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Laviña E, Lumbreras S, Bravo L, Soriano JB, Izquierdo JL, Rodríguez JM. Alpha-1 Antitrypsin Gene Variants in Patients without Severe Deficiency Diagnosed with Pulmonary Emphysema on Chest CT. Int J Chron Obstruct Pulmon Dis 2024; 19:353-361. [PMID: 38333775 PMCID: PMC10849915 DOI: 10.2147/copd.s448593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Although pulmonary involvement due to alpha-1 antitrypsin (AAT) deficiency has been widely described, most studies focus on the genotypes causing severe deficiency (<60 mg/dL). Objective The aim of this study was to analyze the prevalence of the different AAT gene variants that do not cause severe deficiency in patients with pulmonary emphysema diagnosed by thoracic computed tomography (CT). Furthermore, we assessed the risk associated with a non-severe decrease in AAT values in the pathogenesis of emphysema. Methods Case-control study design that included patients who had a CT scan available of the entire thorax. In total, 176 patients with emphysema (cases) and 100 control subjects without emphysema were analyzed. Results The prevalence of variants was higher among cases (25.6%; 45/176) than controls (22%; 22/100), although the difference was not statistically significant (P=0.504) when analyzed globally. In the control group, all the variants detected were MS. Excluding this variant, statistically significant differences were observed in the remaining variants (MZ, SS and SZ). Only 18% of the controls (all MS) presented values below our limit of normality, and all had values very close to the reference value (90 mg/dL). In contrast, 76% of patients with the other variants presented pathological levels. In a logistic regression model, both smoking and a non-severe reduction in AAT (60 to 90 mg/dL) increased the probability of emphysema. Conclusion Our study confirms an association between certain variants in the alpha-1 antitrypsin gene that do not cause severe deficiency and the presence of pulmonary emphysema. This association with variants that are associated with reductions in serum AAT values is statistically significant and independent of smoking habit.
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Affiliation(s)
- Eduardo Laviña
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Escuela de Doctorado, Programa Doctoral en Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Sara Lumbreras
- Departamento de Organización Industrial, Escuela Técnica Superior de Ingeniería (ICAI), Universidad Pontificia Comillas – IIT, Madrid, Spain
| | - Lara Bravo
- Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Joan B Soriano
- Servicio de Neumología, Hospital Universitario de la Princesa; Facultad de Medicina, Universidad Autónoma de Madrid; and Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III; All in Madrid, Madrid, Spain
| | - José Luis Izquierdo
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Jose Miguel Rodríguez
- Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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Godoy R, Benavent Núñez M, Cruz J, López Yepes G, Parralejo Jiménez A, Callejas FJ, Izquierdo JL. Smokers and risk of hospital death by COVID calculated with SAVANA's natural language processing in the Castilla-La Mancha area. Rev Clin Esp 2024; 224:34-42. [PMID: 38142978 DOI: 10.1016/j.rceng.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and Natural Language Processing (NLP) technology is used. METHOD A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla La Mancha using Natural Language Processing and Artificial Intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. RESULTS Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (p < 0.0001).Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (p < 0.0001). CONCLUSION There is an increased risk of dying in hospital in SARS-COV2-infected patients who are active smokers or have smoked in the past.
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Affiliation(s)
- R Godoy
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Spain.
| | | | - J Cruz
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Spain
| | | | | | - F J Callejas
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Spain
| | - J L Izquierdo
- Servicio de Neumología, Hospital Universitario de Guadalajara, Spain
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Morena D, Izquierdo JL, Rodríguez J, Cuesta J, Benavent M, Perralejo A, Rodríguez JM. The Clinical Profile of Patients with COPD Is Conditioned by Age. J Clin Med 2023; 12:7595. [PMID: 38137664 PMCID: PMC10743861 DOI: 10.3390/jcm12247595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In recent years, many studies have analyzed the importance of integrating time, or aging, into the equation that relates genetics and the environment to the development and origin of COPD. Under conditions of daily clinical practice, our study attempts to identify the differences in the clinical profile of patients with COPD according to age and the impact on the global burden of the disease. This study is non-interventional and observational, using artificial intelligence and data captured from electronic medical records. The study population included patients who were diagnosed with COPD between 2011 and 2021. A total of 73,901 patients had a diagnosis of COPD. The mean age was 73 years (95% CI: 72.9-73.1), and 56,763 were men (76.8%). We observed a specific prevalence of obesity, heart failure, depression, and hiatal hernia in women (p < 0.001), and ischemic heart disease and obstructive sleep apnea (OSA) in men (p < 0.001). In the analysis by age ranges, a progressive increase in cardiovascular risk factors was observed with age. In conclusion, in a real-life setting, COPD is a disease that primarily affects older subjects and frequently presents with comorbidities that are decisive in the evolutionary course of the disease.
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Affiliation(s)
- Diego Morena
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Doctoral Program in Health Sciences, University of Alcalá, 28871 Alcalá de Henares, Spain
| | - José Luis Izquierdo
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | - Juan Rodríguez
- Geriatric Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
| | - Jesús Cuesta
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | | | | | - José Miguel Rodríguez
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
- Respiratory Medicine, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
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Morena D, Lumbreras S, Rodríguez JM, Campos C, Castillo M, Benavent M, Izquierdo JL. Chronic Respiratory Diseases as a Risk Factor for Herpes Zoster Infection. Arch Bronconeumol 2023; 59:797-804. [PMID: 37734964 DOI: 10.1016/j.arbres.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Herpes zoster (HZ) is a condition that results from the reactivation of the varicella zoster virus (VZV). Several diseases have been reported to increase the risk of developing HZ and postherpetic neuralgia (PHN). The objective of this study is to analyze the prevalence and risk factors for HZ and PHN in the most frequent chronic respiratory diseases, which are chronic obstructive pulmonary disease (COPD), asthma, lung cancer and obstructive sleep apnea (OSA). METHODS We conducted an observational, retrospective, non-interventional study between January 2012 and December 2020 based on data from the Castilla-La Mancha Regional Health System in Spain. We used the Savana Manager 3.0 artificial intelligence-enabled system to collect information from electronic medical records. RESULTS 31765 subjects presented a diagnosis of HZ. Mean age was 64.5 years (95%CI 64.3-64.7), and 58.2% were women. The prevalence of HZ showed an increasing trend in patients over the age of 50. A risk analysis adjusted for sex and comorbidities in COPD, asthma, lung cancer and OSA presented a higher risk of developing HZ in the first three (OR 1.16 [95%CI 1.13-1.19], 1.67 [1.63-1.71], 1.68 [1.60-1.76], respectively), which further increased in all three when associated with comorbidities. Regarding postherpetic neuralgia, an increased risk was only observed related to COPD and lung cancer (OR 1.24 [95%CI 1.23-1.25], 1.14 [1.13-1.16], respectively), further increasing when associated with comorbidities. CONCLUSIONS In a standard clinical practice setting, the most prevalent respiratory diseases (asthma, COPD and lung cancer) are related to a higher risk of HZ and PHN. These data are fundamental to assess the potential impact of vaccination in this population.
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Affiliation(s)
- Diego Morena
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain; Programa de Doctorado en Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain.
| | | | - José Miguel Rodríguez
- Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carolina Campos
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - María Castillo
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - José Luis Izquierdo
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
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Morena D, Campos C, Castillo M, Alonso M, Benavent M, Izquierdo JL. Impact of the COVID-19 Pandemic on the Epidemiological Situation of Pulmonary Tuberculosis-Using Natural Language Processing. J Pers Med 2023; 13:1629. [PMID: 38138856 PMCID: PMC10744898 DOI: 10.3390/jpm13121629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We aimed to analyze the impact of the COVID-19 pandemic on pulmonary tuberculosis (TB) using artificial intelligence. To do so, we compared the real-life situation during the pandemic with the pre-2020 situation. METHODS This non-interventional, retrospective, observational study applied natural language processing to the electronic health records of the Castilla-La Mancha region of Spain. The analysis was conducted from January 2015 to December 2020. RESULTS A total of 2592 patients were diagnosed with pulmonary tuberculosis; 64.6% were males, and the mean age was 53.5 years (95%CI 53.0-54.0). In 2020, pulmonary tuberculosis diagnoses dropped by 28% compared to 2019. In total, 62 (14.2%) patients were diagnosed with COVID-19 and pulmonary tuberculosis coinfection in 2020, with a mean age of 52.3 years (95%CI 48.3-56.2). The main symptoms in these patients were dyspnea (27.4%) and cough (35.5%), although their comorbidities were no greater than patients with isolated TB. The female sex was more frequently affected, representing 53.4% of this patient subgroup. CONCLUSIONS During the first year of the COVID-19 pandemic, a decrease was observed in the incidence of pulmonary tuberculosis. Women presented a significantly higher risk for pulmonary tuberculosis and COVID-19 coinfection, although the symptoms were not more severe than patients diagnosed with pulmonary tuberculosis alone.
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Affiliation(s)
- Diego Morena
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
- Programa de Doctorado en Ciencias de la Salud, Universidad de Alcalá, 28801 Madrid, Spain
| | - Carolina Campos
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | - María Castillo
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | - Miguel Alonso
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
| | | | - José Luis Izquierdo
- Servicio de Neumología, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain; (C.C.); (M.C.); (M.A.); (J.L.I.)
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28801 Madrid, Spain
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Soler-Cataluña JJ, Izquierdo JL, Juárez Campo M, Sicras-Mainar A, Nuevo J. Impact of COPD Exacerbations and Burden of Disease in Spain: AVOIDEX Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1103-1114. [PMID: 37313500 PMCID: PMC10259458 DOI: 10.2147/copd.s406007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is characterized by high morbidity and mortality, with a considerable consumption of healthcare resources (HRU). This study aims to obtain real world evidence regarding the consequences of COPD exacerbations and to provide updated data on the burden of this disease and its treatment. Patients and Methods A retrospective study in seven Spanish regions was conducted among COPD patients diagnosed between 1/01/2010 and 31/12/2017. The index date was the diagnosis of COPD and patients were followed until lost to follow-up, death or end of the study, whichever occurred first. Patients were classified by patient pattern (incident or prevalent), type and severity of exacerbations, and treatments prescribed. Demographic and clinical characteristics were evaluated, together with the incidence of exacerbations, comorbidities, and the use of HRU, during the baseline (12 months before the index date) and the follow-up periods by incident/prevalent and treatment prescribed. Mortality rate was also measured. Results The study included 34,557 patients with a mean age of 70 years (standard deviation: 12). The most frequent comorbidities were diabetes, osteoporosis, and anxiety. Most patients received inhaled corticosteroids (ICS) with long-acting beta agonists (LABA), or long-acting muscarinic agonists (LAMA), followed by LABA with LAMA. Incident patients (N=8229; 23.8%) had fewer exacerbations than prevalent patients (N=26328; 76.2%), 0.3 vs 1.2 exacerbations per 100 patient-years. All treatment patterns present a substantial disease burden, which seems to increase with the evolution of the disease (ie moving from initial treatments to combination therapies). The overall mortality rate was 40.2 deaths/1000 patient-years. General practitioner visits and tests were the HRU most frequently required. The frequency and severity of exacerbations positively correlated with the use of HRU. Conclusion Despite receiving treatment, patients with COPD suffer a considerable burden mainly due to exacerbations and comorbidities, which require a substantial use of HRU.
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Affiliation(s)
- Juan José Soler-Cataluña
- Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
- Medicine Department, Universitat de València, Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - José Luis Izquierdo
- Medicine and Medical Specialties Department, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
- Respiratory Medicine Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Antoni Sicras-Mainar
- Health Economics and Outcomes Research Department, Atrys Health SA, Barcelona, Spain
| | - Javier Nuevo
- Medical Department, AstraZeneca MC, Madrid, Spain
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José Soler-Cataluña J, Miravitlles M, Fernández-Villar A, Izquierdo JL, García-Rivero JL, Cosio BG, López-Campos JL, Agustí A. Exacerbations in COPD: a personalised approach to care. Lancet Respir Med 2023; 11:224-226. [PMID: 36780913 DOI: 10.1016/s2213-2600(22)00533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023]
Affiliation(s)
- Juan José Soler-Cataluña
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, 46015 Valencia, Spain; Departamento de Medicina, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología, Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro de Vigo, Vigo, Spain
| | - José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Alcalá de Henares, Spain; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Borja G Cosio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario Son Espases, Palma, Spain
| | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Alvar Agustí
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Catedra Salud Respiratoria, Universidad de Barcelona, Institut Respiratori, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Izquierdo JL, Oeste CL, Hernández Medrano I. Artificial Intelligence in Pneumology: Diagnostic and Prognostic Utilities. Arch Bronconeumol 2023; 59:67-68. [PMID: 35908985 DOI: 10.1016/j.arbres.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/07/2023]
Affiliation(s)
- José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain; Servicio de Neumología, Hospital Universitario de Guadalajara, Spain.
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Paly VF, Vallejo-Aparicio LA, Martin A, Izquierdo JL, Riesco JA, Soler-Cataluña JJ, Abreu C, Biswas C, Ismaila AS. Cost-Effectiveness of Once-Daily Single-Inhaler COPD Triple Therapy in Spain: IMPACT Trial. Int J Chron Obstruct Pulmon Dis 2022; 17:3097-3109. [PMID: 36561129 PMCID: PMC9766529 DOI: 10.2147/copd.s366765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose Given between-country differences in healthcare systems, treatment costs, and disease management guidelines, country-specific cost-effectiveness analyses are important. This study evaluated the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI and UMEC/VI among patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations from a Spanish healthcare system perspective. Patients and Methods Baseline data and treatment effects from the IMPACT trial were populated into the validated GALAXY COPD progression model. Utilities were estimated using Spanish observational data. Direct healthcare costs (2019 €) were informed by Spanish public sources. A 3% discount rate for costs and benefits was applied. The time horizon and treatment duration were 3 years (base case). One-way sensitivity, scenario, and probabilistic sensitivity analyses were performed. Results FF/UMEC/VI treatment resulted in fewer exacerbations over 3 years (4.130 vs 3.648) versus FF/VI, with a mean (95% confidence interval [CI]) incremental cost of €444 (€149, €713) per patient and benefit of 0.064 (0.053, 0.076) quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €6887 per QALY gained. FF/UMEC/VI was a dominant treatment strategy versus UMEC/VI, resulting in fewer exacerbations (4.130 vs 3.360), with a mean (95% CI) incremental cost of -€450 (-€844, -€149) and benefit of 0.054 (0.043, 0.064) QALYs. FF/UMEC/VI was cost-effective versus FF/VI and UMEC/VI across all analyses. Conclusion FF/UMEC/VI was predicted to be a cost-effective treatment option versus FF/VI or UMEC/VI in symptomatic COPD patients at risk of exacerbations in Spain, across all scenarios and sensitivity analyses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Correspondence: Afisi S Ismaila, Value Evidence and Outcomes, GSK, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USA, Tel +1 919 315 8229, Email
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Micheletto C, Izquierdo JL, Avdeev SN, Rada Escobar RA, Pacheco Gallego MC. N-acetylcysteine as a therapeutic approach to post-COVID-19 pulmonary fibrosis adjunctive treatment. Eur Rev Med Pharmacol Sci 2022; 26:4872-4880. [PMID: 35856379 DOI: 10.26355/eurrev_202207_29212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Growing interest is directed to the outcomes of COVID-19 in survivors, both in the convalescent period and in the long-term, which are responsible for morbidity and quality of life deterioration. This article aims to describe the mechanisms supporting the possible use of NAC as an adjuvant treatment for post-COVID-19 pulmonary fibrosis. MATERIALS AND METHODS A search was performed in PubMed/MEDLINE. RESULTS Interstitial changes have been observed in the CT scan of COVID-19 pneumonia. In patients with respiratory outcomes in the post-COVID-19 stage, glutathione (GSH) deficiency was found and interpreted as a reaction to the inflammatory cascade caused by the viral infection, while the pathophysiological process of pulmonary fibrosis involves numerous cytokines, such as TGF-β, TNF-α, IL-1, PDGF and VEGF. NAC has a good tolerability profile, is easily administered orally and inexpensively, and has antioxidant and anti-inflammatory effects that may target the pathophysiologic mechanisms involved in pulmonary fibrosis. It may revert GSH deficiency, exerts direct and indirect antioxidant activity, anti-inflammatory activity and improves immune T-cell response. CONCLUSIONS The mechanism of action of NAC suggests a role in the treatment of pulmonary fibrosis induced by COVID-19.
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Affiliation(s)
- C Micheletto
- Respiratory Unit, Cardio-Thoracic Department, Integrated University Hospital of Verona, Verona, Italy.
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Izquierdo JL, Rodríguez JM, Almonacid C, Benavent M, Arroyo-Espliguero R, Agustí A. Real-life burden of hospitalizations due to COPD exacerbations in Spain. ERJ Open Res 2022; 8:00141-2022. [PMID: 35983537 PMCID: PMC9379352 DOI: 10.1183/23120541.00141-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer episodes of exacerbation of symptoms (ECOPD) that may eventually require hospitalization due to several, often overlapping, causes. We aimed to analyse the characteristics of patients hospitalized because of ECOPD in a real-life setting using a big-data approach. The study population included all patients older than 40 years with a diagnosis of COPD (n=69.359; prevalence 3.72%) registered since January 1st, 2011, until March 1, 2020, in the database of the public healthcare service (SESCAM) of Castilla-La Mancha (Spain) (n=1.863.759 subjects). We used natural language processing (Savana Manager v3.0) to identify those who were hospitalized during this period for any cause, including ECOPD. During the study 26.453 COPD patients (38.1%) were hospitalized (at least once). Main diagnoses at discharge were respiratory infection (51%), heart failure (38%) or pneumonia (19%). ECOPD was the main diagnosis at discharge (or hospital death) in 8.331 of them (12.0% of the entire COPD population and 31.5% of those hospitalized). In-hospital ECOPD-related mortality rate was 3.1%. These patients were hospitalized 2.36 times per patient, with a mean hospital stay of 6.1 days. Heart failure (HF) was the most frequent comorbidity in patients hospitalized because of ECOPD (52.6%). This analysis shows that, in a real-life setting, ECOPD hospitalizations are prevalent, complex (particularly in relation to HF), repetitive and associated with significant in-hospital mortality.
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Agustí A, Alcázar B, Ancochea J, Casanova C, Celli B, Cosio B, Echave-Sustaeta JM, Villar AF, Rivero JLG, González C, Izquierdo JL, Lopez-Campos JL, Trigo JMM, Sánchez JM, Miravitlles M, Molina J, Peces-Barba G, Roman M, Cataluña JJS, Villar-Alvarez F. [Translated article] The ANTES Program in COPD: First Year. Arch Bronconeumol 2022. [PMID: 35484017 DOI: 10.1016/j.arbres.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alvar Agustí
- Institut Respiratori, Hospital Clinic, Barcelona, Spain.
| | - Bernardino Alcázar
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Julio Ancochea
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain
| | - Ciro Casanova
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Bartolome Celli
- Brigham and Women's Hospital, Professor of Medicine, Harvard Medical School, Boston, United States
| | - Borja Cosio
- Servei de Pneumologia, Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | - Cruz González
- Servicio de Neumología, Hospital Universitario Clínico de Valencia, Spain
| | | | - José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Marc Miravitlles
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jesús Molina
- Centro de Salud Francia, Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Roman
- Centro de Salud Son Pisa, Palma de Mallorca, Spain
| | | | - Felipe Villar-Alvarez
- Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Agustí A, Alcázar B, Ancochea J, Casanova C, Celli B, Cosio B, Echave-Sustaeta JM, Fernandez Villar A, Garcia Rivero JL, González C, Izquierdo JL, Lopez-Campos JL, Marín Trigo JM, Martín Sánchez J, Miravitlles M, Molina J, Peces-Barba G, Roman M, Soler Cataluña JJ, Villar-Alvarez F. The ANTES program in COPD: First year. Arch Bronconeumol 2022; 58:291-294. [PMID: 35312529 DOI: 10.1016/j.arbres.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Alvar Agustí
- Institut Respiratori, Hospital Clinic, Barcelona, España.
| | - Bernardino Alcázar
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Julio Ancochea
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España
| | - Ciro Casanova
- Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Bartolome Celli
- Brigham and Women's Hospital, Professor of Medicine, Harvard Medical School, Boston, Estados Unidos
| | - Borja Cosio
- Servei de Pneumologia, Universitari Son Espases, Palma de Mallorca, España
| | | | | | | | - Cruz González
- Servicio de Neumología, Hospital Universitario Clínico de Valencia, España
| | | | - José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | | | | | - Marc Miravitlles
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Jesús Molina
- Centro de Salud Francia, Fuenlabrada, Madrid, España
| | - Germán Peces-Barba
- Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Miguel Roman
- Centro de Salud Son Pisa, Palma de Mallorca, España
| | | | - Felipe Villar-Alvarez
- Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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14
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Izquierdo JL, Soriano JB, González Y, Lumbreras S, Ancochea J, Echeverry C, Rodríguez JM. Use of N-Acetylcysteine at high doses as an oral treatment for patients hospitalized with COVID-19. Sci Prog 2022; 105:368504221074574. [PMID: 35084258 PMCID: PMC8795755 DOI: 10.1177/00368504221074574] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infection by SARS-CoV-2 causing coronavirus disease 2019 (COVID-19) can be
associated with serious and life-threatening conditions, including acute
respiratory distress syndrome (ARDS). Severity and mortality have been related
to a cytokine storm, an imbalance of oxidative stress, and a pro-thrombotic
state. We conducted an observational retrospective cohort study from a community-based
large population of hospitalized COVID-19 PCR + patients admitted from March 01,
2020, to January 24, 2021, with integrated primary to tertiary care information
in Castilla la Mancha, Spain. We explored the potential benefits of the
antioxidant, anti-inflammatory and anti-thrombotic drug N-acetylcysteine (NAC)
administered orally in high doses (600 mg every 8 h), added to standard of care
in COVID-19 patients by using the free text information contained in their
electronic health records (EHRs). Out of 19,208 patients with a diagnosis of COVID-19 hospitalized, we studied 2071
(10.8%) users of oral NAC at high doses. COVID-19 patients treated with NAC were
older, predominantly male, and with more comorbidities such as hypertension,
dyslipidemia, diabetes, and COPD when compared with those not on NAC (all
p < 0.05). Despite greater baseline risk, use of NAC in
COVID-19 patients was associated with significantly lower mortality (OR 0.56;
95%CI 0.47–0.67), a finding that remained significant in a multivariate analysis
adjusting by baseline characteristics and concomitant use of corticosteroids.
There were no significant differences with the use of NAC on the mean duration
of hospitalization, admission to the intensive care unit or use of invasive
mechanical ventilation. The observed association signaling to better relevant
outcomes in COVID-19 patients treated with NAC at high doses should be further
explored in other settings and populations and in randomized controlled
trials.
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Affiliation(s)
- José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain.,Respiratory Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Joan B Soriano
- Respiratory Medicine, 16517Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Sara Lumbreras
- SAVANA.,16768Universidad Pontificia Comillas-IIT, Madrid, Spain
| | - Julio Ancochea
- Respiratory Medicine, 16517Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - José Miguel Rodríguez
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain.,Respiratory Medicine, 16269Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Luis Izquierdo J, Casanova C, Celli B, Santos S, Sibila O, Sobradillo P, Agusti A. The 7 cardinal sins of COPD in Spain. Arch Bronconeumol 2022; 58:498-503. [DOI: 10.1016/j.arbres.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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Miravitlles M, Roman-Rodríguez M, Ribera X, Ritz J, Izquierdo JL. Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain. Int J Chron Obstruct Pulmon Dis 2022; 17:245-258. [PMID: 35115771 PMCID: PMC8800566 DOI: 10.2147/copd.s342220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain. Patients and Methods This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use. Results A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67–7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81–3.49), followed by higher mMRC and higher CAT score. Conclusion Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Correspondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, P. Vall d’Hebron 119-129, Barcelona, ES–08035, Spain, Email
| | - Miguel Roman-Rodríguez
- Centro de Salud Dra. Teresa Pique, Mallorca, Spain
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain
| | - Xavier Ribera
- Boehringer Ingelheim España, Sant Cugat del Vallés, Barcelona, Spain
| | - John Ritz
- Syneos Health - Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain
- Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Izquierdo JL, Almonacid C, Campos C, Morena D, Benavent M, González-de-Olano D, Rodríguez JM. Systemic Corticosteroids in Patients with Bronchial Asthma: A Real-Life Study. J Investig Allergol Clin Immunol 2021; 33:0. [PMID: 34779775 DOI: 10.18176/jiaci.0765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The objective of the present study was to determine the use of systemic corti-costeroids (SCs) in patients with bronchial asthma using big data analysis. METHODS We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was per-formed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. RESULTS During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients at some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, ob-esity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%) and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. CONCLUSION In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care.
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Affiliation(s)
- J L Izquierdo
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
- Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | - C Almonacid
- Respiratory Medicine, University Hospital of Toledo, Toledo, Spain
| | - C Campos
- Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | - D Morena
- Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - D González-de-Olano
- Allergy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - J M Rodríguez
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
- Respiratory Medicine, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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18
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Castelao J, Graziani D, Soriano JB, Izquierdo JL. Findings and Prognostic Value of Lung Ultrasound in COVID-19 Pneumonia. J Ultrasound Med 2021; 40:1315-1324. [PMID: 32936491 DOI: 10.1002/jum.15508] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The aim of this study was to systematically describe the findings of lung ultrasound (US) in patients with coronavirus 2019 (COVID-19) pneumonia and to analyze its prognostic value. METHODS Lung US examinations were performed in 63 patients with COVID-19 pneumonia admitted to a university hospital. Lung involvement was evaluated on a 4-point scale with a 12-area pulmonary division, obtaining a lung score (LS). Ultrasound findings and clinical characteristics were recorded. RESULTS All patients showed US involvement in at least 1 area (mean ± SD, 8 ± 3.5). The total LS was 15.3 ± 8.1, without differences between left and right lungs. Most affected regions were the lower region (95.2%) and the posterior region (73.8%). The total LS showed a strong correlation (r = -0.765) with the oxygen pressure-to-fraction of inspired oxygen ratio; by lung region, those with a higher correlation were the LS of the anterior region (r = -0.823) and the LS of the upper region (r = -0.731). In total, 22.2% of patients required noninvasive respiratory support (NIRS). A multivariate analysis showed that the anterior region LS, adjusted for age and sex, was significant (odds ratio, 2.159; 95% confidence interval, 1.309-3.561) for the risk of requiring NIRS. An anterior region LS of 4 or higher and a total LS of 19 or higher had similar characteristics to predict the need for NIRS. CONCLUSIONS Ultrasound involvement in COVID-19 pneumonia is bilateral and heterogeneous. Most affected regions are the posterior and the lower regions. The anterior region has prognostic value because its involvement strongly correlates with the risk of requiring NIRS, and an anterior region LS of 4 or higher has high sensitivity and specificity for predicting the need for NIRS.
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Affiliation(s)
- Jorge Castelao
- Pneumology Department, University Hospital of Guadalajara, Guadalajara, Spain
| | - Desirée Graziani
- Pneumology Department, University Hospital of Guadalajara, Guadalajara, Spain
| | - Joan B Soriano
- University Hospital la Princesa, Autónoma University, Madrid, Spain
- Centro de Investigación Biomédica en Red of Respiratory Diseases, Carlos III Health Institute, Madrid, Spain
| | - José Luis Izquierdo
- Pneumology Department, University Hospital of Guadalajara, Guadalajara, Spain
- Department of Medicine and Medical Specialties, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Izquierdo JL, Almonacid C, González Y, Del Rio-Bermudez C, Ancochea J, Cárdenas R, Lumbreras S, Soriano JB. The impact of COVID-19 on patients with asthma. Eur Respir J 2021; 57:13993003.03142-2020. [PMID: 33154029 PMCID: PMC7651839 DOI: 10.1183/13993003.03142-2020] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Background An association between the severity of coronavirus disease 2019 (COVID-19) and the presence of certain chronic conditions has been suggested. However, unlike influenza and other viruses, the disease burden of COVID-19 in patients with asthma has been less evident. Objective To understand the impact of COVID-19 in patients with asthma. Methods Using big-data analytics and artificial intelligence through the SAVANA Manager clinical platform, we analysed clinical data from patients with asthma from January 1 to May 10, 2020. Results Out of 71 182 patients with asthma, 1006 (1.41%) suffered from COVID-19. Compared to asthmatic individuals without COVID-19, patients with asthma and COVID-19 were significantly older (55 versus 42 years), predominantly female (66% versus 59%), smoked more frequently and had higher prevalence of hypertension, dyslipidaemias, diabetes and obesity. Allergy-related factors such as rhinitis and eczema were less common in asthmatic patients with COVID-19 (p<0.001). In addition, higher prevalence of these comorbidities was observed in patients with COVID-19 who required hospital admission. The use of inhaled corticosteroids (ICS) was lower in patients who required hospitalisation due to COVID-19, as compared to non-hospitalised patients (48.3% versus 61.5%; OR 0.58, 95% CI 0.44–0.77). Although patients treated with biologics (n=865; 1.21%) showed increased severity and more comorbidities at the ear, nose and throat level, COVID-19-related hospitalisations in these patients were relatively low (0.23%). Conclusion Patients with asthma and COVID-19 were older and at increased risk due to comorbidity-related factors. ICS and biologics are generally safe and may be associated with a protective effect against severe COVID-19 infection. The increased risk of hospitalisation due to COVID-19 in patients with asthma is largely associated with age and related comorbidities. ICS and biologics may be associated with a protective effect against the most severe manifestations of COVID-19. https://bit.ly/37yhr5b
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Affiliation(s)
- José Luis Izquierdo
- Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain.,Dept of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
| | - Carlos Almonacid
- Dept of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.,Respiratory Medicine, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | - Julio Ancochea
- Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigatión en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Sara Lumbreras
- Savana Medica, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - Joan B Soriano
- Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain .,Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigatión en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Graziani D, Soriano JB, Del Rio-Bermudez C, Morena D, Díaz T, Castillo M, Alonso M, Ancochea J, Lumbreras S, Izquierdo JL. Characteristics and Prognosis of COVID-19 in Patients with COPD. J Clin Med 2020; 9:E3259. [PMID: 33053774 PMCID: PMC7600734 DOI: 10.3390/jcm9103259] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher prevalence of coronary ischemia and other factors that put them at risk for COVID-19-related complications. We aimed to explore the impact of COVID-19 in a large population-based sample of patients with COPD in Castilla-La Mancha, Spain. We analyzed clinical data in electronic health records from 1 January to 10 May 2020 by using Natural Language Processing through the SAVANA Manager® clinical platform. Out of 31,633 COPD patients, 793 had a diagnosis of COVID-19. The proportion of patients with COVID-19 in the COPD population (2.51%; 95% CI 2.33-2.68) was significantly higher than in the general population aged >40 years (1.16%; 95% CI 1.14-1.18); p < 0.001. Compared with COPD-free individuals, COPD patients with COVID-19 showed significantly poorer disease prognosis, as evaluated by hospitalizations (31.1% vs. 39.8%: OR 1.57; 95% CI 1.14-1.18) and mortality (3.4% vs. 9.3%: OR 2.93; 95% CI 2.27-3.79). Patients with COPD and COVID-19 were significantly older (75 vs. 66 years), predominantly male (83% vs. 17%), smoked more frequently, and had more comorbidities than their non-COPD counterparts. Pneumonia was the most common diagnosis among COPD patients hospitalized due to COVID-19 (59%); 19% of patients showed pulmonary infiltrates suggestive of pneumonia and heart failure. Mortality in COPD patients with COVID-19 was associated with older age and prevalence of heart failure (p < 0.05). COPD patients with COVID-19 showed higher rates of hospitalization and mortality, mainly associated with pneumonia. This clinical profile is different from exacerbations caused by other respiratory viruses in the winter season.
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Affiliation(s)
- Desirée Graziani
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Joan B Soriano
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - Diego Morena
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Teresa Díaz
- SAVANA Medica, 28013 Madrid, Spain; (C.D.R.-B.); (T.D.)
| | - María Castillo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Miguel Alonso
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Julio Ancochea
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - José Luis Izquierdo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
- Department of Medicine and Medical Specialties, University of Alcalá, 28801 Madrid, Spain
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Prats L, Izquierdo JL. [Respiratory Disease in the Era of Big Data]. Open Respir Arch 2020; 2:284-288. [PMID: 38620700 PMCID: PMC7481841 DOI: 10.1016/j.opresp.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
One of the key elements of medicine in the second decade of the 21st century is the exponential growth of patient-produced information, due not only to the transition to the digitization of medical records, but also to the emergence of new sources of information and the capacity for analysis and interpretation of existing ones. The amount of medical information is expected to double every 2 years, which means that there will be 50 times more information available in 2020 than in 2011. In this setting, these large amounts of data or «big data» must be properly managed to implement new initiatives that improve the diagnosis, treatment, and prognosis of patients on the path to personalized medicine.The concept of personalization or precision medicine is of special interest in chronic respiratory disease. In recent years, research in entities such as asthma, COPD, cancer, or SAHS has focused on the identification of genomic, molecular, metabolic, and protein changes (biomarkers). Big data analysis tools can be used to move on from models based on the mean response to treatment, which are suboptimal for most patients, to focus on the individualized response. Part of this journey involves systems medicine, which also integrates clinical and population data to provide a multidimensional view of the disease and help identify causal associations that are usually only evident on big data analysis.
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Affiliation(s)
- Lourdes Prats
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Alcalá de Henares, España
| | - José Luis Izquierdo
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Alcalá de Henares, España
- Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
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Izquierdo JL, Morena D, González Y, Paredero JM, Pérez B, Graziani D, Gutiérrez M, Rodríguez JM. Clinical Management of COPD in a Real-World Setting. A Big Data Analysis. Arch Bronconeumol 2020; 57:94-100. [PMID: 32098727 DOI: 10.1016/j.arbres.2019.12.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform. MATERIALS AND METHODS A total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age. RESULTS In total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients: 4,396 mild, 7,100 moderate, and 6,676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a LAMA in 74% of cases, was observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and a rate of hospital mortality in this group of 10.74%. DISCUSSION This study identifies the main features of an unselected COPD population and the major errors made in the management of the disease.
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Affiliation(s)
- José Luis Izquierdo
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, España; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Diego Morena
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | | | - José Manuel Paredero
- Servicio de Farmacia de Atención Primaria, GAI de Guadalajara, Guadalajara, España
| | - Bernardino Pérez
- Servicio de Informática, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Desirée Graziani
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Matilde Gutiérrez
- Servicio de Contratación Administrativa, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José Miguel Rodríguez
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, España; Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Izquierdo JL, Miravitlles M, Esquinas C, Pérez M, Calle M, López Campos JL, Rodríguez González-Moro JM, Casanova C, Esteban C, de Lucas P. Características de los pacientes con EPOC tratados en neumología en España según grupos GOLD y fenotipos clínicos GesEPOC. Arch Bronconeumol 2018; 54:559-567. [DOI: 10.1016/j.arbres.2018.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 10/14/2022]
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Abstract
Background The use of inhaled corticosteroids (ICS) in combination with bronchodilators in patients with COPD has been shown to decrease the rate of disease exacerbations and to improve the lung function and patients’ quality of life. However, their use has also been associated with an increased risk of pneumonia. Materials and methods We have reviewed existing clinical evidence on the risks and benefits of ICS in COPD, including large randomized clinical trials, meta-analyses, and clinical reviews. Results A large body of evidence supports the clinical benefits of ICS in patients with COPD in terms of exacerbations, symptoms, lung function, and quality of life. The incidence of adverse events related to ICS, including pneumonia, varies strongly among the studies and seems to be dose dependent, with recent well-designed, large studies on low-dose ICS reporting similar safety profiles in ICS and non-ICS groups. Conclusion The benefits of ICS in COPD continue to outweigh the risks, especially when lower ICS doses are employed. Given that the data on ICS withdrawal in COPD are scarce and conflicting, we argue that using reduced doses of ICS could be an optimal strategy to manage patients with COPD.
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Affiliation(s)
- José Luis Izquierdo
- Department of Pneumology and Medicine, Hospital Universitario, Universidad de Alcalá, Guadalajara, Spain,
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa, Palma de Mallorca, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Arias T, Mateo J, España S, Izquierdo JL, Jiménez-Borreguero JJ, Ruiz-Cabello JM. Non-Invasive Imaging of Lung Remodeling and Right Ventricle Metabolic Shift in an Animal Model of Pulmonary Hypertension. ACTA ACUST UNITED AC 2016; 10 Suppl 1:e1-e2. [PMID: 27677127 DOI: 10.1016/j.jash.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T Arias
- National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - J Mateo
- National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - S España
- National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - J L Izquierdo
- Advance Imaging Unit, National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - J J Jiménez-Borreguero
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
| | - J M Ruiz-Cabello
- National Center for Cardiovascular Research (CNIC), Madrid, Spain
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Izquierdo JL, Paredero JM, Piedra R. Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:289-93. [PMID: 26929614 PMCID: PMC4755690 DOI: 10.2147/copd.s96948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this study was to assess the degree of adherence for two standard regimens for administrating anticholinergic drugs (12 and 24 hours) in patients with chronic obstruction of the airflow and to establish whether the use of a once-daily dose improves the level of treatment adherence. Methods We used long-acting anticholinergics (LAMAs) as a study variable, and included the entire health area of Castile-La Mancha, numbering 2,100,998 inhabitants, as the study population. We analyzed a total of 16,446 patients who had been prescribed a LAMA between January 1, 2013 and December 31, 2013. The follow-up period, based on a centralized system of electronic prescription management, was extended until December 2014. Results During 2013, the medication collected was 7.4%–10.7% higher than indicated by labeling. This was very similar for all LAMAs, irrespective of the patient’s sex, the molecule, the device, and the drug dosage. We did not observe seasonal variations in the consumption of LAMAs, nor did we detect differences between prescription drugs for once-daily (every 24 hours) versus twice-daily (every 12 hours) administration, between the different molecules, or between different types of inhalers for the same molecule. The results were similar in 2014. Conclusion The principal conclusion of this study is that, in an area with a centralized management system of pharmacological prescriptions, adherence to treatment with LAMAs is very high, irrespective of the molecules or inhalation device. We did not find that patients who used twice-daily medication had a lower adherence.
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Affiliation(s)
- José Luis Izquierdo
- Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - José Manuel Paredero
- Department of Pharmacy, Guadalajara Integrated Care Management, Guadalajara, Spain
| | - Raul Piedra
- Department of Primary Care, Guadalajara Integrated Care Management, Guadalajara, Spain
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Miravitlles M, Alcázar B, Alvarez FJ, Bazús T, Calle M, Casanova C, Cisneros C, de-Torres JP, Entrenas LM, Esteban C, García-Sidro P, Cosio BG, Huerta A, Iriberri M, Izquierdo JL, López-Viña A, López-Campos JL, Martínez-Moragón E, Pérez de Llano L, Perpiñá M, Ros JA, Serrano J, Soler-Cataluña JJ, Torrego A, Urrutia I, Plaza V. What pulmonologists think about the asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis 2015; 10:1321-30. [PMID: 26270415 PMCID: PMC4507793 DOI: 10.2147/copd.s88667] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. MATERIALS AND METHODS We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. RESULTS A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. CONCLUSION Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bernardino Alcázar
- Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, Spain
| | - Francisco Javier Alvarez
- Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Teresa Bazús
- Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Myriam Calle
- Department of Pneumology, Hospital Clínico San Carlos, Madrid, Spain
| | - Ciro Casanova
- Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Cisneros
- Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, Spain
| | - Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis M Entrenas
- Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Cristóbal Esteban
- Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | - Borja G Cosio
- Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, Spain
| | - Arturo Huerta
- Sección Urgencias Medicina - Neumología, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Milagros Iriberri
- Department of Pneumology, Hospital Universitario de Cruces, Bilbao, Spain
| | - José Luis Izquierdo
- Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Antolín López-Viña
- Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain ; Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | | | | | - Miguel Perpiñá
- Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Antonio Ros
- Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, Spain
| | - José Serrano
- Department of Pneumology, Hospital Comarcal de Inca, Inca, Spain
| | | | - Alfons Torrego
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Urrutia
- Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Rossi A, Aisanov Z, Avdeev S, Di Maria G, Donner CF, Izquierdo JL, Roche N, Similowski T, Watz H, Worth H, Miravitlles M. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respir Med 2015; 109:785-802. [DOI: 10.1016/j.rmed.2015.03.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/04/2015] [Accepted: 03/23/2015] [Indexed: 02/05/2023]
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Izquierdo JL. Looking at the Heart of Patients with Chronic Obstructive Pulmonary Disease. Respiration 2015; 90:187-8. [DOI: 10.1159/000439229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rojas Y, Naz S, Izquierdo JL, Nin N, Ferruelo A, García-Hierro P, Molina-Arana D, Herrero R, Martínez-Caro L, García A, de la Cal MA, Ruiz-Cabello JM, Barbas C, Lorente JA. 0852. Selective decontamination of the digestive tract modulates the metabolic profile in a ventilator-induced lung injury model. Intensive Care Med Exp 2014. [PMCID: PMC4797718 DOI: 10.1186/2197-425x-2-s1-p61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Izquierdo JL, Resano P, El Hachem A, Graziani D, Almonacid C, Sánchez IM. Impact of COPD in patients with lung cancer and advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. Int J Chron Obstruct Pulmon Dis 2014; 9:1053-8. [PMID: 25336937 PMCID: PMC4200171 DOI: 10.2147/copd.s68766] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
While it is relatively well known that the prognosis of patients with lung cancer (LC) treated with surgery is worse in the presence of chronic obstructive pulmonary disease (COPD), it is unknown if this assessment can be extrapolated to patients with advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. The aim of our study is to analyze the clinical characteristics and survival rates in patients with LC and COPD, and to compare these to the patients without airflow obstruction. From 471 evaluable patients, 324 (69%) were not treated with surgery due to disseminated disease (stages 3B and 4). Of them, 47.7% also had COPD. All patients were treated at the moment of diagnosis according to National Comprehensive Cancer Network guidelines with platinum-based chemotherapy or tyrosine kinase inhibitors. Kaplan–Meier curves showed no significant differences in overall survival between COPD and non-COPD patients (log–rank P=0.65). In the multivariate Cox proportional hazard model adjusting for the most relevant variables, the adjusted hazard ratio (HRadj) was statistically significant for performance status (HRadj =1.33, 95% confidence interval [CI]: 1.11–1.59; P=0.002) and clinical stage (HRadj =0.67, 95% CI: 0.50–0.89; P=0.006), but not for COPD status (HRadj =1.20, 95% CI: 0.83–1.50; P=0.46). Our conclusion is that at present, when using standard care in advanced LC (stages 3B and 4), COPD does not have a significant deleterious impact on overall survival.
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Affiliation(s)
| | - Pilar Resano
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | | | - Desiré Graziani
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Carlos Almonacid
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Ignacio M Sánchez
- Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain
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Soler-Cataluña JJ, Cosío B, Izquierdo JL, López-Campos JL, Marín JM, Agüero R, Baloira A, Carrizo S, Esteban C, Galdiz JB, González MC, Miravitlles M, Monsó E, Montemayor T, Morera J, Ortega F, Peces-Barba G, Puente L, Rodríguez JM, Sala E, Sauleda J, Soriano JB, Viejo JL. Consensus Document on the Overlap Phenotype COPD–Asthma in COPD. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.06.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Soler-Cataluña JJ, Cosío B, Izquierdo JL, López-Campos JL, Marín JM, Agüero R, Baloira A, Carrizo S, Esteban C, Galdiz JB, González MC, Miravitlles M, Monsó E, Montemayor T, Morera J, Ortega F, Peces-Barba G, Puente L, Rodríguez JM, Sala E, Sauleda J, Soriano JB, Viejo JL. Consensus document on the overlap phenotype COPD-asthma in COPD. Arch Bronconeumol 2012; 48:331-7. [PMID: 22341911 DOI: 10.1016/j.arbres.2011.12.009] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/02/2011] [Accepted: 12/07/2011] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. METHODS A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. RESULTS Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. CONCLUSIONS It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.
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Izquierdo JL, Martínez A, Guzmán E, de Lucas P, Rodríguez JM. Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors. Int J Chron Obstruct Pulmon Dis 2010; 5:387-94. [PMID: 21103405 PMCID: PMC2981153 DOI: 10.2147/copd.s14063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Indexed: 01/01/2023] Open
Abstract
The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic heart disease and whether this association is related with a greater prevalence of classical cardiovascular risk factors. Ours is a case-control cross-sectional study design. Cases were hospital patients with ischemic heart disease in stable phase, compared with control hospital patients. All patients underwent post-bronchodilator (PBD) spirometry, a standardized questionnaire, and blood analysis. COPD was defined as per GOLD PBD forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.70. In our series of patient cases (n = 204) and controls (n = 100), there were 169 men in the case group (83%) and 84 in the control group (84%). Ages were 67 and 64 years, respectively (P < 0.05). There were no significant differences by weight, body mass index (BMI), packyears, leukocytes, or homocysteine. The abdominal perimeter was significantly greater in cases (mean 101 cm ± standard deviation [SD] 10 versus 96 cm ± 11; P < 0.000). Both groups also had significant differences by C-reactive protein (CRP), fibrinogen, and hemoglobin values. In univariate analysis, increased risks for cases to show with individual classical cardiovascular risk factors were seen, with odds ratio (OR) 1.86 and 95% confidence interval (CI) (1.04–3.33) for diabetes mellitus, dyslipidemia (OR 2.10, 95% CI: 1.29–3.42), arterial hypertension (OR 2.47, 95% CI: 1.51–4.05), and increased abdominal perimeter (OR 1.71, 95% CI: 1.06–2.78). Percent predicted PBD FEV1 was 97.6% ± 23% in the patient group and 104% ± 19% in the control group (P = 0.01), but the prevalence of COPD was 24.1% in cases and 21% in controls. Therefore, COPD was not associated with ischemic heart disease: at the crude level (OR 1.19, 95% CI: 0.67–2.13) or after adjustment (OR 1.14, 95% CI:0.57–2.29). In conclusion, COPD was not associated with ischemic heart disease. The greater prevalence of classical cardiovascular risk factors in COPD patients could explain the higher occurrence of ischemic heart disease in these patients.
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Izquierdo JL, Martín A, de Lucas P, Rodríguez-González-Moro JM, Almonacid C, Paravisini A. Misdiagnosis of patients receiving inhaled therapies in primary care. Int J Chron Obstruct Pulmon Dis 2010; 5:241-9. [PMID: 20714378 PMCID: PMC2921692 DOI: 10.2147/copd.s11123] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Indexed: 11/23/2022] Open
Abstract
Aim: To analyze the accuracy of diagnosis in a population receiving inhaled therapies due to respiratory diseases in a primary care setting. Method: Noninterventional, multicenter, cross-sectional, observational epidemiologic study methodology. Results: A total of 9752 subjects were evaluated. Of these, 4188 (42.9%) patients were diagnosed with asthma, 4175 (42.8%) with chronic obstructive pulmonary disease (COPD), and 1389 had a diagnosis of disease of unknown origin. Of those over the age of 40 years, 4079 (50.9%) had COPD and 2877 (35.9%) had asthma. Sixty percent of the subjects were men, and the proportion of men was higher in patients with COPD (83.2%) than in the group with asthma (39.8%, P < 0.0001). Of subjects with COPD, 17.3% had mild, 55.3% had moderate, 24.1% had severe, and 3.2% had very severe disease. With regard to the level of severity of asthma, 34.9% of subjects had intermittent, 34.6% had mild persistent, 27.1% had moderate persistent, and 3.5% had severe persistent disease. Only 13.9% of patients in the COPD group had all the characteristics of COPD based on the Global Initiative for Chronic Obstructive Lung Disease criteria and an absence of the characteristics of asthma. Conclusions: The majority of patients receiving inhaled therapy in primary care did not have an accurate diagnosis according to current international guidelines for COPD and asthma. More initiatives for improving diagnostic accuracy in respiratory diseases must be implemented in primary care.
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Affiliation(s)
- José Luis Izquierdo
- Pneumology Department, University Hospital of Guadalajara, 19002 Guadalajara, Spain.
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Abstract
BACKGROUND Health-related quality of life measures are widely used in patients with chronic obstructive pulmonary disease (COPD). However, they are extremely limited when used to evaluate patients outside the clinical trials. The aim of this study was to analyse the burden of the disease using a simple, validated, self-administered questionnaire specifically developed for patients in daily clinical practice. METHODS A total of 3935 patients (74.5% men; mean age, 67 years) participated in a cross-sectional study. The burden of COPD on patients was measured using the Clinical COPD Questionnaire (CCQ). COPD was rated at four levels by the forced expiratory volume in one second (FEV(1)) according to The Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale. RESULTS The disease mainly affects old men (more than 50% were over 65 years of age) and non-employed men (23% were employed). Of the patients studied, 22.7% continued smoking, especially men (24.4% of men vs. 18.1% of women). Most patients (54%) were diagnosed with moderate stage II COPD. Severity of COPD was lower in women: 29.6% of men had severe COPD compared with 13.7% of women. During the last year, 65.1% had at least one acute exacerbation and 36.6% were admitted to hospital because of COPD exacerbation. No association was found between the body mass index and COPD stage. The variable that most influenced the disease burden was dyspnoea, as progression from grade 0 to grade 4 increased the disease burden by 1.78 points for symptoms, 2.43 for functional state and 1.53 for mental state. The functional classification of COPD also had a significant influence on the disease burden. CONCLUSIONS The present findings show that dyspnoea and the degree of airflow limitation are the clinical variables that most affect the burden of COPD from the patient's point of view.
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Affiliation(s)
- J L Izquierdo
- Sección de Neumología, Hospital General Universitario de Guadalajara, Guadalajara, Spain.
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Peces-Barba G, Barberà JA, Agustí A, Casanova C, Casas A, Izquierdo JL, Jardim J, López Varela V, Monsó E, Montemayor T, Viejo JL. [Diagnosis and management of chronic obstructive pulmonary disease: joint guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society (ALAT)]. Arch Bronconeumol 2008; 44:271-281. [PMID: 18448019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Peces-Barba G, Albert Barberà J, Agustí À, Casanova C, Casas A, Luis Izquierdo J, Jardim J, Varela VL, Monsó E, Montemayor T, Luis Viejo J. Guía clínica SEPAR-ALAT de diagnóstico y tratamiento de la EPOC. Arch Bronconeumol 2008. [DOI: 10.1157/13119943] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE To study whether patients with chronic obstructive pulmonary disease (COPD) at the same level of flow limitation but with different clinical phenotypes present different degrees of systemic and/or pulmonary inflammation. PATIENTS AND METHODS We studied 15 male smokers without COPD (control group) and 39 males with COPD in stable clinical condition. The COPD patients were assigned to 2 groups based on the ratio of carbon monoxide diffusing capacity (DLCO) to alveolar volume (DLCO/VA) expressed as a percentage as follows: a) mainly emphysema (n = 15) and b) mainly chronic bronchitis (n = 24). Classification was determined by comparing both clinical features and diagnostic images. RESULTS Mean (SD) concentrations of interleukin 8 (IL-8) and 8-isoprostane in exhaled breath condensate (EBC) were significantly lower in patients with mainly emphysema (IL-8, 0.34 [0.70] pg/mL; 8-isoprostane, 0.07 [0.26] pg/mL) than in patients with chronic bronchitis (IL-8, 2.32 [3.10] pg/mL; 8-isoprostane, 1.77 [2.98] pg/mL) or in the controls (IL-8, 3.14 [4.59] pg/mL; 8-isoprostane, 1.92 [2.84] pg/mL); P < .05 for IL-8 comparisons and P < .01 for 8-isoprostane. IL-8, leukotriene B4, and 8-isoprostano in EBC correlated significantly with DLCO/VA (% of predicted) (r = 0.30, P < .05; r = 0.29, P < or = .05; and r = 0.46, P < .01, respectively) but not with forced expiratory volume in 1 second. There was a negative correlation between EBC and serum levels of both IL-8 (r = -0.31; P < .05) and 8-isoprostane (r = -0.51; P < .001). The correlation between leukotriene B4 concentrations in EBC and serum was not significant, however. No significant differences were found between smokers' and ex-smokers' serum levels of IL-8, leukotriene B4, 8-isoprostane in serum or EBC. CONCLUSIONS The results indicate that COPD patients with an emphysematous phenotype have a less intense inflammatory response and less oxidative stress in the lung.
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Bousquet J, Aubier M, Sastre J, Izquierdo JL, Adler LM, Hofbauer P, Rost KD, Harnest U, Kroemer B, Albrecht A, Bredenbröker D. Comparison of roflumilast, an oral anti-inflammatory, with beclomethasone dipropionate in the treatment of persistent asthma. Allergy 2006; 61:72-8. [PMID: 16364159 DOI: 10.1111/j.1398-9995.2005.00931.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roflumilast is an oral, once-daily phosphodiesterase 4 inhibitor with anti-inflammatory activity in development for the treatment of asthma. Roflumilast was compared with inhaled beclomethasone dipropionate (BDP) in patients with asthma. METHODS In a double blind, double-dummy, randomized, noninferiority study, 499 patients (forced expiratory volume in 1 s [FEV1] = 50-85% predicted) received roflumilast 500 microg once daily or BDP 200 microg twice daily (400 microg/day) for 12 weeks. Lung function and adverse events were monitored. RESULTS Roflumilast and BDP significantly improved FEV1 by 12% (270 +/- 30 ml) and 14% (320 +/- 30 ml), respectively (P < 0.0001 vs baseline). Roflumilast and BDP also significantly improved forced vital capacity (FVC) (P < 0.0001 vs baseline). There were no significant differences between roflumilast and BDP with regard to improvement in FEV1 and FVC. Roflumilast and BDP showed small improvements in median asthma symptom scores (-0.82 and -1.00, respectively) and reduced rescue medication use (-1.00 and -1.15 median puffs/day, respectively; P < 0.0001 vs baseline). These small differences between roflumilast and BDP were not considered clinically relevant. Both agents were well tolerated. CONCLUSIONS Once daily, oral roflumilast 500 microg was comparable with inhaled twice-daily BDP (400 microg/day) in improving pulmonary function and asthma symptoms, and reducing rescue medication use in patients with asthma.
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Affiliation(s)
- J Bousquet
- Hôpital Arnaud de Villeneuve, Montpellier, France
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Sampablo Lauro I, Izquierdo JL. ¿Cuál debe ser el papel del neumólogo en el tratamiento quimioterapéutico del cáncer de pulmón? Arch Bronconeumol 2003. [DOI: 10.1157/13053210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Chronic obstructive pulmonary disease is a smoking-related condition of progressive airflow obstruction, with disabling symptoms of chronic dyspnoea, cough and sputum production. In Spain, as in other countries worldwide, only a limited number of studies have attempted to quantify the impact of COPD on the patient, healthcare system and society. To obtain comprehensive information about the burden of this disease, an economic analysis of a large international survey, Confronting COPD in North America and Europe, was conducted. The results of the economic analysis of data from the Spanish survey sample estimated that the annual cost of COPD to the healthcare system was Euro 3238 per patient, with indirect costs amounting to Euro 300 per patient bringing the total societal cost of the disease to Euro 3538 per patient per year. A significant proportion of the economic burden of COPD on the Spanish healthcare system was associated with inpatient hospitalization (Euro 2708), which accounted for almost 84% of the total direct cost of the disease. As the major cause of inpatient hospitalization for COPD is acute exacerbations, these results highlight the need for interventions in the outpatient setting to prevent exacerbations in Spain. The impact of COPD on the healthcare system may also be due to the underdiagnosis and treatment of COPD, suggesting that costs may be reduced by improving the diagnosis and treatment of the disease in primary care. The sub-analysis of costs from the survey showed that patients with severe COPD were associated with considerably higher total societal costs than patients with mild disease (Euro 9850 versus Euro 1316 per patient). Therefore, introducing interventions to reduce the progression to severe COPD could also reduce the impact of the disease.
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Affiliation(s)
- J L Izquierdo
- Pneumology Department, Hospital General Universitario de Guadalajara, Spain.
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Sampablo Lauro I, Izquierdo JL. ¿Cuál debe ser el papel del neumólogo en el tratamiento quimioterapéutico del cáncer de pulmón? Arch Bronconeumol 2003; 39:483-4. [PMID: 14588199 DOI: 10.1016/s0300-2896(03)75436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Finch R, Schürmann D, Collins O, Kubin R, McGivern J, Bobbaers H, Izquierdo JL, Nikolaides P, Ogundare F, Raz R, Zuck P, Hoeffken G. Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment. Antimicrob Agents Chemother 2002; 46:1746-54. [PMID: 12019085 PMCID: PMC127227 DOI: 10.1128/aac.46.6.1746-1754.2002] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective of the present trial was to compare the efficacy, safety, and tolerability of moxifloxacin (400 mg) given intravenously (i.v.) once daily followed by oral moxifloxacin (400 mg) for 7 to 14 days with the efficacy, safety, and tolerability of co-amoxiclav (1.2 g) administered by i.v. infusion three times a day followed by oral co-amoxiclav (625 mg) three times a day, with or without clarithromycin (500 mg) twice daily (i.v. or orally), for 7 to 14 days in adult patients with community-acquired pneumonia requiring initial parenteral therapy. A total of 628 patients were enrolled and assessed by evaluation of their clinical and bacteriological responses 5 to 7 days and 21 to 28 days after administration of the last dose of study medication. Although the trial was designed, on the basis of predefined outcomes, to demonstrate the equivalence of the two regimens, the results showed statistically significant higher clinical success rates (for moxifloxacin, 93.4%, and for comparator regimen, 85.4%; difference [Delta], 8.05%; 95% confidence interval [CI], 2.91 to 13.19%; P = 0.004) and bacteriological success rates (for moxifloxacin, 93.7%, and for comparator regimen, 81.7%; Delta, 12.06%; 95% CI, 1.21 to 22.91%) for patients treated with moxifloxacin. This superiority was seen irrespective of the severity of the pneumonia and whether or not the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster for patients who received moxifloxacin (median time, 2 versus 3 days), and the duration of hospital admission was approximately 1 day less for patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of i.v. administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] versus 57 [17.8%] patients). There were fewer deaths (9 [3.0%] versus 17 [5.3%]) and fewer serious adverse events (38 [12.6%] versus 53 [16.5%]) in the moxifloxacin group than in the comparator group. The rates of drug-related adverse events were comparable in both groups (38.9% in each treatment group). The overall incidence of laboratory abnormalities was similar in both groups. Thus, it is concluded that monotherapy with moxifloxacin is superior to that with a standard combination regimen of a beta-lactam and a beta-lactamase inhibitor, co-amoxiclav, with or without a macrolide, clarithromycin, in the treatment of patients with community-acquired pneumonia admitted to a hospital.
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Affiliation(s)
- R Finch
- Nottingham City Hospital, Nottingham. Bayer plc, Newbury, United Kingdom.
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Barberà JA, Peces-Barba G, Agustí AG, Izquierdo JL, Monsó E, Montemayor T, Viejo JL. [Clinical guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease]. Arch Bronconeumol 2001; 37:297-316. [PMID: 11412529 DOI: 10.1016/s0300-2896(01)75074-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J A Barberà
- Servei de Neumologia, Hospital Clinic, Villarroel, Barcelona, Spain
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Prieto A, Reyes E, Bernstein ED, Martinez B, Monserrat J, Izquierdo JL, Callol L, de LUCAS P, Alvarez-Sala R, Alvarez-Sala JL, Villarrubia VG, Alvarez-Mon M. Defective natural killer and phagocytic activities in chronic obstructive pulmonary disease are restored by glycophosphopeptical (inmunoferón). Am J Respir Crit Care Med 2001; 163:1578-83. [PMID: 11401877 DOI: 10.1164/ajrccm.163.7.2002015] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have investigated both modifications in natural (innate) immunity caused by chronic obstructive pulmonary disease (COPD) and the effects of a glycophosphopeptical immunomodulator (Inmunoferón) treatment on COPD-associated immunoalterations. In a double-blinded clinical trial, 60 patients with COPD received glycophosphopeptical or placebo during 90 consecutive days at oral doses of 3 g/d. Fifty-six sex- and age-matched healthy control subjects were included as a reference group for immunologic parameters. Peripheral blood natural killer (PBNK) cell cytotoxic activity and phagocytic activity of peripheral monocytes/macrophages (Mo/Ma) and polymorphonuclear (PMN) cells were assessed at baseline and then again at the end of treatments. We found both PBNK activity and phagocytic activity to be significantly decreased in patients with COPD compared with levels in healthy volunteers. The treatment with glycophosphopeptical provoked significant stimulatory effects on PBNK cytotoxic activity. This stimulation was not mediated by an increase in CD3(-)CD56(+) NK cells. Further, glycophosphopeptical significantly increased the percentage of monocytes and PMNs that phagocytize Escherichia coli in vitro, as well as increased phagocytic indices. We conclude that peripheral blood cells of patients with COPD show clear defects in natural immunity that are partially rescued by glycophosphopeptical.
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Affiliation(s)
- A Prieto
- Department of Medicine CSIC Associated Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Saetta M, Kim WD, Izquierdo JL, Ghezzo H, Cosio MG. Extent of centrilobular and panacinar emphysema in smokers' lungs: pathological and mechanical implications. Eur Respir J 1994; 7:664-71. [PMID: 8005246 DOI: 10.1183/09031936.94.07040664] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to quantify the extent of centrilobular (CLE) and panacinar (PLE) emphysema and the degree of the possible overlap between the two forms in smokers, the lungs of 25 smokers undergoing lung resection for peripheral lung tumours were studied. The extent of CLE and PLE was assessed by point counting, and the lungs were classified as having pure CLE (C, n = 5), predominant CLE with areas of PLE (CP, n = 7), predominant PLE with features of CLE (PC, n = 7), and pure PLE (P, n = 6) according to the percentage of lung involved by either form. Preoperative pulmonary function tests and the score of inflammation and the diameters of the small airways were also measured. Mean linear intercept (Lm), a measure of mean interalveolar wall distances and forced expiratory volume in one second (FEV1) were similar in the four groups. Small airway pathology was a predominant feature in lungs with CLE, and was significantly decreased in a stepwise fashion as the amount of PLE increased. This was especially so for the amount of muscle in the airway wall and the diameters of the airways. By contrast, lung compliance was higher in panacinar than in centrilobular emphysema.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Saetta
- Istituto di Medicina del Lavoro, Universita di Padova, Italy
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Kim WD, Eidelman DH, Izquierdo JL, Ghezzo H, Saetta MP, Cosio MG. Centrilobular and panlobular emphysema in smokers. Two distinct morphologic and functional entities. Am Rev Respir Dis 1991; 144:1385-90. [PMID: 1741553 DOI: 10.1164/ajrccm/144.6.1385] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to investigate the hypothesis that different morphologic patterns of disease might correspond to different mechanical properties of the lung in emphysema, pulmonary function tests and lung mechanics were measured in 34 subjects undergoing lung resection for peripheral lung tumors. Using standard microscopic criteria, pure or predominant centrilobular (n = 18) or panlobular (n = 16) emphysema was diagnosed in lungs. The degree of emphysema measured by the mean linear intercept (Lm) was not significantly different between the two groups. However, the coefficient of variation of the interalveolar wall distance (CV) was significantly higher for the same Lm in CLE than in PLE. This indicates that CLE has an uneven pattern of destruction, whereas PLE is more homogeneous. CLE had a higher degree of abnormalities in the small airways (SAD) than did PLE (p less than 0.05) mainly because of significantly higher muscle score (p less than 0.001) and fibrosis. CLE also had a higher proportion of airways less than 400 microns in diameter than did PLE (p less than 0.05). Static compliance, specific compliance, and the exponential constant (K) were significantly lower (p less than 0.005, p less than 0.001, and p less than 0.05, respectively) in CLE than in PLE. FEV1/FVC was significantly correlated with SAD in CLE (r = -0.69, p less than 0.01) but not in PLE (r = 0.29 p greater than 0.05); conversely, FEV1/FVC was significantly correlated with elasticity (K) in PLE (r = -0.72, p less than 0.01) but not in CLE (r = 0.08, p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W D Kim
- Respiratory Division of the Royal Victoria Hospital, Montreal, Quebec, Canada
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