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COPD guidelines

Peng Luo, Shuo Li, Yitai Chen, Yuwen Luo, Yun Li, Kai Wang, Yuxia Huang, Xin Chen
BACKGROUND: Roflumilast, a phosphodiesterase-4 inhibitor recommended by clinical guideline, is always being used in combination with at least one long-acting bronchodilator in patients with stable chronic obstructive pulmonary disease (COPD). However, there are few evidences about whether the combination of roflumilast and long-acting bronchodilators is safer and more effective in patients with moderate-to-very severe stable COPD. In our study, we investigate the effect and safety of roflumilast combined with long-acting bronchodilators on moderate-to-severe stable COPD patients...
September 2016: Journal of Thoracic Disease
Praful Schroff, Jason Hitchcock, Christopher Schumann, J Michael Wells, Mark T Dransfield, Surya P Bhatt
Rationale Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. Objective To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea and lung function. Methods Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 was retrospectively analyzed...
October 14, 2016: Annals of the American Thoracic Society
J M Prins, T van der Poll
Better use of current antibiotics is warranted to curb increasing antimicrobial resistance rates. Procalcitonin guidance can safely reduce antibiotic usage when used to initiate or discontinue antibiotics in adult patients with a respiratory tract infection. However, the claimed reductions in antibiotic usage are mainly achieved in patients with acute bronchitis and exacerbations of COPD, conditions for which guidelines already discourage antibiotic treatment. Sequential procalcitonin measurements can also reduce the treatment duration of community-acquired pneumonia from 10-12 to 5-7 days, which is, however, already the recommended treatment duration for in- and outpatients under the current Dutch guidelines...
2016: Nederlands Tijdschrift Voor Geneeskunde
Katy E Mitchell, Vicki Johnson, Linzy Houchen-Wolloff, Louise Sewell, Mike D Morgan, Michael C Steiner, Sally J Singh
INTRODUCTION AND OBJECTIVES: There are various recommendations for physical activity (PA). However agreement between all of these measures has not been established. Furthermore, given the challenges of measuring PA there is interest in evaluating whether a measure of exercise performance can be used as a surrogate measure to identify who is likely to achieve the recommendations. METHODS: A total of 184 people with COPD were recruited, 128 of which had complete data for these analyses...
September 22, 2016: Clinical Respiratory Journal
Sarah Dennis, Helen K Reddel, Sandy Middleton, Iqbal Hasan, Oshana Hermiz, Rosemary Phillips, Alan J Crockett, Sanjyot Vagholkar, Guy B Marks, Nicholas Zwar
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. OBJECTIVES: The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD...
September 30, 2016: Family Practice
Amy Richardson, Elizabeth Tolley, Jonathan Hartmann, Jasmine Reedus, Brandi Bowlin, Christopher Finch, Christopher W Sands, Timothy Self
INTRODUCTION: Approximately 1 in 5 hospitalized COPD patients are readmitted within 30 days of discharge. CHF coexists in more than 20% of patients with COPD, and is associated with early readmission for COPD. Reducing 30-day hospital readmissions for COPD is of intense current interest. METHODOLOGY: A retrospective chart review was performed to identify patients discharged with COPD exacerbation and HFrEF. The primary objective was to evaluate if discharge medication prescribing following guidelines for both COPD and HFrEF correlates with reduced 30-day readmission rates...
October 2016: Respiratory Medicine
Tjard R Schermer, Bas Robberts, Alan J Crockett, Bart P Thoonen, Annelies Lucas, Joke Grootens, Ivo J Smeele, Cindy Thamrin, Helen K Reddel
Clinical guidelines indicate that a chronic obstructive pulmonary disease (COPD) diagnosis is made from a single spirometry test. However, long-term stability of diagnosis based on forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC) ratio has not been reported. In primary care subjects at risk for COPD, we investigated shifts in diagnostic category (obstructed/non-obstructed). The data were from symptomatic 40+ years (ex-)smokers referred for diagnostic spirometry, with three spirometry tests, each 12±2 months apart...
September 29, 2016: NPJ Primary Care Respiratory Medicine
Borja G Cosio, Joan B Soriano, Jose Luis López-Campos, Myriam Calle, Juan José Soler, Juan Pablo de-Torres, Jose Maria Marín, Cristina Martínez, Pilar de Lucas, Isabel Mir, Germán Peces-Barba, Nuria Feu-Collado, Ingrid Solanes, Inmaculada Alfageme
RATIONALE: 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. OBJECTIVE: We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes...
2016: PloS One
Manuela Funke, Thomas Geiser, Otto D Schoch
In 2015, the international guidelines for diagnosis and treatment of pulmonary hypertension (PH) were updated. Group 3 of the current classification includes PH associated with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), other pulmonary diseases with restrictive and obstructive pattern, sleep-disordered breathing, alveolar hypoventilation disorders, chronic exposure to high altitude, and developmental lung diseases [1]. PH associated with COPD and ILD is common but difficult to manage, as no long-term randomised controlled trial (RCT) has been conducted with specific pulmonary arterial hypertension (PAH) drugs in PH associated with COPD, and the one recent RCT in PH associated with ILD had to be stopped early due to a possible increased risk of death and side effects in the treatment group...
2016: Swiss Medical Weekly
Akihiro Yasoda
Today, we can treat osteoporotic patients with multiple drugs of various mechanisms and in various forms. Nevertheless, there exist few clinical evidences that exhibit an efficacy of an anti-osteoporotic drug on osteoporosis with pulmonary disorders, including asthma, COPD and OSAS. We should use drugs for osteoporotic patients with pulmonary disorders in accordance with a guideline on the management and treatment of glucocorticoid-induced osteoporosis or a guideline on the management and treatment of osteoporosis, according to whether they are treated by glucocorticoid or not...
2016: Clinical Calcium
David M G Halpin, Marjan Kerkhof, Joan B Soriano, Helga Mikkelsen, David B Price
BACKGROUND: Management guidelines of chronic obstructive pulmonary disease (COPD) are mainly based on results of randomised controlled trials (RCTs), but some authors have suggested limited representativeness of patients included in these trials. No previous studies have applied the full range of selection criteria to a broad COPD patient population in a real-life setting. METHODS: We identified all RCTs of inhaled long-acting bronchodilator therapy, during 1999-2013, at ClinicalTrials...
2016: Respiratory Research
Mizuho Nishio, Kazuaki Nakane, Yutaka Tanaka
BACKGROUND: Homology is a mathematical concept that can be used to quantify degree of contact. Recently, image processing with the homology method has been proposed. In this study, we used the homology method and computed tomography images to quantify emphysema. METHODS: This study included 112 patients who had undergone computed tomography and pulmonary function test. Low-attenuation lung regions were evaluated by the homology method, and homology-based emphysema quantification (b 0, b 1, nb 0, nb 1, and R) was performed...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Laura-Jane E Smith, Ifrah Ali, Patrick Stone, Liam Smeeth, Jennifer K Quint
INTRODUCTION: People living with advanced chronic obstructive pulmonary disease (COPD) suffer from significant morbidity, reduced quality of life and high mortality, and are likely to benefit from many aspects of a palliative care approach. Prognostic estimates are a meaningful part of decision-making and better evidence for such estimates would facilitate advance care planning. We aim to provide quality evidence on known prognostic variables and scores which predict a prognosis in COPD of <12 months for use in the community...
September 15, 2016: BMJ Open
Norman R Morris, James Walsh, Lewis Adams, Jennifer Alision
Most of the current guidelines for pulmonary rehabilitation recommend higher, over lower, intensity exercise training for COPD. Typically, we consider intensity of exercise training to be a key component of any exercise training programme. Whilst studies of young individuals have demonstrated that higher exercise training intensity results in greater improvements in exercise capacity, the evidence for older patients is not so clear cut. In COPD, there is limited evidence regarding the optimal intensity of exercise training...
October 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
X M Zhou, C Wu, L Zhao, Y Z Gao, Y Yuan, X X Xiao, Y Lu
To investigate physicians' knowledge about chronic obstructive pulmonary disease (COPD) in tertiary hospitals in northeast China. Physicians from 77 tertiary hospitals in northeast China were surveyed with a questionnaire, which included questions such as risk factors, symptoms, exacerbations, comorbidities and diagnostic criteria of COPD. Besides cigarette smoking, air pollution and pulmonary infections, only 22.5%(40/178) physicians recognized that the biomass fuels may induce COPD. Totally 59.0%(105/178) physicians recognized the importance of spirometry to the diagnosis of COPD...
September 1, 2016: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Mohit Kaushal, Parth S Shah, Arti D Shah, Stani A Francis, Nihar V Patel, Kavit K Kothari
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a global health issue with cigarette smoking being an important risk factor. COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension (PH), cor-pulmonale (COR-P), right and left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities...
July 2016: Lung India: Official Organ of Indian Chest Society
I Aumann, L Tedja, J M Graf von der Schulenburg
BACKGROUND: Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). For current smokers who are diagnosed with COPD, their first treatment option is to stop smoking. Motivation is necessary for long-term smoking cessation; therefore, when designing smoking cessation programs, the patients' needs and preferences should be considered. We focused on COPD patients' experiences with existing smoking cessation programs and evaluated their preferences for the improvement of these programs...
2016: Tobacco Induced Diseases
Dmitrij Achelrod, Tobias Welte, Jonas Schreyögg, Tom Stargardt
INTRODUCTION: 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. OBJECTIVE: 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. METHODS: A retrospective, population-based cohort study design is applied, using administrative data...
September 2016: Health Policy
Bert Strookappe, Lesley Ann Saketkoo, Marjon Elfferich, Anne Holland, Jolanda De Vries, Ton Knevel, Marjolein Drent
INTRODUCTION: Sarcoidosis is a multisystemic inflammatory disorder with a great variety of symptoms, including fatigue, dyspnea, pain, reduced exercise tolerance and muscle strength. Physical training has the potential to improve exercise capacity and muscle strength, and reduce fatigue. The aim of this review and survey was to present information about the role of physical training in sarcoidosis and offer practical guidelines. AREAS COVERED: A systematic literature review guided an international consensus effort among sarcoidosis experts to establish practice-basic recommendations for the implementation of exercise as treatment for patients with various manifestations of sarcoidosis...
October 2016: Expert Review of Respiratory Medicine
Christopher Plishka, Thomas Rotter, Leigh Kinsman, Mohammed Rashaad Hansia, Adegboyega Lawal, Donna Goodridge, Erika Penz, Darcy D Marciniuk
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory syndrome characterized by progressive, partially reversible airway obstruction and lung hyperinflation. COPD has a substantial burden which is seen in both patient quality of life and healthcare costs. One proposed method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs aim to guide evidence-based practice and improve the interaction between health services. They bring the best available evidence to a range of healthcare professionals by adapting evidence-based clinical guidelines to a local context and detailing the essential steps in the assessment and care of patients...
2016: Systematic Reviews
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