Physiological impairments and exacerbation risk in COPD patients with less symptom and no frequent exacerbation history

Background. The pulmonary rehabilitation (PR) is beneficial for COPD patients. Due to the poor rate of adherence, we evaluate the factors which will predict the nonadherence of PR. Method. We analyzed the data from a retrospective study of COPD patients who were enrolled to attend the PR program. Patients were classified as the adherence group and the nonadherence group according to completion of over 50% sessions during the 8-week PR program. Demographic characteristics, 6-minute walking distance (6MWD), COPD assessment test (CAT), modified Medical Research Council scale (mMRC), and emotional function were compared between two groups. Univariate and multivariable analyses were performed to determine the factors of poor adherence of PR. Results. Among 418 patients, 170 patients (40.7%) who completed less than 50% sessions of the PR program were categorized as “nonadherence.” Compared to completers, “nonadherence” patients had more cigarette consumption, higher emotional score, less 6MWD, more exacerbation, using nebulizer frequently, and higher rate of smoking at enrollment. On multivariate analysis, more exacerbation frequency (odds ratio (OR) = 1.434, 95% confidence interval (CI): 1.191∼1.796, P=0.046) and smoking at enrollment (OR = 3.349, 95% CI: 1.194∼6.302, P=0.012) were predict factors associated with nonadherence of PR. Conclusion. COPD patients with frequent exacerbation and smoking currently were more likely to be nonadherence during PR.

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Reassessing the Role of Eosinophils as a Biomarker in Chronic Obstructive Pulmonary Disease

Journal of Clinical Medicine ◽

10.3390/jcm8070962 ◽

2019 ◽

Vol 8 (7) ◽

pp. 962 ◽

Cited By ~ 8

Author(s):

Tinè ◽

Biondini ◽

Semenzato ◽

Bazzan ◽

Cosio ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Real Life ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Exacerbation Risk ◽

Blood Eosinophils

Blood eosinophils measurement, as proxy for tissue eosinophils, has become an important biomarker for exacerbation risk and response to inhaled corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease (COPD). Its use to determine the pharmacological approach is recommended in the latest COPD guidelines. The potential role of blood eosinophils is mainly based on data derived from post-hoc and retrospective analyses that showed an association between increased blood eosinophils and risk of exacerbations, as well as mitigation of this risk with ICS. Yet other publications, including studies in real life COPD, do not confirm these assumptions. Moreover, anti-eosinophil therapy targeting interleukin (IL)-5 failed to reduce exacerbations in COPD patients with high blood eosinophils, which casts significant doubts on the role of eosinophils in COPD. Furthermore, a reduction of eosinophils might be harmful since COPD patients with relatively high eosinophils have better pulmonary function, better life quality, less infections and longer survival. These effects are probably linked to the role of eosinophils in the immune response against pathogens. In conclusion, in COPD, high blood eosinophils are widely used as a biomarker for exacerbation risk and response to ICS. However, much is yet to be learned about the reasons for the high eosinophil counts, their variations and their controversial effects on the fate of COPD patients.

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Susceptibility to frequent exacerbation in COPD patients: Impact of the exacerbations history, vaccinations and comorbidities?

Respiratory Medicine ◽

10.1016/j.rmed.2020.106018 ◽

2020 ◽

Vol 169 ◽

pp. 106018

Author(s):

El Hassane Ouaalaya ◽

Laurent Falque ◽

Jean Michel Dupis ◽

Marielle Sabatini ◽

Alain Bernady ◽

...

Keyword(s):

Copd Patients ◽

Frequent Exacerbation

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Diffusing capacity in chronic obstructive pulmonary disease assessment: A meta-analysis

Chronic Respiratory Disease ◽

10.1177/14799731211056340 ◽

2021 ◽

Vol 18 ◽

pp. 147997312110563

Author(s):

Yingmeng Ni ◽

Youchao Yu ◽

Ranran Dai ◽

Guochao Shi

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Carbon Monoxide ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Meta Analysis ◽

Chronic Obstructive ◽

Diffusing Capacity ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Exacerbation Risk

To achieve a multidimensional evaluation of chronic obstructive pulmonary disease (COPD) patients, the spirometry measures are supplemented by assessment of symptoms, risk of exacerbations, and CT imaging. However, the measurement of diffusing capacity of the lung for carbon monoxide (DLCO) is not included in most common used models of COPD assessment. Here, we conducted a meta-analysis to evaluate the role of DLCO in COPD assessment. The studies were identified by searching the terms “diffusing capacity” OR “diffusing capacity for carbon monoxide” or “DLCO” AND “COPD” AND “assessment” in Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and Web of Science databases. The mean difference of DLCO % predict was assessed in COPD patient with different severity (according to GOLD stage and GOLD group), between COPD patients with or without with frequent exacerbation, between survivors and non-survivors, between emphysema dominant and non-emphysema dominant COPD patients, and between COPD patients with or without pulmonary hypertension. 43 studies were included in the meta-analysis. DLCO % predicted was significantly lower in COPD patients with more severe airflow limitation (stage II/IV), more symptoms (group B/D), and high exacerbation risk (group C/D). Lower DLCO % predicted was also found in exacerbation patients and non-survivors. Low DLCO % predicted was related to emphysema dominant phenotype, and COPD patients with PH. The current meta-analysis suggested that DLCO % predicted might be an important measurement for COPD patients in terms of severity, exacerbation risk, mortality, emphysema domination, and presence of pulmonary hypertension. As diffusion capacity reflects pulmonary ventilation and perfusion at the same time, the predictive value of DLCO or DLCO combined with other criteria worth further exploration.

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Correlation of serum uric acid with severity of airflow limitation in the patients of chronic obstructive pulmonary disease

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201114 ◽

2020 ◽

Vol 7 (4) ◽

pp. 634

Author(s):

Sujit Kumar ◽

Vimal Kumar Nishad ◽

Amitabh Das Shukla ◽

Santosh Kumar Chaudhary

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Cross Sectional Study ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Healthy Controls ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Exacerbation Risk

Background: Serum uric acid (sUA) levels were previously found to be correlated with hypoxic states. We aimed to determine the levels of sUA in COPD patients and to evaluate whether sUA level can be used as predictors of exacerbation risk and disease severity.Methods: This cross-sectional study included COPD patients and healthy controls. The sUA levels in each group were evaluated and their correlations with the study parameters were investigated. ROC analyses for exacerbation risk were reported.Results: The study included 106 COPD patients and 110 healthy controls. The mean sUA levels were significantly higher in patients with COPD compared to healthy controls (p<0.05). Mean sUA levels were compared with different stages of COPD according to GOLD criteria. Stage 4 COPD subjects had highest sUA levels compared to other stages. Statistically significant trend was observed for GOLD staging of disease (p<0.05). Surprisingly non-smokers were having higher uric acid level than smokers (p<0.05). The ROC analyses indicated that sUA levels can be useful in predicting exacerbation risk (AUC, 0.412) especially at higher cut-off values, but with low specificity.Conclusions: Study suggested that sUA levels increased in patients with COPD compared to healthy controls. At higher cut-off values sUA levels might be useful in predicting COPD exacerbation risk and disease severity. However, more prospective cohort studies with large number of participants are needed to further analyse the possible different prognostic roles of hyperuricemia.

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A high-risk airway mycobiome is associated with frequent exacerbation and mortality in COPD

European Respiratory Journal ◽

10.1183/13993003.02050-2020 ◽

2020 ◽

pp. 2002050

Author(s):

Pei Yee Tiew ◽

Alison J. Dicker ◽

Holly R. Keir ◽

Mau Ern Poh ◽

Sze Lei Pang ◽

...

Keyword(s):

Alpha Diversity ◽

Specific Ige ◽

Shannon Index ◽

Concomitant Increase ◽

Copd Exacerbations ◽

The United Kingdom ◽

Copd Patients ◽

Acute Exacerbations ◽

Frequent Exacerbation

IntroductionThe COPD bacteriome associates with disease severity, exacerbations, and mortality. While COPD patients are susceptible to fungal sensitisation, the role of the fungal mycobiome remains uncertain.MethodsWe report the largest multicenter evaluation of the COPD airway mycobiome to date including participants from Asia (Singapore and Malaysia) and the United Kingdom (Scotland) when stable (n=337) and during exacerbations (n=66) as well as non-diseased controls (n=47). Longitudinal mycobiome analyses performed during and following COPD exacerbations (n=34) were examined in terms of exacerbation frequency, two-year mortality, and the occurrence of serum specific-IgE against selected fungi.ResultsA distinct mycobiome profile is observed in COPD compared to controls evidenced by increased alpha diversity (Shannon-index) (p<0.001). Significant airway mycobiome differences including greater inter-fungal interaction (by co-occurrence) characterise very frequent COPD exacerbators (≥3 exacerbations per year) (PERMANOVA, adjusted p<0.001). Longitudinal analyses during exacerbations and following treatment with antibiotics and corticosteroids did not reveal any significant change in airway mycobiome profile. Unsupervised clustering resulted in two clinically distinct COPD groups, (1) with increased symptoms (CAT score) and Saccharomyces dominance and (2) with very frequent exacerbations and higher mortality characterised by Aspergillus, Penicillium and Curvularia with a concomitant increase in serum specific IgE levels against the same fungi. During acute exacerbations of COPD, lower fungal diversity associates with higher two-year mortality.ConclusionThe airway mycobiome in COPD is characterised by specific fungal genera associated with exacerbations and increased mortality.

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Mannose binding lectin -HYPDallele is associated with frequent exacerbation in COPD patients

10.1183/13993003.congress-2015.oa2921 ◽

2015 ◽

Author(s):

Bijaya Malla ◽

Jyotshna Mandal ◽

Luigi Costa ◽

Rudi Steffensen ◽

Adrian Egli ◽

...

Keyword(s):

Mannose Binding Lectin ◽

Copd Patients ◽

Mannose Binding ◽

Frequent Exacerbation ◽

Binding Lectin

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Exacerbation Risk Is Not Worse When ICS Are Withdrawn in a Stepwise Manner in Severe to Very Severe COPD Patients Receiving LAMA+LABA: The WISDOM Study

CHEST Journal ◽

10.1378/chest.1994339 ◽

2014 ◽

Vol 146 (4) ◽

pp. 63A ◽

Cited By ~ 1

Author(s):

Helgo Magnussen ◽

Bernd Disse ◽

Roberto Rodriguez-Roisin ◽

Anne Kirsten ◽

Henrik Watz ◽

...

Keyword(s):

Stepwise Manner ◽

Copd Patients ◽

Exacerbation Risk ◽

Severe Copd

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Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-020-00198-5 ◽

2020 ◽

Vol 30 (1) ◽

Author(s):

Lisette van den Bemt ◽

Lotte van den Nieuwenhof ◽

Anne Rutjes ◽

Victor van der Meer ◽

Gerben Stege ◽

...

Keyword(s):

General Practice ◽

Inhaled Corticosteroids ◽

Pragmatic Trial ◽

Severe Exacerbation ◽

Inhaled Corticosteroid ◽

Corticosteroid Withdrawal ◽

Copd Patients ◽

Therapeutic Value ◽

Exacerbation Risk ◽

Bronchodilator Treatment

Abstract The therapeutic value of inhaled corticosteroids (ICSs) for COPD is limited. In published RCTs, ICS could be withdrawn in COPD patients without increasing exacerbation risk when bronchodilator treatment is optimized. Here we report on the feasibility and risks of ICS withdrawal in Dutch general practice for COPD patients without an indication for ICSs. In our pragmatic trial, general practitioners decided autonomously which of their COPD patients on ICS treatment could stop this, how this was done, and whether additional bronchodilator therapy was needed. We recruited 62 COPD patients (58 analysed) who were eligible for ICS withdrawal in 79 practices. In 32 patients (55.2%, 95% CI: 42.5–67.3%) ICS was withdrawn successfully, 19 (32.8%, 95% CI: 22.1–45.6%) restarted ICS treatment within six months, 12 patients (20.7%, 95% CI: 12.3–32.8%) had a moderate exacerbation, and one patient had a severe exacerbation. ICS withdrawal was successful in just over half of the patients with COPD without an indication for ICS.

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Stability of Frequent Exacerbator Phenotype in Patients with Chronic Obstructive Pulmonary Disease

Folia Medica ◽

10.2478/folmed-2018-0023 ◽

2018 ◽

Vol 60 (4) ◽

pp. 536-545

Author(s):

Iliya Krachunov ◽

Nikolay Kyuchukov ◽

Zlatina Ivanova ◽

Nikolay A. Yanev ◽

Petkana A. Hristova ◽

...

Keyword(s):

Significant Risk ◽

Stage Iv ◽

Significant Risk Factor ◽

Stage I ◽

Chronic Obstructive ◽

Exacerbation Rate ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

History Of ◽

Frequent Exacerbation

Abstract Background: At present, there is little information in Bulgaria regarding the rate and stability of frequent-exacerbation phenotype in COPD patients. Aim: To study the rate and stability of frequent-exacerbation phenotype in COPD patients. Materials and methods: We followed up 465 COPD patients for exacerbations over a 3-year period. Exacerbations were defined as events that resulted in treatment with antibiotics and/or corticosteroids (moderate), or that led to hospitalization (severe). Result: Approximately 10% of the patients had two or more exacerbations per year (frequent-exacerbation phenotype), and this structure stayed stable over the study period. The exacerbation rate in the first year of follow up was 0.33 per stage I COPD patients (according to GOLD stages), 0.49 per stage II COPD patients; 0.69 - for stage III, and 1.06 for stage IV COPD patients. The frequent-exacerbation rate increased from stage I to stage IV by 4.35%, 9.17%, 10.79%, and 20.97%, respectively. A history of previous year exacerbations increased the risk of new exacerbations: with a history of one exacerbation - OR 2.1820 (95% CI: 1.4018 to 3.3965, p = 0.0005), and with a history of two exacerbations - OR 4.6460 (95% CI: 2.3286 to 9.2696; p < 0.0001). The frequent-exacerbation phenotype appeared to be unstable over the study period - up to 33% from those patients stayed in the phenotype for the next year. Conclusions: The exacerbation frequency and the rate of frequent-exacerbation phenotype increases with COPD progression. History of exacerbations in the previous year is a significant risk factor for exacerbations of COPD. The frequent-exacerbation phenotype appeared to be unstable over the study period. The pheno-type of non-exacerbators was more likely to remain stable over time.

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