Latest & greatest articles for copd exacerbations

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Top results for copd exacerbations

1. Do Antibiotics Improve Patient Outcomes in Acute Exacerbations of Chronic Obstructive Pulmonary Disease? Full Text available with Trip Pro

, and severity of COPD exacerbations. Thorax . 2002 ; 57 : 759–764 | | | , x 7 Seemungal, T., Harper-Owen, R., Bhowmik, A. et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2001 ; 164 : 1618–1623 | | | , x 8 Sethi, S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon?. Proc Am Thorac Soc . 2004 ; 1 : 109–114 | | | , x 9 Bafadhel, M., McKenna, S (...) ., Frei, A., Steurer-Stey, C.A. et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev . 2018 ; 10 : CD010257 Limitations of this meta-analysis include no consideration of underlying chronic obstructive pulmonary disease severity across trials because of poor reporting of lung function and other parameters. Studies were not limited to patients with suspected bacterial infection, who demonstrate the greatest benefit from antibiotics. Thus, the lack

2020 Annals of Emergency Medicine Systematic Review Snapshots

2. Metoprolol for the Prevention of Acute Exacerbations of COPD. (Abstract)

Metoprolol for the Prevention of Acute Exacerbations of COPD. Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.In this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All (...) the patients had a clinical history of COPD, along with moderate airflow limitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending

2019 NEJM

3. Efficacy and safety of inhaled alpha1-antitrypsin in patients with severe alpha1-antitrypsin deficiency and frequent exacerbations of COPD (Abstract)

Efficacy and safety of inhaled alpha1-antitrypsin in patients with severe alpha1-antitrypsin deficiency and frequent exacerbations of COPD Patients with inherited α1-antitrypsin (AAT) deficiency (ZZ-AATD) and severe chronic obstructive pulmonary disease (COPD) frequently experience exacerbations. We postulated that inhalation of nebulised AAT would be an effective treatment.We randomly assigned 168 patients to receive twice-daily inhalations of 80 mg AAT solution or placebo for 50 weeks (...) . Patients used an electronic diary to capture exacerbations. The primary endpoint was time from randomisation to the first event-based exacerbation. Secondary endpoints included change in the nature of the exacerbation as defined by the Anthonisen criteria. Safety was also assessed.Time to first moderate or severe exacerbation was a median of 112 days (interquartile range (IQR) 40-211 days) for AAT and 140 days (IQR 72-142 days) for placebo (p=0.0952). The mean yearly rate of all exacerbations was 3.12

2019 EvidenceUpdates

4. Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD

of Bias Appendix F. Results From Included Studies Appendix G. Results by Severity Appendix H. Adverse Events Appendix I. Inclusion and Exclusion Criteria of Included Studies Appendix J. Sensitivity Analysis Appendix K. Appendix References ES-1 Evidence Summary Background and Objectives Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by airflow limitation and chronic respiratory symptoms. The global prevalence is estimated to be greater than 10 percent (...) of experiencing exacerbations of COPD (ECOPD). There have been various definitions of what constitutes an ECOPD. The Global Initiative for chronic obstructive lung disease (GOLD) defines ECOPD in its 2019 report as “acute worsening of respiratory symptoms that result in additional therapy.” 5 ECOPD is generally characterized by increased dyspnea, increased frequency and severity of cough, and/or increased sputum production. 6 ECOPD is a leading independent cause of increased mortality and morbidity among

2019 Effective Health Care Program (AHRQ)

5. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Full Text available with Trip Pro

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical (...) practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging

2019 NEJM Controlled trial quality: predicted high

6. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions (Abstract)

CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global (...) Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L-1).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted

2019 EvidenceUpdates

7. [Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease]. Full Text available with Trip Pro

[Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease]. To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year.A triple blind, randomised controlled clinical trial with parallel design.to be between 40-75 years, having been diagnosed with COPD (...) of exacerbations in each group was checked.social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models.A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had

2019 Semergen Controlled trial quality: uncertain

8. Benralizumab for the Prevention of COPD Exacerbations. Full Text available with Trip Pro

Benralizumab for the Prevention of COPD Exacerbations. The efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) are not known.In the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. <220 per cubic millimeter (...) ]) who had frequent exacerbations despite receiving guideline-based inhaled treatment. Patients were randomly assigned to receive benralizumab (30 or 100 mg in GALATHEA; 10, 30, or 100 mg in TERRANOVA) every 8 weeks (every 4 weeks for the first three doses) or placebo. The primary end point was the treatment effect of benralizumab, measured as the annualized COPD exacerbation rate ratio (benralizumab vs. placebo) at week 56 in patients with baseline blood eosinophil counts of 220 per cubic millimeter

2019 NEJM Controlled trial quality: predicted high

9. Effect of Aclidinium Bromide on Major Cardiovascular Events and Exacerbations in High-Risk Patients With Chronic Obstructive Pulmonary Disease: The ASCENT-COPD Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Aclidinium Bromide on Major Cardiovascular Events and Exacerbations in High-Risk Patients With Chronic Obstructive Pulmonary Disease: The ASCENT-COPD Randomized Clinical Trial. There is concern that long-acting muscarinic antagonists increase cardiovascular morbidity or mortality in patients with chronic obstructive pulmonary disease (COPD).To determine the cardiovascular safety (noninferiority) and efficacy (superiority) of aclidinium bromide, 400 μg twice daily, in patients (...) %]), and upper respiratory tract infection (aclidinium, 86 events [4.8%]; placebo, 101 events [5.6%]).Among patients with COPD and increased cardiovascular risk, aclidinium was noninferior to placebo for risk of MACE over 3 years. The rate of moderate to severe COPD exacerbations was reduced over the first year.ClinicalTrials.gov Identifier: NCT01966107.

2019 JAMA Controlled trial quality: predicted high

10. People with chronic obstructive pulmonary disease exacerbations prefer early discharge, then treatment at home. (Abstract)

People with chronic obstructive pulmonary disease exacerbations prefer early discharge, then treatment at home. The studyHome treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluationEchevarria C, Gray J, Hartley T, Miller J, Simpson AJ, Gibson GJ, Bourke SCPublished on 24 April 2018 Thorax 2018;73:713-22This project was funded by the National Institute for Health Research-Research for Patient Benefit Programme (project number (...) PB-PG-0213-30105).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000691/hospital-at-home-treatment-for-copd-flare-ups.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

2019 BMJ Controlled trial quality: uncertain

11. Capturing Exacerbations of Chronic Obstructive Pulmonary Disease with EXACT. A Subanalysis of FLAME Full Text available with Trip Pro

Capturing Exacerbations of Chronic Obstructive Pulmonary Disease with EXACT. A Subanalysis of FLAME Chronic obstructive pulmonary disease exacerbations accelerate lung function decline, reduce quality of life, and increase mortality. A subset of patients (n = 457) from the FLAME (Effect of Indacaterol Glycopyrronium vs. Fluticasone Salmeterol on COPD Exacerbations) study used the Exacerbations of COPD Tool (EXACT) to capture symptom-defined exacerbations.To evaluate the effect of indacaterol (...) /glycopyrronium versus salmeterol/fluticasone on symptom-defined exacerbations measured using EXACT, and to assess differences between these events and exacerbations requiring healthcare resource use (HCRU).All patients in FLAME used an electronic diary to record and detect symptom deteriorations; HCRU-related exacerbations were confirmed by investigators. In patients using the EXACT questionnaire, the onset, recovery, and magnitude of symptom-defined exacerbations were identified by changes in total scores

2019 EvidenceUpdates

12. COPD exacerbation: no systematic use of antibiotics

of moderate aggravation in patients with chronic obstructive pulmonary disease (COPD), it is preferable to prescribe antibiotics as a first-line treatment only when the suspicion of bacterial infection is reinforced by an increase in sputum purulence. Patients with chronic obstructive pulmonary disease (COPD) are subject to exacerbations of their disease, i.e. episodes of prolonged aggravation. The known causes are mainly viral and bacterial infections. Some exacerbations justify hospitalisation: severe (...) COPD, rapid increase in respiratory signs, presence of associated diseases (e.g. diabetes, cardiovascular diseases). When exacerbation is moderate, the results of available trials show that seven out of ten patients recover in less than four weeks without antibiotics. About one in ten patients heals faster with antibiotic therapy, which may also extend the interval until the next exacerbation. Antibiotic therapies expose patients to the carrying of resistant bacteria, which are sources of harder

2019 Prescrire

13. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing

implications 24 Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing (NG114) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 24This guideline should be read in conjunction with NG115. Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for acute exacerbations of chronic obstructive pulmonary disease (COPD). It aims to optimise antibiotic use and reduce (...) antibiotic resistance. See a 2-page visual summary of the recommendations, including tables to support prescribing decisions. See the NICE guideline on COPD in over 16s for other recommendations on preventing and managing an acute exacerbation of COPD, including self-management. Who is it for? Health professionals People with COPD, their families and carers Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing (NG114) © NICE 2019. All rights reserved. Subject to Notice

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

14. Nebulized terbutaline & ipratropium bromide vs terbutaline alone in acute exacerbation of COPD requiring noninvasive ventilation: a randomized double blind controlled trial (Abstract)

Nebulized terbutaline & ipratropium bromide vs terbutaline alone in acute exacerbation of COPD requiring noninvasive ventilation: a randomized double blind controlled trial Short-acting β2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with β2 -agonists (...) regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score

2018 EvidenceUpdates

15. Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. Chronic obstructive pulmonary disease (COPD) is a major global health issue and theophylline is used extensively. Preclinical investigations have demonstrated that low plasma concentrations (1-5 mg/L) of theophylline enhance antiinflammatory effects of corticosteroids in COPD.To investigate the effectiveness of adding low-dose theophylline to inhaled corticosteroids (...) in COPD.The TWICS (theophylline with inhaled corticosteroids) trial was a pragmatic, double-blind, placebo-controlled, randomized clinical trial that enrolled patients with COPD between February 6, 2014, and August 31, 2016. Final follow-up ended on August 31, 2017. Participants had a ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 0.7 with at least 2 exacerbations (treated with antibiotics, oral corticosteroids, or both) in the previous year and were

2018 JAMA Controlled trial quality: predicted high

16. Use of adjunct cardiovascular therapy in patients hospitalised for acute exacerbations of COPD Full Text available with Trip Pro

Use of adjunct cardiovascular therapy in patients hospitalised for acute exacerbations of COPD In real-life practice, acute exacerbation of COPD is often treated as a cardiopulmonary syndrome http://ow.ly/uAnk30luMYz.

2018 ERJ open research

17. Circulating eosinophil levels do not predict severe exacerbations in COPD: a retrospective study Full Text available with Trip Pro

Circulating eosinophil levels do not predict severe exacerbations in COPD: a retrospective study Whether the level of circulating eosinophils in chronic obstructive pulmonary disease (COPD) patients can predict the risk of exacerbations of COPD (ECOPD) or response to treatment is debated. Here, we evaluate the prevalence of elevated eosinophils in COPD patients and its relationship with severe ECOPD requiring hospitalisation. We retrospectively reviewed the charts of COPD patients hospitalised (...) patients, 121 had one or more ECOPD during the year after the index event. The prevalence of eosinophils ≥2% was 72% in ECOPD patients and 71% in controls (p=0.93). Among ECOPD patients, eosinophil levels ≥2%, ≥4% or ≥300 cells·μL-1, either when clinically stable or during hospitalisation, did not show a significant association with the rate of recurrent severe exacerbations. The severity of airflow limitation was associated with recurrent exacerbations, but inhaled corticosteroid treatment

2018 ERJ open research

18. COPD exacerbations

exacerbations : a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) of chronic obstructive pulmonary disease ( COPD ) exacerbations . Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach (...) Week 08, Ovid 2011 12. Management of COPD exacerbations : a European Respiratory Society/American Thoracic Society guideline. This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease ( COPD ) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development

2018 Trip Latest and Greatest

19. Intensified Therapy with Inhaled Corticosteroids and Long-Acting beta2-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled T (Abstract)

Intensified Therapy with Inhaled Corticosteroids and Long-Acting beta2-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled T The efficacy of intensified combination therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) at the onset of upper respiratory tract infection (URTI) symptoms in chronic obstructive pulmonary disease (COPD (...) analysis, effect size was modified by disease severity, fractional exhaled nitric oxide, and the body mass index-airflow obstruction-dyspnea, and exercise score. Compared with the stable period, evidence of at least one virus was significantly more common at URTI, 10 days after URTI, and at exacerbation.Intensified combination therapy with ICS/LABA for 10 days at URTI onset did not decrease the incidence of any COPD exacerbation but prevented severe exacerbation. Patients with more severe disease had

2018 EvidenceUpdates

20. Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation Full Text available with Trip Pro

Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation Previous models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 (...) or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH

2018 EvidenceUpdates