Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD).

Science.gov (United States)

Stellefson, Michael L; Shuster, Jonathan J; Chaney, Beth H; Paige, Samantha R; Alber, Julia M; Chaney, J Don; Sriram, P S

2017-09-05

Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients' eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation's National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = -0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients

Dietary vitamin C intake protects against COPD: the Korea National Health and Nutrition Examination Survey in 2012

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Park HJ

2016-10-01

Full Text Available Hye Jung Park,1 Min Kwang Byun,1 Hyung Jung Kim,1 Jae Yeol Kim,2 Yu-Il Kim,3 Kwang-Ha Yoo,4 Eun Mi Chun,5 Ji Ye Jung,6 Sang Haak Lee,7 Chul Min Ahn1 On behalf of the Korean Smoking Cessation Study Group 1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 2Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, 3Department of Internal Medicine, Chonnam National University Hospital, Gwangju, 4Department of Internal Medicine, Konkuk University School of Medicine, 5Department of Internal Medicine, Ewha Womans University School of Medicine, 6Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, 7Division of Pulmonology, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Background: Vitamin C, as an antioxidant, has recently been suggested to provide protection against COPD; however, only few national cohort studies have investigated these effects. We aimed to confirm the protective effects of vitamin C against COPD in Korean patients. Patients and methods: We analyzed the data of 3,283 adults aged ≥40 years (representing 23,541,704 subjects who underwent pulmonary function tests and responded to questionnaires on smoking history and vitamin C intake, with stratification variables and sampling weight designated by the Korea 2012 National Health and Nutrition Examination Survey. Results: Among all the subjects, 512 (representing 3,459,679 subjects; 15.6% were diagnosed as having COPD based on pulmonary function test results. Male gender, old age, residence in suburban/rural regions, low household income, low educational level, an occupation in agriculture or fisheries, and heavy smoking were significantly associated with COPD. Low intake of nutrients, including potassium, vitamin A, carotene, retinol

Continuing to Confront COPD International Patient Survey: Economic Impact of COPD in 12 Countries.

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Foo, Jason; Landis, Sarah H; Maskell, Joe; Oh, Yeon-Mok; van der Molen, Thys; Han, MeiLan K; Mannino, David M; Ichinose, Masakazu; Punekar, Yogesh

2016-01-01

The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD. This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation), contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient. The annual direct costs of COPD ranged from $504 (South Korea) to $9,981 (USA), with inpatient hospitalisations (5 countries) and home oxygen therapy (3 countries) being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy) to 52% (USA and UK) with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia) to $30,826 (USA) but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease) and a greater number of comorbidities. The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs.

Continuing to Confront COPD International Patient Survey: Economic Impact of COPD in 12 Countries.

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Jason Foo

Full Text Available The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD.This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation, contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient.The annual direct costs of COPD ranged from $504 (South Korea to $9,981 (USA, with inpatient hospitalisations (5 countries and home oxygen therapy (3 countries being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy to 52% (USA and UK with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia to $30,826 (USA but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease and a greater number of comorbidities.The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs.

COPD360social Online Community: A Social Media Review.

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Stellefson, Michael; Paige, Samantha R; Alber, Julia M; Stewart, Margaret

2018-06-01

People living with chronic obstructive pulmonary disease (COPD) commonly report feelings of loneliness and social isolation due to lack of support from family, friends, and health care providers. COPD360social is an interactive and disease-specific online community and social network dedicated to connecting people living with COPD to evidence-based resources. Through free access to collaborative forums, members can explore, engage, and discuss an array of disease-related topics, such as symptom management. This social media review provides an overview of COPD360social, specifically its features that practitioners can leverage to facilitate patient-provider communication, knowledge translation, and community building. The potential of COPD360social for chronic disease self-management is maximized through community recognition programming and interactive friend-finding tools that encourage members to share their own stories through blogs and multimedia (e.g., images, videos). The platform also fosters collaborative knowledge dissemination and helping relationships among patients, family members, friends, and health care providers. Successful implementation of COPD360social has dramatically expanded patient education and self-management support resources for people affected by COPD. Practitioners should refer patients and their families to online social networks such as COPD360social to increase knowledge and awareness of evidence-based chronic disease management practices.

General practitioners' perceptions of COPD treatment

DEFF Research Database (Denmark)

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

2016-01-01

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...

Differences in adjustment between individuals with alpha-1 antitrypsin deficiency (AATD)-associated COPD and non-AATD COPD.

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Holm, Kristen E; Borson, Soo; Sandhaus, Robert A; Ford, Dee W; Strange, Charlie; Bowler, Russell P; Make, Barry J; Wamboldt, Frederick S

2013-04-01

Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD.

Differences in Adjustment between Individuals with Alpha-1 Antitrypsin Deficiency (AATD) Associated COPD and Non-AATD COPD

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Holm, Kristen E.; Borson, Soo; Sandhaus, Robert A.; Ford, Dee W.; Strange, Charlie; Bowler, Russell P.; Make, Barry J.; Wamboldt, Frederick S.

2013-01-01

Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD. PMID:23547634

Comparison of COPD Assessment Test and Clinical COPD Questionnaire to predict the risk of exacerbation

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Jo YS

2017-12-01

Full Text Available Yong Suk Jo,1 Ho Il Yoon,2 Deog Kyeom Kim,3 Chul-Gyu Yoo,1 Chang-Hoon Lee1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea Background and objective: Guidelines recommend the use of simple but comprehensive tools such as COPD Assessment Test (CAT and Clinical COPD Questionnaire (CCQ to assess health status in COPD patients. We aimed to compare the ability of CAT and CCQ to predict exacerbation in COPD patients. Methods: We organized a multicenter prospective cohort study that included COPD patients. The relationships between CAT, CCQ, and other clinical measurements were analyzed by correlation analysis, and the impact of CAT and CCQ scores on exacerbation was analyzed by logistic regression analyses and receiver operating characteristic curve. Results: Among 121 COPD patients, CAT and CCQ score correlated with other symptom measures, lung function and exercise capacity as well. Compared with patients who did not experience exacerbation, those who experienced exacerbation (n=45; 38.2% exhibited more severe airflow limitation, were more likely to have a history of exacerbation in the year prior to enrollment, and demonstrated higher CAT scores. CCQ scores were not significantly associated with exacerbations. A CAT score of ≥15 was an independent risk factor for exacerbation (adjusted odds ratio [aOR], 2.40; 95% CI, 1.03–6.50; P=0.04. Furthermore, CAT scores of ≥15 demonstrated an increased predictive ability for exacerbation compared with currently accepted guidelines for the use of CAT (≥10 and CCQ (≥1 in the assessment of COPD

Updates on the COPD gene list

Science.gov (United States)

Bossé, Yohan

2012-01-01

A genetic contribution to develop chronic obstructive pulmonary disease (COPD) is well established. However, the specific genes responsible for enhanced risk or host differences in susceptibility to smoke exposure remain poorly understood. The goal of this review is to provide a comprehensive literature overview on the genetics of COPD, highlight the most promising findings during the last few years, and ultimately provide an updated COPD gene list. Candidate gene studies on COPD and related phenotypes indexed in PubMed before January 5, 2012 are tabulated. An exhaustive list of publications for any given gene was looked for. This well-documented COPD candidate-gene list is expected to serve many purposes for future replication studies and meta-analyses as well as for reanalyzing collected genomic data in the field. In addition, this review summarizes recent genetic loci identified by genome-wide association studies on COPD, lung function, and related complications. Assembling resources, integrative genomic approaches, and large sample sizes of well-phenotyped subjects is part of the path forward to elucidate the genetic basis of this debilitating disease. PMID:23055711

The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings

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Hernandez-Barrera Valentín

2010-02-01

Full Text Available Abstract Background To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions. Methods Epidemiologic, observational, and descriptive study (EPIDEPOC study. Patients ≥ 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12, seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease. Results A total of 9,390 patients with COPD were examined of whom 1,770 (18.8% had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 ± 2,957 vs. 1,749 ± 2,120, p Conclusion Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.

[End therapeutic nihilism towards COPD].

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Juergens, Uwe R

2007-03-15

Prevention of COPD requires appropriate patient education, especially of adolescents, as well as the establishment of an effective national health policy. The new GOLD guidelines represent the current standard of knowledge on the management of chronic, progressive, obstructive pulmonary diseases. It points out that COPD is avoidable and treatable,and hence, there is no reason for therapeutic nihilism. Chronic bronchitis preceding a progressive respiratory obstruction cannot be improved with the presently available respiratory therapeutics. For this reason, therapeutic measures concentrate on the avoidance of exacerbations, which are primarily responsible for the severity of the course of COPD.

[The German Program for Disease Management Guidelines: COPD Guideline 2006. Short review].

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Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika

2007-01-15

In Germany, the first national consensus on evidence-based recommendations for COPD prevention and disease management was reached in spring 2006. After a development period of 9 months, the National Disease Management Guideline COPD was finalized by nominal group process under the authorship of the scientific societies for pneumology (DGP and Atemwegsliga), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the NICE COPD Guideline 2004, the GOLD Recommendations as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline COPD 2006 (www.copd.versorgungsleitlinien.de).

Socioeconomic impact of asthma, chronic obstructive pulmonary disease and asthma-COPD overlap syndrome.

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Kim, Jinhee; Kim, Young Sam; Kim, Kyungjoo; Oh, Yeon-Mok; Yoo, Kwang Ha; Rhee, Chin Kook; Lee, Jin Hwa

2017-06-01

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is defined as having both features of asthma and COPD, which are airway hyper-responsiveness and incompletely reversible airway obstruction. However, socioeconomic impact of ACOS have not been well appreciated. Adults with available wheezing history and acceptable spirometry were selected from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) in 2007-2009. Their data were merged with the Korean National Health Insurance claim data. 'Asthma group' was defined as having self-reported wheezing history and FEV 1 /FVC ≥0.7, 'COPD group' was defined as having FEV 1 /FVC COPD, 8.4%; asthma, 5.8% and NAD, 83.6%. Total length of healthcare utilization and medical costs of ACOS group was the top among four groups (PCOPD group (P=0.025). Multiple linear regression analyses showed that ACOS group (β=12.63, P<0.001) and asthma group (β=6.14, P<0.001) were significantly associated with longer duration of healthcare utilization and ACOS group (β=350,475.88, P=0.008) and asthma group (β=386,876.81, P<0.001) were associated with higher medical costs. This study demonstrated that ACOS independently influences healthcare utilization after adjusting several factors. In order to utilize limited medical resources efficiently, it may be necessary to find and manage ACOS patients.

Improving quality of care among COPD outpatients in Denmark 2008-2011

DEFF Research Database (Denmark)

Tøttenborg, Sandra Søgaard; Lange, P.; Thomsen, R.W.

2013-01-01

OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program. METHODS: We conducted a nationwide, population-based prospective cohort study...... a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD....... using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85...

COPD exacerbations by disease severity in England

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Merinopoulou E

2016-04-01

Full Text Available Evie Merinopoulou,1 Mireia Raluy-Callado,1 Sreeram Ramagopalan,1 Sharon MacLachlan,1 Javaria Mona Khalid2 1Real-World Evidence, Evidera, 2Takeda Development Centre Europe Ltd, London, UK Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD are associated with accelerated disease progression and are important drivers of health care resource utilization. The study aimed to quantify the rates of COPD exacerbations in England and assess health care resource utilization by severity categories according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2013.Methods: Data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics were used to identify patients with a COPD diagnosis aged ≥40 years. Those with complete spirometric, modified Medical Research Council Dyspnea Scale information, and exacerbation history 12 months prior to January 1, 2011 (index date were classified into GOLD severity groups. Study outcomes over follow-up (up to December 31, 2013 were exacerbation rates and resource utilization (general practitioner visits, hospital admissions.Results: From the 44,201 patients in the study cohort, 83.5% were classified into severity levels GOLD A: 33.8%, GOLD B: 21.0%, GOLD C: 18.1%, and GOLD D: 27.0%. Mean age at diagnosis was 66 years and 52.0% were male. Annual exacerbation rates per person-year increased with severity, from 0.83 (95% confidence interval [CI]: 0.81–0.85 for GOLD A to 2.51 (95% CI: 2.47–2.55 for GOLD D. General practitioner visit rates per person-year also increased with severity, from 4.82 (95% CI: 4.74–4.93 for GOLD A to 7.44 (95% CI: 7.31–7.61 for GOLD D. COPD-related hospitalization rates per person-year increased from less symptoms (GOLD A: 0.28, GOLD C: 0.39 to more symptoms (GOLD B: 0.52, GOLD D: 0.84.Conclusion: Patients in the most severe category (GOLD D experienced nearly three times the number of exacerbations and COPD

COPD online-rehabilitation versus conventional COPD rehabilitation

DEFF Research Database (Denmark)

Hansen, Henrik; Bieler, Theresa; Beyer, Nina

2017-01-01

BACKGROUND: Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program......, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline assessments. DISCUSSION: The study will likely contribute to knowledge regarding COPD tele...... accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). METHODS: This study is a randomized assessor- and statistician blinded superiority multicenter...

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain.

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Baré, Marisa; Montón, Concepción; Mora, Laura; Redondo, Maximino; Pont, Marina; Escobar, Antonio; Sarasqueta, Cristina; Fernández de Larrea, Nerea; Briones, Eduardo; Quintana, Jose Maria

2017-01-01

We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. This was a prospective study and it included patients from 22 hospitals located in Spain - 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients.

COPD: When You Learn More, You'll Breathe Better

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Skip Navigation Bar Home Current Issue Past Issues COPD: When You Learn More, You'll Breathe Better ... Trial to Look at Home Oxygen Therapy for COPD The National Heart, Lung, and Blood Institute (NHLBI) ...

Validity and underrecording of diagnosis of COPD in the Danish National Patient Registry

DEFF Research Database (Denmark)

Thomsen, Reimar W; Lange, Peter; Hellquist, Birthe

2011-01-01

, and for 1546 patients with a discharge diagnosis of either pneumonia or respiratory failure but no COPD diagnosis. Presence of COPD was assessed based on medical history, clinical symptoms and findings, and spirometry results. RESULTS: The overall positive predictive value for COPD was 92% (95% confidence...

Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data.

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Ronaldson, Sarah J; Raghunath, Anan; Torgerson, David J; Van Staa, Tjeerd

2017-04-01

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.

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.

COPD Medicine

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... 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 ...

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

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Calle Rubio M

2017-01-01

Full Text Available Myriam Calle Rubio,1–3 Bernardino Alcázar Navarrete,4 Joan B Soriano,5 Juan J Soler-Cataluña,6 José Miguel Rodríguez González-Moro,7 Manuel E Fuentes Ferrer,2,3,8 José Luis López-Campos9 On behalf of the EPOCONSUL Study 1Pulmonary Department, Hospital Clínico San Carlos, 2Department of Medicine, Faculty of Medicine, University Complutense of Madrid, 3Research Institute of Hospital Clínico San Carlos (IdISSC, Madrid, 4Pulmonary Department, Hospital de Alta Resolución de Noja, Granada, 5Research Institute of Hospital University La Princesa (IISP, University Autónoma of Madrid, 6Pulmonary Department, Hospital de Arnau de Villanova, Valencia, 7Pulmonary Department, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, 8UGC of Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid, 9Pulmonary Department, Hospital University Virgen del Rocio, Institute of Biomedicine of Sevilla (IBiS, Sevilla, Spain 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

Natural course of early COPD

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Rhee CK

2017-02-01

Full Text Available Chin Kook Rhee,1 Kyungjoo Kim,1 Hyoung Kyu Yoon,2 Jee-Ae Kim,3 Sang Hyun Kim,4 Sang Haak Lee,5 Yong Bum Park,6 Ki-Suck Jung,7 Kwang Ha Yoo,8 Yong Il Hwang7 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Pharmaceutical Policy Evaluation Research Team, Research Institution, 4Big Data Division, Health Insurance Review and Assessment Service, Wonju, 5Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, College of Medicine, The Catholic University of Korea, 6Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 8Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea Background and objective: Few studies have examined the natural course of early COPD. The aim of this study was to observe the natural course of early COPD patients. We also aimed to analyze medical utilization and costs for early COPD during a 6-year period. Methods: Patients with early COPD were selected from Korean National Health and Nutrition Examination Survey (KNHANES data. We linked the KNHANES data of patients with early COPD to National Health Insurance data. Results: A total of 2,397 patients were enrolled between 2007 and 2012. The mean forced expiratory volume in 1 second (FEV1 was 78.6%, and the EuroQol five dimensions questionnaire (EQ-5D index value was 0.9. In total, 110 patients utilized health

Determinants of elevated healthcare utilization in patients with COPD

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Bernhard-Scharf Barbara J

2011-01-01

Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients. Results Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p Conclusion Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

The COPD Knowledge Base: enabling data analysis and computational simulation in translational COPD research.

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Cano, Isaac; Tényi, Ákos; Schueller, Christine; Wolff, Martin; Huertas Migueláñez, M Mercedes; Gomez-Cabrero, David; Antczak, Philipp; Roca, Josep; Cascante, Marta; Falciani, Francesco; Maier, Dieter

2014-11-28

Previously we generated a chronic obstructive pulmonary disease (COPD) specific knowledge base (http://www.copdknowledgebase.eu) from clinical and experimental data, text-mining results and public databases. This knowledge base allowed the retrieval of specific molecular networks together with integrated clinical and experimental data. The COPDKB has now been extended to integrate over 40 public data sources on functional interaction (e.g. signal transduction, transcriptional regulation, protein-protein interaction, gene-disease association). In addition we integrated COPD-specific expression and co-morbidity networks connecting over 6 000 genes/proteins with physiological parameters and disease states. Three mathematical models describing different aspects of systemic effects of COPD were connected to clinical and experimental data. We have completely redesigned the technical architecture of the user interface and now provide html and web browser-based access and form-based searches. A network search enables the use of interconnecting information and the generation of disease-specific sub-networks from general knowledge. Integration with the Synergy-COPD Simulation Environment enables multi-scale integrated simulation of individual computational models while integration with a Clinical Decision Support System allows delivery into clinical practice. The COPD Knowledge Base is the only publicly available knowledge resource dedicated to COPD and combining genetic information with molecular, physiological and clinical data as well as mathematical modelling. Its integrated analysis functions provide overviews about clinical trends and connections while its semantically mapped content enables complex analysis approaches. We plan to further extend the COPDKB by offering it as a repository to publish and semantically integrate data from relevant clinical trials. The COPDKB is freely available after registration at http://www.copdknowledgebase.eu.

Impacts of coexisting bronchial asthma on severe exacerbations in mild-to-moderate COPD: results from a national database

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Lee H

2016-04-01

prevalence of severe exacerbations and impact of asthma on severe exacerbations, especially in patients with mild-to-moderate COPD.Methods: Patients with mild-to-moderate COPD (≥40 years were extracted from Korean National Health and Nutrition Examination Survey data (2007–2012 and were linked to the national health insurance reimbursement database to obtain medical service utilization records.Results: Of the 2,397 patients with mild-to-moderate COPD, 111 (4.6% had severe exacerbations over the 6 years (0.012/person-year. Severe exacerbations were more frequent in the COPD patients with concomitant self-reported physician-diagnosed asthma compared with only COPD patients (P<0.001. A multiple logistic regression presented that asthma was an independent risk factor of severe exacerbations in patients with mild-to-moderate COPD regardless of adjustment for all possible confounding factors (adjusted odds ratio, 1.67; 95% confidence interval, 1.002–2.77, P=0.049. In addition, age, female, poor lung function, use of inhalers, and low EuroQoL five dimensions questionnaire index values were independently associated with severe exacerbation in patients with mild-to-moderate COPD.Conclusion: In this population-based study, the prevalence of severe exacerbations in patients with mild-to-moderate COPD was relatively low, compared with previous clinical interventional studies. Coexisting asthma significantly impacted the frequency of severe exacerbations in patients with mild-to-moderate COPD, suggesting application of an exacerbation preventive strategy in these patients. Keywords: bronchial asthma, chronic obstructive pulmonary disease, acute exacerbation

Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001–2011

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de Miguel-Díez J

2015-10-01

Full Text Available Javier de Miguel-Díez,1 Rodrigo Jiménez-García,2 Valentín Hernández-Barrera,2 Pilar Carrasco-Garrido,2 Héctor Bueno,3 Luis Puente-Maestu,1 Isabel Jimenez-Trujillo,2 Alejandro Alvaro-Meca,2 Jesús Esteban-Hernandez,2 Ana López de Andrés21Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; 2Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain; 3Centro Nacional de Investigaciones Cardiovasculares, Instituto de investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, SpainBackground: People with COPD suffering from coronary artery disease are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of these procedures in COPD and non-COPD patients in Spain between 2001 and 2011.Methods: We identified all patients who had undergone percutaneous coronary interventions (PCIs and coronary artery bypass graft (CABG surgeries, using national hospital discharge data. Discharges were grouped into: COPD and no COPD.Results: From 2001 to 2011, 428,516 PCIs and 79,619 CABGs were performed. The sex and age-adjusted use of PCI increased by 21.27% per year from 2001 to 2004 and by 5.47% per year from 2004 to 2011 in patients with COPD. In-hospital mortality (IHM among patients with COPD who underwent a PCI increased significantly from 2001 to 2011 (odds ratio 1.11; 95% confidence interval 1.03–1.20. Among patients with COPD who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 9.77% per year from 2001 to 2003, and then decreased by 3.15% through 2011. The probability of dying during hospitalization in patients who underwent a CABG did not change significantly in patients with and without COPD (odds ratio, 1.06; 95

Early detection of COPD in general practice

DEFF Research Database (Denmark)

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

2011-01-01

Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early...... detection of COPD. The aim, therefore, was to provide evidence for the feasibility and impact of doing spirometry in this target population....

Different impacts of respiratory symptoms and comorbidities on COPD-specific health-related quality of life by COPD severity

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Lee H

2017-11-01

Full Text Available Hyun Lee,1,* Byung Woo Jhun,1,* Juhee Cho,2–4 Kwang Ha Yoo,5 Jin Hwa Lee,6 Deog Kyeom Kim,7 Jong Deog Lee,8 Ki-Suck Jung,9 Jung Yeon Lee,10 Hye Yun Park1 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 2Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea; 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea; 6Division of Pulmonary and Critical Care Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea; 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea; 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, South Korea; 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, South Korea *These authors contributed equally to this work Background: Patients with chronic obstructive pulmonary disease (COPD often have poor health-related quality of life (HRQoL that is disproportionate to their degree of airflow limitation. This study evaluated the association between St

Influence of country-level differences on COPD prevalence

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Aaron SD

2016-09-01

Full Text Available Shawn D Aaron,1 Andrea S Gershon,2 Yuan Gao,1 Jenna Yang,1 GA Whitmore1,3 On behalf of the Canadian Respiratory Research Network 1Ottawa Hospital Research Institute, University of Ottawa, Ottawa, 2Sunnybrook Research Institute, University of Toronto, ON, 3Desautels Faculty of Management, McGill University, Montreal, QC, Canada Purpose: Studies suggest that COPD prevalence may vary between countries. We conducted an ecological study of data from COPD prevalence articles to assess the influence of differences in country-level risk factors on COPD prevalence. Patients and methods: Our study covered English language articles published during 2003–2014. Qualified articles used spirometry to assess COPD prevalence and used representative samples from national or subnational populations. Stepwise binomial regression was used to analyze associations between study- and country-level factors and COPD prevalence. Results: Eighty articles provided 1,583 measures of COPD prevalence for subjects in different sex, age, and smoking categories for 112 districts in 41 countries. Adjusted prevalence rates for COPD were significantly lower for Australia/New Zealand and the Mediterranean and significantly higher for Latin America, compared to North America, Southeast Asia, and Northern Europe. Country-level socioeconomic development variables had an uneven and mixed association with COPD prevalence. High elevation above sea level was shown to be a protective factor for COPD. Study-level variables for the established risk factors of sex, age, and smoking explained 64% of variability in COPD prevalence. Country-level risk factors raised the explanatory power to 72%. Approximately 28% of worldwide variability in COPD prevalence remained unexplained. Conclusion: Our study suggests that COPD prevalence varies across world regions, even after adjustment for established risk factors. Major country-level risk factors contributing to the worldwide epidemic of COPD remain

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

DEFF Research Database (Denmark)

Rennard, Stephen I; Vestbo, Jørgen

2008-01-01

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...... of COPD should qualify for the first criterion if the various conditions that comprise COPD are regarded separately. The subphenotyping of COPD into separate...... 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...

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 - control drugs; ...

Are patients with COPD treated with NIV in accordance with national guidelines?

DEFF Research Database (Denmark)

Titlestad, Ingrid Louise; Olsen, Fanny; Sandqvist, Hanna M

2014-01-01

whether NIV is used appropriately, we conducted an audit of COPD patients admitted to a university hospital in Denmark. Material and methods: Data from medical records were retrieved for two cohorts in 2010: 1) all patients admitted to the Medical Emergency Ward with the diagnosis of COPD, and 2) all...

Economic burden of COPD in a Swedish cohort: the ARCTIC study

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Lisspers K

2018-01-01

Full Text Available Karin Lisspers,1 Kjell Larsson,2 Gunnar Johansson,1 Christer Janson,3 Madlaina Costa-Scharplatz,4 Jean-Bernard Gruenberger,5 Milica Uhde,6 Leif Jorgensen,7 Florian S Gutzwiller,5 Björn Ställberg1 1Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, 2Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna, 3Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, 4Novartis AB, Täby, Sweden; 5Novartis, Basel, Switzerland; 6IQVIA, Solna, Sweden; 7IQVIA, Copenhagen, Denmark Background: We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC setting.Patients and methods: Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related and indirect health care costs (loss of income, absenteeism, loss of productivity were assessed.Results: A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179 versus the reference population (€2,716, largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient were the largest economic burden in COPD patients of working age during 2013.Conclusion: As non-COPD-related hospital nights represent the largest direct cost, management of

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

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Mamta Ruparel

2016-03-01

Full Text Available Chronic obstructive pulmonary disease (COPD care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect. The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis. Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days. Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77 and use of mechanical ventilation (OR 2.15. Few individual resource variables were associated with LOS after accounting for the hospital cluster effect. This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

Depression and anxiety in patients with COPD

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Abebaw M. Yohannes

2014-09-01

Full Text Available Under-recognised and untreated depression and anxiety symptoms have deleterious effects on physical functioning and social interaction increasing fatigue and healthcare utilisation in patients with chronic obstructive pulmonary disease (COPD. Depression and anxiety are challenging to identify and treat because their symptoms often overlap with those of COPD. The cause(s of depression and anxiety symptoms are multifactorial and include behavioural, social and biological factors. Less than one-third of COPD patients with comorbid depression or anxiety symptoms are receiving appropriate treatment. Factors that contribute to the lack of provision of treatment are varied, they include patient perceived barriers, for example lack of knowledge and reluctance to receive antidepressant drug therapy; poor treatment compliance and lack of a standardised diagnostic approach; and scarcity of adequate resources for mental health treatment. The evidence for the efficacy of antidepressant drug therapy in patients with COPD with comorbid depression and anxiety is inconclusive. There are some promising findings regarding pulmonary rehabilitation, psychological therapy and the collaborative care model in reducing depression and anxiety symptoms in patients with COPD, but these findings are limited by short-term follow-up periods. Further work is required to examine the efficacy of these interventions in randomised controlled trials with larger samples and long-term follow-up.

Budgetary impact analysis on funding smoking-cessation drugs in patients with COPD in Spain.

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Jiménez-Ruiz, Carlos A; Solano-Reina, Segismundo; Signes-Costa, Jaime; de Higes-Martinez, Eva; Granda-Orive, José I; Lorza-Blasco, José J; Riesco-Miranda, Juan A; Altet-Gomez, Neus; Barrueco, Miguel; Oyagüez, Itziar; Rejas, Javier

2015-01-01

The aim of the study was to assess the budgetary impact of funding smoking-cessation drugs in COPD patients in Spain. A hybrid model (cohort and Markov) was developed for a 5-year time horizon. Only approved cessation drugs (varenicline, bupropion, and nicotine replacement therapy) were considered. Irrespective of the drug, the model allowed for an initial cessation attempt, and up to three additional attempts in case of failure or smoking relapse during a 5-year period. Drug effectiveness was based on controlled clinical trials. National Health System perspective was applied; therefore, only medical resources were included. The pharmaceutical costs for smoking-cessation drugs, extra medical follow-up as a consequence of public reimbursement, and annual savings for health costs avoided due to stopping smoking were considered. The model estimated that 17,756 COPD patients would stop smoking if public funding was available, compared with 1,303 without reimbursement. In the reimbursement scenario, the savings accounted for a total of €48.0 million, compensating for expenditures on drugs and medical visits (€40.4 million). Accumulated total additional savings in 5 years (€4.3 million) compared with the scenario without reimbursement was shown. Sensitivity analyses supported the results robustness. Funding smoking-cessation drugs in COPD patients seems to be an efficient option and a National Health System drug reimbursement scheme would represent a cost-saving policy in Spain.

Prioritizing chronic obstructive pulmonary disease (COPD) candidate genes in COPD-related networks.

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Zhang, Yihua; Li, Wan; Feng, Yuyan; Guo, Shanshan; Zhao, Xilei; Wang, Yahui; He, Yuehan; He, Weiming; Chen, Lina

2017-11-28

Chronic obstructive pulmonary disease (COPD) is a multi-factor disease, which could be caused by many factors, including disturbances of metabolism and protein-protein interactions (PPIs). In this paper, a weighted COPD-related metabolic network and a weighted COPD-related PPI network were constructed base on COPD disease genes and functional information. Candidate genes in these weighted COPD-related networks were prioritized by making use of a gene prioritization method, respectively. Literature review and functional enrichment analysis of the top 100 genes in these two networks suggested the correlation of COPD and these genes. The performance of our gene prioritization method was superior to that of ToppGene and ToppNet for genes from the COPD-related metabolic network or the COPD-related PPI network after assessing using leave-one-out cross-validation, literature validation and functional enrichment analysis. The top-ranked genes prioritized from COPD-related metabolic and PPI networks could promote the better understanding about the molecular mechanism of this disease from different perspectives. The top 100 genes in COPD-related metabolic network or COPD-related PPI network might be potential markers for the diagnosis and treatment of COPD.

COPD is commonly underdiagnosed in patients with lung cancer: results from the RECOIL study (retrospective study of COPD infradiagnosis in lung cancer

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Parrón Collar D

2017-03-01

Full Text Available Dámaso Parrón Collar,1 Mario Pazos Guerra,1 Paula Rodriguez,1,2 Carolina Gotera,1,2 Ignacio Mahíllo-Fernández,2 Germán Peces-Barba,1,2 Luis M Seijo1,2 1Pulmonary Department, Universidad Autónoma de Madrid, 2Pulmonary Department, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, CIBERES, Madrid, Spain Introduction: Many patients with COPD are underdiagnosed, including patients with coexisting lung cancer. Methods: We conducted a retrospective study of COPD prevalence and outcomes among all patients diagnosed with lung cancer at our institution during a 2-year period. Patients with known COPD (group A were compared with those who received a diagnosis of COPD at the time of their oncologic workup (group B. Results: A total of 306 patients were diagnosed with lung cancer during the study period, including 87 with COPD (28.6%. Sixty percent of patients with coexisting lung cancer and COPD were unaware of their obstructive airways disease prior to the lung cancer diagnosis. Patients in group A were older (74+9 vs 69+9 years; P=0.03, had more severe obstruction (% of predicted forced expiratory volume in one second [FEV1%] 55+17 vs 71+13; P=0.04, more emphysema (91% vs 65%; P=0.02, and worse diffusing capacity of the lungs for carbon monoxide 59+19% vs 72+22%; P=0.01 than patients in group B, but the latter had more advanced lung cancer (27.3% vs 13.8% stage IV disease; P=0.01 and consumed more outpatient resources (P=0.03. Overall mortality was similar (56% vs 58%. However, stage-adjusted mortality showed a trend toward greater mortality in group B patients (1.87 [0.91–3.85]; P=0.087. Conclusion: COPD infradiagnosis is common in patients with coexisting lung cancer and is associated with more advanced cancer stage, greater outpatient resource consumption, and may be associated with greater stage-adjusted mortality. Keywords: lung cancer, COPD, underdiagnosis, staging, survival

COPD in Asia: where East meets West.

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Tan, Wan C; Ng, Tze P

2008-02-01

COPD is a global health concern, and is a major cause of chronic morbidity and mortality worldwide. According to the World Health Organization, it is currently the sixth leading cause of death in the world, and further increases in the prevalence and mortality of the disease is predicted for the coming decades. These increases are mainly linked to the epidemic of tobacco exposure and indoor and outdoor air pollution in Asian countries. The burden of COPD in Asia is currently greater than that in developed Western countries, both in terms of the total number of deaths and the burden of disease, as measured in years of life lost and years spent living with disability. The types of health-care policies and the practice of medicine vary considerably among the regions of Asia and have an impact on the burden of disease. Treatment aims in Asian countries are based on evidence-based management guidelines. Barriers to the implementation of disease management guidelines are related to issues of resource conflict and lack of organizational support rather than cultural differences in medical practice. To reduce this burden of COPD in Asian countries, there is a need for a multifaceted approach in improving awareness of prevalence and disease burden, in facilitating accurate diagnosis of COPD among chronic respiratory diseases, in championing health policies that reduce the burden of the main risk factors for COPD and in the wider use of evidence-based management for COPD.

Continuing to Confront COPD International Patient Survey: methods, COPD prevalence, and disease burden in 2012–2013

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Landis SH

2014-06-01

most countries falling within the range of 7%–9%. In all countries, prevalence increased with age, and in all countries except the US was greater among men (range 6%–14% than among women (range 5%–11%. A significant disease burden was observed when considering COPD symptoms or health status, and showed wide variations across countries. Prevalence of moderate-to-severe dyspnea (mMRC scale ≥2 ranged from 27% to 61%, and mean CAT score ranged from 16.0 to 24.8, indicating medium-to-high impairment. Conclusion: This survey, representing 12 countries, showed similar rates of estimated COPD prevalence across countries that were higher than those reported a decade ago in the original Confronting COPD International Survey. A significant burden of COPD was demonstrated by symptoms and health care-resource use, similar to that reported in the original survey. Keywords: chronic obstructive pulmonary disease, patient perspective, prevalence, patient-reported outcomes

COPD

Science.gov (United States)

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 ...

Folliculin mutations are not associated with severe COPD

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Litonjua Augusto A

2008-12-01

Full Text Available Abstract Background Rare loss-of-function folliculin (FLCN mutations are the genetic cause of Birt-Hogg-Dubé syndrome, a monogenic disorder characterized by spontaneous pneumothorax, fibrofolliculomas, and kidney tumors. Loss-of-function folliculin mutations have also been described in pedigrees with familial spontaneous pneumothorax. Because the majority of patients with folliculin mutations have radiographic evidence of pulmonary cysts, folliculin has been hypothesized to contribute to the development of emphysema. To determine whether folliculin sequence variants are risk factors for severe COPD, we genotyped seven previously reported Birt-Hogg-Dubé or familial spontaneous pneumothorax associated folliculin mutations in 152 severe COPD probands participating in the Boston Early-Onset COPD Study. We performed bidirectional resequencing of all 14 folliculin exons in a subset of 41 probands and subsequently genotyped four identified variants in an independent sample of345 COPD subjects from the National Emphysema Treatment Trial (cases and 420 male smokers with normal lung function from the Normative Aging Study (controls. Results None of the seven previously reported Birt-Hogg-Dubé or familial spontaneous pneumothorax mutations were observed in the 152 severe, early-onset COPD probands. Exon resequencing identified 31 variants, including two non-synonymous polymorphisms and two common non-coding polymorphisms. No significant association was observed for any of these four variants with presence of COPD or emphysema-related phenotypes. Conclusion Genetic variation in folliculin does not appear to be a major risk factor for severe COPD. These data suggest that familial spontaneous pneumothorax and COPD have distinct genetic causes, despite some overlap in radiographic characteristics.

Direct and indirect economic and health consequences of COPD in Denmark

DEFF Research Database (Denmark)

Løkke, Anders; Hilberg, Ole; Tønnesen, Philip

2014-01-01

and higher socioeconomic costs. The employment and the income rates of employed patients with COPD were significantly lower compared with controls. The annual net costs, including social transfers were €8572 for patients with COPD. These consequences were present up to 11 years before first-time diagnosis...... national databases. PARTICIPANTS: 131 811 patients with COPD were identified and compared with 131 811 randomly selected controls matched for age, gender, educational level, residence and marital status. PRIMARY AND SECONDARY OUTCOME MEASURES: Direct and indirect economic and health consequences of COPD...... in Denmark in the time period 1998-2010. RESULTS: Patients with COPD had a poor survival. The average (95% CI) 12-year survival rate was 0.364 (0.364 to 0.368) compared with 0.686 among controls (0.682 to 0.690). COPD was associated with significantly higher rates of health-related contacts, medication use...

Study on drug costs associated with COPD prescription medicine in Denmark

DEFF Research Database (Denmark)

Jakobsen, M; Anker, N; Dollerup, J

2013-01-01

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...... 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...... 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...

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...... 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...... 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...

Patient Views on Three Key Service Areas within Hospital COPD Care

Science.gov (United States)

Roberts, C. Michael; Seiger, Anil; Ingham, Jane

2009-01-01

Objective: The views of patients with Chronic Obstructive Pulmonary Disease (COPD) about three key services (non-invasive ventilation [NIV], early discharge schemes and rehabilitation) were sought in order to inform recommendations for the delivery of optimum care within a national programme of hospital COPD service development. Design: Four focus…

Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany

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Buhl R

2012-02-01

Full Text Available Thomas Glaab1,2, Claus Vogelmeier3, Andreas Hellmann4, Roland Buhl11Department of Respiratory Diseases III, Medical Center of the Johannes Gutenberg-University, Mainz, 2Medical Affairs Germany, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH and Co, KG, Ingelheim, 3Department of Respiratory Diseases, University Hospitals of Giessen and Marburg, Marburg, 4Federal Association of Pneumologists, Augsburg, GermanyBackground: Little is known about the role of guidelines for the practical management of chronic obstructive pulmonary disease (COPD by office-based pulmonary specialists. The aim of this study was to assess their outpatient management in relation to current guideline recommendations for COPD.Methods: A nationwide prospective cross-sectional COPD questionnaire survey in the form of a multiple-choice questionnaire was sent to 1000 office-based respiratory specialists in Germany. The product-neutral questions focused on routine COPD management and were based on current national and international COPD guideline recommendations being consistent in severity classification and treatment recommendations.Results: A total of 590 pulmonary specialists (59% participated in the survey. Body plethysmography was considered the standard for diagnosis (65.9%, followed by spirometry (32%. Most respondents were able to cite the correct spirometric criteria for classifying moderate (87% to very severe COPD (77%. A quarter of the respondents equated the World Health Organization (WHO definition of chronic bronchitis with COPD. Notably, most participants preferred the updated national COPD guidelines (51.4% to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines (40.2%. Improvement of functional exercise capacity and quality of life were considered the two most relevant treatment goals; whereas impact on mortality was secondary. Treatment of COPD largely complied with the guidelines. However, a significant percentage of the

Managing Your COPD Medications

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... Lookup > COPD > Diagnosing and Treating COPD Managing Your COPD Medications There are a range of treatment options ... each use . Types of medicines often prescribed for COPD: Bronchodilator Bronchodilators relax the muscles around the airways ...

COPD

DEFF Research Database (Denmark)

Ankjærgaard, Kasper Linde; Rasmussen, Daniel Bech; Schwaner, Signe Høyer

2017-01-01

In severe COPD, patients having survived acute hypercapnic respiratory failure (AHRF) treated with noninvasive ventilation (NIV) have a high mortality and risk of readmissions. The aim was to analyze the prognosis for patients with COPD having survived AHRF and to assess whether previous admissions...

Are pharmacists reducing COPD'S impact through smoking cessation and assessing inhaled steroid use?

DEFF Research Database (Denmark)

Verma, Arpana; Harrison, Annie; Torun, Perihan

2012-01-01

The National Institute for Health and Clinical Excellence (NICE) COPD 2004 guidelines recommend: ∗ COPD patients who smoke should be encouraged to stop at every opportunity; ∗ Inhaled corticosteroid should be used only among patients with moderate to severe COPD; ∗ Pharmacists should identify...... smokers and provide smoking cessation advice. The community pharmacy contract requires pharmacists to review patients' medications, creating an opportunity for reviewing the prescribing of inhaled corticosteroids in COPD. The survey explored the degree to which community pharmacists in North West England...

A case series of an off-the-shelf online health resource with integrated nurse coaching to support self-management in COPD

Directory of Open Access Journals (Sweden)

Early F

2017-10-01

nurse-coach support aligned to an Internet-based health resource, TPP, in COPD and provide learning about the challenges of such an approach and the importance of the nurse-coach role. Keywords: COPD, self-management, Internet, coaching, patient activation

What Causes COPD?

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... please turn JavaScript on. Feature: The Challenge of COPD What Causes COPD? Past Issues / Fall 2014 Table of Contents Long- ... and the airways usually is the cause of COPD. In the United States, the most common irritant ...

Pinterest as a Resource for Health Information on Chronic Obstructive Pulmonary Disease (COPD): A Social Media Content Analysis

Science.gov (United States)

Paige, Samantha R.; Stellefson, Michael; Chaney, Beth H.; Alber, Julia M.

2015-01-01

Purpose: The purpose of this study was to explore how Pinterest group pinboards are used to communicate health information on chronic obstructive pulmonary disease (COPD). Method A nonprobability census sampling method retrieved 399 pins from the 10 most followed COPD group pinboards. Pins were coded according to COPD information categories,…

Therapietrouw bij COPD.

OpenAIRE

Heins, M.; Heijmans, M.; Schermer, T.

2018-01-01

In Nederland zijn bijna 600.000 mensen met een chronisch obstructieve longziekte (COPD) die daarvoor zorg van hun huisarts of specialist ontvangen [1]. Bij COPD zijn de longen chronisch ontstoken, waardoor mensen moeite hebben met ademhalen en minder energie hebben. Roken is verreweg de meest voorkomende oorzaak van COPD. Klachten zijn continu aanwezig en mensen kunnen daarnaast een plotselinge verergering van de klachten hebben (longaanval). Bijna alle mensen met COPD gebruiken medicijnen vo...

Managing comorbidities in COPD

NARCIS (Netherlands)

Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to

Managing comorbidities in COPD

Science.gov (United States)

Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity. PMID:25609943

Do COPD subtypes really exist? COPD heterogeneity and clustering in 10 independent cohorts

NARCIS (Netherlands)

Castaldi, Peter J; Benet, Marta; Petersen, Hans; Rafaels, Nicholas; Finigan, James; Paoletti, Matteo; Marike Boezen, H; Vonk, Judith M; Bowler, Russell; Pistolesi, Massimo; Puhan, Milo A; Anto, Josep; Wauters, Els; Lambrechts, Diether; Janssens, Wim; Bigazzi, Francesca; Camiciottoli, Gianna; Cho, Michael H; Hersh, Craig P; Barnes, Kathleen; Rennard, Stephen; Boorgula, Meher Preethi; Dy, Jennifer; Hansel, Nadia N; Crapo, James D; Tesfaigzi, Yohannes; Agusti, Alvar; Silverman, Edwin K; Garcia-Aymerich, Judith

Background COPD is a heterogeneous disease, but there is little consensus on specific definitions for COPD subtypes. Unsupervised clustering offers the promise of 'unbiased' data-driven assessment of COPD heterogeneity. Multiple groups have identified COPD subtypes using cluster analysis, but there

Sarcopenia as an Independent Risk Factor for Decreased BMD in COPD Patients: Korean National Health and Nutrition Examination Surveys IV and V (2008-2011)

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Lee, Dong-Won; Choi, Eun-Young

2016-01-01

Background A decrease in bone mineral density (BMD) is a systemic consequence of chronic obstructive pulmonary disease (COPD). Past reports have rarely examined any correlation between sarcopenia and BMD. We investigated the relationship cross-sectionally between the presence of sarcopenia and BMD reduction in COPD patients. Methods COPD patients aged 50 or older with qualifying spirometry and dual-energy X-ray absorptiometry data were from participants in the Korean National Health and Nutrition Examination Surveys IV and V (2008–2011). Results There were 286 (33.3%) subjects in the sarcopenia group and 572 (66.7%) in the non-sarcopenia group. The sarcopenia group had lower T-scores than the non-sarcopenia group (femur: -0.73±0.88 vs. -0.18±0.97, p sarcopenia group and 45.6% and 13.3% in the non-sarcopenia group (both p sarcopenia associated with increased the risk of osteopenia, osteoporosis, and a low BMD (OR = 3.227, 95% CI = 2.125–4.899, p sarcopenia was associated with increased the risk for decreased BMD in COPD. PMID:27749901

Genetics of COPD

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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.

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

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Jakobsen, Marie; Anker, Niels; Dollerup, Jens; Poulsen, Peter Bo; Lange, Peter

2013-10-01

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 that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. To analyse the societal costs associated with prescription medicine for COPD in Denmark. 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 had been either hospitalised with a COPD diagnosis or had at least one prescription for drugs primarily used for COPD. The study population comprised 166 462 individuals of which 97 916 were alive on 31 December 2010. The average annual drug costs (R03) were DKK 7842 (EUR 1055) per patient 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 9416-10 089) per patient (2010 prices). The costs associated with prescription medicine for COPD in Denmark are significant. © 2012 John Wiley & Sons Ltd.

Diagnostic imaging in COPD; Radiologische Diagnostik bei COPD

Energy Technology Data Exchange (ETDEWEB)

Owsijewitsch, Michael; Ley-Zaporozhan, Julia [Universitaetsklinik Heidelberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Eichinger, Monika [Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany). Abt. Radiologie

2011-03-15

COPD is a heterogeneous disease defined by expiratory airflow limitation. Airflow limitation is caused by a variable combination of emphysematous destruction of lung parenchyma and small airway obstruction. Only advanced emphysema can be diagnosed by chest X-ray. Less severe emphysema and changes in small airways are commonly diagnosed by computed tomography. Typical visual appearance of pathologic changes in lung parenchyma and airways of COPD patients are presented, furthermore methods for quantitative assessment of these changes and the crucial role of imaging for surgical and bronchoscopic treatment in COPD are discussed. (orig.)

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

Directory of Open Access Journals (Sweden)

Dhamane AD

2016-12-01

Full Text Available Amol D Dhamane,1 Phil Schwab,2 Sari Hopson,2 Chad Moretz,2 Srinivas Annavarapu,2 Kate Burslem,1 Andrew Renda,3 Shuchita Kaila1 1Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, 2Comprehensive Health Insights Inc, Louisville, 3Humana Inc, Louisville, KY, USA 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

mCOPD: Mobile Phone Based Lung Function Diagnosis and Exercise System for COPD

OpenAIRE

Liu, Xiao

2013-01-01

COPD (Chronic Obstructive Pulmonary Disease) is a serious lung disease which makes people hard to breathe. The number of people who have COPD is on the rise. COPD patients require lung function examinations and perform breathing exercises on a regular basis in order to be more aware of their lung functions, get diagnosed early, and control the shortness of their breaths. In order to help people with COPD, we developed mCOPD which is a smartphone based Android application made especially for C...

Acute kidney injury in stable COPD and at exacerbation

Directory of Open Access Journals (Sweden)

Barakat MF

2015-09-01

Full Text Available MF Barakat,1 HI McDonald,1 TJ Collier,1 L Smeeth,1 D Nitsch,1 JK Quint1,2 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 2Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK Background: While acute kidney injury (AKI alone is associated with increased mortality, the incidence of hospital admission with AKI among stable and exacerbating COPD patients and the effect of concurrent AKI at COPD exacerbation on mortality is not known.Methods: A total of 189,561 individuals with COPD were identified from the Clinical Practice Research Datalink. Using Poisson and logistic regressions, we explored which factors predicted admission for AKI (identified in Hospital Episode Statistics in this COPD cohort and concomitant AKI at a hospitalization for COPD exacerbation. Using survival analysis, we investigated the effect of concurrent AKI at exacerbation on mortality (n=36,107 and identified confounding factors.Results: The incidence of AKI in the total COPD cohort was 128/100,000 person-years. The prevalence of concomitant AKI at exacerbation was 1.9%, and the mortality rate in patients with AKI at exacerbation was 521/1,000 person-years. Male sex, older age, and lower glomerular filtration rate predicted higher risk of AKI or death. There was a 1.80 fold (95% confidence interval: 1.61, 2.03 increase in adjusted mortality within the first 6 months post COPD exacerbation in patients suffering from AKI and COPD exacerbation compared to those who were AKI free.Conclusion: In comparison to previous studies on general populations and hospitalizations, the incidence and prevalence of AKI is relatively high in COPD patients. Coexisting AKI at exacerbation is prognostic of poor outcome. Keywords: acute renal failure, mortality, emphysema, chronic bronchitis, prognosis

Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

Directory of Open Access Journals (Sweden)

Ke X

2016-07-01

Full Text Available Xuehua Ke,1 Jessica Marvel,2 Tzy-Chyi Yu,2 Debra Wertz,1 Caroline Geremakis,1 Liya Wang,1 Judith J Stephenson,1 David M Mannino3 1HealthCore Inc., Wilmington, DE, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, 3University of Kentucky, Lexington, KY, USA Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1 % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013. The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [<50%] and high FEV1% predicted [≥50%] based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars.Results: A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group. COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6% and postindex periods (49.8% vs 36.8%. Mean (standard deviation follow-up all-cause and COPD-related costs were $27,380 ($38,199 and $15,873 ($29,609 for patients in the low FEV1% predicted group, and $22,075 ($28,108 and $10,174 ($18,521 for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD

Living with COPD: Nutrition

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

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

Directory of Open Access Journals (Sweden)

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

Prevalence of COPD in Copenhagen

DEFF Research Database (Denmark)

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

2011-01-01

INTRODUCTION: 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 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. METHODS: 6236 people participated. All non-asthmatic participants aged 35 years or older with adequate lung...... function data were included for the final prevalence analyses (n = 5,299). COPD staging was done according to the GOLD criteria. RESULTS: The overall prevalence of COPD was 17.4%. The prevalence increased with age and was higher among males. 6.2% had mild COPD, 9.2% had moderate COPD, and 2.0% had severe...

Risk of bipolar disorder in patients with COPD: a population-based cohort study.

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Tsai, Pei-Jung; Liao, Yin-To; Lee, Charles Tzu-Chi; Hsu, Chung-Yao; Hsieh, Ming-Hong; Tsai, Chia-Jui; Hsieh, Ming-Han; Chen, Vincent Chin-Hung

2016-01-01

Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and bipolar outcomes in the world. We sought to investigate the association between COPD and risk of bipolar disorder in a large national sample. The insured aged 15 years or more with a new primary diagnosis of COPD (ICD-9: 491, 492, 494 and 496) between 2000 and 2007 were identified from Taiwan's National Health Insurance Research Database. We included individuals with an inpatient diagnosis of COPD and/or at least 1 year of two diagnoses of COPD in outpatient services. These 35,558 cases were compared to 35,558 sex-, age-, residence- and insurance premium-matched controls. We followed both groups until the end of 2008 for incidence of bipolar disorder, defined as ICD-9 codes 296.0-296.16, 296.4-296.81 and 296.89. Competing risk-adjusted Cox regression analyses were applied with adjusting for sex, age, residence, insurance premium, prednisone use, Charlson comorbidity index, diabetes, hypertension, hyperlipidemia, cardiovascular diseases, hospital admission days, outpatients' visits and mortality. Of the total 71,116 subjects, 202 were newly diagnosed with bipolar disorder during the study period. The mean follow-up time was 6.0 (SD=2.2) years. COPD, younger age, lower economic status, lower dose of prednisone use, higher hospital admission days and higher outpatient visits were independent predictors of bipolar disorder. COPD was associated with increased risk of bipolar disorder independent of a number of potential confounding factors in this study. Copyright © 2016 Elsevier Inc. All rights reserved.

Sinonasal inflammation in COPD

DEFF Research Database (Denmark)

Håkansson, Kåre; Konge, L; Thomsen, Simon Francis

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....

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences.

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van der Molen, Thys

2010-12-01

In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality. This review sets out to explore the most frequent co-morbidities in COPD and their implications for treatment. Review of the literature on co-morbidities of COPD. Co-morbidities are frequent, but often remain undiagnosed in the COPD patient. In order to provide the best possible care for people with COPD, the physician should be aware of all potential co-morbidities that may arise, and the critical role that effective management of these co-morbidities can play in improving patient outcomes. Increased awareness of the potential co-morbidities of COPD, although potentially adding to the general practitioner's work burden, may provide insights into this difficult disease state and possibly improve each individual's prospects for effective management.

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.

Comparison of Multiple Chronic Obstructive Pulmonary Disease (COPD) Indices in Chinese COPD Patients.

Science.gov (United States)

Zhang, Jinsong; Miller, Anastasia; Li, Yongxia; Lan, Qinqin; Zhang, Ning; Chai, Yanling; Hai, Bing

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Candidate genes for COPD: current evidence and research

Directory of Open Access Journals (Sweden)

Kim WJ

2015-10-01

Full Text Available Woo Jin Kim,1 Sang Do Lee2 1Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, 2Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Abstract: COPD is a common complex disease characterized by progressive airflow limitation. Several genome-wide association studies (GWASs have discovered genes that are associated with COPD. Recently, candidate genes for COPD identified by GWASs include CHRNA3/5 (cholinergic nicotine receptor alpha 3/5, IREB2 (iron regulatory binding protein 2, HHIP (hedgehog-interacting protein, FAM13A (family with sequence similarity 13, member A, and AGER (advanced glycosylation end product–specific receptor. Their association with COPD susceptibility has been replicated in multiple populations. Since these candidate genes have not been considered in COPD, their pathological roles are still largely unknown. Herein, we review some evidences that they can be effective drug targets or serve as biomarkers for diagnosis or subtyping. However, more study is required to understand the functional roles of these candidate genes. Future research is needed to characterize the effect of genetic variants, validate gene function in humans and model systems, and elucidate the genes’ transcriptional and posttranscriptional regulatory mechanisms. Keywords: chronic obstructive pulmonary disease, genetics, genome-wide association study

Early detection of COPD in general practice

DEFF Research Database (Denmark)

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

2011-01-01

Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detect...

National Sexual Violence Resource Center (NSVRC)

Data.gov (United States)

U.S. Department of Health & Human Services — The National Sexual Violence Resource Center (NSVRC) is a national information and resource hub relating to all aspects of sexual violence. NSVRC staff collect and...

COPD and occupation: a retrospective cohort study of industrial workers.

Science.gov (United States)

Mazitova, Nailya N; Saveliev, Anatoly A; Berheeva, Zuhra M; Amirov, Nail Kh

2012-09-01

. Results of this study were used to substantiate the inclusion of COPD into the National List of Occupational Diseases of the Russian Federation.

Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ)

NARCIS (Netherlands)

Tsiligianni, Ioanna G.; van der Molen, Thys; Moraitaki, Despoina; Lopez, Ilaine; Kocks, Janwillem W. H.; Karagiannis, Konstantinos; Siafakas, Nikolaos; Tzanakis, Nikolaos

2012-01-01

Background: Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two

COPD flare-ups

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COPD exacerbation; Chronic obstructive pulmonary disease exacerbation; Emphysema exacerbation; Chronic bronchitis exacerbation ... health care provider on an action plan for COPD exacerbations so that you know what to do. ...

Smoking and COPD

Science.gov (United States)

Chronic obstructive pulmonary disease - smoking; COPD - secondhand smoke ... Things that make COPD symptoms worse are called triggers. Knowing what your triggers are and how to avoid them can help you feel ...

Management of COPD in the UK primary-care setting: An analysis of real life prescribing patterns

NARCIS (Netherlands)

D. Price (David); D. West (Daniel); G.G. Brusselle (Guy); K. Gruffydd-Jones (Kevin); R.C. Jones (Rupert C.); M. Miravitlles (Marc); A. Rossi (Andrea); C. Hutton (Catherine); V.L. Ashton (Valerie L.); R. Stewart (Rebecca); K. Bichel (Katsiaryna)

2014-01-01

textabstractBackground: Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a

Continuing to Confront COPD International Patient Survey : methods, COPD prevalence, and disease burden in 2012-2013

NARCIS (Netherlands)

Landis, Sarah H.; Muellerova, Hana; Mannino, David M.; Menezes, Ana M.; Han, MeiLan K.; van der Molen, Thys; Ichinose, Masakazu; Aisanov, Zaurbek; Oh, Yeon-Mok; Davis, Kourtney J.

2014-01-01

Purpose: The Continuing to Confront COPD International Patient Survey aimed to estimate the prevalence and burden of COPD globally and to update findings from the Confronting COPD International Survey conducted in 1999-2000. Materials and methods: Chronic obstructive pulmonary disease (COPD)

Elevated ACE activity is not associated with asthma, COPD, and COPD co-morbidity

DEFF Research Database (Denmark)

Lee, Julie; Nordestgaard, Børge G; Dahl, Morten

2009-01-01

The angiotensin-converting enzyme (ACE) gene is a potential candidate gene for risk of asthma, COPD, and COPD co-morbidity. In 9034 Danish adults, we determined whether individuals homozygous or heterozygous for the ACE D allele are at greater risk of asthma, COPD, or COPD co-morbidity compared...... with ACE II homozygous individuals. In the general population, serum ACE activity increased with the number of D alleles (Kruskal-Wallis ANOVA: II vs. ID, p....4-1.2). The results were similar upon adjustment for sex, age, smoking status, body mass index, total cholesterol, and ACE inhibitor/angiotensin II type 1 receptor blocker use. These data suggest that lifelong genetically elevated ACE activity is not a major risk factor for asthma or COPD, or for ischemic heart...

Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia

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Søgaard M

2016-03-01

Full Text Available Mette Søgaard,1 Morten Madsen,1 Anders Løkke,2 Ole Hilberg,2 Henrik Toft Sørensen,1 Reimar W Thomsen1 1Department of Clinical Epidemiology, 2Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark Background: Pneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD exacerbation and influence their outcomes.Methods: We examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006–2012.Results: We identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%. Pneumonia was frequent in first-time exacerbations (36.1%, but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days, intensive care unit admission (7.7% vs 12.5%, and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17–1.24. Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11–1.18, and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07–1.13. In contrast, the aHR of a subsequent exacerbation was 8%–13% lower for patients with pneumonic exacerbations.Conclusions: Pneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care

Roflumilast: a review of its use in the treatment of COPD

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Wedzicha JA

2016-01-01

Full Text Available Jadwiga A Wedzicha,1 Peter MA Calverley,2 Klaus F Rabe3,41Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, 2Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK; 3Department of Internal Medicine, Christian-Albrechts University, Kiel, 4Department of Pulmonary Medicine and Medical Director, LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany Abstract: COPD is a progressive condition involving chronic inflammation and parenchymal destruction with resulting airflow limitation. COPD is associated with worsening airflow limitation over time and increased frequency of COPD exacerbations, leading to increased mortality and morbidity. The effects of COPD extend beyond the lungs, as multiple comorbidities may occur with COPD, including cardiovascular disease, diabetes mellitus, osteoporosis, depression, and pneumonia. COPD exacerbations are associated with a rapid worsening of baseline symptoms that requires prompt management and may necessitate hospitalization in the case of a severe episode. Patients with COPD exacerbations require urgent management of symptoms to prevent further worsening, and preventative steps may be taken to help reduce the number and frequency of future exacerbations. Roflumilast is a potent and selective inhibitor of the enzyme phosphodiesterase-4 that targets the systemic inflammation associated with COPD. Roflumilast has a variety of anti-inflammatory effects including decreasing inflammatory mediators and the expression of cell surface markers and inhibition of apoptosis. Several clinical trials evaluating roflumilast in the treatment of COPD have demonstrated significant improvements from baseline versus placebo in lung function, including increases in mean pre- and postbronchodilator forced expiratory volume in 1 second and forced vital capacity. Data suggest that roflumilast reduces moderate to

Smoking Cessation in COPD patients

OpenAIRE

Carlos A. Jimenez-Ruiz

2016-01-01

Tobacco smoking is the main cause of COPD. Smoking cessation is the only therapeutic measure that can cure COPD and prevent this disorder from its chronic progression. Smoking cessation in COPD patients is difficult because most of these patients have specific characteristics that prevent them to quit. Recently, an ERS Task Force has developed a Consensus Document that contains recommendations for helping COPD smokers to quit.

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...

Responsiveness of blood and sputum inflammatory cells in Japanese COPD patients, non-COPD smoking controls, and non-COPD nonsmoking controls

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Kawayama T

2016-02-01

Full Text Available Tomotaka Kawayama,1 Takashi Kinoshita,1 Kazuko Matsunaga,2 Akihiro Kobayashi,3 Tomoyuki Hayamizu,4 Malcolm Johnson,5 Tomoaki Hoshino11Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, 2Department of Respiratory Medicine, Fukuoka Sanno Hospital, Fukuoka, 3Biomedical Data Science Department, 4Medical Affairs Respiratory Department, GlaxoSmithKline, Shibuya-ku, Tokyo, Japan; 5Respiratory Global Franchise, GlaxoSmithKline, Uxbridge, UKPurpose: To compare pulmonary and systemic inflammatory mediator release, pre- and poststimulation, ex vivo, in cells from Japanese patients with chronic obstructive pulmonary disease (COPD, non-COPD smoking controls, and non-COPD nonsmoking controls (NSC.Patients and methods: This was a nontreatment study with ten subjects per group. Inflammatory biomarker release, including interleukin (IL-6 and -8, matrix metalloproteinase-9, and tumor necrosis factor (TNF-α, was measured in peripheral blood mononuclear cells (PBMC and sputum cells with and without lipopolysaccharide or TNF-α stimulation.Results: In PBMC, basal TNF-α release (mean ± standard deviation was significantly different between COPD (81.6±111.4 pg/mL and nonsmoking controls (9.5±5.2 pg/mL (P<0.05. No other significant differences were observed. Poststimulation biomarker release tended to increase, with the greatest changes in the COPD group. The greatest mean increases were seen in the lipopolysaccharide-induced release of matrix metalloproteinase-9, TNF-α, and IL-6 from PBMC. Pre- and poststimulation data from sputum samples were more variable and less conclusive than from PBMC. In the COPD group, induced sputum neutrophil levels were higher and macrophage levels were lower than in either control group. Significant correlations were seen between the number of sputum cells (macrophages and neutrophils and biomarker levels (IL-8, IL-6, and TNF-α.Conclusion: This was the first

COPD: Learn More, Breathe Better

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... Health Information for the Public » Educational Campaigns & Programs » COPD (Chronic Obstructive Pulmonary Disease) Join the conversation: Doctors ... Diesases explain what you need to know about COPD. Get the Facts COPD is on the rise— ...

Prevalence of COPD in Copenhagen

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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 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....

Occupational exposures and chronic obstructive pulmonary disease (COPD): comparison of a COPD-specific job exposure matrix and expert-evaluated occupational exposures.

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Kurth, Laura; Doney, Brent; Weinmann, Sheila

2017-03-01

To compare the occupational exposure levels assigned by our National Institute for Occupational Safety and Health chronic obstructive pulmonary disease-specific job exposure matrix (NIOSH COPD JEM) and by expert evaluation of detailed occupational information for various jobs held by members of an integrated health plan in the Northwest USA. We analysed data from a prior study examining COPD and occupational exposures. Jobs were assigned exposure levels using 2 methods: (1) the COPD JEM and (2) expert evaluation. Agreement (Cohen's κ coefficients), sensitivity and specificity were calculated to compare exposure levels assigned by the 2 methods for 8 exposure categories. κ indicated slight to moderate agreement (0.19-0.51) between the 2 methods and was highest for organic dust and overall exposure. Sensitivity of the matrix ranged from 33.9% to 68.5% and was highest for sensitisers, diesel exhaust and overall exposure. Specificity ranged from 74.7% to 97.1% and was highest for fumes, organic dust and mineral dust. This COPD JEM was compared with exposures assigned by experts and offers a generalisable approach to assigning occupational exposure. 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/.

Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD

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Laura Miranda de Oliveira Caram

Full Text Available ABSTRACT Objective: To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD in COPD patients according to disease severity. Methods: The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted. Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS score was determined. Results: Of the 50 patients evaluated, 38 (76% had been diagnosed with at least one comorbidity, 21 (42% having been diagnosed with at least one CVD. Twenty-four patients (48% had more than one CVD. Eighteen (36% of the patients were current smokers, 10 (20% had depression, 7 (14% had dyslipidemia, and 7 (14% had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively. The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. Conclusions: Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression, appear to be more prevalent in patients with mild-to-moderate COPD.

Epidemiology of COPD

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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.

Can resistive breathing injure the lung? Implications for COPD exacerbations

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Vassilakopoulos T

2016-09-01

Full Text Available Theodoros Vassilakopoulos, Dimitrios Toumpanakis Pulmonary and Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Greece Abstract: In obstructive lung diseases, airway inflammation leads to bronchospasm and thus resistive breathing, especially during exacerbations. This commentary discusses experimental evidence that resistive breathing per se (the mechanical stimulus in the absence of underlying airway inflammation leads to lung injury and inflammation (mechanotransduction. The potential implications of resistive breathing-induced mechanotrasduction in COPD exacerbations are presented along with the available clinical evidence. Keywords: resistive breathing, COPD, mechanotransduction, bronchoconstriction, inflammation

Reconsidering sex-based stereotypes of COPD.

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Ohar, Jill; Fromer, Leonard; Donohue, James F

2011-12-01

Chronic obstructive pulmonary disease (COPD) has historically been considered a disease of older, white, male smokers, as illustrated in Frank Netter's classic images of the 'pink puffer' and 'blue bloater'. However, women may be more susceptible to COPD than men, and the disease course may be reflective of that increased susceptibility. From a review of epidemiological data of COPD, we found differences in the way men and women present with COPD symptoms, a bias in the way COPD symptoms are treated in men and women, and differences in susceptibility to airway obstruction based on age, sex, and smoking history. These data show that classic stereotypes of COPD - including male predominance - should be abandoned, and that there are not two but multiple COPD phenotypes, which are characterised by differences between women and men in susceptibility, symptoms, and disease progression. These differences impact on physician perception. Although further research into this concept is needed, the differences we found should prompt, in the short term, changes in the way (and in whom) COPD is evaluated, diagnosed, and treated; in the long term, these differences should prompt research into the prognosis of COPD based on sex differences.

Therapietrouw bij COPD.

NARCIS (Netherlands)

Heins, M.; Heijmans, M.; Schermer, T.

2018-01-01

In Nederland zijn bijna 600.000 mensen met een chronisch obstructieve longziekte (COPD) die daarvoor zorg van hun huisarts of specialist ontvangen [1]. Bij COPD zijn de longen chronisch ontstoken, waardoor mensen moeite hebben met ademhalen en minder energie hebben. Roken is verreweg de meest

[Work-related COPD].

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Fell, Anne Kristin Møller; Aasen, Tor Olav Brøvig; Kongerud, Johny

2014-11-01

Work-related COPD occurs as a result of exposure to harmful particles and gases/fumes in the workplace, including among non-smokers. The objective of this article is to present more recent findings on the correlation between occupational exposure and COPD. In addition, we review diagnostic and prognostic considerations and the potential for prevention. We have undertaken literature searches in Medline and EMBASE for the period May 2009 - July 2014. Studies without any measurements of pulmonary function or references to occupational exposure were excluded. We have also included three prospective studies on pulmonary function and occupational exposure that were not indexed with the search terms used for obstructive pulmonary disease. Three population studies and eight studies that described a specific industry or sector were included. Recent studies detect an association between exposure and an increased risk of COPD in the construction industry, metallurgical smelting, cement production and the textile industry. In other respects, the findings from previous review studies are confirmed. Exposure to a number of organic and inorganic particles and fumes in the workplace may cause COPD even at prevailing levels of exposure. Doctors should inquire about such exposure in cases of suspected and established COPD and should have a low threshold for referral to occupational health assessment.

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

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Price, David; West, Daniel; Brusselle, Guy; Gruffydd-Jones, Kevin; Jones, Rupert; Miravitlles, Marc; Rossi, Andrea; Hutton, Catherine; Ashton, Valerie L; Stewart, Rebecca; Bichel, Katsiaryna

2014-01-01

Background Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis. Results A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10). Conclusion COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no

Factors associated with work productivity among people with COPD: Birmingham COPD Cohort.

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Rai, Kiran K; Adab, Peymané; Ayres, Jon G; Siebert, W Stanley; Sadhra, Steven S; Sitch, Alice J; Fitzmaurice, David A; Jordan, Rachel E

2017-12-01

Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. To assess the factors associated with work productivity among COPD patients. Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quality of life in COPD patients

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Mohammed A. Zamzam

2012-10-01

Conclusion: Quality of life is impaired in patients with COPD and it deteriorates considerably with increasing severity of disease. Increasing severity of COPD is associated with a significant increase in SGRQ-C score. A higher smoking index affects the COPD subjects’ QOL especially with patients’ symptoms and impact of disease. Psychological assessment and psychiatric consultation are important for improving COPD symptoms, QOL and for early detection and treatment of superimposed psychiatric symptoms that could worsen COPD condition and seriously affect QOL.

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

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Bartolome R. Celli

2015-06-01

Full Text Available Chronic obstructive pulmonary disease (COPD is a leading cause of morbidity, mortality and resource use worldwide. The goal of this official American Thoracic Society (ATS/European Respiratory Society (ERS Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers and patient advocates believe will have the greatest impact on patient-centred outcomes.

Novel autoantigens immunogenic in COPD patients

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Stephan Bernhard

2009-03-01

Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a respiratory inflammatory condition with autoimmune features including IgG autoantibodies. In this study we analyze the complexity of the autoantibody response and reveal the nature of the antigens that are recognized by autoantibodies in COPD patients. Methods An array of 1827 gridded immunogenic peptide clones was established and screened with 17 sera of COPD patients and 60 healthy controls. Protein arrays were evaluated both by visual inspection and a recently developed computer aided image analysis technique. By this computer aided image analysis technique we computed the intensity values for each peptide clone and each serum and calculated the area under the receiver operator characteristics curve (AUC for each clone and the separation COPD sera versus control sera. Results By visual evaluation we detected 381 peptide clones that reacted with autoantibodies of COPD patients including 17 clones that reacted with more than 60% of the COPD sera and seven clones that reacted with more than 90% of the COPD sera. The comparison of COPD sera and controls by the automated image analysis system identified 212 peptide clones with informative AUC values. By in silico sequence analysis we found an enrichment of sequence motives previously associated with immunogenicity. Conclusion The identification of a rather complex humoral immune response in COPD patients supports the idea of COPD as a disease with strong autoimmune features. The identification of novel immunogenic antigens is a first step towards a better understanding of the autoimmune component of COPD.

JTD special edition 'Hot Topics in COPD'-The microbiome in COPD.

Science.gov (United States)

Chambers, Daniel C; Gellatly, Shaan L; Hugenholtz, Philip; Hansbro, Philip M

2014-11-01

The pathogenesis of chronic obstructive pulmonary disease (COPD) and its exacerbations, are intricately linked to colonisation and infection with bacteria and other microbes. Despite their undeniable importance, we have a poor understanding of the complex relationships between COPD phenotypes, physiology, cellular and molecular biology and the roles of colonising microbe or infecting pathogens. The management algorithms for the care of patients with COPD that include microbial influences, have almost exclusively been developed using microbial methods that were entirely dependent on the ability to grow bacteria on suitable media. The shortcomings of this approach are becoming clear now that it is possible to completely and accurately define the microbial ecology of ecosystems using genomic methods, which do not rely on the ability to cultivate the organisms present. Whilst our appreciation of the relationships between some bacterial ecosystems and the organ in which they reside in humans is now relatively advanced, this is not true for lung. This perspective serves to highlight the growing importance of including an accurate description of bacterial ecology in any attempt to decipher the pathobiology of COPD. While this field is in its infancy, there is significant potential to gain new insights which will translate into more rational and effective treatment algorithms for patients with COPD.

COPD en werk.

NARCIS (Netherlands)

Houtum, L. van; Heijmans, M.

2010-01-01

Drie van de vijf mensen met chronisch obstructieve longziekte werkt niet. In veel gevallen is hun longziekte hiervan de oorzaak, zo blijkt uit de Astma-/COPD-monitor. In Nederland hebben 320.000 mensen de diagnose chronisch obstructieve longziekte (COPD). Daarnaast zijn er nog eens zo’n 300.000

Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease (COPD) Using an Ontario Policy Model

Science.gov (United States)

Chandra, K; Blackhouse, G; McCurdy, BR; Bornstein, M; Campbell, K; Costa, V; Franek, J; Kaulback, K; Levin, L; Sehatzadeh, S; Sikich, N; Thabane, M; Goeree, R

2012-01-01

. Patients were assigned different costs and utilities depending on their severity health state during each model cycle. In addition to moving between health states, patients were at risk of acute exacerbations of COPD in each model cycle. During each cycle, patients could have no acute exacerbation, a minor acute exacerbation, or a major exacerbation. For the purposes of the model, a major exacerbation was defined as one that required hospitalization. Patients were assigned different costs and utilities in each model cycle, depending on whether they experienced an exacerbation, and its severity. Starting cohorts reflected the various patient populations from the trials analyzed. Incremental cost-effectiveness ratios (ICERs)—that is, costs per quality-adjusted life-year (QALY)—were estimated for each intervention using clinical parameters and summary estimates of relative risks of (re)hospitalization, as well as mortality and abstinence rates, from the COPD mega-analysis evidence-based analyses. A budget impact analysis was also conducted to project incremental costs already being incurred or resources already in use in Ontario. Using provincial data, medical literature, and expert opinion, health system impacts were calculated for the strategies investigated. All costs are reported in Canadian dollars. Results All smoking cessation programs were dominant (i.e., less expensive and more effective overall). Assuming a base case cost of $1,041 and $1,527 per patient for MDC and PR, the ICER was calculated to be $14,123 per QALY and $17,938 per QALY, respectively. When the costs of MDC and PR were varied in a 1-way sensitivity analysis to reflect variation in resource utilization reported in the literature, the ICER increased to $55,322 per QALY and $56,270 per QALY, respectively. Assuming a base case cost of $2,261 per year per patient for LTOT as reported by data from the Ontario provincial program, the ICER was calculated to be $38,993 per QALY. Ventilation strategies

COPD: recognizing the susceptible smoker

NARCIS (Netherlands)

Hoonhorst, Susan

2014-01-01

Smoking is the main cause of COPD, a chronic non-curable lung disease. Not all smokers develop COPD and it is still unclear why COPD is only manifested in a small subset of smokers (15-20%). Probably their genetic background makes the difference. We investigated whether young individuals (18-40

A high COPD assessment test score may predict anxiety in COPD

Directory of Open Access Journals (Sweden)

Harryanto H

2018-03-01

Full Text Available Hilman Harryanto,1 Sally Burrows,2 Yuben Moodley1,2 1Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia; 2Faculty of Health and Medical Sciences, Medical School, University of Western Australia, Perth, WA, AustraliaThe prevalence of anxiety is 55% in patients with COPD,1 and it is associated with worse disease control. Therefore, early recognition and institution of treatment of this comorbidity significantly improve patient’s quality of life. Recently, a questionnaire called the COPD assessment test (CAT has been incorporated into the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines for the management of COPD, and a higher score is associated with increased COPD symptoms.2 Considering the regular use of CAT, it was evaluated whether this tool can also be used to identify anxiety. The CAT score was correlated with the Hospital Anxiety and Depression Scale (HADS to determine the level at which CAT may predict anxiety.

Balance impairment in patients with COPD.

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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.

A functional SNP upstream of the ADRB2 gene is associated with COPD

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Li JX

2018-03-01

Full Text Available Jin-Xiu Li,1,2,* Wei-Ping Fu,3,* Jing Zhang,4 Xiao-Hua Zhang,1,2 Chang Sun,1,5 Lu-Ming Dai,3 Li Zhong,1,5,6 Li Yu,1,2 Ya-Ping Zhang1,7 1State Key Laboratory for Conservation and Utilization of Bio-Resource in Yunnan, 2Key Laboratory for Animal Genetic Diversity and Evolution of High Education in Yunnan Province, School of Life Sciences, Yunnan University, 3Department of Respiratory Critical Care Medicine, 4Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 5College of Life Sciences, 6Provincial Demonstration Center for Experimental Biology Education, Shaanxi Normal University, Xi’an, 7State Key Laboratory of Genetic Resources and Evolution, and Yunnan Laboratory of Molecular Biology of Domestic Animals, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China *These authors contributed equally to this work Background: Previous studies have suggested that β2-adrenergic receptor (ADRB2 is associated with COPD. However, the role of genetic polymorphisms in ADRB2 on COPD has not been evaluated yet. Methods: In this study, SNaPshot genotyping, luciferase assay, chromatin immunoprecipitation and real-time polymerase chain reaction were adopted to investigate the association between ADRB2 genetic polymorphisms and COPD, comprehensively. Results: One single nucleotide polymorphism (rs12654778, located upstream of ADRB2, showed a significant association with COPD by the logistic regression analysis after adjusting for age, sex and smoking history (p=0.04 in 200 COPD patients and 222 controls from southwest Chinese population. Furthermore, the luciferase assay indicated that rs12654778-A allele reduced the relative promoter activity by ~26% compared with rs12654778-G allele (p=0.0034. The chromatin immunoprecipitation analysis demonstrated that rs12654778 modulated the binding affinity of transcription factor neurofibromin 1. In addition, a significantly reduced expression of ADRB

Novel anti-inflammatory agents in COPD

DEFF Research Database (Denmark)

Loukides, Stelios; Bartziokas, Konstantinos; Vestbo, Jørgen

2013-01-01

Inflammation plays a central role in chronic obstructive pulmonary disease (COPD). COPD related inflammation is less responsive to inhaled steroids compared to asthma. There are three major novel anti-inflammatory approaches to the management of COPD. The first approach is phosphodiesterase...... on these strategies exist at the moment. A third potential approach involves novel agents whose mechanism of action is closely related to COPD mechanisms and pathophysiology. Such novel treatments are of great interest since they may treat both COPD and co-morbidities. Several novel agents are currently under...

Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.

Science.gov (United States)

Goto, Tadahiro; Faridi, Mohammad Kamal; Gibo, Koichiro; Camargo, Carlos A; Hasegawa, Kohei

2017-10-01

Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission. We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata. Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p reason for 30-day readmission in patients hospitalized for COPD. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Difference in serum magnesium level among patients with stable chronic obstructive pulmonary disease (COPD) and exacerbated COPD

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Sanowara, R.; Keliat, E. N.; Abidin, A.

2018-03-01

Stable COPD is marked with various degrees of inflammation throughout large and small airways also in the alveoli which cause mucus hypersecretion, narrowing of the airway, and alveoli damage. Exacerbation is an episode of elevated inflammation. The relation between inflammation response and magnesium has been observed with the increase of proinflammation cytokines in magnesium deficiency. A cross-sectional study of 34 patients who came to RSUP H. Adam Malik (17 stable COPD patients and 17 acute exacerbated COPD patients) was conducted to examine serum magnesium level and spirometry in stable condition. Mean serum magnesium level for stable COPD patients group was 2.09 ± 0.11 mEq/L. It was higher than in the exacerbated COPD patients group 1.69 ± 0.27 mEq/L. Mann–Whitney statistical analysis showed a significant difference in magnesium level between stable COPD and exacerbated COPD groups (p<0.05).

Emerging pharmaceutical therapies for COPD

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Lakshmi, Sowmya P; Reddy, Aravind T; Reddy, Raju C

2017-01-01

COPD, for which cigarette smoking is the major risk factor, remains a worldwide burden. Current therapies provide only limited short-term benefit and fail to halt progression. A variety of potential therapeutic targets are currently being investigated, including COPD-related proinflammatory mediators and signaling pathways. Other investigational compounds target specific aspects or complications of COPD such as mucus hypersecretion and pulmonary hypertension. Although many candidate therapies have shown no significant effects, other emerging therapies have improved lung function, pulmonary hypertension, glucocorticoid sensitivity, and/or the frequency of exacerbations. Among these are compounds that inhibit the CXCR2 receptor, mitogen-activated protein kinase/Src kinase, myristoylated alanine-rich C kinase substrate, selectins, and the endothelin receptor. Activation of certain transcription factors may also be relevant, as a large retrospective cohort study of COPD patients with diabetes found that the peroxisome proliferator-activated receptor γ (PPARγ) agonists rosiglitazone and pioglitazone were associated with reduced COPD exacerbation rate. Notably, several therapies have shown efficacy only in identifiable subgroups of COPD patients, suggesting that subgroup identification may become more important in future treatment strategies. This review summarizes the status of emerging therapeutic pharmaceuticals for COPD and highlights those that appear most promising. PMID:28790817

Mesenchymal stromal cell therapy in COPD: from bench to bedside

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Antunes MA

2017-10-01

Full Text Available Mariana A Antunes,1,2 José Roberto Lapa e Silva,3 Patricia RM Rocco1,2 1Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro (UFRJ, RJ, Brazil; 2National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil; 3Institute of Thoracic Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ, Rio de Janeiro, RJ, Brazil Abstract: COPD is the most frequent chronic respiratory disease and a leading cause of morbidity and mortality. The major risk factor for COPD development is cigarette smoke, and the most efficient treatment for COPD is smoking cessation. However, even after smoking cessation, inflammation, apoptosis, and oxidative stress may persist and continue contributing to disease progression. Although current therapies for COPD (primarily based on anti-inflammatory agents contribute to the reduction of airway obstruction and minimize COPD exacerbations, none can avoid disease progression or reduce mortality. Within this context, recent advances in mesenchymal stromal cell (MSC therapy have made this approach a strong candidate for clinical use in the treatment of several pulmonary diseases. MSCs can be readily harvested from diverse tissues and expanded with high efficiency, and have strong immunosuppressive properties. Preclinical studies have demonstrated encouraging outcomes of MSCs therapy for lung disorders, including emphysema. These findings instigated research groups to assess the impact of MSCs in human COPD/emphysema, but clinical results have fallen short of expectations. However, MSCs have demonstrated a good adjuvant role in the clinical scenario. Trials that used MSCs combined with another, primary treatment (eg, endobronchial valves found that patients derived greater benefit in pulmonary function tests and/or quality of life reports, as well as reductions in systemic

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

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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 (pCOPD were diagnosed with cancer (n=973, 73%) at a significantly higher rate than patients without COPD (n=708, 2.7%; pCOPD was 2.8 (95% CI 2.6 to 3.1) compared with patients without COPD after adjusting for age, sex and comorbidities. The most common cancers in patients with COPD include lung, liver, colorectal, breast, prostate and stomach cancers. Conclusions The risk of developing cancer is higher in patients with COPD compared with patients without COPD. Cancer screening is warranted in patients with COPD. PMID:28279996

Managing COPD: no more nihilism!

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van der Palen, Job; Monninkhof, Evelyn; van der Valk, Paul; Visser, Adriaan

2004-03-01

This special issue of Patient Education and Counseling is long overdue. During most of the last two decades asthma, and notably asthma self-management has been in the spotlight, while COPD has had to endure a nihilistic approach. The first sign that interest was shifting to the treatment of COPD came from a few large randomized trials on the use of inhaled corticosteroids (ICS) in COPD. Although these studies demonstrated a moderate effect of ICS in COPD, it has become clear that true improvements in the management of this chronic disease will have to come from behavioral interventions. This special issue of Patient Education and Counseling is dedicated solely to the non-pharmaceutical management of COPD. It addresses many issues related to behavioral therapy, such as smoking cessation, exercise training, nutritional aspects, and self-management programs, including action plans to self-treat exacerbations. With the availability of all the treatment and management options, described in this special issue, a nihilistic attitude toward the patient with COPD is no longer justified.

COPD: the patient perspective

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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

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...

What is COPD? | NIH MedlinePlus the Magazine

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... please turn JavaScript on. Feature: The Challenge of COPD What is COPD? Past Issues / Fall 2014 Table of Contents COPD ... a walk, even washing and dressing. What Is COPD? Watch an animation at: NIH's COPD website How ...

Early detection of COPD in primary care--the Copenhagen COPD Screening Project

DEFF Research Database (Denmark)

Lyngsø, Anne Marie; Backer, Vibeke; Gottlieb, Vibeke

2010-01-01

Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world, and further increases in the prevalence and mortality are predicted. Delay in diagnosing COPD appears frequently even though current consensus guidelines emphasize the importance of early detection...

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...... and subsequently applied to classify 200 independent images from the same screening trial. The texture-based measure was significantly better at discriminating between subjects with and without COPD than were the two most common quantitative measures of COPD in the literature, which are based on density...

Identifying possible asthma-COPD overlap syndrome in patients with a new diagnosis of COPD in primary care

DEFF Research Database (Denmark)

Baarnes, Camilla Boslev; Kjeldgaard, Peter; Nielsen, Mia

2017-01-01

(ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD...... of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive...

Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015.

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de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; de Miguel-Yanes, José María; Jiménez-García, Rodrigo

2018-02-13

To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Family History Is a Risk Factor for COPD

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Hokanson, John E.; Lynch, David A.; Washko, George R.; Make, Barry J.; Crapo, James D.; Silverman, Edwin K.

2011-01-01

Background: Studies have shown that family history is a risk factor for COPD, but have not accounted for family history of smoking. Therefore, we sought to identify the effects of family history of smoking and family history of COPD on COPD susceptibility. Methods: We compared 821 patients with COPD to 776 control smokers from the Genetic Epidemiology of COPD (COPDGene) Study. Questionnaires captured parental histories of smoking and COPD, as well as childhood environmental tobacco smoke (ETS) exposure. Socioeconomic status was defined by educational achievement. Results: Parental history of smoking (85.5% case patients, 82.9% control subjects) was more common than parental history of COPD (43.0% case patients, 30.8% control subjects). In a logistic regression model, parental history of COPD (OR, 1.73; P < .0001) and educational level (OR, 0.48 for some college vs no college; P < .0001) were significant predictors of COPD, but parental history of smoking and childhood ETS exposure were not significant. The population-attributable risk from COPD family history was 18.6%. Patients with COPD with a parental history had more severe disease, with lower lung function, worse quality of life, and more frequent exacerbations. There were nonsignificant trends for more severe emphysema and airway disease on quantitative chest CT scans. Conclusions: Family history of COPD is a strong risk factor for COPD, independent of family history of smoking, personal lifetime smoking, or childhood ETS exposure. Although further studies are required to identify genetic variants that influence COPD susceptibility, clinicians should question all smokers, especially those with known or suspected COPD, regarding COPD family history. PMID:21310839

Sarcopenia in COPD: relationship with COPD severity and prognosis

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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

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)....

Risk of fall in patients with COPD.

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Hakamy, Ali; Bolton, Charlotte E; Gibson, Jack E; McKeever, Tricia M

2018-03-21

A matched cohort study was conducted to determine the incidence of falls in patients following a diagnosis of COPD using a UK primary care database. 44 400 patients with COPD and 175 545 non-COPD subjects were identified. The incidence rate of fall per 1000 person-years in patients with COPD was higher (44.9; 95% CI 44.1 to 45.8) compared with non-COPD subjects (24.1; 95% CI 23.8 to 24.5) (P<0.0001). Patients with COPD were 55% more likely to have an incident record of fall than non-COPD subjects (adjusted HR, 1.55; 95% CI 1.50 to 1.59). The greater falls risk in patients with COPD needs consideration and modifiable factors addressed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

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Gruenberger JB

2017-03-01

Full Text Available Jean-Bernard Gruenberger,1 Jeffrey Vietri,2 Dorothy L Keininger,1 Donald A Mahler3 1Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland; 2Health Outcomes Practice, Kantar Health, Horsham, PA, 3Geisel School of Medicine at Dartmouth, Hanover, NH, USA Objective: Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD. However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.Methods: Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000. Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2, work impairment (Work Productivity and Activity Impairment questionnaire, and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.Results: Of the 768 respondents who met the inclusion criteria, 245 (32% were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2. Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, P<0.001 and

Importance of fractional exhaled nitric oxide in the differentiation of asthma-COPD overlap syndrome, asthma, and COPD.

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Chen, Feng-Jia; Huang, Xin-Yan; Liu, Yang-Li; Lin, Geng-Peng; Xie, Can-Mao

2016-01-01

Fractional exhaled nitric oxide (FeNO) is an easy, sensitive, reproducible, and noninvasive marker of eosinophilic airway inflammation. Accordingly, FeNO is extensively used to diagnose and manage asthma. Patients with COPD who share some of the features of asthma have a condition called asthma-COPD overlap syndrome (ACOS). The feasibility of using FeNO to differentiate ACOS patients from asthma and COPD patients remains unclear. From February 2013 to May 2016, patients suspected with asthma and COPD through physician's opinion were subjected to FeNO measurement, pulmonary function test (PFT), and bronchial hyperresponsiveness or bronchodilator test. Patients were divided into asthma alone group, COPD alone group, and ACOS group according to a clinical history, PFT values, and bronchial hyperresponsiveness or bronchodilator test. Receiver operating characteristic (ROC) curves were obtained to elucidate the clinical functions of FeNO in diagnosing ACOS. The optimal operating point was also determined. A total of 689 patients were enrolled in this study: 500 had asthma, 132 had COPD, and 57 had ACOS. The FeNO value in patients with ACOS was 27 (21.5) parts per billion (ppb; median [interquartile range]), which was significantly higher than that in the COPD group (18 [11] ppb). The area under the ROC curve was estimated to be 0.783 for FeNO. Results also revealed an optimal cutoff value of >22.5 ppb FeNO for differentiating ACOS from COPD patients (sensitivity 70%, specificity 75%). FeNO measurement is an easy, noninvasive, and sensitive method for differentiating ACOS from COPD. This technique is a new perspective for the management of COPD patients.

Diagnostic imaging in COPD

International Nuclear Information System (INIS)

Owsijewitsch, Michael; Ley-Zaporozhan, Julia; Eichinger, Monika

2011-01-01

COPD is a heterogeneous disease defined by expiratory airflow limitation. Airflow limitation is caused by a variable combination of emphysematous destruction of lung parenchyma and small airway obstruction. Only advanced emphysema can be diagnosed by chest X-ray. Less severe emphysema and changes in small airways are commonly diagnosed by computed tomography. Typical visual appearance of pathologic changes in lung parenchyma and airways of COPD patients are presented, furthermore methods for quantitative assessment of these changes and the crucial role of imaging for surgical and bronchoscopic treatment in COPD are discussed. (orig.)

Assessing the healthcare resource use associated with inappropriate prescribing of inhaled corticosteroids for people with chronic obstructive pulmonary disease (COPD) in GOLD groups A or B: an observational study using the Clinical Practice Research Datalink (CPRD).

Science.gov (United States)

Chalmers, James D; Poole, Chris; Webster, Samantha; Tebboth, Abigail; Dickinson, Scott; Gayle, Alicia

2018-04-11

Recent recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) position inhaled corticosteroids (ICS) for use in chronic obstructive pulmonary disease (COPD) patients experiencing exacerbations (≥ 2 or ≥ 1 requiring hospitalisation); i.e. GOLD groups C and D. However, it is known that ICS is frequently prescribed for patients with less severe COPD. Potential drivers of inappropriate ICS use may be historical clinical guidance or a belief among physicians that intervening early with ICS would improve outcomes and reduce resource use. The objective of this study was to compare healthcare resource use in the UK for COPD patients in GOLD groups A and B (0 or 1 exacerbation not resulting in hospitalisation) who have either been prescribed an ICS-containing regimen or a non-ICS-containing regimen. Linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) database were used. For the study period (1 July 2005 to 30 June 2015) a total 4009 patients met the inclusion criteria; 1745 receiving ICS-containing therapy and 2264 receiving non-ICS therapy. Treatment groups were propensity score-matched to account for potential confounders in the decision to prescribe ICS, leaving 1739 patients in both treatment arms. Resource use was assessed in terms of frequency of healthcare practitioner (HCP) interactions and rescue therapy prescribing. Treatment acquisition costs were not assessed. Results showed no benefit associated with the addition of ICS, with numerically higher all-cause HCP interactions (72,802 versus 69,136; adjusted relative rate: 1.07 [p = 0.061]) and rescue therapy prescriptions (24,063 versus 21,163; adjusted relative rate: 1.05 [p = 0.212]) for the ICS-containing group compared to the non-ICS group. Rate ratios favoured the non-ICS group for eight of nine outcomes assessed. Outcomes were similar for subgroup analyses surrounding potential influential parameters, including

Comparative effectiveness of budesonide/formoterol combination and tiotropium bromide among COPD patients new to these controller treatments

Directory of Open Access Journals (Sweden)

Trudo F

2015-09-01

Full Text Available Frank Trudo,1 David M Kern,2 Jill R Davis,1 Ozgur Tunceli,2 Siting Zhou,2 Emma L Graham,3 Charlie Strange,4 Setareh A Williams1 1AstraZeneca Pharmaceuticals LP, 2HealthCore, Inc., Wilmington, DE, USA; 3AstraZeneca Pharmaceuticals LP, Alderley Park, Cheshire, UK; 4Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA Background: Inhaled corticosteroid/long-acting β2-agonist combinations and/or long-acting muscarinic antagonists are recommended first-line therapies for preventing chronic obstructive pulmonary disease (COPD exacerbation. Comparative effectiveness of budesonide/formoterol combination (BFC, an inhaled corticosteroid/long-acting β2-agonist combination vs tiotropium (long-acting muscarinic antagonist in the US has not yet been studied.Methods: Using US claims data from the HealthCore Integrated Research Environment, COPD patients (with or without comorbid asthma ≥40 years old initiating BFC or tiotropium between March 1, 2009 and February 28, 2012 and at risk for exacerbation were identified and followed for 12 months. Patients were propensity score matched on demographics and COPD disease severity indicators. The primary outcome was time to first COPD exacerbation. Secondary outcomes included COPD exacerbation rate, health care resource utilization, and costs.Results: The Cox proportional hazards model for time to first exacerbation yielded a hazard ratio (HR of 0.78 (95% CI =[0.70, 0.87], P<0.001, indicating a 22% reduction in risk of COPD exacerbation associated with initiation of BFC versus tiotropium. A post hoc sensitivity analysis found similar effects in those who had a prior asthma diagnosis (HR =0.72 [0.61, 0.86] and those who did not (HR =0.83 [0.72, 0.96]. BFC initiation was associated with lower COPD-related health care resource utilization and costs ($4,084 per patient-year compared with $5,656 for tiotropium patients, P<0.001.Conclusion

Continuing to Confront COPD International Surveys : comparison of patient and physician perceptions about COPD risk and management

NARCIS (Netherlands)

Menezes, Ana M.; Landis, Sarah H.; Han, MeiLan K.; Muellerova, Hana; Aisanov, Zaurbek; van der Molen, Thys; Oh, Yeon-Mok; Ichinose, Masakazu; Mannino, David M.; Davis, Kourtney J.

2015-01-01

Purpose: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians' attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD. Methods:

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

Directory of Open Access Journals (Sweden)

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

Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD.

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Caram, Laura Miranda de Oliveira; Ferrari, Renata; Naves, Cristiane Roberta; Coelho, Liana Sousa; Vale, Simone Alves do; Tanni, Suzana Erico; Godoy, Irma

2016-01-01

To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.

[The evaluation of asthma and COPD awareness in Turkey (GARD Turkey Project-National Control Program of Chronic Airway Diseases)].

Science.gov (United States)

Yıldız, Füsun; Bingöl Karakoç, Gülbin; Ersu Hamutçu, Refika; Yardım, Nazan; Ekıncı, Banu; Yorgancıoğlu, Arzu

2013-01-01

Although chronic respiratory disorders are important causes of morbidity and mortality, health care workers, patients and caretakers are not well informed about these disorders. Therefore these problems are underdiagnosed and undertreated; also preventive measures are not widely taken. Our aim was to evaluate the knowledge of asthma and chronic obstructive pulmonary disease (COPD) in Turkey. This study was designed and performed as a Global Alliance Against Respiratory Disorders (GARD) project. People greater than 15 years of age who lived in cities with a population of 200 or greater were eligible for the study. A questionnaire including demographic data and questions regarding asthma and COPD was used for the evalution of the participants. 12.000 people were selected (6000 in rural and 6000 in urban areas); 8527 people were reached. 8342 people who completed the questionnaire were included to the study. There were 4182 (50.1%) female and 4160 (%49.9) male subjects. 49.6% of the subjcets knew that COPD is a lung disease, 51.1% indicated that smoking is the most important risk factor for COPD and 48% identified quitting smoking as the most important preventive measure. Every other person had baseline knowledge on COPD. However only 25.2% knew that there are treatment options for COPD. 80% of subjects said astma can be seen in all age groups. 51.1% knew asthma is a genetic disease and 58% said it is not an infectious disease. However when whether asthma medications caused drug dependency only 27% answered as "No" while 55.2% said "They do not know". Awareness of COPD and asthma seem to be infsufficient among Turkish people. Since these disorders are important causes of morbidity and mortality and have high impact on work and economic loss, it is important to increase knowledge among public.

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...... in coping with breathlessness appeared to be an endless striving to economise on resources in an effort to preserve their integrity. In this integrity-preserving process, four predominant coping types emerged and were labelled: `Overrater´, `Challenger´, `Underrater´, and `Leveller´. Each coping type...... 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...

Chronic obstructive pulmonary disease (COPD): neutrophils, macrophages and lymphocytes in patients with anterior tuberculosis compared to tobacco related COPD.

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Guiedem, Elise; Ikomey, George Mondinde; Nkenfou, Céline; Walter, Pefura-Yone Eric; Mesembe, Martha; Chegou, Novel Njweipi; Jacobs, Graeme Brendon; Okomo Assoumou, Marie Claire

2018-03-27

The inflammatory profile of chronic obstructive pulmonary disease (COPD) related to tobacco is known in certain studies while that of the post tuberculosis form is not yet known. This study aimed to evaluate the levels of neutrophils, macrophages and lymphocytes cells in sputum of COPD patients with history of smoking or anterior tuberculosis. Enumeration of cells in samples was analyzed using standard microscopy. We enrolled 92 participants, 46 (50%) were COPD subjects comprising 22 (47.83%) smokers and 24 (52.17%) with anterior tuberculosis while 46 (50%) healthy persons constituted the control group. The levels of neutrophils, lymphocytes and monocytes were statistically higher in COPD patients compared to the control group with p-values of 0.0001 respectively. Neutrophils levels were higher in COPD patients with history of tobacco than in COPD patients with anterior tuberculosis with a mean rate of 4.72 × 10 6 /ml and 2.48 × 10 6 /ml respectively (p = 0.04). The monocytes and lymphocytes levels were not statistically different between the two sub-groups of COPD patients with p-value of 0.052 and 0.91 respectively. Neutrophils are the only inflammatory cells that were significantly higher in COPD patients with history of smoking as compared to COPD patients with anterior tuberculosis.

Emerging pharmaceutical therapies for COPD

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Lakshmi SP

2017-07-01

Full Text Available Sowmya P Lakshmi,1,2 Aravind T Reddy,1,2 Raju C Reddy1,2 1Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, 2Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA Abstract: COPD, for which cigarette smoking is the major risk factor, remains a worldwide burden. Current therapies provide only limited short-term benefit and fail to halt progression. A variety of potential therapeutic targets are currently being investigated, including COPD-related proinflammatory mediators and signaling pathways. Other investigational compounds target specific aspects or complications of COPD such as mucus hypersecretion and pulmonary hypertension. Although many candidate therapies have shown no significant effects, other emerging therapies have improved lung function, pulmonary hypertension, glucocorticoid sensitivity, and/or the frequency of exacerbations. Among these are compounds that inhibit the CXCR2 receptor, mitogen-activated protein kinase/Src kinase, myristoylated alanine-rich C kinase substrate, selectins, and the endothelin receptor. Activation of certain transcription factors may also be relevant, as a large retrospective cohort study of COPD patients with diabetes found that the peroxisome proliferator-activated receptor γ (PPARγ agonists rosiglitazone and pioglitazone were associated with reduced COPD exacerbation rate. Notably, several therapies have shown efficacy only in identifiable subgroups of COPD patients, suggesting that subgroup identification may become more important in future treatment strategies. This review summarizes the status of emerging therapeutic pharmaceuticals for COPD and highlights those that appear most promising. Keywords: pulmonary, PPAR, phosphodiesterase, emphysema, cigarette, mucus 

Insomnia in patients with COPD.

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Budhiraja, Rohit; Parthasarathy, Sairam; Budhiraja, Pooja; Habib, Michael P; Wendel, Christopher; Quan, Stuart F

2012-03-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be associated with sleep disturbances. However, the correlates of insomnia in COPD patients have not been well characterized. The aim of the current study was to describe the prevalence of insomnia disorder in COPD and to elucidate the demographic and clinical characteristics of COPD patients that are associated with insomnia. Cross-sectional study. Clinic-based sample from an academic hospital. Patients with stable COPD. An interviewer-conducted survey was administered to 183 participants with COPD. Seventy-two of these participants (30 with and 42 without insomnia) maintained a sleep diary and underwent actigraphy for 7 days. Insomnia (chronic sleep disturbance associated with impaired daytime functioning) was present in 27.3% of participants. Current tobacco users (odds ratio (OR), 2.13) and those with frequent sadness/anxiety (OR, 3.57) had higher odds, but oxygen use was associated with lower odds (OR, 0.35) of insomnia. Patients with insomnia had worse quality of life and a higher prevalence of daytime sleepiness. Actigraphy revealed shorter sleep duration and lower sleep efficiency, and a sleep diary revealed worse self-reported sleep quality in participants with insomnia. Insomnia disorder is highly prevalent in patients with COPD; current tobacco use and sadness/anxiety are associated with a higher prevalence, and oxygen use with a lower prevalence of insomnia; patients with insomnia have poorer quality of life and increased daytime sleepiness; and insomnia is associated with worse objective sleep quality.

Prevalence characteristics of COPD in never smokers

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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.

Pulmonary functional MR imaging for COPD

International Nuclear Information System (INIS)

Ohno, Yoshiharu

2008-01-01

Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease characterized by airflow limitation, cough, sputum production, and, at later stages, dyspnea. COPD is currently the fourth-leading cause of mortality and the twelfth-leading cause of disability, and by the year 2020 it is expected to be the third-leading cause of death and the fifth-leading cause of disability worldwide. The diagnosis of COPD largely relies on a history of exposure to noxious stimuli and abnormal lung function test results. Since the pathology of COPD varies and the molecular mechanisms are only slightly understood, the diagnosis and stage assessment of COPD have relied on the results of pulmonary function test. In addition, CT and nuclear medicine study are utilized for assessment of regional morphological and functional abnormalities. Recently, pulmonary functional MR imaging is suggested as a new technique for assessment of regional physiopathologic information in various pulmonary diseases including COPD, pulmonary thromboembolism, lung cancer and interstitial lung diseases. This review article covers the brief description of theory and clinical application of contrast-enhanced perfusion MR imaging; hyperpolarized noble gas MR imaging and oxygen-enhanced MR imaging in COPD subjects. We believe that further basic studies as well as clinical applications of this new technique will define the real significance of pulmonary functional MR imaging for the future of pulmonary functional imaging and its usefulness for diagnosis and patients' management in COPD. (author)

Continuing to Confront COPD International Surveys: comparison of patient and physician perceptions about COPD risk and management

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Menezes AM

2015-01-01

Full Text Available Ana M Menezes,1 Sarah H Landis,2 MeiLan K Han,3 Hana Muellerova,2 Zaurbek Aisanov,4 Thys van der Molen,5 Yeon-Mok Oh,6 Masakazu Ichinose,7 David M Mannino,8 Kourtney J Davis9 1Federal University of Pelotas, Pelotas, Brazil; 2Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 3Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 4Pulmonology Research Institute, Moscow, Russia; 5University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 6University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 7Tohoku University Graduate School of Medicine, Sendai, Japan; 8University of Kentucky College of Public Health, Lexington, KY, USA; 9Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium Purpose: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians’ attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD prognosis, and compares physician and patient perceptions with respect to COPD. Methods: In 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD. Results: Most physicians (79% responded that the long-term health outlook for patients with COPD has improved over the past decade, largely attributed to the introduction of better medications. However, patient access to medication remains an issue in many countries, and some physicians (39% and patients (46% agreed/strongly agreed with the statement “there are no truly effective treatments for COPD”. There was strong concordance between physicians and patients

Prevention of Acute Exacerbations of COPD

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Bourbeau, Jean; Diekemper, Rebecca L.; Ouellette, Daniel R.; Goodridge, Donna; Hernandez, Paul; Curren, Kristen; Balter, Meyer S.; Bhutani, Mohit; Camp, Pat G.; Celli, Bartolome R.; Dechman, Gail; Dransfield, Mark T.; Fiel, Stanley B.; Foreman, Marilyn G.; Hanania, Nicola A.; Ireland, Belinda K.; Marchetti, Nathaniel; Marciniuk, Darcy D.; Mularski, Richard A.; Ornelas, Joseph; Stickland, Michael K.

2015-01-01

BACKGROUND: COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS: In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS: The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in

Anti-p-benzoquinone antibody level as a prospective biomarker to identify smokers at risk for COPD

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Banerjee S

2017-06-01

Full Text Available Santanu Banerjee,1 Parthasarathi Bhattacharyya,2 Subhra Mitra,3 Somenath Kundu,4 Samiran Panda,5 Indu B Chatterjee1 1Department of Biotechnology and Dr B C Guha Centre for Genetic Engineering and Biotechnology, University College of Science and Technology, University of Calcutta, 2Institute of Pulmocare and Research, 3Department of Pulmonary Medicine, Calcutta National Medical College, 4Department of Chest Medicine, Institute of Post Graduate Medical Education and Research, 5National Institute of Cholera and Enteric Diseases, Kolkata, India Background and objective: Identification of smokers having predisposition to COPD is important for early intervention to reduce the huge global burden of the disease. Using a guinea pig model, we have shown that p-benzoquinone (p-BQ derived from cigarette smoke (CS in the lung is a causative factor for CS-induced emphysema. p-BQ is also derived from CS in smokers and it elicits the production of anti-p-BQ antibody in humans. We therefore hypothesized that anti-p-BQ antibody might have a protective role against COPD and could be used as a predictive biomarker for COPD in smokers. The objective of this study was to compare the serum anti-p-BQ antibody level between smokers with and without COPD for the evaluation of the hypothesis. Methods: Serum anti-p-BQ antibody concentrations of current male smokers with (n=227 or without (n=308 COPD were measured by an indirect enzyme-linked immunoabsorbent assay (ELISA developed in our laboratory. COPD was diagnosed by spirometry according to Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines.Results and discussion: A significant difference was observed in the serum anti-p-BQ antibody level between smokers with and without COPD (Mann–Whitney U-test =4,632.5, P=0.000. Receiver operating characteristic (ROC curve analysis indicated that the ELISA had significant precision (area under the curve [AUC] =0.934, 95% confidence interval [CI]: 0.913–0

Lower airway colonization and inflammatory response in COPD: a focus on Haemophilus influenzae

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Finney LJ

2014-10-01

Full Text Available Lydia J Finney,1 Andrew Ritchie,1 Elizabeth Pollard,2 Sebastian L Johnston,1 Patrick Mallia1 1Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; 2King's College London, London, United Kingdom Abstract: Bacterial infection of the lower respiratory tract in chronic obstructive pulmonary disease (COPD patients is common both in stable patients and during acute exacerbations. The most frequent bacteria detected in COPD patients is Haemophilus influenzae, and it appears this organism is uniquely adapted to exploit immune deficiencies associated with COPD and to establish persistent infection in the lower respiratory tract. The presence of bacteria in the lower respiratory tract in stable COPD is termed colonization; however, there is increasing evidence that this is not an innocuous phenomenon but is associated with airway inflammation, increased symptoms, and increased risk for exacerbations. In this review, we discuss host immunity that offers protection against H. influenzae and how disturbance of these mechanisms, combined with pathogen mechanisms of immune evasion, promote persistence of H. influenzae in the lower airways in COPD. In addition, we examine the role of H. influenzae in COPD exacerbations, as well as interactions between H. influenzae and respiratory virus infections, and review the role of treatments and their effect on COPD outcomes. This review focuses predominantly on data derived from human studies but will refer to animal studies where they contribute to understanding the disease in humans. Keywords: chronic obstructive pulmonary disease, Haemophilus influenzae, nontypeable Haemophilus influenzae, respiratory viruses, vaccination

Idaho National Laboratory Cultural Resource Management Plan

Energy Technology Data Exchange (ETDEWEB)

Julie Braun Williams

2013-02-01

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Office will meet these responsibilities at Idaho National Laboratory in southeastern Idaho. The Idaho National Laboratory is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable, bear valuable physical and intangible legacies, and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through regular reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of appendices

Coping with COPD in patients home

DEFF Research Database (Denmark)

Christensen, Helle Marie

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency admission to medical departments. According to former studies, patients with COPD often awaits and do not react in time to signs of disease worsening, which may result in delay...... of treatment and inappropriate hospital admissions. Aim/objectives: Contributes to increase patients' quality of life and prognosis through an intensified proactive effort and development of competence of patients with COPD, relatives and healthcare professionals involved across sector boundaries, focusing...... on earlier identification and better treatment of exacerbation of COPD. Method: A development study. Through literature and medical journal audit, a tool was developed to identify patients with COPD at special risk for readmission to hospital. Through one year 98 patients were identified and offered two...

Low uptake of palliative care for COPD patients within primary care in the UK.

Science.gov (United States)

Bloom, Chloe I; Slaich, Bhavan; Morales, Daniel R; Smeeth, Liam; Stone, Patrick; Quint, Jennifer K

2018-02-01

Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK.This was a cohort study using electronic healthcare records (2004-2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients.There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients received PCS. Lung cancer had a strong association with PCS compared with other patient characteristics, including Global Initiative for Chronic Obstructive Lung Disease stage and Medical Research Council Dyspnoea score (whole cohort, lung cancer: OR 14.1, 95% CI 13.1-15; deceased patients, lung cancer: OR 6.5, 95% CI 6-7). Only 16.7% of deceased COPD patients without lung cancer received PCS compared with 56.5% of deceased patients with lung cancer. In patients that received PCS, lung cancer co-diagnosis significantly increased the chances of receiving PCS before the last month of life (1-6 versus ≤1 month pre-death: risk ratio 1.4, 95% CI 1.3-1.7).Provision of PCS for COPD patients in the UK is inadequate. Lung cancer, not COPD, was the dominant driver for COPD patients to receive PCS. Copyright ©ERS 2018.

The pharmacological cost of COPD during Greek economic crisis

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Stafyla E

2017-01-01

Full Text Available Eirini Stafyla,1 Theodora Kerenidi,1 Irini Gerogianni,1 Mary Geitona,2 Zoe Daniil,1 Konstantinos I Gourgoulianis1 1Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, 2Department of Social Policy, University of Peloponnese, Korithos, Greece Introduction: The economic crisis in Greece has substantially affected patients with COPD. The reduction of disposable income has its consequences on patients’ ability to afford their medication. The aim of the study is to evaluate the cost of treatment for patients with COPD and the influence of the financial crisis to the patients.Methods: Data were collected from 189 patients (male: 178, mean age: 70.1±8.4 who visited the outpatient department of University Hospital of Larissa in 2014 and 2015. The pharmacological cost of treatment was calculated based on national pharmaceutical formulary prices.Results: COPD patients were classified into four stages according to Global Initiative for Chronic Obstructive Lung Disease (GOLD: 7.4% were in stage I, 43.4% in stage II, 34.4% in stage III, and 14.8% in stage IV. Patients were graded as per GOLD as follows: 18% as grade A, 14.3% as B, 23.3% as C, and 44.4% as D. The annual cost of COPD maintenance treatment per patient was €952.92 (±398.01, of which €239.91 were patients’ expenses. The annual treatment cost for stable disease ranged from €615.44 to €1302.03 depending on disease stages (GOLD stages I–IV and from €715.01 to €1101.05 depending on GOLD grades (grades A–D. The cost of maintenance medication was statistically and significantly higher for patients with advanced disease (GOLD stages III–IV and for patients at high risk (GOLD grades C–D [P=0.000].Conclusion: The pharmacological cost of treatment for COPD patients seems to be considerably high, in all disease stages. As the average income is decreased, patients face difficulties to afford inhaled medication. Keywords

Importance of fractional exhaled nitric oxide in the differentiation of asthma–COPD overlap syndrome, asthma, and COPD

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Chen FJ

2016-09-01

Full Text Available Feng-jia Chen,* Xin-yan Huang,* Yang-li Liu, Geng-peng Lin, Can-mao Xie Department of Respiratory Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: Fractional exhaled nitric oxide (FeNO is an easy, sensitive, reproducible, and noninvasive marker of eosinophilic airway inflammation. Accordingly, FeNO is extensively used to diagnose and manage asthma. Patients with COPD who share some of the features of asthma have a condition called asthma–COPD overlap syndrome (ACOS. The feasibility of using FeNO to differentiate ACOS patients from asthma and COPD patients remains unclear. Methods: From February 2013 to May 2016, patients suspected with asthma and COPD through physician’s opinion were subjected to FeNO measurement, pulmonary function test (PFT, and bronchial hyperresponsiveness or bronchodilator test. Patients were divided into asthma alone group, COPD alone group, and ACOS group according to a clinical history, PFT values, and bronchial hyperresponsiveness or bronchodilator test. Receiver operating characteristic (ROC curves were obtained to elucidate the clinical functions of FeNO in diagnosing ACOS. The optimal operating point was also determined. Results: A total of 689 patients were enrolled in this study: 500 had asthma, 132 had COPD, and 57 had ACOS. The FeNO value in patients with ACOS was 27 (21.5 parts per billion (ppb; median [interquartile range], which was significantly higher than that in the COPD group (18 [11] ppb. The area under the ROC curve was estimated to be 0.783 for FeNO. Results also revealed an optimal cutoff value of >22.5 ppb FeNO for differentiating ACOS from COPD patients (sensitivity 70%, specificity 75%.Conclusion: FeNO measurement is an easy, noninvasive, and sensitive method for differentiating ACOS from COPD. This technique is a new perspective for the management of COPD patients. Keywords

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...

COPD

African Journals Online (AJOL)

Acute exacerbations of chronic obstructive pulmonary disease. (AECOPD) are ... COPD, 726 000 hospitalisations and 120 000 deaths with an annual cost of 32 billion ... environmental pollution, low temperature and interruption of regular ...

Validation of a structured questionnaire for COPD and prevalence of COPD in rural area of Mysore: A pilot study

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Mahesh P

2009-01-01

Full Text Available Background: The prevalence of chronic obstructive pulmonary disease (COPD is increasing in India and there is a need to study the prevalence of COPD, particularly in the rural areas, which may be most affected due to their lifestyle. Materials and Methods: First stage: Validation of the questionnaire-105 consecutive patients underwent administration of the structured questionnaire and spirometry was used as a gold standard for the diagnosis of COPD. Second stage: Adults above 40 years (n = 900 in two villages of Mysore district were administered with the validated questionnaire, Knowledge and Attitude questionnaire and Fagerstorm questionnaire, to assess nicotine dependency. Results: The questionnaire was found to have a sensitivity of 62.5% and specificity of 87.6% to diagnose COPD. Of the total 900 adults surveyed (Males: 453, Females: 447, the total prevalence of COPD was 7.1%. Males had a higher prevalence (11.1% compared to females (4.5%. The prevalence of smoking was very high among men at 71.9% and all the women were nonsmokers. The prevalence of COPD was 14.7% in smokers, 19.3% had mild to moderate nicotine dependency and 12.8% were highly dependent. Of the women exposed to regular biomass fuels, the prevalence of COPD was 3.9%, which increased to 4.8% on addition of regular passive smoking. In smoking, male gender and age were significantly associated with COPD ( P < 0.05. Conclusion: The structured questionnaire is a useful tool for the screening of COPD in field studies. Smoking and biomass fuel exposure are important risk factors for COPD.

Validation of a structured questionnaire for COPD and prevalence of COPD in rural area of Mysore: A pilot study.

Science.gov (United States)

Mahesh, P A; Jayaraj, B S; Prahlad, S T; Chaya, S K; Prabhakar, A K; Agarwal, A N; Jindal, S K

2009-07-01

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in India and there is a need to study the prevalence of COPD, particularly in the rural areas, which may be most affected due to their lifestyle. FIRST STAGE: Validation of the questionnaire-105 consecutive patients underwent administration of the structured questionnaire and spirometry was used as a gold standard for the diagnosis of COPD. Second stage: Adults above 40 years (n = 900) in two villages of Mysore district were administered with the validated questionnaire, Knowledge and Attitude questionnaire and Fagerstorm questionnaire, to assess nicotine dependency. The questionnaire was found to have a sensitivity of 62.5% and specificity of 87.6% to diagnose COPD. Of the total 900 adults surveyed (Males: 453, Females: 447), the total prevalence of COPD was 7.1%. Males had a higher prevalence (11.1%) compared to females (4.5%). The prevalence of smoking was very high among men at 71.9% and all the women were nonsmokers. The prevalence of COPD was 14.7% in smokers, 19.3% had mild to moderate nicotine dependency and 12.8% were highly dependent. Of the women exposed to regular biomass fuels, the prevalence of COPD was 3.9%, which increased to 4.8% on addition of regular passive smoking. In smoking, male gender and age were significantly associated with COPD (P < 0.05). The structured questionnaire is a useful tool for the screening of COPD in field studies. Smoking and biomass fuel exposure are important risk factors for COPD.

COPD Quiz | NIH MedlinePlus the Magazine

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... please turn JavaScript on. Feature: The Challenge of COPD COPD Quiz Past Issues / Fall 2014 Table of Contents ... Only one answer is correct . Questions Question 1. COPD is a lung disease that: usually starts during ...

Q&A: Grace Anne Koppel, Living Well with COPD

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... their own lives back is the most rewarding thing we have ever done. Read More "The Challenge of COPD" Articles Q&A: Grace Anne Koppel, Living Well with COPD / What is COPD? / What Causes COPD? / Getting Tested / Am I at Risk? / COPD Quiz Fall ...

COPD: Are You at Risk?

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... Smoking is the most common cause of COPD, accounting for as many as 9 out of 10 ... spirometry test. Spirometry is a common, noninvasive lung function test that can detect COPD before symptoms become ...

State Fact Sheets on COPD

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... 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 ...

Challenge of COPD: Getting Tested

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... please turn JavaScript on. Feature: The Challenge of COPD Getting Tested Past Issues / Fall 2014 Table of Contents Getting Tested Everyone at risk for COPD who has cough, sputum production, or shortness of ...

Vital prognosis after hospitalization for COPD

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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...

Potential misclassification of causes of death from COPD

DEFF Research Database (Denmark)

Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter

2006-01-01

Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline...... examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory...... COPD, CMH and smoking were predictors of COPD as underlying cause of death, ORs 2.3 (1.5-3.7) and 2.2 (1.4-3.6), respectively. It was concluded that chronic obstructive pulmonary disease is underreported on death certificates, that biases in the use of chronic obstructive pulmonary disease as cause...

Potential misclassification of causes of death from COPD

DEFF Research Database (Denmark)

Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter

2006-01-01

Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline...... examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory...... volume in one second /forced vital capacity ratio at baseline. In COPD patients, having COPD on the death certificate was associated with chronic mucus hypersecretion (CMH) at baseline, an odds ratio (OR) of 3.6 (95% confidence interval 1.7-7.7), and being female (OR 2.7 (1.3-5.6)). In subjects without...

Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD.

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Boixeda, Ramon; Bacca, Sandra; Elias, Lorena; Capdevila, Josep Anton; Vilà, Xavier; Mauri, Montserrat; Almirall, Jordi

2014-12-01

Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n=104) or PCOPD (n=20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P<.01) and need for oxygen therapy (P<.05). PCOPD patients showed increased presence of fever (P<.05), lower blood pressure (P<.001), more laboratory abnormalities (P<.05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P<.01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Increased leptin/leptin receptor pathway affects systemic and airway inflammation in COPD former smokers

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Bruno A

2011-05-01

Full Text Available Andreina Bruno1, Marinella Alessi2, Simona Soresi2, Anna Bonanno1, Loredana Riccobono1, Angela Marina Montalbano1, Giusy Daniela Albano1, Mark Gjomarkaj1, Mirella Profita11Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Palermo, Italy; 2Dipartimento Biomedico di Biomedicina Interna e Specialistica, University Palermo, ItalyBackground: Leptin, a hormone produced mainly by adipose tissue, regulates food intake and energy expenditure. It is involved in inflammatory diseases such as chronic obstructive pulmonary disease (COPD and its deficiency is associated with increased susceptibility to the infection. The leptin receptor is expressed in the lung and in the neutrophils.Methods: We measured the levels of leptin, tumor necrosis factor alpha (TNF-a and soluble form of intercellular adhesion molecule-1 (sICAM-1 in sputum and plasma from 27 smoker and former smoker patients with stable COPD using ELISA methods. Further we analyzed leptin and its receptor expression in sputum cells from 16 COPD patients using immunocytochemistry.Results: In plasma of COPD patients, leptin was inversely correlated with TNF-a and positively correlated with the patient weight, whereas the levels of sICAM-1 were positively correlated with TNF-a. In sputum of COPD patients leptin levels were correlated with forced expiratory volume in 1 second/forced vitality capacity. Additionally, increased levels of sputum leptin and TNF-a were observed in COPD former smokers rather than smokers. Further the expression of leptin receptor in sputum neutrophils was significantly higher in COPD former smokers than in smokers, and the expression of leptin and its receptor was positively correlated in neutrophils of COPD former smokers.Conclusion: Our findings suggest a role of leptin in the local and systemic inflammation of COPD and, taking into account the involvement of neutrophils in this inflammatory disease, describe a novel aspect of the leptin

Transposition and national level resources

DEFF Research Database (Denmark)

Vasev, Nikolay Rumenov; Vrangbæk, Karsten

2014-01-01

Several recent papers have summarised the status of EU implementation studies. In this paper we suggest that the issue of sector specific resources has received too little attention in previous studies. Sector specific resources include “health sector resources” and “state administrative resources......”. Our theoretical contribution is thus to add an explicit and more detailed concern for "sector specific resources" in national transposition. This can refine the understanding of resources, for example in the multi-variable models that are emerging as the state of the art in the field of EU...... implementation studies. To illustrate these points we have chosen an empirical design focusing on a directive with a potentially high impact on system resources and several ambiguous components (the Cross Border Health Care Directive). We have further chosen to focus on two Eastern European countries (Bulgaria...

The effect of rehabilitation on health-care utilisation in COPD patients in Copenhagen

DEFF Research Database (Denmark)

Jacobsen, Ramune; Rusch, Ea; Andersen, Per Kragh

2014-01-01

INTRODUCTION: The Integrated Rehabilitation Programme for Chronic Conditions project (SIKS) implemented rehabilitation programmes for people with four chronic conditions in the local area within the Municipality of Copenhagen. OBJECTIVES: The objective of this study was to evaluate the impact of ...... of Copenhagen with an assessment of the effect of a real-life intervention. It shows that the pulmonary rehabilitation programme introduced had the anticipated effects on health-care utilisation. The study also suggests that the methods used for evaluation were appropriate....... of rehabilitation on health-care utilisation in chronic obstructive pulmonary disease (COPD) patients as a subgroup of SIKS. METHODS: For the analyses, data from Danish National Registers' were obtained. The following outcomes were analysed: (i) COPD hospital admissions, (ii) COPD bed days, (iii) COPD outpatient...... rehabilitation and were matched with the intervention group according to propensity score calculated on the basis of patient socio-demographic characteristics and health-care utilisation pattern in 2 years prior to the rehabilitation programme. The effect was assessed by applying the principle of difference...

Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort.

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Borja G Cosio

Full Text Available The Spanish guideline for COPD (GesEPOC recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE, asthma-COPD overlap syndrome (ACOS, frequent exacerbator phenotype with emphysema (FEE or frequent exacerbator phenotype with chronic bronchitis (FECB. However, little is known on the distribution and outcomes of the four suggested phenotypes.We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes.We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT, BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes.Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%; ACOS, 125 (15.0%; FEE, 38 (4.6%; and FECB, 99 (11.9%; additionally 19 (2.3% COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05. The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes. Frequent exacerbator groups (FEE and FECB were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05 with no differences in one-year mortality. Most of NE (93% and half of exacerbators were stable after one year.There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use.

Determinants of Depression in the ECLIPSE COPD Cohort

DEFF Research Database (Denmark)

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

2010-01-01

RATIONALE: Depression is prevalent in patients with chronic obstructive pulmonary disease (COPD); however, its etiology and relationship to the clinical features of COPD are not well understood. Using data from a large cohort, we explored prevalence and determinants of depression in subjects...... the Center for Epidemiologic Studies of Depression Scale (CES-D). For the purposes of this analysis, depression was defined as a CES-D score of 16 and higher which reflects a high load of depressive symptoms and has a good correspondence with a clinical diagnosis of major depression. RESULTS: The study...... cohort consisted of 2118 subjects with COPD, 335 smokers without COPD (smokers) and 243 non-smokers without COPD (non-smokers). Twenty-six percent, 12% and 7% of COPD, smokers and non-smokers, respectively, suffered from depression. In subjects with COPD, higher depression prevalence was seen in females...

High prevalence of COPD in atherosclerosis patients

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Tuleta I

2017-10-01

Full Text Available Izabela Tuleta, Tarik Farrag, Laura Busse, Carmen Pizarro, Christian Schaefer, Simon Pingel, Georg Nickenig, Dirk Skowasch, Nadjib Schahab Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany Abstract: Atherosclerosis and COPD are both systemic inflammatory diseases that may influence each other. The aim of the present study was to determine the prevalence of COPD in patients with cerebral and/or peripheral artery disease and to assess factors associated with the presence of COPD. Following the diagnosis of cerebral and/or peripheral artery disease by means of duplex sonography, 166 consecutive patients underwent body plethysmography with capillary blood gas analysis. Thereafter, blood tests with determination of different parameters such as lipid profile, inflammatory and coagulation markers were conducted in remaining 136 patients who fulfilled inclusion criteria of the study. Thirty-six out of 136 patients suffered from COPD, mostly in early stages of the disease. Residual volume indicating emphysema was increased (162.9%±55.9% vs 124.5%±37.0%, p<0.05 and diffusion capacity was decreased (55.1%±19.5% vs 75.3%±18.6%, p<0.05 in COPD patients vs non-COPD group. In capillary blood gas analysis, COPD patients had lower partial pressure of oxygen (70.9±11.5 vs 75.2±11.0 mmHg, p<0.05 and higher partial pressure of carbon dioxide (36.8±7.5 vs 34.4±4.4 mmHg, p<0.05 compared with non-COPD individuals. Presence of COPD was associated with predominance of diabetes mellitus, interleukin-8-related systemic neutrophilic inflammation and anemia. In conclusion, COPD is highly prevalent in patients with atherosclerotic artery disease. Keywords: cerebral artery disease, peripheral artery disease, lung function, capillary blood gas, diabetes mellitus, inflammation, interleukin-8, anemia

Evaluation of the psychometric properties of the Nighttime Symptoms of COPD Instrument

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Mocarski M

2015-03-01

Full Text Available Michelle Mocarski,1 Erica Zaiser,2 Dylan Trundell,2 Barry J Make,3 Asha Hareendran21Forest Research Institute, Inc., an affiliate of Actavis, Inc., Jersey City, NJ, USA; 2Evidera, London, UK; 3National Jewish Health, Denver, CO, USA Background: Nighttime symptoms can negatively impact the quality of life of patients with chronic obstructive pulmonary disease (COPD. The Nighttime Symptoms of COPD Instrument (NiSCI was designed to measure the occurrence and severity of nighttime symptoms in patients with COPD, the impact of symptoms on nighttime awakenings, and rescue medication use. The objective of this study was to explore item reduction, inform scoring recommendations, and evaluate the psychometric properties of the NiSCI.Methods: COPD patients participating in a Phase III clinical trial completed the NiSCI daily. Item analyses were conducted using weekly mean and single day scores. Descriptive statistics (including percentage of respondents at floor/ceiling and inter-item correlations, factor analyses, and Rasch model analyses were conducted to examine item performance and scoring. Test–retest reliability was assessed for the final instrument using the intraclass correlation coefficient (ICC. Correlations with assessments conducted during study visits were used to evaluate convergent and known-groups validity.Results: Data from 1,663 COPD patients aged 40–93 years were analyzed. Item analyses supported the generation of four scores. A one-factor structure was confirmed with factor analysis and Rasch analysis for the symptom severity score. Test–retest reliability was confirmed for the six-item symptom severity (ICC, 0.85, number of nighttime awakenings (ICC, 0.82, and rescue medication (ICC, 0.68 scores. Convergent validity was supported by significant correlations between the NiSCI, St George’s Respiratory Questionnaire, and Exacerbations of Chronic Obstructive Pulmonary Disease Tool-Respiratory Symptoms scores.Conclusion: The

Virus-induced exacerbations in asthma and COPD

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Daisuke eKurai

2013-10-01

Full Text Available Chronic obstructive pulmonary disease (COPD is characterized by chronic airway inflammation and/or airflow limitation due to pulmonary emphysema. Chronic bronchitis, pulmonary emphysema, and bronchial asthma may all be associated with airflow limitation; therefore, exacerbation of asthma may be associated with the pathophysiology of COPD. Furthermore, recent studies have suggested that the exacerbation of asthma, namely virus-induced asthma, may be associated with a wide variety of respiratory viruses.COPD and asthma have different underlying pathophysiological processes and thus require individual therapies. Exacerbation of both COPD and asthma, which are basically defined and diagnosed by clinical symptoms, is associated with a rapid decline in lung function and increased mortality. Similar pathogens, including human rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus and coronavirus, are also frequently detected during exacerbation of asthma and/or COPD. Immune response to respiratory viral infections, which may be related to the severity of exacerbation in each disease, varies in patients with both COPD and asthma. In this regard, it is crucial to recognize and understand both the similarities and differences of clinical features in patients with COPD and/or asthma associated with respiratory viral infections, especially in the exacerbative stage.In relation to definition, epidemiology, and pathophysiology, this review aims to summarize current knowledge concerning exacerbation of both COPD and asthma by focusing on the clinical significance of associated respiratory virus infections.

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.

Pulmonary artery stiffness in chronic obstructive pulmonary disease (COPD) and emphysema: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study.

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Liu, Chia-Ying; Parikh, Megha; Bluemke, David A; Balte, Pallavi; Carr, James; Dashnaw, Stephen; Poor, Hooman D; Gomes, Antoinette S; Hoffman, Eric A; Kawut, Steven M; Lima, Joao A C; McAllister, David A; Prince, Martin A; Vogel-Claussen, Jens; Barr, R Graham

2018-01-01

Chronic obstructive pulmonary disease (COPD) and particularly emphysema are characterized by stiffness of the aorta, due in part to accelerated elastin degradation in the lungs and aorta. Stiffness of the pulmonary arteries (PAs) may also be increased in COPD and emphysema, but data are lacking. We assessed PA stiffness using MRI in patients with COPD and related these measurements to COPD severity and percent emphysema. The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited 290 participants, age 50-79 years with 10 or more packyears and free of clinical cardiovascular disease. COPD severity were defined on postbronchodilator spirometry by ATS/ERS criteria. Percent emphysema was defined as the percentage of regions of the lung COPD compared with controls (P = 0.002) and was inversely correlated with COPD severity (P = 0.004). PA strain was inversely associated to percent emphysema (P = 0.01). PA strain was also markedly correlated with right ventricular diastolic dysfunction measured by E/A ratios in the fully adjusted mix models (P = 0.02). PA strain is reduced in COPD, related in part to percent emphysema on CT scan, which may have implications for pulmonary small vessel flow and right ventricular function. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:262-271. © 2017 International Society for Magnetic Resonance in Medicine.

Cognitive impairment in COPD: a systematic review.

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Torres-Sánchez, Irene; Rodríguez-Alzueta, Elisabeth; Cabrera-Martos, Irene; López-Torres, Isabel; Moreno-Ramírez, Maria Paz; Valenza, Marie Carmen

2015-01-01

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.

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.

Resource Management As Panacea For Sustainable National Economic Development And National Unity

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Akanbi Oluwajuwon Mayomi

2017-01-01

Full Text Available This paper examines Resource Management as a Panacea for Sustainable National Economic Development and National Unity. The nation has been besieged by numerous problems due to poor resource management. These problems include corruption health implications poverty and inequality in income distribution ethnic crisis pollutions and it has also resulted in economic losses. These problems have militated against the countrys ability to create wealth for the present and future generation. The paper also looked at the concept of conservation and sustainability and their relationship with resource management. The main thrust of the recommendations was hinged on the problems mentioned. These recommendations include making revenue from resources more equitably distributed compensating the people of the area through the development of infrastructures like health facilities and provision of pipe borne water making and enforcing laws that will reduce pollution and development of capital projects.

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...

Tiotropium and Salmeterol in COPD Patients at Risk of Exacerbations: A Post Hoc Analysis from POET-COPD(®).

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Vogelmeier, Claus F; Asijee, Guus M; Kupas, Katrin; Beeh, Kai M

2015-06-01

Among patients with chronic obstructive pulmonary disease (COPD), the frequency and severity of past exacerbations potentiates future events. The impact of current therapies on exacerbation frequency and severity in patients with different exacerbation risks is not well known. A post hoc analysis of patients at low (≤1 exacerbation [oral steroids/antibiotics requirement] and no COPD-related hospitalization in the year preceding trial entry) or high (≥2 exacerbations [oral steroids/antibiotics requirement] or ≥1 COPD-related hospitalization[s] in the year preceding trial entry) exacerbation risk, from the Prevention of Exacerbations with Tiotropium in Chronic Obstructive Pulmonary Disease (POET-COPD(®)) database. Compared with salmeterol, tiotropium significantly increased time to first COPD exacerbation (hazard ratio 0.84; 95% confidence interval [CI] 0.76-0.92; p = 0.0002) and reduced the number of COPD exacerbations (rate ratio 0.90; 95% CI 0.81-0.99; p = 0.0383) in patients at high exacerbation risk. With treatment, the risk of remaining in the high-risk exacerbator subgroup was statistically lower with tiotropium versus salmeterol (risk ratio [RR] 0.89; 95% CI 0.80-1.00; p = 0.0478). For low-risk patients, time to first COPD exacerbation and number of COPD exacerbations were numerically lower with tiotropium versus salmeterol. With treatment, the risk of transitioning from a low to a high exacerbation risk was lower with tiotropium versus salmeterol (RR 0.87; 95% CI 0.71-1.07; p = 0.1968). This analysis confirms the higher efficacy of tiotropium versus salmeterol in prolonging time to first COPD exacerbation and reducing number of exacerbations in patients both at low and high exacerbation risk. Boehringer Ingelheim and Pfizer. ClinicalTrials.gov NCT00563381.

Is the COPD assessment test (CAT) effective in demonstrating the systemic inflammation and other components in COPD?

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Sarioglu, N; Hismiogullari, A A; Bilen, C; Erel, F

2016-01-01

Chronic obstructive pulmonary disease (COPD) is currently a complex, multicomponent disorder. The COPD Assessment Test (CAT) has been increasingly used to assess COPD patients. This study aims to investigate the relationship between CAT and inflammation markers and other COPD components. We enrolled 110 stable COPD patients and 65 control subjects in this study. All patients completed the CAT questionnaire and the modified Medical Research Council (mMRC) dispnea scale. The quality of life of these patients was measured with St. George's Respiratory Questionnaire (SGRQ). Levels of TNFα, IL-6, CRP were determined in blood samples. In COPD patients, serum levels of TNFα (109.5 ± 58 pg/ml), IL-6 (10.3 ± 18 pg/ml), and C-reactive protein (CRP) (1.6 ± 1.7 mg/L) were found to be significantly higher compared to controls (TNF-α: 14.6 ± 18 pg/ml, IL-6: 2.14 ± 1.9 pg/ml, CRP: 0.4 ± 0.3mg/L, pCAT score correlated with GOLD spirometric stages, mMRC dyspnea score, number of exacerbations in the previous year and FEV1 (pCAT score (r=0.43, pCAT was observed. Systemic inflammation persists in the stable period of COPD. CRP, one of the inflammation markers, was correlated with the CAT. Further studies are required to confirm the relationship between CAT and biomarkers. Copyright © 2015 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Disease burden of COPD in China: a systematic review

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Zhu, Bifan; Wang, Yanfang; Ming, Jian; Chen, Wen; Zhang, Luying

2018-01-01

Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76%) than women (4.07%). The disease was more prevalent in rural areas (7.62%) than in urban areas (6.09%). The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL) included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures need to be taken to improve disease prevention and management to reduce disease burdens raised by COPD. PMID:29731623

Depression and heart failure associated with clinical COPD questionnaire outcome in primary care COPD patients : A cross-sectional study

NARCIS (Netherlands)

Urff, Manon; Van Den Berg, Jan Willem K; Uil, Steven M.; Chavannes, Niels H.; Damoiseaux, Roger Amj

2014-01-01

BACKGROUND: Improvement in health-related quality of life (HRQoL) is one of the main goals in treating chronic obstructive pulmonary disease (COPD). Impaired HRQoL in COPD is associated with increased morbidity and mortality, hospitalisations and burden on our health-care system. The Clinical COPD

A new pulmonary rehabilitation maintenance strategy through home-visiting and phone contact in COPD

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Li Y

2018-01-01

Full Text Available Yi Li,1,2 Jing Feng,3,4 Yuechuan Li,2 Wei Jia,2 Hongyu Qian2 1Graduate School, Tianjin Medical University, 2Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, 3Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 4Neuropharmacology Section, Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA Background: The benefit of pulmonary rehabilitation (PR for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits.Methods: A total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC and PR maintenance group (PRMG randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT, COPD assessment test (CAT, and modified Medical Research Council scale (mMRC scores were evaluated every 3 months.Results: Of the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001, and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001 in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05. Total frequency of exacerbations in PRMG was lower than UC (p=0.021.Conclusion: Maintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate. Keywords: COPD, pulmonary rehabilitation, 6-minute walking test, COPD assessment test, maintenance 

[The revised Dutch College of General Practitioners' standard on COPD and the first international WHO standard: differences and similarities].

Science.gov (United States)

van Schayck, C P

2002-02-23

Two standards on COPD have recently been published: the revised national standard from the Dutch College of General Practitioners and the first international standard published by the World Health Organization and the US National Heart, Lung and Blood Institute. The reduced emphasis on the role of spirometry in the monitoring and evaluation of treatment is an important change in these new standards compared to previous ones. Cessation of smoking is considered to be central to the prevention and treatment of COPD. Doctors should strongly support this approach and, more than before, are urged to view COPD as a disease caused by addiction. Bronchodilators are the cornerstone of symptomatic treatment of COPD, particularly the long-acting ones due to their ease of administration and effective treatment of morning dyspnoea. Inhalation corticosteroids should only be administered as a trial treatment and only under certain conditions. Continuation of treatment with these agents is only justified if there is a demonstrated improvement in lung function, exacerbations or symptoms, although the precise area of indication is not yet clear.

ABPM in COPD patients with sleep desaturation.

Science.gov (United States)

Aidar, Neila Anders; Silva, Márcio Alberto Carvalho da; Melo e Silva, César Augusto; Ferreira Júnior, Pedro Nery; Tavares, Paulo

2009-09-01

Sleep hypoxemia may change blood pressure by sympathetic activation. Few studies have analyzed blood pressure parameters in COPD patients who do not present sleep apnea, but do present sleep desaturation. To analyze blood pressure parameters in COPD patients with sleep desaturation not caused by apnea. Thirteen patients with COPD underwent spirometry, blood gas, polysomnography and ABPM for blood pressure evaluation. Fourteen patients without COPD underwent spirometry, oximetry and ABPM. Blood pressure analyses were carried out both during wakefulness and sleep. Both groups were comprised of patients with no history of hypertension. The two groups were similar as regards age, height, weight, and body mass index. A significant difference (p<0.05) was found between blood pressure levels during the wakefulness, sleep, 24-hour and sleep dip periods. Higher blood pressure levels were observed in patients with COPD, except for diastolic levels during wakefulness and maximum values during sleep and in the 24 hours. Sleep dip in the COPD group was attenuated, whereas physiological dip was observed in the control group, with lower blood pressure levels. Systolic and diastolic blood pressure levels in the COPD group were higher than those of the control group, with a significant difference found for all periods studied, except for diastolic levels during wakefulness and in the 24 hours. We can conclude that the group of COPD patients with sleep desaturation has significantly higher blood pressure levels than the control group.

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

Directory of Open Access Journals (Sweden)

Hertel N

2012-03-01

Full Text Available Nadine Hertel1, Robert W Kotchie1, Yevgeniy Samyshkin1, Matthew Radford1, Samantha Humphreys2, Kevin Jameson21IMS Consulting Group, London, UK; 2MSD Ltd, Hoddesdon, UKPurpose: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD, despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.Patients and methods: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA, a long-acting beta agonist (LABA, an inhaled corticosteroid (ICS, and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.Results: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained. The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13

Prevalence of asthma with airflow limitation, COPD, and COPD with variable airflow limitation in older subjects in a general Japanese population: the Hisayama Study.

Science.gov (United States)

Matsumoto, Koichiro; Seki, Nanae; Fukuyama, Satoru; Moriwaki, Atsushi; Kan-o, Keiko; Matsunaga, Yuko; Noda, Naotaka; Yoshida, Makoto; Koto, Hiroshi; Takata, Shohei; Nakanishi, Yoichi; Kiyohara, Yutaka; Inoue, Hiromasa

2015-01-01

Elucidating the prevalence of asthma and chronic obstructive pulmonary disease (COPD) is important for designing a public health strategy. Recent studies have discriminated a phenotype of COPD with variable airflow limitation (COPD-VAL) associated with asthma-COPD overlap syndrome. Its prevalence remains uncertain. The age and occupational distributions in the town of Hisayama and in Japan are nearly identical. Each disease's prevalence was estimated for the town's residents. In 2008, town residents (≥ 40 years) were solicited to participate in a health checkup. Individuals with abnormal spirometry (forced expiratory volume in 1s/forced vital capacity [FEV1/FVC]fashion reviewed their medical records, including bronchodilator reversibility. Individuals with airflow limitation were classified as having asthma, COPD, COPD-VAL, or other diseases. The prevalence of each disease was then estimated. A total of 2100 residents (43.4% of residents in the age group) completed spirometry. In 455 residents with abnormal spirometry, 190 residents had further evaluations, and the medical records of 174 residents were reviewed. The prevalence of asthma with airflow limitation, COPD, and COPD-VAL, were 2.0%, 8.4%, and 0.9%, respectively. The prevalence of COPD and COPD-VAL were higher in men and smokers than in women and never-smokers. The prevalence of COPD, but not COPD-VAL or asthma, increased with age. The prevalence of asthma with airflow limitation, COPD, and COPD-VAL were estimated in a population of residents (≥ 40 years) in Hisayama. Copyright © 2014 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update.

Science.gov (United States)

Yang, Ian A; Brown, Juliet L; George, Johnson; Jenkins, Sue; McDonald, Christine F; McDonald, Vanessa M; Phillips, Kirsten; Smith, Brian J; Zwar, Nicholas A; Dabscheck, Eli

2017-11-20

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.

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)....

Characteristics of reversible and nonreversible COPD and asthma and COPD overlap syndrome patients: an analysis of salbutamol Easyhaler data

Directory of Open Access Journals (Sweden)

Müller V

2016-01-01

Full Text Available Veronika Müller,1 Gabriella Gálffy,1 Márta Orosz,1 Zsuzsanna Kováts,1 Balázs Odler,1 Olof Selroos,2 Lilla Tamási1 1Department of Pulmonology, Semmelweis University, Budapest, Hungary; 2Semeco AB, Ängelholm, Sweden Abstract: The choice of inhaler device for bronchodilator reversibility is crucial since suboptimal inhalation technique may influence the result. On the other hand, bronchodilator response also varies from time to time and may depend on patient characteristics. In this study, patients with airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70% in chronic obstructive pulmonary disease [COPD]; <80% in asthma were included (n=121, age: 57.8±17.3 years. Bronchodilator reversibility (American Thoracic Society/European Respiratory Society criteria was tested in patients with COPD (n=63 and asthma and COPD overlap syndrome (ACOS; n=12. Forty-six asthmatics served as controls. Reversibility was tested with 400 µg salbutamol dry powder inhaler (Buventol Easyhaler, Orion Pharma Ltd, Espoo, Finland. Demographic data and patients’ perceptions of Easyhaler compared with β2-agonist pressurized metered dose inhalers (pMDIs were analyzed. American Thoracic Society/European Respiratory Society guideline defined reversibility was found in 21 out of 63 COPD patients and in two out of 12 ACOS patients. Airway obstruction was more severe in COPD patients as compared with controls (mean FEV1 and FEV1% predicted both P<0.0001. Average response to salbutamol was significantly lower in COPD patients compared with asthma controls (P<0.0001. Reversibility was equally often found in smokers as in never-smokers (33% vs 34%. Nonreversible COPD patients had higher mean weight, body mass index, and FEV1/FVC compared with reversible COPD patients. Most patients preferred Easyhaler and defined its use as simpler and more effective than use of a pMDI. Never-smokers and patients with asthma experienced

Support needs of patients with COPD: a systematic literature search and narrative review.

Science.gov (United States)

Gardener, A Carole; Ewing, Gail; Kuhn, Isla; Farquhar, Morag

2018-01-01

Understanding the breadth of patients' support needs is important for the delivery of person-centered care, particularly in progressive long-term conditions such as chronic obstructive pulmonary disease (COPD). Existing reviews identify important aspects of managing life with COPD with which patients may need support (support needs); however, none of these comprehensively outlines the full range of support needs that patients can experience. We therefore sought to systematically determine the full range of support needs for patients with COPD to inform development of an evidence-based tool to enable person-centered care. We conducted a systematic search and narrative review of the literature. Medline (Ovid), EMBASE, PsycINFO, Cochrane Library, and CINAHL were systematically searched for papers which included data addressing key aspects of support need, as identified by patients with COPD. Relevant data were extracted, and a narrative analysis was conducted. Thirty-one papers were included in the review, and the following 13 domains (broad areas) of support need were identified: 1) understanding COPD, 2) managing symptoms and medication, 3) healthy lifestyle, 4) managing feelings and worries, 5) living positively with COPD, 6) thinking about the future, 7) anxiety and depression, 8) practical support, 9) finance work and housing, 10) families and close relationships, 11) social and recreational life, 12) independence, and 13) navigating services. These 13 domains of support need were mapped to three of the four overarching categories of need commonly used in relevant national strategy documents (ie, physical, psychological, and social); however, support needs related to the fourth category (spiritual) were notably absent. This review systematically identifies the comprehensive set of domains of support need for patients with COPD. The findings provide the evidence base for a tool to help patients identify and express their support needs, which underpins a proposed

Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

Science.gov (United States)

Qu, Yanjuan; Cao, Yiyuan; Liao, Meiyan; Lu, Zhiyan

2017-07-01

This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

Idaho National Laboratory Cultural Resource Management Plan

Energy Technology Data Exchange (ETDEWEB)

Lowrey, Diana Lee

2009-02-01

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Office will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

Idaho National Laboratory Cultural Resource Management Plan

Energy Technology Data Exchange (ETDEWEB)

Lowrey, Diana Lee

2011-02-01

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Office will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

Associations between DSM-IV mental disorders and subsequent COPD diagnosis

Science.gov (United States)

Rapsey, Charlene M.; Lim, Carmen C.W.; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, J.M.; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; Kessler, Ronald C.; Kovess-Masfety, Viviane; Levinson, Daphna; Elena Medina-Mora, María; Murphy, Sam; Ono, Yutaka; Piazza, Maria; Posada-Villa, Jose; ten Have, Margreet; Wojtyniak, Bogdan; Scott, Kate M.

2016-01-01

Objectives COPD and mental disorder comorbidity is commonly reported, although findings are limited by substantive weaknesses. Moreover, few studies investigate mental disorder as a risk for COPD onset. This research aims to investigate associations between current (12-month) DSM-IV mental disorders and COPD, associations between temporally prior mental disorders and subsequent COPD diagnosis, and cumulative effect of multiple mental disorders. Methods Data were collected using population surveys of 19 countries (n = 52,095). COPD diagnosis was assessed by self-report of physician's diagnosis. The World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) was used to retrospectively assess lifetime prevalence and age at onset of 16 DSM-IV disorders. Adjusting for age, gender, smoking, education, and country, survival analysis estimated associations between first onset of mental disorder and subsequent COPD diagnosis. Results COPD and several mental disorders were concurrently associated across the 12-month period (ORs 1.5–3.8). When examining associations between temporally prior disorders and COPD, all but two mental disorders were associated with COPD diagnosis (ORs 1.7–3.5). After comorbidity adjustment, depression, generalized anxiety disorder, and alcohol abuse were significantly associated with COPD (ORs 1.6–1.8). There was a substantive cumulative risk of COPD diagnosis following multiple mental disorders experienced over the lifetime. Conclusions: Mental disorder prevalence is higher in those with COPD than those without COPD. Over time, mental disorders are associated with subsequent diagnosis of COPD; further, the risk is cumulative for multiple diagnoses. Attention should be given to the role of mental disorders in the pathogenesis of COPD using prospective study designs. PMID:26526305

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients.

Science.gov (United States)

Lau, Christine Sm; Siracuse, Brianna L; Chamberlain, Ronald S

2017-01-01

COPD affects over 13 million Americans, and accounts for over half a million hospitalizations annually. The Hospital Readmission Reduction Program, established by the Affordable Care Act requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission scale to identify COPD patients at higher readmission risk. Demographic and clinical data on 339,389 patients from New York and California (derivation cohort) and 258,113 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006-2011), and the Readmission After COPD Exacerbation (RACE) Scale was developed to predict 30-day readmission risk. Thirty-day COPD readmission rates were 7.54% for the derivation cohort and 6.70% for the validation cohort. Factors including age 40-65 years (odds ratio [OR] 1.17; 95% CI, 1.12-1.21), male gender (OR 1.16; 95% CI, 1.13-1.19), African American (OR 1.11; 95% CI, 1.06-1.16), 1st income quartile (OR 1.10; 95% CI, 1.06-1.15), 2nd income quartile (OR 1.06; 95% CI, 1.02-1.10), Medicaid insured (OR 1.83; 95% CI, 1.73-1.93), Medicare insured (OR 1.45; 95% CI, 1.38-1.52), anemia (OR 1.05; 95% CI, 1.02-1.09), congestive heart failure (OR 1.06; 95% CI, 1.02-1.09), depression (OR 1.18; 95% CI, 1.14-1.23), drug abuse (OR 1.17; 95% CI, 1.09-1.25), and psychoses (OR 1.19; 95% CI, 1.13-1.25) were independently associated with increased readmission rates, P readmission variability. The RACE Scale reliably predicts an individual patient's 30-day COPD readmission risk based on specific factors present at initial admission. By identifying these patients at high risk of readmission with the RACE Scale, patient-specific readmission-reduction strategies can be implemented to improve patient care as well as reduce readmissions and health care expenditures.

National uranium resource evaluation, preliminary report

International Nuclear Information System (INIS)

1976-06-01

The results of the initial phase of the National Uranium Resource Evaluation (NURE) are reported. NURE is a comprehensive nationwide program to evaluate uranium resources and to identify areas favorable for uranium exploration. Part I presents estimates of uranium ore reserves and potential resources available at costs (not prices) of $10, $15, and $30 per pound U 3 O 8 (uranium oxide). These estimates comprise the national uranium resource position. They are, however, preliminary because limitations of time and available geologic data prevented adequate assessment of some areas that may be favorable for potential resources. Part II presents the potential uranium resources for each of 13 regions, whose boundaries have been drawn chiefly on geologic considerations. The general geology is summarized, and the types of uranium deposits are described. Although limited geologic reconnaissance was done in various parts of the country, the report is based primarily on the compilation and evaluation of data in ERDA files. Mining companies furnished a substantial amount of information on exploration results, development, production, and future plans. Published, manuscript, and open-file reports by government agencies, universities, and research organizations were reviewed. In addition, many individuals affiliated with universities and with state and federal agencies provided supplemental geologic information. This was particularly helpful in the eastern and central states and in Alaska, where information on uranium occurrences is limited

Disease burden of COPD in China: a systematic review

Directory of Open Access Journals (Sweden)

Zhu B

2018-04-01

Full Text Available Bifan Zhu,1 Yanfang Wang,2 Jian Ming,3 Wen Chen,4 Luying Zhang4 1Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China; 2The First Affiliated Hospital of Wannan Medical College, Wuhu, China; 3IQVIA, Shanghai, China; 4School of Public Health, Fudan University, Shanghai, China Abstract: Chronic obstructive pulmonary disease (COPD is one of the main contributors to the global burden of disease. The aim of this systematic review was to quantify the disease burden of COPD in China and to determine the risk factors of the disease. The number of studies included in the review was 47 with an average quality assessment score of 7.70 out of 10. Reported COPD prevalence varied between 1.20% and 8.87% in different provinces/cities across China. The prevalence rate of COPD was higher among men (7.76% than women (4.07%. The disease was more prevalent in rural areas (7.62% than in urban areas (6.09%. The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%. The percentage of COPD patients receiving outpatient treatment was around 50%, while the admission rate ranged between 8.78% and 35.60%. Tobacco exposure and biomass fuel/solid fuel usage were documented as two important risk factors of COPD. COPD ranked among the top three leading causes of death in China. The direct medical cost of COPD ranged from 72 to 3,565 USD per capita per year, accounting for 33.33% to 118.09% of local average annual income. The most commonly used scales for the assessment of quality of life (QoL included Saint George Respiratory Questionnaire, Airways Questionnaire 20, SF-36, and their revised versions. The status of QoL was worse among COPD patients than in non-COPD patients, and COPD patients were at higher risks of depression. The COPD burden in China was high in terms of economic burden and QoL. In view of the high smoking rate and considerable concerns related to air pollution and smog in China, countermeasures

The Use of Chinese Herbal Medicine in the Treatment of Chronic Obstructive Pulmonary Disease (COPD).

Science.gov (United States)

Liao, Yen-Nung; Hu, Wen-Long; Chen, Hsuan-Ju; Hung, Yu-Chiang

2017-01-01

In Oriental countries, combinations of Chinese herbal products (CHPs) are often utilized as therapeutic agents for chronic obstructive pulmonary disease (COPD). The effects of CHPs on COPD have been previously reported. This study aimed to analyze the frequency of prescription and usage of CHPs in patients with COPD in Taiwan. In this nationwide population-based cross-sectional study, 19,142 patients from a random sample of one million individuals in the Longitudinal Health Insurance Database 2000 (LHID 2000) of the National Health Insurance Research Database (NHIRD) were enrolled from 2000 to 2011. The multiple logistic regression method was used to evaluate the adjusted odds ratios for the utilization of CHPs. For patients with COPD, there was an average of 6.31 CHPs in a single prescription. The most frequently prescribed CHP for COPD was Xiao-Qing-Long-Tang (XQLT) (2.6%), and the most commonly used combination of two formula CHPs was XQLT with Ma-Xing-Gan-Shi-Tang (MXGST) (1.28%). The most commonly used single CHP for COPD was Bulbus Fritillariae (3.65%), and the most commonly used combination of two single CHPs was Bulbus Fritillariae with Puerariae Lobatae (1.09%). These results provide information regarding personalized therapies and may promote further clinical experiments and pharmacologic research on the use of CHPs for the management of COPD. Furthermore, we found that TCM usage was more prevalent among men, younger, manual workers, residents of Northern Taiwan, and patients with chronic bronchitis and asthma. This information on the distribution of TCM usage around the country is valuable to public health policymakers and clinicians.

Idaho National Laboratory Cultural Resource Monitoring Report for 2013

Energy Technology Data Exchange (ETDEWEB)

Williams, Julie B. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2013-10-01

This report describes the cultural resource monitoring activities of the Idaho National Laboratory’s (INL) Cultural Resource Management (CRM) Office during 2013. Throughout the year, thirty-eight cultural resource localities were revisited including: two locations with Native American human remains, one of which is also a cave; fourteen additional caves; seven prehistoric archaeological sites ; four historic archaeological sites; one historic trail; one nuclear resource (Experimental Breeder Reactor-I, a designated National Historic Landmark); and nine historic structures located at the Central Facilities Area. Of the monitored resources, thirty-three were routinely monitored, and five were monitored to assess project compliance with cultural resource recommendations along with the effects of ongoing project activities. On six occasions, ground disturbing activities within the boundaries of the Power Burst Facility/Critical Infrastructure Test Range Complex (PBF/CITRC) were observed by INL CRM staff prepared to respond to any additional finds of Native American human remains. In addition, two resources were visited more than once as part of the routine monitoring schedule or to monitor for additional damage. Throughout the year, most of the cultural resources monitored had no visual adverse changes resulting in Type 1determinations. However, Type 2 impacts were noted at eight sites, indicating that although impacts were noted or that a project was operating outside of culturally cleared limitations, cultural resources retained integrity and noted impacts did not threaten National Register eligibility. No new Type 3 or any Type 4 impacts that adversely impacted cultural resources and threatened National Register eligibility were observed at cultural resources monitored in 2013.

Asthma & COPD--IQPC's Second Conference.

Science.gov (United States)

Catley, Matthew C

2010-09-01

The International Quality & Productivity Center's (IQPC) Second Asthma & COPD conference, held in Philadelphia, included topics covering new therapeutic developments in the field of asthma and COPD. This conference report highlights selected presentations on mAb treatments for asthma, including targeting IL-5, IL-13, IL-9 and TNFa, CCR3 inhibitors, histamine H4 receptor inhibition, novel mouse models of COPD and inhaled antisense asthma therapies. Investigational drugs discussed include mepolizumab (GlaxoSmithKline plc), benralizumab (BioWa Inc/Kyowa Hakko Kirin Co Ltd/MedImmune LLC), AMG-317 (Amgen Inc/Takeda Bio Development Center Ltd), TPI-ASM-8 (Pharmaxis Ltd) and AIR-645 (Altair Therapeutics Inc).

Help, Resources and Information: National Opioids Crisis

Science.gov (United States)

... Search Search Help, Resources and Information National Opioids Crisis Search Search Need Help? Call the National Helpline ... HHS 5-POINT STRATEGY TO COMBAT THE OPIOIDS CRISIS BETTER ADDICTION PREVENTION, TREATMENT, AND RECOVERY SERVICES BETTER ...

Up-regulation of Pim-3 in Chronic Obstructive Pulmonary Disease (COPD) patients and its potential therapeutic role in COPD rat modeling.

Science.gov (United States)

Yang, Cheng; Li, Li; Guo, Junhua; Zhang, Weiqiang; Zhu, Wenbiao; Rao, Xinhui; Huang, Wenjie

2017-04-01

Pim-3 belongs to the PIM kinase family and plays an important role in promoting inflammation, which is essential in the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Immunohistochemistry (IHC), western blot, and RT-PCR analyses were performed to assess the expression of Pim-3 in both COPD and healthy lung tissue samples. SMA (Smooth Muscle Actin) and Cyclin D1 expression were detected by IHC. We also constructed animal models for the control, COPD, and Pim-3 inhibition groups, in order to analyze the effects of Pim-3 inhibition on COPD, and the role of Pim-3 in the p38 pathway. Compared with normal lung tissue, Pim-3 mRNA and protein were up-regulated in COPD tissue. Expression of Cyclin D1 and SMA were also up-regulated in the COPD group. In the animal model experiment, we found that suppression of Pim-3 decreased Pim-3, Cyclin D1, and SMA expression, as well as ameliorated lung damage in COPD patients. The inhibition of Pim-3 also resulted in the suppression of the p38 pathway. Our study suggests that up-regulation of Pim-3 successfully accelerated COPD development, and aggravated lung damage. The molecular mechanism of Pim-3 in COPD might be related to the p38 pathway, and is correlated with Cyclin D1 and SMA expression. Copyright © 2017 Elsevier GmbH. All rights reserved.

Sleep Problems in Asthma and COPD

Science.gov (United States)

... Mini Series #5 Sleep Problems in Asthma and COPD NORMAL AIRWAY Good quality sleep is important for ... with asthma and/or Chronic Obstructive Pulmonary Disease (COPD) may have sleep issues that can lead to ...

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

Directory of Open Access Journals (Sweden)

Price D

2014-08-01

Full Text Available David Price,1 Daniel West,2 Guy Brusselle,3–5 Kevin Gruffydd-Jones,6 Rupert Jones,7 Marc Miravitlles,8 Andrea Rossi,9 Catherine Hutton,2 Valerie L Ashton,2 Rebecca Stewart,2 Katsiaryna Bichel2 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Research in Real-Life Ltd, Cambridge, UK; 3Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; 4Department of Epidemiology, 5Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; 6Box Surgery, Wiltshire, UK; 7Centre for Clinical Trials and Health Research – Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth UK; 8Department of Pneumology, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 9Pulmonary Unit, Cardiovascular and Thoracic Department, University and General Hospital, Verona, Italy Background: Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods: This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis. Results: A total of 24,957 patients were analyzed, of whom 13,557 (54.3% had moderate airflow limitation (GOLD Stage 2 COPD. The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

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Negewo NA

2017-10-01

Full Text Available Netsanet A Negewo,1,2 Peter G Gibson,1–3 Peter AB Wark,1–3 Jodie L Simpson,1,2 Vanessa M McDonald1–4 1Priority Research Centre for Healthy Lungs, 2Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 3Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, 4School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Background: COPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.Objectives: The aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.Methods: In a cross-sectional study, COPD patients (n=222 were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI.Results: Participants (58.6% males had a mean (SD age of 69.1 (8.3 years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4 and a median of five comorbidities. The median (q1, q3 total MRCI score was 24 (18.5, 31. COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001. Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15

COPD -- how to use a nebulizer

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000699.htm COPD - how to use a nebulizer To use the ... page, please enable JavaScript. A nebulizer turns your COPD medicine into a mist. It is easier to ...

Home-based COPD psychoeducation

DEFF Research Database (Denmark)

Bove, D G; Midtgaard, J; Kaldan, G

2017-01-01

in reducing symptoms of anxiety and increasing mastery of dyspnoea in patients with advanced chronic obstructive pulmonary disease (COPD). However, we do not know if the intervention is perceived as meaningful and applicable in the everyday life of patients with advanced COPD. METHODS: We conducted a nested......OBJECTIVE: To explore the patients' experiences of a minimal home-based psychoeducative intervention aimed at reducing symptoms of anxiety. BACKGROUND: In a randomised controlled trial (RCT) we have shown that a minimal home-based and nurse-led psychoeducative intervention has a significant effect...... post-trial qualitative study. The study methodology was Interpretive Description as described by Thorne. The study was based on semi-structured interviews with twenty patients from the RCT intervention group i.g. home-living people with a diagnosis of advanced COPD and symptoms of anxiety. RESULTS...

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

NARCIS (Netherlands)

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

Forest resources of the Lincoln National Forest

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John D. Shaw

2006-01-01

The Interior West Forest Inventory and Analysis (IWFIA) program of the USDA Forest Service, Rocky Mountain Research Station, as part of its national Forest Inventory and Analysis (FIA) duties, conducted forest resource inventories of the Southwestern Region (Region 3) National Forests. This report presents highlights of the Lincoln National Forest 1997 inventory...

Health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease.

Science.gov (United States)

Jimenez-Garcia, Rodrigo; de Miguel-Díez, Javier; Rejas-Gutierrez, Javier; Martín-Centeno, Antonio; Gobartt-Vázquez, Elena; Hernandez-Barrera, Valentin; Gil de Miguel, Angel; Carrasco-Garrido, Pilar

2009-08-01

To describe the health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease (COPD), and compare it with that of non-diabetic COPD patients. An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged > or =40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, health profile, quality of life (SF-12), treatment and health care resources consumption. The results corresponding to diabetic and non-diabetic patients were compared. A total of 10,711 patients (75.6% males) with COPD were evaluated. The prevalence of diabetes was 16.9%. The diabetic patients were significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients. In addition, the diabetics were more sedentary, smoked less, and presented a higher percentage of obesity (33.6% versus 19.7%) than the non-diabetic patients. The severity of airways obstruction was greater among the diabetics than in the non-diabetic patients (54.57+/-13.37% versus 57.92+/-13.39%, respectively, pconsumption of drugs for COPD. In addition, they consumed significantly more health care (and thus economical) resources than the non-diabetic patients. The results of the multivariate logistic regression analysis showed that the variables that were independently associated to COPD among diabetic patients were: higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, SF-12 mental component, SF-12 physical component and total cost of COPD. The presence of diabetes in patients with COPD shows in the bivariate analysis a more severe lung disease, greater co-morbidity, poorer quality of life, and a greater consumption of resources, as well as a less favorable course in the previous year. However, the multivariate logistic regression shows that the variables that are

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.

E-cigarettes in patients with COPD: current perspectives.

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Morjaria, J B; Mondati, E; Polosa, R

2017-01-01

Conventional cigarette smoking is known to result in significant COPD morbidity and mortality. Strategies to reduce and/or stop smoking in this highly vulnerable patient group are key public health priorities to reduce COPD morbidity and mortality. Unfortunately, smoking cessation efforts in patients with COPD are poor and there is a compelling need for more efficient approaches to cessation for patients with COPD. Electronic cigarettes (ECs) are devices that use batteries to vaporize nicotine. They may facilitate quit attempts and cessation in many smokers. Although they are not risk free, ECs are much less harmful than tobacco smoking. Hence, the use of ECs in vulnerable groups and in patients with challenges to abstain or multiple relapses to this habit may be promising. To date, little is known about health consequences of EC use among COPD smokers and whether their regular use has any effects on subjective and objective COPD outcomes. In the current review, we discuss the current perspectives and literature on the role of ECs in abstaining from conventional smoking and the effects of ECs on the respiratory tract in patients with COPD.

Diaphragm adaptations in patients with COPD.

NARCIS (Netherlands)

Ottenheijm, C.A.C.; Heunks, L.M.A.; Dekhuijzen, P.N.R.

2008-01-01

Inspiratory muscle weakness in patients with COPD is of major clinical relevance. For instance, maximum inspiratory pressure generation is an independent determinant of survival in severe COPD. Traditionally, inspiratory muscle weakness has been ascribed to hyperinflation-induced diaphragm

VT County National Resources Inventory Data 1982-1997

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Vermont Center for Geographic Information — (Link to Metadata) This collection provides tabular USDA - Natural Resource Conservation Service (NRCS), National Resources Inventory (NRI) data (1982-1997), by...

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...

Cognitive performance in patients with COPD

NARCIS (Netherlands)

Liesker, JJW; Postma, DS; Beukema, RJ; ten Hacken, NHT; van der Molen, T; Riemersma, RA; van Zomeren, EH; Kerstjens, HAM

Background: Hypoxemic patients with Chronic Obstructive Pulmonary Disease (COPD) have impaired cognitive performance. These neuropsychological impairments are related to the degree of hypoxemia. So far, cognitive performance has not been tested in non-hypoxemic patients with COPD. Methods: We

Lung function decline in COPD

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Tantucci C

2012-02-01

Full Text Available Claudio Tantucci, Denise ModinaUnit of Respiratory Medicine, Department of Medical and Surgical Sciences, University of Brescia, Brescia, ItalyAbstract: The landmark study of Fletcher and Peto on the natural history of tobacco smoke-related chronic airflow obstruction suggested that decline in the forced expiratory volume in the first second (FEV1 in chronic obstructive pulmonary disease (COPD is slow at the beginning, becoming faster with more advanced disease. The present authors reviewed spirometric data of COPD patients included in the placebo arms of recent clinical trials to assess the lung function decline of each stage, defined according to the severity of airflow obstruction as proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines. In large COPD populations the mean rate of FEV1 decline in GOLD stages II and III is between 47 and 79 mL/year and 56 and 59 mL/year, respectively, and lower than 35 mL/year in GOLD stage IV. Few data on FEV1 decline are available for GOLD stage I. Hence, the loss of lung function, assessed as expiratory airflow reduction, seems more accelerated and therefore more relevant in the initial phases of COPD. To have an impact on the natural history of COPD, it is logical to look at the effects of treatment in the earlier stages.Keywords: chronic obstructive pulmonary disease, decline, forced expiratory volume in 1 second, FEV1

The Effects of Air Pollution and Temperature on COPD.

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Hansel, Nadia N; McCormack, Meredith C; Kim, Victor

2016-06-01

Chronic Obstructive Pulmonary Disease (COPD) affects 12-16 million people in the United States and is the third-leading cause of death. In developed countries, smoking is the greatest risk factor for the development of COPD, but other exposures also contribute to the development and progression of the disease. Several studies suggest, though are not definitive, that outdoor air pollution exposure is linked to the prevalence and incidence of COPD. Among individuals with COPD, outdoor air pollutants are associated with loss of lung function and increased respiratory symptoms. In addition, outdoor air pollutants are also associated with COPD exacerbations and mortality. There is much less evidence for the impact of indoor air on COPD, especially in developed countries in residences without biomass exposure. The limited existing data suggests that indoor particulate matter and nitrogen dioxide concentrations are linked to increased respiratory symptoms among patients with COPD. In addition, with the projected increases in temperature and extreme weather events in the context of climate change there has been increased attention to the effects of heat exposure. Extremes of temperature-both heat and cold-have been associated with increased respiratory morbidity in COPD. Some studies also suggest that temperature may modify the effect of pollution exposure and though results are not conclusive, understanding factors that may modify susceptibility to air pollution in patients with COPD is of utmost importance.

Smoking cessation strategies in patients with COPD

DEFF Research Database (Denmark)

Warnier, Miriam J; van Riet, Evelien E S; Rutten, Frans H

2013-01-01

Smoking cessation is the cornerstone of treatment of chronic obstructive pulmonary disease (COPD) patients. This systematic review evaluates the effectiveness of behavioural and pharmacological smoking cessation strategies in COPD patients. MEDLINE was searched from January 2002 to October 2011....... Randomised controlled trials evaluating the effect of smoking cessation interventions for COPD patients, published in English, were selected. The methodological quality of included trials was assessed using the Delphi list by two reviewers independently. The relative risks of smoking cessation due...... that in COPD patients, pharmacological therapy combined with behavioural counselling is more effective than each strategy separately. Neither the intensity of counselling nor the type of anti-smoking drug made a difference....

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.

A challenge to the seven widely believed concepts of COPD

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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

Global scientific collaboration in COPD research

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Su YB

2017-01-01

Full Text Available Yanbing Su,1 Chao Long,2 Qi Yu,1 Juan Zhang,1 Daisy Wu,3 Zhiguang Duan1 1School of Management, Shanxi Medical University, Taiyuan, People’s Republic of China; 2School of Medicine, Stanford University, Palo Alto, CA, 3Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA 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

Novel aspects of pathogenesis and regeneration mechanisms in COPD

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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

Frequency of COPD in health care workers who smoke

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Ivan Kopitovic

Full Text Available ABSTRACT Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4% were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%; restrictive ventilatory defect, in 5 (1.6%; and small airway disease, in 96 (31.5%. A diagnosis of COPD was made in 29 patients (9.5%, 25 (86.2% of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both; 1 belonged to group D (3.6%; and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01. Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

A Qualitative Content Analysis of Spirituality and Religiosity amongst Greek COPD Patients

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Efthymios Tzounis

2016-03-01

Full Text Available Chronic Obstructive Pulmonary Disease (COPD is a chronic and common disease throughout the world. Spiritual/religious beliefs are often central to patients with serious illnesses and could serve as a resource for coping with such illnesses. A qualitative methodology was chosen in order to gain a thorough understanding of 75 (male n = 69, 92%, female n = 6, 8% Greek COPD patients’ perceptions of spirituality and religiosity and explore the importance of practicing their beliefs while 25 patients refused to participate in the study. The fewer female participant patients in the study are related to the lower percentage of women suffering from COPD in Greece, which can be further linked to the low smoking habit of women. A total of four patients (5.3% stated that they had no religious or spiritual understanding of their life; 41 (54.7% reported a religious belief; eight (10.7% told of a spiritual belief; and 22 (29.3% of the participants reported both a religious and a spiritual belief. Faith in the will of God seems to be a particularly strong feature of patients’ beliefs. Praying and church attendance were more likely to confirm the importance of practicing their beliefs in their daily lives but COPD seems to prevent patients from regular churchgoing. Religion and spirituality were found to be helpful while patients did not seem to have unrealistic expectations from God when dealing with illness. When asked, participants defined spirituality as “happiness”, “love”, “our God”, “the spirit”, and as an act of altruism. Adopting a more holistic perspective for COPD patients in the clinical setting, spirituality and religiosity can offer suggestions for interventions related to their health issues.

[Systemic inflammatory profile of smokers with and without COPD].

Science.gov (United States)

Mosrane, Y; Bougrida, M; Alloui, A S; Martani, M; Rouabah, L; Bourahli, M K; Mehdioui, H; Ben Saad, H

2017-09-01

Studies comparing the systemic inflammatory profiles of smokers with and without COPD present discordant findings. To compare the systemic inflammatory profile of smokers with and without COPD. This is a cross-sectional comparative study. Two groups of active smokers of more than 10 pack-years were included: 56 consecutives stable COPD (postbronchodilator FEV 1 /FVCnon-COPD (postbronchodilator FEV 1 /FVC≥0.70). Smoking and clinical, anthropometric and spirometric data were noted. The following blood biomarkers were identified: leukocytes, hemoglobin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). According to the levels (normal/abnormal) of these markers, two groups of smokers were formed. Quantitative and qualitative data were expressed, respectively, as means±SD and percentages. Compared to the non-COPD group, the COPD group was older (56±12 vs. 65±8 years) and had a higher smoking consumption (30±18 vs. 52±31 pack-years). Compared to the non-COPD group, the COPD group had higher values of CRP (2.06±1.24 vs. 11.32±11.03mg/L), of ESR (9.59±8.29 vs. 15.96±11.56), of IL-6 (9.28±4.69 vs. 20.27±5.31ng/L) and of TNF-α (18.38±7.98ng/L vs. 8.62±3.72ng/L). Compared to the non-COPD group, the COPD group included higher percentages of smokers with elevated CRP (0 % vs. 32 %), with leukocytosis (6 % vs. 16 %), with higher levels of IL-6 (81 % vs. 98 %) or TNF-α (91 % vs. 100 %). Smokers with COPD, compared to smokers free from COPD, have a marked systemic inflammation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

The Challenges of Precision Medicine in COPD.

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Cazzola, Mario; Calzetta, Luigino; Rogliani, Paola; Matera, Maria Gabriella

2017-08-01

Pheno-/endotyping chronic obstructive pulmonary disease (COPD) is really important because it provides patients with precise and personalized medicine. The central concept of precision medicine is to take individual variability into account when making management decisions. Precision medicine should ensure that patients get the right treatment at the right dose at the right time, with minimum harmful consequences and maximum efficacy. Ideally, we should search for genetic and molecular biomarker-based profiles. Given the clinical complexity of COPD, it seems likely that a panel of several biomarkers will be required to characterize pathogenetic factors and their course over time. The need for biomarkers to guide the clinical care of individuals with COPD and to enhance the possibilities of success in drug development is clear and urgent, but biomarker development is tremendously challenging and expensive, and translation of research efforts to date has been largely ineffective. Furthermore, the development of personalized treatments will require a much more detailed understanding of the clinical and biological heterogeneity of COPD. Therefore, we are still far from being able to apply precision medicine in COPD and the treatable traits and FEV 1 -free approaches are attempts to precision medicine in COPD that must be considered still quite unsophisticated.

Prevention of exacerbations of COPD with pharmacotherapy

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M. Miravitlles

2010-06-01

Full Text Available Exacerbations are a frequent event in the evolution of chronic obstructive pulmonary disease (COPD patients. Individuals with COPD have a mean of 1–3 episodes per year, some of which lead to hospital admission and may even be a cause of death. The importance of COPD exacerbations has become increasingly apparent due to the impact these episodes have on the natural history of disease. It is now known that frequent exacerbations can adversely affect health-related quality of life and short- and long-term pulmonary function. Optimising treatment for stable COPD will help to reduce exacerbations. Long-acting bronchodilators, alone or combined with inhaled corticosteroids, have demonstrated efficacy in reducing the rate of exacerbations in patients with COPD. Other innovative approaches are being investigated, such as the long-term use of macrolides or the use of antibiotics in an effort to suppress bronchial colonisation and consequent exacerbations. Other drugs, such as mucolytics and immunomodulators, have recently provided positive results. Non-pharmacological interventions such as rehabilitation, self-management plans and the maintenance of high levels of physical activity in daily life are also useful strategies to prevent exacerbations in patients with COPD and should be implemented in regular clinical practice.

The economic impact of COPD in patients of working age: Results from 'COPD uncovered' the Netherlands

NARCIS (Netherlands)

Van Boven, J.F.; Van Der Molen, T.; Postma, M.J.; Vegter, S.

2012-01-01

OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) poses a significant burden on health care budgets. The impact of impaired and lost productivity is less known. The aim of this study was to explore the economic burden of COPD in patients of working age in The Netherlands across three areas:

COPD predicts mortality in HF: the Norwegian Heart Failure Registry.

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De Blois, Jonathan; Simard, Serge; Atar, Dan; Agewall, Stefan

2010-03-01

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (HF) are common clinical conditions that share tobacco as a risk factor. Our aim was to evaluate the prognostic impact of COPD on HF patients. The Norwegian Heart Failure Registry was used. The study included 4132 HF patients (COPD, n = 699) from 22 hospitals (mean follow-up, 13.3 months). COPD patients were older, more often smokers and diabetics, less often on beta-blockers and had a higher heart rate. They were more often in New York Heart Association (NYHA) Class III or IV (COPD, 63%; no COPD, 51%), although left ventricular ejection fraction (LVEF) distribution was similar. COPD independently predicted death (adjusted hazard ratio [HR], 1.188; 95% CI: 1.015 to 1.391; P = 0.03) along with age, creatinine, NYHA Class III/IV (HR, 1.464; 95% CI: 1.286 to 1.667) and diabetes. beta-blockers at baseline were associated with improved survival in patients with LVEF < or =40% independently of COPD. COPD is associated with a poorer survival in HF patients. COPD patients are overrated in terms of NYHA class in comparison with patients with similar LVEF. Nonetheless, NYHA class remains the strongest predictor of death in these patients. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation.

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Kitaguchi, Yoshiaki; Yasuo, Masanori; Hanaoka, Masayuki

2016-01-01

This study was conducted in order to investigate the differences in the respiratory physiology of patients with chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome (ACOS), and asthma with airflow limitation (asthma FL(+)). The medical records for a series of all stable patients with persistent airflow limitation due to COPD, ACOS, or asthma were retrospectively reviewed and divided into the COPD group (n=118), the ACOS group (n=32), and the asthma FL(+) group (n=27). All the patients underwent chest high-resolution computed tomography (HRCT) and pulmonary function tests, including respiratory impedance. The low attenuation area score on chest HRCT was significantly higher in the COPD group than in the ACOS group (9.52±0.76 vs 5.09±1.16, Pbronchial wall thickening on chest HRCT was significantly higher in the asthma FL(+) group than in the COPD group (55.6% vs 25.0%, P<0.01). In pulmonary function, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate were significantly higher in the asthma FL(+) group than in the ACOS group (76.28%±2.54% predicted vs 63.43%±3.22% predicted, P<0.05 and 74.40%±3.16% predicted vs 61.08%±3.54% predicted, P<0.05, respectively). Although residual volume was significantly lower in the asthma FL(+) group than in the COPD group (112.05%±4.34% predicted vs 137.38%±3.43% predicted, P<0.01) and the ACOS group (112.05%±4.34% predicted vs148.46%±6.25% predicted, P<0.01), there were no significant differences in functional residual capacity or total lung capacity. The increase in FEV1 in response to short-acting β2-agonists was significantly greater in the ACOS group than in the COPD group (229±29 mL vs 72±10 mL, P<0.01) and the asthma FL(+) group (229±29 mL vs 153±21 mL, P<0.05). Regarding respiratory impedance, resistance at 5 Hz and resistance at 20 Hz, which are oscillatory parameters of respiratory resistance, were significantly higher in the asthma FL(+) group than in the COPD group

The extent of emphysema in patients with COPD.

Science.gov (United States)

Shaker, Saher Burhan; Stavngaard, Trine; Hestad, Marianne; Bach, Karen Skjoelstrup; Tonnesen, Philip; Dirksen, Asger

2009-01-01

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. We included 209 patients with COPD. COPD was defined as FEV(1)/FVC or=20 pack-years. Patients were assessed by lung function measurement and visual and quantitative assessment of CT, from which the relative area of emphysema below -910 Hounsfield units (RA-910) was extracted. Mean RA-910 was 7.4% (n = 5) in patients with GOLD stage I, 17.0% (n = 119) in stage II, 24.2% (n = 79) in stage III and 33.9% (n = 6) in stage IV. Regression analysis showed a change in RA-910 of 7.8% with increasing severity according to GOLD stage (P < 0.001). Combined visual and quantitative assessment of CT showed that 184 patients had radiological evidence of emphysema, whereas 25 patients had no emphysema. The extent of emphysema 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.

COPD: time to improve its taxonomy?

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Bartolomé R. Celli

2018-02-01

Full Text Available Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who proposed that diseases can be defined by four key characteristics: 1 clinical description (syndrome, 2 disorder of structure (morbid anatomy, 3 disorder of function (pathophysiology and 4 causation (aetiology. Here, we propose a pragmatic approach to the taxonomy of COPD based on different processes that result in a similar syndromic presentation. It can accommodate changes over time, as the pathobiology that may lead to COPD expands. We hope that stakeholders in the field may find it useful to better define the patients now boxed into one single entity, so that specific studies can be designed and conducted for each type of COPDs.

Management of COPD: Is there a role for quantitative imaging?

International Nuclear Information System (INIS)

Kirby, Miranda; Beek, Edwin J.R. van; Seo, Joon Beom; Biederer, Juergen; Nakano, Yasutaka; Coxson, Harvey O.; Parraga, Grace

2017-01-01

Highlights: • Multicentre studies with CT are enabling a better understanding of COPD phenotypes. • New pulmonary MRI techniques have emerged that provide sensitive COPD biomarkers. • OCT is the only imaging modality that can directly quantify the small airways. • Imaging may identify phenotypes for effective COPD management to improve outcomes. - Abstract: While the recent development of quantitative imaging methods have led to their increased use in the diagnosis and management of many chronic diseases, medical imaging still plays a limited role in the management of chronic obstructive pulmonary disease (COPD). In this review we highlight three pulmonary imaging modalities: computed tomography (CT), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) imaging and the COPD biomarkers that may be helpful for managing COPD patients. We discussed the current role imaging plays in COPD management as well as the potential role quantitative imaging will play by identifying imaging phenotypes to enable more effective COPD management and improved outcomes.

Management of COPD: Is there a role for quantitative imaging?

Energy Technology Data Exchange (ETDEWEB)

Kirby, Miranda [Department of Radiology, University of British Columbia, Vancouver (Canada); UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul' s Hospital, Vancouver (Canada); Beek, Edwin J.R. van [Clinical Research Imaging Centre, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh (United Kingdom); Seo, Joon Beom [Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of); Biederer, Juergen [Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg (Germany); Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL) (Germany); Radiologie Darmstadt, Gross-Gerau County Hospital (Germany); Nakano, Yasutaka [Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga (Japan); Coxson, Harvey O. [Department of Radiology, University of British Columbia, Vancouver (Canada); UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul' s Hospital, Vancouver (Canada); Parraga, Grace, E-mail: gparraga@robarts.ca [Robarts Research Institute, The University of Western Ontario, London (Canada); Department of Medical Biophysics, The University of Western Ontario, London (Canada)

2017-01-15

Highlights: • Multicentre studies with CT are enabling a better understanding of COPD phenotypes. • New pulmonary MRI techniques have emerged that provide sensitive COPD biomarkers. • OCT is the only imaging modality that can directly quantify the small airways. • Imaging may identify phenotypes for effective COPD management to improve outcomes. - Abstract: While the recent development of quantitative imaging methods have led to their increased use in the diagnosis and management of many chronic diseases, medical imaging still plays a limited role in the management of chronic obstructive pulmonary disease (COPD). In this review we highlight three pulmonary imaging modalities: computed tomography (CT), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) imaging and the COPD biomarkers that may be helpful for managing COPD patients. We discussed the current role imaging plays in COPD management as well as the potential role quantitative imaging will play by identifying imaging phenotypes to enable more effective COPD management and improved outcomes.

Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care

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Duenk RG

2017-07-01

Full Text Available RG Duenk,1 C Verhagen,1 EM Bronkhorst,2 RS Djamin,3 GJ Bosman,4 E Lammers,5 PNR Dekhuijzen,6 KCP Vissers,1 Y Engels,1,* Y Heijdra6,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Health Evidence, Radboud University Medical Center, Nijmegen, 3Department of Respiratory Medicine, Amphia Hospital, Breda, 4Department of Respiratory Medicine, Slingeland Hospital, Doetinchem, 5Department of Respiratory Medicine, Gelre Hospitals, Zutphen, 6Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands *These authors contributed equally to this work Background: Our objective was to develop a tool to identify patients with COPD for proactive palliative care. Since palliative care needs increase during the disease course of COPD, the prediction of mortality within 1 year, measured during hospitalizations for acute exacerbation COPD (AECOPD, was used as a proxy for the need of proactive palliative care.Patients and methods: Patients were recruited from three general hospitals in the Netherlands in 2014. Data of 11 potential predictors, a priori selected based on literature, were collected during hospitalization for AECOPD. After 1 year, the medical files were explored for the date of death. An optimal prediction model was assessed by Lasso logistic regression, with 20-fold cross-validation for optimal shrinkage. Missing data were handled using complete case analysis.Results: Of 174 patients, 155 patients were included; of those 30 (19.4% died within 1 year. The optimal prediction model was internally validated and had good discriminating power (AUC =0.82, 95% CI 0.81–0.82. This model relied on the following seven predictors: the surprise question, Medical Research Council dyspnea questionnaire (MRC dyspnea, Clinical COPD Questionnaire (CCQ, FEV1% of predicted value, body mass index, previous hospitalizations for AECOPD and specific comorbidities. To ensure minimal miss out of patients in need

Roflumilast: clinical benefit in patients suffering from COPD

DEFF Research Database (Denmark)

Ulrik, Charlotte Suppli; Calverley, Peter Michael Anthony

2010-01-01

BACKGROUND AND AIMS: Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality and is characterised by persistent airway inflammation, which leads to impaired airway function, quality of life and intermittent exacerbations. In spite of recent advances...... in the treatment of COPD, new treatment options for COPD are clearly necessary. The oral phosphodiesterase-4 (PDE4) inhibitor roflumilast represents a new class of drugs that has shown efficacy and acceptable tolerability in preclinical and short-term clinical studies in patients with COPD. METHODS AND RESULTS......) , and a reduction in frequency and severity of COPD exacerbations, as well as a positive effect on several patient-reported outcomes. The clinical benefit of roflumilast appears to be greatest in patients with more symptomatic and severe disease who experience exacerbations. The most common adverse effects...

Roflumilast: clinical benefit in patients suffering from COPD

DEFF Research Database (Denmark)

Ulrik, Charlotte Suppli; Calverley, Peter Michael Anthony

2010-01-01

BACKGROUND AND AIMS:  Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity and mortality and is characterised by persistent airway inflammation, which leads to impaired airway function, quality of life and intermittent exacerbations. In spite of recent advances...... in the treatment of COPD, new treatment options for COPD are clearly necessary. The oral phosphodiesterase-4 (PDE4) inhibitor roflumilast represents a new class of drugs that has shown efficacy and acceptable tolerability in preclinical and short-term clinical studies in patients with COPD. METHODS AND RESULTS......) , and a reduction in frequency and severity of COPD exacerbations, as well as a positive effect on several patient-reported outcomes. The clinical benefit of roflumilast appears to be greatest in patients with more symptomatic and severe disease who experience exacerbations. The most common adverse effects...

Static end-expiratory and dynamic forced expiratory tracheal collapse in COPD

International Nuclear Information System (INIS)

O'Donnell, C.R.; Bankier, A.A.; O'Donnell, D.H.; Loring, S.H.; Boiselle, P.M.

2014-01-01

Aim: To determine the range of tracheal collapse at end-expiration among chronic obstructive pulmonary disease (COPD) patients and to compare the extent of tracheal collapse between static end-expiratory and dynamic forced-expiratory multidetector-row computed tomography (MDCT). Materials and methods: After institutional review board approval and obtaining informed consent, 67 patients meeting the National Heart, Lung, and Blood Institute (NHLBI)/World Health Organization (WHO) Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD were sequentially imaged using a 64-detector-row CT machine at end-inspiration, during forced expiration, and at end-expiration. Standardized respiratory coaching and spirometric monitoring were employed. Mean percentage tracheal collapse at end-expiration and forced expiration were compared using correlation analysis, and the power of end-expiratory cross-sectional area to predict excessive forced-expiratory tracheal collapse was computed following construction of receiver operating characteristic (ROC) curves. Results: Mean percentage expiratory collapse among COPD patients was 17 ± 18% at end-expiration compared to 62 ± 16% during forced expiration. Over the observed range of end-expiratory tracheal collapse (approximately 10–50%), the positive predictive value of end-expiratory collapse to predict excessive (≥80%) forced expiratory tracheal collapse was <0.3. Conclusion: COPD patients demonstrate a wide range of end-expiratory tracheal collapse. The magnitude of static end-expiratory tracheal collapse does not predict excessive dynamic expiratory tracheal collapse

Diagnosis, assessment, and phenotyping of COPD

DEFF Research Database (Denmark)

Lange, Peter; Halpin, David M; O'Donnell, Denis E

2016-01-01

COPD is now widely recognized as a complex heterogeneous syndrome, having both pulmonary and extrapulmonary features. In clinical practice, the diagnosis of COPD is based on the presence of chronic airflow limitation, as assessed by post-bronchodilator spirometry. The severity of the airflow limi...

Impact of air quality guidelines on COPD sufferers

Science.gov (United States)

Liu, Youcheng; Yan, Shuang; Poh, Karen; Liu, Suyang; Iyioriobhe, Emanehi; Sterling, David A

2016-01-01

Background COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers. Objective This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers. Methods PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles. Results Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females. Conclusion There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden. PMID:27143874

Cellular assessment of muscle in COPD: case studies of two males

Directory of Open Access Journals (Sweden)

Howard J Green

2009-11-01

Full Text Available Howard J Green1, Eric Bombardier1, Margaret E Burnett1, Christine L D’Arsigny2, Sobia Iqbal1, Katherine A Webb2, Jing Ouyang1, Denis E O’Donnell21Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada; 2Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen’s University, Kingston, ON, CanadaAbstract: The objective of this paper is to provide an overview of the recent developments in muscle physiology and biochemistry in general, and with respect to chronic obstructive pulmonary disease (COPD specifically. As a way of illustration, we have presented data on the remodeling that occurs in vastus lateralis in two patients with COPD (COPD #1, forced expiratory volume in one second/forced vital capacity [FEV1/FVC] = 63%; COPD #2, FEV1/FVC = 41% exhibiting differences in muscle wasting as compared to healthy controls (CON;FEV1/FVC = 111 ± 2.2%, n = 4. Type I fibers percentages were lower in both COPD #1 (16.7 and COPD #2 (24.9 compared to CON (57.3 ± 5.2. Cross sectional area of the type I fibers of the patients ranged between 65%–68% of CON and for the type II subtypes (IIA, IIAX, IIX between 74% and 89% (COPD #1 and 17%–32% (COPD #2. A lower number of capillary contacts were observed for all fiber types in COPD #1 but not COPD #2. Lower concentrations of adenosine triphosphate (ATP (24%–26% and phosphocreatine (18%–20%, but not lactate occurred in COPD. In contrast to COPD #1, who displayed normal glucose transporter content, GLUT1 and GLUT4 were only 71% and 54%, respectively of CON in COPD #2. Lower monocarboxylate contents were found for MCT1 in both COPD #1 (63% and COPD #2 (41% and for MCT4 (78% in COPD #1. Maximal oxidative enzyme activities (Vmax for COPD #2 ranged between 37% (succinic dehydrogenase and 70% (cytochrome C oxidase of CON. For the cytosolic enzymes, Vmax ranged between 89% (hexokinase to 31% (pyruvate kinase of CON. Depressions were also observed in Vmax of the Na

Sarcopenia as an Independent Risk Factor for Decreased BMD in COPD Patients: Korean National Health and Nutrition Examination Surveys IV and V (2008-2011.

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Dong-Won Lee

Full Text Available A decrease in bone mineral density (BMD is a systemic consequence of chronic obstructive pulmonary disease (COPD. Past reports have rarely examined any correlation between sarcopenia and BMD. We investigated the relationship cross-sectionally between the presence of sarcopenia and BMD reduction in COPD patients.COPD patients aged 50 or older with qualifying spirometry and dual-energy X-ray absorptiometry data were from participants in the Korean National Health and Nutrition Examination Surveys IV and V (2008-2011.There were 286 (33.3% subjects in the sarcopenia group and 572 (66.7% in the non-sarcopenia group. The sarcopenia group had lower T-scores than the non-sarcopenia group (femur: -0.73±0.88 vs. -0.18±0.97, p < 0.001; femur neck: -1.44±0.98 vs. -0.99±1.06, p < 0.001; lumbar: -1.38±1.36 vs. -0.84±1.38, p < 0.001. The prevalences of osteopenia and osteoporosis were 60.8% and 22.0%, respectively, in the sarcopenia group and 45.6% and 13.3% in the non-sarcopenia group (both p < 0.001. After adjusting for multiple variables, the presence of sarcopenia associated with increased the risk of osteopenia, osteoporosis, and a low BMD (OR = 3.227, 95% CI = 2.125-4.899, p < 0.001, OR = 6.952, 95% CI = 3.418-14.139, p < 0.001, and OR = 3.495, 95% CI = 2.315-5.278, p < 0.001, respectively. In a subgroup analysis, similar OR changes were confirmed in the high-body-weight group (n = 493 (OR = 2.248, 95% CI = 1.084-4.665, p = 0.030, OR = 4.621, 95% CI = 1.167-18.291, p = 0.029, and OR = 2.376, 95% CI = 1.158-4.877, p = 0.018, respectively.The presence of sarcopenia was associated with increased the risk for decreased BMD in COPD.

Associations of IL6 polymorphisms with lung function decline and COPD

Science.gov (United States)

He, Jian-Qing; Foreman, Marilyn G.; Shumansky, Karey; Zhang, Xuekui; Akhabir, Loubna; Sin, Don D; Man, S F Paul; DeMeo, Dawn L.; Litonjua, Augusto A.; Silverman, Edwin K.; Connett, John E; Anthonisen, Nicholas R; Wise, Robert A; Paré, Peter D; Sandford, Andrew J

2010-01-01

Background Interleukin-6 (IL6) is a pleiotropic pro-inflammatory and immunomodulatory cytokine which likely plays an important role in the pathogenesis of COPD. There is a functional single nucleotide polymorphism (SNP), −174G/C, in the promoter region of IL6. We hypothesized that IL6 SNPs influence susceptibility for impaired lung function and COPD in smokers. Methods Seven and 5 SNPs in IL6 were genotyped in two nested case-control samples derived from the Lung Health Study (LHS) based on phenotypes of rate of decline of forced expiratory volume in one second (FEV1) over 5 years and baseline FEV1 at the beginning of the LHS. Serum IL6 concentrations were measured for all subjects. A partially overlapping panel of 9 IL6 SNPs was genotyped in 389 COPD cases from the National Emphysema Treatment Trial (NETT) and 420 controls from the Normative Aging Study (NAS). Results In the LHS, three IL6 SNPs were associated with FEV1 decline (0.023 ≤ P ≤ 0.041 in additive models). Among them the IL6_−174C allele was associated with rapid decline of lung function. The association was more significant in a genotype-based analysis (P = 0.006). In the NETT-NAS study, IL6_−174G/C and four other IL6 SNPs, all of which are in linkage disequilibrium with IL6_−174G/C, were associated with susceptibility to COPD (0.01 ≤ P ≤ 0.04 in additive genetic models). Conclusion Our results suggest that the IL6_−174G/C SNP is associated with rapid decline of FEV1 and susceptibility to COPD in smokers. PMID:19359268

Serum Metabolite Biomarkers Discriminate Healthy Smokers from COPD Smokers

Science.gov (United States)

Chen, Qiuying; Deeb, Ruba S.; Ma, Yuliang; Staudt, Michelle R.; Crystal, Ronald G.; Gross, Steven S.

2015-01-01

COPD (chronic obstructive pulmonary disease) is defined by a fixed expiratory airflow obstruction associated with disordered airways and alveolar destruction. COPD is caused by cigarette smoking and is the third greatest cause of mortality in the US. Forced expiratory volume in 1 second (FEV1) is the only validated clinical marker of COPD, but it correlates poorly with clinical features and is not sensitive enough to predict the early onset of disease. Using LC/MS global untargeted metabolite profiling of serum samples from a well-defined cohort of healthy smokers (n = 37), COPD smokers (n = 41) and non-smokers (n = 37), we sought to discover serum metabolic markers with known and/or unknown molecular identities that are associated with early-onset COPD. A total of 1,181 distinct molecular ions were detected in 95% of sera from all study subjects and 23 were found to be differentially-expressed in COPD-smokers vs. healthy-smokers. These 23 putative biomarkers were differentially-correlated with lung function parameters and used to generate a COPD prediction model possessing 87.8% sensitivity and 86.5% specificity. In an independent validation set, this model correctly predicted COPD in 8/10 individuals. These serum biomarkers included myoinositol, glycerophopshoinositol, fumarate, cysteinesulfonic acid, a modified version of fibrinogen peptide B (mFBP), and three doubly-charged peptides with undefined sequence that significantly and positively correlate with mFBP levels. Together, elevated levels of serum mFBP and additional disease-associated biomarkers point to a role for chronic inflammation, thrombosis, and oxidative stress in remodeling of the COPD airways. Serum metabolite biomarkers offer a promising and accessible window for recognition of early-stage COPD. PMID:26674646

Oxidative Stress in COPD: Sources, Markers, and Potential Mechanisms

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Adam John Anthony McGuinness

2017-02-01

Full Text Available Markers of oxidative stress are increased in chronic obstructive pulmonary disease (COPD and reactive oxygen species (ROS are able to alter biological molecules, signaling pathways and antioxidant molecule function, many of which have been implicated in the pathogenesis of COPD. However, the involvement of ROS in the development and progression of COPD is not proven. Here, we discuss the sources of ROS, and the defences that have evolved to protect against their harmful effects. We address the role that ROS may have in the development and progression of COPD, as well as current therapeutic attempts at limiting the damage they cause. Evidence has indicated that the function of several key cells appears altered in COPD patients, and expression levels of important oxidant and antioxidant molecules may be abnormal. Therapeutic trials attempting to restore equilibrium to these molecules have not impacted upon all facets of disease and whilst the theory behind ROS influence in COPD appears sound, current models testing relevant pathways to tissue damage are limited. The heterogeneity seen in COPD patients presents a challenge to our understanding, and further research is essential to identify potential targets and stratified COPD patient populations where ROS therapies may be maximally efficacious.

Natural resource assessment: an approach to science based planning in national parks

Science.gov (United States)

Mahan, C.G.; Vanderhorst, J.P.; Young, J.A.

2009-01-01

We conducted a natural resource assessment at two national parks, New River Gorge National River and Shenandoah National Park, to help meet the goals of the Natural Resource Challenge-a program to help strengthen natural resource management at national parks. We met this challenge by synthesizing and interpreting natural resource information for planning purposes and we identified information gaps and natural significance of resources. We identified a variety of natural resources at both parks as being globally and/or nationally significant, including large expanses of unfragmented, mixed-mesophytic forests that qualify for wilderness protection, rare plant communities, diverse assemblages of neotropical migratory birds and salamanders, and outstanding aquatic recreational resources. In addition, these parks function, in part, as ecological reserves for plants in and wildlife. With these significant natural resources in mind, we also developed a suite of natural resource management recommendations in light of increasing threats from within and outside park boundaries. We hope that our approach can provide a blueprint for natural resource conservation at publically owned lands.

Idaho National Laboratory Cultural Resource Monitoring Report for FY 2009

Energy Technology Data Exchange (ETDEWEB)

Brenda R. Pace; Julie B. Braun

2009-10-01

This report describes the cultural resource monitoring activities of the Idaho National Laboratory’s (INL) Cultural Resource Management (CRM) Office during fiscal year 2009 (FY 2009). Throughout the year, thirty-eight cultural resource localities were revisited including: two locations with Native American human remains, one of which is a cave, two additional caves, twenty-two prehistoric archaeological sites, six historic homesteads, two historic stage stations, two historic trails, and two nuclear resources, including Experimental Breeder Reactor-I, which is a designated National Historic Landmark. Several INL project areas were also monitored in FY 2009 to assess project compliance with cultural resource recommendations and monitor the effects of ongoing project activities. Although impacts were documented at a few locations and trespassing citations were issued in one instance, no significant adverse effects that would threaten the National Register eligibility of any resources were observed. Monitoring also demonstrated that several INL projects generally remain in compliance with recommendations to protect cultural resources.

Physical training moves mountains in COPD, but people with COPD lack information about it

DEFF Research Database (Denmark)

Østergaard, Elisabeth Bomholt; Kristiansen, Anne Dal; Thomsen, Pernille Maja

, and participation in a closed Facebook-group for people with COPD, were conducted. We transcribed the interviews, transformed the spoken language to a written language and made a thematic analysis based on The Health Belief Model and Self Determination Theory. Results: One of the main reasons for not doing physical...... in physical activity and to gain insight in the motivational factors for being physically active, as well as the barriers. Methods/Analysis: Fieldwork among five people with COPD in Jutland, Denmark 2013-2015 using semi-structured interviews. Supplementary, unstructured interviews with three GPs...... activity until years after the diagnosis was that people with COPD did neither receive the necessary information from the GPs about the benefits of physical training nor about the negative consequences of an inactive lifestyle. Motivational factors for living a physically active life were first of all...

Geothermal energy. A national proposal for geothermal resources research

Energy Technology Data Exchange (ETDEWEB)

Denton, J.C. (ed.)

1972-01-01

Discussions are given for each of the following topics: (1) importance to the Nation of geothermal resources, (2) budget recommendations, (3) overview of geothermal resources, (4) resource exploration, (5) resource assessment, (6) resource development and production, (7) utilization technology and economics, (8) environmental effects, (9) institutional considerations, and (10) summary of research needs.

The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD): the COPD-Home model.

Science.gov (United States)

Sunde, Synnøve; Walstad, Rolf Aksel; Bentsen, Signe Berit; Lunde, Solfrid J; Wangen, Eva Marie; Rustøen, Tone; Henriksen, Anne Hildur

2014-09-01

Adherence to guidelines for managing stable chronic obstructive pulmonary disease (COPD) and its exacerbations is inadequate among healthcare workers and patients. An appropriate care model would meet patient needs, enhance their coping with COPD and improve their quality of life (QOL). This study aims to present the 'COPD-Home' as an integrated care model for patients with severe or very severe COPD. One principle of the COPD-Home model is that hospital treatment should lead to follow up in the patient's home. The model also includes education, improved coordination of levels of care, improved accessibility and a management plan. One of the main elements of the COPD-Home model is the clear role of the home-care nurse. Model development is based on earlier research and clinical experience. It comprises: (i) education provided through an education programme for patients and involved nurses, (ii) joint visits and telephone checks, (iii) a call centre for support and communication with a general practitioner and (iv) an individualised self-management plan including home monitoring and a plan for pharmacological and nonpharmacological interventions. The COPD-Home model attempts to cultivate competences and behaviours of patients and community nurses that better accord with guidelines for interventions. The next step in its development will be to evaluate its ability to assist both healthcare workers and planners to improve the management of COPD, reduce exacerbations and improve QOL and coping among patients with COPD. © 2013 Nordic College of Caring Science.

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.......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...

Blood eosinophil levels as a biomarker in COPD.

Science.gov (United States)

Brusselle, Guy; Pavord, Ian D; Landis, Sarah; Pascoe, Steven; Lettis, Sally; Morjaria, Nikhil; Barnes, Neil; Hilton, Emma

2018-05-01

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder and patients respond differently to treatment. Blood eosinophils are a potential biomarker to stratify patient subsets for COPD therapy. We reviewed the value of blood eosinophils in predicting exacerbation risk and response to corticosteroid treatment in the available literature (PubMed articles in English; keywords: "COPD" and "eosinophil"; published prior to May 2017). Overall, clinical data suggest that in patients with a history of COPD exacerbations, a higher blood eosinophil count predicts an increased risk of future exacerbations and is associated with improved response to treatment with inhaled corticosteroids (in combination with long-acting bronchodilator[s]). Blood eosinophils are therefore a promising biomarker for phenotyping patients with COPD, although prospective studies are needed to assess blood eosinophils as a biomarker of corticosteroid response for this. Copyright © 2018 Elsevier Ltd. All rights reserved.

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...... analysis was conducted to compare the internal structure of the Danish version and the American source version. The study included 151 patients with COPD, recruited from three outpatient clinics. Estimates of reliability were in accordance with the original version of CSES (Cronbach's a = 0.97, test...

Disconnection of pulmonary and systemic arterial stiffness in COPD

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Weir-McCall JR

2018-05-01

Full Text Available Jonathan R Weir-McCall,1 Patrick SK Liu-Shiu-Cheong,2 Allan D Struthers,1 Brian J Lipworth,2 J Graeme Houston1 1Division of Molecular and Clinical Medicine, Medical Research Institute, University of Dundee, Dundee, UK; 2Scottish Centre for Respiratory Research, Medical Research Institute, University of Dundee, Dundee, UK Background: Both pulmonary arterial stiffening and systemic arterial stiffening have been described in COPD. The aim of the current study was to assess pulse wave velocity (PWV within these two arterial beds to determine whether they are separate or linked processes. Materials and methods: In total, 58 participants with COPD and 21 healthy volunteers (HVs underwent cardiac magnetic resonance imaging (MRI and were tested with a panel of relevant biomarkers. Cardiac MRI was used to quantify ventricular mass, volumes, and pulmonary (pulse wave velocity [pPWV] and systemic pulse wave velocity [sPWV]. Results: Those with COPD had higher pPWV (COPD: 2.62 vs HV: 1.78 ms-1, p=0.006, higher right ventricular mass/volume ratio (RVMVR; COPD: 0.29 vs HV: 0.25 g/mL, p=0.012, higher left ventricular mass/volume ratio (LVMVR; COPD: 0.78 vs HV: 0.70 g/mL, p=0.009, and a trend toward a higher sPWV (COPD: 8.7 vs HV: 7.4 ms-1, p=0.06. Multiple biomarkers were elevated: interleukin-6 (COPD: 1.38 vs HV: 0.58 pg/mL, p=0.02, high-sensitivity C-reactive protein (COPD: 6.42 vs HV: 2.49 mg/L, p=0.002, surfactant protein D (COPD: 16.9 vs HV: 9.13 ng/mL, p=0.001, N-terminal pro-brain natriuretic peptide (COPD: 603 vs HV: 198 pg/mL, p=0.001, and high-sensitivity troponin I (COPD: 2.27 vs HV: 0.92 pg/mL, p<0.001. There was a significant relationship between sPWV and LVMVR (p=0.01 but not pPWV (p=0.97 nor between pPWV and RVMVR (p=0.27. Conclusion: Pulmonary arterial stiffening and systemic arterial stiffening appear to be disconnected and should therefore be considered independent processes in COPD. Further work is warranted to determine whether both these

Evaluation of atopy in patients with COPD

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Margarida Celia Lima Costa Neves

2013-06-01

Full Text Available 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.

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

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López-Campos JL

2017-03-01

Full Text Available Jose Luis López-Campos,1,2 Maria Abad Arranz,1 Carmen Calero-Acuña,1,2 Fernando Romero-Valero,3 Ruth Ayerbe-García,4 Antonio Hidalgo-Molina,3 Ricardo I Aguilar-Pérez-Grovas,4 Francisco García-Gil,5 Francisco Casas-Maldonado,6 Laura Caballero-Ballesteros,5 María Sánchez-Palop,6 Dolores Pérez-Tejero,7 Alejandro Segado Soriano,7 Jose Calvo-Bonachera,8 Bárbara Hernández-Sierra,8 Adolfo Doménech,9 Macarena Arroyo-Varela,9 Francisco González-Vargas,10 Juan J Cruz-Rueda10 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, 2CIBER de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, 3Sección de Neumología, Hospital Puerta del Mar, Cádiz, 4Servicio de Neumología, Hospital Juan Ramón Jiménez, Huelva, 5Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, 6Servicio de Neumología, Hospital Universitario San Cecilio, Granada, 7Sección de Neumología, Hospital Infanta Margarita, Cabra, Córdoba, 8Servicio de Neumología, Hospital Torrecárdenas, Almería, 9Servicio de Neumología, Hospital Regional Universitario de Málaga, Málaga, 10Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain Objectives: Clinical practice in chronic obstructive pulmonary disease (COPD can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013–2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons.Methods: The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants with retrospective data gathering. For the present analysis

Inflammatory biomarkers in asthma-COPD overlap syndrome

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Kobayashi S

2016-09-01

Full Text Available Seiichi Kobayashi, Masakazu Hanagama, Shinsuke Yamanda, Masatsugu Ishida, Masaru YanaiDepartment of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, JapanBackground: The clinical phenotypes and underlying mechanisms of asthma-COPD overlap syndrome (ACOS remain elusive. This study aimed to investigate a comparison of COPD patients with and without ACOS, focusing on inflammatory biomarkers, in an outpatient COPD cohort.Methods: We conducted a cross-sectional study analyzing prospectively collected data from the Ishinomaki COPD Network registry. All participants were diagnosed with COPD, confirmed by using spirometry, and were aged 40–90 years and former smokers. Patients with features of asthma including both variable respiratory symptoms and variable expiratory airflow limitation were identified and defined as having ACOS. Then, the inflammatory biomarkers such as fractional exhaled nitric oxide level, blood eosinophil count and percentage, total immunoglobulin E (IgE level, and presence of antigen-specific IgE were evaluated.Results: A total of 257 patients with COPD were identified, including 37 (14.4% with ACOS. Patients with ACOS tended to be younger, have a shorter smoking history, and use more respiratory medications, especially inhaled corticosteroids and theophylline. Mean fractional exhaled nitric oxide level was significantly higher in those with ACOS than in those without ACOS (38.5 parts per billion [ppb] vs 20.3 ppb, P<0.001. Blood eosinophil count and percentage were significantly increased in those with ACOS (295/mm3 vs 212/mm3, P=0.032; 4.7% vs 3.2%, P=0.003, respectively. Total IgE level was also significantly higher, and presence of antigen-specific IgE was observed more frequently in patients with ACOS. Receiver operating characteristic curve analysis indicated that the sensitivity and specificity of these biomarkers were relatively low, but combinations of these biomarkers showed high specificity for

The COPD assessment test and St George's Respiratory Questionnaire: are they equivalent in subjects with COPD?

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Morishita-Katsu M

2016-07-01

Full Text Available Mariko Morishita-Katsu,1,2 Koichi Nishimura,3 Hiroyuki Taniguchi,1 Tomoki Kimura,1 Yasuhiro Kondoh,1 Kensuke Kataoka,1 Tomoya Ogawa,4 Fumiko Watanabe,4 Shinichi Arizono,5 Osamu Nishiyama,6 Kazuhito Nakayasu,7 Kazuyoshi Imaizumi,8 Yoshinori Hasegawa2 1Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan; 2Division of Respiratory Medicine, Department of Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan; 4Department of Rehabilitation, Tosei General Hospital, Seto, Japan; 5School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan; 6Department of Respiratory Medicine and Allergology, Kinki University School of Medicine, Osakasayama, Japan; 7Data Research Section, Kondo P.P. Inc., Osaka, Japan; 8Department of Respiratory Medicine, Fujita Health University, Nagoya, Japan Background: The chronic obstructive pulmonary disease (COPD assessment test (CAT is a short questionnaire that has facilitated health status measurements in subjects with COPD. However, it remains controversial as to whether the CAT can be used as a suitable substitute for the St George’s Respiratory Questionnaire (SGRQ. This study investigated the reliability and score distributions of the CAT and SGRQ and evaluated which factors contributed to health status for each questionnaire.Methods: A total of 109 consecutive subjects with stable COPD from a single center were enrolled in this study. Each subject completed pulmonary function tests, exercise tests, and the following self-administered questionnaires: the Baseline Dyspnea Index, the Hospital Anxiety and Depression Scale, the CAT, and SGRQ.Results: Internal consistencies of CAT and SGRQ total scores were both excellent (Cronbach’s α coefficients =0.890 and 0.933. Statistically significant correlations were observed between CAT and SGRQ total scores (R=0

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

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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

A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: rationale and methods.

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Rajkumar, Prabu; Pattabi, Kamaraj; Vadivoo, Selvaraj; Bhome, Arvind; Brashier, Bill; Bhattacharya, Prashanta; Mehendale, Sanjay M

2017-05-29

Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable chronic respiratory disease, which affects 210 million people globally. Global and national guidelines exist for the management of COPD. Although evidence-based, they are inadequate to address the phenotypic and genotypic heterogeneity in India. Co-existence of other chronic respiratory diseases can adversely influence the prognosis of COPD.India has a huge burden of COPD with various risk factors and comorbid conditions. However, valid prevalence estimates employing spirometry as the diagnostic tool and data on important comorbid conditions are not available. This study protocol is designed to address this knowledge gap and eventually to build a database to undertake long-term cohort studies to describe the phenotypic and genotypic heterogeneity among COPD patients in India. The primary objective is to estimate the prevalence of COPD among adults aged ≥25 years for each gender in India. The secondary objective is to identify the risk factors for COPD and important comorbid conditions such as asthma and post-tuberculosis sequelae. It is also proposed to validate the currently available definitions for COPD diagnosis in India. A cross-sectional study will be undertaken among the populations of sub-urban areas of Chennai and Shillong cities, which represent the Southern and Northeastern regions of India. We will collect data on sociodemographic variables, economic characteristics, risk factors of COPD and comorbidities. The Global Initiative for Obstructive Lung Disease (GOLD) and Global Initiative for Asthma (GINA) definitions will be used for the diagnosis of COPD and asthma. Data will be analysed for estimation of the prevalence of COPD, asthma and associated factors. This study proposal was approved by the respective institutional ethics committees of participating institutions. The results will be disseminated through publications in the peer-reviewed journals and a report

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...

Soluble common gamma chain exacerbates COPD progress through the regulation of inflammatory T cell response in mice

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Lee B

2017-03-01

Full Text Available Byunghyuk Lee,1 Eunhee Ko,1 Jiyeon Lee,2 Yuna Jo,1 Hyunju Hwang,1 Tae Sik Goh,1,3 Myungsoo Joo,2 Changwan Hong1 1Department of Anatomy and Cell Biology, Pusan National University School of Medicine, 2Division of Applied Medicine, School of Korean Medicine, Pusan National University, Yangsan, 3Department of Orthopedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Busan, South Korea Abstract: Cigarette smoking (CS is a major cause of considerable morbidity and mortality by inducing lung cancer and COPD. COPD, a smoking-related disorder, is closely related to the alteration of immune system and inflammatory processes that are specifically mediated by T cells. Soluble common gamma chain (sγc has recently been identified as a critical regulator of the development and differentiation of T cells. We examined the effects of sγc in a cigarette smoke extract (CSE mouse model. The sγc level in CSE mice serum is significantly downregulated, and the cellularity of lymph node (LN is systemically reduced in the CSE group. Overexpression of sγc enhances the cellularity and IFNγ production of CD8 T cells in LN and also enhances Th1 and Th17 differentiation of CD4 T cells in the respiratory tract. Mechanistically, the downregulation of sγc expression mediated by CSE is required to prevent excessive inflammatory T cell responses. Therefore, our data suggest that sγc may be one of the target molecules for the control of immunopathogenic progresses in COPD. Keywords: COPD, T cell, soluble common gamma chain, cytokine

Journal Articles Applying National Aquatic Resource Survey Data

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The National Aquatic Resource Surveys (NARS) data are being used and applied above and beyond the regional and national assessments. This page includes a list of recent journal articles that reference NARS data.

E-cigarettes in patients with COPD: current perspectives

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Morjaria JB

2017-11-01

Full Text Available JB Morjaria,1,2 E Mondati,3,4 R Polosa3–5 1Department of Respiratory Medicine, Royal Brompton and Harefield Hospital Foundation Trust, Harefield Hospital, Harefield, 2Department of Respiratory Medicine, Imperial College, London, UK; 3Department of Clinical and Experimental Medicine, 4Department of Internal and Emergency Medicine, 5Centro per la Prevenzione e Cura del Tabagismo (CPCT, “Policlinico-V. Emanuele,” University of Catania, Catania, Italy Abstract: Conventional cigarette smoking is known to result in significant COPD morbidity and mortality. Strategies to reduce and/or stop smoking in this highly vulnerable patient group are key public health priorities to reduce COPD morbidity and mortality. Unfortunately, smoking cessation efforts in patients with COPD are poor and there is a compelling need for more efficient approaches to cessation for patients with COPD. Electronic cigarettes (ECs are devices that use batteries to vaporize nicotine. They may facilitate quit attempts and cessation in many smokers. Although they are not risk free, ECs are much less harmful than tobacco smoking. Hence, the use of ECs in vulnerable groups and in patients with challenges to abstain or multiple relapses to this habit may be promising. To date, little is known about health consequences of EC use among COPD smokers and whether their regular use has any effects on subjective and objective COPD outcomes. In the current review, we discuss the current perspectives and literature on the role of ECs in abstaining from conventional smoking and the effects of ECs on the respiratory tract in patients with COPD. Keywords: smoking cessation, electronic cigarette, COPD, tobacco harm reduction 

Biologic Drugs: A New Target Therapy in COPD?

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Yousuf, Ahmed; Brightling, Christopher E

2018-04-23

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease associated with significant morbidity and mortality. Current diagnostic criteria based on the presence of fixed airflow obstruction and symptoms do not integrate the complex pathological changes occurring within the lung and they do not define different airway inflammatory patterns. The current management of COPD is based on 'one size fits all' approach and does not take the importance of heterogeneity in COPD population into account. The available treatments aim to alleviate symptoms and reduce exacerbation frequency but do not alter the course of the disease. Recent advances in molecular biology have furthered our understanding of inflammatory pathways in pathogenesis of COPD and have led to development of targeted therapies (biologics and small molecules) based on predefined biomarkers. Herein we shall review the trials of biologics in COPD and potential future drug developments in the field.

Bacterial microbiome of lungs in COPD

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Sze MA

2014-02-01

Full Text Available Marc A Sze,1 James C Hogg,2 Don D Sin1 1Department of Medicine, 2Department of Pathology and Laboratory Medicine, The James Hogg Research Centre, Providence Heart-Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada Abstract: Chronic obstructive pulmonary disease (COPD is currently the third leading cause of death in the world. Although smoking is the main risk factor for this disease, only a minority of smokers develop COPD. Why this happens is largely unknown. Recent discoveries by the human microbiome project have shed new light on the importance and richness of the bacterial microbiota at different body sites in human beings. The microbiota plays a particularly important role in the development and functional integrity of the immune system. Shifts or perturbations in the microbiota can lead to disease. COPD is in part mediated by dysregulated immune responses to cigarette smoke and other environmental insults. Although traditionally the lung has been viewed as a sterile organ, by using highly sensitive genomic techniques, recent reports have identified diverse bacterial communities in the human lung that may change in COPD. This review summarizes the current knowledge concerning the lung microbiota in COPD and its potential implications for pathogenesis of the disease. Keywords: chronic obstructive pulmonary disease, bacterial microbiome, lungs

DAMPs, endogenous danger signals fueling airway inflammation in COPD

NARCIS (Netherlands)

Pouwels, Simon

2017-01-01

COPD is a severe and progressive lung disease characterized by both chronic bronchitis as well as emphysema. In the Netherlands alone every year 7,000 people die from the consequences of COPD. COPD is caused by the chronic inhalation of toxic gases, like cigarette smoke. Furthermore, genetic

Increased T-regulatory cells within lymphocyte follicles in moderate COPD

DEFF Research Database (Denmark)

Plumb, J; Smyth, L J C; Adams, H R

2009-01-01

Lymphoid follicles in the lung parenchyma are a characteristic feature of chronic obstructive pulmonary disease (COPD). There are reports of altered CD4 T-regulatory cell numbers in COPD lungs, but the location of these cells within COPD lung tissue specific follicles has not been investigated......, as well as lymphoid clusters lacking organisation. The percentage of CD4 cells that were T-regulatory cells were significantly increased (p = 0.02) within COPD (16%) follicles compared with smokers (10%) and nonsmokers (8%). In contrast, there was no change (p>0.05) in the percentage of T-regulatory cells...... in clusters or the subepithelium between groups. Lymphoid follicles in COPD patients have increased T-regulatory cells. Therefore, T-regulatory activity may be altered within COPD lymphoid follicles....

Idaho National Laboratory Cultural Resource Monitoring Report for FY 2010

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INL Cultural Resource Management Office

2010-10-01

This report describes the cultural resource monitoring activities of the Idaho National Laboratory’s (INL) Cultural Resource Management (CRM) Office during fiscal year 2010 (FY 2010). Throughout the year, thirty-three cultural resource localities were revisited, including somethat were visited more than once, including: two locations with Native American human remains, one of which is a cave, two additional caves, twenty-six prehistoric archaeological sites, two historic stage stations, and Experimental Breeder Reactor-I, which is a designated National Historic Landmark. The resources that were monitored included seventeen that are routinely visited and sixteen that are located in INL project areas. Although impacts were documented at a few locations and one trespassing incident (albeit sans formal charges) was discovered, no significant adverse effects that would threaten the National Register eligibility of any resources were observed. Monitoring also demonstrated that several INL projects generally remain in compliance with recommendations to protect cultural resources.

Epidemiology and clinical impact of major comorbidities in patients with COPD

Science.gov (United States)

Smith, Miranda Caroline; Wrobel, Jeremy P

2014-01-01

Comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and significantly impact on patients’ quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD. PMID:25210449

Positioning new pharmacotherapies for COPD

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Barjaktarevic IZ

2015-07-01

Full Text Available Igor Z Barjaktarevic,1 Anthony F Arredondo,1 Christopher B Cooper1,2 1Department of Medicine, 2Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA Abstract: COPD imposes considerable worldwide burden in terms of morbidity and mortality. In recognition of this, there is now extensive focus on early diagnosis, secondary prevention, and optimizing medical management of the disease. While established guidelines recognize different grades of disease severity and offer a structured basis for disease management based on symptoms and risk, it is becoming increasingly evident that COPD is a condition characterized by many phenotypes and its control in a single patient may require clinicians to have access to a broader spectrum of pharmacotherapies. This review summarizes recent developments in COPD management and compares established pharmacotherapy with new and emerging pharmacotherapies including long-acting muscarinic antagonists, long-acting β-2 sympathomimetic agonists, and fixed-dose combinations of long-acting muscarinic antagonists and long-acting β-2 sympathomimetic agonists as well as inhaled cortiocosteroids, phosphodiesterase inhibitors, and targeted anti-inflammatory drugs. We also review the available oral medications and new agents with novel mechanisms of action in early stages of development. With several new pharmacological agents intended for the management of COPD, it is our goal to familiarize potential prescribers with evidence relating to the efficacy and safety of new medications and to suggest circumstances in which these therapies could be most useful. Keywords: COPD phenotypes, once-daily inhalers, fixed-combination inhalers, long-acting muscarinic antagonist, LAMA, long-acting β-2 sympathomimetic agonist, LABA

Nutrition Therapy in Elderly with Chronic Obstructive Pulmonary Disease (COPD

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Minidian Fasitasari

2013-06-01

Full Text Available Nutrition is an important health element for elderly people and influence aging process. Malnutrition prevalence is increasing in this population. Chronic Obstructive Pulmonary Disease (COPD is one of the chronic diseases in elderly that is related to malnutrition. The association between malnutrition and pulmonary disease (including COPD has been known for a long time. Malnutrition has negative impacts on pulmonary structure, elasticity, and function, strength and endurance of respiratory muscles, pulmonary immunity defense mechanism, and breath control. Inversely, pulmonary disease (including COPD will increase energy need and may reduce dietary intake. Nutrition intervention in COPD patient is intended for regulating anorexia, improving pulmonary function, and controlling weight loss. Nutrient requirements will be calculated according to the results of nutrition assessment. This article will discuss about nutrition therapy in elderly with COPD. It describes respiratory system in aging, association COPD and nutrition, and nutrition assessment, as well as nutrition intervention in elderly people with COPD.

Idaho National Laboratory Cultural Resource Monitoring Report for FY 2008

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Brenda R. Pace

2009-01-01

This report describes the cultural resource monitoring activities of the Idaho National Laboratory’s (INL) Cultural Resource Management (CRM) Office during fiscal year 2008 (FY 2008). Throughout the year, 45 cultural resource localities were revisited including: two locations of heightened Shoshone-Bannock tribal sensitivity, four caves, one butte, twenty-eight prehistoric archaeological sites, three historic homesteads, two historic stage stations, one historic canal construction camp, three historic trails, and Experimental Breeder Reactor-I, which is a designated National Historic Landmark. Several INL project areas were also monitored in FY 2008 to assess project compliance with cultural resource recommendations, confirm the locations of previously recorded cultural resources in relation to project activities, to assess the damage caused by fire-fighting efforts, and to watch for cultural materials during ground disturbing activities. Although impacts were documented at a few locations, no significant adverse effects that would threaten the National Register eligibility of any resource were observed. Monitoring also demonstrated that INL projects generally remain in compliance with recommendations to protect cultural resources

COPD depicted – patients drawing their lungs

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Kaptein AA

2017-11-01

Full Text Available Ad A Kaptein,1 Jitske Tiemensma,2 Elizabeth Broadbent,3 Guus M Asijee,4,5 Maarten Voorhaar4,5 1Medical Psychology, Leiden University Medical Centre (LUMC, Leiden, the Netherlands; 2Psychological Sciences, University of California, Merced, CA, USA; 3Psychology Department, Auckland University Medical School, Auckland, New Zealand; 4CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; 5Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany Background: Given the increasing importance of patient-reported outcomes (PRO in quality medical care, we examined the value and feasibility of an innovative method for assessing patients’ illness perceptions, represented in drawings made by patients with COPD of their lungs. Aim: The aim of our study was: to study patients’ representation of COPD as reflected in their drawings of their lungs; and to examine scores on a validated measure that assesses illness perceptions (ie, Brief Illness Perception Questionnaire [B-IPQ]. Patients and methods: One hundred outpatients with COPD, mean age 70 years, selected from a pharmacy database, participated and 98 filled out the B-IPQ. Eighty-seven patients completed the drawing task. Results: The illness perceptions as reflected in the responses to the B-IPQ scales represented a quite optimistic view of COPD and its consequences. The drawings of the lungs reflected a considerable discordance between patients’ representations and medically accepted representations of lungs of a person with COPD. Conclusion: Assessing illness perceptions in clinical care and research about COPD offers opportunities to identify goals for patient education and self-management. Inviting patients to draw their illness is an innovative and promising approach to assessing PRO. Keywords: COPD, drawings, illness perceptions, PRO, quality of life, self-management

The concept of control of COPD in clinical practice

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Soler-Cataluña JJ

2014-12-01

Full Text Available Juan José Soler-Cataluña,1,2 Bernardino Alcázar-Navarrete,3 Marc Miravitlles2,4 1Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES, 3Respiratory Department, Hospital de Alta Resolucion, Granada, Spain; 4Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Abstract: Treatment of chronic obstructive pulmonary disease (COPD requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state. Keywords: COPD, control, CAT, CCQ, exacerbations, prognosis

The Saudi Guidelines for the Diagnosis and Management of COPD

Science.gov (United States)

Khan, Javed H.; Lababidi, Hani M. S.; Al-Moamary, Mohamed S.; Zeitouni, Mohammed O.; AL-Jahdali, Hamdan H.; Al-Amoudi, Omar S.; Wali, Siraj O.; Idrees, Majdy M.; Al-Shimemri, Abdullah A.; Al Ghobain, Mohammed O.; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

2014-01-01

The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD. PMID:24791168

Lower corticosteroid skin blanching response is associated with severe COPD.

Directory of Open Access Journals (Sweden)

Susan J M Hoonhorst

Full Text Available 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.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.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.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.

Variants of the ADRB2 Gene in COPD

DEFF Research Database (Denmark)

Nielsen, Anne Orholm; Steen Jensen, Camilla; Arredouani, Mohamed Simo

2017-01-01

The β2-adrenergic receptor (ADRB2) is an important regulator of airway smooth muscle tone in chronic obstructive pulmonary disease (COPD). Variants that impair ADRB2 function could increase disease risk or reduce the response to endogenous and inhaled adrenergic agonists in COPD. We performed...... a systematic review and three meta-analyses to assess whether three functional variants (Thr164Ile, Arg16Gly, and Gln27Glu) in the ADRB2 gene are associated with elevated risk of disease or reduced therapeutic response to inhaled β2-agonists in COPD. We searched the medical literature from 1966 to 2017...... and found 16 relevant studies comprising 85381 study subjects. The meta-analyses found no significant association between ADRB2 genotype and COPD risk. The summary odds ratios (ORs) for COPD in Thr164Ile homozygotes and heterozygotes were 2.57 (95% confidence interval (CI): 0.54-12.4) and 1.17 (95% CI: 0...

Chronic obstructive pulmonary disease (COPD) assessment test scores corresponding to modified Medical Research Council grades among COPD patients.

Science.gov (United States)

Lee, Chang-Hoon; Lee, Jinwoo; Park, Young Sik; Lee, Sang-Min; Yim, Jae-Joon; Kim, Young Whan; Han, Sung Koo; Yoo, Chul-Gyu

2015-09-01

In assigning patients with chronic obstructive pulmonary disease (COPD) to subgroups according to the updated guidelines of the Global Initiative for Chronic Obstructive Lung Disease, discrepancies have been noted between the COPD assessment test (CAT) criteria and modified Medical Research Council (mMRC) criteria. We investigated the determinants of symptom and risk groups and sought to identify a better CAT criterion. This retrospective study included COPD patients seen between June 20, 2012, and December 5, 2012. The CAT score that can accurately predict an mMRC grade ≥ 2 versus COPD patients, the percentages of patients classified into subgroups A, B, C, and D were 24.5%, 47.2%, 4.2%, and 24.1% based on CAT criteria and 49.3%, 22.4%, 8.9%, and 19.4% based on mMRC criteria, respectively. More than 90% of the patients who met the mMRC criteria for the 'more symptoms group' also met the CAT criteria. AUROC and CART analyses suggested that a CAT score ≥ 15 predicted an mMRC grade ≥ 2 more accurately than the current CAT score criterion. During follow-up, patients with CAT scores of 10 to 14 did not have a different risk of exacerbation versus those with CAT scores COPD patients.

Forest resources of the Nez Perce National Forest

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Michele Disney

2010-01-01

As part of a National Forest System cooperative inventory, the Interior West Forest Inventory and Analysis (IWFIA) Program of the USDA Forest Service conducted a forest resource inventory on the Nez Perce National Forest using a nationally standardized mapped-plot design (for more details see the section "Inventory methods"). This report presents highlights...

Prevalence and Determinants of Chronic Obstructive Pulmonary Disease (COPD) in Bangladesh.

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Alam, Dewan S; Chowdhury, Muhammad Ah; Siddiquee, Ali T; Ahmed, Shyfuddin; Clemens, John D

2015-01-01

There is a paucity of population-based data on COPD prevalence and its determinants in Bangladesh. To measure COPD prevalence and socioeconomic and lifestyle determinants among ≥40 years Bangladeshi adults. In a cross-sectional study, we measured lung function of 3744 randomly selected adults ≥40 years from rural and urban areas in Bangladesh, using a handheld spirometer. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) COPD was also assessed by the lower limit of normal (LLN) threshold defined as lower fifth percentile for the predicted FEV1/FVC. The prevalence of COPD was 13.5% by GOLD criteria and 10.3% by LLN criteria. Prevalence of COPD was higher among rural than urban residents and in males than females. More than half of the COPD cases were stage II COPD by both criteria. Milder cases (Stages I and II) were over estimated by the GOLD fixed criteria, but more severe cases (Stages III and IV) were similarly classified. In multiple logistic regression analysis, older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD. COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD.

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. © 2016 Asian Pacific Society of Respirology.

Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation

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Kitaguchi Y

2016-05-01

Full Text Available Yoshiaki Kitaguchi, Masanori Yasuo, Masayuki Hanaoka First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan Background: This study was conducted in order to investigate the differences in the respiratory physiology of patients with chronic obstructive pulmonary disease (COPD, asthma-COPD overlap syndrome (ACOS, and asthma with airflow limitation (asthma FL+. Methods: The medical records for a series of all stable patients with persistent airflow limitation due to COPD, ACOS, or asthma were retrospectively reviewed and divided into the COPD group (n=118, the ACOS group (n=32, and the asthma FL+ group (n=27. All the patients underwent chest high-resolution computed tomography (HRCT and pulmonary function tests, including respiratory impedance. Results: The low attenuation area score on chest HRCT was significantly higher in the COPD group than in the ACOS group (9.52±0.76 vs 5.09±1.16, P<0.01. The prevalence of bronchial wall thickening on chest HRCT was significantly higher in the asthma FL+ group than in the COPD group (55.6% vs 25.0%, P<0.01. In pulmonary function, forced expiratory volume in 1 second (FEV1 and peak expiratory flow rate were significantly higher in the asthma FL+ group than in the ACOS group (76.28%±2.54% predicted vs 63.43%±3.22% predicted, P<0.05 and 74.40%±3.16% predicted vs 61.08%±3.54% predicted, P<0.05, respectively. Although residual volume was significantly lower in the asthma FL+ group than in the COPD group (112.05%±4.34% predicted vs 137.38%±3.43% predicted, P<0.01 and the ACOS group (112.05%±4.34% predicted vs148.46%±6.25% predicted, P<0.01, there were no significant differences in functional residual capacity or total lung capacity. The increase in FEV1 in response to short-acting ß2-agonists was significantly greater in the ACOS group than in the COPD group (229±29 mL vs 72±10 mL, P<0.01 and the asthma FL+ group (229±29 mL vs 153±21 mL, P<0.05. Regarding

Support needs of patients with COPD: a systematic literature search and narrative review

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Gardener AC

2018-03-01

commonly used in relevant national strategy documents (ie, physical, psychological, and social; however, support needs related to the fourth category (spiritual were notably absent.Conclusion: This review systematically identifies the comprehensive set of domains of support need for patients with COPD. The findings provide the evidence base for a tool to help patients identify and express their support needs, which underpins a proposed intervention to enable the delivery of person-centered care: the Support Needs Approach for Patients (SNAP. Keywords: COPD, person-centered care, support needs

Candidate genes for COPD in two large data sets.

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Bakke, P S; Zhu, G; Gulsvik, A; Kong, X; Agusti, A G N; Calverley, P M A; Donner, C F; Levy, R D; Make, B J; Paré, P D; Rennard, S I; Vestbo, J; Wouters, E F M; Anderson, W; Lomas, D A; Silverman, E K; Pillai, S G

2011-02-01

Lack of reproducibility of findings has been a criticism of genetic association studies on complex diseases, such as chronic obstructive pulmonary disease (COPD). We selected 257 polymorphisms of 16 genes with reported or potential relationships to COPD and genotyped these variants in a case-control study that included 953 COPD cases and 956 control subjects. We explored the association of these polymorphisms to three COPD phenotypes: a COPD binary phenotype and two quantitative traits (post-bronchodilator forced expiratory volume in 1 s (FEV₁) % predicted and FEV₁/forced vital capacity (FVC)). The polymorphisms significantly associated to these phenotypes in this first study were tested in a second, family-based study that included 635 pedigrees with 1,910 individuals. Significant associations to the binary COPD phenotype in both populations were seen for STAT1 (rs13010343) and NFKBIB/SIRT2 (rs2241704) (p<0.05). Single-nucleotide polymorphisms rs17467825 and rs1155563 of the GC gene were significantly associated with FEV₁ % predicted and FEV₁/FVC, respectively, in both populations (p<0.05). This study has replicated associations to COPD phenotypes in the STAT1, NFKBIB/SIRT2 and GC genes in two independent populations, the associations of the former two genes representing novel findings.

Enhancement in anomalous Hall resistivity of Co/Pd multilayer and CoPd alloy by Ga+ ion irradiation

KAUST Repository

Guo, Zaibing

2014-02-01

In this paper, we report the effect of Ga+ ion irradiation on anomalous Hall effect (AHE) and longitudinal resistivity (ρxx) in [Co(3 Å)/Pd(5 Å)]80 multilayer and Co 42Pd58 alloy. 4- and 2-fold increases in anomalous Hall resistivity (ρAH) in the Co/Pd multilayer and CoPd alloy have been observed after irradiations at doses of 2.4 × 1015 and 3.3×10 15 ions/cm2, respectively. Skew scattering and side jump contributions to AHE have been analyzed based on the scaling relationship ρAH = aρxx + bρ2xx. For the Co/Pd multilayer, AHE is mainly affected by ion irradiation-induced interface diffusion and defects. For the CoPd alloy, the increase in doses above 1.5 × 1015 ions/cm2 induces a sign change in skew scattering, followed by the skew scattering contribution to AHE overwhelming the side jump contribution, this phenomenon should be attributed to irradiation-induced defects and modifications in chemical ordering. © Copyright EPLA, 2014.

Resource nationalism and credit growth in FSU countries

International Nuclear Information System (INIS)

Kalyuzhnova, Yelena; Nygaard, Christian

2009-01-01

This paper analyses the connection between resource nationalism and financial sector intervention in the FSU countries. We consider recent financial development in the FSU and the special features of energy rich emerging economies (Russia and Kazakhstan, in particular) which are influencing recent credit expansions. We find that the hydrocarbon sector has boosted boosting domestic credits through a number of direct and indirect routes. Recent decline in oil prices may change government attitudes to a continued resource nationalist strategy. Sovereign wealth funds that were established in a majority of energy rich emerging economies may, to the extent that they enable the selection of winners in specific economic sectors, create path dependency or exacerbate longer term allocative inefficiency arising from the governance structure associated with resource nationalism.

Resource nationalism and credit growth in FSU countries

Energy Technology Data Exchange (ETDEWEB)

Kalyuzhnova, Yelena; Nygaard, Christian [The Centre for Euro-Asian Studies, The University of Reading, Whiteknights, PO Box 218, Reading RG6 6AA (United Kingdom)

2009-11-15

This paper analyses the connection between resource nationalism and financial sector intervention in the FSU countries. We consider recent financial development in the FSU and the special features of energy rich emerging economies (Russia and Kazakhstan, in particular) which are influencing recent credit expansions. We find that the hydrocarbon sector has boosted boosting domestic credits through a number of direct and indirect routes. Recent decline in oil prices may change government attitudes to a continued resource nationalist strategy. Sovereign wealth funds that were established in a majority of energy rich emerging economies may, to the extent that they enable the selection of winners in specific economic sectors, create path dependency or exacerbate longer term allocative inefficiency arising from the governance structure associated with resource nationalism. (author)

COPD and stroke: are systemic inflammation and oxidative stress the missing links?

Science.gov (United States)

Austin, Victoria; Crack, Peter J; Bozinovski, Steven; Miller, Alyson A; Vlahos, Ross

2016-07-01

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and loss of lung function, and is currently the third largest cause of death in the world. It is now well established that cardiovascular-related comorbidities such as stroke contribute to morbidity and mortality in COPD. The mechanisms linking COPD and stroke remain to be fully defined but are likely to be interconnected. The association between COPD and stroke may be largely dependent on shared risk factors such as aging and smoking, or the association of COPD with traditional stroke risk factors. In addition, we propose that COPD-related systemic inflammation and oxidative stress may play important roles by promoting cerebral vascular dysfunction and platelet hyperactivity. In this review, we briefly discuss the pathogenesis of COPD, acute exacerbations of COPD (AECOPD) and cardiovascular comorbidities associated with COPD, in particular stroke. We also highlight and discuss the potential mechanisms underpinning the link between COPD and stroke, with a particular focus on the roles of systemic inflammation and oxidative stress. © 2016 The Author(s).

Impact of air quality guidelines on COPD sufferers

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Liu Y

2016-04-01

Full Text Available Youcheng Liu,1,* Shuang Yan,2,* Karen Poh,1 Suyang Liu,3 Emanehi Iyioriobhe,1 David A Sterling1 1Department of Environmental and Occupational Health Sciences, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA; 2Department of Endocrinology and Metabolism, Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China; 3Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA *These authors contributed equally to this work Background: COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers. Objective: This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers. Methods: PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles. Results: Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD

Caregivers' burden in patients with COPD.

Science.gov (United States)

Miravitlles, Marc; Peña-Longobardo, Luz María; Oliva-Moreno, Juan; Hidalgo-Vega, Álvaro

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions.

Ethnic Differences in Persistence with COPD Medications

DEFF Research Database (Denmark)

Hu, Yusun; Cantarero-Arévalo, Lourdes; Frølich, Anne

2017-01-01

BACKGROUND: Long-acting bronchodilators (LABDs) are recommended as a first-line maintenance therapy in patients with moderate or severe chronic obstructive pulmonary disease (COPD). The aim of the study was to explore potential ethnic differences in persistence with LABD in COPD patients. METHODS...

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

Directory of Open Access Journals (Sweden)

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

Gastroesophageal reflux disease in COPD: links and risks

Science.gov (United States)

Lee, Annemarie L; Goldstein, Roger S

2015-01-01

COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment. PMID:26392769

Noncanonical WNT-5A signaling impairs endogenous lung repair in COPD

Science.gov (United States)

Baarsma, Hoeke A.; John-Schuster, Gerrit; Heinzelmann, Katharina; Dagouassat, Maylis; Boczkowski, Jorge; Brusselle, Guy G.; Smits, Ron; Yildirim, Ali Ö.

2017-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. One main pathological feature of COPD is the loss of functional alveolar tissue without adequate repair (emphysema), yet the underlying mechanisms are poorly defined. Reduced WNT–β-catenin signaling is linked to impaired lung repair in COPD; however, the factors responsible for attenuating this pathway remain to be elucidated. Here, we identify a canonical to noncanonical WNT signaling shift contributing to COPD pathogenesis. We demonstrate enhanced expression of noncanonical WNT-5A in two experimental models of COPD and increased posttranslationally modified WNT-5A in human COPD tissue specimens. WNT-5A was increased in primary lung fibroblasts from COPD patients and induced by COPD-related stimuli, such as TGF-β, cigarette smoke (CS), and cellular senescence. Functionally, mature WNT-5A attenuated canonical WNT-driven alveolar epithelial cell wound healing and transdifferentiation in vitro. Lung-specific WNT-5A overexpression exacerbated airspace enlargement in elastase-induced emphysema in vivo. Accordingly, inhibition of WNT-5A in vivo attenuated lung tissue destruction, improved lung function, and restored expression of β-catenin–driven target genes and alveolar epithelial cell markers in the elastase, as well as in CS-induced models of COPD. We thus identify a novel essential mechanism involved in impaired mesenchymal–epithelial cross talk in COPD pathogenesis, which is amenable to therapy. PMID:27979969

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

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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

Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): A Comparison of Clinical Outcomes Before and After the MISSION Clinic.

Science.gov (United States)

Lanning, Eleanor; Roberts, Claire; Green, Ben; Brown, Thomas; Storrar, Will; Jones, Thomas; Fogg, Carole; Dewey, Ann; Longstaff, Jayne; Bassett, Paul; Chauhan, Anoop J

2017-06-05

Chronic obstructive pulmonary disorder (COPD) affects over 1 million people in the United Kingdom, and 1 person dies from COPD every 20 minutes. The cost to people with COPD and the National Health Service is huge - more than 24 million working days lost a year and the annual expenditure on COPD is £810 million and £930 million a year. We aim to identify patients with COPD who are at risk of exacerbations and hospital admissions as well as those who have not been formally diagnosed, yet remain at risk. This mixed-methods study will use both data and interviews from patients and health care professionals. The project Modern Innovative SolutionS in Improving Outcomes iN COPD (MISSION COPD) will hold multidisciplinary carousel style clinics to rapidly assess the patients' COPD and related comorbidities, and enhance patient knowledge and skills for self-management. This study is ongoing. This research will capture quantitative and qualitative outcomes to accompany a program of quality improvement through delivery of novel care models. ©Eleanor Lanning, Claire Roberts, Ben Green, Thomas Brown, Will Storrar, Thomas Jones, Carole Fogg, Ann Dewey, Jayne Longstaff, Paul Bassett, Anoop J Chauhan. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 05.06.2017.

LEFT VENTRICULAR DYSFUNCTION IN COPD WITH OR WITHOUT COR PULMONALE

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Uma Shankar Mishra

2018-01-01

Full Text Available BACKGROUND Chronic Obstructive Pulmonary Disease (COPD is a disease state characterised by the presence of airflow obstruction due to chronic bronchitis or emphysema, which is progressive and partially reversible. Right ventricular failure (cor pulmonale is a well-known complication of COPD. But, it also involves left ventricle leading to systolic as well as diastolic dysfunction, which maybe present with associated RV failure and also as a separate entity. Diastolic dysfunction is due to defective filling of the left ventricle because of the hyperinflated lung. On the other hand, systolic dysfunction maybe secondary to RV failure due to the effects of hypoxia in the cardiac muscle fibres as a part of the systemic hypoxaemia or it may be due to the effects of the circulatory inflammatory mediators leading to atherosclerosis and ischaemia of cardiac muscles. MATERIALS AND METHODS It was a prospective study of 100 patients of COPD classified according to GOLD criteria with or without cor pulmonale admitted to our hospital in the period of January 2014 to October 2015 meeting our inclusion and exclusion criteria. Investigations like chest x-ray, spirometry, 2D-echocardiography and electrocardiography were done and data was collected. Data were pooled and interpreted using standard statistical methods. RESULTS Prevalence of COPD was common after middle age, the peak being around 5th and 6 th decade of life without much gender inequality. Cor pulmonale was found in 65% patients of COPD, of which more number were in the severe COPD. LV systolic dysfunction was found in 44% of all COPD patients and LV diastolic dysfunction was found in 59% of cases. LV diastolic dysfunction was found in 64% and LV systolic dysfunction was found in 49% of patients of COPD with cor pulmonale. LV systolic dysfunction was found in 62% of COPD patients who showed a resting hypoxaemia (SpO2 <90%. CONCLUSION In our study of 100 COPD patients, we found LV diastolic dysfunction

Accelerated extracellular matrix turnover during exacerbations of COPD

DEFF Research Database (Denmark)

Sand, Jannie M B; Knox, Alan J; Lange, Peter

2015-01-01

progression. Extracellular matrix (ECM) turnover reflects activity in tissues and consequently assessment of ECM turnover may serve as biomarkers of disease activity. We hypothesized that the turnover of lung ECM proteins were altered during exacerbations of COPD. METHODS: 69 patients with COPD hospitalised...... of circulating fragments of structural proteins, which may serve as markers of disease activity. This suggests that patients with COPD have accelerated ECM turnover during exacerbations which may be related to disease progression....

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...

Estimating the effectiveness of pulmonary rehabilitation for COPD exacerbations: reduction of hospital inpatient days during the following year

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Katajisto M

2017-09-01

Full Text Available Milla Katajisto,1,2 Tarja Laitinen3 1Clinical Research Unit for Pulmonary Diseases, Division of Pulmonology, Helsinki University Hospital Heart and Lung Center, 2Helsinki University, Helsinki, 3Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, University of Turku, Turku, Finland Aims: To study the short- and long-term results of pulmonary rehabilitation (PR given in the Helsinki University Heart and Lung Center and to understand the hospital resources used to treat severe COPD exacerbations in the city of Helsinki.Materials and methods: Seventy-eight inactive patients with severe COPD were recruited for a PR course; three of them did not finish the course. The course took 6–8 weeks and included 11–16 supervised exercise sessions. Using electronic medical records, we studied all COPD patients with hospital admission in the city of Helsinki in 2014, including COPD diagnosis, criteria for exacerbation, and potential exclusion/inclusion criteria for PR.Results: Seventy-five of the patients finished the PR course and 92% of those patients showed clinically significant improvement. Their hospital days were reduced by 54% when compared to the year before. At 1 year after the course, 53% of the patients reported that they have continued with regular exercise training. In the city of Helsinki, 437 COPD patients were treated in a hospital due to exacerbation during 2014. On the basis of their electronic medical records, 57% of them would be suitable for PR. According to a rough estimate, 10%–20% hospital days could be saved annually if PR was available to all, assuming that the PR results would be as good as those shown here.Conclusions: The study showed that in a real-world setting, PR is efficient when measured by saved hospital days in severe COPD. Half of the patients could be motivated to continue exercising on their own. Keywords: COPD, severe exacerbation, pulmonary rehabilitation, physical inactivity, COPD

A simple algorithm for the identification of clinical COPD phenotypes

NARCIS (Netherlands)

Burgel, Pierre-Régis; Paillasseur, Jean-Louis; Janssens, Wim; Piquet, Jacques; ter Riet, Gerben; Garcia-Aymerich, Judith; Cosio, Borja; Bakke, Per; Puhan, Milo A.; Langhammer, Arnulf; Alfageme, Inmaculada; Almagro, Pere; Ancochea, Julio; Celli, Bartolome R.; Casanova, Ciro; de-Torres, Juan P.; Decramer, Marc; Echazarreta, Andrés; Esteban, Cristobal; Gomez Punter, Rosa Mar; Han, MeiLan K.; Johannessen, Ane; Kaiser, Bernhard; Lamprecht, Bernd; Lange, Peter; Leivseth, Linda; Marin, Jose M.; Martin, Francis; Martinez-Camblor, Pablo; Miravitlles, Marc; Oga, Toru; Sofia Ramírez, Ana; Sin, Don D.; Sobradillo, Patricia; Soler-Cataluña, Juan J.; Turner, Alice M.; Verdu Rivera, Francisco Javier; Soriano, Joan B.; Roche, Nicolas

2017-01-01

This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses. Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of

Dysregulated Functions of Lung Macrophage Populations in COPD.

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Kapellos, Theodore S; Bassler, Kevin; Aschenbrenner, Anna C; Fujii, Wataru; Schultze, Joachim L

2018-01-01

Chronic obstructive pulmonary disease (COPD) is a diverse respiratory disease characterised by bronchiolitis, small airway obstruction, and emphysema. Innate immune cells play a pivotal role in the disease's progression, and in particular, lung macrophages exploit their prevalence and strategic localisation to orchestrate immune responses. To date, alveolar and interstitial resident macrophages as well as blood monocytes have been described in the lungs of patients with COPD contributing to disease pathology by changes in their functional repertoire. In this review, we summarise recent evidence from human studies and work with animal models of COPD with regard to altered functions of each of these myeloid cell populations. We primarily focus on the dysregulated capacity of alveolar macrophages to secrete proinflammatory mediators and proteases, induce oxidative stress, engulf microbes and apoptotic cells, and express surface and intracellular markers in patients with COPD. In addition, we discuss the differences in the responses between alveolar macrophages and interstitial macrophages/monocytes in the disease and propose how the field should advance to better understand the implications of lung macrophage functions in COPD.

[Are there specific characteristics of COPD in women?].

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Raherison, C; Biron, E; Nocent-Ejnaini, C; Taillé, C; Tillie-Leblond, I; Prudhomme, A

2010-06-01

Chronic Obstructive Pulmonary Disease (COPD) is a disorder resulting from an interaction between a genetic predisposition, still poorly understood, and the impact of environmental factors including tobacco smoke or professional or domestic air contaminants. The prevalence of COPD in the world concerns women as much as men, but it remains under diagnosed among women smokers. The mortality data show an increase in mortality among women compared to men. It thus seems that COPD in women presents more often a particular phenotype, characterized more by bronchial attacks than by emphysema, and by more marked functional effects on the quality of life. Anxiety and depression seem more marked with further repercussions on the quality of life. The effectiveness of treatment may be different, in particular with regard to nicotine weaning and respiratory rehabilitation. In the evaluation of chronic diseases in women little is known about COPD. Further studies, focusing specifically on these differences, are needed in order to improve the diagnosis and management of COPD in women. Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Dysregulated Functions of Lung Macrophage Populations in COPD

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Bassler, Kevin; Aschenbrenner, Anna C.

2018-01-01

Chronic obstructive pulmonary disease (COPD) is a diverse respiratory disease characterised by bronchiolitis, small airway obstruction, and emphysema. Innate immune cells play a pivotal role in the disease's progression, and in particular, lung macrophages exploit their prevalence and strategic localisation to orchestrate immune responses. To date, alveolar and interstitial resident macrophages as well as blood monocytes have been described in the lungs of patients with COPD contributing to disease pathology by changes in their functional repertoire. In this review, we summarise recent evidence from human studies and work with animal models of COPD with regard to altered functions of each of these myeloid cell populations. We primarily focus on the dysregulated capacity of alveolar macrophages to secrete proinflammatory mediators and proteases, induce oxidative stress, engulf microbes and apoptotic cells, and express surface and intracellular markers in patients with COPD. In addition, we discuss the differences in the responses between alveolar macrophages and interstitial macrophages/monocytes in the disease and propose how the field should advance to better understand the implications of lung macrophage functions in COPD. PMID:29670919

Airflow obstruction: is it asthma or is it COPD?

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Rogliani P

2016-11-01

Full Text Available Paola Rogliani, Josuel Ora, Ermanno Puxeddu, Mario Cazzola Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy Abstract: Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition. The association of asthma and COPD in the same patient has been designated mixed asthma–COPD phenotype or overlap syndrome. However, since the absence of a clear definition and the inclusion of patients with different characteristics under this umbrella term, it may not facilitate treatment decisions, especially in the absence of clinical trials addressing this heterogeneous population. We are realizing that neither asthma nor COPD are single diseases, but rather syndromes consisting of several endotypes and phenotypes, consequently comprising a spectrum of diseases that must be recognized and adequately treated with targeted therapy. Therefore, we must treat patients by personalizing therapy on the basis of those treatable traits present in each subject. Keywords: airway obstruction, asthma, ACOS, chronic obstructive pulmonary disease

Natural History of COPD Exacerbations in a General Practice Based COPD Population.

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Rothnie, Kieran J; Müllerová, Hana; Smeeth, Liam; Quint, Jennifer K

2018-02-23

Rationale Acute exacerbations (AECOPD) are important adverse events in the natural history of COPD. Objectives To investigate the natural history of AECOPD over 10-years of follow-up. Methods and Results We identified 99,574 patients with COPD 01/Jan/04-31/March/15 from the UK Clinical Practice Research Datalink. We defined moderate AECOPD as those managed outside hospital and severe as those requiring hospitalisation. During the baseline period (first year of follow-up), patients were grouped according to the number and severity of AECOPD and then followed for a maximum of 10 years (mean 4.9 years). We investigated the effect of baseline AECOPD number and severity on risk of further events and death. Around one-quarter of the COPD patients did not exacerbate during follow-up. Compared to no AECOPD in the baseline period, AECOPD number predicted the future long-term rate of AECOPD in a graduated fashion, ranging from HR 1.71(1.66-1.77) for one to HR 3.41(3.27-3.56) for 5+ events. Two or more moderate AECOPD were also associated with an increased risk of death in a graduated fashion, ranging from HR 1.10(1.03-1.18) for 2 moderate AECOPD to HR 1.57(1.45-1.70) for 5+ moderate AECOPD, compared to those with no AECOPD at baseline. Severe AECOPD were associated with an even higher risk of death (HR 1.79,1.65-1.94). Conclusions A large proportion of COPD patients do not exacerbate over a maximum 10 years of follow-up. AECOPD frequency in a single year predicts long-term AECOPD rate. Increasing frequency and severity of AECOPD is associated with risk of death, and highlights the importance of preventing AECOPD.

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.

A score to predict short-term risk of COPD exacerbations (SCOPEX

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Make BJ

2015-01-01

Full Text Available Barry J Make,1 Göran Eriksson,2 Peter M Calverley,3 Christine R Jenkins,4 Dirkje S Postma,5 Stefan Peterson,6 Ollie Östlund,7 Antonio Anzueto8 1Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden; 3Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK; 4George Institute for Global Health, The University of Sydney and Concord Clinical School, Woolcock Institute of Medical Research, Sydney, NSW, Australia; 5Department of Pulmonology, University of Groningen and GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; 6StatMind AB, Lund, Sweden; 7Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; 8Department of Pulmonary/Critical Care, University of Texas Health Sciences Center and South Texas Veterans Healthcare System, San Antonio, TX, USA Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC curves and the corresponding C-index were used to investigate the discriminatory

Early detection of COPD: a case finding study in general practice.

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Vandevoorde, Jan; Verbanck, Sylvia; Gijssels, Lieve; Schuermans, Daniel; Devroey, Dirk; De Backer, Joan; Kartounian, Jan; Vincken, Walter

2007-03-01

To estimate the prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in a population of general practice patients at risk for developing COPD. A further aim was to evaluate the presence of respiratory symptoms as a predictor for the diagnosis of COPD. This study was conducted by eight general practitioners (GP) in six semi-rural general practices. During two consecutive months all patients attending their GP were included if they met the following criteria: current smokers between 40 and 70 yr of age, and a smoking history of at least 15 pack-years. A questionnaire regarding smoking history, respiratory symptoms, exposure to dust or chemical fumes, and history of respiratory diseases was completed for all patients. Subjects without known COPD were invited for spirometric testing. Off the 146 general practice patients included, 17.1% already had an established COPD diagnosis. Screening by spirometry revealed a 46.6% prevalence of COPD. Underdiagnosis of COPD was more frequent in the younger age categories (40-49 Yr; 50-59 Yr). Objective wheezing was the only sign that was significantly more frequent in COPD patients than in non-COPD patients (Pfatigue than newly detected patients. Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

Asthma-chronic obstructive pulmonary disease overlap syndrome in the urban Chinese population: prevalence and disease burden using the 2010, 2012, and 2013 China National Health and Wellness Surveys.

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Ding, Bo; DiBonaventura, Marco; Karlsson, Niklas; Ling, Xia

2016-01-01

Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, few studies have studied this population in the People's Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China. Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935). Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD). A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls) who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls) were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2), work productivity, and health care resource use using generalized linear models. Patients with ACOS (N=366) comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People's Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively) and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively) and health care resource use (eg, physician visits in the past 6 months =5.13, 3.84, 4.65, and 2.39, respectively) compared with matched controls and patients with COPD only. Few significant differences were observed between patients with ACOS and asthma only. Patients with ACOS have a greater comorbidity burden and significantly worse health

Forest resources of Mississippi’s national forests, 2006

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Sonja N. Oswalt

2011-01-01

This bulletin describes forest resource characteristics of Mississippi’s national forests, with emphasis on DeSoto National Forest, following the 2006 survey completed by the U.S. Department of Agriculture Forest Service, Forest Inventory and Analysis program. Mississippi’s national forests comprise > 1 million acres of forest land, or about 7 percent of all forest...

Trends in intensive care unit admissions of COPD patients from 2003 to 2013 in Taiwan

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Liao KM

2018-06-01

Full Text Available Kuang-Ming Liao,1 Yi-Chen Chen,2 Kuo-Chen Cheng,3 Jhi-Joung Wang,2 Chung-Han Ho2,4 1Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; 2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Objective: The objective of this study was to investigate the trends in COPD patients admitted to the intensive care unit (ICU in Taiwan from 2003 to 2013. Patients and methods: A retrospective study was conducted to analyze the available data in the National Health Insurance Research Database compiled by the Taiwan Department of Health. We selected patients admitted to the ICU nationwide from 2003 to 2013. Patients older than 40 years with a diagnosis of COPD were enrolled. The ICU admission date was used as the index date. Baseline comorbidities existing before the index date were identified. The comorbidities of interest included diabetes, hypertension, diabetes mellitus, coronary artery disease, stroke, dyslipidemia, cancer, and end-stage renal disease. Results: The number of COPD patients in the ICU increased from 12,384 in 2003 to 13,308 in 2013 (P<0.0001. The mean age of patients and SD was 76.66±9.48 and 78.32±10.59 in 2003 and 2013, respectively. The percentage of COPD patients aged ≥70 years in the ICU decreased markedly. COPD patients per 10,000 ICU patients decreased for both males and females. The length of ICU stays, and in-hospital mortality increased from 21.58 to 23.14 days and 14.97% to 30.98% from 2003 to 2013, respectively. Conclusion: The number of COPD patients admitted to the ICU in Taiwan increased over the 11-year study period. Increased mean patient age, length of ICU stays, hospital mortality, and comorbidities were observed. The use of a nationwide population-based database allowed for a

Aging-related systemic manifestations in COPD patients and cigarette smokers.

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Laurent Boyer

Full Text Available Chronic obstructive pulmonary disease (COPD is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear.To look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO corrected for alveolar volume (KCO.Cross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD.Compared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV, lower bone mineral density (BMD and appendicular skeletal muscle mass index (ASMMI, and shorter telomere length (TL. Insulin resistance (HOMA-IR and glomerular filtration rate (GFR were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO.Aging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening.

Caregivers’ burden in patients with COPD

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Miravitlles, Marc; Peña-Longobardo, Luz María; Oliva-Moreno, Juan; Hidalgo-Vega, Álvaro

2015-01-01

Objective Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. Methods We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. Results A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. Conclusion The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions. PMID:25709429

Gastroesophageal reflux disease in COPD: links and risks

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Lee AL

2015-09-01

Full Text Available Annemarie L Lee,1–3 Roger S Goldstein1,2,4 1West Park Healthcare Centre, 2Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; 3Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia; 4Department of Medicine, University of Toronto, Toronto, ON, Canada Abstract: COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the

Association of sputum and blood eosinophil concentrations with clinical measures of COPD severity: an analysis of the SPIROMICS cohort.

Science.gov (United States)

Hastie, Annette T; Martinez, Fernando J; Curtis, Jeffrey L; Doerschuk, Claire M; Hansel, Nadia N; Christenson, Stephanie; Putcha, Nirupama; Ortega, Victor E; Li, Xingnan; Barr, R Graham; Carretta, Elizabeth E; Couper, David J; Cooper, Christopher B; Hoffman, Eric A; Kanner, Richard E; Kleerup, Eric; O'Neal, Wanda K; Paine, Richard; Peters, Stephen P; Alexis, Neil E; Woodruff, Prescott G; Han, MeiLan K; Meyers, Deborah A; Bleecker, Eugene R

2017-12-01

(receiver operating characteristic area under the curve of 0·64, p<0·0001), but with a high false-discovery rate of 72%. In a large, well characterised cohort of former and current smoking patients with a broad range of COPD severity, high concentrations of sputum eosinophils were a better biomarker than high concentrations of blood eosinophils to identify a patient subgroup with more severe disease, more frequent exacerbations, and increased emphysema by QCT. Blood eosinophils alone were not a reliable biomarker for COPD severity or exacerbations, or for sputum eosinophils. Clinical trials targeting eosinophilic inflammation in COPD should consider assessing sputum eosinophils. National Institutes of Health, and National Heart, Lung, and Blood Institute. Copyright © 2017 Elsevier Ltd. All rights reserved.

Role of the inflammasome in chronic obstructive pulmonary disease (COPD).

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Colarusso, Chiara; Terlizzi, Michela; Molino, Antonio; Pinto, Aldo; Sorrentino, Rosalinda

2017-10-10

Inflammation is central to the development of chronic obstructive pulmonary disease (COPD), a pulmonary disorder characterized by chronic bronchitis, chronic airway obstruction, emphysema, associated to progressive and irreversible decline of lung function. Emerging genetic and pharmacological evidence suggests that IL-1-like cytokines are highly detected in the sputum and broncho-alveolar lavage (BAL) of COPD patients, implying the involvement of the multiprotein complex inflammasome. So far, scientific evidence has focused on nucleotide-binding oligomerization domain-like receptors protein 3 (NLRP3) inflammasome, a specialized inflammatory signaling platform that governs the maturation and secretion of IL-1-like cytokines through the regulation of caspase-1-dependent proteolytic processing. Some studies revealed that it is involved during airway inflammation typical of COPD. Based on the influence of cigarette smoke in various respiratory diseases, including COPD, in this view we report its effects in inflammatory and immune responses in COPD mouse models and in human subjects affected by COPD. In sharp contrast to what reported on experimental and clinical studies, randomized clinical trials show that indirect inflammasome inhibitors did not have any beneficial effect in moderate to severe COPD patients.

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.

Empowerment in people with COPD

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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

Validity of COPD diagnoses reported through nationwide health insurance systems in the People’s Republic of China

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Kurmi OP

2016-03-01

Full Text Available Om P Kurmi,1 Julien Vaucher,1 Dan Xiao,2 Michael V Holmes,1 Yu Guo,3 Kourtney J Davis,4 Chen Wang,5 Haiyan Qin,6 Iain Turnbull,1 Peng Peng,7 Zheng Bian,3 Robert Clarke,1 Liming Li,8 Yiping Chen,1 Zhengming Chen1 On behalf of the China Kadoorie Biobank collaborative group 1Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 2Tobacco Medicine and Tobacco Cessation Center, China–Japan Friendship Hospital, Beijing, People’s Republic of China; 3National Coordinating Centre for China Kadoorie Biobank Study, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Worldwide Epidemiology, GlaxoSmithKline R&D, Collegeville, PA, USA; 5National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 6Medical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 7Radiology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 8Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China Background: COPD is the fourth leading cause of death worldwide, with particularly high rates in the People’s Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People’s Republic of China. Methods: The CKB study recruited 0.5 million adults aged 30–79 years from ten diverse regions in the People’s Republic of China during the period 2004–2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national

COPD management: role of symptom assessment in routine clinical practice

Science.gov (United States)

van der Molen, Thys; Miravitlles, Marc; Kocks, Janwillem WH

2013-01-01

Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients’ everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed. PMID:24143085

Chronic Obstructive Pulmonary Disease (COPD): Data and Statistics

Science.gov (United States)

... and Statistics Recommend on Facebook Tweet Share Compartir COPD Death Rates in the United States Printable Version [ ... Ohio and Mississippi Rivers. Printable Version [PDF 733KB] COPD Prevalence in the United States Printable Version [PDF ...

Marketing a national forest: the resource manager's dilemma

Science.gov (United States)

Howard A. Clonts; Jeffrey R. Hibbert

1995-01-01

National Forests throughout the United States are facing critical management decisions regarding optimal resource use amidst strong countervailing pressures for access. Visitors to Talladega National Forest in Alabama were surveyed to develop appropriate marketing strategies. Cluster analysis showed that separate homogeneous user groups exist. This information was...

Recommendations for epidemiological studies on COPD

DEFF Research Database (Denmark)

Bakke, P S; Rönmark, E; Eagan, T

2011-01-01

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...... 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......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...

Epidemiology and clinical impact of major comorbidities in patients with COPD

Directory of Open Access Journals (Sweden)

Smith MC

2014-08-01

Full Text Available Miranda Caroline Smith,1 Jeremy P Wrobel2 1Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia; 2Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia Abstract: Comorbidities are frequent in chronic obstructive pulmonary disease (COPD and significantly impact on patients' quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD. Keywords: cardiovascular disease, prevalence, mortality, chronic bronchitis, emphysema

A simple algorithm for the identification of clinical COPD phenotypes

DEFF Research Database (Denmark)

Burgel, Pierre-Régis; Paillasseur, Jean-Louis; Janssens, Wim

2017-01-01

This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses. Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification...... of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative...... International Assessment (3CIA) initiative. Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated...

VitalQPlus: a potential screening tool for early diagnosis of COPD

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Sui CF

2015-08-01

Full Text Available Chee Fai Sui,1 Long Chiau Ming,2,3 Chin Fen Neoh,2,4 Baharudin Ibrahim1 1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 2Faculty of Pharmacy, Universiti Teknologi MARA, 3Brain Degeneration and Therapeutics Group, 4Collaborative Drug Discovery Research (CDDR Group, Pharmaceutical and Life Sciences (PLS Community of Research (CoRe, UiTM, Selangor, Malaysia Background: This study utilized a validated combination of a COPD Population Screener (COPD-PS questionnaire and a handheld spirometric device as a screening tool for patients at high risk of COPD, such as smokers. The study aimed to investigate and pilot the feasibility and application of this combined assessment, which we termed the “VitalQPlus”, as a screening tool for the early detection of COPD, especially in primary care settings. Methods: This was a cross-sectional study screening potentially undiagnosed COPD patients using a validated five-item COPD-PS questionnaire together with a handheld spirometric device. Patients were recruited from selected Malaysian government primary care health centers. Results: Of the total of 83 final participants, only 24.1% (20/83 were recruited from Perak and Penang (peninsular Malaysia compared to 75.9% (63/83 from Sabah (Borneo region. Our dual assessment approach identified 8.4% of the surveyed patients as having potentially undiagnosed COPD. When only the Vitalograph COPD-6 screening tool was used, 15.8% of patients were detected with a forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6 ratio at <0.75, while 35.9% of patients were detected with the COPD-PS questionnaire. These findings suggested that this dual assessment approach has a greater chance of identifying potentially undiagnosed COPD patients compared to the Vitalograph COPD-6 or COPD-PS questionnaire when used alone. Our findings show that patients with more symptoms (scores of ≥5 yielded twice the percentage of outcomes of FEV1

34 CFR 656.1 - What is the National Resource Centers Program?

Science.gov (United States)

2010-07-01

... STUDIES OR FOREIGN LANGUAGE AND INTERNATIONAL STUDIES General § 656.1 What is the National Resource... Foreign Language and International Studies (National Resource Centers Program), the Secretary awards... international studies and the international and foreign language aspects of professional and other fields of...

Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers

Science.gov (United States)

Boyer, Laurent; Marcos, Elisabeth; Margarit, Laurent; Le Corvoisier, Philippe; Vervoitte, Laetitia; Hamidou, Leila; Frih, Lamia; Audureau, Etienne; Covali-Noroc, Ala; Andujar, Pascal; Saakashvili, Zakaria; Lino, Anne; Ghaleh, Bijan; Hue, Sophie; Derumeaux, Geneviève; Housset, Bruno; Dubois-Randé, Jean-Luc; Boczkowski, Jorge; Maitre, Bernard; Adnot, Serge

2015-01-01

Rationale Chronic obstructive pulmonary disease (COPD) is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear. Objectives To look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO) corrected for alveolar volume (KCO). Methods Cross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD). Measurements and Main Results Compared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV), lower bone mineral density (BMD) and appendicular skeletal muscle mass index (ASMMI), and shorter telomere length (TL). Insulin resistance (HOMA-IR) and glomerular filtration rate (GFR) were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO. Conclusions Aging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening. PMID:25785739

The Water Resources Board: England and Wales’ Venture into National Water Resources Planning, 1964-1973

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Christine S. McCulloch

2009-10-01

Full Text Available An era of technocratic national planning of water resources is examined against the views of a leading liberal economist and critics, both contemporary and retrospective. Post Second World War Labour Governments in Britain failed to nationalise either land or water. As late as 1965, the idea of public ownership of all water supplies appeared in the Labour Party manifesto and a short-lived Ministry of Land and Natural Resources, 1964-1966, had amongst its duties the development of plans for reorganising the water supply industry under full public ownership. However, instead of pursuing such a politically dangerous takeover of the industry, in July 1964, a Water Resources Board (WRB, a special interest group dominated by engineers, was set up to advise on the development of water resources. In its first Annual Report (1965 WRB claimed its role as "the master planner of the water resources of England and Wales". The WRB had a great deal of influence and justified its national planning role by promoting large-scale supply schemes such as interbasin transfers of water, large reservoirs and regulated rivers. Feasibility studies were even carried out for building innovative, large storage reservoirs in tidal estuaries. Less progress was made on demand reduction. Yet the seeds of WRB’s demise were contained in its restricted terms of reference. The lack of any remit over water quality was a fatal handicap. Quantity and quality needed to be considered together. Privatisation of the water industry in 1989 led to a shift from national strategic planning by engineers to attempts to strengthen economic instruments to fit supply more closely to demand. Engineers have now been usurped as leaders in water resources management by economists and accountants. Yet climate change may demand a return to national strategic planning of engineered water supply, with greater democratic input.

The effect of dietary antioxidant on the COPD risk: the community-based KoGES (Ansan–Anseong cohort

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Joshi P

2015-10-01

Full Text Available Pankaj Joshi,1,2 Woo Jin Kim,3,4 Sang-Ah Lee1–3 1Department of Preventive Medicine, 2BIT Medical Convergence Graduate Program, 3Department of Internal Medicine, 4Environmental Health Center, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, South Korea Background: Dietary antioxidants have been suggested to have protective role against chronic obstructive pulmonary disease (COPD, but few prospective studies examined this relationship. The prospective study was conducted to evaluate the effect of dietary antioxidants on COPD risk and lung function in the Korean population.Methods: The data were collected from the community-based Korean Genome Epidemiology Study (KoGES cohort. To diagnose COPD, forced expiratory volume (FEV1 and forced vital capacity (FVC were measured by spirometry. The dietary intake of antioxidant vitamins was estimated from validated Food-Frequency Questionnaire. For the analysis, 325 COPD patients and 6,781 at risk subjects were selected from the cohort of 10,038 subjects. Multiple logistic regression models were used to examine the odds ratio (OR after adjusting for age, sex, marital status, income, history of asthma, history of tuberculosis, and smoking.Results: The risk of COPD was positively associated with aging, low education, low household income, lower body mass index, and cigarette smoking. The risk of COPD decreased with increase in the dietary vitamin C (ORQ1 vs Q5=0.66, Ptrend=0.03 and vitamin E (ORQ1 vs Q5=0.56, Ptrend=0.05 intake, predominantly, in men (Ptrend=0.01 and 0.05 for vitamins C and E, respectively. In addition, the lung function was significantly improved with increase in vitamins C (FEV1, P=0.04; FVC, P=0.03 and E (FEV1, P=0.03; FVC, P=0.04 intake. No statistically significant interactions were observed between smoking and vitamin C or E intake in relation to COPD risk among men.Conclusion: Our results suggest the independent beneficial effect of antioxidants, particularly

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

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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

Disability related to COPD tool (DIRECT: towards an assessment of COPD-related disability in routine practice

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Aguilaniu B

2011-07-01

Full Text Available B Aguilaniu1, J Gonzalez-Bermejo2, A Regnault3, C Dias Barbosa3, B Arnould3, M Mueser4, G Granet5, M Bonnefoy6, T Similowski2,71HYLAB, Physiologie Clinique, Grenoble, France; 2Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France; 3Mapi Values, Lyon, France; 4Formerly Boehringer Ingelheim, Paris, France; 5General Practitioner, Sainte-Foy-lès-Lyon, Paris, France; 6Centre Hospitalier Lyon Sud, Lyon, France; 7Université Paris 6 Pierre et Marie Curie, ER10, Paris, FranceBackground: Chronic Obstructive Pulmonary Disease (COPD is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability.Methods: The DIsability RElated to COPD Tool (DIRECT was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity.Results: The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach's alpha = 0.95. The score was highly correlated with the Saint George's Respiratory Questionnaire Activity score (r = 0.83 and the London Handicap Scale (r = –0.70, a generic disability measure. It was highly statistically significantly associated to four clinical parameters (P < 0.001: GOLD classification, BODE index, FEV1 and 6-minute walk distance.Conclusion: DIRECT is a

Directly measured secondhand smoke exposure and COPD health outcomes

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Balmes John

2006-06-01

Full Text Available Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD, secondhand smoke (SHS exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL, and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9 and dyspnea (1.0 pts; 95% CI 0.4 to 1.7 after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054, disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063, and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

Online Communication and Chronic Obstructive Pulmonary Disease (COPD)

DEFF Research Database (Denmark)

Sølling, Ina Koldkjær; Carøe, Per; Lindgren, Kurt

This is an explorative and qualitative study that examines a municipal’s rehabilitation program “Online Viva” (2014–2015). The questions are whether “Online Viva” improves the citizens’ participatory health and prevent exacerbation of COPD. “Online Viva” includes respiratory training and dis......-trict nursing consultancy for elderly people with COPD. The district nurses’ presence in the citizens’ homes is replaced by online communication. The study includes 9 citizens and 5 health professionals. Preliminary results show that online consultations and training prevent anxiety and exacerbation and support...... the citizens’ management of COPD. The citizens find that the “Online Viva” reduces their need for hospitalization, and this is confirmed by the district nurses. Furthermore, the citizens find that their specific needs are fulfilled, which make them feel comfortable in managing their COPD. It is emphasized...

Water resources of the Apostle Islands National Lakeshore, northern Wisconsin

Science.gov (United States)

Rose, W.J.

1988-01-01

The Apostle Islands National Lakeshore consists of 21 islands, part of the Bayfield Peninsula, and the adjacent waters of Lake Superior. Selected water resources of the Apostle Islands National Lakeshore were assessed to aid the National Park Service in developing and managing the Lakeshore and to provide a data base against which future changes can be compared. This summary of water-resources data, collected by the U.S. Geological Survey during 1979-84, provides a qualitative description of selected hydrologic components of the Lakeshore.

Improving physical activity, sedentary behaviour and sleep in COPD : Perspectives of people with COPD and experts via a Delphi approach

NARCIS (Netherlands)

Lewthwaite, Hayley; Effing, Tanja W.; Lenferink, Anke; Olds, Tim; Williams, Marie T.

2018-01-01

Background. Little is known about how to achieve enduring improvements in physical activity (PA), sedentary behaviour (SB) and sleep for people with chronic obstructive pulmonary disease (COPD). This study aimed to: (1) identify what people with COPD from South Australia and the Netherlands, and

Online Communication and Chronic Obstructive Pulmonary Disease (COPD)

DEFF Research Database (Denmark)

Sølling, Ina Koldkjær; Carøe, Per; Lindgren, Kurt

2016-01-01

in “Online Viva”, the objective of which was to support the citi-zens’ participatory health and to prevent exacerbation of COPD. The intention was to include 30 citizens with COPD or another chronic disease. As the demographic development results in more elderly people living longer with chronic dis-eases......In 2013 Slagelse Municipality implemented an online rehabili-tation program, “Online Viva” with respiratory training and district nursing consultancy for elderly people (aged 61-90) with COPD. In September 2014, 20 citizens with moderate (50%) to severe (15%) reduced lung function were included...

Prognosis of asymptomatic and symptomatic, undiagnosed COPD in the general population in Denmark

DEFF Research Database (Denmark)

Çolak, Yunus; Afzal, Shoaib; Nordestgaard, Børge G.

2017-01-01

Background: COPD can be diagnosed early using spirometry, but spirometry use is only recommended in symptomatic smokers, even though early stages of COPD can be asymptomatic. We investigated the prognosis of individuals with asymptomatic and symptomatic, undiagnosed COPD in the general population...... of COPD are needed. Funding:The Danish Lung Association, the Danish Cancer Society, Herlev and Gentofte Hospital, Copenhagen University Hospital, and University of Copenhagen.......Background: COPD can be diagnosed early using spirometry, but spirometry use is only recommended in symptomatic smokers, even though early stages of COPD can be asymptomatic. We investigated the prognosis of individuals with asymptomatic and symptomatic, undiagnosed COPD in the general population......%) were at high risk of having COPD. 3699 (11%) of these participants met the COPD criteria and 2903 (78%) were undiagnosed, of whom 2052 (71%) were symptomatic. During a median follow-up of 6·1 years (IQR 4·9), we recorded 800 exacerbations, 2038 cases of pneumonia, and 2789 deaths in the 32 518...

The United Nations Framework Classification for World Petroleum Resources

Science.gov (United States)

Ahlbrandt, T.S.; Blystad, P.; Young, E.D.; Slavov, S.; Heiberg, S.

2003-01-01

The United Nations has developed an international framework classification for solid fuels and minerals (UNFC). This is now being extended to petroleum by building on the joint classification of the Society of Petroleum Engineers (SPE), the World Petroleum Congresses (WPC) and the American Association of Petroleum Geologists (AAPG). The UNFC is a 3-dimansional classification. This: Is necessary in order to migrate accounts of resource quantities that are developed on one or two of the axes to the common basis; Provides for more precise reporting and analysis. This is particularly useful in analyses of contingent resources. The characteristics of the SPE/WPC/AAPG classification has been preserved and enhanced to facilitate improved international and national petroleum resource management, corporate business process management and financial reporting. A UN intergovernmental committee responsible for extending the UNFC to extractive energy resources (coal, petroleum and uranium) will meet in Geneva on October 30th and 31st to review experiences gained and comments received during 2003. A recommended classification will then be delivered for consideration to the United Nations through the Committee on Sustainable Energy of the Economic Commission for Europe (UN ECE).

COPD uncovered: an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population

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Barnes Neil

2011-08-01

Full Text Available Abstract Background Approximately 210 million people are estimated to have chronic obstructive pulmonary disease [COPD] worldwide. The burden of disease is known to be high, though less is known about those of a younger age. The aim of this study was to investigate the wider personal, economic and societal burden of COPD on a cross country working-age cohort. Methods A cross-country [Brazil, China, Germany, Turkey, US, UK] cross-sectional survey methodology was utilised to answer the research questions. 2426 participants aged 45-67 recruited via a number of recruitment methods specific to each country completed the full survey. Inclusion criteria were a recalled physician diagnosis of COPD, a smoking history of > 10 pack years and the use of COPD medications in the previous 3 months prior to questioning. The survey included items from the validated Work Productivity and Activity Impairment [WPAI] scale and the EuroQoL 5 Dimension [EQ-5D] scale. Disease severity was measured using the 5-point MRC [Medical Research Council] dyspnoea scale as a surrogate measure. Results 64% had either moderate [n = 1012] or severe [n = 521] COPD, although this varied by country. 75% of the cohort reported at least one comorbid condition. Quality of life declined with severity of illness [mild, mean EQ-5D score = 0.84; moderate 0.58; severe 0.41]. The annual cost of healthcare utilisation [excluding treatment costs and diagnostic tests] per individual was estimated to be $2,364 [£1,500]. For those remaining in active employment [n: 677]: lost time from work cost the individual an average of $880 [£556] per annum and lifetime losses of $7,365 [£4,661] amounting to $596,000 [£377,000] for the cohort. 447 [~40%] of the working population had retired prematurely because of COPD incurring individual estimated lifetime income losses of $316,000 [£200,000] or a combined total of $141 m [£89.6 m]. As the mean age of retirees was 58.3 and average time since retirement

America's Changing Energy Landscape - USGS National Coal Resources Data System Changes to National Energy Resources Data System.

Science.gov (United States)

East, J. A., II

2016-12-01

The U.S. Geological Survey's (USGS) Eastern Energy Resources Science Center (EERSC) has an ongoing project which has mapped coal chemistry and stratigraphy since 1977. Over the years, the USGS has collected various forms of coal data and archived that data into the National Coal Resources Data System (NCRDS) database. NCRDS is a repository that houses data from the major coal basins in the United States and includes information on location, seam thickness, coal rank, geologic age, geographic region, geologic province, coalfield, and characteristics of the coal or lithology for that data point. These data points can be linked to the US Coal Quality Database (COALQUAL) to include ultimate, proximate, major, minor and trace-element data. Although coal is an inexpensive energy provider, the United States has shifted away from coal usage recently and branched out into other forms of non-renewable and renewable energy because of environmental concerns. NCRDS's primary method of data capture has been USGS field work coupled with cooperative agreements with state geological agencies and universities doing coal-related research. These agreements are on competitive five-year cycles that have evolved into larger scope research efforts including solid fuel resources such as coal-bed methane, shale gas and oil. Recently these efforts have expanded to include environmental impacts of the use of fossil fuels, which has allowed the USGS to enter into agreements with states for the Geologic CO2 Storage Resources Assessment as required by the Energy Independence and Security Act. In 2016 they expanded into research areas to include geothermal, conventional and unconventional oil and gas. The NCRDS and COALQUAL databases are now online for the public to use, and are in the process of being updated to include new data for other energy resources. Along with this expansion of scope, the database name will change to the National Energy Resources Data System (NERDS) in FY 2017.

Gait speed as a measure of functional status in COPD patients

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Karpman C

2014-11-01

Full Text Available Craig Karpman, Roberto Benzo Mindful Breathing Laboratory, Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA Abstract: Chronic obstructive pulmonary disease (COPD is a disease associated with dyspnea, fatigue, and exercise intolerance. The degree of functional debility and level of exercise capacity greatly influences quality of life and mortality in patients with COPD, and the measures of exercise capacity are to be an integral part of patient assessment but often not feasible in routine daily practice, resulting in likely suboptimal care. There is a need for simple ways to identify functional decline in the clinical setting in order to guide resources to preventive interventions or proper care, including palliative care. Gait speed, or measuring how long it takes for a patient to walk a short distance, takes very little time and space, and can serve as a candidate measure of physical function in COPD. Gait speed has been shown to be an indicator of disability, health care utilization, and survival in older adults. It is a simple, reliable, and feasible measure to perform in the clinic and has been promoted as the next vital sign, providing insight into patients' functional capacity. Gait speed is mainly determined by exercise capacity but reflects global well-being as it captures many of the multisystemic effects of disease severity in COPD rather than pulmonary impairment alone. It is an excellent screening measure for exercise capacity and frailty; in COPD, the usual gait speed (4-m course with rolling start has been very accurate in identifying clinically relevant benchmarks of the 6-minute walk test, poor (<350 m and very poor (<200 m 6-minute walk test distances. A specific cut-off point of 0.8 m⋅s-1 had a positive predictive value of 69% and negative predictive value of 98% in predicting very poor exercise capacity. The increasing evidence on gait speed is promising as a simple test that can inform the

Amarillo National Resource Center for Plutonium 1999 plan

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-01-30

The purpose of the Amarillo National Resource Center for Plutonium is to serve the Texas Panhandle, the State of Texas and the US Department of Energy by: conducting scientific and technical research; advising decision makers; and providing information on nuclear weapons materials and related environment, safety, health, and nonproliferation issues while building academic excellence in science and technology. This paper describes the electronic resource library which provides the national archives of technical, policy, historical, and educational information on plutonium. Research projects related to the following topics are described: Environmental restoration and protection; Safety and health; Waste management; Education; Training; Instrumentation development; Materials science; Plutonium processing and handling; and Storage.

Amarillo National Resource Center for Plutonium 1999 plan

International Nuclear Information System (INIS)

1999-01-01

The purpose of the Amarillo National Resource Center for Plutonium is to serve the Texas Panhandle, the State of Texas and the US Department of Energy by: conducting scientific and technical research; advising decision makers; and providing information on nuclear weapons materials and related environment, safety, health, and nonproliferation issues while building academic excellence in science and technology. This paper describes the electronic resource library which provides the national archives of technical, policy, historical, and educational information on plutonium. Research projects related to the following topics are described: Environmental restoration and protection; Safety and health; Waste management; Education; Training; Instrumentation development; Materials science; Plutonium processing and handling; and Storage

Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care.

Science.gov (United States)

Koblizek, Vladimir; Chlumsky, Jan; Zindr, Vladimir; Neumannova, Katerina; Zatloukal, Jakub; Zak, Jaroslav; Sedlak, Vratislav; Kocianova, Jana; Zatloukal, Jaromir; Hejduk, Karel; Pracharova, Sarka

2013-06-01

COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world. The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version. The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype. Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care. Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.

A Self-Management Programme of Activity Coping and Education - SPACE for COPD(C) - in primary care: The protocol for a pragmatic trial.

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Bourne, Claire LA; Kanabar, Pratiksha; Mitchell, Katy; Schreder, Sally; Houchen-Wolloff, Linzy; Bankart, M John G; Apps, Lindsay; Hewitt, Stacey; Harvey-Dunstan, Theresa; Singh, Sally J

2017-07-10

National guidance for chronic obstructive pulmonary disease (COPD) suggests that self-management support be provided for patients. Our institution has developed a standardised, manual-based, supported self-management programme: Self-Management Programme of Activity Coping and Education (SPACE for COPD(C)). SPACE was previously piloted on a 1-2-1 basis, delivered by researchers, to individuals with COPD. Discussions with stakeholders highlighted considerable interest in delivering the SPACE for COPD(C) intervention as a group-based self-management programme facilitated by healthcare professionals (HCPs) in primary care settings. The study aims are to explore the feasibility, acceptability and efficacy for the intervention to be delivered and supported by HCPs and to examine whether group-based delivery of SPACE for COPD(C), with sustained support, improves patient outcomes following the SPACE for COPD(C) intervention. A prospective, multi-site, single-blinded randomised controlled trial (RCT) will be conducted, with follow-up at 6 and 9 months. Participants will be randomly assigned to either the control group (usual care) or intervention group (a six-session, group-based SPACE for COPD(C)self-management programme delivered over 5 months). The primary outcome is change in COPD assessment test at 6 months.A discussion session will be conducted with HCPs who deliver the intervention to discuss and gain insight into any potential facilitators/barriers to implementing the intervention in practice. Furthermore, we will conduct semi-structured focus groups with intervention participants to understand feasibility and acceptability. All qualitative data will be analysed thematically. The project has received a favourable opinion from South Hampshire B Research Ethics Committee, REC reference: 14/SC/1169 and full R&D approval from the University Hospitals of Leicester NHS Trust: 152408.Study results will be disseminated through appropriate peer-reviewed journals, national

Deaf-Blindness: National Organizations and Resources. Reference Circular No. 93-1.

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Library of Congress, Washington, DC. National Library Service for the Blind and Physically Handicapped.

This circular lists national organizations and print and audiovisual resources on areas of service to persons with deaf blindness, including rehabilitation, education, information and referral, recreation, and sources for adaptive devices and products. Section I is an alphabetical list of 40 national organizations and resources, including…

The United Nations' endeavour to standardize mineral resource classification

International Nuclear Information System (INIS)

Schanz, J.J. Jr.

1980-01-01

The United Nations' Economic and Social Council passed a resolution in July 1975 calling for the development of a mineral resources classification system to be used in reporting data to the United Nations. Following preparation of background papers and an agenda by the UN Centre for Natural Resources, Energy and Transport, a panel of experts recommended a classification system to the Council's Committee on Natural Resources. The Committee met in Turkey in June 1979 and has reported favourably to the Council on the proposed system. The classification system is designed to provide maximum capability for requesting and receiving data from the resources data systems already used internally by major mineral producing nations. In addition, the system provides for flexibility in adjusting to the particular needs of individual mineral commodities. The proposed system involves three basic categories of in-situ resources: R-1, reliable estimates of known deposits; R-2, preliminary estimates of the extensions of known deposits; and, R-3, tentative estimates of quantities to be found in undiscovered deposits. As an option for given countries and commodities, the R-1 category can be further sub-divided into: R-1-E, economic; R-1-M, marginal; and R-1-S, sub-economic. Finally, the classification scheme provides for all categories to have a parallel set of estimates of recoverable mineral quantities. (author)

Influence of heart failure on resting lung volumes in patients with COPD

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de Souza, Aline Soares; Sperandio, Priscila Abreu; Mazzuco, Adriana; Alencar, Maria Clara; Arbex, Flávio Ferlin; de Oliveira, Mayron Faria; O'Donnell, Denis Eunan; Neder, José Alberto

2016-01-01

ABSTRACT Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil. PMID:27832235

The COPD Helplessness Index: a new tool to measure factors affecting patient self-management.

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Omachi, Theodore A; Katz, Patricia P; Yelin, Edward H; Iribarren, Carlos; Knight, Sara J; Blanc, Paul D; Eisner, Mark D

2010-04-01

Psychologic factors affect how patients with COPD respond to attempts to improve their self-management skills. Learned helplessness may be one such factor, but there is no validated measure of helplessness in COPD. We administered a new COPD Helplessness Index (CHI) to 1,202 patients with COPD. Concurrent validity was assessed through association of the CHI with established psychosocial measures and COPD severity. The association of helplessness with incident COPD exacerbations was then examined by following subjects over a median 2.1 years, defining COPD exacerbations as COPD-related hospitalizations or ED visits. The CHI demonstrated internal consistency (Cronbach alpha = 0.75); factor analysis was consistent with the CHI representing a single construct. Greater CHI-measured helplessness correlated with greater COPD severity assessed by the BODE (Body-mass, Obstruction, Dyspnea, Exercise) Index (r = 0.34; P Controlling for sociodemographics and smoking status, helplessness was prospectively associated with incident COPD exacerbations (hazard ratio = 1.31; P controlling for the BODE Index, helplessness remained predictive of COPD exacerbations among subjects with BODE Index useful tool in analyzing differential clinical responses mediated by patient-centered attributes.

Serotonin and corticosterone rhythms in mice exposed to cigarette smoke and in patients with COPD: implication for COPD-associated neuropathogenesis.

Directory of Open Access Journals (Sweden)

Isaac K Sundar

Full Text Available The circadian timing system controls daily rhythms of physiology and behavior, and disruption of clock function can trigger stressful life events. Daily exposure to cigarette smoke (CS can lead to alteration in diverse biological and physiological processes. Smoking is associated with mood disorders, including depression and anxiety. Patients with chronic obstructive pulmonary disease (COPD have abnormal circadian rhythms, reflected by daily changes in respiratory symptoms and lung function. Corticosterone (CORT is an adrenal steroid that plays a considerable role in stress and anti-inflammatory responses. Serotonin (5-hydroxytryptamine; 5HT is a neurohormone, which plays a role in sleep/wake regulation and affective disorders. Secretion of stress hormones (CORT and 5HT is under the control of the circadian clock in the suprachiasmatic nucleus. Since smoking is a contributing factor in the development of COPD, we hypothesize that CS can affect circadian rhythms of CORT and 5HT secretion leading to sleep and mood disorders in smokers and patients with COPD. We measured the daily rhythms of plasma CORT and 5HT in mice following acute (3 d, sub-chronic (10 d or chronic (6 mo CS exposure and in plasma from non-smokers, smokers and patients with COPD. Acute and chronic CS exposure affected both the timing (peak phase and amplitude of the daily rhythm of plasma CORT and 5HT in mice. Acute CS appeared to have subtle time-dependent effects on CORT levels but more pronounced effects on 5HT. As compared with CORT, plasma 5HT was slightly elevated in smokers but was reduced in patients with COPD. Thus, the effects of CS on plasma 5HT were consistent between mice and patients with COPD. Together, these data reveal a significant impact of CS exposure on rhythms of stress hormone secretion and subsequent detrimental effects on cognitive function, depression-like behavior, mood/anxiety and sleep quality in smokers and patients with COPD.

Nebulized corticosteroids in the management of acute exacerbation of COPD

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Gaude G

2010-01-01

Full Text Available Acute exacerbations in chronic onstructive pulmonary disease (COPD are common and systemic steroids play an important role in the management of these cases along with the bronchodilators. Nebulized budesonide is being used in the acute attacks of bronchial asthma either in children or in adults. But the role of nebulized steroids in acute exacerbation of COPD is not much studied in the literature. In this clinical review we have evaluated the role of nebulized corticosteroids in the management of acute exacerbation of COPD (AECOPD. Through Medline, Pubmed and Embase we analyzed the various studies that has been done to study the role of nebulized corticosteroids in the management of acute exacerbation of COPD. The key words used for the search criteria were: acute exacerbation, COPD, nebulized corticosteroids, budesonide, fluticasone. Only eight studies were found which had evaluated the role of nebulized corticosteroids in acute exacerbations of COPD. All these studies had used nebulized budesonide in AECOPD in different dosages, and had been compared with both either parental or oral steroids, and standard bronchodilator therapy. All the studies had found the clinical efficacy of nebulized budesonide to be of similar extent to that of either parental or oral steroids in AECOPD. Side effects profile of nebulized budesonide was minimal and acceptable as compared to systemic steroids. Nebulized budesonide may be an alternative to parental/oral prednisolone in the treatment of acute exacerbations of COPD but further studies should be done to evaluate its long-term impact on clinical outcomes after an initial episode of COPD exacerbation.

Sex-specific features of emphysema among current and former smokers with COPD.

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Hardin, Megan; Foreman, Marilyn; Dransfield, Mark T; Hansel, Nadia; Han, MeiLan K; Cho, Michael H; Bhatt, Surya P; Ramsdell, Joe; Lynch, David; Curtis, Jeffrey L; Silverman, Edwin K; Washko, George; DeMeo, Dawn

2016-01-01

Recent studies suggest that males with chronic obstructive pulmonary disease (COPD) have more emphysema than females. It is not known if these differences persist across degrees of COPD severity. Our aim was to identify sex-specific differences in quantitative emphysema within COPD subgroups based on COPD severity.We included non-Hispanic white and African-American subjects from the COPDGene study with at least 10 pack-years of smoking and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry grade II or greater. We examined sex-specific differences in log-transformed emphysema (log per cent low-attenuation area (%LAA)) by GOLD spirometry grade among subjects with early-onset COPD (25% emphysema).Compared with females, males had higher log %LAA: overall (1.97±1.4 versus 1.69±1.6, β=0.32 (0.04), p=1.34×10(-14)), and among non-Hispanic white (p=8.37×10(-14)) and African-American subjects (p=0.002). Females with early-onset COPD, severe emphysema and GOLD grade IV COPD had similar emphysema as males, but markedly fewer pack-years smoking (early-onset, p=0.01; severe emphysema and GOLD grade IV, psmokers with COPD who are particularly susceptible to parenchymal destruction. Copyright ©ERS 2016.

Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort.

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Khan, Ainee; Dickens, Andrew P; Adab, Peymane; Jordan, Rachel E

2017-07-20

Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided. CALL FOR

Fine particulate matter in acute exacerbation of COPD

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Lei eNi

2015-10-01

Full Text Available Chronic obstructive pulmonary disease (COPD is a common airway disorder. In particular, acute exacerbations of COPD (AECOPD can significantly reduce pulmonary function. The majority of AECOPD episodes are attributed to infections, although environmental stress also plays a role. Increasing urbanization and associated air pollution, especially in developing countries, have been shown to contribute to COPD pathogenesis. Elevated levels of particulate matter (PM in polluted air are strongly correlated with the onset and development of various respiratory diseases. In this review, we have conducted an extensive literature search of recent studies of the role of PM2.5 (fine PM in AECOPD. PM2.5 leads to AECOPD via inflammation, oxidative stress, immune dysfunction, and altered airway epithelial structure and microbiome. Reducing PM2.5 levels is a viable approach to lower AECOPD incidence, attenuate COPD progression and decrease the associated healthcare burden.

Clinical issues of mucus accumulation in COPD

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Osadnik CR

2014-03-01

Full Text Available Christian R Osadnik,1,2 Christine F McDonald,2,3 Anne E Holland2,4,51Department of Physiotherapy, Monash University, 2Institute for Breathing and Sleep, Austin Health, 3Department of Respiratory and Sleep Medicine, Austin Health, 4Department of Physiotherapy, La Trobe University, 5Department of Physiotherapy, Alfred Health, Melbourne, VIC, AustraliaWe wish to thank Ramos et al for presenting a succinct and up-to-date synthesis of the evidence relating to the important issue of mucus hypersecretion in COPD.1 The authors highlight the association of mucus hypersecretion with poor outcomes, including increased risk of exacerbations, hospitalization and mortality. These associations have led to interest in the potential benefits of mucus clearance techniques in COPD. As Ramos et al1 point out, although the physiological rationale for airway clearance techniques (ACTs in COPD is strong, clinical efficacy has historically been difficult to establish, perhaps due to the variety of techniques and outcomes that have been employed in small studies. We have recently synthesized this body of evidence in a Cochrane systematic review of ACTs for individuals with COPD. The review demonstrated ACTs are safe and meta-analysis showed they confer small beneficial effects on a limited range of important clinical outcomes, such as the need for and duration of ventilatory assistance during an acute exacerbation of COPD (AECOPD.2View original paper by Ramos and colleagues.

Definition of a COPD self-management intervention: International Expert Group consensus

NARCIS (Netherlands)

Effing, T.W.; Vercoulen, Jan H.; Bourbeau, Jean; Trappenburg, Jaap C.A.; Lenferink, Anke; Cafarella, Paul; Coultas, David; Meek, Paula; van der Valk, Paul; Bischoff, Erik W.M.A.; Bucknall, Christine E.; Dewan, Naresh A.; Early, Frances; Fan, Vincent; Frith, Peter; Janssen, Daisy J.A.; Mitchell, Katy; Morgan, Mike; Nici, Linda; Patel, Irem; Walters, Haydn; Rice, Kathryn L.; Singh, Sally J.; ZuWallack, Richard; Benzo, Roberto; Goldstein, Roger S.; Partridge, Martyn R.; van der Palen, Jacobus Adrianus Maria

2016-01-01

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management

The accuracy and efficiency of electronic screening for recruitment into a clinical trial on COPD.

Science.gov (United States)

Schmickl, Christopher N; Li, Man; Li, Guangxi; Wetzstein, Marnie M; Herasevich, Vitaly; Gajic, Ognjen; Benzo, Roberto P

2011-10-01

Participant recruitment is an important process in successful conduct of randomized controlled trials. To facilitate enrollment into a National Institutes of Health-sponsored clinical trial involving patients with chronic obstructive pulmonary disease (COPD), we developed and prospectively validated an automated electronic screening tool based on boolean free-text search of admission notes in electronic medical records. During a 2-week validation period, all patients admitted to prespecified general medical services were screened for eligibility by both the electronic screening tool and a COPD nurse. Group discussion was the gold standard for confirmation of true-positive results. Compared with the gold standard, electronic screening yielded 100% sensitivity, 92% specificity, 100% negative predictive value, and 72% positive predictive value. Compared with traditional manual screening, electronic screening demonstrated time-saving potential of 76%. Thus, the electronic screening tool accurately identifies potential study subjects and improves efficiency of patient accrual for a clinical trial on COPD. This method may be expanded into other institutional and clinical settings. Copyright © 2011 Elsevier Ltd. All rights reserved.

Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program

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Blackmore C

2017-06-01

Full Text Available Claire Blackmore,1 Vicki L Johnson-Warrington,2 Johanna EA Williams,2 Lindsay D Apps,2 Hannah ML Young,2 Claire LA Bourne,2 Sally J Singh2 1Kettering General Hospital National Health Service (NHS Trust, Kettering, Northamptonshire, 2Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, UK Background: With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of ­Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management.Aim: This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD.Methods: Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre- and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program.Results: Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self

Changes in physical activity and all-cause mortality in COPD

DEFF Research Database (Denmark)

Vaes, Anouk W; Garcia-Aymerich, Judith; Marott, Jacob L

2014-01-01

-up was associated with an increased mortality risk in subjects with and without COPD. These observational data suggest that it is important to assess and encourage physical activity in the earliest stages of COPD in order to maintain a physical activity level that is as high as possible, as this is associated......Little is known about changes in physical activity in subjects with chronic obstructive pulmonary disease (COPD) and its impact on mortality. Therefore, we aimed to study changes in physical activity in subjects with and without COPD and the impact of physical activity on mortality risk. Subjects......, respectively) were included. COPD subjects with moderate or high baseline physical activity who reported low physical activity level at follow-up had the highest hazard ratios of mortality (1.73 and 2.35, respectively; both pphysical activity, no differences were...

Chronic obstructive pulmonary disease phenotypes: the future of COPD

DEFF Research Database (Denmark)

Han, MeiLan K; Agusti, Alvar; Calverley, Peter M

2010-01-01

Significant heterogeneity of clinical presentation and disease progression exists within chronic obstructive pulmonary disease (COPD). Although FEV(1) inadequately describes this heterogeneity, a clear alternative has not emerged. The goal of phenotyping is to identify patient groups with unique...... prognostic or therapeutic characteristics, but significant variation and confusion surrounds use of the term "phenotype" in COPD. Phenotype classically refers to any observable characteristic of an organism, and up until now, multiple disease characteristics have been termed COPD phenotypes. We, however......, propose the following variation on this definition: "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death)." This more...

The implication of telehealthcare in COPD management of China.

Science.gov (United States)

Lao, Xiangda; Zhang, Jing; Bai, Chunxue

2013-10-01

Chronic obstructive pulmonary disease (COPD) is a very common disease all around the world and has become an increasing public health concern to the Chinese medical community. In the past decades, telehealthcare technology has become a good way to manage COPD but current evidence makes it hard to determine the effectiveness of this technology. Internet of things (Iot) is a recent breakthrough in communication technology, which links the virtual world to the real world through connection between sensors and working devices. It relates people and items in any ways so that data collection and management become more flexible. Our review concentrates on the effectiveness and potential application of telehealthcare in COPD management and how IoT technology may stimulate COPD healthcare delivery through telehealthcare technology.

Focusing on outcomes: Making the most of COPD interventions

Directory of Open Access Journals (Sweden)

Noreen M Clark

2008-10-01

Full Text Available Noreen M Clark1, Julia A Dodge1, Martyn R Partridge2, Fernando J Martinez31Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA; 2Imperial College of Science, Technology and Medicine, London, England, UK; 3Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USAAbstract: A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b identify the type of interventions most associated with outcomes, c examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d explore implications for future COPD research. Studies reviewed comprised large scale comprehensive reviews including randomized clinical trials and meta-analysis as these forms of investigation engender the greatest confidence in clinicians and health care researchers. Extant research suggests that the most significant improvements in COPD health care utilization have been realized from interventions specifically designed to enhance disease management by patients. A range of interventions have produced modest changes in quality of life. Evidence of impact for other outcomes and for a particular type of intervention is not strong. Research in other chronic diseases, particularly asthma, suggests that interventions grounded in learning theory and models of behavior change can consistently produce desired results for patients and clinicians. Use of a model of self-regulation may

A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD.

Science.gov (United States)

Silver, Patty C; Kollef, Marin H; Clinkscale, Darnetta; Watts, Peggy; Kidder, Robin; Eads, Brittany; Bennett, Debbie; Lora, Carolyn; Quartaro, Michael

2017-01-01

Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99). Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.). Copyright © 2017 by Daedalus Enterprises.

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

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Anthony A Laverty

Full Text Available We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation.Interrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1 other NHS trusts in London and (2 all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011.Nine NHS acute trusts in the London, England.Patients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012.Annual trend readmission rates (and in total bed days within 7, 28 and 90 days, before and after implementation.In hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa pre and -5.32% pa post (p for difference in trends = 0.012. Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44. Comparisons with a national control group were similar.The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

COPD management: role of symptom assessment in routine clinical practice

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van der Molen T

2013-10-01

Full Text Available Thys van der Molen,1,2 Marc Miravitlles,3 Janwillem WH Kocks1,21Department of General Practice, 2GRIAC (Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Pneumology Department, Hospital Universitari Vall d'Hebron, Biomedical Research Networking Centre in Respiratory Diseases (CIBERES, Barcelona, SpainAbstract: Patients with chronic obstructive pulmonary disease (COPD present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients' everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed.Keywords: chronic obstructive pulmonary disease, symptoms, questionnaires

Relationship between airway colonization, inflammation and exacerbation frequency in COPD.

Science.gov (United States)

Tumkaya, Munir; Atis, Sibel; Ozge, Cengiz; Delialioglu, Nuran; Polat, Gurbuz; Kanik, Arzu

2007-04-01

To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (> or = 3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). BAL revealed the microorganisms with potential pathogenicity above the established threshold (> or = 10(3)cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls (P=0.05). BAL MPO, IL-8 and TNF-alpha levels were found to be significantly higher in COPD as compared to controls (P=0.001). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent (P=0.001). Airway bacterial load correlated with levels of airway inflammation markers in COPD (P<0.05). The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

Not all COPD is caused by cigarette smoking

African Journals Online (AJOL)

COPD was not considered because she was a lifetime non-smoker. Exposure to burning of ... regions of the world, attention to the non-smoking causes of COPD is critical as part of the ..... with previously (300 mg v. 60 mg). There is good ...

The quality of COPD care in general practice

DEFF Research Database (Denmark)

Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.

2008-01-01

We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p quality of management. We conclude that participation in an educational...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

Obesity and Functioning Among Individuals with Chronic Obstructive Pulmonary Disease (COPD).

Science.gov (United States)

Katz, Patricia; Iribarren, Carlos; Sanchez, Gabriela; Blanc, Paul D

2016-06-01

In COPD, body composition studies have focused primarily on low BMI. We examined obesity (BMI ≥ 30 kg/m(2)) as a risk factor for poor function and longitudinal functional decline. Data from a longitudinal cohort of adults with COPD (n = 1096) and an age- and sex-matched comparison group collected in two in-person visits ∼49 months apart were analyzed. Two measures of functioning were examined: six-minute walk distance (6MWD) and Short Physical Performance Battery (SPPB). Multivariate regression analyses examined relationships of obesity with functioning. Secondary analyses stratified by GOLD classification (GOLD-0/1, GOLD-2, GOLD-3/4). Obesity (53% of COPD cohort) was associated cross-sectionally with 6MWD and SPPB in COPD, and only with 6MWD in the comparison group. Obesity predicted significant functional decline in 6MWD for individuals with COPD (odds ratio (OR) for decline [95% CI] 1.8 [1.1, 2.9]), but not the comparison group. Secondary analyses revealed that the risk of decline was significant only in those with more severe COPD (GOLD 3/4, OR = 2.3 [1.0, 5.4]). Obesity was highly prevalent and was associated with poor function concurrently and with subsequent decline in 6MWD in COPD. Obesity in COPD should be considered a risk not only for more co-morbidities and greater health care use, but also for functional decline.

Study Design and Interim Outcomes of Guangzhou Institute of Respiratory Disease COPD Biobank.

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Lu, Wenju; Zheng, Zeguang; Chen, Xindong; Tan, Hui; Wang, Jian; Zhang, Zili; Zheng, Jinping; Chen, Rongchang; Zhang, Chenting; Xu, Xiaoming; Chen, Yuqin; Yang, Quan; Xiong, Mingmei; Guo, Meihua; Zhou, Qipeng; Tang, Chun; Wang, Yingfeng; Ye, Jinmei; Li, Defu; Shu, Jiaze; Tan, Shu; Xu, Chuyi; Wang, Yan; Lai, Ning; Yang, Kai; Lu, Jiachun; Ran, Pixin; Zhong, Nanshan

2016-01-01

GIRD COPD Biobank is a multicenter observational study blood-based database with local characteristics, in order to investigate the causes, risk factors, pathogenesis, prevalence patterns and trends of COPD and promote new pathogenic insights in China. We enrolled 855 clinically COPD patients and 660 controls with normal lung function. Extensive data collection has been undertaken with questionnaires, clinical measurements, and collection and storage of blood specimens, following Standard Operating Procedures (SOP). All surveys had similar quality controls, supervisions, and training of the investigator team. Since September 2010, a total of 1515 subjects (1116 [73.7%] males; 855 [56.4%] diagnosed with COPD) were enrolled. Analyses of the design and interim results of the GIRD COPD Biobank Study identified patients with COPD were older, lower educational level, a longer history of pack-year smoking, less in kitchen fan usage, X-ray exposure, and history of disease (P < 0.01 for all); Most of the COPD subjects belonged to moderately severe or worse, stratified according to Global Lung Function Initiative (GLI); COPD patients had relatively more co-morbidities than controls; Environmental hazard exposures might be the main contributors to the reported respiratory symptoms; Cold air, haze, and influenza acted the top three factors to induce respiratory symptoms in both COPD cases and controls. The GIRD COPD Biobank Study has the potential to provide substantial novel insights into the genetics, biomarkers, environmental and lifestyle aspects of COPD. It is expected to provide new insights for pathogenesis and the long-term progression of COPD.

Assessing and monitoring urban resilience using COPD in Porto.

Science.gov (United States)

Monteiro, Ana; Carvalho, Vânia; Velho, Sara; Sousa, Carlos

2012-01-01

COPD morbidity is a good example of how the urban form may interfere with a disease's severity. Then, it may play an important role as a stimulus to increase the acceptability of several policy actions that aim to upgrade urban resilience. Despite the multiple dimensions of wellbeing, health is surely a key variable attracting everyone's attention, which is thus more likely to be able to persuade people that actions that may at first seem undesirable are fundamental in improving urban sustainability and well-being. After creating a short list of socio-economic and environmental factors relating to the onset and aggravation of COPD, daily admissions distributions were compared using both a non-weighted and a weighted multi-criteria hierarchical analysis procedure. Porto's COPD Social and Environmental Inequalities Index (SEII), calculated with a hierarchical analysis procedure, accurately illustrates a great relationship between COPD admissions and adverse urban form variables. COPD may be an important communication tool to stimulate the acceptability of some otherwise unpopular planning measures to improve urban resilience (sustainability and well-being). Copyright © 2011 Elsevier B.V. All rights reserved.

Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

Directory of Open Access Journals (Sweden)

Davis KJ

2014-12-01

Full Text Available Kourtney J Davis,1 Sarah H Landis,2 Yeon-Mok Oh,3 David M Mannino,4 MeiLan K Han,5 Thys van der Molen,6 Zaurbek Aisanov,7 Ana M Menezes,8 Masakazu Ichinose,9 Hana Muellerova11Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium; 2Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 3University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 4University of Kentucky College of Public Health, Lexington, KY, USA; 5Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 6University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 7Pulmonology Research Institute, Moscow, Russia; 8Federal University of Pelotas, Pelotas, Brazil; 9Tohoku University Graduate School of Medicine, Sendai, JapanAim: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs and respiratory specialists.Materials and methods: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios.Results: Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001 to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001. Respiratory

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

Science.gov (United States)

Ariel, Amnon; Altraja, Alan; Belevskiy, Andrey; Boros, Piotr W; Danila, Edvardas; Fležar, Matjaz; Koblizek, Vladimir; Fridlender, Zvi G; Kostov, Kosta; Krams, Alvils; Milenkovic, Branislava; Somfay, Attila; Tkacova, Ruzena; Tudoric, Neven; Ulmeanu, Ruxandra; Valipour, Arschang

2018-01-01

COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups. PMID:29317810

Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)-A large population-based cohort study.

Science.gov (United States)

Achelrod, Dmitrij; Welte, Tobias; Schreyögg, Jonas; Stargardt, Tom

2016-09-01

To curb costs and improve health outcomes in chronic obstructive pulmonary disease (COPD), a nationwide disease management programme (DMP) was introduced in Germany in 2005. Yet, its effectiveness has not been comprehensively evaluated. To examine the effects of the German COPD DMP over three years on costs and health resource utilisation from the payer perspective, process quality, morbidity and mortality. A retrospective, population-based cohort study design is applied, using administrative data. After eliminating differences in observable characteristics between the DMP and the control group with entropy balancing, difference-in-difference estimators were computed to account for time-invariant unobservable heterogeneity. 215,104 individuals were included into the analysis of whom 25,269 were enrolled in the DMP. DMP patients had a reduced mortality hazard ratio (0.89, 95%CI: 0.84-0.94) but incurred excess costs of €553 per year. DMP enrolees reveal higher healthcare utilisation with larger shares of individuals being hospitalised (3.14%), consulting an outpatient clinic due to exacerbations (11.13%) and pharmaceutical prescriptions (2.78). However, average length of hospitalisation due to COPD fell by 0.49 days, adherence to medication guidelines as well as indicators for morbidity improved. The German COPD DMP achieved significant improvements in mortality, morbidity and process quality, but at higher costs. Given the low ICER per life year gained, DMP COPD may constitute a cost-effective option to promote COPD population health. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

Directory of Open Access Journals (Sweden)

van den Berg JWK

2006-04-01

Full Text Available Abstract Background Patient-reported outcomes (PRO questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID. This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM. Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4.

Idaho National Laboratory Cultural Resource Management Annual Report FY 2006

Energy Technology Data Exchange (ETDEWEB)

Clayton F. Marler; Julie Braun; Hollie Gilbert; Dino Lowrey; Brenda Ringe Pace

2007-04-01

The Idaho National Laboratory Site is home to vast numbers and a wide variety of important cultural resources representing at least a 13,500-year span of human occupation in the region. As a federal agency, the Department of Energy Idaho Operations Office has legal responsibility for the management and protection of those resources and has delegated these responsibilities to its primary contractor, Battelle Energy Alliance (BEA). The INL Cultural Resource Management Office, staffed by BEA professionals, is committed to maintaining a cultural resource management program that accepts these challenges in a manner reflecting the resources’ importance in local, regional, and national history. This annual report summarizes activities performed by the INL Cultural Resource Management Office staff during Fiscal Year 2006. This work is diverse, far-reaching and though generally confined to INL cultural resource compliance, also includes a myriad of professional and voluntary community activities. This document is intended to be both informative to internal and external stakeholders, and to serve as a planning tool for future cultural resource management work to be conducted on the INL.

A review of the value of innovation in inhalers for COPD and asthma.

Science.gov (United States)

Virchow, Johann Christian; Akdis, Cezmi A; Darba, Josep; Dekhuijzen, Richard; Hartl, Sylvia; Kobelt, Gisela; Roger, Albert; Simoens, Steven; Toumi, Mondher; Woodhouse, Ben; Plich, Adam; Torvinen, Saku

2015-01-01

Appropriate use of inhaled therapies for asthma and chronic obstructive pulmonary disease (COPD) is critical to ensuring good patient outcomes, efficient use of healthcare resources and limiting the effects of high-morbidity. The appropriate choice of inhaler and active therapy, incorporating patient preferences, can help improve treatment adherence and long-term outcomes. Despite this, many current inhalers are non-intuitive to use, and require extensive training. In this review, an expert panel considers the evidence for the use of inhaler devices in management of COPD and asthma. The panel also evaluates the value of innovation in inhaler technologies, which optimise the use of existing molecules from a clinical, economic and societal perspective. The panel conclusion is that there remains a substantial unmet need in inhaler technology and that innovation in inhaler devices can provide real-world health benefits to patients. Furthermore, we recommend that these innovations should be supported by healthcare systems through appropriate pricing and reimbursement mechanisms.

Socioeconomic status and COPD among low- and middle-income countries.

Science.gov (United States)

Grigsby, Matthew; Siddharthan, Trishul; Chowdhury, Muhammad Ah; Siddiquee, Ali; Rubinstein, Adolfo; Sobrino, Edgardo; Miranda, J Jaime; Bernabe-Ortiz, Antonio; Alam, Dewan; Checkley, William

2016-01-01

Socioeconomic status (SES) is a strong social determinant of health. There remains a limited understanding of the association between SES and COPD prevalence among low- and middle-income countries where the majority of COPD-related morbidity and mortality occurs. We examined the association between SES and COPD prevalence using data collected in Argentina, Bangladesh, Chile, Peru, and Uruguay. We compiled lung function, demographic, and SES data from three population-based studies for 11,042 participants aged 35-95 years. We used multivariable alternating logistic regressions to study the association between COPD prevalence and SES indicators adjusted for age, sex, self-reported daily smoking, and biomass fuel smoke exposure. Principal component analysis was performed on monthly household income, household size, and education to create a composite SES index. Overall COPD prevalence was 9.2%, ranging from 1.7% to 15.4% across sites. The adjusted odds ratio of having COPD was lower for people who completed secondary school (odds ratio [OR] =0.73, 95% CI 0.55-0.98) and lower with higher monthly household income (OR =0.96 per category, 95% CI 0.93-0.99). When combining SES factors into a composite index, we found that the odds of having COPD was greater with lower SES (interquartile OR =1.23, 95% CI 1.05-1.43) even after controlling for subject-specific factors and environmental exposures. In this analysis of multiple population-based studies, lower education, lower household income, and lower composite SES index were associated with COPD. Since household income may be underestimated in population studies, adding household size and education into a composite index may provide a better surrogate for SES.

Inflammation and Immune Response in COPD: Where Do We Stand?

Directory of Open Access Journals (Sweden)

Nikoletta Rovina

2013-01-01

Full Text Available Increasing evidence indicates that chronic inflammatory and immune responses play key roles in the development and progression of COPD. Recent data provide evidence for a role in the NLRP3 inflammasome in the airway inflammation observed in COPD. Cigarette smoke activates innate immune cells by triggering pattern recognition receptors (PRRs to release “danger signal”. These signals act as ligands to Toll-like receptors (TLRs, triggering the production of cytokines and inducing innate inflammation. In smokers who develop COPD there appears to be a specific pattern of inflammation in the airways and parenchyma as a result of both innate and adaptive immune responses, with the predominance of CD8+ and CD4+ cells, and in the more severe disease, with the presence of lymphoid follicles containing B lymphocytes and T cells. Furthermore, viral and bacterial infections interfere with the chronic inflammation seen in stable COPD and exacerbations via pathogen-associated molecular patterns (PAMPs. Finally, autoimmunity is another novel aspect that may play a critical role in the pathogenesis of COPD. This review is un update of the currently discussed roles of inflammatory and immune responses in the pathogenesis of COPD.

Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients.

Science.gov (United States)

Karamanli, Harun; Ilik, Faik; Kayhan, Fatih; Pazarli, Ahmet Cemal

2015-01-01

A number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function. The present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year. In the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

“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; PCOPD 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

Development of the chronic obstructive pulmonary disease morning symptom diary (COPD-MSD).

Science.gov (United States)

Globe, Gary; Currie, Brooke; Leidy, Nancy Kline; Jones, Paul; Mannino, David; Martinez, Fernando; Klekotka, Paul; O'Quinn, Sean; Karlsson, Niklas; Wiklund, Ingela

2016-07-16

The morning tends to be the most difficult time of day for many patients with chronic obstructive pulmonary disease (COPD) when symptoms can limit one's ability to perform even simple activities. Morning symptoms have been linked to higher levels of work absenteeism, thereby increasing the already substantial economic burden associated with COPD. A validated patient-reported outcome (PRO) instrument designed to capture morning symptoms will allow for a more comprehensive approach to the evaluation of treatment benefit in COPD clinical trials. A qualitative interview study was conducted among a sample of symptomatic adults with COPD. Concept elicitation interviews (n = 35) were conducted to identify COPD morning symptoms, followed by cognitive interviews (n = 21) to ensure patient comprehension of the items, instructions and response options of the draft COPD Morning Symptom Diary (COPD-MSD). All interview transcript data were coded using ATLAS.ti software for content analysis. Mean age of the concept elicitation and cognitive interview sample was 65.0 years (±7.5) and 62.3 years (±8.3), respectively. The study sample represented the full range of COPD severity (Global Initiative for Chronic Lung Disease [GOLD] classifications I-IV) and included a mix of racial backgrounds, employment status and educational achievement. During the concept elicitation interviews, the three most frequently reported morning symptoms were shortness of breath (n = 35/35; 100 %), phlegm/mucus (n = 31/35; 88.6 %), and cough (n = 30/35; 85.7 %). A group of clinical and instrument development experts convened to review the concept elicitation data and develop the initial 32-item draft COPD-MSD. Cognitive interviews indicated subjects found the draft COPD-MSD to be comprehensive, clear, and easy to understand. The COPD-MSD underwent minor editorial revisions and streamlining based on cognitive interviews and input from the experts to yield the final 19-item daily

Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD.

Science.gov (United States)

Ouellette, Daniel R; Lavoie, Kim L

2017-01-01

COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.

Co-morbidity, body mass index and quality of life in COPD using the Clinical COPD Questionnaire.

Science.gov (United States)

Sundh, Josefin; Ställberg, Björn; Lisspers, Karin; Montgomery, Scott M; Janson, Christer

2011-06-01

Quality of life is an important patient-oriented measure in COPD. The Clinical COPD Questionnaire (CCQ) is a validated instrument for estimating quality of life. The impact of different factors on the CCQ-score remains an understudied area. The aim of this study was to investigate the association of co-morbidity and body mass index with quality of life measured by CCQ. A patient questionnaire including the CCQ and a review of records were used. A total of 1548 COPD patients in central Sweden were randomly selected. Complete data were collected for 919 patients, 639 from primary health care and 280 from hospital clinics. Multiple linear regression with adjustment for sex, age, level of education, smoking habits and level of care was performed. Subanalyses included additional adjustment for lung function in the subgroup (n = 475) where spirometry data were available. Higher mean CCQ score indicating lower quality of life was statistically significant and independently associated with heart disease (adjusted regression coefficient (95%CI) 0.26; 0.06 to 0.47), depression (0.50; 0.23 to 0.76) and underweight (0.58; 0.29 to 0.87). Depression and underweight were associated with higher scores in all CCQ subdomains. Further adjustment for lung function in the subgroup with this measure resulted in statistically significant and independent associations with CCQ for heart disease, depression, obesity and underweight. The CCQ identified that heart disease, depression and underweight are independently associated with lower health-related quality of life in COPD.

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

Science.gov (United States)

Gilkes, Alexander; Ashworth, Mark; Schofield, Peter; Harries, Timothy H; Durbaba, Stevo; Weston, Charlotte; White, Patrick

2016-01-01

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. 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. 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; Pwhites 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 COPD.

Resource nationalism in Indonesia—Effects of the 2014 mineral export ban

Science.gov (United States)

Lederer, Graham W.

2016-09-27

Resource nationalism encompasses a broad range of political and economic actions taken by Governments to regulate the extraction of natural resources within their borders. Policies such as increased tariffs or export restrictions can have far-reaching economic effects on international trade. As the Governments of several developing countries consider enacting nationalistic policies, an examination of the 2014 mineral export ban in Indonesia provides an instructive example of the possible impacts of resource nationalism. Significant changes in the production and trade of unprocessed (that is, ores and concentrates) and processed (that is, refined metal) aluminum, copper, and nickel before and after the export ban form the basis of this study.The U.S. Geological Survey (USGS) National Minerals Information Center (NMIC) tracks production and trade of mineral commodities between producer and consumer countries. Materials flow studies clarify the effects of an export ban on different mineral commodities by assessing changes in production, processing capacity, and trade. Using extensive data collection and monitoring procedures, the USGS NMIC investigated the effects of resource nationalism on the flow of mineral commodities from Indonesia to the global economy.

US Coast Guard national spill response resource inventory

International Nuclear Information System (INIS)

Giraitis, D.M.

1993-01-01

The Oil Pollution Act of 1990 (OPA 90) mandated the establishment of a National Response Unit, now renamed the National Strike Force Coordination Center (NSFCC). Among the duties OPA 90 assigned to this new Coast Guard unit was to compile and maintain a comprehensive list of spill removal resources, personnel, and equipment that is available to Federal and State agencies and to the public. The Coast Guard's Research and Development Center has been developing this project, the Response Resource Inventory (RRI), for one year. The RRI is expected to be operational, with resource data from industry in the data base, by the time of the International Oil Spill Conference in March 1993. The RRI will contain data on skimmers, specialized oil recovery vessels, oil/water separators, dispersants and delivery systems, etc. Previous attempts to maintain a national data base of these response resources, including an earlier Coast Guard system called the Spill Cleanup Equipment Inventory System (SKIM), fell into disuse for a number of reasons. Inaccuracies caused by inadvertent double counting of equipment and outdated information coupled with difficulties in accessing the information were common shortfalls of early systems. During the development of the RRI, user-group meetings were held to determine system requirements and study the failures of previous systems. Methods of obtaining and entering data were a major concern during RRI development. A data collection system that supplies the resource holder with a DOS-formatted diskette containing a collection program will be used. The program will make extensive use of pick lists to minimize the data entry burden on the resource holder and maintain standard entries. When the program is completed, the diskette will be mailed to the NSFCC, where the data will be transferred quickly to the RRI data base. Easy access to the data for the public and industry will be afforded mainly through a computer bulletin board

Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD

Directory of Open Access Journals (Sweden)

Rai KK

2017-01-01

Full Text Available Kiran K Rai,1 Rachel E Jordan,1 W Stanley Siebert,2 Steven S Sadhra,3 David A Fitzmaurice,1 Alice J Sitch,1 Jon G Ayres,1,3 Peymané Adab1 1Institute of Applied Health Research, 2The Department of Business and Labour Economics, 3Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK Background: Employment rates among those with chronic obstructive pulmonary disease (COPD are lower than those without COPD, but little is known about the factors that affect COPD patients’ ability to work. Methods: Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. Results: In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8% were in work. Older age (60–64 years vs 30–49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12–0.65, lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19–0.97, poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE score: OR =0.10; 95% CI =0.03–0.33, and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12–0.85 were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. Conclusion: This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD. Keywords: chronic obstructive pulmonary disease, work, employed, breathlessness, severity, VGDF, UK

Beta-blocker under-use in COPD patients

Directory of Open Access Journals (Sweden)

Lim KP

2017-10-01

Full Text Available Kuan Pin Lim,1,2 Sarah Loughrey,1 Michael Musk,1,2 Melanie Lavender,1,2 Jeremy P Wrobel1–3 1Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia; 2Respiratory Department, Fiona Stanley Hospital, Murdoch, WA, Australia; 3School of Medicine, University of Notre Dame, Fremantle, WA, Australia Background: Cardiovascular (CVS comorbidities are common in COPD and contribute significantly to morbidity and mortality, especially following acute exacerbations of COPD (AECOPD. Beta-blockers (BBs are safe and effective in COPD patients, with demonstrated survival benefit following myocardial infarction. We sought to determine if BBs are under-prescribed in patients hospitalized with AECOPD. We also sought to determine inpatient rates of CVS and cerebrovascular complications, and their impact on patient outcomes. Methods: Retrospective hospital data was collected over a 12-month period. The medical records of all patients >40 years of age coded with a diagnosis of AECOPD were analyzed. Prevalent use and incident initiation of BBs were assessed. Comorbidities including indications and contraindications for BB use were analyzed. Results: Of the 366 eligible patients, 156 patients (42.6% had at least one indication for BB use – of these patients, only 53 (34.0% were on BB therapy and 61 (39.1% were not on BB therapy but had no listed contraindication. Prevalent use of BBs at the time of admission in all 366 patients was 19.7%, compared with 45.6%, 39.6% and 45.9% use of anti-platelets, statins and angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, respectively. CVS and cerebrovascular complications were common in this population (57 patients, 16% and were associated with longer length of stay (p<0.01 and greater inpatient mortality (p=0.02. Conclusions: BBs are under-prescribed in COPD patients despite clear indication(s for their use. Further work is required to explore barriers to BB prescribing in COPD patients

COPD, stage and treatment in a large outpatient clinic

DEFF Research Database (Denmark)

Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette

2017-01-01

of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics...... was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62...

National Library of Medicine Web Resources for Student Health Professionals

Energy Technology Data Exchange (ETDEWEB)

Womble, R.

2010-04-02

Familiarize students affiliated with the Student National Medical Association with the National Library of Medicine's online resources that address medical conditions, health disparities, and public health preparedness needs.