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Latest & greatest articles for copd exacerbations
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Home treatment of COPDexacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation Previous models of Hospital at Home (HAH) for COPDexacerbation (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
Dapagliflozin for prednisone-induced hyperglycaemia in acute exacerbation of chronicobstructivepulmonarydisease The aim of the present study was to compare the effectiveness and safety of add-on treatment with dapagliflozin to placebo in patients with prednisone-induced hyperglycaemia during treatment for acute exacerbation of chronicobstructivepulmonarydisease (AECOPD). We enrolled 46 patients hospitalized for an AECOPD in a multicentre double-blind randomized controlled study in which
Management of chronicobstructivepulmonarydiseaseexacerbations at the Nasser Medical Complex: a clinical audit. The frequency and severity of chronicobstructivepulmonarydisease (COPD) exacerbations are the most important determinants of prognosis in COPD. The aim of this study was to assess the management of patients presenting with COPDexacerbations at the Nasser Medical Complex in the Gaza Strip and to compare the management with the Global Initiative for ChronicObstructiveLung (...) Disease guidelines (GOLD 2015).We reviewed the medical records of all patients admitted to Nasser Medical Complex and diagnosed with COPDexacerbation between Jan 1, 2014, and Dec 31, 2016. Clinical practice was compared with GOLD guidelines. Ethical approval was obtained from the General Directorate of Human Resources.55 patient records were reviewed. The mean age was 66·4 years (SD 8·5), and 54 (98%) patients were male. All patients received inhaled bronchodilators. 36 (65%) patients received short
) and/or diarrhoea, including Clostridium difficile -associated diarrhoea (associated with the use of antibiotics). Definition Chronicobstructivepulmonarydisease (COPD) is "a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflowlimitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis (...) , management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ An exacerbation of COPD may be defined as "an acute worsening of respiratory symptoms that results in additional therapy." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis, management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ History and exam
Effect of erdosteine on the rate and duration of COPDexacerbations: the RESTORE study Oxidative stress contributes to chronicobstructivepulmonarydisease (COPD) exacerbations and antioxidants can decrease exacerbation rates, although we lack data about the effect of such drugs on exacerbation duration.The RESTORE (Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD) study was a prospective randomised, double-blind, placebo-controlled study, enrolling patients aged (...) 40-80 years with Global Initiative for ChronicObstructiveLungDisease stage II/III. Patients received erdosteine 300 mg twice daily or placebo added to usual COPD therapy for 12 months. The primary outcome was the number of acute exacerbations during the study.In the pre-specified intention-to-treat population of 445 patients (74% male; mean age 64.8 years, forced expiratory volume in 1 s 51.8% predicted) erdosteine reduced the exacerbation rate by 19.4% (0.91 versus 1.13 exacerbations·patient
on the management of #COPDexacerbations from @ERStalk and @atscommunity Executive summary Chronicobstructivepulmonarydisease (COPD) exacerbations are episodes of increased respiratory symptoms, particularly dyspnoea, cough and sputum. The European Respiratory Society (ERS) and American Thoracic Society (ATS) collaborated to develop guidelines that address questions regarding the treatment of COPDexacerbations that are not clearly answered by current guidelines. Key recommendations from the guidelines (...) recommendation, very low quality of evidence). Introduction The chronic and progressive course of chronicobstructivepulmonarydisease (COPD) is often punctuated by “exacerbations”, defined clinically as episodes of increasing respiratory symptoms, particularly dyspnoea, cough and sputum production, and increased sputum purulence. COPDexacerbations have a negative impact on the quality of life of patients with COPD [ , ], accelerate disease progression, and can result in hospital admissions and death
Discontinuing noninvasive ventilation in severe chronicobstructivepulmonarydiseaseexacerbations: a randomised controlled trial We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronicobstructivepulmonarydisease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted (...) for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59). The primary outcome was relapse of AHRF within 8 days after NIV discontinuation.Except for a shorter median (interquartile range) intermediate respiratory care unit (IRCU) stay in the direct discontinuation group (4 (2-6) versus 5 (4-7) days, p=0.036), no differences were
Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronicobstructivepulmonarydisease (COPD) exacerbations (...) and hospital-based PR remained independent predictors of a lower risk for 1) acute COPDexacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPDexacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI
the use of colistin for the prophylactic treatment of adults with either non-CF bronchiectasis or patients with COPD experiencing exacerbations. Tags copd, infection control, bronchiectasis, colistin, pulmonarydisease, chronicobstructive, pulmonaryemphysema, respiratory, colistimethate sodium, polymyxin E, Colisticin, chronicairflowobstruction, Chronicobstructiveairwaydisease, Chronicobstructivelungdisease, Chronicobstructivepulmonarydisease, chronic bronchitis, emphysema, colomycin (...) pulmonarydisease experiencing exacerbations? What is the cost-effectiveness of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronicobstructivepulmonarydisease experiencing exacerbations? What are the evidence-based guidelines associated with the use of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronicobstructivepulmonarydisease experiencing exacerbations
Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPDExacerbation: A Randomized Clinical Trial. Outcomes after exacerbations of chronicobstructivepulmonarydisease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.To investigate the effect of home NIV plus oxygen on time to readmission or death in patients with persistent (...) hypercapnia after an acute COPD exacerbation.A randomized clinical trial of patients with persistent hypercapnia (Paco2 >53 mm Hg) 2 weeks to 4 weeks after resolution of respiratory acidemia, who were recruited from 13 UK centers between 2010 and 2015. Exclusion criteria included obesity (body mass index [BMI] >35), obstructive sleep apnea syndrome, or other causes of respiratory failure. Of 2021 patients screened, 124 were eligible.There were 59 patients randomized to home oxygen alone (median oxygen
Procalcitonin and CRP as Biomarkers in Discrimination of Community-acquired Pneumonia and Exacerbation of COPD Serum procalcitonin (PCT) and C-reactive protein (CRP) are markers of systemic inflammation and bacterial infection. We aimed to compare the usefulness of procalcitonin and CRP in patients with community-acquired pneumonia and exacerbations of chronicobstructivepulmonarydisease (COPD).A total of 116 consecutive patients were included in the study: 76 with chronicobstructive (...) pneumonia.Procalcitonin and CRP levels were significantly higher in patients with community-acquired pneumonia presenting to the emergency department with indications for hospitalization than in patients with exacerbations of chronicobstructivepulmonarydisease. Serum CRP and procalcitonin concentrations were strongly correlated. CRP might be a more valuable marker in these patients with lower respiratory tract infections.
Does Telehealth Monitoring Identify Exacerbations of ChronicObstructivePulmonaryDisease and Reduce Hospitalisations? An Analysis of System Data The increasing prevalence and associated cost of treating chronicobstructivepulmonarydisease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured (...) during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD.The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission.A total of 23 participants received a telehealth-supported intervention
Mario Cazzola , Paola Rogliani Statistics from Altmetric.com Commentary on: Horita N, Goto A, Shibata Y, et al . Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronicobstructivepulmonarydisease (COPD). Cochrane Database Syst Rev 2017;2:CD012066. Context The Global Initiative for Chronic Obstrictove LungDisease 2017 report recommends the use of long-acting muscarinic antagonist (LAMA) + long-acting beta (...) -agonist (LABA), or alternatively LABA + inhaled corticosteroid (ICS), in patients with chronicobstructivepulmonarydisease (COPD) at risk of exacerbations regardless of the entity of symptoms. 1 However, it does not specify whether it is preferable to start with LAMA+LABA rather than LABA+ICS. In fact, no firm conclusions can be drawn from the current literature. Methods The aim of this study was to compare the benefits and harms of LAMA+LABA versus LABA+ICS in the treatment of COPD. The authors
provides clinical recommendations for the prevention of chronicobstructivepulmonarydisease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society. Comprehensive evidence syntheses 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 and the results were summarised (...) M, Hurst JR, et al. Management of COPDexacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017; 49: 1600791. 7 National Institute for Health and Clinical Excellence. Chronicobstructivepulmonarydisease: management of chronicpulmonaryobstructivedisease in adults in primary and secondary care (partial update). London, National Clinical Guideline Centre, 2010. 8 Poole P, Chong J, Cates CJ. Mucolytic agents versus placebo for chronic bronchitis
A validation of the National Early Warning Score to predict outcome in patients with COPDexacerbation The National Early Warning Score (NEWS), proposed as a standardised track and trigger system, may perform less well in acute exacerbation of COPD (AECOPD). This study externally validated NEWS and modifications (ChronicRespiratory Early Warning Score (CREWS) and Salford-NEWS) in AECOPD.An observational cohort study (2012-2014, two UK acute medical units (AMUs)), compared AECOPD (2361 (...) found modest discrimination to predict mortality. Lower specificity of NEWS in patients with AECOPD versus other AMU patients reflects acute and chronicrespiratory physiological disturbance (including hypoxia), with resultant low PPV at NEWS=5. CREWS and Salford-NEWS, adjusting for chronic hypoxia, increased the specificity and PPV but there was no gain in discrimination.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go