scholarly journals Comparison of Fluoroquinolone Versus Non-Fluoroquinolone Therapy for Inpatient Treatment of Chronic Obstructive Pulmonary Disease Exacerbations

2019 ◽  
Vol 35 (6) ◽  
pp. 251-257
Author(s):  
Kassandra Ramos ◽  
Bryan Allen ◽  
Chad Cannon ◽  
Kristal Cunningham ◽  
Calvin Tucker
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Antimicrobial Therapy ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Inpatient Setting ◽  
Obstructive Pulmonary Disease ◽  
Clinical Resolution ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Background: While antimicrobial use in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) is reserved for more severe cases, the current evidence available comparing fluoroquinolones (FQs) to other classes in the inpatient setting are lacking. Objective: To compare the effectiveness of FQ therapy compared with non-FQs (NFQs) during acute COPD exacerbations in hospitalized patients. Methods: In this single-centered institutional review board–approved retrospective chart review, participants were included if they were at least 18 years of age and hospitalized for an acute exacerbation of COPD. Patients were stratified into FQ or NFQ groups based on the initial antimicrobial regimen administered. The primary outcome was the clinical resolution rate after antimicrobial therapy. Secondary outcomes included length of hospital stay, duration of antimicrobial therapy, 30-day readmission rates, and Clostridioides difficile infection rates. Results: A total of 375 patients were included (FQ = 201; NFQ = 174). The NFQ group had a higher rate of clinical resolution (84.5% vs 76.1%, P = .0435). In a multivariable regression analysis, the association between NFQ therapy and higher rates of clinical resolution remained significant (odds ratio = 2.31; 95% confidence interval = 1.3-4.10; P = .0043). The FQ group had a shorter length of stay (4 vs 5 days; P = .0022) and shorter inpatient antibiotic duration (4 vs 5 days; P = .0200). Rates of Clostridioides difficile infection and readmission were similar between groups. Conclusions: NFQ therapy may provide a higher rate of clinical resolution while avoiding exposure to FQ therapy and known adverse effects associated with FQ use.

scholarly journals The Effects and Safety of Chinese Oral Herbal Paste on Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-16 ◽  
Author(s):  
Yan Zeng ◽  
Yu Li ◽  
Hua Wei ◽  
Chan Xiong ◽  
Li Liao ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Randomized Controlled Trials ◽  
Pulmonary Disease ◽  
Meta Analysis ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Chinese Herbal

Background. Chinese oral herbal paste has been widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the treatment effects of herbal paste were controversial and lack evidence to support its clinical use. This study aims to systematically assess the efficacy and safety of Chinese oral herbal paste for the treatment of stable COPD. Methods. PubMed, Web of Science, CENTRAL, EMBASE, CNKI, VIP, CBM, and WANFANG database in addition to two websites of clinical trial registry were searched from respective inception to August 2019. Only randomized controlled trials (RCTs) studying Chinese herbal paste for the treatment of stable COPD were included. Methodological quality was assessed based on Cochrane risk of bias and GRADE approach. Data were analyzed using RevMan 5.3. Results. A total of 19 RCTs with 1303 individuals compared Chinese oral herbal paste and Western medicine (WM) with WM alone were included for meta-analysis. The review showed compared with WM alone, the combination of herbal paste and WM reduced exacerbation frequency. Subgroup analyses showed that after two to three months of treatment, compared with WM alone, Chinese herbal paste plus WM significantly decreased the St George’s Respiratory Questionnaire (SGRQ) scores, COPD assessment test (CAT) scores, and scores of traditional Chinese medicine (TCM) syndrome, and improved clinical effective rates, lung function, and 6-minute walk distance. No serious adverse events related to herbal paste were reported. Conclusion. Current evidence showed that Chinese oral herbal paste may be an effective and well-tolerated adjuvant therapy for stable COPD. Considering the risks of bias and heterogeneity, more high-quality, well-designed RCTs are still needed.

scholarly journals Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030358 ◽  
Author(s):  
Clint Moloney ◽  
Emily Sneath ◽  
Tania Phillips ◽  
Hancy Issac ◽  
Gavin Beccaria ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Emergency Department ◽  
Pulmonary Disease ◽  
Scoping Review ◽  
Data Extraction ◽  
Extraction Process ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Holistic Management

IntroductionChronic obstructive pulmonary disease (COPD) is a common respiratory condition that causes persistent respiratory symptoms and decline in lung function over many years. This chronic disease significantly affects health-related quality of life and is known to contribute to frequent emergency department (ED) presentations. Multidimensional management of these patients, including interconnecting health disciplinarians will allow holistic care provision in the ED. The purpose of this scoping review is to synthesise current evidence on holistic management and assessment, and referral practices stemming from acute COPD presentation in the ED. Specifically, to determine: (1) What are the known causal factors associated with COPD ED presentations and (2) Is there an identified connection with appropriate healthcare professional assessment within ED presentations and reported referral pathways?Methods and analysisThe iterative stages of the Arskey and O’Malley, and Levac advanced scoping review framework informs this review. Using published and unpublished studies in English, a three-tiered search strategy will be applied. After duplicates are removed, screen 1 (title and abstract) and screen 2 (full-text) will be conducted by two independent reviewers to determine eligibility of articles. Disputes will be settled through discussion or by using a third reviewer. A data collection tool developed by the authors will inform the data extraction process. Schematic tabular format of results with a narrative summary will depict how the results link with the scoping review objectives. Categorisation of results will be narrowed down as key conceptual findings and will align with the strategic intent of this review.Ethics and disseminationEthics approval was not required for this study. A multidisciplinary team of authors will participate in dissemination activities (publications, reports, conference presentations, framework development).

scholarly journals Interventions to Increase the Rate of Influenza and Pneumococcal Vaccination in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 277
Author(s):  
Samuel P. Trethewey ◽  
Neil Patel ◽  
Alice M. Turner
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Health Beliefs ◽  
Tertiary Care ◽  
Pneumococcal Vaccination ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Vaccination Rates ◽  
Evidence Based Care

Background and Objective: Current evidence suggests that patients with chronic obstructive pulmonary disease (COPD) should receive influenza and pneumococcal vaccinations. Despite international guidelines recommending vaccination in patients with COPD, many patients remain unvaccinated. Reasons for vaccine non-acceptance are multifaceted and are likely to be influenced by multiple psychosocial factors and pre-existing health beliefs. The aim of this review was to identify interventions which have been shown to effectively increase vaccination rates in patients with COPD. Materials and Methods: A structured search of PubMed returned 491 titles. Following title and abstract screening, seven full-text articles reporting on 6 unique interventional studies were extracted for narrative synthesis. A variety of interventions were investigated which, for the purposes of this review, were grouped into patient-focussed, clinician-focussed and mixed interventions. Results: Three papers reported findings from clinical trials (2 unique studies) and 4 papers reported findings from before-after studies. Two studies were conducted in the primary care setting, the remaining studies were conducted in secondary and tertiary care. Most studies reported both influenza and pneumococcal vaccination rates. These studies suggest that multimodal interventions, which target multiple aspects of evidence-based care and use both patient-focussed and clinician-focussed techniques, may have the greatest impact on vaccination rates in patients with COPD. Conclusions: Further, adequately powered, high quality studies are needed. It is crucial for individual institutions to monitor their own vaccination rates to determine if there is scope for performance improvement.

Long-Term Auscultation in Chronic Obstructive Pulmonary Disease: Renaissance of an Ideograph of Medical Care

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Sarah Bettina Schwarz ◽  
Wolfram Windisch ◽  
Daniel Sebastian Majorski ◽  
Jens Callegari ◽  
Marilena Pläcking ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Prospective Trial ◽  
Respiratory Sounds ◽  
Chronic Obstructive ◽  
Inpatient Setting ◽  
Obstructive Pulmonary Disease ◽  
Additional Information ◽  
Copd Patients

<b><i>Background:</i></b> Electronic auscultation technology has advanced dramatically in the last few years. Therefore, long-term pulmonary auscultation could provide additional information about respiratory system by monitoring acute chronic obstructive pulmonary disease (AECOPD) exacerbations or by identifying wheezing phenotypes amongst stable COPD patients. <b><i>Objectives:</i></b> Comparison of respiratory sounds in stable versus AECOPD patients recorded with a portable respiratory sound monitor over a period of 24 h. <b><i>Methods:</i></b> This prospective trial evaluated cough and wheezing events using an auscultation monitor specially developed for this purpose with 4 integrated highly sensitive microphones, in stable and severely AECOPD patients for a period of 24 h in an inpatient setting. <b><i>Results:</i></b> Twenty stable COPD patients (12 male, 60%) and 20 severely exacerbated COPD patients (14 male, 70%) were analyzed. In AECOPD patients, long-term auscultation revealed a significantly higher number of wheezing epochs than stable COPD patients (591 [IQR: 145–1,645] vs. 152 [IQR: 90–400]; <i>p</i> = 0.021). Conversely, cough epochs did not differ between AECOPD and stable COPD patients (213 [IQR: 140–327] vs. 162 [IQR: 123–243]; <i>p</i> = 0.256). The Borg-dyspnea scale, CAT score, and total CCQ score each showed no correlation with wheezing frequency, while CAT and CCQ scores did correlate with coughing frequency. <b><i>Conclusion:</i></b> Wheezing, but not coughing, occurs more frequently in AECOPD patients than in stable COPD patients, indicating that severe wheezing is an important clinical sign of exacerbation, while coughing is not. Therefore, the patterns of wheezing and coughing, as assessed by long-term auscultation, differ in stable versus exacerbated COPD patients.

scholarly journals NK Cells in the Pathogenesis of Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Yafei Rao ◽  
Yanqing Le ◽  
Jing Xiong ◽  
Yuqiang Pei ◽  
Yongchang Sun
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Nk Cells ◽  
Pulmonary Disease ◽  
Airway Disease ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Current State ◽  
Chronic Airway Disease ◽  
Underlying Mechanisms

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic airway disease with varied frequencies of acute exacerbations, which are the main cause of morbidity and mortality of the disease. It is, therefore, urgent to develop novel therapies for COPD and its exacerbations, which rely heavily on understanding of the pathogenesis and investigation for potential targets. Current evidence indicates that natural killer (NK) cells play important roles in the pathological processes of COPD. Although novel data are revealing the significance of NK cells in maintaining immune system homeostasis and their involvement in pathogenesis of COPD, the specific mechanisms are largely unknown. Specific and in-depth studies elucidating the underlying mechanisms are therefore needed. In this review, we provided a brief overview of the biology of NK cells, from its development to receptors and functions, and outlined their subsets in peripheral blood and lungs. Then we reviewed published findings highlighting the important roles played by NK cells in COPD and its exacerbations, with a view of providing the current state of knowledge in this area to facilitate related in-depth research.

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