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COPD exacerbation and antibiotics

Fernando J Martinez, Jørgen Vestbo, Julie A Anderson, Robert D Brook, Bartolome R Celli, Nicholas J Cowans, Courtney Crim, Mark Dransfield, Sally Kilbride, Julie Yates, David E Newby, Dennis Niewoehner, Peter Ma Calverley
BACKGROUND: Inhaled corticosteroids have been shown to decrease exacerbations in COPD patients with moderate to severe COPD. Their effect in patients with milder airflow obstruction remains unclear. OBJECTIVE: This was an analysis of exacerbations in the Study to Understand Mortality and MorbidITy (SUMMIT) study. DESIGN: In a double-blind randomized controlled trial, once daily inhaled placebo, fluticasone furoate (FF, 100 μg), vilanterol (VI, 25 μg) or the combination (FF/VI) was administered...
October 21, 2016: American Journal of Respiratory and Critical Care Medicine
A Vora, Amit Bhargava
INTRODUCTION: Cough is significant health problem with greater implication for impaired quality of life. Acute and chronic cough due to infective (viral/bacterial), allergic conditions or bronchial asthma including cough variant asthma are often treated with combination of mucolytics, expectorants and bronchodilators. Bronchodilators reduces cough sensitivity, promotes clearance of cough secretions while reducing protrusive inflammatory mediator release. AIMS AND OBJECTIVES: To further understand the clinical utility and safety of Bronchodilatory cough formulations (BCF) containing Levosalbutamol in real world settings...
September 2016: Journal of the Association of Physicians of India
Erin Davis, Carlo Marra, John-Michael Gamble, Jamie Farrell, Joe Lockyer, J Mark FitzGerald, Waseem Abu-Ashour, Charlie Gillis, John Hawboldt
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are often nonadherent with medications and have poor inhaler technique. Community pharmacists can help to improve health-related quality of life and overall outcomes in patients with COPD. We aim to measure the effectiveness of a systematic, pharmacist-driven intervention on patients with diagnosed COPD. METHODS/DESIGN: This pragmatic, parallel-group, cluster randomized controlled trial is designed to determine the effectiveness of a multifactorial, pharmacist-led intervention on medication adherence, inhaler technique, health-related quality of life, health care resource utilization including COPD exacerbations, and use of medications...
October 13, 2016: Trials
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
Tony S Brar, Neeka Akhavan
This is a 78 year old male with a past medical history of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and gastroesophageal reflux disorder (GERD) who presented to the emergency room with worsening shortness of breath (SOB) and low-grade fevers for one week prior to admission. He was originally diagnosed with healthcare associated pneumonia (HCAP) and an acute on chronic COPD exacerbation and treated with prednisone, inhalers, ipratropium/albuterol, and broad-spectrum antibiotics...
2016: Respiratory Medicine Case Reports
L A Loza Vargas, Henar Núñez Rodríguez, Marina Benito Sanz, Tomás Zamora Martínez, Pilar Díez Redondo, Manuel Pérez Miranda
An 82-year-old male with a history of high blood pressure, COPD, chronic myeloid leukemia, and stage-4 chronic renal failure. Admitted to hospital for lower-limb cellulitis and severe COPD exacerbation, he received antibiotic therapy and bronchodilators. During his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. A complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleeding stigmata and submucosal bleeding suggestive of infectious colitis; stool culture was negative and Clostridium difficile toxins were positive...
October 2016: Revista Española de Enfermedades Digestivas
Carla S Andrews, Shingo Matsuyama, Byung-Cheol Lee, Jian-Dong Li
Upper respiratory tract inflammatory diseases such as asthma and chronic obstructive pulmonary diseases (COPD) affect more than one-half billion people globally and are characterized by chronic inflammation that is often exacerbated by respiratory pathogens such as nontypeable Haemophilus influenzae (NTHi). The increasing numbers of antibiotic-resistant bacterial strains and the limited success of currently available pharmaceuticals used to manage the symptoms of these diseases present an urgent need for the development of novel anti-inflammatory therapeutic agents...
September 28, 2016: Scientific Reports
Marc Miravitlles, Anthony D'Urzo, Dave Singh, Vladimir Koblizek
Identifying patients at risk of exacerbations and managing them appropriately to reduce this risk represents an important clinical challenge. Numerous treatments have been assessed for the prevention of exacerbations and their efficacy may differ by patient phenotype. Given their centrality in the treatment of COPD, there is strong rationale for maximizing bronchodilation as an initial strategy to reduce exacerbation risk irrespective of patient phenotype. Therefore, in patients assessed as frequent exacerbators (>1 exacerbation/year) we propose initial bronchodilator treatment with a long-acting muscarinic antagonist (LAMA)/ long-acting β2-agonist (LABA)...
September 10, 2016: Respiratory Research
J Picart, M P Moiton, B-A Gaüzère, V Gazaille, X Combes, S DiBernardo
OBJECTIVES: Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin (PCT) is a useful biomarker that helps reduce the rate of antibiotic therapies. However, its proper cut-off levels are often unknown. We aimed to assess the impact of a PCT-based algorithm to guide antibiotic therapy prescription in COPD exacerbations. METHODS: We conducted an observational, retrospective, and before/after study. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation...
September 5, 2016: Médecine et Maladies Infectieuses
Giulia Scioscia, Isabel Blanco, Ebymar Arismendi, Felip Burgos, Concepción Gistau, Maria Pia Foschino Barbaro, Bartolome Celli, Denis E O'Donnell, Alvar Agustí
BACKGROUND: Some patients with COPD report frequent acute exacerbations (AECOPD) of the disease (FE), whereas others suffer them infrequently (IE). Because the current diagnosis of exacerbation relies on patient's perception of increased symptoms (mostly dyspnoea), we hypothesised that dyspnoea perception might be different in COPD patients with FE (≥2 exacerbations or 1 hospitalisation due to AECOPD in the previous year) or IE (≤1 exacerbation in the previous year), AECOPD being defined by the institution antibiotics and/or steroids treatment, or hospital admission...
September 1, 2016: Thorax
Jason D Keene, Sean Jacobson, Katerina Kechris, Gregory L Kinney, Marilyn G Foreman, Claire M Doerschuk, Barry J Make, Jeffrey L Curtis, Stephen I Rennard, R Graham Barr, Eugene R Bleecker, Richard E Kanner, Eric C Kleerup, Nadia N Hansel, Prescott G Woodruff, MeiLan K Han, Robert Paine Iii, Fernando J Martinez, Russell P Bowler, Wanda K O'Neal
RATIONALE: COPD exacerbations are associated with disease progression, higher healthcare cost, and increased mortality. Published predictors of future exacerbations include previous exacerbation, airflow obstruction, poor overall health, home oxygen use, and gastroesophageal reflux. The value of adding blood biomarkers to clinical variables to predict exacerbations remains unproven. METHODS: Subjects from SPIROMICS (n=1544) and COPDGene (n=602) cohorts had 90 plasma or serum candidate proteins measured on study entry using Myriad-RBM multiplex panels...
August 31, 2016: American Journal of Respiratory and Critical Care Medicine
Juan Miguel Sánchez-Nieto, Rubén Andújar-Espinosa, Roberto Bernabeu-Mora, Chunshao Hu, Beatriz Gálvez-Martínez, Andrés Carrillo-Alcaraz, Carlos Federico Álvarez-Miranda, Olga Meca-Birlanga, Eva Abad-Corpa
BACKGROUND: Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD. METHODS: Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Stephen I Rennard, Fernando J Martinez, Klaus F Rabe, Sanjay Sethi, Emilio Pizzichini, Andrew McIvor, Shahid Siddiqui, Antonio Anzueto, Haiyuan Zhu
BACKGROUND: Roflumilast, a once-daily, selective phosphodiesterase-4 inhibitor, reduces the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. The RE(2)SPOND study is examining whether roflumilast, when added to an inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) fixed-dose combination (FDC), further reduces exacerbations. The methodology is described herein. METHODS: In this Phase IV, multicenter, double-blind, placebo-controlled, parallel-group trial, participants were randomized 1:1 (stratified by long-acting muscarinic antagonist use) to receive roflumilast or placebo, plus ICS/LABA FDC, for 52 weeks...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Mark T Dransfield, Ken M Kunisaki, Matthew J Strand, Antonio Anzueto, Surya P Bhatt, Russell P Bowler, Gerard J Criner, Jeffrey L Curtis, Nicola A Hanania, Hrudaya Nath, Nirupama Putcha, Sarah E Roark, Emily S Wan, George R Washko, J Michael Wells, Christine H Wendt, Barry J Make
Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung function decline is unknown. Methods We examined data on the first 2,000 subjects who returned for a second COPDGene visit 5 years after enrolment. Baseline data included demographics, smoking history and CT emphysema...
August 24, 2016: American Journal of Respiratory and Critical Care Medicine
Elodie Ehrmann, Anne Jolivet-Gougeon, Martine Bonnaure-Mallet, Thierry Fosse
INTRODUCTION: Capnocytophaga genus was recently known to highly contribute to the beta-lactam (BL) and macrolide-lincosamide-streptogramin (MLS) resistance gene reservoir in the oral microbiota (BL: blaCSP-1 and blaCfxA; MLS: erm(F) and erm(C)). But fluoroquinolone (FQ) resistance remains uncommon in literature, without available data on resistance mechanisms. CASE REPORT: For the first time, a case of acute exacerbation of chronic obstructive pulmonary disease (COPD) was described in a 78-year-old immunocompetent patient due to a multidrug-resistant Capnocytophaga gingivalis isolate with significant microbiological finding...
August 13, 2016: Anaerobe
Francesco Blasi, Clive Page, Gian Maria Rossolini, Lucia Pallecchi, Maria Gabriella Matera, Paola Rogliani, Mario Cazzola
OBJECTIVES: In airway infections, biofilm formation has been demonstrated to be responsible for both acute and chronic events, and constitutes a genuine challenge in clinical practice. Difficulty in eradicating biofilms with systemic antibiotics has led clinicians to consider the possible role of non-antibiotic therapy. The aim of this review is to examine current evidence for the use of N-acetylcysteine (NAC) in the treatment of biofilm-related respiratory infections. METHODS: Electronic searches of PUBMED up to September 2015 were conducted, searching for 'biofilm', 'respiratory tract infection', 'N-acetylcysteine', 'cystic fibrosis', 'COPD', 'bronchiectasis', 'otitis', and 'bronchitis' in titles and abstracts...
August 2016: Respiratory Medicine
Padmaja Ananth Shenoy, Kiran Chawla, Shashidhar Vishwanath, Dipika Shaw
INTRODUCTION: Haemophilus influenzae is responsible for wide range of localized and invasive lower respiratory tract infections (LRTI) with the highest burden of disease in low and middle income countries. AIM: The aim of the present study was to characterize the H.influenzae isolates from suspected LRTI. MATERIALS AND METHODS: A prospective study was conducted over a period of one and half years (December 2012 to May 2014) including patients with LRTI...
May 2016: Journal of Clinical and Diagnostic Research: JCDR
Dino B A Tan, Nathanael E Ong, Maja Zimmermann, Patricia Price, Yuben P Moodley
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are characterized by increased pulmonary and systemic inflammation and commonly caused by bacterial and/or viral infection. Little is known about the T-cell dysregulation in AECOPD that promotes these outcomes. CD39 is an ectonucleotidase able to hydrolyse adenosine triphosphate to create adenosine that may inhibit T-cell responses in patients with AECOPD. Here T-cell expression of CD39 measured by flow cytometry was higher in AECOPD patients than stable COPD patients or healthy controls...
October 2016: Human Immunology
Caspar Corti, Markus Fally, Andreas Fabricius-Bjerre, Katrine Mortensen, Birgitte Nybo Jensen, Helle F Andreassen, Celeste Porsbjerg, Jenny Dahl Knudsen, Jens-Ulrik Jensen
BACKGROUND: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD). METHODS: One-hundred and twenty adult patients admitted with AECOPD were enrolled in this open-label randomized trial. Patients were allocated to either the POC PCT-guided intervention arm (n=62) or the control arm, in which antibiotic therapy followed local guidelines (n=58)...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Miguel Santibáñez, Roberto Garrastazu, Mario Ruiz-Nuñez, Jose Manuel Helguera, Sandra Arenal, Cristina Bonnardeux, Carlos León, Juan Luis García-Rivero
BACKGROUND AND AIM: Exacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs-particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients. METHODS: This was a retrospective population-based cohort study...
2016: PloS One
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