Pulmonary complications and survival after elective infrarenal endovascular abdominal aneurysm repair in patients with documented chronic obstructive pulmonary disease

Vascular ◽  
2020 ◽  
Vol 28 (5) ◽  
pp. 557-567
Author(s):  
Fieke K Oussoren ◽  
Suzanne Holewijn ◽  
Niels Claessens ◽  
Daphne van der Veen ◽  
Michel MPJ Reijnen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Events ◽  
Pulmonary Disease ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Co Morbidity ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Gold Classification

Background Elective abdominal aortic aneurysm (AAA) repair is advocated in patients where risk of rupture exceeds the risks of peri-procedural morbidity and mortality. Chronic obstructive pulmonary disease (COPD) is a known risk factor for AAA and increased operative morbidity in general. Since literature on the correlation between the clinical classification of COPD and morbidity following endovascular infrarenal AAA repair (EVAR) is scarce, assessment per individual remains a challenge. Objective To analyse the pulmonary and all-cause morbidity and mortality in patients with documented COPD and relate this to their GOLD classification. Methods Sixty-eight patients with COPD, documented by a lung function test, who underwent elective EVAR between July 2002 and July 2018 were retrospectively reviewed. The primary endpoint was the incidence of 30-day pulmonary adverse events. Procedural characteristics, length of hospital stay, pulmonary and all-cause morbidity including major adverse events (MAEs) during follow-up and five-year survival divided per GOLD classification were the secondary endpoints. Results There was no statistically significant difference in the incidence of pulmonary adverse events between GOLD I/II and GOLD III/IV patients. There was neither procedural nor 30-day mortality in either group. Through 30 days and 1 year, there was no difference in pulmonary and all-cause morbidity between groups. Three MAEs occurred in the GOLD I/II group versus 2 MAE in the GOLD III/IV group during the first postoperative year. The five-year survival was 66.0%, 60.9% and 61.9% for patients with GOLD I, GOLD II and GOLD III, respectively. Three of four GOLD IV died within the first year after EVAR. Conclusion EVAR can be safely performed in patients with COPD, with low 30-day morbidity and mortality rates. Although severe co-morbidity should be taken into account, EVAR seems to be justified in patients with COPD with a GOLD classification I, II or III. Further research should focus on optimising the pulmonary condition in patients selected for EVAR.

scholarly journals Revefenacin, a once-daily, long-acting muscarinic antagonist, for nebulized maintenance therapy in patients with chronic obstructive pulmonary disease

2021 ◽  
Author(s):  
Christopher Hvisdas
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Events ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Suitable Alternative ◽  
Once Daily ◽  
Muscarinic Antagonist ◽  
Significant Difference ◽  
Long Acting

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article reviews the efficacy and safety of revefenacin, the first once-daily, long-acting muscarinic antagonist, when delivered via a standard jet nebulizer in patients with chronic obstructive pulmonary disease (COPD). Summary Revefenacin 175 µg is indicated for the maintenance treatment of patients with moderate to very severe COPD. Preclinical studies showed that revefenacin is a potent and selective antagonist with similar affinity for the different subtypes of muscarinic receptor (M1-M5). Furthermore, prevention of methacholine- and acetylcholine-induced bronchoconstrictive effects was dose dependent and lasted longer than 24 hours, demonstrating a long duration of action. In phase 2 and 3 trials, treatment with revefenacin was demonstrated to result in statistical improvements in pulmonary function (≥100 mL, P < 0.05) vs placebo, including among patients with markers of more severe disease and those who received concomitant long-acting β-agonists or long-acting β-agonists together with inhaled corticosteroids. Revefenacin was also demonstrated to have efficacy similar to that of tiotropium. The clinical trial findings indicated no significant difference between revefenacin and tiotropium with regard to rates of adverse events. Overall, revefenacin was well tolerated, with COPD worsening/exacerbation, dyspnea, headache, and cough among the most common adverse events noted in the clinical trials. Conclusions Revefenacin treatment delivered via nebulization led to improvements in lung function in patients with COPD. It was also generally well tolerated with no major safety concerns. Revefenacin provides a viable treatment option for patients with COPD and may be a suitable alternative for those with conditions that may impair proper use of traditional handheld inhalers.

scholarly journals Allogeneic human umbilical cord-derived mesenchymal stem/stromal cells for chronic obstructive pulmonary disease (COPD): study protocol for a matched case–control, phase I/II trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045788
Author(s):  
Duc M Hoang ◽  
Kien T Nguyen ◽  
Anh H Nguyen ◽  
Bach N Nguyen ◽  
Liem Thanh Nguyen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Events ◽  
Phase I ◽  
Pulmonary Disease ◽  
Stromal Cells ◽  
Case Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Control Phase ◽  
Matched Case

IntroductionThe global prevalence of chronic obstructive pulmonary disease (COPD) is increasing, and it has become a major public health burden worldwide, including in Vietnam. A large body of preclinical and clinical studies supports the safety of mesenchymal stem/stromal cells (MSCs) in the treatment of lung injury, including COPD. The aim of this trial is to investigate the safety and potential therapeutic efficacy of allogeneic administration of umbilical cord-derived MSCs (UC-MSCs) as a supplementary intervention in combination with standard COPD medication treatments in patients with moderate-to-severe COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 and Vietnam Ministry of Health’s guidelines.Methods and analysisThis matched case–control phase I/II trial is conducted at Vinmec Times City International Hospital, Hanoi, Vietnam between June 2020 and December 2021. In this study, 40 patients will be enrolled and assigned into two age-matched, gender-matched and COPD condition-matched groups, including a UC-MSC group and a control group. Both groups will receive standard COPD medication treatment based on the GOLD 2019 guidelines and the Vietnam Ministry of Health protocol. The UC-MSC group will receive two doses of thawed UC-MSC product with an intervention interval of 3 months. The primary outcome measures will include the incidence of prespecified administration-associated adverse events and serious adverse events. The efficacy will be evaluated based on the absolute changes in the number of admissions, arterial blood gas analysis, lung function and lung fibrosis via CT scan and chest X-ray. The clinical evaluation will be conducted at baseline and 3, 6 and 12 months postintervention.Ethics and disseminationEthical approval was secured from the Ethical Committee of Vinmec International Hospital (number:166/2019/QĐ-VMEC) and Vietnam Ministry of Health (number:2002/QĐ-BYT). The results will be reported to trial collaborators, publication in peer-reviewed academic journals.Trial registration numberNCT04433104.

scholarly journals Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

2022 ◽  
Vol 19 (2) ◽  
pp. 970
Author(s):  
Elena Jurevičienė ◽  
Greta Burneikaitė ◽  
Laimis Dambrauskas ◽  
Vytautas Kasiulevičius ◽  
Edita Kazėnaitė ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Kidney Diseases ◽  
Screening Tools ◽  
National Database ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
The Impact

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

scholarly journals Effect of Pharmacy Counseling on Readmissions in Patients with Acute Exacerbations of COPD: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Narachai Prasungriyo ◽  
Nungruthai Sooksai
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Direct Costs ◽  
Disease Assessment ◽  
Chronic Obstructive ◽  
P Value ◽  
Intervention Period ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Acute Exacerbations

Objective: To investigate the effects of pharmacy counseling on clinical and economic outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.Material and Methods: The outcomes consisted of 28-day hospital readmissions related to AECOPD, direct costs, medication adherence calculated by proportion of days covered (PDC), and health-related quality of life (HRQoL) measured by chronic obstructive pulmonary disease assessment test (CAT). The data derived from the intervention group, for which pharmacy counseling was provided, was compared with that obtained from the control group provided with usual pharmaceutical care. The study also drew comparisons between the PDC and CAT scores of pre- and postintervention periods.Results: Forty-four patients (23 intervention and 21 control) were included in the analysis. There were no significant differences in the readmission rate (13% vs 19%, p-value>0.050), nor the number of readmitted patients (3 vs 3, p-value >0.050). A decrease in direct costs did not reach statistical significance (p-value>0.050). In addition, no difference between the PDC scores was found (96.67 vs 100.00, p-value>0.050). Intervention patients obtained significantly lower CAT scores than the control patients did (9 vs 19, p-value<0.050). Compared with the pre-intervention period, PDC scores were identical; however, CAT scores measured during the post-intervention period were significantly different.Conclusion: Pharmacy counseling for AECOPD patients could enhance HRQoL. Drug therapy and pulmonary rehabilitation may cause such improvement. Further work, which has adequate participants, is required to detect a significant difference in readmissions between the two groups.

scholarly journals Predictors of co-morbidities in chronic obstructive pulmonary disease patients at a tertiary care centre in north India

2019 ◽  
Vol 7 (11) ◽  
pp. 4154
Author(s):  
Kaushlendra Pratap Narayan ◽  
S. K. Verma ◽  
Surya Kant ◽  
R. A. S. Kushwaha ◽  
Santosh Kumar ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inflammatory Process ◽  
Tertiary Care ◽  
Airflow Limitation ◽  
Pulmonary Vasculature ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Co Morbidity

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.

scholarly journals Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2003

2003 ◽  
Vol 10 (suppl a) ◽  
pp. 11A-33A ◽  
Author(s):  
Denis E O’donnell ◽  
Shawn Aaron ◽  
Jean Bourbeau ◽  
Paul Hernandez ◽  
Darcy D Marciniuk ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Early Diagnosis ◽  
Pulmonary Disease ◽  
Management Strategies ◽  
Management Plan ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
Activity Levels ◽  
Obstructive Pulmonary Disease ◽  
Comprehensive Management

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise and the economic burden is enormous. The main goal of the Canadian Thoracic Society (CTS) Evidence-Based Guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and exsmokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated in accordance with the increasing severity of symptoms and disability. Long acting anticholinergics and beta2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Management strategies consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation/exercise training) can effectively improve symptoms, activity levels, and quality of life, even in patients with severe COPD. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care.

scholarly journals Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

PLoS ONE ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. e0169429 ◽  
Author(s):  
Chao-Shun Lin ◽  
Chun-Chuan Shih ◽  
Chun-Chieh Yeh ◽  
Chaur-Jong Hu ◽  
Chi-Li Chung ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Events ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Post Stroke

Urinary Incontinence in Chronic Obstructive Pulmonary Disease: A Common Co-morbidity or a Typical Adverse Effect?

Drugs & Aging ◽  
2019 ◽  
Vol 36 (9) ◽  
pp. 799-806 ◽  
Author(s):  
Salvatore Battaglia ◽  
Alida Benfante ◽  
Stefania Principe ◽  
Laura Basile ◽  
Nicola Scichilone
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Effect ◽  
Urinary Incontinence ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Co Morbidity

scholarly journals Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

2016 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Amber Lanae Smith ◽  
Valerie Palmer ◽  
Nada Farhat ◽  
James S. Kalus ◽  
Krishna Thavarajah ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Ambulatory Care ◽  
Pulmonary Disease ◽  
Clinical Pharmacy ◽  
Chronic Obstructive ◽  
Pharmacy Services ◽  
Obstructive Pulmonary Disease ◽  
Clinical Pharmacy Services ◽  
Significant Difference ◽  
The Impact

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group ( P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days ( P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

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