Exercise capacity and dyspnea challenge of adult chronic obstructive lung disease (COPD) patients when using a novel mesh nebulizer compared to traditional jet nebulizer (TJN)

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 >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.

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The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience

Chronic Obstructive Pulmonary Diseases Journal of the COPD Foundation ◽

10.15326/jcopdf.2021.0229 ◽

2021 ◽

Author(s):

Fortune O. Alabi ◽

Hadaya A. Alkhateeb ◽

Kayla M. DeBarros ◽

Pierina S. Barletti Benel ◽

Rachel L. Sanchez-Martez ◽

...

Keyword(s):

Lung Disease ◽

Real World ◽

Obstructive Lung Disease ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Community Based ◽

Copd Patients ◽

Global Initiative

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

European Respiratory Journal ◽

10.1183/13993003.00164-2019 ◽

2019 ◽

Vol 53 (5) ◽

pp. 1900164 ◽

Cited By ~ 331

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.

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Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132007000400007 ◽

2007 ◽

Vol 33 (4) ◽

pp. 389-396 ◽

Cited By ~ 5

Author(s):

Clarice Guimarães de Freitas ◽

Carlos Alberto de Castro Pereira ◽

Carlos Alberto de Assis Viegas

Keyword(s):

Body Mass Index ◽

Lung Disease ◽

Airway Obstruction ◽

Exercise Capacity ◽

Body Mass ◽

Obstructive Lung Disease ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Global Initiative ◽

Indice Bode

OBJETIVO: Correlacionar a capacidade inspiratória (CI), % do previsto, pós-broncodilatador (pós-BD), com outras variáveis indicativas de gravidade e prognóstico, na doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Oitenta pacientes estáveis com DPOC realizaram manobras de capacidade vital forçada, capacidade vital lenta, e teste de caminhada de 6 min, antes e após salbutamol spray (400 µg). Foram divididos em quatro grupos, segundo o volume expiratório forçado no primeiro segundo pós-BD. Diversas variáveis foram testadas, por análise univariada e multivariada, com a distância caminhada pós-BD, % do previsto. A CI pós-BD foi correlacionada com o estadiamento Global Initiative for Chronic Obstructive Lung Disease (GOLD) e o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE). RESULTADOS: Por análise de regressão multivariada, a CI pós BD, % do previsto, (p = 0,001), o uso de oxigênio a longo prazo (p = 0,014), e o número de medicamentos usados (p = 0,044), mantiveram associação significativa com a distância caminhada, % do previsto. A CI < 70% foi observada em 56% dos pacientes em estágios GOLD 3 ou 4 comparado a 20% em estágios GOLD 1 ou 2 ( p < 0,001). A CI < 70% foi observada em 60% dos pacientes com escore BODE 3 ou 4 vs. 33% com BODE 1 ou 2 (p = 0,02). CONCLUSÃO: A CI, % do previsto, pós-BD é o melhor preditor funcional da distância caminhada, associando-se significativamente com o escore GOLD e o índice BODE. Por isso, propomos que a CI seja incluída na rotina de avaliação dos portadores de DPOC.

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