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Sample records for copd case studies

  1. Flexible bronchoscopy with moderate sedation in COPD: a case-control study.

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    Grendelmeier, Peter; Tamm, Michael; Jahn, Kathleen; Pflimlin, Eric; Stolz, Daiana

    2017-01-01

    Flexible bronchoscopy is increasingly used for diagnostic and therapeutic purposes. We aimed to examine the safety of flexible bronchoscopy with moderate sedation in patients with COPD. This study is a prospective, longitudinal, case-control, single-center study including 1,400 consecutive patients. After clinical and lung function assessments, patients were dichotomized in COPD or non-COPD groups. The primary end point was the combined incidence of complications. The incidence of complications was similar in patients with and without COPD and independent of forced expiratory volume in the first second % predicted. Patients with COPD more frequently required insertion of a naso- or oropharyngeal airway; however, this difference was no longer significant after adjustment for age, gender, and duration of the procedure. Hypotension was significantly more common among patients with COPD. The number of episodes of hypoxemia ≤90% did not differ between the groups. However, patients with COPD had a lower mean and nadir transcutaneous oxygen saturation. Transcutaneous carbon dioxide tension (PtcCO2) change over the time course was similar in both groups, but both peak PtcCO2 and time on PtcCO2 >45 mmHg were higher in the COPD group. There were no differences in patient-reported outcomes. The safety of flexible bronchoscopy is similar in patients with and without COPD. This finding confirms the suitability of the procedure for both clinical and research indications.

  2. Insomnia in older adults with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study.

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    Xiang, Yu-Tao; Wong, Tak-Shun; Tsoh, Joshua; Ungvari, Gabor S; Correll, Christoph U; Ko, Fanny W S; Hui, David S C; Chiu, Helen F K

    2014-06-01

    This study aimed to determine the frequency and sociodemographic/clinical correlates of insomnia in Chinese patients aged ≥60 years suffering from chronic obstructive pulmonary disease (COPD). In this case-control study of 142 outpatients with COPD and 218 sex- and age-matched control subjects, COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥2 major COPD symptoms or >1 major+minor COPD symptoms for ≥2 consecutive days). Controls were recruited from social centres in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale, life events were evaluated using the Life Event Scale, depressive symptoms were ascertained with the Geriatric Depression Scale, and quality of life was measured using the Medical Outcomes Study Short Form-12. Early, middle and late insomnia were measured using items 4, 5 and 6 of the Hamilton Rating Scale for Depression. The frequency of ≥1 type of insomnia was 47.2% in patients and 25.7% in controls; frequencies of early, middle and late insomnia in patients were 24.6%, 31.0%, and 26.1%, respectively, compared to 14.7%, 14.7% and 11.9% in controls. Group differences were non-significant after controlling for relevant covariates. However, in multiple logistic regression analysis, more physical illnesses (p = 0.02, OR = 1.3, 95% CI = 1.1-1.7) and more severe depressive symptoms (p = 0.009, OR = 1.1, 95% CI = 1.03-1.3) were independently associated with any type of insomnia in COPD patients, accounting for 21.3% of the variance. A significant proportion of older adult Chinese COPD patients suffer from insomnia that warrants more attention in clinical practice.

  3. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

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    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  4. COPD and levels of Hsp70 (HSPA1A) and Hsp27 (HSPB1) in plasma and lymphocytes among coal workers: a case-control study.

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    Cui, Xiuqing; Xing, Jingcai; Liu, Yuewei; Zhou, Yun; Luo, Xin; Zhang, Zhihong; Han, Wenhui; Wu, Tangchun; Chen, Weihong

    2015-05-01

    This case-control study aimed to investigate whether the levels of Hsp70 (HSPA1A) and Hsp27 (HSPB1) in plasma and lymphocytes were associated with the risk of chronic obstructive pulmonary disease (COPD) among coal workers. A total of 76 COPD cases and 48 age-matched healthy controls from a group of coal workers were included. The case group consisted of 35 COPD patients whose condition was complicated with coal workers' pneumoconiosis (CWP) and 41 COPD patients without CWP. Heat shock proteins (Hsps) in plasma and lymphocytes were detected by ELISA and flow cytometry, respectively. Multiple logistic regression models were applied to estimate the association between Hsp levels and COPD risk. Our results showed that plasma Hsp70 and lymphocyte Hsp27 levels were significantly higher and plasma Hsp27 levels were significantly lower in COPD cases than in controls (p < 0.01). No significant differences in lymphocyte Hsp70 levels were found between COPD cases and the matched subjects. Higher plasma Hsp70 levels (odds ratio (OR) = 13.8, 95 % confidence interval (CI) = 5.7-33.5) and lower plasma Hsp27 levels (OR = 4.6, 95 % CI = 2.0-10.5) were significantly associated with an increased risk of COPD after adjusting for confounders. Higher lymphocyte Hsp27 levels were only associated with an increased risk of COPD with CWP (OR = 6.6, 95 % CI = 2.0-22.1) but not with an increased risk of COPD without CWP (OR = 3.0, 95 % CI = 0.9-8.9). Additionally, there were strong joint effects of different Hsps on COPD risk. These results showed that higher levels of plasma Hsp70 and lower levels of plasma Hsp27 might be associated with an increased risk of COPD among coal workers. They may have the potential to serve as monitoring markers for COPD in coal workers.

  5. Adherence to Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Relation to Chronic Obstructive Pulmonary Disease (COPD): A Case-Control Study.

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    Ardestani, Mohammad Emami; Onvani, Shokouh; Esmailzadeh, Ahmad; Feizi, Awat; Azadbakht, Leila

    2017-09-01

    This case-control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD. This is a case-control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method. This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015. Eight-four patients with COPD and 80 subjects without a history of COPD participated in study. The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were significantly lower in patients with COPD (p = 0.0001). Among COPD symptoms, cough was significantly decreased across tertiles of DASH score (p = 0.03). Significant differences were found for DASH score between patients with COPD and control subjects (19.82 + 3.63 vs 21.13 + 3.82, p = 0.02). Vitamin C, vitamin E, and dietary fiber intake were lower in patients with COPD (144.32 + 70.51 vs 166.97 + 71.88, p = 0.04, 7.49 + 3.91 vs 8.72 + 3.21, p = 0.02 and 19.34 + 7.05 vs 22.19 + 7.87, p = 0.01, respectively). We observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.

  6. Analyses of association between PPAR gamma and EPHX1 polymorphisms and susceptibility to COPD in a Hungarian cohort, a case-control study

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    Dezso Balazs

    2010-11-01

    Full Text Available Abstract Background In addition to smoking, genetic predisposition is believed to play a major role in the pathogenesis of chronic obstructive pulmonary disease (COPD. Genetic association studies of new candidate genes in COPD may lead to improved understanding of the pathogenesis of the disease. Methods Two proposed casual single nucleotide polymorphisms (SNP (rs1051740, rs2234922 in microsomal epoxide hydrolase (EPHX1 and three SNPs (rs1801282, rs1800571, rs3856806 in peroxisome proliferator-activated receptor gamma (PPARG, a new candidate gene, were genotyped in a case-control study (272 COPD patients and 301 controls subjects in Hungary. Allele frequencies and genotype distributions were compared between the two cohorts and trend test was also used to evaluate association between SNPs and COPD. To estimate the strength of association, odds ratios (OR (with 95% CI were calculated and potential confounding variables were tested in logistic regression analysis. Association between haplotypes and COPD outcome was also assessed. Results The distribution of imputed EPHX1 phenotypes was significantly different between the COPD and the control group (P = 0.041, OR for the slow activity phenotype was 1.639 (95% CI = 1.08- 2.49; P = 0.021 in our study. In logistic regression analysis adjusted for both variants, also age and pack-year, the rare allele of His447His of PPARG showed significant association with COPD outcome (OR = 1.853, 95% CI = 1.09-3.14, P = 0.0218. In haplotype analysis the GC haplotype of PPARG (OR = 0.512, 95% CI = 0.27-0.96, P = 0.035 conferred reduced risk for COPD. Conclusions The "slow" activity-associated genotypes of EPHX1 were associated with increased risk of COPD. The minor His447His allele of PPARG significantly increased; and the haplotype containing the minor Pro12Ala and the major His447His polymorphisms of PPARG decreased the risk of COPD.

  7. IL6 and CRP haplotypes are associated with COPD risk and systemic inflammation: a case-control study

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    Passos Valéria

    2009-03-01

    Full Text Available Abstract Background Elevated circulating levels of C-reactive protein (CRP, interleukin (IL-6 and fibrinogen (FG have been repeatedly associated with many adverse outcomes in patients with chronic obstructive pulmonary disease (COPD. To date, it remains unclear whether and to what extent systemic inflammation is primary or secondary in the pathogenesis of COPD. The aim of this study was to examine the association between haplotypes of CRP, IL6 and FGB genes, systemic inflammation, COPD risk and COPD-related phenotypes (respiratory impairment, exercise capacity and body composition. Methods Eighteen SNPs in three genes, representing optimal haplotype-tagging sets, were genotyped in 355 COPD patients and 195 healthy smokers. Plasma levels of CRP, IL-6 and FG were measured in the total study group. Differences in haplotype distributions were tested using the global and haplotype-specific statistics. Results Raised plasma levels of CRP, IL-6 and fibrinogen were demonstrated in COPD patients. However, COPD population was very heterogeneous: about 40% of patients had no evidence of systemic inflammation (CRP CRP gene and CRP plasma levels (P = 0.0004 and IL6 gene and COPD (P = 0.003. Subsequent analysis has shown that IL6 haplotype H2, associated with an increased COPD risk (p = 0.004, OR = 4.82; 1.64 to 4.18, was also associated with very low CRP levels (p = 0.0005. None of the genes were associated with COPD-related phenotypes. Conclusion Our findings suggest that common genetic variation in CRP and IL6 genes may contribute to heterogeneity of COPD population associated with systemic inflammation.

  8. Probabilistic data linkage: a case study of comparative effectiveness in COPD

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    Christopher M Blanchette

    2013-10-01

    Full Text Available Background: In this era of comparative effectiveness research, new, advanced techniques are being investigated by the research community to overcome the limitations of existing data sources. We describe the approach of probabilistic data linkage as a means to address this critical issue. Methods: We employed a historical retrospective cohort design. Patients aged 40 and older with a principal or secondary diagnosis of COPD (ICD-9-CM codes 491.xx, 492.xx, and 496 and at least 3 years of continuous enrollment between January 1, 2004 and April 30, 2009 were selected from two US-based commercial administrative claims databases. The index date was designated as the date of the first claim (defined by a 12-month wash-out pre-index period for the study drugs, for illustration purposes referred to as Treatment 1 or Treatment 2. The primary effectiveness measure was risk of any COPD-related exacerbation observed in the 12-month post-index period, with baseline characteristics being identified in the 12-month pre-index period. Results: The percentage of the study sample receiving Treatment 1 at index who had an exacerbation was 39.3% for Database A and 39.7% for Database B; for Treatment 2, the percentages were 46.3% and 47.1%, respectively. The event rate of hospitalizations in each database sample was nearly identical as were the odds ratio and corresponding confidence intervals from the adjusted logistic regression models (OR – Database A: 0.72, Database B: 0.74, Database A with imputed outcomes: 0.72. Conclusions: The probabilistic linkage demonstrated that patients from different databases matched on similar pre-index characteristics may demonstrate similar outcomes in the post-index period.

  9. The role of IREB2 and transforming growth factor beta-1 genetic variants in COPD: a replication case-control study

    LENUS (Irish Health Repository)

    Chappell, Sally L

    2011-02-14

    Abstract Background Genetic factors are known to contribute to COPD susceptibility and these factors are not fully understood. Conflicting results have been reported for many genetic studies of candidate genes based on their role in the disease. Genome-wide association studies in combination with expression profiling have identified a number of new candidates including IREB2. A meta-analysis has implicated transforming growth factor beta-1 (TGFbeta1) as a contributor to disease susceptibility. Methods We have examined previously reported associations in both genes in a collection of 1017 white COPD patients and 912 non-diseased smoking controls. Genotype information was obtained for seven SNPs in the IREB2 gene, and for four SNPs in the TGFbeta1 gene. Allele and genotype frequencies were compared between COPD cases and controls, and odds ratios were calculated. The analysis was adjusted for age, sex, smoking and centre, including interactions of age, sex and smoking with centre. Results Our data replicate the association of IREB2 SNPs in association with COPD for SNP rs2568494, rs2656069 and rs12593229 with respective adjusted p-values of 0.0018, 0.0039 and 0.0053. No significant associations were identified for TGFbeta1. Conclusions These studies have therefore confirmed that the IREB2 locus is a contributor to COPD susceptibility and suggests a new pathway in COPD pathogenesis invoking iron homeostasis.

  10. Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study

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    Ramires Bruna

    2012-06-01

    Full Text Available Abstract Background Elderly patients with chronic obstructive pulmonary disease (COPD usually have a compromised nutritional status which is an independent predictor of morbidity and mortality. To know the Resting Energy Expenditure (REE and the substrate oxidation measurement is essential to prevent these complications. This study aimed to compare the REE, respiratory quotient (RQ and body composition between patients with and without COPD. Methods This case–control study assessed 20 patients with chronic obstructive pulmonary disease attending a pulmonary rehabilitation program. The group of subjects without COPD (control group consisted of 20 elderly patients attending a university gym, patients of a private service and a public healthy care. Consumption of oxygen (O2 and carbon dioxide (CO2 was determined by indirect calorimetry and used for calculating the resting energy expenditure and respiratory quotient. Body mass index (BMI and waist circumference (WC were also measured. Percentage of body fat (%BF, lean mass (kg and muscle mass (kg were determined by bioimpedance. The fat free mass index (FFMI and muscle mass index (MMI were then calculated. Results The COPD group had lower BMI than control (p = 0.02. However, WC, % BF, FFMI and MM-I did not differ between the groups. The COPD group had greater RQ (p = 0.01, REE (p = 0.009 and carbohydrate oxidation (p = 0.002. Conclusions Elderly patients with COPD had higher REE, RQ and carbohydrate oxidation than controls.

  11. External validation of a COPD prediction model using population-based primary care data: a nested case-control study

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    Nwaru, Bright I; Simpson, Colin R; Sheikh, Aziz; Kotz, Daniel

    2017-01-01

    Emerging models for predicting risk of chronic obstructive pulmonary disease (COPD) require external validation in order to assess their clinical value. We validated a previous model for predicting new onset COPD in a different database. We randomly drew 38,597 case-control pairs (total N = 77,194) of individuals aged ≥35 years and matched for sex, age, and general practice from the United Kingdom Clinical Practice Research Datalink database. We assessed accuracy of the model to discriminate between COPD cases and non-cases by calculating area under the receiver operator characteristic (ROCAUC) for the prediction scores. Analogous to the development model, ever smoking (OR 6.70; 95%CI 6.41–6.99), prior asthma (OR 6.43; 95%CI 5.85–7.07), and higher socioeconomic deprivation (OR 2.90; 95%CI 2.72–3.09 for highest vs. lowest quintile) increased the risk of COPD. The validated prediction scores ranged from 0–5.71 (ROCAUC 0.66; 95%CI 0.65–0.66) for males and 0–5.95 (ROCAUC 0.71; 95%CI 0.70–0.71) for females. We have confirmed that smoking, prior asthma, and socioeconomic deprivation are key risk factors for new onset COPD. Our model seems externally valid at identifying patients at risk of developing COPD. An impact assessment now needs to be undertaken to assess whether this prediction model can be applied in clinical care settings. PMID:28304375

  12. Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study

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    Saito H

    2015-10-01

    Full Text Available Hitoshi Saito,1,2 Koichiro Nomura,1,2,† Shinji Abe,1,2 Takashi Motegi,2,3 Takeo Ishii,2,3 Kumiko Hattori,2,3 Yuji Kusunoki,2,3 Akihiko Gemma,2 Kozui Kida2,3 1Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, 2Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan, 3Respiratory Care Clinic, Nippon Medical School †Koichiro Nomura passed away on July 30, 2014 Objective: Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD.Participants: Subjects included 87 patients either with COPD or at risk of COPD (symptomatic who underwent gastrectomy between December 2003 and October 2013 (group A, and 174 patients either with COPD or at risk of COPD, matched by age (±5 years, sex, and forced expiratory volume in 1 second (FEV1 as percentage of predicted (FEV1% predicted (±5% (group B.Methods: All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT, high-resolution chest computed tomography scans, and nutritional assessments.Results: The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00, and walked a significantly shorter distance in the 6MWT (P<0.05. Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV to total lung capacity (TLC as percentage of predicted (%RV/TLC alone was an independent and significant predictor of reduced distances in the 6MWT.Conclusion: We concluded

  13. Gait patterns in COPD: the Rotterdam Study.

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    Lahousse, Lies; Verlinden, Vincentius J A; van der Geest, Jos N; Joos, Guy F; Hofman, Albert; Stricker, Bruno H C; Brusselle, Guy G; Ikram, M Arfan

    2015-07-01

    Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling. Gait was measured within the prospective, population-based Rotterdam Study (age ≥55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken. Persons with COPD (n=196) exhibited worse Rhythm (-0.21 SD, 95% CI -0.36- -0.06 SD) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: -0.83 SD, 95% CI -1.25- -0.41 SD) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD. This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations.

  14. [Nutritional status, pulmonary functions, and exercise performance in COPD cases].

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    Deveci, Figen; Tuğ, Tuncer; Turgut, Teyfik; Ogetürk, Murat; Kirkil, Gamze; Kaçar, Canan; Muz, M Hamdi

    2005-01-01

    The aim of this study was evaluation of nutritional status in attack and stable chronic obstructive pulmonary disease (COPD) cases, and investigating the relation between nutrition parameters and pulmonary functions, exercise performance and general healthy status. Anthropometric measures of 10 cases with attack (group 1), 14 stabilized COPD cases (group 2) and 10 control cases (group 3) were evaluated by measuring serum albumin, transferrin, tumor necrosis factor-alpha (TNF-alpha) levels, and fat-free mass (FFM) levels. Six minutes walking test (mwt) and SGRQ questionnaire were performed. Body mass index (BMI) of group 1 and 2 were significantly lower than group 3 (p= 0.023, p= 0.008, respectively). Albumin levels were significantly lower in group 1 than group 2 (pnutritional defect was seen and a significant relation was observed between nutrition parameters and effort capacity.

  15. COPD

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    COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate ...

  16. Recommendations for epidemiological studies on COPD

    DEFF Research Database (Denmark)

    Bakke, P S; Rönmark, E; Eagan, T

    2011-01-01

    The prevalence of chronic obstructive pulmonary disease (COPD) has been extensively studied, especially in Western Europe and North America. Few of these data are directly comparable because of differences between the surveys regarding composition of study populations, diagnostic criteria...... of the disease and definitions of the risk factors. Few community studies have examined phenotypes of COPD and included other ways of characterising the disease beyond that of spirometry. The objective of the present Task Force report is to present recommendations for the performance of general population...... studies in COPD in order to facilitate comparable and valid estimates on COPD prevalence by various risk factors. Diagnostic criteria in epidemiological settings, and standardised methods to examine the disease and its potential risk factors are discussed. The paper also offers practical advice...

  17. Recommendations for epidemiological studies on COPD

    DEFF Research Database (Denmark)

    Bakke, P S; Rönmark, E; Eagan, T

    2011-01-01

    The prevalence of chronic obstructive pulmonary disease (COPD) has been extensively studied, especially in Western Europe and North America. Few of these data are directly comparable because of differences between the surveys regarding composition of study populations, diagnostic criteria...... for planning and performing an epidemiological study on COPD. The main message of the paper is that thorough planning is worth half the study. It is crucial to stick to standardised methods and good quality control during sampling. We recommend collecting biological markers, depending on the specific...

  18. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

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    Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, J M

    2017-01-01

    COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (Pmanagement program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

  19. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

    Science.gov (United States)

    Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, JM

    2017-01-01

    Background COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. Aim The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. Materials and methodology We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. Results A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (Pmanagement program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

  20. Up-to-date on mortality in COPD - report from the OLIN COPD study

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    Lindberg Anne

    2012-01-01

    Full Text Available Abstract Background The poor recognition and related underdiagnosis of COPD contributes to an underestimation of mortality in subjects with COPD. Data derived from population studies can advance our understanding of the true burden of COPD. The objective of this report was to evaluate the impact of COPD on mortality and its predictors in a cohort of subjects with and without COPD recruited during the twenty first century. Methods All subjects with COPD (n = 993 defined according to the GOLD spirometric criteria, FEV1/FVC 1 % predicted and reported heart disease. Results The mortality was significantly higher among subjects with COPD, 10.9%, compared to subjects without COPD, 5.8% (p 1 % predicted in the multivariate model resulted in the decreasing level of FEV1 being a significant risk factor for death, while heart disease was not a significant risk factor for death in any of the models. Conclusions In this cohort COPD and decreased FEV1 were significant risk factors for death when adjusted for age, gender, smoking habits and reported heart disease.

  1. A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care.

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    Summers, Rachael H; Sharmeen, Taniya; Lippiett, Kate; Gillett, Kate; Astles, Carla; Vu, Linh; Stafford-Watson, Mark; Bruton, Anne; Thomas, Mike; Wilkinson, Tom

    2017-08-29

    'Finding the missing millions' with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using 'Framework Approach'. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams. SUPPORT NEEDED TO IDENTIFY THOSE UNDIAGNOSED: Additional staff and resources would facilitate targeted searches for patients showing symptoms of early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) costs the UK economy billions of

  2. Residential radon and COPD. An ecological study in Galicia, Spain.

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    Barbosa-Lorenzo, Raquel; Ruano-Ravina, Alberto; Ramis, Rebeca; Aragonés, Nuria; Kelsey, Karl T; Carballeira-Roca, Consuelo; Fernández-Villar, Alberto; López-Abente, Gonzalo; Barros-Dios, Juan M

    2017-02-01

    Radon is a human lung carcinogen but it might be linked with other respiratory diseases. We aimed to assess the relationship between residential radon exposure and COPD (chronic obstructive pulmonary disease) prevalence and hospital admissions at a municipal level. We designed an ecological study where we included those municipalities with at least three radon measurements. Using mixed Poisson regression models, we calculated the relative risk (RR) for COPD for each 100 Bq/m(3) of increase in radon concentration and also the relative risk for COPD using a cut-off point of 50 Bq/m(3). We did not have individual data on cigarette smoking and therefore we used a proxy (bladder cancer standardized mortality rate) that has proved to account for tobacco consumption. We performed separate analyses for sex and also sensitivity analysis considering age and rurality. A total of 3040 radon measurements and 49,393 COPD cases were included. The relative risk for COPD prevalence was 0.95 (95% CI: 0.92-0.97) while for hospital admissions the RR was 1.04 (95% CI: 1.00-1.10) for each 100 Bq/m(3). Relative risks were higher for women compared to men. Using a categorical analysis with a cut-off point of 50 Bq/m(3), the RR for COPD prevalence was 1.06 (95% CI: 1.02-1.10) and for hospital admissions it was 1.08 (95% CI: 1.00-1.17) for women living in municipalities with more than 50 Bq/m(3). All risks were also higher for women. No relevant differences were observed for age, rurality or other categories for radon exposure. While the influence of radon on COPD prevalence is unclear depending on the approach used, it seems that residential radon might increase the risk of hospital admissions in COPD patients. Women have a higher risk than men in all situations. Since this is an ecological study, results should be interpreted cautiously.

  3. Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

    DEFF Research Database (Denmark)

    Løkke, Anders; Ulrik, Charlotte Suppli; Dahl, Ronald;

    2012-01-01

    Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n = 241) recruited subjects with no previous diagnosis of lung disease,...

  4. Use of "Cold Spell" indices to quantify excess chronic obstructive pulmonary disease (COPD) morbidity during winter (November to March 2000-2007): case study in Porto.

    Science.gov (United States)

    Monteiro, Ana; Carvalho, Vânia; Góis, Joaquim; Sousa, Carlos

    2013-11-01

    The aim of this study was to examine the relationship between the occurrence of cold episodes and excess hospital admissions for chronic obstructive pulmonary disease (COPD) in Porto, Portugal, in order to further understand the effects of cold weather on health in milder climates. Excess COPD winter morbidity was calculated from admissions for November to March (2000-2007) in the Greater Porto Metropolitan Area (GPMA). Cold spells were identified using several indices (Díaz, World Meteorological Organization, Cold Spell Duration Index, Australian Index and Ondas' Project Index) for the same period. Excess admissions in the periods before and after the occurrence of cold spells were calculated and related to the cold spells identified. The COPD seasonal variation admission coefficient (CVSA) showed excess winter admissions of 59 %, relative to other months. The effect of cold spell on the aggravation of COPD occurs with a lag of at least 2 weeks and differs according to the index used. This study indicates the important role of the persistence of cold periods of at least 2 weeks duration in the increase in COPD admissions. The persistence of moderate temperatures (Tmin ≤5 °C) for a week can be more significant for increasing COPD admissions than very low temperatures (Tmin ≤ 1.6 °C) for just a few days. The Ondas projects' index provides the most accurate detection of the negative impacts of cold persistency on health, while the Diaz index is better at evaluating the consequences of short extreme cold events.

  5. Community pharmacy-based case finding for COPD in urban and rural settings is feasible and effective

    Directory of Open Access Journals (Sweden)

    Fathima M

    2017-09-01

    Full Text Available Mariam Fathima,1 Bandana Saini,1,2 Juliet M Foster,1 Carol L Armour1,3 1Woolcock Institute of Medical Research, Sydney Medical School, 2Faculty of Pharmacy, The University of Sydney, 3Central Sydney Area Health Service, Sydney, NSW, Australia Background and objective: Case finding of patients at risk of COPD by community pharmacists could identify a substantial number of people with undiagnosed COPD, but little is known about the feasibility and effectiveness of pharmacy-based COPD case finding using microspirometry. The objective of this study was to assess the feasibility and effectiveness of COPD case-finding service provided by community pharmacists, utilizing a combination of risk assessment questionnaire and microspirometry. Methods: A 6-month service was conducted in 21 community pharmacies in Australia. Pharmacists trained in COPD case finding, including lung function test (LFT, invited their patients aged ≥35 years with a history of smoking and/or respiratory symptoms to participate. High-risk patients were identified via a COPD risk assessment questionnaire (Initial Screening Questionnaire [ISQ] and underwent LFT. Pharmacists referred patients with a forced expiratory volume in 1 second (FEV1/forced expiratory volume in 6 seconds (FEV6 ratio <0.75 to their general practitioner (GP for further assessment and diagnosis. Results: In all, 91 of 167 (54% patients had an ISQ score >3 indicating high COPD risk. Of the 157 patients who were able to complete LFT, 61 (39% had an FEV1/FEV6 ratio of <0.75 and were referred to their GP. Patients with high ISQ symptoms scores (>3 were at a significantly higher risk of an FEV1/FEV6 ratio of <0.75, compared to patients with fewer COPD symptoms. A total of 15 (10% patients were diagnosed with COPD by their GP. Another eight (5% patients were diagnosed with other medical conditions and 87% of these were initiated on treatment. Although only half of all screened patients lived in regional areas, 93

  6. Statins and morbidity and mortality in COPD in the COMIC study: a prospective COPD cohort study.

    Science.gov (United States)

    Citgez, Emanuel; van der Palen, Job; Koehorst-Ter Huurne, Kirsten; Movig, Kris; van der Valk, Paul; Brusse-Keizer, Marjolein

    2016-01-01

    Both chronic inflammation and cardiovascular comorbidity play an important role in the morbidity and mortality of patients with chronic obstructive pulmonary disease (COPD). Statins could be a potential adjunct therapy. The additional effects of statins in COPD are, however, still under discussion. The aim of this study is to further investigate the association of statin use with clinical outcomes in a well-described COPD cohort. 795 patients of the Cohort of Mortality and Inflammation in COPD (COMIC) study were divided into statin users or not. Statin use was defined as having a statin for at least 90 consecutive days after inclusion. Outcome parameters were 3-year survival, based on all-cause mortality, time until first hospitalisation for an acute exacerbation of COPD (AECOPD) and time until first community-acquired pneumonia (CAP). A sensitivity analysis was performed without patients who started a statin 3 months or more after inclusion to exclude immortal time bias. Statin use resulted in a better overall survival (corrected HR 0.70 (95% CI 0.51 to 0.96) in multivariate analysis), but in the sensitivity analysis this association disappeared. Statin use was not associated with time until first hospitalisation for an AECOPD (cHR 0.95, 95% CI 0.74 to 1.22) or time until first CAP (cHR 1.1, 95% CI 0.83 to 1.47). In the COMIC study, statin use is not associated with a reduced risk of all-cause mortality, time until first hospitalisation for an AECOPD or time until first CAP in patients with COPD.

  7. Statins and morbidity and mortality in COPD in the COMIC study: a prospective COPD cohort study

    Science.gov (United States)

    Citgez, Emanuel; van der Palen, Job; Koehorst-ter Huurne, Kirsten; Movig, Kris; van der Valk, Paul; Brusse-Keizer, Marjolein

    2016-01-01

    Background Both chronic inflammation and cardiovascular comorbidity play an important role in the morbidity and mortality of patients with chronic obstructive pulmonary disease (COPD). Statins could be a potential adjunct therapy. The additional effects of statins in COPD are, however, still under discussion. The aim of this study is to further investigate the association of statin use with clinical outcomes in a well-described COPD cohort. Methods 795 patients of the Cohort of Mortality and Inflammation in COPD (COMIC) study were divided into statin users or not. Statin use was defined as having a statin for at least 90 consecutive days after inclusion. Outcome parameters were 3-year survival, based on all-cause mortality, time until first hospitalisation for an acute exacerbation of COPD (AECOPD) and time until first community-acquired pneumonia (CAP). A sensitivity analysis was performed without patients who started a statin 3 months or more after inclusion to exclude immortal time bias. Results Statin use resulted in a better overall survival (corrected HR 0.70 (95% CI 0.51 to 0.96) in multivariate analysis), but in the sensitivity analysis this association disappeared. Statin use was not associated with time until first hospitalisation for an AECOPD (cHR 0.95, 95% CI 0.74 to 1.22) or time until first CAP (cHR 1.1, 95% CI 0.83 to 1.47). Conclusions In the COMIC study, statin use is not associated with a reduced risk of all-cause mortality, time until first hospitalisation for an AECOPD or time until first CAP in patients with COPD. PMID:27403321

  8. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

    Directory of Open Access Journals (Sweden)

    Alshabanat A

    2017-03-01

    Full Text Available Abdulmajeed Alshabanat,1 Michael C Otterstatter,2,3 Don D Sin,4,5 Jeremy Road,5,6 Carmen Rempel,6 Jane Burns,6 Stephan F van Eeden,4,5 JM FitzGerald5–7 On behalf of the COPD Transition Team Program 1Department of Experimental Medicine, University of British Columbia, 2British Columbia Centre for Disease Control, 3School of Population and Public Health, 4Department of Medicine, Centre for Heart Lung Innovation, St Paul’s Hospital, 5Division of Respirology, Department of Medicine, 6Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia, 7Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada Background: COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.Aim: The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP in reducing length of stay (LOS and risk of hospital admissions and readmissions in patients with COPD.Materials and methodology: We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation.Results: A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all

  9. Association of MMP - 12 polymorphisms with severe and very severe COPD: A case control study of MMPs - 1, 9 and 12 in a European population.

    LENUS (Irish Health Repository)

    Haq, Imran

    2010-01-15

    Abstract Background Genetic factors play a role in chronic obstructive pulmonary disease (COPD) but are poorly understood. A number of candidate genes have been proposed on the basis of the pathogenesis of COPD. These include the matrix metalloproteinase (MMP) genes which play a role in tissue remodelling and fit in with the protease - antiprotease imbalance theory for the cause of COPD. Previous genetic studies of MMPs in COPD have had inadequate coverage of the genes, and have reported conflicting associations of both single nucleotide polymorphisms (SNPs) and SNP haplotypes, plausibly due to under-powered studies. Methods To address these issues we genotyped 26 SNPs, providing comprehensive coverage of reported SNP variation, in MMPs- 1, 9 and 12 from 977 COPD patients and 876 non-diseased smokers of European descent and evaluated their association with disease singly and in haplotype combinations. We used logistic regression to adjust for age, gender, centre and smoking history. Results Haplotypes of two SNPs in MMP-12 (rs652438 and rs2276109), showed an association with severe\\/very severe disease, corresponding to GOLD Stages III and IV. Conclusions Those with the common A-A haplotype for these two SNPs were at greater risk of developing severe\\/very severe disease (p = 0.0039) while possession of the minor G variants at either SNP locus had a protective effect (adjusted odds ratio of 0.76; 95% CI 0.61 - 0.94). The A-A haplotype was also associated with significantly lower predicted FEV1 (42.62% versus 44.79%; p = 0.0129). This implicates haplotypes of MMP-12 as modifiers of disease severity.

  10. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  11. Case-fatality of COPD exacerbations: a meta-analysis and statistical modeling approach

    DEFF Research Database (Denmark)

    Hoogendoorn, M; Hoogenveen, R T; Rutten-van Mölken, M P

    2010-01-01

    Objective of the study was to estimate the case-fatality of a severe exacerbation from long-term survival data presented in the literature. A literature search identified studies reporting at least 1.5 year survival after a severe COPD exacerbation resulting in hospitalization. Each study's survi...

  12. Cardiovascular morbidity in COPD: A study of the general population

    DEFF Research Database (Denmark)

    Lange, Peter; Møgelvang, Rasmus; Marott, Jacob Louis

    2010-01-01

    ventricular ejection fraction (LVEF) are sparse. We used data from the 4th examination of The Copenhagen City Heart Study, which comprises 5,890 individuals with data on pulmonary and cardiac symptoms, risk factors for cardiovascular diseases, pulmonary function tests, ECG and relevant medical history. Among.......4% for moderate COPD (GOLD stage 2) and 2.5% for severe and very severe COPD (GOLD stages 3+4). Individuals with COPD were older and had a higher prevalence of cardiovascular risk factors and a higher prevalence of cardiovascular diseases. Among the echocardiographical findings, only the presence of left...... ventricular hyperthrophy was significantly more frequent among individuals with COPD (17.7%) than among participants without COPD (12.1%.), yet this relationship was no longer significant after statistical adjustment for age and gender. In the general population, subjects with COPD have a higher prevalence...

  13. Epidemiological studies on the relation between diet and COPD

    NARCIS (Netherlands)

    Tabak, C.

    2000-01-01

    Chronic Obstructive Pulmonary Disease (COPD) is an important cause of morbidity and mortality around the world. In the early 1990's several dietary factors were suggested to protect against COPD, based on proposed biological mechanisms and a small number of epidemiological studies. Antioxidants (e.g

  14. COPD and microalbuminuria: a 12-year follow-up study.

    Science.gov (United States)

    Romundstad, Solfrid; Naustdal, Thor; Romundstad, Pål Richard; Sorger, Hanne; Langhammer, Arnulf

    2014-04-01

    Chronic obstructive pulmonary disease (COPD), low lung function independent of diagnosis and markers of inflammation are all associated with increased morbidity and mortality. Microalbuminuria, reflecting endothelial dysfunction, could be a relevant inflammatory marker of potential systemic effects of COPD. We hypothesised that there was a positive association between microalbuminuria and mortality in individuals with COPD. We conducted a 12-year follow-up study of 3129 participants in the second survey of the Nord-Trøndelag Health Study (HUNT), Norway. At baseline, albuminuria was analysed in three urine samples and spirometry was performed. Among the participants, 136 had COPD and microalbuminuria, defined as a urinary albumin/creatinine ratio between 2.5 and 30.0 mg·mmol(-1). The main outcome measures were hazard ratio of all-cause mortality according to microalbuminuria. Compared to those with COPD without microalbuminuria, the adjusted hazard ratio for all-cause mortality in those with COPD and microalbuminuria was 1.54, 95% CI 1.16-2.04. This result was similar after excluding cardiovascular disease at baseline. Classifying COPD severity by Global Initiative for Chronic Obstructive Lung Disease, there was a positive association trend with increasing severity stages. Microalbuminuria is associated with all-cause mortality in individuals with COPD and could be a relevant tool in identification of patients with poor prognosis.

  15. Blood Pressure Profile and Hypertensive Organ Damage in COPD Patients and Matched Controls. The RETAPOC Study.

    Directory of Open Access Journals (Sweden)

    Rafael Golpe

    Full Text Available Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases.Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed.classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05. There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01 and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001.Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.

  16. Cardiovascular morbidity in COPD: A study of the general population

    DEFF Research Database (Denmark)

    Lange, Peter; Møgelvang, Rasmus; Marott, Jacob Louis

    2010-01-01

    Although there are a number of studies on the coexistence of heart disease and COPD among patients acutely admitted to hospital, this relationship has not been accurately described in the general population. Especially data on the prevalence of both reduced lung function and impaired left...... ventricular ejection fraction (LVEF) are sparse. We used data from the 4th examination of The Copenhagen City Heart Study, which comprises 5,890 individuals with data on pulmonary and cardiac symptoms, risk factors for cardiovascular diseases, pulmonary function tests, ECG and relevant medical history. Among...... ventricular hyperthrophy was significantly more frequent among individuals with COPD (17.7%) than among participants without COPD (12.1%.), yet this relationship was no longer significant after statistical adjustment for age and gender. In the general population, subjects with COPD have a higher prevalence...

  17. Attitudes and beliefs about COPD: data from the BREATHE study.

    Science.gov (United States)

    Sayiner, Abdullah; Alzaabi, Ashraf; Obeidat, Nathir M; Nejjari, Chakib; Beji, Majed; Uzaslan, Esra; Nafti, Salim; Khan, Javaid Ahmed; Tageldin, Mohamed Awad; Idrees, Majdy; Rashid, Nauman; El Hasnaoui, Abdelkader

    2012-12-01

    Although COPD is a debilitating pulmonary condition, many studies have shown awareness of the disease to be low. This article presents data on attitudes and beliefs about COPD in subjects with respiratory symptoms participating in the BREATHE study in the Middle East and North Africa region. This study was a large general population survey of COPD conducted in ten countries of the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A total of 62,086 subjects were screened, of whom 2,187 fulfilled the "epidemiological" definition of COPD. A detailed questionnaire was administered to these subjects, which documented knowledge about the disease, attitudes to care, beliefs about COPD and satisfaction with treatment. 1,392 subjects were analysable. Overall, 58.6% of subjects claimed to be very well or adequately informed about their respiratory condition. Two-thirds of subjects reported receiving information about COPD from their physician and 10.6% from television; the internet was cited by 6% and other health professionals or patient associations by education and more effective patient-physician communication are clearly required. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Phenomenology of COPD: interpreting phenotypes with the ECLIPSE study.

    Science.gov (United States)

    Papi, Alberto; Magnoni, Maria Sandra; Muzzio, Carmelo Caio; Benso, Gianmarco; Rizzi, Andrea

    2016-10-14

    The Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study was a large 3-year observational multicentre international study aimed at defining COPD phenotypes and identifying biomarkers and/or genetic parameters that help to predict disease progression. The study has contributed to a better understanding of COPD heterogeneity, with the characterization of clinically important subtypes/phenotypes of patients, such as the frequent exacerbators or patient with persistent systemic inflammation, who may have different prognosis or treatment requirements. Because of the big amount of information that is starting to be produced from metabolomic, proteomic and genomic approaches, one of the biggest challenges is the integration of data in a biological prospective such as clinical prognosis and response to medicinal products. In this article we highlight some of the progress in phenotyping the heterogeneity of the disease that have been made thanks to the analyses of this longitudinal study.

  19. Cardiovascular events in patients with COPD: TORCH study results

    DEFF Research Database (Denmark)

    Calverley, Peter M A; Anderson, Julie A; Celli, Bartolome;

    2010-01-01

    BACKGROUND: Previous studies have suggested that long-term use of beta agonists to treat chronic obstructive pulmonary disease (COPD) may increase the risk of cardiovascular adverse events. In this post hoc analysis, data from the TOwards a Revolution in COPD Health (TORCH) study were used...... to investigate whether use of the long-acting beta(2) agonist salmeterol over 3 years increased the risk of cardiovascular adverse events in patients with moderate to severe COPD. METHODS: TORCH was a randomised, double-blind, placebo controlled study conducted at 444 centres in 42 countries. Patients (n=6184.......2% for placebo, 22.7% for salmeterol, 24.3% for fluticasone propionate and 20.8% for SFC. Although a history of myocardial infarction doubled the probability of cardiovascular adverse events, the event rates remained similar across treatment groups. CONCLUSION: Post hoc analysis of the 3-year TORCH dataset...

  20. An estimation of COPD cases and respiratory mortality related to Ground-Level Ozone in the metropolitan Ahvaz during 2011

    Directory of Open Access Journals (Sweden)

    Sahar Geravandi

    2016-02-01

    Full Text Available Background & Aims of the Study :  Ground-Level Ozone (GLO is the component of one of greatest concern that threatened human health in both developing as well as developed countries. The GLO mainly enters the body through the respiration and can cause decrements in pulmonary complications, eye burning, shortness of breath, coughing, failure of immune defense, decreases forced vital capacity, reduce lung function of the lungs and increase rate of mortality. Ahwaz with high emission air pollutants because of numerous industries is one of the metropolitan Iranian polluted. The aim of this study is evaluate to Chronic Obstructive Pulmonary Disease (COPD and respiratory mortality related to GLO in the air of metropolitan Ahvaz during 2011. Materials & Methods: We used the generalized additive Air Q model for estimation of COPD and respiratory mortality attributed to GLO pollutant. Data of GLO were collected in four monitoring stations Ahvaz Department of Environment. Raw data processing by Excel software and at final step they were converted as input file to the Air Q model for estimate number of COPD Cases and respiratory mortality. Results: According to result this study, The Naderi and Havashenasi had the highest and the lowest GLO concentrations. The results of this study showed that cumulative cases of COPD and respiratory mortality which related to GLO were 34 and 30 persons, respectively. Also, Findings showed that approximately 11 % COPD and respiratory mortality happened when the GLO concentrations was more than 20 μg/m 3 . Conclusions: exposure to GLO pollution has stronger effects on human health in Ahvaz. Findings showed that there were a significant relationship between concentration of GLO and COPD and respiratory mortality. Therefore; the higher ozone pollutant value can depict mismanagement in urban air quality.  

  1. A pilot study: mindfulness meditation intervention in COPD.

    Science.gov (United States)

    Chan, Roxane Raffin; Giardino, Nicholas; Larson, Janet L

    2015-01-01

    Living well with chronic obstructive pulmonary disease (COPD) requires people to manage disease-related symptoms in order to participate in activities of daily living. Mindfulness practice is an intervention that has been shown to reduce symptoms of chronic disease and improve accurate symptom assessment, both of which could result in improved disease management and increased wellness for people with COPD. A randomized controlled trial was conducted to investigate an 8-week mindful meditation intervention program tailored for the COPD population and explore the use of breathing timing parameters as a possible physiological measure of meditation uptake. Results demonstrated that those randomized to the mindful meditation intervention group (N=19) had a significant increase in respiratory rate over time as compared to those randomized to the wait-list group (N=22) (P=0.045). It was also found that the mindful meditation intervention group demonstrated a significant decrease in level of mindfulness over time as compared to the wait-list group (P=0.023). When examining participants from the mindful meditation intervention who had completed six or more classes, it was found that respiratory rate did not significantly increase in comparison to the wait-list group. Furthermore, those who completed six or more classes (N=12) demonstrated significant improvement in emotional function in comparison to the wait-list group (P=0.032) even though their level of mindfulness did not improve. This study identifies that there may be a complex relationship between breathing parameters, emotion, and mindfulness in the COPD population. The results describe good feasibility and acceptability for meditation interventions in the COPD population.

  2. A genome-wide association study of COPD identifies a susceptibility locus on chromosome 19q13.

    Science.gov (United States)

    Cho, Michael H; Castaldi, Peter J; Wan, Emily S; Siedlinski, Mateusz; Hersh, Craig P; Demeo, Dawn L; Himes, Blanca E; Sylvia, Jody S; Klanderman, Barbara J; Ziniti, John P; Lange, Christoph; Litonjua, Augusto A; Sparrow, David; Regan, Elizabeth A; Make, Barry J; Hokanson, John E; Murray, Tanda; Hetmanski, Jacqueline B; Pillai, Sreekumar G; Kong, Xiangyang; Anderson, Wayne H; Tal-Singer, Ruth; Lomas, David A; Coxson, Harvey O; Edwards, Lisa D; MacNee, William; Vestbo, Jørgen; Yates, Julie C; Agusti, Alvar; Calverley, Peter M A; Celli, Bartolome; Crim, Courtney; Rennard, Stephen; Wouters, Emiel; Bakke, Per; Gulsvik, Amund; Crapo, James D; Beaty, Terri H; Silverman, Edwin K

    2012-02-15

    The genetic risk factors for chronic obstructive pulmonary disease (COPD) are still largely unknown. To date, genome-wide association studies (GWASs) of limited size have identified several novel risk loci for COPD at CHRNA3/CHRNA5/IREB2, HHIP and FAM13A; additional loci may be identified through larger studies. We performed a GWAS using a total of 3499 cases and 1922 control subjects from four cohorts: the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE); the Normative Aging Study (NAS) and National Emphysema Treatment Trial (NETT); Bergen, Norway (GenKOLS); and the COPDGene study. Genotyping was performed on Illumina platforms with additional markers imputed using 1000 Genomes data; results were summarized using fixed-effect meta-analysis. We identified a new genome-wide significant locus on chromosome 19q13 (rs7937, OR = 0.74, P = 2.9 × 10(-9)). Genotyping this single nucleotide polymorphism (SNP) and another nearby SNP in linkage disequilibrium (rs2604894) in 2859 subjects from the family-based International COPD Genetics Network study (ICGN) demonstrated supportive evidence for association for COPD (P = 0.28 and 0.11 for rs7937 and rs2604894), pre-bronchodilator FEV(1) (P = 0.08 and 0.04) and severe (GOLD 3&4) COPD (P = 0.09 and 0.017). This region includes RAB4B, EGLN2, MIA and CYP2A6, and has previously been identified in association with cigarette smoking behavior.

  3. Case-fatality of COPD exacerbations: a meta-analysis and statistical modeling approach

    DEFF Research Database (Denmark)

    Hoogendoorn, M; Hoogenveen, R T; Rutten-van Mölken, M P

    2010-01-01

    Objective of the study was to estimate the case-fatality of a severe exacerbation from long-term survival data presented in the literature. A literature search identified studies reporting at least 1.5 year survival after a severe COPD exacerbation resulting in hospitalization. Each study...... and was calculated as 1 minus the (backwardly) extrapolated survival during the stable period at the time of exacerbation onset. The 95% confidence intervals of the estimated case-fatalities were obtained by bootstrapping. A random effect model was used to combine all estimates into a weighted average with 95......'s survival curve was divided into a critical and a stable period. Mortality during the stable period was then estimated by extrapolating the survival curve during the stable period back to the time of exacerbation onset. Case-fatality was defined as the excess mortality that results from an exacerbation...

  4. The effect of comorbidities on COPD assessment: a pilot study

    Directory of Open Access Journals (Sweden)

    Weinreich UM

    2015-02-01

    Full Text Available Ulla Møller Weinreich,1–3 Lars Pilegaard Thomsen,2 Barbara Bielaska,4 Vania Helbo Jensen,5,6 Morten Vuust,4 Stephen Edward Rees2 1Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; 2Respiratory and Critical Care Group (RCARE, Centre for Model-Based Medical Decision Support Systems, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; 3The Clinical Institute, Aalborg University Hospital, Aalborg, Denmark; 4Department of Radiology, Vendsyssel Hospital, Hjørring, Denmark; 5Department of Radiology, Horsens Regional Hospital, Horsens, Denmark; 6Department of Radiology, Aalborg University Hospital, Aalborg, Denmark Introduction: Patients with chronic obstructive pulmonary disease (COPD frequently suffer from comorbidities. COPD severity may be evaluated by the Global initiative for chronic ­Obstructive Lung Disease (GOLD combined risk assessment score (GOLD score. Spirometry, body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO, and high-resolution computed tomography (HR-CT measure lung function and elucidate pulmonary pathology. This study assesses associations between GOLD score and measurements of lung function in COPD patients with and without (≤1 comorbidities. It evaluates whether the presence of comorbidities influences evaluation by GOLD score of COPD severity, and questions whether GOLD score describes morbidity rather than COPD severity.Methods: In this prospective study, 106 patients with stable COPD were included. Patients treated for lung cancer were excluded. Demographics, oxygen saturation (SpO2, modified Medical Research Council Dyspnea Scale, COPD exacerbations, and comorbidities were recorded. Body plethysmography and DLCO were measured, and HR-CT performed and evaluated for emphysema and airways disease. COPD severity was stratified by the GOLD score. Correlation analyses: 1 GOLD score, 2 emphysema grade, and 3 airways disease and lung

  5. A Qualitative Study of Televideo Consultations for COPD Patients

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Sandholm Larsen, Niels

    2015-01-01

    . In public the expectations are high that digital mediation between clients' everyday lives and the health care system can strengthen patients' abilities regarding their self-management. Nonetheless, the study shows that patients have a number of reservations concerning televideo consultations at home......This article presents results from a small qualitative study investigating COPD patients' experiences with televideo consultations at home as a supplement to conventional control and treatment. The research question is: what are the experiences and preferences of COPD patients related to discharge...... from hospital with televideo consultations? The study shows that the patients' assessments of the effectiveness and value of the televideo consultations in their everyday lives are based on tough cost-benefit calculation of the extent to which the intervention makes their lives easier or more difficult...

  6. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study.

    Directory of Open Access Journals (Sweden)

    Meriam Denguezli

    Full Text Available It's currently well known that smoking and increasing age constitute the most important risk factors for chronic obstructive pulmonary disease (COPD. However, little is known about COPD among nonsmokers. The present study aimed to investigate prevalence, risk factors and the profiles of COPD among nonsmokers based on the Tunisian Burden of Obstructive Lung Disease (BOLD study.807 adults aged 40 years+ were randomly selected from the general population. We collected information about history of respiratory disease, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed for assessment of COPD. COPD diagnostic was based on the post-bronchodilator FEV1/FVC ratio, according to the Global Initiative for Obstructive Lung Disease (GOLD guidelines. The lower limit of normal (LLN was determined as an alternative threshold for the FEV1/FVC ratio.Among 485 nonsmokers, 4.7% met the criteria for GOLD grade I and higher COPD. These proportions were similar even when the LLN was used as a threshold. None of the nonsmokers with COPD reported a previous doctor diagnosis of COPD compared to 7.1% of smokers. Nonsmokers accounted for 45.1% of the subjects fulfilling the GOLD spirometric criteria of COPD. Nonsmokers were predominately men and reported more asthma problems than obstructed smokers. Among nonsmokers significantly more symptoms and higher co-morbidity were found among those with COPD. Increasing age, male gender, occupational exposure, lower body mass index and a previous diagnosis of asthma are associated with increased risk for COPD in nonsmokers. This study confirms previous evidence that nonsmokers comprise a substantial proportion of individuals with COPD. Nonsmokers with COPD have a specific profile and should, thus, receive far greater attention to prevent and treat chronic airway obstruction.

  7. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study

    Science.gov (United States)

    Denguezli, Meriam; Daldoul, Hager; Harrabi, Imed; Gnatiuc, Louisa; Coton, Sonia; Burney, Peter; Tabka, Zouhair

    2016-01-01

    Background It’s currently well known that smoking and increasing age constitute the most important risk factors for chronic obstructive pulmonary disease (COPD). However, little is known about COPD among nonsmokers. The present study aimed to investigate prevalence, risk factors and the profiles of COPD among nonsmokers based on the Tunisian Burden of Obstructive Lung Disease (BOLD) study. Methods 807 adults aged 40 years+ were randomly selected from the general population. We collected information about history of respiratory disease, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed for assessment of COPD. COPD diagnostic was based on the post-bronchodilator FEV1/FVC ratio, according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The lower limit of normal (LLN) was determined as an alternative threshold for the FEV1/FVC ratio. Results and Conclusions Among 485 nonsmokers, 4.7% met the criteria for GOLD grade I and higher COPD. These proportions were similar even when the LLN was used as a threshold. None of the nonsmokers with COPD reported a previous doctor diagnosis of COPD compared to 7.1% of smokers. Nonsmokers accounted for 45.1% of the subjects fulfilling the GOLD spirometric criteria of COPD. Nonsmokers were predominately men and reported more asthma problems than obstructed smokers. Among nonsmokers significantly more symptoms and higher co-morbidity were found among those with COPD. Increasing age, male gender, occupational exposure, lower body mass index and a previous diagnosis of asthma are associated with increased risk for COPD in nonsmokers. This study confirms previous evidence that nonsmokers comprise a substantial proportion of individuals with COPD. Nonsmokers with COPD have a specific profile and should, thus, receive far greater attention to prevent and treat chronic airway obstruction. PMID:27010214

  8. [COPD in dairy farmers: screening, characterization and constitution of a cohort. The BALISTIC study].

    Science.gov (United States)

    Degano, B; Bouhaddi, M; Laplante, J-J; Botebol, M; Annesi-Maesano, I; Marescaux, A; Roux, P; Thaon, I; Wolf, J-P; Regnard, J; Dalphin, J-C

    2012-11-01

    A pilot study from our group suggests that the prevalence of chronic obstructive pulmonary disease (COPD) among dairy farmers is higher than in the general population although dairy workers are less frequently smokers. The study presented here aims at (i) determining the prevalence of COPD in a large and representative population of dairy farmers; (ii) characterizing these patients in terms of smoking habits, dyspnoea, quality of life, lung function, bronchial exhaled nitric oxide, systemic inflammation, arterial stiffness and exercise capacity; (iii) comparing characteristics of dairy farmers' COPD with the characteristics of COPD in patients without any occupational exposure; (iv) identifying the etiological factors of COPD in dairy farmers; and (v) constituting a cohort of COPD patients and control subjects for further longitudinal studies. Two groups of COPD patients (dairy farmers or not) and two groups of controls subjects will be selected among a representative panel of 2000 dairy workers and 2000 subjects without any occupational exposure, all aged 40 to 75 years. A better knowledge of the epidemiology and pathophysiology of COPD in dairy farmers should guide a specific strategy of prevention. The knowledge of the characteristics of COPD occurring in dairy farmers will help to define the therapeutic modalities that might be different compared with the therapeutic recommendations for COPD secondary to tobacco smoking. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  9. A genome-wide association study in chronic obstructive pulmonary disease (COPD: identification of two major susceptibility loci.

    Directory of Open Access Journals (Sweden)

    Sreekumar G Pillai

    2009-03-01

    Full Text Available There is considerable variability in the susceptibility of smokers to develop chronic obstructive pulmonary disease (COPD. The only known genetic risk factor is severe deficiency of alpha(1-antitrypsin, which is present in 1-2% of individuals with COPD. We conducted a genome-wide association study (GWAS in a homogenous case-control cohort from Bergen, Norway (823 COPD cases and 810 smoking controls and evaluated the top 100 single nucleotide polymorphisms (SNPs in the family-based International COPD Genetics Network (ICGN; 1891 Caucasian individuals from 606 pedigrees study. The polymorphisms that showed replication were further evaluated in 389 subjects from the US National Emphysema Treatment Trial (NETT and 472 controls from the Normative Aging Study (NAS and then in a fourth cohort of 949 individuals from 127 extended pedigrees from the Boston Early-Onset COPD population. Logistic regression models with adjustments of covariates were used to analyze the case-control populations. Family-based association analyses were conducted for a diagnosis of COPD and lung function in the family populations. Two SNPs at the alpha-nicotinic acetylcholine receptor (CHRNA 3/5 locus were identified in the genome-wide association study. They showed unambiguous replication in the ICGN family-based analysis and in the NETT case-control analysis with combined p-values of 1.48 x 10(-10, (rs8034191 and 5.74 x 10(-10 (rs1051730. Furthermore, these SNPs were significantly associated with lung function in both the ICGN and Boston Early-Onset COPD populations. The C allele of the rs8034191 SNP was estimated to have a population attributable risk for COPD of 12.2%. The association of hedgehog interacting protein (HHIP locus on chromosome 4 was also consistently replicated, but did not reach genome-wide significance levels. Genome-wide significant association of the HHIP locus with lung function was identified in the Framingham Heart study (Wilk et al., companion article

  10. The cost of treating patients with COPD in Denmark--a population study of COPD patients compared with non-COPD controls

    DEFF Research Database (Denmark)

    Bilde, L; Rud Svenning, A; Dollerup, J;

    2007-01-01

    population than in the control group. COPD patients contacted their general practitioner 12 times more per year than non-COPD controls, but for specialist and paramedic treatment in the primary care sector there was no significant difference between COPD patients and non-COPD controls. Only one third...

  11. Use of spirometry in the diagnosis of COPD: a qualitative study in primary care.

    Science.gov (United States)

    Joo, Min J; Sharp, Lisa K; Au, David H; Lee, Todd A; Fitzgibbon, Marian L

    2013-08-01

    Guidelines that recommend spirometry to confirm airflow obstruction among patients with suspected COPD are not routinely followed. We conducted a qualitative study to identify attitudes and barriers of primary care physicians to performing spirometry for patients with possible COPD. We conducted four focus groups, each with three primary care physicians (PCPs) who practice in an urban, academic medical center. In general, PCPs believed that spirometry was not necessary to confirm the diagnosis of COPD. Compared to other co-morbid conditions, in a patient with a diagnosis of COPD without self-reported symptoms, COPD was not a priority during a clinic visit. This was in part due to the belief that there was lack of evidence that medication used in COPD lead to improved outcomes and that there was no point of care measure for COPD compared to other co-morbid conditions such as diabetes mellitus or hypertension. Health system barriers specific to spirometry use was not identified. In conclusion, in our sample of PCPs, there was skepticism that spirometry is warranted to diagnose and manage COPD. Availability of spirometry was not a perceived barrier. Our results explain, in part, why previous interventions to improve access to spirometry and diagnosis of COPD in primary care settings have been difficult to conduct and/or have had marginal success. Our findings strongly suggest that a first step toward increasing the use of spirometry among primary care physicians is to have them believe in its utility in the diagnosis of COPD.

  12. Multicenter study of the COPD-6 screening device

    DEFF Research Database (Denmark)

    Kjeldgaard, Peter; Lykkegaard Karlsen, Jesper; Spillemose, Heidi

    2017-01-01

    BACKGROUND AND AIM: Early detection of COPD may reduce the future burden of the disease. We aimed to investigate whether prescreening with a COPD-6 screening device (measuring FEV1 and FEV6) facilitates early detection of COPD in primary care. METHODS: In primary care, individuals at high risk of...

  13. Developing COPD: a 25 year follow up study of the general population

    DEFF Research Database (Denmark)

    Løkke, Anders; Lange, Peter; Scharling, H;

    2006-01-01

    population. METHODS: As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed. RESULTS: The percentage......BACKGROUND: Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general...... cessation, especially early in the follow up period, decreased the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning...

  14. Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies.

    Science.gov (United States)

    Rodriguez Gonzalez-Moro, J M; de Lucas Ramos, P; Izquierdo Alonso, J L; López-Muñiz Ballesteros, B; Antón Díaz, E; Ribera, X; Martín, A

    2009-05-01

    The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91-30.25) vs. 21.4 (CI 95%: 20.8-21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters.

  15. Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study

    OpenAIRE

    Strang, Susann; Ekberg-Jansson, Ann; Henoch, Ingela

    2014-01-01

    Objectives: Anxiety often arises in conjunction with dyspnoea in patients with severe COPD. Considering the provoking symptomatology and the high mortality rate for COPD, it is reasonable to believe that these conditions trigger death-related and existential anxiety. Although anxiety causes considerable distress and reduces quality of life, people's experience of anxiety has been studied relatively little. The aim of this study was to explore severely ill COPD patients’ experience of anxiety ...

  16. STUDY ON DRUG COSTS ASSOCIATED WITH COPD PRESCRIPTION MEDICINE IN DENMARK

    DEFF Research Database (Denmark)

    Jakobsen, Iris Marie; Anker, Niels; Dolleru, Jens

    2012-01-01

    that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. OBJECTIVES: To analyse the societal costs associated with prescription medicine for COPD in Denmark. METHODS: The study was designed as a nationwide retrospective register study...... of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who...... in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70,000-75,000 (EUR 9,416-10,089) per patient (2010 prices). CONCLUSION: The costs associated with prescription medicine for COPD in Denmark...

  17. The study to understand mortality and morbidity in COPD (SUMMIT) study protocol

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Anderson, Julie; Brook, Robert D;

    2013-01-01

    medications on CVD in patients with both diseases.The "Study to Understand Mortality and MorbidITy in COPD" (SUMMIT) aims at determining the impact of Fluticasone Furoate/Vilanterol combination (FF/VI), and the individual components on the survival of patients with moderate COPD and either a history of CVD...... or at increased risk for CVD.SUMMIT is a multi-center, randomised, double-blind, parallel-group, placebo-controlled trial of 16,000 patients with moderate COPD randomly assigned to once daily treatment with FF/VI (100/25 ;mcg), Fluticasone Furoate (100 ;mcg), Vilanterol (25 ;mcg) or matched placebo; mortality...

  18. Flexible bronchoscopy with moderate sedation in COPD: a case–control study

    Science.gov (United States)

    Grendelmeier, Peter; Tamm, Michael; Jahn, Kathleen; Pflimlin, Eric; Stolz, Daiana

    2017-01-01

    Background Flexible bronchoscopy is increasingly used for diagnostic and therapeutic purposes. We aimed to examine the safety of flexible bronchoscopy with moderate sedation in patients with COPD. Methods This study is a prospective, longitudinal, case–control, single-center study including 1,400 consecutive patients. After clinical and lung function assessments, patients were dichotomized in COPD or non-COPD groups. The primary end point was the combined incidence of complications. Results The incidence of complications was similar in patients with and without COPD and independent of forced expiratory volume in the first second % predicted. Patients with COPD more frequently required insertion of a naso- or oropharyngeal airway; however, this difference was no longer significant after adjustment for age, gender, and duration of the procedure. Hypotension was significantly more common among patients with COPD. The number of episodes of hypoxemia ≤90% did not differ between the groups. However, patients with COPD had a lower mean and nadir transcutaneous oxygen saturation. Transcutaneous carbon dioxide tension (PtcCO2) change over the time course was similar in both groups, but both peak PtcCO2 and time on PtcCO2 >45 mmHg were higher in the COPD group. There were no differences in patient-reported outcomes. Conclusion The safety of flexible bronchoscopy is similar in patients with and without COPD. This finding confirms the suitability of the procedure for both clinical and research indications. PMID:28115841

  19. Developing COPD: a 25 year follow up study of the general population

    DEFF Research Database (Denmark)

    Løkke, Anders; Lange, Peter; Scharling, H

    2006-01-01

    BACKGROUND: Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general populat...

  20. Study on drug costs associated with COPD prescription medicine in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, M; Anker, N; Dollerup, J;

    2013-01-01

    INTRODUCTION: Spirometric studies of the general population estimate that 430,000 Danes have chronic obstructive pulmonary disease (COPD). COPD is mainly caused by smoking, and smoking cessation is the most important intervention to prevent disease progression. Cost-of-illness studies conclude th...

  1. Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations

    Science.gov (United States)

    Mahboub, Bassam; Alzaabi, Ashraf; Iqbal, Mohammed Nizam; Salhi, Hocine; Lahlou, Aïcha; Tariq, Luqman; El Hasnaoui, Abdelkader

    2016-01-01

    Objective To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations. Materials and methods This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life. Results A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P<0.0001), most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03) associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03). Conclusion Comorbidities are frequent in COPD and associated with more severe respiratory symptoms. This highlights the importance of identification and appropriate management of comorbidities in all subjects with a diagnosis of COPD. PMID:26917957

  2. RELATIONSHIP BETWEEN PSYCHOPATHOLOGY & SOCIO-DEMOGRAPHIC AND CLINICAL VARIABLES IN COPD AND BRONCHIAL ASTHMA: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Mayank

    2014-11-01

    Full Text Available This is a cross sectional comparative case control study assessing the Relationship between psychopathology and socio demographic and clinical variables in chronic obstructive pulmonary disease (COPD and Bronchial Asthma in comparison to healthy individuals. The investigation reveals that there is psychopathology in all the three groups. The psychopathology is significantly more in patients with COPD. Psychopathology in COPD patients is related to age, duration, severity of illness and steroid medication. It is found that psychopathology in bronchial asthma patients are more than those of healthy controls but there is no significant difference. The psychopathology is significantly related to relate to age, marital status, occupational status, and smoking. Duration severity of illness and steroid medication.

  3. Dehydroepiandrosterone (DHEA) improves pulmonary hypertension in chronic obstructive pulmonary disease (COPD): a pilot study.

    Science.gov (United States)

    Dumas de La Roque, Eric; Savineau, Jean-Pierre; Metivier, Anne-Cécile; Billes, Marc-Alain; Kraemer, Jean-Philippe; Doutreleau, Stéphane; Jougon, Jacques; Marthan, Roger; Moore, Nicholas; Fayon, Michael; Baulieu, Etienne-Émile; Dromer, Claire

    2012-02-01

    It was previously shown that dehydroepiandrosterone (DHEA) reverses chronic hypoxia-induced pulmonary hypertension (PH) in rats, but whether DHEA can improve the clinical and hemodynamic status of patients with PH associated to chronic obstructive pulmonary disease (PH-COPD) has not been studied whereas it is a very severe poorly treated disease. Eight patients with PH-COPD were treated with DHEA (200mg daily orally) for 3 months. The primary end-point was the change in the 6-minute walk test (6-MWT) distance. Secondary end-points included pulmonary hemodynamics, lung function tests and tolerance of treatment. The 6-MWT increased in all cases, from 333m (median [IQR]) (257; 378) to 390m (362; 440) (PDHEA treatment did not change respiratory parameters of gas exchange and the 200mg per day of DHEA used was perfectly tolerated with no side effect reported. DHEA treatment significantly improves 6-MWT distance, pulmonary hemodynamics and DLCO of patients with PH-COPD, without worsening gas exchange, as do other pharmacological treatments of PH (trial registration NCT00581087). Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  4. Validating the Concept of COPD Control: A Real-world Cohort Study from the United Kingdom.

    Science.gov (United States)

    Nibber, Anjan; Chisholm, Alison; Soler-Cataluña, Juan José; Alcazar, Bernardino; Price, David; Miravitlles, Marc

    2017-10-01

    The concept of Chronic Obstructive Pulmonary Disease (COPD) control has been developed to inform therapeutic decision-making. We explored the validity of a definition of COPD control in a representative population of patients with COPD in the United Kingdom. Electronic medical records and linked COPD questionnaire data from the Optimum Patient Care Research Database were used to characterize control status. Patients were aged ≥40 years, with spirometry-confirmed COPD, current or ex-smokers, and continuous records throughout the study period. Control was evaluated based on COPD stability and patients' (i) clinical features or (ii) COPD Assessment Test (CAT) score over a three-month baseline period and linked to time to first exacerbation. Of 2788 eligible patients, 2511 (90%) had mild/moderate COPD and 277 (10%) had severe/very severe COPD based on Body Mass Index, Obstruction, Dyspnoea, Exacerbations (BODEx) cut-off of 4. Within the mild/moderate cohort, 4.5% of patients were controlled at baseline according to clinical features and 21.5% according to CAT threshold of 10. Within the severe/very severe cohort, no patients were controlled at baseline according to the proposed clinical features and 8.3% were controlled according to CAT threshold of 20. Compared with uncontrolled patients, time to first exacerbation was longer for controlled patients with mild/moderate COPD but not for those with severe/very severe COPD. Lowering the BODEx threshold for severity classification to 2 increased the number of patients achieving control. CAT scores were not good predictors of the risk of future exacerbation. With the proposed definition, very few patients were defined as controlled.

  5. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study).

    Science.gov (United States)

    Caballero, Andrés; Torres-Duque, Carlos A; Jaramillo, Claudia; Bolívar, Fabio; Sanabria, Fernando; Osorio, Patricia; Orduz, Carlos; Guevara, Diana P; Maldonado, Darío

    2008-02-01

    The prevalence of COPD in Colombia is unknown. This study aimed to investigate COPD prevalence in five Colombian cities and measure the association between COPD and altitude. A cross-sectional design and a random, multistage, cluster-sampling strategy were used to provide representative samples of adults aged >or= 40 years. Each participant was interviewed (validated Spanish version of the Ferris Respiratory Questionnaire) and performed spirometry before and after 200 microg of inhaled salbutamol, using a portable spirometer according to American Thoracic Society recommendations. COPD definitions were as follows: (1) spirometric: fixed ratio (primary definition): FEV1/FVC or= 3 months every year during >or= 2 consecutive years (chronic bronchitis). Analysis was performed using statistical software. A total of 5,539 orsubjects were included. The overall COPD prevalence using the primary definition (spirometric) was 8.9%, ranging from 6.2% in Barranquilla to 13.5% in Medellín. The prevalence measured by the spirometric definition was higher than medical (2.8%) and clinical (3.2%) definitions. After the logistic regression analysis, the factors related with COPD were age >or= 60 years, male gender, history of tuberculosis, smoking, wood smoke exposure >or= 10 years, and very low education level. There was a nonsignificant tendency toward larger prevalence with higher altitude. COPD is an important health burden in Colombia. Additional studies are needed to establish the real influence of altitude on COPD prevalence.

  6. Identification and distribution of COPD phenotypes in clinical practice according to Spanish COPD Guidelines: the FENEPOC study

    Directory of Open Access Journals (Sweden)

    Calle Rubio M

    2017-08-01

    Full Text Available Myriam Calle Rubio,1,2 Ricard Casamor,3 Marc Miravitlles4 On behalf of the FENEPOC study group1Pulmonary Department, Hospital Clínico San Carlos, 2Department of Medicine, Faculty of Medicine, University Complutense of Madrid, Research Institute of Hospital Clínico San Carlos (IdISSC, Madrid, 3Medical Department, Novartis Farmaceutica, Barcelona, 4Pneumology Department, University Hospital Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES, Barcelona, SpainBackground: The Spanish Guidelines for COPD (GesEPOC describe four clinical phenotypes: non-exacerbator (NE, asthma-COPD overlap syndrome (ACO, frequent exacerbator with emphysema (EE, and exacerbator with chronic bronchitis (ECB. The objective of this study was to determine the frequency of COPD phenotypes, their clinical characteristics, and the availability of diagnostic tools to classify COPD phenotypes in clinical practice.Materials and methods: This study was an epidemiological, cross-sectional, and multicentered study. Patients ≥40 years old with a post-bronchodilator forced expiratory volume in 1 s (FEV1/forced vital capacity ratio of <0.7 and who were smokers or former smokers (with at least 10 pack-years were included. The availability of diagnostic tools to classify COPD phenotypes was assessed by an ad hoc questionnaire.Results: A total of 647 patients (294 primary care [PC], 353 pulmonology centers were included. Most patients were male (80.8%, with a mean age (SD of 68.2 (9.2 years, mean post-bronchodilator FEV1 was 53.2% (18.9% and they suffered a mean of 2.2 (2.1 exacerbations in the last year. NE was the most frequent phenotype (47.5% found, followed by ECB (29.1%, EE (17.0%, and ACO (6.5%. Significant differences between the four phenotypes were found regarding age; sex; body mass index; FEV1; body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE/body mass index, airflow obstruction, dyspnea and exacerbations (BODEx index; modified Medical

  7. A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic biomarkers of inflammation.

    Directory of Open Access Journals (Sweden)

    Silvana P Barros

    Full Text Available BACKGROUND: In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities. OBJECTIVES: Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD. METHODS: Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group. Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation. RESULTS: A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events. CONCLUSIONS: These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to

  8. A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece

    OpenAIRE

    Tzanakis Nikolaos E; van der Molen Thys; Tsiligianni Ioanna G; Siafakas Nikolaos M; van Heijst Ellen; Lionis Christos

    2010-01-01

    Abstract Background Chronic obstructive pulmonary disease (COPD) and asthma are considered underdiagnosed and misdiagnosed chronic diseases. In The Netherlands, a COPD-asthma telemedicine service has been developed to increase GPs' ability to diagnose and manage COPD and asthma. A telemedicine COPD-asthma service may benefit Greece as it is a country, partly due to its geography, that does not have easy access to pulmonologists. Findings Therefore, a pilot feasibility study has been designed ...

  9. Incidence and relative risk for developing cancer among patients with COPD: a nationwide cohort study in Taiwan

    Science.gov (United States)

    Ho, Chung-Han; Chen, Yi-Chen; Wang, Jhi-Joung; Liao, Kuang-Ming

    2017-01-01

    Objectives This observational study aimed to examine the incidence of malignant diseases, including specific cancer types, after the diagnosis of chronic obstructive pulmonary disease (COPD) in Taiwanese patients. Setting Taiwan's National Health Insurance Research Database. Participants The definition of a patient with COPD was a patient with a discharge diagnosis of COPD or at least 3 ambulatory visits for COPD. The index date was the date of the first COPD diagnosis. Patients with a history of malignancy disorders before the index date were excluded. After matching age and gender, 13 289 patients with COPD and 26 578 control participants without COPD were retrieved and analysed. They were followed from the index date to malignancy diagnosis, death or the end of study follow-up (31 December 2011), whichever came first. Primary outcome measures Patients were diagnosed with cancer (n=1681, 4.2%; 973 (7.3%) for patients with COPD and 728 (2.7%) for patients without COPD). The risk of 7 major cancer types, including lung, liver, colorectal, breast, prostate, stomach and oesophagus, between patients with COPD and patients without COPD was also estimated. Results The mean age of all study participants was 57.9±13.5 years. The average length of follow-up to cancer incidence was 3.9 years for patients with COPD and 5.0 years for patients without COPD (prisk of developing cancer is higher in patients with COPD compared with patients without COPD. Cancer screening is warranted in patients with COPD. PMID:28279996

  10. [Pilot study: Apricena Marble District quarry workers and COPD].

    Science.gov (United States)

    Zefferino, R; Arsa, A; Masullo, M; Nigri, A G; Fanelli, A; Carella, F; Ambrosi, L

    2012-01-01

    The aim of the present article was to verify the Chronic Obstructive Pulmonary Disease (COPD) prevalence in a cohort of quarry workers who belong to the Apricena Marble District. We studied 70 workers. They received a questionnaire about the disease and confounding factors. The spirometry showed that the FEV1 was normal in 95% of workers, instead 5% showed values lower than former (Average: 73%). TNF alpha and IL-1 Beta in Exhaled breath condensate (EBC) were lower than the method limit in all workers. Our cohort is limited, but we could retain that the lung disease is not present in workers taken into consideration. Our results are in according to Rushton who demonstrated that only a prolonged occupation, higher than thirty years, is able to induce lung disease.

  11. What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study

    Science.gov (United States)

    Karrasch, Stefan; Brüske, Irene; Smith, Maia P; Thorand, Barbara; Huth, Cornelia; Ladwig, Karl-Heinz; Kronenberg, Florian; Heinrich, Joachim; Holle, Rolf; Peters, Annette; Schulz, Holger

    2016-01-01

    Background There is an ongoing debate about the appropriate spirometric criterion for airway obstruction to detect COPD. Furthermore, the association of different criteria with comorbidity prevalence and inflammatory biomarkers in advanced age is unclear. Materials and methods Spirometry was performed in a population-based study (n=2,256) covering an age range of 41–90 years. COPD was spirometrically determined either by a fixed ratio (FR) of <0.7 for forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) or by FEV1/FVC below the lower limit of normal (LLN). Comorbidity prevalences and circulating biomarker levels (C-reactive protein [CRP], interleukin [IL]-6) were compared between subjects with or without COPD by the two criteria using logistic and multiple regression models, adjusting for sex and age. Results The prevalence of spirometrically defined COPD by FR increased with age from 10% in subjects aged <65 years to 26% in subjects aged ≥75 years. For LLN-defined COPD, it remained below 10% for all age groups. Overall, COPD diagnosis was not associated with specific comorbidities, except for a lower prevalence of obesity in both FR- and LLN-defined cases. Both CRP and IL-6 tended to be higher in cases by both criteria. Conclusion In a population-based cohort of adults up to the age of 90 years, the prevalence of spirometrically defined COPD was higher for the FR criterion than for the LLN criterion. This difference increased with age. Neither prevalences of common comorbidities nor levels of the biomarkers, CRP or IL-6, were conclusively associated with the selection of the COPD criterion. Results have to be considered in light of the predominantly mild cases of airway obstruction in the examined study population. PMID:27574413

  12. The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

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    Quintana José M

    2011-11-01

    Full Text Available Abstract Background Patients with chronic obstructive pulmonary disease (COPD often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study. Methods/Design The RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data. Discussion The IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.

  13. COPD Medicine

    Science.gov (United States)

    ... Education & Training Home Treatment & Programs Medications COPD Medications COPD Medications Make an Appointment Ask a Question Refer ... control the symptoms of chronic obstructive pulmonary disease (COPD). Most people with COPD take long-acting medicine ...

  14. Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study

    Science.gov (United States)

    Calle Rubio, Myriam; Alcázar Navarrete, Bernardino; Soriano, Joan B; Soler-Cataluña, Juan J; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; López-Campos, José Luis

    2017-01-01

    Background Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. Methodology This is an observational study with prospective recruitment (May 2014–May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. Results A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. Conclusion The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing

  15. Flexible bronchoscopy with moderate sedation in COPD: a case–control study

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    Grendelmeier P

    2017-01-01

    Full Text Available Peter Grendelmeier, Michael Tamm, Kathleen Jahn, Eric Pflimlin, Daiana Stolz Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Petersgraben, Basel, Switzerland Background: Flexible bronchoscopy is increasingly used for diagnostic and therapeutic purposes. We aimed to examine the safety of flexible bronchoscopy with moderate sedation in patients with COPD. Methods: This study is a prospective, longitudinal, case–control, single-center study including 1,400 consecutive patients. After clinical and lung function assessments, patients were dichotomized in COPD or non-COPD groups. The primary end point was the combined incidence of complications. Results: The incidence of complications was similar in patients with and without COPD and independent of forced expiratory volume in the first second % predicted. Patients with COPD more frequently required insertion of a naso- or oropharyngeal airway; however, this difference was no longer significant after adjustment for age, gender, and duration of the procedure. Hypotension was significantly more common among patients with COPD. The number of episodes of hypoxemia ≤90% did not differ between the groups. However, patients with COPD had a lower mean and nadir transcutaneous oxygen saturation. Transcutaneous carbon dioxide tension (PtcCO2 change over the time course was similar in both groups, but both peak PtcCO2 and time on PtcCO2 >45 mmHg were higher in the COPD group. There were no differences in patient-reported outcomes. Conclusion: The safety of flexible bronchoscopy is similar in patients with and without COPD. This finding confirms the suitability of the procedure for both clinical and research indications. Keywords: bronchoalveolar lavage, propofol, complication, risk, respiratory insufficiency

  16. Validity of physician-diagnosed COPD in relation to spirometric definitions of COPD in a general population aged 50–64 years – the SCAPIS pilot study

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    Torén K

    2017-08-01

    Full Text Available Kjell Torén,1,2 Nicola Murgia,1,2 Anna-Carin Olin,1 Jan Hedner,3 John Brandberg,4 Annika Rosengren,5 Göran Bergström51Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; 2Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Italy; 3Department of Medicine/Lung Medicine, Sahlgrenska Academy, University of Gothenburg, 4Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 5Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden Background: In epidemiological studies, items about physician-diagnosed COPD are often used. There is a lack of validation and standardization of these items.Materials and methods: In a general population-based study, 1,050 subjects completed a questionnaire and performed spirometry, including forced expiratory volume in 1 second (FEV1 and forced vital capacity (FVC after inhalation of 400 µg of salbutamol. COPD was defined as the ratio of FEV1/FVC <0.7 after bronchodilation. Physician-diagnosed COPD was defined as an affirmative answer to the single item: “Have you ever had COPD diagnosed by a physician?”, physician-diagnosed COPD/emphysema as an affirmative answer to any of the two single items; “Have you ever had COPD diagnosed by a physician?” or “Have you ever been told by a physician that you have emphysema?”, physician-diagnosed chronic bronchitis as an affirmative answer to; “Have you ever been told by a physician that you have chronic bronchitis?” and physician-diagnosed COPD, emphysema or chronic bronchitis was defined as an affirmative answer to either of the three items above.Results: For the single item about physician-diagnosed COPD, the sensitivity was around 0.11 and the specificity was almost 0.99 in relation to COPD. The sensitivity of the combined items about COPD

  17. A real-world evaluation of indacaterol and other bronchodilators in COPD: the INFLOW study

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    Juvelekian G

    2015-10-01

    Full Text Available Georges Juvelekian,1 Waleed El-Sorougi,2 Chaicharn Pothirat,3 Faisal Yunus,4 Teresita De Guia,5 Han-Pin Kuo,6 Shalma Basu Patnaik,7 Virginia Pilipovic8 1St Georges Hospital University Medical Center, Ashrafieh, Beirut, Lebanon; 2Chest Department, Faculty of Medicine, Helwan University, Cairo, Egypt; 3Division of Pulmonary and Critical Care, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia, Persahabatan Hospital, Jakarta Timur, Indonesia; 5Department of Pulmonary Medicine, Philippine Heart Center, Quezon City, Philippines; 6Linkou Chang Gung Memorial Hospital, Taoyuan Hsien, Taiwan, ROC; 7Novartis Healthcare Pvt Ltd, Rangareddy, Telangana, India; 8Novartis Pharma AG, Basel, Switzerland Aim: INFLOW (INdacaterol eFfectiveness and utiLizatiOn in COPD: real World evaluation was a prospective, noninterventional study assessing the effectiveness and safety of long-acting bronchodilators in patients with chronic obstructive pulmonary disease (COPD from the Middle East, Asia, and South Africa.Methods: Patients newly prescribed or switched to indacaterol or other long-acting β2-agonist (LABA, or tiotropium (monotherapy or in combination were evaluated over 6 months. The primary endpoint was the clinical COPD questionnaire overall score at the end of the study.Results: Data were analyzed from 1,710 patients (mean postbronchodilator forced expiratory volume in 1 second, 59% predicted who received indacaterol (n=1,179, other LABA (n=68, tiotropium (n=271, indacaterol plus tiotropium (n=167, or other LABA plus tiotropium (n=25. Across treatments, clinical COPD questionnaire overall score improved from baseline by 0.81–1.26 points (all P<0.0001, 63%–84% of patients were satisfied/very satisfied, and physicians rated effectiveness as good/very good in 63%–80% of cases. The indacaterol inhaler was rated easy/very easy to use by the majority

  18. Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area

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    Almagro P

    2015-05-01

    Full Text Available Pere Almagro,1 Carme Hernandez,2,3,7 Pable Martinez-Cambor,4,5 Ricard Tresserras,2,6 Joan Escarrabill2,7 1Acute Geriatric Care Unit, Internal Medicine, University Hospital Mútua de Terrasa, University of Barcelona, Barcelona, Spain; 2Respiratory Disease Management Plan, Department of Health of the Autonomous Government of Catalonia, Observatory of Respiratory Therapy, 3Integrated Care Unit, Medical and Nursing Management, Hospital Clínic Barcelona, Barcelona, 4Oficina de Investigación Biosanitaria de Oviedo, Asturias, Spain; 5Universidad Autonoma de Chile, Santiago, Chile; 6Health Department, 7Chronic Diseases Care Program, Hospital Clinic, Hospital Clínic & REDISSEC (Health Services Research on Chronic Patients Network, Barcelona, Spain Background: Excluding the tropics, exacerbations of chronic obstructive pulmonary disease (COPD are more frequent in winter. However, studies that directly relate hospitalizations for exacerbation of COPD to ambient temperature are lacking. The aim of this study was to assess the influence of temperature on the number of hospitalizations for COPD.Methods: This was a population-based study in a metropolitan area. All hospital discharges for acute exacerbation of COPD during 2009 in Barcelona and its metropolitan area were analyzed. The relationship between the number of hospitalizations for COPD and the mean, minimum, and maximum temperatures alongside comorbidity, humidity, influenza rate, and environmental pollution were studied.Results: A total of 9,804 hospitalization discharges coded with COPD exacerbation as a primary diagnosis were included; 75.4% of cases were male with a mean age of 74.9±10.5 years and an average length of stay of 6.5±6.1 days. The highest number of admissions (3,644 [37.2%] occurred during winter, followed by autumn with 2,367 (24.1%, spring with 2,347 (23.9%, and summer with 1,446 (14.7%; P<0.001. The maximum, minimum, and mean temperatures were associated similarly with the

  19. Simulation environment and graphical visualization environment: a COPD use-case.

    Science.gov (United States)

    Huertas-Migueláñez, Mercedes; Mora, Daniel; Cano, Isaac; Maier, Dieter; Gomez-Cabrero, David; Lluch-Ariet, Magí; Miralles, Felip

    2014-11-28

    Today, many different tools are developed to execute and visualize physiological models that represent the human physiology. Most of these tools run models written in very specific programming languages which in turn simplify the communication among models. Nevertheless, not all of these tools are able to run models written in different programming languages. In addition, interoperability between such models remains an unresolved issue. In this paper we present a simulation environment that allows, first, the execution of models developed in different programming languages and second the communication of parameters to interconnect these models. This simulation environment, developed within the Synergy-COPD project, aims at helping and supporting bio-researchers and medical students understand the internal mechanisms of the human body through the use of physiological models. This tool is composed of a graphical visualization environment, which is a web interface through which the user can interact with the models, and a simulation workflow management system composed of a control module and a data warehouse manager. The control module monitors the correct functioning of the whole system. The data warehouse manager is responsible for managing the stored information and supporting its flow among the different modules. It has been proved that the simulation environment presented here allows the user to research and study the internal mechanisms of the human physiology by the use of models via a graphical visualization environment. A new tool for bio-researchers is ready for deployment in various use cases scenarios.

  20. Sleep and Quality of Life in People With COPD: A Descriptive-Correlational Study.

    Science.gov (United States)

    Dignani, Lucia; Toccaceli, Andrea; Lucertini, Carla; Petrucci, Cristina; Lancia, Loreto

    2016-08-01

    Sleep disorders are very common in patients with chronic obstructive pulmonary disease (COPD). However, it is not clear how sleep disorders and quality of life (QoL) affect each other in the different stages of disease progression. This descriptive-correlational study investigated the relationship between QoL, quality of sleep, and degree of disease progression in 102 outpatients with COPD. The results showed that the QoL in patients with COPD is compromised and worsens with disease progression, and the quality of sleep is significantly associated with QoL and worsened as the disease progressed. The early identification of a risk of alteration of the quality of sleep, especially in nursing care, could facilitate a preventive approach for COPD patients that could positively affect their QoL. © The Author(s) 2015.

  1. Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study

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    Planquette B

    2015-02-01

    Full Text Available Benjamin Planquette,1–4 Julien Péron,2 Etienne Dubuisson,1 Ariane Roujansky,1 Virginie Laurent,1 Alban Le Monnier,3 Stephane Legriel,1 Alexis Ferre,4 Fabrice Bruneel,1 Peter G Chiles,5 Jean P Bedos1 1Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France; 2Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France; 3Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France; 4Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France; 5Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA, USA Summary: Chronic obstructive pulmonary disease (COPD is a frequent source of hospitalization. Antibiotics are largely prescribed during COPD exacerbation. Our hypothesis is that large broad-spectrum antibiotics are more and more frequently prescribed. Our results confirm this trend and highlight that the increase in large broad-spectrum use in COPD exacerbation is largely unexplained. Background: Acute COPD exacerbation (AECOPD is frequently due to respiratory tract infection, and the benefit of antipseudomonal antibiotics (APA is still debated. Health care–associated pneumonia (HCAP was defined in 2005 and requires broad-spectrum antibiotherapy. The main objectives are to describe the antibiotic use for AECOPD in intensive care unit and to identify factors associated with APA use and AECOPD prognosis. Methods: We conducted a monocentric, retrospective study on all AECOPDs in the intensive care unit treated by antibiotics for respiratory tract infection. Treatment failure (TF was defined by death, secondary need for mechanical ventilation, or secondary systemic steroid treatment. A multivariate analysis was used to assess factors associated with APA prescription and TF. Results: From January 2000 to December 2011, 111 patients were included. Mean age was 69 years (±12, mean

  2. Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

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    Salameh P

    2012-09-01

    Full Text Available Pascale Salameh,1 Georges Khayat,2 Mirna Waked31Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, 2Faculty of Medicine, Hôtel Dieu de France Hospital, Beirut and Saint Joseph University, Beirut, 3Faculty of Medicine, Saint George Hospital, Beirut and Balamand University, Beirut, LebanonBackground: Diagnosing chronic obstructive pulmonary disease (COPD without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD, which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%. The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.Keywords: diagnosis, scale, development, spirometry

  3. Incidence and long-term outcome of severe asthma–COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults

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    Baarnes CB

    2017-02-01

    Full Text Available Camilla Boslev Baarnes,1 Zorana Jovanovic Andersen,2 Anne Tjønneland,3 Charlotte Suppli Ulrik1,4 1Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, 2Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, 3Danish Cancer Society Research Center, 4Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Background: Incidence and prognosis for severe asthma–COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma–COPD overlap compared to asthma and COPD alone. Materials and methods: A total of 57,053 adults (aged 50–64 years enrolled in the Danish Diet, Cancer, and Health cohort (1993–1997 were followed in the National Patients Registry for admissions for asthma (DJ45–46 and COPD (DJ40–44 and vital status. Asthma–COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points, and incident asthma–COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. Results: A total of 1,845 (3.2% and 4,037 (7.1% participants had admissions for asthma and COPD, respectively, with 662 (1.2% participants with asthma–COPD overlap. Incidence rate of asthma–COPD overlap per 1,000 person-years was higher in women (0.73 than in men (0.54 (P<0.02. Mortality rate was higher in asthma–COPD overlap (25.9 per 1,000 person-years compared with COPD (23.1, P<0.05 and asthma (7.9, P<0.001 alone. Compared to COPD alone, mortality was higher in women with asthma–COPD overlap (19.6 and 25.5, respectively; P<0.01, and the excess mortality rate for asthma–COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; P<0.01. Conclusion: This large population-based study revealed a higher incidence of severe asthma–COPD overlap in women compared to men, and

  4. Sinonasal inflammation in COPD

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Konge, Lars; Thomsen, Sf

    2013-01-01

    In this review we demonstrate that patients with chronic obstructive pulmonary disease (COPD) frequently report sinonasal symptoms. Furthermore, we present evidence that smoking on its own can cause nasal disease, and that in COPD patients, nasal inflammation mimics that of the bronchi. All...... this evidence suggests that COPD related sinonasal disease does exist and that smoking on its own rather than systemic inflammation triggers the condition. However, COPD related sinonasal disease remains to be characterized in terms of symptoms and endoscopic findings. In addition, more studies are needed...... to quantify the negative impact of sinonasal symptoms on the quality of life in COPD patients....

  5. Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study.

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    Francisco Pozo-Rodríguez

    Full Text Available BACKGROUNDS: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD, assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. METHODOLOGY/PRINCIPAL FINDINGS: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%. Among discharged patients, 37% required readmission (0-62% and 6.5% died (0-35%. The overall mortality rate was 11.6% (0-50%. Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50% addressed guidance on healthy life-styles. CONCLUSIONS/SIGNIFICANCE: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

  6. Does COPD risk vary by ethnicity? A retrospective cross-sectional study

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    Gilkes A

    2016-04-01

    Full Text Available Alexander Gilkes, Mark Ashworth, Peter Schofield, Timothy H Harries, Stevo Durbaba, Charlotte Weston, Patrick White Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Kings College London, London, UK Background: Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking. Method: A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, severity (% predicted forced expiratory volume in 1 second [FEV1], smoking status, and treatment were compared between ethnic groups, adjusting for age, sex, smoking, deprivation, and practice clustering. Results: Among 358,614 patients in 47 general practices, 47.6% were white, 20% black, and 5% Asian. Prevalence of COPD was 1.01% overall, 1.55% in whites, 0.58% in blacks, and 0.78% in Asians. COPD was less likely in blacks (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI] 0.39–0.51 and Asians (0.82; CI, 0.68–0.98 than whites. Black COPD patients were less likely to be current smokers (OR, 0.56; CI, 0.44–0.71 and more likely to be never-smokers (OR, 4.9; CI, 3.4–7.1. Treatment of patients with similar disease severity was similar irrespective of ethnic origin, except that long-acting muscarinic antagonists were prescribed less in black COPD patients (OR, 0.53; CI, 0.42–0.68. Black ethnicity was a predictor of poorer lung function (% predicted FEV1: B coefficient, -7.6; P<0.0001, an effect not seen when ethnic-specific predicted FEV1 values were used. Conclusion: Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to

  7. An evaluation of early medication use for COPD: a population-based cohort study

    Science.gov (United States)

    Falk, Jamie; Dik, Natalia; Bugden, Shawn

    2016-01-01

    Purpose The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. Patients and methods A population-based cohort study of COPD medication use was conducted using administrative health care data (1997–2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Results Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (PICS as a first medication increased from 23.5% to 34.4% (PICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% (PICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria. Conclusion The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly predominant use of multiple first medications, indicates a significant degree of medication burden in this already complex patient population. PMID:27994449

  8. The association between inhaled corticosteroid and pneumonia in COPD patients: the improvement of patients’ life quality with COPD in Taiwan (IMPACT study

    Directory of Open Access Journals (Sweden)

    Wang CY

    2016-11-01

    Full Text Available Cheng-Yi Wang,1,2 Chih-Cheng Lai,3 Wei-Chih Yang,4 Chia-Chieh Lin,1,2 Likwang Chen,4 Hao-Chien Wang,5 Chong-Jen Yu5 On behalf of the Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE 1Department of Internal Medicine, 2Medical Research Center, Cardinal Tien Hospital, Fu Jen Catholic University College of Medicine, New Taipei City, 3Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, 4Institute of Population Health Sciences, National Health Research Institutes, Zhunan, 5Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan Abstract: To investigate the association between inhaled corticosteroid (ICS exposure patterns and the risk of pneumonia in chronic obstructive pulmonary disease (COPD patients, we performed a nested case-control study. Between 1998 and 2010, 51,739 patients, including 19,838 cases of pneumonia, were matched to 74,849 control subjects selected from a cohort of COPD patients using ICSs via risk-set sampling of the database constructed by the National Health Research Institutes of Taiwan. After adjusting for covariates, the current use of ICSs was associated with a 25% increase in the risk of pneumonia (odds ratio [OR] =1.25, 95% confidence interval [CI] =1.20–1.30, and there was an increase in the OR with increase in the average daily dosage. Additionally, users of fluticasone/salmeterol, fluticasone, and either fluticasone/salmeterol or fluticasone were more likely to be at a higher risk of pneumonia (OR =1.35, 95% CI =1.28–1.41; OR =1.22, 95% CI =1.10–1.35; and OR =1.33, 95% CI =1.27–1.39, respectively. In contrast, there were no statistically significant associations between the risk of pneumonia and the use of budesonide/formoterol, budesonide, or either budesonide/formoterol or budesonide. In conclusion, ICSs are significantly associated with an increased risk of pneumonia in COPD patients

  9. The association between periodontal disease and chronic obstructive pulmonary disease: a case control study.

    Science.gov (United States)

    Öztekin, Görkem; Baser, Ulku; Kucukcoskun, Meric; Tanrikulu-Kucuk, Sevda; Ademoglu, Evin; Isik, Gulden; Ozkan, Gulcihan; Yalcin, Funda; Kiyan, Esen

    2014-08-01

    Although there are studies evaluating the effects of periodontal health on chronic obstructive pulmonary disease (COPD), the effects of COPD - a systemic disease, on periodontal tissue is unknown. The aim of this study is to evaluate the effects of COPD on periodontal tissues by comparing COPD patients and controls. Fifty-two COPD patients and 38 non-COPD controls were included in this case-control study. Number of teeth, plaque index (PI), gingival index (GI), bleeding on probing, clinical attachment level and probing depth were included in the periodontal examination. In addition to clinical evaluations, gingival crevicular fluid (GCF) levels of high-sensitive C-reactive protein (hs-CRP), interleukin-1 beta (IL-lb) and prostaglandin-E2 (PGE2), and serum hs-CRP levels were measured in COPD patients and the controls. The number of teeth was significantly lower while PI and GI were significantly higher in COPD patients when compared to the controls. As well as serum hs-CRP levels, the GCF levels of hs-CRP, IL-1b and PGE2 were significantly higher in COPD patients than the controls. Our results demonstrated that COPD may be associated with periodontal disease as manifested by lower number of teeth and higher levels of inflammatory mediators especially CRP in GCF. This finding may be a reflection of systemic effects of COPD on periodontal tissues. Poor oral health behavior of COPD patients have to be considered in larger size group studies in the future.

  10. The quality of COPD care in general practice in Denmark: the KVASIMODO study

    DEFF Research Database (Denmark)

    Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;

    2007-01-01

    AIM: We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve...... in the second. RESULTS: Based on analysis of all patient records, we observed a substantial improvement in the quality of care: recording of FEV1 improved from 52.7% of cases in the first survey to 71.4% in the second (p....8% in the second. When analysing the results focussing on the performance of single GPs there was an improvement in quality, but this was less than the improvement for patients overall - suggesting that improvement in quality of care was not equally distributed throughout the GPs' practices. CONCLUSION: We...

  11. The view of pulmonologists on palliative care for patients with COPD: a survey study

    Science.gov (United States)

    Duenk, RG; Verhagen, C; Dekhuijzen, PNR; Vissers, KCP; Engels, Y; Heijdra, Y

    2017-01-01

    Introduction Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results The 256 respondents (31.8%) covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2%) indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%), communication between pulmonologist and general practitioner (77%), and identification of the palliative phase (75.8%), while the latter was considered the most important aspect for improvement (67.6%). Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%), while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT). In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%). Conclusion To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification criteria. Furthermore, pulmonologists should improve their skills of palliative care, and the members of the SPCT should be better informed about the management of COPD to improve care during hospitalization. Communication between pulmonologist and general practitioner should be emphasized in training to improve

  12. STUDY OF ECG AND ECHOCARDIOGRAPHIC FINDINGS IN COPD PATIENTS IN A TERTIARY CARE CENTRE

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    Ramakrishna

    2016-03-01

    Full Text Available COPD is a major cause of death worldwide. Early identification of the complications, particularly pulmonary hypertension and right ventricular dysfunction can prevent or delay long-term complications. AIM OF THE STUDY To study ECG and Echocardiographic profile among COPD patients and study their importance in the management of COPD. MATERIALS AND METHODS We have studied 103 (N=103 patients diagnosed as COPD in our tertiary care centre. We categorized them into mild (FEV1/FVC80% predicted, Moderate (FEV1/FVC1 was seen in 4.44%. Atrial ectopics were seen in 18.55% and ventricular ectopics were seen in 3.09%. Right axis deviation was seen in 5.55% and no ECG changes in 39.17%. Echocardiogram showed consistent abnormal findings in 94%. Pulmonary arterial hypertension was seen in 94.84%, RV hypertrophy was seen in 26.82%. Cardiac arrhythmias and cardiac failure were seen in 8.24% each. ECG and Echocardiography can identify early pulmonary hypertension and right ventricular dysfunction. Proper institution of therapy can prevent long-term complications of severe pulmonary hypertension and right heart failure and can prolong the life and improve quality of life among COPD patients.

  13. Incidence and long-term outcome of severe asthma–COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults

    Science.gov (United States)

    Baarnes, Camilla Boslev; Andersen, Zorana Jovanovic; Tjønneland, Anne; Ulrik, Charlotte Suppli

    2017-01-01

    Background Incidence and prognosis for severe asthma–COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma–COPD overlap compared to asthma and COPD alone. Materials and methods A total of 57,053 adults (aged 50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–1997) were followed in the National Patients Registry for admissions for asthma (DJ45–46) and COPD (DJ40–44) and vital status. Asthma–COPD overlap was defined as at least one hospital admission for asthma and one for COPD (different time points), and incident asthma–COPD overlap as at least one of the diagnoses occurring after enrollment into the Diet, Cancer, and Health cohort. Results A total of 1,845 (3.2%) and 4,037 (7.1%) participants had admissions for asthma and COPD, respectively, with 662 (1.2%) participants with asthma–COPD overlap. Incidence rate of asthma–COPD overlap per 1,000 person-years was higher in women (0.73) than in men (0.54) (P<0.02). Mortality rate was higher in asthma–COPD overlap (25.9 per 1,000 person-years) compared with COPD (23.1, P<0.05) and asthma (7.9, P<0.001) alone. Compared to COPD alone, mortality was higher in women with asthma–COPD overlap (19.6 and 25.5, respectively; P<0.01), and the excess mortality rate for asthma–COPD overlap patients was most prominent for younger age groups (12.9 compared to 7.2 and 4.6 for COPD and asthma alone, respectively; P<0.01). Conclusion This large population-based study revealed a higher incidence of severe asthma–COPD overlap in women compared to men, and furthermore that all-cause mortality is higher in women and younger subjects with asthma–COPD overlap compared with those with asthma or COPD alone.

  14. Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study.

    Science.gov (United States)

    Strang, Susann; Ekberg-Jansson, Ann; Henoch, Ingela

    2014-12-01

    Anxiety often arises in conjunction with dyspnoea in patients with severe COPD. Considering the provoking symptomatology and the high mortality rate for COPD, it is reasonable to believe that these conditions trigger death-related and existential anxiety. Although anxiety causes considerable distress and reduces quality of life, people's experience of anxiety has been studied relatively little. The aim of this study was to explore severely ill COPD patients' experience of anxiety and their strategies to alleviate anxiety. This qualitative, in-depth interview study explored perceptions of anxiety and the alleviation strategies that are adopted. Interviews were analyzed using a thematic content analysis approach, involving interpretive coding and identification of themes. People suffering from COPD (stage III or IV) were recruited from a pulmonary outpatient clinic in the west of Sweden. Purposive sampling was used, and thirty-one (31) patients were included. Most of the patients had experienced anxiety associated with COPD. Analyses revealed three major themes, death anxiety, life anxiety, and counterweights to anxiety. Death anxiety included fear of suffocation, awareness of death, fear of dying and separation anxiety. Life anxiety included fear of living and fear of the future. Counterweights to anxiety concerned coping with suffocation, avoiding strategy, and a sense of joy that defied their vulnerable situation. The majority of patients experienced anxiety, which limited their lives. Although the patients experienced both life anxiety and death anxiety, they were able to cope with the situation and find a defiant joy to some extent.

  15. New evidence of increased risk of rhinitis in subjects with COPD: a longitudinal population study

    Science.gov (United States)

    Bergqvist, Joel; Andersson, Anders; Olin, Anna-Carin; Murgia, Nicola; Schiöler, Linus; Bove, Mogens; Hellgren, Johan

    2016-01-01

    Background The aim of this population-based study was to investigate the risk of developing noninfectious rhinitis (NIR) in subjects with chronic obstructive pulmonary disease (COPD). Materials and methods This is a longitudinal population-based study comprising 3,612 randomly selected subjects from Gothenburg, Sweden, aged 25–75 years. Lung function was measured at baseline with spirometry and the included subjects answered a questionnaire on respiratory symptoms. At follow-up, the subjects answered a questionnaire with a response rate of 87%. NIR was defined as symptoms of nasal obstruction, nasal secretion, and/or sneezing attacks without having a cold, during the last 5 years. COPD was defined as a spirometry ratio of forced expiratory volume in 1 second divided by forced vital capacity (FEV1/FVC) 40 years. Smoking, atopy, and occupational exposure to gas, fumes, or dust were also associated with new-onset NIR. COPD, smoking, and atopy remained individual risk factors for new-onset NIR in the logistic regression analysis. Conclusions This longitudinal population-based study of a large cohort showed that COPD is a risk factor for developing NIR. Smoking and atopy are also risk factors for NIR. The results indicate that there is a link present between upper and lower respiratory inflammation in NIR and COPD. PMID:27799760

  16. POPE study: rationale and methodology of a study to phenotype patients with COPD in Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    Zbozinkova Z

    2016-03-01

    Full Text Available Zuzana Zbozinkova,1 Adam Barczyk,2 Ruzena Tkacova,3 Arschang Valipour,4 Neven Tudoric,5 Kirill Zykov,6 Attila Somfay,7 Marc Miravitlles,8 Vladimir Koblizek91Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; 2Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; 3Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia; 4Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Wien, Austria; 5School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia; 6Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia; 7Department of Pulmonology, University of Szeged, Deszk, Hungary; 8Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 9Department of Pneumology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech RepublicIntroduction: Chronic obstructive pulmonary disease (COPD constitutes a major health challenge in Central and Eastern European (CEE countries. However, clinical phenotypes, symptom load, and treatment habits of patients with COPD in CEE countries remain largely unknown. This paper provides a rationale for phenotyping COPD and describes the methodology of a large study in CEE.Methods/design: The POPE study is an international, multicenter, observational cross-sectional survey of patients with COPD in CEE. Participation in the study is offered to all consecutive outpatients with stable COPD in 84 centers across the CEE region if they fulfill the following criteria: age >40 years, smoking history ≥10 pack-years, a confirmed diagnosis of COPD with postbronchodilator FEV1/FVC ,0.7, and absence

  17. Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective.

    Science.gov (United States)

    Lundell, Sara; Tistad, Malin; Rehn, Börje; Wiklund, Maria; Holmner, Åsa; Wadell, Karin

    2017-07-10

    Chronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD. The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers. The study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics. The analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on 'shaky' organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by

  18. Length of stay of COPD hospital admissions between 2006 and 2010: a retrospective longitudinal study

    Directory of Open Access Journals (Sweden)

    Harries TH

    2015-03-01

    Full Text Available Timothy H Harries,1 Hannah V Thornton,2 Siobhan Crichton,1 Peter Schofield,1 Alexander Gilkes,1 Patrick T White1 1King’s College London, King’s Health Partners, Division of Health and Social Care Research, London, UK; 2University of Bristol, Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, Canynge Hall, Bristol, UK Background: Hospitalizations for COPD are associated with poor patient prognosis. Length of stay (LOS of COPD admissions in a large urban area and patient and hospital factors associated with it are described. Methods: Retrospective longitudinal study. All COPD patients registered with London general practitioners and admitted as an emergency with COPD (2006–2010, not having been admitted with COPD in the preceding 12 months were included. Association of patient and hospital characteristics with mean LOS of COPD admissions was assessed. Association between hospital and LOS was determined by negative binomial regression. Results: The total number of admissions was 38,504, from 22,462 patients. The mean LOS for first admissions fell by 0.8 days (95% confidence interval [CI]: 0.7–1.5 from 8.2 to 7.0 days between 2006 and 2010. Seventy-nine percent of first admissions were ≤10 days, with a mean LOS of 3.7 days (2009–2010. The mean LOS of successive COPD admissions of the same patients was the same or less throughout the study period. The interval between successive admissions fell from a mean of 357 days between the first and second admission to a mean of 19 days after eight admissions. Age accounted for 2.3% of the variance in LOS. Socioeconomic deprivation did not predict LOS. Fewer discharges happened at the weekend (1,893/day than on weekdays (5,218/day. The mean LOS varied between hospitals, from 4.9 days (95% CI: 3.8–5.9 to 9.5 days (95% CI: 8.6–10.3 when adjusting for clustering, age, sex, and socioeconomic deprivation.Conclusion: The fall in LOS of

  19. Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study.

    Science.gov (United States)

    Waked, Mirna; Salame, Joseph; Khayat, Georges; Salameh, Pascale

    2012-01-01

    Our objective was to assess the prevalence of chronic bronchitis and chronic obstructive pulmonary disease (COPD) and their correlates among a Lebanese nonsmoker group. A cross-sectional study was conducted between October 2009 and September 2010, using a multistage cluster sample throughout Lebanon including Lebanese residents aged 40 years and above with no exclusion criteria. Pre- and postbronchodilator spirometry measurements were performed and carbon monoxide level was measured in exhaled air. COPD was defined and classified according to the Global Initiative for Chronic Obstructive Lung Disease guidelines or according to the lower limit of normal (forced expiratory volume in 1 second/forced vital capacity postbronchodilator bronchitis was defined by the declaration of morning cough and expectorations for more than 3 months a year over more than 2 years in individuals with normal spirometry. Out of 2201 individuals, 732 were never-smokers: 25 (3.4%) of them had COPD, and 86 (11.75%) fulfilled the definition of chronic bronchitis. Correlates of COPD included a childhood respiratory disease, house heated by diesel, and older age. On the other hand, correlates of chronic bronchitis included childhood respiratory diseases, living in southern Lebanon versus other regions, heating home by gas, older age, number of smokers at work, and lower height. A substantial percentage of the nonsmoking population may exhibit chronic bronchitis or COPD. The significant correlates mentioned above should be taken into consideration in order to reduce the risk of developing such chronic and debilitating respiratory diseases.

  20. Ageing and COPD affect different domains of nutritional status: the ECCE study.

    Science.gov (United States)

    Battaglia, S; Spatafora, M; Paglino, G; Pedone, C; Corsonello, A; Scichilone, N; Antonelli-Incalzi, R; Bellia, V

    2011-06-01

    Chronic obstructive pulmonary disease (COPD) and ageing may contribute to malnutrition. We aimed to explore whether COPD and ageing determine malnutrition in different manners. 460 stable COPD outpatients (376 males and 84 females) from the Extrapulmonary Consequences of COPD in the Elderly (ECCE) study database were investigated (age 75.0±5.9 yrs; forced expiratory volume in 1 s 54.7±18.3% predicted). Nutritional status was evaluated using the Mini Nutritional Assessment® (MNA) questionnaire. From the MNA, three scores exploring the domains of the nutritional status were calculated: body composition, energy intake and body functionality scores. Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages were negatively correlated with five MNA items exploring mobility, patient's perception of own nutrition and health status, and arm and calf circumferences (lowest Spearman's rho (rs)=-0.011; highest p=0.039). GOLD stages were independently correlated with body composition and body functionality scores (model r2=0.073). Age was negatively correlated with four MNA items exploring loss of appetite, fluid intake, mobility and autonomy in daily life (lowest rs=-0.013; highest p=0.030). Age was independently correlated with body functionality score (model r2=0.037). Severe COPD and ageing are independent and probably concurrent conditions leading to malnutrition. The MNA questionnaire allows a valuable insight into the complexity of components of nutritional status and may provide useful clues for treatment strategies.

  1. Cigarette smoke promotes dendritic cell accumulation in COPD; a Lung Tissue Research Consortium study

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    Yi Eunhee S

    2010-04-01

    Full Text Available Abstract Background Abnormal immune responses are believed to be highly relevant in the pathogenesis of chronic obstructive pulmonary disease (COPD. Dendritic cells provide a critical checkpoint for immunity by their capacity to both induce and suppress immunity. Although evident that cigarette smoke, the primary cause of COPD, significantly influences dendritic cell functions, little is known about the roles of dendritic cells in the pathogenesis of COPD. Methods The extent of dendritic cell infiltration in COPD tissue specimens was determined using immunohistochemical localization of CD83+ cells (marker of matured myeloid dendritic cells, and CD1a+ cells (Langerhans cells. The extent of tissue infiltration with Langerhans cells was also determined by the relative expression of the CD207 gene in COPD versus control tissues. To determine mechanisms by which dendritic cells accumulate in COPD, complimentary studies were conducted using monocyte-derived human dendritic cells exposed to cigarette smoke extract (CSE, and dendritic cells extracted from mice chronically exposed to cigarette smoke. Results In human COPD lung tissue, we detected a significant increase in the total number of CD83+ cells, and significantly higher amounts of CD207 mRNA when compared with control tissue. Human monocyte-derived dendritic cells exposed to CSE (0.1-2% exhibited enhanced survival in vitro when compared with control dendritic cells. Murine dendritic cells extracted from mice exposed to cigarette smoke for 4 weeks, also demonstrated enhanced survival compared to dendritic cells extracted from control mice. Acute exposure of human dendritic cells to CSE induced the cellular pro-survival proteins heme-oxygenase-1 (HO-1, and B cell lymphoma leukemia-x(L (Bcl-xL, predominantly through oxidative stress. Although activated human dendritic cells conditioned with CSE expressed diminished migratory CCR7 expression, their migration towards the CCR7 ligand CCL21 was not

  2. Efficacy and safety of tiotropium Respimat SMI in COPD in two 1-year randomized studies.

    Science.gov (United States)

    Bateman, Eric; Singh, Dave; Smith, David; Disse, Bernd; Towse, Lesley; Massey, Dan; Blatchford, Jon; Pavia, Demetri; Hodder, Rick

    2010-08-09

    Two 1-year studies evaluated the long-term efficacy and safety of tiotropium 5 or 10 microg versus placebo, inhaled via the Respimat Soft Mist Inhaler (SMI). The two studies were combined and had 4 co-primary endpoints (trough FEV(1) response, Mahler Transition Dyspnea Index [TDI] and St George's Respiratory Questionnaire scores all at week 48, and COPD exacerbations per patient-year). A total of 1990 patients with COPD participated (mean FEV(1): 1.09 L). The mean trough FEV(1) response of tiotropium 5 or 10 microg relative to placebo was 127 or 150 mL, respectively (both P SMI 5 microg demonstrated sustained improvements in patients with COPD relative to placebo and similar to the 10 microg dose but with a lower frequency of anticholinergic adverse events.

  3. Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

    OpenAIRE

    Drivenes, Elin; Østrem, Anders; Melbye, Hasse

    2014-01-01

    Background A combination of inhaled corticosteroid and long-acting beta2 agonist (ICS/LABA) is used frequently to treat chronic obstructive pulmonary disease (COPD) patients. The aim of the study was to determine whether prescribing ICS/LABA to COPD patients in primary care in 2009/10 was within the GOLD guidelines and whether and to what degree patient characteristics were associated with prescription of these drugs by GPs. Methods This was a cross-sectional study in seven Norwegian GP pract...

  4. New evidence of increased risk of rhinitis in subjects with COPD: a longitudinal population study

    Directory of Open Access Journals (Sweden)

    Bergqvist J

    2016-10-01

    Full Text Available Joel Bergqvist,1 Anders Andersson,2 Anna-Carin Olin,3 Nicola Murgia,3,4 Linus Schiöler,3 Mogens Bove,5 Johan Hellgren1 1Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, 2Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, 3Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 4Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy; 5Department of ENT and Oral Maxillofacial Surgery, NU Hospital Group, Trollhättan, Sweden Background: The aim of this population-based study was to investigate the risk of developing noninfectious rhinitis (NIR in subjects with chronic obstructive pulmonary disease (COPD. Materials and methods: This is a longitudinal population-based study comprising 3,612 randomly selected subjects from Gothenburg, Sweden, aged 25–75 years. Lung function was measured at baseline with spirometry and the included subjects answered a questionnaire on respiratory symptoms. At follow-up, the subjects answered a questionnaire with a response rate of 87%. NIR was defined as symptoms of nasal obstruction, nasal secretion, and/or sneezing attacks without having a cold, during the last 5 years. COPD was defined as a spirometry ratio of forced expiratory volume in 1 second divided by forced vital capacity (FEV1/FVC <0.7. Subjects who reported asthma and NIR at baseline were excluded from the study. The odds ratios for developing NIR (ie, new-onset NIR in relation to age, gender, body mass index, COPD, smoking, and atopy were calculated. Results: In subjects with COPD, the 5-year incidence of NIR was significantly increased (10.8% vs 7.4%, P=0.005 and was higher among subjects aged >40 years. Smoking, atopy, and occupational exposure to gas, fumes, or dust were also associated with new-onset NIR. COPD, smoking, and atopy remained

  5. An evaluation of early medication use for COPD: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Falk J

    2016-12-01

    Full Text Available Jamie Falk,1 Natalia Dik,2 Shawn Bugden1 1College of Pharmacy, Rady Faculty of Health Sciences, 2Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada Purpose: The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada.Patients and methods: A population-based cohort study of COPD medication use was conducted using administrative health care data (1997–2012. Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS was based on exacerbation history and past medication use.Results: Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (P<0.0001, whereas the use of ICS as a first medication increased from 23.5% to 34.4% (P<0.0001. Dispensation of an ICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% (P<0.0001. By the end of the study period, the majority of patients (53.3% were being initiated on two or more medications. Of 5,823 patients dispensed an ICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria

  6. A genome-wide association study of COPD identifies a susceptibility locus on chromosome 19q13

    DEFF Research Database (Denmark)

    Cho, Michael H; Castaldi, Peter J; Wan, Emily S

    2012-01-01

    The genetic risk factors for chronic obstructive pulmonary disease (COPD) are still largely unknown. To date, genome-wide association studies (GWASs) of limited size have identified several novel risk loci for COPD at CHRNA3/CHRNA5/IREB2, HHIP and FAM13A; additional loci may be identified through...

  7. Genome-wide association study of smoking behaviours in patients with COPD.

    Science.gov (United States)

    Siedlinski, Mateusz; Cho, Michael H; Bakke, Per; Gulsvik, Amund; Lomas, David A; Anderson, Wayne; Kong, Xiangyang; Rennard, Stephen I; Beaty, Terri H; Hokanson, John E; Crapo, James D; Silverman, Edwin K

    2011-10-01

    Background Cigarette smoking is a major risk factor for chronic obstructive pulmonary disease (COPD) and COPD severity. Previous genome-wide association studies (GWAS) have identified numerous single nucleotide polymorphisms (SNPs) associated with the number of cigarettes smoked per day (CPD) and a dopamine beta-hydroxylase (DBH) locus associated with smoking cessation in multiple populations. Objective To identify SNPs associated with lifetime average and current CPD, age at smoking initiation, and smoking cessation in patients with COPD. Methods GWAS were conducted in four independent cohorts encompassing 3441 ever-smoking patients with COPD (Global Initiative for Obstructive Lung Disease stage II or higher). Untyped SNPs were imputed using the HapMap (phase II) panel. Results from all cohorts were meta-analysed. Results Several SNPs near the HLA region on chromosome 6p21 and in an intergenic region on chromosome 2q21 showed associations with age at smoking initiation, both with the lowest p=2×10(-7). No SNPs were associated with lifetime average CPD, current CPD or smoking cessation with p<10(-6). Nominally significant associations with candidate SNPs within cholinergic receptors, nicotinic, alpha 3/5 (CHRNA3/CHRNA5; eg, p=0.00011 for SNP rs1051730) and cytochrome P450, family 2, subfamily A, polypeptide 6 (CYP2A6; eg, p=2.78×10(-5) for a non-synonymous SNP rs1801272) regions were observed for lifetime average CPD, however only CYP2A6 showed evidence of significant association with current CPD. A candidate SNP (rs3025343) in DBH was significantly (p=0.015) associated with smoking cessation. Conclusion The authors identified two candidate regions associated with age at smoking initiation in patients with COPD. Associations of CHRNA3/CHRNA5 and CYP2A6 loci with CPD and DBH with smoking cessation are also likely of importance in the smoking behaviours of patients with COPD.

  8. Developing COPD: a 25 year follow up study of the general population

    DEFF Research Database (Denmark)

    Løkke, Anders; Lange, Peter; Scharling, H

    2006-01-01

    population. METHODS: As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed. RESULTS: The percentage...

  9. Prevalence of COPD in Copenhagen

    DEFF Research Database (Denmark)

    Fabricius, Peder; Løkke, Anders; Marott, Jacob Louis

    2011-01-01

    COPD is a leading cause of death worldwide; however, prevalence estimates have varied considerably in previous studies. This study aimed to determine the prevalence and severity of COPD in Copenhagen using data from the 4th examination of The Copenhagen City Heart Study, to investigate the relati...... the relationship between tobacco consumption and COPD, and to characterize the subjects with COPD with regard to BMI, dyspnoea, treatment with respiratory medication and co-morbidities....

  10. A real-world evaluation of indacaterol and other bronchodilators in COPD: the INFLOW study.

    Science.gov (United States)

    Juvelekian, Georges; El-Sorougi, Waleed; Pothirat, Chaicharn; Yunus, Faisal; De Guia, Teresita; Kuo, Han-Pin; Basu Patnaik, Shalma; Pilipovic, Virginia

    2015-01-01

    INFLOW (INdacaterol eFfectiveness and utiLizatiOn in COPD: real World evaluation) was a prospective, noninterventional study assessing the effectiveness and safety of long-acting bronchodilators in patients with chronic obstructive pulmonary disease (COPD) from the Middle East, Asia, and South Africa. Patients newly prescribed or switched to indacaterol or other long-acting β2-agonist (LABA), or tiotropium (monotherapy or in combination) were evaluated over 6 months. The primary endpoint was the clinical COPD questionnaire overall score at the end of the study. Data were analyzed from 1,710 patients (mean postbronchodilator forced expiratory volume in 1 second, 59% predicted) who received indacaterol (n=1,179), other LABA (n=68), tiotropium (n=271), indacaterol plus tiotropium (n=167), or other LABA plus tiotropium (n=25). Across treatments, clinical COPD questionnaire overall score improved from baseline by 0.81-1.26 points (all Pindacaterol inhaler was rated easy/very easy to use by the majority of patients, and physicians considered its use clearly understood by most patients. All treatments had acceptable tolerability. In real life clinical practice across a diverse region, indacaterol and other long-acting bronchodilators improved health status and were well regarded by patients and physicians.

  11. Brazilian studies on pulmonary function in COPD patients: what are the gaps?

    Science.gov (United States)

    Lopes, Agnaldo José; de Melo, Pedro Lopes

    2016-01-01

    Background COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease. Objectives This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century. Materials and methods The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function. Results After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields. Conclusion There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using prospective and longitudinal design may be of interest to elucidate the use of these new methods in the diagnosis and prevention of COPD. PMID:27468230

  12. A Phenomenological Study of Hospital Readmissions of Chinese Older People With COPD.

    Science.gov (United States)

    Tang, Fiona Wing-Ki; Lee, Diana Tze-Fan

    2016-10-27

    Hospital readmission is prevalent among older people with chronic obstructive pulmonary disease (COPD). Studies in this area have primarily identified the associated factors. A thorough understanding of the issue can be achieved by interpreting the related experiences in its context. This study aimed to explore the lived experience of hospital readmissions of Chinese older people with COPD. The lived experience of hospital readmissions was acquired through descriptive phenomenology. Unstructured interviews were conducted with 22 Chinese older people readmitted to a hospital for COPD. Narrative descriptions were analyzed using the phenomenological method described by Giorgi. Six constituents emerged from the general structure of the lived experience. "Refraining from unnecessary readmissions" describes how older people manage COPD in relation to hospital readmissions. "Craving for survival" explains why they seek hospital readmissions. "Feeling disregarded and powerless" and "being conscious of relieving burden to families" characterize their experience of hospital readmissions. "Resigning to hospital readmissions" illustrates how they understand the phenomenon, and "living for the moment" illuminates how they live with these experiences. These constituents are interrelated in meaningful ways and comprise the whole phenomenon of hospital readmissions. The Chinese older people's experience revealed that hospital readmissions are complex experiences shaped by their sociocultural context. Older people appear to accept and cope well with hospital readmissions. However, this study uncovered their unmet needs, which may undermine their dignity. The findings of this study offer implications for promoting wellness among Chinese older people with COPD. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. OCCUPATIONAL EXPOSURE AND COPD

    DEFF Research Database (Denmark)

    Würtz, Else Toft

    Chronic Obstructive Pulmonary Disease (COPD) is a common disease. The main risk factor is smoking although 15% of the COPD cases are expected to be preventable if the occupational exposures from vapour, gas, dust, and fume were eliminated; the population attributable fraction (PAF). The thesis...... addresses the association between occupational exposure and COPD in a population-based cohort of Danes aged 45-84-years. 4717 participants were included at baseline and 2624 at the four year follow-up. COPD was defined by spirometry and the occupational exposure was based on specialist defined jobs...... and questionnaires. The main occupational exposure was organic dust and 49% reported no lifetime occupational exposure. The results suggest occupational exposures to be associated to COPD also in never smokers and women. We found an exposure-response relation in the cross sectional analyses. The results...

  14. Genetics of COPD

    Directory of Open Access Journals (Sweden)

    Hidetoshi Nakamura

    2011-01-01

    Full Text Available Previous family studies suggested that genetic variation contributes to COPD susceptibility. The only gene proven to influence COPD susceptibility is SERPINA1, encoding α1-antitrypsin. Most studies on COPD candidate genes except SERPINA1, have not been consistently replicated. However, longitudinal studies of decline in lung function, meta-analyses of candidate gene studies, and family-based linkage analyses suggested that variants in EPHX1, GST, MMP12, TGFB1, and SERPINE2 were associated with susceptibility to COPD. A genome-wide association (GWA study has recently demonstrated that CHRNA3/5 in 15q25 was associated with COPD compared with control smokers. It was of interest that the CHRNA3/5 locus was associated with nicotine dependence and lung cancer as well. The associations of HHIP on 4q31 and FAM13A on 4q22 with COPD were also suggested in GWA studies. Another GWA study has shown that BICD1 in 12p11 was associated with the presence or absence of emphysema. Although every genetic study on COPD has some limitations including heterogeneity in smoking behaviors and comorbidities, it has contributed to the progress in elucidating the pathogenesis of COPD. Future studies will make us understand the mechanisms underlying the polygenic disease, leading to the development of a specific treatment for each phenotype.

  15. COPD – PREVALENCE AND RISK STUDY AMONG FEMALES OF RURAL AREA, DISTRICT AMBALA, HARYANA, INDIA

    Directory of Open Access Journals (Sweden)

    Mukhmohit

    2014-04-01

    Full Text Available BACKGROUND: The increasing impact of COPD on health care resources is now being recognized as a major public health problem and is projected to be the third leading cause of death worldwide by 2020. Factually, the huge variability across our nation makes it pivotal to make epidemiological mapping and prevalence data be calculated and represented by different regions. This study was undertaken to assess the epidemiology of COPD among females from rural area of district Ambala, Haryana. MATERIAL AND METHODS: A community based, cross sectional study was conducted in 1027 females from the field practice area of Rural Training health centre located in village barara district Ambala, Haryana. The data was collected by interviewing the individuals by doing house to house visit by questionnaire based interview method, clinical examination and spirometry where necessary, after obtaining an informed and written consent. The data was statistically tested using Microsoft excel 2007, Epi Info 3.1.1 and SPSS version 17. RESULTS: The overall prevalence of COPD was observed as 5.1%. On MLR analysis, age more than 50 years (OR 13.140; CI 5.64 – 23.095, low socio economic status (OR 3.11; CI 1.547-6.25, smoking (OR 6.187; CI 2.274 – 16.836 and use of biomass as a source of fuel for cooking (OR 1.46; CI 1.087 – 3.248 and kitchen smoke exposure for more than 30 years (OR 2.479; CI 1.414 – 4.374 were found to be significantly associated with COPD. CONCLUSION: Kitchen fuel exposure and using biomass and coal as a fuel are strongly associated with development of COPD in rural females.

  16. A challenge to the seven widely believed concepts of COPD

    Directory of Open Access Journals (Sweden)

    Al-Kassmimi FA

    2013-01-01

    Full Text Available Feisal A Al-Kassimi, Esam H AlhamadDivision of Pulmonology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaAbstract: This review proposes a critical reassessment (based entirely on published evidence of the following seven common beliefs about chronic obstructive pulmonary disease (COPD: (1 COPD is one disease. (2 There is a valid definition for COPD. (The current definition includes cases of irreversible asthma and bronchiectasis, and occasionally, other obstructive lung conditions. (3 Irreversible asthma in smokers and COPD cannot be differentiated. (4 A “chronic bronchitis” form of COPD exists and is characterized by blue bloater status and normal carbon monoxide diffusion studies. (5 Phenotyping has no bearing on medication choice in COPD. (6 Computerized scoring of lung attenuation on CT scans can diagnose emphysema. (Emphysema scores overlap in irreversible asthma and COPD; however, qualitative visual changes may be useful for differentiation. (7 A definable entity called the overlap (of COPD and asthma syndrome exists. Conflict over the abovementioned points denies patients proper phenotype-guided therapy and encourages a multidrug approach to COPD management. The recently coined term, overlap syndrome, invites a double-barreled therapy aimed at asthma and COPD, despite the absence of any agreement about how to define the syndrome and the lack of any related drug trials (in the area of inhaled corticosteroids. A diagnosis of COPD is associated with high morbidity and escalating costs, suggesting the need for a thorough new examination of the evidence.Keywords: asthma, computerized tomography, COPD, global initiative for chronic obstructive lung disease, overlap syndrome

  17. Lung function and blood markers of nutritional status in non-COPD aging men with smoking history: a cross-sectional study.

    Science.gov (United States)

    Shiozawa, Nobuyoshi; Hayashimoto, Kanae; Suzuki, Etsuji; Kikuchi, Hiroshi; Takata, Shingo; Ashida, Kozo; Watanabe, Masutaka; Hosaki, Yasuhiro; Mitsunobu, Fumihiro

    2010-08-09

    Cigarette smoking and advanced age are well known as risk factors for chronic obstructive pulmonary disease (COPD), and nutritional abnormalities are important in patients with COPD. However, little is known about the nutritional status in non-COPD aging men with smoking history. We therefore investigated whether reduced lung function is associated with lower blood markers of nutritional status in those men. This association was examined in a cross-sectional study of 65 Japanese male current or former smokers aged 50 to 80 years: 48 without COPD (non-COPD group), divided into tertiles according to forced expiratory volume in one second as percent of forced vital capacity (FEV(1)/FVC), and 17 with COPD (COPD group). After adjustment for potential confounders, lower FEV(1)/FVC was significantly associated with lower red blood cell count (RBCc), hemoglobin, and total protein (TP); not with total energy intake. The difference in adjusted RBCc and TP among the non-COPD group tertiles was greater than that between the bottom tertile in the non-COPD group and the COPD group. In non-COPD aging men with smoking history, trends toward reduced nutritional status and anemia may independently emerge in blood components along with decreased lung function even before COPD onset.

  18. The view of pulmonologists on palliative care for patients with COPD: a survey study

    Directory of Open Access Journals (Sweden)

    Duenk RG

    2017-01-01

    Full Text Available RG Duenk,1 C Verhagen,1 PNR Dekhuijzen,2 KCP Vissers,1 Y Engels,1,* Y Heijdra2,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work Introduction: Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective: Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods: A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results: The 256 respondents (31.8% covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2% indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%, communication between pulmonologist and general practitioner (77%, and identification of the palliative phase (75.8%, while the latter was considered the most important aspect for improvement (67.6%. Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%, while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT. In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%. Conclusion: To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification

  19. COPD - control drugs

    Science.gov (United States)

    Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - ...

  20. COPD and the microbiome.

    Science.gov (United States)

    Mammen, Manoj J; Sethi, Sanjay

    2016-05-01

    Traditional culture techniques confirm that bacteria have an important role in Chronic Obstructive Pulmonary Disease (COPD). In individuals with COPD, acquisition of novel bacterial strains is associated with onset of acute exacerbation of COPD, which leads to further lung dysfunction and enormous health-care costs. Recent study of the human microbiome, the total composite of the bacteria on the human body, posited the microbiome as the last human organ studied, as the microbiome performs a multitude of metabolic functions absent in the human genome. The largest project to study the human microbiome was the National Institutes of Health (NIH) human microbiome project (HMP) started in 2007 to understand the 'normal' microbiome. However due to the presumption that the healthy human lung was sterile, the respiratory tract was not included in that study. The advent of next-generation sequencing technologies has allowed the investigation of the human respiratory microbiome, which revealed that the healthy lung does have a robust microbiome. Subsequent studies in individuals with COPD revealed that the microbiome composition fluctuates with severity of COPD, composition of the individual aero-digestive tract microbiomes, age, during an acute exacerbation of COPD and with the use of steroids and/or antibiotics. Understanding the impact of the microbiome on COPD progression and risk of exacerbation will lead to directed therapies for prevention of COPD progression and exacerbation.

  1. Detection of COPD in smokers

    NARCIS (Netherlands)

    Geijer, R.M.M.

    2006-01-01

    Smoking is the main risk factor for Chronic Obstructive Pulmonary Disease (COPD), formerly known as lung emphysema or ‘chronic bronchitis’. Early detection of COPD and smoking cessation may result in significant health gain. In a thesis titled ‘Detection of COPD in smokers’ the results of 6 studies

  2. Natural history of COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lange, Peter

    2016-01-01

    The natural history of chronic obstructive pulmonary disease (COPD) is usually described with a focus on change in forced expiratory volume in 1 s (FEV1 ) over time as this allows for exploration of risk factors for an accelerated decline-and thus of developing COPD. From epidemiological studies we...

  3. Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

    Directory of Open Access Journals (Sweden)

    Sørensen SS

    2015-06-01

    Full Text Available Sabrina Storgaard Sørensen,1 Kjeld Møller Pedersen,1 Ulla Møller Weinreich,2,3 Lars Holger Ehlers,1 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Aalborg East, Denmark; 2Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; 3The Clinical Institute, Aalborg University Hospital, Aalborg, Denmark Background: Case management interventions are recommended to improve quality of care and reduce costs in chronic care, but further evidence on effectiveness and cost-effectiveness is needed. The objective of this study is the reporting of the design and participant enrollment of a randomized controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD. With a focus on support for self-care and care coordination, the intervention was hypothesized to result in a reduced number of COPD-related hospital admissions. Patients and methods: The design was a randomized controlled trial conducted from 2012 to 2014 with randomization and intervention at patient level. The study took place in Aalborg Municipality, a larger municipality in Denmark. A total of 150 COPD patients were randomized into two groups: the case-managed group and the usual-care group. Participant characteristics were obtained at baseline, and measures on effectiveness and costs were obtained through questionnaires and registries within a 12-month follow-up period. In the forthcoming analysis, effectiveness will be evaluated on COPD-related hospital admissions, mortality, health- related quality of life, and self-care. An economic evaluation will examine the cost-effectiveness of case management against current usual care from the perspective of the health care sector. Results: Baseline characteristics were comparable between the two groups except for the

  4. Brazilian studies on pulmonary function in COPD patients: what are the gaps?

    Directory of Open Access Journals (Sweden)

    Lopes AJ

    2016-07-01

    Full Text Available Agnaldo José Lopes,1,2 Pedro Lopes de Melo3 1Pulmonary Function Laboratory, State University of Rio de Janeiro, 2Pulmonary Rehabilitation Laboratory, Augusto Motta University Center, 3Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, BrazilBackground: COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease.Objectives: This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century.Materials and methods: The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function.Results: After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields.Conclusion: There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using

  5. Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy

    Science.gov (United States)

    Fedeli, Ugo; De Giorgi, Alfredo; Gennaro, Nicola; Ferroni, Eliana; Gallerani, Massimo; Mikhailidis, Dimitri P; Manfredini, Roberto; Fabbian, Fabio

    2017-01-01

    Background COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD) is frequently diagnosed in older people living in Western societies and could impact COPD patients’ mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD. Methods A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI) were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression. Results Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up). After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30–1.42) independently from comorbidities summarized by the CCI was a significant risk factor for mortality. Conclusion In spite of limitations due to the use of claims data, long-term survival of COPD patients was heavily affected by the presence of CKD and other comorbidities. PMID:28184156

  6. Management of COPD, equal treatment across age, gender, and social situation? A register study

    Directory of Open Access Journals (Sweden)

    Henoch I

    2016-10-01

    Full Text Available Ingela Henoch,1,2 Susann Strang,1,2 Claes-Göran Löfdahl,1,3 Ann Ekberg-Jansson1,4 1Angered Hospital, Research and Development Department, 2The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, 3University of Lund, Lund, 4Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden Abstract: Chronic obstructive pulmonary disease (COPD is a progressive chronic disease where treatment decisions should be based on disease severity and also should be equally distributed across age, gender, and social situation. The aim of this study was to determine to what extent patients with COPD are offered evidence-based interventions and how the interventions are distributed across demographic and clinical factors in the sample. Baseline registrations of demographic, disease-related, and management-related variables of 7,810 patients in the Swedish National Airway Register are presented. One-third of the patients were current smokers. Patient-reported dyspnea and health-related quality of life were more deteriorated in elderly patients and patients living alone. Only 34% of currently smoking patients participated in the smoking cessation programs, and 22% of all patients were enrolled in any patient education program, with women taking part in them more than men. Less than 20% of the patients had any contact with physiotherapists or dieticians, with women having more contact than men. Men had more comorbidities than women, except for depression and osteoporosis. Women were more often given pharmacological treatments. With increasing severity of dyspnea, participation in patient education programs was more common. Dietician contact was more common in those with lower body mass index and more severe COPD stage. Both dietician contact and physiotherapist contact increased with deteriorated health-related quality of life, dyspnea, and increased exacerbation frequency. The present study

  7. Rosuvastatin, lycopene and omega-3 fatty acids: A potential treatment for systemic inflammation in COPD; a pilot study

    Directory of Open Access Journals (Sweden)

    Evan J. Williams

    2016-09-01

    Conclusion: This study shows that rosuvastatin, omega-3 fatty acids and lycopene have some anti-inflammatory effects systemically, but rosuvastatin may increase airway neutrophils, which would be undesirable in COPD patients, warranting further investigation.

  8. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    OpenAIRE

    Korpershoek, Y. J. G.; Vervoort, S.C.J.M.; Nijssen, L. I T; Trappenburg, J.C.A.; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. Methods: A qualitative study using semi-structured in-d...

  9. Prevalence characteristics of COPD in never smokers

    Directory of Open Access Journals (Sweden)

    Ramadan M. Bakr

    2012-07-01

    Conclusions: This study revealed that never smokers constitute a significant proportion of the Egyptian COPD patients. When dealing with COPD management, clinicians must be oriented with the different risk factors, other than tobacco smoke, that play a key role in the development and pathogenesis of COPD, because despite smoking is the most important risk factor, its absence doesn’t exclude COPD diagnosis.

  10. A PROSPECTIVE STUDY OF ELECTROCARDIOGRAPHIC CHANGES IN COPD

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    Jimnaz

    2014-05-01

    Full Text Available OBJECTIVES OF STUDY: To study the electrocardiographic findings in Chronic obstructive pulmonary disease. To correlate these findings with duration, severity of the disease and pulmonary function test. MATERIALS AND METHODS: This study consists of 50 patients selected randomly from the cases admitted in the medical wards with symptoms suggestive of airway obstruction of more than 2 years duration, and in whom clinical diagnosis of chronic obstructive pulmonary disease was made. All these patients were subjected to Spirometric tests, the values of forced expiratory volume in first second (FEV1 less than 80% of the expected value, which does not alter significantly after bronchodilator inhalation (<200ml were included in this study. The cases like Bronchial asthma, Pulmonary tuberculosis, Bronchiectasis, Cor pulmonale in failure, Cardiac illness, hypertension, and diabetes mellitus were excluded from the study. RESULT: 50 patients of chronic obstructive pulmonary disease were studied Majority of patient had moderate airflow obstruction. The commonest ECG changes were P wave axis ≥+900, QRS axis ≥ + 90and P wave height in L2 ≥ 2.5mm. R wave in V6 < 5 mm and R/S ratio in V5 V6 ≤1 were seen less commonly. Unifocal right ventricular ectopics and RBBB were seen rarely. CONCLUSION: E.C.G. changes correlate significantly with low value of FEV1/FVC ratio. The commonest ECG changes were P wave axis ≥+900, QRS axis ≥ + 90 and P wave height in L2 ≥2.5mm. R wave in V6 <5 mm and R/S ratio in V5 V6 ≤1 were seen less commonly. Unifocal right ventricular ectopics and RBBB were seen rarely.

  11. A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece

    Directory of Open Access Journals (Sweden)

    Tzanakis Nikolaos E

    2010-07-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD and asthma are considered underdiagnosed and misdiagnosed chronic diseases. In The Netherlands, a COPD-asthma telemedicine service has been developed to increase GPs' ability to diagnose and manage COPD and asthma. A telemedicine COPD-asthma service may benefit Greece as it is a country, partly due to its geography, that does not have easy access to pulmonologists. Findings Therefore, a pilot feasibility study has been designed in Greece in order to establish this telemedicine service. Ten rural practices, in the island of Crete, with an average population of 2000 patients per practice will pilot the project supported by three pulmonologists. This paper presents the translated interfaces, the flowcharts and the steps that are considered as necessary for this feasibility study in Crete, Greece.

  12. Impact of non-linear smoking effects on the identification of gene-by-smoking interactions in COPD genetics studies

    DEFF Research Database (Denmark)

    Castaldi, P J; Demeo, D L; Hersh, C P

    2010-01-01

    Background The identification of gene-by-environment interactions is important for understanding the genetic basis of chronic obstructive pulmonary disease (COPD). Many COPD genetic association analyses assume a linear relationship between pack-years of smoking exposure and forced expiratory volume...... in 1 s (FEV(1)); however, this assumption has not been evaluated empirically in cohorts with a wide spectrum of COPD severity. Methods The relationship between FEV(1) and pack-years of smoking exposure was examined in four large cohorts assembled for the purpose of identifying genetic associations...... with COPD. Using data from the Alpha-1 Antitrypsin Genetic Modifiers Study, the accuracy and power of two different approaches to model smoking were compared by performing a simulation study of a genetic variant with a range of gene-by-smoking interaction effects. Results Non-linear relationships between...

  13. HOLD study (Home care Obstructive Lung Disease): natural history of patients with advanced COPD.

    Science.gov (United States)

    Gainza Miranda, Daniel; Sanz Peces, Eva María; Alonso Babarro, Alberto; Prados Sánchez, Maria Concepción; Varela Cerdeira, María

    2016-03-22

    Chronic obstructive pulmonary disease (COPD) is the fourth cause of death in western countries. Its final stage has clearly been forgotten by medical research in recent years. There exists consensus regarding the need to integrate palliative care in assisting these patients, but the difficulty in establishing a prognosis for the disease, establishing limits for life support measures, the lack of information about the disease's natural course and ignorance as to the most effective health-care structure for these patients' palliative treatment may be responsible for their late inclusion or non-inclusion in specific programmes. The main purpose of this work is to find out the natural background of patients with stage IV COPD and the main prognostic factors that influence these patients' survival. Prospective observational study of a home patient cohort with stage IV COPD sent from Neumology consultations and Palliative Care Unit in La Paz Hospital in Madrid and Primary Care Health Centres in the area to the palliative care home support team. The goal is to study socio-demographic variables, prognosis, nutritional status, use of health resources, perceived quality of life, functionality, main symptomatology, use and effectiveness of opioids, adherence to treatment, prognostic information regarding the disease, information given by professionals, advance directives, social backup requirements and overburden level of the main caregiver. The HOLD study is a project aimed at finding out the prognostic factors and evolution of the disease COPD in its most advanced stage. The final goal is to improve the health and quality of life, in a personalised, integral way up to end of life and explore and foster communication with patients, as well as their participation and collaboration in decision-taking. The HOLD study can help us better understand what these patients' real palliative and care needs are, in order to more efficiently organise their treatment at end of life.

  14. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

  15. Which is the Best Screening Strategy for COPD among Smokers in Primary Care?

    Science.gov (United States)

    Llordés, Montserrat; Zurdo, Elba; Jaén, Ángeles; Vázquez, Inmaculada; Pastrana, Luís; Miravitlles, Marc

    2017-02-01

    We developed a questionnaire to detect cases of chronic obstructive pulmonary disease (COPD) and compared its reliability with other strategies. In order to develop the new questionnaire (COPD screening questionnaire from Terrassa [EGARPOC]) we used data from an epidemiological study on the prevalence of COPD in smokers and calculated the odds ratio for each variable showing significance for the diagnosis of COPD on regression analysis. For comparison among questionnaires and the portable spirometer COPD-6, a cross-sectional multicenter study was performed. The study included 407 smokers or ex-smokers over the age of 40 years with no known diagnosis of COPD, who completed the different questionnaires (EGARPOC, Respiratory Health Screening Questionnaire, COPD-population screener and 2 questions) and underwent spirometry with the COPD-6. We determined the sensitivity, specificity, positive and negative predictive values (S, Sp, PPV and NPV, respectively) and the area under the receiver operating characteristic ROC curve (AUC ROC) of all the questionnaires and the different COPD-6 cut-offs. The prevalence of COPD was 26.3%. The EGARPOC questionnaire showed an S of 81.8%, an Sp of 70.6%, and an NPV of 91.8%; 73.3% of individuals were correctly classified, and the AUC ROC was 0.841. On comparing the questionnaires by the Chi-square test, the 2-question questionnaire showed the worst discrimination; while with an optimal cut-off of forced expiratory volume in one 1 second (FEV1)/FEV6 of 0.78, the COPD-6 was significantly better than the questionnaires in the detection of COPD. Using a cut-off of FEV1/FEV6 of 0.78 the COPD-6 was found to be the best screening tool for COPD in primary care compared to the questionnaires tested, which did not show differences among them.

  16. Sing Your Lungs Out: a qualitative study of a community singing group for people with chronic obstructive pulmonary disease (COPD)

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    McNaughton, Amanda; Aldington, Sarah; Williams, Gayle; Levack, William M M

    2016-01-01

    Objective To explore the ways in which participation in a community singing group contributed to the health and well-being of patients with chronic obstructive pulmonary disease (COPD). Design Qualitative description, based on transcripts from individual interviews and a focus group meeting with people with COPD participating in the singing group, regarding their experience. Setting Urban community, Wellington, New Zealand. Participants 23 people (13 women and 10 men), 51–91 years with COPD (21) or interstitial lung disease (2). Results The weekly singing group was a well-attended activity, with self-reported benefits to health and well-being. 4 key themes were identified: being in the ‘right space’, connection, purpose and growth, and participation in a meaningful physical activity. Conclusions This study helps us to better understand how participation in a community singing group can benefit the health and well-being of patients with COPD. Trial registration number ACTRN12615000736549; Results. PMID:27650768

  17. Geographic differences in clinical characteristics and management of COPD: the EPOCA study

    Science.gov (United States)

    Miravitlles, Marc; Murio, Cristina; Tirado-Conde, Gema; Levy, Gur; Muellerova, Hana; Soriano, Joan B; Ramirez-Venegas, Alejandra; Ko, Fanny WS; Canelos-Estrella, Byron; Giugno, Eduardo; Bergna, Miguel; Chérrez, Ivan; Anzueto, Antonio

    2008-01-01

    Aims Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines. Method This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study. Results A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1(%) (r = −0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries. Conclusions Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings. PMID:19281096

  18. Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study

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    Nuno Morais

    2016-01-01

    Full Text Available ABSTRACT Background There is limited evidence regarding interactions between pulmonary (dysfunction, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD. Objectives This exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals. Method Fifteen patients with COPD (67.93±9.71yrs and 15 healthy controls (66.80±7.47yrs participated. Pulmonary function (FEV1, FVC was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function. Results Patients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02 and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02 and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01 than controls. Patients’ non-dominant PmM length and maximal head protraction were predictors of FEV1 (r2adjusted=0.34. These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r2adjusted=0.68. Conclusion Our findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.

  19. Burden of Respiratory Disease in Korea: An Observational Study on Allergic Rhinitis, Asthma, COPD, and Rhinosinusitis.

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    Yoo, Kwang Ha; Ahn, Hae Ryun; Park, Jae Kyoung; Kim, Jong Woong; Nam, Gui Hyun; Hong, Soon Kwan; Kim, Mee Ja; Ghoshal, Aloke Gopal; Muttalif, Abdul Razak Bin Abdul; Lin, Horng Chyuan; Thanaviratananich, Sanguansak; Bagga, Shalini; Faruqi, Rab; Sajjan, Shiva; Baidya, Santwona; Wang, De Yun; Cho, Sang Heon

    2016-11-01

    The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.

  20. Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

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    Thorpe O

    2014-01-01

    Full Text Available Olivia Thorpe, Saravana Kumar, Kylie JohnstonInternational Centre for Allied Health Evidence, The Samson Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, AustraliaBackground: Chronic obstructive pulmonary disease (COPD is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.Methods: This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.Results: A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness environment-related (weather, transport, and finance, and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and "feeling better".Conclusion: This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is

  1. Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study

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    Donohue JF

    2014-07-01

    Full Text Available James F Donohue,1 Nancy Herje,2 Glenn Crater,2 Kathleen Rickard2 1Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 2Aerocrine, Inc., Morrisville, NC, USA Objective: To characterize fractional exhaled nitric oxide (FeNO levels that may be indicative of Th2-mediated airway inflammation in patients with chronic obstructive pulmonary disease (COPD. Methods: This single-visit, outpatient study was conducted in 200 patients aged 40 years and older with COPD. All patients underwent spirometry and FeNO testing. COPD severity was classified according to the Global initiative for chronic Obstructive Lung Disease (GOLD 2010 guidelines. Results: Patients who participated in the study had a mean age of 63.9±11.3 years and a mean smoking history of 46±29 pack years. Patients had a mean forced expiratory volume in 1 second % predicted of 53.9%±22.1%. The percentage of patients classified with COPD severity Stage I, II, III, and IV was 13%, 40%, 39%, and 8%, respectively. In addition, according to current procedural terminology codes, 32% of patients were classified as mixed COPD/asthma, 26% as COPD/emphysema, and 42% as all other codes. The mean FeNO level for all patients was 15.3±17.2 parts per billion (ppb. Overall, 89% of patients had a FeNO <25 ppb, 8% had a FeNO 25–50 ppb, and 3% had a FeNO >50 ppb. The percentages of patients with FeNO in the intermediate or high ranges of FeNO were greatest among patients with mixed COPD/asthma (intermediate, 11.5%; high, 6.6% compared with COPD/emphysema (intermediate, 8%; high, 0 and all other codes (intermediate, 6.3%; high, 1.3%. Conclusion: Increases in FeNO were identified in a subset of patients with COPD, particularly in those previously diagnosed with both COPD and asthma. Since FeNO is useful for identifying patients with airway inflammation who will have a beneficial response to treatment with an inhaled corticosteroid, these data may have important

  2. Chronic obstructive pulmonary disease (COPD and occupational exposures

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    Zeni Elena

    2006-06-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is one of the leading causes of morbidity and mortality in both industrialized and developing countries. Cigarette smoking is the major risk factor for COPD. However, relevant information from the literature published within the last years, either on general population samples or on workplaces, indicate that about 15% of all cases of COPD is work-related. Specific settings and agents are quoted which have been indicated or confirmed as linked to COPD. Coal miners, hard-rock miners, tunnel workers, concrete-manufacturing workers, nonmining industrial workers have been shown to be at highest risk for developing COPD. Further evidence that occupational agents are capable of inducing COPD comes from experimental studies, particularly in animal models. In conclusion, occupational exposure to dusts, chemicals, gases should be considered an established, or supported by good evidence, risk factor for developing COPD. The implications of this substantial occupational contribution to COPD must be considered in research planning, in public policy decision-making, and in clinical practice.

  3. Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study.

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    Bianca Beghé

    Full Text Available Chronic obstructive pulmonary disease (COPD and chronic heart failure (CHF may coexist in elderly patients with a history of smoking. Low-grade systemic inflammation induced by smoking may represent the link between these 2 conditions. In this study, we investigated left ventricular dysfunction in patients primarily diagnosed with COPD, and nonreversible airflow limitation in patients primarily diagnosed with CHF. The levels of circulating high-sensitive C-reactive protein (Hs-CRP, pentraxin 3 (PTX3, interleukin-1β (IL-1 β, and soluble type II receptor of IL-1 (sIL-1RII were also measured as markers of systemic inflammation in these 2 cohorts. Patients aged ≥ 50 years and with ≥ 10 pack years of cigarette smoking who presented with a diagnosis of stable COPD (n=70 or stable CHF (n=124 were recruited. All patients underwent echocardiography, N-terminal pro-hormone of brain natriuretic peptide measurements, and post-bronchodilator spirometry. Plasma levels of Hs-CRP, PTX3, IL-1 β, and sIL-1RII were determined by using a sandwich enzyme-linked immuno-sorbent assay in all patients and in 24 healthy smokers (control subjects. Although we were unable to find a single COPD patient with left ventricular dysfunction, we found nonreversible airflow limitation in 34% of patients with CHF. On the other hand, COPD patients had higher plasma levels of Hs-CRP, IL1 β, and sIL-1RII compared with CHF patients and control subjects (p < 0.05. None of the inflammatory biomarkers was different between CHF patients and control subjects. In conclusion, although the COPD patients had no evidence of CHF, up to one third of patients with CHF had airflow limitation, suggesting that routine spirometry is warranted in patients with CHF, whereas echocardiography is not required in well characterized patients with COPD. Only smokers with COPD seem to have evidence of systemic inflammation.

  4. Interactions between single nucleotide polymorphism of SERPINA1 gene and smoking in association with COPD: a case–control study

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    Deng, Xiaowei; Yuan, Cun-hua; Chang, De

    2017-01-01

    Background SERPINA1 gene has been implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD), while smoking is a known risk factor for COPD. Little is known on the effect of SERPINA1 gene and its interaction with smoking in the Chinese population. In this study, the effect of SERPINA1 gene polymorphisms on COPD risk and its interaction with smoking status has been investigated. Method A total of 120 COPD patients and 481 healthy controls were recruited at The Armed Police Corps Hospital. Data on demographic variables, smoking status, history of occupational dust exposure, and allergies were collected. Genotyping for single nucleotide polymorphism’s (SNP) rs1243160, rs2854254, and rs8004738 was performed in all participants. Results SNP rs8004738 genotype was associated with a significantly higher risk for COPD (odds ratio (OR) =1.835, 95% confidence interval (CI): 1.002–3.360), whereas SNPs rs1243160 and rs2854254 did not exhibit such an association. Smoking habit also significantly increased the risk for COPD (OR =2.306, 95% CI: 1.537–3.459). On stepwise logistic regression analysis, advanced age, smoking, and SNP rs8004738 variant were associated with increased risk for COPD, while female gender and higher educational status decreased the risk. On additive interaction analysis, a significant interactive effect of SNP rs8004738 and smoking was observed in this population (relative excess risk due to interaction =0.478; attributable proportion due to interaction (AP) =0.123; S=1.197). Conclusion SNP rs8004738 of SERPINA1 gene significantly interacted with smoking status and was associated with a higher risk for COPD in the Chinese population. PMID:28138235

  5. Effectiveness of diagnostic screening tests in mass screening for COPD using a cooperative regional system in a region with heavy air pollution: a cross-sectional study

    Science.gov (United States)

    Kotaki, Kenji; Ikeda, Hisao; Fukuda, Takeshi; Yuki, Fumiko; Hasuo, Kanehiro; Kawano, Yuhei; Kawasaki, Masayuki

    2017-01-01

    Objectives This study aimed to evaluate the effectiveness of a cooperative healthcare model for early detection and diagnosis of chronic obstructive pulmonary disease (COPD). Methods This was a cross-sectional observational study. We performed diagnosis of COPD at 4 public health centres in Ōmuta, Japan from March 2015 to March 2016, by adding screening for COPD at the time of routine medical evaluations. All patients aged over 40 years were eligible to participate. Among 397 eligible patients, 293 agreed to participate in the study. Results The estimated prevalence of COPD in Ōmuta was 10% among patients aged over 40 years and was 17% among smokers. Among those who were screened, over half of them had questionnaire scores over the cut-off of 17 points and decreased FEV1/FVC%, indicating COPD (p>0.05). 30 patients with suspected COPD were referred for further investigation at a local central hospital, but only 6 underwent further medical examinations. Conclusions The combination of a COPD questionnaire and medical examination is effective as a COPD screening tool. Future research should investigate behavioural interventions for smoking cessation that can be offered in a cooperative model, as well as for improving participation in COPD screening and for encouraging early presentation for treatment in those suspected of having COPD. PMID:28082365

  6. A possible genetic influence in parenchyma and small airway changes in COPD: a pilot study of twins using HRCT.

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    Tarnoki, D L; Tarnoki, A D; Lazar, Zs; Korom, Cs; Berczi, V; Horvath, I; Karlinger, K

    2014-06-01

    Genetic effects that contribute to the risk of developing chronic obstructive pulmonary disease (COPD) have been reported. Our purpose was to estimate the possible genetic influence on CT features related to COPD in twins. Two COPD-discordant and one COPD-concordant monozygotic (MZ) twin pair, in addition to 2 control dizygotic (DZ) twin pairs underwent a low-dose high resolution computer tomography (HRCT) in inspiration and expiration (Philips Brilliance 16). Monozygotic twins were more similar in lung volume expiration and in air trapping score compared to dizygotics (382 cm(3) vs. 2303 cm(3) and 17.6% vs. 26.6%, respectively). In general, MZ twin pairs showed almost identical HRCT features independently of smoking attitude and COPD status. The dizygotic twin pairs showed larger differences in HRCT features compared to MZ twins. Lung parenchymal and small airway changes (lung density, presence of bronchial wall thickening, bronchiectasis and/or mucus plug formation, air trapping and emphysema score) seem to be genetically associated traits, independently of smoking/COPD history. A future study with a larger sample size should confirm our findings.

  7. Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study

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    Fleehart S

    2014-12-01

    Full Text Available Sara Fleehart,1,* Vincent S Fan,2,3,* Huong Q Nguyen,4 Jungeun Lee,1 Ruth Kohen,3 Jerald R Herting,5 Gustavo Matute-Bello,2,3 Sandra G Adams,6,7 Genevieve Pagalilauan,3 Soo Borson3 1School of Nursing, University of Washington, Seattle, WA, USA; 2VAPuget Sound Health Care Center, Seattle, WA, USA; 3School of Medicine, University of Washington, Seattle, WA, USA; 4Reseach and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 5Department of Sociology, University of Washington, Seattle, WA, USA; 6School of Medicine, University of Texas Health Science Center; 7South Texas Veterans Health Care System, San Antonio, TX, USA *These authors contributed equally to this paper Purpose: The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD. Patients and methods: We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9, which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment. Results: Of 202 participants, 121 (60% had depressive symptoms (PHQ ≥6; 51 (25% had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11% reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004; had worse dyspnea (P=0.009, depression (P<0.001, and anxiety (P=0.003; and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001 and more hospitalizations for COPD exacerbations (P=0.03 but had similar

  8. Dissecting direct and indirect genetic effects on chronic obstructive pulmonary disease (COPD) susceptibility.

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    Siedlinski, Mateusz; Tingley, Dustin; Lipman, Peter J; Cho, Michael H; Litonjua, Augusto A; Sparrow, David; Bakke, Per; Gulsvik, Amund; Lomas, David A; Anderson, Wayne; Kong, Xiangyang; Rennard, Stephen I; Beaty, Terri H; Hokanson, John E; Crapo, James D; Lange, Christoph; Silverman, Edwin K

    2013-04-01

    Cigarette smoking is the major environmental risk factor for chronic obstructive pulmonary disease (COPD). Genome-wide association studies have provided compelling associations for three loci with COPD. In this study, we aimed to estimate direct, i.e., independent from smoking, and indirect effects of those loci on COPD development using mediation analysis. We included a total of 3,424 COPD cases and 1,872 unaffected controls with data on two smoking-related phenotypes: lifetime average smoking intensity and cumulative exposure to tobacco smoke (pack years). Our analysis revealed that effects of two linked variants (rs1051730 and rs8034191) in the AGPHD1/CHRNA3 cluster on COPD development are significantly, yet not entirely, mediated by the smoking-related phenotypes. Approximately 30% of the total effect of variants in the AGPHD1/CHRNA3 cluster on COPD development was mediated by pack years. Simultaneous analysis of modestly (r (2) = 0.21) linked markers in CHRNA3 and IREB2 revealed that an even larger (~42%) proportion of the total effect of the CHRNA3 locus on COPD was mediated by pack years after adjustment for an IREB2 single nucleotide polymorphism. This study confirms the existence of direct effects of the AGPHD1/CHRNA3, IREB2, FAM13A and HHIP loci on COPD development. While the association of the AGPHD1/CHRNA3 locus with COPD is significantly mediated by smoking-related phenotypes, IREB2 appears to affect COPD independently of smoking.

  9. Prevalence of COPD and Tobacco Smoking in Tunisia — Results from the BOLD Study

    Science.gov (United States)

    Daldoul, Hager; Denguezli, Meriam; Jithoo, Anamika; Gnatiuc, Louisa; Buist, Sonia; Burney, Peter; Tabka, Zouhair; Harrabi, Imed

    2013-01-01

    In Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD) prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Six hundred and sixty one (661) subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking. PMID:24351745

  10. Prevalence of COPD and Tobacco Smoking in Tunisia — Results from the BOLD Study

    Directory of Open Access Journals (Sweden)

    Hager Daldoul

    2013-12-01

    Full Text Available In Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines. Six hundred and sixty one (661 subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively. COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking.

  11. Global burden of COPD.

    Science.gov (United States)

    López-Campos, José Luis; Tan, Wan; Soriano, Joan B

    2016-01-01

    It is estimated that the world population will reach a record 7.3 billion in 2015, and the high burden of chronic conditions associated with ageing and smoking will increase further. Respiratory diseases in general receive little attention and funding in comparison with other major causes of global morbidity and mortality. In particular, chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the 21st century. Worldwide, COPD is in the spotlight, since its high prevalence, morbidity and mortality create formidable challenges for health-care systems. This review emphasizes the magnitude of the COPD problem from a clinician's standpoint by drawing extensively from the new findings of the Global Burden of Disease study. Updated, distilled information on the population distribution of COPD is useful for the clinician to help provide an appreciation of the relative impact of COPD in daily practice compared with other chronic conditions, and to allocate minimum resources in anticipation of future needs in care. Despite recent trends in reduction of COPD standardized mortality rates and some recent successes in anti-smoking efforts in a number of Western countries, the overarching demographic impact of ageing in an ever-expanding world population, joined with other factors such as high rates of smoking and air pollution in Asia, will ensure that COPD will continue to pose an ever-increasing problem well into the 21st century.

  12. Characteristics of patients with COPD newly prescribed a long-acting bronchodilator: a retrospective cohort study

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    Wurst KE

    2014-09-01

    Full Text Available Keele E Wurst,1 Samantha St Laurent,1 Hana Mullerova,2 Kourtney J Davis3 1Worldwide Epidemiology, GlaxoSmithKline R&D, Research Triangle Park, NC, USA; 2Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK; 3Worldwide Epidemiology, GlaxoSmithKline R&D, Wavre, Belgium Introduction: This study aimed to characterize patients with chronic obstructive pulmonary disease (COPD newly prescribed a long-acting bronchodilator (LABD, and to assess changes in medication over 24 months. Methods: A cohort of patients with COPD aged ≥40 years newly prescribed an LABD between January 1, 2007 and December 31, 2009 were identified from the Truven Marketscan® Commercial Database (Truven Health Analytics, Ann Arbor, MI, USA and followed for 24 months. Inclusion criteria included no prior prescription for an LABD or inhaled corticosteroids for 12 months prior to the LABD index date (baseline. Patient characteristics were examined. As LABDs were mainly long-acting muscarinic antagonists (LAMAs, additions, switches, discontinuation, adherence to (medication possession ratio, and persistence (proportion of days covered with LAMA monotherapy were assessed for 24 months following the index date. Adherence and persistence with long-acting β2-agonists (LABAs were also assessed. Results: A cohort of 3,268 patients aged 40–65 years was identified (mean age 55.8 years, 48% male. LAMA monotherapy was prescribed to 93% of patients who received an LABD. During the 24-month follow-up, 16% of these patients added COPD medication, 10% switched to an inhaled corticosteroid-containing medication, and 25% discontinued after one LAMA prescription at baseline. Over 12 and 24 months, adherence to LAMA was 40% and 33%, respectively, and adherence to LABA was 29% and 24%, respectively. Over the same time periods, persistence with LAMA monotherapy was 19% and 15%, respectively, and persistence with LABA was 9% and 7%, respectively. Conclusion: Adherence to newly initiated LAMA

  13. Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis.

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    Bloemsma, Lizan D; Hoek, Gerard; Smit, Lidwien A M

    2016-11-01

    Epidemiological studies have shown an increase in morbidity and mortality rates in patients with chronic obstructive pulmonary disease (COPD) following exposure to elevated levels of air pollution. Panel studies have been used to assess short-term effects of air pollution which are not detected by registry studies, specifically lung function and symptoms. The aim of this systematic review was to assess the evidence of panel studies on acute effects of air pollution among patients with COPD. We searched the PubMed database, and identified additional studies by inspecting reference lists and literature reviews. We identified and summarized 25 panel studies that were published between 1993 and February 2016. Results were presented in forest plots and effect estimates of sufficiently comparable outcomes and pollutants were summarized by a random-effects meta-analysis. Meta-analysis showed that a 10µg/m(3) increase in ambient levels of particles less than 10µm in diameter (PM10) had a small, but statistically significant impact on FEV1 (-3.38mL, 95% CI -6.39 to -0.37) and PEF (-0.61L/min, -1.20 to -0.01). There was significant heterogeneity across the included studies. A forest plot showing associations between PM10 and respiratory symptoms was also suggestive of an adverse effect of particulate air pollution, but this was not formally tested in a meta-analysis due to the heterogeneity of outcomes. Results for gaseous pollutants were inconsistent for lung function or symptoms. Evidence from the identified panel studies indicated statistically significant associations of particulate matter air pollution with lung function in patients with COPD. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

    DEFF Research Database (Denmark)

    Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

    2015-01-01

    patients were randomized into two groups: the case-managed group and the usual-care group. Participant characteristics were obtained at baseline, and measures on effectiveness and costs were obtained through questionnaires and registries within a 12-month follow-up period. In the forthcoming analysis......Background: Case management interventions are recommended to improve quality of care and reduce costs in chronic care, but further evidence on effectiveness and cost-effectiveness is needed. The objective of this study is the reporting of the design and participant enrollment of a randomized...... controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD). With a focus on support for self-care and care coordination, the intervention was hypothesized to result...

  15. Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Ecological Study in the Basque Country, Spain (2000-2011).

    Science.gov (United States)

    Tamayo-Uria, Ibon; Altzibar, Jone M; Mughini-Gras, Lapo; Dorronsoro, Miren

    2016-12-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent condition in adults aged ≥40 years characterized by progressive airflow limitation associated with chronic inflammatory response to noxious particles in the airways and lungs. Smoking, genetics, air pollution, nutrition and other factors may influence COPD development. Most hospitalizations and deaths for COPD are caused by its acute exacerbations, which greatly affect the health and quality of life of COPD patients and pose a high burden on health services. The aims of this project were to identify trends, geographic patterns and risk factors for COPD exacerbations, as revealed by hospitalizations and deaths, in the Basque Country, Spain, over a period of 12 years (2000-2011). Hospitalization and mortality rates for COPD were 262 and 18 per 100,000 population, respectively, with clusters around the biggest cities. Hospital mortality was 7.4%. Most hospitalized patients were male (77.4%) and accounted for 72.1% of hospital mortality. Hospitalizations decreased during the study period, except for 50-64 year-old women, peaking significantly. Using a multivariate modeling approach it was shown that hospitalizations were positively correlated with increased atmospheric concentrations of NO2, CO, PM10, and SO2, and increased influenza incidence, but were negatively associated with increased temperatures and atmospheric O3 concentration. COPD exacerbations decreased in the Basque Country during 2000-2011, but not among 50-64-year-old women, reflecting the high smoking prevalence among Spanish women during the 1970-1990s. The main metropolitan areas were those with the highest risk for COPD exacerbations, calling attention to the role of heavy car traffic. Influenza virus, cold temperatures, and increased atmospheric NO2, CO, PM10, and SO2 (but decreased O3) concentrations were identified as potential contributors to the burden of COPD exacerbations in the community. These findings are important for both the

  16. Lung and kidney: a dangerous liaison? A population-based cohort study in COPD patients in Italy

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    Fedeli U

    2017-01-01

    Full Text Available Ugo Fedeli,1 Alfredo De Giorgi,2 Nicola Gennaro,1 Eliana Ferroni,1 Massimo Gallerani,3 Dimitri P Mikhailidis,4 Roberto Manfredini,2 Fabio Fabbian2 1Epidemiological Department, Veneto Region, 2Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, 3Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy; 4Department of Clinical Biochemistry (Vascular Disease Prevention Clinic, University College London Medical School, London, UK Background: COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD is frequently diagnosed in older people living in Western societies and could impact COPD patients’ mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD.Methods: A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM. Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression.Results: Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up. After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30–1.42 independently from comorbidities summarized by the CCI was a significant risk factor for mortality.Conclusion: In spite of limitations due to the use of claims data, long-term survival

  17. Understanding the factors affecting self-management of COPD from the perspectives of healthcare practitioners: a qualitative study.

    Science.gov (United States)

    Ogunbayo, Oladapo J; Russell, Sian; Newham, James J; Heslop-Marshall, Karen; Netts, Paul; Hanratty, Barbara; Kaner, Eileen

    2017-09-18

    Self-management is recognised as an essential criteria for the provision of high quality care for chronic obstructive pulmonary disease (COPD). The management of COPD is usually delivered by a wide range of healthcare practitioners. This study aimed to understand the factors affecting self-management of COPD from the perspectives of the different multidisciplinary healthcare teams involved in COPD care. Semi-structured interviews were conducted with participants from primary care, specialist respiratory and pulmonary rehabilitation (PR) teams. Purposive sampling and snowballing were employed in participant recruitment. All interviews were audio-recorded and transcribed verbatim and data were analysed thematically. A total of 20 participants (eight primary care practitioners, seven respiratory specialists and five PR practitioners) were interviewed until data saturation was reached. Participants identified a range of complex and interrelated factors affecting COPD self-management that were grouped into three broad categories-patient, practitioner and organisational/system-level factors. Patient-level factors were predominantly considered as barriers, with COPD knowledge and understanding, and the individual patients' life circumstances/context being the most prominent issues. Practitioner-level factors identified were practitioners' speciality, interest and experience in respiratory conditions as the overarching factor that influenced how self-management was understood and practiced. A number of organisational/system-level factors were identified by all practitioners, including inconsistency of referral pathways and the wide variations of different self-management planning tools. Factors affecting self-management of COPD across these three levels need to be tackled equally in order to improve the effectiveness of interventions and to embed and integrate self-management support approaches into routine practice. A BALANCED APPROACH FOR IMPROVED SELF-MANAGEMENT: Better

  18. Facial Oedema Is Not Always Angioedema: A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema during COPD Exacerbation

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    Sarah Damanti

    2015-10-01

    Full Text Available We report a case of acute facial oedema in an elderly hospitalized patient which was initially misdiagnosed as angioedema secondary to antibiotics in a patient with an allergic diathesis. We describe the differential aetiologies and then the true cause of the oedema, which was an uncommon complication of a very common condition in the elderly: a pneumomediastinum with subcutaneous emphysema probably due to rupture of an emphysematous lung bulla during chronic obstructive pulmonary disease (COPD exacerbation. Lastly, we focus on the therapeutic procedures instituted for the treatment of the pneumomediastinum.

  19. Impact of exacerbations on respiratory system impedance measured by a forced oscillation technique in COPD: a prospective observational study

    Science.gov (United States)

    Kamada, Takahiro; Kaneko, Masahiro; Tomioka, Hiromi

    2017-01-01

    Background Forced oscillation technique (FOT) has been reported to be useful in the evaluation and management of obstructive lung disease, including COPD. To date, no data are available concerning long-term changes in respiratory system impedance measured by FOT. Additionally, although exacerbations have been reported to be associated with excessive lung function decline in COPD, the impact of exacerbations on the results of FOT has not been demonstrated. The aim of this study was to investigate the longitudinal changes in respiratory system impedance and the influence of exacerbations thereon. Methods Between March 2011 and March 2012, outpatients who attended Kobe City Medical Center West Hospital with a diagnosis of COPD were assessed for eligibility. Baseline patient characteristics (age, sex, body mass index, smoking history, current smoking status, COPD stage), lung function (post-bronchodilator forced expiratory volume in 1 second [FEV1]), blood tests (neutrophils and eosinophils), FOT, and COPD assessment test results were collected at enrollment. Lung function and FOT were examined every 6 months until March 2016. Annual changes in FEV1 and FOT parameters were obtained from the slope of the linear regression curve. The patients were divided into 2 groups based on exacerbation history. Results Fifty-one of 58 patients with COPD were enrolled in this study. The median follow-up period was 57 (52–59) months. Twenty-five (49%) patients experienced exacerbations. A significant annual decline in FEV1 and respiratory system impedance were shown. Additionally, annual changes in FEV1, respiratory system resistance at 5 Hz, respiratory system reactance at 5 Hz, and resonant frequency were greater in patients with exacerbations than in those without exacerbations. Conclusion Exacerbations of COPD lead not only to a decline in lung function but also to an increase in respiratory system impedance.

  20. Characterisation of COPD heterogeneity in the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Agusti, Alvar; Calverley, Peter M A; Celli, Bartolome

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE)....

  1. Characterisation of COPD heterogeneity in the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Agusti, Alvar; Calverley, Peter M A; Celli, Bartolome

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE)....

  2. Symptoms and impact of COPD assessed by an electronic diary in patients with moderate-to-severe COPD: psychometric results from the SHINE study

    Directory of Open Access Journals (Sweden)

    Kulich K

    2015-01-01

    Full Text Available Károly Kulich,1 Dorothy L Keininger,1 Brian Tiplady,2 Donald Banerji31Novartis Pharma AG, Basel, Switzerland; 2eResearch Technologies Ltd, Peterborough, UK; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USABackground: Symptoms, particularly dyspnea, and activity limitation, have an impact on the health status and the ability to function normally in patients with chronic obstructive pulmonary disease (COPD.Methods: To develop an electronic patient diary (eDiary, qualitative patient interviews were conducted from 2009 to 2010 to identify relevant symptoms and degree of bother due to symptoms. The eDiary was completed by a subset of 209 patients with moderate-to-severe COPD in the 26-week QVA149 SHINE study. Two morning assessments (since awakening and since the last assessment and one evening assessment were made each day. Assessments covered five symptoms (“shortness of breath,” “phlegm/mucus,” “chest tightness,” “wheezing,” and “coughing” and two impact items (“bothered by COPD” and “difficulty with activities” and were scored on a 10-point numeric scale.Results: Patient compliance with the eDiary was 90.4% at baseline and 81.3% at week 26. Correlations between shortness of breath and impact items were >0.95. Regression analysis showed that shortness of breath was a highly significant (P<0.0001 predictor of impact items. Exploratory factor analysis gave a single factor comprising all eDiary items, including both symptoms and impact items. Shortness of breath, the total score (including five symptoms and two impact items, and the five-item symptom score from the eDiary performed well, with good consistency and reliability. The eDiary showed good sensitivity to change, with a 0.6 points reduction in the symptoms scores (on a 0–10 point scale representing a meaningful change.Conclusion: The eDiary was found to be valid, reliable, and responsive. The high correlations obtained between “shortness of breath

  3. Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kauffman KS

    2014-12-01

    Full Text Available Karen S Kauffman,1 Megan Doede,1 Montserrat Diaz-Abad,2 Steven M Scharf,2,3 Wanda Bell-Farrell,2 Valerie E Rogers,1 Jeanne Geiger-Brown1 1Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA; 2Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD, USA; 3The University of Maryland Sleep Disorders Center, Baltimore, MD, USA Abstract: Persons with chronic obstructive pulmonary disease (COPD are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18 with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy, although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible. Keywords

  4. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Science.gov (United States)

    2011-01-01

    Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision

  5. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Directory of Open Access Journals (Sweden)

    Fenwick Angela

    2011-02-01

    Full Text Available Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge; were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development

  6. Characterisation of COPD heterogeneity in the ECLIPSE cohort

    DEFF Research Database (Denmark)

    Agusti, Alvar; Calverley, Peter M A; Celli, Bartolome

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE).......Chronic obstructive pulmonary disease (COPD) is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE)....

  7. Distribution of body mass index among subjects with COPD in the Middle East and North Africa region: data from the BREATHE study

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    Koniski ML

    2015-08-01

    Full Text Available Marie-Louise Koniski,1 Hocine Salhi,2 Aïcha Lahlou,3 Nauman Rashid,4 Abdelkader El Hasnaoui4 1Respiratory Division, Lebanese American University Medical Center – Rizk Hospital, Beirut, Lebanon; 2Foxymed, Paris, France; 3MS Health, Rabat, Morocco; 4GlaxoSmithKline, Dubai, United Arab Emirates Background: Data describing the potential relationship between chronic obstructive pulmonary disease (COPD and body mass index (BMI are limited within the Middle East and North Africa (MENA region. Objective: To evaluate the distribution of BMI among subjects with COPD in the general population of the MENA region. Methods: This study was a subanalysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of ten countries in the MENA region and Pakistan. The study population consisted of subjects screened for COPD who documented their weight and height. A COPD questionnaire was administered to subjects who screened positively for COPD in order to collect data on patient characteristics, symptom severity, management and burden of disease, comorbidities, and health care resource utilization and data allowing calculation of the BMI. The COPD Assessment Test (CAT was administered to those screened positively for COPD to collect data on the impact of respiratory symptoms. Results: Nine hundred and ninety-six subjects with COPD, who completed the detailed COPD questionnaire and documented their weight and height, were included in this analysis. The mean BMI was 27.7±5.7 kg/m2. The proportion of COPD patients with a BMI ≥25 kg/m2 is significantly higher than the proportion with a BMI <25 kg/m2 (64.6% [n=643] vs 35.4% [n=353], respectively; P<0.0001. There were no significant differences between the distribution of BMI, ages, sex, COPD symptoms, exacerbations, CAT scores, COPD-associated health care resource consumption, and GOLD severity groups. However, the occurrence of comorbidities such as diabetes and cardiovascular

  8. High-dose N-acetylcysteine in the prevention of COPD exacerbations: rationale and design of the PANTHEON Study.

    Science.gov (United States)

    Zheng, Jin-Ping; Wen, Fu-Qiang; Bai, Chun-Xue; Wan, Huan-Ying; Kang, Jian; Chen, Ping; Yao, Wan-Zhen; Ma, Li-Jun; Xia, Qi-Kui; Gao, Yi; Zhong, Nan-Shan

    2013-04-01

    Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation; from a pathophysiological point of view it involves many components, including mucus hypersecretion, oxidative stress and inflammation. N-acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties. Long-term efficacy of NAC 600mg/d in COPD is controversial; a dose-effect relationship has been demonstrated, but at present it is not known whether a higher dose provides clinical benefits. The PANTHEON Study is a prospective, ICS stratified, randomized, double-blind, placebo-controlled, parallel-group, multi-center trial designed to assess the efficacy and safety of high-dose (1200 mg/daily) NAC treatment for one year in moderate-to-severe COPD patients. The primary endpoint is the annual exacerbation rate. Secondary endpoints include recurrent exacerbations hazard ratio, time to first exacerbation, as well as quality of life and pulmonary function. The hypothesis, design and methodology are described and baseline characteristics of recruited patients are presented. 1006 COPD patients (444 treated with maintenance ICS, 562 ICS naive, aged 66.27±8.76 yrs, average post-bronchodilator FEV1 48.95±11.80 of predicted) have been randomized at 34 hospitals in China. Final results of this study will provide objective data on the effects of high-dose (1200 mg/daily) long-term NAC treatment in the prevention of COPD exacerbations and other outcome variables.

  9. Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study.

    Science.gov (United States)

    McKeever, Tricia M; Hearson, Glenn; Housley, Gemma; Reynolds, Catherine; Kinnear, William; Harrison, Tim W; Kelly, Anne-Maree; Shaw, Dominick E

    2016-03-01

    Identifying acute hypercapnic respiratory failure is crucial in the initial management of acute exacerbations of COPD. Guidelines recommend obtaining arterial blood samples but these are more difficult to obtain than venous. We assessed whether blood gas values derived from venous blood could replace arterial at initial assessment. Patients requiring hospital treatment for an exacerbation of COPD had paired arterial and venous samples taken. Bland-Altman analyses were performed to assess agreement between arterial and venous pH, CO2 and HCO3-. The relationship between SpO2 and SaO2 was assessed. The number of attempts and pain scores for each sample were measured. 234 patients were studied. There was good agreement between arterial and venous measures of pH and HC)3- (mean difference 0.03 and -0.04, limits of agreement -0.05 to 0.11 and -2.90 to 2.82, respectively), and between SaO2 and SpO2 (in patients with an SpO2 of >80%). Arterial sampling required more attempts and was more painful than venous (mean pain score 4 (IQR 2-5) and 1 (IQR 0-2), respectively, pArterial sampling is more difficult and more painful than venous sampling. There is good agreement between pH and HCO3- values derived from venous and arterial blood, and between pulse oximetry and arterial blood gas oxygen saturations. These agreements could allow the initial assessment of COPD exacerbations to be based on venous blood gas analysis and pulse oximetry, simplifying the care pathway and improving the patient experience. 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/

  10. A two-year evaluation of the 'real life' impact of COPD on patients in Germany: The DACCORD observational study.

    Science.gov (United States)

    Kardos, Peter; Vogelmeier, Claus; Worth, Heinrich; Buhl, Roland; Lossi, Nadine S; Mailänder, Claudia; Criée, Carl-Peter

    2017-03-01

    DACCORD is an observational, non-interventional study being conducted in German primary and secondary care centres. The study aims to describe the impact of disease (including exacerbations) and treatments over 2 years on 'real-life' patients with chronic obstructive pulmonary disease (COPD). Patients had a clinical and spirometry diagnosis of COPD, were aged ≥40 years and, on recruitment, were initiating or changing COPD maintenance medication. The only exclusion criteria were asthma and randomised clinical trial participation. Exacerbations data were collected every 3 months. COPD medication, COPD Assessment Test (CAT) and forced expiratory volume in 1 s (FEV1) were recorded at baseline and after 1 and 2 years. A total of 6122 patients were recruited, 3137 (51.2%) of whom completed the 2-year visit. The mean age of these patients was 65.6 years, 59% were male, 69% had mild or moderate airflow limitation, and their mean COPD Assessment Test (CAT) total score was 20.3. Overall, there was a trend towards decreasing COPD exacerbation rates over the 2-year follow-up period, with rates of 0.390 during Year 1 and 0.347 during Year 2. Rates were lower in patients with no exacerbation during the 6 months prior to entry (0.263 and 0.251 during Years 1 and 2, respectively), with 51.6% of patients having no exacerbation during the 6 months prior to entry and over the 2-year follow-up. Approximately 50% of the overall population experienced a clinically relevant improvement from baseline in CAT total score at Year 1 and 2. When assessed by treatment class (or classes), persistence to medication was high (77.8% in Year 1 and 71.4% in Year 2). Overall, the 2-year follow-up data from DACCORD suggest that for most patients with COPD exacerbations are a rare event. For the majority of patients, the focus should be on managing symptoms, and the impact that these symptoms have on their daily lives. Even for those patients who do exacerbate, although prevention of exacerbations is

  11. What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study

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    Karrasch S

    2016-08-01

    age.Results: The prevalence of spirometrically defined COPD by FR increased with age from 10% in subjects aged <65 years to 26% in subjects aged ≥75 years. For LLN-defined COPD, it remained below 10% for all age groups. Overall, COPD diagnosis was not associated with specific comorbidities, except for a lower prevalence of obesity in both FR- and LLN-defined cases. Both CRP and IL-6 tended to be higher in cases by both criteria.Conclusion: In a population-based cohort of adults up to the age of 90 years, the prevalence of spirometrically defined COPD was higher for the FR criterion than for the LLN criterion. This difference increased with age. Neither prevalences of common comorbidities nor levels of the biomarkers, CRP or IL-6, were conclusively associated with the selection of the COPD criterion. Results have to be considered in light of the predominantly mild cases of airway obstruction in the examined study population. Keywords: chronic obstructive pulmonary disease, spirometry, prevalence, comorbidity, biomarkers

  12. Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study

    Science.gov (United States)

    Cabrera, Carlos; Casanova, Ciro; Martín, Yolanda; Mirabal, Virginia; Sánchez, María del Carmen; Álvarez, Felisa; Juliá, Gabriel; Cabrera-Navarro, Pedro; García-Bello, Miguel Ángel; Marín, José María; de-Torres, Juan Pablo; Divo, Miguel; Celli, Bartolomé

    2016-01-01

    Introduction Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline. Methods We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations. Results We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort. Conclusion A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative. PMID:27354780

  13. Interactions between single nucleotide polymorphism of SERPINA1 gene and smoking in association with COPD: a case–control study

    Directory of Open Access Journals (Sweden)

    Deng XW

    2017-01-01

    Full Text Available Xiaowei Deng,1 Cun-hua Yuan,1 De Chang2 1Health Medical Center, 2Department of Respiratory Medicine, General Hospital of Chinese People’s Armed Police Forces, Beijing, People’s Republic of China Background: SERPINA1 gene has been implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD, while smoking is a known risk factor for COPD. Little is known on the effect of SERPINA1 gene and its interaction with smoking in the Chinese population. In this study, the effect of SERPINA1 gene polymorphisms on COPD risk and its interaction with smoking status has been investigated.Method: A total of 120 COPD patients and 481 healthy controls were recruited at The Armed Police Corps Hospital. Data on demographic variables, smoking status, history of occupational dust exposure, and allergies were collected. Genotyping for single nucleotide polymorphism’s (SNP rs1243160, rs2854254, and rs8004738 was performed in all participants.Results: SNP rs8004738 genotype was associated with a significantly higher risk for COPD (odds ratio (OR =1.835, 95% confidence interval (CI: 1.002–3.360, whereas SNPs rs1243160 and rs2854254 did not exhibit such an association. Smoking habit also significantly increased the risk for COPD (OR =2.306, 95% CI: 1.537–3.459. On stepwise logistic regression analysis, advanced age, smoking, and SNP rs8004738 variant were associated with increased risk for COPD, while female gender and higher educational status decreased the risk. On additive interaction analysis, a significant interactive effect of SNP rs8004738 and smoking was observed in this population (relative excess risk due to interaction =0.478; attributable proportion due to interaction (AP =0.123; S=1.197.Conclusion: SNP rs8004738 of SERPINA1 gene significantly interacted with smoking status and was associated with a higher risk for COPD in the Chinese population. Keywords: chronic obstructive pulmonary disease (COPD, single nucleotide polymorphism

  14. How Is COPD Diagnosed?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is COPD Diagnosed? Your doctor will diagnose COPD based on ... Rate This Content: NEXT >> Featured Video What is COPD? 05/22/2014 Describes how COPD, or chronic ...

  15. How Is COPD Treated?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is COPD Treated? COPD has no cure yet. However, lifestyle ... Rate This Content: NEXT >> Featured Video What is COPD? 05/22/2014 Describes how COPD, or chronic ...

  16. Four types of coping with COPD-induced breathlessness in daily living: a grounded theory study

    DEFF Research Database (Denmark)

    Bastrup, Lene; Dahl, Ronald; Pedersen, Preben Ulrich

    2013-01-01

    COPD predominantly cope with breathlessness during daily living. We chose a multimodal grounded theory design that holds the opportunity to combine qualitative and quantitative data to capture and explain the multidimensional coping behaviour among poeple with COPD. The participants' main concern...... comprised distrinctive physiological, cognitive, affective and psychosocial features constituting coping-type-specific indicators. In theory, four predominant coping types with distinct physiological, cognitive, affective and psychosocial properties are observed among people with COPD. The four coping types...

  17. Smoke, Biomass Exposure, and COPD Risk in the Primary Care Setting: The PUMA Study.

    Science.gov (United States)

    Montes de Oca, Maria; Zabert, Gustavo; Moreno, Dolores; Laucho-Contreras, Maria E; Lopez Varela, Maria Victorina; Surmont, Filip

    2017-08-01

    The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America. Subjects attending routine primary care visits, ≥40 y old, who were current or former smokers or were exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC 30), and biomass exposure was defined as an exposure to coal or wood (for heating, cooking, or both) for ≥ 10 y. One thousand seven hundred forty-three individuals completed the questionnaire, and 1,540 performed spirometry. Irrespective of COPD definition, approximately 40% of COPD subjects reported exposure to biomass versus 30% of those without COPD. A higher proportion of COPD subjects (post-bronchodilator FEV1/FVC 30 pack-years (66% vs 39%); similar results were found with the lower limit of normal definition. Analysis of exposure to biomass > 10 y plus smoking > 20 pack-years (reference was no exposure) found that tobacco smoking (crude odds ratio [OR] 4.50, 95% CI 2.73-7.41; adjusted OR 3.30, 95% CI 1.93-5.63) and biomass exposure (crude OR 3.66, 95% CI 2.00-6.73; adjusted OR 2.28, 95% CI 1.18-4.41) were risk factors for COPD, with smoking a possible confounder for the association between biomass and COPD (post-bronchodilator FEV1/FVC exposure to biomass and smoking compared with non-COPD subjects. Smoking and biomass are both risk factors for COPD, but they do not appear to have an additive effect. Copyright © 2017 by Daedalus Enterprises.

  18. A study on quantifying COPD severity by combining pulmonary function tests and CT image analysis

    Science.gov (United States)

    Nimura, Yukitaka; Kitasaka, Takayuki; Honma, Hirotoshi; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi; Mori, Kensaku

    2011-03-01

    This paper describes a novel method that can evaluate chronic obstructive pulmonary disease (COPD) severity by combining measurements of pulmonary function tests and measurements obtained from CT image analysis. There is no cure for COPD. However, with regular medical care and consistent patient compliance with treatments and lifestyle changes, the symptoms of COPD can be minimized and progression of the disease can be slowed. Therefore, many diagnosis methods based on CT image analysis have been proposed for quantifying COPD. Most of diagnosis methods for COPD extract the lesions as low-attenuation areas (LAA) by thresholding and evaluate the COPD severity by calculating the LAA in the lung (LAA%). However, COPD is usually the result of a combination of two conditions, emphysema and chronic obstructive bronchitis. Therefore, the previous methods based on only LAA% do not work well. The proposed method utilizes both of information including the measurements of pulmonary function tests and the results of the chest CT image analysis to evaluate the COPD severity. In this paper, we utilize a multi-class AdaBoost to combine both of information and classify the COPD severity into five stages automatically. The experimental results revealed that the accuracy rate of the proposed method was 88.9% (resubstitution scheme) and 64.4% (leave-one-out scheme).

  19. Magnetism, structure and chemical order in small CoPd clusters: A first-principles study

    Energy Technology Data Exchange (ETDEWEB)

    Mokkath, Junais Habeeb, E-mail: Junais.Mokkath@kaust.edu.sa

    2014-01-15

    The structural, electronic and magnetic properties of small Co{sub m}Pd{sub n}(N=m+n=8,m=0−N) nanoalloy clusters are studied in the framework of a generalized-gradient approximation to density-functional theory. The optimized cluster structures have a clear tendency to maximize the number of nearest-neighbor CoCo pairs. The magnetic order is found to be ferromagnetic-like (FM) for all the ground-state structures. Antiferromagnetic-like spin arrangements were found in some low-lying isomers. The average magnetic moment per atom μ{sup ¯}{sub N} increases approximately linearly with Co content. A remarkable enhancement of the local Co moments is observed as a result of Pd doping. This is a consequence of the increase in the number of Co d holes, due to CoPd charge transfer, combined with the reduced local coordination. The influence of spin–orbit interactions on the cluster properties is also discussed. - Highlights: • This work analyses the structural and magnetic properties of CoPd nanoclusters. • The magnetic order is found to be ferromagnetic-like for all the ground-state structures. • The average magnetic moment per atom increases approximately linearly with Co content. • The influence of spin–orbit interactions on the cluster properties is discussed.

  20. Statins dose-dependently exert a chemopreventive effect against lung cancer in COPD patients: a population-based cohort study

    Science.gov (United States)

    Hsu, Yi-Ping; Hao, Wen-Rui; Kao, Pai-Feng; Sung, Li-Chin; Chen, Chun-Chao; Wu, Szu-Yuan

    2016-01-01

    Purpose Chronic obstructive pulmonary disease (COPD) is associated with increased lung cancer risk. We evaluated the association of statin use with lung cancer risk in COPD patients and identified which statins possess the highest chemopreventive potential. Results After adjustment for age, sex, CCI, diabetes, hypertension, dyslipidemia, urbanization level, and monthly income according to propensity scores, lung cancer risk in the statin users was lower than that in the statin nonusers (adjusted hazard ratio [aHR] = 0.37). Of the individual statins, lovastatin and fluvastatin did not reduce lung cancer risk significantly. By contrast, lung cancer risk in patients using rosuvastatin, simvastatin, atorvastatin, and pravastatin was significantly lower than that in statin nonusers (aHRs = 0.41, 0.44, 0.52, and 0.58, respectively). Statins dose-dependently reduced lung cancer risk in all subgroups and the main model with additional covariates (nonstatin drug use). MATERIALS AND METHODS The study cohort comprised all patients diagnosed with COPD at health care facilities in Taiwan (n = 116,017) between January 1, 2001 and December 31, 2012. Our final study cohort comprised 43,802 COPD patients: 10,086 used statins, whereas 33,716 did not. Patients were followed up to assess lung cancer risk or protective factors. In addition, we also considered demographic characteristics, namely age, sex, comorbidities (diabetes, hypertension, dyslipidemia, and Charlson comorbidity index [CCI]), urbanization level, monthly income, and nonstatin drug use. The index date of statin use was the COPD confirmation date. To examine the dose–response relationship, we categorized statin use into four groups in each cohort: 365 cumulative defined daily doses (cDDDs). Patients receiving Statins dose-dependently exert a significant chemopreventive effect against lung cancer in COPD patients. Rosuvastatin, simvastatin, and atorvastatin exhibited the highest chemopreventive potential. PMID:27517752

  1. Predictors of lung function and its decline in mild to moderate COPD in association with gender : Results from the Euroscop study

    NARCIS (Netherlands)

    Watson, L; Vonk, JM; Lofdahl, CG; Pride, NB; Pauwels, RA; Laitinen, LA; Schouten, JP; Postma, DS

    2006-01-01

    Background: There is increasing appreciation of gender differences in COPD but scant data whether risk factors for tow lung function differ in men and women. We analysed data from 3 years follow-up in 178 women and 464 men with COPD, participants in the Euroscop Study who were smokers unexposed to i

  2. The association of antidepressant treatment with COPD maintenance medication use and adherence in a comorbid Medicare population: A longitudinal cohort study.

    Science.gov (United States)

    Wei, Yu-Jung; Simoni-Wastila, Linda; Albrecht, Jennifer S; Huang, Ting-Ying; Moyo, Patience; Khokhar, Bilal; Harris, Ilene; Langenberg, Patricia; Netzer, Giora; Lehmann, Susan W

    2017-08-22

    The effect of treating comorbid depression to achieve optimal management of chronic obstructive pulmonary disease (COPD) has not yet empirically tested. We examined the association between antidepressant treatment and use of and adherence to COPD maintenance medications among patients with new-onset COPD and comorbid depression. Using 2006-2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new-onset major depression. Two exposures-antidepressant use (versus non-use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)-were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time-varying confounders. A total of 25 458 COPD-depression patients, 82% with antidepressant treatment, were followed for a median of 2.5 years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR] = 1.15, 95% confidence interval [CI] = 1.12- 1.17) and adhere to (RR = 1.08, 95% = 1.03-1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers. Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression. Copyright © 2017 John Wiley & Sons, Ltd.

  3. Assessment of satisfaction with different dry powder inhalation devices in Greek patients with COPD and asthma: the ANASA study

    Directory of Open Access Journals (Sweden)

    Zervas E

    2016-08-01

    Full Text Available Eleftherios Zervas, Konstantinos Samitas, Mina Gaga 7th Respiratory Department and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece Background: Poor adherence to inhaled therapy is common in patients with asthma and COPD. An inhaler selection based on patients’ preference could be beneficial to adherence and treatment effectiveness. Properly designed questionnaires can assess patients’ satisfaction with their medication devices. The aim of this study was to estimate, using the Feeling of Satisfaction with Inhaler (FSI-10 questionnaire, the ease of use and satisfaction of patients regarding three different marketed dry powder inhalers (DPIs: Diskus® (DK, Elpenhaler® (EH, and Turbuhaler® (TH. The FSI-10 is a self-completed questionnaire to assess patients’ opinions regarding ease of use, portability, and usability of devices, irrespective of the drug used.Patients and methods: We performed a 4-week, open, noninterventional, multicenter, parallel clinical study in 560 asthmatic and 561 COPD patients. During the first visit, patients were classified into three groups according to the DPI they were already using. Patients were regularly receiving their treatments (Seretide DK, Rolenium EH, and Symbicort TH and agreed to complete the FSI-10 questionnaire in the second visit.Results: A total of 517 COPD and 523 asthma patients completed the study. All DPIs tested received satisfactory results, while the EH obtained consistently higher scores in the FSI-10 in both COPD and asthma patients (44.7 and 44.1 vs 41.5 and 43 for TH, 40.8 and 41.4 for DK, P<0.001 and P<0.01, respectively. TH was rated better than DK by asthma patients. Patients suffering with severe COPD tended to express higher feeling of satisfaction than those with moderate or mild disease, irrespective of the device used.Conclusion: All DPIs tested were highly acceptable by asthma and COPD patients of different ages; nevertheless, EH received significantly higher

  4. Impact of non-linear smoking effects on the identification of gene-by-smoking interactions in COPD genetics studies

    DEFF Research Database (Denmark)

    Castaldi, P J; Demeo, D L; Hersh, C P;

    2010-01-01

    with COPD. Using data from the Alpha-1 Antitrypsin Genetic Modifiers Study, the accuracy and power of two different approaches to model smoking were compared by performing a simulation study of a genetic variant with a range of gene-by-smoking interaction effects. Results Non-linear relationships between...

  5. Prevention of exacerbations in patients with COPD and vitamin D deficiency through vitamin D supplementation (PRECOVID): a study protocol

    NARCIS (Netherlands)

    Rafiq, R.; Aleva, F.E.; Schrumpf, J.A.; Heijdra, Y.F.; Taube, C.; Daniels, J.M.; Lips, P.; Bet, P.M.; Hiemstra, P.S.; Ven, A.J.A.M. van der; Heijer, M. den; Jongh, R.T. de

    2015-01-01

    BACKGROUND: Vitamin D is well known for its function in calcium homeostasis and bone mineralisation, but is increasingly studied for its potential immunomodulatory properties. Vitamin D deficiency is a common problem in patients with COPD. Previous studies have not demonstrated a beneficial effect o

  6. Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations

    Directory of Open Access Journals (Sweden)

    Mahboub B

    2016-02-01

    Full Text Available Bassam Mahboub,1 Ashraf Alzaabi,2 Mohammed Nizam Iqbal,3 Hocine Salhi,4 Aïcha Lahlou,5 Luqman Tariq,6 Abdelkader El Hasnaoui6 1Department of Pulmonary Medicine and Allergy, University of Sharjah, Sharjah, 2Respirology Division, Zayed Military Hospital, Abu Dhabi, 3Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates; 4Foxymed, Paris, France; 5MS Health, Rabat, Morocco, 6GlaxoSmithKline, Dubai, United Arab Emirates Objective: To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations.Materials and methods: This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life.Results: A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2% than subjects without COPD (39.1%, P<0.0001, most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03 associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03.Conclusion: Comorbidities are frequent in COPD and associated with more severe respiratory symptoms

  7. Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study

    Directory of Open Access Journals (Sweden)

    Dueñas-Espín I

    2016-06-01

    regression models with a repeated measures approach.Results: Patients had a mean (standard deviation age of 67 (8 years, forced expiratory volume in 1 second 57 (20% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, -149 to -12, P=0.02 per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA.Conclusion: In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later. Keywords: COPD, anxiety, depression, HADS, physical activity, prospective study

  8. Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study

    Directory of Open Access Journals (Sweden)

    Gunen H

    2015-11-01

    Full Text Available Hakan Gunen,1 Mehmet Yilmaz,2 Oguz Aktas,1 Pinar Ergun,3 Mediha Gonenc Ortakoylu,4 Atike Demir,5 Pelin Cetinkaya,6 Alev Gurgun,7 Muge Otlu,8 Aykut Cilli,9 Ufuk Yilmaz,5 Nurdan Kokturk,10 Ipek Candemir,3 Halil Ibrahim Yakar,1 Idilhan Ar,11 Aylin Konya111Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 2Department of Chest Diseases, Safranbolu State Hospital, Karabuk, Turkey; 3Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey; 4Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 5Department of Chest Diseases, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey; 6Department of Chest Diseases, Cukurova Dr Askim Tufekci State Hospital, Adana, Turkey; 7Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey; 8Department of Chest Diseases, Bingol State Hospital, Bingol, Turkey; 9Department of Chest Diseases, Akdeniz University, Faculty of Medicine, Antalya, Turkey; 10Department of Chest Diseases, Gazi University Faculty of Medicine, Ankara, Turkey; 11Medical Department, Novartis Pharmaceuticals, Istanbul, TurkeyObjective: To determine distribution of COPD assessment categories and physicians’ adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD 2013 strategy in Turkish COPD patients.Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed.Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to

  9. The protease inhibitor PI*S allele and COPD

    DEFF Research Database (Denmark)

    Hersh, C P; Ly, N P; Berkey, C S

    2005-01-01

    In many countries, the protease inhibitor (SERPINA1) PI*S allele is more common than PI*Z, the allele responsible for most cases of chronic obstructive pulmonary disease (COPD) due to severe alpha 1-antitrypsin deficiency. However, the risk of COPD due to the PI*S allele is not clear. The current...... authors located studies that addressed the risk of COPD or measured lung function in individuals with the PI SZ, PI MS and PI SS genotypes. A separate meta-analysis for each genotype was performed. Aggregating data from six studies, the odds ratio (OR) for COPD in PI SZ compound heterozygotes compared...... with PI MM (normal) individuals was significantly increased at 3.26 (95% confidence intervals (CI): 1.24-8.57). In 17 cross-sectional and case-control studies, the OR for COPD in PI MS heterozygotes was 1.19 (95%CI: 1.02-1.38). However, PI MS genotype was not associated with COPD risk after correcting...

  10. Automated telecommunication to obtain longitudinal follow-up in a multicenter cross-sectional COPD study.

    Science.gov (United States)

    Stewart, Jeffrey I; Moyle, Sarah; Criner, Gerard J; Wilson, Carla; Tanner, Ron; Bowler, Russell P; Crapo, James D; Zeldin, Robert K; Make, Barry J; Regan, Elizabeth A; For The Copdgene Investigators

    2012-08-01

    It can be challenging to maintain longitudinal follow-up of subjects in clinical studies. COPDGene is a multicenter, observational study designed to identify genetic factors associated with COPD and to characterize COPD-related phenotypes. To obtain follow-up data on patient's vital status and outcomes, the COPDGene Longitudinal Follow-up (LFU) Program was developed to supplement its parent study. We used a telecommunication system that employed automated telephone contact or web-based questions to obtain longitudinal follow-up data in our subjects. A branching questionnaire asked about exacerbations, new therapies, smoking status, development of co-morbid conditions, and general health status. Study coordinators contacted subjects who did not respond to one of the automated methods. We enrolled 10,383 subjects in the COPDGene study. As of August 29, 2011, 7,959 subjects completed 19,955 surveys. On the first survey, 68.8% of subjects who completed their survey did so by electronic means, while 31.3% required coordinator phone follow-up. On each subsequent survey the number of subjects who completed their survey by electronic means increased, while the number of subjects who required coordinator follow-up decreased. Despite many of the patients in the cohort being chronically ill and elderly, there was broad acceptance of the system with over half the cohort using electronic response methods. The COPDGene LFU Study demonstrated that telecommunications was an effective way to obtain longitudinal follow-up of subjects in a large multicenter study. Web-based and automated phone contacts are accepted by research subjects and could serve as a model for LFU in future studies.

  11. Genome-wide study identifies two loci associated with lung function decline in mild to moderate COPD

    NARCIS (Netherlands)

    Hansel, Nadia N; Ruczinski, Ingo; Rafaels, Nicholas; Sin, Don D; Daley, Denise; Malinina, Alla; Huang, Lili; Sandford, Andrew; Murray, Tanda; Kim, Yoonhee; Vergara, Candelaria; Heckbert, Susan R; Psaty, Bruce M; Li, Guo; Elliott, W Mark; Aminuddin, Farzian; Dupuis, Josée; O'Connor, George T; Doheny, Kimberly; Scott, Alan F; Boezen, Hendrika; Postma, Dirkje S; Smolonska, Joanna; Zanen, Pieter; Mohamed Hoesein, Firdaus A; de Koning, Harry J; Crystal, Ronald G; Tanaka, Toshiko; Ferrucci, Luigi; Silverman, Edwin; Wan, Emily; Vestbo, Jorgen; Lomas, David A; Connett, John; Wise, Robert A; Neptune, Enid R; Mathias, Rasika A; Paré, Peter D; Beaty, Terri H; Barnes, Kathleen C

    2013-01-01

    Accelerated lung function decline is a key COPD phenotype; however, its genetic control remains largely unknown. We performed a genome-wide association study using the Illumina Human660W-Quad v.1_A BeadChip. Generalized estimation equations were used to assess genetic contributions to lung function

  12. ICE COLD ERIC – International collaborative effort on chronic obstructive lung disease: exacerbation risk index cohorts – Study protocol for an international COPD cohort study

    Directory of Open Access Journals (Sweden)

    Muggensturm Patrick

    2009-05-01

    Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a systemic disease; morbidity and mortality due to COPD are on the increase, and it has great impact on patients' lives. Most COPD patients are managed by general practitioners (GP. Too often, GPs base their initial assessment of patient's disease severity mainly on lung function. However, lung function correlates poorly with COPD-specific health-related quality of life and exacerbation frequency. A validated COPD disease risk index that better represents the clinical manifestations of COPD and is feasible in primary care seems to be useful. The objective of this study is to develop and validate a practical COPD disease risk index that predicts the clinical course of COPD in primary care patients with GOLD stages 2–4. Methods/Design We will conduct 2 linked prospective cohort studies with COPD patients from GPs in Switzerland and the Netherlands. We will perform a baseline assessment including detailed patient history, questionnaires, lung function, history of exacerbations, measurement of exercise capacity and blood sampling. During the follow-up of at least 2 years, we will update the patients' profile by registering exacerbations, health-related quality of life and any changes in the use of medication. The primary outcome will be health-related quality of life. Secondary outcomes will be exacerbation frequency and mortality. Using multivariable regression analysis, we will identify the best combination of variables predicting these outcomes over one and two years and, depending on funding, even more years. Discussion Despite the diversity of clinical manifestations and available treatments, assessment and management today do not reflect the multifaceted character of the disease. This is in contrast to preventive cardiology where, nowadays, the treatment in primary care is based on patient-specific and fairly refined cardiovascular risk profile corresponding to differences in

  13. COPD patient satisfaction with ipratropium bromide/albuterol delivered via Respimat: a randomized, controlled study

    Directory of Open Access Journals (Sweden)

    Ferguson GT

    2013-03-01

    Full Text Available Gary T Ferguson,1 Mo Ghafouri,2 Luyan Dai,2 Leonard J Dunn31Pulmonary Research Institute of Southeast Michigan, Livonia, MI, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA; 3Clinical Research of West Florida, Inc, Clearwater, FL, USABackground: Ipratropium bromide/albuterol Respimat inhaler (CVT-R was developed as an environmentally friendly alternative to ipratropium bromide/albuterol metered-dose inhaler (CVT-MDI, which uses a chlorofluorocarbon propellant.Objective: The objective of this study was to evaluate patient satisfaction, device usage, and long-term safety of CVT-R compared to CVT-MDI, and to the simultaneous administration of ipratropium bromide hydrofluoroalkane (HFA; I and albuterol HFA (A metered-dose inhalers as dual monotherapies (I + A.Design: This is a 48-week, open-label, randomized, active-controlled, parallel-group study (n = 470 comparing CVT-R to CVT-MDI and to I + A.Participants: Patients were at least 40 years of age, diagnosed with chronic obstructive pulmonary disease (COPD, and current or exsmokers.Interventions: Patients were randomized to receive: (1 CVT-R, one inhalation four times daily (QID; or (2 CVT-MDI, two inhalations QID; or (3 I + A two inhalations of each inhaler QID.Main measures: Patient Satisfaction and Preference Questionnaire (PASAPQ performance score (primary endpoint and adverse events.Key results: PASAPQ performance score was significantly higher (CVT-R versus CVT-MDI, 9.6; and CVT-R versus I + A, 6.2; both P < 0.001 when using CVT-R compared to CVT-MDI or I + A at all visits starting from week 3, while CVT-MDI and I + A treatment groups were similar. Time to first COPD exacerbation was slightly longer in the CVT-R group compared to the other treatment groups, although it did not reach statistical significance (CVT-R versus CVT-MDI, P = 0.57; CVT-R versus I + A, P = 0.22. Rates of withdrawal and patient refusal to continue treatment were lower in CVT-R compared with CVT

  14. CD4-regulatory cells in COPD patients

    DEFF Research Database (Denmark)

    Smyth, Lucy J C; Starkey, Cerys; Vestbo, Jørgen

    2007-01-01

    BACKGROUND: The numbers of airway CD8 and B lymphocytes are increased in COPD patients, suggesting an autoimmune process. CD4-regulatory T cells control autoimmunity but have not been studied in patients with COPD. OBJECTIVE: To compare T-regulatory cell numbers in the BAL from COPD patients, smo...

  15. Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study.

    Directory of Open Access Journals (Sweden)

    Patrick White

    Full Text Available INTRODUCTION: Combined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD. They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse. METHODS: Data were extracted from the electronic and paper records of 41 London general practices (population 310,775 including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision. RESULTS: 3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%. 709(29% did not meet GOLD criteria. 1749(49% with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38% and in GOLD III or IV without exacerbations (n=231, 33.6% was common. An estimated 12 cases (95%CI 7-19 annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03. Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22 in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7 in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS. CONCLUSION: Over-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits

  16. Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data

    Directory of Open Access Journals (Sweden)

    Baker CL

    2014-05-01

    Full Text Available Christine L Baker,1 Kelly H Zou,1 Jun Su21Pfizer Inc., New York, NY, USA; 2Boehringer-Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USABackground: Treatment of stable chronic obstructive pulmonary disease (COPD with long-acting bronchodilator (LABD medications is recommended by the 2014 Global initiative for chronic Obstructive Lung Disease (GOLD guidelines. The primary objective of this study was to examine LABD prescription fills after a COPD-related hospitalization.Methods: This retrospective observational study used claims from Truven Health MarketScan® Commercial and Medicare Supplemental databases. Patients (age ≥40, commercial; age ≥65, Medicare supplemental had a first hospitalization with a primary COPD diagnosis between April 1, 2009 and June 30, 2011 (index hospitalization and were continuously enrolled for 1 year before and 9 months after hospitalization. Patients were categorized according to pre-index and/or post-index pharmacy claims.Results: A total of 27,738 patients had an index hospitalization and met inclusion/exclusion criteria. Of those, 19,783 patients had COPD as a primary or secondary diagnosis during the year before index hospitalization and were included in the analysis. Approximately one quarter of the patients (26.32% did not fill a prescription for an LABD or short-acting bronchodilator both 90 days before and 90 days after hospitalization. During the 90-day pre-index period, 40.57% of patients filled an LABD (with or without a short-acting bronchodilator prescription. Over half of the patients (56.88% filled an LABD prescription at some point during the 180-day post-index period, but, of those, a significantly greater proportion of patients filled an LABD prescription in the 1- to 90-day post-index period than in the 91- to 180-day post-index period (51.27% versus 43.66%; P<0.0001.Conclusion: A significant proportion of COPD patients in this study did not fill an LABD prescription before hospitalization for

  17. COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

    Science.gov (United States)

    Casas Herrera, Alejandro; Montes de Oca, Maria; López Varela, Maria Victorina; Aguirre, Carlos; Schiavi, Eduardo; Jardim, José R.

    2016-01-01

    Background Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay. Objectives To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting. Methods COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed. Results 1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV1/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV1/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV1/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m2), milder airway obstruction (GOLD I–II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry. Conclusions COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting. PMID:27073880

  18. LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD

    Directory of Open Access Journals (Sweden)

    Zhong N

    2015-06-01

    Full Text Available Nanshan Zhong,1 Changzheng Wang,2 Xiangdong Zhou,3 Nuofu Zhang,1 Michael Humphries,4 Linda Wang,4 Chau Thach,5 Francesco Patalano,6 Donald Banerji5On behalf of the LANTERN Investigators 1State Key Laboratory of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 2Institute of Respiratory Disease, Xin Qiao Hospital, 3Department of Respiratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing City, Chongqing, 4Beijing Novartis Pharma Co. Ltd., Shanghai, People’s Republic of China; 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 6Novartis Pharma AG, Basel, SwitzerlandBackground: The current Global initiative for chronic Obstructive Lung Disease (GOLD treatment strategy recommends the use of one or more bronchodilators according to the patient’s airflow limitation, their history of exacerbations, and symptoms. The LANTERN study evaluated the effect of the long-acting β2-agonist (LABA/long-acting muscarinic antagonist (LAMA dual bronchodilator, QVA149 (indacaterol/glycopyrronium, as compared with the LABA/inhaled corticosteroid, salmeterol/fluticasone (SFC, in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year.Methods: In this double-blind, double-dummy, parallel-group study, 744 patients with moderate-to-severe COPD with a history of ≤1 exacerbations in the previous year were randomized (1:1 to QVA149 110/50 µg once daily or SFC 50/500 µg twice daily for 26 weeks. The primary endpoint was noninferiority of QVA149 versus SFC for trough forced expiratory volume in 1 second (FEV1 at week 26.Results: Overall, 676 patients completed the study. The primary objective of noninferiority between QVA149 and SFC in trough FEV1 at week 26 was met. QVA149 demonstrated statistically significant superiority to SFC for trough FEV1 (treatment difference [∆]=75 mL; P<0.001. QVA149 demonstrated a statistically significant

  19. Usability of digital media in patients with COPD: a pilot study.

    Science.gov (United States)

    Cheung, Amy; Janssen, Anton; Amft, Oliver; Wouters, Emiel F M; Spruit, Martijn A

    2013-04-01

    Digital media can be integrated in tele-monitoring solutions, serving as the main interface between the patient and the caregiver. Consequently, the selection of the most appropriate digital medium for the specified target group is critical to ensure compliance with the tele-monitoring system. This pilot study aims to gather insights from patients with chronic obstructive pulmonary disease (COPD) on the ease-of-use, efficacy, effectiveness, and satisfaction of different types of digital media. Five off-the-shelf digital media devices were tested on nine patients at CIRO+ in Horn, The Netherlands. Usability was evaluated by asking patients to use each device to answer questions related to their symptoms and health status. Subsequently, patients completed a paper-based device usability questionnaire, which assessed prior experience with digital media, device dimensions, device controllability, response speed, screen readability, ease-of-use, and overall satisfaction. After testing all the devices, patients ranked the devices according to their preference. We identified the netbook as the preferred type of device due to its good controllability, fast response time, and large screen size. The smartphone was the least favorite device as patients found the size of the screen to be too small, which made it difficult to interact with. The pilot study has provided important insights to guide the selection of the most appropriate type of digital medium for implementation in tele-monitoring solutions for patients with COPD. As the digital medium is an important interface to the patient in tele-monitoring solutions, it is essential that patients feel motivated to interact with the digital medium on a regular basis.

  20. Home-Based Telemanagement in Advanced COPD: Who Uses it Most? Real-Life Study in Lombardy.

    Science.gov (United States)

    Vitacca, Michele; Fumagalli, Lia Paola; Borghi, Gabriella; Colombo, Fausto; Castelli, Alberto; Scalvini, Simonetta; Masella, Cristina

    2016-08-01

    Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study.  A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program.  Presence of relapses (p HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144-3.910], p HTP prescription (p HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient 'identikit' to improve prioritization for HTP prescriptions.

  1. The many "small COPDs": COPD should be an orphan disease

    DEFF Research Database (Denmark)

    Rennard, Stephen I; Vestbo, Jørgen

    2008-01-01

    status, therefore, could facilitate the development of treatments for both phenotypic subsets of COPD patients as well as aid the development of agents to alter the natural history of the disease. Post-drug approval regulations could require that agents approved under the orphan provisions......COPD is one of the most common causes of morbidity and mortality. Perhaps paradoxically, COPD also should be an orphan disease. Importantly, this could advance the development of treatments for COPD. There are two criteria for orphan status in the United States. Most widely known is the criterion...... groups based on mechanism sets the stage for the rational development of therapeutics. In addition, many candidate treatments may alter the natural history of COPD. Testing them, however, will require large studies for a duration that will compromise the commercial life of any resulting product. Orphan...

  2. A cross-sectional study to assess inhalation device handling and patient satisfaction in COPD

    Directory of Open Access Journals (Sweden)

    Miravitlles M

    2016-02-01

    Full Text Available Marc Miravitlles,1 Jéssica Montero-Caballero,2 Frank Richard,2 Salud Santos,3 Juan Luis Garcia-Rivero,4 Francisco Ortega,5 Xavier Ribera61Pneumology Department, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 2Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany; 3Pulmonology Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Ciber de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 4Pneumology Department, Hospital de Laredo, Cantabria, Spain; 5Pneumology Department, Hospital Virgen del Rocío, Sevilla, Spain; 6Boehringer Ingelheim Pharma GmbH & Co KG, Barcelona, Spain Abstract: Delivery of inhaled medications via an inhaler device underpins the effectiveness of treatment for patients with chronic obstructive pulmonary disease (COPD. Correct inhaler technique among patients is also a predictor of achieving treatment compliance and adherence. Reporting of patient satisfaction with inhalers is therefore gaining increasing attention and is now recognized as an important patient-reported outcome in clinical trials involving patients with COPD or asthma. In this cross-sectional study, we use the validated Patient Satisfaction and Preference Questionnaire (PASAPQ to assess the handling and satisfaction for Respimat® Soft Mist™ Inhaler (SMI compared with the Breezhaler® dry powder inhaler (DPI among patients with COPD in Spain. Patients were already assigned to therapy with either SPIRIVA® (tiotropium Respimat® or with Hirobriz®/Onbrez®/Oslif® (indacaterol Breezhaler® for at least 3 but not more than 6 months before completing the PASAPQ at a single visit to the study site. The primary endpoint of the trial was the mean total PASAPQ score. Secondary endpoints were the performance score domain of the PASAPQ, the convenience score domain of the PASAPQ, and the overall satisfaction score of the PASAPQ. For the primary endpoint, the mean PASAPQ

  3. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Background Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. Objective The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1.78, all P<0.01). Conclusion Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD

  4. Circulating surfactant protein D as a potential lung-specific biomarker of health outcomes in COPD: a pilot study

    Directory of Open Access Journals (Sweden)

    Man SF Paul

    2007-10-01

    Full Text Available Abstract Background There is a paucity of surrogate lung-specific biological markers that can be used to track disease progression and predict clinical outcomes in chronic obstructive pulmonary disease (COPD. The principal aim of this pilot study was to determine whether circulating surfactant protein D (SPD or Clara Cell protein-16 (CC16 levels are associated with lung function or health status in patients with severe COPD. Methods We studied 23 patients with advanced COPD. Lung function measurements, Chronic Respiratory Disease Questionnaire (CRQ scores, and serum levels of SPD, CC16, and C-reactive protein (CRP were determined at baseline and at 3 months. Results At baseline, FEV1 was inversely associated with serum SPD levels (P = 0.045 but not with CC16 (P = 0.675 or CRP levels (P = 0.549. Over a 3 month period, changes in SPD levels correlated significantly with changes in CRQ scores (adjusted P = 0.008 such that patients who had the largest declines in serum SPD levels experienced the largest gains in health status. The association was particularly notable between circulating SPD level and the dyspnea domain of the CRQ score (P = 0.018. Changes in CC16 or CRP levels did not correlate with changes in CRQ scores. Conclusion Changes in serum SPD levels tracked well with changes in health status over a 3 month period in patients with severe COPD. These data suggest that circulating SPD levels may be useful biomarkers to track health outcomes of COPD patients.

  5. Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes: A Historical Matched Cohort Study.

    Science.gov (United States)

    Price, David B; Russell, Richard; Mares, Rafael; Burden, Anne; Skinner, Derek; Mikkelsen, Helga; Ding, Cherlyn; Brice, Richard; Chavannes, Niels H; Kocks, Janwillem W H; Stephens, Jeffrey W; Haughney, John

    Management guidelines for chronic obstructive pulmonary disease (COPD) recommend that inhaled corticosteroids (ICS) are prescribed to patients with the most severe symptoms. However, these guidelines have not been widely implemented by physicians, leading to widespread use of ICS in patients with mild-to-moderate COPD. Of particular concern is the potential risk of worsening diabetic control associated with ICS use. Here we investigate whether ICS therapy in patients with COPD and comorbid type 2 diabetes mellitus (T2DM) has a negative impact on diabetic control, and whether these negative effects are dose-dependent. This was a historical matched cohort study utilising primary care medical record data from two large UK databases. We selected patients aged ≥40 years with COPD and T2DM, prescribed ICS (n = 1360) or non-ICS therapy (n = 2642) between 2008 and 2012. The primary endpoint was change in HbA1c between the baseline and outcome periods. After 1:1 matching, each cohort consisted of 682 patients. Over the 12-18-month outcome period, patients prescribed ICS had significantly greater increases in HbA1c values compared with those prescribed non-ICS therapies; adjusted difference 0.16% (95% confidence interval [CI]: 0.05-0.27%) in all COPD patients, and 0.25% (95% CI: 0.10-0.40%) in mild-to-moderate COPD patients. Patients in the ICS cohort also had significantly more diabetes-related general practice visits per year and received more frequent glucose strip prescriptions, compared with those prescribed non-ICS therapies. Patients prescribed higher cumulative doses of ICS (>250 mg) had greater odds of increased HbA1c and/or receiving additional antidiabetic medication, and increased odds of being above the Quality and Outcomes Framework (QOF) target for HbA1c levels, compared with those prescribed lower cumulative doses (≤125 mg). For patients with COPD and comorbid T2DM, ICS therapy may have a negative impact on diabetes control. Patients prescribed higher

  6. Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes: A Historical Matched Cohort Study

    Science.gov (United States)

    Price, David B.; Burden, Anne; Skinner, Derek; Mikkelsen, Helga; Ding, Cherlyn; Brice, Richard; Chavannes, Niels H.; Kocks, Janwillem W. H.; Stephens, Jeffrey W.; Haughney, John

    2016-01-01

    Background Management guidelines for chronic obstructive pulmonary disease (COPD) recommend that inhaled corticosteroids (ICS) are prescribed to patients with the most severe symptoms. However, these guidelines have not been widely implemented by physicians, leading to widespread use of ICS in patients with mild-to-moderate COPD. Of particular concern is the potential risk of worsening diabetic control associated with ICS use. Here we investigate whether ICS therapy in patients with COPD and comorbid type 2 diabetes mellitus (T2DM) has a negative impact on diabetic control, and whether these negative effects are dose-dependent. Methods and Findings This was a historical matched cohort study utilising primary care medical record data from two large UK databases. We selected patients aged ≥40 years with COPD and T2DM, prescribed ICS (n = 1360) or non-ICS therapy (n = 2642) between 2008 and 2012. The primary endpoint was change in HbA1c between the baseline and outcome periods. After 1:1 matching, each cohort consisted of 682 patients. Over the 12–18-month outcome period, patients prescribed ICS had significantly greater increases in HbA1c values compared with those prescribed non-ICS therapies; adjusted difference 0.16% (95% confidence interval [CI]: 0.05–0.27%) in all COPD patients, and 0.25% (95% CI: 0.10–0.40%) in mild-to-moderate COPD patients. Patients in the ICS cohort also had significantly more diabetes-related general practice visits per year and received more frequent glucose strip prescriptions, compared with those prescribed non-ICS therapies. Patients prescribed higher cumulative doses of ICS (>250 mg) had greater odds of increased HbA1c and/or receiving additional antidiabetic medication, and increased odds of being above the Quality and Outcomes Framework (QOF) target for HbA1c levels, compared with those prescribed lower cumulative doses (≤125 mg). Conclusion For patients with COPD and comorbid T2DM, ICS therapy may have a negative impact on

  7. A cross sectional observational study on the influence of chronic obstructive pulmonary disease on activities of daily living: the COPD-Life study.

    Science.gov (United States)

    Polatlı, Mehmet; Bilgin, Cahit; Şaylan, Bengü; Başlılar, Şeyma; Toprak, Evren; Ergen, Hasan; Bakan, Nur Dilek; Kart, Levent; Kılıç, Zennur; Üstünel, Azize; Şengün, Ahmet; Varol, Yelda; Yılmaz, Adem; Ataol, Çağatay; Bulgur, Didem; Bozdoğan, Serap; Tunaboyu, İlknur; Özkan, Zehra Gülcihan; Uysal, Ekrem; Gülgösteren, Sevtap; Akın, Neşe; Selim, Yavuz; Irmak, Mustafa; Turgut, Erhan; Keskin, Olgun; Bektaş Uysal, Hilal; Sofuoğlu, Nevin; Yılmaz, Mehmet

    2012-01-01

    This study was designed to identify the impact of chronic obstructive pulmonary disease (COPD) on activities of daily living, life styles and needs in patients. Participants of this national, multi-centered, cross-sectional observational study included 497 stable COPD patients from 41 centers. The mean age (standard deviation; SD) was 63.3 (9.3) years with 59.0% of the patients under the age of 65, and 89.9% of the participants were male. Sociodemographic and COPD-related data were gathered at enrollment and during the 1-month telephone follow-up. The mean (SD) COPD duration was 7.3 (6.5) years in the overall population while 5.4 (4.6) years for patients who recieved COPD diagnosis at least one year after the onset of symptoms. Dyspnea was the most common (83.1%) symptom and walking up stairs (66.6%) was the most difficult activity to be performed. Majority of the patients were aware of COPD as a chronic disease (63.4%), requiring ongoing treatment (79.7%), mainly caused by smoking (63.5%). 59% of the patients were under the age of 65 years-old. In 84% of patients, graduation from at least a primary school was identified. Results revealed an average number of two dependants that were obliged to look after per patient, ability to go on an outing in 91% of the patients, and going grocery shopping with ease in more than two-thirds of the study population. There was no significant difference in regular use of medication device across different educational or age groups. The top three COPD treatment expectations of the patients were being able to breathe (24.1%), walking (17.1%), and walking up stairs (11.7%), while shortness of breath (43.3%) was the first priority treatment need. In contrast to the common view that COPD prevalance is higher in old age population, this study showed that the rate of the disease is higher among younger patients than expected; indispensability of out of the house activities in majority of patients; and use of regular medication device to

  8. A Preference Study of Two Placebo Dry Powder Inhalers in Adults with COPD: ELLIPTA® Dry Powder Inhaler (DPI) versus DISKUS® DPI.

    Science.gov (United States)

    Yun Kirby, Suyong; Zhu, Chang-Qing; Kerwin, Edward M; Stanford, Richard H; Georges, George

    2016-01-01

    Patients' preference is an important factor in selecting an inhaler treatment for COPD. The DISKUS® dry powder inhaler (DPI), which has been available to deliver several COPD medications for a decade, and the ELLIPTA® DPI, developed for the delivery of newer once-daily medications for patients with COPD, were studied in terms of patient preference and inhaler-specific attributes. We conducted a randomized, open-label, crossover study in patients with COPD. Patients used placebo ELLIPTA DPI once daily and placebo DISKUS DPI twice daily, for ∼1 week each, while continuing their COPD medications. Endpoints were: inhaler preference based on size of the numbers on the dose-counter (primary); the number of steps needed and inhaler size (secondary); and based on comfort of the mouthpiece, ease of opening, overall preference, and dosing regimen preference ('other'). Safety assessments included adverse events (AEs). A total of 287 patients were randomized. A significantly (p ELLIPTA DPI over DISKUS DPI for each of the tested attributes and overall, and preferred once-daily over twice-daily dosing. AEs were reported for 36 patients (13%); one (dry mouth) was considered to be related to the placebo-containing DISKUS DPI. Three patients had five non-fatal serious AEs, none were deemed inhaler-related. This study demonstrated that more patients with COPD preferred five specific inhaler attributes of the ELLIPTA DPI over DISKUS DPI and overall, and preferred once-daily versus twice-daily dosing. Safety profiles were consistent with those expected for COPD.

  9. A Phase I Study of iPS Cell Generation From Patients With COPD

    Science.gov (United States)

    2016-06-30

    Thoracic Diseases; Respiratory Tract Diseases; Cancer of Lung; Cancer of the Lung; Lung Cancer; Lung Diseases, Obstructive; COPD; Pulmonary Emphysema; Neoplasms, Lung; Neoplasms, Pulmonary; Pulmonary Cancer; Pulmonary Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell

  10. Spirometry, questionnaire and electronic medical record based COPD in a population survey: Comparing prevalence, level of agreement and associations with potential risk factors

    Science.gov (United States)

    Yzermans, C. Joris; Krop, Esmeralda; Aalders, Bernadette; Rooijackers, Jos; Zock, Jan-Paul; van Dijk, Christel E.; Maassen, Catharina B. M.; Schellevis, François; Heederik, Dick; Smit, Lidwien A. M.

    2017-01-01

    Background COPD-diagnosis is confirmed by post-bronchodilator (BD) spirometry. However, epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study aims to determine COPD-prevalence based on four different operational definitions and their level of agreement, and to compare associations between COPD-definitions and risk factors. Methods COPD-prevalence in 1,793 adults from the general Dutch population (aged 18–70 years) was assessed based on self-reported data, Electronic Medical Records (EMR), and post-BD spirometry: using the FEV1/FVC below the lower limit of normal (LLN) and GOLD fixed cut-off (FEV1/FVC <0.70). Using spirometry as a reference, sensitivity was calculated for self-reported and EMR-based COPD. Associations between COPD and known risk factors were assessed with logistic regression. Data were collected as part of the cross-sectional VGO study (Livestock Farming and Neighboring Residents’ Health Study). Results The highest prevalence was found based on spirometry (GOLD: 10.9%, LLN: 5.9%), followed by self-report (4.6%) and EMR (2.9%). Self-reported or EMR-based COPD identified less than 30% of all COPD-cases based on spirometry. The direction of association between known risk factors and COPD was similar across the four definitions, however, magnitude and significance varied. Especially indicators of allergy were more strongly associated with self-reported COPD compared to the other definitions. Conclusions COPD-prevalence varied depending on the used definition. A substantial number of subjects with spirometry-based COPD cannot be identified with questionnaires or medical records which can cause underestimation of COPD-prevalence. The influence of the different COPD-definitions on associations with known risk factors was limited. PMID:28273094

  11. Asthma and COPD in cystic fibrosis intron-8 5T carriers. A population-based study

    DEFF Research Database (Denmark)

    Dahl, Morten; Tybjaerg-Hansen, Anne; Lange, Peter;

    2005-01-01

    Carriers of cystic fibrosis intron-8 5T alleles with high exon-9 skipping could have increased annual lung function decline and increased risk for asthma or chronic obstructive pulmonary disease (COPD).......Carriers of cystic fibrosis intron-8 5T alleles with high exon-9 skipping could have increased annual lung function decline and increased risk for asthma or chronic obstructive pulmonary disease (COPD)....

  12. Associations between COPD related manifestations:a cross-sectional study

    OpenAIRE

    Romme, Elisabeth Apm; McAllister, David A.; Murchison, John T; Van Beek, Edwin J; Petrides, George S; Price, Cameron OS; Rutten, Erica Pa; Smeenk, Frank WJM; Wouters, Emiel FM; MacNee, William

    2013-01-01

    Background Cardiovascular disease, osteoporosis and emphysema are associated with COPD. Associations between these factors and whether they predict all-cause mortality in COPD patients are not well understood. Therefore, we examined associations between markers of cardiovascular disease (coronary artery calcification [CAC], thoracic aortic calcification [TAC] and arterial stiffness), bone density (bone attenuation of the thoracic vertebrae), emphysema (PI-950 and 15th percentile) and all-caus...

  13. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients.

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. COPD patients were identified using a large administrative claims database. Selected patients were 40-89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38-1.78, all PAdherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD medications.

  14. BODE index versus GOLD classification for explaining anxious and depressive symptoms in patients with COPD – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Burghuber Otto

    2009-01-01

    Full Text Available Abstract Background Anxiety and depression are common and treatable risk factors for re-hospitalisation and death in patients with COPD. The degree of lung function impairment does not sufficiently explain anxiety and depression. The BODE index allows a functional classification of COPD beyond FEV1. The aim of this cross-sectional study was (1 to test whether the BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms; and (2 to assess which components of the BODE index are associated with these psychological aspects of COPD. Methods COPD was classified according to the GOLD stages based on FEV1%predicted in 122 stable patients with COPD. An additional four stage classification was constructed based on the quartiles of the BODE index. The hospital anxiety and depression scale was used to assess anxious and depressive symptoms. Results The overall prevalence of anxious and depressive symptoms was 49% and 52%, respectively. The prevalence of anxious symptoms increased with increasing BODE stages but not with increasing GOLD stages. The prevalence of depressive symptoms increased with both increasing GOLD and BODE stages. The BODE index was superior to FEV1%predicted for explaining anxious and depressive symptoms. Anxious symptoms were explained by dyspnoea. Depressive symptoms were explained by both dyspnoea and reduced exercise capacity. Conclusion The BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms in COPD patients. These psychological consequences of the disease may play a role in future classification systems of COPD.

  15. Association of MicroRNA-196a2 Variant with Response to Short-Acting β2-Agonist in COPD: An Egyptian Pilot Study.

    Directory of Open Access Journals (Sweden)

    Manal S Fawzy

    Full Text Available Chronic obstructive pulmonary disease (COPD is a multifactorial chronic respiratory disease, characterized by an obstructive pattern. Understanding the genetic predisposition of COPD is essential to develop personalized treatment regimens. MicroRNAs (miRNAs are small, endogenous, non-coding RNAs that modulate the expression levels of specific proteins based on sequence complementarity with their target mRNA molecules. Emerging evidences demonstrated the potential use of miRNAs as a disease biomarker. This pilot study aimed to investigate the association of the MIR-196a2 rs11614913 (C/T polymorphism with COPD susceptibility, the clinical outcome and bronchodilator response to short-acting β2-agonist. Genotyping of rs11614913 polymorphism was determined in 108 COPD male patients and 116 unrelated controls using real-time polymerase chain reaction technology. In silico target prediction and network core analysis were performed. COPD patients did not show significant differences in the genotype distribution (p = 0.415 and allele frequencies (p = 0.306 of the studied miRNA when compared with controls. There were also no associations with GOLD stage, dyspnea grade, disease exacerbations, COPD assessment test for estimating impact on health status score, or the frequency of intensive care unit admission. However, COPD patients with CC genotype corresponded to the smallest bronchodilator response after Salbutamol inhalation, the heterozygotes (CT had an intermediate response, while those with the TT genotype showed the highest response (p < 0.001. In conclusion MIR-196a2 rs11614913 polymorphism is associated with the bronchodilator response of COPD in our sample of the Egyptian population, generating hypothesis of the potential use of MIR-196a2 variant as a pharmacogenetic marker for COPD.

  16. Association of MicroRNA-196a2 Variant with Response to Short-Acting β2-Agonist in COPD: An Egyptian Pilot Study.

    Science.gov (United States)

    Fawzy, Manal S; Hussein, Mohammad H; Abdelaziz, Eman Z; Yamany, Hussain A; Ismail, Hussein M; Toraih, Eman A

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a multifactorial chronic respiratory disease, characterized by an obstructive pattern. Understanding the genetic predisposition of COPD is essential to develop personalized treatment regimens. MicroRNAs (miRNAs) are small, endogenous, non-coding RNAs that modulate the expression levels of specific proteins based on sequence complementarity with their target mRNA molecules. Emerging evidences demonstrated the potential use of miRNAs as a disease biomarker. This pilot study aimed to investigate the association of the MIR-196a2 rs11614913 (C/T) polymorphism with COPD susceptibility, the clinical outcome and bronchodilator response to short-acting β2-agonist. Genotyping of rs11614913 polymorphism was determined in 108 COPD male patients and 116 unrelated controls using real-time polymerase chain reaction technology. In silico target prediction and network core analysis were performed. COPD patients did not show significant differences in the genotype distribution (p = 0.415) and allele frequencies (p = 0.306) of the studied miRNA when compared with controls. There were also no associations with GOLD stage, dyspnea grade, disease exacerbations, COPD assessment test for estimating impact on health status score, or the frequency of intensive care unit admission. However, COPD patients with CC genotype corresponded to the smallest bronchodilator response after Salbutamol inhalation, the heterozygotes (CT) had an intermediate response, while those with the TT genotype showed the highest response (p < 0.001). In conclusion MIR-196a2 rs11614913 polymorphism is associated with the bronchodilator response of COPD in our sample of the Egyptian population, generating hypothesis of the potential use of MIR-196a2 variant as a pharmacogenetic marker for COPD.

  17. The extent of emphysema in patients with COPD

    DEFF Research Database (Denmark)

    Shaker, Saher Burhan; Stavngaard, Trine; Hestad, Marianne

    2009-01-01

    BACKGROUND AND AIMS: The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate...... this extent to the GOLD stage of airway obstruction. MATERIALS AND METHODS: We included 209 patients with COPD. COPD was defined as FEV(1)/FVC or=20 pack-years. Patients were assessed by lung function...... increases with increasing severity of COPD and most patients with COPD have emphysema. Tissue destruction by emphysema is therefore an important determinant of disease severity in COPD....

  18. Frailty syndrome in ambulatory patients with COPD

    Directory of Open Access Journals (Sweden)

    Limpawattana P

    2017-04-01

    Full Text Available Panita Limpawattana,1 Siraphong Putraveephong,2 Pratchaya Inthasuwan,2 Watchara Boonsawat,3 Daris Theerakulpisut,4 Jarin Chindaprasirt5 1Division of Geriatric Medicine, 2Department of Internal Medicine, 3Division of Respiratory System, Department of Internal Medicine, 4Division of Nuclear Medicine, Department of Radiology, 5Division of Oncology Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Abstract: Frailty is a state of increased risk of unfavorable outcomes when exposed to stressors, and COPD is one of the several chronic illnesses associated with the condition. However, few studies have been conducted regarding the prevalence of COPD and its related factors in Southeast Asia. The objectives of this study were to determine the prevalence of frailty in COPD patients and to identify the associated factors in these populations. A cross-sectional study of COPD patients who attended a COPD clinic was conducted from May 2015 to December 2016. Baseline characteristics were collected, and the diagnosis of frailty was based on the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight scale. Descriptive statistics were used to analyze baseline data. Factors associated with frailty were analyzed using univariate and multivariate regression analyses. The results showed that the prevalence rates of frailty and pre-frailty were 6.6% (eight out of 121 cases and 41.3% (50 out of 121 cases, respectively, among COPD patients. Fatigue was the most common component of the FRAIL scale that was found more frequently in frail patients than in non-frail patients (odds ratio [OR] 91.9. Factors associated with frailty according to multivariate analyses were comorbid cancer (adjusted OR [AOR] 45.8, at least two instances of nonelective admission over the past 12 months (AOR 112.5, high waist circumference (WC (AOR 1.3, and presence of sarcopenia (AOR 29.5. In conclusion, frailty affected 6.6% of

  19. Genetic evidence linking lung cancer and COPD: a new perspective

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    Crapo JD

    2011-07-01

    Full Text Available Robert P Young1,4, Raewyn J Hopkins1, Gregory D Gamble1, Carol Etzel2, Randa El-Zein2, James D Crapo31Department of Medicine and School of Biological Sciences, University of Auckland, Auckland, New Zealand; 2Department of Epidemiology, UT MD Anderson Cancer Center, Houston, TX, USA; 3National Jewish Health, Denver, CO, USA; 4Synergenz Biosciences Ltd, Auckland, New ZealandAbstract: Epidemiological studies indicate that tobacco smoke exposure accounts for nearly 90% of cases of chronic obstructive pulmonary disease (COPD and lung cancer. However, genetic factors may explain why 10%–30% of smokers develop these complications. This perspective reviews the evidence suggesting that COPD is closely linked to susceptibility to lung cancer and outlines the potential relevance of this observation. Epidemiological studies show that COPD is the single most important risk factor for lung cancer among smokers and predates lung cancer in up to 80% of cases. Genome-wide association studies of lung cancer, lung function, and COPD have identified a number of overlapping “susceptibility” loci. With stringent phenotyping, it has recently been shown that several of these overlapping loci are independently associated with both COPD and lung cancer. These loci implicate genes underlying pulmonary inflammation and apoptotic processes mediated by the bronchial epithelium, and link COPD with lung cancer at a molecular genetic level. It is currently possible to derive risk models for lung cancer that incorporate lung cancer-specific genetic variants, recently identified “COPD-related” genetic variants, and clinical variables. Early studies suggest that single nucleotide polymorphism-based risk stratification of smokers might help better target novel prevention and early diagnostic strategies in lung cancer.Keywords: lung cancer, chronic obstructive pulmonary disease, association study, single nucleotide polymorphism, risk model

  20. What Causes COPD?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Causes COPD? Long-term exposure to lung irritants that damage ... Rate This Content: NEXT >> Featured Video What is COPD? 05/22/2014 Describes how COPD, or chronic ...

  1. Smoking and COPD

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000696.htm Smoking and COPD To use the sharing features on this page, ... enable JavaScript. Smoking is the leading cause of COPD. Smoking is also a trigger for COPD flare- ...

  2. Does roflumilast decrease exacerbations in severe COPD patients not controlled by inhaled combination therapy? the REACT study protocol

    Directory of Open Access Journals (Sweden)

    Calverley PM

    2012-06-01

    Full Text Available Peter MA Calverley,1 Fernando J Martinez,2 Leonardo M Fabbri,3 Udo-Michael Goehring,4 Klaus F Rabe5–71Clinical Science Center, University Hospital Aintree, Liverpool, United Kingdom; 2Department of Internal Medicine, University of Michigan, MI, USA; 3Department of Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy; 4Nycomed (a Takeda company, Konstanz, Germany; 5University of Kiel, Kiel, Germany; 6Krankenhaus Grosshansdorf, Center for Pulmonology and Thoracic Surgery, Grosshansdorf, Germany; 7Department of Pulmonology, Leiden University Medical Center, Leiden, The NetherlandsBackground: Many patients with chronic obstructive pulmonary disease (COPD continue to suffer exacerbations, even when treated with maximum recommended therapy (eg, inhaled combinations of long-acting β2-agonist and high dose inhaled corticosteroids, with or without a long-acting anticholinergic [long-acting muscarinic antagonist]. Roflumilast is approved to treat severe COPD in patients with chronic bronchitis – and a history of frequent exacerbations – as an add-on to bronchodilators.Purpose: The REACT (Roflumilast in the Prevention of COPD Exacerbations While Taking Appropriate Combination Treatment study (identification number RO-2455-404-RD, clinicaltrials.gov identifier NCT01329029 will investigate whether roflumilast further reduces exacerbations when added to inhaled combination therapy in patients still suffering from frequent exacerbations.Patients and methods: REACT is a 1-year randomized, double-blind, multicenter, phase III/IV study of roflumilast 500 µg once daily or placebo on top of a fixed long-acting β2-agonist/inhaled corticosteroid combination. A concomitant long-acting muscarinic antagonist will be allowed at stable doses. The primary outcome is the rate of moderate or severe COPD exacerbations. Using a Poisson regression model with a two-sided significance level of 5%, a sample size of 967 patients per treatment group

  3. Is airway inflammation in chronic obstructive pulmonary disease (COPD) a risk factor for cardiovascular events?

    Science.gov (United States)

    Calverley, Peter M A; Scott, Stephen

    2006-12-01

    Cardiovascular disease (CVD) is a very common cause of death in patients with chronic obstructive pulmonary disease (COPD). Smoking is a well-described risk factor for both COPD and CVD, but CVD in patients with COPD is likely to be due to other factors in addition to smoking. Inflammation may be an important common etiological link between COPD and CVD, being well described in both diseases. It is hypothesized that in COPD a "spill-over" of local airway inflammation into the systemic circulation could contribute to increased CVD in these patients. Inhaled corticosteroids (ICS) have well-documented anti-inflammatory effects and are commonly used for the treatment of COPD, but their effects on cardiovascular endpoints and all-cause mortality have only just started to be examined. A recent meta-analysis has suggested that ICS may reduce all-cause mortality in COPD by around 25%. A case-controlled study specifically examined the effects of ICS on myocardial infarction and suggested that ICS may decrease the incidence of MI by as much as 32%. A large multicenter prospective randomized trial (Towards a Revolution in COPD Health [TORCH]) is now ongoing and will examine the effect of fluticasone propionate in combination with salmeterol on all-cause mortality.

  4. Changes of Number and Function of Late Endothelial Progenitor Cells in Peripheral Blood of COPD Patients Combined with Pulmonary Hypertension.

    Science.gov (United States)

    Liu, Pei; Zhang, Hongmei; Liu, Jianxin; Sheng, Chunfeng; Zhang, Linlin; Zeng, Yanjun

    2016-06-01

    Objective The objective of this study was to investigate the changes of number and function of late endothelial progenitor cells (EPCs) in peripheral blood of chronic obstructive pulmonary disease (COPD) patients combined with pulmonary hypertension. Subjects and Methods The study enrolled 120 cases including 40 non-COPD and pulmonary arterial hypertension (PAH) patients (non-COPD group), 40 COPD non-PAH patients (COPD group), and 40 COPD patients combined with PAH (COPD + PAH group). Peripheral blood mononuclear cells were separated by density gradient centrifugation, cultured for 21 days, and then identified as late endothelial progenitor cells. The cell colonies were counted. MTT assay, modified Boyden chamber assay, and human fibronectin plates were used to measure the proliferation, migration, and adhesion functions of the late endothelial progenitor cells, respectively. Results Compared with non-COPD and COPD groups, the number of peripheral blood late EPCs in COPD + PAH group was significantly reduced, and the proliferation, adhesion, and migration capacities were significantly lowered; the differences were statistically significant (p number and function of late EPCs decreased with the increase of pulmonary artery pressure (p number of late EPCs in COPD patients combined with pulmonary hypertension was reduced, which implies the impaired cell functions. The changes of number and function were negatively correlated with the severity of pulmonary hypertension.

  5. Tai chi mind-body exercise in patients with COPD: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Yeh, Gloria Y; Wayne, Peter M; Litrownik, Daniel; Roberts, David H; Davis, Roger B; Moy, Marilyn L

    2014-08-28

    Chronic obstructive pulmonary disease (COPD) is a chronic, progressively debilitating condition that is prevalent in the US and worldwide. Patients suffer from progressive dyspnea and exercise intolerance. Physical exercise is beneficial, but conventional pulmonary rehabilitation programs are underutilized. There remains a need for novel interventions that improve symptoms, quality-of-life, and functional capacity. Tai chi is an increasingly popular mind-body exercise that includes physical exercise, breathing training, mindful awareness, and stress management--components that are essential to the self-management of COPD. There are, however, limited data on the effectiveness of tai chi as a therapeutic intervention in this population. The Primary Aims are to evaluate the efficacy, safety, and feasibility of a 12-week tai chi program for patients with COPD. We utilize a randomized controlled trial design, with participants assigned in a 2:1 ratio to either a group tai chi program (N = 63) or a time/attention-matched education control (N = 31). Our primary outcomes are COPD-specific quality-of-life and exercise capacity. Secondary outcomes include dyspnea, mood, functional status, self-efficacy, and lung function. Cardiopulmonary exercise testing is done in a subset of patients (N = 50). To explore optimal training duration, a subgroup of patients in tai chi are randomly assigned to complete an additional 12 weeks training (total 24 weeks) (Exploratory Aim 1). To explore the impact of a simplified seated intervention including only a subset of tai chi's training components, a third randomly assigned group (N = 31) receives a 12- week mind-body breathing program (N = 31) (Exploratory Aim 2). Results of the BEAM study (Breathing, Education, Awareness, Movement) will provide preliminary evidence regarding the value of tai chi for improving quality of life and exercise capacity in patients with COPD, including information regarding optimal duration. They will also inform

  6. Trajectories of physical and mental health among persons with morbid obesity and persons with COPD: a longitudinal comparative study

    Directory of Open Access Journals (Sweden)

    Bonsaksen T

    2016-04-01

    of HRQoL was found for persons with morbid obesity than for persons with COPD, possibly due to the obese persons' better chances of recovery.Keywords: health-related quality of life, longitudinal study, SF 12, change patterns, patient education course

  7. EFFECTIVENESS OF THORACIC CORE CONDITIONING USING STRETCH POLE FOR COMMUNITY ELDERLY WITH MODERATE COPD- A SINGLE BLIND STUDY

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    Kritica Boruah

    2014-02-01

    Full Text Available Back ground and introduction: Thoracic Core conditioning exercises are found to be effective in increasing chest expansion in healthy middle aged individuals. The purpose is to find the short term effect of thoracic core conditioning using stretch pole on improving thoracic expansion, intensity of perceived exertion of breathlessness and functional performance for community elderly with moderate COPD. Method: A Single blinded experimental study design, 40 subjects with moderate COPD randomized 20 subjects into each Study and Control group. Study group received thoracic core conditioning exercises with stretch pole while Control group received thoracic core conditioning exercises without stretch pole for one week. Subjects were followed up after one week post intervention where no intervention was given during follow up week. Results: Analysis using RMANOVA found that there was a statistically significant (p<0.05 greater percentage of improvement in Chest expansion, intensity of perceived exertion and functional performance following one week of intervention in Study group when compared with Control Group. During follow-up there is statistically significant greater percentage of maintenance of improvements were found in study group than control group. Conclusion: It is concluded that thoracic core conditioning exercises with stretch pole found to be more effective than without stretch pole in short term improving chest expansion, intensity of perceived exertion and functional performance in community elderly with moderate COPD.

  8. Increased mortality in patients with severe COPD associated with high-intensity exercise: a preliminary cohort study.

    Science.gov (United States)

    Schaadt, Lone; Christensen, Robin; Kristensen, Lars Erik; Henriksen, Marius

    2016-01-01

    Intensity of exercise is believed to be a key determinant of response to chronic obstructive pulmonary disease (COPD) rehabilitation. We hypothesized that a higher intensity of exercise, in combination with physiotherapist-led instructions and education in management of breathlessness, would lead to better self-management, possibly delaying calls to the emergency service and preventing hospitalization. We aimed to test this hypothesis in a subsequent randomized trial, and in order to test study processes and estimate hospitalization rates, we did a small preliminary prospective cohort study on severe COPD patients referred to outpatient rehabilitation. In 2013, four rehabilitation courses were scheduled (spring, summer, autumn, and winter) each lasting 8 weeks and including eight to ten patients. This preliminary study was designed as a controlled cohort study. The bi-weekly exercise sessions in the spring and autumn courses included a high-intensity walking exercise at 95% of estimated VO2 max for as long as possible. The other two rehabilitation courses included the usual walking exercise intensity (85% of estimated VO2 max). Hospitalization rates were assessed from the participants' medical records in an 18-month period. We were able to enroll 31 patients in total (15 in the high-intensity exercise group and 16 in regular intensity). There were no group differences in the hospitalization rates. However, during review of the medical records, we observed a striking mortality rate among participants who had attended the high-intensity rehabilitation courses (five deaths) compared to the standard rehabilitation (zero deaths). Four of the five deaths were COPD exacerbations. Fisher's exact test was statistically significant (P=0.046), as was a log-rank test (P=0.019) of the Kaplan-Meier estimated survival rates. These results from this small preliminary cohort study are alarming and raise concerns about the possible serious risks associated with high

  9. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: A number needed to treat study

    Directory of Open Access Journals (Sweden)

    Gian Galeazzo Riario-Sforza

    2009-08-01

    Full Text Available Gian Galeazzo Riario-Sforza1, Cristoforo Incorvaia1, Fulvia Paterniti1, Laura Pessina1, Roberta Caligiuri1, Chiara Pravettoni1, Fabiano Di Marco2, Stefano Centanni21Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2Unit of Respiratory Medicine, University of Milan, San Paolo Hospital, Milan, ItalyBackground: Pulmonary rehabilitation (PR is recognized as an evidence-based treatment in improving dyspnea and quality of life in patients with COPD. We evaluated the number needed to treat (NNT to achieve an increase in physical capacity, as defined by a significant improvement in the six-minute walk test (6MWT in patients with COPD undergoing PR.Methods: The study enrolled 284 patients aged 41 to 86 years (mean age 69.4 years divided into two groups: a study group (222 patients undergoing a PR program, and a control group (62 patients treated only with drugs. The study group included patients with COPD divided in four subgroups according to GOLD stages.Results: In the study group, 142 out of 222 patients (64% had an increase of at least 54 m in the 6MWT following PR versus 8 out of 62 patients (13% in the control group after the same time interval. The NNT in the overall study group was 2; the same NNT was obtained in GOLD stages 2, 3, and 4, but was 8 in stage 1.Conclusions: PR is highly effective in improving the exercise capacity of patients with COPD, as demonstrated by a valuable NNT, with better results in patients with a more severe disease.Keywords: chronic obstructive lung disease, exercise capacity, number needed to treat, pulmonary rehabilitation, six-minute walk test

  10. New drug therapies for COPD.

    Science.gov (United States)

    Ross, Clare L; Hansel, Trevor T

    2014-03-01

    Clinical trials with new drugs for chronic obstructive pulmonary disease (COPD) have been performed. Viruses exacerbate COPD and bacteria may play a part in severe COPD; therefore, antibiotic and antiviral approaches have a sound rationale. Antiinflammatory approaches have been studied. Advances in understanding the molecular basis of other processes have resulted in novel drugs to target reactive oxidant species, mucus, proteases, fibrosis, cachexia, and muscle wasting, and accelerated aging. Studies with monoclonal antibodies have been disappointing, highlighting the tendency for infections and malignancies during treatment. Promising future directions are lung regeneration with retinoids and stem cells.

  11. Air pollution and COPD in China.

    Science.gov (United States)

    Hu, Guoping; Zhong, Nanshan; Ran, Pixin

    2015-01-01

    Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.

  12. Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD

    Directory of Open Access Journals (Sweden)

    Huong Q Nguyen

    2009-08-01

    Full Text Available Huong Q Nguyen1, Dawn P Gill1, Seth Wolpin1, Bonnie G Steele2, Joshua O Benditt11University of Washington, seattle, WA, USA; 2VA Puget Sound Health Care System, Seattle, WA, USAObjective: To determine the feasibility and efficacy of a six-month, cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease (COPD following pulmonary rehabilitation.Methods: Participants who completed a two-week run-in were randomly assigned to either MOBILE-Coached (n = 9 or MOBILE-Self-Monitored (n = 8. All participants met with a nurse to develop an individualized exercise plan, were issued a pedometer and exercise booklet, and instructed to continue to log their daily exercise and symptoms. MOBILE-Coached also received weekly reinforcement text messages on their cell phones; reports of worsening symptoms were automatically flagged for follow-up. Usability and satisfaction were assessed. Participants completed incremental cycle and six minute walk (6MW tests, wore an activity monitor for 14 days, and reported their health-related quality of life (HRQL at baseline, three, and six months.Results: The sample had a mean age of 68 ± 11 and forced expiratory volume in one second (FEV1 of 40 ± 18% predicted. Participants reported that logging their exercise and symptoms was easy and that keeping track of their exercise helped them remain active. There were no differences between groups over time in maximal workload, 6MW distance, or HRQL (p > 0.05; however, MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months (p = 0.04.Conclusions: We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring. The latter finding needs to be interpreted with caution since this was a purely exploratory study.Trial registration: Clinical

  13. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS: Study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Uzun Sevim

    2012-06-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is a direct relationship between the severity of the disease and the intensity of the inflammatory response. Besides smoking, one of the hypotheses for the persistent airway inflammation is the presence of recurrent infections. Macrolide antibiotics have bacteriostatic as well as anti-inflammatory properties in patients with cystic fibrosis and other inflammatory pulmonary diseases. There is consistent evidence that macrolide therapy reduces infectious exacerbations, decreases the requirement for additional antibiotics and improves nutritional measures. Because of these positive effects we hypothesised that maintenance macrolide therapy may also have beneficial effects in patients with COPD who have recurrent exacerbations. The effects on development of bacterial resistance to macrolides due to this long-term treatment are unknown. Until now, studies investigating macrolide therapy in COPD are limited. The objective of this study is to assess whether maintenance treatment with macrolide antibiotics in COPD patients with three or more exacerbations in the previous year decreases the exacerbation rate in the year of treatment and to establish microbial resistance due to the long-term treatment. Methods/design The study is set up as a prospective randomised double-blind placebo-controlled single-centre trial. A total of 92 patients with COPD who have had at least three exacerbations of COPD in the previous year will be included. Subjects will be randomised to receive either azithromycin 500 mg three times a week or placebo. Our primary endpoint is the reduction in the number of exacerbations of COPD in the year of treatment. Discussion We investigate whether

  14. Biomarker-based detection of asthma–COPD overlap syndrome in COPD populations

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    Tamada T

    2015-10-01

    Full Text Available Tsutomu Tamada,1 Hisatoshi Sugiura,1 Tsuneyuki Takahashi,2 Kazuto Matsunaga,3 Keiji Kimura,4 Uichiro Katsumata,5 Daisuke Takekoshi,1 Toshiaki Kikuchi,1 Ken Ohta,6 Masakazu Ichinose1 1Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, 2Nippon Telegraph and Telephone East Corporation Tohoku Hospital, Sendai, 3Division of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, 4Hiraka General Hospital, Yokote, 5Iwate Prefectural Isawa Hospital, Oshu, 6National Hospital Organization, Tokyo National Hospital, Kiyose, Tokyo, Japan Abstract: Asthma–chronic obstructive pulmonary disease (COPD overlap syndrome (ACOS was proposed by the science committees of both Global Initiative for Asthma (GINA and Global Initiative for Chronic Obstructive Lung Disease (GOLD. However, the definition of ACOS has remained unclear all over the world, and the prevalence rate of ACOS is basically dependent on the patient’s symptoms or the physician’s opinion, based on questionnaire testing. In the current case report, we investigated the prevalence rate of COPD patients with high levels of fractional exhaled nitric oxide (FENO or immunoglobulin E (IgE as candidate markers of ACOS in COPD, as a multicenter, cross-sectional study. Outpatients with COPD were enrolled from Tohoku University Hospital, Sendai, Japan, and five hospitals (Tohoku University Hospital, Sendai, Japan; NTT East Tohoku Hospital, Sendai, Japan; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan with pulmonary physicians from March 1, 2013 to February 28, 2014. When they were estimated using 35 ppb as the cutoff value of FENO, the prevalence rate of ACOS was 16.3% in COPD. When estimated by both FENO and IgE, the high-FENO/high-IgE group was 7.8% in COPD. To the best of our knowledge, this study is the first to detect the

  15. Inhaled indacaterol for the treatment of COPD patients with destroyed lung by tuberculosis and moderate-to-severe airflow limitation: results from the randomized INFINITY study.

    Science.gov (United States)

    Kim, Cheong-Ju; Yoon, Hyoung-Kyu; Park, Myung-Jae; Yoo, Kwang-Ha; Jung, Ki-Suck; Park, Jeong-Woong; Lim, Seong Yong; Shim, Jae Jeong; Lee, Yong Chul; Kim, Young-Sam; Oh, Yeon-Mok; Kim, Song; Yoo, Chul-Gyu

    2017-01-01

    Pulmonary tuberculosis (TB) is a risk factor for chronic obstructive pulmonary disease (COPD); however, few clinical studies have investigated treatment effectiveness in COPD patients with destroyed lung by TB. The Indacaterol effectiveness in COPD patients with Tuberculosis history (INFINITY) study assessed the efficacy and safety of once-daily inhaled indacaterol 150 µg for the treatment of Korean COPD patients with destroyed lung by TB and moderate-to-severe airflow limitation. This was a multicenter, double-blind, parallel-group study, in which eligible patients were randomized (1:1) to receive either once-daily indacaterol 150 µg or placebo for 8 weeks. The primary efficacy endpoint was change from baseline in trough forced expiratory volume in 1 s at Week 8; the secondary endpoints included changes in transition dyspnea index score and St George's Respiratory Questionnaire for COPD score at Week 8. Safety was evaluated over 8 weeks. Of the 136 patients randomized, 119 (87.5%) completed the study treatment. At Week 8, indacaterol significantly improved trough forced expiratory volume in 1 s versus placebo (treatment difference [TD] 140 mL, Pindacaterol versus placebo at Week 8. Incidence of adverse events was comparable between the treatment groups. Indacaterol provided significantly superior bronchodilation, significant improvement in breathlessness and improved health status with comparable safety versus placebo in Korean COPD patients with destroyed lung by TB and moderate-to-severe airflow limitation.

  16. EVALUATION OF NOCTURNAL OXYGEN DESATURATION IN COPD

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    Vaddadi Sailendra

    2016-09-01

    Full Text Available BACKGROUND Patients of COPD become hypoxic during sleep to a significant extent. Florid hypoxic episodes occur during REM sleep secondary to central diminution in respiratory output, accentuated by hypotonia of postural muscles, intercostals and accessory muscles of respiration. MATERIALS AND METHODS This is a cross-sectional study carried out prospectively in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to evaluate breathing disorders during sleep in COPD patients and to correlate them with the stage of the disease. SAMPLE SIZE A total of 36 COPD patients were enrolled into the study. They are classified into Mild, Moderate and Severe COPD categories in accordance to the Indian guidelines. The study was conducted between April 2014 and May 2016. POLYSOMNOGRAPHY Overnight sleep study was conducted using Compumedics Profusion Polysomnographic Machine. A total of 20 leads were utilised for the study. The sleep data recorded by the computer was manually scored for analysing Sleep stages, Apnoeas and Hypopnoeas. Sleep scoring was done according to R and K classification. Nocturnal oxygen desaturation is defined as >30% of total recording time with a SaO2 <90% (or nocturnal SaO2 <85% for at least 5 minutes. RESULTS Out of the 36 patients enrolled into the study, 6 were having mild COPD, 22 had moderate COPD and 8 had severe COPD. Total number of patients who had significant oxygen desaturation during sleep were 5 (13.9%. Out of these, 1 patient (16.67% belonged to Mild COPD, 1 (4.54% belonged to Moderate COPD and 3 (37.5% belonged to Severe COPD. CONCLUSION We conclude that in patients with COPD, daytime SpO2 is the single most useful determinant that contributes to NOD; daytime hypercapnia being the other important factor. In Severe COPD group, daytime PaO2 contributes to NOD whereas in Mild COPD, a raised AHI might explain the occurrence of NOD.

  17. Magnetism, structure and chemical order in small CoPd clusters: A first-principles study

    KAUST Repository

    Mokkath, Junais Habeeb

    2014-01-01

    The structural, electronic and magnetic properties of small ComPdn (N=m+n=8,m=0-N) nanoalloy clusters are studied in the framework of a generalized-gradient approximation to density-functional theory. The optimized cluster structures have a clear tendency to maximize the number of nearest-neighbor CoCo pairs. The magnetic order is found to be ferromagnetic-like (FM) for all the ground-state structures. Antiferromagnetic-like spin arrangements were found in some low-lying isomers. The average magnetic moment per atom μ̄N increases approximately linearly with Co content. A remarkable enhancement of the local Co moments is observed as a result of Pd doping. This is a consequence of the increase in the number of Co d holes, due to CoPd charge transfer, combined with the reduced local coordination. The influence of spin-orbit interactions on the cluster properties is also discussed. © 2013 Elsevier B.V.

  18. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999–2008

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    Schnell Kerry

    2012-07-01

    Full Text Available Abstract Background Treatment of chronic diseases such as chronic obstructive pulmonary disease (COPD is complicated by the presence of comorbidities. The objective of this analysis was to estimate the prevalence of comorbidity in COPD using nationally-representative data. Methods This study draws from a multi-year analytic sample of 14,828 subjects aged 45+, including 995 with COPD, from the National Health and Nutrition Examination Survey (NHANES, 1999–2008. COPD was defined by self-reported physician diagnosis of chronic bronchitis or emphysema; patients who reported a diagnosis of asthma were excluded. Using population weights, we estimated the age-and-gender-stratified prevalence of 22 comorbid conditions that may influence COPD and its treatment. Results Subjects 45+ with physician-diagnosed COPD were more likely than subjects without physician-diagnosed COPD to have coexisting arthritis (54.6% vs. 36.9%, depression (20.6% vs. 12.5%, osteoporosis (16.9% vs. 8.5%, cancer (16.5% vs. 9.9%, coronary heart disease (12.7% vs. 6.1%, congestive heart failure (12.1% vs. 3.9%, and stroke (8.9% vs. 4.6%. Subjects with COPD were also more likely to report mobility difficulty (55.6% vs. 32.5%, use of >4 prescription medications (51.8% vs. 32.1, dizziness/balance problems (41.1% vs. 23.8%, urinary incontinence (34.9% vs. 27.3%, memory problems (18.5% vs. 8.8%, low glomerular filtration rate (16.2% vs. 10.5%, and visual impairment (14.0% vs. 9.6%. All reported comparisons have p  Conclusions Our study indicates that COPD management may need to take into account a complex spectrum of comorbidities. This work identifies which conditions are most common in a nationally-representative set of COPD patients (physician-diagnosed, a necessary step for setting research priorities and developing clinical practice guidelines that address COPD within the context of comorbidity.

  19. Association between the interleukin-13 gene and development of chronic obstructive pulmonary disease in southern Chinese Han population: a case-control study

    Institute of Scientific and Technical Information of China (English)

    GONG Yi; SHI Guo-chao; WAN Huan-ying; YANG Kun; PAN Chun-ming; CHENG Qi-jian; DAI Ran-ran

    2013-01-01

    Background Interleukin-13 (IL-13) has been implicated to be responsible for recruitment of inflammatory cells from the blood to the lung,regulation of matrix metalloproteinase and induction of mucin production and secretion in chronic obstructive pulmonary disease (COPD).We determined plasma IL-13 levels in patients with COPD and investigated its association with common polymorphisms of IL-13 gene in a case-control study.Methods We genotyped 160 cases and 175 control subjects in a local hospital using Mass-ArrayTM Technology Platform then tested the association of four SNPs in IL-13 (rs1295685,rs1800925,rs1881457,rs20541) with COPD,and then determined plasma IL-13 levels in patients with COPD and controls.Results Association was found between IL-13 gene SNPs (rs20541 and rs1800925) and an increased risk of COPD.By linkage disequilibrium (LD) analysis,two blocks (rs1881457 and rs1800925; rs20541 and rs1295685) were found.The risk of COPD was found associated with the IL-13 gene polymorphism among southern Chinese Han population.Plasma IL-13 level was increased in COPD patients compared with controls.Conclusions The polymorphism of the IL-13 gene is associated with an increased risk of COPD in southern Chinese Han population.Plasma IL-13 levels were found elevated in patients with COPD.

  20. The Study of Efficacy, Tolerability and Safety of Theophylline Given Along with Formoterol Plus Budesonide in COPD

    Science.gov (United States)

    Ragulan; Jindal, Apar; Viswambhar, V.; V, Arun Babu

    2015-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is a common disease causing significant socioeconomic burden. COPD patients, commonly smokers develop resistance to inhaled steroids attributed to deficiency of histone deacetylase 2 (HDAC2). The study of relationship between systemic inflammation and functional performance demonstrated that increased CRP level is inversely related to six minute walk distance (SMWD) and Forced Expired Volume in one second (FEV1). Theophylline restores HDAC2 activity thereby unlocking steroid resistance and potentiating inhaled corticosteroids (ICS) action culminating in reduced airway inflammation and mortality. Aim: To study the effects of addition of Theophylline to the combination of Formoterol plus Budesonide on various objective and subjective parameters in moderate to severe COPD patients and to assess the safety profile of the combination. Setting and Study design: A single blinded, prospective, randomized, placebo controlled study at a tertiary care hospital in Jaipur, India. Materials and Methods: Fifty eight patients diagnosed with moderate to severe COPD were randomized into two groups. Group A patients received Formoterol 24μg plus budesonide 800μg daily in divided doses along with Theophylline while group B patients received Formoterol 24μg plus budesonide 800μg daily in divided doses along with placebo tablets. Both groups were followed up on 15th, 30th &60th day. During every visit all patients were assessed subjectively (symptom scoring) and objectively (spirometry, CRP, SMWT) and adverse effects if any were recorded. The obtained data subject to statistical analysis using“Graph pad Instat3” software. Results: Statistically significant improvement with a decline in total symptom score (p < 0.0001) was found with respect to “Night symptoms”&“SOB on rising” in group A. Theophylline group showed significant improvement in SMWD and FEV1.Mean fall in CRP was greater in Group A (not statistically

  1. Associations between statins and COPD: a systematic review

    Directory of Open Access Journals (Sweden)

    Wong Keith K

    2009-07-01

    Full Text Available Abstract Background Statins have anti-inflammatory and immunomodulating properties which could possibly influence inflammatory airways disease. We assessed evidence for disease modifying effects of statin treatment in patients with chronic obstructive pulmonary disease (COPD. Methods A systematic review was conducted of studies which reported effects of statin treatment in COPD. Data sources searched included MEDLINE, EMBASE and reference lists. Results Eight papers reporting nine original studies met the selection criteria. One was a randomized controlled trial (RCT, one a retrospective nested case-control study, five were retrospective cohort studies of which one was linked with a case-control study, and one was a retrospective population-based analysis. Outcomes associated with treatment with statins included decreased all-cause mortality in three out of four studies (OR/HR 0.48–0.67 in three studies, OR 0.99 in one study, decreased COPD-related mortality (OR 0.19–0.29, reduction in incidence of respiratory-related urgent care (OR 0.74, fewer COPD exacerbations (OR 0.43, fewer intubations for COPD exacerbations (OR 0.1 and attenuated decline in pulmonary function. The RCT reported improvement in exercise capacity and dyspnea after exercise associated with decreased levels of C-reactive protein and Interleukin-6 in statin users, but no improvement of lung function. Conclusion There is evidence from observational studies and one RCT that statins may reduce morbidity and/or mortality in COPD patients. Further interventional studies are required to confirm these findings.

  2. Hospitalized patients with COPD: analysis of prior treatment

    Directory of Open Access Journals (Sweden)

    Irai Luis Giacomelli

    2014-06-01

    Full Text Available Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook. Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

  3. Efficacy and safety of tiotropium Respimat® SMI in COPD in two 1-year randomized studies

    Directory of Open Access Journals (Sweden)

    Eric Bateman

    2010-06-01

    Full Text Available Eric Bateman1, Dave Singh2, David Smith3, Bernd Disse4, Lesley Towse5, Dan Massey5, Jon Blatchford5, Demetri Pavia5, Rick Hodder61Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa; 2University Hospital of South Manchester Foundation Trust, University of Manchester, Manchester, UK; 3North Bristol Lung Centre, Southmead Hospital, Bristol, UK; 4Boehringer Ingelheim, GmbH, Ingelheim, Germany; 5Boehringer Ingelheim, Ltd., Bracknell, Berkshire, UK; 6Divisions of Pulmonary and Critical Care Medicine, University of Ottawa, Ottawa, Ontario, CanadaAbstract: Two 1-year studies evaluated the long-term efficacy and safety of tiotropium 5 or 10 μg versus placebo, inhaled via the Respimat® Soft MistTM Inhaler (SMI. The two studies were combined and had 4 co-primary endpoints (trough FEV1 response, Mahler Transition Dyspnea Index [TDI] and St George’s Respiratory Questionnaire scores all at week 48, and COPD exacerbations per patient-year. A total of 1990 patients with COPD participated (mean FEV1: 1.09 L. The mean trough FEV1 response of tiotropium 5 or 10 μg relative to placebo was 127 or 150 mL, respectively (both P < 0.0001. The COPD exacerbation rate was significantly lower with tiotropium 5 μg (RR = 0.78; P = 0.002 and tiotropium 10 μg (RR = 0.73; P = 0.0008; the health-related quality of life and Mahler TDI co-primary endpoints were significantly improved with both doses (both P < 0.0001. Adverse events were generally balanced except anticholinergic class effects, which were more frequent with active treatment. Fatal events occurred in 2.4% (5 μg, 2.7% (10 μg, and 1.6% (placebo of patients; these differences were not significant. Tiotropium Respimat® SMI 5 μg demonstrated sustained improvements in patients with COPD relative to placebo and similar to the 10 μg dose but with a lower frequency of anticholinergic adverse events.Keywords: COPD, exacerbations, FEV1, quality of life, Respimat

  4. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, P.; Andersen, Klaus Kaae; Munch, E.;

    2009-01-01

    of dyspnoea using MRC dyspnoea scale increased from 7.2 to 47.2% (both p analysing the results with focus on the performance of the individual outpatient clinics we also observed an improvement in the quality. Conclusion: We conclude that it is possible to improve the quality of care for COPD...

  5. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management

  6. Calprotectin--a marker of mortality in COPD? Results from a prospective cohort study.

    Science.gov (United States)

    Holmgaard, Dennis B; Mygind, Lone H; Titlestad, Ingrid; Madsen, Hanne; Pedersen, Svend Stenvang; Mortensen, Ole H; Pedersen, Court

    2013-10-01

    Calprotectin comprises more than 45% of the cytosolic content of neutrophil granulocytes. Because pathogenesis, disease activity and disease progression in COPD are believed to be partly dependent of neutrophil driven inflammation we decided to investigate whether plasma level of calprotectin (p-calprotectin) was associated with all-cause mortality in patients with COPD. We measured p-calprotectin in blood samples from 460 patients with moderate to very severe COPD in stable phase. Patients were stratified into three groups according to p-calprotectin level. Outcome measure was all-cause mortality. Analyses were adjusted for factors known to influence mortality using a Cox regression analysis. We found a time dependent correlation between p-calprotectin levels and mortality during the first 5 years of follow-up. Increasing levels of p-calprotectin were associated with concomitant increases in mortality from HR 1.56 (CI 95%: 1.03 -2.38) at calprotectin between 100 -200 ng/ml to HR 2.02 (CI 95%: 1.27-3.19) at calprotectin >200 ng/ml. P-calprotectin could be a useful marker of all-cause mortality in patients suffering from moderate to very severe COPD.

  7. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related

  8. Importance of Aspergillus spp. isolation in Acute exacerbations of severe COPD: prevalence, factors and follow-up: the FUNGI-COPD study.

    Science.gov (United States)

    Huerta, Arturo; Soler, Nestor; Esperatti, Mariano; Guerrero, Mónica; Menendez, Rosario; Gimeno, Alexandra; Zalacaín, Rafael; Mir, Nuria; Aguado, Jose Maria; Torres, Antoni

    2014-02-11

    Acute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. However, the importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear. The aims of the study were to analyze the prevalence and risk factors associated with Aspergillus spp. isolation in AECOPD, and to investigate the associated clinical outcomes during a 1-year follow-up period. Patients presenting with an AECOPD requiring hospitalization were prospectively included from four hospitals across Spain. Clinical, radiological and microbiological data were collected at admission and during the follow-up period (1, 6 and 12 months after discharge), and re-admissions and mortality data collected during the follow-up. A total of 240 patients with severe AECOPD were included. Valid sputum samples were obtained in 144 (58%) patients, and in this group, the prevalence of Aspergillus spp. isolation was 16.6% on admission and 14.1% at one-year follow-up. Multivariate logistic-regression showed that AECOPD in the previous year (OR 12.35; 95% CI, 1.9-29.1; p < 0.001), concurrent isolation of pathogenic bacteria (OR 3.64; 95% CI 1.65-9.45, p = 0.001) and concomitant isolation of Pseudomonas aeruginosa (OR 2.80; 95% IC, 1.81-11.42; p = 0.001) were the main risk factors for Aspergillus spp. isolation. The main risk factors for Aspergillus spp. isolation were AECOPD in the previous year and concomitant isolation of Pseudomonas aeruginosa. However, although Aspergillus spp. is often isolated in sputum samples from patients with AECOPD, the pathogenic and clinical significance remains unclear.

  9. COPD and cognitive impairment: the role of hypoxemia and oxygen therapy

    Directory of Open Access Journals (Sweden)

    Neeta Thakur

    2010-08-01

    Full Text Available Neeta Thakur1, Paul D Blanc2, Laura J Julian1, Edward H Yelin3, Patricia P Katz3, Stephen Sidney4, Carlos Iribarren4, Mark D Eisner1,21Department of Medicine, 2Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine, 3Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA, 4Division of Research, Kaiser Permanente, Oakland, CA, USABackground: Several studies have shown an association between chronic obstructive pulmonary disease (COPD and cognitive impairment. These studies have been limited by methodological issues such as diagnostic uncertainty, cross-sectional design, small sample size, or lack of appropriate referent group. This study aimed to elucidate the association between COPD and the risk of cognitive impairment compared to referent subjects without COPD. In patients with established COPD, we evaluated the impact of disease severity and impairment of respiratory physiology on cognitive impairment and the potential mitigating role of oxygen therapy.Methods: We used the Function, Living, Outcomes and Work (FLOW cohort study of adults with COPD (n = 1202 and referent subjects matched by age, sex, and race (n = 302 to study the potential risk factors for cognitive impairment among subjects with COPD. Cognitive impairment was defined as a Mini-Mental State Exam score of <24 points. Disease severity was using Forced Expiratory Volume in one second (FEV1; the validated COPD Severity Score; and the BMI (Body Mass Index, Obstruction, Dyspnea, Exercise Capacity (BODE Index. Multivariable analysis was used to control for confounding by age, sex, race, educational attainment, and cigarette smoking.Results: COPD was associated with a substantive risk of cognitive impairment compared to referent subjects (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.043–6.64. Among COPD patients, none of the COPD severity measures were associated with the

  10. Vaccines for Patients with COPD.

    Science.gov (United States)

    Moreno, Dolores; Barroso, Judith; Garcia, Alexis

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow limitation. This disease is currently the fourth higher cause of death in the world, and it is predicted to be the third by the year 2020. Patients with COPD are frequently exposed to Human Rhinovirus, Respiratory Syncytial and Influenza Virus, as well as to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. These infectious agents are responsible for exacerbations increasing morbidity and mortality in COPD patients. Prevention of infectious exacerbations by vaccination would improve quality of life and patient survival. A literature search: "vaccination of COPD patients" was performed using Medline, the Cochrane Library and other Non-Indexed Citations for this review. This article presents a brief overview of the different studies found, on the new patents, and the future strategies on the field.

  11. Characteristics of Patients with Chronic Obstructive Pulmonary Disease at the First Visit to a Pulmonary Medical Center in Korea: The KOrea COpd Subgroup Study Team Cohort.

    Science.gov (United States)

    Lee, Jung Yeon; Chon, Gyu Rak; Rhee, Chin Kook; Kim, Deog Kyeom; Yoon, Hyoung Kyu; Lee, Jin Hwa; Yoo, Kwang Ha; Lee, Sang Haak; Lee, Sang Yeub; Kim, Tae-Eun; Kim, Tae-Hyung; Park, Yong Bum; Hwang, Yong Il; Kim, Young Sam; Jung, Ki Suck

    2016-04-01

    The Korea Chronic Obstructive Pulmonary Disorders Subgroup Study Team (Korea COPD Subgroup Study team, KOCOSS) is a multicenter observational study that includes 956 patients (mean age 69.9 ± 7.8 years) who were enrolled from 45 tertiary and university-affiliated hospitals from December 2011 to October 2014. The initial evaluation for all patients included pulmonary function tests (PFT), 6-minute walk distance (6MWD), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, and the COPD-specific version of St. George's Respiratory Questionnaire (SGRQ-C). Here, we report the comparison of baseline characteristics between patients with early- (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage I and II/groups A and B) and late-stage COPD (GOLD stage III and IV/groups C and D). Among all patients, the mean post-bronchodilator FEV1 was 55.8% ± 16.7% of the predicted value, and most of the patients were in GOLD stage II (520, 56.9%) and group B (399, 42.0%). The number of exacerbations during one year prior to the first visit was significantly lower in patients with early COPD (0.4 vs. 0.9/0.1 vs. 1.2), as were the CAT score (13.9 vs. 18.3/13.5 vs. 18.1), mMRC (1.4 vs. 2.0/1.3 vs.1.9), and SGRQ-C total score (30.4 vs. 42.9/29.1 vs. 42.6) compared to late-stage COPD (all P COPD will provide important information towards early detection, proper initial management, and design of future studies.

  12. Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

    Directory of Open Access Journals (Sweden)

    Jose Luis Lopez-Campos

    Full Text Available Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy.The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival.A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650. The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality.The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in

  13. Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study

    Directory of Open Access Journals (Sweden)

    Todd Christopher J

    2011-11-01

    Full Text Available Abstract Background Hospital readmission for acute exacerbation of COPD (AECOPD occurs in up to 30% of patients, leading to excess morbidity and poor survival. Physiological risk factors predict readmission, but the impact of modifiable psychosocial risk factors remains uncertain. We aimed to evaluate whether psychosocial risk factors independently predict readmission for AECOPD in patients referred to early discharge services (EDS. Methods This prospective cohort study included 79 patients with AECOPD cared for by nurse led EDS in the UK, and followed up for 12 months. Data on lung function, medical comorbidities, previous hospital admissions, medications, and sociodemographics were collected at baseline; St George's Respiratory Questionnaire (SGRQ, Hospital Anxiety and Depression Scale (HADS, and social support were measured at baseline, 3 and 12-months. Exploratory multivariate models were fitted to identify psychosocial factors associated with readmission adjusted for known confounders. Results 26 patients were readmitted within 90 days and 60 patients were readmitted at least once during follow-up. Depression at baseline predicted readmission adjusted for sociodemographics and forced expiratory volume in 1 second (odds ratio 1.30, 95% CI 1.06 to 1.60, p = 0.013. Perceived social support was not significantly associated with risk of readmission. Home ownership was associated with the total number of readmissions (B = 0.46, 95% CI -0.86 to -0.06, p = 0.024. Compared with those not readmitted, readmitted patients had worse SGRQ and HADS scores at 12 months. Conclusion Depressive symptoms and socioeconomic status, but not perceived social support, predict risk of readmission and readmission frequency for AECOPD in patients cared for by nurse-led EDS. Future work on reducing demand for unscheduled hospital admissions could include the design and evaluation of interventions aimed at optimising the psychosocial care of AECOPD patients managed at

  14. CD4-regulatory cells in COPD patients

    DEFF Research Database (Denmark)

    Smyth, Lucy J C; Starkey, Cerys; Vestbo, Jørgen

    2007-01-01

    BACKGROUND: The numbers of airway CD8 and B lymphocytes are increased in COPD patients, suggesting an autoimmune process. CD4-regulatory T cells control autoimmunity but have not been studied in patients with COPD. OBJECTIVE: To compare T-regulatory cell numbers in the BAL from COPD patients......, smokers with normal lung function, and healthy nonsmokers (HNS). METHODS: BAL and peripheral blood mononuclear cell (PBMC) samples were obtained from 26 COPD patients, 19 smokers, and 8 HNS. Flow cytometry was performed for regulatory phenotypic markers. RESULTS: COPD patients had increased BAL CD8...... numbers compared to smokers and HNS. CD4 numbers were similar between groups. There was increased BAL CD4CD25(bright) expression in smokers (median 28.8%) and COPD patients (median 23.1%) compared to HNS (median 0%). Increased FoxP3 expression was confirmed in BAL CD4CD25(bright) cells. BAL CD4CD25 cells...

  15. Pathophysiology of viral-induced exacerbations of COPD

    Science.gov (United States)

    Alfredo, Potena; Gaetano, Caramori; Paolo, Casolari; Marco, Contoli; Johnston, Sebastian L; Alberto, Papi

    2007-01-01

    Inflammation of the lower airways is a central feature of chronic obstructive pulmonary disease (COPD). Inflammatory responses are associated with an increased expression of a cascade of proteins including cytokines, chemokines, growth factors, enzymes, adhesion molecules and receptors. In most cases the increased expression of these proteins is the result of enhanced gene transcription: many of these genes are not expressed in normal cells under resting conditions but they are induced in the inflammatory process in a cell-specific manner. Transcription factors regulate the expression of many pro-inflammatory genes and play a key role in the pathogenesis of airway inflammation. Many studies have suggested a role for viral infections as a causative agent of COPD exacerbations. In this review we will focus our attention on the relationship between common respiratory viral infections and the molecular and inflammatory mechanisms that lead to COPD exacerbation. PMID:18268922

  16. Mucoactive therapy in COPD

    Directory of Open Access Journals (Sweden)

    M. Decramer

    2010-06-01

    Full Text Available It has been shown that mucus hypersecretion is associated with greater susceptibility for chronic obstructive pulmonary disease (COPD, excess forced expiratory volume in 1 s decline, hospitalisations and excess mortality. The effects of mucoactive drugs on outcomes have been reviewed in several meta-analyses, the largest one including 26 studies. 21 studies were performed in patients with chronic bronchitis and five in patients with COPD. The majority of these trials were performed with N-acetylcysteine (n = 13 and carbocysteine (n = 3. Overall, there was a significant reduction in exacerbations (0.05 per patient per month and the number of days with disability (0.56 days per patient per month. Mucolytics were well tolerated and the number of adverse events was lower than with placebo (odds ratio 0.78. In the largest and best designed study with N-acetylcysteine in 523 patients with COPD, the reduction in exacerbations was only observed in patients not taking inhaled corticosteroids. In addition, a 374 mL reduction in functional residual capacity was found. A recent large study (n = 709 with high-dose carbocysteine (1,500 mg·day–1 demonstrated a significant effect on exacerbations (25% reduction and also reported an improvement in health-related quality of life (-4.06 units in St George's Respiratory Questionnaire. It is unclear what the mechanisms underlying these effects may be and which phenotypes benefit from this treatment. On the basis of this evidence mucoactive drugs may deserve consideration in the long-term treatment of COPD.

  17. Mucoactive therapy in COPD.

    Science.gov (United States)

    Decramer, M; Janssens, W

    2010-06-01

    It has been shown that mucus hypersecretion is associated with greater susceptibility for chronic obstructive pulmonary disease (COPD), excess forced expiratory volume in 1 s decline, hospitalisations and excess mortality. The effects of mucoactive drugs on outcomes have been reviewed in several meta-analyses, the largest one including 26 studies. 21 studies were performed in patients with chronic bronchitis and five in patients with COPD. The majority of these trials were performed with N-acetylcysteine (n = 13) and carbocysteine (n = 3). Overall, there was a significant reduction in exacerbations (0.05 per patient per month) and the number of days with disability (0.56 days per patient per month). Mucolytics were well tolerated and the number of adverse events was lower than with placebo (odds ratio 0.78). In the largest and best designed study with N-acetylcysteine in 523 patients with COPD, the reduction in exacerbations was only observed in patients not taking inhaled corticosteroids. In addition, a 374 mL reduction in functional residual capacity was found. A recent large study (n = 709) with high-dose carbocysteine (1,500 mg·day⁻¹) demonstrated a significant effect on exacerbations (25% reduction) and also reported an improvement in health-related quality of life (-4.06 units in St George's Respiratory Questionnaire). It is unclear what the mechanisms underlying these effects may be and which phenotypes benefit from this treatment. On the basis of this evidence mucoactive drugs may deserve consideration in the long-term treatment of COPD.

  18. Case study

    DEFF Research Database (Denmark)

    Milana, Marcella; Bernt Sørensen, Tore

    that time Roskilde University Centre and Learning Lab Denmark, DK)3. The case here presented is based on results from research activity carried out over a 1 year period (spring 2006 - spring 2007). Detailed information concerning participation in the project was collected in two DHSs only: the Sports Day...

  19. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study

    OpenAIRE

    Korpershoek YJG; Vervoort SCJM; Nijssen LIT; Trappenburg JCA; Schuurmans MJ

    2016-01-01

    YJG Korpershoek,1,2 SCJM Vervoort,3 LIT Nijssen,2 JCA Trappenburg,2 MJ Schuurmans1,2 1Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht, 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate...

  20. Increased mortality in patients with severe COPD associated with high-intensity exercise: a preliminary cohort study

    Directory of Open Access Journals (Sweden)

    Schaadt L

    2016-09-01

    Full Text Available Lone Schaadt,1,2 Robin Christensen,2 Lars Erik Kristensen,2 Marius Henriksen1,21Department of Physio- and Occupational Therapy, 2The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, DenmarkIntroduction: Intensity of exercise is believed to be a key determinant of response to chronic obstructive pulmonary disease (COPD rehabilitation. We hypothesized that a higher intensity of exercise, in combination with physiotherapist-led instructions and education in management of breathlessness, would lead to better self-management, possibly delaying calls to the emergency service and preventing hospitalization.Objective: We aimed to test this hypothesis in a subsequent randomized trial, and in order to test study processes and estimate hospitalization rates, we did a small preliminary prospective cohort study on severe COPD patients referred to outpatient rehabilitation.Methods: In 2013, four rehabilitation courses were scheduled (spring, summer, autumn, and winter each lasting 8 weeks and including eight to ten patients. This preliminary study was designed as a controlled cohort study. The bi-weekly exercise sessions in the spring and autumn courses included a high-intensity walking exercise at 95% of estimated VO2 max for as long as possible. The other two rehabilitation courses included the usual walking exercise intensity (85% of estimated VO2 max. Hospitalization rates were assessed from the participants’ medical records in an 18-month period.Results: We were able to enroll 31 patients in total (15 in the high-intensity exercise group and 16 in regular intensity. There were no group differences in the hospitalization rates. However, during review of the medical records, we observed a striking mortality rate among participants who had attended the high-intensity rehabilitation courses (five deaths compared to the standard rehabilitation (zero deaths. Four of the five deaths were COPD exacerbations. Fisher

  1. The utility of inflammatory markers to predict readmissions and mortality in COPD cases with or without eosinophilia [Corrigendum

    Directory of Open Access Journals (Sweden)

    Duman D

    2016-03-01

    Full Text Available Duman D, Aksoy E, Agca MC, et al. International Journal of COPD. 2015;10(1:2469–2478.Page 2475, Table 4, the second column heading “Odds ratio” is incorrect. The correct column heading is “Hazard ratio”. Read the original article 

  2. Action plans and coping strategies in elderly COPD patients influence the result of pulmonary rehabilitation: an observational study.

    Science.gov (United States)

    Russo, Patrizia; Prinzi, Giulia; Kisialiou, Aliaksei; Cardaci, Vittorio; Stirpe, Emanuele; Conti, Vittoria; Fini, Massimo; Bonassi, Stefano

    2017-04-14

    COPD management needs a comprehensive assessment of clinical features (symptoms severity, co-morbidities) together with life-style, behavioural, socio-economic and multi-omics parameters. Among the other issues, psycho-cognitive assessment plays a critical role. Coping strategies are used to manage psychological stress. To evaluate the association between coping strategies and outcome of Pulmonary Rehabilitation (PR). Observational study. Inpatients comprehensive 3 weeks PR programme. Seventy-six patients, 70 years or older affected by COPD GOLD 3-4. Disease-specific status was examined using the Medical Research Council Dyspnea Scale, St. George's Respiratory Questionnaire, Maugeri Respiratory Failure, Borg And Barthel Scales. Cognitive And Psychological Clinical Alterations/Disorders Using: Mini-Mental State Examination; Montreal Cognitive Assessment; Center for Epidemiologic Studies Depression Scale; Zung Self-Rating Anxiety Scale. Quality of Life Using Activities of Daily Living; Instrumental Activities of Daily Living; 36-Item Short Form Health Survey General and Mental Health. Functional exercise capacity was measured at baseline and after PR using the Six-Minute Walking Test (6MWT). Coping strategies were measured with the Brief COPE. Internal consistency was determined examining Cronbach's α values. Concurrent validity was determined by examining Spearman r correlations between the single-item and multi-items. Brief-COPE scores after PR between patients who had a different response to respiratory outcomes was evaluated using Student's t and Mann-Whitney U tests. The change in distance (Delta6MWD) between final and baseline value in meters was positively associated with Self-distraction, Active Coping, and Planning strategies. Respiratory disease-specific health status outcomes, as well as the presence of use of long-term oxygen therapy, were not associated with coping strategies. Self-distraction and Planning strategies are associated to the success of

  3. Acute exacerbation of COPD.

    Science.gov (United States)

    Ko, Fanny W; Chan, Ka Pang; Hui, David S; Goddard, John R; Shaw, Janet G; Reid, David W; Yang, Ian A

    2016-10-01

    The literature of acute exacerbation of chronic obstructive pulmonary disease (COPD) is fast expanding. This review focuses on several aspects of acute exacerbation of COPD (AECOPD) including epidemiology, diagnosis and management. COPD poses a major health and economic burden in the Asia-Pacific region, as it does worldwide. Triggering factors of AECOPD include infectious (bacteria and viruses) and environmental (air pollution and meteorological effect) factors. Disruption in the dynamic balance between the 'pathogens' (viral and bacterial) and the normal bacterial communities that constitute the lung microbiome likely contributes to the risk of exacerbations. The diagnostic approach to AECOPD varies based on the clinical setting and severity of the exacerbation. After history and examination, a number of investigations may be useful, including oximetry, sputum culture, chest X-ray and blood tests for inflammatory markers. Arterial blood gases should be considered in severe exacerbations, to characterize respiratory failure. Depending on the severity, the acute management of AECOPD involves use of bronchodilators, steroids, antibiotics, oxygen and noninvasive ventilation. Hospitalization may be required, for severe exacerbations. Nonpharmacological interventions including disease-specific self-management, pulmonary rehabilitation, early medical follow-up, home visits by respiratory health workers, integrated programmes and telehealth-assisted hospital at home have been studied during hospitalization and shortly after discharge in patients who have had a recent AECOPD. Pharmacological approaches to reducing risk of future exacerbations include long-acting bronchodilators, inhaled steroids, mucolytics, vaccinations and long-term macrolides. Further studies are needed to assess the cost-effectiveness of these interventions in preventing COPD exacerbations.

  4. Awareness of COPD in a high risk Korean population.

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    Seo, Jae Yong; Hwang, Yong Il; Mun, So Yeong; Kim, Jin Hee; Kim, Joo Hee; Park, Sung Hoon; Jang, Seung Hun; Park, Yong Bum; Shim, Jae Jung; Jung, Ki-Suck

    2015-03-01

    Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is an important aspect of disease management. The aim of this study was to explore COPD awareness among smokers participating in a smoking cessation program. Face-to-face interviews were conducted with 289 subjects in three smoking cessation clinics, using a structured questionnaire. A total of 68.2% of subjects had COPD-related symptoms, and 19.7% were in poor health. Only 1.0% of the subjects knew that COPD was a respiratory disease. A total of 2.4% of subjects had been diagnosed with COPD and received treatment. Television was the most common source of information about COPD, with 57.1% of the subjects receiving information in this way. After being informed about COPD, smoking-cessation willingness increased in 84.1% of the study group. It increased in 86.3% of the subjects without awareness of COPD and in 81.2% of subjects with COPD-related symptoms. We found that awareness of COPD is very poor among current smokers in Korea. Many smokers perceived their health status as good, despite the presence of COPD-related symptoms. As the level of smoking-cessation willingness was different between those with and without awareness of COPD or COPD-related symptoms, a personalized education program with various educational tools may be needed to enhance awareness of the disease and to motivate smokers to quit.

  5. [The importance of determining the prevalence of COPD].

    Science.gov (United States)

    Măgureanu, Irina-Laura; Furtunescu, Florentina

    2013-01-01

    The chronic obstructive pulmonary disease (COPD) is a common, preventable and partially treatable disease. COPD often remains undiagnosed, until it reaches advanced stages and significantly affects thepatient's quality of life. In the European Union the direct costs of COPD represent 56% (38.6 billion euro annually) of the direct costs of pulmonary diseases in the health budget. We analyzed a series of studies and we observed that the prevalence values vary between 6.5% (Lu Ming, China), 8.13% (Mihălţan Florin, Romania), 10.1% (the BOLD study), 17.4% (Peder Fabricius, Denmark). In Romania, the COPD prevalence is partially known, a recent study that evaluated the COPD prevalence on national level revealing a value of 8.13% in the population with an age over 40 years. Most of the studies include a selected population (smokers, age over 40, with or without symptoms). Establishing the prevalence of this disease as precise as possible becomes a necessity, even if this is pretty difficult to accomplish; the methods used in many studies on this subject are not uniform, thus the obtained results cannot be compared and correctly evaluated. Getting to know the prevalence of this disease as exact as possible is a difficult challenge, but extremely necessary for evaluating the seriousness of the phenomenon and getting to know the prevention and fighting measures. It is necessary to establish a methodology that has maximum effectiveness in identifying the COPD cases not only at an age over 40, but at lower ages as well, as it was proven that the disease can appear, even if more rarely, at ages below 40 as well. This article is part of a study which intends to try to determine a national wide applicable methodology.

  6. Clinical and economic outcomes in an observational study of COPD maintenance therapies: multivariable regression versus propensity score matching

    Directory of Open Access Journals (Sweden)

    Roberts MH

    2012-03-01

    Full Text Available Melissa H Roberts1, Anand A Dalal21Lovelace Clinic Foundation, (Lovelace Respiratory Research Institute at the time of the study, Albuquerque, NM, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USAPurpose: To investigate equivalency of results from multivariable regression (MR and propensity score matching (PSM models, observational research methods used to mitigate bias stemming from non-randomization (and consequently unbalanced groups at baseline, using, as an example, a large study of chronic obstructive pulmonary disease (COPD initial maintenance therapy.Methods: Patients were 32,338 health plan members, age ≥40 years, with COPD initially treated with fluticasone propionate/salmeterol combination (FSC, tiotropium (TIO, or ipratropium (IPR alone or in combination with albuterol. Using MR and PSM methods, the proportion of patients with COPD-related health care utilization, mean costs, odds ratios (ORs, and incidence rate ratios (IRRs for utilization events were calculated for the 12 months following therapy initiation.Results: Of 12,595 FSC, 9126 TIO, and 10,617 IPR patients meeting MR inclusion criteria, 89.1% (8135 of TIO and 80.2% (8514 of IPR patients were matched to FSC patients for the PSM analysis. Methods produced substantially similar findings for mean cost comparisons, ORs, and IRRs for most utilization events. In contrast to MR, for TIO compared to FSC, PSM did not produce statistically significant ORs for hospitalization or outpatient visit with antibiotic or significant IRRs for hospitalization or outpatient visit with oral corticosteroid. As in the MR analysis, compared to FSC, ORs and IRRs for all other utilization events, as well as mean costs, were less favorable for IPR and TIO.Conclusion: In this example of an observational study of maintenance therapy for COPD, more than 80% of the original treatment groups used in the MR analysis were matched to comparison treatment groups for the PSM analysis. While some sample

  7. Case Study: Testing with Case Studies

    Science.gov (United States)

    Herreid, Clyde Freeman

    2015-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

  8. Case Study: Testing with Case Studies

    Science.gov (United States)

    Herreid, Clyde Freeman

    2015-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

  9. Assessing efficacy of indacaterol in moderate and severe COPD patients: a 12-week study in an Asian population.

    Science.gov (United States)

    To, Yasuo; Kinoshita, Masaharu; Lee, Sang Haak; Hang, Liang-Wen; Ichinose, Masakazu; Fukuchi, Yoshinosuke; Kitawaki, Tetsuji; Okino, Naoko; Prasad, Niyati; Lawrence, David; Kramer, Benjamin

    2012-12-01

    This post hoc analysis evaluated the efficacy of indacaterol, a novel inhaled once-daily long-acting β(2)-agonist, by disease severity (GOLD 2005) in patients with moderate-to-severe COPD from six Asian countries/areas (Hong Kong, India, Japan, Korea, Singapore, Taiwan). Data from a 12-week, double-blind, placebo-controlled, parallel-group study in patients randomized to indacaterol 150 μg, indacaterol 300 μg or placebo once daily were analyzed based on baseline disease severity (moderate or severe). Endpoints were: trough FEV(1) (average of 23 h 10 min and 23 h 45 min post-dose values), transition dyspnoea index (TDI) and St George's Respiratory Questionnaire (SGRQ) at Week 12. Safety data were collected. Of 347 patients randomized, 59.7% had moderate, and 40.3% had severe COPD. Least squares means (LSMs) indacaterol-placebo differences in trough FEV(1) at Week 12 exceeded the pre-specified minimal clinically important difference (MCID) of 0.12L and were statistically superior (p indacaterol (150 μg, 300 μg) versus placebo in the two subgroups [0.19L, 0.20L (moderate); 0.15L, 0.19L (severe) respectively]. LSM TDI scores for both indacaterol doses versus placebo in both subgroups were statistically superior (p indacaterol doses showed improvements in LSM SGRQ total scores at Week 12 which exceeded the MCID (4 units) versus placebo in both subgroups, with indacaterol 300 μg-placebo difference in the severe subgroup being statistically significant (p indacaterol than with placebo across both subgroups. Indacaterol demonstrated clinically relevant improvements versus placebo in lung function, dyspnea and health status in Asian COPD patients irrespective of disease severity. NCT00794157. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Clinic continuity of care, clinical outcomes and direct costs for COPD in Sweden: a population based cohort study

    Science.gov (United States)

    Sveréus, Sofia; Larsson, Kjell; Rehnberg, Clas

    2017-01-01

    ABSTRACT Introduction: In this study we investigate whether clinic level continuity of care (COC) for individuals with chronic obstructive pulmonary disease (COPD) is associated with better health care outcomes and lower costs in a Swedish setting. Methods: Individuals with COPD (N = 20,187) were identified through ICD-10 codes in all Stockholm County health care registries in 2007–2011 (59% female, 40% in the age group 65–74 years). We followed the individuals prospectively for 365 days after their first outpatient visit in 2012. Individual associations between COC and incidence of any hospitalization or emergency department visit and total costs for health care and pharmaceuticals were quantified by regression analysis, controlling for age, sex, comorbidity and number of visits. Clinic level COC was measured through the Bice–Boxerman COC index, grouped into quintiles. Results: At baseline, 26% of the individuals had been hospitalized at least once and 73% had dispensed at least seven prescription drugs (23% at least 16) in the last year. Patients in the lowest COC quintile (Q1) had higher probabilities of any hospitalization and any emergency department visit compared to those in Q5 (odds ratio 2.17 [95% CI 1.95–2.43] and 2.06 [1.86–2.28], respectively). Patients in Q1 also on average had 58% [95% CI: 52–64] higher costs. Conclusion: The findings show robust associations between clinic level COC and outcomes. These results verify the importance of COC, and suggest that clinic level COC is of relevance to both better outcomes for COPD patients and more efficient use of resources. PMID:28326179

  11. Prognostic utility of the 2011 GOLD classification and other multidimensional tools in Asian COPD patients: a prospective cohort study

    Science.gov (United States)

    Chan, Hiang Ping; Mukhopadhyay, Amartya; Chong, Pauline Lee Poh; Chin, Sally; Wong, Xue Yun; Ong, Venetia; Chan, Yiong Huak; Lim, Tow Keang; Phua, Jason

    2016-01-01

    Background How well the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification prognosticates for Asian patients with COPD is unknown. Objective The authors aimed to study the predictive utility of the GOLD 2011 classification for exacerbations and mortality as compared with other multidimensional tools in an Asian population. Methods In all, 1,110 COPD patients were prospectively followed between March 2008 and March 2013. They were classified using the 2011 and 2007 GOLD guidelines, modified Medical Research Council score, St. George’s Respiratory Questionnaire (SGRQ), and Body mass index, Obstruction, Dyspnea (BOD) index. Outcome measures were exacerbations and mortality. Multivariable survival analyses and receiver operating characteristic (ROC) curves were used to assess the different classification systems. Results Time-to-event analyses demonstrated earlier exacerbations in 2011’s GOLD D when compared with GOLD A (hazard ratio [HR] 0.54, 95% confidence interval [CI]: 0.31–0.95, P=0.032) and GOLD B (HR 0.62, 95% CI: 0.45–0.85, P=0.003) and higher mortality when compared with GOLD A (HR 0.37, 95% CI: 0.16–0.88, P=0.025) and GOLD B (HR 0.46, 95% CI: 0.31–0.70, PBOD index were 0.62, 0.59, 0.61, 0.60, and 0.61, respectively, for the prediction of exacerbations and 0.71, 0.70, 0.71, 0.71, and 0.72, respectively, for the prediction of mortality (ROC comparator, P>0.05). Conclusion The 2011 GOLD classification predicts exacerbations and mortality moderately well in Asian COPD patients. Its prognostic utility is similar to that of other multidimensional systems. PMID:27217739

  12. Vital capacity and COPD: the Swedish CArdioPulmonary bioImage Study (SCAPIS

    Directory of Open Access Journals (Sweden)

    Torén K

    2016-05-01

    Full Text Available Kjell Torén,1 Anna-Carin Olin,1 Anne Lindberg,2 Jenny Vikgren,3 Linus Schiöler,1 John Brandberg,3 Åse Johnsson,3 Gunnar Engström,4 H Lennart Persson,5 Magnus Sköld,6 Jan Hedner,7 Eva Lindberg,8 Andrei Malinovschi,8 Eeva Piitulainen,9 Per Wollmer,9 Annika Rosengren,10 Christer Janson,8 Anders Blomberg,2 Göran Bergström10 1Section of Occupational and Environmental Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 2Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, 3Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 4Department of Clinical Science, Malmö, Lund University, Lund, 5Department of Respiratory Medicine and Department of Medicine and Health Sciences, Linköping University, Linköping, 6Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, 7Department of Internal Medicine/Lung Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 8Department of Medical Sciences, Clinical Physiology and Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, 9Department of Translational Medicine, Lund University, Malmö, 10Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Background: Spirometric diagnosis of chronic obstructive pulmonary disease (COPD is based on the ratio of forced expiratory volume in 1 second (FEV1/vital capacity (VC, either as a fixed value <0.7 or below the lower limit of normal (LLN. Forced vital capacity (FVC is a proxy for VC. The first aim was to compare the use of FVC and VC, assessed as the highest value of FVC or slow vital capacity (SVC, when assessing the FEV1/VC ratio in a general population

  13. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study

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    Bernabeu-Mora R

    2016-12-01

    Full Text Available Roberto Bernabeu-Mora,1–3 Gloria García-Guillamón,2 Joaquina Montilla-Herrador,2,3 Pilar Escolar-Reina,2,3 José Antonio García-Vidal,2 Francesc Medina-Mirapeix2,3 1Division of Pneumology, Hospital Morales Meseguer, 2Department of Physical Therapy, University of Murcia, 3Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB, Murcia, Spain Background: Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. Objective: The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. Materials and methods: This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. Results: A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming

  14. The squamous cell carcinoma case that received long-term COPD treatment

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    Figen Türk

    2013-03-01

    Full Text Available Primary tracheal tumors are rare, and composed of variousbenign and malignant pathologies. They often cansimulate obstructive pulmonary diseases, such as asthmaand chronic obstructive pulmonary disease, and patientswith malign tracheal tumors sometimes undergolong-term treatment for such diseases, without any improvement.Therefore, these tumors should be includedin the differential diagnosis in patients presenting tracheobronchialtree obstruction. We present a squamous cellendotracheal carcinoma case that had received treatmentwith a diagnosis of chronic obstructive pulmonarydisease for a long time. The recent increase in symptomshad been thought to be due to an exacerbation of the disorderbut the bronchoscopy performed after 3 months ofno improvement revealed an endotracheal mass lesion.Full recovery was obtained with bronchoscopic resectionof the tumor.Key words: Endotracheal tumor, chronic obstructive pulmonary disease, squamous cell carcinoma

  15. A novel study design for antibiotic trials in acute exacerbations of COPD: MAESTRAL methodology

    Directory of Open Access Journals (Sweden)

    Wilson R

    2011-06-01

    Full Text Available Robert Wilson1, Antonio Anzueto2, Marc Miravitlles3, Pierre Arvis4, Geneviève Faragó5, Daniel Haverstock6, Mila Trajanovic5, Sanjay Sethi71Host Defence Unit, Royal Brompton Hospital, London, England, UK; 2University of Texas Health Science Center at San Antonio, South Texas Veterans HealthCare System, San Antonio, TX, USA; 3Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS, Ciber de Enfermedades Respiratorias (CIBERES, Hospital Clinic, Barcelona, Spain; 4Bayer HealthCare, Loos, France; 5Bayer Inc, Toronto, ON, Canada; 6Bayer HealthCare Pharmaceuticals, Montville, NJ, USA; 7Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York, Buffalo, NY, USAAbstract: Antibiotics, along with oral corticosteroids, are standard treatments for acute exacerbations of chronic obstructive pulmonary disease (AECOPD. The ultimate aims of treatment are to minimize the impact of the current exacerbation, and by ensuring complete resolution, reduce the risk of relapse. In the absence of superiority studies of antibiotics in AECOPD, evidence of the relative efficacy of different drugs is lacking, and so it is difficult for physicians to select the most effective antibiotic. This paper describes the protocol and rationale for MAESTRAL (moxifloxacin in AECBs [acute exacerbation of chronic bronchitis] trial; www.clinicaltrials.gov: NCT00656747, one of the first antibiotic comparator trials designed to show superiority of one antibiotic over another in AECOPD. It is a prospective, multinational, multicenter, randomized, double-blind controlled study of moxifloxacin (400 mg PO [per os] once daily for 5 days vs amoxicillin/clavulanic acid (875/125 mg PO twice daily for 7 days in outpatients with COPD and chronic bronchitis suffering from an exacerbation. MAESTRAL uses an innovative primary endpoint of clinical failure: the requirement for additional or alternate treatment for the exacerbation at 8 weeks

  16. Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit.

    Science.gov (United States)

    Hartl, Sylvia; Lopez-Campos, Jose Luis; Pozo-Rodriguez, Francisco; Castro-Acosta, Ady; Studnicka, Michael; Kaiser, Bernhard; Roberts, C Michael

    2016-01-01

    Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes.

  17. Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden

    Directory of Open Access Journals (Sweden)

    Nihlén Ulf

    2009-01-01

    Full Text Available Abstract Background There is growing evidence that air pollution from traffic has adverse long-term effects on chronic respiratory disease in children, but there are few studies and more inconclusive results in adults. We examined associations between residential traffic and asthma and COPD in adults in southern Sweden. A postal questionnaire in 2000 (n = 9319, 18–77 years provided disease status, and self-reported exposure to traffic. A Geographical Information System (GIS was used to link geocoded residential addresses to a Swedish road database and an emission database for NOx. Results Living within 100 m of a road with >10 cars/minute (compared with having no heavy road within this distance was associated with prevalence of asthma diagnosis (OR = 1.40, 95% CI = 1.04–1.89, and COPD diagnosis (OR = 1.64, 95%CI = 1.11–2.4, as well as asthma and chronic bronchitis symptoms. Self-reported traffic exposure was associated with asthma diagnosis and COPD diagnosis, and with asthma symptoms. Annual average NOx was associated with COPD diagnosis and symptoms of asthma and chronic bronchitis. Conclusion Living close to traffic was associated with prevalence of asthma diagnosis, COPD diagnosis, and symptoms of asthma and bronchitis. This indicates that traffic-related air pollution has both long-term and short-term effects on chronic respiratory disease in adults, even in a region with overall low levels of air pollution.

  18. Determinants of Depression in the ECLIPSE COPD Cohort

    DEFF Research Database (Denmark)

    Hanania, Nicola A; Müllerova, Hana; Locantore, Nicholas W

    2010-01-01

    with COPD. METHODS: The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study is an observational three-year multicenter study that enrolled smokers with and without COPD and non-smoker controls. At baseline, several patient-reported outcomes were measured including...

  19. COPD flare-ups

    Science.gov (United States)

    COPD exacerbation; Chronic obstructive pulmonary disease exacerbation; Emphysema exacerbation; Chronic bronchitis exacerbation ... with your doctor on an action plan for COPD exacerbations so that you know what to do. ...

  20. Living with COPD: Nutrition

    Science.gov (United States)

    ... Diseases > Lung Disease Lookup > COPD > Living With COPD Nutrition Most people are surprised to learn that the ... asking your doctor or visiting the Academy of Nutrition and Dietetics at EatRight.org . Be sure to ...

  1. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis

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    Davies Adeloye

    2015-12-01

    Full Text Available The burden of chronic obstructive pulmonary disease (COPD across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases. We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals reported separately for World Health Organization (WHO regions, the World Bank's income categories and settings (urban and rural. We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more. Our search returned 37 472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI 7.3%–14.0% in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%. This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010, and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010. The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%, followed by the African region (102.1%, while the European region recorded the lowest increase (22.5%. In 1990, we estimated about 120.9 million COPD cases among urban dwellers

  2. Panax ginseng C.A Meyer root extract for moderate Chronic Obstructive Pulmonary Disease (COPD: study protocol for a randomised controlled trial

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    Story David

    2011-06-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD impairs quality of life and leads to premature mortality. COPD sufferers experience progressive deterioration of lung function and decreased ability to undertake day-to-day activities. Ginseng has been used for thousands of years in Chinese medicine for respiratory symptoms. Several controlled clinical trials using ginseng for COPD have shown promising clinical effect, however these studies were generally small and with some potential bias, prompting the need for rigorously designed studies. Aim The objective of this study is to evaluate the therapeutic value and safety profile of a standardised root extract of Panax ginseng C.A Meyer (ginseng for symptomatic relief, with a focus on quality of life (QoL improvements in individuals with moderate (Stage II COPD FEV1/FVC 1 50% - 80% predicted. Methods This paper describes the design of a randomised, multi-centre, double-blind, placebo controlled, two-armed parallel clinical trial. Two trial sites in Melbourne Australia will proportionately randomise a total of 168 participants to receive either ginseng capsule (100 mg or matching placebo twice daily for 24 weeks. The primary outcomes will be based on three validated QoL questionnaires, St Georges Respiratory Questionnaire (SGRQ, Short Form Health Survey (SF-36 and the COPD Assessment Test (CAT. Secondary outcomes are based on lung function testing, relief medication usage and exacerbation frequency and severity. Safety endpoints include blood tests and adverse event reporting. Intention-to-treat will be applied to all data analyses. Discussion Findings from this study may lead to new therapeutic development for chronic respiratory diseases, particularly COPD. This protocol may also guide other investigators to develop quality herbal medicine clinical trials in the future. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR: ACTRN12610000768099

  3. Efficacy and safety of a multifactor intervention to improve therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD: protocol for the ICEPOC study

    Directory of Open Access Journals (Sweden)

    Prados-Torres Daniel

    2011-02-01

    Full Text Available Abstract Background Low therapeutic adherence to medication is very common. Clinical effectiveness is related to dose rate and route of administration and so poor therapeutic adherence can reduce the clinical benefit of treatment. The therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD is extremely poor according to most studies. The research about COPD adherence has mainly focussed on quantifying its effect, and few studies have researched factors that affect non-adherence. Our study will evaluate the effectiveness of a multifactor intervention to improve the therapeutic adherence of COPD patients. Methods/Design A randomized controlled clinical trial with 140 COPD diagnosed patients selected by a non-probabilistic method of sampling. Subjects will be randomly allocated into two groups, using the block randomization technique. Every patient in each group will be visited four times during the year of the study. Intervention: Motivational aspects related to adherence (beliefs and behaviour: group and individual interviews; cognitive aspects: information about illness; skills: inhaled technique training. Reinforcement of the cognitive-emotional aspects and inhaled technique training will be carried out in all visits of the intervention group. Discussion Adherence to a prescribed treatment involves a behavioural change. Cognitive, emotional and motivational aspects influence this change and so we consider the best intervention procedure to improve adherence would be a cognitive and emotional strategy which could be applied in daily clinical practice. Our hypothesis is that the application of a multifactor intervention (COPD information, dose reminders and reinforcing audiovisual material, motivational aspects and inhalation technique training to COPD patients taking inhaled treatment will give a 25% increase in the number of patients showing therapeutic adherence in this group compared to the control group. We will

  4. Functional and psychosocial effects of pulmonary Daoyin on patients with COPD in China: study protocol of a multicenter randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Xue-qing Yu; Jian-sheng Li; Su-yun Li; Yang Xie; Ming-hang Wang; Hai-long Zhang; Hai-feng Wang

    2013-01-01

    BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide.Pulmonary rehabilitation (PR) is an established intervention for the management of patients with COPD.Exercise training is an important part of PR,and its effectiveness in patients with COPD is well established.However,alternative methods of PR training such as Daoyin have not been appropriately studied.Hence,alternative forms of exercise training that require less exercise equipment and no specific training place should be evaluated.This paper describes the study protocol of a clinical trial that aims to determine if pulmonary Daoyin training will improve the exercise capacity and psychosocial function of patients with COPD in China.METHODS AND DESIGN:A multicenter,randomized,controlled trial will be conducted.A total of 464 patients meeting the inclusion criteria will be enrolled into this study with 232 patients in each of the trial group and the control group.Based on patient education,patients in the trial group will receive pulmonary Daoyin and continue with their usual therapy for three months.In the control group,patients will continue with their usual therapy.The primary outcomemeasures are exercise capacity assessed by the six-minute walking distance test and lung function.Secondary outcomes include dyspnea and quality of life.Measurements will be taken at baseline (month 0) and after the study period (month 3).DISCUSSION:It is hypothesized that pulmonary Daoyin will have beneficial effects in improving exercise capacity and psychosocial function of patients with stable COPD,and will provide an alternative form of exercise training that is accessible for the large number of people with COPD.TRIAL REGISTRATION:This trial has been registered in C/inicalTria/s.gov.The identifier is NCT01482000.

  5. Balance impairment in patients with COPD.

    Directory of Open Access Journals (Sweden)

    Alexandru Florian Crişan

    Full Text Available Chronic obstructive pulmonary disease (COPD is a respiratory disease that results in progressive airflow limitation and respiratory distress. Physiopathological features of COPD suggest that people who suffer from this disease have many risk factors for falls that have been identified in older individuals. The aim of the study was to compare and quantify functional balance between COPD patients and healthy subjects; to investigate the risk of falls in acute stages of the disease and to identify risk factors that could lead to falls.We studied 46 patients with moderate-severe COPD (29 stable and 17 in acute exacerbation--AECOPD and 17 healthy subjects (control group having similar demographic data. We analyzed the difference in Berg Balance Scale (BBS, Single Leg Stance (SLS and Timed Up and Go test (TUG between these three groups and the correlation of these scores with a number of incriminatory factors.The presence of COPD was associated with significant worsening of balance tests: BBS (55 control, vs. 53 COPD, vs. 44 AECOPD points p<0.001, TUG (8.6 control vs. 12.3 COPD vs. 15.9 AECOPD seconds. p<0.001, SLS (31.1 control vs. 17.7 COPD vs. 7.2 AECOPD seconds p<0.001 which may be associated with an increased risk of falls. Anxiety and depression were significantly associated with decreased balance test scores; anxiety (2 control vs. 6 COPD vs. 9 AECOPD points p<0.001 depression (2 control vs. 7 COPD vs. 12 AECOPD points p<0.001.According to our results COPD patients in moderate-severe stages and especially those in exacerbation have a high risk of falls.

  6. Effect of endurance versus resistance training on quadriceps muscle dysfunction in COPD: a pilot study

    Directory of Open Access Journals (Sweden)

    Iepsen UW

    2016-10-01

    Full Text Available Ulrik Winning Iepsen,1 Gregers Druedal Wibe Munch,1 Mette Rugbjerg,1 Anders Rasmussen Rinnov,1 Morten Zacho,1 Stefan Peter Mortensen,1,2 Niels H Secher,3 Thomas Ringbaek,4 Bente Klarlund Pedersen,1 Ylva Hellsten,5 Peter Lange,1,4,6 Pia Thaning1,4 1The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark, 2Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, 3Department of Anesthesiology, University of Copenhagen, Rigshospitalet, Copenhagen, 4Department of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, 5Department of Nutrition, Exercise and Sports, University of Copenhagen, 6Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark Introduction: Exercise is an important countermeasure to limb muscle dysfunction in COPD. The two major training modalities in COPD rehabilitation, endurance training (ET and resistance training (RT, may both be efficient in improving muscle strength, exercise capacity, and health-related quality of life, but the effects on quadriceps muscle characteristics have not been thoroughly described.Methods: Thirty COPD patients (forced expiratory volume in 1 second: 56% of predicted, standard deviation [SD] 14 were randomized to 8 weeks of ET or RT. Vastus lateralis muscle biopsies were obtained before and after the training intervention to assess muscle morphology and metabolic and angiogenic factors. Symptom burden, exercise capacity (6-minute walking and cycle ergometer tests, and vascular function were also assessed.Results: Both training modalities improved symptom burden and exercise capacity with no difference between the two groups. The mean (SD proportion of glycolytic type IIa muscle fibers was reduced after ET (from 48% [SD 11] to 42% [SD 10], P<0.05, whereas there was no significant change in muscle fiber distribution with RT. There was

  7. Increased systemic inflammation is a risk factor for COPD exacerbations

    NARCIS (Netherlands)

    K.H. Groenewegen (Karin); D.S. Postma (Dirkje); W.C.J. Hop (Wim); P.L.M.L. Wielders (Pascal); N.J.J. Schlösser (Noel); E.F.M. Wouters (Emiel)

    2008-01-01

    textabstractBackground: COPD is characterized by episodic increases in respiratory symptoms, so-called exacerbations. COPD exacerbations are associated with an increase in local and systemic inflammation. Data of a previously published study in a well-characterized COPD cohort were analyzed to defin

  8. Increased systemic inflammation is a risk factor for COPD exacerbations

    NARCIS (Netherlands)

    Groenewegen, Karin H.; Postma, Dirkje S.; Hop, Wim C. J.; Wielders, Pascal L. M. L.; Schlosser, Noel J. J.; Wouters, Entiel F. M.

    2008-01-01

    Background: COPD is characterized by episodic increases in respiratory symptoms, so-called exacerbations. COPD exacerbations are associated with an increase in local and systemic inflammation. Data of a previously published study in a well-characterized COPD cohort were analyzed to define predictive

  9. Successful Smoking Cessation in COPD : Association with Comorbidities and Mortality

    NARCIS (Netherlands)

    Kupiainen, H; Kinnula, V L; Lindqvist, A; Postma, D S; Boezen, H M; Laitinen, T; Kilpeläinen, M

    2012-01-01

    Smoking cessation is the cornerstone of COPD management, but difficult to achieve in clinical practice. The effect of comorbidities on smoking cessation and risk factors for mortality were studied in a cohort of 739 COPD patients recruited in two Finnish University Hospitals. The diagnosis of COPD w

  10. Vital prognosis after hospitalization for COPD

    DEFF Research Database (Denmark)

    Vestbo, J; Prescott, E; Lange, P

    1998-01-01

    STUDY AIM: To examine survival after admission due to chronic obstructive pulmonary disease (COPD) in a population sample over a time span of 15 years. DESIGN: Linkage between a prospective population cohort and register information on hospitalization and mortality. SETTING: The Copenhagen City...... Heart Study (CCHS). PARTICIPANTS: A total of 267 men and 220 women who had participated in the CCHS and who were hospitalized with a discharge diagnosis of COPD (ICD-8 491-2). MAIN RESULTS: The crude 5-yr survival rate after a COPD admission was 45% (37% for men and 52% for women). Mortality risk...... associated with prognosis. Survival after admission due to COPD did not change significantly over time. CONCLUSION: Compared to previous studies of COPD patients, the present study indicates that prognosis after hospital admission remains virtually unchanged over the last decades. FEV1 is still the strongest...

  11. Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.

    Science.gov (United States)

    Fairbrother, Peter; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

    2012-09-01

    Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways. A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research. Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion. Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities. Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.

  12. Study on the Influences of Comprehensive Clinical Treatments in COPD Patients%实施综合性临床治疗对COPD患者的影响研究

    Institute of Scientific and Technical Information of China (English)

    彭军; 林常青

    2011-01-01

    Objective:Analyze the influences of comprehensive treatments in COPD patients so as to improve efficacy and patients' life quality. Methods:Comprehensive treatments including medication, oxygen therapy, expectorant and steam inhalation treatments,rehabilitation and psychotherapy etc. were applied to 70 qualified cases;observe and investigate the clinical efficacy, blood gas analysis as well as amelioration of pulmonary function at the same time,and perform correlation studies on the results. Results:The total effective ratio for these COPD patients was 92.86%,and the overall pulmonary function was improved in comparison to its former level before the treatments (()P<0. 05).Conclusion:Comprehensive treatments were of crucial importance to COPD patients.%目的:分析实施综合性治疗措施对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的影响,以期提高治疗效果、改善患者生活质量.方法:对符合条件的70例患者实施综含性治疗措施,包括药物治疗、给氧治疗、排痰和雾化治疗、康复治疗及心理治疗等,并对患者进行临床疗效观察、血气分析及肺功能改善情况调查,对其结果进行相关研究.结果:COPD患者临床总有效率为92.86%、并且患者血气分析及肺功能与治疗前相比均得以改善(P<0.5).结论:实臆综合性临床治疗措施对COPD患者至关重要.

  13. Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study.

    Science.gov (United States)

    Almagro, Pedro; Cabrera, Francisco Javier; Diez, Jesus; Boixeda, Ramon; Alonso Ortiz, M Belen; Murio, Cristina; Soriano, Joan B

    2012-11-01

    Comorbidities are frequent in patients hospitalized for COPD exacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge. A longitudinal, observational, multicenter study of patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge. We studied 606 patients, 594 men (89.9%), with a mean (SD) age of 72.6 (9.9) years and a postbronchodilator FEV1 of 43.2% (21.2). The mean Charlson index score was 3.1 (2.0). On admission, 63.4% of patients had arterial hypertension, 35.8% diabetes mellitus, 32.8% chronic heart failure, 20.8% ischemic heart disease, 19.3% anemia, and 34% dyslipemia. Twenty-seven patients (4.5%) died within 3 months. The Charlson index was an independent predictor of mortality (P < .003; OR,1.23; 95% CI, 1.07-1.40), even after adjustment for age, FEV1, and functional status measured with the Katz index. Comorbidity was also related with the need for hospitalization from the ED, length of stay, and hospital readmissions for COPD or other causes. Comorbidities are common in patients hospitalized for a COPD exacerbation, and they are related to short-term prognosis.

  14. Associations of the stair climb power test with muscle strength and functional performance in people with COPD: A cross-sectional study

    DEFF Research Database (Denmark)

    Roig, Marc; Eng, Janice J.; MacIntyre, Donna L.

    2010-01-01

    : The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. CONCLUSIONS: The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT...... torque (r =.46) and strongly associated (r=.68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r =.66); however, no significant relationship between the SCPT and measures of functional performance was found. LIMITATIONS...

  15. Long-term effects of 1-year maintenance training on physical functioning and health status in patients with COPD: A randomized controlled study

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brondum, Eva; Martinez, Gerd;

    2010-01-01

    PURPOSE: To examine whether maintenance training (MT) for 1 year improved the long-term effects of a 7-week chronic obstructive pulmonary disease (COPD) rehabilitation program. METHODS: After a 7-week outpatient rehabilitation program, 96 patients with COPD were randomized to either an MT group (n...... study period. Primary effect parameters were Endurance Shuttle Walk Test (ESWT) time and health status (St. George's Respiratory Questionnaire, SGRQ). Secondary effect parameters were adherence to supervised training, dropout rates, and hospitalization. RESULTS: Compared with the control group, the MT...

  16. Incidence and long-term outcome of severe asthma–COPD overlap compared to asthma and COPD alone: a 35-year prospective study of 57,053 middle-aged adults

    OpenAIRE

    Baarnes, Camilla Boslev; Andersen, Zorana Jovanovic; Tjønneland, Anne; Ulrik,Charlotte Suppli

    2017-01-01

    Background Incidence and prognosis for severe asthma–COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma–COPD overlap compared to asthma and COPD alone. Materials and methods A total of 57,053 adults (aged 50–64 years) enrolled in the Danish Diet, Cancer, and Health cohort (1993–1997) were followed in the National Patients Registry for admissions for asthma (DJ45–46) and COPD (DJ40–44) and vital status. Asthma–COPD overlap was defined...

  17. The potential for integrated care programmes to improve quality of care as assessed by patients with COPD: early results from a real-world implementation study in The Netherlands

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.P.M.H. Rutten-van Mölken (Maureen); A.P. Nieboer (Anna)

    2012-01-01

    textabstractObjective: We investigated whether patients with chronic obstructive pulmonary disease (COPD) who were enrolled in disease-management programmes (DMPs) felt that they received a better quality of care than non-enrolled COPD patients. Methods: Our cross-sectional study was performed among

  18. General practitioners' perceptions of COPD treatment

    DEFF Research Database (Denmark)

    Molin, Katrine Rutkær; Egerod, Ingrid; Staun Valentiner, Laura

    2016-01-01

    BACKGROUND: In Denmark, the treatment of COPD is mainly managed by general practitioners (GPs). Pulmonary rehabilitation (PR) is available to patients with COPD in the local community by GP referral, but in practice, many patients do not participate in rehabilitation. The aim of our study...... was to explore 1) GPs' perceptions of their role and responsibility in the rehabilitation of patients with COPD, and 2) GPs' perceptions of how patients manage their COPD. METHODS: The study was based on a qualitative design with semi-structured key-informant interviews with GPs. Investigator triangulation...... the resources to discuss rehabilitation and follow up on individual plans. CONCLUSION: Our study suggested a potential self-reinforcing problem with the treatment of COPD being mainly focused on medication rather than on PR. Neither GPs nor patients used a proactive approach. Further, GPs were not fully...

  19. COPD in Taiwan: a National Epidemiology Survey

    Directory of Open Access Journals (Sweden)

    Cheng SL

    2015-11-01

    Full Text Available Shih-Lung Cheng,1,2 Ming-Cheng Chan,3 Chin-Chou Wang,4 Ching-Hsiung Lin,5 Hao-Chien Wang,6 Jeng-Yuan Hsu,3 Liang-Wen Hang,7,8 Chee-Jen Chang,9 Diahn-Warng Perng,10,* Chong-Jen Yu6,* On behalf of the Taiwan COPD Consortium 1Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 2Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li City, Taoyuan County, 3Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 4Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 5Division of Chest Medicine, Changhua Christian Hospital, Changhua City, Changhua County, 6Department of Internal Medicine, National Taiwan University Hospital, Taipei, 7Department of Pulmonary and Critical Care Medicine, Sleep Medicine Center, China Medical University Hospital, 8Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, 9Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou Branch, Guishan Township, Taoyuan County, 10Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China *These authors contributed equally to this work Objectives: To determine the prevalence of COPD in Taiwan and to document the disease characteristics and associated risk factors.Methods: We conducted a random cross-sectional national survey of adults older than 40 years in Taiwan. Respiratory health screening questions identified subjects with diagnosed COPD or whose reported symptoms also fulfilled an epidemiological case definition; these were eligible to complete the survey, which also included indices of symptom severity and disability and questions on comorbidities, medical treatments, smoking habits, and occupations potentially harmful to respiratory health. Subjects with diagnosed COPD were subdivided by smoking status. Subjects who fulfilled the case definition

  20. Efficacy and safety of indacaterol/glycopyrronium in Japanese patients with COPD: a subgroup analysis from the SHINE study

    Directory of Open Access Journals (Sweden)

    Hashimoto S

    2016-10-01

    Full Text Available Shu Hashimoto,1 Hisataro Ikeuchi,2 Shujiro Murata,2 Tetsuji Kitawaki,2 Kimitoshi Ikeda,2 Donald Banerji3 1Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; 2Novartis Pharma KK, Minato-ku, Tokyo, Japan; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA Background: COPD-related deaths are increasing in Japan, with ~5.3 million people at risk.Methods: The SHINE was a 26-week, multicenter, randomized, double-blind, parallel-group study that evaluated safety and efficacy of indacaterol (IND/glycopyrronium (GLY 110/50 µg once daily (od compared with GLY 50 µg od, IND 150 µg od, open-label tiotropium (TIO 18 µg od, and placebo. The primary end point was trough forced expiratory volume in 1 second (FEV1 at Week 26. Other key end points included peak FEV1, area under the curve for FEV1 from 5 minutes to 4 hours (FEV1 AUC5 min–4 h, Transition Dyspnea Index focal score, St George’s Respiratory Questionnaire total score, and safety. Here, we present efficacy and safety of IND/GLY in the Japanese subgroup.Results: Of 2,144 patients from the SHINE study, 182 (8.5% were Japanese and randomized to IND/GLY (n=42, IND (n=41, GLY (n=40, TIO (n=40, or placebo (n=19. Improvement in trough FEV1 from baseline was 190 mL with IND/GLY and treatment differences versus IND (90 mL, GLY (100 mL, TIO (90 mL, and placebo (280 mL along with a rapid onset of action at Week 26. IND/GLY showed an improvement in FEV1 AUC5 min–4 h versus all comparators (all P<0.05. All the treatments were well tolerated and showed comparable effect on Transition Dyspnea Index focal score and St George’s Respiratory Questionnaire total score. The effect of IND/GLY in the Japanese subgroup was consistent to overall SHINE study population.Conclusion: IND/GLY demonstrated superior efficacy and comparable safety compared with its monocomponents, open-label TIO, and placebo and may be used as a

  1. Validation of the Spanish Version of the COPD-Q Questionnaire on COPD Knowledge.

    Science.gov (United States)

    Puente-Maestu, Luis; Chancafe-Morgan, Jorge; Calle, Myriam; Rodríguez-Hermosa, Juan L; Malo de Molina, Rosa; Ortega-González, Ángel; Fuster, Antonia; Márquez-Martín, Eduardo; Marcos, Pedro J; Ramírez, Laura; Ray, Shaunta'; Franks, Andrea

    2016-01-01

    Although recognition of the importance of educating chronic obstructive pulmonary disease (COPD) patients has grown in recent years, their understanding of this disease is not being measured due to a lack of specific instruments. The aim of this study was to validate the COPD-Q questionnaire, a 13-item instrument for determining COPD knowledge. The COPD-Q was translated and backtranslated, and subsequently submitted to logic and content validation by a group of COPD experts and 8 COPD patients. Reliability was studied in an independent group of 59 patients with severe COPD seen in the pulmonology ward or clinics of 6 hospitals in Spain (Andalusia, Baleares, Castilla-La Mancha, Galicia and Madrid). This sample was also used for other internal and external validations. The mean age of the group was approximately 70 years and their health awareness was low-to-medium. The number of correct answers was 8.3 (standard deviation: 1.9), median 8, range 3-13. Floor and ceiling effects were 0% and 1.5%, respectively. Internal consistency of the questionnaire was good (Cronbach's alpha=0.85) and reliability was also high, with a kappa coefficient >0.6 for all items and an intraclass correlation efficient of 0.84 for the total score. The 13-item COPD-Q is a valid, applicable and reliable instrument for determining patients' knowledge of COPD. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  2. Epidemiology, radiology, and genetics of nicotine dependence in COPD

    Directory of Open Access Journals (Sweden)

    Hokanson John E

    2011-01-01

    Full Text Available Abstract Background Cigarette smoking is the principal environmental risk factor for developing COPD, and nicotine dependence strongly influences smoking behavior. This study was performed to elucidate the relationship between nicotine dependence, genetic susceptibility to nicotine dependence, and volumetric CT findings in smokers. Methods Current smokers with COPD (GOLD stage ≥ 2 or normal spirometry were analyzed from the COPDGene Study, a prospective observational study. Nicotine dependence was determined by the Fagerstrom test for nicotine dependence (FTND. Volumetric CT acquisitions measuring the percent of emphysema on inspiratory CT (% of lung Results Among 842 currently smoking subjects (335 COPD cases and 507 controls, 329 subjects (39.1% showed high nicotine dependence. Subjects with high nicotine dependence had greater cumulative and current amounts of smoking. However, emphysema severity was negatively correlated with the FTND score in controls (ρ = -0.19, p Conclusions Nicotine dependence was a negative predictor for emphysema on CT in COPD and control smokers. Increased inflammation in more highly addicted current smokers could influence the CT lung density distribution, which may influence genetic association studies of emphysema phenotypes. Trial registration ClinicalTrials (NCT: NCT00608764

  3. Adherence to COPD guidelines in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse

    2013-01-01

    BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...

  4. Self-efficacy for physical activity and insight into its benefits are modifiable factors associated with physical activity in people with COPD a mixed-methods study

    NARCIS (Netherlands)

    Hartman, Jorine E.; ten Hacken, Nick H. T.; Boezen, H. Marike; de Greef, Mathieu H. G.

    2013-01-01

    Questions: What are the perceived reasons for people with chronic obstructive pulmonary disease (COPD) to be physically active or sedentary? Are those reasons related to the actual measured level of physical activity? Design: A mixed-methods study combining qualitative and quantitative approaches. P

  5. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD : A pilot study

    NARCIS (Netherlands)

    Flokstra-de Blok, Bertine; de Greef, Mathieu; ten Hacken, Nicolaas; Sprenger, S.; Postema, Klaas; Wempe, Johan

    Objective: To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation. Methods: Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation

  6. Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study

    Directory of Open Access Journals (Sweden)

    Danilo Cortozi Berton

    Full Text Available Abstract Objective: To compare a once-daily long-acting β2 agonist (indacaterol 150 µg with a once-daily long-acting anticholinergic (tiotropium 5 µg in terms of their effects on exercise endurance (limit of tolerance, Tlim in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Methods: This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted. Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments. Results: Nineteen patients completed the study (one having been excluded because of COPD exacerbation. Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06. Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010 but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678. There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39. Conclusions: In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003

  7. Surfactant Protein B Intron 4 Variation in German Patients with COPD and Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Carola Seifart

    2002-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a major health problem. Genetic factors that contribute to the disease have been postulated. The pulmonary surfactant protein B (SP-B, which is essential for normal lung function, is considered as a candidate gene for COPD in this case-control study. We studied the SP-B intron 4 size variants in 346 individuals. This group consisted of 118 patients with chronic bronchitis or COPD, including 24 patients with acute respiratory failure (ARF in COPD, 118 matched controls without pulmonary disease and 110 healthy individuals (population control. The frequency of intron 4 variants was similar in either control group (10.9%, 14.4% respectively, with a small increase in the COPD group (18.6%. This increase was due to a high increase of intron 4 variants in the ARF subgroup (37.5%, p = 0.003, OR 4.9, 95% CI: 1.76–13.6. The data indicate that SP-B intron 4 variants may associate with increased risk of ARF in COPD and may be used as a marker of susceptibility in this disease subgroup.

  8. [COPD-nonpharmacological treatment].

    Science.gov (United States)

    Pfeifer, Michael

    2006-04-15

    The modern concept of chronic obstructive pulmonary disease (COPD) goes far beyond pure medical therapy. Solely treating obstruction and inflammation of the airways does not correspond to the complexity of this illness which now is considered a systemic disease. Therapeutic planning comprises prevention, early physiotherapy and physical training, educational measures, and, in advanced stages, long-term oxygen therapy, mechanical support of the ventilatory muscular system by noninvasive ventilation and surgical measures. To stop smoking is the most important preventive measure which succeeds in up to 40% when carried through consequently. COPD will eventually lead to a steadily decreasing cardiopulmonary performance. Physical training therefore is of utmost importance. Physical training will be accompanied by ventilatory and physiotherapy, a sophisticated dietary treatment, as well as education and motivation of the patient in order to develop competence in self-management. Further treatments in advanced stages consist of long-term oxygen therapy and intermittent noninvasive ventilation. The latter is the treatment of choice for acute respiratory insufficiency. Operative treatments like lung volume reduction and lung transplantation are only indicated in selected cases.

  9. Theoretical study of the structures and chemical ordering of CoPd nanoalloys supported on MgO(001)

    Science.gov (United States)

    Taran, Songul; Garip, Ali Kemal; Arslan, Haydar

    2016-06-01

    Metal nanoalloys on oxide surface are a widely studied topic in surface science and technology. In this study, the structures of CoPd nanoalloys adsorbed on MgO(001) have been searched by basin-hopping global optimization method within an atomistic model. Two different sizes (34 and 38 atom) have been considered for all compositions of CoPd/MgO(001) nanoalloys. Co and Pd atoms, for all the compositions, have cube-on-cube (001) epitaxy with substrate at interface. For both sizes, we have found that Pd rich composition nanoalloys have three layers, Co rich composition nanoalloys have four layers in morphology. Excess energy and second difference in energy analyzes have been performed to investigate the relative stability of nanoalloys with respect to their size and composition.

  10. Use of concomitant inhaled corticosteroids: pooled data from two phase III studies of aclidinium plus formoterol in COPD.

    Science.gov (United States)

    D'Urzo, Anthony; Singh, Dave; Garcia Gil, Esther

    2017-12-01

    Bronchodilator therapy is the backbone of the management of chronic obstructive pulmonary disease. In some patients, inhaled corticosteroids can be prescribed in combination with bronchodilators. Through a subgroup analysis of pooled data from two large phase III clinical trials of bronchodilator therapy according to concomitant inhaled corticosteroid use (user vs. non-user), we sought to evaluate the clinical benefit of adding inhaled corticosteroids to dual bronchodilator therapy in chronic obstructive pulmonary disease. The primary focus of this analysis of pooled data from the phase III ACLIFORM and AUGMENT studies was to evaluate the efficacy of aclidinium/formoterol on lung function stratified by inhaled corticosteroid use. We found that lung-function end points were significantly improved regardless of concomitant inhaled corticosteroid use among patients treated with the dual bronchodilator aclidinium/formoterol 400/12 µg twice daily compared with placebo and both monotherapies. Together with the previously reported observations that aclidinium/formoterol 400/12 µg reduces exacerbations vs. placebo in inhaled corticosteroid users and improves dyspnoea compared to monotherapy in inhaled corticosteroid non-users, these data suggest that both groups achieve lung function improvements, which translates to different clinical benefits depending on whether or not a patient is receiving concomitant inhaled corticosteroids.CHRONIC LUNG DISEASE: 'TRIPLE' THERAPY COULD PROVE BENEFICIAL: A dual bronchodilator therapy taken together with corticosteroid inhalers may benefit patients with severe chronic lung disease. Bronchodilator drugs relax the lungs and widen airways in patients with chronic obstructive pulmonary disease (COPD). While recent studies have shown that a dual bronchodilator therapy containing aclidinium and formoterol significantly improves lung function in COPD, little is known about combining the dual therapy with inhaled corticosteroids (ICSs

  11. Case Study: Writing a Journal Case Study

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    Prud'homme-Genereux, Annie

    2016-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes incorporating a journal article into the classroom by first converting it into a case study.

  12. Case Study: Writing a Journal Case Study

    Science.gov (United States)

    Prud'homme-Genereux, Annie

    2016-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes incorporating a journal article into the classroom by first converting it into a case study.

  13. Faster reduction in hyperinflation and improvement in lung ventilation inhomogeneity promoted by aclidinium compared to glycopyrronium in severe stable COPD patients. A randomized crossover study.

    Science.gov (United States)

    Santus, Pierachille; Radovanovic, Dejan; Di Marco, Fabiano; Raccanelli, Rita; Valenti, Vincenzo; Centanni, Stefano

    2015-12-01

    Standard spyrometric assessment in chronic obstructive pulmonary disease (COPD) only evaluates bronchial obstruction. However, airflow limitation and hyperinflation are the main pathophysiological factors responsible for dyspnoea and reduced exercise tolerance in patients with COPD. This study evaluated the effects of aclidinium bromide 400 μg and glycopyrronium bromide 50 μg on these parameters. Patients with stable severe/very severe COPD were randomized in this double-blind, double-dummy, crossover, Phase IV study. Patients received single doses of each drug on separate days. Primary endpoints were changes in residual volume (RV) and intra-thoracic gas volume (ITGV), assessed by full-body plethysmography. Other endpoints included changes variations in lung ventilation inhomogeneity (Phase III slope of single-breath nitrogen washout test, SBN2), dyspnoea visual analogue scale, and pulmonary specific total airway resistances. Assessments were performed at baseline and 5, 15, 30, 60, and 180 min post-administration. Thirty-seven patients were randomized (31 male; mean age 71 years). Aclidinium and glycopyrronium significantly improved ITGV versus baseline at all-time points (p hyperinflation and dyspnoea in severe and very severe COPD patients. Aclidinium however promoted a faster reduction in RV and was the only able to reduce lung ventilation inhomogeneity. Trial Registration numbers available on Clinicaltrials.gov: NCT02181023.

  14. Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

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    Menezes, A.M.B.; Perez-Padilla, R.; Hallal, P.C.; Jardim, J.R.; Muino, A.; Lopez, M.V.; Valdivia, G.; Pertuze, J.; de Oca, M.M.; Talamo, C. [Universidade Federal de Pelotas, Pelotas (Brazil)

    2008-07-15

    The objective of the paper is to describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America. Five Latin American cities were investigated, namely, Sao Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela. This is a multi Centre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV1/FVC < 0.7 (fixed ratio criterion). Global Obstructive Lung Disease (GOLD) stages were also analysed. The combined population aged {>=} 40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest actiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged {>=} 40 years in these cities, corresponding to approximately 25 million smokers in this age group. Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America.

  15. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based Internet of Things in the management of patients with stable COPD.

    Science.gov (United States)

    Zhang, Jing; Song, Yuan-Lin; Bai, Chun-Xue

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a common disease that leads to huge economic and social burden. Efficient and effective management of stable COPD is essential to improve quality of life and reduce medical expenditure. The Internet of Things (IoT), a recent breakthrough in communication technology, seems promising in improving health care delivery, but its potential strengths in COPD management remain poorly understood. We have developed a mobile phone-based IoT (mIoT) platform and initiated a randomized, multicenter, controlled trial entitled the 'MIOTIC study' to investigate the influence of mIoT among stable COPD patients. In the MIOTIC study, at least 600 patients with stable GOLD group C or D COPD and with a history of at least two moderate-to-severe exacerbations within the previous year will be randomly allocated to the control group, which receives routine follow-up, or the intervention group, which receives mIoT management. Endpoints of the study include (1) frequency and severity of acute exacerbation; (2) symptomatic evaluation; (3) pre- and post-bronchodilator forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) measurement; (4) exercise capacity; and (5) direct medical cost per year. Results from this study should provide direct evidence for the suitability of mIoT in stable COPD patient management.

  16. A study of oxidative stress, thiol proteins and role of vitamin E supplementation in chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Anita M. Raut

    2013-04-01

    Full Text Available Background: Lipid peroxide plays an important role in inflammatory lung disease. Increased epithelial permeability produced by cigarette smoke is likely to be mediated through depletion of thiol proteins. Imbalance between oxidants and thiol proteins is also an established fact in these patients. Materials & methods: In the present study 30 healthy non-smokers were served as controls and 20 patients with stable COPD were included. Their base line clinical examination, Malondialdehyde (MDA as an oxidant, alpha tocopherol and erythrocyte superoxide dismutase (SOD as an antioxidants and thiol proteins levels were measured. All above parameters were repeated after 12 weeks of supplementation with 400 IU of vitamin E daily. Results: We observed that the mean malondialdehyde levels in these patients at base line were high (p<0.001 than Control Plasma alpha-tocopherol, SOD and thiol proteins levels were low (p<0.001 in the patients compared to controls. Exogenous vitamin E (400 IU twice daily Supplementation did not bring about any significant change in plasma Erythrocyte Superoxide Dismutase and vitamin E. But slight increase in the plasma thiol proteins levels was seen. The present study shows that initially the plasma lipid peroxide (MDA levels were high antioxidant (alpha- tocopherol, SOD and thiol proteins were low in patients with COPD. Exogenous supplementation with vitamin E increases slightly thiol proteins levels and brings down the levels of MDA showing attenuation of further damage. Conclusion: Our study confirmed the existence of oxidative stress and and the augmentation of antioxidant defenses as shown by slight increase in thiol proteins level. The antioxidant therapy is adjunct in lung disease patients and opens a promising field in prevention of oxidative stress related complications in these patients.

  17. Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study

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    Wensing Michel

    2005-02-01

    Full Text Available Abstract Background The increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which may influence physicians' documentation behaviour. For that reason it is unclear to what respect ICD-10 codes reflect the real problems of the patients in general practice. The aim of this study was to assess the appropriateness of the recorded diagnoses and to determine what diagnostic information is used to guide medical treatment. Methods All patients with lower airway symptoms (n = 857 who had attended six general practices between January and June 2003 were included into this cross sectional observational study. Patients were selected from the computerised medical record systems, focusing on ICD-10-codes concerning lower airway diseases (J20-J22, J40-J47, J98 and R05. The performed diagnostic procedures and actual medication for each identified patient were extracted manually. Then we examined the associations between recorded diagnoses, diagnostic procedures and prescribed treatment for asthma and COPD in general practice. Results Spirometry was used in 30% of the patients with a recorded diagnosis of asthma and in 58% of the patients with a recorded diagnosis of COPD. Logistic regression analysis showed an improved use of spirometry when inhaled corticosteroids were prescribed for asthma (OR = 5.2; CI 2.9–9.2 or COPD (OR = 4.7; CI 2.0–10.6. Spirometry was also used more often when sympathomimetics were prescribed (asthma: OR = 2.3; CI 1.2–4.2; COPD: OR = 4.1; CI 1.8–9.4. Conclusions This study revealed that spirometry was used more often when corticosteroids or sympathomimetics were prescribed. The findings suggest that treatment was based on diagnostic test results rather than on recorded diagnoses. The documented ICD-10 codes

  18. Six-minute walking distance improvement after pulmonary rehabilitation is associated with baseline lung function in complex COPD patients: a retrospective study.

    Science.gov (United States)

    Zanini, Andrea; Chetta, Alfredo; Gumiero, Federico; Della Patrona, Sabrina; Casale, Silvia; Zampogna, Elisabetta; Aiello, Marina; Spanevello, Antonio

    2013-01-01

    Conflicting results have been so far reported about baseline lung function, as predicting factor of pulmonary rehabilitation (PR) efficacy. To ascertain whether or not baseline lung function could predict a benefit in terms of a significant change in 6-min walk test (6 MWT) after PR. Seventy-five stable moderate-to-severe COPD inpatients with comorbidities (complex COPD), allocated to a three-week PR program, were retrospectively evaluated. Pulmonary function, 6 MWT, dyspnea (BDI/TDI), and quality of life (EQ-VAS) were assessed before and after PR program. The patients were divided into two groups depending on the change in 6 MWT (responders > 30 m and nonresponders ≤ 30 m). Logistic regression analysis was used. Results. After PR, 6 MWT performance all outcome measures significantly improved (P function (P PR efficacy. Our study shows that in stable moderate-to-severe complex COPD inpatients, baseline lung function may predict the response to PR in terms of 6 MWT. We also found that complex COPD patients with poor lung function get more benefit from PR.

  19. The effects of long-term noninvasive ventilation in hypercapnic COPD patients: a randomized controlled pilot study

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    De Backer L

    2011-11-01

    Full Text Available L De Backer¹, W Vos², B Dieriks¹, D Daems¹, S Verhulst¹, S Vinchurkar², K Ides¹, J De Backer², P Germonpre¹, W De Backer¹1Antwerp University Hospital, Department of Respiratory Medicine, 2FluidDa, Antwerp, BelgiumIntroduction: Noninvasive ventilation (NIV is a well-established treatment for acute-on-chronic respiratory failure in hypercapnic COPD patients. Less is known about the effects of a long-term treatment with NIV in hypercapnic COPD patients and about the factors that may predict response in terms of improved oxygenation and lowered CO2 retention.Methods: In this study, we randomized 15 patients to a routine pharmacological treatment (n = 5, age 66 [standard deviation ± 6] years, FEV1 30.5 [±5.1] %pred, PaO2 65 [±6] mmHg, PaCO2 52.4 [±6.0] mmHg or to a routine treatment and NIV (using the Synchrony BiPAP device [Respironics, Inc, Murrsville, PA] (n = 10, age 65 [±7] years, FEV1 29.5 [±9.0] %pred, PaO2 59 [±13] mmHg, PaCO2 55.4 [±7.7] mmHg for 6 months. We looked at arterial blood gasses, lung function parameters and performed a low-dose computed tomography of the thorax, which was later used for segmentation (providing lobe and airway volumes, iVlobe and iVaw and post-processing with computer methods (providing airway resistance, iRaw giving overall a functional image of the separate airways and lobes.Results: In both groups there was a nonsignificant change in FEV1 (NIV group 29.5 [9.0] to 38.5 [14.6] %pred, control group 30.5 [5.1] to 36.8 [8.7] mmHg. PaCO2 dropped significantly only in the NIV group (NIV: 55.4 [7.7] → 44.5 [4.70], P = 0.0076; control: 52.4 [6.0] → 47.6 [8.2], NS. Patients actively treated with NIV developed a more inhomogeneous redistribution of mass flow than control patients. Subsequent analysis indicated that in NIV-treated patients that improve their blood gases, mass flow was also redistributed towards areas with higher vessel density and less emphysema, indicating that flow was

  20. Living with chronic obstructive pulmonary disease (COPD): part II. RNs' experience of nursing care for patients with COPD and impaired nutritional status.

    Science.gov (United States)

    Odencrants, Sigrid; Ehnfors, Margareta; Grobe, Susan J

    2007-03-01

    This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future.

  1. COPD and other health problems

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000701.htm COPD and other health problems To use the sharing ... diabetes, and high blood pressure. Staying Healthy With COPD Work closely with your doctor to keep COPD ...

  2. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners.

    NARCIS (Netherlands)

    Yohannes, A.M.; Hann, M.; Sibbald, B.S.

    2011-01-01

    AIMS: We examined the management of depression by general practitioners (GPs), through the use of case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. BACKGROUND: Depression is common in patients with COPD. Untreated

  3. Indacaterol once-daily provides superior efficacy to salmeterol twice-daily in COPD: a 12-week study.

    Science.gov (United States)

    Korn, Stephanie; Kerwin, Edward; Atis, Sibel; Amos, Carolynn; Owen, Roger; Lassen, Cheryl

    2011-05-01

    Indacaterol is a novel, inhaled once-daily ultra-long-acting β(2)-agonist for the treatment of COPD. This 12-week randomised, parallel-group study compared the efficacy of indacaterol 150 μg once-daily to salmeterol 50 μg twice-daily in patients with moderate-to-severe COPD. Assessments included FEV(1) standardised area under curve (AUC) from 5 min to 11 h 45 min at Week 12 (primary endpoint), 24-h trough FEV(1) (mean of 23 h 10 min and 23 h 45 min post-dose) at Week 12 (key secondary endpoint), FEV(1) and FVC measured over 24-h, transition dyspnoea index (TDI) and rescue medication use. Of 1123 patients randomised 92.1% completed. Mean ± SD age was 62.8±8.78 years, post-bronchodilator FEV(1) 51.8±12.32% predicted, FEV(1)/FVC 50.6±9.54%. At Week 12, FEV(1) AUC(5 min-11 h 45 min) for indacaterol was statistically superior (pIndacaterol also showed statistical superiority over salmeterol in terms of FEV(1) and FVC measured over 24-h at Week 12. For TDI at Week 12, the mean total score was statistically superior for indacaterol versus salmeterol (difference 0.63 [0.30, 0.97], pindacaterol used fewer puffs/day (difference -0.18 [-0.36, 0.00] puffs/day, pindacaterol provided statistically superior bronchodilation with an improvement in breathlessness and rescue use compared with twice-daily salmeterol. ClinicalTrials.gov NCT00821093. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study.

    Science.gov (United States)

    Montes de Oca, Maria; Tálamo, Carlos; Halbert, Ronald J; Perez-Padilla, Rogelio; Lopez, Maria Victorina; Muiño, Adriana; Jardim, José Roberto B; Valdivia, Gonzalo; Pertuzé, Julio; Moreno, Dolores; Menezes, Ana Maria B

    2009-07-01

    Recurrent exacerbations are common in COPD patients. Limited information exists regarding exacerbation frequency in COPD patients from epidemiologic studies. We examined the frequency of self-reported exacerbations and the factors influencing exacerbation frequency among COPD patients in a population-based study conducted in Latin America. We used a post-bronchodilator FEV(1)/FVC ratio of < 0.70 to define COPD. Exacerbation was self-reported and defined by symptoms (deterioration of breathing symptoms that affected usual daily activities or caused missed work). Spirometry was performed in 5,314 subjects. There were 759 subjects with airflow limitation; of these, 18.2% reported ever having had an exacerbation, 7.9% reported having an exacerbation, and 6.2% reported having an exacerbation requiring at least a doctor visit within the past year. The proportion of individuals with an exacerbation significantly increased by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, from 4.2% in stage 1 to 28.9% in stages 3 and 4. The self-reported exacerbation rate was 0.58 exacerbations per year. The rate of exacerbations requiring at least a doctor visit and length of stay in hospital due to exacerbations also increased as COPD severity progressed. The factors associated with having an exacerbation in the past year were dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and disease severity of GOLD stages 3 and 4. The proportion of individuals with airflow limitation and self-reported exacerbation increases as the disease severity progresses. Dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and more severe obstruction were significantly associated with having an exacerbation in the past year.

  5. Comorbidities of COPD

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    Arnaud Cavaillès

    2013-12-01

    Full Text Available By 2020, chronic obstructive pulmonary disease (COPD will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately.

  6. Cognitive impairment in COPD: a systematic review

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    Irene Torres-Sánchez

    2015-04-01

    Full Text Available The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.

  7. Advances in understanding COPD

    Science.gov (United States)

    Anderson, Gary P.

    2016-01-01

    In recent years, thousands of publications on chronic obstructive pulmonary disease (COPD) and its related biology have entered the world literature, reflecting the increasing scientific and medical interest in this devastating condition. This article is a selective review of several important emerging themes that offer the hope of creating new classes of COPD medicines. Whereas basic science is parsing molecular pathways in COPD, its comorbidities, and asthma COPD overlap syndrome (ACOS) with unprecedented sophistication, clinical translation is disappointingly slow. The article therefore also considers solutions to current difficulties that are impeding progress in translating insights from basic science into clinically useful treatments.

  8. Clinical study on self evaluation of exercise intensity of patients with COPD by CS%计数法用于评估 COPD 患者运动强度的临床研究

    Institute of Scientific and Technical Information of China (English)

    苗青; 王浩彦

    2015-01-01

    Objective To explore the relationship between CS and heart rate in patients with COPD during exercise. Methods Two groups of persons were participated in this study,28 outpatients with chronic obstructive pulmonary disease(COPD)(22 males;6 females;with age at 66. 6 ± 8. 22 years old)from the Department of Respiratory Medicine of Beijing Friendship Hospital were allocated in group 1,they were di-agnosed as chronic obstructive pulmonary disease(COPD)during January 2014 to July 2014,and 25 healthy persons(3 males;22 females;aged at 24. 8 ± 2. 80 years old)were listed in group 2 for control. After being introduced with the experimental method and guided with trial tests,these persons were first exercised with cycle ergometer until the heart rate increased by 20% to the stable value,CS test started afterwards,the CSN and average heart rate were recorded and labeled as CSN1 and HR1,respectively. These persons then took the treadmill test after rest for thirty mi-nutes. The exercise intensity was adjusted by changing the treadmill speed till CSN fell into CSN1 ± 5,then CSN and the average heart rate were recorded and labeled CSN2 and HR2,respectively. Results The values of HR1 and HR2 in each group were compared with paired t test. No sig-nificant difference had been observed in both group 1( t = - 1. 523,P = 0. 139)and group 2( t = - 1. 427,P = 0. 167). HR1 and HR2 showed significant correlation in both groups,with a correlation coefficient r = 0. 932 in group 1 and r = 0. 944 in group 2. Conclusion CS shows good correlation with heart rate of patients with COPD,and it can be used as a self - evaluation indicator to determine the exercise intensity for guidance of the rehabilitation and daily exercise.%目的:探讨运动中计数法(CS)与慢性阻塞性肺疾病(COPD)患者心率乃至运动强度的相关性。方法收集两组人群参加测试,第一组为2014年1月至2014年7月北京友谊医院呼吸科门诊 COPD 患者,共28人

  9. A study to assess COPD Symptom-based Management and to Optimise treatment Strategy in Japan (COSMOS-J based on GOLD 2011

    Directory of Open Access Journals (Sweden)

    Betsuyaku T

    2013-10-01

    Full Text Available Tomoko Betsuyaku,1 Motokazu Kato,2 Keisaku Fujimoto,3 Gerry Hagan,4 Akihiro Kobayashi,5 Hideki Hitosugi,5 Mark James,5 Paul W Jones61Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan; 2Department of Respiratory Disease, Kishiwada City Hospital, Osaka, Japan; 3Department of Clinical Laboratory Sciences, Shinshu University, Nagano, Japan; 4Private Practice, Marbella, Spain; 5GlaxoSmithKline KK, Tokyo, Japan; 6Division of Clinical Science, St George’s, University of London, London, UKBackground and objective: The Global initiative for chronic Obstructive Lung Disease (GOLD Committee has proposed a COPD assessment framework focused on symptoms and on exacerbation risk. This study will evaluate a symptom and exacerbation risk-based treatment strategy based on GOLD in a real-world setting in Japan. Optimal management of COPD will be determined by assessing symptoms using the COPD Assessment Test (CAT and by assessing the frequency of exacerbations.Methods: This study (ClinicalTrials.gov identifier: NCT01762800 is a 24-week, multicenter, randomized, double-blind, double-dummy, parallel-group study. It aims to recruit 400 patients with moderate-to-severe COPD. Patients will be randomized to receive treatment with either salmeterol/fluticasone propionate (SFC 50/250 µg twice daily or with tiotropium bromide 18 µg once daily. Optimal management of patients will be assessed at four-weekly intervals and, if patients remain symptomatic, as measured using the CAT, or experience an exacerbation, they have the option to step up to treatment with both drugs, ie, SFC twice daily and tiotropium once daily (TRIPLE therapy. The primary endpoint of the study will be the proportion of patients who are able to remain on the randomized therapy.Results: No data are available. This paper summarizes the methodology of the study in advance of the study starting.Conclusion: The results of this study will help physicians to understand

  10. Texture-based analysis of COPD

    DEFF Research Database (Denmark)

    Sørensen, Lauge; Nielsen, Mads; Lo, Pechin Chien Pau

    2012-01-01

    This study presents a fully automatic, data-driven approach for texture-based quantitative analysis of chronic obstructive pulmonary disease (COPD) in pulmonary computed tomography (CT) images. The approach uses supervised learning where the class labels are, in contrast to previous work, based...... on measured lung function instead of on manually annotated regions of interest (ROIs). A quantitative measure of COPD is obtained by fusing COPD probabilities computed in ROIs within the lung fields where the individual ROI probabilities are computed using a k nearest neighbor (kNN ) classifier. The distance...

  11. A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: the COPE-III study protocol.

    Science.gov (United States)

    Lenferink, Anke; Frith, Peter; van der Valk, Paul; Buckman, Julie; Sladek, Ruth; Cafarella, Paul; van der Palen, Job; Effing, Tanja

    2013-09-01

    Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment approach directed towards COPD and frequently existing comorbidities can reduce COPD exacerbation days. We hypothesise that this approach, which combines self-initiated action plans and nurse support, will accelerate proper treatment actions and lead to better control of deteriorating symptoms. In this multicenter randomised controlled trial we aim to include 300 patients with COPD (GOLD II-IV), and with at least one comorbidity (cardiovascular disease, diabetes, anxiety and/or depression). Patients will be recruited from hospitals in the Netherlands (n = 150) and Australia (n = 150) and will be assigned to an intervention or control group. All patients will learn to complete daily symptom diaries for 12-months. Intervention group patients will participate in self-management training sessions to learn the use of individualised action plans for COPD and comorbidities, linked to the diary. The primary outcome is the number of COPD exacerbation days. Secondary outcomes include hospitalisations, quality of life, self-efficacy, adherence, patient's satisfaction and confidence, health care use and cost data. Intention-to-treat analyses (random effect negative binomial regression and random effect mixed models) and cost-effectiveness analyses will be performed. Prudence should be employed before extrapolating the use of COPD specific action plans in patients with comorbidities. This study evaluates the efficacy of tailored action plans for both COPD and common comorbidities. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Case Study Teaching

    Science.gov (United States)

    Herreid, Clyde Freeman

    2011-01-01

    This chapter describes the history of case study teaching, types of cases, and experimental data supporting their effectiveness. It also describes a model for comparing the efficacy of the various case study methods. (Contains 1 figure.)

  13. Case Study Teaching

    Science.gov (United States)

    Herreid, Clyde Freeman

    2011-01-01

    This chapter describes the history of case study teaching, types of cases, and experimental data supporting their effectiveness. It also describes a model for comparing the efficacy of the various case study methods. (Contains 1 figure.)

  14. Sarcopenia in COPD: relationship with COPD severity and prognosis

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    Tatiana Munhoz da Rocha Lemos Costa

    2015-10-01

    Full Text Available Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE index. Results: We recruited 91 patients (50 females, with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6% of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction. The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001. Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009. The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.

  15. Sarcopenia in COPD: relationship with COPD severity and prognosis

    Science.gov (United States)

    Costa, Tatiana Munhoz da Rocha Lemos; Costa, Fabio Marcelo; Moreira, Carolina Aguiar; Rabelo, Leda Maria; Boguszewski, César Luiz; Borba, Victória Zeghbi Cochenski

    2015-01-01

    Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis. PMID:26578132

  16. Sarcopenia correlates with systemic inflammation in COPD

    Science.gov (United States)

    Byun, Min Kwang; Cho, Eun Na; Chang, Joon; Ahn, Chul Min; Kim, Hyung Jung

    2017-01-01

    Background Muscle wasting and chronic inflammation are predominant features of patients with COPD. Systemic inflammation is associated with an accelerated decline in lung function. In this study, the prevalence of sarcopenia and the relationships between sarcopenia and systemic inflammations in patients with stable COPD were investigated. Materials and methods In a cross-sectional design, muscle strength and muscle mass were measured by handgrip strength (HGS) and bioelectrical impedance analysis in 80 patients with stable COPD. Patients (≥40 years old) diagnosed with COPD were recruited from outpatient clinics, and then COPD stages were classified. Sarcopenia was defined as the presence of both low muscle strength (by HGS) and low muscle mass (skeletal muscle mass index [SMMI]). Levels of circulating inflammatory biomarkers (IL-6 and high-sensitivity TNFα [hsTNFα]) were measured. Results Sarcopenia was prevalent in 20 (25%) patients. Patients with sarcopenia were older, had lower body mass index, and a higher percentage of cardiovascular diseases. In addition, they had significantly higher modified Medical Research Council scores and lower 6-minute walk distance than those without sarcopenia. HGS was significantly correlated with age, modified Medical Research Council score, and COPD Assessment Test scores. Both HGS and SMMI had associations with IL-6 and hsTNFα (HGS, r=−0.35, P=0.002; SMMI, r=−0.246, P=0.044) level. In multivariate analysis, old age, lower body mass index, presence of cardiovascular comorbidities, and higher hsTNFα levels were significant determinants for sarcopenia in patients with stable COPD. Conclusion Sarcopenia is very common in patients with stable COPD, and is associated with more severe dyspnea-scale scores and lower exercise tolerance. Systemic inflammation could be an important contributor to sarcopenia in the stable COPD population. PMID:28255238

  17. COPD patients' medical care and support in Greece during financial crisis

    Directory of Open Access Journals (Sweden)

    Mitonas G

    2016-11-01

    Full Text Available George Mitonas,1 Alexia Juvana,2 Zoe Daniil,3 Chryssa Hatzoglou,4 Konstantinos Gourgoulianis3 1Diavata Health Center, Gennimatas General Hospital, 2Papageorgiou General Hospital, Thessaloniki, 3Pulmonary Medicine Department, University Hospital of Larissa, 4Physiology Department, Medical School, University of Thessaly, Larissa, Greece Background: The need to follow a multidisciplinary strategy in chronic obstructive ­pulmonary disease (COPD management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece.Methods: Two primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio <0.7, according to Global Initiative for Chronic Obstructive Lung Disease guidelines.Results: Males comprised 70% of the sample, with cough and sputum being the prominent signs. Regarding COPD staging, 68.5% were classified in stages I/II. Arterial hypertension and coronary heart disease were the most common comorbidities. Current smokers accounted for 88.5%, while 88% were heavy drinkers. A general practitioner made the diagnosis in 68.5% of the cases, among which offspring and spouses provided home care in 38% and 8% of the cases, respectively, while an informal caregiver other than a relative was reported in 34% of the cases. No caregiver (self-care was reported in 20% of the cases. All patients of stage III and IV had a COPD Assessment Test score >10

  18. Safety of indacaterol in the treatment of patients with COPD.

    Science.gov (United States)

    Donohue, James F; Singh, Dave; Kornmann, Oliver; Lawrence, David; Lassen, Cheryl; Kramer, Benjamin

    2011-01-01

    Pooled data were analyzed to evaluate the safety and tolerability of indacaterol, a once-daily inhaled long-acting β(2)-agonist for chronic obstructive pulmonary disease (COPD). Data were pooled from clinical studies of 3-12 months' duration in patients with moderate-to-severe COPD receiving double-blind indacaterol 75 μg (n = 449), 150 μg (n = 2611), 300 μg (n = 1157), or 600 μg once daily (n = 547); formoterol 12 μg twice daily (n = 556); salmeterol 50 μg twice daily (n = 895); placebo (n = 2012); or tiotropium 18 μg once daily, given open label or blinded (n = 1214). Outcomes were adverse events, serious adverse events and deaths, plasma potassium, blood glucose, and QTc interval and vital signs. The commonest adverse events with indacaterol were COPD worsening, nasopharyngitis, and headache; most cases were mild or moderate and incidence was generally similar to placebo and other active treatments. The risk of acute respiratory serious adverse events (leading to hospitalization, intubation, or death) was not significantly increased with any of the active treatments compared with placebo. COPD exacerbation rates (analyzed in the intent-to-treat population) were significantly reduced with all active treatments versus placebo. Hazard ratios versus placebo for major cardiovascular adverse events were indacaterol doses. Notable values for vital signs and measures of systemic β(2)-adrenoceptor activity were rare with indacaterol. The number of deaths adjusted per patient-year was lower with indacaterol (all doses combined) than with placebo (relative risk 0.21 [95% confidence interval 0.07-0.660], P = 0.008). Indacaterol has a good profile of safety and tolerability that is appropriate for the maintenance treatment of patients with COPD.

  19. Systemic effects in COPD

    NARCIS (Netherlands)

    Wouters, E.F.M.; Creutzberg, E.C.; Schols, A.M.W.J.

    2002-01-01

    Systemic effects in COPD. Wouters EF, Creutzberg EC, Schols AM. Department of Pulmonary Diseases, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. ewo@ms-azm-3.azm.nl The pathogenesis and clinical manifestations of COPD are not restricted to pulmonary inflammation an

  20. Systemic effects in COPD

    NARCIS (Netherlands)

    Wouters, E.F.M.; Creutzberg, E.C.; Schols, A.M.W.J.

    2002-01-01

    Systemic effects in COPD. Wouters EF, Creutzberg EC, Schols AM. Department of Pulmonary Diseases, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands. ewo@ms-azm-3.azm.nl The pathogenesis and clinical manifestations of COPD are not restricted to pulmonary inflammation an

  1. [Inhaled corticosteroids for COPD

    NARCIS (Netherlands)

    Dekhuijzen, P.N.R.

    2003-01-01

    Over 60% of patients with COPD are treated with inhaled corticosteroids (ICS), even though their use is still subject to debate. The inflammatory process in the lungs of patients with COPD is dominated by macrophages, CD8+ T-lymphocytes, neutrophilic granulocytes and mast cells, as well as an increa

  2. To what extent and why are COPD and Willis-Ekbom disease associated?

    Science.gov (United States)

    Mandal, Tugba; Aydın, Şenay; Kanmaz, Dilek; Karasulu, Ahmet Levent; Aras, Gülfidan; Tuncay, Esin

    2016-09-01

    Willis-Ekbom disease (RLS/WED) is common in chronic obstructive pulmonary disease (COPD). Patients with RLS/WED have poorer quality of sleep and more fatigue and depressive symptoms. The prevalence of RLS/WED in patients with COPD has been reported to vary between 29.1 and 36.8 %. However, during exacerbation, the prevalence can increase up to 54 %. These rates are higher than those seen in general population. We have not enough knowledge regarding the association between RLS and COPD. In this study, we aimed to determine the frequency of RLS in patients with stable COPD without comorbid conditions. In addition, we also aimed to determine possible related causative factors. We included 80 COPD patients without comorbid conditions who presented to our outpatient clinic between April 2013 and September 2013 for RLS/WED evaluation. Three cases that have polyneuropathy and one case that refused undergoing electromyography (EMG) examination were excluded from the study. Demographic data, P-A chest X-rays, pulmonary function tests (PFT), biochemical parameters (including hemogram), and dyspnea scales were evaluated for each patient. In addition, the RLS/WED rating scale and Epworth Sleep Scale (ESS) were applied. Further, each patient diagnosed with RLS/WED underwent a detailed neurological examination (performed by a neurologist) and an EMG examination to rule out polyneuropathy. Out of 76 COPD cases included in our study, 26.3 % (n = 20) were diagnosed with RLS/WED (mean age 60.4 ± 7.5 years, 20 males). The cases with RLS/WED had significantly lower body mass index (BMI) than cases without RLS/WED (p = 0.009). There were no significant differences between cases with and without RLS/WED with respect to PFT, dyspnea scales, and arterial blood gas values. However, ESS was significantly different (p = 0.016). There were no significant differences in RLS/WED scores and mean hs-CRP levels between COPD stages (p = 0.424; p = 0.518, respectively

  3. Prevalence of renal and hepatobiliary disease, laboratory abnormalities, and potentially toxic medication exposures among persons with COPD

    Directory of Open Access Journals (Sweden)

    Mapel DW

    2013-03-01

    Full Text Available Douglas W Mapel,1 Jenõ P Marton21Lovelace Clinic Foundation, Albuquerque, New Mexico, NM, USA; 2Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USABackground: The purpose of this study was to describe the prevalence of renal and hepatic disease, related laboratory abnormalities, and potentially hepatotoxic and nephrotoxic medication use in a population-based cohort of persons with chronic obstructive pulmonary disease (COPD.Methods: This was a retrospective case-control cohort analysis of COPD patients enrolled in one regional health system for at least 12 months during a 36-month study period (n = 2284. Each COPD patient was matched by age and gender to up to three persons not diagnosed with COPD (n = 5959.Results: The mean age for cases and controls was 70.3 years, and 52.5% were women. The COPD cohort had significantly higher prevalences (cases/100 of acute, chronic, and unspecified renal failure as compared with controls (1.40 versus 0.59, 2.89 versus 0.79, and 1.09 versus 0.44, respectively. Among the cases, 31.3% had at least one renal or urinary tract diagnosis during the study period, as compared with 21.1% of controls. COPD cases also had more gallbladder disease (2.76 versus 1.63 and pancreatic disease (1.40 versus 0.60, but not hepatic disease. COPD patients were more likely to have at least one serum creatinine level (5.1 versus 2.1 or liver aspartate aminotransferase level (4.5 versus 2.7 that was more than twice the upper limit of normal. COPD patients had prescription fills for an average of 17.6 potentially nephrotoxic and 27.4 hepatotoxic drugs during the study period, as compared with 13.6 and 19.9 for the controls (P value for all comparisons < 0.01.Conclusion: COPD patients have a substantially increased prevalence of renal, gallbladder, and pancreatic diseases, as well as abnormal renal and hepatic laboratory values, but not diagnosed liver disease. COPD patients are also more likely to be prescribed

  4. COPD, COOP and BREATH at the VA

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2011-02-01

    Full Text Available No abstract available. Article truncated at 150 words. The February 2011 Pulmonary Journal Club reviews a study by Rice and colleagues (1 of high-risk COPD patients (click here for Pulmonary Journal Club. This review was authored by Kevin Park who also authored an ACP Journal Club review (2. In Rice’s study a single educational session, an individualized care plan, and monthly case-manager telephone calls, resulted in a 41% decrease in hospitalizations and emergency room visits and a nonsignficant trend toward decreased mortality.Rice’s study was supported and conducted in the Veterans Integrated Service Network (VISN 23 (Minnesota, Iowa, Nebraska and the Dakotas. The COPD patients in this study were recruited and followed primarily using the VA computer system. The study represents a potential model of data-based management leading to improved patient outcomes. The authors; Robert Petzel MD, then VISN 23 Director (now Veterans Healthcare Administration Undersecretary; and Janet Murphy, then VISN Primary Care Service Line CEO (now VISN …

  5. [Distinguishing asthma from COPD].

    Science.gov (United States)

    Ohara, Kouhei; Samukawa, Takuya; Inoue, Hiromasa

    2016-05-01

    Asthma and chronic obstructive pulmonary disease (COPD) are major public health burdens. Asthma is characterized by airway inflammation, airway narrowing with reversibility, and hyperresponsiveness of airways. COPD has been associated with smoking and exposure to environmental fumes, which typically characterized by persistent airflow limitation and chronic inflammation of the airways. These differences are most apparent when young non-smoker with asthma and older smokers with COPD are compared. However, it would be difficult to differentiate asthma from COPD, especially in elderly who currently smoke or have a significant history of smoking. Furthermore, some patients exhibit characteristics of both diseases, this may represent a phenotype known as asthma-COPD overlap syndrome (ACOS). Therefore, the precise understanding of these diseases is important.

  6. The reasons for triple therapy in stable COPD patients in Japanese clinical practice

    Directory of Open Access Journals (Sweden)

    Miyazaki M

    2015-06-01

    Full Text Available Masaki Miyazaki,1 Hidetoshi Nakamura,1,2 Saeko Takahashi,1 Shotaro Chubachi,1 Mamoru Sasaki,1 Mizuha Haraguchi,1 Hideki Terai,1 Makoto Ishii,1 Koichi Fukunaga,1 Sadatomo Tasaka,1 Kenzo Soejima,1 Koichiro Asano,3 Tomoko Betsuyaku1 On behalf of the Keio COPD Comorbidity Research (K-CCR group 1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 2Department of Respiratory Medicine, Saitama Medical University, Saitama, 3Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan Background: Triple combination therapy involving long-acting muscarinic antagonists long-acting β2 agonists, and inhaled corticosteroids has recently become an option for maintenance treatment of COPD. Some add-on clinical trials have reported the benefits of these combinations. However, the process to step up to triple therapy varies for individual cases.Methods: Keio University and affiliated hospitals conducted an observational COPD cohort study, recruiting patients diagnosed as having COPD by pulmonary physicians and those referred for investigation of possible COPD. Their prescription history and clinical course were retrospectively analyzed based on the physicians’ medical records and patient questionnaires. This study was registered with UMIN (UMIN000003470, April 10, 2010.Results: A total of 95 of the 445 COPD patients (21% were treated with inhaled corticosteroids/long-acting β2 agonists/long-acting muscarinic antagonists as maintenance therapy, including 12 in COPD Grade I, 31 in Grade II, 38 in Grade III, and 14 in Grade IV, based on the Global Initiative for Chronic Obstructive Lung Disease spirometric grading. For more than half of the patients on triple therapy, the treatment had been intensified due to unsatisfactory improvement of symptoms, and 32% were treated with triple therapy due to comorbid asthma. In contrast, there were COPD patients whose therapy was

  7. Project management case studies

    CERN Document Server

    Kerzner, Harold R

    2013-01-01

    A new edition of the most popular book of project management case studies, expanded to include more than 100 cases plus a ""super case"" on the Iridium Project Case studies are an important part of project management education and training. This Fourth Edition of Harold Kerzner''s Project Management Case Studies features a number of new cases covering value measurement in project management. Also included is the well-received ""super case,"" which covers all aspects of project management and may be used as a capstone for a course. This new edition:Contains 100-plus case studies drawn from re

  8. Feasibibility study - cases

    DEFF Research Database (Denmark)

    2004-01-01

    The chapter presents two case studies to show the tools of feasibiliy studies within the context of technological innovation.......The chapter presents two case studies to show the tools of feasibiliy studies within the context of technological innovation....

  9. Chronic obstructive pulmonary disease and altered risk of lung cancer in a population-based case-control study.

    Directory of Open Access Journals (Sweden)

    Jill Koshiol

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD has been consistently associated with increased risk of lung cancer. However, previous studies have had limited ability to determine whether the association is due to smoking. METHODOLOGY/PRINCIPAL FINDINGS: The Environment And Genetics in Lung cancer Etiology (EAGLE population-based case-control study recruited 2100 cases and 2120 controls, of whom 1934 cases and 2108 controls reported about diagnosis of chronic bronchitis, emphysema, COPD (chronic bronchitis and/or emphysema, or asthma more than 1 year before enrollment. We estimated odds ratios (OR and 95% confidence intervals (CI using logistic regression. After adjustment for smoking, other previous lung diseases, and study design variables, lung cancer risk was elevated among individuals with a history of chronic bronchitis (OR = 2.0, 95% CI = 1.5-2.5, emphysema (OR = 1.9, 95% CI = 1.4-2.8, or COPD (OR = 2.5, 95% CI = 2.0-3.1. Among current smokers, association between chronic bronchitis and lung cancer was strongest among lighter smokers. Asthma was associated with a decreased risk of lung cancer in males (OR = 0.48, 95% CI = 0.30-0.78. CONCLUSIONS/SIGNIFICANCE: These results suggest that the associations of personal history of chronic bronchitis, emphysema, and COPD with increased risk of lung cancer are not entirely due to smoking. Inflammatory processes may both contribute to COPD and be important for lung carcinogenesis.

  10. Important, misunderstood, and challenging: a qualitative study of nurses’ and allied health professionals’ perceptions of implementing self-management for patients with COPD

    Directory of Open Access Journals (Sweden)

    Young HML

    2015-06-01

    Full Text Available Hannah ML Young,1 Lindsay D Apps,1 Samantha L Harrison,1 Vicki L Johnson-Warrington,1 Nicky Hudson,2 Sally J Singh1,3 1National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, 2School of Applied Social Sciences, De Montfort University, Leicester, 3Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, UK Background: In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses’ and allied health professionals’ (AHPs’ understanding and provision of self-management in clinical practice. This study explores nurses’ and AHPs’ understanding and implementation of supported COPD self-management within routine clinical practice. Materials and methods: Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. Results: A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients’ perceived self-management abilities. Conclusion: Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding

  11. Acute Dietary Nitrate Supplementation and Exercise Performance in COPD: A Double-Blind, Placebo-Controlled, Randomised Controlled Pilot Study.

    Directory of Open Access Journals (Sweden)

    Katrina J Curtis

    Full Text Available Dietary nitrate supplementation can enhance exercise performance in healthy people, but it is not clear if it is beneficial in COPD. We investigated the hypotheses that acute nitrate dosing would improve exercise performance and reduce the oxygen cost of submaximal exercise in people with COPD.We performed a double-blind, placebo-controlled, cross-over single dose study. Subjects were randomised to consume either nitrate-rich beetroot juice (containing 12.9 mmoles nitrate or placebo (nitrate-depleted beetroot juice 3 hours prior to endurance cycle ergometry, performed at 70% of maximal workload assessed by a prior incremental exercise test. After a minimum washout period of 7 days the protocol was repeated with the crossover beverage.21 subjects successfully completed the study (age 68 ± 7 years; BMI 25.2 ± 5.5 kg/m2; FEV1 percentage predicted 50.1 ± 21.6%; peak VO2 18.0 ± 5.9 ml/min/kg. Resting diastolic blood pressure fell significantly with nitrate supplementation compared to placebo (-7 ± 8 mmHg nitrate vs. -1 ± 8 mmHg placebo; p = 0.008. Median endurance time did not differ significantly; nitrate 5.65 (3.90-10.40 minutes vs. placebo 6.40 (4.01-9.67 minutes (p = 0.50. However, isotime oxygen consumption (VO2 was lower following nitrate supplementation (16.6 ± 6.0 ml/min/kg nitrate vs. 17.2 ± 6.0 ml/min/kg placebo; p = 0.043, and consequently nitrate supplementation caused a significant lowering of the amplitude of the VO2-percentage isotime curve.Acute administration of oral nitrate did not enhance endurance exercise performance; however the observation that beetroot juice caused reduced oxygen consumption at isotime suggests that further investigation of this treatment approach is warranted, perhaps targeting a more hypoxic phenotype.ISRCTN Registry ISRCTN66099139.

  12. All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

    Science.gov (United States)

    Lykkegaard, Jesper; Søndergaard, Jens; Kragstrup, Jakob; Rømhild Davidsen, Jesper; Knudsen, Thomas; Andersen, Morten

    2012-04-01

    This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients. Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed. During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased. Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS)

    OpenAIRE

    Janson, Christer; Larsson, Kjell; Lisspers, Karin H; Ställberg, Björn; Stratelis, Georgios; Goike, Helena; Jorgensen, Leif; Johansson, Gunnar

    2013-01-01

    Objective To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting beta(2) agonist. Design Observational retrospective pairwise cohort study matched (1:1) for propensity score. Setting Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009. Participants Patients with CO...

  14. Collection, synthesis, and interpretation of evidence: a proof-of-concept study in COPD.

    Science.gov (United States)

    Di Scala, L; Kerman, J; Neuenschwander, B

    2013-05-10

    We present a clinical proof-of-concept (PoC) study in chronic obstructive pulmonary disease with the objective of assessing the bronchodilatory effect of an experimental drug as compared with an active control treatment. In such an exploratory Phase II setting, we discuss the formal inclusion of relevant historical information and tailored PoC criteria for the purpose of a more efficient use of the available evidence to support clinical decision making. We provide guidance with regard to practical and methodological aspects for assessing the relevance of the historical data, synthesizing the evidence via a meta-analytic-predictive approach, and defining transparent statistical PoC decision criteria that are aligned with the clinical context. The case study was implemented using the Bayesian approach, which offers an ideal framework for the early phases of drug development. Copyright © 2013 John Wiley & Sons, Ltd.

  15. Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study

    Directory of Open Access Journals (Sweden)

    Kozma Chris M

    2011-12-01

    Full Text Available Abstract Background The purpose of this analysis was to compare health care costs and utilization among COPD patients who had long-acting beta-2 agonist (LABA OR long-acting muscarinic antagonist (LAMA; LABA AND LAMA; or LABA, LAMA, AND inhaled corticosteroid (ICS prescription claims. Methods This was a 12 month pre-post, retrospective analysis using COPD patients in a national administrative insurance database. Propensity score and exact matching were used to match patients 1:1:1 between the LABA or LAMA (formoterol, salmeterol, or tiotropium, LABA and LAMA (tiotropium/formoterol or tiotropium/salmeterol, and LABA, LAMA and ICS (bronchodilators plus steroid groups. Post-period comparisons were evaluated with analysis of covariance. Costs were evaluated from a commercial payer perspective. Results A total of 523 patients were matched using 29 pre-period variables (e.g., demographics, medication exposure. Post-match assessments indicated balance among the cohorts. COPD-related costs differed among groups (LABA or LAMA $2,051 SE = 91; LABA and LAMA $2,823 SE = 62; LABA, LAMA and ICS $3,546 SE = 89; all p Conclusions Significant cost differences driven mainly by pharmaceuticals were observed among LABA or LAMA, LABA and LAMA and LABA, LAMA and ICS therapies. A COPD-related cost offset was observed from single bronchodilator to two bronchodilators. Addition of an ICS with two bronchodilators resulted in higher treatment costs without reduction in other COPD-related costs compared with two bronchodilators.

  16. A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study.

    Science.gov (United States)

    Verberkt, C A; van den Beuken-van Everdingen, M H J; Franssen, F M E; Dirksen, C D; Schols, J M G A; Wouters, E F M; Janssen, D J A

    2016-03-01

    Dyspnea is one of the most reported symptoms of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and is often undertreated. Morphine has proven to be an effective treatment for dyspnea and is recommended in clinical practice guidelines, but questions concerning benefits and respiratory adverse effects remain. This study primarily evaluates the impact of oral sustained release morphine (morphine SR) on health-related quality of life and respiratory adverse effects in patients with COPD. Secondary objectives include the impact on exercise capacity, the relationship between description and severity of dyspnea and the presence of a clinically relevant response to morphine, and cost-effectiveness. A single-center, randomized, double blind, placebo controlled intervention study will be performed in 124 patients with COPD who recently completed a comprehensive pulmonary rehabilitation program. Participants will receive 20-30 mg/24h morphine SR or placebo for four weeks. After the intervention, participants will be followed for twelve weeks. Outcomes include: the COPD Assessment Test, six minute walking test, Multidimensional Dyspnea Scale and a cost diary. Furthermore, lung function and arterial blood gasses will be measured. These measures will be assessed during a baseline and outcome assessment, two home visits, two phone calls, and three follow-up assessments. The intervention and control group will be compared using uni- and multivariate regression analysis and logistic regression analysis. Finally, an economic evaluation will be performed from a societal and healthcare perspective. The current manuscript describes the rationale and methods of this study and provides an outline of the possible strengths, weaknesses and clinical consequences.

  17. Inhaled indacaterol for the treatment of COPD patients with destroyed lung by tuberculosis and moderate-to-severe airflow limitation: results from the randomized INFINITY study

    Directory of Open Access Journals (Sweden)

    Kim CJ

    2017-05-01

    Full Text Available Cheong-Ju Kim,1 Hyoung-Kyu Yoon,2 Myung-Jae Park,3 Kwang-Ha Yoo,4 Ki-Suck Jung,5 Jeong-Woong Park,6 Seong Yong Lim,7 Jae Jeong Shim,8 Yong Chul Lee,9 Young-Sam Kim,10 Yeon-Mok Oh,11 Song Kim,12 Chul-Gyu Yoo13 1Department of Internal Medicine, National Health Insurance System Ilsan Hospital, Koyang, 2Division of Pulmonology, Department of Internal Medicine, St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 3Division of Respiratory and Critical Care Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, 4Department of Internal Medicine, Konkuk University School of Medicine, Gwangjin-gu, 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang-si, 6Division of Pulmonary and Allergy Medicine, Gachon University Gil Medical Center, Incheon, 7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 8Department of Internal Medicine, Korea University College of Medicine, Seoul, 9Department of Internal Medicine and Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonbuk, 10Department of Internal Medicine, Yonsei University College of Medicine, 11Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 12Clinical Development and Medical Affairs, Novartis Korea Ltd., Seoul, 13Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Background and objective: Pulmonary tuberculosis (TB is a risk factor for chronic obstructive pulmonary disease (COPD; however, few clinical studies have investigated treatment effectiveness in COPD patients with destroyed lung by TB. The Indacaterol effectiveness in COPD patients with Tuberculosis history (INFINITY

  18. Effects of roflumilast in COPD patients receiving inhaled corticosteroid/long-acting β2-agonist fixed-dose combination: RE2SPOND rationale and study design

    Directory of Open Access Journals (Sweden)

    Rennard SI

    2016-08-01

    Full Text Available Stephen I Rennard,1,2 Fernando J Martinez,3,4 Klaus F Rabe,5–7 Sanjay Sethi,8 Emilio Pizzichini,9 Andrew McIvor,10 Shahid Siddiqui,11 Antonio Anzueto,12 Haiyuan Zhu13 1Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA; 2AstraZeneca, Cambridge, UK; 3Joan and Sanford I Weill Department of Medicine, Weill Cornell University, New York, NY, 4Department of Internal Medicine, Michigan Health System, Ann Arbor, MI, USA; 5LungenClinic Grosshansdorf, Großhansdorf, 6Department of Medicine, University Kiel, Kiel, 7Airway Research Center North, German Center for Lung Research, Großhansdorf, Germany; 8Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA; 9Department of Medicine, Universidade Federal de Santa Catarina, Santa Catarina, Brazil; 10Firestone Institute of Respiratory Health, St Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada; 11AstraZeneca, Gaithersburg, MD, 12South Texas Veterans Health Care System at San Antonio, University of Texas Health Science Center, San Antonio, TX, 13Allergan plc, Jersey City, NJ, USA Background: Roflumilast, a once-daily, selective phosphodiesterase-4 inhibitor, reduces the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. The RE2SPOND study is examining whether roflumilast, when added to an inhaled corticosteroid/long-acting β2-agonist (ICS/LABA fixed-dose combination (FDC, further reduces exacerbations. The methodology is described herein. Methods: In this Phase IV, multicenter, double-blind, placebo-controlled, parallel-group trial, participants were randomized 1:1 (stratified by long-acting muscarinic antagonist use to receive roflumilast or placebo, plus ICS/LABA FDC, for 52 weeks. Eligible participants had severe COPD associated with chronic bronchitis, had two or more moderate–severe exacerbations within 12 months, and were receiving ICS

  19. Addition of vitamin B12 to exercise training improves cycle ergometer endurance in advanced COPD patients: A randomized and controlled study.

    Science.gov (United States)

    Paulin, Fernanda Viana; Zagatto, Alessandro Moura; Chiappa, Gaspar R; Müller, Paulo de Tarso

    2017-01-01

    Vitamin B12 is essential in the homocysteine, mitochondrial, muscle and hematopoietic metabolisms, and its effects on exercise tolerance and kinetics adjustments of oxygen consumption (V'O2p) in rest-to-exercise transition in COPD patients are unknown. This randomized, double-blind, controlled study aimed to verify a possible interaction between vitamin B12 supplementation and these outcomes. After recruiting 69 patients, 35 subjects with moderate-to-severe COPD were eligible and 32 patients concluded the study, divided into four groups (n = 8 for each group): 1. rehabilitation group; 2. rehabilitation plus B12 group; 3. B12 group; and 4. placebo group. The primary endpoint was cycle ergometry endurance before and after 8 weeks and the secondary endpoints were oxygen uptake kinetics parameters (time constant). The prevalence of vitamin B12 deficiency was high (34.4%) and there was a statistically significant interaction (p  0.05 for both). Supplementation with vitamin B12 appears to lead to discrete positive effects on exercise tolerance in groups of subjects with more advanced COPD and further studies are needed to establish indications for long-term supplementation.

  20. COPD phenotype description using principal components analysis

    DEFF Research Database (Denmark)

    Roy, Kay; Smith, Jacky; Kolsum, Umme

    2009-01-01

    BACKGROUND: Airway inflammation in COPD can be measured using biomarkers such as induced sputum and Fe(NO). This study set out to explore the heterogeneity of COPD using biomarkers of airway and systemic inflammation and pulmonary function by principal components analysis (PCA). SUBJECTS...... AND METHODS: In 127 COPD patients (mean FEV1 61%), pulmonary function, Fe(NO), plasma CRP and TNF-alpha, sputum differential cell counts and sputum IL8 (pg/ml) were measured. Principal components analysis as well as multivariate analysis was performed. RESULTS: PCA identified four main components (% variance...... associations between the variables within components 1 and 2. CONCLUSION: COPD is a multi dimensional disease. Unrelated components of disease were identified, including neutrophilic airway inflammation which was associated with systemic inflammation, and sputum eosinophils which were related to increased Fe...

  1. [Vasodilator therapy in pulmonary hypertension and chronic obstructive lung disease (COPD). Hemodynamic studies exemplified by nifedipine and nitroglycerin].

    Science.gov (United States)

    Gassner, A; Fridrich, L; Magometschnigg, D; Sommer, G; Klicpera, M

    1986-08-01

    In 41 patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension, the effects of sublingual administration of 20 mg nifedipine and 0.8 mg nitroglycerin on the hemodynamics were assessed at rest and during bicycle ergometry. Additionally, in six patients, the effects of nifedipine during longterm treatment were analyzed. On acute testing, at rest and during exercise nifedipine led to decreases in mean pulmonary artery pressure of 16% and 23% and pulmonary arteriolar resistance of 23 and 35%, respectively, in 81% (17/21) of the patients. The reduction in the pulmonary vascular resistance was greater than that of the systemic resistance. In all patients, cardiac output increased. There was a similar number of responders to nitroglycerin (16/20). The reductions in mean pulmonary artery pressure and pulmonary arteriolar resistance ranging between 20 and 25% at rest and during exercise were comparable to those affected by nifedipine. In addition to the right ventricular afterload reduction, there was a decrease in cardiac output of 17%. During longterm treatment with nifedipine (average 18 months), the reduction in mean pulmonary artery pressure and pulmonary arteriolar resistance was not of the same magnitude as seen on acute testing. This may be due primarily to progression of the underlying disease since pulmonary function studies demonstrated an increase in the obstructive component. With the intention of circumventing or postponing the onset of right ventricular failure, the individual patient should undergo hemodynamic studies to delineate the optimal medication.

  2. Fibrinogen and alpha(1)-antitrypsin in COPD exacerbations

    DEFF Research Database (Denmark)

    Sylvan Ingebrigtsen, Truls; Marott, J. L.; Rode, L.

    2015-01-01

    Background We tested the hypotheses that fibrinogen and alpha(1)-antitrypsin are observationally and genetically associated with exacerbations in COPD. Methods We studied 13 591 individuals with COPD from the Copenhagen General Population Study (2003-2013), of whom 6857 were genotyped for FGB -455...... and exacerbations in instrumental variable analyses. Results Elevated fibrinogen and alpha(1)-antitrypsin levels were associated with increased risk of exacerbations in COPD, HR=1.14 (1.07 to 1.22, p...

  3. Determinants of underdiagnosis of COPD in national and international surveys.

    Science.gov (United States)

    Bernd, Lamprecht; Joan, B Soriano; Michael, Studnicka; Bernhard, Kaiser; Lowie, E Vanfleteren; Louisa, Gnatiuc; Peter, Burney; Marc, Miravitlles; Francisco, García-Rio; Kaveh, Akbari; Julio, Ancochea; Ana, M Menezes; Rogelio, Perez-Padilla; Maria, Montes de Oca; Carlos, A Torres-Duque; Andres, Caballero; Mauricio, González-García; Sonia, Buist

    2015-10-01

    COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.

  4. Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

    Directory of Open Access Journals (Sweden)

    Mats Arne

    2016-11-01

    Full Text Available Background: Pulmonary rehabilitation (PR is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD. In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9% of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients – neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  5. The promoter polymorphism -1562C/T in matrix metalloproteinase-9 and COPD severity

    Directory of Open Access Journals (Sweden)

    D. G. Yanbaeva

    2006-12-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a complex heterogeneous respiratory disease. COPD is characterized by a progressive irreversible airflow limitation that is due to a loss of lung elasticity resulting from peripheral airflow obstruction (chronic bronchitis and parenchymal destruction (emphysema. Matrix metalloproteinases (MMP are a major group of proteases known to regulate extracellular matrix turnover. They have been suggested to be important in the process of lung diseases associated with tissue remodeling. Polymorphisms in MMPs which known to upregulate their activity may result in the degradation of a lung matrix. A case-control study was performed to investigate the association of polymorphisms of MMP type 1 (-1607G/GG, 9 (-1562C/T and 12 (-82A/G genes with COPD and disease severity. A total of 309 COPD patients admitted to departments of respiratory medicine have been recruited in Ufa city hospitals (## 13, 21, and 22. COPD patients have been undergone a spirometry and a physical examination by a chest physician to refer the GOLD II-IV stages. The control group comprised of 305 healthy subjects without evidence of chronic diseases (Table Basic characteristic of study groups.

  6. Evaluation of atopy in patients with COPD*

    Science.gov (United States)

    Neves, Margarida Célia Lima Costa; Neves, Yuri Costa Sarno; Mendes, Carlos Mauricio Cardeal; Bastos, Monalisa Nobre; Camelier, Aquiles Assunção; Queiroz, Cleriston Farias; Mendoza, Bernardo Fonseca; Lemos, Antônio Carlos Moreira; Junior, Argemiro D'Oliveira

    2013-01-01

    OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood. PMID:23857681

  7. Impact of night-time symptoms in COPD: a real-world study in five European countries

    Directory of Open Access Journals (Sweden)

    Price D

    2013-11-01

    Full Text Available David Price,1 Mark Small,2 Gary Milligan,2 Victoria Higgins,2 Esther Garcia Gil,3 Jordi Estruch3 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Adelphi Real World, Adelphi Mill, Bollington, UK; 3Almirall S.A., Barcelona, Spain Background: Sleep quality is often poor in patients with chronic obstructive pulmonary disease (COPD. A cross-sectional European survey investigated the prevalence of night-time symptoms in COPD to evaluate the level of disconnect between physician and patient perceptions of the presence of night-time symptoms, and to compare the characteristics of patients with and without night-time symptoms. Methods: A total of 251 primary care physicians and 251 respiratory specialists completed record forms on 2,807 patients with COPD. The forms captured information on patient demographics, lung function, COPD severity, and symptoms. Patients completed questionnaires on the time of day when their COPD symptoms bothered them, and the impact of COPD on their ability to get up in the morning and on sleep. Data were compared between groups (those with and without night-time symptoms using t-tests or Wilcoxon signed rank tests. The kappa statistic was used to assess the level of disconnect between physician and patient perceptions of the impact of night-time symptoms. Results: Most patients (78% reported night-time disturbance. Patients with night-time symptoms experienced more daytime breathlessness (mean modified Medical Research Council dyspnea scale score 2.4 versus 1.1 and exacerbations in the previous 12 months (mean 1.7 versus 0.4, and received more maintenance therapy (mean of 2.8 versus 2.3 products than those without. Concordance between the frequency of physician-reported (67.9% of patients and patient-reported (68.5% of patients night-time symptoms was good. Physicians significantly underestimated the impact of COPD on the patient's ability to get up in the morning and on sleep (fair

  8. A randomized controlled trial of inhaled corticosteroids (ICS on markers of epithelial–mesenchymal transition (EMT in large airway samples in COPD: an exploratory proof of concept study

    Directory of Open Access Journals (Sweden)

    Sohal SS

    2014-05-01

    Full Text Available Sukhwinder Singh Sohal,1,* Amir Soltani,1,* David Reid,1,2 Chris Ward,1,3 Karen E Wills,1,4 H Konrad Muller,1 Eugene Haydn Walters1 1National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia; 2Iron Metabolism Laboratory, Queensland Institute of Medical Research, Brisbane, Queensland, Australia; 3Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK; 4Department of Biostatistics, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia *These authors contributed equally to this workBackground: We recently reported that epithelial–mesenchymal transition (EMT is active in the airways in chronic obstructive pulmonary disease (COPD, suggesting presence of an active profibrotic and promalignant stroma. With no data available on potential treatment effects, we undertook a blinded analysis of inhaled corticosteroids (ICS effects versus placebo on EMT markers in previously obtained endobronchial biopsies in COPD patients, as a “proof of concept” study.Methods: Assessment of the effects of inhaled fluticasone propionate (FP; 500 µg twice daily for 6 months versus placebo in 34 COPD patients (23 on fluticasone propionate and eleven on placebo. The end points were epidermal growth factor receptor (EGFR; marker of epithelial activation and the biomarkers of EMT: reticular basement membrane (Rbm fragmentation (“hallmark” structural marker, matrix metalloproteinase-9 (MMP-9 cell expression, and S100A4 expression in basal epithelial and Rbm cells (mesenchymal transition markers.Results: Epithelial activation, “clefts/fragmentation” in the Rbm, and changes in the other biomarkers all regressed on ICS, at or close to conventional levels of statistical significance. From these data, we have been able to nominate primary and secondary end points and develop

  9. Role of club cells and CCSP in COPD

    OpenAIRE

    Knabe, Lucie

    2016-01-01

    A defective in Club Cell Secretory Protein (CCSP) produced by nonciliated Club cells was observed in COPD (Chronic Obstructive Pulmonary Disease) airways. Our aim was to understand CCSP biological mechanisms of action and its dysregulation in COPD and whether it might be a therapeutic axis in COPD.First, the influence of the CCSP G38A polymorphism on CCSP transcription levels and its regulatory mechanisms were analyzed. Our in vivo study conducted in a 1 year prospective cohort consisting of ...

  10. Drugs (including oxygen) in severe COPD.

    Science.gov (United States)

    Albert, P; Calverley, P M A

    2008-05-01

    Access to comprehensive guidelines on the management of chronic obstructive pulmonary disease (COPD) is now available, and several treatment goals of therapy have been identified from these guidelines, which have since been studied in clinical trials. Drug therapy is a key component of an individual patient's management plan, particularly in more severe disease. During the past few years, a number of new drug treatments have become available, although these are not always appropriately prescribed; this is particularly the case for oxygen. For patients with a history of exacerbations, there is good evidence for the use of inhaled long-acting anticholinergic agents or combined inhaled steroids and long-acting beta-agonists. Evidence for prophylactic antibiotics and antioxidant agents is lacking. Nutritional and calorie supplementation have not been shown to improve exercise capacity. Statins may improve outcomes in COPD, but prospective trials are needed to confirm this. The evidence for the use of long-term oxygen therapy in hypoxaemic patients is robust. Ambulatory oxygen improves exercise capacity, but whether it is used appropriately is in doubt. Overall, short burst oxygen therapy does not offer a benefit and therefore cannot be recommended.

  11. [Role of ICS/LABA on COPD treatment].

    Science.gov (United States)

    Shibata, Yoko

    2016-05-01

    In the treatment of chronic obstructive pulmonary disease (COPD), bronchodilators such as long acting muscarinic antagonist (LAMA) and long acting β agonist(LABA) play key roles for improving respiratory function and symptoms, and reducing risk of exacerbation. However, inhaled corticosteroid (ICS), a key medicine for bronchial asthma, is limitedly used in COPD treatment. Japanese Respiratory Society recommends to use ICS for severe COPD patients who have been frequently exacerbated, because previous clinical studies indicated that ICS reduces exacerbation in moderate to severe COPD patients. Asthma sometimes overlaps with COPD, and symptoms of those patients are not well controlled by the bronchodilation therapy alone. Therefore, ICS/LABA or ICS/LAMA should be prescribed to those overlapped patients. Concentration of exhaled nitrogen oxide and percentage of peripheral eosinophil may be good biomarkers for discriminating the COPD patients who have good response to ICS treatment.

  12. Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study

    Science.gov (United States)

    Wedzicha, Jadwiga A; Zhong, Nanshan; Ichinose, Masakazu; Humphries, Michael; Fogel, Robert; Thach, Chau; Patalano, Francesco; Banerji, Donald

    2017-01-01

    Background The FLAME study demonstrated that indacaterol/glycopyrronium (IND/GLY), the fixed-dose combination of a long-acting β2-agonist (LABA, IND) and a long-acting muscarinic antagonist (LAMA, GLY), was superior to salmeterol/fluticasone combination (SFC) in preventing exacerbations in COPD patients with a high risk of exacerbations. In this study, we report a prespecified analysis of the efficacy and safety of IND/GLY versus SFC in Asian patients from the FLAME study. Patients and methods Patients from Asian centers with moderate-to-very severe COPD and ≥1 exacerbation in the previous year from the 52-week, randomized FLAME study were included. IND/GLY was compared versus SFC for effects on exacerbations, lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), health status (St George’s Respiratory Questionnaire [SGRQ]), rescue medication use, and safety. Results A total of 510 Asian patients (IND/GLY, n=250 or SFC, n=260) were included. Compared to the overall FLAME population, the Asian cohort had more males, a shorter duration of COPD, fewer patients using inhaled corticosteroid (ICS) at screening, fewer current smokers, and more patients with very severe COPD. IND/GLY significantly reduced the rate of moderate/severe exacerbations (rate ratio: 0.75; 95% confidence interval: 0.58–0.97; P=0.027) and prolonged time to first moderate/severe exacerbation versus SFC (hazard ratio: 0.77; 95% confidence interval: 0.59–1.01; P=0.055). Predose trough FEV1 and FVC significantly improved in Asian patients (PCOPD (SGRQ-C score; P=0.006) and reduced rescue medication use (P=0.058) at week 52. Pneumonia incidence was 3.6% with IND/GLY and 7.7% with SFC (P=0.046). Conclusion In exacerbating Asian COPD patients, IND/GLY was more effective than SFC. PMID:28176893

  13. Case study research.

    Science.gov (United States)

    Taylor, Ruth; Thomas-Gregory, Annette

    2015-06-10

    This article describes case study research for nursing and healthcare practice. Case study research offers the researcher an approach by which a phenomenon can be investigated from multiple perspectives within a bounded context, allowing the researcher to provide a 'thick' description of the phenomenon. Although case study research is a flexible approach for the investigation of complex nursing and healthcare issues, it has methodological challenges, often associated with the multiple methods used in individual studies. These are explored through examples of case study research carried out in practice and education settings. An overview of what constitutes 'good' case study research is proposed.

  14. Association between RTEL1 gene polymorphisms and COPD susceptibility in a Chinese Han population

    Science.gov (United States)

    Ding, Yipeng; Xu, Heping; Yao, Jinjian; Xu, Dongchuan; He, Ping; Yi, Shengyang; Li, Quanni; Liu, Yuanshui; Wu, Cibing; Tian, Zhongjie

    2017-01-01

    Objective We investigated the association between single-nucleotide polymorphisms in regulation of telomere elongation helicase 1 (RTEL1), which has been associated with telomere length in several brain cancers and age-related diseases, and the risk of chronic obstructive pulmonary disease (COPD) in a Chinese Han population. Methods In a case–control study that included 279 COPD cases and 290 healthy controls, five single-nucleotide polymorphisms in RTEL1 were selected and genotyped using the Sequenom MassARRAY platform. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression after adjusting for age and gender. Results In the genotype model analysis, we determined that rs4809324 polymorphism had a decreased effect on the risk of COPD (CC versus TT: OR =0.28; 95% CI =0.10–0.82; P=0.02). In the genetic model analysis, we found that the “C/C” genotype of rs4809324 was associated with a decreased risk of COPD based on the codominant model (OR =0.33; 95% CI =0.13–0.86; P=0.022) and recessive model (OR =0.32; 95% CI =0.12–0.80; P=0.009). Conclusion Our data shed new light on the association between genetic polymorphisms of RTEL1 and COPD susceptibility in the Chinese Han population.

  15. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): Study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    S. Uzun (Sevim); R.S. Djamin (Remco); J.A.J.W. Kluytmans (Jan); M.B. Van't Veer (Mars); A.A.M. Ermens (Anton); A.J. Pelle (Aline); P.G.H. Mulder (Paul); M. van der Eerden (Menno); J.G.J.V. Aerts (Joachim)

    2012-01-01

    textabstractBackground: Chronic obstructive pulmonary disease (COPD) is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is

  16. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): Study protocol for a randomised controlled trial

    NARCIS (Netherlands)

    S. Uzun (Sevim); R.S. Djamin (Remco); J.A.J.W. Kluytmans (Jan); N.E. van 't Veer (Nils); A.A.M. Ermens (Anton); A.J. Pelle (Aline); P.G.H. Mulder (Paul); M. van der Eerden (Menno); J.G.J.V. Aerts (Joachim)

    2012-01-01

    textabstractBackground: Chronic obstructive pulmonary disease (COPD) is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is

  17. Challenge of COPD: Am I at Risk?

    Science.gov (United States)

    ... please turn JavaScript on. Feature: The Challenge of COPD Am I at Risk? Past Issues / Fall 2014 ... or the American Lung Association's COPD information section. COPD Learn More Breathe Better ® Program The COPD Learn ...

  18. Examining fatigue in COPD

    DEFF Research Database (Denmark)

    Al-Shair, Khaled; Muellerova, Hana; Yorke, Janelle

    2012-01-01

    ABSTRACT: INTRODUCTION: Fatigue is a disruptive symptom that inhibits normal functional performance of COPD patients in daily activities. The availability of a short, simple, reliable and valid scale would improve assessment of the characteristics and influence of fatigue in COPD. METHODS......: At baseline, 2107 COPD patients from the ECLIPSE cohort completed the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scale. We used well-structured classic method, the principal components analysis (PCA) and Rasch analysis for structurally examining the 13-item FACIT-F. RESULTS: Four items...... were less able to capture fatigue characteristics in COPD and were deleted. PCA was applied to the remaining 9 items of the modified FACIT-F and resulted in three interpretable dimensions: i) general (5 items); ii) functional ability (2 items); and iii) psychosocial fatigue (2 items). The modified...

  19. Epidemiology of COPD

    Directory of Open Access Journals (Sweden)

    C. Raherison

    2009-12-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is responsible for early mortality, high death rates and significant cost to health systems. The projection for 2020 indicates that COPD will be the third leading cause of death worldwide (from sixth in 1990 and fifth leading cause of years lost through early mortality or handicap (disability-adjusted life years (12th in 1990. Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex. This disease is also associated with significant comorbidities. COPD is a disorder that includes various phenotypes, the continuum of which remains under debate. The major challenge in the coming years will be to prevent onset of smoking along with early detection of the disease in the general population.

  20. Managing Your COPD Medications

    Science.gov (United States)

    ... the First-Ever COPD National Action Plan Blog: Yoga, Tai Chi and Your Lungs: The Benefits of ... number of items"); $("#local_list_xml").quickPagination(); }, error: function() { console.log("An error occurred while processing XML ...

  1. MIOTIC study: a prospective, multicenter, randomized study to evaluate the long-term efficacy of mobile phone-based Internet of Things in the management of patients with stable COPD

    Directory of Open Access Journals (Sweden)

    Zhang J

    2013-09-01

    Full Text Available Jing Zhang, Yuan-lin Song, Chun-xue Bai Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China Abstract: Chronic obstructive pulmonary disease (COPD is a common disease that leads to huge economic and social burden. Efficient and effective management of stable COPD is essential to improve quality of life and reduce medical expenditure. The Internet of Things (IoT, a recent breakthrough in communication technology, seems promising in improving health care delivery, but its potential strengths in COPD management remain poorly understood. We have developed a mobile phone-based IoT (mIoT platform and initiated a randomized, multicenter, controlled trial entitled the ‘MIOTIC study’ to investigate the influence of mIoT among stable COPD patients. In the MIOTIC study, at least 600 patients with stable GOLD group C or D COPD and with a history of at least two moderate-to-severe exacerbations within the previous year will be randomly allocated to the control group, which receives routine follow-up, or the intervention group, which receives mIoT management. Endpoints of the study include (1 frequency and severity of acute exacerbation; (2 symptomatic evaluation; (3 pre- and post-bronchodilator forced expiratory volume in 1 second (FEV1 and FEV1/forced vital capacity (FVC measurement; (4 exercise capacity; and (5 direct medical cost per year. Results from this study should provide direct evidence for the suitability of mIoT in stable COPD patient management. Keywords: Internet of Things, mobile phone, chronic obstructive pulmonary disease, efficacy

  2. [Treatment of COPD].

    Science.gov (United States)

    Roche, Nicolas; Huchon, Gérard

    2011-06-01

    COPD treatment begins with smoking cessation and influenza and pneumococcal vaccines. Bronchodilators are indicated when dyspnea on exertion is reported (usually, FEV1 COPD has to integrate treatment of comorbidities such as cardio-vascular diseases, anxiety-depression, malnutrition, muscle dysfunction, osteoporosis, anemia ... Ongoing research aims at identifying new therapeutic targets, focusing on inflammation, remodeling, protease-antiprotease balance, oxidative stress, lung regeneration/repair and mucus production.

  3. Erdosteine for COPD exacerbations.

    Science.gov (United States)

    2008-10-01

    The mucolytic drug erdosteine (Erdotin - Galen) is licensed in the UK as treatment for up to 10 days "for the symptomatic treatment of acute exacerbations of chronic bronchitis in adults". This indication differs from that for carbocisteine and mecysteine, two older mucolytic drugs that are licensed for adjunctive treatment in respiratory disorders characterised by viscous mucus, and typically used for longer to prevent exacerbations of chronic obstructive pulmonary disease (COPD). Does erdosteine have a role for people with COPD exacerbations?

  4. Old dilemma: asthma with irreversible airway obstruction or COPD.

    Science.gov (United States)

    Fattahi, Fatemeh; Vonk, Judith M; Bulkmans, Nicole; Fleischeuer, Ruth; Gouw, Annette; Grünberg, Katrien; Mauad, Thais; Popper, Helmut; Felipe-Silva, Aloisio; Vrugt, Bart; Wright, Joanne L; Yang, Hui-Min; Kocks, Janwillem W H; Hylkema, Machteld N; Postma, Dirkje S; Timens, Wim; Ten Hacken, Nick H T

    2015-11-01

    Older asthmatic patients may develop fixed airway obstruction and clinical signs of chronic obstructive pulmonary disease (COPD). We investigated the added value of pathological evaluation of bronchial biopsies to help differentiate asthma from COPD, taking into account smoking, age, and inhaled corticosteroid (ICS) use. Asthma and COPD patients (24 of each category) were matched for ICS use, age, FEV(1), and smoking habits. Five pulmonary and five general pathologists examined bronchial biopsies using an interactive website, without knowing patient information. They were asked to diagnose asthma or COPD on biopsy findings in both a pairwise and randomly mixed order of cases during four different phases, with intervals of 4-6 weeks, covering a maximal period of 36 weeks. Clinically concordant diagnoses of asthma or COPD varied between 63 %-73 %, without important differences between pairwise vs randomly mixed examination or between general vs pulmonary pathologists. The highest percentage of concordant diagnoses was in young asthmatic patients without ICS use and in COPD patients with ICS use. In non ICS users with fixed airway obstruction, a COPD diagnosis was favored if abnormal presence of glands, squamous metaplasia, and submucosal infiltrate was present and an asthma diagnosis in case of abnormal presence of goblet cells. In ICS users with fixed airway obstruction, abnormal presence of submucosal infiltrates, basement membrane thickening, eosinophils, and glands was associated with asthma. Histological characteristics in bronchial biopsies are reproducibly recognized by pathologists, yet the differentiation by histopathology between asthma and COPD is difficult without information about ICS use.

  5. Pathological changes in the COPD lung mesenchyme - Novel lessons learned from in vitro and in vivo studies

    NARCIS (Netherlands)

    Ojo, Oluwaseun; Lagan, Anna L.; Rajendran, Vijayanand; Spanjer, Anita; Chen, Ling; Sohal, Sukhwinder Singh; Heijink, Irene H.; Jones, Robin; Maarsingh, Harm; Hackett, Tillie L.

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death worldwide and, in contrast to the trend for cardiovascular diseases, mortality rates still continue to climb. This increase is in part due to an aging population, being expanded by the "Baby boomer" generatio

  6. Surface structure effect on the magnetic anisotropy of Co/Pd (001) thin film: A first principles study

    Energy Technology Data Exchange (ETDEWEB)

    Je, Minyeong [Department of Materials Science and Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791 (Korea, Republic of); Choi, Heechae [Computational Science Research Center, Korea Institute of Science and Technology, 14-Gil 5, Hwarang-Ro, Seoungbuk-Gu, Seoul (Korea, Republic of); Hwang, Yubin; Yun, Kyung-Han [Department of Materials Science and Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791 (Korea, Republic of); Chung, Yong-Chae, E-mail: yongchae@hanyang.ac.kr [Department of Materials Science and Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791 (Korea, Republic of)

    2015-08-31

    Perpendicular magnetic anisotropy (PMA) in thin film is the key factor to obtain good properties for high density storage devices. Although the importance of the properties of PMA is well-known for Co/Pd thin film, it is still unclear which surface structure and composition indicate that PMA is present. In this work, the surface structure and magnetic properties of L1{sub 0}-ordered Co/Pd (001) were analyzed using density functional theory calculations. It was confirmed that only Pd-rich A among the facile surface structures indicates PMA properties. However, according to the calculated surface energy, not only Pd-rich A but also Co-rich B is among the most energetically stable structures. The density of states showed a clear distinct electronic structure between Pd-rich A and Co-rich B derived from the structural difference. This result indicates that PMA is not always present in a sandwich structure such as Pd-rich A. The results provide a useful guide to magnetic devices created using L1{sub 0}-ordered Co/Pd (001) on substrate Pd. - Highlights: • Investigation on the possible surface structure of L1{sub 0}-ordered Co/Pd (001) • Using surface phase diagram, the stable structures were Pd-rich A and Co-rich B. • The magnetic property of Pd-rich A and Co-rich B has been measured and discussed. • Pd-rich A only showed perpendicular magnetic anisotropy.

  7. Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes : A Historical Matched Cohort Study

    NARCIS (Netherlands)

    Price, David B.; Russell, Richard; Mares, Rafael; Burden, Anne; Skinner, Derek; Mikkelsen, Helga; Ding, Cherlyn; Brice, Richard; Chavannes, Niels H.; Kocks, Janwillem W. H.; Stephens, Jeffrey W.; Haughney, John

    2016-01-01

    Background Management guidelines for chronic obstructive pulmonary disease (COPD) recommend that inhaled corticosteroids (ICS) are prescribed to patients with the most severe symptoms. However, these guidelines have not been widely implemented by physicians, leading to widespread use of ICS in patie

  8. Pathological changes in the COPD lung mesenchyme - Novel lessons learned from in vitro and in vivo studies

    NARCIS (Netherlands)

    Ojo, Oluwaseun; Lagan, Anna L.; Rajendran, Vijayanand; Spanjer, Anita; Chen, Ling; Sohal, Sukhwinder Singh; Heijink, Irene H.; Jones, Robin; Maarsingh, Harm; Hackett, Tillie L.

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death worldwide and, in contrast to the trend for cardiovascular diseases, mortality rates still continue to climb. This increase is in part due to an aging population, being expanded by the "Baby boomer" generatio

  9. Convergence of the epidemiology and pathology of COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Hogg, J C

    2006-01-01

    The epidemiology of chronic obstructive pulmonary disease (COPD) has been dominated by one hypothesis stating that cigarette smoking and chronic bronchitis were the key to pathogenesis and another that asthma, chronic bronchitis, and even emphysema are related to different expressions of a primary...... airway abnormality. The first hypothesis was rejected in the late 1960s based on a longitudinal study of working men where only a fraction of smokers developed COPD and where development of COPD was independent of the absence or presence of chronic bronchitis. Chronic bronchitis in more advanced COPD...

  10. Danish version of 'The COPD self-efficacy scale'

    DEFF Research Database (Denmark)

    Emme, Christina; Mortensen, Erik L; Rydahl-Hansen, Susan

    2012-01-01

    Scand J Caring Sci; 2012; 26; 615-623 Danish version of 'The COPD self-efficacy scale': translation and psychometric properties The aim of the study was to translate 'The COPD self-efficacy scale' (CSES) into Danish and to evaluate the psychometric properties of the Danish version (CSES-DK). CSES...... enables assessment of self-efficacy in individuals with chronic obstructive pulmonary disease (COPD). The scale consists of 34 items, describing situations which may cause dyspnoea in patients with COPD. The CSES was translated into Danish using a standard forward-backward translation procedure...

  11. Inhaled corticosteroids can reduce osteoporosis in female patients with COPD

    Directory of Open Access Journals (Sweden)

    Liu SF

    2016-07-01

    Full Text Available Shih-Feng Liu,1–3 Ho-Chang Kuo,1,2,4 Guan-Heng Liu,5 Shu-Chen Ho,4 Huang-Chih Chang,1,3 Hung-Tu Huang,6 Yu-Mu Chen,1 Kuo-Tung Huang,1,3 Kuan-Yi Chen,2 Wen-Feng Fang,1–3 Meng-Chih Lin1–3 1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, 3Chang Gung University College of Medicine, 4Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, 5Li-Chih Valuable School, 6Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China Background: Whether the use of inhaled corticosteroids (ICSs in patients with COPD can protect from osteoporosis remains undetermined. The aim of this study is to assess the incidence of osteoporosis in patients with COPD with ICS use and without.Patients and methods: This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496. The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs for incidences of lung cancer.Results: Totally, 10,723 patients with COPD, including ICS users (n=812 and nonusers (n=9,911, were enrolled. The incidence rate of osteoporosis per 100

  12. Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD – a qualitative study

    Directory of Open Access Journals (Sweden)

    Levack WMM

    2016-03-01

    Full Text Available William MM Levack, Bernadette Jones, Rebecca Grainger, Pauline Boland, Melanie Brown, Tristram R Ingham Department of Medicine, University of Otago, Wellington, New Zealand Background: Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD. However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand. Method: Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed “by Māori, for Māori”, or had experienced both. Results: Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1 participants’ past experiences (eg, of exercise; of health care systems, 2 attitudes and expectations, 3 access issues (eg, time, transport, and conflicting responsibilities, and 4 initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services

  13. An international randomized study of a home-based self-management program for severe COPD: the COMET

    Directory of Open Access Journals (Sweden)

    Bourbeau J

    2016-06-01

    Full Text Available Jean Bourbeau,1 Pere Casan,2 Silvia Tognella,3 Peter Haidl,4 Joëlle B Texereau,5,6 Romain Kessler7 On behalf of the COMET investigators 1Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; 2Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain; 3Lung Department, Ospedale Orlandi, Bussolengo VR, Italy; 4Krankenhaus Kloster Grafschaft, Schmallenberg, Germany; 5Air Liquide Healthcare, Medical Research and Development, Jouy-en-Josas, 6Assistance Publique-Hôpitaux de Paris, Service de Physiologie Clinique, Hôpital Cochin, Paris, 7Department of Pulmonary Medicine, Translational Medicine Federation of Strasbourg, University Hospital of Strasbourg, Strasbourg, France Introduction: Most hospitalizations and costs related to COPD are due to exacerbations and insufficient disease management. The COPD patient Management European Trial (COMET is investigating a home-based multicomponent COPD self-management program designed to reduce exacerbations and hospital admissions.Design: Multicenter parallel randomized controlled, open-label superiority trial.Setting: Thirty-three hospitals in four European countries.Participants: A total of 345 patients with Global initiative for chronic Obstructive Lung Disease III/IV COPD.Intervention: The program includes extensive patient coaching by health care professionals to improve self-management (eg, develop skills to better manage their disease, an e-health platform for reporting frequent health status updates, rapid intervention when necessary, and oxygen therapy monitoring. Comparator is the usual management as per the center’s routine practice.Main outcome measures: Yearly number of hospital days for acute care, exacerbation number, quality of life, deaths, and costs. Keywords: COPD, disease management, exacerbations, hospitalization, home care, clinical trial

  14. Cytokine inhibition in the treatment of COPD

    Directory of Open Access Journals (Sweden)

    Caramori G

    2014-04-01

    Full Text Available Gaetano Caramori,1 Ian M Adcock,2,3 Antonino Di Stefano,4 Kian Fan Chung2,3 1Dipartimento di Scienze Mediche, Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF; formerly Centro di Ricerca su Asma e BPCO, Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Ferrara, Italy; 2Airway Diseases Section, National Heart and Lung Institute, Imperial College London, UK; 3Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK; 4Divisione di Pneumologia e Laboratorio di Citoimmunopatologia dell'Apparato Cardio-Respiratorio, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy Abstract: Cytokines play an important part in many pathobiological processes of chronic obstructive pulmonary disease (COPD, including the chronic inflammatory process, emphysema, and altered innate immune response. Proinflammatory cytokines of potential importance include tumor necrosis factor (TNF-α, interferon-γ, interleukin (IL-1β, IL-6, IL-17, IL-18, IL-32, and thymic stromal lymphopoietin (TSLP, and growth factors such as transforming growth factor-β. The current objectives of COPD treatment are to reduce symptoms, and to prevent and reduce the number of exacerbations. While current treatments achieve these goals to a certain extent, preventing the decline in lung function is not currently achievable. In addition, reversal of corticosteroid insensitivity and control of the fibrotic process while reducing the emphysematous process could also be controlled by specific cytokines. The abnormal pathobiological process of COPD may contribute to these fundamental characteristics of COPD, and therefore targeting cytokines involved may be a fruitful endeavor. Although there has been much work that has implicated various cytokines as potentially playing an important role in COPD, there have been very few studies that have examined the effect of specific cytokine blockade in

  15. TWO CASES OF TYPE II RESPIRATORY FAILURE IN COPD TREATED IN KATURI MEDICAL COLLEGE HOSPITAL, GUNTUR AND AN OVERVIEW OF TREATMENT OF ACUTE EXACERBATION AND RESPIRATORY FAILURE

    Directory of Open Access Journals (Sweden)

    Ramakrishna

    2015-04-01

    Full Text Available Treatment of Type II Respiratory Failure in a COPD patient is a difficult task for the ICU and Pulmonary physician. Multi factorial and multi - disciplinary approach is required . Our experience of two cases treated recently in Katuri medical College Hospita l have common features. One is a male of 54 years age and the other is a female of similar age. Both of them were obese and were nonsmokers. Both were poor and could not afford any ICU treatment on their own. Both were rescued by State sponsored Arogyasree programme. Both of them had the advantage of support from their families. Aided by Arogyasree programme, dedicated staff of ICU, Pulmonology, ENT departments , timely interventions with electrolyte balance, balanced antibiotic therapy, Noninvasive and inva sive ventilator strategies, Nutritional support, Blood transfusions, Timely Tracheostomy and excellent nursing care and drug administration in ICU both patients recovered back to normalcy . Initially both required home oxygen therapy and both were subsequen tly seen maintaining normal oxygenation status even without oxygen causing happiness to family members and the treating physicians

  16. INSTEAD : a randomised switch trial of indacaterol versus salmeterol/fluticasone in moderate COPD

    NARCIS (Netherlands)

    Rossi, Andrea; van der Molen, Thys; del Olmo, Ricardo; Papi, Alberto; Wehbe, Luis; Quinn, Matthew; Lu, Chengxing; Young, David; Cameron, Ray; Bucchioni, Enrica; Altman, Pablo

    2014-01-01

    The Indacaterol: Switching Non-exacerbating Patients with Moderate COPD From Salmeterol/Fluticasone to Indacaterol (INSTEAD) study investigated the effect of switching patients at low risk of chronic obstructive pulmonary disease (COPD) exacerbations from salmeterol/fluticasone (SFC; inhaled

  17. Proteasome inhibition improves diaphragm function in an animal model for COPD.

    NARCIS (Netherlands)

    Hees, H.W.H. van; Ottenheijm, C.A.C.; Ennen, L.; Linkels, M.; Dekhuijzen, R.; Heunks, L.M.A.

    2011-01-01

    Diaphragm muscle weakness in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality. Recent studies indicate that increased contractile protein degradation by the proteasome contributes to diaphragm weakness in patients with COPD. The aim of

  18. Lung cancer gene associated with COPD: triple whammy or possible confounding effect?

    Science.gov (United States)

    Young, R P; Hopkins, R J; Hay, B A; Epton, M J; Black, P N; Gamble, G D

    2008-11-01

    Recently, several large genome-wide association studies have identified a putative "lung cancer" locus in the nicotinic acetylcholine receptor subunit genes (nAChR) on 15q25. However, these findings may be confounded by the presence of chronic obstructive pulmonary disease (COPD), which is also strongly associated with smoking exposure and lung cancer. This is likely as the prevalence of COPD in lung cancer cohorts is as much as two-fold greater than that reported in smoking control populations (50 versus 20%). The present authors compared the genotype frequencies of the most strongly associated single nucleotide polymorphism (rs16969968) in the alpha5 subunit of the nAChR gene cluster between three matched smoking cohorts. The AA genotype was found to be more frequent and was seen in 437 (16%) lung cancer cases and 445 (14%) COPD cases compared with 475 (9%) healthy smoking controls. More importantly, when 429 lung cancer cases were divided according to spirometry results (performed within 3 months of diagnosis, prior to surgery and in the absence of effusions or collapse), the AA genotype was present in 19 and 11% of cases with and without COPD, respectively. These findings suggest that the association between the alpha5 subunit nicotinic acetylcholine receptor single nucleotide polymorphism and lung cancer may, in part, be confounded by chronic obstructive pulmonary disease.

  19. Diagnostic values of electrocardiogram in chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Agarwal R

    2008-01-01

    Full Text Available Background : Chronic obstructive pulmonary diseases (COPD, a broad spectrum of respiratory diseases represents a worldwide problem. Electrocardiographic (ECG findings may help in clinical decision making regarding this disease entity. Aims: To evaluate the extent and diagnostic values of ECG changes among COPD patients suffering from broad spectrum of respiratory diseases. Material & Methods : A hos-pital based cross-sectional study was conducted in Sworoop Rani Nehru Hospital, Allahabad in Eastern Uttar Pradesh (UP, India. A sample of 60 patients attending respiratory diseases OPD for treatment of various respiratory problems including 14 COPD patients was selected randomly during 2000-2001. Patients of respiratory diseases were also evaluated electrocardiographically along with other investiga-tions. Results : Respiratory problems were more common among rural males of low socio-economic group. COPD particularly chronic bronchitis was the commonest respiratory problem next to pulmonary tuberculosis. Inspite of normal heart rate observed in 71.4% COPD patients, ECG changes were present in 35.7% COPD patients. Peaked P-wave was observed in 35.7% COPD patients, whereas duration of QRS complex was abnormal in only 8.1% of the patients. None of the COPD patients showed abnormal P-wave duration. ECG changes were found less sensitive (35.7% but highly specific (95.6%. Conclusion : Diagnostic values of ECG among patients with respiratory problems suggest that COPD patients should be screened electrocardiographically in addition to other clinical investigations.

  20. Global scientific collaboration in COPD research

    Science.gov (United States)

    Su, Yanbing; Long, Chao; Yu, Qi; Zhang, Juan; Wu, Daisy; Duan, Zhiguang

    2017-01-01

    Purpose This study aimed to investigate the multiple collaboration types, quantitatively evaluate the publication trends and review the performance of institutions or countries (regions) across the world in COPD research. Materials and methods Scientometric methods and social network analysis were used to survey the development of publication trends and understand current collaboration in the field of COPD research based on the Web of Science publications during the past 18 years. Results The number of publications developed through different collaboration types has increased. Growth trends indicate that the percentage of papers authored through multinational and domestic multi-institutional collaboration (DMIC) have also increased. However, the percentage of intra-institutional collaboration and single-authored (SA) studies has reduced. The papers that produced the highest academic impact result from international collaboration. The second highest academic impact papers are produced by DMIC. Out of the three, the papers that are produced by SA studies have the least amount of impact upon the scientific community. A handful of internationally renowned institutions not only take the leading role in the development of the research within their country (region) but also play a crucial role in international research collaboration in COPD. Both the amount of papers produced and the amount of cooperation that occurs in each study are disproportionally distributed between high-income countries (regions) and low-income countries (regions). Growing attention has been generated toward research on COPD from more and more different academic domains. Conclusion Despite the rapid development in COPD research, collaboration in the field of COPD research still has room to grow, especially between different institutions or countries (regions), which would promote the progress of global COPD research.

  1. Global scientific collaboration in COPD research.

    Science.gov (United States)

    Su, Yanbing; Long, Chao; Yu, Qi; Zhang, Juan; Wu, Daisy; Duan, Zhiguang

    2017-01-01

    This study aimed to investigate the multiple collaboration types, quantitatively evaluate the publication trends and review the performance of institutions or countries (regions) across the world in COPD research. Scientometric methods and social network analysis were used to survey the development of publication trends and understand current collaboration in the field of COPD research based on the Web of Science publications during the past 18 years. The number of publications developed through different collaboration types has increased. Growth trends indicate that the percentage of papers authored through multinational and domestic multi-institutional collaboration (DMIC) have also increased. However, the percentage of intra-institutional collaboration and single-authored (SA) studies has reduced. The papers that produced the highest academic impact result from international collaboration. The second highest academic impact papers are produced by DMIC. Out of the three, the papers that are produced by SA studies have the least amount of impact upon the scientific community. A handful of internationally renowned institutions not only take the leading role in the development of the research within their country (region) but also play a crucial role in international research collaboration in COPD. Both the amount of papers produced and the amount of cooperation that occurs in each study are disproportionally distributed between high-income countries (regions) and low-income countries (regions). Growing attention has been generated toward research on COPD from more and more different academic domains. Despite the rapid development in COPD research, collaboration in the field of COPD research still has room to grow, especially between different institutions or countries (regions), which would promote the progress of global COPD research.

  2. BACTERIOLOGICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN ACUTE EXACERBATION OF ADVANCED CASES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD

    Directory of Open Access Journals (Sweden)

    Avik

    2016-01-01

    Full Text Available Acute exacerbations are significant and frequent events in the natural history of chronic obstructive pulmonary disease. Majority of these exacerbations are of infectious aetiology, bacteria being responsible for 30-50% of these cases. With not many studies of similar type being conducted in the Indian context, this study was undertaken with the purpose of determining the bacteriology of acute exacerbations of chronic obstructive pulmonary disease in hospitalized patients with advanced disease and their antibiotic susceptibility pattern to formulate a cost effective algorithm for antibiotic usage while at the same time reducing the chances of emergence of drug resistance. Sputum sample from a total of 338 patients were send for Gram’s stain and culture sensitivity testing using an array of the commonly used antibiotics. Pathogenic bacteria were isolated from 203 (60.1% samples. Gram negative bacteria were isolated from 79.8 percent (162/203 cases while the rest were Gram positive. Klebsiella species were the commonest (49.2%; 100/203 Gram negative isolates from the sputum samples. Among the gram negative organisms, Carbapenem had the highest sensitivity (90.2% followed by Amikacin, Ciprofloxacin and Piperacillin-Tazobactam. Linezolid was found to be 100 percent sensitive amongst the Gram positive organisms while both Amoxicillin Clavulanate and Azithromycin showed a rather low sensitivity profile overall. 5.0 percent of the Klebsiella infections were multi drug resistant. It was thereby concluded that either Amikacin, Ciprofloxacin or Piperacillin-Tazobactam for be considered for Gram negative organisms and Linezolid be considered for Gram positive organisms as first line antibiotics in empirical therapy while Carbapenems may be kept as reserve drugs should the first line drugs fail.

  3. Bacterial aetiology and mortality in COPD patients with CAP: results from the German Competence Network, CAPNETZ.

    Science.gov (United States)

    Braeken, D C W; Franssen, F M E; von Baum, H; Schütte, H; Pletz, M W; Rupp, J; Stassen, F; Mooij, M J; Rohde, G G U

    2017-02-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P CAP-COPD patients without pathogen detection (P CAP-COPD without pathogen detection. It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.

  4. Prevalence of Osteoporosis and Its Risk Factors in Men with COPD in Qazvin

    OpenAIRE

    Mahnaz Abbasi; Mohammadali Zohal; Banafsheh Atapour; Zohreh Yazdi

    2016-01-01

    Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Proper diagnosis of osteoporosis as a systemic adverse effect of COPD is of significant importance. The present study aimed at evaluating the prevalence of osteoporosis and its risk factors in men suffering from COPD in Qazvin (2014). Methods. This descriptive-analytical study was conducted on 90 patients with COPD using random sampling. Anthropometric data and results from physic...

  5. Ethnic Differences in Persistence with COPD Medications

    DEFF Research Database (Denmark)

    Hu, Yusun; Cantarero-Arévalo, Lourdes; Frølich, Anne

    2017-01-01

    : A cohort of COPD patients diagnosed in 2003-2007 in Copenhagen, Denmark, was followed for 2 years in the Danish national registers. According to the number of the LABD medications dispensed, individuals were categorized into three therapy groups: monotherapy, drug combination therapy, and multiple drug...... therapy. Persistence was defined as the period from the first prescription date to the date of discontinuation. Treatment was considered discontinued if the interval between the two prescriptions was longer than the number of days of cumulative medication supply according to defined daily doses plus 7...... days. RESULTS: In total, 1129 incident COPD patients using LABDs were included; 6.7% had other than Danish ethnic background. Survival analyses showed that in the cases where LABD medication combination presented COPD maintenance therapy, ethnic background was associated with the higher risk...

  6. How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

    Directory of Open Access Journals (Sweden)

    Meltem Çoban Ağca

    2017-04-01

    Full Text Available Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD-related acute hypercapnic respiratory failure (AHRF. Methods: The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO2 values were recorded. Baseline pH values were categorized as severe (pH<7.26, moderate (pH≥7.26–7.30, and mild (pH≥7.30 acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer. Results: Treatment resulted in success in 477 (88% patients. Albumin levels were significantly low and the mean Charlson index (CI score was significantly high in Group 2. Admission pH and PaCO2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO2 and lower pH values as well as a lower level of decrease in PaCO2 values within 2 hours of treatment in ED. Similarly, higher PaCO2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05. Conclusion: The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO2 values after a few hours of treatment and not the baseline pH or PaCO2 values are better predictors than the baseline pH and PaCO2 values.

  7. Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study.

    Science.gov (United States)

    Berton, Danilo Cortozi; Santos, Álvaro Huber Dos; Bohn, Ivo; Lima, Rodrigo Quevedo de; Breda, Vanderléia; Teixeira, Paulo José Zimermann

    2016-01-01

    To compare a once-daily long-acting β2 agonist (indacaterol 150 µg) with a once-daily long-acting anticholinergic (tiotropium 5 µg) in terms of their effects on exercise endurance (limit of tolerance, Tlim) in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted). Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments). Nineteen patients completed the study (one having been excluded because of COPD exacerbation). Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06). Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010) but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678). There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39). In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003 [http://www.clinicaltrials.gov/]). Comparar um β2-agonista de

  8. Prevalence of Osteoporosis and Its Risk Factors in Men with COPD in Qazvin.

    Science.gov (United States)

    Abbasi, Mahnaz; Zohal, Mohammadali; Atapour, Banafsheh; Yazdi, Zohreh

    2016-01-01

    Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Proper diagnosis of osteoporosis as a systemic adverse effect of COPD is of significant importance. The present study aimed at evaluating the prevalence of osteoporosis and its risk factors in men suffering from COPD in Qazvin (2014). Methods. This descriptive-analytical study was conducted on 90 patients with COPD using random sampling. Anthropometric data and results from physical examination were collected. Pulmonary function test and bone mineral densitometry were done for all participants as well. Results. The prevalence of osteopenia and osteoporosis in COPD patients was 31.5 and 52.8 percent, respectively. Bone mineral density (BMD) at the femoral neck was associated significantly with body mass index (BMI), increased severity of COPD, and use of oral corticosteroid (P < 0.05). Conclusion. The results showed that patients' BMI and severity of COPD are two valuable risk factors for osteoporosis screening in COPD patients.

  9. COPD: the patient perspective

    Directory of Open Access Journals (Sweden)

    Jones PW

    2016-02-01

    Full Text Available Paul W Jones,1 Henrik Watz,2 Emiel FM Wouters,3 Mario Cazzola4 1Division of Clinical Science, St George’s, University of London, London, UK; 2Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN, Member of the German Center for Lung Research (DZL, Grosshansdorf, Germany; 3CIRO+, Department of Respiratory Medicine, Maastricht University, Maastricht, the Netherlands; 4Unit of Respiratory Clinical Pharmacology, Department of Systemic Medicine, University of Rome ‘Tor Vergata,’ Rome, Italy Abstract: Chronic obstructive pulmonary disease (COPD is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD. Keywords: COPD, patients, physical actiity levels, pulmonary rehabilitation

  10. The many "small COPDs": COPD should be an orphan disease

    DEFF Research Database (Denmark)

    Rennard, Stephen I; Vestbo, Jørgen

    2008-01-01

    of 200,000 affected individuals; however, secondarily, is the impossibility for development costs to be recovered during the patent life of a product. COPD should qualify for the first criterion if the various conditions that comprise COPD are regarded separately. The subphenotyping of COPD into separate...

  11. Novel aspects of pathogenesis and regeneration mechanisms in COPD

    Directory of Open Access Journals (Sweden)

    Bagdonas E

    2015-06-01

    Full Text Available Edvardas Bagdonas, Jovile Raudoniute, Ieva Bruzauskaite, Ruta Aldonyte State Research Institute Center for Innovative Medicine, Vilnius, Lithuania Abstract: Chronic obstructive pulmonary disease (COPD, a major cause of death and morbidity worldwide, is characterized by expiratory airflow limitation that is not fully reversible, deregulated chronic inflammation, and emphysematous destruction of the lungs. Despite the fact that COPD is a steadily growing global healthcare problem, the conventional therapies remain palliative, and regenerative approaches for disease management are not available yet. We aim to provide an overview of key reviews, experimental, and clinical studies addressing lung emphysema development and repair mechanisms published in the past decade. Novel aspects discussed herein include integral revision of the literature focused on lung microflora changes in COPD, autoimmune component of the disease, and environmental risk factors other than cigarette smoke. The time span of studies on COPD, including emphysema, chronic bronchitis, and asthmatic bronchitis, covers almost 200 years, and several crucial mechanisms of COPD pathogenesis are described and studied. However, we still lack the holistic understanding of COPD development and the exact picture of the time-course and interplay of the events during stable, exacerbated, corticosteroid-treated COPD states, and transitions in-between. Several generally recognized mechanisms will be discussed shortly herein, ie, unregulated inflammation, proteolysis/antiproteolysis imbalance, and destroyed repair mechanisms, while novel topics such as deviated microbiota, air pollutants-related damage, and autoimmune process within the lung tissue will be discussed more extensively. Considerable influx of new data from the clinic, in vivo and in vitro studies stimulate to search for novel concise explanation and holistic understanding of COPD nowadays. Keywords: dysbiosis in COPD, autoimmune

  12. “What are my chances of developing COPD if one of my parents has the disease?” A systematic review and meta-analysis of prevalence of co-occurrence of COPD diagnosis in parents and offspring

    Science.gov (United States)

    Li, Lok Sze Katrina; Paquet, Catherine; Johnston, Kylie; Williams, Marie T

    2017-01-01

    Introduction Intergenerational associations in chronic obstructive pulmonary disease (COPD) have been well recognized and may result from genetic, gene environment, or exposure to life course factors. Consequently, adult offspring of parents with COPD may be at a greater risk of developing COPD. The aim of this study was to review the prevalence of co-occurrence of COPD in adult offspring with one or both parents having COPD independent of specific genetic variations. Methods In total, five databases were searched for original studies in which prevalence of COPD was reported in both offspring (children) and one or both parents. Studies were excluded if COPD was not clearly defined, COPD was linked to specific genetic variations, COPD was combined with other chronic respiratory conditions, or estimates included other first-degree relatives. Data extraction (ie, sample characteristics, prevalence of COPD, and odds ratio [OR] if reported) was completed by two independent reviewers. A meta-analysis of prevalence and OR was conducted, where possible. Results Of the 3,382 citations, 129 full texts were reviewed to include eight studies (six case–control, one cross-sectional, and one cohort) reflecting either prevalence of COPD in offspring of parents with COPD (descendent approach, n=3), which ranged from 0% to 17.3%, or prevalence of people with COPD reporting positive parental history of COPD (antecedent approach, n=5), for which the pooled prevalence was 28.6%. Offspring of people with COPD had 1.57 times greater odds (95% confidence interval =1.29–1.93; P<0.001) of having COPD compared with people not having a parental history of COPD. Conclusion The prevalence of COPD in adult offspring of people with COPD is greater than population-based estimates, and the ORs indicate a higher risk in this group. This offers clinicians a potential strategy for opportunistic screening, early identification, and intervention in this at-risk group. PMID:28182144

  13. State Fact Sheets on COPD

    Science.gov (United States)

    ... Submit Search The CDC Chronic Obstructive Pulmonary Disease (COPD) Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . COPD Homepage Data and Statistics Fact Sheets Publications Publications ...

  14. Day to day with COPD

    Science.gov (United States)

    COPD - day to day; Chronic obstructive airways disease - day to day; Chronic obstructive lung disease - day to ... Having COPD can sap your energy. These simple changes can make your days easier and preserve your strength. Ask ...

  15. COPD: Unique to Older Adults

    Science.gov (United States)

    ... care and improve or maintain quality of life. Depression and COPD When your COPD symptoms eventually become ... as reducing bright lights and noise, using soothing music, doing yoga or meditating, or taking up a ...

  16. Challenge of COPD: Getting Tested

    Science.gov (United States)

    ... this page please turn JavaScript on. Feature: The Challenge of COPD Getting Tested Past Issues / Fall 2014 ... Your Seasonal Flu Shot" here .) Read More "The Challenge of COPD" Articles Q&A: Grace Anne Koppel, ...

  17. Hospitalisation for chronic obstructive pulmonary disease and risk of suicide: a population-based case–control study

    DEFF Research Database (Denmark)

    Strid, JM; Christiansen, Christian Fynbo; Olsen, Morten Smærup

    2014-01-01

    Objectives To examine risk of suicide among individuals with hospitalised chronic obstructive pulmonary disease (COPD) and to profile differences according to sex, age, psychiatric history, and recency and frequency of COPD hospitalisations. Design Nested case–control study. Setting Data were...... with COPD was computed using conditional logistic regression and adjusted for effects of psychiatric history and important sociodemographic factors. Results In our study population, 3% of suicide cases had been hospitalised for COPD compared with 1% of matched population controls. Thus, a hospitalised COPD...

  18. Nasal high-flow therapy for type II respiratory failure in COPD: A report of four cases

    Directory of Open Access Journals (Sweden)

    Ivan Pavlov

    2017-01-01

    Full Text Available Herein we present a report of four cases of severe type II respiratory failure that had contraindications both to conventional non-invasive ventilation and to endotracheal intubation. In all four cases, we successfully used a high-flow nasal oxygen device as a rescue device, with very reassuring outcomes.

  19. Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD. TECEPOC: study protocol for a partially randomized controlled trial (preference trial

    Directory of Open Access Journals (Sweden)

    Leiva-Fernández Francisca

    2012-05-01

    Full Text Available Abstract Background Drugs for inhalation are the cornerstone of therapy in obstructive lung disease. We have observed that up to 75 % of patients do not perform a correct inhalation technique. The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction. The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease (COPD. Methods This study uses both a multicenter patients´ preference trial and a comprehensive cohort design with 495 COPD-diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers. The participants will be divided into two groups and five arms. The two groups are: 1 the patients´ preference group with two arms and 2 the randomized group with three arms. In the preference group, the two arms correspond to the two educational interventions (Intervention A and Intervention B designed for this study. In the randomized group the three arms comprise: intervention A, intervention B and a control arm. Intervention A is written information (a leaflet describing the correct inhalation techniques. Intervention B is written information about inhalation techniques plus training by an instructor. Every patient in each group will be visited six times during the year of the study at health care center. Discussion Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 %. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, considering that it will be adequate and feasible within the context of clinical practice. Trial registration Current Controlled Trials ISRTCTN15106246

  20. Antioxidant therapies in COPD

    Science.gov (United States)

    Rahman, Irfan

    2006-01-01

    Oxidative stress is an important feature in the pathogenesis of COPD. Targeting oxidative stress with antioxidants or boosting the endogenous levels of antioxidants is likely to be beneficial in the treatment of COPD. Antioxidant agents such as thiol molecules (glutathione and mucolytic drugs, such as N-acetyl-L-cysteine and N-acystelyn), dietary polyphenols (curcumin, resveratrol, green tea, catechins/quercetin), erdosteine, and carbocysteine lysine salt, all have been reported to control nuclear factor-kappaB (NF-κ B) activation, regulation of glutathione biosynthesis genes, chromatin remodeling, and hence inflammatory gene expression. Specific spin traps such as α-phenyl-N-tert-butyl nitrone, a catalytic antioxidant (ECSOD mimetic), porphyrins (AEOL 10150 and AEOL 10113), and a superoxide dismutase mimetic M40419 have also been reported to inhibit cigarette smoke-induced inflammatory responses in vivo. Since a variety of oxidants, free radicals, and aldehydes are implicated in the pathogenesis of COPD, it is possible that therapeutic administration of multiple antioxidants will be effective in the treatment of COPD. Various approaches to enhance lung antioxidant capacity and clinical trials of antioxidant compounds in COPD are discussed. PMID:18046899

  1. Lower corticosteroid skin blanching response is associated with severe COPD.

    Directory of Open Access Journals (Sweden)

    Susan J M Hoonhorst

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive to steroids in COPD than in asthma. The underlying mechanisms are yet unclear. This study aimed to assess whether skin corticosteroid insensitivity is associated with COPD and COPD severity using the corticosteroid skin blanching test. METHODS: COPD patients GOLD stage I-IV (n = 27, 24, 22, and 16 respectively and healthy never-smokers and smokers (n = 28 and 56 respectively were included. Corticosteroid sensitivity was assessed by the corticosteroid skin blanching test. Budesonide was applied in 8 logarithmically increasing concentrations (0-100 μg/ml on subject's forearm. Assessment of blanching was performed after 7 hours using a 7-point scale (normal skin to intense blanching. All subjects performed spirometry and body plethysmography. RESULTS: Both GOLD III and GOLD IV COPD patients showed significantly lower skin blanching responses than healthy never-smokers and smokers, GOLD I, and GOLD II patients. Their area under the dose-response curve values of the skin blanching response were 586 and 243 vs. 1560, 1154, 1380, and 1309 respectively, p<0.05. Lower FEV1 levels and higher RV/TLC ratios were significantly associated with lower skin blanching responses (p = 0.001 and p = 0.004 respectively. GOLD stage I, II, III and IV patients had similar age and packyears. CONCLUSIONS: In this study, severe and very severe COPD patients had lower skin corticosteroid sensitivity than mild and moderate COPD patients and non-COPD controls with comparable age and packyears. Our findings together suggest that the reduced skin blanching response fits with a subgroup of COPD patients that has an early-onset COPD phenotype.

  2. COPD: Are You at Risk?

    Science.gov (United States)

    CoPD: the more you know, the better For you anD your loveD ones. PeoPle who have CoPD: • Become short of breath while doing everyday activities ... time goes by, these symPtoms get graDually worse. COPD develops slowly, and can worsen over time. Many ...

  3. Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study

    Directory of Open Access Journals (Sweden)

    Wedzicha JA

    2017-01-01

    Full Text Available Jadwiga A Wedzicha,1 Nanshan Zhong,2 Masakazu Ichinose,3 Michael Humphries,4 Robert Fogel,5 Chau Thach,5 Francesco Patalano,6 Donald Banerji5 1National Heart and Lung Institute, Imperial College London, London, UK; 2State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 4Beijing Novartis Pharma Co. Ltd., Shanghai, People’s Republic of China; 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 6Novartis Pharma AG, Basel, Switzerland Background: The FLAME study demonstrated that indacaterol/glycopyrronium (IND/GLY, the fixed-dose combination of a long-acting β2-agonist (LABA, IND and a long-acting muscarinic antagonist (LAMA, GLY, was superior to salmeterol/fluticasone combination (SFC in preventing exacerbations in COPD patients with a high risk of exacerbations. In this study, we report a prespecified analysis of the efficacy and safety of IND/GLY versus SFC in Asian patients from the FLAME study.Patients and methods: Patients from Asian centers with moderate-to-very severe COPD and ≥1 exacerbation in the previous year from the 52-week, randomized FLAME study were included. IND/GLY was compared versus SFC for effects on exacerbations, lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC], health status (St George’s Respiratory Questionnaire [SGRQ], rescue medication use, and safety.Results: A total of 510 Asian patients (IND/GLY, n=250 or SFC, n=260 were included. Compared to the overall FLAME population, the Asian cohort had more males, a shorter duration of COPD, fewer patients using inhaled corticosteroid (ICS at screening, fewer current smokers, and more patients with very severe COPD

  4. Development and validity of the Patient-centred COPD Questionnaire (PCQ)

    DEFF Research Database (Denmark)

    Pommer, Antoinette M; Prins, Lonneke; van Ranst, Dirk;

    2013-01-01

    ; although highly recommended, both have several limitations regarding structure, content, and/or methodological qualities. In the present study a new COPD-specific instrument was developed to measure impairment: the 'Patient-centred-COPD-Questionnaire' (PCQ). METHODS: Six focus groups with COPD patients...

  5. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    The objective of the present study was to determine the association between CT phenotypes-emphysema by low attenuation area and bronchitis by airway wall thickness-and body composition parameters in a large cohort of subjects with and without COPD. In 452 COPD subjects and 459 subjects without COPD...

  6. The role of indacaterol for chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Cazzola, Mario; Bardaro, Floriana; Stirpe, Emanuele

    2013-08-01

    Indacaterol is the first long-acting β2-agonist (LABAs) approved for the treatment of chronic obstructive pulmonary disease (COPD) that allows for once-daily (OD) administration. It is rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. In long-term clinical studies (12 weeks to 1 year) in patients with moderate to severe COPD, OD indacaterol 150 or 300 μg improved lung function (primary endpoint) significantly more than placebo, and improvements were significantly greater than twice-daily formoterol 12 μg or salmeterol 50 μg, and noninferior to OD tiotropium bromide 18 μg. Indacaterol was well tolerated at all doses and with a good overall safety profile. Cost-utility analyses show that indacaterol 150 μg has lower total costs and better outcomes than tiotropium and salmeterol. These findings suggest that indacaterol can be considered a first choice drug in the treatment of the patient with mild/moderate stable COPD. However, in people with COPD who remain symptomatic on treatment with indacaterol, adding a long-acting muscarinic antagonist (LAMA) is the preferable option. In any case, it is advisable to combine indacaterol with a OD inhaled corticosteroid (ICS), such as mometasone furoate or ciclesonide, in patients with low FEV1, and, in those patients who have many symptoms and a high risk of exacerbations, to combine it with a LAMA and a OD ICS.

  7. Detection of COPD in a high-risk population

    DEFF Research Database (Denmark)

    Kjeldgaard, Peter; Dahl, Ronald; Løkke, Anders

    2015-01-01

    BACKGROUND: Underdiagnosis of chronic obstructive pulmonary disease (COPD) is widespread. Early detection of COPD may improve the outcome by timely smoking cessation, a change in lifestyle, and treatment with an inhaled bronchodilator (BD). The objective of this study was to evaluate the diagnost...

  8. Novel aspects of pathogenesis and regeneration mechanisms in COPD.

    Science.gov (United States)

    Bagdonas, Edvardas; Raudoniute, Jovile; Bruzauskaite, Ieva; Aldonyte, Ruta

    2015-01-01

    Chronic obstructive pulmonary disease (COPD), a major cause of death and morbidity worldwide, is characterized by expiratory airflow limitation that is not fully reversible, deregulated chronic inflammation, and emphysematous destruction of the lungs. Despite the fact that COPD is a steadily growing global healthcare problem, the conventional therapies remain palliative, and regenerative approaches for disease management are not available yet. We aim to provide an overview of key reviews, experimental, and clinical studies addressing lung emphysema development and repair mechanisms published in the past decade. Novel aspects discussed herein include integral revision of the literature focused on lung microflora changes in COPD, autoimmune component of the disease, and environmental risk factors other than cigarette smoke. The time span of studies on COPD, including emphysema, chronic bronchitis, and asthmatic bronchitis, covers almost 200 years, and several crucial mechanisms of COPD pathogenesis are described and studied. However, we still lack the holistic understanding of COPD development and the exact picture of the time-course and interplay of the events during stable, exacerbated, corticosteroid-treated COPD states, and transitions in-between. Several generally recognized mechanisms will be discussed shortly herein, ie, unregulated inflammation, proteolysis/antiproteolysis imbalance, and destroyed repair mechanisms, while novel topics such as deviated microbiota, air pollutants-related damage, and autoimmune process within the lung tissue will be discussed more extensively. Considerable influx of new data from the clinic, in vivo and in vitro studies stimulate to search for novel concise explanation and holistic understanding of COPD nowadays.

  9. Maatschappelijke kosten van astma, COPD en respiratoire allergie

    NARCIS (Netherlands)

    Suijkerbuijk, Anita W M; de Wit, G A Ardine; Wijga, Alet H; Heijmans, Monique J W M; Hoogendoorn, Martine; Rutten-van Mölken, Maureen P M H; Maurits, Erica E M; Hoogenveen, Rudolf T; Feenstra, Talitha L

    2013-01-01

    OBJECTIVE: To estimate the societal costs of asthma, COPD and respiratory allergy for the year 2007 and future healthcare costs for the period 2007-2032. DESIGN: Descriptive study. METHODS: Representative registries were used to estimate the healthcare costs of asthma, COPD and respiratory allergy f

  10. How do COPD patients distribute their daily activities?

    NARCIS (Netherlands)

    Tabak, Monique; Vollenbroek-Hutten, Miriam Marie Rosé; van der Valk, P.; van der Palen, Jacobus Adrianus Maria; Tönis, Thijs; Hermens, Hermanus J.

    2011-01-01

    Better insight in daily activity behaviour of COPD patients is needed as a first step to enable a tailoring of their treatment. The objective of this study was to measure the daily activity of COPD patients and to compare the daily activity distribution with asymptomatic controls, using triaxial acc

  11. Empowerment in people with COPD

    Directory of Open Access Journals (Sweden)

    Disler RT

    2015-12-01

    Full Text Available Rebecca T Disler,1–3 Jessica Appleton,1 Tracy A Smith,4,5 Matthew Hodson,6 Sally C Inglis,1,2 DorAnne Donesky,7 Patricia M Davidson8 1Faculty of Health, University of Technology Sydney, 2Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 3Improving Palliative Care through Clinical Trials (ImPACCT, Sydney, 4Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, 5Faculty of Medicine, University of NSW, Sydney, NSW, Australia; 6ACERS, Integrated Medicine and Rehabilitation Services Division, Homerton University Hospital NHS Foundation Trust, London, UK; 7Department of Physiological Nursing, UCSF School of Nursing, San Francisco, CA, 8School of Nursing, Johns Hopkins University, Baltimore, MD, USA Background: Patient empowerment is recognized as an important aspect of chronic disease management. There is an increasing expectation that health providers engage patients as active participants in their own self-management. This engagement is crucial to the chronic care model as patients with COPD and their families manage the majority of the care in the community. Understanding what influences empowerment will help health care professionals to better engage in collaborative care planning and decision making that meet the needs of this new generation of health consumers. Aim: The aim of the present study was to identify interventions or approaches that empower patients in the management of COPD. Methods: An integrative review was undertaken following the preferred reporting items for systematic reviews and meta-analyses approach. Papers were included if they 1 provided a definition or conceptualization of empowerment, and 2 reported interventions or approaches fostering empowerment in patients with COPD. Thematic analysis was used to develop conceptual themes on patient empowerment in COPD. These conceptual themes were validated by a panel of specialists in COPD, chronic disease

  12. Long-term safety and efficacy of indacaterol, a long-acting β₂-agonist, in subjects with COPD: a randomized, placebo-controlled study.

    Science.gov (United States)

    Chapman, Kenneth R; Rennard, Stephen I; Dogra, Angeli; Owen, Roger; Lassen, Cheryl; Kramer, Benjamin

    2011-07-01

    Indacaterol is an inhaled, long-acting β(2)-agonist providing 24-h bronchodilation with once-daily dosing in patients with COPD. Subjects with moderate to severe COPD who completed a 26-week, randomized, double-blind study were eligible for enrollment in an extension, during which treatment with double-blind indacaterol, 150 or 300 μg once daily, or placebo was continued for a further 26 weeks. The primary objective was to evaluate the long-term safety of indacaterol. Efficacy end points included trough (24 h postdose) FEV(1) at 52 weeks, exacerbations, and health status (St. George Respiratory Questionnaire [SGRQ]). Four hundred fifteen subjects participated in the extension. Adverse events, mostly mild or moderate, occurred in 76%, 77%, and 68% of subjects receiving indacaterol, 150 μg; indacaterol, 300 μg; and placebo, respectively. Serious adverse events occurred in 10.4%, 12.3%, and 10.5%, respectively. Indacaterol had no clinically significant effects on ECG findings (corrected QT interval) or on serum potassium or plasma glucose levels. Indacaterol increased trough FEV(1) relative to placebo throughout the study (difference of ≥ 170 mL at week 52). No tolerance to its bronchodilator effect was detected. Indacaterol treatment was accompanied by significant reductions in COPD exacerbations (rate ratios compared with placebo, 0.62-0.64; P indacaterol treatment, with decreases from baseline in mean total SGRQ score generally > 4 units. During 1 year of treatment, indacaterol was well tolerated and provided significant and well-maintained bronchodilation that was accompanied by improved clinical outcomes. ClinicalTrials.gov; No.: NCT00677807; URL: www.clinicaltrials.gov.

  13. Efficacy and safety of indacaterol 150 μg once-daily in COPD: a double-blind, randomised, 12-week study

    Directory of Open Access Journals (Sweden)

    Piggott Simon

    2010-03-01

    Full Text Available Abstract Background Indacaterol is a novel, once-daily (o.d. inhaled, long-acting β2-agonist in development for chronic obstructive pulmonary disease (COPD. This 12-week, double-blind study compared the efficacy, safety, and tolerability of indacaterol to that of placebo in patients with moderate-to-severe COPD. Methods Efficacy variables included 24-h trough FEV1 (mean of 23 h 10 min and 23 h 45 min post-dose at Week 12 (primary endpoint and after Day 1, and the percentage of COPD days with poor control (i.e., worsening symptoms. Safety was assessed by adverse events (AEs, mean serum potassium and blood glucose, QTc (Fridericia, and vital signs. Results Patients were randomised (n = 416, mean age 63 years to receive either indacaterol 150 μg o.d. (n = 211 or placebo (n = 205 via a single-dose dry-powder inhaler; 87.5% completed the study. Trough FEV1 (LSM ± SEM at Week 12 was 1.48 ± 0.018 L for indacaterol and 1.35 ± 0.019 L for placebo, a clinically relevant difference of 130 ± 24 mL (p 1 after one dose was significantly higher with indacaterol than placebo (p 1 than placebo, both on Day 1 and at Week 12, with indacaterol-placebo differences (LSM ± SEM of 190 ± 28 (p 1 (between 5 min and 4 h, 5 min and 1 h, and 1 and 4 h post-dose at Week 12 were all significantly greater with indacaterol than placebo (p 500 ms. Conclusions Indacaterol 150 μg o.d. provided clinically significant and sustained bronchodilation, reduced rescue medication use, and had a safety and tolerability profile similar to placebo. Trial registration NCT00624286

  14. Efficacy and safety of coadministration of once-daily indacaterol and glycopyrronium versus indacaterol alone in COPD patients: the GLOW6 study

    Directory of Open Access Journals (Sweden)

    Vincken W

    2014-02-01

    Full Text Available Walter Vincken,1 Joseph Aumann,2 Hungta Chen,3 Michelle Henley,3 Danny McBryan,4 Pankaj Goyal4 1Respiratory Division, University Hospital, UZ Brussel, Free University of Brussels, Brussels, Belgium; 2Longartsenpraktijk, Prins Bisschopssingel, Hasselt, Belgium; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 4Novartis Pharma AG, Basel, Switzerland Background: Addition of a second bronchodilator from a different pharmacological class may benefit patients with moderate-to-severe chronic obstructive pulmonary disease (COPD whose symptoms are insufficiently controlled by bronchodilator monotherapy. GLOW6 evaluated the efficacy and safety of once-daily coadministration of the long-acting β2-agonist indacaterol (IND and the long-acting muscarinic antagonist glycopyrronium (GLY versus IND alone in patients with moderate-to-severe COPD. Materials and methods: In this randomized, double-blind, parallel group, placebo-controlled, 12-week study, patients were randomized 1:1 to IND 150 µg and GLY 50 µg daily (IND + GLY or IND 150 µg daily and placebo (IND + PBO (all delivered via separate Breezhaler® devices. The primary objective was to demonstrate the superiority of IND + GLY versus IND + PBO for trough forced expiratory volume in 1 second (FEV1 at week 12. Other end points included trough FEV1 at day 1, FEV1 area under the curve from 30 minutes to 4 hours (AUC30min–4h, peak FEV1, inspiratory capacity and trough forced vital capacity (FVC at day 1 and week 12, and transition dyspnea index (TDI focal score, COPD symptoms, and rescue medication use over 12 weeks. Results: A total of 449 patients were randomized (IND + GLY, 226; IND + PBO, 223; 94% completed the study. On day 1 and at week 12, IND + GLY significantly improved trough FEV1 versus IND + PBO, with treatment differences of 74 mL (95% CI 46–101 mL and 64 mL (95% CI 28–99 mL, respectively (both P<0.001. IND + GLY significantly improved postdose peak FEV1, FEV1 AUC30min–4h

  15. Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study

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    Wilke Sarah

    2012-08-01

    Full Text Available Abstract Background Longitudinal studies analyzing the correlations between disease-specific and generic health status questionnaires at different time points in patients with advanced COPD are lacking. The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George’s Respiratory Questionnaire, SGRQ correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36 at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. Methods Demographic and clinical characteristics were assessed in 105 outpatients with advanced COPD at baseline. Disease-specific health status (SGRQ and generic health status (EQ-5D, AQoL, SF-36 were assessed at baseline, four, eight, and 12 months. Correlations were determined between SGRQ and EQ-5D, AQoL, and SF-36 scores and changes in these scores. Agreement in direction of change was assessed. Results Eighty-four patients (80% completed one-year follow-up and were included for analysis. SGRQ total score and EQ-5D index score, AQoL total score and SF-36 Physical Component Summary measure (SF-36 PCS score were moderately to strongly correlated. The correlation of the changes between the SGRQ total score and EQ-5D index score, AQoL total score, SF-36 PCS, and SF-36 Mental Component Summary measure (SF-36 MCS score were weak or absent. The direction of changes in SGRQ total scores agreed slightly with the direction of changes in EQ-5D index score, AQoL total score, and SF-36 PCS score. Conclusions At four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores

  16. Characterisation of COPD heterogeneity in the ECLIPSE cohort

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    Agusti Alvar

    2010-09-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a complex condition with pulmonary and extra-pulmonary manifestations. This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort (ECLIPSE. Methods We studied 2164 clinically stable COPD patients, 337 smokers with normal lung function and 245 never smokers. In these individuals, we measured clinical parameters, nutritional status, spirometry, exercise tolerance, and amount of emphysema by computed tomography. Results COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function. Co-morbidities were more prevalent in COPD patients than in controls, and occurred to the same extent irrespective of the GOLD stage. The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness, health status, presence of co-morbidity, exercise capacity and number of exacerbations reported in the year before the study. The distribution of these variables within each GOLD stage was wide. Even in subjects with severe airflow obstruction, a substantial proportion did not report symptoms, exacerbations or exercise limitation. The amount of emphysema increased with GOLD severity. The prevalence of bronchiectasis was low (4% but also increased with GOLD stage. Some gender differences were also identified. Conclusions The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease.

  17. Should mild COPD be treated? Evidence for early pharmacological intervention.

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    Elbehairy, Amany F; Webb, Katherine A; Neder, J Alberto; Alberto Neder, J; O'Donnell, Denis E

    2013-12-01

    Chronic obstructive pulmonary disease (COPD) is a common and often progressive inflammatory disease of the airways that is both preventable and treatable. It is well established that those with mild-to-moderate disease severity represent the majority of patients with COPD, yet this subpopulation is relatively under-studied. Because of an insidious pre-clinical phase, COPD is both under-diagnosed and under-treated. Recent studies have confirmed that even patients with mild, grade 1 COPD [i.e. those with a reduced forced expiratory volume in one second (FEV1)/forced vital capacity ratio but normal FEV1], have measurable physiological impairment with increased morbidity and a higher risk of mortality compared with non-smoking healthy controls. Beyond the imperative of smoking cessation-the pivotal intervention in all COPD stages-the role of pharmacotherapy for prevention of disease progression has yet to be established. The main objective of this review is to provide a concise overview of the heterogeneous pathophysiology of COPD with only mild airway obstruction on spirometry and obstacles for early diagnosis. We emphasize that the absence of sufficiently powered trials involving a large number of patients precludes definitive recommendations in support of (or against) long-term pharmacological treatment in mild COPD. Despite these limitations, we present a rationale for earlier pharmacological intervention derived from recent physiological studies performed in symptomatic patients with mild COPD.

  18. Central airways remodeling in COPD patients

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    Pini L

    2014-09-01

    Full Text Available Laura Pini,1 Valentina Pinelli,2 Denise Modina,1 Michela Bezzi,3 Laura Tiberio,4 Claudio Tantucci1 1Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, 2Department of Respiratory Medicine, Spedali Civili di Brescia, 3Department Bronchoscopy, Spedali Civili di Brescia, 4Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy Background: The contribution to airflow obstruction by the remodeling of the peripheral airways in chronic obstructive pulmonary disease (COPD patients has been well documented, but less is known about the role played by the large airways. Few studies have investigated the presence of histopathological changes due to remodeling in the large airways of COPD patients. Objectives: The aim of this study was to verify the presence of airway remodeling in the central airways of COPD patients, quantifying the airway smooth muscle (ASM area and the extracellular matrix (ECM protein deposition, both in the subepithelial region and in the ASM, and to verify the possible contribution to airflow obstruction by the above mentioned histopathological changes. Methods: Biopsies of segmental bronchi spurs were performed in COPD patients and control smoker subjects and immunostained for collagen type I, versican, decorin, biglycan, and alpha-smooth muscle actin. ECM protein deposition was measured at both subepithelial, and ASM layers. Results: The staining for collagen I and versican was greater in the subepithelial layer of COPD patients than in control subjects. An inverse correlation was found between collagen I in the subepithelial layer and both forced expiratory volume in 1 second and ratio between forced expiratory volume in 1 second and forced vital capacity. A statistically significant increase of the ASM area was observed in the central airways of COPD patients versus controls. Conclusion: These findings indicate that airway remodeling also affects

  19. Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data

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    Sarah J. Ronaldson

    2017-06-01

    Full Text Available It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who attended their general practice for a COPD exacerbation during 2000–2013 was identified from the Clinical Practice Research Datalink. Two groups were formed (“immediate antibiotics” or “no antibiotics” based on whether antibiotics were prescribed during the index general practice (GP consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks in the base case. The use of antibiotics for COPD exacerbations resulted in cost savings and an improvement in all outcomes analysed; i.e. GP visits, hospitalisations, community respiratory team referrals, all referrals, infections and subsequent antibiotics prescriptions were lower for the antibiotics group. Hence, the use of antibiotics was dominant over no antibiotics. The economic analysis suggests that use of antibiotics for COPD exacerbations is a cost-effective alternative to not prescribing antibiotics for patients who present to their GP, and remains cost-effective when longer time horizons of 3 months and 12 months are considered. It would be useful for a definitive trial to be undertaken in this area to determine the cost-effectiveness of antibiotics for COPD exacerbations.

  20. Sex-specific effect of body weight gain on systemic inflammation in subjects with COPD: results from the SAPALDIA cohort study 2.

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    Bridevaux, P-O; Gerbase, M W; Schindler, C; Dietrich, D Felber; Curjuric, I; Dratva, J; Ackermann-Liebrich, U; Probst-Hensch, N M; Gaspoz, J-M; Rochat, T

    2009-08-01

    Systemic inflammation may mediate the association between chronic obstructive pulmonary disease (COPD) and extrapulmonary comorbidities. We measured high-sensitivity C-reactive protein (hs-CRP) in COPD and quantified the effect modification by body weight change and sex. Using data from the Swiss study on Air Pollution and Lung Diseases in Adults (SAPALDIA; n = 5,479) with measurements of forced expiratory volume in 1 s (FEV(1)), body weight and hs-CRP, we examined the association of hs-CRP and categories of body weight change (lost weight and weight gained 0-5%, 5-9%, 9-14% and >14%) with fast FEV(1) decline. hs-CRP was elevated both in association with fast FEV(1) decline and body weight gain. Subjects with fast FEV(1) decline and weight gain (>14%) had higher hs-CRP (2.0 mg L(-1) for females versus 1.6 mg L(-1) for males). After adjustment for age, smoking, physical activity, hormonal therapy and diabetes, elevated hs-CRP (>3 mg) was found to be more likely in subjects with fast FEV(1) decline (OR(males) 1.38, OR(females) 1.42) and in those with weight gain >14% (OR(males) 2.04, OR(females) 4.51). The association of weight gain and fast FEV(1) decline predicts a higher level of systemic inflammation. Since the effect of weight gain on systemic inflammation is larger in females than in males, weight gain may be a risk factor for extrapulmonary comorbidities in females with COPD.

  1. Efficacy and safety of indacaterol 150 μg once-daily in COPD: a double-blind, randomised, 12-week study

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    2010-01-01

    Background Indacaterol is a novel, once-daily (o.d.) inhaled, long-acting β2-agonist in development for chronic obstructive pulmonary disease (COPD). This 12-week, double-blind study compared the efficacy, safety, and tolerability of indacaterol to that of placebo in patients with moderate-to-severe COPD. Methods Efficacy variables included 24-h trough FEV1 (mean of 23 h 10 min and 23 h 45 min post-dose) at Week 12 (primary endpoint) and after Day 1, and the percentage of COPD days with poor control (i.e., worsening symptoms). Safety was assessed by adverse events (AEs), mean serum potassium and blood glucose, QTc (Fridericia), and vital signs. Results Patients were randomised (n = 416, mean age 63 years) to receive either indacaterol 150 μg o.d. (n = 211) or placebo (n = 205) via a single-dose dry-powder inhaler; 87.5% completed the study. Trough FEV1 (LSM ± SEM) at Week 12 was 1.48 ± 0.018 L for indacaterol and 1.35 ± 0.019 L for placebo, a clinically relevant difference of 130 ± 24 mL (p indacaterol than placebo (p Indacaterol demonstrated significantly higher peak FEV1 than placebo, both on Day 1 and at Week 12, with indacaterol-placebo differences (LSM ± SEM) of 190 ± 28 (p indacaterol than placebo (p Indacaterol significantly reduced the percentage of days of poor control versus placebo by 22.5% (p indacaterol 49.3%, placebo 46.8%), with the most common AEs being COPD worsening (indacaterol 8.5%, placebo 12.2%) and cough (indacaterol 6.2%, placebo 7.3%). One patient died in the placebo group. Serum potassium and blood glucose levels did not differ significantly between the two groups, and no patient had QTc >500 ms. Conclusions Indacaterol 150 μg o.d. provided clinically significant and sustained bronchodilation, reduced rescue medication use, and had a safety and tolerability profile similar to placebo. Trial registration NCT00624286 PMID:20211002

  2. Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD: a pilot study

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    Braz Júnior DS

    2015-01-01

    Full Text Available Donato S Braz Júnior, Arméle Dornelas de Andrade, Andrei S Teixeira, Cléssyo A Cavalcanti, André B Morais, Patrícia EM Marinho Department of Physical Therapy, Cardiopulmonary Physical Therapy Laboratory, Universidade Federal de Pernambuco, Recife, Brazil Background: Exercise intolerance is a common development in patients with chronic obstructive pulmonary disease (COPD. There is little data on the use of an isolated program using vibration platform training on functional capacity in these patients, which is an area that deserves investigation.Aim: To investigate the effect of training on a vibrating platform (whole-body vibration [WBV] on functional performance and quality of life of subjects with COPD.Methods: A randomized controlled crossover pilot study with eleven subjects with COPD (forced expiratory volume in 1 second [FEV1]% predicted =14.63±11.14; forced vital capacity [FVC]% predicted =48.84±15.21; FEV1/FVC =47.39±11.63 underwent a 12-week WBV training program. Participants were randomized into the intervention group (IG undergoing three sessions per week for a total of 12 weeks and control group (CG without intervention. We evaluated the 6-minute walk test (6MWT, distance walked (DW, duration of the walk (TW, and index of perceived exertion (IPE, quality of life using St George’s Respiratory Questionnaire (SGRQ and developed a 12-week program of training on a vibrating platform.Results: The mean age was 62.91±8.82 years old (72.7% male. The DW increased at the end of training with a difference between groups of 75 m; all domains of the SGRQ improved at the end of training. The effect size Cohen’s d ranged from small to large for all the measured results.Conclusion: These preliminary results suggest that WBV may potentially be a safe and feasible way to improve functional capacity in the 6MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life

  3. [Regenerative approach for COPD].

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    Kubo, Hiroshi

    2011-10-01

    No treatment to cure of chronic obstructive pulmonary disease (COPD) is available. Regenerative medicine is one of promising areas for this intractable disease. Several reagents and growth factors are known to promote lung regeneration in small animal models. However, regenerative medicines for human lungs are not achieved yet. Recent advances in stem cell biology and tissue engineering have expanded our understanding of lung endogenous stem cells, and this new knowledge provides us with new ideas for future regen