety were assessed. Results Of the 1,756 patients randomized, 1,740 patients were included in the intent-to-treat population (mean age 64.2 years, 74.1% male, and 40.2% Asian). GFF MDI significantly improved morning predose trough FEV1 at Week 24 (primary endpoint) vs placebo MDI, GP MDI, and FF MDI (least squares mean differences: 165, 59, and 72 mL, respectively; all P<0.0001). GFF MDI also significantly improved other lung function endpoints vs placebo MDI, GP MDI, and FF MDI and patient-reported outcomes vs placebo MDI and GP MDI. A larger proportion of patients treated with GFF MDI achieved the minimum clinically important difference in Transition Dyspnea Index score vs GP MDI and placebo MDI and in St George’s Respiratory Questionnaire score vs placebo MDI. Adverse event rates were similar across treatment groups. Conclusion These results demonstrated the efficacy of GFF MDI in patients with moderate-to-very severe COPD. GFF MDI was well tolerated, with a safety profile commensurate with long-acting bronchodilators.
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Affiliation(s)
- Brian J Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK,
| | - David J Collier
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Yasuhiro Gon
- Itabashi Hospital, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Koichi Nishi
- Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Rongchang Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | | | - Andrea Maes
- Pearl - a member of the AstraZeneca group, Morristown, NJ, USA
| | | | - Colin Reisner
- Pearl - a member of the AstraZeneca group, Morristown, NJ, USA.,AstraZeneca, Gaithersburg, MD, USA
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Lai CC, Wu CH, Wang YH, Wang CY, Wu VC, Chen L. The association between COPD and outcomes of patients with advanced chronic kidney disease. Int J Chron Obstruct Pulmon Dis 2018; 13:2899-2905. [PMID: 30271136 PMCID: PMC6147210 DOI: 10.2147/copd.s174215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of COPD on the outcomes of patients with advanced chronic kidney disease (CKD). Patients and methods All patients with advanced CKD from 2000 to 2010 were identified from the Taiwanese National Health Insurance Research Database. Associations between COPD and the risk of long-term dialysis and all-cause mortality were assessed. Results A total of 33,399 advanced CKD patients were enrolled, of whom 31,536 did not have COPD (non-COPD group) and 1,863 had COPD (COPD group). The incidence of end-stage renal disease (ESRD) was higher for those with COPD than those without COPD (744.2 per 1,000 person-years vs 724.6 per 1,000 person-years, adjusted HR [aHR] 1.04; 95% CI 0.96–1.12). The cumulative incidence rates of ESRD were similar between the COPD and non-COPD groups (log-rank test, P=0.356). Overall, the patients with COPD had a higher risk of death than those without COPD (151.7 per 1,000 person-years vs 125.5 per 1,000 person-years, aHR 1.22; 95% CI 1.11–1.33). The cumulative mortality rate was higher in the COPD group than in the non-COPD group (log-rank test, P<0.001). Conclusion COPD increased the risk of mortality among the advanced CKD patients in this study, especially the elderly and male patients. In contrast, COPD did not increase the risk of ESRD among the advanced CKD patients.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Zhunan, Taiwan
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ;
| | - Cheng-Yi Wang
- Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ;
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Likwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
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45
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D'Urzo AD, Cazzola M, Hanania NA, Buhl R, Maleki-Yazdi MR. New developments in optimizing bronchodilator treatment of COPD: a focus on glycopyrrolate/formoterol combination formulated by co-suspension delivery technology. Int J Chron Obstruct Pulmon Dis 2018; 13:2805-2819. [PMID: 30233171 PMCID: PMC6135066 DOI: 10.2147/copd.s113306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COPD causes considerable health and economic burden worldwide, with incidence of the disease expected to continue to rise. Inhaled bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), are central to the maintenance treatment of patients with COPD. Clinical studies have demonstrated that combined LAMA + LABA therapies improve efficacy while retaining a safety profile similar to LAMA or LABA alone. This has led to the development of several LAMA/LABA fixed-dose combination (FDC) therapies, which provide patients with the convenience of two active compounds in a single inhaler. GFF MDI (Bevespi Aerosphere®) is an FDC of glycopyrrolate/formoterol fumarate 18/9.6 µg formulated using innovative co-suspension delivery technology for administration via metered dose inhaler (MDI). GFF MDI was developed to make a treatment option available for patients who have a requirement or preference to use an MDI, rather than a dry powder or soft mist inhaler. Now that several LAMA/LABA FDCs have been approved for use in COPD, we review the impact of dual-bronchodilator treatment on COPD therapy and discuss recent clinical studies that are helping to develop a more comprehensive understanding of how LAMA/LABA FDCs can improve patient outcomes.
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Affiliation(s)
- Anthony D D'Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - M Reza Maleki-Yazdi
- Division of Respiratory Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Igarashi A, Fukuchi Y, Hirata K, Ichinose M, Nagai A, Nishimura M, Yoshisue H, Ohara K, Gruenberger JB. COPD uncovered: a cross-sectional study to assess the socioeconomic burden of COPD in Japan. Int J Chron Obstruct Pulmon Dis 2018; 13:2629-2641. [PMID: 30214181 PMCID: PMC6118262 DOI: 10.2147/copd.s167476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background COPD remains a major health problem in Japan. Patients with COPD experience a reduced quality of life (QoL) and have a higher chance of work impairment and productivity loss. However, there is a lack of data on the impact of COPD in terms of QoL and work activity impairment in Japan. This study assessed the socioeconomic burden of COPD in Japan and the impact it may have on the working age population. Patients and methods This was a 2-year retrospective chart review in COPD patients aged ≥40 years, with at least one health care visit to clinic or hospital in the previous 12 months. Patients were required to have available medical charts for at least the previous 24 months. Symptoms were assessed using COPD assessment test score; EuroQoL Group 5 Dimension (EQ-5D-5L) and work productivity and activity impairment general health questionnaires were used to evaluate health-related QoL and work productivity, and health care resource utilization data were obtained from clinical charts. Results In total, 71 patients aged <65 years, and 151 patients aged ≥65 years were included; the majority of patients had moderate or severe airflow limitation. Exacerbations (moderate or severe) were reported by ~35% of patients in both age groups; 52.1% and 62.9% of patients in the <65-year and ≥65-year age groups had COPD assessment test scores ≥10. EQ-5D-5L index scores in the <65-year and ≥65-year age groups were 0.79 and 0.77, respectively. Work productivity and activity impairment scores were higher in <65-year age group. Annual costs of health care resource use per patient in the <65-year and ≥65-year age groups were ¥438,975 (US$4,389) and ¥467,871 (US$4,678), respectively. Costs due to productivity loss were estimated to be ¥5,287,024 (US$52,870) in the <65-year age group and ¥3,018,974 (US$30,187) in the ≥65-year age group. Conclusion COPD represents a significant socioeconomic burden in Japan. Patients with COPD report significant use of health care resources. Higher impact on work impairment and productivity loss was observed frequently in the working age population.
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Affiliation(s)
- Ataru Igarashi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan,
| | - Yoshinosuke Fukuchi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Nagai
- Research Institute for Respiratory Diseases, Shin-Yurigaoka General Hospital, Kawasaki City, Japan
| | - Masaharu Nishimura
- Department of Pulmonary Medicine, Faculty School of Medicine, Hokkaido University, Hokkaido, Japan
| | | | - Kenichi Ohara
- Market Access Division, Novartis Pharma K.K., Tokyo, Japan
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Burgel PR, Laurendeau C, Raherison C, Fuhrman C, Roche N. An attempt at modeling COPD epidemiological trends in France. Respir Res 2018; 19:130. [PMID: 29950169 PMCID: PMC6022451 DOI: 10.1186/s12931-018-0827-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/08/2018] [Indexed: 11/24/2022] Open
Abstract
Background Anticipating the future burden of chronic obstructive pulmonary disease (COPD) is required to develop adequate public health policies. Methods A dynamic population model was built to estimate COPD prevalence by 2025 using data collected during the most recent large general population study on COPD prevalence in France (2005) as baseline values. Sensitivity analyses were performed to test the effect of variations in key input variables. Results The model predicted a steady increase in crude COPD prevalence among subjects aged≥45 years from 2005 (prevalence estimate: 84.51‰) to 2025 (projected prevalence: 95.76‰, + 0.56‰/yr). There was a 4-fold increase in the prevalence of GOLD grade 3–4 cases, a 23% relative increase in women and a 21% relative increase in subjects ≥75 years. In sensitivity analyses, these temporal trends were robust. Factors associated with > 5% relative variations in projected 2025 prevalence estimates were baseline prevalence and severity distribution, incidence in women and severity of incident cases, transition rates between severity grades, and mortality. Conclusions Projections of future COPD epidemiology consistently predict an increase in the prevalence of moderate-to-very severe COPD, especially due to increases among women and subjects aged ≥75 years. Developing robust prediction models requires collecting reliable data on current COPD epidemiology. Electronic supplementary material The online version of this article (10.1186/s12931-018-0827-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre-Régis Burgel
- Respiratory Medicine, Hôpital Cochin, AP-HP, EA2511, Université Paris Descartes, Sorbonne Paris Cité, 75014, Paris, France. .,Service de Pneumologie, Hôpital Cochin, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
| | | | - Chantal Raherison
- U1219 institut de santé publique, d'épidémiologie et de développement (ISPED), Service des maladies respiratoires, Université Bordeaux-Segalen, CHU de Bordeaux, 33600, Pessac, France
| | - Claire Fuhrman
- Respiratory Medicine, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - Nicolas Roche
- Respiratory Medicine, Hôpital Cochin, AP-HP, EA2511, Université Paris Descartes, Sorbonne Paris Cité, 75014, Paris, France
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Fukushima Y, Nakatani Y, Ide Y, Sekino H, St Rose E, Siddiqui S, Maes A, Reisner C. Randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of three doses of co-suspension delivery technology glycopyrronium MDI in Japanese patients with moderate-to-severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1187-1194. [PMID: 29695902 PMCID: PMC5905841 DOI: 10.2147/copd.s159246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Due to the burden of COPD in Japan, new pharmacologic treatments are needed to meet patient requirements. This study assessed the efficacy and safety of glycopyrronium (GP) delivered via metered dose inhaler (MDI) in Japanese patients with moderate-to-severe COPD. Methods This Phase IIb, multicenter, randomized, double-blind, 7-day, crossover study compared GP MDI 28.8, 14.4, and 7.2 μg with placebo MDI (all administered as two inhalations, twice daily). The primary endpoint was change from baseline in morning pre-dose trough forced expiratory volume in 1 second (FEV1) on Day 8. Secondary endpoints included FEV1 area under the curve from 0 to 2 hours (AUC0–2) and peak change from baseline in FEV1 on Days 1 and 8 and forced vital capacity AUC0–2 on Day 8. Safety was also assessed. ClinicalTrials.gov Identifier: NCT03256552; http://www.ClinicalTrials.gov. Results Sixty-six patients were randomized and 62 were included in the modified intent-to-treat population (mean age 67.5 years). All three GP MDI doses significantly improved change from baseline in morning pre-dose trough FEV1 on Day 8 compared with placebo MDI (least squares mean differences 108–131 mL; all p<0.0001). Significant improvements in secondary efficacy endpoints were also observed for all three GP MDI doses compared with placebo MDI (all p<0.0001). Dose–response plateaued at GP MDI 14.4 μg. No significant safety findings were observed with any GP MDI dose or placebo MDI. Conclusions The results of this study suggest that GP MDI 14.4 μg (7.2 μg per inhalation) is the most appropriate dose for use in Phase III studies in Japanese patients with moderate-to-severe COPD.
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Affiliation(s)
| | - Yuji Nakatani
- Department of Internal Medicine, Nakatani Hospital, Hyogo, Japan
| | - Yumiko Ide
- Department of Internal Medicine, Tokyo Center Clinic, Tokyo, Japan
| | - Hisakuni Sekino
- Department of Internal Medicine, Sekino Hospital, Tokyo, Japan
| | - Earl St Rose
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA
| | | | - Andrea Maes
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA
| | - Colin Reisner
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA.,AstraZeneca, Gaithersburg, MD, USA
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Zhu L, Ni Z, Luo X, Zhang Z, Wang S, Meng Z, Gu X, Wang X. The outcome and the influencing factors of the age of onset in post-mortem of chronic bronchitis patients: a retrospective study. Int J Chron Obstruct Pulmon Dis 2018; 13:645-652. [PMID: 29503538 PMCID: PMC5825962 DOI: 10.2147/copd.s157084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Chronic bronchitis is thought to occur in elderly patients, and smoking seems to be an important risk factor. The outcomes related to the age of onset in patients with chronic bronchitis are still unclear. Patients and methods A retrospective study was conducted on deceased patients whose diagnosis included bronchitis from 2010 to 2016. Patients were separated into two groups according to the age of onset (Group I, age ≤50 years old; Group II, age >50 years old). Information regarding disease course, smoking history, death age, number of admissions per year, Hugh Jones Index, and self-reported comorbidities of the patients was recorded. Results The courses of chronic cough and sputum were 33.38±7.73 years and 14.44±8.60 years in Group I and Group II, respectively (p<0.05). The death ages of Group I and Group II were 77.65±7.87 years and 84.69±6.67 years, respectively (p<0.05). There was a significant negative correlation between the number of hospital admissions per year and the age of onset. The age of onset was negatively associated with daily smoking count (r=−0.210) and total smoking count (r=−0.146). In Group I, there were fewer cases of coronary heart disease (OR =0.41 [0.24–0.71]), neurological diseases (OR =0.48 [0.24–0.97]), and total comorbidities (OR =0.67 [0.54–0.85]) than in Group II. Conclusion Patients with early onset chronic bronchitis had a longer history, younger death age, poorer health status, and lower incidence of comorbidities.
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Affiliation(s)
- Linyun Zhu
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhenhua Ni
- Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuming Luo
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhuhua Zhang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Shiqiang Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Ziyu Meng
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiandong Gu
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiongbiao Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
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Kurmi OP, Davis KJ, Hubert Lam KB, Guo Y, Vaucher J, Bennett D, Wang J, Bian Z, Du H, Li L, Clarke R, Chen Z. Patterns and management of chronic obstructive pulmonary disease in urban and rural China: a community-based survey of 25 000 adults across 10 regions. BMJ Open Respir Res 2018. [PMID: 29531747 PMCID: PMC5844384 DOI: 10.1136/bmjresp-2017-000267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with COPD deaths in China accounting for one-third of all such deaths. However, there is limited available evidence on the management of COPD in China. Methods A random sample of 25 011 participants in the China Kadoorie Biobank, aged 38–87 years, from 10 regions in China was surveyed in 2013–2014. Data were collected using interviewer-administered questionnaires on the diagnosis (‘doctor-diagnosed’ or ‘symptoms-based’) and management of COPD (including use of medication and other healthcare resources), awareness of diagnosis and severity of symptoms in COPD cases. Results Overall, 6.3% of the study population were identified as COPD cases (doctor-diagnosed cases: 4.8% and symptom-based cases: 2.4%). The proportion having COPD was higher in men than in women (7.9% vs 5.3%) and varied by about threefold (3.7%–10.0%) across the 10 regions. Among those with COPD, 54% sought medical advice during the last 12 months, but <10% reported having received treatment for COPD. The rates of hospitalisation for COPD, use of oxygen therapy at home and influenza or pneumococcal vaccinations in the previous year were 15%, 3% and 4%, respectively. Of those with COPD, half had moderate or severe respiratory symptoms, and over 80% had limited understanding of their disease and need for treatment. Conclusion Despite a high prevalence of COPD in China and its substantial impact on activities of daily living, knowledge about COPD and its management were limited.
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Affiliation(s)
- Om P Kurmi
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kourtney J Davis
- Real World Evidence and Epidemiology, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- National Co-ordinating Centre for China Kadoorie Biobank, Chinese Academy of Medical Sciences, Beijing, China
| | - Julien Vaucher
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jenny Wang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- National Co-ordinating Centre for China Kadoorie Biobank, Chinese Academy of Medical Sciences, Beijing, China
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology, Peking University Health Science Center, School of Public Health, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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