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Exacerbations of chronic obstructive pulmonary disease

Ravi Kalhan, R Kannan Mutharasan
Patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose particularly high costs to the healthcare system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Here we present 10 practical tips to reduce readmissions in this challenging population. 1: Diagnose the population accurately. 2: Detect admissions for exacerbations early and consider risk-stratification...
June 13, 2018: Chest
Giuseppe Bello, Alessandra Ionescu Maddalena, Valentina Giammatteo, Massimo Antonelli
Noninvasive ventilation (NIV) has assumed a central role in the treatment of selected patients with acute respiratory failure due to exacerbated chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema. Recent advances in the understanding of physiologic aspects of NIV application through different interfaces and ventilator settings have led to improved patient-machine interaction, enhancing favorable NIV outcome. In recent years, the growing role of NIV in the acute care setting has led to the development of technical innovations to overcome the problems related to gas leakage and dead space, improving the quality of the devices and optimizing ventilation modes...
July 2018: Critical Care Clinics
Cristina Estirado, Adrian Ceccato, Monica Guerrero, Arturo Huerta, Catia Cilloniz, Olivia Vilaró, Albert Gabarrús, Joaquim Gea, Ernesto Crisafulli, Nestor Soler, Antoni Torres
BACKGROUND: Antimicrobial treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains controversial. In some cases AECOPD are caused by microorganisms that are resistant to treatments recommended by guidelines. Our aims were: 1) identify the risk factors associated with infection by microorganisms resistant to conventional treatment (MRCT), 2) Compare the clinical characteristics and outcomes of patients with AECOPD resulting from MRCT against those with AECOPD from other causes...
June 15, 2018: Respiratory Research
Jarrod Sonett, Monica Goldklang, Piotr Sklepkiewicz, Adam Gerber, Jordis Trischler, Tina Zelonina, Marit Westerterp, Vincent Lemaître, Yasunori Okada, Jeanine D'Armiento
Macrophage infiltration is common to both emphysema and atherosclerosis, and cigarette smoke down-regulates the macrophage cholesterol efflux transporter ATP binding cassette (ABC)A1. This decreased cholesterol efflux results in lipid-laden macrophages. We hypothesize that cigarette smoke adversely affects cholesterol transport via an ABCA1-dependent mechanism in macrophages, enhancing TLR4/myeloid differentiation primary response gene 88 (Myd88) signaling and resulting in matrix metalloproteinase (MMP) up-regulation and exacerbation of pulmonary inflammation...
June 15, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
Nikolaos-Dimitrios Pantzaris, Diamantina-Xanthi Spilioti, Aikaterini Psaromyalou, Ioanna Koniari, Dimitrios Velissaris
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major complication in COPD patients which can be triggered by bacterial or viral infections, environmental pollutants and other causes. Procalcitonin (PCT), a peptide that markedly increases in cases of bacterial infection, has been extensively investigated as a biomarker in the diagnosis, prognosis and treatment in patients with AECOPD. A number of studies published in the last decade, tried to investigate whether PCT levels can differentiate between bacterial and other causes of exacerbations, if they can be used as a guide for optimal antibiotic therapy and if they can be a tool in the assessment of the severity and the need for further interventions in the management of those patients...
July 2018: Journal of Clinical Medicine Research
Maria Montes de Oca, Maria Eugenia Laucho-Contreras
Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) are associated with increased mortality, rate of hospitalization, use of healthcare resources, and have a negative impact on disease progression, quality of life and lung function of patients with chronic obstructive pulmonary disease (COPD). There is an imperative need to homogenize the definition of AECOPD because the incidence of exacerbations has a significant influence or implication on treatment decision making, particularly in pharmacotherapy and could impact the outcome or change the statistical significance of a therapeutic intervention in clinical trials...
June 14, 2018: Medical Sciences: Open Access Journal
Robert Wu, Daniyal Liaqat, Eyal de Lara, Tatiana Son, Frank Rudzicz, Hisham Alshaer, Pegah Abed-Esfahani, Andrea S Gershon
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated decline in lung function, diminished quality of life, and higher mortality. Proactively monitoring patients for early signs of an exacerbation and treating them early could prevent these outcomes. The emergence of affordable wearable technology allows for nearly continuous monitoring of heart rate and physical activity as well as recording of audio which can detect features such as coughing...
June 14, 2018: JMIR MHealth and UHealth
Pedro J Marcos, José Luis López-Campos
The employment of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to improve airway limitation, decrease treatment failure and risk of relapse, and may improve symptoms in addition to decreasing the length of hospital stay. Nowadays, all clinical guidelines recommend systemic corticosteroids to treat moderate or severe COPD exacerbations. However, their use is associated with potential side effects, mainly hyperglycemia. In the era of precision medicine, the possibility of employing blood eosinophil count has emerged as a potential way of optimizing therapy...
June 8, 2018: Medical Sciences: Open Access Journal
Jing Yang, Man Qiao, Yanxia Li, Guohua Hu, Chunxia Song, Liping Xue, Hong Bai, Jie Yang, Xi Yang
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is closely associated with airway inflammation including monocytes, lymphocytes, and neutrophils. Monocytes play an essential role in the pathogenesis of chronic obstructive pulmonary disease (COPD). To elucidate the association of circulating monocyte alteration with AECOPD, we analyzed monocyte subpopulation in the peripheral blood of 16 healthy volunteers and 22 AECOPD patients at the stages of admission and remission after clinical therapy...
2018: Mediators of Inflammation
Joanna Miłkowska-Dymanowska, Adam J Białas, Waldemar Obrębski, Paweł Górski, Wojciech J Piotrowski
BACKGROUND: Exacerbations of COPD (ECOPD) are important events in the course of COPD and they accelerate the rate of decline of lung function, and exacerbations requiring hospitalization are associated with significant mortality. Therefore, developing approaches of prevention and early treatment of ECOPDs are of special clinical interests. One of such approaches is telecare, including home telemonitoring. MATERIAL AND METHODS: Daily telemonitoring of HR, BP, SpO2 and spirometry was performed...
August 2018: International Journal of Medical Informatics
Aran Singanayagam, Nicholas Glanville, Jason L Girkin, Yee Man Ching, Andrea Marcellini, James D Porter, Marie Toussaint, Ross P Walton, Lydia J Finney, Julia Aniscenko, Jie Zhu, Maria-Belen Trujillo-Torralbo, Maria Adelaide Calderazzo, Chris Grainge, Su-Ling Loo, Punnam Chander Veerati, Prabuddha S Pathinayake, Kristy S Nichol, Andrew T Reid, Phillip L James, Roberto Solari, Peter A B Wark, Darryl A Knight, Miriam F Moffatt, William O Cookson, Michael R Edwards, Patrick Mallia, Nathan W Bartlett, Sebastian L Johnston
Inhaled corticosteroids (ICS) have limited efficacy in reducing chronic obstructive pulmonary disease (COPD) exacerbations and increase pneumonia risk, through unknown mechanisms. Rhinoviruses precipitate most exacerbations and increase susceptibility to secondary bacterial infections. Here, we show that the ICS fluticasone propionate (FP) impairs innate and acquired antiviral immune responses leading to delayed virus clearance and previously unrecognised adverse effects of enhanced mucus, impaired antimicrobial peptide secretion and increased pulmonary bacterial load during virus-induced exacerbations...
June 8, 2018: Nature Communications
Mouhamad Hasan Pourrashid, Farzaneh Dastan, Jamshid Salamzadeh, Alireza Eslaminejad, Maryam Edalatifard
Burden of Chronic Obstructive Pulmonary Disease (COPD) is substantial and increasing in the world. There are controversial reports regarding vitamin D supplementation in COPD. We investigated relationship between vitamin D3 (Cholecalciferol) supplementation with Health Related Quality of Life (HRQOL) and symptom recovery in AECOPD patients with concurrent Vitamin D Deficiency (VDD). A placebo-controlled randomized clinical trial was designed. AECOPD patients with VDD were randomly allocated to receive either vitamin D 300,000 IU (n = 35) or placebo (n = 35) by intramuscular injection...
2018: Iranian Journal of Pharmaceutical Research: IJPR
Hideki Yasui, Naoki Inui, Tomoyuki Fujisawa, Masato Karayama, Noriyuki Enomoto, Yutaro Nakamura, Shigeki Kuroishi, Hisano Ohba, Koshi Yokomura, Jun Sato, Masaki Sato, Naoki Koshimizu, Mikio Toyoshima, Takashi Yamada, Masafumi Masuda, Toshihiro Shirai, Takafumi Suda
Inhaled corticosteroids are widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, their use has been questioned for appropriate dose and a possible increased risk of pneumonia. Here, we reviewed patients with COPD who had received fluticasone-salmeterol combination treatment using data from a linked electronic medical record database. A total of 180 patients received salmeterol with 250 µg fluticasone propionate twice daily and 78 received salmeterol and 100 µg fluticasone propionate twice daily...
2018: Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine
Hyeon-Kyoung Koo, Sung-Woo Park, Jeong-Woong Park, Hye Sook Choi, Tae-Hyung Kim, Hyoung Kyu Yoon, Kwang Ha Yoo, Ki-Suck Jung, Deog Kyeom Kim
Background and purpose: Chronic cough can be a dominant symptom of chronic obstructive pulmonary disease (COPD), although its clinical impact remains unclear. The aim of our study was to identify phenotypic differences according to the presence of chronic cough or sputum and evaluate the impact of chronic cough on the risk of acute exacerbation of COPD (AECOPD). Methods: In a nationwide COPD cohort including 1,613 COPD patients, patients with chronic cough only, those with sputum only, those with chronic bronchitis (CB), and those without cough and sputum were compared with regard to dyspnea, lung function, quality of life (QoL), and risk of AECOPD...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Tania Janaudis-Ferreira, S Jocelyn Carr, Samantha L Harrison, Andrea S Gershon, Siobhan C Milner, Sean Carr, David Fishbein, Roger Goldstein
BACKGROUND: The study aimed to determine the feasibility and effectiveness of an introductory disease-specific education program delivered during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) on objective measures of disease-specific knowledge. METHODS: Patients admitted to a community hospital with an AECOPD were randomly assigned to a control group (standard care) or intervention group (standard care + brief education). The intervention group received two 30-minute education sessions in hospital or at home within two weeks of hospital admission...
June 4, 2018: Chest
Corey Lyon, Roxanne Radi, Thomas Staff, Joan Nashelsky
Yes for exacerbations, no for hospitalizations. Prophylactic azithro-mycin reduces the number of exacerbations by about 25%. It also extends the time between exacerbations by approximately 90 days for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Azithromycin benefits patients who are >65 years, patients with Global Initiative for Obstructive Lung Disease (GOLD) stage II or III COPD, former smokers, and patients using long-term oxygen; it doesn't benefit patients ≤65 years, patients with GOLD stage IV COPD, current smokers, or patients not using oxygen (strength of recommendation [SOR]: B, randomized controlled trials [RCTs])...
June 2018: Journal of Family Practice
(no author information available yet)
Eosinophilic chronic obstructive pulmonary disease (COPD) is characterised by a peripheral blood differential eosinophil count of 2% or more. This phenotype is found in roughly 40% of patients with COPD. These patients have an increased frequency of exacerbations, but benefit from inhaled glucocorticoids as part of a triple therapy regime. However, 30-40% of these patients continue to have significant exacerbations, meaning targeted therapy to reduce eosinophil counts could play a role in future therapy. Mepolizumab blocks interleukin-5 and has been associated with a decreased rate of exacerbation in eosinophilic asthma...
June 2018: Breathe
Andrzej Witusik, Łukasz Mokros, Piotr Kuna, Katarzyna Nowakowska-Domagała, Adam Antczak, Tadeusz Pietras
BACKGROUND Stress and psychological factors can induce dyspnea in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess selected elements of the clinical presentation of COPD in the context of the severity of type A pattern of behavior, impulsiveness, and tendency for empathy. MATERIAL AND METHODS This was a cross-sectional study. The study group consisted of 179 men with COPD and the control group consisted of 31 healthy male smokers. In all patients, the number of infectious exacerbations over the past year, the result on the dyspnea scale (MRC), and the FEV1-to- predicted FEV1 ratio was assessed...
June 6, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Kirsten Koehorst-Ter Huurne, Catharina Gm Groothuis-Oudshoorn, Paul Dlpm vanderValk, Kris Ll Movig, Job van der Palen, Marjolein Brusse-Keizer
Aim: The aim of this study was to analyze the association between therapy adherence to inhaled corticosteroids (ICSs) and tiotropium on the one hand and morbidity and mortality in COPD on the other hand. Methods: Therapy adherence to ICSs and tiotropium over a 3-year period of, respectively, 635 and 505 patients was collected from pharmacy records. It was expressed as percentage and deemed optimal at ≥75-≤125%, suboptimal at ≥50%-<75%, and poor at <50% (underuse) or >125% (overuse)...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Wiebke Bartels, Simon Adamson, Lisa Leung, Don D Sin, Stephan F van Eeden
Rationale: Readmissions are common following acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and are partially responsible for increased morbidity and mortality in COPD. Numerous factors have been shown to predict readmission of patients previously admitted to hospital for AECOPD; however, factors related to readmission in patients who are triaged in emergency departments (EDs) and sent directly home are poorly understood. We postulate that patients seen in the ED for AECOPD and directly sent home have a high readmission rate, and we suspect that inadequate management and follow-up contribute to this high readmission rate...
2018: International Journal of Chronic Obstructive Pulmonary Disease
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