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The inflammasome pathway in stable COPD and acute exacerbationsChronicobstructivepulmonarydisease (COPD) is characterised by pulmonary and systemic inflammation that bursts during exacerbations of the disease (ECOPD). The NLRP3 inflammasome is a key regulatory molecule of the inflammatory response. Its role in COPD is unclear. We investigated the NLRP3 inflammasome status in: 1) lung tissue samples from 38 patients with stable COPD, 15 smokers with normal spirometry and 14 never-smokers (...) ; and 2) sputum and plasma samples from 56 ECOPD patients, of whom 41 could be reassessed at clinical recovery. We observed that: 1) in lung tissue samples of stable COPD patients, NLRP3 and interleukin (IL)-1β mRNA were upregulated, but both caspase-1 and ASC were mostly in inactive form, and 2) during infectious ECOPD, caspase-1, oligomeric ASC and associated cytokines (IL-1β, IL-18) were significantly increased in sputum compared with clinical recovery. The NLRP3 inflammasome is primed
Another Choice for Prevention of COPDExacerbations. 27181835 2016 06 21 2018 12 02 1533-4406 374 23 2016 Jun 09 The New England journal of medicine N. Engl. J. Med. Another Choice for Prevention of COPDExacerbations. 2284-6 10.1056/NEJMe1604444 Donohue James F JF From the Division of PulmonaryDiseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill. eng Editorial Comment 2016 05 15 United States N Engl J Med 0255562 0028-4793 0 (...) PulmonaryDisease, ChronicObstructive drug therapy Quinolones therapeutic use 2016 5 17 6 0 2016 5 18 6 0 2016 6 22 6 0 ppublish 27181835 10.1056/NEJMe1604444
Understanding variation in length of hospital stay for COPDexacerbation: European COPD audit Chronicobstructivepulmonarydisease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect. The European COPD Audit in 13 countries included data from 16 018 hospitalised patients (...) . The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis. Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4-11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including
Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools.The study took place in the two hospitals within the derivation study (...) performance; it can identify low-risk patients (DECAF 0-1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3-6) for escalation planning or appropriate early palliation.UKCRN ID 14214.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
in patients with acute exacerbations of chronicobstructiveairwaysdisease? Respir Med. 2001;95(5):336-340. 13. Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y, Jones PW. Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronicobstructivepulmonarydisease. International Journal of Copd. 2014;9:155-162. 14. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic (...) Care of the Hospitalized Patient with Acute Exacerbation of COPD 1 UMHS ChronicObstructivePulmonaryDisease May 2016 Quality Department Guidelines for Clinical Care Inpatient COPD Guideline Team Team Leads Rommel L Sagana, MD Internal Medicine David H Wesorick, MD Internal Medicine Team Members Benjamin S Bassin, MD Emergency Medicine Todd E Georgia, RRT Respiratory Care F Jacob Seagull, PhD Learning Health Sciences Linda J Stuckey, PharmD Pharmacy Services Initial Release: May, 2016
Do Systemic Corticosteroids Improve Outcomes in ChronicObstructivePulmonaryDiseaseExacerbations? Systematic Review Snapshot TAKE-HOME MESSAGE Systemic corticosteroid treatment (oral or parenteral) in the setting of chronicobstructivepulmonarydiseaseexacerbations is effective in reducing the likelihood oftreatmentfailureandrelapseat1monthwhileshorteninghospitallengthofstay. Do Systemic Corticosteroids Improve OutcomesinChronic ObstructivePulmonary DiseaseExacerbations? EBEM Commentators (...) - steroidcomparedwithplacebo(n¼ 1,319;OR1.00;95%CI0.60to1.66). Systemic corticosteroid treatment compared with placebo for chronicobstructivepulmonarydiseaseexacerbations. Outcomes (N) Effect Size (95% CI) Treatment failure (917)* OR 0.48 (0.35 to 0.67) Relapse (415) HR 0.78 (0.63 to 0.97) Mortality (1,319) OR 1.00 (0.60 to 1.66) Adverse drug effect (736) OR 2.33 (1.59 to 3.43) Length of hospitalization (298), days MD –1.22 (–2.26 to –0.18) HR, Hazard ratio; MD, mean difference. *Treatment failure: necessity
antibiotic prescription rates among patients with nonbacterial COPD infections, decrease rates of adverse reactions to antibiotics and potentially decrease cost through reductions in hospital admissions/LOS and reduced consumption. Editor Comment AUC, area under the curve; CAP, community acquired pneumonia; COAD, chronicobstructiveairwaysdisease; COPD, chronicobstructivepulmonarydisease; HAP, hospital acquired pneumonia; LOS, length of stay; PCT, procalcitonin; RCT, randomised controlled trial (...) of chronicobstructivepulmonarydisease (COPD)] can [use of a procalcitonin algorithm compared to physician gestalt] result in [lower rates of antibiotic consumption with no adverse effects] Clinical Scenario A 78 year old female presents to your emergency department reporting increased wheezing over the last 24 hours. She reports a mildly productive cough and denies fever. A chest x-ray reveals no clear evidence of pneumonia. In addition to therapy for what you believe is a COPDexacerbation, you
) in 21 countries. Eligible patients were 40 years of age or older with a smoking history of at least 20 pack-years and a diagnosis of chronicobstructivepulmonarydisease with severe airflowlimitation, symptoms of chronic bronchitis, and at least two exacerbations in the previous year. We used a computerised central randomisation system to randomly assign patients in a 1:1 ratio to the two treatment groups: roflumilast 500 μg or placebo given orally once daily together with a fixed inhaled (...) Effect of roflumilast on exacerbations in patients with severe chronicobstructivepulmonarydisease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Roflumilast reduces exacerbations in patients with severe chronicobstructivepulmonarydisease. Its effect in patients using fixed combinations of inhaled corticosteroids and longacting β2 agonists is unknown. We postulated that roflumilast would reduce exacerbations in patients with severe chronic
2015LancetControlled trial quality: predicted high
is still required to assess the pO2, however, the BTS guidelines support using transcutanous oxygen saturations to titrate O2 therapy. Editor Comment AECOPD, acute exacerbation of chronicobstructivepulmonarydisease; COPD, chronicobstructivepulmonarydisease; ED, emergency department; LOA, limits of agreement; NPV, negative predictive value; pCO2, partial pressure of carbon dioxide; VBG, venous blood gas. Clinical Bottom Line In patients presenting with AECOPD, if they have a normal pCO2 on a VBG (...) with acute respiratorydisease J Emerg Med 2002 Jan; 22(1): 15-9. Kelly AM, Kerr D, Middleton P. Validation of venous pCO2 to screen for arterial hypercarbia in patients with chronicobstructiveairwaysdisease J Emerg Med 2005; 28(4): 377-379. Ak A, Ogun CO, Bayor A et al. Prediction of arterial blood gas values from venous blood gas values in patients with acute exacerbation of chronicobstructivepulmonarydisease Tohoku J Exp Med 2006; 210: 285-290. Razi E, Moosavi GA. Comparison of arterial
Comparison of Global Initiative for ChronicObstructivePulmonaryDisease 2013 Classification and Body Mass Index, AirflowObstruction, Dyspnea, and Exacerbations Index in Predicting Mortality and Exacerbations in Elderly Adults with ChronicObstructive P To examine whether the Global Initiative for ChronicObstructivePulmonaryDisease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflowobstruction, dyspnea, and exacerbations (BODEx) index in elderly adults (...) with chronicobstructivepulmonarydisease (COPD).Prospective cohort study.University-affiliated medical center.Taiwanese outpatients with COPD (N = 354).Participants were classified as Group A (low risk with mild dyspnea), Group B (low risk with more-severe dyspnea), Group C (high risk with mild dyspnea), and Group D (high risk with more-severe dyspnea) for GOLD 2013 and from Quartile 1 (0-2 points) to 4 (7-9 points) for BODEx score. Ability to predict exacerbations and mortality was compared using
, actual cost savings largely depend on the expansion of current PR capacity in Ontario. Pulmonary Rehabilitation for Postacute Exacerbations of ChronicObstructivePulmonaryDisease (COPD): A Cost-Effectiveness and Budget Impact Analysis. February 2015; pp. 1-47 6 PLAIN LANGUAGE SUMMARY Chronicobstructivepulmonarydisease (COPD) is a lungdisease that causes worsening breathlessness. The symptoms fluctuate from stable to flare-ups that might need hospital care. Pulmonary rehabilitation (PR) is a key (...) ratio LHIN Local Health Integration Network OHTAC Ontario Health Technology Advisory Committee PATH Programs for Assessment of Technology in Health PR Pulmonary rehabilitation PSA Probabilistic sensitivity analysis RCT Randomized controlled trial RT Respiratory therapist SGRQ St. George’s Respiratory Questionnaire THETA Toronto Health Economics and Technology Assessment Collaborative Pulmonary Rehabilitation for Postacute Exacerbations of ChronicObstructivePulmonaryDisease (COPD): A Cost
studies, prospective studies, retrospective studies • Acute exacerbations • COPD, chronicobstructivelungdisease, emphysema, chronic bronchitis, lungdiseases (obstructive) • Chronicdisease management, prevention • Nonpharmacologic therapies, education • Self-management • Case management • Action plans • In-home monitoring • Tele-intervention, telehealth, tele-health, Ehealth, e-health, telehealthcare, telecare, telemedicine, tele-monitoring, Emedicine, telecommunications and medicine, teleconsult (...) of acute exacerbations of COPD together with improved health- related quality of life, reduced dyspnea, less rescue medication use, and improved lung function and a relatively lower value on the risks and consequences of oral candidiasis, upper respiratory tract infections, and pneumonia. 22. For patients with stable moderate to very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting b 2 -agonist therapy compared with inhaled corticosteroid monotherapy to prevent acute
is not well documented, COPD is underdiagnosed, and the rate of hospitaliza- tion due to COPD is increasing. 11 Exacerbations are to COPD what myocardial infarctions are to coronary artery disease: Th ey are acute, trajectory- changing, and oft en deadly manifestations of a chronicdisease. Exacerbations cause frequent hospital admis- sions, relapses, and readmissions 12 ; contribute to death during hospitalization or shortly thereaft er 12 ; r e d uce quality of life dramatically 12 , 13 ; consume fi (...) - erbations of COPD together with improved health-related quality of life, reduced dyspnea, less rescue medication use, and improved lung function and a relatively lower value on the risks and consequences of oral candidiasis, upper respiratory tract infections, and pneumonia. 22. For patients with stable moderate to very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting b 2 -agonist therapy compared with inhaled corticosteroid monotherapy to prevent acute exacerbations
Withdrawal of inhaled glucocorticoids and exacerbations of COPD. Treatment with inhaled glucocorticoids in combination with long-acting bronchodilators is recommended in patients with frequent exacerbations of severe chronicobstructivepulmonarydisease (COPD). However, the benefit of inhaled glucocorticoids in addition to two long-acting bronchodilators has not been fully explored.In this 12-month, double-blind, parallel-group study, 2485 patients with a history of exacerbation of COPD (...) monitored.As compared with continued glucocorticoid use, glucocorticoid withdrawal met the prespecified noninferiority criterion of 1.20 for the upper limit of the 95% confidence interval (CI) with respect to the first moderate or severe COPDexacerbation (hazard ratio, 1.06; 95% CI, 0.94 to 1.19). At week 18, when glucocorticoid withdrawal was complete, the adjusted mean reduction from baseline in the trough forced expiratory volume in 1 second was 38 ml greater in the glucocorticoid-withdrawal group than
Short- and medium-term prognosis in patients hospitalized for COPDexacerbation: the CODEX index No valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge (...) in patients hospitalized for COPD.A multicenter study of patients hospitalized for COPDexacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airfl ow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes
, and Schering-Plough. He holds Fiduciary Positions with the American College of Chest Physicians, the Chest Foundation, and the Lung Health Institute of Canada. RAM - no disclosure JO – no disclosure JDR – no disclosure MKS - no disclosure INTRODUCTION Chronicobstructivepulmonarydisease (COPD) is a common disease with substantial associated morbidity and mortality. Patients with COPD usually have a progression of airflowobstruction that is not fully reversible and can lead to a history of progressive (...) efforts to make this guideline a current and valuable addition to the management of the COPD patient. REFERENCES 1 Global strategy for the diagnosis, management n prevention of chronicobstructivepulmonarydisease. Updated 2103.http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Fe b20.pdf. 2 Brusasco V. Reducing cholinergic constriction: the major reversible mechanism in COPD. European Respiratory Review 2006; 15:32-36 3 Cooper CB. Airflowobstruction and exercise. Respir Med 2009; 103:325
Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD. Retrospective studies have shown that statins decrease the rate and severity of exacerbations, the rate of hospitalization, and mortality in chronicobstructivepulmonarydisease (COPD). We prospectively studied the efficacy of simvastatin in preventing exacerbations in a large, multicenter, randomized trial.We designed the Prospective Randomized Placebo-Controlled Trial of Simvastatin in the Prevention of COPD (...) Exacerbations (STATCOPE) as a randomized, controlled trial of simvastatin (at a daily dose of 40 mg) versus placebo, with annual exacerbation rates as the primary outcome. Patients were eligible if they were 40 to 80 years of age, had COPD (defined by a forced expiratory volume in 1 second [FEV1] of less than 80% and a ratio of FEV1 to forced vital capacity of less than 70%), and had a smoking history of 10 or more pack-years, were receiving supplemental oxygen or treatment with glucocorticoids