A Multidisciplinary Intervention to Improve Care for High-Risk COPD Patients

Chronic obstructive pulmonary disease (COPD) exacerbations contribute to both costs and patient morbidity. The authors designed a quality project to improve care for high-risk COPD patients admitted with an exacerbation. An electronic medical record report was used to target admitted high-risk COPD patients for an intervention that included pulmonary and respiratory therapy consults, post-discharge phone calls from a patient navigator, referrals to palliative services when appropriate, and bedside delivery of medications. The control population was a similar group of patients at a community partner hospital who received usual care. In all, 157 unique patients were enrolled over 16 months; referrals to palliative care services increased and rates of outpatient follow-up improved. There was no difference in readmissions or emergency department visits between the 2 groups. Better coordination of outpatient care and attention to psychosocial burdens were identified as possible targets for future interventions.

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Domiciliary Cough Monitoring for the Prediction of COPD Exacerbations

Lung ◽

10.1007/s00408-021-00435-9 ◽

2021 ◽

Vol 199 (2) ◽

pp. 131-137

Author(s):

Michael G. Crooks ◽

Albertus C. den Brinker ◽

Susannah Thackray-Nocera ◽

Ralph van Dinther ◽

Caroline E. Wright ◽

...

Keyword(s):

Automated System ◽

Chronic Obstructive ◽

Service Utilisation ◽

Alert System ◽

Obstructive Pulmonary Disease ◽

Prospective Longitudinal Study ◽

Copd Exacerbations ◽

Cough Frequency ◽

Copd Patients ◽

Prospective Longitudinal

Abstract Introduction Acute exacerbations of COPD (AE-COPD) are a leading cause of health service utilisation and are associated with morbidity and mortality. Identifying the prodrome of AE-COPD by monitoring symptoms and physiological parameters (telemonitoring) has proven disappointing and false alerts limit clinical utility. We report objective monitoring of cough counts around AE-COPD and the performance of a novel alert system identifying meaningful change in cough frequency. Methods This prospective longitudinal study of cough monitoring included chronic obstructive pulmonary disease (COPD) patients experienced in telemonitoring that had two or more AE-COPD in the past year. Participants underwent cough monitoring and completed a daily questionnaire for 90 days. The automated system identified deteriorating trends in cough and this was compared with alerts generated by an established telemonitoring questionnaire. Results 28 patients [median age 66 (range 46–86), mean FEV-1% predicted 36% (SD 18%)] completed the study and had a total of 58 exacerbations (43 moderate and 15 severe). Alerts based on cough monitoring were generated mean 3.4 days before 45% of AE-COPD with one false alert every 100 days. In contrast, questionnaire-based alerts occurred in the prodrome of 88% of AE-COPD with one false alert every 10 days. Conclusion An alert system based on cough frequency alone predicted 45% AE-COPD; the low false alert rate with cough monitoring suggests it is a practical and clinically relevant tool. In contrast, the utility of questionnaire-based symptom monitoring is limited by frequent false alerts.

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Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis

European Respiratory Review ◽

10.1183/16000617.00002215 ◽

2015 ◽

Vol 24 (137) ◽

pp. 451-461 ◽

Cited By ~ 81

Author(s):

Mario Cazzola ◽

Luigino Calzetta ◽

Clive Page ◽

Josè Jardim ◽

Alexander G. Chuchalin ◽

...

Keyword(s):

Relative Risk ◽

Airway Obstruction ◽

Chronic Bronchitis ◽

Meta Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Regular Treatment ◽

Copd Exacerbations ◽

Copd Patients ◽

High Doses

In order to clarify the possible role of N-acetylcysteine (NAC) in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD), we have carried out a meta-analysis testing the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis or COPD and evaluating whether there is a substantial difference between the responses induced by low (≤600 mg per day) and high (>600 mg per day) doses of NAC.The results of the present meta-analysis (13 studies, 4155 COPD patients, NAC n=1933; placebo or controls n=2222) showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis or COPD (relative risk 0.75, 95% CI 0.66–0.84; p<0.01), although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria (relative risk 0.75, 95% CI 0.68–0.82; p=0.04). NAC was well tolerated and the risk of adverse reactions was not dose-dependent (low doses relative risk 0.93, 95% CI 0.89–0.97; p=0.40; high doses relative risk 1.11, 95% CI 0.89–1.39; p=0.58).The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents a documented airway obstruction, NAC should be administered at a dose of ≥1200 mg per day to prevent exacerbations, while if a patient suffers from chronic bronchitis, but is without airway obstruction, a regular treatment of 600 mg per day seems to be sufficient.

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Periodontal Health and Chronic Obstructive Pulmonary Disease (COPD) Exacerbations: A Systematic Review

10.21203/rs.3.rs-138210/v1 ◽

2021 ◽

Author(s):

Niamh Kelly ◽

Lewis Winning ◽

Christopher Irwin ◽

Fionnuala Lundy ◽

Dermot Linden ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Risk Of Bias ◽

Chronic Obstructive ◽

Periodontal Health ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Copd Patients

Abstract BackgroundA growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal health and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. MethodsPubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life and hospitalisation. Studies were assessed for eligibility and quality by two assessors independently.Results Searches identified 532 records and 8 met the inclusion criteria. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores with exacerbation but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of high risk of bias.ConclusionThe data supports possible association between poor periodontal health, the frequency of exacerbations and quality of life in COPD patients. The evidence is limited by high risk of bias suggesting need for well-designed and adequately powered randomised control trials.The PROSPERO registration number CRD42020180328

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Sleep Quality in Chronic Obstructive Pulmonary Disease With High Risk of Acute Exacerbation

10.21203/rs.3.rs-446799/v1 ◽

2021 ◽

Author(s):

Chong Xing ◽

Hui Shen ◽

Wenyang Li ◽

Wei Wang

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

High Risk ◽

Sleep Quality ◽

Acute Exacerbation ◽

Overlap Syndrome ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Sleep Parameters

Abstract This was a prospective case-control study aimed to explore the sleep quality, especially sleep-related disorders, among chronic obstructive pulmonary disease (COPD) patients with high risk of acute exacerbation, and to determine the risk factors. We enrolled COPD patients with acute exacerbation or health control visited the first hospital of China Medical University from October 1st, 2017 to October 28th, 2018. The subjective and objective sleep parameters were compared among them, and then the stepwise multiple regression analysis were performed. We found that COPD patients with high risk of acute exacerbation had decreased subjective and objective sleep quality. Patients with COPD-obstructive sleep apnea overlap syndrome revealed decreased slow wave sleep than patients with COPD alone. The subjective sleep parameters were correlated with the frequency of acute exacerbation, dyspnea index and Epworth sleepiness score. The objective sleep parameters were related to the degree of airflow obstruction, COPD Assessment Test score and the Modified British Medical Research Council dyspena score. So, we believe that the subjective and objective sleep quality of patients with high risk of acute exacerbations of COPD was poor, and the sleep quality of patients with overlap syndrome was worse than that of patients with COPD alone.

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LABA/LAMA fixed-dose combinations versus LAMA monotherapy in the prevention of COPD exacerbations: a systematic review and meta-analysis

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620937194 ◽

2020 ◽

Vol 14 ◽

pp. 175346662093719

Author(s):

Ching-Yi Chen ◽

Wang-Chun Chen ◽

Chi-Hsien Huang ◽

Yi-Ping Hsiang ◽

Chau-Chyun Sheu ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Meta Analysis ◽

Similar Efficacy ◽

Fixed Dose ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Copd Patients ◽

History Of ◽

Long Acting

Background: Long-acting muscarinic antagonist (LAMA) monotherapy is recommended for chronic obstructive pulmonary disease (COPD) patients with high risk of exacerbations. It is unclear whether long-acting β2-agonist (LABA)/LAMA fixed-dose combinations (FDCs) are more effective than LAMAs alone in preventing exacerbations. The aim of this study was to systematically review the literature to investigate whether LABA/LAMA FDCs are more effective than LAMA monotherapy in preventing exacerbations. Methods: We searched several databases and manufacturers’ websites to identify relevant randomized clinical trials comparing LABA/LAMA FDC treatment with LAMAs alone ⩾24 weeks. Outcomes of interest were time to first exacerbation and rates of moderate to severe, severe and all exacerbations. Results: We included 10 trials in 9 articles from 2013 to 2018 with a total of 19,369 patients for analysis in this study. Compared with LAMA monotherapy, LABA/LAMA FDCs demonstrated similar efficacy in terms of time to first exacerbation [hazard ratio, 0.96; 95% confidence interval (CI) 0.79–1.18; p = 0.71], moderate to severe exacerbations [risk ratio (RR), 0.96; 95% CI 0.90–1.03; p = 0.28], severe exacerbations (RR, 0.92; 95% CI 0.81–1.03; p = 0.15), and a marginal superiority in terms of all exacerbations (RR, 0.92; 95% CI 0.86–1.00; p = 0.04). The incidence of all exacerbation events was lower in the LABA/LAMA FDC group for the COPD patients with a history of previous exacerbations and those with a longer treatment period (52–64 weeks). Conclusion: This study provides evidence that LABA/LAMA FDCs are marginally superior in the prevention of all exacerbations compared with LAMA monotherapy in patients with COPD. The reviews of this paper are available via the supplemental material section.

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Bronchoalveolar Lavage Fluid from COPD Patients Reveals More Compounds Associated with Disease than Matched Plasma

Metabolites ◽

10.3390/metabo9080157 ◽

2019 ◽

Vol 9 (8) ◽

pp. 157 ◽

Cited By ~ 2

Author(s):

Eitan Halper-Stromberg ◽

Lucas Gillenwater ◽

Charmion Cruickshank-Quinn ◽

Wanda Kay O’Neal ◽

Nichole Reisdorph ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Cell Metabolism ◽

Lavage Fluid ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

False Discovery ◽

Copd Patients ◽

Clinical Covariates

Smoking causes chronic obstructive pulmonary disease (COPD). Though recent studies identified a COPD metabolomic signature in blood, no large studies examine the metabolome in bronchoalveolar lavage (BAL) fluid, a more direct representation of lung cell metabolism. We performed untargeted liquid chromatography–mass spectrometry (LC–MS) on BAL and matched plasma from 115 subjects from the SPIROMICS cohort. Regression was performed with COPD phenotypes as the outcome and metabolites as the predictor, adjusted for clinical covariates and false discovery rate. Weighted gene co-expression network analysis (WGCNA) grouped metabolites into modules which were then associated with phenotypes. K-means clustering grouped similar subjects. We detected 7939 and 10,561 compounds in BAL and paired plasma samples, respectively. FEV1/FVC (Forced Expiratory Volume in One Second/Forced Vital Capacity) ratio, emphysema, FEV1 % predicted, and COPD exacerbations associated with 1230, 792, eight, and one BAL compounds, respectively. Only two plasma compounds associated with a COPD phenotype (emphysema). Three BAL co-expression modules associated with FEV1/FVC and emphysema. K-means BAL metabolomic signature clustering identified two groups, one with more airway obstruction (34% of subjects, median FEV1/FVC 0.67), one with less (66% of subjects, median FEV1/FVC 0.77; p < 2 × 10−4). Associations between metabolites and COPD phenotypes are more robustly represented in BAL compared to plasma.

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Neutrophil proteases alter the interleukin-22-receptor-dependent lung antimicrobial defence

European Respiratory Journal ◽

10.1183/09031936.00215114 ◽

2015 ◽

Vol 46 (3) ◽

pp. 771-782 ◽

Cited By ~ 25

Author(s):

Antoine Guillon ◽

Youenn Jouan ◽

Deborah Brea ◽

Fabien Gueugnon ◽

Emilie Dalloneau ◽

...

Keyword(s):

Chronic Obstructive ◽

Dependent Lung ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Interleukin 22 ◽

Copd Patients ◽

Acute Exacerbations ◽

Underlying Mechanisms

Chronic obstructive pulmonary disease (COPD) is punctuated by episodes of infection-driven acute exacerbations. Despite the life-threatening nature of these exacerbations, the underlying mechanisms remain unclear, although a high number of neutrophils in the lungs of COPD patients is known to correlate with poor prognosis. Interleukin (IL)-22 is a cytokine that plays a pivotal role in lung antimicrobial defence and tissue protection. We hypothesised that neutrophils secrete proteases that may have adverse effects in COPD, by altering the IL-22 receptor (IL-22R)-dependent signalling.Using in vitro and in vivo approaches as well as reverse transcriptase quantitative PCR, flow cytometry and/or Western blotting techniques, we first showed that pathogens such as the influenza virus promote IL-22R expression in human bronchial epithelial cells, whereas Pseudomonas aeruginosa, bacterial lipopolysaccharide or cigarette smoke do not. Most importantly, neutrophil proteases cleave IL-22R and impair IL-22-dependent immune signalling and expression of antimicrobial effectors such as β-defensin-2. This proteolysis resulted in the release of a soluble fragment of IL-22R, which was detectable both in cellular and animal models as well as in sputa from COPD patients with acute exacerbations.Hence, our study reveals an unsuspected regulation by the proteolytic action of neutrophil enzymes of IL-22-dependent lung host response. This process probably enhances pathogen replication, and ultimately COPD exacerbations.

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Real-Life Clinical and Functional Effects of Fluticasone Furoate/Umeclidinium/Vilanterol-Combined Triple Therapy in Patients with Chronic Obstructive Pulmonary Disease

Respiration ◽

10.1159/000512064 ◽

2020 ◽

pp. 1-8

Author(s):

Corrado Pelaia ◽

Giada Procopio ◽

Maria Rosaria Deodato ◽

Olivia Florio ◽

Angelantonio Maglio ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Triple Therapy ◽

Real Life ◽

Chronic Obstructive ◽

Fluticasone Furoate ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Copd Patients ◽

Inhaled Therapy ◽

Long Acting

Background: Triple therapy consisting of a drug association including an inhaled corticosteroid, a long-acting muscarinic receptor antagonist and a long-acting β2-adrenergic agonist, delivered via a single device, can be a valuable treatment for chronic obstructive pulmonary disease (COPD) patients experiencing frequent disease exacerbations. Objectives: The aim of this real-life, single-center, observational study was to evaluate, in 44 COPD patients with recurrent exacerbations, the effects of the triple inhaled therapy combining fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI). Methods: Within such a therapeutic context, several clinical and lung functional parameters were considered at baseline and after 24 weeks of treatment with combined inhaled triple therapy. Results: With respect to baseline, after 24 weeks of treatment with FF/UMEC/VI, significant changes were recorded with regard to Modified British Medical Research Council (p < 0.0001) and COPD Assessment Test (p < 0.0001) scores, COPD exacerbations (p < 0.001), forced expiratory volume in the first second (p < 0.001), residual volume (p < 0.01), forced mid-expiratory flow between 25 and 75% of FVC (p < 0.0001), inspiratory capacity (p < 0.01), forced vital capacity (p < 0.05), and peak expiratory flow (p < 0.0001). Moreover, in a subgroup of 28 patients, a significant increase of diffusion lung capacity (p < 0.01) was also detected. Conclusions: In conclusion, our real-life results suggest that triple inhaled therapy with FF/UMEC/VI, when given to COPD patients with frequent exacerbations, is able to positively impact on dyspnea and global health status as well as to significantly decrease COPD exacerbations and improve airflow limitation and lung hyperinflation.

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Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

European Respiratory Review ◽

10.1183/16000617.0113-2017 ◽

2018 ◽

Vol 27 (147) ◽

pp. 170113 ◽

Cited By ~ 39

Author(s):

Panagiotis Paliogiannis ◽

Alessandro G. Fois ◽

Salvatore Sotgia ◽

Arduino A. Mangoni ◽

Elisabetta Zinellu ◽

...

Keyword(s):

Complete Blood Count ◽

Neutrophil To Lymphocyte Ratio ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Future Perspectives ◽

Obstructive Pulmonary Disease ◽

Lymphocyte Ratio ◽

Copd Exacerbations ◽

Copd Patients ◽

Acute Exacerbations

Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group.

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Periodontal status and chronic obstructive pulmonary disease (COPD) exacerbations: a systematic review

BMC Oral Health ◽

10.1186/s12903-021-01757-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Niamh Kelly ◽

Lewis Winning ◽

Christopher Irwin ◽

Fionnuala T. Lundy ◽

Dermot Linden ◽

...

Keyword(s):

Quality Of Life ◽

Intervention Studies ◽

Risk Of Bias ◽

Chronic Obstructive ◽

Periodontal Health ◽

Obstructive Pulmonary Disease ◽

Bias Assessment ◽

Copd Exacerbations ◽

Copd Patients

Abstract Background A growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal status and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. Methods PubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life (QoL) and hospitalisation. Quality and risk of bias assessment were carried out using the Newcastle Ottawa Scale for observational studies, Robins-1 tool for non-randomised intervention studies and Cochrane risk of bias assessment (RoB-2) tool for randomised clinical trials. Studies were assessed for eligibility and quality by two assessors independently. Results Searches identified 532 records and 8 met the inclusion criteria. Included studies were three clinical trials, one prospective cohort study, one case–control, and three cross-sectional studies. A narrative synthesis was performed. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores and fewer teeth with exacerbation, but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of a high risk of bias. Conclusion The data supports possible association between poor periodontal health, the frequency of exacerbations, hospitalisation and quality of life in COPD patients. The evidence is of moderate to low certainty and is limited by high risk of bias suggesting the need for well-designed and adequately powered randomised controlled trials, to inform future research and clinical practice. The PROSPERO registration number CRD42020180328.

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