Antibiotic de-escalation principle in elderly patients with chronic obstructive pulmonary disease complicated with severe pneumonia

Safety and Tolerability of Antimicrobial Agents in the Older Patient

Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug-drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.

Effect of terbutaline plus doxofylline on chronic obstructive pulmonary disease

OBJECTIVES

This study focused on patients with chronic obstructive pulmonary disease (COPD) and aimed at investigating the effect of terbutaline plus doxofylline on their pulmonary function and quality of life.

METHODS

Ninety COPD patients were divided by using a random number table into a control group (administration of doxofylline) and experimental group (administration of terbutaline combined with doxofylline), with 45 patients in each group. The therapeutic efficacy, pre- and post-treatment pulmonary function and the quality of life were compared between the control and experimental groups.

RESULTS

After treatment, patients in the experimental group had lower levels of interleukin-8, tumor necrosis factor α and C-reactive protein (all P<0.001), higher forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEVl/FVC (all P<0.001), and lower total score of COPD assessment test (P<0.05) compared with the control group.

CONCLUSION

Terbutaline combined with doxofylline for the treatment of COPD patients can efficiently decrease inflammatory factor levels, and bring them better pulmonary function and quality of life.

Post-discharge extended care contributes to the disease control of patients with COPD: a Chinese study

Background

The aim of this study was to evaluate the efficacy of extended care in patients with COPD.

Patients and methods

A total of 140 patients with GOLD-2 to -4 of COPD were included in final analysis. The care efficacy was evaluated by the St George’s Respiratory Questionnaire 12-item General Health Questionnaire (GHQ-12), pulmonary function test and blood gas analysis.

Results

The extended care improved the activity ability of COPD patients, relieved the clinical symptoms as well as reduced the impact degree of COPD to daily life (P<0.05). In addition, the extended care improved the mental health condition of patients with COPD compared with usual care (P<0.05). Moreover, the extended care improved the ventilation function of COPD patients, reduced the acute exacerbation rate and improved the blood gas levels compared with the usual care (P<0.05).

Conclusion

The extended care improves the quality of life, respiratory function and the mental health condition of patients with COPD after discharge, indicating that it contributes to the disease control of patients with COPD.

Effect of Pingchuan Guben decoction on patients with chronic obstructive pulmonary disease: Results from a randomized comparative effectiveness research trial

Chronic obstructive pulmonary disease (COPD) is known to be a systemic low-grade ongoing inflammation exerting major health and economic burden worldwide. Complementary and alternative medicines, such as Traditional Chinese Medicine, are widely used for the treatment of patients with COPD. The present study was designed to investigate the efficacy of Pingchuan Guben decoction on patients with COPD through a double-blinded, open-labeled, randomized controlled trial. A total of 86 patients were randomly assigned to two groups, with 43 patients in the intervention group and 43 cases in the control group. The patients in the control group were treated with conventional western medicine, and the intervention group received a combination of conventional western medicine and Pingchuan Guben decoction. After 12 weeks of treatment, the mean 6-minute walking distance, forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) and FEV1/FVC in the intervention group were significantly higher than those of the control group (P<0.05). The levels of inflammation factors and protease molecules were significantly ameliorated in the intervention group compared with the control group (P<0.05). The levels of Kelch-like ECH-associated protein 1 (Keap1), nuclear factor-E2-related factor-2 (Nrf2), superoxide anions, malondialdehyde, glutathione S-transferase and glutathione peroxidase were significantly more improved in the intervention group compared with those in the control group over the 12-week study period (P<0.05). Therefore, combinations of western medicine with Pingchuan Guben decoction may exert therapeutic effects on patients with COPD via modulations of inflammation factors and protease molecules, as well as the activation of the Keap1/Nrf2 signaling pathway.