scholarly journals Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019

2019 ◽  
Vol 53 (5) ◽  
pp. 1900164 ◽  
Author(s):  
Dave Singh ◽  
Alvar Agusti ◽  
Antonio Anzueto ◽  
Peter J. Barnes ◽  
Jean Bourbeau ◽  
...  
Keyword(s):  
Lung Disease ◽  
Pharmacological Treatment ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Pharmacological Management ◽  
Copd Patients ◽  
Eosinophil Counts

Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.

Blood eosinophil counts and the development of obstructive lung disease: the Kangbuk Samsung Health Study

2021 ◽  
pp. 2003823
Author(s):  
Hye Yun Park ◽  
Yoosoo Chang ◽  
Danbee Kang ◽  
Yun Soo Hong ◽  
Di Zhao ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Health Study ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
History Of ◽  
The Impact ◽  
Eosinophil Counts

The impact of blood eosinophil counts on the development of chronic obstructive lung disease (COPD) is unknown. We investigated whether a higher blood eosinophil counts was associated with the risk of developing obstructive lung disease (OLD) in a large cohort of men and women free lung disease at baseline.Cohort study of 359 456 Korean adults without a history of asthma and without OLD at baseline who participated in health screening exams including spirometry. OLD was defined as pre-bronchodilator FEV1/FVC<0.7 and FEV1<80% predicted.After a median follow-up of 5.6 years (interquartile range, 2.9–9.2), 5008 participants developed incident OLD (incidence rate, 2.1 per 1000 person-years; 95% CI, 2.1–2.2). In the fully-adjusted model, the HR (95% CI) for incident OLD comparing eosinophil counts of 100–<200, 200–<300, 300–<500 and ≥500 cells·μL−1 to <100 cells·μL−1 were 1.07 (1.00–1.15), 1.30 (1.20–1.42), 1.46 (1.33–1.60) and 1.72 (1.51–1.95) (p for trend <0.001). These associations were consistent in clinically relevant subgroups, including never, former, and current smokers.In this large longitudinal cohort study, blood eosinophil counts were positively associated with the risk of developing of OLD. Our findings indicate a potential role of eosinophil count as an independent risk factor for developing COPD.

scholarly journals Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study

2020 ◽  
Vol 30 (4) ◽  
pp. 822-827
Author(s):  
Maria T Castañ-Abad ◽  
Josep Montserrat-Capdevila ◽  
Pere Godoy ◽  
Josep R Marsal ◽  
Marta Ortega ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Lung Disease ◽  
Prospective Cohort ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Copd Patients ◽  
Global Initiative

Abstract Background Type 2 diabetes comorbidity is common in patients with COPD. One of the most frequent causes of hospital admission in patients with COPD are exacerbations. Methods Prospective cohort study, which included 512 patients with COPD recruited in a primary care centre in Mollerussa (Lleida, Spain). Inclusion criteria were: patients &gt;40 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease. Variables collected were as follows: age, gender, civil status, education level, smoking habit, severity (Global Initiative for Chronic Obstructive Lung Disease), comorbidities (Charlson), history of severe exacerbations, dyspnoea (mMRC), BODEx, EuroQol 5 D and depression (HAD). Logistic regression was used to determine the association of diabetes with risk of hospital admission and death. Results Prevalence of diabetes was 25.8%. During the second year of follow up, 18.2% of patients with COPD and diabetes were admitted for exacerbation, in comparison with 8.9% non-diabetic COPD patients. The variables associated with hospital admission were diabetes (ORa=1.54); gender (men, ORa=1.93); age (ORa=1.02); number of hospital admissions during the previous year: 1 (ORa=2.83) or more than one admission (ORa=4.08); EuroQol 5 D (ORa=0.76) and BODEx (ORa=1.24). With the exclusion of BODEx, all these variables were associated with a higher risk of death. Conclusion Prevalence of diabetes is high in patients suffering from COPD. COPD patients with diabetes are at higher risk of severe exacerbation and death. The suggested predictive model could identify patients at higher risk so that adequate preventive and therapeutic measures can be implemented.

scholarly journals Inhaled Corticosteroids and the Lung Microbiome in COPD

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1312
Author(s):  
Holly R. Keir ◽  
Marco Contoli ◽  
James D. Chalmers
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Inhaled Corticosteroids ◽  
Bacterial Load ◽  
Chronic Obstructive Lung Disease ◽  
Lower Airway ◽  
Chronic Obstructive ◽  
Pharmacological Management ◽  
Lung Microbiome ◽  
Increased Risk

The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. However, real-world studies reveal overprescription of ICS in COPD, irrespective of disease presentation and inflammatory endotype, leading to increased risk of side effects, mainly respiratory infections. The optimal use of ICS in COPD therefore remains an area of intensive research, and additional biomarkers of benefit and risk are needed. Although the interplay between inflammation and infection in COPD is widely acknowledged, the role of the microbiome in shaping lower airway inflammation has only recently been explored. Next-generation sequencing has revealed that COPD disease progression and exacerbation frequency are associated with changes in the composition of the lung microbiome, and that the immunosuppressive effects of ICS can contribute to potentially deleterious airway microbiota changes by increasing bacterial load and the abundance of potentially pathogenic taxa such as Streptococcus and Haemophilus. Here, we explore the relationship between microbiome, inflammation, ICS use and disease phenotype. This relationship may inform the benefit:risk assessment of ICS use in patients with COPD and lead to more personalised pharmacological management.

scholarly journals Pharmacological treatment and current controversies in COPD

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1533 ◽  
Author(s):  
Mario Cazzola ◽  
Paola Rogliani ◽  
Daiana Stolz ◽  
Maria Gabriella Matera
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Disease ◽  
Pulmonary Disease ◽  
Pharmacological Treatment ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
New Drugs ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Bronchodilators, corticosteroids, and antibiotics are still key elements for treating chronic obstructive pulmonary disease in the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and this is due in part to our current inability to discover new drugs capable of decisively influencing the course of the disease. However, in recent years, information has been produced that, if used correctly, can allow us to improve the use of the available therapies.

Pharmacological Management of Chronic Obstructive Lung Disease (COPD). Focus on Mutations - Part 1

2019 ◽  
Vol 26 (10) ◽  
pp. 1721-1733 ◽  
Author(s):  
Patrizia Russo ◽  
Filippo Lococo ◽  
Aliaksei Kisialiou ◽  
Giulia Prinzi ◽  
Palma Lamonaca ◽  
...  
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Molecular Profile ◽  
Chronic Obstructive ◽  
Specific Gene ◽  
Special Focus ◽  
Comprehensive Overview ◽  
Pharmacological Management ◽  
Markers Of Inflammation

Background: We report a comprehensive overview of current Chronic Obstructive Lung Disease (COPD) therapies and discuss the development of possible new pharmacological approaches based on “new” knowledge. Specifically, sensitivity/resistance to corticosteroids is evaluated with a special focus on the role of gene mutations in drug response. Objective: Critically review the opportunities and the challenges occurring in the treatment of COPD. Conclusion: Findings from “omics” trials should be used to learn more about biological targeted drugs, and to select more specific drugs matching patient’s distinctive molecular profile. Specific markers of inflammation such as the percentage of eosinophils are important in determining sensitivity/resistance to corticosteroids. Specific gene variations (Single nucleotide polymorphisms: SNPs) may influence drug sensitivity or resistance. Clinicians working in a real-world need to have a suitable interpretation of molecular results together with a guideline for the treatment and recommendations. Far more translational research is required before new results from omics techniques can be applied in personalized medicine in realworld settings.

Sign in / Sign up

Export Citation Format

Share Document